August 28, 2016

Selecting a New Doctor? Here's How I Decide.

This year, I've changed my two most important doctors: my primary care provider and my neurologist. 

Here, in no particular order, are some of the factors I kept in mind while making those decisions.

Office Location
In light of my age (87) and my Parkinson's disease, the closer the office is to my house, the better. I'm fortunate to live in the Palisades section of Washington ("country living in the city" is how we describe it), where many doctors practice from several small office buildings (and most of these docs know one another – another advantage). Whether I use Joey (my part-time driver) or Uber, it’s a snap getting to these offices within 10 minutes.

My dentist and my dermatologist have offices just over the DC line in Chevy Chase, MD, and getting there is almost as easy. When I have to make trips to doctors’ offices in downtown DC -- along the K St. corridor or around Washington Circle -- it's more of a hassle.

Hospital Access
When I have to go to a hospital for tests or other reasons, I prefer Sibley Hospital. It’s the closest to me, and the only Washington DC hospital that earned three stars in Medicare's recent rating of hospitals. The neighborhood doctors I’ve chosen are more likely to use Sibley. I liked this facility best when it was a small, independent hospital, before it became larger, more crowded, and more bureaucratic as part of the Johns Hopkins network.

Doctors Affiliated with Hospitals
Several of the doctors I've used recently are affiliated with either Georgetown University Hospital or George Washington University Hospital. I've come away with the feeling that these doctors tend to be clock-watchers, eager to keep our visits as short as possible. I've talked with other people who’ve developed similar impressions of hospital-affiliated doctors.

Office Ambience
OK, call me an elitist snob, but I prefer walking into a doctor's office with a nice comfortable reception room and a receptionist who greets me with "Hello, Mr. Schappi." It doesn’t happen very often, which is probably why it makes such a positive impression on me when it does.

August 27, 2016

"Why me? I'm a general neurologist, not a Parkinson's specialist."

I decided to switch to a new neurologist.

When I had my first meeting with her, she began our visit with the question and comment above. We were off to a good start because she immediately got us sharing our views about the doctor-patient relationship.

After my 2009 Parkinson's disease (PD) diagnosis, I worked with a neurologist in the Parkinson's unit at Georgetown University Hospital. After a while, I switched to neurologist at George Washington University Hospital. Why? A PD neurologist at the Parkinson’s and Movement Disorders Center of Maryland (a clinic affiliated with Johns Hopkins University) thought the Georgetown doctor was overdosing me on carbidopa-levodopa (Sinemet), the key PD med.

All three of those doctors had an issue with my use of 5-HTP, the over-the-counter supplement that boosts serotonin and -- when combined with the carbidopa in Sinemet -- has a potential for increasing my blood pressure (BP). The Georgetown doctor listened… and accepted my explanation that 5-HTP warded off PD’s most common non-motor side effects: insomnia, constipation, and depression. The other two neurologist didn't pay much attention to my case for 5-HTP. I felt like they conveyed these messages:
  • They were in charge of my treatment plan, not me.
  • I should stop taking the supplement I knew worked so well for me.
  • I needed to continue with my blood pressure meds.
How I Explained My Pressure Spikes
My high BP readings they saw in their offices convinced them that I needed BP meds. They seemed indifferent when I explained that the readings I took on my own monitor at home usually fell within the new guideline of 150/90 for people aged 60+. And they didn’t seem especially interested in my observation that my BP spiked
  • during my PD “off periods," and
  • when I was in their offices (the common “white coat syndrome”).
I probably would have been beaten into submission were it not for my BP doctor, who worked with me on sticking with the 5-HTP while finding other ways to deal with the BP spikes. I told him I’d seen reports that some doctors thought that people aged 80+ without coronary issues could discontinue taking blood pressure medication altogether. As we discussed alternatives, he said, "I won't lose any sleep if you decide to stop taking the meds."

August 25, 2016

Dealing with Depression: Beet Juice Helps, but Nothing Beats Exercise

Last week, I began experiencing bouts of depression that were unusual for me. I was also seeing an uptick in my blood pressure (BP) readings, which was not unusual for me; for years, I’ve been on a BP roller coaster ride, with numbers all over the place. Those extreme pressure variations – with the consequences they bring – has been a regular theme on this blog.

I had used beet juice in the past to manage BP spikes, so I decided to give it another try last week. I drank my first glass of juice with coffee at my usual afternoon "happy hour." Then, about an hour later, I realized my mood was significantly brighter. When the same thing happened the next day, I decided to Google "depression" and "beet juice." 

Beet Juice and the Brain
I found reports that linked the two. Beet juice is a source of nitrates which have been shown to dilate blood vessels, increase blood flow to tissue, reduce demand of muscles for oxygen, and inhibit blood clots. Beet juice also is rich in red-yellow pigments called betalains, which display potent antioxidant activity. Beets are a good source of potassium and folate, both of which help regulate BP. 

Here are the two most-cited studies about beet juice:
  • study from Wake Forest University found that older people who drank 16 ounces of beet juice a day for two days showed greater blood flow to the frontal lobe of the brain, an area involved in skills like planning and problem-solving. A part of the brain particularly affected by Parkinson's, the frontal lobe is also associated with dementia and poor cognition.
  • 2015 study of beet juice and blood pressure found that older adults who drank a daily cup (eight ounces) of beet juice lowered their systolic pressure (the upper reading) by eight points on average, and their diastolic pressure by two to five points over four weeks. Results also showed Improvements in blood pressure functioning and arterial flexibility.

My Observations
I've continued to experience mood improvements after drinking beet juice. But I've also found that increasing the time I spend on tai chi and other exercises has an even greater impact on the depression.

August 18, 2016

Health Pot-pourri: Reading, Whole Grains: Yes. Antioxidant Supplements: Maybe Not

I subscribe to a dozen or more print newsletters about health care, and I get as many regular news updates in my email inbox. I make occasional reports like this one when I find items of particular interest.

Read Books, Live Longer?
Reading books is tied to longer life, according to a new report. Researchers used data on 3,635 people aged 50+ who had already answered questions about reading as part of a larger health study.

The scientists divided those people into three groups:
  1. those who read no books,
  2. those who read books up to three and a half hours a week, and
  3. those who read books more than three and a half hours every week.

Published in Social Science & Medicine, the study found that book readers tended to be female, college-educated and more affluent. Researchers then controlled for those factors as well as age, race, self-reported health, depression, employment, and marital status.

Compared with study subjects who did not read books, those who read for up to three and a half hours a week were 17 percent less likely to die during the next 12 years, while those who read more than that were 23 percent less likely to die. On average, people who read books lived almost two years longer than those who didn't.

Senior author Becca R. Levy, a professor of epidemiology at Yale, said the "survival advantage remained after adjusting for wealth, education, cognitive ability and many other variables."

Study leaders found a similar association among readers of newspapers and periodicals, but it was weaker. 

I need to get back to my bedside copy of The Boys in the Boat.

Eat More Whole Grains
If you want to live longer and healthier, you might want to munch on a slice of whole grain bread while sitting in your rocking chair reading a book.

August 15, 2016

Controversy over Medicare's New Hospital Ratings

Earlier this month, Medicare released its first comprehensive rating of hospitals. That review slapped average or below average scores on many of the nation's best-known hospitals, and awarded top scores to dozens of unheralded ones.

Medicare assigned one to five stars to the 3617 hospitals it reviewed. Only 102 hospitals got the top five-star rating, and very few of those are among the nation's best according to private rating services, like the one from U.S. News & World Report. In addition, very few of Medicare’s top picks are viewed as particularly elite by the medical profession.

Instead, five stars were awarded to relatively obscure hospitals, and to at least 40 hospitals that specialize in just a few types of surgery, like knee replacements.

Nearly half the hospitals -- 1,752 of them -- received average three-star ratings. Medicare gave the lowest one-star rating to 129 hospitals. In my hometown of Washington DC, five hospitals received only one star, including George Washington University Hospital and MedStar Georgetown University Hospital, both of which teach medical residents.

I was pleased that the top rating for a DC-based hospital (3 stars) went to Sibley Hospital (now affiliated with John Hopkins).  It is the hospital closest to me and my first choice when I have to pick a hospital to get tests or other procedures done. A few of the hospitals in D.C.'s Maryland and Virginia suburbs did get 4 and 5 star ratings. 

Medicare based its ratings on 64 individual criteria, including patient reviews and rates for death and infection. All criteria are shown on Medicare's Hospital Compare website.

The Trade Association Reacts 
In a statement, the American Hospital Association characterized the new ratings confusing for patients and families: "We are especially troubled that the current rating scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor."

Medicare acknowledged that hospitals treating large numbers of low-income patients tended to do worse in the ratings, which didn’t consider patients’ social and financial situations.

August 10, 2016

"Smart 911" -- Signing Up Is a Smart Move

Today I received an email from my Palisades Village with the August newsletter. It included information about “Smart 911,” which I’d never heard of before. It sounds like a great idea, and I just spent about half an hour signing up and entering my personal data.

I've placed 911 calls several times in the past few years. This new service will give 911 responders instant access to my medical information. During an emergency, it might be difficult – or impossible -- to provide that important information.

Our community newsletter described the service – and the sign-up process – very clearly, so I'll just reproduce it here.

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Smart 911 is a free service that allows a participant to create a safety profile that will be provided to 911 responders in the event of an emergency. A call to 911 from any of the phone numbers listed on the safety profile will automatically display the safety profile information to the 911 call taker. Smart 911 allows safety profiles to be created for all the individuals associated with the phone numbers listed on the profile. This system can be invaluable in an emergency by giving emergency responders instant access to medical and safety information.

To sign up for Smart 911, go to https://www.smart911.com. Signing up is relatively straight forward; if computers are alien terrritory, enlist a computer literate friend to help you with the process (there is no option for signing up by telephone). The online system will ask you to input your name, email, user ID, password, phone number(s), and address. You must verify your phone number by following the instructions on the screen; once you click on the verification "button," you will get an almost instantaneous call back on your phone, and will have to press "1" to complete the verification process.

August 9, 2016

Ronni Bennett: "A Meditation on Making Friends While Old"

My last blog post was based on a recent piece in the Harvard Health Letter about the risks -- especially for seniors -- posed by loneliness and isolation. That article included some suggestions for combating those threats, although I've regularly seen similar tips from other sources. 

Today, I read a post by Ronni Bennett (my favorite blogger) in which she reflects on what many of us long for... not just a friend, but a close friend. A best friend. 

The Washington Post has characterized Ronni's blog Time Goes By as "the quintessential seniors' blog." I couldn't agree more. After checking it out, you may want to do what I did -- click on the "Subscribe" link. Here's Ronni's post, in full.

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Judging by the number of online stories about loneliness and feeling alone many, many people are longing for a close friend. A best friend. Most of all, someone to trust.

These articles are usually written by people much younger than you and I who presumably get out and about to a wider variety of places than old people tend to do and meet more people.

But one particular change in employment – working from home – has made finding friends much harder for them than during my career years.

According to a recent study, 45 percent (!) of U.S. employees work from home and that doesn't count freelancers. So finding a friend may be one area of living where youth and age have a lot in common these days.

Or not. Old people are not as likely to hang out in bars and clubs. Old people's oldest friends die at a greater rate. Our energy and stamina trim the number and duration of sports and other physical activities where we might meet others.

August 5, 2016

Loneliness and Isolation Can Be Deadly!

A recent article in  the Harvard Health Letter – titled 5 ways to fight loneliness and isolation -- was the most recent in a series of reports I've seen warning that loneliness is a health threat, particularly for the elderly.
  • One in six adults aged 65+ is isolated socially or geographically, according to The National Council on Aging.
  • 25% of seniors aged 70+ reported feeling lonely, according to a 2010 AARP survey.
The health risks from loneliness are pretty scary:
  •  A 29% higher risk of coronary artery disease and a 32% higher risk of stroke are associated with loneliness and isolation, according to a July report in the Harvard publication. 
  • Thinking skills declined about 20% faster over 12 years among the loneliest people in a recent study, compared with study participants who reported that they were not lonely, according to Harvard researchers.
  • A 2012 study in JAMA Internal Medicine reported that people who identified themselves as lonely were 59% more likely to lose the ability to perform tasks of daily living, and 45% more likely to die early than those who didn't identify as lonely.
  • Other studies have associated loneliness with depression and high blood pressure.
There's the usual caveat here – these studies have identified only "associations" between loneliness and these reported risks. No evidence conclusively proves cause and effect.

Is There a Way to Explain the Link?
Several factors come into play, according to Dr. Michael Craig Miller, a Harvard Medical School assistant professor of psychiatry:
We do better physically when we're part of a community. We are social animals who have evolved to do best when we're engaged with others. Also, when we're with friends and family, we benefit from “social contagion,” where you pick up on what others are doing for health, or others encourage you to do something about your health.

In addition, Dr. Miller identified isolation as a risk factor for loneliness: “There’s no hard-and-fast rule that everyone needs to be involved with others all the time, but we tend to feel better when we're with others, and we may feel worse if we're often alone.”

August 4, 2016

How Can I Find a Way to Help Others? A Tibetan Buddhist’s Answer

Recently, I was chatting with a friend about Buddhism, compassion, and the like. She asked a question I've heard before and once asked myself: 
How can I find a way to help others?​

​I had an immediate flashback to the memorable day I spent during my last visit to Nepal touring a beggars’ encampment with my friend James Hopkins. That trip came in March 2012, when I had returned to Kathmandu for the wedding of Nimesh and Bhawana, my current housemates (and the parents of the current love of my life, their four-month-old daughter Nivah).

I had known James back in Washington when he was the stockbroker for a good friend of mine. But he wasn't the stereotypical stockbroker. He and his girlfriend lived on a houseboat docked along the Potomac River waterfront. They became interested in Buddhism and made several trips to India and Nepal. Eventually, James decided to retire early (very early, at age 43).

He moved to Kathmandu to study Buddhism at the monastery associated with Bodhnath, one of the few places left in the world where Tibetan Buddhism is openly practiced and studied.

A major tenet of Buddhism is a desire to free all human beings from suffering. James asked one of the lamas, “What exactly can I do?” The lama answered, “Just go outside and help the first person you see.”

A short walk from Bodhnath is an encampment where hundreds of Indian beggars live in tents. The men and children go out on the streets of Kathmandu to beg during the day, while the women stay home sewing quilts from scraps of cloth. James thought some of the quilts looked attractive.

He came up with the idea for a project that would empower the women and help educate the children. The quilts are sold to Westerners, including James’s friends. When I bought mine, they were $170 each. That price enabled one child from the begging camp to go to school. It also covered the cost of school supplies, a backpack, school uniforms, and two pairs of shoes.

Touring the camp ​with James was a terrific experience, which I recapped in a blog post four years ago. Here are a few highlights.
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