Song of the Other Sister

Glucosamine chondroitin
maybe some ibuprofen
Viactiv with calcium
fish oil and Senior Centrum.

Ohioans need some D,
build those bones for all to see;
Stretch and bend, wear socks and shoes,
Take a walk after the news.

Breathe deeply, now in and out,
wave to your friends give a shout,
life is good we can't complain,
but we'd settle for less pain.

Summer poem

Bikes and grass and summer things
Tea with ice, a thought that clings--
Yellow roses, gray blue eyes,
Summer romance--a young girl's sighs.
Hot rod cars, loud and steamy,
Didn't we think they were so dreamy?
Now we smile and say good-bye,
while watching rain clouds in the sky.

Glucosamine chondroitin

On my last check up I mentioned to my doctor that I've developed some hip pain, that goes away within a few minutes after moving around. "Arthritis," he said, and suggested I try Glucosamine chondroitin.

"Osteoarthritis is the most common form of arthritis in the United States and has a major effect on the health-related quality of life. In 2004, the estimated direct and indirect medical costs associated with all forms of arthritis exceeded $86 billion. Glucosamine and chondroitin sulfate are the most widely used dietary supplements for osteoarthritis, with estimated sales in 2004 approaching $730 million."

This study looked at its use, but decided stricter standards were needed before a final decision could be made.

Time to Talk campaign

The National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health (NIH), has launched Time to Talk, an educational campaign to encourage patients—particularly those age 50 or older—and their health care providers to openly discuss the use of complementary and alternative medicine (CAM). CAM is a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine, such as herbal supplements, meditation, naturopathy, and acupuncture. Read more

Fat grandmothers

I had none. I'm so fortunate that I had both my paternal and maternal grandparents in my life, and my great-grandparents lived just a few doors away when I was very young. My grandmothers weren't fat, or even plump or curvy. If your grandmother is a member of my generation, you probably can't say that.

Today I was reading "Aging, adiposity, and calorie restriction," by Luigi Fontana and Samuel Klein in the March 7, 2007 JAMA. It's a very cautious and conservative review of the literature from 1966 through December 2006 in PubMed (the largest and most famous medical literature database) which concludes from all the studies done on calorie restriction in the last 40 years that calorie restriction in adult men and women causes beneficial metabolic, hormonal, and functional changes, but (and here's the cautious part) the precise amount of calorie intake or body fat mass associated with optimal health and longevity in humans is not known. And after laying out all this fabulous research (139 citations), the authors take a buy-out and decide that because calorie restriction is difficult to maintain long-term, we might have to turn to a pharmacological agent for a solution. Cha-ching. There's no money in eating less, moving more.

That's what got me thinking about my grandmothers, both of whom lived to their late 80s. One was born in 1876 and the other in 1895, young enough to be the other's daughter (my great grandmother was born in 1873), a time when life expectancy at birth was about 45. Their generations benefited from better hygiene, but I doubt that either ever had a vaccination. It's possible that very late in life they might have had an antibiotic. I don't know much about their early lives, but given the times, I'm sure they were both breast fed by non-smoking mothers. They didn't give birth in hospitals. They both lived their childhood and early married life on farms a few miles from each other, but didn't work in the fields. Housework, however, was much more physical in those days. I use Grandma Mary's pressing irons as book-ends--they were heated on the cookstove and weigh 10-15 lbs. Water was pumped outside and carried in to be heated either in the stove or on it. Grandma Mary was wealthier than Grandma Bessie and did have a German woman as household help, but they would've worked side by side. And both gardened (potatoes, carrots, cabbage, tomatoes, beans, turnips) and raised chickens for meat and eggs. Root crops could be stored, and beans and tomatoes were canned for winter, but table fare was pretty bland and boring. Both women baked their own bread. Beef was not on the table in either household. Grandma Mary rarely served meat, except chicken occasionally, and Grandma Bessie would have only had fatty pork, sausage, or a tough old chicken, too old to lay. Cows were for milk (cash crop) and butter (for cooking), and when you think about it, they were much more difficult to butcher for a single family than a pig or chicken. There wasn't even much in the way of fruit, maybe a few apples, grapes for juice or berries.

According to the authors, the first calorie restriction study was done in 1935 when it was discovered that limiting calories in lab rats increased their life span by 30-60%. Food shortages during WWII in some European countries were associated with a sharp decrease in coronary heart disease, and although this article didn't mention it, I've seen reports like that on breast cancer. Again, the authors use cautious language, but say "population studies suggest that lifestyle factors, such as sedentary lifestyle, dietary intake, and adiposity, are responsible for up to 70% of chronic disease and are a major contributor to reduced longevity. . . data suggest that a BMI at the low end of normal (18.5-24.9) is associated with optimal metabolic and cardiovascular health."

Cross posted at Collecting My Thoughts.

Reduce need for drugs with massage

The Wall St. Journal on March 10 had an article about the Providence Rest nursing home which caters to retired nuns. A licensed massage therapist has cut the home's use of antipsychotic drugs for agitated patients from 30% down to 2 or 3%. Read the story here.

Don't forget your nap

Retirees can enjoy the health benefits of a nap. I was browsing my sign-in at JAMA and the archives today, and noticed this at Arch Intern Med. 2007;167:296-301, "Siesta in Healthy Adults and Coronary Mortality in the General Population." They don't have much evidence for women because very few died during the study, but for men it is clear: the habit of a regular mid-day nap lengthens their lives.

How this study was done: This study involved 23,681 men and women in Greece between the ages of 20 and 86 who volunteered to take part in the European Prospective Investigation into Cancer and Nutrition (EPIC). All those in the study were asked whether they took a midday nap and, if so, how long they napped. They were divided into groups: those who never napped, those who took naps of 30 minutes or more at least three times per week and those who took midday naps occasionally or whose naps lasted less than 30 minutes. The researchers also asked about their levels of activity and diet. The study excluded those who had previously had heart disease, stroke or cancer.

What was found: Of those in the study, 792 died, and 133 of those died of heart disease. The researchers found that the risk of dying from heart disease was 37 percent lower for those who took naps of 30 minutes or more at least three times a week than for those who took no naps. Occasional napping did not have an effect on the risk of dying from heart disease. It appeared that the effect of napping was stronger in men, and in particular, men who worked. The authors said that findings are consistent with the fact that occupational stress can increase heart disease risk. Summary

Five Healthly Resolutions for Women

Five Healthy Resolutions for Women appeared at WebMD. I've added my own comments, and not lifted large sections to post, so pop on over and read the whole article. We've heard it all before, but January 2008 is a good time to renew your resolves of 2007.

Eat, but don’t pig out. All or nothing approach will kill your resolution. When I lost 20 lbs. a year ago, I had a list of things I would avoid, like French fries and cheese, but I allowed myself my favorite restaurant meal on Friday nights--Philly Cheese steak with Fries--which had just about everything on the list!

Jump outside the box. Most workout intentions fall by the wayside by February. Like the diet, don’t be unrealistic. If you hate exercise or you aren’t athletic (like me), you won’t get there by resolving to be different. It’s just you. Park further away. Take the stairs. Take dance lessons. Volunteer to walk a neighbor’s dog. Wear a pedometer.

Guard against the bone thief. Women and osteoporosis. For postmenopausal women 1,000-1,500 milligrams daily if on menopausal hormone therapy. Exercise helps the bones too, as does good nutrition. Smoking and alcohol have to be watched too. To paraphrase Ben Stein, nothing you overindulge in when you're young is worth being disabled or an invalid when you're older.

Get an A+ in taking health exams. Mammogram. Bone density. Pap smear. The colonoscopy is the only exam we have that actually can prevent cancer--find a polyp and have it removed before it causes trouble all during the exam. Colon cancer is so nasty--and so preventable.

Take care of the caregiver. Stress can really lower your immune system. Moms and daughters seem to always be looking out for someone else. Take the time to assess your situation. Who'll take care of everyone else if you're laid up?

Besdine's Boomers

Dr. Richard Besdine uses the mnemonic "Besdine's Boomers" to remember these mid-life strategies for healthy aging.

Blood pressure -- get screened at least once a year and treat appropriately if high
Exercise -- keep the mind and body as vigorously active as possible
Smoking -- stop as soon as you can; the benefits accrue immediately
Driving -- have a physician evaluate you for driving risk
Immunizations -- get a flu shot every year and a pneumococcal vaccine once
Nutrition -- proper nutrition is critical, especially for cardiovascular health
Environment -- keep your home environment safe with smoke and carbon monoxide detectors; get rid of toxic substances under the sink
Screen for cancer regularly -- Colon cancer screening as recommended by your physician; skin should be evaluated by a physician once a year; for women a mammogram annually and a pap smear as recommended by your physician

Booze -- avoid excessive alcohol; alcohol and smoking accelerate bone loss
Osteoporosis -- women and men should get a minimum of 1500 mg. calcium a day; one-quarter of all hip fractures in the elderly occur in men
Oral health -- healthy teeth and good dentures are important for proper eating; see your dentist annually
Mobility -- stay as active as possible
Emotional health -- too little attention is paid to stress reduction in old age, when events such as the loss of work and the death of friends and spouses can cause stress and emotional upheaval
Rx drug safety -- beware of taking outdated and conflicting medicines
Social Networks -- important for stress reduction and overall emotional health

Richard W. Besdine, M.D.
Professor of Medicine and Director,
University of Connecticut Center on Aging,
University of Connecticut Health Center

Seen at Alliance for Aging Research

Unbelievably good deals

This is a terrific little reference book. "Unbelievably good deals and great adventures that you absolutely can't get unless you're over 50" by Joan Rattner Heilman, 2007-2008 edition, McGraw Hill, 2007, will set you to dreaming about what you're going to do with all that free time when you are retired. There are 19 chapters on travel, education, sports, shopping, etc. Chapters 2-12 actually deal in some way with travel--lodging or airfares, tours, cutting costs, etc. This author doesn't want you to pay sticker price for anything. Always ask about a senior discount.

If you are a single man over age 45 and a great dancer, consider being a "host". You can cruise for (almost) free, working 3-4 hours a day. All you have to do is not get romantically involved with any of the passengers.

This summer at Lakeside I met a kite-flying teacher who was wildly enthusiastic about the Evergreen bed and breakfast club, which is featured in this book. It's for people over 50, has 3,500 members and 2,000 host locations. A couple pays $15 for each overnight stay. The club dues are $60 (single) and $75 (couple). Check www.evergreenclub.com.

Recommended automobiles

Jonathan Welsh of the WSJ recommends the following cars if you've had a knee replacement: 4 door Ford 500 (Taurus), Chevrolet Impala, Buick Lucerne and Dodge Charger or Chrysler 300. Can't imagine trying to get into a Charger with bad or stiff knees.

More stuff, more stress

A few years ago, a well-heeled girlfriend told me that her 80-something mother was living in a tiny trailer in Arizona with a minimum amount of furnishings. She'd told her family, "When I die, just push it over the cliff." She wasn't poor; but she'd learned what most of us do after awhile--your possessions own you, not the other way around. In an article, about "Stressed out Moms" Ingrid Schlueter writes,

One factor seems to be expectations going into marriage. Newlyweds of my parents’ generation had very modest expectations financially. My parents started out in a basement apartment in Des Moines, Iowa that didn’t have much in the way of amenities. They graduated to a studio apartment later and then to a three bedroom flat where my brother, sister and I spent our early childhood years. From there it was a very simple, three-bedroom Milwaukee bungalow. No family room, one bathroom, old, basic kitchen and bath. The carpet when we moved in was the original and that goes for the linoleum as well. Mom made it all comfortable and homey, and we kids didn’t know that we lacked a thing. That’s where my parents lived until I was married.

Today, few newlyweds start out this way. Home ownership is seen as essential for many, even if it requires both husband and wife to work outside the home. It’s a dangerous way to begin because once the couple starts relying on two incomes to live, it is very hard to stop when a baby comes. Then the couple begins the stressed out years of trying to find and pay for exorbitant childcare, while strangers get the privilege of caring for their baby. Add a couple more children to the picture, and you have a lot of outgo for that same two-income couple and the race to meet all the demands begins."

That's exactly the same thing our Irish bus driver John (50 and the father of 5) said about the younger Irish generation setting up homes and getting mortgages. It's not a local problem. [See my Ireland trip log]

Cross posted from Collecting My Thoughts

Adorable baby gifts

If I had to buy a baby gift, here's where I'd go on the internet.

Thirty years ago

Thirty years ago I would have never dreamed that topics like retirement, 401-k plans, osteoporosis, nutrition or exercise could become so interesting. My reading tastes have changed completely--in fact, on Thursday I think I'll tell you 13 things about JAMA.

Cross posted from Collecting My Thoughts.

Saved by a case of poison ivy

We've known each other about 40 years--were neighbors when we were both apartment dwellers in 1967. At an art show this morning she told me she'd had a cervical something-ectomy, didn't get the exact term. She's an avid tennis player, but had called her doctor for some poison ivy treatment, and in passing mentioned that she had a tingling in her neck--sort of felt like little bugs crawling around. He told her he would schedule an MRI, which sort of surprised her. Well, she had bone spurs on her spine, but had felt no pain except the tingling. One wrong move on the tennis court or a fall, and she might have been paralyzed. She immediately had the surgery and was recuperating most of last summer. Now she has two small rods supporting her neck, but everything is fine, and she's back to making her art work and playing tennis.

I looked up "bone spurs + tingling + neck" and learned that, "In persons 60 and older, bone spurs are common. Only a little more than 40% of the population will develop symptoms that require medical treatment as a result of bone spurs." She really had no significant pain. Pay attention to those tingles, and Thank God for poison ivy!

Sex and the sixty year old

The February 14 issue of JAMA has an article on the sexual difficulties of a 60 year old woman, just in time for Valentine's Day, but I didn't see it until April 1. It seems that Ms. B has diabetes, hypertension, hyperlipidemia, and asthma now, and when she was younger she had endometriosis, bladder suspension surgery for incontinence and a hysterectomy for uterine fibroids. As might be expected, she takes a lot of medication, has back pain, and is allergic to some of her meds. She doesn't smoke or drink, and works as a psychologist. Oh yes, she didn't go through menopause until 58, so she dates her complaints to decreased desire and less stimulating sex to that. The author isn't specific, but says Ms. B. has some "body image" issues. One of the comments about obesity and sexual issue made me suspect that might be the problem.

I would be out of the mood just listing her health problems, so I can imagine trying to live with them. The article lists all sorts of reasons for sexual dysfunction and what life style or medical changes can be made. However, I found the very last paragraph quite instructive--almost humorous.

PHYSICIAN: How should I bill for a sexual health consultation in order to be reimbursed?
DR. POTTER: . . . Examples of reimbursable ICD-10 diagnoses include: lack or loss of sexual desire (F52.0), failure of genital response (F52.2), menopausal and female climacteric states (N95.1), postmenopausal atrophic vaginitis (N95.2), dyspareunia (N94.1), and orgasmic dysfunction (F52.3).

There are 122 references in the bibliography.

The old to extremely old ratio

There's a proposal to reexamine the health care of the elderly, and not so elderly. It used to be that there were a lot of people in their 50s and 60s to help care for those in their 80s and 90s. For instance, my parents were in their 50s when my mother's parents died, and 70s when my father's died. They were there for errands to the doctor, taking in food, helping with home chores, taking them to church, supervising medications, and visiting them for companionship. And they had brothers and sisters, cousins, nieces, nephews and grandchildren also available. People today are living longer (although in my family we always had people living into at least their 80s it seems in every generation), having children later or none at all, and when they do have families, they are smaller. This will have an impact as the boomers age.

"They estimate that in Switzerland, the oldest old support ratio has fallen from 139.7 in 1890 to 13.4 in 2003. They predict that these oldest old support ratios will decrease to 3.5 in Switzerland and 4.1 in the US by 2050." Seen at Medscape.com

Late in life divorce

"One woman in her eighties, married for fifty-three years, woke up after transplant surgery and announced to her husband: 'I don't know how many years I have left, but I do know I don't want to spend them with you.' "

That's probably a bit drastic but Calling it Quits author Deirdre Bair says it's happening. And often it's the ladies making the move.

New treatment for wrinkles

Possibly you were too busy over the holidays developing wrinkles while buying gifts and anticipating bills to notice that the FDA has approved a new treatment for those deep lines--something that lasts longer than Botox and Restylane. It's called Radiesse and is produced by BioForm Medical Inc.

And if you don't care about lines and wrinkles, you might use it to plump your retirement portfolio. Sales are expected to rise 15% annually through 2010--just 3 years away-- to $935 million.

Communication tips for doctors

"As baby boomers increase in age, the face of the American population will change dramatically. By the year 2030, a projected 71 million Americans will be age 65 or older, an increase of more than 200 percent from the year 2000, according to the U.S. Census Bureau. It's estimated that some 6,000 people turn age 65 every day and, by 2012, 10,000 people will turn age 65 every day."

This is the opening paragraph of an article in the Family Practice Management journal, Sept. 2006. As you and/or your parents age, you might be getting less face time with your doctor. The article suggests tips for the doctors, but it also alerts us patients to the problems.

Here's the summary, but stop and read the whole article.

1. Allow extra time for older patients.

2. Minimize visual and auditory distractions.

3. Sit face to face with the patient.

4. Don't underestimate the power of eye contact.

5. Listen without interrupting the patient.

6. Speak slowly, clearly and loudly.

7. Use short, simple words and sentences.

8. Stick to one topic at a time.

9. Simplify and write down your instructions.

10. Use charts, models and pictures to illustrate your message.

11. Frequently summarize the most important points.

12. Give the patient a chance to ask questions.

13. Schedule older patients earlier in the day.

14. Greet them as they arrive at the practice.

15. Seat them in a quiet, comfortable area.

16. Make signs, forms and brochures easy to read.

17. Be prepared to escort elderly patients from room to room.

18. Check on them if they've been waiting in the exam room.

19. Use touch to keep the patient relaxed and focused.

20. Say goodbye, to end the visit on a positive note.