ELDR blogs

Our Last Kiss

Wed, 06 Aug 2008 23:55:23 -0400

On August 2, 2001, I kissed Robert for the first time in the moonlight after our line dance class.

On August 2, 2008, I kissed him for the last time.

***

Those of you who read Better Than I Ever Expected: Straight Talk about Sex after Sixty know our love story, and know that Robert was living with leukemia and lymphoma. After the book was published, Robert had six months of chemotherapy , leaving his cancer in remission. We had two glorious years of health, vigor, and intense, joyful love after that. We felt we were the happiest, luckiest couple in the world.

Last April, Robert was diagnosed with a new blood cancer: multiple myeloma. It's a debilitating, painful, and incurable cancer of the bone marrow, causing extreme bone pain and fragility. Within a month he was living with five spinal fractures and excruciating pain, despite the best efforts of his medical team and an array of powerful narcotics.

I didn't write anything about our life during this time because Robert asked for privacy. If you're a regular reader, surely you noticed that I became curiously silent for most of the past couple of months, and when I did post, it lacked the personal candor that you expect from me.

Ten days before his death, Robert entered into home hospice care, and the marvelous hospice team was able to bring him relief from the pain. He then wavered between sleeping and waking, sometimes marvelously lucid and rational, often only partially conscious, and occasionally uttering beautiful messages from the world he was visiting. Here are some of the things he told me as he floated in and out of lucidity, and I'll treasure them always:

* "Do you remember the time we laughed so hard that we shook the feathers off our caps?"

* "We did have fun together, didn't we? We did have fun."

* "Wasn't it wonderful when we walked in the water in every state, or almost every state?"

* "It was just yesterday that we walked and walked, and I knew the name of every flower."

* "I came by here hoping to see you."

Yes, I'm still committed to this work I do as an activist for elder sexuality, and don't worry, I'll have my voice back soon. My work was almost as important to Robert as it is to me, and he made me promise I'd keep my torch burning. He was a private person, and sometimes I embarrassed him with my candor, but he believed I was doing the right thing talking out loud about this hush-hush topic, and he supported me all the way.

I welcome your comments here and your private emails to me. I know I have many readers who have visited without commenting. If my work here has made a difference to you, if you learned something useful or were moved by my book, I hope you'll honor me with your words. I could use them now.

Warmly,

Joan

– Joan Price is the author of Better Than I Ever Expected: Straight Talk about Sex after Sixty. Visit her website at joanprice.com and her sex and aging blog at betterthanieverexpected.blogspot.com. You can email her at joan [at] joanprice [dot] com.

Driving the Dying to the Back Alley

Wed, 06 Aug 2008 23:38:30 -0400

Ask any woman. The back alley is an inherently unsafe and degrading place to go for medical treatment.

At one time the epicenter of the back alley for end-of-life choice was a Volkswagen bus in Michigan. Today's epicenter is a veterinary pharmacy in Tijuana, Mexico.

A recent New York Times article, ("In Tijuana, A Market for Death in a Bottle," July 21, 2008) explains it all and has quickly become one of the most visited and emailed pieces on the Times website. The zebra-striped burro featured in the accompanying photo gives the whole scene a surreal, Fellini-like tone.

Yet desperate, determined people from around the globe regularly visit this scene to obtain the short-acting barbiturates they know could deliver to them or their loved one the same rapid mercy they have seen delivered to their beloved pets. They come with no Spanish language skills. They carry pictures of the bottle they seek as they labor to decipher confusing instructions on dosage.

If it weren't so sad it would be comical, in addition to surreal, to watch the couple on a linked video lamely explain to a quizzical shopkeeper how the reason they need a really big dose is they have a "really big" dog (150 pounds). The shopkeeper doesn't seem to be buying that story.

Tragically, after bickering about which one of them is right on the dose, this couple returns to Australia empty-handed. The woman, with advancing Alzheimer's Disease, resigns herself to her fall-back plan, obtaining a pistol and shooting herself when she no longer recognizes her husband.

Now this is where I get angry. What kind of barbaric, merciless society would consign a loving, conscientious, thoughtful and considerate woman to such a cruel ending to her fruitful and meaningful life? Shame on this callous, cruel world.

Only a few places in the world have made it legal for dying patients to receive life-ending medication from their physician and self-administer it: Belgium, Luxembourg, Netherlands, Switzerland and Oregon.

In Oregon the practice has been closely watched and voluminously reported for 10 years. Most Oregonians are comforted to have a death with dignity option; few use it (about one in 1000 deaths) and hospice and pain care have grown and flourished with the law in place. Just last month an esteemed panel of pain care experts awarded Oregon an "A" grade for pain care, joining only four other states so honored.

Here's the irony. Solid medical research, over long periods of time and across many geographic regions, shows underground, back alley assistance happens FOUR TIMES as often (one in 250 deaths) as legal death with dignity in Oregon. Meticulous studies show the underground practice in Oregon has completely ceased, having been replaced with an open, transparent, regulated, safe medical practice one-fourth the size of covert, illegal assisted deaths in the other 49 states.

So you'd think, rationally, death with dignity opponents would promote legalization, to keep the incidence down at least. You'd be wrong! Apparently right-to-lifers prefer to drive the dying to a rampant, dangerous back alley of degradation than to a rare, safe medical practice of dignity. Go figure.

Yes, underground practice goes on unfettered in 49 states. But just because you're venturing in the underground, is no reason to stay in the dark.

Promise me this. If you or someone you love needs to talk with a non-judgmental, knowledgeable and compassionate expert in peaceful dying, please, please, call Compassion & Choices. Our consultation program applies over 20 years' experience walking people through the labyrinth of end-of-life choices. Our network of medical professionals and trained volunteers covers over the nation.

We understand each person, situation and family is different and regardless of the situation, we can always identify a peaceful, humane escape from unbearable suffering. Different situations call for different options. There's no need to break the law. Often the answer is right there, waiting to be discovered through a careful, frank conversation. Effective medication is almost always available without traveling to Mexico or any other country.

Compassion & Choices never abandons a client to their suffering and never charges a fee for consultation. Our counselors and volunteers will stay with you through the tough times— ongoing consultation lasts an average of five months until the time of death.

Assurance of a peaceful death brings great comfort to people facing terminal illness. We often say that assurance "enhances the celebration of life." It's just that the assurance and the celebration are usually available without the risks of foreign travel.

- Barbara Coombs Lee is President of Compassion & Choices, a nonprofit organization dedicated to improving care and expanding choice at the end of life.

When Wishes are Fishes

Wed, 06 Aug 2008 23:30:02 -0400

How do we get doctors to honor our wishes at the end of life? Everyone recommends preparing an Advance Directive, and I'm no exception. These documents are not infallible, but they are the best thing we've got going for us when we can't speak for ourselves.

But I must warn you about one popular Advance Directive form that purports to implement your wishes, but could actually subvert them with its stealth anti-choice language. It's called "Five Wishes."

There are two general kinds of Advance Directive. One is called a "health care proxy" or "power of attorney for health care" and it delegates a person to make decisions on your behalf. The other, the "living will" specifies your wishes. Because anti-choice activists keep tightening the rules of evidence that govern end-of-life decisions, you need both documents. One names the decision-maker. The other guides the decisions.

Most people use their state-approved Advance Directive form, and these are the most trouble-free and reliable. But the widespread form called "Five Wishes" should come with a warning label. Why? Because the religious dogma imbedded in it could actually subvert your wishes when the time comes.

In 1997 James Towey started a Florida organization called "Aging with Dignity" and wrote "Five Wishes." With the help of the Robert Wood Johnson Foundation and others, Five Wishes spread across the country. Aging with Dignity claims more than 15,000 organizations distribute Five Wishes, and most of them probably do not know about the religious slant. Many people now have these on file, instead of their own state forms. Five Wishes is a wonderful form in many ways, but fair warning is in order.

One good thing about Five Wishes is its simplicity. It really does avoid the legalese that makes forms written by legislatures so tedious and opaque. Five Wishes includes things you might never think to include in your "wishes," like the wish to be rubbed with warm oils as you die, or be soothed with a cool cloth. Also, Five Wishes wisely includes brain damage (that would include dementia) along with terminal illness and coma, as a condition that triggers your instructions about life-support treatment.

But Towey makes no secret of his desire to spread the tenets of his Catholic faith and encourage others to live by them. When he left Florida to lead faith-based initiatives at the White House he described his goal unabashedly as to "get into heaven."

Five Wishes incorporates the Catholic creed that while it is permissible to take action you know will cause death, it is never permissible to intend death. It's a subtle concept, but central to Catholic theology related to the end of life. It carries the name "doctrine of double effect."

Those of us trained in the law usually assume responsibility covers what we know will result from our action, in addition to what we intend. "I didn't intend to break the window" is no defense if I knew the window was closed and chose to throw a baseball to my friend outside anyway.

The double effect dogma can trip you up if you don't see it coming. Wish Number 2, "My Wish For the Kind of Medical Treatment I Want Or Don't Want," includes the general instruction "I do not want anything done or omitted by my doctors or nurses with the intention of taking my life."

Then the form goes on to list medical interventions that keep a person alive and allows you to check the box, "I do not want life-support treatment." Thus it creates internal conflict within the document.

Even if you check the "do not want life-support" box, a hospital or doctor could object that stopping life support would "intend" death and the form you signed expressly prohibits that. What a confusing mess that could create!

My advice—use your own state form. You can download them free, along with instructions and useful additions to the form, at the Compassion & Choices website.

If you have already filled out Five Wishes and want to keep it instead of changing to a state form, consider crossing out the part that does not allow an intention to end life. The Five Wishes form itself instructs you to cross out portions you don't agree with. (That instruction somehow went missing from the stealth anti-choice part.)

You can cross it out anyway. Initial and date the cross-out. Congratulations. You have just transformed a fish back into your own, personal end-of-life wish.

- Barbara Coombs Lee is President of Compassion & Choices, a nonprofit organization dedicated to improving care and expanding choice at the end of life.

The Joy of Dropping Dead While Running

Wed, 06 Aug 2008 23:22:07 -0400

I am well aware that this blog might make me sound pompous and self-aggrandizing, and I hope I'm neither. I am posting it anyway. It might help prove my contention that it's possible for old age to be fun, exciting and rewarding.

But there's a price you have to pay. Good health is an absolute essential and it takes lots of hard work, determination and self-discipline to stay healthy, strong and physically fit. Maintaining a positive, happy outlook on life is equally important. For me, all this involves eating sensibly, following a regular and rigorous, five-days-a-week year round running and full-body workout routine and staying very busy both mentally and physically. The rewards for me have been well beyond my wildest dreams.

Way back yonder when I had just turned 90, shortly before competing in a Senior Olympic track event, I asked my very special family physician, Dr. John Dryer, if he thought I should have a physical exam. His response was, "Why waste money on a physical? You've already had a good, long life and I can think of no better way to go than to drop dead running." I was a bit taken aback at first but soon saw both the humor and wisdom of his words. Since then, my goal has been to drop dead running but not before breaking a world record. I am now at the midpoint of my 95^th year on this planet and I've won 17 gold medals in state and national senior Olympic competitions and have broken four national NSGA records since Dr. Dryer's classic response back when I was 90, but that world record is still in my future.

You might say that to drop dead running is my long-term goal since I still have absolutely no health problems, feel great and expect to break that world record next year at the National Senior Olympics in San Francisco. If I do break it then, who's to say, if the good Lord doesn't, that I can't still victoriously cross several more finish lines before I cross that final one and drop dead?

– Jim Hammond

Get Ready for Olympic Mania

Sat, 02 Aug 2008 21:04:06 -0400

Dear Readers,

I'm ready for Olympia mania. Assuming the Chinese government doesn't flip out even more in their zeal to close websites, arrest reporters, crack down on Tibet or their own dissidents we'll be bombarded by images of amazingly gifted athletes competing in dozens of sports. I love it and can't wait.

Dave Bunnell

However, this is not to say I don't care about the politics swirling around the Beijing Olympics. I wish Chinese President Hu Jintao would meet with the Dalai Lama, withdraw his support of the genocidal generals in Khartoum and Burma, and nudge his buddy Kim Jong-il to get with the nuclear-disarmament program. And I wish they'd lighten up on the press--maybe the Chinese government needs a new PR firm. Whatever they've been doing seems to have badly backfired.

We all know China needs to end the censorship and open up its political system. And they need to seriously go after the real criminals, the ones who make fraudulent pharmaceuticals, mercury-laced makeup, carcinogenic children's candy, contaminated toothpaste, and all the rest.

But boycotting the Olympics would have accomplished none of this. I've been absolutely against this idea, and just in case any of you favored it, I'll try to explain why.

When President Jimmy Carter issued his famous ultimatum demanding that Soviet troops be withdrawn from Afghanistan by 12:01 a.m. EST on February 20, 1980 or we wouldn't go to the Moscow Olympics, I remember laughing out loud. No one believed the maniacs in the Kremlin would pay any attention to Jimmy's whimpering. And they didn't. The tanks kept rolling down the streets of Kabul. It was probably the most foolish moment of his presidency, worse than the sweater thing.

The Russians retaliated by boycotting the 1984 Los Angeles Olympics. Athletes on both sides of the Iron Curtain were shafted; they paid the price for this political tomfoolery.

People who say the Olympics are "just another sporting event" are naive or worse. Sure, the Olympics are all about sports, but at the same time they are all about politics. It is for this reason and my understanding of Olympic history that I believe the politically wise thing to do is to show up. If you want to have an impact, you need to be there.

Just imagine what we'd be missing if President Roosevelt had boycotted the 1936 Berlin Olympics. Jesse Owens would not be a symbol of the African-American struggle for equality. And on a lesser note, we might not have Leni Riefenstahl's great Olympia, a film that revolutionized modern editing techniques. The final gold medal tally of this Olympics, the one remembered by history: Jesse Owens 4, Hitler 0.

In 1964, the Mexican government massacred hundreds of students in the Plaza de las Tres Culturas just two weeks before the opening of the Mexico City Olympics. Yet the games went on. And in one dramatic moment, two American athletes shook the world and provided us with one of the most enduring photographs of all time, when they each lowered their heads and defiantly raised a black-gloved fist as "The Star-Spangled Banner" was played during the award ceremony.

Tommie Smith and John Carlos paid a heavy price for their theatrics; they were suspended from the U.S. team and banned from future Olympics. Back in America they and their families received death threats. But today, Smith, age 63, and Carlos, age 62, are revered across the world and considered heroes of the Civil Rights Movement. There is even a beautiful, imposing bronze statue of these two at San Jose State University, where they went to college.

Without question, the Munich Olympics were the most disastrous. Eleven brave Israeli athletes and one German police officer lost their lives at the hands of the Black September terrorists, and I suppose if this one Olympics could have been cancelled ahead of time I would have been all for it. However, there was no advance warning, no calls for a boycott. The world learned something about how horribly twisted terrorists can be, and if there was a silver lining it was the tremendous solidarity of the athletes who continued on with the games.

Certainly things aren't going as planned for the Chinese government. They are feeling the heat as millions around the globe denounce their bullying of smaller countries and their lack of regard for basic human rights. More importantly, freedom-loving native Chinese, Tibetans, Burmese, and the victims in Darfur are seeing they aren't alone. Will this translate into positive change? Perhaps not, but it's nice to see the Chinese master sweat.

I'm still mad as hell, but I say, let the games begin.

Can't Remember What I Forgot

Fri, 01 Aug 2008 17:34:58 -0400

Here's what top scientists are learning about memory.

For anyone worried about memory loss, here is a book with the greatest title ever: Can't Remember What I Forgot: The Good News from the Front Lines of Memory Research (Harmony Books, Crown Publishing Group, Random House, 2008) by Sue Halpern.

Halpern's book is a report on the current state of scientific and medical knowledge about possible preventatives or treatment for Alzheimer's and other forms of dementia.

Capturing the subtitle of her book, here is her summary of the state of good news (as of the time she wrote the book):

• The sorLA gene had been discovered, enabling scientists to use a whole new way to explain what was going on in the brains of people with Alzheimer's.
• Thanks to a new imaging technique, amyloid plaques could now be seen in a living brain.
• There was a growing open-source Alzheimer's gene bank.
• Preliminary data from a Mayo Clinic-University of Southern California study of the Posit Science program had shown that people who completed the training had significant improvements in auditory memory.
• Biomarkers in the blood and cerebral spinal fluid could show Alzheimer's nearly a decade before there are symptoms.
• Exercise had been shown to cause new brain cells to grow in old brains. That process, neurogenesis, had been shown to improve memory.
• A diagnosis of mild cognitive impairment (MCI) was not necessarily a "sentence to die from Alzheimer's."
• Memory loss in older people was normal.
• The first neural prosthesis, an artificial hippocampus, was close to being tested in living animals.
• The first round of immunizations for Alzheimer's disease had been completed, no one had gotten sick, and the method of delivery had worked.
• The majority of researchers were working from discoveries that the sticky plaques that had defined Alzheimer's for years were not the "bad guys," but that the bad guy was soluble beta-amyloid, which Alzheimer's patients had in toxic excess. "And while no one yet knew why that was," she wrote, "the retromer theory put forth by Scott Small and his associates offered a plausible explanation."

The not-so-good news, at least for me, is what Halpern was finally told after asking many scientists if working crossword puzzles helps stave off dementia or Alzheimer's.

"You know what crossword puzzles are really good for?" said Dr. Michael Merzenich, professor of integrative neuroscience at the University of California, San Francisco, and developer of a computer-based program for children with language-based learning disabilities. "Doing crosswords are really good for... doing crosswords. Do the puzzle every day and you'll get pretty good at it."

Unfortunately, Dr. Merzenich concluded, crossword puzzles don't do anything for memory.

What? You mean remembering that "adit" means "mine opening" doesn't mean I have a great memory? Rats!

- Lee Callaway of Redwood City, CA, has reinvented himself several times, including a transition from corporate executive to consultant, two trips back to graduate school and, most recently, as the founder of RebootYou.com. His driving force is staying active, discovering and trying new things, and continually searching for new challenges.

Steps to Preventing Alzheimer's

Tue, 29 Jul 2008 22:39:40 -0400

Q. What can you do to prevent Alzheimer's disease?

A. "If you have a family history of Alzheimer's, or simply if you are older, you may want to make a few lifestyle changes.

Mental stimulation and creative activities, regular exercise, social interaction, a healthy diet that includes fruits and vegetables high in antioxidants (the darker the better), cold-water fish high in omega-3 fatty acids, and nuts (which contain vitamin E) all can play a protective role.

Also, take care to maintain a healthy weight. In a long-term study of 1,500 adults that was presented in 2004, researchers from the Karolinska Institute in Stockholm found that those who were obese in middle age were twice as likely to develop dementia in later life."

– Stephen Wong, Ph.D., is chief of medical physics and director of bioinformatics at The Methodist Hospital Research Institute in Houston, Texas.

Reverse Mortgages: Fact Versus Fiction

Tue, 29 Jul 2008 14:00:52 -0400

Fueled by an escalating number of Americans who are reaching their retirement years and finding that Social Security benefits are not enough, reverse mortgages are becoming more popular than ever. The loans, which allow seniors 62 and older to tap the equity in their home, do not have to be repaid until the owner dies or sells the home. For this reason, reverse mortgages are appealing, especially for people with small nest eggs.

The FHA's Home Equity Conversion Mortgage (HECM) is the most popular reverse mortgage program and is federally insured. All reverse mortgages are regulated by the Department of Housing and Urban Development (HUD), which requires recipients to obtain a certificate from a credit counseling agency before gaining approval from the lender.

Even with these safeguards, some eligible consumers are hesitant to take advantage of the reverse mortgage opportunities because of negative stories they have read or heard.

To explain what reverse mortgages are all about, here are clarifications:

Fiction: A reverse mortgage is no better than a traditional home loan.

Fact: Unlike a conventional home loan, a reverse mortgage requires no monthly payments. Instead, it is a loan against your home that you are not required to pay back as long as you live there. The loan is repaid from the borrower's estate or the eventual sale of the home when the last surviving borrower no longer lives in the home. You can receive the money through a lump sum, monthly payments or a line of credit. To qualify, consumers must own and live in the home, and be 62 or older.

Fiction: A person 62 or older might have a difficult time qualifying for a reverse mortgage.

Fact: There are no income or credit requirements for a reverse mortgage. There is also no risk of default, and borrowers can receive payments and remain in their homes until they die or are no longer physically or mentally able to reside there. The amount you can borrow in a reverse mortgage is determined by your age, your home's value and interest rates. The older you are, the more you can borrow.

Fiction: The lender will own your home.

Fact: The bank never takes over the deed unless there is a default. Defaults can occur if the taxes and insurance are not paid current.

Fiction: Only the poorest of homeowners can benefit from a reverse mortgage.

Fact: Today, many homeowners with more expensive homes are turning to reverse mortgages to eliminate larger payments and free up cash in order to invest, travel, pay for college educations among other expenses.

Fiction: If the homeowners outlive the equity in their house, then they have to pay the mortgage or leave their house.

Fact: Once a reverse mortgage is executed, the residents can never outlive their equity, and the home can not be taken from them. On each reverse mortgage there is an upfront mortgage insurance premium paid to ensure that that never happens and the bank doesn't lose their money either.

Fiction: If, through a reverse mortgage, I receive more than my home is worth, my heirs or the estate will be responsible for overages.

Fact: Reverse mortgages are non-recourse mortgages, meaning that the heirs or the estate will never be responsible for any over payouts to the residents.

Fiction: Reverse mortgages cost significantly more than other types of home loans.

Fact: Typically, a reverse mortgage costs approximately one percent more than normal forward mortgages. Compared to most conventional mortgages with monthly payments, reverse mortgages can cost much less in origination fees.

- Mike Scarantino is a mortgage industry veteran and a motivational speaker for real estate agents. He is co-founder and CEO of Florida Household Mortgage and Southern Tier Home Loans.

Aging is NOT a Medical Event

Tue, 29 Jul 2008 12:51:51 -0400

Let me say it out loud: "Aging is not a medical event!" Normal aging does not require hospitalization. It is a natural process, a part of life. In fact, most people live their entire life at home.

But what happens when an older adult gets sick? Usually, they continue to stay at home. And they recuperate with much less risk of infection and a higher level of satisfaction than is possible in a hospital.

The limits to aging in place have more to do with safety, nutrition and security than medical events. Is the house or apartment a safe place that is designed to minimize the possibility of falling? Is there proper provision for nutrition so that regular healthy shopping and eating are a part of the aging lifestyle? Is there a risk for fire or for crime to occur? And is the older adult still driving when it is past the time when they can accomplish it safely?

Then there is the question of social life. Is the older adult alone too much of the time? Is this leading to despair and possibly even depression and thoughts of death?

The answer to these questions or limits doesn't have to do with buildings or building material. It doesn't have to do with a physician or a nurse. Rather, it has to do with human care and kindness.

For years family members have helped their elders as they got older. In some cultures elders have even been given a special place of honor so they are included as important components of the society. But that is not how it is in contemporary America. It is important that we come to terms with the difference.

In America we rely on caregivers to provide support for aging adults. They are either family members or paid caregivers who provide the safety, security, nutrition, transportation and socialization that seniors need to live a normal live.

These caregivers offer kindness and companionship, help in preventing falls, do driving, cleaning and cooking—and generally make it possible for seniors to continue to live alone in their own homes despite factors of age and frailty. With all this, it is safe and sensible for seniors to continue to age in their own home without thought or need for institutionalized medical care.

- Kathy Johnson is the Ceo and co-founder of Palo Alto, CA, based Home Care Assistance, which specializes in 24/7 live-in care and customized programs for hourly, daily and weekly care in locations throughout the United States and Canada. You can read more about Kathy and her company at HomeCareAssistance.com.

Don’t Beware of Greeks Bearing Gifts

Mon, 28 Jul 2008 14:01:41 -0400

I have a passion for travel, whether it's solo, with my husband or with my grandchildren. This is how I nourish my mind and discover and embrace history, cultures, architecture and landscapes. Sometimes, a travel experience is absolutely indelible.

While on a Greek Islands cruise aboard the beautiful and very Italian ship, Costa Classica, I saw fertile, pine-clad valleys, sleepy olive groves and hilly, goat-trodden terrain. I explored the ruins of Doric temples and fragments of statuary fashioned from limestone and legend. For me, the most enchanting port was Kithera.

Mythology dictates that Aphrodite sprang from the waters of Kithera, an island of goat farmers, old churches and narrow, sand-and-rock beaches lying at the crossroads of the sea routes to the Ionian, Aegean and Cretan Seas.

Here, the smell of fresh-caught fish wafts from old wooden boats. At the tavernas, tourists eat al fresco beneath striped umbrellas. Royal blue shutters and red flowers in window boxes give a vibrant flush of color to the white stone houses along steep paved streets. I passed a narrow alleyway garden bordering a modest house.

Behind the garden gate, three middle-aged women dressed in black cotton dresses were gathered around a wooden table laden with bowls. The women were shelling nuts. One woman, a grandmotherly sort with an apron around her waist, noticed me standing by her gate. I held up my camera and pointed to it. She smiled, rose from her chair, scurried to the gate, and gently took hold of my wrist to draw me into her garden.

"Do you speak English?" I asked. She shrugged. She asked me a question in Greek. I shrugged. Ignoring the language barrier, the woman laughed and turned my hands palms upward. She dipped her hand into the bowl of almonds and scooped the nuts into my palms. The other two women laughingly dropped nuts into my skirt pockets. I kept saying, "Thank you." I snapped a picture of the women.

The woman wearing the apron patted my back as she accompanied me to the gate. Silently, we nodded, smiled and waved goodbye. With one generous gesture in a Greek garden, we had bridged opposing cultures to connect in a moment of friendship. Here's what I think: If grandmothers ruled the world, there would be peace.

Kithera is accessible via ferry from Athens. Tripadvisor.com gives a great review to a B&B in Kithera: Hotel Pelagia Aphrodite (Agia Pelagia, Kythira, Lakonian Islands; 00 30 27360 33926; kythira.com).

– Roberta Sandler is an award-winning writer/author. Her newest book is A Brief Guide to Florida's Monuments and Memorials, published by University Press of Florida. She and her husband live in Wellington, FL.

The Need to Be Right

Mon, 28 Jul 2008 13:42:36 -0400

Dr. Phil often asks, "Do you want to be right or happy?" Although I am not a big fan of either/or thinking, I understand what he means.

Lately, I am noticing people's need to be right everywhere I turn. For example, last week I helped throw a baby shower for my Goddaughter whom I dearly love. Although I wanted to take charge of the party so she could just show up and enjoy it, she was uncomfortable with this arrangement. Believing that no one could or would do it as well as her, she insisted on choosing the decorations, planning the menu, cooking some of the food, setting up the room and micromanaging every detail of the party. When a friend of hers commented on how lovely the decorations were she said, "If I hadn't gone to the store to buy them we wouldn't have had them." "That's true," I replied. But you would have had decorations which were equally as lovely."

A few days later, I received feedback from colleagues of a scientist I am beginning to coach. "She's too forceful in her opinions," they said. "When we try to show her another perspective, she gets loud and aggressive. She acts like she's the only competent one in the room."

Then last night at my Zen study group, a well-intentioned student told me that the energy work I learned through aikido and have practiced for thirty years was unimportant. Without knowing what the work consisted of, she likened it to seeing auras and advised me to forget everything I have studied and just meditate in silence.

In the past, I would have defended my years of energy awareness training and educated her about its benefits. Recently, however, I have noticed that my need to grapple for the top-dog position is beginning to dim. Truth is, I see the need to be right within myself and as Gandhi said, I know that the change I seek begins with me. Thus, I have been reflecting on this tendency. Here is what I have come up with so far...

Most of us believe that our way of seeing the world is objectively correct and that those who dare to see the world differently are in some way defective. They are not smart, experienced or wise enough we may conclude. Categorizing others allows us to dismiss them and in so doing, we get to hold on to our feelings of safety and superiority. This kind of thinking separates people into them and us and damages the very relationships we most cherish. On a global level, it is the root cause of wars, genocide and other horrific acts of humanity.

Although I realize my view of the world is only a slice of the pie called reality, I'm so used to it that I rarely question its veracity. However, instead of assuming that my view is the Absolute Truth, would owning it as a preference open my mind to new possibilities? Would it deepen my connection with others?

Furthermore, instead of assuming that I understand what the other person is saying and then rush off to show the limitations of that thinking or to provide advice, I take a pause to immerse myself in the other person's way of seeing the world. That may mean asking questions to elicit more information. Since my mind moves so quickly and is so results-oriented, slowing down the conversation may be challenging. Yet, isn't it in the slowness, the moment to moment living, that true connection occurs? Isn't this the birthplace of compassion?

A friend told me this story. A client goes to her psychotherapist office and doesn't say anything. The therapist sits in silence with her, finally telling her that if she wants to talk, he is there to listen. Still she says nothing. After a while, tears begin to stream down her cheek and she starts to sob. Still the therapist says and does nothing. After a while, he reminds her that if she wants to talk, he is there to listen. At the end of the session, the woman thanks him profusely for being there for her.

What do you make of all this?

– Aimee will be providing a tele-class in August on The Enneagram, a personality tool that describes nine ways of thinking, being and behaving in the world. For more information, contact her at aimee [at] openmindadventures [dot] com

Use of BNP to Diagnose Heart Disease

Sun, 27 Jul 2008 11:24:12 -0400

A CASE STUDY

A 60-year-old man came into the office complaining of abdominal bloating and gas. He also had intermittent shortness of breath and a vague shoulder discomfort. He said that Pepto-Bismol made him feel better. There was a prior history of heart attack several years before.

His blood pressure was normal and his pulse was not increased. His electrocardiogram (EKG) revealed evidence of old cardiac damage from the prior heart attack, but no new cardiac event.

Because of his history of heart problems I ordered an immediate BNP (B type natriuretic hormone) blood test, even though it seemed like his problem was intestinal. Our lab can run this test in 10 minutes. The BNP was elevated at 200 (normal less than 100). He went to the hospital, where other studies indicated a heart attack, and he was admitted.

Without the BNP test, this patient would certainly have gone home, since his symptoms did not suggest a heart problem. He was much safer in the hospital, where he could be treated, and monitored for complications.

BNP is a hormone produced by the heart muscle in increasing amounts when the heart is under stress, such as during a heart attack or heart failure. The test should be available in more private offices, as the machine to run it is relatively inexpensive and very easy to use. BNP can be followed as an indicator of cardiac muscle strength. If it is normal, it is likely that a patient with chest pain is not having a heart attack.

If you want to clarify your cardiac status, especially if you are having chest discomfort, request a stat (immediate) BNP. It could save your life.

- Dr. Sosin is the Founder and Medical Director of the Institute for Progressive Medicine in Irvine, California. He has authored two books, Alpha Lipoic Acid: Nature's Ultimate Antioxidant, and The Doctor's Guide to Diabetes and Your Child.

^{The information contained on this blog is provided for educational purposes only and is not intended to diagnose, treat or cure any illness or condition. The recommendations contained on this site have not been reviewed by the U.S. Food and Drug Administration (FDA). No content contained on this site is a substitute for professional medical advice, diagnosis or treatment. Never increase, reduce or discontinue any medication or treatment without first consulting your doctor.}

Reaching for Creativity

Sat, 19 Jul 2008 11:24:12 -0400

Once upon a time, we were all children. We played, talked, painted with abandon. Those stick figures never seemed awkward when we drew them, we did not have the consciousness of exactitude or photographic imaging. We had pride in our work and went back again and again to draw more.

But as we matured, a different consciousness took hold. We had an awareness of the visual experience and our capability to replicate it. For some, this provided an exciting challenge to learn the nuances of representational art, yet for others, it encouraged avoidance behavior. But there is a big chasm here. There is an opportunity to release your inhibitions and creatively express yourself. Look at the differences in the work of Picasso, Jackson Pollack, Dali and others who defied classic portraiture and explored colors, shapes, and brush strokes to communicate their vision. Don't use rules—use your energy and find your passion. Sure, some of us are born with more intuitive visual talent or sharper music skills but all of us can benefit from taking the plunge to being creative and maintaining creativity in our lives.

The Linden Center for Creativity and Aging within the Gerontology Institute at Ithaca College is less than a year old and was established to understand the involvement between aging and creativity and ways that people, institutions and our society can benefit. "There is a growing recognition among those who study aging that involvement in creative activities such as the arts can contribute significantly to well-being across a person's life span," said John Krout, professor of Gerontology and director of the Gerontology Institute at Ithaca College. "The fact is, an older person doesn't have to be Picasso to embark on new creative pursuits or continue lifelong creative endeavors."

Can you learn to be creative? David Perkins, a Harvard scholar, has written The Eureka Effect, a book about "breakthrough thinking" which is thinking creatively and thinking outside-the-box. He confirms that for some of us it comes more easily than for others and says much is in attitude. "It's sort of like running:" Perkins says" anyone can do it, but you can learn to do it better."

It is always the right time to reevaluate, reinvent and renew ourselves. In the third stage of life, we should feel excited to fill our life journal with new experiences and challenges met. Think outside the box because it is the creative spirit that empowers us to be free of rigid constraints and engages us to invent and inspire positive experiences.

As George Burns said "You can't help getting older, but you don't have to get old."

- Judith Zausner is the Founder and President of Caring Crafts, Inc. which offers craft kits and supplies to adults with fine motor skill problems and/or attention difficulties. Awarded a grant from the Society for the Arts in Health Care, Judith is dedicated to empowering creativity to encourage independence and enhance wellbeing.

Getting Back in the Dating Game

Tue, 08 Jul 2008 13:36:35 -0400

Many of us are wary about starting to date again after divorce or the death of a spouse. We may tread lightly, even fearfully, into this brave new world that barely resembles the world we grew up in. The rules have changed, the venues are unfamiliar (online dating? cybersex? speed dating?), and certainly we have changed.

Here are some tips for getting back in the dating game safely and successfully. Good luck—and please let me know your stories!

1. Don't date until you're really ready—before that, go out with friends, go dancing for the pleasures of physical touching, and have buddies of both genders whose company you enjoy and to whom you can talk honestly and deeply.

2. Engage in activities you really enjoy where you'll meet other people (friends or potential dates) who also like your favorite activities, like hiking, book discussion groups, and dancing.

3. Try online dating. Some people have great luck with it. Others don't. Keep in mind that people often describe themselves inaccurately and sometimes (often?) lie about their age, looks, marital status, finances, and their emotional stability. So have plenty of email talk and then phone conversations before you decide to meet, and then be sure to follow #4, 5, and 6 below.

4. Meet new people for coffee or a walk in a public place. Don't go on a "date" before getting to know him/her. Trust your gut if you feel uneasy, and end the meeting politely but firmly.

5. When you go out on a first date, be sure a friend knows where you're going and with whom, and when to expect a call from you. Call your buddy when you get home or, if you can do this discretely, from the date venue. If you decide to go somewhere else with your date, call your buddy about the change in plans.

6. When you're ready to have sex again, use condoms every time. Don't believe someone who tells you, "I'm safe, we don't need to use condoms." If she/he's willing to go to bed with you without protection, then how many other people has she/he done this with? It's a hassle, sure, but it's a myth that only young people are at risk for HIV or other STDs. (Please see my blog post, How Do You Handle Sex and Dating.)

– Joan Price is the author of Better Than I Ever Expected: Straight Talk about Sex after Sixty. Visit her website at joanprice.com and her sex and aging blog at betterthanieverexpected.blogspot.com.

Listen to Joan's Podcast

Tue, 08 Jul 2008 13:31:16 -0400

I was honored to be invited to be a part of the marvelous Seal Press "By Women For Women" podcasts, presenting interviews with Seal authors. Please click here to listen to the podcast, where I discuss some lively strategies for keeping sex spicy and satisfying.

After you listen, I hope you'll comment here and share what you think.

The podcast mentions a free download of a nicely formatted, print-worthy .PDF of my Tips for Hot Sex After Sixty. To receive the Tips, please email me at joan [at] joanprice [dot] com with your request and I'll send the tips to you as a .PDF attachment.

No Excuses

Tue, 08 Jul 2008 10:47:32 -0400

Human nature is fallible, but that's no reason to let it dictate our behavior.

"Well, it's only human nature." How often have you heard someone say that when excusing a bad deed or perplexing behavior?

The belief that our behavior is programmed physically or biologically frightens me because it implies that we have no control over our lives or our souls. Everything I have learned over the years has in fact led me to believe that the great things that humans have accomplished have been in defiance of natural tendencies to remain animalistic. We are not animals. If you want to restore your perspective on what we can be when we are not guided by basic instincts, read again the great books that have shaped our civilization, or visit a museum or go to a concert and listen to the music of the human spirit, soaring, reaching, transcending the base and the ordinary.

Take a walk in the woods. Nature and "our nature" are not the same. It's important to distinguish the two, particularly now when we are bombarded with more and more information promoting "natural" everything, from foods to healing. We can lose perspective on what is good and bad about the natural world, what we should appreciate as well as what we should question.

Civilization represents the taming of nature and our ability to evolve toward a higher level of understanding of the world. Electricity, air travel, antibiotics are just some examples of our capabilities to move beyond natural limits. Civilization at its best is expressive of our human potential and possibilities.

As we age, we are faced with the choice of giving in to nature, which puts such impediments as arthritis and presbyopia (farsightedness) before us, or defying the natural sequence of things and determining to combat them. We can make excuses by saying, "It's our age." And when we get up in the morning, we can give in to aches and pains or mental fatigue and seek comfort and sympathy. Or we can say, "No, I know what I can be and I will not flee from this day. It's in my power to define my own human nature, with no excuses."

- Leda has published a book of essays called, "Look for the Moon in the Morning." To learn more about Leda Sanford, visit her website, l edasanford.com.

Find Yourself A Good Doctor

Tue, 08 Jul 2008 10:39:49 -0400

They don't all disappoint at life's end. What with all the research coming out about doctors lying about prognosis, refusing to discuss hospice, ignoring advance directives and generally setting the stage for traumatic and painful death, a person could get discouraged.

Don't despair. There are many wise, forthright and compassionate doctors prepared to be your companion and ally. You will find them eager to offer cure, care and expert advice, but also willing to let you direct the last scene of your life, when it comes to that.

This column comes in praise of physicians who put the "care" in healthcare. I think, of course, of icons like Dr. Timothy Quill, who wrote A Midwife Through the Dying Process, and all those who came under his magnificent mentoring. I think of the gentle doctor who sat at my mother's knee and cried as he broke the news that her husband of sixty years was gone. I think of the researchers and practitioners at Dartmouth Medical School who lead an emerging "slow medicine" movement to put the brakes on aggressive, intrusive procedures for frail elderly. I think of those who know "truth" and "hope" are not mutually exclusive and a doctor's job is to share both. How do you find one of them?

At Compassion & Choices we often tell people to interview their doctor. The day you start wondering about end-of-life options is no time to discover your doctor's values and beliefs don't match your own. You might like some clues now to what your doctor's approach might be later. What kind of questions would get your doctor to open up?

I recommend starting with a positive, upbeat declaration that, by gum, you feel healthy, you love life and you intend to savor its fullness as long as humanly possible. But you also believe in preparedness, and you'd like to make sure the two of you would be on the same wavelength in an end-of-life situation. Try one of these questions:

Doc, if I had an illness that looked pretty grim, how would you feel if I wanted to take a pass on the heroics and let nature take its course?
I wouldn't want my family fighting over keeping me alive if I were in the condition of Terri Schiavo, with no chance of recovery. How would you handle a situation like that?
What if I were dying and really struggling with pain or other agonies? Would you prescribe enough pain medication and sedatives to keep me comfortable, even if it meant my life might be a little shorter?

Above all, value humility in your physician. Find a doctor who utters the words, "I don't know" and you've found true gold.

Happily, the time is gradually passing when the doctor's only source of pride lies in "doing everything" possible to prolong life. Some also take pride in serving as midwife to a good death.

I spent my formative years as an intensive care nurse, and to my everlasting shame, I pushed down tubes and pounded on chests and delivered electric shocks to many whose greatest need was for a little quiet time and the caress of their beloved. Treasure the doctor who might respond to a family asking that "everything" be done, in the way suggested ten years ago by Duke University physician David Pisetsky:

"I would like to say, ‘Family, only you can do everything. Only you can talk of your love and give kisses before the skin is cold. Only you can talk of the future and of dreams to be fulfilled. Only you can talk of the past when life was resplendent because time seemed infinite. Family, only you can oppose the flow of time and enjoy one last day together. Only you can give peace and sustenance for the next journey. Family, only you can do everything. I am only a physician. I can do nothing at all.'"

Find a doctor like that!

– Barbara Coombs Lee is President of Compassion & Choices, a nonprofit organization dedicated to improving care and expanding choice at the end of life.

Alternatives to Petroleum-Based Plastic

Mon, 30 Jun 2008 16:39:59 -0400

Q. What are the environmental pros and cons of corn-based plastic as an alternative to conventional petroleum-based plastic? — Laura McInnes, Glasgow, Scotland

A. Polylactic acid (PLA), a plastic substitute made from fermented plant starch (usually corn) is quickly becoming a popular alternative to traditional petroleum-based plastics. As more and more countries and states follow the lead of China, Ireland, South Africa, Uganda and San Francisco in banning plastic grocery bags responsible for so much so-called "white pollution" around the world, PLA is poised to play a big role as a viable, biodegradable replacement.

Proponents also tout the use of PLA—which is technically "carbon neutral" in that it comes from renewable, carbon-absorbing plants—as yet another way to reduce our emissions of greenhouse gases in a quickly warming world. PLA also will not emit toxic fumes when incinerated.

But critics say that PLA is far from a panacea for dealing with the world's plastic waste problem. For one, although it does biodegrade, it does so very slowly. According to Elizabeth Royte, writing in Smithsonian, PLA may well break down into its constituent parts (carbon dioxide and water) within three months in a "controlled composting environment," that is, an industrial composting facility heated to 140 degrees Fahrenheit and fed a steady diet of digestive microbes. But it will take far longer in a compost bin or in a landfill packed so tightly that no light and little oxygen are available to assist in the process. Indeed, analysts estimate that a PLA bottle could take anywhere from 100 to 1,000 years to decompose in a landfill.

Another issue with PLA is that, because it is of different origin than regular plastic, it must be kept separate when recycled, lest it contaminate the recycling stream. Being plant-based, PLA needs to head to a composing facility, not a recycling facility, per se, when it has out-served its usefulness. And that points to another problem: There are presently only 113 industrial-grade composting facilities across the U.S.

Another downside of PLA is that it is typically made from genetically modified corn, at least in the U.S. The largest producer of PLA in the world is NatureWorks, a subsidiary of Cargill, which is the world's largest provider of genetically modified corn seed. With increasing demand for corn to make ethanol fuel let alone PLA, it's no wonder that Cargill and others have been tampering with genes to produce higher yields. But the future costs to the environment and human health of genetic modification are still largely unknown and could be very high.

While PLA has promise as an alternative to conventional plastic once the means of disposal are worked out, grocery shoppers could do well to by simply switch to reusable containers, from cloth bags, baskets and backpacks for grocery shopping (most chains now sell canvas bags for less than a dollar apiece) to safe, reusable (non-plastic) bottles for beverages. As for other types of PLA items—such as those plastic "clamshells" that hold cut fruit (and there is a whole host of industrial and medical products now made from PLA)—there is no reason to pass them by. But until the kinks are worked out on the disposal and reprocessing end, PLA may not be much better than the plain old plastic it's designed to make obsolete.

– From the Editors of E/The Environmental Magazine. Learn more at emagazine.com. Got an environmental question? Submit it here or e-mail earthtalk [at] emagazine [dot] com.

Article Sources
Smithsonian's "Corn Plastic to the Rescue;" NatureWorks.

Using Hydrogen as Fuel on the Distant Horizon

Sun, 29 Jun 2008 16:48:11 -0400

Q. How is it that hydrogen can replace oil to run our cars? There seems to be a lot of controversy over whether hydrogen can really be generated and stored in such a way to be practical. – Stephane Kuziora, Thunder Bay, ON

A. The jury is still out on whether hydrogen will ultimately be our environmental savior, replacing the fossil fuels responsible for global warming and various nagging forms of pollution. Two main hurdles stand in the way of mass production and widespread consumer adoption of hydrogen "fuel cell" vehicles: the still-high cost of producing fuel cells and the lack of a hydrogen refueling network.

Reining in manufacturing costs of fuel cell vehicles is the first major issue the automakers are addressing. While several have fuel cell prototype vehicles on the road—Toyota and Honda are even leasing them to the public in Japan and California—they are spending upwards of $1 million to produce each one due to the advanced technology involved and low production runs. Toyota hopes to reduce its costs per fuel cell vehicle to around $50,000 by 2015, which would make such cars economically viable in the marketplace. On this side of the Pacific, General Motors plans to sell hydrogen-powered vehicles in the U.S. by 2010.

Another problem is the lack of hydrogen refueling stations. Major oil companies have been loathe to set up hydrogen tanks at existing gas stations for many reasons ranging from safety to cost to lack of demand. But obviously the oil companies are also trying to keep customers interested in their highly profitable bread-and-butter—gasoline. A more likely scenario is what is emerging in California, where some 38 independent hydrogen fuel stations are located around the state as part of a network created by the non-profit California Fuel Cell Partnership, a consortium of automakers, state and federal agencies and other parties interested in furthering hydrogen fuel cell technologies.

The benefits of ditching fossil fuels for hydrogen are many, or course. Burning fossil fuels like coal, natural gas and oil to heat and cool our buildings and run our vehicles takes a heavy toll on the environment, contributing significantly to both local problems like elevated particulate levels and global ones like a warming climate. The only by-product of running a hydrogen-powered fuel cell is oxygen and a trickle of water, neither of which will cause any harm to human health or the environment.

But right now 95 percent of the hydrogen available in the U.S. is either extracted from fossil fuels or made using electrolytic processes powered by fossil fuels, thus negating any real emissions savings or reduction in fossil fuel usage. Only if renewable energy sources—solar, wind and others—can be harnessed to provide the energy to process hydrogen fuel can the dream of a truly clean hydrogen fuel be realized.

Stanford University researchers in 2005 assessed the environmental effects of three different hydrogen sources: coal, natural gas, and water electrolysis powered by wind. They concluded that we'd lower greenhouse gas emissions more by driving gasoline/electric hybrid cars than by driving fuel cell cars run on hydrogen from coal. Hydrogen made using natural gas would fare a little bit better in terms of pollution output, while making it from wind power would a slam-dunk for the environment.

- From the Editors of E/The Environmental Magazine. Learn more at emagazine.com. Got an environmental question? Submit it here or e-mail earthtalk [at] emagazine [dot] com.

Article Source: California Fuel Cell Partnership

Relief for Bladder Control Problems

Sun, 29 Jun 2008 12:02:24 -0400

Q. This is embarrassing to discuss with anyone so I thought I'd write to you about it. I'm having bladder-control problems. What can I do?

A. About 10 percent of men and women over the age of 65 have trouble with bladder control, also know officially as urinary incontinence. Women suffer from this more than men.

During urination, muscles in the bladder contract, forcing urine into the urethra, a tube that carries urine out of the body. At the same time, muscles surrounding the urethra relax and let the urine pass. If the bladder muscles contract or the muscles surrounding the urethra relax without warning, the result is incontinence.

Short-term incontinence is caused by infections, constipation, and some medicines. If the problem persists, it might be caused by weak bladder muscles, overactive bladder muscles, blockage from an enlarged prostate, damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinson's.

In most cases urinary incontinence can be treated and controlled, if not cured. If you are having bladder control problems, go to your doctor. Doctors see this problem all the time, so there is no need to be embarrassed.

Your doctor may do a number of tests on your urine, blood and bladder. You may be asked to keep a daily chart about your urination.

There are several different types of urinary incontinence. If urine leaks when you sneeze, cough, laugh or put pressure on the bladder in other ways, you have "stress incontinence." When you can't hold urine, you have "urge incontinence." When small amounts of urine leak from a bladder that is always full, you have "overflow incontinence." Many older people who have normal bladder control but have difficulty getting to the bathroom in time, have "functional incontinence."

There are many ways to treat urinary incontinence. The method depends upon the type of problem.

You can train your bladder with exercises and biofeedback. You can also chart your urination and then empty your bladder before you might leak.

Your doctor has other tools he can use. There are urethral plugs and vaginal inserts for women with stress incontinence. There are medicines that relax muscles, helping the bladder to empty more fully during urination. Others tighten muscles in the bladder and urethra to cut down leakage.

Surgery can improve or cure incontinence if it is caused by a problem such as a change in the position of the bladder or blockage due to an enlarged prostate. Common surgery for stress incontinence involves pulling the bladder up and securing it. When stress incontinence is serious, the surgeon may use a wide sling. This holds up the bladder and narrows the urethra to prevent leakage.

Even if treatment is not fully successful, management of incontinence can help you feel more relaxed and comfortable about the problem.

About Fred Cicetti:

Healthcare writer Fred Cicetti has been a professional journalist for more than 40 years. Fred's sources are the National Institutes of Health, the academies for medical specialties and the leading medical institutions. His articles are not intended as a substitute for professional medical advice; please talk to your doctor about your specific health issues.

If you would like to ask a question, please write to fred [at] healthygeezer [dot] com. Learn more about Fred at healthygeezer.com.

Cancer Doctors Avoid the Big Talk

Tue, 24 Jun 2008 15:13:27 -0400

The American Society of Clinical Oncology met in Chicago recently to discuss new therapies and review scientific data. Two research papers grabbed our attention.

One debunks the theory that talking about end-of-life options depresses people and upsets them. Researchers followed advanced cancer patients, asking, among other things, if they'd talked with their doctor about the end of life. Only 31% had. How did they fare, compared with patients who never discussed the subject? (Read Abstract)

It turns out, talking about death won't kill you. The researchers learned "the big talk" doesn't harm people, doesn't make them nervous or worried. But it does change how they die.

People who had "the big talk" were more likely to value comfort over life extension and to receive hospice care. They were one-third as likely to enter an intensive care unit and one-fourth as likely to be put on mechanical ventilation. Most people hope when death comes it will creep up peacefully while they're at home in their own bed. Now we know talking about it can help make that happen.

The other paper, appearing in the Journal of the American Medical Association, lists study after study showing that oncologists continue aggressive chemotherapy long after it does any good. Cancer doctors really, really dread candid conversations and avoid them if they can. (Read Abstract)

Patients said they learn more from other patients in the waiting room than from their doctors. Even when patients specifically ask about survival and prognosis, doctors admitted they usually (63 percent of the time) give false data, or none at all. Studies found doctors routinely exaggerate life expectancy estimates by 350 percent.

Is it kind to mislead patients—or cruel? My view is "it depends." Patients who don't want the truth don't ask for it. In that case no one should force it on them. But when they ask, it means they want and deserve accurate, complete information. And then, no one has the right to keep it from them.

This week a bill sponsored by Compassion & Choices, the "Right to Know End-of-Life Options Act," comes before the Health Committee of the California Senate. If it becomes law it will create the right for terminally ill patients, who ask about their options, to learn the whole truth.

Guess who is working hard to kill this bill—California oncologists! That's right, lobbyists for cancer doctors are fighting in the state Capitol to withhold truthful information from their patients. It's hard to believe they would do this, when their own evidence shows "the big talk" eases the transition from curative therapy to comfort care and helps patients plan for a peaceful death. But there you have it. The oncologists don't want this bill to pass and they've joined right to lifers in coaxing lawmakers to vote against it. Why?

Theories abound. Maybe oncologists don't want to admit the cancer is winning and will soon claim their patient. Maybe treating so many dying patients makes honest dialogue too emotionally draining. Last June the New York Times noted that oncologists pocketed billions of dollars on the chemotherapy they prescribed until Medicare was forced to crack down on the way it reimbursed for these drugs.

The writer asserted that "With the new limits on cancer drug profits, some cancer doctors are searching for new income—like performing chemotherapy more often or installing multimillion-dollar imaging machines where they profit when their patients receive diagnostic scans."

The Times quoted Dr. Robert Geller, a former oncologist now working at a biotechnology company: "It's clear that physicians stopped making decisions based on what made scientific or clinical sense in lieu of what made better business sense."

Barbara Roberts is a former Oregon governor, and much beloved throughout the state. She's written a book about grief and often talks about Oregon's enlightened attitude toward end-of-life choice. Barbara tells audiences, "I believe anything you can talk about, you can make better."

Of course this is true. But the converse is also true. Until we can talk about choices to be made, we have no chance to improve end-of-life care and spare cancer patients' needless pain, agony and invasive technologies. Fortunately, good research is coming out, and it's pointing the way toward wise end-of-life policies. The studies say we should trust and empower patients to chart their own end-of-life course. I agree.

Be careful out there, and love one another.

– Barbara Coombs Lee is President of Compassion & Choices, a nonprofit organization dedicated to improving care and expanding choice at the end of life.

Omega-3: The Super Nutrient

Tue, 24 Jun 2008 14:49:47 -0400

I have a long history of stressing the importance of nutrients to good health, dating back 25 years—even in the days when I was active as a cardiovascular surgeon. Omega-3 is a nutrient I single out for its broad effectiveness, its benefits reported in virtually thousands of research articles.

The story of Omega-3 started 40 years ago when epidemiologic studies evaluated the health of Greenland Eskimos and found an interesting paradox. The Eskimos, who eat a diet high in fat—mainly consisting of whale blubber—had a remarkably low incidence of heart attacks. The paradox was solved when an analysis revealed that their diet was high in Omega-3 fatty acids. Since that time, there has been an avalanche of scientific studies establishing the myriad benefits of Omega-3.

Fish, the natural source of Omega-3, has always been considered a healthy food, and the American Heart Association recommends a diet that includes three to four servings of fish per week. But—and I am convinced of this by personal experience—the high mercury content found in many deep water fish, as well as the high PCB, count makes eating excessive amounts of fish risky. Therefore, I strongly recommend that Omega-3 fatty acids be taken in supplements.

AHA Recommends Supplements
Years ago when I was attending a conference of the American Heart Association, I was pleased to hear the speakers recommending Omega-3 for a healthy diet; and, surprisingly, they added that if Omega -3 were not sufficiently available in fish at meals, then there should be Omega-3 supplementation. This was the first time I had ever heard a medical society that is generally very conservative recommend supplementation. Times have changed, and today vitamin supplements, specifically vitamin B to lower homocysteine levels, are recommended by the AHA. Not only does the American Heart Association recommend Omega-3 supplements, but the American Diabetes Association has followed suit, advising supplementation intake of Omega-3.

Indicative of the interest in supplementation, the August 21, 2006 issue of the American journal Cardiology included a special 40-page supplement titled "Omega-3 Fatty Acids and Cardiovascular Disease Reduction." A recent article in the British journal Lancet reported a 20% cardiovascular risk reduction in individuals taking statin drugs who were getting Omega-3 in a high fish diet or in supplements. The four benefits these researchers found were reduction in triglycerides, reduction in thrombogenicity, reduced inflammation, and stabilization of cardiac rhythm.

In my practice, I have used Omega-3 supplementation together with Coenzyme Q10, magnesium, and carnitine for cardiac rhythm problems with great success. To that very point, the New England Journal of Medicine reported recently that high Omega-3 intake protects the heart's electrophysiologic system and prevents irregular heartbeat or arrhythmia. This beneficial effect of Omega-3 is most likely secondary to its anti-inflammatory effect and also to its cell membrane stabilization effect because the Omega-3 fatty acids incorporate themselves into cell membranes.

Benefits for the Heart
Additional studies have reported that Omega-3 fatty acids can reduce the incidence of sudden cardiac death. And their effect in reducing high triglycerides is one of the reasons why the American Diabetes Association recommends their supplementation. Diabetics and also persons with visceral adiposity (fat stomach) and/or metabolic syndrome are generally found to have hypertriglyceridemia, which is itself an independent risk factor for heart disease and sudden thrombosis. Omega-3 anti-inflammatory, cardiac regulatory, blood pressure regulatory, and blood vessel wall enhancement benefits are also of great importance for the management of diabetes.

Here is a summary list of the cardiovascular benefits of Omega-3 fatty acids:

1. Prevention of deadly heart arrhythmias and reduced incidence of sudden cardiac death.

2. Decreased cardiovascular disease-provoking inflammation.

3. Relief of endothelial dysfunction.

4. Improved blood vessel elasticity.

5. Reduced blood pressure.

6. Reduced triglycerides.

7. Reduced postprandial hyperlipidemia, which is a significant contributing cause of acute myocardial infarction (heart attack after dinner), and chronic increase in cardiovascular deterioration.

8. Stabilization of arteriosclerotic plaque.

9. Reduced thrombogenicity or blood clotting.

10. Improvement in HDL metabolism.

These multiple cardiac benefits are all documented by scientific studies and are the reasons I recommend Omega-3 fish oils to all of my patients for cardiovascular disease prevention and for other therapeutic considerations.

And More...
Besides cardiovascular, there are many other health benefits of Omega-3 supplementation. New research indicates that fish oils can reduce the progression of early Alzheimer's disease. Studies also show that Omega-3 enhances mood, behavior, cognition, and counters depression. Other beneficial effects include enhanced immunity and improvement in bone and joint problems, especially arthritis and other inflammatory joint conditions. I use Omega-3 fatty acid supplements as a principal therapy for patients with arthritis.

Skin problems, such as eczema and psoriasis respond to Omega-3 supplementation. Gastrointestinal function is markedly improved, especially problems such as ulcerative colitis, Crohn's disease, and irritable bowel syndrome. Ocular benefits include a reduced progression of macular degeneration.

Of special importance for my practice is new research reported by the Endocrine Society that shows Omega-3 supplementation aids in weight management, not only through its anti-inflammatory effect but also by promoting fat oxidation. Other recent research reports improved wound healing and decreased prostate cancer progression with Omega-3 fish oil supplements. The list goes on. It is truly a super nutrient.

About Dr. Vagnini
Dr. Vagnini is ELDR's chief medical advisor. He is the coauthor, along with ELDR Editor-in-Chief Dave Bunnell, of the book, Count Down Your Age (McGraw-Hill). To learn more about Dr. Vagnini, visit his website »

Exercise: The Spark for Your Brain

Tue, 24 Jun 2008 14:28:10 -0400

Does exercise benefit your brain?

You bet it does, and if you want to know the many ways it does, get this book: Spark: The Revolutionary New Science of Exercise and the Brain, by Dr. John J. Ratey with Eric Hagerman.

"We all know that exercise makes us feel better, but most of us have no idea why," Ratey writes. "We assume it's because we're burning off stress or reducing muscle tension or boosting endorphins, and we leave it at that. But the real reason we feel so good when we get our blood pumping is that it makes the brain function at its best, and in my view, this benefit of physical activity is far more important—and fascinating—than what it does for the body.

"Building muscles and conditioning the heart and lungs are essentially side effects. I often tell my patients that the point of exercise is to build and condition the brain."

Ratey is a clinical associate professor of psychiatry at Harvard Medical School. He has put together a wonderfully fascinating account of what goes on inside your head when you exercise.

Ratey describes these almost unbelievable chemical and neurological processes in terms that a lay person can understand. And they make a convincing case that "...you have the power to change your brain. All you have to do is lace up your running shoes."

For me the most interesting chapter of all was the one on aging. Ratey lists nine ways that exercise keeps you going:

1. It strengthens the cardiovascular system.
2. It regulates fuel (glucose).
3. It reduces obesity.
4. It elevates your stress threshold.
5. It lifts your mood.
6. It boosts the immune system.
7. It fortifies your bones.
8. It boosts motivation.
9. It fosters neuroplasticity (keeps your brain growing).

Considering a list like that, why would anyone let laziness keep them from exercising?

Kiss Tomorrow Hello: Midlife Underground

Tue, 24 Jun 2008 13:42:23 -0400

I really enjoyed reading Kiss Tomorrow Hello: Notes from the Midlife Underground by 25 Women Over Forty. These essays reflect the thoughts, life events and relationships of 25 excellent women writers reflecting on age, health, love, sex, and change.

The writers range in age from 40 to much older, and I found their experiences and perspectives fascinating. For example, Joyce Maynard, at 51, discusses what she discovered from her foray into Internet dating ("maybe an amazing relationship is something you painstakingly build, not something that hits you like a lightning bolt... viewing the process as a search more like a road trip to parts unknown."). Karen Karbo discloses details about her relationship with a man 16 years younger ("OWs [Older Women] have learned that guys...like sex, and they like it when their women like it, and that's about it. [Younger women] worry far too much about cellulite. Basically if you're naked and smiling, men are pretty happy.")

The essay that gripped me the hardest was "Tearing Up the Sheets: A Meditation on Middle-Age Sex" by Ellen Sussman. As I read it, I kept running to my husband to read him parts. For example,

My husband and I prefer to make love in the afternoon. In the evening, we're, well, tired. And we like energetic, tear-up-the-sheets kind of sex. So we steal away from our work and spend some time imitating porn stars. Then we take a long middle-age nap.

Boys come quickly. Men do not. Hallelujah.

I fumble with my jeans, pushing them down and off. I scramble to pull his T-shirt over his head—wait, it's caught in his glasses—and the shirt and glasses fall to the floor... He grunts when he turns toward me—an old hip injury—and I cringe when I lean into the cushion—my damn back. And then we've got it right... When he enters me, he fills me. I pull him close, wanting all of him. I give him all of me.

If you're interested in this lively and provocative book, it's available from Amazon here.

Yes, We Can Change… But Will We?

Mon, 16 Jun 2008 13:33:45 -0400

Barack and Hillary have been telling us lately that "Yes we can." I agree. The question is, will we? I am not talking about political change. I am talking about the daily stuff of life such as finding a new purpose after retirement, losing weight and embracing new interests.

My work as a specialist in the management of change is to guide people and organizations to go from their current reality to their desired future state. After 30 years in the business, I can tell you with certainty that change is difficult for most people. I am sure that is not a surprise for you.

Even the good stuff—the birth of a grandchild, the relocation to your dream house, the finding of your perfect mate—produces ripples of energy that have us counting our blessings one moment and ready to run out the back door the next. Yet, most of us are seeking "More." It doesn't matter whether we want more money, more love, more power, more health or more self-mastery. Our desire for change seems to be in our DNA. So why do we fight the very thing that we say we want?

Some people would say that we need more motivation, will power, discipline or better time management. I am not convinced. Over thirty years of aikido, meditative practice, and energy awareness training has taught me that there are specific laws of nature that affect us all. Consider this change principle. Whenever there is a job or task to do, energy moves through your mind/body to help you do the job. For example, if you are healthy and the job is to stand up, you will not even notice the extra energy that moves through your system to help you rise. However, if you are infirmed, the amount of energy necessary to stand will be a great deal more. The bigger the job, which often depends on your perception and skill, the more energy is required. If you resist the increased energy, which I call pressure, you experience tiredness, discomfort, stress and/or disease. However, when you open to it, you feel energized, happy and confident.

Think about the speeches you have given, the times you asked your boss for a raise, the moments you stepped up to bat at a big game, and you will relate to what I am saying. I call the process of resisting energy the "180 degree turn." One moment you are moving in a certain direction only to find yourself spun around heading in the opposite direction. This happens to all of us, yet, if you want the "More" in life, you need to stop fighting the energy of change. How do you do that?

1. Don't believe everything you think. Your mind will con you. Do what you say you want to do, especially if you don't feel like it.

2. Reframe. Recognize that your resistance is just a sign that more aliveness is coming into your system to help you do the job. Say "YES!" to it.

3. Move. Take a walk, stretch, sing, or anything physical that helps you re-center and open your mind/body system.

4. Get as big as the job. Allow the pressure of change to move through you with ease. Energy outflow produces aliveness, joy and high performance. Imagine, like the sun, you radiate 360 degrees around you.

–Aimee Bernstein will be leading a women's retreat on Sanibel Island, Florida during the last weekend of October. To learn more, visit to her website: openmindadventures.com.

Trolling for Dates... for Dad

Sat, 14 Jun 2008 10:00:44 -0400

Father and son—they're an odd pair to be enmeshed together in the dating scene.

Bob is gay, 40, erudite, picky, fashion-snooty, and he recoils from dating anyone who resembles him. Joe is 81, a widower, sloppy, grudgingly willing to brush the accumulated trash off the passenger seat for a date (though not willing to turn off the baseball game), seeking a nice, Jewish woman who plays bridge and is willing to do more than hold hands.

Joe sends Bob into a squirming fit by telling him he wants Bob's help answering the personals ads.

Assisted Loving is a thoroughly delightful and funny memoir of Bob and Joe and their dating travails. More, it's a story of how Bob, so judgmental at first that you wonder if he even likes his father, comes to see Joe's deeper qualities—and his own. Highly recommended.

Of course I must chastise Bob for seeing his father's desire for sex as "unseemly" and embarrassing. Joe had an affectionate, dynamic relationship with Bob's mother, and of course he would want to share this kind of intimacy with someone else rather than stay lonely. (We understand this better than Bob did, I think.) Why should sex be "unseemly" just because Joe has wrinkles, a paunch and a hip replacement, and talks with his mouth full? More power to him if he feels sexual vigor and wants to express it—don't you agree?

If you're a dating, elder dad, this book would be a marvelous gift for your grown kids! Be sure to visit Bob Morris's website, too—it's very funny.

–Joan Price is the author of Better Than I Ever Expected: Straight Talk about Sex after Sixty. Visit her website at joanprice.com and her sex and aging blog at betterthanieverexpected.blogspot.com.

The Answer to High Blood Pressure

Wed, 11 Jun 2008 11:34:14 -0400

One quarter of the adult population of the United States has high blood pressure. In most of these people blood pressure is not under control despite medication. Most patients are taking 2, 3, or 4 blood pressure medications, and are subject to all the incident side effects: weakness, impotence or loss of libido, muscle cramps, rash, cough, high blood sugar, and others.

Most people with high blood pressure have what is called "essential hypertension," as if it were something they needed. It is intended to mean we do not know what causes it. We do know. Essential hypertension has two causes: salt and being overweight.

In areas of the world where salt intake is low—primitive areas—there is no such thing as essential hypertension, and there is no age-related hypertension. We only require about 2 grams of salt a day, and we eat at least five times that amount, often a lot more. Our food is loaded with salt, and it is added before we buy it. Only 5% of the salt in food is added during cooking.

With all the talk about reducing fat, eliminating trans fats, and reducing sugar, there has been no movement whatsoever to reduce our excessive salt habit.

I recommend you start to read food labels for their salt content. Salt will be listed as sodium. One mg of sodium represents 2.5 mg of salt. Thus your daily intake of sodium should be less than 1000 mg (one gram). If the label indicates that one serving of the product contains more than 100 mg of sodium, I suggest you do not buy it. You will be surprised, if not shocked, by what you see. Items such as sausage and other lunch meats, and cheese will be out of the question. Note that an 8 ounce serving of milk contains 150 mg of sodium. One slice of bread contains about 80 mg of sodium.

Restaurants, perhaps without exception, salt their foods heavily. This includes not only fast food restaurants, but also expensive ones. Soups especially are laden with salt. Chinese and Mexican restaurants offer perhaps the most heavily salted preparations.

There is no salt in fruits and vegetables provided they are fresh and not processed. Fruits and vegetables, in fact, are loaded with potassium, which has the effect of lowering blood pressure. Thus, the more fruits and vegetables you eat, the lower your blood pressure will go.

Add up the sodium in the foods you eat. Aim toward less than one gram of sodium per day. You will see your blood pressure go down, as well as your weight, because foods high in salt are often calorically dense. Make sure the nuts and popcorn you eat are also unsalted. You will get used to eating less salt, and eventually find heavily salted foods to be distasteful.

- Dr. Sosin is the Founder and Medical Director of the Institute for Progressive Medicine in Irvine, California. He has authored two books, Alpha Lipoic Acid: Nature's Ultimate Antioxidant, and The Doctor's Guide to Diabetes and Your Child.

The Art of Living Well and Dying Well

Tue, 10 Jun 2008 18:14:17 -0400

As Epicurus noted centuries ago, the art of living well and dying well are one.

Last month, ELDR's poll showed people want choices in how they die. A whopping 81.5%, to be exact, believe it is up to an individual—not government, not church and not some 3^rd party—to decide about life's end.

No surprise to me. But it was gratifying, because since 1994 I've devoted my life to end-of-life choices. That's when I co-authored and campaigned for Oregon's trail-blazing Death with Dignity Act. Now I lead Compassion & Choices, a national organization aimed at improving care and expanding choices at the end of life.

It's a big job and we're the only ones doing it. We litigate under-treated pain cases as elder abuse. We fight to put teeth in advance health care directives. We campaign for laws that empower people with knowledge and opportunities to choose. And our End-of-Life Consultation program gives people information and confidence to make their way through some pretty tough decisions. We never charge a dime for the consultation and support we provide to our clients and their families all over the nation.

People want to decide for themselves when a long downhill course of terminal illness is no longer living—it's prolonged dying. They want a good quality life as long as humanly possible. They are willing to tolerate a lot of suffering if they can still do a few worthwhile things and express their love of family and life. But if life becomes just suffering, with no joy and poor bodily function, many would like the assurance of a peaceful, humane way out.

We didn't used to have this problem. Devastating, untreatable diseases took lives quickly. A cancer diagnosis rarely lasted more than a year. Heart and lung disease had few effective treatments. Pneumonia was called "the old man's friend" because without antibiotics, it often brought the final release to a frail, weakened body.

No more. With the latest chemotherapy, radiation and bio-engineered treatments, people can carry on a valiant fight against cancer for twenty years or more. Transplanted and artificial organs work almost as well as the originals.

Even with no reasonable expectation of improvement, terminal patients often find themselves in intensive care, hooked up to tubes and machines, enduring one invasive technology after another to forestall the inevitable. Most people say if they could choose where to die, it would be at home. Yet 80% die in acute care hospitals.

Something is seriously haywire. Probably the most haywire we saw things was a few years ago when a Florida family fought a fierce, vitriolic public battle about their wife and daughter, Terri Schiavo. Schiavo had been in a vegetative state over a decade, and her husband believed, if she could decide, she would not want to be kept alive artificially. In last month's survey, 93.6% answered that would be their decision as well.

Politicians disagreed. And we were treated to the spectacle of Florida officials, Congress, and even the president, pressing government into the private, personal, gut-wrenching deliberations of one family. Shock was the most common reaction, and horror that a personal tragedy could be so politicized. A wise and courageous judge finally over-ruled the politicians and Ms. Schiavo was allowed to die.

This was the turning point for a nation. People everywhere now realize how precious, and fragile, is the right to remain an individual, and die in accordance with the beliefs and values of a lifetime. They have seen their government over-reach terribly and know they must protect themselves and their families.

I plan to use this blog to help people do just that. I hope readers will get information, get angry, and get prepared. We'll not only cry together, but laugh together, as well. Because the most important things to pack for the end-of-life journey are knowledge, love and a gentle sense of humor.

Be careful out there, and love one another.

–Barbara Coombs Lee is President of Compassion & Choices, a nonprofit organization dedicated to improving care and expanding choice at the end of life.

Flings, Frolics, and Faking

Mon, 09 Jun 2008 11:16:23 -0400

I've been reading Flings, Frolics, and Forever Afters: A Single Woman's Guide to Romance after Fifty by Katherine E. Chaddock & Emilie Chaddock Egan (Ten Speed Press, 2005). This self-help action plan for finding romance gives advice applicable to singles of any age who want to enter (or re-enter) the dating scene, with just a few tips specifically targeted to our age group, such as getting your adult children to accept that you're dating again.

Though the section on sex is only one chapter, it's a long chapter, and very specific, including the need for safer sex. Most of the advice is okay—though of course not as splendid as in Better Than I Ever Expected—but I really didn't like the command to "have an orgasm: real or fake" and the explanation that it's harmless and "it will make him feel great." I don't think so! What man would feel great knowing his partner just faked an orgasm? Oh, I forgot—the point is that he wouldn't know. That's so manipulative that I shudder. And how would it help your future sex life, if he thinks he's figured out how to set off your personal fireworks and will keep repeating a technique that actually didn't do it for you?

I also didn't like the suggestion to sneak off to the bathroom to apply a lubricant. "You want him to think you are juiced because of him, not because of a gel in a tube." Boo. There's nothing to be ashamed of if we no longer lubricate freely, if our hormonally deprived bodies don't match our emotional juiciness. Make applying a lubricant part of the love play and ask your partner to do it for you, and it can be very sexy. Each time one of you reaches for the bottle of Liquid Silk (my personal favorite), you both know what's about to happen. So much sexier than running into the bathroom and returning suddenly (and artificially) moist!

Here's the bottom line, as far as I'm concerned: If you can't communicate honestly with a partner what you need for comfortable, pleasurable sex and what you need to reach orgasm, what are you doing in bed with this person?

What do you think?

–Joan Price is the author of Better Than I Ever Expected: Straight Talk about Sex after Sixty. Visit her website at joanprice.com and her sex and aging blog at betterthanieverexpected.blogspot.com.