Category: Health

The Crisis in American Medicine: Limited and Costly


This morning my wife shared a letter just received from her former health care provider in Santa Fe, New Mexico. She writes that she’ll no longer bill insurance, with the exception of Medicare. To continue with her, she asks that you join her health community at $4100 annually. Medicare recipients must also join.

I ran into this same thing two years ago when I saw a specialist for a leg ailment. In the future, her clients would need to pay a $3700 annual retainer fee. That was two years ago. I’m reasonably sure with inflation her fee has increased.

I want to warn you that American medicine, formerly the finest in the world, is likely to become more expensive, limited and inequitable. Increasingly with the rise of corporate medicine, the emphasis is on quantity rather than quality. On average, you may need to wait several months before accessing your primary care physician, and even more to see a specialist, and when you do, it’s a physician’s assistant.

Concurrently, private insurance coverage is becoming more discriminating in what it pays for and how much. Medicare payout to physicians suffered a 4% cut this year, with an additional 4.5 anticipated cut for next year unless Congress intervenes before its adjournment next month.

Cuts like these result in reduced treatment, hiring of staff, and implementation of new technologies.

In response, doctors are increasingly resorting to concierge medicine, i.e., retainer fee medicine, now averaging $4000 annually per individual. Obviously, this will accelerate the already large number of Americans foregoing or delaying medical treatment, resulting in tardy diagnosis of mortality threatening illnesses.

As for hospitals, Mayo Clinic, accepts Medicare, but will bill you for the difference between original billing and Medicare payout. I fear this may become a growing trend.

—rj

Business as Usual: Lockdown Unenforced

Protestors in Texas

As experts have warned and a rogue president, prioritizing reelection, has ignored, recharging the economy when Covid-19 continues to ravage has exacted a surge in the pandemic’s victims, with a new wave anticipated this fall.

But Americans are its lead cause, a spoiled populace ignoring the laws governing exit from the crisis, wearing a mask in public, practicing social distancing, limiting unnecessary activity. Fifty states, each with its own governance, unequal to enforcing these mandates of public safety, subservient to economic interests, fuel our crisis. Shamefully, we lead the world in the pandemic’s victims.

Meanwhile, climate change exacts its continuing world toll. We tied the record in May for the highest monthly average on record; investment in renewable energy has plummeted; in the next five years, five-hundred species will disappear as humanity continues its assault on Nature, despoiling fauna and flora in a greedy rush for profit. Worse is the meat industry, a virus hotspot, progenitor of the pandemic, not just now, but historically in its previously related strains.

As I write, the Amazon forest continues to burn to make room for cattle ranches, environmentalists have been killed or discredited, indigenous tribes decimated. In Croatia, yesterday, 50 million bees died, suspected victims of pesticides. You think it only happens abroad? It’s happening here. Last year in Texas, someone deliberately set fire to beehives, killing 500,000 bees. Almonds, a prime contributor to California’s agricultural sector, may soon devolve into memory.

Where do we go from here? For the sake of the present we are ravaging our children’s future. I think anew of poet Robinson Jeffers’ credo of “inhumanism,” a summons to abandon a plethora of mass murder and commodification, to simplify our lives, to embrace with stoic discipline those values that both uplift and secure our children’s destiny.

—rjoly

Alzheimer Breakthrough? Bredeson’s The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline

Death has many doorways. Yet most of us go by way of heart disease, cancer, or respiratory disease; in fact, 50%.

The good thing is that we can preempt these diseases, if not reverse them through lifestyle changes.

Not so when it comes to Alzheimer’s disease, ranking sixth for causes of mortality. Shockingly prevalent, some 5.4 million Americans have it, with 200,000 of them below the age of sixty-five. All of them will die.

Estimates have it that this number will swell to 14 million by 2050.

Cost wise, treating dementia comes to a mind-blowing $250 billion annually .

Alzheimer’s differs from other types of dementia in that ultimately you become totally unable to perform normal body functions and require round the clock monitoring. You also lose long and short term memory. Alzheimer patients live in an eternal present. There is neither a past or future.

Aside from stroke, it may consequently be the illness we fear most.

But it could be that a breakthrough has appeared, thanks to the diligent clinical research of neurologist Dr. Dale Bredeson at UCLA, who has researched the disease for 30 years. For the first time, we have evidence that those strictly heeding his protocol can both prevent and even reverse early Alzheimer’s. The proof lies in some 200 plus survivors of mild cognitive impairment (MCI) and early stage Alzheimer’s who’ve experienced either remission or reversal.

Bredeson details his research in his just published (2017) The End of Alzheimer’s: The First Program to End and Reverse Cognitive Decline.  When I learned that Maria Shriver enthusiastically endorsed the book, along with several respected neurologists on the forefront of Alzheimer research, I was hooked.

In September, I lost my sister, though probably due to vascular dementia, not Alzheimer’s. Additionally, I had already become more sensitive as an older person to the the plight of those confronting cognitive decline in either themselves or their loved ones and, of course, my own potential fate in growing older.

I’ve now read the book, difficult going in some places because of the underlying genetic and chemical factors involved, but worth your time, though Bredeson says you can skip such chapters if you want. I read the entire book in three days, virtually mesmerized.

Presently, there are four principal drugs used to treat Alzheimer’s. At best, while perhaps relieving confusion or memory loss, they’re ineffectual in halting the ultimate ravages of this progressive illness.

Bredeson attributes this to the current medical paradigm of treating Alzheimer’s as a single disease rather than the consequence of several contributing causes. Almost always, Alzheimer’s is described as simply a build-up of beta-amyloid and tau proteins, resulting in abnormal plaque deposits that damage brain cells and promote consequent memory loss. Find the right pharmaceutical formula—and bingo!—you’ll slow or prevent the disease.

As to what causes the excessive amyloid/tau accretion, conjectures exist, but none of them validated. As with virtually all contemporary medicine, we treat the symptoms rather than cause.

Bredeson proposes that Alzheimer’s is primarily a response to inflammatory insults (e.g., infections, or trans fats, sub-optimal nutrients, trophic factors and/or hormone levels, toxic compounds including bio-toxins such as those from mole or bacteria), any and all of which contribute to an imbalance between reorganization of older and newer synapses, the latter not sufficiently produced to replace the former synapses and enhance healthy neuron molecule production.

Bredeson further contends there are three subtypes of Alzheimer’s inflammatory response initiated principally by the common genetic variable ApoE4, each requiring its own treatment protocol.

75 million Americans carry a single copy of ApoE4, giving them a 30 percent risk for the disease. If you have two copies of the ApoE4, one from each of your parents, you have a substantially higher than 50 percent risk for developing Alzheimer’s. Presently, that’s 7 million of us.

Symptoms of Alzheimer’s usually appear when you’re in your sixties or seventies, traceable in blood-work that identifies your subtype, requiring a specific treatment protocol, though we know Alzheimer’s can sometimes occur earlier.

Obviously, genetic evaluation is required as a starting point in treatment. Catching Alzheimer’s in its early stage, especially when asymptomatic, may halt or slow its progression. Simply following the present medical scenario of trying to reduce amyloid-beta production is ineffectual unless its inducers are eliminated.

Everyone 45 and up should undergo a “cognoscopy,” or genetic and blood work-ups, Bredeson contends.

Bredeson’s treatment formula, called ReCODE, is potentially expensive, requiring in addition to the usual lifestyle formulae of a healthy diet, sufficient sleep, exercise,  elimination of stress, numerous supplements, and brain exercise. In short, such treatment would seemingly exclude those with marginal income.

You may also find it difficult to locate a ReCODE physician in your area, although word is spreading and more physicians are practicing it.

Bredeson’s ketogenic diet recommendation, not the previously reported Mediterranean diet, may likewise prove challenging, if not unpalatable for many, requiring substantially reduced carbohydrate intake, replaced by healthy fats. No sweets or grains. It also includes twelve hour fasting daily. Meat choices should derive from grass-fed beef and free-range chickens. Be careful about mercury laden fish like tuna. Alaska salmon is your better choice.

Chapters 8-9 detail 36 factors that individually or collectively may induce Alzheimer’s. Eliminating these is essential and requires discipline, which perhaps many, even if they can afford treatment, will find difficult. You simply can’t cheat. Alzheimer’s doesn’t take holidays.

Bredeson also gives readers sample programs that two of his patients with mild cognitive impairment have pursued successfully, with the caveat that the regimen must be life-long.

Refreshingly cautious, Bredeson isn’t proposing he’s actually found a cure, but rather that those in Alzheimer’s early stages heeding his research-based protocol faithfully have proven to be successful thus far. Depart from the regimen in even minor aspects and you’ll retrogress.

As he’s commented elsewhere, “The longest we have a person on the program is four and a half years. We’ve not had a single example yet out of hundreds in which someone has gone on the program, gotten better, stayed on the program, and then gotten worse.”

Leonard Hood, M.D., Ph. D, National Medal of Science recipient, writes that “Dr. Bredeson has provided enormous hope for the heretofore intractable clinical problem of Alzheimer’s. Bredeson’s early studies suggest that this approach can halt and in many cases reverse early Alzheimer’s.”

This is good news!
—rj

Does American Sign Language (ASL) Have a Future?

We all have hobbies or special interests. Mine has been studying languages. As a child, it literally became an obsession. I’d buy paperbacks with my meager allowance, seemingly offering a pathway to fluency in German, a language I desperately wanted to learn given my brother’s return from post-war Europe with a German bride.

On one occasion, I made the long trudge, several miles, to the voluminous Philadelphia Library on Benjamin Franklin Parkway, checking out several books in Russian. When I got home, I must have somehow fantasized that this new tongue in Cyrillic would instantly dissolve into comprehension. No such luck!

In subsequent years, I pursued some thirteen languages more or less, but several very seriously. I took Latin, French, and German in high school; had to read Beowulf in Old English as part of my Ph. D., took language courses in France and Mexico, and traveled much of the world.

For all this, I still don’t speak any of these languages with any fluency, not because they’re difficult, or I lack discipline, or due to inadequate exposure, but simply because I don’t hear well, never really have, and it’s gotten worse, forcing me to resort to hearing aids a decade ago.

Only recently did I figure things out why I wasn’t mastering these languages orally. Years ago, a colleague, who was a professional speech therapist, gave me a hearing test. It showed significant hearing loss.

Sometimes this happens to a great many of us as part of the aging process, but it happened to me a lot earlier. I know genetics can play a role and that my mother became totally deaf later in life.

If I underwent an illness of some sort when I was little, I don’t have any family members around to tell me.

It’s not fun being hearing impaired, which makes me aware, compassionately so, of the lot of those born that way.

As is, my tendency to not hear, mishear, and sometimes invent can border on the edge of absurdity, softened on occasion by the confused, tolerant silence of my listeners, mostly my long-suffering spouse who, like other females, save maybe for a low voiced Lauren Bacall, I cannot comprehend in their high pitch lanes.

Writing in The New York Review of Books (December 7, 2017), Jerome Groopman spells out my dilemma, as well as for many others with diminished hearing:

Several years ago, I noticed difficulty hearing: testing showed diminished perception of high frequencies, a common consequence of aging. Hearing aids were prescribed, which helped to amplify sounds but weren’t a complete remedy. Background noise in restaurants made it difficult to discern the conversation of dinner partners, and I often missed muttered dialog in movies. Most vexing was what Oliver Sacks termed  “mishearing”—I thought I heard certain words, but they were distortions of what was actually said, and my response corresponded to the distortions. For example, recently a scientific colleague told me he was going to a conference in Milan. I heard “Iran” and replied that he was sure to be harassed at US Customs given Trump’s travel ban. He looked confused.  “Since when is Italy on the list?” 

My hearing has gotten so bad that I recently explored getting a cochlear implant, but then surprised the university staff, including my otolaryngologist, when tested with a hearing aid in separate ears, I scored 93 in the left ear; 89 in the really bad ear. I thought maybe I’d somehow outwitted the test, but they told me they’d recently toughed it up. My accompanying MRI brain scan showed no evidence of any tumor.

In a Mexican restaurant a short time later with my wife, the same damn problem, a tsunami of background noise drowning out any semblance of meaningful conversation.

Recently, I’ve been combing the Web to find available ASL classes, either on site, or online, feeling that a deadline is nearing when I’ll not hear anything at all. Sign language works for the deaf. Maybe it can work for me.

But American Sign Language, what’s taught in North American, can be a formidable challenge in itself, requiring lots of practice and finger dexterity. You also need a partner, so my wife would also need to learn it.

I didn’t know until Gerald Shea’s recent insightful book, The Sounds of Silence, that Sign Language, that nearly universal fixture of communication among the deaf, or so I thought, faces its own imminent demise, given the rise of cochlear implants and the increasing dominance of the oral approach, which seeks to encourage the deaf to acquire spoken language. I think this is wrong and a revival of a sort of the historical cruelties imposed upon the deaf in past eras, sometimes torture.

Until Shea’s book, I hadn’t any knowledge of these cruelties. The Byzantine Justinian Code, for example, disallowed the deaf from inheriting property.

Thirteenth-century bishop Guilaume Durand de Mende believed the deaf were unwilling to hear the word of God.

At times, the deaf were tortured, with hot coals pushed into their throats to force them to speak, or catheters twisted into the nasal cavity and shoved down into the Eustachian tubes, or burning liquids poured into drilled holes in the skull.

Sign language began in earnest in mid-18th century France with a priest, Michel de l’Épée who believed that seeing could replace hearing in learning concepts.

In the early 19th century, Roche-Ambroise Auguste Bébian, who had normal hearing, mastered French Sign Language and did much to emancipate the deaf.

Bébian’s methodology spread to America, and the American School for the Deaf was founded in Hartford in 1817, arousing disdain from oralists from the very beginning, who associated sign language with primitive people.  Oralists believe that the deaf can learn to hear and speak.

Unfortunately, I only recently learned that oralists have won the debate, as only a minority of the deaf learn sign language today. With the exception of Gallaudet University, the vast majority are mainstreamed, with classroom interpreters employing coded systems.

Additionally, cochlear implants have abetted the oralist approach, with 80% of those born deaf now fitted in the West with these devices. Implants, unlike the hearing aids I use, which merely amplify sounds, transmit sounds directly to the auditory nerve. In the U. S., cochlear implants is a $5 billion annual industry.

Research indicates cochlear implants, while beneficial to those with impaired hearing, are substantially less so for those born deaf.   Those favoring the implants, however, have predicted that within a few decades, signing will be gone.

Shea argues that cochlear implants are measured in labs, which don’t mirror life in the outside world. A British test found that children fitted with the devices were no more educationally advanced than those with hearing aids. Likewise, a University of Toronto study found that children fitted with cochlear implants didn’t fare any better than children with hearing aids. And with both, background noise made things worse.

The sad truth, as a French study shows, few children fitted with the cochlear develop “intelligible” speech. As those children grow older, they frequently resort to sign language, avoiding the strain to hear with the devices.  Sign language, on the other hand, affords them both fluency and dignity.

As Shea concludes, depriving an individual of his or her language denigrates their identity.

—rj

Open the door and come right in….

o-mindfulness-practice-facebookMindfulness is everywhere these days. I was at our local Kroger store yesterday, sampling its magazine section and, sure enough, there were two mindfulness magazines. Go to Whole Foods, it’s the same.

Mindfulness has taken off in the medical community as well, where it’s become increasingly a centerpiece in psychological therapy, helping patients cope with stress, anxiety and depression. (For a sample listing of leading medical schools offering mindfulness curricula, see Medical schools.)

It’s also proven a boon to helping cancer patients live with their pain and the stress of chemotherapy.

Last week, I completed an online course, housed at Leiden University in Holland, called “Demystifying Mindfulness.” According to the university’s figures, some 8000 students have now taken the course, which introduces you to mindfulness and its origins and contemporary applications–psychological, cultural, and political, with a look at its future.

You also get right down to practicing it, listening to guided MP3
sessions, generally 30-40 minutes.

To me, that’s the hard part, finding a time for practice removed from the distractions of daily life, compounded by living in a digital age. Of this, I’m well aware, so I try to get at it right out of bed in the early morning.

Mindfulness practice can take on a myriad of formats, as it teaches you to focus, and you soon discover you can focus on just about anything. But it isn’t easy.

Our minds are wanton wanderers. Buddhists call it the “monkey mind,” where your thoughts just seem to jump randomly, or like a monkey, from tree to tree.

I’m okay with that.

The trick is concentrating on some sensory aspect, i.e, taste, sight, smell, etc., and when the chatter comes, as it surely will, getting back on track. You do this by returning to a focus on your breathing, no mantra or chant needed as in most meditation.

Ultimately, mindfulness helps you live more fully in the present, unburdening yourself from the past with its nostalgia, self-pity, regret, and perhaps anger; likewise, helping you toss your worrying about the future.

Mindfulness teaches you how to get on with life, even in the hard places.

You can practice it in so many ways, like focusing on a candy in your mouth, or intently listening to a loved one, or even while walking or listening to music.

If I were to sum up mindfulness, I’d say it primarily aims, not merely at increasing your awareness, but helping you become more insightful as its reward. In turn, you’ll respond more positively to those around you.

Properly done and practiced daily, mindfulness increases your capacity for empathy, or compassion, for others. After all, when you become more mindful of others, that is, when you really start listening to them, you begin to see yourself as kindred in life’s journey.

As my instructor at Leiden put it, the evidence of your having effectively done mindfulness ultimately exhibits itself in an ethical response to your fellows, along with an effort to ameliorate their life contexts, often imposed by seemingly inherent cultural injustice.

Think about it: Just maybe if we’d all get down to mindfulness we could ultimately bring about a world of fraternity. The revolution I’m talking about doesn’t derive from armed struggle, but the collective, incremental empowerment of reconciliation fostered by a salient awareness of the human kinship that bonds us.

Mindfulness even features exercises that have a direct bearing on helping you achieve greater empathy, or what I like to call emotional intelligence (EQ).

An example of this comes from Dr. Ronald Siegel, a mindfulness therapist at Harvard Medical School:

Cross your hands over your heart.

Think of someone you love, or even of someone who’s brought stress into your life.

Visualize them and say the following:

May you be happy.
May you be peaceful.
May you be free from suffering.

Do this several times.

But keep this caveat in mind: You can’t really love others fully without
self-esteem, resulting in your needing others to validate yourself.

Now say to yourself,

May I be happy.
May I be peaceful.
May I be free from suffering.

While mindfulness won’t cure all of life’s ills, it helps you cope with them, making you aware we’re all in this together.

Discovering yourself and becoming more mindful of others leads to that reciprocal joy Judy Collins famously sings about, and–yes–it can be yours:

Open the door and come right in
I’m so glad to see you my friend
You’re like a rainbow coming around the bend
And when I see you smilie’
Well, it sets my heart free
I’d like to be as good a friend to you
As you are to me.

–rj

The war on cancer: New treatments lock-out most of us

trialsDeath has many doorways, none of them particularly pleasant, but some downright gruesome, cancer for instance.

My father died from lung cancer at age 79. That’s a generous portion of life, when you consider the mean is several years less. Nonetheless, I remember his final hours at the Veterans’ hospital in Chelsea, MA, strapped to his narrow bed, and the moaning that even massive morphine couldn’t assuage.

And then there was my brother, Donald, so full of life, with robust talent and zeal to harness success. I had been doing a seminar at Claremont Graduate School in California that summer in 1979. Weekends I’d spend with him and his lovely wife, Barbe. Six months later, the devastating news of brain cancer, immediate surgery that made him no longer Donald, and death seven months after–cruelly, on his birthday. He had turned 47.

Then there’s my niece, Denise. She passed away several months ago from myeloma dysplasia (considered a blood cancer malady). I had spoken with her on the phone several months earlier. She’d been eagerly looking forward to her upcoming bone marrow transplant from brother, Richard. Initially, it went well, then relapse. She was 57.

Two of my siblings survived cancer. Ruth was experiencing intestinal distress suggestive of colon cancer, but doctors at the local hospital failed to find anything wrong after administering a CT. Thanks to my niece’s insistence on a second opinion, doctors at Massachusetts General, doing their own CT, found a baseball size tumor, diagnosed as Stage 3 cancer. They seem to have got it all in the surgery the very next day.

My brother David received chemotherapy and radiation for his colon cancer, following surgery. Proving the cure can be as devastating as the disease, radiation destroyed his digestive capacity, subjecting him to a hugely diminished quality of life.

I realize this is painful reading, but cancer insidiously invades our life premises in one way or another despite our efforts to wall it out. We get nowhere “crossing the street” to ignore it.

One thing about cancer is it is impartiality. It respects neither age, wealth, nor origin; the pious or the amoral.

One of its monstrous cruelties is when it ravages children. It’s what the Jimmy Fund is all about.

I remember how, in 1971, President Nixon, meaning well, declared war on cancer. Now, forty-five years later, it continues to assault many millions. Recently President Obama renewed that war in this year’s State of the Union address, pledging $1 billion for new research.

Each year, more than 500,000 Americans succumb to cancer.

That surpasses by more than 100 million the toll of American deaths in all of WWII!

In this year, 2016, an estimated 595,690 deaths will occur.

Even more ghastly, 14 million Americans have the disease right now!

But there’s good news to be had as well: a 21 percent drop in cancer mortality from 1991 to the present.

This may result from a more knowledgeable public, making lifestyle changes that include giving-up smoking, exercising more, eating healthier foods, undergoing yearly physicals, and taking advantage of screening venues that include colonoscopies and mammograms.

What’s more, there’s a plethora of new drugs along with innovative trial therapies that utilize one’s immune system, potentially bypassing radiation and chemotherapy protocols with their often serious side effects. In early phase 1 trials, we’ve seen B-cell leukemias and lymphomas disappear.

The problem is that these trials are often highly specialized, focusing on rare, sub-category cancers.

Additionally, there are all too few trials available even for those who qualify.

Frequently, doctors contribute to the dilemma, refusing to recommend patients for inclusion in a trial or committing to a new approach until the traditional cancer options of chemotherapy, radiation, and surgery have proven ineffectual. In short, it’s imperative we advocate for ourselves, keeping aware of new methodologies and of doctors and cancer centers on the cutting edge.

Former president Jimmy Carter, however, lucked-out. On August 20, 2015, he made public that he had melanoma induced cancer that had metastasized to his brain. With a 3-5 pound tumor, experts gave him only several months to live.

Along with radiation, his treatment protocol included infusion of pembrolizumab (keytruda), one of several of the new immunotherapy drugs employing the immune system and endorsed by the FDA for those having exhausted other therapies.

On December 6, 2015, Carter shared the good news that his recent brain scans were negative for cancer.

This would seem to bode well for the rest of us that the day may be coming when we’ll see the scourge of cancer pushed back, sparing ourselves and our loved ones.

But keytruda doesn’t come cheap at $150,000 for a year of treatment. For seniors, the most prone to cancer, Medicare, which won’t even pay for your glasses, hearing aids, etc., isn’t likely to cough up money for your treatment any time soon. Same story with private or employee insurance.

Fame and fortune access, as always, the best medical care. The poor and minorities needn’t apply.

But let me add another caveat to all of this: immunotherapy, while promising, is hardly around the corner as a standard protocol any time soon. Was Carter actually cured, or is this simply cancer’s quirky finesse to tease with remission rather than resolution?

Beware media hype! In the trials for keytruda, 76% of 173 patients receiving the drug didn’t see their tumors shrink.

In the follow-up on those who did experience tumor shrinkage, the time element was a paltry 8.5 months. Normally, we’d like to view things in a five-year context.

As I see it, however, it’s the prohibitive cost factor that largely hinders the delivery of effective cancer treatment, delaying the finding of a cure.

In summing up, though life and death are inextricably bound together, we prefer avoiding any discussion of death and do our best to masquerade its occurrence.   On the other hand, when we confront our mortality we enter into the larger, more important question as to how then ought we to live?

We may not have an an answer to the riddle of cancer in our lifetime, but we can defy it with courage and living out our destiny with human sympathy and loving kindness,   indulging  in each new day as unique in its capacity to enthrall with the cornocupia  of life.

–rj

 

 

 

 

 

 

Why I Relish Going to the Gym

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For many of us, throwing off the blankets and crawling out of bed on cold winter mornings to go to the gym seems pretty dumb.

I felt that way too until my pre-diabetic diagnosis several years ago which meant that if I didn’t do something about it, I might well succumb to full-blown diabetes with its many lethal complications that include heart disease, kidney failure, blindness and even limb amputation.

Still, I didn’t do anything about it until a chiropractor friend had me do a full blood workup that showed I had moved even closer to diabetes with an A1c of 5.9 and ominous glucose average of 123.   If you get to 125, you’ve got the disease, for which there’s no cure, only management.

Now, fifteen month later, I’ve gotten the A1c down to 5.2. The A1c tests your blood for glucose management over the previous two to three months. The pre-diabetic range is 5.7-6.4. In short, I’m no longer pre-diabetic.

How did I do it? Quite plainly, by cutting carbs and exercising regularly.

Exercise is good for you no matter what ails you or–if you’re an outlier–from nothing at all, promoting good health, better sleep, stress reduction, more energy, and self-esteem.   What’s nicer than people commenting on how good you look?

But let me add to these verities several other reasons exercise has become a mainstay of my daily regimen.

Personally, I can wax euphoric at the gym like this morning walking my fourteen laps (2 miles), with Herbie Hancock’s pulsating jazz rhythms funneling into my ears via my wireless headset, making me pump my arms still more vigorously.

I like, too, the camaraderie going to the gym gives me, a sense of being part of a group. I see many of these people regularly, of both sexes and of all ages and body types. On occasion, we say our hellos or share smiles and sometimes conversation. Call it tribalism. I like the feeling.

I admire many I see at the gym for the obviously hard work they put into their workouts, whether pumping weights, walking raised treadmills or elliptical machines, or doing stair-steppers, etc. I see the payoffs in their lithe bodies with muscular arms, wide shoulders, and developed pecs. I know it didn’t come easily. Many of them exercise before going to work.   No wonder they inspire me.

But I also get a sense of personal satisfaction, or of time well spent. Call it a relish in self-discipline: I haven’t surrendered to the couch or big screen TV. I take pride in that, knowing my former tendency to both procrastinate and be downright lazy.

Every session becomes a moral lesson, and I remember what my high school track coach told me: “We all get stiches in our side. The good runner, win or lose, ignores the stich, holding out for the second wind that propels him to the finish line.” Today, I resisted cutting my four sets of curls to three. I like to think such lessons learned at the gym can help me better cope with life at large.

And then there’s that sense of jubilation in sharing my good news with my dear wife that today I did 70 sit-ups. Just a few months ago, I could barely do 25!

The Chinese have this wonderful saying that “the longest journey begins with the first step.” In going to the gym, I’ve taken more than one step now and I’m eager to do infinitely more in the climb to good health and the contentment it confers.

–rj

 

 

 

 

 

 

 

 

You Aren’t Who You Think You Are!

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Have you ever found yourself so angry, say in an argument, that you’ve yelled, or said mean things, or left the room, or slammed a door, only to feel ashamed later?

Have you ever panicked, ready to pull your hair out, because your fear seemed overwhelming, demanding a quick fix that seemed elusive?

Perhaps it was in getting bad news such as being fired, or being told you have a serious illness, or finding out your spouse wants out.

It’s been said many times you are what you think about. If you’re having happy thoughts, then chances are they’ll carry you through the day, making it a good one.

Conversely, when you’re upset–who knows about what?–you’re apt to put in motion unhappy scenarios throughout your day. Not only that, you may be spreading your viral malcontent to others.

But it’s your unconscious thoughts that may influence you even more, and with greater fall out, since you’re unwitting of the sources behind what you say and do. In short, it goes a lot deeper than just what you think about.

It’s as though you’re living with a stranger usurping your identity. There he is, randomly, unexpectedly, projecting himself upon your conscious world.

Your thoughts, then, seldom come close to mirroring who you really are, though they may try to tell you that you’re either lacking or even very special.

And this is the good news, since your thoughts most likely come short of who you really are.

Your mistake is identifying with them.

This becomes clearer when we resort to linguistics.

In English, we always say things like “I’m angry” or “I’m lucky” or I’m afraid,” when logically this can never be so.

This gets corrected in languages like Spanish, French and German in which we say we have anger, or luck or fear.

Now try this little exercise in predicate adjectives to catch my drift. To

I am, add an adjective that describes you:

I am …

I am happy.

I am sad.

Et cetera.

I call it the name tag game and we all play it.

As such, these tags can never summarize in any moment the totality of who you are in your uniqueness, and thus you err when you identify with them.

Name tags reach back into your childhood as you strive for validation, or self-worth, often by comparing yourself to others.

My mother likes my sister more than me.

I’m smarter than Bill.

I’m not popular.

Unfortunately, such scripts program us; that is, unless you learn to identify the falsity of their self limitations.

By doing so, you free yourself from their tyranny.

You don’t replay them anymore.

Self-acceptance prospers in an environment saturated with love. Too many of us we’re raised, however, by parents who themselves were never accepted for who they were, and thus never fully loved.

Accordingly, their love was, in turn, conditional, or a projection of themselves.

The truth is you’re far more than the stories you’ve come to believe about yourself.

You don’t need to keep modeling yourself on what you think or have been told you are or should be.

You’re worthy now.

Too often you try to compensate for life having dealt you a bad hand:

A broken home replete with violence.

An alcoholic parent.

Bullying at school.

A physical or mental handicap.

Sexual abuse.

A friend’s betrayal.

An insensitive teacher.

And while measured by status and/or accumulation, you may even seem successful to others, you find you’re still battling feelings of inferiority or unworthiness daily.

In a kind of guerrilla war, your anxiety pushes you to flush out the enemy by doing still more.

You hunger for approval, but it’s never enough.

Afraid of disapproval, you retreat from doing new things because you might do it wrong or even fail.

Freeing yourself by identifying the stories you’ve come to falsely believe about yourself is your passport to loving yourself, and with it, finding confidence and joy.

Anxiety about yourself, unfortunately, is an acquired practice.

It follows you must undo the habit.

When you think negatively or act out destructively, catch yourself at it.

This isn’t my true self.

This isn’t me.

And you’re right.

You can help yourself by retrieving your thoughts in a strainer, as it were, by practicing mindfulness,

Breathe deeply through your nose for a count of six seconds, your hand on your belly

Feel your stomach inflate.

Now breathe out for a count of four. feeling your stomach contract.

Visualize happy scenes.

Let your body relax, beginning with your toes, then your feet, legs, back, arms and neck, each in its turn.

Now listen to your thoughts,

Do this without judging them.

If you stray, as we always do, return to deep breathing.

By listening to ourselves, detached from censure, we see objectively, freeing ourselves from anxiety’s tyranny.

We don’t allow our emotions to boss us around anymore.

To this end, I find restorative yoga the most peace-rendering exercise of any I’ve come upon.

Unfortunately, most yoga practice in the West confines itself to bodily exercise, or fitness,

True yoga is much more, or holistic, the “yoking” of mind and body, for they are ultimately one. Yoga mean “to yoke.”

This is where Western medicine so often fails, treating symptoms, not causes.

We are not mere physical creatures.

We possess a spiritual component.

We are sentient beings.

In traditional parlance, we have a Soul.

In modern life, however, we’ve disconnected Body and Soul.

The consequence is that we find ourselves out-of-balance, resulting in stress, fatigue and, ultimately, illness.

Yoga reverses this, restoring health, both physical and mental.

Yoga helps you let go.

Yoga enables you to love yourself and, with it, forgive yourself and others.

I’m sadly limited to a blog, when there’s so much else I’d like to say.

But let me recommend a book that will jump start your reconnecting mind and body. I promise you’ll not want to set it down:

Brad Willis. Warrior Pose:  How Yoga (Literally) Saved My Life.

We listen too much to our head, when we should be living life with our heart.

If you follow my suggestions, hand over my heart, you’ll increasingly gain power over that stranger who’s usurped the premises.

You’ll dislike him so much, you’ll ask him to leave.

The good news is that he will!

–rj

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Medicine’s Desertion of the Elderly

elderly“There’s no escaping the tragedy of life, which is that we are all aging from the day we are born,” writes Dr. Atul Gawande in his latest book, Being Mortal: Medicine and What Matters in the End.

Accordingly, I’ve reached that point in life when I wish I could consult with a geriatrician, or specialist on the aging process. Given that we are increasingly an aging population, you’d surmise it’s no problem finding one.

Count yourself lucky, if you do. And if you do, that you’ll get in.

I live in a city of 300,000, and home of a major university with a respected medical school and first class hospitals. Still, I couldn’t find one.

In fact, it may surprise you to learn that geriatricians are an increasingly rare breed.

Take the University of Minnesota, for instance. It recently shut down its Department of Geriatrics, despite its success in enhancing the quality of life for many seniors, reducing disability, both physical and mental, remarkably and, what’s more, the need for costly home services.

Unfortunately, treatment costs exceeded any savings (Gawande 45).

Other medical centers have followed suit, reducing or eliminating their geriatric services.

The medical establishment prides itself on fixing things, when for the elderly it’s management, not healing, that should define appropriate treatment.

Technology, however, is where the big bucks are and even Medicare, tailored for those 65 and over, falls short in paying for services specific to seniors.

Additionally, doctors often feel overwhelmed by elders coming to them with not one, but several ailments. Think hypertension, diabetes, asthma, arthritis, anemia, failing hearing and eyesight, etc.

in the meantime, most Americans will ultimately spend at least a year in a nursing home at considerable expense, which quality geriatric care might well have preempted.

I can’t help but think this sorry state of affairs is somehow related to our general disregard of older people in America, often the butt of jokes or derision.

One study indicates that 68% of the elderly believe that the public is indifferent to its older citizenry.

I don’t think it was always this way. I grew up in a time when we revered age. It’s still this way in countries like China, Japan, Korea and in Latin America. China recently enacted an Elderly Rights Law, mandating its citizens “never snub or neglect the elderly.”

In Korea, turning 60 and 70 are celebrated events.

In contrast, American culture–as in other Western countries–is youth-centric, with emphasis on independence.

Maybe it’s because, thanks to many of modern medicine’s achievements, there are too many of us now, with 20% of Americans projected to be over 65 in the next twenty years.

Currently, those over 65 constitute 26% of all doctor visits, 47% of all hospital stays, 34% of all prescriptions, and 90% of all nursing home stays (Institute of Medicine Report: Retooling for an Aging America).

Unfortunately, there are only 7,000 geriatricians, and that number is declining. As such, it’s only half of what’s needed to meet a growing need (americangeriatrics.org).

The elderly often have emotional as well as physical needs. Sadly, only 3% of psychologists devote the majority of their practice to those over 65.

Geriatric psychiatrists number only about 2,000 and, like geriatricians at large, that number is declining, according to the American Association for Geriatric Psychology.

How foolhardy all of this is, since the elderly constitute a minority most of us are destined to join.

Most of us don’t like to go there when it comes to thinking about growing old and confronting our mortality. Certainly, we don’t prepare ourselves for it very well, though it may be closing in on us sooner than we think.

The UN associates age 60 with elderly status.

In the USA, several states use the same criterion.

The bottom line is that sound medicine isn’t about money. It’s about compassion

–rj

Reflections in the Aftermath of Brittany Maynard’s Death

maynard

On November 1, Brittany Maynard, 29, slipped into eternity, choosing to end her ordeal with terminal brain cancer under Oregon’s Death with Dignity Act.

Hopefully, her heroic efforts on behalf of the rights of terminally ill patients will initiate renewed focus in other states.

Unfortunately, Brittany had to move to Oregon to realize her choice.

Accordingly, I can’t help but think that the right to die with dignity is our last foremost civil rights barrier.

For that reason, I chose to vote Green in the 2012 election and will do so again. My compassion for those who suffer demands this. The Green Party includes such legislation in its platform.

There are many who oppose such legislation, even doctors, who espouse the Hippocratic oath with its rejoinder, ” I will do no harm.”    Oddly, they don’t object to termination of life support in scenarios of brain death.

A few decades ago, passive euthanasia was nearly universally frowned upon in medical circles and only through brave, legal persistence were laws changed. Nowadays, one of the first things asked when you go to emergency is, “Do you have a living will?”

The Oregon distinction is that patients, fully conscious, make their own decision in cases of terminal illness prognosing death within six months, with the proviso they are state residents and obtain a physician’s prescription for a lethal dose of medication.

The biggest obstacle to progressive, compassionate reform comes from religious interests, who view God as the proper author of life and death, though I’ve found many among them committed to retaining the death penalty option for heinous crimes.

Several days after Brittany died, a Vatican official termed her act “reprehensible,” adding that “the gesture in and of itself should be condemned.”

None of this surprises me, given the sorry, bloody legacy of religion in history and the troubled landscape of today. Much of religion forecloses on free choice, so fundamental to a democratic society.

Unfortunately, there are also those who shackle their potential for empathy with buzz words like “suicide,” and “cowardice,” vestiges of cultural conditioning rather than reasoned judgment.

I actually find the Oregon law, now mirrored in Washington and Vermont, and by default in New Mexico and Montana, still circumscribed by these same interests.

I believe undue suffering should also allow an individual to choose when to exit with dignity apart from terminal illness.

We now live in a time when medical progress has extended life past former norms, howbeit, at the cost of progressive morbidity like Parkinson’s and Alzheimer’s, along with decreased coronary and kidney function.

I remember reading about British author Somerset Maugham, in his ninth decade, confined to a wheel chair and nearly totally blind, longing to die.

I place no premium on the nobility of gratuitous suffering.

Further, it’s easy to make shallow judgments when you don’t enter into the shadow of someone’s suffering.

I was surprised the other day to come upon a doctor in PubMed who has foresworn medical treatment for himself after age 75, finding it more preferable to die than live in prolonged decline and its inevitable forfeiture of quality of life.

Something to think about, though unpleasant, given the alternatives.

–rj

 

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