Saturday, October 18, 2014

What's the Risk?

     I will admit that I don't like to fly. I don't like the airport experience. I don't like being cooped up in that narrow, cylindrical aluminum tube. I don't like being 30,000 feet up in the sky with only a cushion of air holding me up. And I sure don't like sitting in the middle seat.

     The analytical, left side of my brain knows that flying in an airplane is safe. But the more impressionable right side of my brain imagines how sometimes, very quickly, things can go wrong.

     Things can go wrong in a car. But I can get out and walk. Things can go wrong in a boat, but I can swim. But in an airplane . . .

     So now people are saying they are reluctant to board an airplane because of Ebola. You never know if one of the passengers has been to West Africa or is a health worker who has treated someone with the disease. They may not show any symptoms, but they could still be carrying the virus.

     But what are the chances of getting Ebola? About the same, I read recently, as getting hit by lighting while picking up your multimillion-dollar winnings from the lottery.

     Exactly one person has died of Ebola so far in this country. But every year over 50,000 people die of flu and pneumonia. And of course, like most things, these diseases hit older people a lot harder than they hit young people, proving infinitely more deadly. (So get your flu shot!)

     Recently, the Center for Disease Control (CDC) published its latest list of most common ways to die in this country. The list doesn't change much from year to year, or even decade to decade. Heart disease is still No. 1. Cancer is No. 2.

     We have made some progress on cancer -- as much because people have given up smoking as because of medical advances. But medical treatment has definitely improved the survival rate for breast cancer, colon cancer, and skin cancer -- especially if they're caught early. (So get your breast exam, your colonoscopy and your skin screening!)

     But we know the risks that are familiar never seem as threatening or scary as those that are new or unusual or dramatic. I'm scared of stepping onto an airplane, which if you average it out kills about 140 Americans a year. But I'm not afraid to get in the car and drive to the grocery store, when over 30,000 Americans are killed on the road every year.

     Although I have to amend the statement. Sometimes I have a crisis of confidence when I'm out on the highway, and all around me people are speeding, tailgating, changing lanes without signaling, etc., etc. etc. Sometimes I'm amazed that the death rate on the roads isn't higher than it already is!

     In fact, while overall, accidents are the fifth leading cause of death in America, killing over 120,000 people a year, auto accidents do not kill as many people as accidental poisonings. The top three in 2011, according to the CDC:

                Accidental falls:  27,483
                Auto accidents:  33,783
                Accidental poisonings:  36,280

     But the poisoning figures are so high because they include drug overdoses -- and according to the CDC those numbers have gone up in recent years largely due to prescription pain medications. Heroin overdoses mainly affect younger people. But older people are definitely at risk when it comes to pain medications. (So dispose of those old prescriptions in a proper manner!)

     I don't know. After reviewing all these figures, now I'm scared to get out of my chair. What's the death rate for people sitting in front of their computer?


Thursday, October 16, 2014

Filling the Bucket List

     As I mentioned a couple of posts ago, Rebecca Mead at The New Yorker recently took a jaundiced look at the concept of The Bucket List, occasioned by a stopover that President Obama made at Stonehenge on his last trip to England. Obama looked over the monolith, then quipped that he'd "knocked it off the bucket list," before hopping back on Air Force One to jet back to Washington.

     I myself have not made a Bucket List. The idea seems a little ghoulish to me. But last year B brought home a book called The 100 Best Vacations to Enrich Your Life by Pam Grout. The two of us leafed through the book, but to be honest, we didn't both choose a lot of the same experiences.

     So, for example, she wants to "Take a Gourmet Raft Trip Down the Rio Grande" (p. 262); while I thought it might be fun to "Protect Loggerhead Sea Turtles" (p. 134) at the Wassaw National Wildlife Reserve in Georgia. (The book is a few years old, so you have to google the listings to make sure the information is up-to-date.)

     However, we were both intrigued by one suggestion. And that's how we ended up going to "Sit at the Feet of the Masters" (p. 172) at the Chautauqua Institution in Chautauqua, NY, this past summer.

     I don't know what we'll do next. I'd like to "Tour History in a Covered Wagon" (p. 207) on an Oregon Trail wagon train. But she found a candidate for a different kind of whistlestop: "Tour the Canadian Maritimes Aboard a Luxury Train" (p. 177).

     Meantime, I'm beginning to plan my annual search to find a bit of sunshine in January, and so I started researching some other options on Road Scholar. You see, I have a problem. I've been going to Florida for three weeks every year since I left work in 2002. The problem is:  B is still working, which cuts into our vacation time dramatically. And also . . . B hates Florida. She thinks it's too crowded and too cold.

     The one time I got her to go with me, a week in Naples, there was a cold snap. We only got to the beach one day, and even then I will admit it was chilly, and the rest of the time we needed at least a windbreaker, if not more.

     "But isn't it better to have 60 degrees in Florida, instead of 20 degrees at home?" I asked.

     "Not if I'm still cold," she replied.

     So anyway, this year as usual, I'll be going to Florida by myself. I spend a couple of days with my sister, who lives in Jacksonville. And then, let's see. There's a Road Scholar tour of historic St. Augustine, Florida, and another that offers a journey through the Everglades. I've never been on a Road Scholar excursion, so I don't know what to expect.

     I'll be by myself. Will everybody else be a couple? I'm in my 60s. Will everyone else be ten years older than I am? I like to do things, not walk around and look at things. Will I be spending too many hours riding on a bus and walking around a museum? Will I be required to stay with a group that eats dinner at 5:15 p.m. and gets shepherded around all day like a bunch of sheep?

     I guess those are the questions anyone asks when they try something new. So now I'm sure you understand . . . it would make things a lot easier if B wasn't still tied down to a job. (And if she liked Florida.)

     But anyway, in other respects we are beginning to focus in on some of the same things. We both are interested in "Reaching for the Stars" (p. 170) at the University of Arizona's Astronomy Camp. Maybe next year. 

Tuesday, October 14, 2014

How Do You Talk to Your Children?

    B has dutiful children. Her two sons call her on the phone about once a week. Her older son lives some 60 miles away, in his own apartment, and he will call when he gets home from work if he's not doing anything with his girlfriend. We also see him once or twice a month. In fact, we drove down to have dinner with him and his girlfriend over the weekend.

     Her younger son lives more like 800 miles away, in South Carolina with his fiancee. He also calls his mom once a week, usually on his way home from work -- yes, he has a hands-free phone -- although we obviously don't get to see him as much. He was home for a long weekend last Christmas; and B flew down to see him over the summer. He and his fiancee are planning another trip home around Thanksgiving.

     So that's how B talks to her children, mostly by voice, over the phone, and occasionally in person. Kind of the old-fashioned way. In fact, she was thrilled when she found out her older son did something almost unheard of among the 20-something crowd -- he installed a land-line telephone in his new apartment!

     Maybe the way you communicate with your children changes once you have grandchildren. But for us, we're not there yet. And I wonder if we're at all typical; or if we're missing out somehow.

     As for my daughter, she will not pick up the phone. She simply does not use the phone for voice communication. She communicates by messaging. If I call her, she never answers. If I leave her a voice-mail message, she will not respond. And she never calls me. But she will message me; and she will respond to a message. That's just the way she communicates, and I've found that I just had to adapt.

     My daughter lives almost 400 miles away. We see her a couple of times a year -- largely (I think) because despite the fact that she's crossed the 30-year-old threshold, she's still living an itinerant lifestyle and is storing most of her worldly possessions in our basement. She stops off a couple of times a year to drop something off, or pick something up. Although this past weekend I met up with a friend of hers whose family lives near us, and the friend was home for the long Columbus Day weekend. We met at the mall, and I gave her my daughter's snowboard, and some winter clothes, to take up to her. That's how I "communicated" with my daughter this past weekend.

     But honestly, my daughter is better at visiting me than I am at visiting her. But she's living in Buffalo -- which means the visiting season is short. We drove up there in August, which was my first-ever visit to Buffalo and Niagara Falls, and I did enjoy the trip. But I won't be venturing up there again until after the snow stops flying -- sometime after mid-May.

     My son, who lives in New York City, will not answer the phone either. But he uses aol instant message at work. I can never reach him on a weekend. But during the week when he's at work, he's on AIM, and he almost always answers me. That's good, because I feel like he's available pretty much whenever I want to talk to him (you know, as long as it's not a weekend).

     My son occasionally comes to visit -- usually when he travels home to see a friend -- and he'll often stay with us overnight. But even then he doesn't really talk to me. The exception -- when I drive him back to the train station. Do you remember those days, when your kids were young, and the best time to talk to them was when you were alone in the car, driving them to soccer practice or piano lessons?

     Well, for me, it's still true. The car is dark; you don't have to look at the other person. There are no distractions; and you can't walk away. The perfect time and place to find out what's really going on in your kid's life.

Friday, October 10, 2014

Short Takes for October

      In my Sept. 28 post What Are Boomers Blogging About? fellow blogger Meryl Baer reported on her visit to the Flight #93 Memorial in Shanksville, Pa. Sadly, USA Today and several other news outlets have reported that there was a fire at the memorial on Oct. 3. The fire destroyed the flag that flew over the U. S. Capitol on 9/11, as well as a number of other artifacts. The cause of the fire is unknown, but no foul play is suspected -- it was possibly a result of some construction going on at the site.

     Meanwhile, a lot of people were interested in my two posts on the subject of long-term care insurance -- as well as the more authoritative one Is Long-Term Care Insurance for You? brought to us from financial adviser Jeremy Kisner. As a follow-up, if you're interested, here's another pretty clear and thorough look at the issue of long-term care insurance from Rodney Brooks at USA Today.

     I'm not saying LTC insurance is for everyone -- but just maybe it's something to put on your Bucket List.

     And speaking of the Bucket List, Rebecca Mead takes a jaundiced view of the whole concept of The Bucket List in an article in The New Yorker. Her piece was prompted by President Obama's recent hour-long side trip to Stonehenge as he casually quipped that he'd "knocked it off the bucket list" -- before jetting back to Washington an hour behind his official schedule.

     I myself have not made a Bucket List. And my travels have been closer to home -- to Buffalo, NY, and Cape Cod, Mass. But I'm at a loss right this moment. We have no vacation planned. None at all. And that makes me feel anxious. Aren't we retired people supposed to be traveling all the time? One problem: B is still working, which cuts into our vacation time dramatically.

     And so for now we're both staying home, trying to stay warm (we dipped down to 41 degrees last night) and focusing on our health by getting our flu shots and scheduling annual physical exams.

     It distressed me to learn that Medicare will pay for an annual exam -- but only with a physician's assistant, not with a doctor. If I want to see my primary care physician, I will have to pay $185. To me it's worth it. He knows my history; he knows my usual aches and pains vs. something that might be unusual, atypical or possibly serious. But I thought Medicare was supposed to focus on prevention, since prevention costs a lot less than tests and treatments and follow-up visits.

     Oh well, Medicare is saving me a lot more than $185 compared to my previous medical insurance plan, so I guess I don't mind paying. Besides, Medicare did pay for my flu shot.

     Finally, in case you do not want to follow Dr. Ezekiel Emanuel's advice to die at age 75, here are two health notes:  

     1. Artificial sweeteners make you fat. Several previous studies have suggested that artificial sweeteners can give people a "sweet tooth," making them more likely to seek out sugary foods. But a new study from Israel suggests that the artificial sweeteners might have a direct effect on the body's metabolism to make weight gain more likely.

     The Israeli researchers studied the use of saccharin and aspartame in a group of mice, and they found the artificial sweeteners raised the level of blood sugar in the animals and increased their glucose intolerance -- which can in turn lead to obesity and diabetes. The researchers then gave saccharin to an admittedly small group of volunteers (only seven people) and four of them developed glucose intolerance, suggesting that the effect of artificial sweeteners shown in mice could also show up in humans. So if you want to stay thin and healthy . . . no Diet Coke for you!

     2. Standing up is good for you. A group of Swedish scientists took blood samples from a group of sedentary, overweight men and women, all over age 68. The researchers measured the length of the subjects' telemeres -- the ends of DNA that typically shorten and fray with age. Half the volunteers then started a moderate exercise program, which included less time sitting down, while the other group just continued with their normal lives.

     Six months later the Swedish researchers found that the telemeres of the normal group had shortened, as expected. But those of the exercise group had actually grown longer -- their telemeres had become younger. The surprise:  the telemeres of the volunteers who had done the most exercise grew less than the others, and in some cases not at all.

     So the most beneficial factor in lengthening the telemeres was not exercise, but simply time spent standing up. Or conversely, the less time people spent sitting down, the more their telemeres grew, and the healthier they were. The conclusion:  Exercise is good. Standing up is even better.

     Finally, on a happier note (I think): I saw my first Christmas ad the other day, for the holiday extravaganza at Radio City in New York. I know, the ads for Christmas seem to show up earlier and earlier every year. But Christmas is the happiest time of year, isn't it?

Tuesday, October 7, 2014

Are You Supposed to Die at 75?

     The Atlantic recently published an article called "Why I Hope to Die at 75" by Dr. Ezekiel Emanuel. He is a Harvard-educated doctor who's the brother of Chicago mayor Rahm Emanuel. He also heads the Department of Medical Ethics & Health Policy at the University of Pennsylvania, and served as an adviser to the Obama Administration in developing the Affordable Health Act.

     Dr. Emanuel says that he wants to die at age 75. Why? First of all, he argues, most people have made whatever contribution they will make to society by the time they are 75 -- or even long before that. In fact, most people see their most productive years in their 40s, and after that they slowly decline and fade away. By age 75 any man or woman will have lived a full life -- they will have finished their career, raised their family, seen their grandchildren begin to grow up. By age 75, there's nothing left to do but hang on and suffer the degradations of old age.

     He then points out that modern medicine has lengthened our life expectancy -- and for a long time it also improved our quality of life. But in recent years, he says, increases in longevity have instead been accompanied by increases in disability.

     He cites a study by Eileen Crimmins, a researcher at the University of Southern California, who found that between 1998 and 2006, the loss of functional mobility in the elderly actually increased. In 1998, about 28 percent of American men 80 and older had a functional limitation; by 2006, that figure was nearly 42 percent. And for women the result was even worse: more than half of women 80 and older had a functional limitation. Crimmins’s conclusion: There was an “increase in the life expectancy with disease and a decrease in the years without disease.”

     Dr. Emanuel's conclusion:  "Over the past 50 years, health care hasn’t slowed the aging process so much as it has slowed the dying process. The contemporary dying process has been elongated ... So modern Americans may live longer than their parents, but they are likely to be more incapacitated. Does that sound very desirable? Not to me."

     Dr. Emanuel does not want to live with inevitably decreasing mental and physical abilities. He also doesn't want his grandchildren to remember him as a dottering old man, but as the man he was when he was in command of his abilities. And he doesn't want to subject his children and grandchildren to the "very real and oppressive financial and caregiving burdens" that fall to people who are responsible for the aged and infirm.

     Dr. Emanuel is not in favor of euthanasia. He has no plans to commit suicide at age 75. What he plans to do is refuse any preventive care after age 75. He will instead let nature take its course. He will have no more colonoscopies, prostate exams or flu shots. He will not undergo heart surgery or chemotherapy. He will accept palliative care, if need be, to lessen his suffering; but he sees no point in going to extreme measures to extend his debilitated and useless life after age 75.

     So ... do you buy his argument? I might. Except I'd put the age at 85 instead of 75. But then, I'm a few years older than Dr. Emanuel. So we'll see. Dr. Emanuel is 57 years old. Let's check in on him, and see if he still holds the same view, in 18 years.

     Meanwhile, as a postscript, another doctor, Atul Gawande, a professor at Harvard Medical School, has written a book called Being Mortal, which addresses end-of-life issues from a similar but slightly different perspective. He points out that modern medicine has focused on fixing and managing both injury and disease -- and continues to try to fix problems right up to the bitter end, beyond the time when it can really be of much help, and in the process often causes a great deal of physical and emotional suffering.

     Dr. Gawande argues that there comes a point when medicine should focus on a person's well-being more than their life expectancy. That instead of trying to prolong a person's life by an extra week, or an extra month, doctors should instead offer them as much comfort as possible, and let them go with some degree of autonomy and dignity.

     And I'd agree with Dr. Gawande. Let me go with some degree of autonomy and dignity ... you know, in 20 years or so.