Category: Family and Friends

California/General interest/Health/seniors/USA
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Nobody wants to talk about it

by Fran Johns

It’s the new Great American Conspiracy, the game of eternal youth. A little plastic surgery here, personal trainer there, here a test, there a scan, everywhere denial again. Death is optional, isn’t it?

Doctors are the happy co-conspirators in the game. They can always fix things up, can’t they?

Well, no. But a new study shows that doctors are just as happy to put off talking about end-of-life issues as their patients. This means that discussions get put off until they are beside the point because the patient died. Which saves all those uncomfortable moments… even if by the time he or she dies the patient has suffered distress that might easily have been avoided, the doctor has likely ordered expensive, agonizing, unnecessary tests and procedures (after all, isn’t the mandate always to treat, no matter what?) and friends and family are left emotional wrecks. All because it’s easier to be in denial than consider the possibility that we might actually — gasp — die.

It’s a conversation that most people dread, doctors and patients alike. The cancer is terminal, time is short, and tough decisions loom — about accepting treatment or rejecting it, and choosing where and how to die.

When is the right time — if there is one — to bring up these painful issues with someone who is terminally ill?

Guidelines for doctors say the discussion should begin when a patient has a year or less to live. That way, patients and their families can plan whether they want to do everything possible to stay alive, or to avoid respirators, resuscitation, additional chemotherapy and the web of tubes, needles, pumps and other machines that often accompany death in the hospital.

The right time to bring up these issues is today. When you’re 26. Or 52. Or 78 and feeling okay. Once someone is terminally ill it’s a whole new game, but to postpone talking about it, to behave as if never uttering the D-word means you’ll still live forever at that point is both foolish and costly. The reality is that we do postpone the conversation. But once a diagnosis suggests a foreseeable end to the living-forever fantasy the discussion should, for those very good reasons above, begin that day.

But many doctors, especially older ones and specialists, say they would postpone those conversations, according to a study published online Monday in the journal Cancer.

It’s not entirely clear whether these doctors are remiss for not speaking up — or whether the guidelines are unrealistic. Advice that sounds good on paper may be no match for the emotions on both sides when it comes to facing patients and their families and admitting that it will soon be over, that all medicine can offer is a bit of comfort while the patient waits to die.

Dr. Nancy L. Keating, the first author of the study and an associate professor of medicine and health care policy at Harvard, said not much was known about how, when or even if doctors were having these difficult talks with dying patients. But she said that her research team suspected that communication was falling short, because studies have shown that even though most people want to die at home, most wind up dying in the hospital.

The researchers surveyed 4,074 doctors who took care of cancer patients, instructing them to imagine one who had only four to six months left, but was still feeling well. Then the doctors were asked when they would discuss the prognosis, whether the patient wanted resuscitation or hospice care, and where he or she wanted to die.

The results came as a surprise: the doctors were even more reluctant to ask certain questions than the researchers had expected. Although 65 percent said they would talk about the prognosis “now,” far fewer would discuss the other issues at the same time: resuscitation, 44 percent; hospice, 26 percent; site of death, 21 percent. Instead, most of the doctors said they would rather wait until the patients felt worse or there were no more cancer treatments to offer.

How much worse are patients supposed to feel? How many treatments will be offered, for how long, at what expense in dollars and in human suffering?

If doctors were honest about the pain, distress and discomfort involved in end-of-life treatments, if patients could be informed and then clear about what they would choose, if friends and families could be open, the savings in dollars and in human suffering would be immense. Sarah Palin didn’t want you to talk about it. Is she still calling the shots?

Second Opinion – Doctors Often Delay Conversations About Death With Terminal Patients – NYTimes.com.

California/General interest/Health/Lifestyle/seniors/Sports/USA/Women
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Adventure travel for the young — at heart

by Fran Johns

Not long ago I was fond of bragging, with more than a small amount of smug self- satisfaction, about completing Circus 101 class at the San Francisco Circus School shortly after I became eligible for Medicare. Although it was quickly evident that I can’t do upside down any more without tending to throw up, I was more flexible than the muscular hunks and quite good, if I do say so, on the top of the pyramids. I was always the top of the pyramid because nobody wanted to step on the little old lady. Moments of grandeur and glory, those were.

Well, tell that to Ilse Telesmanich, 90. She’ll be hiking in South Africa this summer. Or Tom Lackey, who is into wing-walking over the English Channel at 89. (“My family thinks I’m mad,” Mr. Lackey said in a telephone interview discussing the flight with New York Times writer Kirk Johnson — his 20th wing-walk. “I probably am.”)

Intensely active older men and women who have the means and see the twilight years as just another stage of exploration are pushing further and harder, tossing aside presumed limitations. And the global travel and leisure industry, long focused on youth, is racing to keep up.

“This is an emerging market phenomenon based on tens of millions of longer-lived men and women with more youth vitality than ever imagined,” said Ken Dychtwald, a psychologist and author who has written widely about aging and economics.

And the so-called experiential marketplace — sensation, education, adventure and culture, estimated at $56 billion and growing, according to a new study from George Washington University — is where much of that new old-money is headed.

At the Grand Circle Corporation, for example, a Boston-based company that specializes in older travelers, adventure tours have gone from 16 percent of passenger volume in 2001 to 50 percent for advance bookings this year, even as the average traveler’s age has risen to 68 from 62.

At Exploritas, a nonprofit educational travel group previously known as Elderhostel, the proportion of people over 75 choosing adventure-tour options is up 27 percent since 2004. The sharpest growth has been in the over-85 crowd, more than 70 percent.

At VBT, a bike touring company in Vermont that does rides in countries around the world, the number of bikers over 70 has doubled in the last 10 years.

“Unusual is way more popular now,” said Alan E. Lewis, chairman of Grand Circle, “and with this audience, that’s a major shift.”

It’s not all fun and high adventure — medical insurance with companies such as  InsureMyTrip.com is likely to quadruple, transporting medications can be problematical, and ordinary risk factors (though wiser elders often fare better than macho youngers) remain.

But it’s enough to make me renew my Exploritas membership, hit the par course more often and shut up about circus school.

Seeing Old Age as a Never-Ending Adventure – NYTimes.com.

California/General interest/Health/seniors/Sports/USA/Women
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Skip the cold meds – hit the gym

by Fran Johns

Just in case the cold weather and a few sniffles are luring you toward the couch in front of the TV, you may want to stop and read Wall Street Journal health writer Laura Landro’s article in today’s “Personal Journal” section first.

Regular workouts may help fight off colds and flu, reduce the risk of certain cancers and chronic diseases and slow the process of aging.

Who knew? Well, most of us knew, we just haven’t been convinced. But Landro’s piece is stuffed — no offense to couches or potatoes — with evidence from new research, including data on fitness v the common cold. The fit, it turns out, have fewer and less severe colds, of shorter duration than the afflictions of their less-fit fellow creatures.

No pill or nutritional supplement has the power of near-daily moderate activity in lowering the number of sick days people take,” says David Nieman, director of Appalachian State University’s Human Performance Lab in Kannapolis, N.C. Dr. Nieman has conducted several randomized controlled studies showing that people who walked briskly for 45 minutes, five days a week over 12 to 15 weeks had fewer and less severe upper respiratory tract infections, such as colds and flu. These subjects reduced their number of sick days 25% to 50% compared with sedentary control subjects, he says.

Medical experts say inactivity poses as great a health risk as smoking, contributing to heart disease, diabetes, hypertension, cancer, depression, arthritis and osteoporosis. The Centers for Disease Control and Prevention says 36% of U.S. adults didn’t engage in any leisure-time physical activity in 2008.

Even lean men and women who are inactive are at higher risk of death and disease. So while reducing obesity is an important goal, “the better message would be to get everyone to walk 30 minutes a day” says Robert Sallis, co-director of sports medicine at Fontana Medical Center, a Southern California facility owned by managed-care giant Kaiser Permanente. “We need to refocus the national message on physical activity, which can have a bigger impact on health than losing weight.”

[INFORMED]

Researchers are also investigating whether exercise can influence aging in the body. In particular, they are looking at whether exercise lengthens telomeres, the strands of DNA at the tips of chromosomes. When telomeres get too short, cells no longer can divide and they become inactive, a process associated with aging, cancer and a higher risk of death.

A companion article goes further, suggesting that “spurring more exercise out of the half of Americans who are already active is just as important as coaxing the sedentary off the sofa.” The jury on this, however, is still out. For the time being, you could focus on warding off the January chest cold and stretching out the telomeres.

The Hidden Benefits of Exercise – WSJ.com.

California/General interest/teens/USA
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Texting while driving kills, at any age

by Fran Johns

I had an e-mail just now from a friend who read the story, below, of my granddaughter’s accident earlier today. “You missed the point,” he said. (Why can’t I get him to register, and say this on the T/S site?) “The point is that distracted drivers total cars, distracted drivers kill. No matter how old they are.”

It’s true.

As a pedestrian, which I usually am since who wants to drive in a city like San Francisco, I have had more brushes with death from distracted drivers than I like to think about. They are talking on their phones, eating hamburgers, applying make-up, texting friends, day-dreaming, just not paying any attention to the person stepping into the street with the green light and the right-of-way. And yes, they are not all teenagers.

As a driver, if another distracted driver is in your area you can’t often jump back onto the sidewalk and survive.

We all know this, that distracted drivers kill. The knowledge doesn’t stop us. As my granddaughter says, “Everybody does it.”

California/Lifestyle/seniors/teens/USA
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The perils of parenting… and iPods… and texting while driving…

by Fran Johns

My granddaughter’s birthday is today. She’s 19. A gifted art student, a remarkably grounded, neat kid. That’s the good news.

The bad news is that this afternoon she totaled her car.

The further good news is that she’s okay, and she didn’t hurt anyone else. But it was her fault. I understand the music was playing customarily loud; I certainly wouldn’t be surprised if she had been texting a friend.

The really bad news is that I don’t imagine either of the above behaviors will change.

In 2008, the latest year for which a lot of data has been collected and digested, some 3,500 teens between the ages of 15 and 19 died in car wrecks. About 10 times that many wound up in emergency rooms, but survived. The 15 to 24 age group accounts for 14% of the population, but it accounted for 30% of the costs of motor vehicle injuries ($19 billion) among males, and 28% ($7 billion) among females. Nobody knows how many of the young drivers causing those accidents were texting their friends at the time — cell phones tend to fly out the window, although many of them have survived to incriminate people who murdered other people during casual conversation. There’s a very popular YouTube video that ought to cure you; my granddaughter has seen it.

A few months ago I was driving my granddaughter to catch the BART train back to campus, fairly late one night, when I committed a minor traffic violation under the immediate gaze of a San Francisco policewoman. During the interminable length of time it took for the policewoman to sit in her car studying her computer I did a lot of beating on the steering wheel, ranting about how this would ruin our insurance, how I hadn’t had a ticket in decades, how furious I was with myself for a dumb move. Eventually the policewoman returned, congratulated me on my excellent driving record, and said, “I’m going to give you a break this time, Ms. Johns…” and my granddaughter and I exhaled.

For the next few minutes we talked about my driving record. I said at least some of it has to relate to the fact that I do not talk on the phone while driving and I do not text while driving, and I like soft music (actually, I don’t think I mentioned the music business.) Those, however, are not dots one is interested in connecting if one is 18 years old… or any age, probably, coming from a little-old-lady driver who just got off lucky.

My greatly beloved granddaughter said she often texts while driving. “Everybody does,” she said.

Health/Religion/seniors/USA
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Catholic bishops mandate treatment to keep comatose patients alive

by Fran Johns

Catholic hospitals across the country face a new mandate this year to provide life-sustaining treatment to comatose patients regardless of the wishes of those patients and/or their families, and even when there is no hope of recovery.

The U.S. Conference of Catholic Bishops issued the directive Nov. 17 to the more than 1,000 church-affiliated hospitals and nursing homes in the United States and to all Catholic doctors and nurses. Invoking a 2004 speech by Pope John Paul II, the bishops said Catholics must provide nutritional assistance to patients with “presumably irreversible conditions … who can reasonably be expected to live indefinitely if given such care.”

A previous directive let Catholic hospitals and doctors decide whether the burdens on the patient outweighed the benefits of prolonging life. The bishops said the new policy was guided by “Catholic teaching against euthanasia” and by John Paul’s observation that providing food and water “always represents a natural means of preserving life, not a medical act.”

The issue of whose wishes will be observed — the patient’s or the bishops’ — is certain to be raised. And in the case of a comatose patient, having someone else to advocate in one’s behalf will be critical.

Catholic hospital officials say the November decree isn’t rigid and leaves room for accommodating patients’ wishes. But the bishops’ language appears to conflict with a hospital’s legal duty to follow a patient’s instructions to withdraw life support, as expressed in an advance written directive or by a close relative or friend who knows the patient’s intentions.

Courts have ordered hospitals to disconnect feeding tubes when an unconscious patient’s wishes were clearly established. The best-known case involved Terri Schiavo, the Florida woman who died in 2005 after 15 years in a coma and unsuccessful attempts by her parents and Republicans in Congress to keep her alive.

The decree itself does not require life-sustaining care that would be “excessively burdensome for the patient” or would cause “significant physical discomfort.” If those exemptions don’t apply, a hospital will send a patient elsewhere rather than violate his or her expressed wishes, the (Catholic hospitals) organizations said.

The Catholic Health Association of the United States, which represents both hospitals and nursing homes, said a facility’s ethics committee would probably meet with the doctor and the patient’s representative to “explore the alternatives” whenever a patient’s decision to withdraw life support clashed with Catholic doctrine.”In some instances, this might include the transfer of the patient to another facility,” the association said.

Considering the number of Catholic hospitals, nursing homes, doctors and nurses under the bishops’ directive and the number of people who would not choose to spend their final weeks and months hooked up to tubes and wires, ethics committees are going to be very busy. It is hard to make sense of this across-the-board imposition of one religion’s views on countless patients whose own wishes may differ.

New Catholic mandate on comatose patients.

California/Health/seniors/USA/Women
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Montana court affirms aid in dying

by Fran Johns

Montana has become the third U.S. state to give terminally ill adults the right to choose aid in dying. The decision, which came from the State Supreme Court on New Year’s Eve, 2009, was handed down by the highest body for state issues and thus cannot be appealed. The other two states honoring a patient’s wish to choose aid in dying are Oregon, which has successfully maintained its Death with Dignity legislation for more than a decade, and Washington, which passed a similar law last year.

The Montana ruling came too late for one plaintiff.

Roberta King, of Missoula, the daughter of plaintiff Bob Baxter, said, “My father died without the peace and dignity he so dearly wanted for himself and others. He feared when he filed this lawsuit that he would not live long enough to benefit from it. I’m sure he would be deeply gratified that other terminally ill Montanans will have the choice and comfort that aid in dying affords them.”

The Montana case was backed by Compassion and Choices, with C&C Legal Director Kathryn Tucker serving as co-counsel to the plaintiffs/respondents. (Full disclosure: I serve on the board of Compassion and Choices’ Northern California chapter.) The decision gave Tucker a major boost for her New Year’s celebrations. She was quoted on New Year’s Day as saying,

Montanans trapped in an unbearable dying process deserve, and will now have, this end-of-life choice. This is the first state high court to find protection of this choice, and makes clear that in Montana, patients are able to make this choice and physicians can provide this care without risking sanction.”

Others, including medical professionals and critically ill patients who invested long hours in seeking the new ruling, were equally gratified.

Dr. Stephen Speckart, a Missoula cancer specialist and a plaintiff in the lawsuit, said, “This decision affirms that a terminal patient’s fundamental right to self-determination will guide end-of-life health decisions. I regularly treat patients dying from cancer, and many of these deaths are slow and painful. Terminal patients will no longer be forced to choose between unrelenting pain and an alert mental state as they approach the end of their lives from terminal diseases. The comfort this brings to their last days can have an immeasurable benefit.”

Missoula attorney Mark Connell, who argued the case to the Supreme Court on behalf of the plaintiff physicians and patients, described the decision as “a victory for individual rights over government control.” Connell added: “The Montana Supreme Court has now recognized that, where intensely personal and private choices regarding end-of-life care are involved, Montana law entrusts those decisions to the individuals whose lives are at stake, not the government. I know Bob Baxter would be very pleased that the court has now reaffirmed that these choices should be left to the terminally ill people in our state.”

Steve Johnson, 71, of Helena, who is terminally ill with brain cancer, hailed the decision and asked the Montana medical profession to provide patients like himself with aid in dying. “I approach the end of my life with a clear mind, and I would like to work with my doctor to minimize the pain and maximize the peacefulness in my dying. I would like my physician to be able to respect and honor my choice to die with dignity. Adults like myself should have the option, if terminally ill, to request physician aid in dying. It’s only compassionate to minimize unnecessary suffering at the end of life, and to let me make the choice about how much suffering to endure, based on my own values and beliefs,” said Johnson.

The movement had widespread support across the state.

Montana State Sen. Christine Kaufmann, Rep. Dick Barrett and twenty-nine other state legislators; the American Medical Women’s Association, the American Medical Students Association, and a coalition of Montana clinicians; the American College of Legal Medicine; the American Civil Liberties Union of Montana; the Montana Human Rights Network; the Northwest Women’s Law Center; terminal patients’ surviving family members; Montana religious leaders; and Montana’s leading constitutional law experts had urged the Court to find in favor of the terminal patient’s right to receive aid in dying from their physicians.

According to Compassion and Choices president Barbara Coombs Lee, the battle for “the right to choose a humane and compassionate death will continue. (We) encourage terminally ill patients to call 800 247-7421 if they would like information about aid in dying, or suggestions on how to open a dialogue with their physician and loved ones.”

California/General interest/Health/Holidays/Money/Politics & Causes/seniors/USA
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Goodbye to all that — & hello 2010

by Fran Johns

It’s hard to mourn the passage of 2009. Jobless friends struggled to survive while our own family income took a dive. Gay friends watched meanness triumph over decency in equality battles. Friends of many stripes lamented choices made by the president we elected with unrealistically high hopes. And my hometown paper this morning lists, among the top stories of the year, teenage gang rape, government insolvency and a bunch of senseless killings.

Other front pages aren’t much different: my second-favorite city winds up the year in the red and worried about the shadow of 9/11 (New York Times.) Murder and assault — specifically assault compounded by injustice — are among today’s concerns in Chicago. And a couple of other former hometown papers lead off the year’s last day with stories of car crashes, shootouts (Atlanta Journal Constitution) and a tragic, child-abandoning, now dead, alcoholic mom (Richmond Times-Dispatch). Plus another doozy about four or five hundred dead animals found in one house — and that happened in Philadelphia.

Optimism, these days, is a full-time job.

But hey. We’re inching toward health reform. Umar’s bomb didn’t go off.  Some of those bad guys (above) went to jail, and a few good guys who’d been jailed as bad guys for a very long time got out of jail thanks to the Innocence Project.  And even if the best we can do for employment optimism is note that the rate of jobs lost is getting smaller — can the country’s jobless find hope in that? — the jobless recovery seems to be happening. Surely jobs will follow.

Plus: even if we don’t like all of his choices and decisions, we have an articulate president who comes across, still, as thoughtful and decent — and doesn’t make you cringe when you see him on TV. There’s hope.

And True/Slant, which you’d never heard of this time last year, is closing in on a million readers.

Happy New Year from the Boomers and Beyond page.

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