Cycling a relief for Parkinson’s?

That old saw about bike-riding as something one never forgets has taken on a new meaning. According to a report in the latest New England Journal of Medicine, cycling skills learned long ago can remain even when the ravages of Parkinson’s have destroyed most other abilities to get around… or even to stand without aid.

Dr. Bastiaan R. Bloem of the Radboud University Nijmegen Medical
Center in the Netherlands thought he had seen it all in his years of
caring for patients with Parkinson’s disease. But the 58-year-old
man who came to see him recently was a total surprise.

The New England Journal of Medicine

A video from the Netherlands of a 58-year-old man
with a 10-year history of Parkinson’s disease showed him freezing in his
movements after a few steps. Yet he was able to ride a bicycle.

The man had had Parkinson’s disease for 10 years, and it

had progressed until he was severely affected. Parkinson’s, a
neurological disorder in which some of the brain cells that control
movement die, had made him unable to walk. He trembled and could walk
only a few steps before falling. He froze in place, his feet feeling as
if they were bolted to the floor.

But the man told Dr. Bloem something amazing: he said he was a regular
exerciser — a cyclist, in fact — something that should not be possible
for patients at his stage of the disease, Dr. Bloem thought.

“He said, ‘Just yesterday I rode my bicycle for 10 kilometers’ — six
miles,” Dr. Bloem said. “He said he rides his bicycle for miles and
miles every day.”

“I said, ‘This cannot be,’ ” Dr. Bloem, a professor of neurology and
medical director of the hospital’s Parkinson’s Center, recalled in a
telephone interview. “This man has end-stage Parkinson’s disease. He is
unable to walk.”

But the man was eager to demonstrate, so Dr. Bloem took him outside
where a nurse’s bike was parked.

“We helped him mount the bike, gave him a little push, and he was gone,”
Dr. Bloem said. He rode, even making a U-turn, and was in perfect
control, all his Parkinson’s symptoms gone.

Yet the moment the man got off the bike, his symptoms returned. He froze
immediately, unable to take a step.

Parkinson’s has to be among the most bewildering of diseases, to the patient and caregiver alike. A very old friend of mine, former dean of a major theological school and author of a long list of acclaimed books, has had Parkinson’s for decades. He is fortunate also to have a wife with spine of steel and persistence of Job. More than a decade ago, when he was in a period of severe decline, she agitated for changes in his medications she felt needed to be made — and they subsequently left for an anniversary cruise to Scandinavia.  Some years later, after he had lost control of his mobility and most other functions it was determined that his Parkinson’s was not Parkinson’s after all, but “Parkinson’s-like symptoms,” and once again his treatment was dramatically changed. To dramatic effect. Having missed his sharp wit and ability to make conversation on earlier visits, the last time I was in their town the three of us enjoyed a long and hilarious lunch in a local restaurant.

If the old, familiar bicycle can be utilized to revive mobility and offer a new route to exercise and enjoyment, it will be very good news for Parkinson’s families.

For Some, Cycling Eases Parkinson’s Symptoms – NYTimes.com.

How not to get Alzheimer's

Of all the Big Fears, for aging parents or our aging selves, Alzheimer’s probably ranks #1. So what if we could stave it off?

A new project, the Cognitive Fitness and Innovative Therapies, or CFIT, is trying to keep people at risk for Alzheimer’s intellectually and physically fit with quizzes and other cognitive challenges to see if onset of the disease can be delayed, perhaps indefinitely. The program, which is being advised by many famous names in Alzheimer’s research and treatment, also promotes diet changes and maintaining a social life to try to slow cognitive decline and lower the risk for Alzheimer’s.

Try some problems some people practice to delay the onset of Alzheimer’s.

The Wall Street Journal’s invitation to try a few of these Alzheimer’s-prevention exercises seemed tempting for this reporter, so I clicked on over. It should be noted here that although I hold undergraduate and graduate degrees from reputable institutions, they are in Art and Short Fiction. These exercises are not for the faint-hearted, or the right-brained. (Actually, after following a few more links and trying another quiz it was determined that my right brain/left brain dominance is split 16 to 16; this may be the problem.) Maybe they are for the MIT alumni.

Kenneth S. Kosik, co-director of the Neuroscience Research Institute at the University of California, Santa Barbara, launched CFIT with a center in Santa Barbara last year. Dr. Kosik recommends that individuals start efforts to prevent the disease in their 50s.

“By the time someone walks in my door with symptoms of the disease, it’s too late” to stop it, says Dr. Kosik, who plans to open four CFIT centers in New York and California. The idea behind the new research is that lifestyle interventions may delay or prevent the disease before symptoms appear—or slow the progression of Alzheimer’s once they do manifest.

The CFIT exercises seem to go a step — or perhaps a leap — farther than the SharpBrain exercises, which are also recommended by all sorts of people who understand brain function. (And seem, I have to say, a lot more like fun and less like Alzheimer’s prevention.) Any of them will keep you awake, and quite possibly stave off dementia.

The shift in thinking has been bolstered by public health efforts to prevent cognitive decline and delay or prevent Alzheimer’s disease, which affects some 5.3 million Americans. A 2007 report by the Centers for Disease Control and Prevention and the Alzheimer’s Association, a nonprofit group that funds research and supports advocacy and education, called for implementing findings on exercise and diet into actions people can do to maintain cognitive health. A CDC review of the scientific literature is expected to be released this year. The groups have been working together to gather data from individual states on the extent of cognitive impairment and meeting with state health officials to develop public campaigns to promote brain health.

Scientists don’t know exactly what causes Alzheimer’s, a progressive brain disorder that accounts for the majority of dementia cases, although genetics and age likely play a role. There are only four drugs approved for the disease, but these just treat individual symptoms and don’t stop the relentless course of the illness. New medicines are in testing but are likely to take years before they reach medical clinics.

This space highly recommends that you get started right away. We all want to believe it’s not too late.

Ways You Can Stave Off Alzheimer’s – WSJ.com.

Palin, Pelosi & the politics of scorn

Much ado is being made over two lady politicos these days, Sarah Palin for her six-figure fees and Nancy Pelosi for her legislative expertise. Both are commendable — depending on how one chooses to commend — but unfortunately they are continuing to feed the politics of scorn. Which is unlikely to lead to bi-partisanship or collegiality any time soon. Maybe both are dead.

Palin’s usefulness to her party is a matter of dispute. According to two prominent speakers at a Wednesday breakfast sponsored by the Christian Science Monitor (as reported by Monitor writer Dave Cook), Palin’s rise is great good news for the Democrats.

“Look at this dynamic that is produced with Sarah Palin,” said Stanley Greenberg, chairman of Greenberg Quinlan Rosner Research. “You have John McCain having to have Sarah Palin to save him [in a primary election race]…”

In the aftermath of the passage of healthcare reform, the ongoing discussion is “Barack Obama against Sarah Palin on healthcare,” he said.

Mr. Greenberg, who served as President Clinton’s pollster, argued that “The face of the Republican Party to the country is not the ‘tea party,’ it is Sarah Palin.”

James Carville, President Clinton’s campaign manager and the other speaker at Wednesday’s breakfast, suggested a test to the assembled journalists. “Do me favor. Call five Democratic consultants and leave a message and say I am doing a story on Sarah Palin and call five Republicans, and see who returns the phone call. I think we all know the answer to that. The Democrats will be on the phone so fast.”

Much as some of us do not admire Sarah Palin, the sneer factor employed by her detractors can be oppressive. (Come on, if you’re an anti-Palin, think of the slurs you have slung her way.) She is, herself, a master of derision in a by-golly sort of fashion, and it is this that brings loud huzzahs from her audiences when she takes on the Democrats.

Not to be outdone, Speaker Pelosi (whom I appreciate and respect) was heaping scorn upon the Republicans in speeches to California audiences this week,

… saying they “have nothing to sell” to the American people except a crude caricature of her as the midterm elections approach.

Pelosi, D-San Francisco, was surrounded at the Phillip and Sala Burton Center by ardent advocates of health reform, who cheered when she was cheerful and roared when she was defiant. And she was proudly defiant.

“I couldn’t care less,” she said of GOP efforts to use her as campaign fundraising bait. “I should be thanking them. … It really helps me with my fundraising.”

The issues are real, and occasionally that is made clear:

“This is a bill about the middle class. This is a bill about small businesses. This is a bill about affordability,” Pelosi said.

Still, Pelosi warned Democrats that the fight isn’t over, saying Republicans “are unabashed in wanting to rid us of this … and one way they think they can do it is by making gross misrepresentations to senior citizens” with what she called a “campaign of fear.”

Appearing before a crowd dominated by seniors carrying signs of appreciation – “Thank you, madame speaker” – Pelosi was lauded by a parade of admirers, including Rep. George Miller, D-Martinez, doctors and senior advocates who praised her tireless push for the measure.

Admittedly, Pelosi was in friendly territory this week, as Palin has been in recent days herself.

Palin last weekend put Pelosi and Democratic Senate Majority Leader Harry Reid at the center of her campaign-style speech to Tea Partiers attending a rally in Searchlight, Nev., Reid’s hometown. “You’re fired,” she said of the two Democratic standard-bearers.

This may be the way politics works. But wouldn’t it be nice if occasionally, some way could be found for opposing sides at least to be civil in the interest of the common good.

Defiant Pelosi scorns Republicans.

When Mom & Dad stay home — and need care

Years ago when my grandmother was dying — a process that seemed to consume her for a very long time — her children took turns having their semi-invalid mother live with them for a period of months. Grandmother was not an easy patient. She spent most of her days talking about how everyone she loved was dead — which used to make me wonder where my sisters, my long-suffering mother and I stood with her. But Grandmother’s decline was before technology complicated such events, and pretty much all that was needed was to put a borrowed bed somewhere, try to keep her comfortable and entertained and call the doctor if she needed anything. Most of her six children had at least one at-home family member who could handle Grandmother’s care for a few months without straining the family budget or everyone’s patience and good humor.

Caring for aging family members today is not so simple. Few families have a stay-at-home member able to juggle regular routine with patient care, such  care now often calls for high-tech equipment and/or high-cost drugs and interventions, and doctors don’t make house calls every other night.

In an informative and enlightening ‘Encore’ feature, Wall Street Journal writer Anne Tergesen follows the adventures of several families wherein siblings have become caregivers to aging parents.

Family cohesiveness is a tall order at any time of life. But as parents grow frail, brothers and sisters often encounter new obstacles to togetherness—at precisely the time they most need to rely on one another. Sibling rivalry can emerge or intensify as adult children vie, one last time, for a parent’s love or financial support. And even as parents grow dependent on children, the desire to cling to old, familiar roles can create a dysfunctional mess.

Today, with the economy and household finances in disrepair, such strains are more pronounced. According to a recent report by the National Alliance for Caregiving and AARP, about 43.5 million Americans look after someone 50 or older, 28% more than in 2004. In comparison with 2004, a smaller percentage—41% versus 46%—are hiring help. And more—70% versus 59%—are reaching out to unpaid help, such as family and friends.

Experts say it’s crucial that families figure out ways to work together, to work through their differences, for the common goal of caring for a parent. If they don’t, their parents will suffer—and so will they.

“Family caregivers are the backbone of the long-term-care system in this country,” says Francine Russo, author of a new book about how siblings can cope with aging parents, “They’re Your Parents, Too!” Siblings who work together, she adds, can help preserve not just one another’s health and sanity but also a “last link to their first family.”

There is, fortunately, a lot of support for family caregivers, through sources listed above, the Family Caregiver Alliance and other local or national groups. There are also helpful tips, many of which are outlined in Tergesen’s article: use new technologies, seek help, be flexible, keep lists, and laugh a lot.

The latter was what saved my family from collapse during Grandmother’s stays in our home. Grandmother would today be easily identified as clinically, chronically, severely depressed. My sister Mimi and I devised a game, after the first few days of jockeying for position as the one not to have to spend the afternoon with Grandmother. Whoever came up with the most hilarious joke to tell and see if we could make her laugh, or the most bizarre question (“Did Uncle James really go to jail, like we’ve heard?”) to prompt a family story, would win. I don’t know if this technique has real merit but it worked for us. We laughed a great deal, and Grandmother got to tell a LOT of previously untold family stories. Some of them were even true.

Siblings Overcome Conflicts to Care for Aging Parents – WSJ.com.

Moving Mom & Dad – but to where?

With the over-5o population expected to grow from 100 million this year to 130 million in 2030, the question of how and where to house these older adults is one that’s not going away. And it is not just a question of quantity and variety — enough houses, apartments, retirement communities — it’s how to ensure that needed services will be accessible to all.

A new report just released by AARP’s Public Policy Institute and authored by the Center for Housing Policy offers a comprehensive look at a complicated picture. Insight on the Issues: Strategies to Meet the Housing Needs of Older Adults and is designed to help state and local policy makers understand the needs of this growing population segment.

All of these Boomers, who are now beginning to swell the ranks of the Seriously Senior, have specific wish lists: independence, security, and above all avoidance of the N-word — the dreaded nursing home. The wish lists change almost by the day, but some things stay the same.

“With the population of older adults on the rise, this report helps to identify the essential housing policy strategies that can help them to balance their increasing needs with a desire to continue to stay closely connected to their families, communities and society,” said Center for Housing Policy Chair John K. McIlwain, senior resident fellow and the J. Ronald Terwilliger chair for housing at the Urban Land Institute.

According to Susan Reinhard, AARP Senior Vice President and Director of the AARP Public Policy Institute, “These resources will be invaluable for policymakers at the state and local levels as they adapt to the changing needs of an aging population.”

If you, or your parents or grandparents, are over 50, chances are you have already had The Talk. Where in the world will Mom and Dad go, and how in the world will they stay there? What’s going to be comfortable? How will we afford it?

Nine fact sheets accompanying the newly released report are divided into three sections. It all makes the task of plowing through the talk a little easier, especially if local and state policy makers are paying attention at the same time.

This space will be looking at the different points over the coming weeks. Your comments and personal stories are welcome.

Moving in with mom and dad

Waiting lines at the bathroom? Overflow in the kitchen cabinets? Welcome to the suddenly multi-generational family home.

Yesterday a friend of mine was alternately laughing and crying (I mean, literally) over the tales of her once comfortable, now overstuffed home. Her daughter and son-in-law, both unemployed for an extended time and overwhelmed by mounting debt and loss of health insurance, recently moved in with the older generation. With them came three grandchildren, ages 3, 8 and 11. It could make a great sitcom pilot. “My husband was so desperate to get into one of our two and a half bathrooms the other day,” she said, “that he suggested getting one of those take-a-number things they have in hospital waiting areas. The kids put labels on their snack bar boxes, but now I can’t even find which shelf the boxes got stuffed into or what they’re hiding behind.”

Welcome to the brave new world of extended-family housing.

The extended family is making something of a comeback, thanks to delayed marriage, immigration and recession-induced job losses and foreclosures that have forced people to double-up under one roof, an analysis of Census Bureau figures has found.

“The Waltons are back,” said Paul Taylor, executive vice president of the Pew Research Center, which conducted the analysis.

Multigenerational families, which accounted for 25 percent of the population in 1940 but only 12 percent by 1980, inched up to 16 percent in 2008, according to the analysis.

For the rapidly growing 65+ segment of the population, there’s good news and bad news in this. Loneliness is often cited as a great fear among the aged. At talks and workshops this writer often does on end-of-life issues (advance directives, end-of-life choices, etc.) the response to any “What do you fear most?” question is never “death,” almost always “pain,” “isolation” or “loneliness.” When younger generations move in, loneliness is unlikely, but other problems may well take its place.

The analysis also found that the proportion of people 65 and older who live alone, which had been rising steeply for nearly a century — from 6 percent in 1900 to 29 percent in 1990 — declined slightly, to 27 percent.

At the same time, the share of older people living in multigenerational families, which plummeted to 17 percent in 1980 from 57 percent in 1900, rose to 20 percent.

While the pre-World War II extended family may have been idealized as a nurturing cocoon, the latest manifestation is too recent and a result of too many factors, positive and negative, to be romanticized.

“It calls to mind one of the famous lines in American poetry, from Robert Frost: ‘Home is the place where, when you have to go there, they have to take you in,’ ” Mr. Taylor said. “I don’t know that I can offer a value judgment of whether it’s good or bad. It reflects our time.”

The decline of extended families coincided with an exodus to the suburbs, where many young adults preferred to raise their children, and the enactment of Social Security and Medicare, which made older adults more financially independent.

A lot of factors combine to create the more than 49 million adults currently living in multi-generational homes, the census figures show. We’re living longer, getting married later, getting divorced more often, losing jobs and losing homes. One ray of good news is that the homes now housing multiple generations tend to be larger than a generation ago. Two and a half bathrooms for three generations still beats the olden days of one bathroom for a family of five. But not many families get along as well as the Waltons did. “We love the kids and the grandchidren,” remarked my stressed-out friend mentioned above, “but my son-in-law’s first paycheck is going to go for the down payment on a new apartment.”

Households With Extended Families Are on the Rise, Census Shows – NYTimes.com.

Health reform: a start

Victory finally came, but only for those who were hanging onto the shreds of earlier wishes, and it wasn’t ever pretty. Watching C-SPAN on Sunday, in fact, was a little like watching grass grow, with every other blade sniping at the blade just around the corner. But at least that much is over.

Congress gave final approval on Sunday to legislation that would provide medical coverage to tens of millions of uninsured Americans and remake the nation’s health care system along the lines proposed by President Obama.

By a vote of 219 to 212, the House passed the bill after a day of tumultuous debate that echoed the epic struggle of the last year. The action sent the bill to President Obama, whose crusade for such legislation has been a hallmark of his presidency.

“This isn’t radical reform, but it is major reform,” Mr. Obama said after the vote. “This legislation will not fix everything that ails our health care system, but it moves us decisively in the right direction. This is what change looks like.”

Minutes after thebill was approved, the House passed a package of changes to it and sent it to the Senate. The Senate majority leader, Harry Reid of Nevada, has promised House Democrats that the Senate would quickly take up the reconciliation bill with the changes in it, and that he had secured the votes to pass it.

But while the Senate is bracing for a fierce floor fight over the reconciliation measure, the landscape was permanently altered by passage of the original Senate bill. Should the reconciliation bill, which cannot be filibustered, collapse for any reason, the core components of the Democrats’ health care overhaul would move forward. Indeed, Senate Republicans were quickly faced with a need to recalibrate their message from one aimed at stopping the legislation to one focused on winning back a sufficient number of seats in Congress to repeal it.

It was mean and divisive and ugly, and will surely get more so, but at least it’s a start. We can finally begin to reform what is a cruel and unworkable system. And maybe, just maybe, there will some day be access to health care for all. Does anyone remember when there was no Social Security or Medicare?

House Approves Health Overhaul, Sending Landmark Bill to Obama – NYTimes.com.

Catholic nuns urge passage of health bill

There’s hope. The U.S. Conference of Catholic Bishops may be trying to sink health reform because they feel they know best about women, but a few thousand good sisters are raising their own voices. And not just your everyday sisters.

Catholic nuns are urging Congress to pass President Barack Obama’s health care plan, in an unusual public break with bishops who say it would subsidize abortion.

Some 60 leaders of religious orders representing 59,000 Catholic nuns Wednesday sent lawmakers a letter urging them to pass the Senate health care bill. It contains restrictions on abortion funding that the bishops say don’t go far enough.

The letter says that “despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions.” The letter says the legislation also will help support pregnant women and “this is the real pro-life stance.”

This space, a space which claims several priests as good friends despite our frequent and vehement disagreements, hereby sides with the sisters. And offers a sincerely respectful three cheers.

Catholic nuns urge passage of Obama’s health bill – Politics – Wire – TheState.com.

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