Surviving to live another day

It started innocently enough: I was complaining about being short of breath at a dinner party. Several physicians were at the table; one suggested that it might be possible to increase lung capacity by doing exercises with a spirometer. “I’m not a pulmonologist,” he said, “so I don’t know; it’s just a thought.”

Incentive_spirometer

The thought was planted. I fired off an email to my primary care physician (we love Kaiser Permanente) asking if she knew of such a thing, and/or might refer me to someone to give it a try. She replied with a request that I come into the office so she could evaluate me. Well, grump, grump; all I wanted was a quick fix, but anyway. It takes all of about 10 minutes to get to the Kaiser Medical Center. I arrived for an 11 AM appointment.

The good Dr. Tang patiently explained that she did not prescribe via email. And because it had been 2 or 3 years since we last examined the heart/lung situation she would like to do another work-up, to see about this shortness of breath business. She went very lightly on the issue of my being 83 years old for heavens sakes, although she did mention she had 60-ish patients in worse shape than I. (This is a compliment, coming from one’s physician whom one reminds of her mother, although I was still looking for some magic way to walk uphill without having to stop and catch my breath.)

She then ordered a zillion blood tests, an EKG and a chest X-ray. Still grumping a little, I set out for all these, vowing that if even the smallest of lines appeared I would just come do it all another day. It took me roughly 3 minutes to get in for the EKG, less for the X-ray, and when I got down one more floor to the lab and pulled ticket #372 the automated voice was already saying “Now serving #372 at Station #4.” After dutifully following all these instructions, I went home to take a nap.

Within an hour, a voice mail message arrived from my doctor. “Your tests are fine, I don’t want to alarm you. But I’d like for you to come back in right away. Just tell the front desk you’re here.” Alarmed, I set out for the Medical Center once again. Lung cancer. Definitely. A spot on the lung showed up on the X-ray, and I will definitely die of lunch cancer in the immediate future. fear

Fortunately, the 10-minute drive didn’t allow too much time to contemplate my impending demise. “No, your X-ray is fine!,” she said. “Your lungs are fine! It’s just this one test that came back pretty high. It’s a screening test for possible blood clot. These tests are set very high because we don’t want to miss anything. Still, I want to be sure there’s no clot there that could indicate a pulmonary embolism causing your shortness of breath.” OK, I prefer not to have clots floating around in my bloodstream.

So does Dr. Tang. Whereupon she ordered a CT scan – which meant walking uphill a block to the hospital where they have those fancy machines (and radiologists to read what the machines report.) “Once you’re done,” she said, “come back to the office and as soon as we have the results we can talk about them.” I set out on the brief uphill walk. Pulmonary embolism. Definitely. Isn’t that what did in my mother at age 70? Embolism, aneurism, something blood-clotty. I’ll probably die of pulmonary embolism before I get back down this hill.Grim reaper

It is now close enough to closing time that most Kaiser people are closing up. But the CT scan people wait for me, hook me up to the dye thing and run me back and forth through the machine. I walk back downhill, mildly optimistic because nobody gasped while I was getting dressed in the cubicle several feet from the scan people. With nobody now at the receptionist desk, I walk into the nursing/examining room area and tell a smiling nurse that I’ll be outside if Dr. Tang needs me. And sure enough, in another 5 minutes – not enough time to consider calling the crematorium – she comes bursting through the door saying she’s so glad I waited.

“As I said, these screens are set very high so that we don’t miss anything,” she begins. “In your case, there was nothing to miss. It was just a false positive.” I exhale. We talk briefly about how I might increase my exercise regimen if possible – which might even address the shortness of breath issue; I concede that I am, indeed, 83.

On the way home, no longer planning to die in the immediate future, I count the cost: six hours, several hundred dollars co-pay. And I give thanks for our Kaiser membership, modern medical technology and my good doctor.

happiness

 

 

Age, Agility and National Stamina

It is a little known but verifiable fact that this writer is a graduate of Circus 101. Well, I completed the course, that is, some five or six decadespast my turning-cartwheels-in-the-backyard days.

The author and sister Mimi, circa 1940

The author and sister Mimi, circa 1940

This comes to mind because of all the recent stamina talk. At the time of my circus experience I was several years younger than the current candidates for president of the United States. I am still the age of Ruth Bader Ginsberg, and frankly, Justice Ginsberg and I (I am not officially authorized to speak for my 1933-babe sister) resent the stamina talk. She, of course, is making her debut (speaking only, opening night) with the Washington National Opera this year; I’m afraid opera performance is not on my bucket list. But still.

Stamina-wise there is at least the circus thing. As I recall, my late-life circus experience began with an article in the San Francisco Chronicle about a class offered by the San Francisco School of Circus Arts (now Circus Center) titled Circus 101. It sounded interesting, and at least worth undertaking for a good story. So I called the Circus School.

“Could a reasonably flexible 60-something woman be eligible to take your Circus 101 class,” I asked the nice lady at the other end of the line? She replied, essentially, if you’ve got the money we can work you in. “You can set your own limits,” she said.

So I showed up for the first class, raising the median age by two or three decades, and quickly learned my limits: upside-down is not for 60-somethings. Oh, I could still do upside-down, headstands with my feet on the wall or the occasional cartwheel; but then I tended to get dizzy and throw up, which is not in the curriculum. I found I was very good, though, at balancing the peacock feather on my chin and at being part of the human pyramid; I always got to be the top of the pyramid because nobody wanted to step on the little old lady. I was also quite good at the Ooze – a sort of backward roll-over with a collapse at the end.

In my class was a lovely Chinese-American girl named Yvonne, who measured approximately 24-18-24 and could juggle three balls before we even started. By the second class her husband Ken had been talked into joining. Ken and Kit, another husky young man who showed up at the same time, could perform great feats of strength and skill, but because they had all those muscles getting in the way I could beat them at grabbing my ankles and doing bend-overs and such that they couldn’t even approximate – which made me feel initially quite superior.

Rola-bola performer, not the author

Rola-bola performer, not the author

All feelings of superiority quickly disappeared. We learned the egg roll, the diablo and the rola-bola, that last being a balancing act on a board set on a large pipe, which when circus people do it looks easy as pie. It is not. (Nor is juggling four balls.)

I did discover that I really shone at the human caterpillar. This begins with a base person on all fours (hands and feet, not knees.) The next person rests on top of the base person, feet crossed, hands on the floor, and additional caterpillar people are similarly arranged. The rear legs and all hands move in unison, theoretically, until somebody giggles.

Is any of this relevant to today’s world, nearly two decades later? Well, it provides food for thought and some great metaphors.

One can only hope that everyone on the political spectrum will have the stamina – not to mention agility – required for running the country at all levels and branches of government. And that our collective community can master the rola-bola without turning into one great Ooze.

 

To Have (or maybe not) a Stroke

Heart attack

“You’re not leaving here with your blood pressure that high,” the doctor said. It was 189 over something equally ridiculous. It was not interested in coming down. Finally she said, “Okay, pick up this prescription on your way out and take it the minute you get home.”

Vividly running through my head were images of my mother, who suffered a series of strokes that eventually killed her in her 70th year. Plus images of assorted aunts and others who suffered debilitating strokes and often early deaths.

“But . . . but,” I said to the doctor, as I have repeatedly said since my carefree youth; “I don’t have high blood pressure. My three older sisters? They all had high blood pressure. They also all had beautiful auburn curls, while I got the utterly straight, dishwater blond hair. So, shortly into our adulthood, I took to saying, ‘OK, keep your gorgeous curly hair, I’ve got the good blood pressure.’ It seemed like a pretty fair trade.” My physician said, not unsympathetically, “Those genes may have caught up with you.” And just like that, I joined the ranks of the hypertensive. That great mass of humanity waiting apprehensively for the stroke or heart attack that might swoop in and end it all.

By the time I got home I was visualizing an immediate demise.

Unlike my mother’s generation, though, today’s hypertensives have internet encyclopedias worth of information and an arsenal of drugs bewildering enough to induce a small stroke if you really try to figure them all out. Beta blockers. Diuretics. Angiotensin II receptor blockers. Vasodilators. A good doctor, whose advice you can follow, at least on which meds to take, is a great boon. french fries

The rest of the try-not-to-have-a-stroke business is fairly straightforward. Quit with the nicotine, and moderate the booze (or quit that too.) Watch the weight – extra poundage, especially around the midsection, can increase your stroke probability rather dramatically. Walk for at least 30 minutes a day, increasing the distance as you can. (Swim, bike, exercise.) Salt can do you in fast; if you’re trying to stay within the recommended 1,000 to 2,000 mg per day, a large order of fries (350 mg) might not be a wise choice.

This writer is good with most of the above – excepting an occasional uncontrollable urge for a small order of fries. Plus whatever that was I picked up from the Kaiser pharmacy definitely worked. One tiny little pill, and the next day my blood pressure was 114 over 85.

Maybe I’ll stick around for a while.

Fighting off dementia

DementiaAlzheimer’s – already afflicting well over 5 million Americans – is expected to claim more than 16 million of us by 2050 if a cure isn’t found. Today it is at the top of the Bad News list of potential diagnoses for almost anyone over 50. Justifiably so, since the Centers for Disease Control and Prevention reports than one in three seniors now die with Alzheimer’s or other dementia.

That’s the bad news.

The good news, explained recently by Patricia Spilman, M.S. at a sold-out Commonwealth Club event in San Francisco, is that there are things one can to do lower the risk, and perhaps slow the progress of the disease. Spilman, who is Staff Scientist at the Buck Institute’s Bredesen Lab, should know. She has spent more than two decades researching neurodegenerative disease, and has written and spoken extensively on Alzheimer’s and related diseases.

“Forgetting,” Spilman says, by way of reassurance, “is normal. You don’t need to remember where you put the car keys last week, or a doctor’s appointment last month.” And studies – including one by Buck Institute founding President and CEO Dale Bredesen M.D. that is fascinating even for a lay reader – suggest that cognitive decline can be slowed, or in some cases reversed.

Spilman’s prepared remarks consisted largely of useful, realistic advice about how to delay the cognitive decline most of us will experience at some point. The audience, ranging from 20-somethings to more than a few senior citizens, was furiously note-taking throughout (or furiously jotting down questions for the Q&A session to follow.)

Exercise – particularly activities that combine movement and navigation such as tennis or golf – is at the top of the list. “It’s easier if you have a partner,” Spilman suggests, “because this adds the important element of socialization. Walking, plus climbing, is particularly good if you try new routes.” More than a few audience members nodded knowingly when Spilman noted the increasing, widespread dependence on mindless GPS. “Take the opportunity to look at a map,” she said.

Cognitive decline can also be offset by paying attention to the critical need for plenty of sleep. To help with a good night’s sleep, Spilman advises allowing at least several hours between eating and going to bed, and having a dark room. Chronic stress is relieved by a combination of exercise and sleep, along with those other preservatives of gray matter, yoga and mindfulness meditation.

Also good for the brain: almost any sensory stimulation. Music, smells, touch. Spilman cites Oliver Sacks’ Musicophilia: Tales of Music and the Brain, and Norman Cousins’ Anatomy of an Illness, in which Cousins treated himself with comedy as useful reading.

“Do something new every week,” Spilman suggests; “every day. Have goals in later life. Take classes, volunteer, build intergenerational relationships, pursue spirituality, encourage others to change and to grow.”

Computer games can improve cognition also. Spilman did not mention any specific sites, but this writer has enjoyed BrainHQ, and other brainy items from Posit Science’s Karen Merzenich, as well as introductory games on the Lumosity site. Most fascinating of all is the University of California San Francisco (UCSF)’s Brain Health Registry, in which anyone can participate; it’s free, and your brain might wind up helping someone else’s brain one day.

The Q&A segment following Spilman’s talk was fast and full of both personal stories and pertinent questions: “What’s normal decline?” (The difference between not remembering the movie star’s name and not being able to do a job well. You might keep a diary of cognitive function.) “What about genetics – the father-daughter-son factors?” (Yet unproven.) “How about overexposure to electromagnetic fields? (Don’t have unnecessary radiation.) And enough other issues raised for two or three more hours.

No one’s brain, in any event, was idle. Which indicates that everyone in Spilman’s audience was lowering his or her risk of Alzheimer’s.

Walk, Text, Crash: the Orwellian future

Park.ukThe man coming toward me in the park, maybe 500 yards up the path, was walking a large, mixed-breed black-and-white dog. He (the man, that is) was bearded and graying, nattily dressed in black pants, a red plaid sports shirt and gray sweater.

Just ahead of me, walking in the same direction as I, was a younger man dressed in sweat pants and jacket and holding the end of a leash attached to a tan Labrador retriever.

Both men were totally absorbed in texting.

It was a slow-motion episode exquisitely orchestrated for a YouTube video, if only I had been quick enough with my cellphone; as it was, I could only watch, fascinated and wordless. They collided at full speed, one cellphone clattering onto the asphalt and one leash dropped. But there were no apparent casualties. The dogs, at least, had sense enough to have steered themselves safely onto the grass where they were sniffing each other with unconcerned abandon. I smiled politely and kept going.

The episode underlined the hazards of texting while walking, which can surely be as dangerous as texting while doing almost anything else. Almost: there are no available statistics on the adverse effects of texting while having sex, which seems popular in some demographics.

Not long ago, New York Times columnist Nick Bilton wrote a piece in which he shared a New Year’s resolution to quit texting while walking.

“The realization that I may have a problem (along with a lot of other people),” Bilton wrote, “hit me smack in the face, literally, a few weeks ago when I was strolling through Kennedy International Airport, avoiding obstacles with my peripheral vision as I clambered out a text message. Without any warning (as I couldn’t actually see), I was involved in a head-on collision with another man who was also texting while walking.”

Most walking-zombie texters do survive, as Bilton did, with only bruised egos or minimal damage, but that’s not always the case. An Ohio State University study links “distracted walking” to the dramatic increase in pedestrian injuries and deaths.

Equally dismal, for the future of the planet, is how texting while walking may alter human interaction, whether texters live or die with their devices. One report, an interview with Dietrich Jehle, professor of emergency medicine at the University of Buffalo, suggests an Orwellian solution to texting/walking hazards: a cellphone app that shows the landscape ahead, so that texters can text interminably, and see where they’re going without ever looking up.

Is there life beyond a 2 ½ x 5 inch screen?

When Fences Come Down

Fence.Mtn Lake

“Something there is that doesn’t love a wall,” wrote Robert Frost, and I think he was onto a larger truth. Of course, Frost – in his “Mending Wall” – was talking about rocks and neighbors, and the poem leaves us with ambivalence about the goodness of fences.

Fences and walls may, at times, make good neighbors – but the big ones tend to be symbols of enmity (think Berlin, Israel, Arizona…) and we just want them down.

A few months ago a high, dark fence went up around lovely Mountain Lake, in the San Francisco park that is one of my favorite spots on the planet. It’s a city park, but the lake (fortunately for us all) is part of the Presidio National Park and has been undergoing an extraordinary restoration for the past few years. It may not yet be back to the purity that made its water just fine for Spanish settlers (and probably the Ohlone and Coast Miwok indigenous people before them) to drink, but years of accumulated glunk, trash and sludge have been hauled away and the lake’s return to life has been a rare joy to watch.

The problem? Although the waters began to clear and native greenery emerged, a proliferation of non-native fish were quashing any hope of bringing back the fish who once belonged. We’re not talking just a couple of ordinary intruders. It was possible to stand on the beach near the murky water’s edge and watch goldfish the size of ahi tuna swimming casually back and forth. With native fish and turtles long displaced by casually dumped household pets, the lake was overrun with carp, bullfrogs – somebody reported a sturgeon – and who knows what else. This writer remembers the brief residence of an alligator, who famously evaded a gator hunter imported from Florida but was eventually removed to the local zoo.

Presidio Trust personnel tried snagging, netting and every known removal method before conceding that the only solution would be to poison the lake. They chose plant-based Rotenone, which kills everything with gills (and happily not much without) and disappears within three days. Thus the fence went up – presumably it was still not a good idea for gill-free people to be wandering near the water. Almost the moment the solution was poured into the four-acre lake, the alien fish died. They were scooped up by the thousands to be studied by ecologists (who reluctantly went along with the project) to determine their origin and soon composted as a final act of goodness. But the fence, for assorted reasons, did not come down.

Sign.Mtn Lake

And over the long weeks that followed it was as if the park itself was inhabited by an alien being. Children still played on the adjacent swings and slides, dog walkers still tossed tennis balls, this writer still exercised on the bars of the fitness trail – but the now-sparkling lake was hidden behind its foreboding shield. Even when the gulls could be heard returning beyond the black screen, and actually seen if you peered through the mesh, the park felt bifurcated and somehow forlorn. Thanksgiving came and went, Christmas was less merry, the New Year not yet happy.

A few days ago, the fence came down. Mountain Lake, the shimmering heart of Mountain Lake Park reappeared, putting on a show of new life. A few familiar ducks may never have left; now they have been joined by coots and grebes and a spiffy ruddy duck who is apparently courting two slightly less flashy lady ruddy ducks. Western pond turtles, chorus frogs and native fish will begin to return in the spring.

Lake.Mtn Lake

The metaphors are abundant: fences come down, sunlight spreads from reflected waters, varied creatures happily coexist, romance blooms.

 

Where is Robert Frost when we need him?