Category: Locations

California/Health/Lifestyle/seniors
Posted on

Your latte or your life

by Fran Johns

At last, an addiction I can be proud of. Having given up nicotine, alcohol and sin in general over the years, I was beginning to despair about the remaining unbreakable habits:  sugar, butterfat… and caffeine.  But now, suggests Wall Street Journal health writer Melinda Beck, caffeine might just be putting a little distance between Alzheimer’s and me. It might not be an anti-dementia guarantee, and it could have a few downer side effects, but still. A ray of sunshine on the addiction scene.

To judge by recent headlines, coffee could be the latest health-food craze, right up there with broccoli and whole-wheat bread.

But don’t think you’ll be healthier graduating from a tall to a venti just yet. While there has been a splash of positive news about coffee lately, there may still be grounds for concern.

  • Cancer: Earlier studies implicating coffee in causing cancer have been disproven; may instead lower the risk of colon, mouth, throat and other cancers.
  • Heart disease: Long-term coffee drinking does not appear to raise the risk and may provide some protection.
  • Hypertension: Caffeine raises blood pressure, so sufferers should be wary.
  • Cholesterol: Some coffee—especially decaf—raises LDL, the bad kind of cholesterol.
  • Alzheimer’s: Moderate coffee drinking appears to be protective.
  • Osteoporosis: Caffeine lowers bone density, but adding milk can balance out the risk.
  • Pregnancy: Caffeine intake may increase the risk of miscarriage and low birth-weight babies.
  • Sleep: Effects are highly variable, but avoiding coffee after 3 p.m. can avert insomnia.
  • Mood: Moderate caffeine boosts energy and cuts depression, but excess amounts can cause anxiety.

So let’s see. My bone reports have actually upscaled recently, so all that butterfat and a few bone meds are outpacing the latte. I can fall asleep midway through a cappuccino, and I don’t have time to be depressed. Unlikely to get pregnant. Addiction situation looks better and better. Further insight comes from Duke University Medical Center psychophysiologist Jim Lane, who’s been studying the effects of caffeine for more than 25 years, and from a distinguished addiction psychiatrist (I wonder if I should volunteer for a study) at Vanderbilt University.

“When I went to medical school, I was told that coffee was harmful. But in the ’90s and this decade, it’s become clear that if you do these studies correctly, coffee is protective in terms of public health,” says Peter R. Martin, a professor of psychiatry and pharmacology at Vanderbilt University and director of the school’s Institute for Coffee Studies, founded in 1999 with a grant from coffee-producing countries.Still, many researchers believe that the only way to draw firm conclusions about something like coffee is through experimental trials in which some subjects are exposed to measured doses and others get a placebo, with other variables tightly controlled. When that’s been done, says Duke’s Dr. Lane, “the experimental studies and the [observational] studies are in very sharp disagreement about whether caffeine is healthy or not.”

Harmful Effects

His own small, controlled studies have shown that caffeine—administered in precise doses in tablet form—raises blood pressure and blood-sugar levels after a meal in people who already have diabetes. Other studies have found that caffeine and stress combined can raise blood pressure even more significantly. “If you are a normally healthy person, that might not have any long-term effect,” says Dr. Lane. “But there are some groups of people who are predisposed to get high blood pressure and heart disease and for them, caffeine might be harmful over time.”

[HEALTHCOLfront]

Epidemiologists counter that such small studies don’t mirror real-world conditions, and they can’t examine the long-term risk of disease.

The debate goes on. Do people remember how many cups they drink? How big is your mug? How random is your study? Did your ancestors have a history of — uh, oh, my parents met and married in Brazil where I was born. Maybe that’s where it all started.

I will welcome your comments on caffeine addictions; they will be compiled over a take-out tall extra-foamy latte.

Seeking Coffee’s Benefits to Health – WSJ.com.


California/Health/seniors/USA
Posted on

End-of-year look at end-of-life issues

by Fran Johns

Two end-of-year stories offer stark insights into end-of-life issues in the U.S., one from a purely financial perspective, the other purely about compassion. Between the two, the conflicted American way of dying comes into focus.

First the finance. The Wall Street Journal of December 30 features a front page story by Laura Saunders about wealthy families coming to grips with the disappearance, thanks to a quirk of Congress, of the estate tax beginning January 1, 2010. It will only disappear for a year, and in 2011 it will return at a higher rate with lower exemption. For those approximately 5,500 super-rich taxpayers to whom this tax applies, a lot of money is at stake. Presumably if a member of one of these families is now near death every possible measure will be taken to keep him or her alive into the new year and presumably that will be done for the best of reasons. But imagine the struggles involved if someone is near death this time next year, and his or her heirs stand to benefit in the millions if that death happens before January 1st rather than soon after. An altogether new meaning will have to be added to “letting go.” Not something one really wants to think through.

But the last two sentences of the WSJ article demonstrate how extensively the scenario is indeed being thought through, not from the heir’s point of view but from the soon-to-be-departed:

The situation is causing at least one person to add the prospect of euthanasia to his estate-planning mix, according to Mr. (Andrew) Katzenstein (a lawyer with) Proskauer Rose (LLP in Los Angeles.) An elderly, infirm client of his recently asked whether undergoing euthanasia next year in Holland, where it’s legal, might allow his estate to dodge the tax.

His answer: Yes.

However hard we might try to eliminate costs (and cost/benefit ratios) from considerations of end-of-life care and decision-making, they are here to stay and sure to remain complex. Another complexity — and this one should not be as difficult as it continues to be — surrounds the subject of palliative care. Palliative care is simply comfort care. It means, do everything possible to insure that a dying person might go about his or her dying with as little pain and anguish as humanly, medically possible.  A long, careful look into the issue is in the New York Times most recent “Months to Live” series article, “Hard Choice for a Comfortable Death” by health writer Anemona Hartocollis.

In almost every room people were sleeping, but not like babies. This was not the carefree sleep that would restore them to rise and shine for another day. It was the sleep before — and sometimes until — death.

In some of the rooms in the hospice unit at Franklin Hospital, in Valley Stream on Long Island, the patients were sleeping because their organs were shutting down, the natural process of death by disease. But at least one patient had been rendered unconscious by strong drugs.

The patient, Leo Oltzik, an 88-year-old man with dementia, congestive heart failure and kidney problems, was brought from home by his wife and son, who were distressed to see him agitated, jumping out of bed and ripping off his clothes. Now he was sleeping soundly with his mouth wide open.

“Obviously, he’s much different than he was when he came in,” Dr. Edward Halbridge, the hospice medical director, told Mr. Oltzik’s wife. “He’s calm, he’s quiet.”

Mr. Oltzik’s life would end not with a bang, but with the drip, drip, drip of an IV drug that put him into a slumber from which he would never awaken. That drug, lorazepam, is a strong sedative. Mr. Oltzik was also receiving morphine, to kill pain. This combination can slow breathing and heart rate, and may make it impossible for the patient to eat or drink. In so doing, it can hasten death.

Mr. Oltzik received what some doctors call palliative sedation and others less euphemistically call terminal sedation. While the national health coverage debate has been roiled by questions of whether the government should be paying for end-of-life counseling, physicians like Dr. Halbridge, in consultations with patients or their families, are routinely making tough decisions about the best way to die.

Writer Hartocollis covers in thoughtful detail the long, sometimes conflicted process through which the medical team and the patient’s family arrived at his eventual, peaceful death. The article looks at the multiplicity of issues that cry out for reasoned public dialogue — palliative care, physician aid in dying, end-of-life choice, family decision-making — that have been raised on this page in recent months and will be back again. It’s a story worth reading in full.

And meanwhile, the beginning of the year is a fine time to get your advance directives and other documents completed and to have those conversations with friends and loved ones that keep you from becoming another Terri Schiavo. Getting this done is one great way to put dying behind you and go about the business of living for a happy new year.

Months to Live – Hard Choice for a Comfortable Death – Sedation – Series – NYTimes.com.

California/General interest/USA
Posted on

Terrorist sons, anguished parents

by Fran Johns

I can’t get my mind off of Mr., and presumably Mrs., Mutallab, whose son is accused of trying to blow up a plane full of innocent people, or the parents of the five American Muslim students who allegedly planned to join forces with anti-American jihadists. In both cases, family concerns about their sons’ radical leanings led them to alert authorities.

We are indebted to the older generations. Umar Abdulmutallab, of course, managed to buy a ticket to Detroit and travel a long way to get there despite his father’s rather courageous action; but no one knows how much damage might have been done by the five aspiring jihadists had they not been apprehended.

We will also probably never know what emotional struggles went on before those family decisions were made. But these young men didn’t grow up unattended on the streets. They were presumably loved and nurtured and cared for, given opportunities to pursue the American dream before they opted to try invoking an American nightmare. Making the decision to take action which would, in all probability, have those sons wind up in jail had to have been a nightmare itself close to the top of the worst a parent can imagine.

Decades ago my young daughter came to me one afternoon in tears, literally shaking with fear and remorse. She had been to a department store with a fifth-grade friend who professed skill and experience in shoplifting and urged my daughter to give it a try. The friend was right, she knew how to pull this off. My daughter dropped a piece of costume jewelry she had taken into my hand, recoiling as if it were molten lava.

We got in the car, drove to the store and sat for what seemed an interminable length of time outside the store manager’s office. My daughter repeated her story and we handed over the loot. The manager was, I thought, unduly harsh. No acceptance of apology or points for repentance and return of the necklace, no pat on the back for my good parenting. He told my daughter about crime and punishment and citizenship. He did call me later, explaining that it was necessary to deal harshly with teenage (she was not yet a teen) crime, “because it only takes one persuasive bad person to sway dozens of others.” I thought I detected a suggestion of Bad Parent in there too — but I was such a wreck by that time the suggestion could have come from within.

My daughter, I hasten to say, grew up to be an extraordinarily good person, the mother of two of my flawless grandchildren. She may remember little of this adventure. But it is seared into my own memory. Partly because of the reflexive hesitancy I felt, the reflexive wish to protect her from retribution — a black-mark communication from store to school, ostracism by her popular friend (I wonder what happened to that child; her parents didn’t seem overly concerned by my call to them), potential trauma from store security people. My stomach can still churn over it all.

Every parent has a collection of those stories. Most of us, though, are looking at things like potential pre-teen shoplifting; the Mutallabs were looking at potential jihad. Did their son never have doubts? Were the people who persuaded him to try blowing himself and a plane load of others to smithereens so convincing he never looked back? When did he turn from being his parent’s son to a jihadist tool? What amount of wrenching debate preceded his father’s call to American security people?

I don’t have any answers, only those heartbreaking questions.

California/General interest/Lifestyle/seniors
Posted on

Thank-you notes come due

by Fran Johns

E-mails are efficient, text messages — God help us — are here to stay, but the handwritten thank-you note is not dead yet. If Geoffrey Parker and I have anything to do with it, furthermore, the handwritten note will survive and prosper. Parker’s commitment to this disappearing art form was outlined in a Wall Street Journal report by Cheryl Lu-Lien Tan. If you want to make points with gift-givers, you might note his words of wisdom.

During the holidays, Geoffrey Parker, branding consultant for Parker Pen Co. and great-grandson of its founder, George S. Parker, is careful not to overlook what he calls a ‘critical’ aspect of the gift-giving season: thank-you notes.

‘It’s common courtesy,’ he says. ‘If someone does something for me, I need to acknowledge that.’ Mr. Parker sometimes thanks a gift-giver or party host with a phone call, email or text message. But he believes that these modes are ‘insufficient’ and always follows up with a handwritten message. ‘As these modern electronic devices become more common and overused, they become cheap,’ he says.

And more power to Mr. Parker. A phone call or an e-mail message might acknowledge your gratitude, but a handwritten note has soul. Quick: think of a piece of paper with words written on it, addressed to you, by someone of your acquaintance. Some little shred ties those words to that person, doesn’t it? Handwriting used to serve that purpose.

A quick check with several teacher friends turned up no one who could recall the time when cursive was routinely taught throughout the fourth grade year (though you can now learn to write online.) By fourth grade today every student on the planet knows how to text in abbreviated expletives. But nothing conveys a message — expletive or smiley face — like a handwritten note. You will be forgiven if you use a ball point pen, though Parker prefers a fountain pen with a broad nib and fountain pens can emote better than anything else. The flourish that such an implement can create — think John Hancock before he got commercialized — used to be able to paint eloquent pictures in words. My father (broad nib, dark blue ink) favored x’s at the end of his sentences, but when he left off with a dash you knew you had done something fine.

Today, a thank-you note is also an investment. But go ahead, spend the 44 cents, drop a line. Your appreciation will be appreciated.

California/USA
Posted on

Tightened Airline Security Guarantees Rise in Stress Levels

by Fran Johns

Get ready for this: random wanding of hitherto unexamined body parts; syringe searches; interminable landing-pattern hours spent with hands in full view and no foreign objects in your lap — including that good book you were about to finish. This is what Umar Farouk Abdulmutallab has brought us, but it’s not all his fault. It has simply, quietly, come to this.

In the wake of the terrorism attempt Friday on a Northwest Airlines flight, federal officials on Saturday imposed new restrictions on travelers that could lengthen lines at airports and limit the ability of international passengers to move about an airplane.

The government was vague about the steps it was taking, saying that it wanted the security experience to be “unpredictable” and that passengers would not find the same measures at every airport — a prospect that may upset airlines and travelers alike.

But several airlines released detailed information about the restrictions, saying that passengers on international flights coming to the United States will apparently have to remain in their seats for the last hour of a flight without any personal items on their laps. It was not clear how often the rule would affect domestic flights.

Airline travel has traveled a long route from the days of white-gloved passengers (remember legroom?) and spiffy stewardesses asking if you’d like coffee, tea or milk. Most of us can recall the unlamented lunches and snacks on trays — although the salad dressing was spicy and the ice cream was good. Almost everyone can remember getting on a plane without first removing your shoes. And although we now stock 3-ounce containers of everything cosmetic and medicinal under the sun, everyone can recall, with a little effort, the day when you could bring a bottle of water from home in your purse.

All of the changes have now become routine, and hardly worth a grumble. Routine is reassuring. New ones will slide into the mix eventually. But it’s that “unpredictable” business that distresses more than a few of us.

The homeland security secretary, Janet Napolitano, said in a statement Saturday that new measures were ‘designed to be unpredictable, so passengers should not expect to see the same thing everywhere.’ She said passengers should proceed with their holiday plans and ‘as always, be observant and aware of their surroundings and report any suspicious behavior or activity to law enforcement officials.’

Here we are, with the back-zip boots, the 3-ounce plastic containers, the 10-minute book and the anticipation of no bathroom privileges on 90-minute flights, and we’re supposed to remain observant while expecting not to know what to expect?

Thanks a lot, Umar.

New Restrictions Quickly Added for Air Passengers – NYTimes.com.

California/Health/Politics & Causes/seniors/USA
Posted on

The cost of trying to live forever

by Fran Johns

Why is this not an encouraging word? In a front page article, part of a Months to Live series,  New York Times writer Reed Abelson leads with a glimpse into the Ronald Reagan U.C.L.A. Medical Center, a top-rated academic hospital noted for extensive, aggressive end-of-life care (and very high costs):

‘If you come into this hospital, we’re not going to let you die,’ said Dr. David T. Feinberg, the hospital system’s chief executive.

Feinberg’s commitment to “success” might be admirable, but the statement is patently false; people die at U.C.L.A. Medical Center. This is what people do: we die. Until this culture gets its act together on that subject our health care system — whatever the reform bill eventually looks like — will continue to flounder.

Difficult as it is to talk dollars when you’re talking lives, the issue of cost has to be factored in. There are only so many dollars, and there are countless lives needing care those dollars can buy: infants, children, young adults, boomers, elderly. In each of those care-needing groups, some die.  Feinberg’s philosophy somewhere has to encounter reality.

…that ethos (keep testing, treating, keeping alive no matter what) has made the medical center a prime target for critics in the Obama administration and elsewhere who talk about how much money the nation wastes on needless tests and futile procedures. They like to note that U.C.L.A. is perennially near the top of widely cited data, compiled by researchers at Dartmouth, ranking medical centers that spend the most on end-of-life care but seem to have no better results than hospitals spending much less.

Listening to the critics, Dr. J. Thomas Rosenthal, the chief medical officer of the U.C.L.A. Health System, says his hospital has started re-examining its high-intensity approach to medicine. But the more U.C.L.A.’s doctors study the issue, the more they recognize a difficult truth: It can be hard, sometimes impossible, to know which critically ill patients will benefit and which will not.

That distinction tends to get lost in the Dartmouth end-of-life analysis, which considers only the costs of treating patients who have died. Remarkably, it pays no attention to the ones who survive.

No one, not the doctors, not the patients, not the best crystal ball reader around can guarantee that this patient will die or that patient will live. If there is a good chance a patient will survive — and it would be nice to add “with a reasonable quality of life” here — everything possible, and affordable, certainly should be done. Abelson’s carefully balanced article details the arguments for going to extraordinary lengths to save lives, as well as the arguments to draw the line on end-of-life expenses.

According to Dartmouth, Medicare pays about $50,000 during a patient’s last six months of care by U.C.L.A., where patients may be seen by dozens of different specialists and spend weeks in the hospital before they die.

By contrast, the figure is about $25,000 at the Mayo Clinic in Rochester, Minn., where doctors closely coordinate care, are slow to bring in specialists and aim to avoid expensive treatments that offer little or no benefit to a patient.

“One of them costs twice as much as the other, and I can tell you that we have no idea what we’re getting in exchange for the extra $25,000 a year at U.C.L.A. Medical,” Peter R. Orszag, the White House budget director and a disciple of the Dartmouth data, has noted. “We can no longer afford an overall health care system in which the thought is more is always better, because it’s not.”

By some estimates, the country could save $700 billion a year if hospitals like U.C.L.A. behaved more like Mayo. High medical bills for Medicare patients’ final year of life account for about a quarter of the program’s total spending.

So…. to spend that $25,000/$50,000 or not to spend? Unless we the people somehow face the reality that living forever is not a human option, the dilemma will continue.

The benefits of coming to terms with non-optional dying could be huge. We could focus on quality living. On palliative care and hospice care and end-of-life peace and comfort. Advances in palliative care now make it possible for most of us to spend final months at home (or in special hospital rooms), in comfort, surrounded by loved ones; given the choice, would you prefer a few weeks or months in a bright-lit sterile room with a lot of tubes and wires keeping you alive? U.C.L.A. now offers the choice of palliative care. Not everyone in charge, however, is convinced.

Dr. Bruce Ferrell, who helps lead the palliative care program, recalls a patient two years ago who got a liver transplant but developed serious complications afterward and remained in the hospital for a year. “He had never, ever been told that he would have to live with a ventilator and dialysis,” Dr. Ferrell said. “He was never told that this is as good as it’s going to get.”

Dr. Ferrell talked with the patient about whether he might want to leave the intensive-care unit to go home and receive hospice care. But when the surgeon overseeing the case found out, he was furious.

“We do not use the h-word” — hospice — “on my patients,” the surgeon told Dr. Ferrell. “Don’t ever come back.”

The patient chose to leave.

But lately, Dr. Ferrell says, more of the transplant surgeons appreciate the value of what he is trying to do.

“We’re not the bad guys,” he said. “We offer options.”

We the people would do well to quit being the bad guys. To quit behaving as if death were always preventable. We could learn about the options to spending all those thousands of dollars on exhaustive, often futile treatment. We could talk about what we would or would not want for ourselves, write things down, make choices.

If more of us would do that for ourselves, the House and Senate wouldn’t have such a time trying to do it for us.

California/Health/Politics & Causes/seniors/USA/Women
Posted on

Taking on MoveOn

by Fran Johns

I am a certified MoveOn supporter. Though I had to opt out of the e-feeds because my Inbox overfloweth, I have sent money, forwarded news, heeded their messages.

But enough is enough. They are pushing for measures we should have, but won’t get today. I am coming down on the side of those who say just get us a bill. In the words of Washington Post editorial writer E. J. Dionne — in a column today aptly titled Don’t scream: organize:

Instead of trying to derail the process – exactly what conservative opponents want to do – those on the left dissatisfied with the Senate bill should focus their efforts over the next few weeks on getting as many fixes into it as they can.

What we have in the Senate bill is a mishmash of stuff we didn’t want, along with the absence of stuff we did. Ridiculous obstacles to a woman’s right to choose to have an abortion — write two checks every month just so Ben Nelson can get benefits in perpetuity for Nebraska and maybe we’ll satisfy the U.S. Conference of Catholic Bishops in the bargain? — piled on top of other obstacles for the poor and benefits for the rich (read: Big Pharma.) But come on, folks, it’s a bill. If we get a bill, it can be improved. If we fail, it’ll be another generation of a punitive, non-working “system” of health care before we get this far again. By then there will be other Joe Liebermans eager to grab the spotlight and claim the power to derail every other beneficial detail. I’ll be dead, but I plan to haunt you.

Dionne points out that the House bill is superior, the two bills will now have to be reconciled, and there will be future opportunities to build on this beginning.

Enactment of a single bill will not mark the end of the struggle. It will open a series of new opportunities. It’s a lot easier to improve a system premised on the idea that everyone should have health coverage than to create such a system in the first place. Better to take a victory and build on it than to label victory as defeat.

Successful political movements prosper on the confidence that they can sustain themselves over time so they can finish tomorrow what they start today. At this moment, rage is understandable, but hope is what’s necessary.

Progressives – don’t scream: organize.

California/General interest/Health/seniors/USA
Posted on

Needless pain, senseless dying

by Fran Johns

His wife is dying. If she’s lucky, she will be dead before you read this. If he has his way, she will hang on — for what purpose I am not sure, since she is now barely conscious and in terrible pain — but, in his words, she is “not ready to close the curtain.” He cannot bring himself to say the D-word out loud.

Joe — not his real name — called me last night. I am not sure for what purpose the call was either, except he’s quite understandably angry and I was a handy person to be angry with for a while. His wife was a supporter of an organization I serve, as a board member and a one-on-one client volunteer. Compassion and Choices N.CA is a chapter of the national Compassion and Choices nonprofit organization. We advocate for everyone’s right to a humane and compassionate death, which Cathy — not her real name — is not having. We also advocate for changing the laws that ban physician aid in dying, and the right of a terminally ill, mentally competent adult to hasten his or her own dying if living a few more days or weeks becomes unbearable. Cathy’s life is past unbearable by now.

After suffering for several months with back pain, trying chiropractic sessions and over-the-counter medications, Cathy wound up in an emergency room in mid-November, almost accidentally having an MRI that showed the tumors throughout her body. Lung cancer had metastasized to her brain, spine and almost everywhere else. THIS IS A GOOD TIME TO CALL HOSPICE. Joe encouraged Cathy to fight on. She is in terrible pain, and worse than the pain, Joe says, is the difficulty she has breathing, which keeps her from sleeping because she feels like she’s drowning — “but she doesn’t scream out, exactly…” he said. I wonder how heroic she must need to be for him. She is down to 89 pounds.

As gently as possible, I suggested he call one of several excellent local hospice organizations which I’d earlier mentioned to Cathy’s friend who connected us. As a matter of fact, Joe said, he had already called one of them, they’d been over, he was impressed with them. I was almost beginning to breathe myself when he added that he still wanted to talk with the other I had mentioned (Big mistake. Why did I do that?) and had made an appointment with them to come after the weekend. I suggested they would not mind coming on a weekend.

Denial is a perfectly legal way to deal with things, but it should have its limits. If your spouse, partner, child, friend or parent is terminally ill and in unremitting pain, hospice can be the kindest word you have ever spoken. Hospice care IS NOT about “giving up,” or about dying. It is about comfort, pain management, living, peace. It is entirely possible to sign up for hospice care, change your mind and start some newly-discovered intervention later if one should be found. Probably at some point, you will say the D-word out loud. It won’t kill you.

Joe and Cathy are highly educated, financially well off, widely known and admired. He spoke of moving her to their second home nearby where she could enjoy the ocean, and perhaps take time “to say goodbye to her friends when she feels a little better.”

1 … 33 34 35 36 37 … 39