Life With Chronic Conditions: Show Up with Hope

I use to love fall but this year it just seems to be a bit tougher. We had major problems with our heating system at the end of last season and so far, while work has been done we still don’t have heat and the Vermont chill is settling in. This in turn has caused me to tense up, so I feel the aches and pains more. So much for my complaining, because in the scope of things it’s not a big deal as we should be nice and toasty shortly.

This week I happened to come across an article by Anne Lamott in the October 2018 National Geographic  and it improved my outlook on things considerable. So instead of my trying to expound on why it’s important to be hopeful, I’ll just post Lamott’s article

Show Up With Hope’: Anne Lamott’s Plan for Facing Adversity

With Earth beset by conflict, climate change, pollution, and other ills, the best-selling author asks: What better time to be hopeful?

You would almost have to be nuts to be filled with hope in a world so rife with hunger, hatred, climate change, pollution, and pestilence, let alone the self-destructive or severely annoying behavior of certain people, both famous and just down the hall, none of whom we will name by name.

Yet I have boundless hope, most of the time. Hope is a sometimes cranky optimism, trust, and confidence that those I love will be OK—that they will come through, whatever life holds in store. Hope is the belief that no matter how dire things look or how long rescue or healing takes, modern science in tandem with people’s goodness and caring will boggle our minds, in the best way.

Hope is (for me) not usually the religious-looking fingers of light slanting through the clouds, or the lurid sunrise. It’s more a sturdy garment, like an old chamois shirt: a reminder that I’ve been here before, in circumstances just as frightening, and I came through, and will again. All I have to do is stay grounded in the truth.

Oh, that’s very nice, you may well respond. And what does that even mean, the truth?

I don’t presume to say what capital-T Truth is. But I do know my truth, and it’s this: Everyone I know, including me, has lived through devastating times at least twice, through seemingly unsurvivable loss. And yet we have come through because of the love of our closest people, the weird healing properties of time, random benevolence, and, of course, our dogs

At regular intervals, life gets a little too real for my taste. The wider world seems full of bombers, polluters, threats of all kinds. My own small world suffers ruptures—a couple of deaths, a couple of breakups, a young adult who had me scared out of my wits for a couple of years—that leave me struggling to stay on my feet.

In these situations I usually have one of two responses: either that I am doomed or that I need to figure out whom to blame (and then correct their behavior). But neither of these is true. The truth is that—through the workings of love, science, community, time, and what I dare to call grace—some elemental shift will occur and we will find we are semi-OK again. And even semi-OK can be a miracle.

“Sometimes I have to believe that heaven is just a new pair of glasses.” That was said by a priest who helped establish Alcoholics Anonymous roughly 80 years ago—and when I remember to put on such glasses, I spy reasons for hope on every street. You can’t walk a block without seeing recycling bins. Nations are pledging serious action on climate change. My young friend Olivia, who has cystic fibrosis, got into a clinical trial two years ago for a newfangled drug—and it’s working, meaning she will live a great deal longer than we ever dared to hope.

I like these days in spite of our collective fears and grief. I love antibiotics. I’m crazy about electricity. I get to fly on jet airplanes! And in the face of increased climate-related catastrophes—after I pass through the conviction that we are doomed, that these are End Times—I remember what Mister Rogers’s mother said: In times of disaster we look to the helpers.

Look to the volunteers and aid organizations clearing away the rubble, giving children vaccines; to planes and trains and ships bringing food to the starving. Look at Desmond Tutu and Malala Yousafzai, Bill Gates and the student activists of Parkland, Florida; anyone committed to public health, teachers, and all those aging-hippie folk singer types who galvanized the early work of decontaminating the Hudson River.

You could say that river cleanup was child’s play compared with the melting of the ice caps—and I would thank you for sharing and get back to doing what is possible. Those who say it can’t be done should get out of the way of those who are doing it.

We take the action—soup kitchens, creek restoration, mentoring—and then the insight follows: that by showing up with hope to help others, I’m guaranteed that hope is present. Then my own hope increases. By creating hope for others, I end up awash in the stuff.

We create goodness in the world, and that gives us hope. We plant bulbs in the cold, stony dirt of winter and our aging arthritic fingers get nicked, but we just do it, and a couple of months later life blooms—as daffodils, paperwhites, tulips.

Hope is sometimes a decision that we won’t bog down in analysis paralysis. We show up in waders or with checkbooks. We send money to India, and the Sierra Club, the Union of Concerned Scientists, and to Uncle Ed’s GoFundMe account for his surgery.

You want hope? In India you see families waking up on hard, dusty streets and the poorest moms combing their kids’ hair for school. School is hope. Closer to home you see a teenager recover from a massive brain bleed and head off to a college for kids with special needs—not only alive but carrying a backpack full of books and supplies, and lunch. (Lunch gives me hope.)

You saw someone, maybe yourself or your child, get and stay sober. You read that the number of mountain gorillas in central Africa has risen consistently over the past few years. One had barely dared to hope, and yet? If this keeps up, we’ll be up to our necks in mountain gorillas.

We might hope that this or that will happen, and be disappointed—but when we instead have hope in the resilience and power of the human spirit, in innovation, laughter, and nature, we won’t be.

I wish I had a magic wand and could make people in power believe in climate science, but I don’t. I do, however, have good shoes in which to march for science and sanity. (Sanity: Is that so much to hope for? Never!) I see people rising up to their highest, most generous potential in every direction in which I remember to look, when I remember to look up and around and not at my aching feet.

My friend Olivia hates having cystic fibrosis, and every moment of life is a little harder than it is for people without the disease. But most of the time she’s the happiest person I’m going to see on any given day. She is either in gratitude or in the recording studio, where she is recording her second album of songs she wrote and plays on guitar. The engineer hits the mute button when she needs to cough, which is fairly frequently. She got a terrifying diagnosis 23 years ago, but with her community’s support, she and her parents kept hoping that she would somehow be OK or at least OK-ish—and then voilà, the successful clinical trial of a miracle drug.

Children pour out of school labs equipped with the science and passion to help restore estuaries and watersheds. Church groups pitch in to build water wells to nourish developing-world villages. As John Lennon said, “Everything will be OK in the end. If it’s not OK, it’s not the end.” This has always been true before; we can decide to hope that it will be again.

Sometimes hope is a radical act, sometimes a quietly merciful response, sometimes a second wind, or just an increased awareness of goodness and beauty. Maybe you didn’t get what you prayed for, but what you got instead was waking to the momentousness of life, the power of loving hearts. You hope to wake up in time to see the dawn, the first light, a Technicolor sunrise, but the early morning instead is cloudy with mist. Still, as you linger, the ridge stands majestically black against a milky sky. And if you pay attention, you’ll see the setting of the moon that illumined us all as we slept. And you see a new day dawn.

Take a Break: Make a Kaleidoscope Picture

Yes this is easy to do if you have Photoshop, but if you don’t, use Lunapic on line for free  You can even choose how many sides you want. Below is my original picture and the one I made using Lunapic. Lots of possibilities.

My original picture.

As a kaleidoscope picture

Not interested in today’s activities, try the Take a Break Pinterest Board.

Life with Chronic Conditions: Flu & Ticks

October 1 marks the beginning of flu season. It’s also the second peak time in the year for ticks, so special reminders about both.

The cooler temps and even a first frost, can make it seem like ticks are no longer an issue. However, if you live in the Northeast, ticks that carry Lyme Disease, black legged ticks, can be very abundant early in October and will remain active through the winter as long as the temperatures are above freezing and the ground is not frozen or covered by snow. Follow the CDC guidelines for tick prevention.

Believe it or not, in some parts of the country flu has already arrived. The CDC recommends vaccination by the end of October. For those with chronic health conditions vaccination has been associated with lower rates of some cardiac events among people with heart disease, especially among those who had a cardiac event in the past year. Vaccination has also been shown to be associated with reduced hospitalizations among people with diabetes and chronic lung disease. 

Flu shots not only protect you, but also the people you come in contact with. The more people who are vaccinated the better because it lessens everyone’s chance of exposure to the disease.

Other Flu Considerations:

•  It is recommended that anyone older than 6 months should receive a flu vaccination.

• The nasal spray flu vaccine is a recommended option for non pregnant individuals 2-49 years of age. There is a precaution against the use of the spray for those with underlying medical conditions.

• Serious allergic reactions to flu vaccines are very rare. If they do occur, it is usually within a few minutes to a few hours after the vaccination. While these reactions can be life-threatening, effective treatments are available.

• It takes about 2 weeks after vaccination for protection so plan get vaccinated earlier rather than later. The CDC recommends being vaccinated by the end of October

• If you’re sick with a cold or other mild illness (respiratory or otherwise) and you don’t have a fever, you can get your flu vaccine.  If you have a fever (temp over 99.5ish), the general consensus has always been that you should hold off on getting the flu vaccine until it breaks. 

Where to get free flu shots: Job site; your physician through your health insurance; health department. Check newspapers as well as your local health department’s website for locations of vaccination services. You can also check the HealthMap Vaccine Finder.  Note that Medicare does cover the shot as long as the healthcare provider accepts Medicare.

Cover and Wash: Because flu shots are not 100 percent effective, it’s important to practice Cover and Wash:

• Cover your mouth and nose every time you cough or sneeze. Use a tissue and throw it away. Use your arm (not your hand).

• Observe regular cleaning habits if someone at home has the flu. Pay special attention to doorknobs, faucets, refrigerator handles, phones, smartphones and toys.

• Vaccinate.

• Every time you use a tissue, throw it in the trash and then wash your hands. Skip the antibacterial stuff as it may contribute to the rise in antibiotic resistant bugs.

• Remember not to share anything that goes into the mouth.

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• Wash your hands often and well. Use soap and water for at least 20 seconds. Skip the antibacterial soaps as regular soap and water works fine.

• Avoid contact with sick people.

• Stay home when you are sick.

• Have alcohol hand sanitizer on hand if you don’t have access to soap and water.

Other ways to prevent cold and flu:

• Get plenty of sleep-at least six or more hours a day.

• Get sufficient Vitamin D. The sun is a lot less effective in providing Vitamin D during the winter months-peak time for colds and flu-so take a supplement

• Take Exercise Breaks

• Skip the handshake. Fist bumps and elbow bumps are replacing handshakes during cold and flu season. If your really hip, the ‘Namaste’ bow is becoming very popular- put your hands together at chest level, make eye contact and give a little bow

In the Work Place: In addition to practicing Cover & Wash, consider the following

• Use Paper Towels to clean work spaces as they do a better job than sponges and cleaning cloths used previously.

• Use Disinfectant Spray to clean doorknobs, handles, light switches, phones, computer mice, railings, microwave, coffee maker handle, elevator buttons and escalator rails. Note that viruses can live up to 48 hours on plastic and stainless steel surfaces. Identify the germ “hot spots” in your office and make sure they are regularly cleaned.

• Use Hand Sanitizer: Reduce transferring nasty cold and flu germs by using hand sanitizer and using hand sanitizer wipes to clean public surfaces, such as keyboards.

• Don’t share your pens with colleagues as these can be particularly dirty. Helps to carry a pen or two in your pocket.

• Ask your manager to supply the office with the necessary tools to keep the workplace healthy.

• Stay home when you are sick

At Home: In addition to practicing Cover & Wash, consider the following:

• Create a “sick room” where the person who is sick can have all the things they need.

• Sanitize shared items

• Take care of yourself so your resistance isn’t lowered

Take a Break: Try “Grounding” or “Earthing”

Research is showing that barefoot contact can produce nearly instant changes in a variety of physiological measures, help improve sleep, reduce pain, and decrease muscle tension and lower stress. Lots of research shows the importance of being in nature, so whether the “grounding” activity is effective because you are in nature or it’s the mind-body-earth connection isn’t really known.

Called “grounding” or “earthing” connect your skin with any natural conductor of the earth’s electricity. This includes walking barefoot on grass, moist soil, sand, gravel, ceramic tile, or concrete (but not other types of pavement). Swim in the ocean, a lake or other natural body of water. Sit under a tree, leaning against the trunk. Dig gloveless in the garden.

For me there is nothing better than standing at the shore in sand, letting the water lap over my feet. Have always loved this and honestly a day at the beach digging my feet in sand makes me a happy camper. So before the temps change, head outside for some barefooting.

Learn more

• Earthing Institute

• Barefoot on Nature: Health on your feet

• Could Walking barefoot on grass improve your health? Some Research Suggests it can.

Not interested in today’s activities, try the Take a Break Pinterest Board.

Journal Watch September 2018

 CHRONIC PAIN

Prevalence and Profile of High Impact Chronic Pain: Almost 11 million U.S. adults have “High Impact Chronic Pain.” That is, pain that has lasted 3 months or longer and is accompanied by at least one major activity restriction, such as being unable to work outside the home, go to school, or do household chores. These people report more severe pain, more mental health problems and cognitive impairments, more difficulty taking care of themselves, and higher health care use than those who have chronic pain without these activity restrictions. Chronic pain is a common problem, affecting about 40 million U.S. adults, but its impact on people’s daily lives has been difficult to define. Journal of Pain

About One in Five U.S. Adults Have Chronic Pain: Higher prevalence of chronic pain, high-impact chronic pain for women, older adults, rural residents. About 20.4 percent of U.S. adults have chronic pain and 8.0 percent have high-impact chronic pain, according to research published in the Sept. 14 issue of the U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

Mindful People feel less pain: Some people are more mindful than others, and those people seemingly feel less pain. In the study, 76 healthy volunteers who had never meditated first completed the Freiburg Mindfulness Inventory, a reliable clinical measurement of mindfulness, to determine their baseline levels. Then, while undergoing functional magnetic resonance imaging, they were administered painful heat stimulation (120°F). Whole brain analyses revealed that higher dispositional mindfulness during painful heat was associated with greater deactivation of a brain region called the posterior cingulate cortex, a central neural node of the default mode network. Further, in those that reported higher pain, there was greater activation of this critically important brain region. Pain

Pharmacovigilance Needed for Rheumatology Patients: American College of Rheumatologists urges health care providers to monitor for adverse events

Chronic Pain May be a Contributor to Suicide:Chronic pain may be an important contributor to suicide, with 8.8 percent of suicide decedents having evidence of chronic pain, according to a study published online Sept. 11 in the Annals of Internal Medicine.

Total ankle arthroplasty offers patients greater range of motion and less pain: New research reveals patients with end-stage ankle arthritis can expect enhanced quality of life within six months of surgical reconstruction. The Journal of Bone and Joint Surgery 

Why do women getmore migraines?: Estrogen and other sex hormones may be responsible for the higher prevalence of migraine in women: Differing levels of sex hormones, especially estrogens, may explain why many more women than men suffer from migraines. A study provides evidence that these hormones affect cell mechanisms that control responses to migraine triggers, offering a possible pathway to more effective, personalized treatments.  Frontiers in Molecular Biosciences

COMPLEMENTARY & ALTERNATIVE MEDICINE

Anxiety and Complementary Health Approaches: Researchers are studying a variety of complementary health approaches to see whether they might be helpful for occasional anxiety or anxiety disorders. There is some evidence that mindfulness and other forms of meditation, music, relaxation techniques, and melatonin may be efficacious for anxiety, especially anxiety associated with medical procedures or chronic medical problems. However, there is not enough evidence on other complementary health approaches for anxiety to draw definitive conclusions about their efficacy. NCCIH Digest provides a summary of current research on several complementary health approaches for anxiety, including mind and body practices and natural products.

Hypnosis Doesn’t Cut Pot Op Pain in Breast Cancer Surgery: Hypnosis before general anesthesia does not reduce postoperative breast pain among patients undergoing minor breast cancer surgery, according to a study published online Aug. 17 in JAMA Network Open. However, those who perceived that they received hypnosis had significantly reduced fatigue and anxiety.

Cannabis extract helps reset brain function in psychosis: Research from King's College London has found that a single dose of the cannabis extract cannabidiol can help reduce brain function abnormalities seen in people with psychosis. Results from a new MRC-funded trial, published in JAMA Psychiatry, provide the first evidence of how cannabidiol acts in the brain to reduce psychotic symptoms.

Medical cannabis effective in treating a wide range of health conditions: Utilizing new mobile application technology, researchers found that medical cannabis provides immediate symptom relief across dozens of health symptoms with relatively minimal negative side effects. Frontiers in Pharmacology & Medicines

Tai Chi Effective at Reducing Number of Falls in Older Adults: Tai chi is more effective than conventional exercise at preventing falls among high-risk, older adults, according to a study published online Sept. 10 in JAMA Internal Medicine. 

Cannabinoid in Breast Milk Up to Six Days After Marijuana Use: Most breast milk samples have measurable Δ-9-tetrahydrocannabinol (Δ9-THC) up to about six days after maternal use, according to a study published online Aug. 27 in Pediatrics.

FDA ACTION

• Approved Lenvatinib for hepatocellular carcinoma

• Approved Migalastat for Fabry Disease

• Approves first targeted RNA based therapy polyneuropathy of hereditary transthyretin-mediated amyloidosis

• Approved the Natural Cycles app that helps women avoid pregnancy by tracking their body temperature and menstrual cycle- “fertility awareness”

• Approves new dosage strength of buprenorphine and naloxone sublingual film as maintenance treatment for opioid dependence

• Warns that it has found a second impurity in three lots of Torrent Pharmaceuticals' valsartan drug products.

• Recalled Montelukast Tablet Bottles for asthma because they contained the wrong medicine.

• Warns of dangers of liquid Nitrogen in food, drinks

• Issued a warning on type 2 diabetes medicine, SGLT2 Inhibitor, which caused genital infections (Fournier’s gangrene) in some patients.

• Extends EpiPen Expiration Dates to tackle shortage

PREVENTION

Amount of Physical Exercise Affects Mental Health Burden: Those who exercised had 1.49 fewer days of poor mental health in past month vs. those who did not. The Lancet Psychiatry

Recommendation for Annual Urinary Incontience Screening: The Women's Preventive Services Initiative (WPSI) recommends annual urinary incontinence screening for women and referral for further evaluation and treatment if indicated, according to a clinical guideline published online Aug. 14 in the Annals of Internal Medicine.

Air pollution reduces global life expectancy by more than one year: Air pollution shortens human lives by more than a year, according to a new study from a team of leading environmental engineers and public health researchers. Better air quality could lead to a significant extension of lifespans around the world. Environmental Science & Technology Letters

Effects of Aspirin for Primary Prevention in People with Diabetes: The use of low-dose aspirin led to a lower risk of serious vascular events than placebo among persons with diabetes who did not have evident cardiovascular disease at trial entry. However, the absolute lower rates of serious vascular events were of similar magnitude to the absolute higher rates of major bleeding, even among participants who had a high vascular risk. The use of low-dose aspirin did not result in a lower risk of gastrointestinal tract cancer or other cancer over the mean follow-up of 7.4 years, but further follow-up is needed to assess any longer-term effects on cancer reliably. NEJM

Exposure to ToxicMetals May Up Cardiovascular Disease Risk: Exposure to arsenic, lead, cadmium, and copper is associated with elevated risk of clinical cardiovascular disease outcomes, according to a review and meta-analysis published online Aug. 29 in The BMJ.

Chronic Vaping Exerts Biological Effects on Lung: Chronic vaping exerts biological effects on the lung, some of which are mediated by the propylene glycol/vegetable glycerin (PG/VG) base, according to a study published recently in the American Journal of Respiratory and Critical Care Medicine.

Monitoring at home yields better blood pressure control: People with high blood pressure are more likely to get it under control if they record blood pressure readings at home and share the data with their healthcare provider. At-home monitoring gives providers a better sense of patients' true blood pressure readings, leading to more customized treatment and better hypertension control. Combining at-home readings with traditional provider care saves money by reducing medications and doctor and emergency department visits. American Heart Association's Joint Hypertension 2018 Scientific Sessions.

Lifestyle changes reduce the need for blood pressure medications Men and women with high blood pressure reduced the need for antihypertensive medications by making lifestyle changes. A 16-week program, focused on the DASH diet, weight management and exercise, resulted in the most dramatic declines in blood pressure. American Heart Association's Joint Hypertension 2018 Scientific Sessions

New blood pressure app: Researchers have invented a proof-of-concept blood pressure app that can give accurate readings using an iPhone -- with no special equipment. "By leveraging optical and force sensors already in smartphones for taking 'selfies' and employing 'peek and pop,' we've invented a practical tool to keep tabs on blood pressure.” An app could be available in late 2019. Scientific Reports

People With High Levels of Aldosterone Have an Increased Risk of Developing Diabetes Increased levels of aldosterone, already associated with hypertension, can play a significant role in the development of diabetes, particularly among certain racial groups, according to a study published in the Journal of the American Heart Association.

Obstructive Sleep Apnoea Linked With Higher Risk of Gout: People with obstructive sleep apnoea (OSA) have a higher risk of developing gout, even beyond the first years after being diagnosed with the sleep disorder, according to a study published in Arthritis & Rheumatology.

Breast cancer screening does not reduce mortality: Fewer and fewer women die from breast cancer in recent years but, surprisingly, the decline is just as large in the age groups that are not screened. The decline is therefore due to better treatment and not screening for breast cancer. International Journal of Cancer

Chronic Vaping Exerts Biological Effects on Lung: Chronic vaping exerts biological effects on the lung, some of which are mediated by the propylene glycol/vegetable glycerin (PG/VG) base, according to a study published recently in the American Journal of Respiratory and Critical Care Medicine.

Poor Shared Decision-Making for Lung Cancer Screening: Physicians universally recommended screening, with almost no discussion of harms. The quality of shared decision-making (SDM) about the initiation of lung cancer screening (LCS) is poor, according to a study published online Aug. 13 in JAMA Internal Medicine.

Breastfeeding Linked to Lower Risk of Stroke Post-Menopause: Breastfeeding is associated with a lower risk of stroke among older women, with a stronger correlation for longer duration of breastfeeding, according to a study published online Aug. 22 in the Journal of the American Heart Association.

NUTRITION/SUPPLEMENTS/VITAMINS

Consuming More Protein After Weight Loss May Reduce Fatty Liver Disease: Increasing the amount of protein in the diet may reduce the liver’s fat content and lower the risk of diabetes in people with nonalcoholic fatty liver disease (NAFLD), according to a study published in the American Journal of Physiology--Endocrinology and Metabolism.

Effects of N-3 Fatty Acid Supplements in People with Diabetes: Among patients with diabetes without evidence of cardiovascular disease, there was no significant difference in the risk of serious vascular events between those who were assigned to receive n−3 fatty acid supplementation and those who were assigned to receive placebo. NEJM

Changes in breakfast and dinner timings can reduce body fat: Modest changes to breakfast and dinner times can reduce body fat, a new pilot study in the Journal of Nutritional Sciences reports. 

High Quality Diet Linked to Lower Mortality in Cancer Survivors: For cancer survivors, a high-quality diet is associated with a reduced risk of overall and cancer-specific mortality, according to a study recently published in JNCI: Cancer Spectrum. 

High, Low Carbohydrate Diets Linked to Increased Mortality: Increase in mortality when carbohydrates were exchanged for animal-derived fat or protein. Both high and low percentages of carbohydrates in diets are associated with increased mortality, according to a study published online Aug. 16 in The Lancet Public Health.

TREATMENT

Nerve Stimulation Improves Quality of Life in Patients With Depression People with depression who are treated with nerve stimulation experience significant improvements in quality of life, even when their depression symptoms do not completely subside, according to a study published in The Journal of Clinical Psychiatry.

No safe level of alcohol, new study concludes: There is no safe level of drinking alcohol, concludes a new study. It shows that in 2016, nearly 3 million deaths globally were attributed to alcohol use, including 12 percent of deaths in males between the ages of 15 and 49. "Our findings are consistent with other recent research, which found clear and convincing correlations between drinking and premature death, cancer, and cardiovascular problems. Zero alcohol consumption minimizes the overall risk of health loss." While the study's authors say that moderate drinking may safeguard people against heart disease, they found that the potential to develop cancer and other diseases offsets these potential benefits, as do other risks of harm. The report urges governments to revise health guidelines to suggest lower levels of consumption.

 Multiple sclerosis drug slows brain shrinkage, study finds: Results from a clinical trial of more than 250 participants with progressive multiple sclerosis (MS) revealed that ibudilast was better than a placebo in slowing down brain shrinkage. The study also showed that the main side effects of ibudilast were gastrointestinal and headaches. NEJM

Single-Dose Drug Can Shorten Flu Symptoms by About 1 Day: A single dose of a new influenza drug can significantly shorten the duration of the illness in teens and adults, according to a study published in the New England Journal of Medicine. Two multicentre, double-blind randomised trials found that baloxavir marboxil shortened the duration of flu symptoms by about 1 day and more quickly cleared the virus compared with placebo in otherwise healthy teens and adults.

Behavioural Intervention Prevents Cognitive Decline in Patients With Mild Cognitive Impairment A behavioural intervention reduced the risk of future memory loss in black patients with mild cognitive impairment (MCI)  reduced the risk of cognitive decline by 88% compared with Supportive Therapy. To test whether it was possible to help people set goals and engage in a more active lifestyle researchers used a treatment called Behavioural Activation, which helps participants increase cognitive, physical or social activity by guiding someone through goal setting and action planning. JAMA Neurology

New Guidelines for the Evaluation, Treatment of Perimenopausal Depression: The North American Menopause Society (NAMS) expert panel was convened by NAMS and the Women and Mood Disorders Task Force of the National Network of Depression Centers (NNDC) to conduct a systematic review of the existing literature, and develop clinical guidelines for the evaluation and treatment of depression during the perimenopause. Women’s Health and Menopause.

Resistant Hypertension Diagnosis, Tx Guidelines Updated: A correct diagnosis of resistant hypertension is necessary to avoid overmedicating, according to a scientific statement from the American Heart Association published online Sept. 13 in Hypertension. 

Single, Fixed-Dose Combo Pills Improve Hypertension Outcomes: Single-pill, fixed-dose combination (FDC) treatment may be more effective for improving blood pressure control in older patients, according to a study recently published in PLOS Medicine. 

Prospect of a new treatment for rheumatoid arthritis An international research group has completed testing a new drug to treat rheumatoid arthritis. The drug is effective in patients with moderate to severe forms of the disease who have shown an inadequate response to conventional disease modifying drugs. The Lancet

No Apparent Short-Term Cancer Risk From Recalled Valsartan: Users of valsartan contaminated with N-nitrosodimethylamine (NDMA) seem not to have increased cancer risk, according to a study published online Sept. 12 in The BMJ. For single cancer outcomes, risk for colorectal, uterine cancer increased, but not significantly so.

Long-Term PPI Use Linked to Pneumonia Risk in Older Adults: Among older adults in primary care, use of proton pump inhibitors (PPIs) is associated with greater risk of pneumonia in the second year of treatment, according to a study published in the July issue of the Journal of the American Geriatrics Society.

OTHER

Hospital Groups Launch Own Generic Drug Company: Three U.S. health care foundations and seven hospital groups have formed a generic drug company to combat high prices and chronic shortages of medicines. The company, Civica Rx, will start with 14 widely used hospital drugs, including generic pills, patches, and injectable drugs for treating infections, pain, and heart conditions, board chairman Dan Liljenquist said, the Associated Press reported. "The mission of Civica is to make sure these drugs remain in the public domain, that they're available and affordable to everyone," Liljenquist added. 

Situation Framing, Language Can Influence Decision-Making: How a situation is framed and the language used to describe risks can influence patients' decision-making, according to an article published in Physicians Practice. Docs should provide risks of both having treatment and not having treatment to minimize loss aversion 

BPA replacements in plastics cause reproductive problems in lab mice: Twenty years ago, researchers made the accidental discovery that BPA had leached out of plastic cages used to house female mice in the lab, causing an increase in chromosomally abnormal eggs. Now, the same team is back to report that the array of alternative bisphenols now used to replace BPA in BPA-free bottles, cups, cages, and other items appear to come with similar problems for their mice. Current Biology

Take a Break: Make Refrigerator Door Art

Your refrigerator can be an amazing canvas for art. Instead of hanging up your kids latest project create some of your own.

Need some inspiration?

• Check out Freezer Friday.  The artist’s freezer surface is made of dry erase board and every Friday he spends 25 minutes and draws something new. You can purchase very inexpensive dry erase boards, affix to your frig and draw whatever inspires you. Another option is Dry Erase Contact Paper. These are available at Amazon and probably at various stores, just have never looked for it.

• Get some magnetic sheets, which are available at craft stores, in the craft section at Wal-Mart, Amazon etc. Color with acrylics. Cut into various shapes and create hours of amusement on your refrigerator door.

• Color, draw or paint something and hang it with fun magnets

• Use word pieces, letters static cling vinyl, post its or anything else that sticks to the frig but also comes off and make all sorts of fun stuff.

• Yes you can paint your refrigerator door with chalkboard paint. You can use different colors and make interesting patterns, plus there is lots of colored chalk to choose from.

• Try removable wallpaper. It comes in lots of colors and patterns.

• On a small patch, try a Dry Erase Marker and see if it works. If it does, let the doodling commence!

Not interested in today’s activities, try the Take a Break Pinterest Board.

Take a Break: Watch the Great British Baking Show

I’ve been hooked on the Great British Baking Show since the first episode. It’s very different from American cooking shows. The most recent competition is available via Netflix, plus all of the previous seasons. PBS is airing some of the episodes, which are available at their website or you can watch it on Friday evenings at 9 pm.

While the level of baking is beyond anything I want to do, it’s pretty amazing, particularly the “show stoppers.” However, I did improve my Irish Soda Bread when that was part of the competition. Paul Hollywood showed the correct way to cut it before the bake. Much better than what I had been doing.

Not interested in today’s activities, try the Take a Break Pinterest Board.

RESILIENT LIVES: SOLZHENITSYN & GAGE

It’s not often that something I’ve written in my capacity as director of the Cavendish Historical Society is also relevant to my blog for those affected by chronic conditions. However, since this article is about resilience, a theme which I’ve blogged about quite a bit over the years, I thought it would be worth a cross post.

This is a major year for our little town of Cavendish, VT. It’s the 100^th birthday of Aleksandr Solzhenitsyn, the Soviet dissident and Noble Laureate who lived 18 years of his 20 years exiled in Cavendish. It’s also the 170^th anniversary of Phineas Gage’s accident. 

On September 13, 1848, Phineas Gage, a foreman, was working with his crew excavating rocks in preparing the bed for the Rutland and Burlington Railroad in Cavendish. An accidental explosion of a charge Gage had set blew his tamping iron through his head. Not only did he survive the accident, but he lived for 12 more years and became the first documented case of traumatic brain injury (TBI), ushering in a new understanding of the brain.

Born on Dec. 11, 1918, Alexander Solzhenitsyn was a soldier in the Red Army fighting on the front lines of WWII when he was arrested for writing “disrespectful” comments about Stalin to a friend. Sentenced to eight years in the labor camps and then permanent exile, his experience was the basis for “One Day in the Life of Ivan Denisovich,” “Gulag Archipelago,” “Cancer Ward,” “In the First Circle,” and many other books, poems, plays and essays. While his writing won him the Nobel Prize in Literature in 1970, it also resulted in his being exiled from his Russian homeland. He and his family spent almost 18 of their 20 years in exile living in Cavendish.

Other than their Cavendish connections, and sharing a significant anniversary in 2018, what else could these two men have in common?

• They both lived for extended periods of time in countries other than where they were born-Gage in Chile and Solzhenitsyn in the United States.

• Both nearly died, Gage from his injury and subsequent infections and Solzhenitsyn from metastatic cancer, and an assassination attempt by the KGB. 

• Both played a role in changing history-Gage’s injury and recovery was the gateway to the modern understanding of the brain and the field of neurology. Solzhenitsyn’s writings contributed to the end of the Soviet Union.

One of their most significant commonalities maybe their resiliency-that ability to adapt over time to life-changing situations and stressful conditions.

The American Psychological Association has identified five factors that contribute to people becoming resilient.

1.     Having caring and supportive relationships within and outside the family: Research indicates that having good relationships with close family, friends, neighbors or others is possibly the most important factor for developing resilience.  Accepting help and support as well as assisting others in their time of need is of great benefit.

2.     Capacity to make realistic plans and take steps to carry them out. Recognizing that change is part of life, stressful events happen and understanding that crisis isn’t necessarily insurmountable is key. Accepting circumstances-e.g. having a brain injury, being imprisoned or exiled-can help to focus on circumstance that can be altered by taking decisive actions.

3.     Positive View of yourself and confidence in strengths and abilities: People often learn from adversity, recognizing their own growth as a result of loss.

4.     Skills in communication and problem solving

5.     Capacity to manage strong feelings and impulses

Below is a brief overview of how Solzhenitsyn and Gage met this criteria. Note that while we have Solzhenitsyn’s writings, his family, as well as various biographies, articles and essays to drawn from, unfortunately, much less is known about Gage.

Gage: Within hours of his injury, his family immediately gathered in Cavendish. Throughout  his life, Gage’s family was an important touchstone for him. The Gages traveled by boat from Boston to San Francisco, with Phineas disembarking in Santiago, Chili, where he worked as a coachmen. When he became ill-most likely the development of epilepsy from his brain injury-Gage returned to his family in San Francisco, where he ultimately died.

Once he returned home after his accident, Gage knew he had to make a living. He recognized that he was a curiosity so he spent several years “exhibiting” himself. The daguerreotype shows him as well dressed and self confidant, though he was blind in one eye. He carried his tamping rod with him everywhere he went and even had it engraved- This is the bar that was shot through the head of Mr. Phinehas P. Gage.” The engraver misspelled the name.

Again and again Gage would show himself as resourceful. Whether he was exhibiting himself as a curiosity,  working as a stage coach driver, or finding work after he joined his family in San Francisco, Gage was rarely without work even though by today’s standards he would have been considered compromised.

Poor impulse control and being quick to anger are certainly characteristic of the type of TBI Gage sustained, yet to drive a coach for as long as he did, first at what is now the Hanover Inn in Hanover, NH and then in Santiago, would have required that he learn to master these behaviors.

Gage drove a Concord coach in Santiago for seven years, which required excellent cognitive and motor skills. An 1860 advertisement says the 13 hour, 110 mile journey from Valparaiso to Santiago started at 4am.  Passengers paid $10.00 for the journey and were allowed 50 pounds of luggage.  Before arriving at the starting station at 4 a.m. Phineas would have had to check (if not actually perform) the feeding, grooming and harnessing of the horses.  Once there he would have had to load the luggage, collect the fares, give change, make the passengers comfortable, and keep them so for the next 13 hours.  He would have driven back to Valparaiso 24 hours after arrival in Santiago. Psychosocial Adaptation

Dr. Henry Trevitt, of Valparasio knew Gage well and reported he was engaged in stage driving; and that he was in the enjoyment of good health, with no impairment whatever of his mental faculties. Not only did Gage have to learn the complexities of his job, but he would have also had to adapt to a completely new way of life Chile. It is possible that his highly structured occupation as coach driver helped to “rewire his brain,” much as current rehabilitation programs, based on “neuroplasticity,” provide today’s TBI patients.

An interesting side note, it would be a cousin of Gage’s, Fred “Rusty” Gage, that would pioneer the field of neuroplasticity-the human brain is capable of generating nerve cells throughout life. Until then it was believed that humans are born with all their brain cells and lose them as they age. Rusty Gage’s research is paving the way for not only new treatments for those with TBI, but also stroke and Alzheimer’s Disease. When asked about tips for a successful research career, Rusty Gage stated, “Don’t plan too far in advance; be open to new opportunities and ways of looking at the world.” And when asked what did he think his biggest accomplishments outside of the lab would be, he noted, “Having a family that apparently still loves me.”  It would seem that the Gage family understands the basics of resiliency.

Solzhenitsyn: Even though his father died in a hunting accident before he was born, he was much loved by his mother and her family. In fact, his mother never remarried as she didn’t want a step father that would be too hard on him.

While living in Cavendish, Solzhenitsyn was surrounded with strong support by his wife, Natalia, her mother and their sons. Everyone was involved in the “family business” as Solzhenitsyn spent his time writing “The Red Wheel.” The children would type, his wife would edit, and his mother-in-law had the precise task of carefully turning every letter into Cyrillic script, since the IBM Selectric typewriters did not have a Russian alphabet.

Solzhenitsyn returned Cavendish’s gift of privacy and sanctuary by offering safety to others in exile, including the Soviet dissident Aleksandr Ginsburg. In addition, the royalties in the West from “Gulag Archipelago,” were used to establish an aid program, the Solzhenitsyn Fund, to help Soviet political prisoners and their families.  

His experience in “external conditions of unfreedom” (being in the forced labor camps) helped him formulate the idea that true freedom is possible even in the most restrictive human situations. He wrote in From Under the Rubble, “We are creatures born with inner freedom of will, freedom of choice-the most part of freedom is a gift to us at birth. External, or social freedom is very desirable for the sake of undistorted growth, but it is no more than a condition, a medium, and to regard it as the object of our existence is nonsense. We can firmly assert our freedom even in external conditions of unfreedom.”

Solzhenitsyn expressed his inner freedom and individuality by continuing to write while in prison. When he could not write prose, he memorized verse. His role as writer and truth teller was so central to who he was that when he was told that his cancer had returned and only had a few weeks to live, he proceeded to hide his writings in bottles, burying them in the hopes they would be found.

Through his writings, Solzhenitsyn provides clues to how he and others endured life in the camps. In various novels, his characters engage in various forms of “mindfulness” -focusing on the present moment in a non judgmental way. Research is now showing that mindfulness breeds resilience. “Satiety depends not at all on how much we eat, but on how we eat. It's the same with happiness, the very same...happiness doesn't depend on how many external blessings we have snatched from life. It depends only on our attitude toward them. There's a saying about it in the Taoist ethic: 'Whoever is capable of contentment will always be satisfied.”  In the First Circle

 

In  “One Day in the Life of Ivan Denisovich” at the close of day, the “zek,” (prisoner) engages in what is now encouraged by positive psychologists-acknowledging the good that is in your daily life. Shukhov felt pleased with life as he went to sleep.  A lot of good things had happened that day.  He hadn't been thrown in the hole.  The gang hadn't been dragged off to Sotsgorodok.  He'd swiped the extra gruel at dinnertime.  The foreman had got a good rate for the job.  He'd enjoyed working on the wall.  He hadn't been caught with the blade at the search point.  He'd earned a bit from Tsezar that evening.  And he'd bought his tobacco.