Sunday, September 29, 2013


Saws whine, dust flies and the installation of new travertine flooring is finally underway. I’ve envisioned this for years. The work began Wednesday afternoon with removal of the old carpet and chiseling out the tile. They ground-and-filled to level the slab concrete on Thursday before slathering on a dark brown, rubbery compound that will absorb small movements in the foundation and keep the tile from cracking. Then on Friday, they began laying tile.
I am sequestered in sections of my house, sometimes denied access from crossing to the other side. My fridge and kitchen table are side-by-side in the garage for meal prep. The stove sits idly by. I used the opportunity to clean 14-year-old construction debris from behind the corner Lazy-Susan and scrub dried dribble from the stove’s sides. Ick. 

As I shift my stuff from one side of the house to the other, I can weigh its import, value, and worth. I clearly own more shit than anyone should. S’cuse my French. And speaking of fecal impaction... I moved into this home in haste. Boxes were stacked in the garage, and there, some remain. Many contained books that have since found new, temporary residence at The Bookworm, my favorite used bookstore. Box by box, I’ve worked to disimpact my garage.
Can I just say that books are painful to part with? I’m having difficulty entering the intergalactic wormhole, the portal, that digital divide to the digital world. But I can appreciate the thought of a spartan office and bookshelves. I can. I lack confidence, however, that it will happen in my office, in this lifetime. I like the feel and texture of paper, its musty scent that wafts when I turn a page and yes, even the clunk when it thunks and startles my repose.

As an aside, I had a recent epiphany as it relates to my garage and want for it to house both cars. The impasse to garaging two cars is where to store three bicycles, lawn equipment, wheel barrows, luggage, and Christmas stuff - if not the garage. My epiphany was that a small house needs the biggest, baddest shed available. To that end, I’ve found a 10X10 with a loft. Next!

Last year I was approached by a nursing girlfriend who was raised by nuns in an orphanage of the Yucatan. “Do you give clothes to Goodwill?”
“Of course,” I said.
“Would you give them to me instead? We need little clothes.” 
Have you seen the people of the Yucatan? Mayan descendants, they are eensy-teensy-tiny. A pedi-endocrine nurse tells me the population has a known growth hormone deficiency and poor nutrition - but that's another story. Biannually, Maria and a fellow orphan caravan to the Yucatan bearing clothing, bedding, soap, pencils, toys, etc. 
Included in my first pass and purge were 29 t-shirts. 29 t-shirts LB? Yep - and I don’t even like or wear t-shirts. I owned a number of event shirts like the Mercy Heart Day shirt and the Kaiser American Lung Ride team shirt. I found a 1998 Aloha Week t-shirt and a poi pounding t-shirt. 

Next week, the tile setter moves into the master bedroom and closet; impetus for yet another disimpaction and purge.
I looked long at my favorite 3/4 length, indigo, wool gaberdine, circle skirt - size 3/4. While I my current weight is below that of high school, I’ve broadened through the butt and thickened through the waist. Egads! I want to blame this on menopause. Never in my adult life have I culled my wardrobe of clothes that no longer fit - sadly that day is here. I see that my body is remodeling as well, time to relinquish my fantasies and remove the old carpets.
What for have I four pairs of black jeans and numerous in blue? I don’t like or wear jeans. Nothing is sacred. If its the wrong color - that lovely, soft, dove gray that makes me look ill - its out. Purple is passé. Blue is banished. I intend to bag my scrubs but doubt they’ll be discarded until the end of my career - kinda like a hedge against a rainy day. Call me superstitious.

Unsettled => upset. I’ve been uprooted and it makes me notably short-tempered. It’s good to know that about myself. Having that awareness helps me be mindful in the present; that its not about the issue at hand but uprooted, unsettled and upset playing in the background - like elevator music.
The contractor reached into my cabinet with dusty digits for a glass. How do I know? The adjacent cups bore telltale prints along with shattered shards on the floor. Flash-point. The toilet seat is up. Flash-point. Where is the remote for the overhead fan? Flash-point.
Wait  a sec - who declared I am graciousness and grace? Me! Moí! Counterpoint: Were I home, wouldn’t I offer them ice water? Yes. Don’t I want my house to be warm and welcoming - even to workers and strangers? Yes. Given that the contractors and sub-contractors are all men - isn’t an up toilet better than down? Yes indeedy!

Hold close those for whom you are generous and compassionate, for they will teach you grace. And grace, my friends, is the beanstalk to heaven on earth. In The Places that Scare You, Pema Chödrön touts the same. Learn grace where its easy, she says, then learn to include others: acquaintances, strangers, the difficult, the enemy and the world.
I try to do this everywhere and especially with the invisible: the wait-staff in restaurants, salesgirl Jessica at Talbot’s, receptionist Amy at the oil change, the medical assistants at work, and Vadím the tile setter. 

This afternoon, and for the third consecutive year, we will hold the G-Court BBQ. We will block off the cul-de-sac, set up tables and chairs in the shade of my giant sycamore, and come together to commune and break bread. Last month, and by request, I published the first G-Court Gardner’s Gazette. I’ve remodeled my neighborhood too, to one of connection and assistance and inclusion and goodwill. It’s the single most rewarding thing I’ve done in my neighborhood. 
Kenny Rankin sang poignantly, “What matters most is that we loved at all.” Sometimes I need to remind myself who I say I am. Sometimes I get by with a little help from my friends. I see that I am remodeling in many spheres: mind, body, workplace, home and neighborhood.

Change is inevitable and life is naught but crossing the pond, one unstable lily pad to the next. I’ve been accused of being a Pollyanna but recognizing that my life is always in some stage of remodel, and that inherent to remodel is unsettled => upset enables me to see beyond to the miraculous; flash-point => flash-dance.
Tappin' a tango on travertine. I've got my dancin' slippers on. You?

Saturday, September 21, 2013

Dad's 84th - or woulda been

Today is Dad’s 84th birthday - or would have been - had Alzheimer’s Disease (AD) not stolen first his mind, then body. Dad’s last years were an agonizingly slow, unfolding tragedy. I wish it on no one. On his birthday, I find myself reflecting upon my first year of work in the Memory Clinic.

What follows is a poem penned the year before his death.
Who says, “A watched pot never boils?”
Life on the back burner, 
Father - Simmering to a boil.

He seethes silently, Simmering in his seat
Glaring at the TV following an outburst.
 “I know what I see!” he spit, “Stop lying to me!”

He is determined to be angry; 
Predestined to be hurtful… even hateful.
Possessed by inner demons, His cup-half-empty theology amplified.

When neurons unhinge and little is familiar
The world is threatening
And family is enemy.

Calm seems vacant, apathetic… waiting.
Anger seems present and passionate,
The spark of synaptic connection… ALIVE.

Reaction is the locked step that enlivens, imprisons,
The doh-see-doh of struggle.
Difficult for me to BE no preference and no reaction.
I expect a night of little sleep.

Sometimes, newly diagnosed patients threaten suicide. Dad frequently threatened suicide. Then he threatened Mom, brandishing a long kitchen knife and she hid them thereafter. From my perspective, suicide is not a completely irrational thought, rather a lucid mind seeking solution for a terrifying and terminal diagnosis. They fear not for themselves but for their families - and rightly so. As a healthcare provider, I understand and suicidal ideation is something against which I must act.

Did you know that AD is definitively diagnosed at autopsy? So how do we make the diagnosis in the living? It is a disease diagnosed by symptoms and exclusion. What does that mean? We look for memory loss that is greater than normal in the absence of reversible or explainable causes like brain tumors, strokes, alcohol consumption, vitamin B-12 deficiency, and psychiatric disorders - all of which can affect memory and mimmic dementia. Exclusion of other causes, in the face of abnormal memory loss in the elderly, points toward a diagnosis of AD.
Other dementias include: vascular dementia (memory loss suffered after stroke) and dementia seen in the late stages of Parkinson’s disease or Multiple Sclerosis, to name just a few. The current rise in elderly dementia is primarily related to a rise in AD or vascular dementia or an almost certain combination of both.
New amyloid scans might help differentiate early AD from other dementias but as none are curable, early diagnosis and differentiation is academic; prevention better medicine than the bitter pill of early diagnosis. You know the old adage: an ounce of prevention...

What we know. An estimated 5.2 million people in the US are living with a diagnosis of AD. At this point, few of us remain untouched by the disease. Someone is diagnosed every 68-seconds. (And the tide of baby-boomers with dementia has barely begun.) AD is the sixth leading cause of death in the US. One in three senior dies with Alzheimer’s or another dementia. In 2012, 15.4 million family/friends provided 17.5 BILLION hours of unpaid care to those with dementia. (Statistics from The impact to family dynamics and relationships is staggering.

Factors for increased risk of developing dementia? The greatest known risk factor is age. We are witnessing a wave of dementia as the ranks of the elderly swell. While actuarial tables show the average lifespan in the US has increased only 5-7 years since 1900, in that same interval the population has more than quadrupled; we are witnessing the tidal surge of sheer numbers. It stands to reason, the body is organic, its parts wear out and decompose. When the body fails, we call it chronic disease. When the mind fails, its called dementia. Pick your poison. 
Is there evidence for dementia historically? Yes, migratory tribes left people behind and Shakespeare wrote of it in King Lear.
Family history - those with afflicted nuclear family members (mother, father, sibling, child) are more likely to develop AD. This is not pre-destined however, a combination of family history and environmental factors are thought to be at play.
What about genetics and heredity? Genes coding three proteins: amyloid precursor protein (APP), presenilin-1 (PS-1) and presenilin-2 (PS-2) directly cause “Familial AD”. This “early onset” AD is seen through multiple generations, as early as age 30 and seldom later than age 60.  This variation has been found in only “a few hundred extended families worldwide.” 

What does that mean? It means that most of us are NOT dealing with a familial (genetic) variant but the combination of family history and environmental factors - which are impacted by lifestyle choices. My Dad had AD. Am I worried? Yes. He was diagnosed late in life, as were his sister, my maternal grandmother, aunt and uncle. Yikes - both sides of the family LB? Yes. But all were diagnosed late in life. Most were lifelong smokers, all were carnivores without regular exercise. Therefore, methinks I have some sway over destiny - I can live a “brain healthy” lifestyle and exert favorable pressure upon the complex interactions of family history and modifiable risk factors.

Oh Gawd - are we back to diet and exercise AGAIN? Yes indeedy we are. Sorry.

Risk factors over which we have sway:
  1. Head trauma - there seems to be strong link between repeated head trauma and dementia (think boxers, football and soccer players). This group is high profile and accounts for a tiny percentage of the afflicted. Wear a helmet and protect yer noggin from falls at home. (Consider removing throw/area rugs and clutter upon which one can trip.)
  2. Stay socially connected and intellectually active. Seniors who are socially isolated and disconnected seem to be more at risk for disease development. Its why I constantly tout that I will return to Hawaii upon retirement. People like me, alone and removed from family, don’t do well. I get it. The purchase of an island-bound-one-way-ticket looms large in my future. Look at your relationships - mend them and form new ones. Learn the skills required to maintain long, nurturing and healthy relationships. These are learned skills and we are never too old to learn this new trick. It may be the most rewarding trick EVER. 
  3. Intellectual activity - musicians seem magically spared. Mind games improve cognitive ability be it Sudoko or the NY Times crossword puzzle. Watching TV is a brain drain. Limit your time in front of the tube and balance it with equal parts of physical activity. Consider something drastic - lose your TV. I don’t have one and my life is better for it. I read more, I write more, I exercise more and I interact with those who bring life.
  4. Heart - Head connection - Did you know that with each pump, your heart first sends blood to itself and then 20-25% to the brain? It stands to reason that what is good for the heart is good for the brain. There is a plethora of heart research. Run with it! People with chronic disease have more dementia. Most of our chronic diseases (the top five US killers) are REVERSIBLE. Yes - reversible.
  • Diet: heart healthy = brain healthy. A Mediterranean diet (fish, legumes, whole grains, nuts, fruits and veggies) has been shown to improve cognition in those with mild memory loss. There are populations with no, or very low rates of dementia and heart disease. They are vegetarian. Eliminate red meat; start by reducing intake to twice/month. Increase vegetables, fruit, salad to 50% of each meal.
  • Exercise daily: yes, MOVE - every... single... day. Exercise is definitely cardio-protective and likely to be brain protective as well. But... but my knees hurt. Uh-huh. Chair Dancing is but one of many chair workouts. But... but my back hurts. Uh-huh. Go walk in a pool. But... but... my feet hurt. Uh-huh. So? Do one of the two workouts mentioned above. Try a stationary bike. Don’t let your big, fat BUT keep you stuck!
  • No way around this one - STOP SMOKING.
That’s what we know. Its not much and its a place to start. If you’ve read my blog for any length of time, you know I count myself amongst the average. I never exclude self from statistics. The statistics are that only 10% die in their sleep, 40% die of a chronic illness. The remaining 50% will die with dementia and frailty. At age 85, 50% of us will suffer with AD.
I come from a long lived family and intend to live well beyond 85. So when I look at the things I can modify, I modify. I never want this diagnosis - for outside of pediatric terminal illness - I don’t think there is one more devastating to both patient and family. Everything about who we are resides between our ears. When that becomes unhinged, we are reduced to the primal animal who lives within - and I don’t use the term animal lightly.
What are the odds? 50%. I take this statistic seriously. You?

"People do not decide their futures, they decide their habits and their habits decide their futures."  ~ Frederick M. Alexander ~ Like I said, pick your poison.

The Walk to END Alzheimer’s occurs nationwide on October 5th. Our entire Memory Clinic is walking. Join us! Go to and register in Sacramento with the KP Mind Joggers or walk in your city. The national Heart Walk is tomorrow. Do that too - it will count toward daily movement.