LiveLongAgeWell

[First: if there is an emergency now, don't read this post: call 911]…Since LLAW is a blog for adult health, on this Halloween I won’t talk about the dangers in candy or flammable costumes, but I’ll try to scare you—just slightly—with one statistic: accidents are the fifth leading cause of death overall, but for those under age 45, they are the number one cause!

Living Long means cutting our accident risks. With the holiday season gearing up, we might be rushing around more, talking and eating (perhaps drinking alcohol) in social situations and all this increases the odds for one type of accident—choking on food. Today let’s review how you might help someone choking, and even how you can help yourself if you are alone.

The best treatment for choking (as it is in most areas of medicine) is controversial.  The American Red Cross recommends five blows to the back first to try to dislodge an obstructing object, and the American Heart Association recommends first doing the Heimlich maneuver. I recommend you study the links below to get a good sense of both approaches.

Remember though that treatment of choking is not a trivial matter— you can hurt someone if you do it badly, or if you do it when someone really doesn’t need it, so read the links carefully and go over the videos several times until you really understand it. Done in the right situation and done correctly, these techniques have saved many lives…to age well, it helps to be prepared!

1.    The American Red Cross video tutorial: to navigate through the Flash site, first “Click Here To Begin”, then click the “Table of Contents” tab, then find “Conscious Choking” to start the video.
2.    This WebMD site has a good discussion of the American Heart Association approach, and includes information about doing the Heimlich maneuver on yourself if you are alone.
3.    Bonus: since our pets are also important (and for our own mental well-being), you might be interested in this SPCA information on performing the Heimlich maneuver on pets…whatever, have a safe and fun Halloween weekend!

One goal of this blog is to encourage you to adopt good health practices so to minimize your chances of needing extensive medical care, including surgery; nevertheless, at some point in your life a doctor may recommend some sort of operation. So it’s good to keep up with what’s current in surgery to help you make intelligent choices in the future.

The biggest revolution in surgery over the past twenty years has been the explosion in “minimally invasive” techniques—procedures done through tiny incisions, assisted by miniature video cameras and endoscopes (internal telescopes).  Often the surgeon works by looking at a monitor rather than directly at the patient. This sort of surgery is now common, and the norm in many areas such as gall bladder removal, sinus surgery, and orthopedic joint procedures.
Surgeons—probably the specialists most likely to aggressively “push the envelope” in technological matters—have been attempting more and more procedures through smaller and smaller incisions, and so I noted with interest this recent report about stomach surgery for obesity control, done without any incisions at all….only by passing instruments through the mouth and into the stomach! While now offered only on a very limited basis, in another ten or fifteen years, depending on the results, this could become the “standard of care” for certain operations.

There are many advantages to minimally invasive approaches including smaller skin scars and less internal scarring. Endoscopic procedures also require much shorter hospitalizations, so that a minimally invasive procedure might mean a one-day hospitalization, whereas ten years ago, the traditional procedure required a one-week hospital stay. Further, minimally invasive procedures typically result in much less swelling and pain, and the results are often as good or better than the traditional, “open” approach.

Besides the amazing ability now to do some surgeries entirely through the mouth, vagina, or rectum (called NOTES for “natural orifice transluminal endoscopic surgery”), another amazing development—one that is already becoming common for some procedures—is surgery done by “robot”. Here, the surgeon sits at a computer console and, utilizing a joystick, controls a remote robot which does the actual cutting. Most major medical centers have robots, and the surgery may be offered for heart valve repair, hysterectomy, and a big push now is for robot prostatectomy (for prostate cancer), since it may offer a lower risk of nerve damage and post-operative impotence.

All these highly technical approaches still carry risk. Even more than in “open” surgeries, these latest approaches depend on the experience level of the surgeon and the medical center. So if your surgeon recommends some newly developed endoscopic or robot or particularly a “natural orifice” approach, you should consider asking:

1.    How many of these procedures have you done on patients? (many doctors learn the latest procedures at courses, in the lab, and by observing experts at medical centers).
2.    What has been your success and complication rate?
3.    Why do you think this newer approach is better for me than a more standard method?

Don’t be embarrassed to ask these basic questions, and if your doctor is not forthcoming or you aren’t comfortable with her answers or experience level, seek a second opinion. You might say: I’d like to talk to an expert at a university medical center where many of these operations have already been done. Who would you recommend? Then visit the medical center, compare, and go where you are most comfortable.

Most likely you have seen the flashy advertising for pomegranate juice, and primarily these ads promote it as a health drink, not for great taste or that it’s refreshing. Fortunately, there is good evidence that this juice is full of wonderful anti-oxidants; it probably cuts the risk of atherosclerosis, and may slow the growth of various cancers, particularly prostate and breast. However it’s expensive, rather bitter, full of calories, and if you buy the most heavily advertised brand, you actually might be getting more cherry juice than pomegranate (for all fruit juices, it’s important to read the label fine print carefully). You might find 100% pomegranate juice—just not the most heavily advertised brand—in some warehouse stores at a reasonable price.

For some years now it has been known that another healthy juice— grapefruit—can cause problems for people taking certain prescription medications, particularly blood pressure and “statin” drugs for high cholesterol. Grapefruit interferes with the metabolism, or breakdown, of certain medications in the body, so if you take one of those medications and also drink grapefruit juice, you could end up with too much of the medication in your system. It seems pomegranate might cause similar problems.

While it’s an ancient fruit that was celebrated centuries ago for its longevity and protective powers, pomegranate has burst into the U.S. scene so recently that scientists need more time and research to figure out exactly how it might interact with medications…still, there is enough concern such that if you take prescription medications, you should check with your doctor or pharmacist before drinking grapefruit or pomegranate juice (or eating the fruit, of course). Likewise if you have cancer, or are undergoing chemotherapy or radiation treatment, check with your physician (it could actually impair your treatments). Still, for most people, pomegranate is a very interesting and promising fruit. It just might fulfill its legendary promise and give many health benefits, and I will cover it, and other new, exotic fruits more in future posts (one pleasant Friday post will include the pomegranate martini, otherwise titled: how you can make alcoholic drinks healthier).

One of the most compelling aspects of my medical practice in California was encountering those older patients who stood out as exceptionally happy and accomplished. I found some of the happiest people were those open to attempting a big new project or even a career change, and they were not constrained by their age.

One of my favorite patients had been one of Walt Disney’s original animators (he had worked on the movie Fantasia), and he seemed to become most alive and animated himself when he talked about his new book project, even though he was in his 70s.

It was clear to me that this ability, or willingness, to be a “late bloomer” was one secret to aging well, so I was very interested to read the article last week in The New Yorker by Malcolm Gladwell (author of The Tipping Point) entitled “Late Bloomers”. He starts with the example of a young lawyer, dissatisfied with his career, who quit and took up writing at age 30, then Gladwell dissects the difference between artists who peak early (such as Picasso), and late (like Cézanne, who struggled during his younger years). He notes other “late bloomers” such as Mark Twain, the poet Robert Frost, and Alfred Hitchcock, whose largest run of successes occurred from his mid- 50s to early 60s.

Of course most of us will not become famous artists or authors or singers or furniture makers, but if we regularly test our minds and bodies and try out talents that (might) lie dormant within us, we will age better, both mentally and physically. And if you have a loving partner, encourage him or her in their endeavors also…you will both benefit. If you read the New Yorker article to the end, you will see that stories of successful late bloomers are actually, often love stories.

Click here for a podcast of an interview with the very cerebral Malcolm Gladwell.  Have a great weekend.

On Monday I addressed the importance of moisturizers and sunscreen for your hands, fingers, and arms. Many people remember sunscreen for their face, but forget about it elsewhere, so, over time, your face might look pretty good but your hands—because they were not well protected—look like hands of an old person. (Remember too that sunscreen decreases the risk of skin cancer, which occur commonly on the back of the hands.)

Today we consider other creams you can use for your hands. First you might ask: should I see a dermatologist? Yes, if you have spots you are concerned might be cancerous, or you already have extensive aging changes. A dermatologist has many stronger treatments than you can find over-the-counter; her arsenal includes (from easiest to most complicated): prescription-strength bleaching agents and Retin-A, chemical peel, intense pulsed light, laser resurfacing, and injection of filling agents. Your doctor can combine several of these, and they tend to be very effective.

If you are younger and your hands currently look quite good and you want to keep them that way, or you have only mild changes at this point, there are effective products you can buy “OTC” (over-the-counter).  First are the alpha-hydroxy acids, and with these you can give your hands a mild chemical peel. They may give some mild benefit, but by far the most effective creams are the retinoids, derived from vitamin A (Retin-A is the prescription-strength form).

Retinoids are, well, fantastic, and I will devote a future post just to them and how they work, but in short, they are the very best agents we have to restore the collagen framework—the firmness and elasticity that your skin loses from aging and sun. The best OTC form is retinol, and I recommend the Neutrogena line because they are high quality and not overpriced (in skin creams, you can spend a fortune for a chic package and a psueudo-European name complete with accent marks, but often these are far inferior to the less flashy brands such as Neutrogena). One good choice is Neutrogena Healthy Skin Original Formula or the stronger Neutrogena Anti-Wrinkle Intensive.

Spread about a pea-sized amount on your hands, at first every several days, and if you don’t get any irritation, slowly increase to every night use. The main side effect is redness and irritation, and if that occurs, use it less often, then after a few weeks again try to use it more frequently. You need at least a month to see any improvement, and if you aren’t happy with the results after three months, see a dermatologist. You might benefit from a stronger retinoid or other types of treatment.

Finally, retinoids have the catch-22 that they make your skin more sensitive to sun damage, so it’s best to use them at night, and you need to be really serious about using a sunscreen. Monday I mentioned Lubriderm with SPF 15, but if you are using retinoids regularly, you might move up a notch in sun-protection to something like Neutrogena Norwegian Formula Age Shield SPF 30 Hand Cream. Carry a tube in your bag to use whenever you wash your hands, so even on-the-go keep up your younger hands program!

I hope you now have a good idea how to get younger-looking hands, and Friday, we leave the most superficial part of the body and dig towards a much deeper subject.

You may know that a current hot procedure in cosmetic dermatology involves “facial fillers”—artificial and in some cases natural substances, such as one’s own fat cells, injected to expand facial areas that have shrunk as a natural result of aging. But you might not be aware that these same plumping-out techniques are becoming all the rage for a different area—the hands. More individuals, who may have young-looking faces, are directing attention now to their hands, which, they feel, “give away” their age. It’s a valid concern, and they want something done.

As detailed in this New York Times article, more than a few people are spending a small fortune trying to reverse the natural tissue shrinkage (which gives a “bony” or “veiny” look) that occurs in some people’s hands over time. The cost of filling procedures for the hands can range from $3,000 for results that last about a year, to $12,000 for results (using fat) that might last a decade. Certainly not a trivial amount, so you will be happy to know there are several simpler, cheaper, and less painful routes to help prevent, and then treat, some of the age-related changes that might occur.

Besides the atrophy, or shrinkage, problem, other age-giveaways are hand wrinkles and brown spots. Prevention is best of course, and if you are in your 20s or 30s still with perfect hands, notice your grandparents’ hands and consider: sun damage may have caused much of the changes you see, and in large part, it’s preventable.

Point one: faithfully use at least an SPF 15 sunscreen (with both UVA and UVB protection), on the backs of your hands and fingers…wrists and arms too if they are sun-exposed. Do this no matter if you are young and unwrinkled, or already have a problem…even if you already have wrinkles, this will help slow down their progression.

Two: moisturize and hydrate your hands, and your body in general. For a daytime hand moisturizer, best is to use a moisturizer-sunscreen combination. One quality, economical, and convenient choice is Lubriderm Daily Moisture with SPF 15. Leave a 16 oz press-top dispenser handy, and make a habit of using a couple squirts before you go out into the sun and weather.

Then hydrate your skin from inside by drinking enough water. Especially with winter approaching, the indoor heated environment can be very drying, wrecking havoc on your skin, so consider purchasing a portable humidifier or two for your home. It’s slightly inconvenient to deal with filling up the device, cleaning it, changing the filters, etc., but the results are well worth the effort. Your wrinkled skin might noticeably “flesh-out” as the humidity rises in your environment. And the increased humidity has other health benefits that will be detailed in a future post.

On Wednesday… several specific creams that work well for age spots and wrinkles!

Finishing the “mini-series” on stress reduction, we end the week with the easiest hint so far. This anti-stress action might seem obvious and simple, but we (myself included), probably need to do it much more often.

I suspect many people, despite being inundated with usually depressing news, are strangely drawn to it, at times nearly addicted to the constant feed, 24/7  available. While energy becomes more expensive, information becomes cheaper; it’s easy to get addicted to it, and I suspect a near constant flow of volatile and often negative news might not be a positive factor for our aging well.

Next time you find yourself glued to, for example, the Dow, and it’s making you a little sick but you can’t pull yourself away, shut it off. Do something else. Take a walk, watch YouTube, work, call a loved one, drink tea, listen to music. The earth will continue to rotate and the news will continue the same whether or not you are watching.

Then consider the times you are lucky enough to be talking with a loved one, yet you are also multi-tasking some trivial news feed, turn off the one that is not vital, and tune into your partner. The more you connect with what’s truly important, the happier you should be.

Next week we’ll cover less-weighty topics such as ways to improve your looks…and a podcast! Have a great weekend!

Over the years, various vitamins are touted as the having the most wonderful benefits, yet some—such as vitamins C and E—while still important, have lost their super-star status. Now the new darling of the vitamin world is vitamin D, and numerous reports have been published recently linking higher levels of vitamin D (the “sunshine vitamin”) with decreased risk of heart disease, diabetes, even various cancers. Hopes are running high that this vitamin will, over time, maintain its lofty status.

This week’s study showed that people with Parkinson’s disease and Alzheimer’s had lower blood levels of vitamin D, but since this was not a clinical trial, it’s not known if taking more vitamin D will cut the risk of those diseases. Again, more studies are needed. Until then, it seems wise to ensure you are getting plenty of vitamin D either through your diet (not so easy for adults), sunshine, or supplements. This site will keep you informed of the various studies that appear. Much more vitamin D information, including how to ensure you are getting an adequate intake, can be found here (from the very useful Dietary Supplement Index on the LLAW right sidebar).

If we undergo a medical test and the results come out “normal”, we probably trust that whatever was studied, is indeed truly “normal”.  Read this report in the New York Times, and you will see that your trust may not be justified, at least in the case of MRI scans.

While not a scientific study, I highly recommend you read this article, as it emphasizes that when we undergo a test, particularly an x-ray, we still need to “listen to our body”. And if a test result comes out very different than what our body is telling us, consider a second opinion and repeating the test, probably at a university or specialized medical center.

Part of the issue is the quality of MRI machines vary greatly from center to center—the machine that scanned you might be several generations removed from what the university medical center has available…it could be the difference between “a black-and-white TV and HDTV” in image quality!

Further, the radiologist who read your scan may have been the “on call” weekend radiologist who is an expert on say, chest scanning, not on your knee scan. So investigate further if results don’t make sense to you, and this article gives you some places to start. (Part of the issue is that many doctors rely much more on test and x-ray results than on your history and physical examination… another reason you want a doctor who really listens to you…more in future posts.)

The next few months will probably be marked by financial and political volatility, so especially during these times I’ll feature some tips to help us all cope better with stress. Chronic stress depresses our immune system, and among other issues, raises the risk of high blood pressure, heart disease, and stroke. To live long and age well, we each need to figure out, for ourselves, what works to help us control the inevitable periods of higher anxiety.

Last week I talked about eating more fish and perhaps taking fish oil as ways to boost mood. Fish is fantastic “brain food”, but it doesn’t work instantly, so today let’s talk about something that does—deep (abdominal) breathing. It’s free, easy to do, and can be done almost anywhere at anytime. It’s so simple and basic that typically we don’t even think about it, but for many people, focused breathing can have a very powerful calming effect.

When tense, we tighten our chests and take shallow, weak breaths (which can make us even more tense). We fail to expand the lowest part of our lungs; pulse and blood pressure rise. Now if we breathe in the opposite way—deep, slow, and using the abdomen more than the chest—our body seems to reset itself to what it experiences when we are calm…easy and relaxed. Such breathing is fundamental for meditation and yoga, but when we don’t have the time or training or desire for those, we can get much of the benefit from just practicing this abdominal breathing.

Next time you feel “uptight”, try this:  first breathe out completely, then inhale very slowly and deeply through your nose, and as you breathe in, make sure your abdominal muscles are relaxed, and that your abdomen protrudes out as you breathe in. Feel the oxygen expanding the bottom of your lungs. Breathe in for the count of three, hold the breath for a second or two, then even more slowly breathe out either through your nose or mouth. When first practicing, it’s good to place your hand on your navel and note that your hand rises an inch or so each time you inhale.

There is no one formula as to how to do this right, so experiment to see what makes you feel most relaxed. Don’t hyperventilate or try too hard. You can do it for just a few breaths, or up to 10 minutes or longer if you are advanced, at best several times a day. Try picking a calming word to say as you let out each breath, and imagine the tension leaving your body each time. For much more about the subject, read this article from Discovery Health.

On Friday, after a couple news items, I’ll finish out this mini-series on stress reduction with one more quick (and even easier) technique. In the meantime, give focused, abdominal breathing a try and see what happens!