Belief

Our actions reflect our belief.

Treatment of Vitamin D Deficiency

Sun exposure
Sun exposure is perhaps the most important source of vitamin D because exposure to sunlight provides most humans with their vitamin D requirement [13]. UV rays from the sun trigger vitamin D synthesis in skin [13-14]. Season, geographic latitude, time of day, cloud cover, smog, and sunscreen affect UV ray exposure and vitamin D synthesis [14]. For example, sunlight exposure from November through February in Boston is insufficient to produce significant vitamin D synthesis in the skin. Complete cloud cover halves the energy of UV rays, and shade reduces it by 60%. Industrial pollution, which increases shade, also decreases sun exposure and may contribute to the development of rickets in individuals with insufficient dietary intake of vitamin D [15]. Sunscreens with a sun protection factor (SPF) of 8 or greater will block UV rays that produce vitamin D, but it is still important to routinely use sunscreen to help prevent skin cancer and other negative consequences of excessive sun exposure. An initial exposure to sunlight (10 -15 minutes) allows adequate time for Vitamin D synthesis and should be followed by application of a sunscreen with an SPF of at least 15 to protect the skin. Ten to fifteen minutes of sun exposure at least two times per week to the face, arms, hands, or back without sunscreen is usually sufficient to provide adequate vitamin D [14]. It is very important for individuals with limited sun exposure to include good sources of vitamin D in their diet. 

Vitamin D Deficiency

Vitamin D deficiency reaches epidemic proportions among people over 50. Only about 5 percent of these men and 1 to 3 percent of the women get their RDI for this nutrient from diet alone. Supplement use bumps up the share of older adults getting the RDI to about 35 percent of whites, 17 percent of Hispanics, and roughly 10 percent blacks.

Answer to Howard

Howard:

The blog is for anything that interests me and is useful for a personal reference when I am writing a newsletter or book or preparing a speech. It is not intended for anyone to read. Indeed, you are probably the first person to read anything written on it, because the vastness of the Internet makes my blog the tiniest astroid in the universe.

The equality of opportunity essay was not intended to mean we should be satisfied with our best effort, but we should continue to improve on our best effort. Our best effort tomorrow should produce better results than our best effort today. If we fail to grow and improve we are failing to give our best effort.

The above paragraph is an example of why it is nice when someone with a discerning mind can read my material. It helps me clarify my ideas--sort of like lounging around in the college dorm talking philosophy.

The tennis/bike analogy is false. When you don't play tennis for two decades, your strokes are rusty, your timing is off, your judgement of where the ball will bounce is off. Plus you have lost a couple of steps, maybe three or four steps. Your stop and start conditioning is off. It will take a tremendous work effort to get to 25% of my level in 1985, but I am going to extend myself if the local pro will give me lessons without requiring me to join the tennis club. 

Brad beat me badly (6-0, 6-0, 6-0, 6-0) in January and I cannot abide rudeness in a son. I am determined to pay him back. (But don't tell him. I want him cocky and overconfident.) After I beat Brad, I will take you on which might mean we will never meet on the court. I know this: I will give my best effort to send Brad packing with his racket tucked between his legs.

I ordered the two books from Amazon yesterday.

If you ever read my blog again please try to make a comment on it. It will be neat to have a comment.

Comment from Howard

'Brief essay' is an understatement!  Or maybe 'trenchant' is a better word because it

is certainly an accurate observation.  And this 'blog' seems to be some sort of professional

forum directed to your clients.  One can not be too careful with such forums.  Personally,

I would sterilize the bitch and be done with it.  But that would be in another reality wouldn't

it? (I'm kidding, I"m really a compassionate liberal...)

    The 'Equality of opportunity' essay was more interesting to me.  I understand that your

words are meant to encourage those who might not have the wherewithal to be the very best

they can be, but something about it rankles, also.  The tennis analogy is telling because I

have experienced it many times.  I get a lot of satisfaction out of giving my best effort when

I win, but when I lose to some young punk who overpowers me, I think that my best effort

is not enough and I need to strive for a higher best effort!  I guess the key point is that I

think one should never be satisfied with a losing 'effort' because even if it is one's best, that

doesn't mean one can't set a higher standard for 'best effort'. 

    OK, I accept your challenge.  I prefer singles myself.  The loneliness of you against the

world!  No fall guys; no excuses.  If you have relearned to hit the ball.  (It's like riding a bike!)

Brad didn't say how good a tennis player you were, but if you turn up to be a 4.5, 5.0, then

I'm toast, but what doesn't kill us only makes us stronger! 

    Reading list:  I do not recommend books lightly to a person as sensitive as Brad because

I am mindful of Dwayne Hoover, the lead character of Vonnegut's "Breakfast of Champions".

His mind was 'poisoned', as mine was, by reading "Sirens of Titan".  But all of the books I

mentioned are exemplary 'cautionary tales' about where we are going as a culture.  And I

admire Zamyatin the most becuase he was able to recognize this trend as early as 1921....

That qualifies as 'visionary' in my book!  I was a science fiction fan in my early childhood

and came across Vonnegut's "Sirens of Titan" when it was first published in 1961 or so.

I have never recovered!  Nor do I want to....

Equality of opportunity and not equality of result

All of us seek equality of opportunity. Opportunity, however, fails to guarantee equality of results. We may be given the opportunity to try out for the basketball team, but that opportunity fails to assure that we will make the team. 

Some people can jump higher and run faster than others. Some have better minds than others. Some have more musical talent than others. Not everyone will win. We will not receive equal prizes. 

Joy comes from doing the very best we can with the gifts we possess. Doing our very best is good enough. A 3.5 tennis player can have just as much fun as a 7.0 player as long as that 3.5 player gives best effort. 

For the right minded, effort trumps result. We can expect the opportunity to give our best effort, but we cannot expect that our best effort will produce results better than the efforts of others. Doing our best is the best we can expect of ourselves. 

The Hidden Consequence of Compassion

Compassion, a wonderful virtue, has the potential for generating a troubling consequence. Recipients of a  "compassionate government" can develop an infantilizing sense of entitlement--an addiction as lethal as drug dependence.

A patient with six children had been admitted to our psychiatric unit six times with post partum depression. I suggested she consider a tubal ligation. She replied, “I couldn’t do that. I need more money. Every time I have a baby I get a bigger government check.” 

Unearned gifts kill personal responsibility.

 

A Healthy Method to Ban Illegal Immigrants

A British woman planning to start a new life with her husband in New Zealand has been banned from entering the country because she is too fat. Rowan Trezise, 33 has been left behind in England, while her husband, Richie, 35, has already made the move down under leaving her desperately trying to lose weight.  When the couple first tried to gain entry to the country they were told that they were both overweight and were a potential burden on the health care system.   

Source: The Daily Mail

A Cosmic View of Life

We have a serious responsibility not to take anything seriously.    

Maharishi Mahesh Yogi

The Law of Unintended Consequences

A recent study done by the Dutch

Obese people are much less costly to the health care system than thin people because obese people tend to die 7-10 years earlier and more money is spent on the aged in the last years of life

Healing

Not everyone who comes to God is  cured. 

•   Curing is temporary
  
•   Healing is eternal
•   We may not be cured but we can be healed
•   Jesus came to make people whole. He came to heal.

Schrodinger's Cat: A thought experiment

In his original thought experiment, Schrodinger imagined that a cat is locked in a box, along with a radioactive atom that is connected to a vial containing a deadly poison. If the atom decays, it causes the vial to smash and the cat to be killed. When the box is closed we do not know if the atom has decayed or not, which means that it can be in both the decayed state and the non-decayed state at the same time. Therefore, the cat is both dead and alive at the same time - which clearly does not happen in classical physics.

Number and Cost of Organ Transplants

Organ	Number of US Transplants Each year	Cost of Transplant Procedure
Heart	2,192	$287,000
Bone marrow	30,000  (Since 1987)	$201,180
Lung	1000	$264,482
Liver	5000	$325,218
Kidney	14,000	$158,490
Pancreas	450	$135,000

Rhetorical Questions on Death

When should we die?

When we are no longer serving a function???

When the cost becomes more than the potential economic benefit of continued life???

How should we die?

Without artificial support???

When does length of life sacrifice quality of life?

A joyless life is not worth living???

Money

Keep your lives free from the love of money and be content with with you have.

Hebrews 13:5

Command those who are rich in this present world not to be arrogant nor to put their hope in wealth, which is so uncertain, but to put their hope in God, who richly provides us with everything for our enjoyment. Command them to do good, to be rich in good deeds, and to be generous and willing to share. In this way they will lay up treasure for themselves as a firm foundation for the coming age so that they may take hold of the life that is truly life.

1 Timothy 6:17-19

Retirement Need

Here is a simple formula to determine how long after retirement we can live in the way we have grown accustomed:

Cash + investments/ annual Debt + annual budget = years until money is gone 

Examples:

$1,000,000 retirement money/$100,000 in debt + $100,000 annual budget = 5 years until money gone

$2,000,000 retirement money/$150,000 annual budget = 13.3 years until money gone

Alternative calculation

If you want to live on $100,000 for 25 years and have no debt you will need $2.5 M in investments

($100,000 x 25 = $2.5 M)

$50,000 x 25 years = $1.25 M 

$100,000 x 25 years = $2.5 M

$200,000 x 25 years = $5 M

400,000 x 25 years = $10 M

What if you want to be retired for 20 years at $100,000 annual budget?

$100,000 x 20 years = $2 M

($100,000 annual budget = $8,333 each month)

$120,000 x 20 years = $2.4 M

($120,000 annual budget = $10,000 each month)

$150,000 annual budget x 20 years = $3 M

($150,000 annual budget = $12,500 each month)

Truth

 A great truth is a truth whose opposite is also a great truth. 

Neils Bohr

What Makes Life Worth Living

Someone you love  who loves you in return

Something to look forward to

Work that you enjoy

Cultivating a Life of Quality

Walk 30 minutes 3 x weekly

Stretching 15 minutes 3 x week

Strength training 15 minutes 3 x week

Get out of chair using leg muscles 10 x day

Maintain ideal weight

Eat vegetables, fruits, bread

Vitamin and Ca supplementation

8 glasses of water daily

81 mg aspirin daily

Puzzles and thinking games daily

Limit television and other passive activity

Party once a week/laugh daily/be a friend

Avoid negative people and negative talk

Serve others

Pray and read the scriptures everyday

Worship weekly

2000 Census Figures

Largest 5-yr. age group = 35-39 year olds

Second largest = 40-44 year olds

Largest percentage growth = 50-55 

Over age 65 = 35 million 

12% of the population

1,019,928 over age 90 (0.4% of population)

55,000 over age 100 (in 2005)

United States Life Expectancy

In 1900 the U. S. life expectancy was 47.3

At birth (Actuary Tables July 9, 2007): 

Male = 74.4 Female = 79.6

At 50 years of age:

Male = 78.09 Female = 81.91

At 60:

Male = 80    Female = 83.21

At 65:

Male = 81.33 Female = 84.2

At 70:

Male = 82.98 Female = 85.45

At 80:

Male = 87.43 Female = 89.00

Life-sustaining Treatments from the AMA

• Life-sustaining treatments should provide medical benefits and should respect a patient’s preferences, as communicated by the patient or a legally recognized surrogate.  Treatments such as mechanical ventilation and artificial nutrition and hydration should be provided only with appropriate authorization from a patient, a surrogate, or a court.  Once initiated, life sustaining treatments may be ethically withdrawn upon request of the patient, or a surrogate or court acting on the patient's behalf.
• To assist patients and surrogates in the decision-making process, physicians have an obligation to provide medical expertise, competent diagnosis based on an appropriate evaluation of the patient, and therapeutic options that are in accord with accepted professional standards of care.

Health Care Cost in the United States From the AMA

Health care costs in the United States hit a new mark in 2006, increasing 6.7 percent to $2.1 trillion, or $7,026 per person, according to the most recent issue of Health Affairs. That’s more than 16 percent of the nation’s gross domestic product (GDP), highest among developed countries. And it’s nearly double the median average of GDP that the Organisation for Economic Cooperation and Development, which includes 30 countries (including the U.S.), reported in 2004.

It’s easy to see how the money adds up. According to the Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey, the nation’s 10 most expensive medical conditions cost about $500 billion to treat in 2005. That includes visits to doctors’ offices, clinics, and emergency departments; hospital stays; home health care; and prescription medications. Heart conditions top the list at an estimated $76 billion, followed by trauma disorders at $72 billion and cancer at $70 billion. It’s important to note thatspending on physician and clinical services accounted for only about 21 percent of total health care costs in the U.S. in 2006.

Increases in chronic disease and unhealthy behaviors are partly to blame for these skyrocketing costs. For example, the prevalence of obesity and diabetes has doubled during the past 25 years, and more than a quarter of health care spending growth in recent years is attributable to the rise in obesity and related growth of diabetes, high cholesterol, and heart disease. Modifiable lifestyle behaviors such as unhealthy nutrition, physical inactivity, smoking, and alcohol abuse, as well as motor-vehicle collisions, gun violence, domestic violence, and other forms of trauma, are contributing to the problem.

Meanwhile, inefficiencies in the nation’s health care system continue to drive up costs. One study found that unnecessary medical tests are costing the U.S. health care system millions—and potentially billions—of dollars annually. According to the study, the estimated annual costs of unwarranted use of just three low-cost tests alone—urinalysis, electrocardiograms, and X-rays—cost $50 million to $200 million a year.

Overuse of medical services also occurs because of the high risk of medical liability lawsuits. A March 2003 report from the U.S. Department of Health and Human Services estimated that defensive medicine cost the nation between $70 and $126 billion in 2001.

End-of-life care has been cited as a source of significant overuse. A quarter of the cost of Medicare services is for patients in the last year of life, but reducing these costs is challenging.

Other research suggests that services known to yield savings aren’t being used enough. One particular study found that patients only receive 55 percent of services recommended by clinical guidelines, including preventive services and care for chronic conditions such as hypertension, high cholesterol, and diabetes.

Fragmentation of care is an issue, causing repeated medical histories and duplicative diagnostic tests because patient records are not readily available. In addition, administrative costs, profits, marketing, and other nonclinical spending often add to health system costs without contributing demonstrable value to patient care.

These are some of the root causes. Now what are the solutions? The AMA has pinpointed several broad strategies (PDF, 58KB) that would address these rising costs and generate better value for what the nation spends on health care.

First, we must reduce the burden of preventable disease. To accomplish this, we can lessen risk factors for illness and injury and prevent the onset of chronic disease, by improving patient compliance with medications andpreventive care recommendations; by helping patients avoid tobacco use and alcohol abuse; by encouraging patients to eat better and exercise more; and by preventing intentional and unintentional injuries. Public health programs and policies can go a long way toward getting the message across on this front.

Second, health care delivery must be more efficient. Better efficiency will result from improving the coordination of care, using unnecessary services less often, and increasing our use of services that are proven to have a positive return on investment in terms of reducing future disease and costs. We also need to better manage chronic illnesses, reduce medical errors, and shift care to cost-effective sites of service.

Third, we must reduce nonclinical health system costs that do not contribute to patient care by eliminating excessive spending on administration, profits, and marketing (PDF, 67KB).

Fourth, we should promote value-based decision-making at all levels. That means improving the processes by which decisions are made so that they take into consideration both cost and benefit, particularly clinical outcomes. Examples of value-based decision-making include physicians and patients choosing among drug therapies, insurers designing health plan cost-sharing features, and legislators determining public health budgets and considering mandated insurance coverage of particular benefits. The AMA Council on Medical Service is developing a report on this subject that should be ready for the 2008 Annual Meeting of the AMA House of Delegates in June.

The AMA also has identified a list of specific actions to put these four strategies into effect. Among them are promoting patient lifestyle counseling and treatment, supporting cost-effectiveness research, and using clinical performance measurement, as we’re doing through the Physician Consortium for Performance Improvement, to improve efficiency. More details on the AMA’s broad strategies and a complete list of these specific actions can be found in a report from the AMA Council on Medical Service (Word, 171KB) issued last year.

That’s the AMA’s stance on how to limit the nation’s health care spending; now I’d like to hear what you think. What are your views on these broad strategies and specific actions?

Lowering Health Care Cost

by Ron PaulRon Paul

As a medical doctor, I’ve seen first-hand how bureaucratic red tape interferes with the doctor-patient relationship and drives costs higher. The current system of third-party payers takes decision-making away from doctors, leaving patients feeling rushed and worsening the quality of care. Yet health insurance premiums and drug costs keep rising. Clearly a new approach is needed. Congress needs to craft innovative legislation that makes health care more affordable without raising taxes or increasing the deficit. It also needs to repeal bad laws that keep health care costs higher than necessary.

We should remember that HMOs did not arise because of free-market demand, but rather because of government mandates. The HMO Act of 1973 requires all but the smallest employers to offer their employees HMO coverage, and the tax code allows businesses – but not individuals – to deduct the cost of health insurance premiums. The result is the illogical coupling of employment and health insurance, which often leaves the unemployed without needed catastrophic coverage.

While many in Congress are happy to criticize HMOs today, the public never hears how the present system was imposed upon the American people by federal law. As usual, government intervention in the private market failed to deliver the promised benefits and caused unintended consequences, but Congress never blames itself for the problems created by bad laws. Instead, we are told more government – in the form of “universal coverage” – is the answer. But government already is involved in roughly two-thirds of all health care spending, through Medicare, Medicaid, and other programs.

For decades, the U.S. healthcare system was the envy of the entire world. Not coincidentally, there was far less government involvement in medicine during this time. America had the finest doctors and hospitals, patients enjoyed high-quality, affordable medical care, and thousands of private charities provided health services for the poor. Doctors focused on treating patients, without the red tape and threat of lawsuits that plague the profession today. Most Americans paid cash for basic services, and had insurance only for major illnesses and accidents. This meant both doctors and patients had an incentive to keep costs down, as the patient was directly responsible for payment, rather than an HMO or government program.

The lesson is clear: when government and other third parties get involved, health care costs spiral. The answer is not a system of outright socialized medicine, but rather a system that encourages everyone – doctors, hospitals, patients, and drug companies – to keep costs down. As long as “somebody else” is paying the bill, the bill will be too high.

The following are bills Congress should pass to reduce health care costs and leave more money in the pockets of families:

HR 3075 provides truly comprehensive health care reform by allowing families to claim a tax credit for the rising cost of health insurance premiums. With many families now spending close to $1000 or even more for their monthly premiums, they need real tax relief – including a dollar-for-dollar credit for every cent they spend on health care premiums – to make medical care more affordable.

HR 3076 is specifically designed to address the medical malpractice crisis that threatens to drive thousands of American doctors – especially obstetricians – out of business. The bill provides a dollar-for-dollar tax credit that permits consumers to purchase "negative outcomes" insurance prior to undergoing surgery or other serious medical treatments. Negative outcomes insurance is a novel approach that guarantees those harmed receive fair compensation, while reducing the burden of costly malpractice litigation on the health care system. Patients receive this insurance payout without having to endure lengthy lawsuits, and without having to give away a large portion of their award to a trial lawyer. This also drastically reduces the costs imposed on physicians and hospitals by malpractice litigation. Under HR 3076, individuals can purchase negative outcomes insurance at essentially no cost.

HR 3077 makes it more affordable for parents to provide health care for their children. It creates a $500 per child tax credit for medical expenses and prescription drugs that are not reimbursed by insurance. It also creates a $3,000 tax credit for dependent children with terminal illnesses, cancer, or disabilities. Parents who are struggling to pay for their children's medical care, especially when those children have serious health problems or special needs, need every extra dollar.

HR 3078 is commonsense, compassionate legislation for those suffering from cancer or other terminal illnesses. The sad reality is that many patients battling serious illnesses will never collect Social Security benefits – yet they continue to pay into the Social Security system. When facing a medical crisis, those patients need every extra dollar to pay for medical care, travel, and family matters. HR 3078 waives the employee portion of Social Security payroll taxes (or self-employment taxes) for individuals with documented serious illnesses or cancer. It also suspends Social Security taxes for primary caregivers with a sick spouse or child. There is no justification or excuse for collecting Social Security taxes from sick individuals who literally are fighting for their lives.

August 23, 2006

The Value of Exercise

All adults should set a long-term goal to do at least 30 minutes or more of moderate-intensity physical activity on most, or preferably all, days of the week. Intermittent or shorter periods of activity (at least 10 minutes), including occupational or nonoccupational tasks and everyday activities of daily life, confer similar cardiovascular and other health benefits if performed at a level of moderate intensity (such as brisk walking) for a total of 30 minutes per day. Additional health and fitness benefits may be conferred by burning up to 3,500 calories per week with additional physically activities or more vigorous workouts. Increasing calories expenditure from 1,000 to 3,500 calories per week can be accomplishedby doing one or more of the following: Spending more time doing current exercises and activities. Doing the exercises and activities at a higher intensity level. Adding more exercises and activities to a fitness program.

Eating Better

Lycopene is a natural chemical that is most commonly found in tomato products. Lycopene has an antioxidant effect and can help prevent and slow the growth of prostate cancer in men. Try to eat at least 10 servings of cooked tomato products per week for optimal health benefits. For better lycopene absorption, include a small amount of healthy fat when you eat tomato products. Take the RealAge Nutrition Assessment for an in-depth nutrition analysis. ACTION PLAN: Eat 7 servings of tomato-based dishes or 10 tablespoons of tomato paste a week to make your RealAge the youngest it can be for this Age Reduction factor. Tomato juice is another good choice. However, tomato juice may be high in sodium. Also, it must be consumed along with food that has some fat in it. Fat is needed to best absorb lycopene, so you should eat a little bit of healthy fat with any of your tomato products.

CONSUME MORE UNSATURATED FAT WITHOUT INCREASING YOUR CONSUMPTION OF SATURATED FAT. Your answers suggest that you consume less than the average amount of unsaturated fats (mono- and poly-unsaturated), making your RealAge slightly older. Many foods contain both unsaturated and saturated fats. Polyunsaturated fat helps prevent high blood pressure and possibly some cancers. Monounsaturated fat helps reduce the amount of bad cholesterol in the blood while increasing the amount of good cholesterol. Therefore, you want a higher amount of unsaturated fat in your diet than saturated fat. You want only a low amount of saturated fat and trans fat in your diet, as high levels cause arterial aging. Adjust the proportion of unsaturated, saturated, and trans fats in your diet so that most of your fats are unsaturated. ACTION PLAN: Do not increase your total fat intake. Review your RealAge nutrition report to see what percentage of your total calories comes from polyunsaturated, monounsaturated and saturated fat. Less than 30% of your total calories should come from fat. More than 7.5% of your total calories should come from polyunsaturated fat. More than 7.5% of your total calories should come from monounsaturated fat. Less than 10% of your total calories should come from saturated fat. Use cooking oils such as soybean and corn oils. These are rich in polyunsaturated fat, low in saturated fat, and low in transfats. Make sure that most of your fat intake is from monounsaturated fat sources. Olive and canola oils are rich in monounsaturated fats and are low in saturated fat. Neither oil has trans fat. Do not use butter, lard, coconut oil, or palm oil. These contain high levels of saturated fats.

FOR MAXIMUM HEALTH BENEFITS INCREASE YOUR VEGETABLE INTAKE. Ideally, you should be eating at least 5 servings of vegetables every day. A diet high in vegetables is not only a diet high in vitamins and nutrients but also fiber. Maximize the anti-aging properties of antioxidants by increasing your vegetable intake. Take the RealAge Nutrition Assessment for an in-depth nutrition analysis. ACTION PLAN: Eat at least 5 servings of vegetables every day. By doing this, you are boosting your intake of antioxidants, which help keep you young. Not only are vegetables nutritious, but also most of them are high in fiber and low in calories. Good choices include broccoli, cauliflower, cabbage, kale, carrots, celery and cucumbers. For maximum benefits, eat vegetables that are yellow, orange, green, or red in color as these are loaded with vitamins and antioxidants.

FOR MAXIMUM HEALTH BENEFITS, INCREASE YOUR WHOLE GRAIN INTAKE. By increasing your grain intake, you can effectively lower your RealAge. Whole grains (bread, cereal, rice, pasta) provide the foundation of a healthful diet. You should consume 6 to 11 servings a day from this food group. Not only are whole grains nutrient-packed but they are also high in fiber that aids in the prevention of colon cancer and other digestive disorders.

The Secret to Health in Old Age--Muscles

by Holcomb B. Noble
(from The New York Times Science,

10/10/98)

Fred Kovaleski, a former State Department official, stares across the net at Jason Morton in the thick of their fight for the title of No. 1 tennis player in the world. Mr. Kovaleski is losing, something he has not had much experience with during the past 60 years, and he is not delighted. But in a corner of his brain is lodged a thought that is becoming more and more common in a rapidly expanding segment of the American population: “I can’t wait to get older.”

They are actually battling to become world champion in the over-70 division at the International Tennis Federation World Championships in Palm Beach Gardens, Fla. But at the moment there is no other division and no other world. Mr. Kovaleski, of Manhattan, knows that Jan. 1 starts the year he turns 75. The odds will then suddenly shift in his favor, putting him in line to become No. 1 among the over-75s. And he can expect to hold that title for some time — at least until that young pup Jason Morton, a teaching pro at Sun Lakes, Ariz., joins the over-75 age group in five years.

These senior warriors are part of a poweful new development among an elderly population that is becoming far more physically active. Many start lifting weights after they retire and continue well into their 90s. They participate in an explosion of organized games and health-club activities. The physical activity is, in turn, demonstrably improving their health and the quality and grace of their lives.

A number of recent studies show that nutrition and aerobic exercise are no longer sufficient — apart from the wisdom of sidestepping things like illness and moving freight trains — to protect the aging body. The research has made clear that working to restore muscle strength and bone density is crucial in realizing the potential for a healthy old age. Although they cannot turn back the clock, elderly athletes are finding that they can take part in sports requiring strong arms, legs and shoulders much longer and more successfully by using resistance-weight machines to restore muscle lost through aging.

Mr. Morton and Mr. Kovaleski provide a case in point. Mr. Morton won the over-70 competition and will try next year to win what might be called American’s first Granddad Slam — national singles and doubles titles on four surfaces, the indoor, clay, grass and hard courts.

Mr. Morton lifts weights. Mr. Kovaleski does not. Whether that matters when it comes to a specific tennis match is debatable, but in day-to-day living among an older population, the value of strength-training exercise is virtually indispsutable.

For the very old and frail the simple act of crossing a room can become something of a high-wire balancing act. But with strengthened leg muscles, the endeavor becomes more routine and the risk of serious injury from a fall decreases.

The American College of sports Medicine recently released a study analyzing some 250 original research projects, most completed in the past five years.

The director of the study, Dr. Robert S. Mazzeo, a professor of exercise physiology at the University of Colorado in Boulder, said the work showed the aging process was far more complex than once thought, involving a complicated interaction of genetics, life style, disease and other factors.

In one of two startling studies, by Dr. Maria Fiatarone, Dr. William J. Evans and others at the Tufts University Research Center, nine women and men, ages 87 to 101, strengthened their arms and legs by exercising with resistance weights, which, as part of a controllable system of pulleys and cables, are safer than free weights. In eight weeks, they increased the strength in the front thigh muscles by an average of almost 175 percent. Dr. Abraham Datch, a 101-year-old retired dentist, increased his strength by 200 percent over what it was at 95.

The second study by Dr. Evans and Dr. Miriam E. Nelson, divided 40 postmenopausal women, none of whom were on hormone replacement therapy, into two groups, one that lifted weights and one that did not. The group that did not lift lost bone and muscle mass, but the other group increased its average strength to the equivalent of women 15 to 20 years younger.

Dr. Mazzeo said he was surprised to see how quicky the elderly benefited from training with resistance weights.

“They can build muscle strength,” Dr. Mazzeo said, “and this then allows them to do other things, like aerobic exercises, that they had not been able to do, and that can then improve their cardiovascular systems.”

Norman A. Fitz is a retired meteorologist from Silver Spring, Md., and a ranked tennis player in his age division for 30 years. In December, his shoulder broke down with a tear in the rotator cuff and damaged in eight other areas.

The injury should have put him out of commssion for at least a year. But after surgery, he started an elaborate program of stretching, aerobic exercise and strength-building, lifting weights for the first time in his life. His first exercise of the day, prescribed by his physical therapist, Peter Boyle, director of Sports and Spinal Physical Therapy in Washington, is simply to lie on his back on a rolling pin for five minutes, and do nothing. The rolling pin, wrapped in two towels and placed under the small of his back, helped stretch and gradually correct Mr. Fitz’s posture, which had become bent from long hours at a desk, Mr. Boyle said, “With Norman we were also able to re-strengthen his shoulder muscles with weight lifting and other exercise,” he added.

Within six months, half the time expected, Mr. Fitz was back on the courts and soon at the top of the tennis ladder in the Mid-Atlantic over-60 division. Last month, he made a credible showing in the national grass-court championships in his division in Cedarhurst, N.Y.

Without exercise, Dr. Mazzeo’s study concluded, total muscle mass decreases by nearly 50 percent between ages 20 and 90. Computer tomography of individual muscles shows that after age 30 there is a decrease in cross-sectional areas of the thigh, decreased muscle density and increased intramuscle fat.

Loss of muscle mass, or atrophy, occurs notably in Type 2 muscle fibers — the fast-twitch muscles used in high-intensity activities. Atrophy, a normal response to lack of use, appears to be accentuated in older people if dietary protein is not increased.

Typically, researchers say, people lose about 30 percent of their strength between 50 and 70, and another 30 percent per decade after that. At the same time, fat-free body mass declines 15 percent, which in turn slows the body’s metabolism — the rate at which it converts food to energy. To make matters worse, the loss of lean body mass makes people lose energy and become more sedentary, continuing the unhealthy cycle by contributing to loss of lean body mass.

But increased physical activity can reverse that cycle. “A number of studies have demonstrated that, given adequate training stimulus, older men and women show similar or greater strength gains compared with young individuals as a result of resistance training,” the researchers said.

Still, because the aging process is so complex, getting and staying in shape and competing becomes more complicated as the body ages. Dr. Gari I. Wadler, a sports medicine-expert at New York University School of Medicine, said in an interview: “After 30, reaction time slows, as information processing in the brain slows and nerves conduct impulses more slowly. The heart no longer pumps at the same maximal rate it once did. The arteries begin to stiffen, and oxygen is transported less efficiently. Finally, recovery time slows.”

And a decline in one system drags down the others. One elderly champion of a few years ago used to say that his overall conditioning was much harder to maintain, that missing a week of tennis at his age would be like a young adult’s missing six months.

Eventually, everyone in the later stages of life faces a difficult decision: when to discard the strategies of youth. Sam Shore of Port Washington, N.Y., long No. 1 in the over-85 tennis group, made the transition smoothly. His strategy: If you can’t speed around much anymore, go where a younger tennis person will never tread. He positioned himself in no man’s land in the middle of the court — a shrewd tactic for those who volley superbly, hitting the ball before it bounces. Even younger competitors were often unable to pass Sam Shore, and if they put the ball where he could reach it, he could put it and them away. Mr. Shore died in July at 92, still world champion in the over-85s division.

To watch him dancing about in his final years in tennis’s no-man’s land was to watch Baryshnikov in slow time at the ballet.

FEEDING TUBES

When the body's natural immune system is weakened, as it is with any chronic illness or trauma, it is particularly important that the patient maintain good nutritional habits. Eating both the right amounts and right types of food will give the patient carbohydrates, protein, fat, and other nutrients that will help give them strength and may improve their ability to fight infection.

When the patient's dietary needs cannot be met by a regular well balanced diet, it may be recommended the patient  be placed on alternative means of nutritional support. Nutritional support options range from blended food products to commercial formulas, which are taken by mouth or by a feeding tube. The physician will choose the most appropriate route for nutritional support based on each patients gastrointestinal function, physical capability, and degree of cooperation.

Placement of a feeding tube does not always mean that eating by mouth is over but supplementation is necessary for proper nutrition and health.

 

A feeding tube can be short or long term and must be discussed with a physician and a nutritionist. A feeding tube must be cared for and the spot where it is placed is prone to infection or irritation.

 

The excess movement involved in HD may cause the feeding tube to become tender or even loosened. Aspiration can still occur with a feeding tube in place, so make sure the head is above the level of the tube to keep this from happening.

 

Enteral Nutrition means the formula is given to the patient through a feeding tube directly into the digestive tract. If the patient has a functioning gastrointestinal tract and cannot be sustained nutrition-ally through oral feedings, they must rely on Enteral feeding. This nutritional support must be ordered by a physician and considered reasonable and necessary.

 

WHEN DO YOU CONSIDER A FEEDING TUBE?

 

Progression must be considered when making the decision. If the patient is at the end of their struggle and cannot utilize nutrients a feeding tube may not be helpful.

 

If the above listed techniques for safe swallowing are not successful a feeding tube may be considered. A physician will not place a feeding tube if all attempts at feeding by mouth have been exhausted. In some cases placing the tube can be detrimental and may not be the best decision.

 

Here are some times when feeding tubes may be needed:

• severe nutritional problems
• severe dehydration
• aspiration pneumonia on several occasions
• great fear of suffocation from choking or aspiration

PERSISTENT VEGATATIVE STATE

FROM QUESTIA.COM by Michael Panicola

Catholic teaching on prolonging life: setting the record straight: although many do not seem to recognize it, the half-millenium-old tradition of Catholic teachings on providing care at the end of life offers a nuanced, carefully balanced doctrine, centering on a finely tuned distinction between ordinary and extraordinary care. Given the significant Catholic contribution to the contemporary pluralist debate about end of life care, getting clear on that tradition is important.

Recently there has been a lot of confusion among Catholics regarding the Church's teaching on prolonging life, especially when it comes to prolonging life with medically assisted nutrition and hydration. This was well illustrated in the nationally publicized case of Hugh Finn. a forty-four-year-old former newscaster in Louisville, Kentucky, who in 1995 suffered a ruptured aorta in a car accident near his home. (1) The lack of oxygen to the brain that Finn sustained as a result of the injury left him in a persistent vegetative state.

PVS is characterized by the loss of all higher brain functions with either complete or partial preservation of hypothalamic and brain stem autonomic functions. (2) Given the absence of higher brain activity, patients in a persistent vegetative state are completely unaware of themselves and their environment and are unable to interact with others. Yet because lower brain function is relatively intact, such patients exhibit periodic wakefulness manifested by sleep-wake cycles and have the capacity to achieve a wide range of reflex activities. As happened with Finn, a PVS is frequently caused by an acute incident, either traumatic (such as a gunshot wound to the head) or nontraumatic (such as hypoxic ischermic encephalopathy). Recovery of consciousness is highly unlikely after twelve months for patients in a PVS caused by an acute traumatic incident and after three months for patients in a PVS caused by an acute nontraumatic incident. (3) The life expectancy of such patients is greatly reduced compared with the normal population. The average ranges from two to five years, and survival of ten years is extremely unusual. The length of survival depends in part on how aggressively the complications are treated. Death for patients in a persistent vegetative state is commonly brought on by an infection in the lungs or urinary tract, respiratory failure, or a sudden event of unknown cause. (4)

From the time of the accident, Finn was unconscious and unable to communicate. He was kept alive by a feeding tube medically inserted into his gastrointestinal tract that provided the essential nutrients and fluids to maintain life. After being treated in an acute care facility and two rehabilitation hospitals with no improvement in his overall condition, he was transferred to a nursing home, where he continued to receive medical treatment, including medically assisted nutrition and hydration. Controversy over his care arose when his wife, Michelle, with the support of his sister, sought to remove the feeding tube so that her husband could be allowed to die.

Strength Building

GRADUALLY WORK UP TO AT LEAST 90 MINUTES OF STRENGTH-BUILDING EXERCISES EACH WEEK.  Your RealAge is older because you spend less than 90 minutes a week doing strength-building exercises. Doing strength exercises, independent of your level of cardiovascular fitness, can make your RealAge younger. For motivation and ideas, build a personalized Fitness Plan here. ACTION PLAN: If you are not performing strength-building exercises, consult a certified personal trainer or qualified fitness consultant to help you start a safe and effective program. Work out three days per week on spaced days (e.g., Monday, Wednesday, and Friday). Before any exercise session stretch and warm up with activities such as running on a treadmill or riding a stationary bicycle. Stretch the muscles that you will be working on, holding the stretch under mild tension for 10 seconds. During each session, do at least 8 to 12 repetitions for each of the major muscle groups of the leg, trunk, arm, and shoulder.