A Different Look at Alzheimer's: A Book Review

A review of Still Alice, by Lisa Genova (Pocket Books, 2009).

This is not a book to read for amusement or quick entertainment. It iis a short and provocative read for anyone seriously wondering about the ravages of Alzheimer's
Disease, or anyone faced by the disease among family or friends. It's a disease that nobody wants to get, but one that seems to be getting more prevalent.

In her first novel, Lisa Genova, neurologist and Alzheimer's advocate, creates an early-onset victim of the disease, Harvard professor Alice Howland, who gradually sees her world crumbling. A world-renowned experst in linguistics with a successful professor husband and three grown children, Alice lives a very active life of research, teaching, and speaking at conferences all over the world. She is also a runner.

Imagine the horror when this active woman can't find her way home from a run in her neighborhood, forgets the ingredients in a favorite recipe, and generally finds her life crumbling around her. She seeks extensive medical opinions and has many tests, but despite her husband's doubts, the outcome is the dreaded one: at age 50, she has early stage Alzheimer's.

Through extensive research, Genova has managed to create a seemingly realistic picture of what it must be like for an intelligent, successful person to notice her mind and memory crumbling. Alice tries various drugs, but to little avail. She worries about having to give up her teaching job, and eventually, she must.

Her family relationships change considerably, leading to greater understanding and patience, although her husband feels compeled to take a new job in New York. Early on, she starts a support group for others also suffering the disease, so she still feels she's making a difference in the world. One of her final public acts is giving a speech before the Dementia Care Conference.

With the help of her son, her daughters, and a devoted care giver, Alice survives in her own way.
This book probably takes us as directly as possible into the life of an Alzheimer's patient through the eyes of Lisa Genova, who has done her research carefully. It is a fascinating, if frightening, book.

A Short Lesson on Chicago Politics

There I was, sitting at the Washington Street information desk at the Chicago Cultural Center, reading a book on a day when the cold weather deterred tourists from coming in, when I noticed an assembly of large men entering the lobby. They were obviously waiting for someone; the guard informed me that the Mayor was coming soon. He was appearing at a meeting in the building.

This information aroused my interest only slightly; I've seen Mayor Richard M. Daley before. I'm not very interested in politics, and he's no hero of mine. I do have a picture of him handing me an award for teaching some years ago.

As time passed and I read on, the retainers began to get slightly anxious. Then, finally, the Mayor entered in his characteristic hat; he handed the hat and his overcoat coat to one of his assistants and proceeded toward the elevator. Imagine my surprise when he looked my way, came to my desk, and shook my hand, as a camera flashed. I am a political nobody, just an elderly Cultural Center volunteer, and he's not even running for office this year. An aide handed me a card for claiming a copy of my picture with the Mayor, but I'll probably decline.

This experience reminded me how politicians work. They seem to be on the lookout for hands to shake, even when they are being ignored. I remembered that when I lived in my Old Town condo, at least three other residents of the small building also displayed pictures of themselves with the Mayor. He surely gets around. I guess that's one of the secrets of getting elected: greet everybody like a long-lost friend and shake many hands. It seems to work for Mayor Daley. Will I vote for him next time around? Probably not, but I can see why he's popular.

Trying My Best

This is a NuStep cross trainer exercise machine. It is one of two machines from the Clare fitness room that I can use, but unfortunately inertia often sets in and I stay away. I am, at best, a reluctant exerciser.

I'm sold on the value of staying active, but I seem to be the ultimate recliner potato. I am lazy and tend to be inactive. Anyway, every Monday, Wednesday, and Friday (barring special appointments and responsibilities) I appear for exercise classes on the 19th floor. The leader, Jan, is wonderful: always complimentary and encouraging no matter what one does or does not manage to do. "Modify this exercise" is her frequent instruction, usually directed to me. Why?

Some parts of the exercise routine are simply impossible for me. For one thing, I cannot raise my right arm; it's been that way since an accident in 1942, followed by another in 1952. By then, my arm was misshapen and nearly useless, although I continue to write with my right hand. Due to arthritis in my shoulders, my left arm can't be raised very far, either. Despite various bouts with physical therapy, arm exercises are a lost cause.

My legs don't work especially well, either. Two knee replacements helped, but I still lack strength and a sense of balance. I'm the one who can't get out of a chair without using my hands, and the one who clings to the back of the chair during most standing exercises.

Fortunately, my fellow senior exercisers are not toned athletes, but some of them, including some of those considerably older than I, do very well indeed. My many unathletic years seem to have caught up with me. I'm overweight and clumsy, even after more than a year of these exercise classes. It bothered me when our oldest resident, age 101, connected to her oxygen tank, did some of the excercises better than I did.

Many times, I've thought about discontinuing my participation in the exercise program. Still, I keep going. This is one area in which I cannot be a perfectionist, but I'm conquering my embarrassment and trying my best. Some movement is undoubtedly better than none! I'm reminded again, though, that old age is not for the weak. And I'll try to visit my favorite exercise machine regularly soon!

More on Senior Travel

I've noted a lot of concern about the new air safety rules. On my recent trip to Tulsa (or actually on the way home) I was exposed to a full-body scan for the first time. Actually, it was easier for me than the usual pat-down brought on by my two knee replacements always setting off the alarm.

Privacy? Perhaps younger people feel differently, but I just don't care. My ugly, misshapen body is sure to be ignored once explosives are ruled out, and I'm sure no one will bother to look further. Yes, all these security measures are a bother, but they seem necessary. Safe flights are a high priority for me. Such things wouldn't be necessary if we lived in a perfect world, but that's not the way things are. Let's welcome full-body scans as long as they are needed.

Looking back at Christmas in Tulsa

A Blizzard? In Tulsa?

There's Work to be Done!

The Gifts Await!

The Stockings Were Hung . . .

The first surprise of my Christmas trip was a blizzard: the first ever to hit Tulsa, I believe. Unlike 2008. I managed to avoid airport delays. I arrived before the blizzard and left after it. As usual, the food was excellent; I gained five pounds! That was with careful eating. I can't imagine how much I would have gained if I had "pigged out."

Tulsa lacks Chicago's huge snow-clearing crew, so the side streets were never plowed. Needless to say, we stayed in a lot. It was cold, too. I read a lot and did a lot of puzzles (I never travel without those puzzle books), and I received some fine gifts, including a Flip Video Camera. Now I need to find some suitable subjects for video.

The best part of the holiday was being with family. My grandniece, Lauren, a junior at the University of Arizona, is thinking about her medical school entrance exams already. I wish her luck. Although there were some doctors on her maternal grandmother's side of the family, there have been none among the Marshalls. We seem to be descended from a long line of farmers and craftsmen. Lauren is very inteligent and a diligent scholar, so she should make it as a doctor.

Now I'm back home, and the new year has begun. Life at The Clare will soon be back to normal. My first anniversary of moving in comes in just a bit over a week. As I get older, the time seems to fly past faster and faster. I'm hoping for another great Christmas in Tulsa in 2010.

(Photos by John Marshall)

Another Christmas in Tulsa!

I'm spending a second Christmas in Tulsa with my niece Cindy and her family. How fortunate I am to have at least the remnants of a family to spend the holidays with! Being old and childless can send me into a deep depression, so Cindy's invitation is wonderful. My brother (Cindy's father) comes here from Utah, and we always have a good, if quiet, time.

There comes a time when the old childhood home is gone, the parents are long gone, and it's time for new traditions. Cindy loves Christmas; she always has a lovely tree surrounded by a lot of presents, and she cooks up a storm. Her food is too tempting for my fat body, but it's certainly enjoyable.

I seldom do any decorating or gift buying on my own, so I really appreciate this new holiday tradition, transported here from Houston, where Cindy used to live. Even as we wait for a predicted snow storm, the fireplaces burn cheerfully and the Christmas carols play. I can feel a bit of Christmas spirit just beginning to affect me. Happy holidays to all, and a great 2010!

Politics? Why me?

As you may have noticed, I usually steer clear of poilitics in my writing. I do not belong to any party; I'm as afraid of the liberal left as of the religious right, and my usual reaction is just to shrug my shoulders at the goings on in government.

Imagine my surprise when I received an official-looking notice, a "2010 Obama Agenda Survey" from the Republican National Committee. It included a survey marked "DO NOT DESTROY" and a letter admonishinbg, "So please, no matter what, do not discard or destroy your survey." It contains an ID number, so there's no chance of remaining unanimous.

The letter begins as follows:

"Please carefully read and complete the enclosed survey which is registered in your name and affixed with a tracking code to ensure tha it is accounted for in the tabulated results. . . . .I am sending out this questionnaire to gauge here you and other grassroots Republicans stand on the critical issues facing our nation.. I need to hear back from you right away."

Grassroots Republican? I am no such thing. Where did they get my name? Is there an assumption that all old people are Republicans, or just old people who live in luxury buildings? The letter is four pages long and rather repetitious; it accuses President Obama of just about every "sin" in the Republican repertoire.

"That's why we are asking where you stand on Barack Obama's promise to raise taxes...on his plans to give amnesty to illegal immigrants, which could lead to billions of dollars in government handouts and possibly bankrupt Social Security. And how do you feel about Obama's efforts to nationalize health care and have it run by bureaucrats in Washington, D.C.? These are Obama's top priorities!"

Then we get to the bottom line: fundraising. Several times this sentence appears: "please complete your Registered copy of the 2010 Obama Agenda Survey, then make out your check or provide your credit card information in the space provided for your contribution of $500, $250, $100, $50, or even $30 to the Republican National Committee, place it in the postage-paid envelope provided, and mail it right away." The implication is, "no contribution, no survey."

As you can imagine, they won't hear from me. I may return an empty envelope, although that's probably coded too. I'm not a strong supporter or critic of Barack Obama. I guess my basic attitude is to give him a chance. He couldn't do worse than his predecessor. I like his idealism, although I think he is sometimes unrealistic about what he can accomplish. At any rate, I don't see him as a destroyer of our country or an enemy, as this letter presumes I should.

If I'm on some list of Republicans--or Democrats--please remove my name. I am srtrictly independent, and no appreciator of political rhetoric on either side. Please respect my privacy, and don't insult my intelligence!

Thanksgiving Again!

Last Thanksgiving, I wrote about enjoying a Healthy Choice frozen turkey dinner in the privacy of my condo. This year, I'll be having dinner here at The Clare; the menu seems to include almost everything. This year, my problem will be trying not to eat too much to sabotage my recent weight loss. I still have a lot of weight to lose. I still remember Thanksgivings past, most of them fondly, so I have decided to repeat my 2007 post, also repeated last year.

"I remember the hot kitchen, the wonderful smells, my grandma in her white "cooking dress" making sure that everything was just right. I remember the spotless white linen tablecloth and napkins, the polished silver, the gleaming china and crystal, the place settings arranged just right, no fork out of place.I remember the small family gathered about, just five of us, my father silent as usual, my mother trying to be helpful despite her barely-disguised dislike of her mother-in-law. I remember my brother impatiently waiting for the food, eager to escape to a more active atmosphere somewhere, perhaps a ball game with his friends if the weather was good. I remember sneaking just one more chocolate from the Whitman’s Sampler box that was a holiday tradition. I had no fear of "spoiling" my gigantic appetite when I was surrounded by such great smells!

'I remember my own little apartment kitchen, my husband struggling to cook everything on the tiny stove and in the tiny oven while I tried to find places for all the mismatched plates on the long, makeshift table with the slightly stained gold permanent press tablecloth. The napkins were paper.I remember the crowd of ten or twelve crammed into the little apartment, mostly the single patrons of my husband’s bar who had nowhere else to go for the holiday. Family Thanksgivings had been a tradition in my husband’s family, so this was an important day for him. I was as inept at cooking then as I am now, but he did it enthusiastically. Most of the guests were men, and they ate every crumb of food. We seldom had leftovers in those years. A few guests fell asleep immediately after dinner, usually on the floor if any space was available there.
We continued this Thanksgiving dinner tradition for several years after we moved to our house nearby. It was not a large house, but we filled it with good food and holiday joy for many of the same guests, and a few more.

"I remember the year when we finally ran out of friends to invite for Thanksgiving dinner; everyone had a family and lived in the suburbs by then, while we were still a city family of two. We made reservations for dinner at the Signature Room at the top of the John Hancock Center. It seemed very expensive to my frugal husband, but he ultimately enjoyed the experience. We ate so much at the sumptuous buffet that we couldn’t eat much of the small turkey provided for us, so we took it home (as advertised and recommended). Jules made turkey soup and turkey sandwiches enough to last at least a week. I think we got our money’s worth that year.

"I remember our last Thanksgiving together in 1999. It was also my last Thanksgiving with my mother, who was eighty-eight years old by then and living in a retirement condo in Northfield, Minnesota. My nephew and his wife cooked dinner at their house, and two grand-nieces were there as well. The food was fine, but I remember little about it. My mother lived on until this year, and I always sent her flowers for Thanksgiving. However, I didn’t join her in Northfield for the holiday again.

"I remember mostly that my husband was not feeling well on Thanksgiving, 1999, that he left immediately after dinner to return to the motel to rest. That was very uncharacteristic of him; he was usually the life of the party. I was very worried. He seemed to feel better later, but it wasn’t long after our return home that his pancreatic cancer was diagnosed. He would die in March of the following year.

"I remember later Thanksgivings with a friend’s family, including her husband and her two daughters. That tradition, begun when Jules was still alive, ended when one of my friends’ daughters moved away and her parents began to visit her for Thanksgiving. I understood.

"This year [2007], I’ll enjoy my Lean Cuisine turkey dinner, watch parades on television, read, write, and feel content. I may even open a bottle of Chardonnay. I’ve come to terms with the changes brought by aging and the passing of time and loved ones, and it’s all right. However, I am happy to remember those Thanksgivings from the past and many more, the good and the bad. Life goes on."

Travel Tips for Senior Citizens

The following guest post was contributed by Christine Howell who frequently writes about Online Health Care Degrees and college related topics for Online College Guru, an online college directory and comparison website.

Now that you have more time on your hands as you've reached the "golden years," you find that you may want to travel more so you can see the things you missed all those years while working on a career and raising the kids. Of course life has changed for you and you're not that "spring chicken" anymore, but that doesn't mean you still can't enjoy yourself. Here are a few tips to make your traveling a lot more enjoyable and secure.

Do some pre-planning before your trip:

1. Contact your travel agent about where you are thinking of going. A lot of travel agencies cater to seniors these days.

2. Make sure to find out about medical facilities in the area where you are planning to go.

3. Do research on the climate where you will be visiting.

4. If you are traveling with a wheelchair or guide dog, make sure these can be accommodated.

5. Think about purchasing travel insurance and make sure that it will cover any pre-existing illness that you might have.

When packing, keep these things in mind:

1. Make sure that your carryon bag contains everything you will need during your flight, if you are flying.

2. Always make sure that your carryon bag contains a medical kit, which should include everything from your medications to band aids.

3. Try to use suitcases that have wheels on them for an easier commute.

Traveling with a disability:

1. It might be wise to call the airports and airlines to make sure that your disability can be taken care of.

2. Make all reservations in advance to save time and hassles.

3. Book direct flights whenever possible.

4. Contact the local tourist information center at your destination to get information about their public transportation system.

5. If you are going outside of the country, make sure to find out from the embassy about any regulations there might be about wheelchairs, guide dogs and medicines.

Pre-trip medical checkups:

1. Always make sure to get a physical before leaving on a trip and ask your doctor about anything special you may need to do or know.

2. Discuss your trip plan with your doctor so they are aware of what to expect. That way they will be able to give you sound medical advice based on what information you have given them.
If you are a diabetic, it's important that you find out from your doctor how to stagger your medication in different time zones.

3. Make sure to get flu and pneumonia shots before leaving for any extended trip.

4. If you are going somewhere that is known for having a high ratio of infectious disease, make sure to be vaccinated accordingly.

When traveling with medications:

1. Make sure you discuss your medications with your doctor so you know what you should be taking.

2 Get a letter from your doctor explaining what the drugs are you are taking and why you are taking them.

3. Always leave the drugs in their original containers so as not to cause confusion and suspicion, especially to other countries.

4. If you have to inject your medication, make sure to bring plenty of syringes of your own with you and not rely on places to buy them at your destination.

Clothing while traveling:

1. Make sure that the clothing you are traveling in is loose fit and comfortable. Wearing comfortably fitting clothing allows for better blood circulation, which is important when you may be sitting for long periods of time.

2. Always avoid tight socks or stocking.

Important information you should carry with you:

1. All of your doctors' contact information.

2. Travel agent's number if you booked your trip with an agency.

3. Airline's contact number.

4. Number for the U.S. Embassy if you are traveling out of the country.

5. Emergency contact numbers.

New Hearing Aids: Will They Help?

Yesterday, my new heraring aids were delivered and fitted. Unlike my old ones, which I wore on and off for about six years, these fit behind the ear, with only a little plastic tube going inside the ear.

I've learned a lot about hearing aids over the years: (1) They are expensive, and Medicare does not pay for them. (2) No hearing aid can restore absolutely normal hearing. (3) Sometimes they can be more trouble than help, especially in a place where you'd rather not hear the heating system, noisy neighbors, or other unwelcome sounds. (4) They seem to be a sign of old age; some elders reject them long after they become isolated by silence. (5) In-the-ear models like my old ones can react to heat and humidity (as mine did in Egypt) and short out. Repairs are expensive.

So why have I resolved to try again? The old aids are worn out; one worked on occasion, the other not at all. Part of it is noticing those around me at The Clare. Trying to share a table with three other hard-of-hearing resdidents becomes a comedy of errors punctuated by "What did you say? Can you speak louder?" I've found myself just nodding, as if I've heard everything. This is enough to make me even more of a loner than I am naturally.

Young people often complain about elders refusing to wear hearing aids, implying that doing so would solve all communication problems. 'Taint so. Perfect hearing is often a dream, even with the best hearing aids available. Be careful: don't attribute difficult conversations with seniors to lack of intelligence or knowledge or to crankiness. Despite hearing aids, we sometimes just can't get it, especially if you have an unfamiliar accent. Even British accents on TV seem to bother me, hearing aids or not. Be sure to speak slowly and clearly.

Anyway, I got the latest and supposedly best digital aids this time; I have several fittings to go, and I've had some uncomfortable sound feedback. So far, I do think I hear better, but I'll need to try the aids out in social situations and get more adjustments before I can make a true evaluation. In the meantime, I'm hoping to become more aware of what's going on around me. I'm hoping that cocktail parties cease to be annoying experiences. Hearing aids won't make me a social butterfly, but if I'm lucky, they'll help a bit. I certainly hope so.