Bones: Unlearning

 

Huesos Hermosos (Beautiful Bones). Artist: Wayne Hilton. El Paso Art Museum. November 2016. Photo credit: Mzuriana

In June 2021, I learned that I have osteoporosis. 

Oh, and it seems that where I used to be 5'2 and 3/4" tall, I've apparently misplaced half an inch somewhere. 

Well, fuck.

I have no remarkable symptoms of osteoporosis, although sometimes I experience mild lower back pain, which has been the case for years. 

Just one of the bummers about this fresh intel was that more than 10 years ago, a DXA stated unequivocally that I had osteopenia, which is an ENORMOUS YELLOW MOUNTAIN-ROAD SIGN WITH FLASHING RED LIGHTS that announces: 

Osteoporosis may be ahead! Falling rocks! Turn on flashers! Put on snow chains! Big curve! Steep decline because you're getting old! 

But I am truly gifted at denial, so as I glanced at that yellow flashing sign 10+ years ago, I turned up the volume of my music player, and looked out my window at the pretty passing scenery.  

But now, now that I'm over 65 and my mortality appears to be inevitable, I'm giving the osteoporosis diagnosis the gravitas that it had already taken for itself, anyway. 

However, I do have a bone to pick with these DXA reports. They are unnecessarily obtuse. Although I've searched Dr. Google for "how to read a DXA report," the answers never align with what is in the report. 

Three non-intuitive things that I've learned recently about exercise and osteoporosis

1.    Don't bend over

2.    Don't do crunches

3.    Not all walking is equal. Brisk walking is what the bones need to get their shit together. 

Don't bend over

This was counter-intuitive to me because my thought was that bending over stretches the spine, right? Reduces compression? No, it is the opposite! 

Spinal fracture risk bending over or back. Credit: BHOF

A puzzle to me until I learned, while writing this, that my mental image of a spine has been wrong since the beginning. Oh, I've had the visual of disks right and their knobby-handled reverse sides fixed correctly in my brain, but ........... I somehow thought the smooth curve of the disks were the posterior side of the spine - the side closest to my skin. Which is why I thought bending over would stretch out the disks in a good way. 

Plus it feels as if I'm stretching out my spine in a satisfying way when I mindfully bend over and feel/hear a little pop that seems to relieve tightness in my spine. I visualize the expansion of the space between my disks. 

My flawed imagery was, to some extent, a function of: I'll see it when I believe it. In other words, I'd got fixed in my mind what I described above, so even when I saw images that pointed to the opposite, I didn't see them. 

Articulated spine views. Credit: Pocket Dentistry

But now that I've got it embedded firmly in my human html that the smooth curve of the disks is on the inside, it now makes sense that when I bend over I'm actually compressing the disks. 

At least this is what I think I know today. 

Crunches

I do did those crunches where you lay on the floor and just barely lift your back, keeping the small of the back rounded and grounded. I thought this protected your back. But no, for the same reason that we shouldn't bend over, i.e. curve our spines forward. 

Some confusion remains, however ... 

When I look for osteoporosis-good exercises that will strengthen my core, I see examples that contradict what I think I know now, so clearly I've still got some unlearning and learning to do. 

In the meantime, I'm mindfully:

• Sitting up straighter in my office chair
• Walking briskly
• Training myself to consistently put my shoulders back instead of allowing them to lazily slump forward

The above actions also promote my objective to "looking good, not looking young," as all three project confidence, alertness, and strength.  

Drugs and BEERS

 

Bottles of elixir. September 2010. Photo credit: Mzuriana.

Summary

• There are prescription and over-the-counter (OTC) meds that carry a risk of deleterious effects on elder folk, which is not present for younger adults. 
• Historically, researchers have excluded older people from their clinical trials on new drugs' effectiveness and side effects. 
• There is a list of medications that a panel of experts in medicine and pharmacology have identified as potentially harmful to elders. 
• That list is the BEERS Criteria for Potentially Inappropriate Medication Use in Older Adults. 
• More of us need to know that the BEERS Criteria exists so that we can make more informed decisions. 

How many drugs do elders take, on average?

Last fall, on a wellness visit with my new healthcare provider, I was asked for the names of the medications I was on. I said I took a B12 supplement. The nurse expressed some surprise, and I asked about that. Why? Do most of the patients my age take meds? Yes, she said. 

So I did some digging on the subject: How many meds do 65+ year-olds ingest on a regular basis? 

From Kaiser Family Foundation:

Nearly nine in ten (89%) adults 65 and older report they are currently taking any prescription medicine. This compares to three-fourths of 50-64 year olds who report taking prescription drugs, half (51%) of 30-49 year olds, and four in ten (38%) 18-29 year olds. Older adults are also more likely than their younger counterparts to be taking multiple prescription medications. More than half of adults 65 and older (54%) report taking four or more prescription drugs compared to one-third of adults 50-64 years old (32%) and about one in ten adults 30-49 (13%) or 18-29 (7%).

From Aging Care: 

Research shows that the average older adult takes four or more prescription drugs each day, but a whopping 39 percent of seniors take five or more prescriptions each day. While each one was created to treat or manage a specific medical problem, each also comes with its own risks and side effects. The more medications a person takes, the higher the chances are for experiencing adverse reactions, negative side effects and even life-threatening conditions. Overall, polypharmacy in the elderly is a major contributor to disability, frailty, falls, long-term care placement and a decreased quality of life. [Emphasis added.]

NOTE: A bucket called "age 65 and older" is not terribly useful, as it spans up to 25+ years (or until death). So based on our current medical culture, of course a 90 year-old might be expected to take more meds than a 65 year-old, thus her high number skews the average for the 65 year-olds. I'd prefer to see five-year statistical sets for comparative analysis, e.g. 65-69, 70-74, etc. 

BEERS

From Elderhood, by Louise Aronson, I learned about the AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. 

The American Geriatric Society's (AGS) BEERS Criteria (2019) includes both over-the-counter and prescription drugs. 

Examples: Ingredients in the three common pain relievers below are on the BEERS Criteria for potentially serious harm, depending on the frequency of use, the reason one is taking these meds, and the user's age (e.g. older than 70 versus older than 65): 

Aspirin, nighttime acetaminophen, and ibuprofen bottles. December 2021. 

Although the bottle labels on these three list contraindications, none explicitly speak to older adults except for: 

Aspirin and ibuprofen: Higher risk for stomach bleeding if over age 60

Consequently, elders don't have the information they need to make informed decisions about their self-care for pain management (in particular, the management of chronic pain).  

Resources

On one hand, I like that Health in Aging provides this Tip Sheet: Ten Medications Older Adults Should Avoid Or Use With Caution. For one, I like that the very title is a heads-up to people that there are special considerations at all for older adults and meds. On the other hand, it is frustratingly opaque about the caution against NSAIDs: It withholds the most common examples of NSAIDS. Which are aspirin and ibuprofen. Also, the tip sheet is completely silent on the daily use of low-dose aspirin as a preventive for heart attack or stroke. The guide's curious opacity is irresponsible, in my opinion.  

A more helpful guide is Health in Aging's Tip Sheet: What To Do And What To Ask If A Medication You Take Is Listed In The AGS Beers Criteria® For Potentially Inappropriate Medication Use In Older Adults. It includes examples of NSAIDs and also specifically that there is a pro/con relationship between aspirin and heart attacks. 

Funereal Thoughts: Back Stories

 

Rose in El Paso Municipal Rose Garden. El Paso, Texas. May 2019. Credit: Mzuriana

The fragrance of roses

When still in high school, I worked at the high-end fragrance counter at the flagship store of The May Company. 

The experienced saleswoman at that counter introduced me to Joy Perfume by Jean Patou (now defunct for the most part), which she said was the most expensive perfume in the world. Indeed, it branded itself as "the costliest perfume in the world." (I learned later that this wasn't quite accurate, but still, it was and is damned dear.)

Joy by Jean Patou, vintage ad. Source: Fragrantica.

At her invitation, I took a whiff. 

Oh, I thought, underwhelmed. Funerals. 

My paternal grandparents owned a funeral home

When I was a child, my family spent many a holiday, especially around Christmas, at the funeral home. The family living quarters were split between the basement level and the second-floor bedrooms. On the main level were the viewing rooms, the gathering rooms for the grieving, the funeral office, and the embalming rooms. 

The fragrance of roses, emanating from wreaths and sprays and urns, dwelt on the main floor, as did the dead. 

I felt no creepiness about vacationing among the dead and their grieving families and friends, and I have no negative associations between roses and death. 

Nevertheless, anointing myself with the fragrance of funerals is not the aromatic statement I wish to make. 

Cemetery. Grand Coteau, Louisiana. March 2015. Credit: Mzuriana

My father's funeral

My father's death was not unexpected; he'd been in hospice care at home for some time. My mother and two siblings were with him when he died. 

When he died at age 75, on the cusp between "young-old" and "middle-old," I accompanied my mother to the funeral home, to the florist, and to other funereal stops. 

A rite of passage: Shadowing an elder to learn how to arrange a loved one's funeral. 

My mother's funeral

At the time my mother arranged for my father's funeral, she - a pragmatic woman - decided to pre-plan and pre-pay for an almost-identical funeral for herself, which would come 15 years hence at the age of 91. 

She wrote out her entire plan, and also instructed me verbally. The instructions included three important features: 

• She would be buried in a pretty, white cotton nightgown.
• In her hands would be a book that she would enjoy reading in her eternity; not the Bible. (One of her brothers was buried with a Wall Street Journal.)
• Ave Maria would be sung at her funeral. 

She wrote out her own obituary, keeping it formulaic, and indeed, bland. Fortunately, I was asked to write a blurb for her funeral Mass program, and thus had the freedom to bring color to the summary of her life essence. 

We honored all of her wishes, and her final gathering was a lovely one, to the surprise of no one, as she'd always been an accomplished hostess. 

My funeral plan

As a new arrival in the Land of Age, it is wise to consider my own demise. Travel insurance, you might say. A courtesy to my daughter. 

I wrote up my funeral preferences years ago, but it's been years since I pulled it out from whatever archival resting place I interred it, and so I have to go dig it up. 

San Lázaro Cemetery, Antigua, Guatemala. April 2016. Credit: Mzuriana.

The Five Remembrances ~ or ~ Memento Mori

 

Day of the Dead, Concordia Cemetery. El Paso, Texas. October 2016.

Recently I came upon The Five Remembrances. 

1. I am of the nature to grow old. There is no way to escape growing old.
2. I am of the nature to have ill health. There is no way to escape ill health.
3. I am of the nature to die. There is no way to escape death.
4. All that is dear to me and everyone I love are the nature to change. There is no way to escape being separated from them.
5. My actions are my only true belongings. I cannot escape the consequences of my actions. My actions are the ground upon which I stand.

Thich Nhat Hanh's version of an early Buddhist scripture

Cemetery, Mtatsminda, Caucasus Georgia. April 2012.

Numbers 4 and 5 provoke pause. And some urgency, because of numbers 1, 2, and 3.

I am reminded of a 12-step aphorism: We tend to judge ourselves by our intentions; others judge us by our actions. 

Cemetery. Cheyenne, Wyoming. May 2016.

Romance in the Land of Age: A Valentine Gift, Mayhaps

 

Red burlesque. UTEP campus, El Paso, Texas. May 2017. Credit: Mzuriana.

Today is Valentine's Day. 

Back when my eyes fell victim to presbyopia, it was so maddening! It was now my lot, like my forebears, to hold afar, bring near, hold afar, bring near, a piece of reading material to just the right distance to read the damn thing. Or to vainly try to thread a needle.  Sisyphean tasks delivered upon us by a whim of nature.

But there came a day when I saw a benefit. 

In the land of age, it is a blessing that, when one's lover is up close, their vision is such that one's face is a bit of a soft blur. Nature's image filter, you might say.  

A gift from Eros, perhaps, taking pity upon us. 

Gray Panthers, Cougars, and Silver Foxes

 

Mountain lion, Living Desert Zoo and Gardens, Carlsbad, NM. March 2010. Credit: Mzuriana

In addition to this, something that really cranks my case are headlines like these:

• Grandma battles bear!
• Superfit grandma ... 
• For 82 year-old Utah grandma, traveling to Rose Bowl Game ... 
• 100-year-old Tampa grandma sets Guinness World Record for weightlifting 

The implication of amazement (or amusement) that a person of age can do shit. Or that the output of their loins are the defining metric of their decades of life. 

I do not see such references to military generals of similar age, to presidents and prime ministers of similar age, of CEOs of similar age, of scientists of similar age, of news anchors of similar age. 

I don't think I will ever see this on my newsfeed: 

An Interview With 75-year-old Grandpa Arnold Schwarzenegger 

I am on board with these descriptors for elders: 

• Gray Panthers (although, sadly, this group with such a brilliant name seems largely toothless these days)
• Cougars
• Silver foxes  

Here is what I'd like to see normalized:

From the BBC: Can the 'Silver Fox' Outwit Vladimir Putin? 

Where the fox in question is a highly-skilled American diplomat, Wendy Sherman, who is a woman of age - and the BBC journalist doesn't even mention her age until the final third of the article! Nor does the author mention Mx Sherman's marital or parental status. It was the Iranians who bestowed the Silver Fox title on the ambassador, in admiration for and wariness of her negotiation skills.  

Gray panthers, cougars, and silver foxes are all actors. 

The names pair age with power; the names are not attendant modifiers, like granny or grandpa. 

Or as James Lee Burke's Dave Robicheaux would say: Gray panthers, cougars, and silver foxes are nouns and not adverbs.

Cheetah, Kansas City Zoo, Missouri. September 2018. Credit: Mzuriana

 

Looking Good v. Looking Young

 

Jane Goodall. Source: World Conservation Congress

Fifteen years or so ago, I placed a magazine photo on my refrigerator. The photo was a headshot of a silver-haired woman, of mature age, a striking beauty. Age lines on her skin. Crinkly eyes. Direct eye contact into the camera. A confident air. 

The woman did not look young. She looked good. 

The woman did not look good "for her age." She looked good. 

This woman became my model for how I wanted to age. 

Mary in her garden. Rustavi, Caucasus Georgia. July 2011.

Sure, looking good has the superficial layer - physical attractiveness - most of which we get from genetics or the regular, skillful application of ointments and cosmetics. 

But it's more than that. Look at what I wrote in my description of that now-lost photo on my refrigerator: 

• Age lines on her skin. 
• Crinkly eyes. 
• Direct eye contact into the camera. 
• A confident air. 

If I strive to look young, then I commit myself to a race that, ultimately, I have no chance to win, even if I have unlimited funds for plastic surgery or other interventions. 

But I can look good. 

Direct eye contact. 

Alertness. 

Lipstick.

Eyeliner and mascara.

Shoulders back, stomach in. 

Mouth closed when I'm not speaking. Or laughing. 

And, by God, if I need to use a cane some day, I will use it. With flair. 

 

My Inspirations: Dancing in the 90s

This month's inspirations: Women dancing in their 90s. 

96-year-old woman is a dancing machine!

90 year old woman walks onto the dance floor but no one expected this...

90-Year Old Woman Can Dance

And this one ... this one .... first it made me cry and then I shouted involuntarily (to no one): "Oh, fuck!" in amazed admiration.  

It made me cry, not in a sentimental, patronizing way toward an old lady who can dance. On the contrary, this woman's complete ownership of her sensuality and power as an adult woman is what made me cry. Holy fuckity-fuck. Now that is some inspiration.  

So I leave you with it. 

92 Year Old Woman and Her 29yr Old Grandson Dance the Salsa!