Use it or Lose it (2004)

Use it or lose it

by Fred Lane PhD

As we see more and more people reporting dementia, a big question arises: should the aging brain and body meditate or activate?

Yes.

On the one hand, completely relaxed lifestyles are not only boring, but well-founded research suggests that they contribute to mental as well as physical problems. Sedentary couch potatoes will probably develop a number of mental and physical disabilities, ranging from memory impairment to obesity and osteoporosis.

“Use it or lose it,” the aging brain literature has been saying for years, loud and clear.

On the other hand, highly active or overstressed lifestyles are also dangerous. Broken bones and torn muscles go with high impact physical activity and highly emotional people are prone to a host of disorders, including heart attacks, brain infarcts and high blood pressure. The aging body is not only more vulnerable to both physical and mental stress, it takes longer to repair itself.

Some stress is inescapable, for instance coping with unforseen financial burdens and the inevitable loss of loved ones and friends. There is also the stress that accompanies age-related physical ailments, such as arthritis, that might limit our favourite forms of physical activity. Even decreased libido, whether due directly to aging or indirectly to the loss of a partner, is frequently reported in the literature to be correlated with harmful stress.

More often than not, how we behave in old age depends on how we behaved in adult life. Long-standing research suggests that within the same cognitive and physical environment, our behavior in later life tends to be an exaggeration of our usual adult behavior.

For instance, according to unbiased observers, if we are predominantly passive, aggressive, trusting or irascible, that kind of behavior tends to become more pronounced as we age. We might not notice this change in ourselves, but if this kind of behaviour has been rewarded in the past, Skinnerian logic says that as the opportunities for those kinds of rewards diminish in retirement, we would strive harder using the same techniques to try to achieve the same satisfaction reward.

There is a sensible middle ground that depends on each person’s prior lifestyle. Exercise is important for both physical and mental wellbeing. We know that simply popping pills can delay but not prevent crippling diseases like osteoporosis. Weight-bearing exercises, like regular daily 30 minutes brisk walking, is strongly recommended to help preserve healthy bones. Oddly enough, simple exercise like this has also been shown to cure common forms of depression found in the elderly, including the form that accompanies bereavement.

Pill popping

Research also demonstrates that popping pills rarely prevents further mental deterioration of the kind that goes with the dementias. Despite claims to the contrary seen in the popular press from time to time, there is no sure cure yet for presently irreversible common dementias, such as Alzheimer’s disease and Multi-Infarct Dementia that account for 70 per cent or so of all the 200 or more causes of dementia. Conversely, there are well-proven simple interventions for the benign forms of mild memory impairment that go with aging and a number of other age-associated disorders, including the reversible dementias.

One of the first signs of Alzheimer’s disease and other dementias is mild memory impairment. That, by itself, might not be important because it is also a symptom shared by half the people over age 65, and only a quarter (not 90 per cent as claimed in some newspaper reports) will ever go on to develop dementia. Importantly, there are a number of differences in the quality of memory impairment that separates benign memory impairment from the malignant (dementia) form of the disorder.

If memory impairment or a minor stroke is detected, one of the worst things to do is to lie back convinced that nothing can be done to halt the inevitable slide towards dementia, decay and death. Instead, get busy. Stay active.

When planning for a healthy post-retirement, consider a number of strategies. Plan ahead and start early. It’s too late and too hard to recover from damage done. Keep up the medical and dental inspections. Annual examinations will not detect every problem, but they do detect many and are an important diagnostic aid when a serious illness pops up. Oddly, investigations suggest poor oral hygiene and gum disease is correlated with an increased dementia risk. Consider regular visits to heart, skin, dental and other specialists to head off problems found in these areas.

Planned maintainence

Get that minor operation done. Why put off that cataract, prostate or tooth implant operation if they are limiting your lifestyle or generating discomfort?

Look after the pump and the plumbing. The brain demands clean arteries, just like the circulation system, so keep bad cholesterol low, by for instance, a healthy low-fat diet, no smoking and planned exercise.

Keep stress manageably low. Don’t switch off. That’s just as bad, but try to monitor emotions like road rage and learn a relaxation technique or assertion skill to handle these and other forms of stress. Another driver shows you road rage? Blow him a kiss. That will really tick him off and defuse the road rage response in you.

Keep up the vitamin and food intake. Maintain a balanced diet that should include seafood, meat, spinach, beans, nuts, etc. Natural foods are much better than the vitamins and supplements found in health stores, but don’t hesitate to take these and other pills if recommended by your GP. Avoid overeating when exercise loads drop.

Hormone Replacement Therapy (HRT)?

The HRT jury is still out. There are clear risks for some aging women, but there are also a number of clear benefits. Consult your GP and read the literature. Beginners might want to start with the Internet, but choose your sites carefully. There are plenty of good USA Government and leading university sites. Studies reported with tens of thousands of subjects are usually more convincing than the four- or five-subject week-long “experiment” favoured by some of our magazines and commercial TV stations.

Drink tea or coffee, take aspirin and use alcohol in moderation. Moderate amounts of theophylline, caffeine and aspirin stimulate the central nervous system and dilate blood vessels, but beware, too much can trigger stomach problems, insomnia and even palpitations. There is some preliminary evidence that half to one aspirin a day helps to ward off dementia. There are similar claims for tooth flossing.

Keep the mind active. Play games that exercise the mind, such as chess, poker, Scrabble and crossword puzzles. Learn to play an instrument. Learn sign language. Play video games to maintain hand-eye coordination, but avoid sitting and watching TV for long periods. Join a theatre group. Go back to school. Travel (and wear anti-DVT stockings when sitting in an aircraft or bus for a couple of hours or more).

Recent scientific literature is full of promise regarding stem cell research and replacement brain cells, but none suggest there will be a practical application here in Australia for many years. There are also ethical and political questions that might limit such work. The most promising line of research of this kind might be in Parkinson’s disease.

Just about any activity increases brain cell activity, but so can relaxation exercises like tai chi and yoga. Have no fear that too much brain activity or trying to remember too much is bad for the normal aging brain. The “brain storm” and “overload” theories are well-demolished by modern research.

There is little doubt that the older aging brain has a slower neural response, in that the speed of transmission of neural signals across the cell network, especially in the frontal lobes, is slower. However, that is no cause for despair. This deficit is more than made up by the amount of knowledge stored away in the elderly brain. That’s called wisdom. In the meantime, enjoy life and stay active, mentally and physically.

 


Chronic pain and the physician (2008)

Chronic pain and the physician (2008)

by Fred Lane, PhD
Medical practitioners, generally, are poorly trained in the management of chronic pain. The USA has many physicians who do not keep up with the complex and frequently frustrating task of pain management. However, it also has a very few others who stand out as world leaders in pain research and treatment. Unfortunately, this field has many grey areas and traps, even for the experts. Remember this when you are asking your physician for more medication to treat your chronic pain.

World leader

One of those in the forefront of chronic pain interventions, William Eliot Hurwitz MD, was a highly respected 58-years old researcher and practitioner. In 2002 he had a prosperous surgery in the very fashionable Washington suburb of McLean, Virginia. He charged assessment fees of US$1000 and maintenance fees of US$250 a month, cash in advance. His work had been profiled on the American TV program 60 Minutes. He says that pain must be treated aggressively, sometimes by prescribing massive doses of analgesics, including opiate-based analgesics, for long periods.

This brought him into conflict with the American Drug Enforcement Administration (DEA) who initially worked with Hurwitz, in that he opened his patient records to their inspectors. He received feedback that a small proportion of his patients might not be true pain sufferers but drug dealers who might be converting his prescriptions into drugs for sale to others and making vast profits.

Hurwitz dismissed 17 of these patients and reduced the amount of medication in others, but found that his surgery consultations failed to confirm many of these accusations. If the police wanted to arrest his patients, that was their prerogative; he would not stand in their way. On the other hand, drug dealers could feel as much chronic pain as non-dealers. Therefore he felt he was sometimes obliged to prescribe large doses of strong analgesics like acetaminophen hydrocodone (Vicodin) and oxycodone (OxyContin), even to proven drug dealers, if he perceived them to be in genuine pain.

Detecting duplicity

He admitted that he might not be able to detect a patient skilled in duplicity any better than any other physician. He was not alone. A 2007 Cornell University study found that representative samples of police officers and judges, who should be experts in the field, could detect lying at no better than chance rates (Jung and Reidenberg, 2007). Hurwitz said he was not a policeman, but a physician bound by very clear medical ethics. Hurwitz also pointed out, correctly, that there was no objective test in the world that could determine the amount of pain felt by any individual. Finally, after years of discussion, there was no accepted guideline that said how much was too much when it came to long-term opiates treatment. If in doubt, he was obliged to treat the patient (vide amicus curiae brief, 6 September 2005.)

This brought him into conflict once more with the DEA who were instrumental in shutting down his practice in 2002 and prosecuting Hurwitz in 2004. After a 44-day trial with 76 witnesses, he was found guilty on 50 counts and received four sentences of 25 years and 46 of 15 years, concurrent, in prison. He appealed this sentence and was granted a retrial in 2007. That retrial found him not guilty of the major charges related to narcotics trafficking but guilty of 16 others and reduced his sentence to 57 months, less the 30 months he had served in prison. The judge at this trial said that although she thought initially that the Hurwitz medication regimes were “crazy”, defence witnesses persuaded her that there was “an increasing body of respectable medical literature and expertise” that supported Hurwitz.

Two of his patients subsequently committed suicide saying they could not get adequate pain relief elsewhere.

In Australia, in 1999-2000, there were about 8750 “known abusers” obtaining more than a quarter of a million codeine compound prescriptions, sometimes from 15 different doctors. In America, there are about 50 million with chronic pain, many of whom would qualify as “known abusers” under DEA policy.

DEA Guidelines withdrawn in 2002

Unfortunately, there is no objective guideline on exactly how much is too much when it comes to prescription pain medication. The DEA worked with researchers over many years to publish guidelines around 2002, but abruptly withdrew them just before the first Hurwitz trial. Perhaps the withdrawal was sparked by the notice that the defence intended to quote from those guidelines that the amount or duration of pain medication prescribed was a “physician’s decision” and of itself “should not spark a criminal investigation.”

The prosecution, instead, argued in his first trial that a Hurwitz prescription of 195 mg of morphine a day was “beyond the bounds of medicine.” On the other hand, a dosage of more than 60 times that level is considered acceptable in at least one medical textbook. Furthermore, the president, Dr R.K. Portenoy and seven past presidents of the highly regarded American Pain Society criticised the prosecution’s chief “medical expert” witness for being “factually wrong” and aspects of his evidence “without foundation in the medical literature … in fact absurd,” (Portenoy et al letter 10 December 2004). New DEA guidelines suggest that doctors who prescribe high doses of opioids for long periods are subject to investigation. Unfortunately, they do not specify how much is “too much” nor how long is “too long”.

All this raises the question as to who sets the bar for the “too much, too long” objective standard. The medical profession strongly asserts that it is not the province of the DEA or any other government organ, but the medical profession itself. For the time being, there is no convincing data that will resolve the question. Hurwitz might well have been a little more conservative in prescribing pills, but should that not result in the loss of his licence to practice, not prison as a drug trafficker?< p/>

Bottom line

Modern research suggests the bottom line for pain patients remains unchanged. Don’t put up with pain. Ask, nay demand, more and more intervention until the pain is reliably controlled, even for brief periods, then gradually extend the time of these pain-free periods, through distraction, exercise, self hypnosis, acupuncture etc., whatever works, as the medication is gradually reduced. Too little medication certainly risks more severe and more lasting chronic pain.

References:

Amicus curiae brief: Docket 05-4474 US Court of Appeals, Fourth Circuit, The Association of American Physicians and Surgeons in support of William Eliot Hurwitz, 6 September 2005.
Jung, B. and M.M. Reidenberg, Physicians being deceived: Whose responsibility? Pain Medicine, Vol 8/5, pp. 433-437, July 2007.
Portenoy R.K. et al, letter to Marvin D. Miller, 10 December 2004.

(Google “William Eliot Hurwitz” for updates.)

 


Submarine aircraft carriers

Submarine aircraft carriers

by Fred Lane

There has been a recent upsurge in interest, mainly on the internet and in journal articles, about submarine aircraft carriers. Most of these involve the giant Japanese I-400 class but they tend to neglect earlier attempts, going back to 1915, when a German submarine became the first to launch a seaplane on a bombing mission.

I-400sketch

The Japanese Sen-Toku I 400 class submarines were the most capable submarine aircraft carriers ever built. They displaced 5223/6560 tons surfaced/submerged on a 122 x 12 x 7 metres (400 x 39 x 23 feet) hull. Propulsion was four 3000 hp diesels, giving 18.75 knots on the surface, while two 1200 hp electric motors could drive the boat at 6.5 knots submerged. They could carry three Aichi M6A1 Seiran seaplanes and were armed with eight 533 mm (for Type 95 modified Long Lance) torpedo tubes forward, one 140 mm (6.5 inch) gun aft and three triple-barrel 25 mm machine cannon plus one single .25 mm cannon. The aircraft loaded directly from the hangar onto a 37 metres (120 feet) long catapult. Complement varied between 144 and 220.

i400fw

First wartime use: 1915

The German U-12 sailed from Zeebrugge, Belgium, on 15 January 1915 with a Friedrichshafen FF-29 seaplane armed with small bombs lashed down on its foredeck. They intended to close the English coast before launching the aircraft but the swell was too steep to ensure safe passage of the delicate aircraft. U-12 submerged shortly after leaving harbour, allowing the aircraft to float off and fly away. The FF-29 reached the English coast and returned safely to Zeebrugge without suffering or inflicting notable damage.

Other experiments were conducted by both sides. For example, on 24 April 1916, in an attempt to intercept raiding Zeppelins, the British submarine E-22 carried a couple of small Sopwith Schneider Scout seaplanes out to sea on the after-casing, then submerged to allow them to fly off. The seaplanes returned to Felixstowe after their launch but the E-22 was torpedoed the next day by a German submarine and the experiment was never replicated.

u-12

In 1916 the German U-12 carries a fragile Friedrichshafen FF-29 seaplane on its forward casing.

Limited all-weather application

This method of lashing an unprotected seaplane onto a submarine’s casing continued until at least the1930s, when the Dutch submarine K-15; performed the trick of flooding the forward ballast tanks until the deck was awash, then loading and getting under way with a Fokker C-VII-W seaplane tied down on her foredeck. Of course, dead calm seas are required for such an evolution.

dutch-k15-1930sfw

The Dutch replicated the German 1916 experiment in the 1930s with this Fokker C-VII-W seaplane.

All these exercises aimed to help increase an aircraft’s range or extend the submarine’s scouting horizon, but they compromised one of the submarine’s greatest assets: the ability to submerge in an emergency. With an aircraft tied to its casing, this was grossly impaired. Logically, a number of attempts followed, chiefly by mounting a large submersible hangar on a submarine, while parallel development continued to construct a fold-up seaplane with good range, endurance and payload. Many navies experimented with different submarine and aircraft capabilities in the 1920s and 1930s. The USN, for instance, built a watertight aircraft hangar abaft the conning tower of their submarine S-1. This housed a tiny Martin MS-1, which was derived from a German WW I-era design.

British M-2

One (then) big British submarine, the M-2 (90.1 metres long, 1620 tons surfaced) was launched in 1917 with an enormous 12-inch (305 mm) gun but this submarine gun size was subsequently outlawed by the 1922 Washington Treaty. Around 1927, an aircraft hangar, a hydraulic catapult and a small Parnall Peto two-place reconnaissance seaplane re[laced the gun. The concept was proven, but it was a cumbersome arrangement. The delicate aircraft was easily damaged, and so was the hangar door seal. Additionally, the aircraft launch and recovery process was slow, requiring the submarine to remain on the surface for extended periods.

m2steamcatfw
The big British M-2 submarine launches a Parnell Peto seaplane from its catapult.

M-2 foundered with all hands in 1932 and divers subsequently found its hangar door open with the aircraft inside. It was assumed that either the aft dive planes malfunctioned or the hangar was swamped, perhaps by a rogue wave, as an overeager crew opened the hangar door.

uss-s1fw
The Americans also experimented with the aircraft-carrying submarine concept.
USS
S-1 carried a tiny Martin MS-1 in 1923.

French Surcouf

The French Surcouf commissioned in 1934 as the biggest submarine in the world. Measuring 110 metres (361 feet) long, Surcouf displaced 3304 tons (surfaced) and 4218 tons (submerged). The submarine combined both British M class initiatives by mounting two large eight-inch (203 mm) guns forward of the conning tower and incorporating a water-tight hangar aft that initially housed a two-seat Besson MB411 spotter/reconnaissance sea-plane. The spotter was desirable because the guns had a 24-mile range while the submarine’s rangefinder was only good for 6.8 miles. Surcouf sank with all hands in the Caribbean after a probable collision with a merchant ship in 1942.

surcouffw

The French Surcouf carrried twin eight-inch guns and a Besan411B spotter-reconnaissance seaplane.

The Italians also dabbled in the submarine aircraft carrier field in the 1920s, constructing a hangar in the submarine Ettore Fieramosca. A number of aircraft were constructed to fit this hangar, but they employed none operationally.

Japanese successes

The Japanese, meanwhile, persevered with productive research into the submarine aircraft carrier concept. Experiments began as early as 1923 with a small Heinkel seaplane. By 1935 the locally-built Watanabe E9W1 “Slim” aircraft had joined the submarine force. From 1941 onwards, a much improved Yokosuka E14Y1 “Glen” seaplane was frequently carried by the 44 submarines built for this purpose. It was a Glen from the Type B1 submarine I-25 that scouted Sydney, Melbourne and Hobart in February and March, 1942.

glen-e4y1
The aircraft type most carried by submarines in WW II was the Japanese Yokosuka E14Y1 “Glen” seaplane. These aircraft performed valuable reconnaissance duties.

Japanese wartime research culminated in the deployment of three big Sen-Toku I-400 class submarines, the type that arouses most interest in recent submarine aircraft carrier discussion. It was planned to build 18 of these monsters in 1942 but by 1943 this number was reduced to five and only three were completed. They were the largest of all submarines until nuclear-powered craft appeared in the 1960s. Importantly, two of the I-400s could carry three Aichi M6A1 Seiran seaplanes each, plus spares, aircraft ordnance and aircraft stores.

Advanced design

These Seirans were not the simple reconnaissance or spotter types carried in earlier submarines, but high performance aircraft designed to penetrate a defended war zone to deliver a useful load of torpedoes or bombs. Intending to attack the Panama Canal’s Gatun Locks from the east, the Seirans practised with targets constructed ashore in Toyama Bay. For the submarines, the Gatun Locks raid involved a non-stop transit from Japan, around the Cape of Good Hope and across the Atlantic. The I-400s had an amazing maximum range of 37,500 miles at 14 knots.

aichi-m6a-seiran-afw

The Aichi M6A1 Seiran was unknown to Allied intelligence until after WW II. It had a crew of two and an empty weight of 3301 kg (7277 pounds). It could carry one torpedo or 1800 pounds of bombs over 642 miles. Its inverted V 12-cylinder engine developed 1400 hp. Seirans could fly at a handy 256 knots and they had a service ceiling of 32,000 feet. A total of 28 were constructed, but only one survives, housed in the Udvar-Hazy Centre, near Dulles airport, VA.

They also had a 98-foot (30 metres) catapult that could launch a heavily-laden Seiran. In the hangar, with the aircraft’s wings folded back, the floats detached and the elevators, fin and rudder folded down, the whole aircraft maintained a cross-section no greater than the aircraft propeller. The seaplane’s floats could carry extra fuel and be jettisoned, if necessary. It was claimed that a worked up crew of four could range, rig, fuel, arm and launch the first aircraft within seven minutes, and all three Seirans in about 45 minutes after surfacing. In a calm sea, the aircraft might be recovered and stowed from alongside using the ship’s folding hydraulic crane in about the same time, but not all Seirans were expected to return from high value sorties, such as the Gatun Locks raid. Instead, after using the fuel stowed in them, the floats could be jettisoned before the aircraft reached a highly defended zone.

Unique construction

These big submarines had a number of unusual construction features, apart from their huge size. The hull was essentially a pair of cylinders lain side by side. The pressure hull’s midships cross section was a figure eight but this tapered to a single cylinder aft and a vertical figure eight forward to accommodate the craft’s eight torpedo tubes in two compartments, one above the other. There was also a separate aircraft engine overhaul and test bed under the hangar.

One report said that underwater steering was difficult at slow speeds. This seems logical, given that the conning tower was offset two metres to port and the aircraft hangar, with its large frontal area, was offset to starboard. As may be expected from such a large submarine, it also tended to take more time than more nimble vessels to submerge.

Propulsion

The four diesel engines produced a total 7,700 hp but their arrangement was unique in the Japanese navy. Two diesels were coupled in pairs to each propeller shaft, which could also be powered by a 1200 hp electric motor when submerged. A rudimentary snorkel was added during construction, permitting limited underwater cruising on the diesel engines.

Starting with the Friedrichshafen FF-29 in 1915, the submarine aircraft carrier development concept executed a full cycle, from bombers through fighters and scouts and back to bombers. Nowadays, the I-400’s role has been usurped by missile-firing submarines.


Chronic pain (2009)

Chronic pain (2009)

by Fred Lane PhD

A large Australian study (Blyth et al 2001), supported by overseas research (e.g. Tunks et al 2008 and Breivika et al 2006) suggests that about one in five adults have chronic pain. That equates to about 133 Naval Officers Club members.

The saga of diagnosing and treating chronic pain goes on. Definitions vary, but when defined as persistent pain without underlying physical cause (e.g. perceived pain in the fingers of an arm amputated at the shoulder) the psychological nature of the disorder becomes immediately apparent.

Acute pain from a surgical operation or tooth extraction should fade gradually over a few days, or a few weeks at the most. Sometimes acute pain fails to dissipate, perhaps due to insufficient analgesic drugs.

Chronic pain intrudes when acute pain fails to dissipate in a timely fashion or the pain is associated with long term morbidity, such as migraine, arthritis or degenerative joint back pain.

Chronic pain unfortunately interacts with other conditions, particularly depression and anxiety, that in turn tend to exacerbate the perception of pain. Decreased physical activity linked to the apprehension of pain is common, typically making pain worse. Then again, too much or the wrong kind of physical activity can do just as much damage. Be guided by the physical therapist in a good pain management team.

Modern research aims

Modern research finds that it is rare, but not impossible, to achieve absolute and sustained pain relief. The clinical goal nowadays is simple pain management. Once pain management is demonstrated, steady gains inevitably follow.

Another trend is that even though many new pain drugs have been developed, multidisciplinary teams (medical, psychological, chiropractic, alternative medicine, etc.) report greater success rates than the old unitary pill-popping GP or specialist approach.

tmjgfw
The hardest working joint in the body and a common site of chronic pain is the temporomandibular joint (TMJ), a hinge and gliding joint. On the upper end of the lower jaw is a condyle and its socket is the articular fossa. Between the fossa and the condyle is a flexible disk or cushion that absorbs stress and allows the condyle to move smoothly as the jaw opens and closes. TMJ disorders sometimes resist treatment and have many different causes, including hyperextension during dentistry, arthritis, osteoporosis and sudden trauma.
There are pitifully few well-trained pain specialists or multidisciplinary teams available in Australia and virtually none outside the big capital cities. Therefore, as Khazzoom (2009) asserts, some pain sufferers might have to become their own diagnostic and medication expert. This does not mean that you cut the family doctor or specialist out of the treatment process, but people with chronic pain might have to learn how to discuss their problem with their GP or specialist in a more educated, more assertive and more objective manner.

Perhaps the simplest advice is not to accept pain as inevitable, but to tell everybody, in no uncertain terms, that there is pain and that pain persists. Initially, think about demanding more analgesic medication.

Objective data record

Start a written log of the pain levels experienced at, say, 1000, 1400 and 2000 each day. Use a 1 to 9 scale, where 1 equals no pain and 9 equals unbearable agony. Log significant physical activities (including rest) over the preceding six hours.

Next, establish a reliable pain free period every day, by whatever means that works. Try medication first but alternative treatments from the table below might help. Then add one or more of the listed interventions systematically to gradually extend this pain-free period. Keep the pain log going.

Positive reinforcement

Importantly, give yourself a pat on the back when your log demonstrates improvement.
Importantly, give yourself a pat on the back when your log demonstrates improvement, and just in case you forget:
Importantly, give yourself a pat on the back when your log demonstrates improvement.

The following table, derived from Kazoom (2009) shows many of the interventions chronic pain teams use to control pain. The list is fairly comprehensive but by no means complete. For instance it does not mention self-hypnosis, transcutaneous electrical stimulation (TENS), distraction, copper bracelets, magnetic pillows or the better-researched arthritis nonprescription drug combination glucosomine and chondroitin. Kazoom also fails to mention the important kitchen and other tools devised to help those with arthritis. Rather, it is a generic list that a good pain control team will consider. It demonstrates chiefly that, as pain science presently stands, not one intervention suits everbody and that two or three or more interventions are frequently recommended before success can be claimed.

The bottom line is that whatever works (other than lying down doing nothing), use it. Essentially, gain mastery over the pain, never let it control you. Use whatever method, including powerful analgesics, to guarantee at least one designated period every day to be free of pain. Then extend that time by whatever other method that works. Head off pain by using one of the interventions below or taking analgesics before you embark on a known pain-causing activity, such as essential hard work.

Invariably, don’t forget that pat on the back once you have demonstrated success and gradually wean yourself offf the analgesics and other interventions.


Movement-Based Therapies:

Type: Physical exercises and practices.
What they help: Musculoskeletal pain, joint pain and lower-back pain.
How: By strengthening muscles supporting joints, improving alignment, and releasing endorphins.
Examples
Physical therapy: Specialised movements to strengthen weak areas of the body, often through resistance training.
Yoga: An Indian practice of meditative stretching and posing.
Pilates: A resistance regimen that strengthens core muscles.
Tai chi: A slow, flowing Chinese practice that improves balance.
Feldenkrais: A therapy that builds efficiency of movement.

Nutritional and Herbal Remedies:

Type: Food choices and dietary supplements. (Ask your doctor before using supplements.)
What they help: All chronic pain, but especially abdominal discomfort, headaches, and inflammatory conditions such as rheumatoid arthritis.
How: By boosting the body’s natural Immunity, reducing pain-causing inflammation, soothing pain,and decreasing insomnia.
Examples
Anti-inflammatory diet: A Mediterranean eating pattern high in whole grains, fresh fruits, leafy vegetables, fish, and olive oil.
Omega-3 fatty acids: Nutrients abundant in fish oil and flaxseed that reduce inflammation in the body.
Ginger: A root that inhibits pain-causing molecules
Turmeric: A spice that reduces inflammation
MSM: Methyl sulfonylmethane, a naturally occurring nutrient that helps build bone and cartilage.

Mind-Body Interactions:

Type: Using the powers of the mind to produce changes in the body.
What they help: All types of chronic pain.
How: By reducing stressful (and, hence, pain-inducing) emotions such as panic and fear, and by refocusing attention on subjects other than pain.
Examples
Meditation: Focusing the mind on something specific (such as breathing or repeating a word or phrase) to quiet it.
Guided imagery: Visualising a particular outcome or scenario with the goal of mentally changing one’s physical reality.
Biofeedback: With a special machine, becoming alert to body processes, such as muscle tightening, to learn to control them.
Relaxation: Releasing tension in the body through exercises such as controlled breathing.
Cognitive behavior therapy (CBT): teaches skills, such as guided imagery, relaxation, attribution therapy, self-talk therapy, log-keeping and selective positive reinforcement.

Energy Healing:

Type: Manipulating the electrical energy (called chi in Chinese medicine) emitted by the body’s nervous system.
What they help: Pain that lingers after an injury heals, as well as pain complicated by trauma, anxiety, or depression.
How: By relaxing the body and the mind, distracting the nervous system, producing natural painkillers, activating natural pleasure centers, and manipulating chi.
Examples
Acupuncture: The insertion of hair-thin needles into points along the body’s meridians, or energetic pathways, to stimulate the flow of energy throughout the body; proven helpful for post-surgical pain and dental pain, among other types.
Acupressure: Finger pressure applied to points along the meridians, to balance and increase the flow of energy.
Chigong: Very slow, gentle physical movements, similar to tai chi, that cleanse the body and circulate chi.
Reiki: Moving a practitioner’s hands over the energy fields of the client’s body to increase energy flow and restore balance.

Physical Manipulation:

Type: Hands-on massage or movement of painful areas.
What they help: Musculoskeletal pain, especially patterns of lower-back and neck pain; pain from muscle underuse or overuse; and pain from adhesions or scars.
How: By restoring mobility, improving circulation, decreasing blood pressure, and relieving stress.
Examples
Massage: The manipulation of tissue to relax clumps of knot­ted muscle fibre, increase circulation, and release patterns of chronic tension.
Chiropractic: Physically moving vertebrae or other joints into proper alignment, to relieve stress.
Osteopathy: Realigning vertebrae, ribs, and other joints as with chiropractic; osteopaths have training equivalent to that of medical doctors.

Lifestyle Changes:

Type: Developing healthy habits at home and work.
What they help: All types of chronic pain.
How: By strengthening the immune system and enhancing well-being, and by reframing one’s relationship to (and, thus, experience of) chronic pain.
Examples
Sleep hygiene: Creating an optimal sleep environment to get deep, restorative rest; strategies include establishing a regular sleep-and-wake schedule and minimising light and noise.
Positive work environment: Having a comfortable workspace and control over one’s activities to reduce stress and contribute to the sense of mastery over pain.
Healthy relationships: Nurturing honest and supportive friendships and family ties to ease anxiety that exacerbate pain.
Exercise: Regular activity to build strength and lower stress.


Another bottom line could be financial. Don’t rush in and end up with worse pain and an empty wallet. Do your internet research and discuss the best interventions with your GP. For a quick and dirty internet start, Google “chronic pain” then “NIH”, or go directly to http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm. There you will find easy-to-read summaries and links to important research papers.


References:

Blyth F.M, L.M. March, A.J. M. Brnabic, L.R. Jorm, M. Williamson, and M.J. Cousins. Chronic pain in Australia: a prevalence study. Pain 2001 Jan; 82 (2-3) pp127-34.
Breivika H., B.Collett, V. Ventafridda, R. Cohen, and D.Gallacher. Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European journal of pain, Vol 10, May 2006, pp.287-333.
Khazzoom L. Drug-free remedies for chronic pain. AARP the magazine, Jan-Feb 2009, pp 26-30.
Tunks E.R, J. Crook, and R.Weir. Epidemiology of chronic pain with psychological comorbidity: Prevalence, risk, course, and prognosis. Canadian journal of psychiatry, Vol 53, No 4, April 2008. pp 224-44.


Aged aphorisms

Aged aphorsisms: standing the test of time

Anon.

Statistics show that at the age of seventy, there are five women to every man. Isn’t that an ironic time for a guy to get those odds?

You know when you have reached middle age when it takes longer to rest than to get tired.

You’re getting old when you don’t care where your spouse goes, just as long as you don’t have to go along.

It’s better to be over the hill than under it.

By the time a man is wise enough to watch his step, he’s too old to go anywhere.

Middle age is when you have stopped growing at both ends, and have begun to grow in middle.

You’re getting old when “getting lucky” means you find your car in the parking lot.

Someone has described heaven as a family reunion that never ends. What could hell possibly be like? Home
videos of the same reunion?

A man has reached middle age when he is cautioned to slow down by his doctor instead of by the police.

Middle age is having a choice of two temptations and choosing the one that will get you home earlier.

You know you’re into middle age when you realise that caution is the only thing you care to exercise.

At my age, “getting a little action” means I don’t need to take a laxative.

Don’t worry about avoiding temptation. As you grow older, it will avoid you.

The aging process could be slowed down if it had to work its way through parliament.

You’re getting old when you wake up with that morning-after feeling, and you didn’t do anything the night before.

The cardiologist’s diet: If it tastes good, spit it out.

It’s hard to be nostalgic when you can’t remember anything.

 


Alzheimer’s Disease Update (2005)

Alzheimer’s disease update (2005)

by Fred Lane PhD
The Alzheimer’s debate continues and it remains an important issue for ever-increasing numbers of retired and elderly people in Australia. Last year (2004) Australian scientists were loudly hailed on TV after reporting a new intervention that looked good, theoretically, and even seemed to work with specially bred mice. Another group announced that a non-invasive blood test would predict Alzheimer’s disease some two years before behavioural signs appeared.

Failed promise

Unfortunately, the history of Alzheimer’s research is littered with such claims. The late 1990s drugs, like Aricept, Reminyl and Exelon, introduced with such high hopes, have proven once more to be of limited value. Some demonstrate small changes early on, but none provide significant long term benefit. Non-invasive CAT-scans were detecting the early signs of brain atrophy that go with Alzheimer’s disease in the 1980s, but that discovery has led to little substantive progress towards a cure.

The first and most important point to be made is that, contrary to official death rate data, there is little difference in Alzheimer’s incidence rates in any society, other than what can be explained by simple age demographics. A stigma still attaches to mental disorders in our society. People who die, incontinent and bed-ridden with Alzheimer’s disease, are frequently listed as dying from pnuemonia or other disorder that their immune system, virtually destroyed by Alzheimer’s, could not fight.

However, since Ronald Reagan’s candor, Nancy Reagan’s strong support over her husband’s 10-year course of the disease and the publicity associated with Hazel Hawke’s dementia, the Alzheimer’s stigma is gradually wearing away. This should lead to better reporting and, more importantly, better research.

Perhaps one of the most persistent myths is that exposure to aluminium causes Alzheimer’s disease. Except for a very rare Guam-related Parkinsonian dementia, there is no difference whatsoever between the age-corrected rates of Alzheimer’s in societies that have never seen an aluminium cooking pot and individuals who both cook with aluminium utensils and use heavy applications of aluminium-based deodorants.

Prevalence claims untrue

The doomsayers’ claim that half those over 80 years of age have Alzheimer’s is simply not true. Official dementia death rates of around ten per cent certainly suggest a much lower figure, but these data are not accurate. Probably only one in four people over 80 nowadays is likely to have dementia of any kind and only about half of these will have Alzheimer’s disease. Alzheimer’s is just one of 200 or more disorders that contribute to both the benign (potentially treatable) and malignant forms of dementia in the elderly and there is no certainty at this stage that what we call Alzheimer’s is in fact a single entity. Because of the many variations in the progress of the disease and because of its chequered treatment response history it is possible that there are many different diseases lumped into the one diagnostic “Alzheimer’s” category.

Simple tests

Another serious problem is that although simple and fairly reliable pencil and paper dementia tests have existed for years (e.g., the Mini Mental State Exam), some GPs seem reluctant to use them. Misdiagnosis, especially in the early stages, is not uncommon.

The American National Institutes of Health report that research funding has increased from US$298 million in 1994 to US$680 million ten years later. Additionally, Americans spend US$1 billion or more a year on dementia-related drugs, many of which have demonstrated little efficacy in properly controlled tests. Recent discoveries, including research in Australia, are at last claiming causal links between the well-known amyloid plaques and neurofibrillary tangles found in the atrophied brains of demented people at autopsy. Identifying the precursors and finding substances that will control them safely will advance the science markedly.

The statins?

There are suggestions that statins, the cholesterol lowering drugs, may be effective in reducing the numbers of people contracting the disease. The anti-inflammatory properties of ibu-profen and aspirin also show promise, at least for some forms of dementia.

The injection of processed stem cells into diseased brains is also showing encouraging results. However, it is the advocacy of people such as Nancy Reagan and Christopher (Superman) Reeve for stem cell investigation that is equally important because it has increased interest in that very promising line of research.

Vitamins E, C, B-6 and B-12, a regular fish diet and even a plant-derived traditional Chinese herbalist supplement, huperzine, are all subjects for ongoing investigations, but none have yet demonstrated robust long term efficacy.

Use it or lose it

What can be done by us all right now, in the early stages or before the disease manifests itself? The “Use it or lose it” philosophy remains sound. Keep physically and mentally active. Don’t use arthritis or other infirmity as an excuse not to keep fit. Join a gym.

Do crosswords, learn a new skill, join a bridge club, play chess, learn to surf the internet, sign up for a university or TAFE course. Eat a low fat balanced diet, rich in fruit and vegetables, and include an omega 3-rich fish meal, such as tuna, salmon or mackerel, at least once a week. Ensure you maintain correct levels of folic acid and vitamins C, E, B-6 and B-12, but for best results, do this through diet rather than pills. Reduce linoleic acid intake, such as that found in margarine, butter and dairy products. Eat plenty of darkly coloured fruit and vegetables. Keep blood pressure in check.

Unfortunately, one important aspect of Alzheimer’s treatment is showing little advance, because it is poorly funded and there is practically no research into the problem. This is the education and support of carers. It may be strongly argued that many Alzheimer’s patients in the latter stages of the disease know little about what is going on and care even less. It might be the person attempting to care for a patient at home who requires a stronger focus of support and assistance.

If the carer network fails because of lack of support, the Alzheimer’s patient must enter a hospital or nursing home of some sort, but this can be expensive, wasteful of trained staff and is perceived by many to be less than humane. Certainly, a time will come when such care becomes essential, but the longer an Alzheimer’s patient can be cared for at home, the better it is for all concerned.

Websites:

Try www.alz.org, www.aarp.org/ life/cargiving, or www.alzheimers. org.au for further information.

Reference:

Pieters-Hawke, S. and H Flynn. Hazel’s journey: A personal experience of Alzheimer’s. Pan Macmillan: South Yarra. 2004

 


Fat old people live longer

Fat old people do live longer than skinny old people

by Fred Lane PhD

Getting good workouts at the gym? Want to keep your brain in shape? Try internet sites such as www.aarp.com and search there for “games.” Take your pick of on-screen trivia, crosswords or other beneficial, entertaining and educational problems.

But, at the same time, be careful to avoid obsessing about being slightly overweight. Contrary to mainstream medical and popular magazine advice, it has long been suspected that people over age 65 live longer if they are a bit fat, rather than a bit skinny. The Journal of the American Medical Association published a 20 April 2005 article (Flegal et al 2005) that strongly supports the “bit fat” position.This in turn is supported by many studies, including an important paper presented at the  2008 Australian Gerontological Conference and published in the prestigious Journal of the American Geriatric Society (Flicker et al 2010).

Major Surveys

Scientists from the Centers for Disease Control (CDC) and the National Cancer Institute (NCI) analysed data from three major American community surveys conducted between 1971 and 1994, involving nearly half a million person-years. Their findings clearly debunk myths published by the CDC in 2004 that obesity was killing an extra 400,000 people a year. The CDC  later revised this figure downwards to 365,000, but even this was found to be exaggerated.

There is no doubt that extreme obesity, as measured chiefly by belly fat, together with a lack of fitness, threatens life and increases the chance of contracting diabetes, arthritis and other potentially crippling disorders. However, it is a simple fact of life that few people with extreme obesity see their 65th birthday. On top of that, when potentially confounding factors, including smoking, sex and race, are taken into account, a body mass index (BMI) of 25-29 is not only nothing to worry about, it is suprisingly superior to the “normal” BMI.

(One of the best measures of obesity is the BMI, see the table below.)

Too rich? Too thin?

The study also confirms serious concern for those with BMIs of 18.5 or below. Contrary to Wallace Simpson, Duchess of Windsor, who said you could never be too rich or too slim, this study once more stresses the danger of being too thin after age 65.

There is no doubt that extreme obesity kills. It might well be responsible for some 112,000 extra American deaths a year in all age groups. On the other hand, being modestly overweight probably prevents 86,000 American deaths a year. Maybe modestly overweight elderly people weather medical emergencies better.

All this is no more a licence to overindulge or regress to couch potato behaviour than it is for the uncritical rejection of all the diet industry’s propaganda. Instead, as some of the propaganda correctly says, keep your brain active, exercise regularly, observe a sensible well-balanced diet and  control stress. Adopt a lifestyle that contributes to normal blood pressure and low ‘bad’ cholesterol intake. Drink alcohol moderately and ditch the cigarettes and junk food. Have regular medical checkups. However, importantly, don’t obsess about trying to get below a BMI of 25-29.

Bottom line

If you are over 65 and fit, don’t worry yourself into a depression if you can’t hit the “Normal” BMI touted by the crash diet and insurance industries. On the other hand, seek help if you can’t boost your BMI to a figure above18.5.

Reference

Flegal K., Graubard B.I. et al. Excess deaths associated with underweight, overweight and obesity. Journal of the American Medical Association. Vol 293. pp 1861-7. 2005.

Flicker,L., K. McCaul, et al. Body Mass Index and Survival in Men and Women Aged 70 to 75, Journal of the American Geriatric Society, 58:234-241, 2010.

Body Mass Index for Adults

There are two methods:

1. BMI = WEIGHT in kg divided by HEIGHT in metres SQUARED. A person 1.67m in height and weighing 65kg would have a BMI of 23.3 (BMI = 65 divided by 1.672 = 65 divided by 2.79 = 23.3). OR

2. Use the table below to determine your BMI. First, find your approximate height on the far left column. Next, move across the row to find your weight. Once you’ve found your weight, move to the very top of that column. This number is your BMI.

What does BMI mean?   BMI 18.5–24.9 = “Normal”; BMI 25.0–29.9 = Overweight;
BMI 30.0–39.9 = Obese; BMI 40.0 and above = Extreme obesity.

Height

21

22

23

24

25

26

27

28

29

30

31

1.47m (4’10”)

45.4kg
100lbs

47.6kg
105lbs

49.9kg
110lbs

52.2kg
115lbs

54.0kg
119lbs

56.3kg
124lbs

58.5kg
129lbs

60.8kg
134lbs

62.6kg
138lbs

64.9kg
143lbs

67.1kg
148lbs

1.52m(5’0″)

48.5kg
107lbs

50.8kg
112lbs

53.5kg
118lbs

55.8kg
123lbs

58.0kg
128lbs

60.3kg
133lbs

62.6kg
138lbs

64.9kg
143lbs

67.1kg
148lbs

69.4kg
153lbs

71.7kg
158lbs

1.55m(5’1″)

50.3kg
111lbs

52.6kg
116lbs

53.3kg
122lbs

57.6kg
127lbs

59.9kg
132lbs

62.1kg
137lbs

64.9kg
143lbs

76.1kg
148lbs

69.4g
153lbs

71.7kg
158lbs

74.4kg
164lbs

1.6m(5’3″)

53.5kg
118lbs

56.2kg
124lbs

59.0kg
130lbs

61.2kg
135lbs

64.0kg
141lbs

66.2kg
146lbs

68.9kg
152lbs

71.7kg
158lbs

73.9kg
163lbs

76.7kg
169lbs

79.4kg
175lbs

1.65m(5’5″)

57.2kg
126lbs

59.9kg
132lbs

62.6kg
138lbs

65.3kg
144lbs

68.0kg
150lbs

70.8kg
156lbs

73.5kg
162lbs

76.2kg
168lbs

78.9kg
174lbs

81.6kg
180lbs

84.4kg
186lbs

1.7m(5’7″)

60.8kg
134lbs

63.5kg
140lbs

66.2kg
146lbs

69.4kg
153lbs

72.1kg
159lbs

75.3kg
166lbs

78.0kg
172lbs

80.7kg
178lbs

83.9kg
185lbs

86.6kg
191lbs

89.8kg
198lbs

1.75m(5’9″)

64.4kg
142lbs

67.6kg
149lbs

70.3kg
155lbs

73.5kg
162lbs

76.7kg
169lbs

79.8kg
176lbs

82.6kg
182lbs

85.7kg
189lbs

88.9kg
196lbs

92.1kg
203lbs

94.8kg
209lbs

1.8m(5’11”)

68kg
150lbs

71.2kg
157lbs

74.8kg
165lbs

78.0kg
172lbs

81.2kg
179lbs

84.4kg
186lbs

87.5kg
193lbs

90.7kg
200lbs

94.3kg
208lbs

97.5kg
215lbs

100.7kg
222lbs

1.85m(6’1″)

72kg
159lbs

75.3kg
166lbs

78.9kg
174lbs

82.6kg
182lbs

85.7kg
189lbs

89.4kg
197lbs

92.5kg
204lbs

96.2kg
212lbs

99.3kg
219lbs

103.0kg
227lbs

106.6kg
235lbs

1.91m(6’3″)

76.2kg
168lbs

79.8kg
176lbs

83.5kg
184lbs

87.1kg
192lbs

90.7kg
200lbs

94.3kg
208lbs

98.0kg
216lbs

101.6kg
224lbs

105.23kg
232lbs

108.9kg
240lbs

112.5kg
248lbs