Navigation Aggravation: Trying to Schedule a Doctor’s Appointment

My experience shown within a flowchart in trying to set up an appointment with my general practitioner. I can’t call the office directly. I have to go through a centralized portal. I waited over 20 minutes to get a representative and in that time I was barraged by their automated marketing and promotional messages.

P.S. I could not get an appointment within a period of time so that they could address my immediate issues.

Lifespan: Why We Age and Why We Don’t Have To by David A. Sinclair (Review and Notes)

If you are over 50 years old, this book is an excellent resource related to your health, general fitness and quality of life.

I have included some excerpts for the book as my notes and reference:

I believe that aging is a disease. I believe it is treatable. I believe we can treat it within our lifetimes. And in doing so, I believe, everything we know about human health will be fundamentally changed.

There are some simple tests to determine how biologically old you probably are. The number of push-ups you can do is a good indicator. If you are over 45 and can do more than 20, you are doing well. The other test of age is the sitting rising test. Sit on the floor, barefooted, with the legs crossed. Lean forward quickly and see if you can get up in one move. A young person can. A middle-age person typically needs to push off with one of their hands. An elderly person often needs to get onto one knee.

There’s also a difference between extending life and prolonging vitality. We’re capable of both, but simply keeping people alive – – decades after their lives have been defined by pain, disease, frailty, and immobility – – is no virtue.

Multiple “hallmarks” of aging:
Genomic instability caused by DNA damage
Attrition of the protective chromosomal endocaps, the telomeres
Alterations to the epigenome that controls which genes are turned on and off
Loss of healthy protein maintenance, known as proteostatis
Deregulated nutrient sensing caused by metallic changes
Mitochondrial dysfunction
Accumulation of senescent zombielike cells that inflame healthy cells
Exhaustion of stem cells
Altered intercellular communication and the production of inflammatory molecules

Youth—broken DNA genome instability— disruption of DNA packaging and gene regulation (the epigenome)— loss of cell identity —cellular senescence— disease— death

The older we get, the less it takes for an injury or illness to drive us to our deaths. We are pushing closer and closer to the precipice until it takes nothing more than a gentle went to send us over. This is the very definition of frailty.

When we stay healthy and vibrant, as long as we feel young physically and mentally, our age doesn’t matter. That’s true whether you are 32, 52, or 92. Most middle-aged and older adults in the United States report feeling 10 to 20 years younger than their age, because they feel healthy. And feeling younger than your age predicts lower mortality and better cognitive abilities later in life.

After 25 years of researching aging and having read thousands of scientific papers, if there is one piece of advice I can offer, one sure fire way to stay healthy longer, one thing you can do to maximize your lifespan right now, it’s this: eat less often.

The important thing is not just what we eat but the way we eat. Many of the centenarians have spent their lives eschewing a morning meal. They generally eat their first small meal of the day around noon, then share a larger meal with their families at twilight. In this way, they typically spend 16 hours or more of each day without eating.

According to one study funded by the Centers for Disease Control and Prevention and published in 2017, individuals who exercise more – – the equivalent of at least a half hour of jogging five days a week – –have telomeres that appear to be nearly a decade younger than those who live a more sedentary life.

One recent study found that those who ran 4-5 miles a week – – for most people, that’s an amount of exercise that can be done in less than 15 minutes per day – – reduce the chance of death from a heart attack by 45% and all cause mortality by 30%.

It’s high intensity interval training (HIIT) the sort that significantly raises your heart and respiration rates— that engages the greatest number of health promoting genes and more of them in older exercisers.

A study of more than 41,000 metformin users between the ages of 68 and 81 concluded that metformin reduced the likelihood of dementia, cardiovascular disease, cancer, frailty, and depression, and not by a small amount.

People taking metformin were living notably healthier lives – – independent, it seemed, of its affects on diabetes.

The beauty of metformin is that it impacts many diseases. Through the power of AMPK activation, it makes more NAD and turns on sirtuins and other defenses against aging as a whole -– engaging the survival circuit upstream of these conditions, ostensibly slowing the loss of epi-genetic information and keeping metabolism in check, so all organs stay younger and healthier.

Like most people, I don’t want unlimited years, just ones filled with less sickness and more love. And for most of those I know who are engaged in this work, the fight against aging is not about ending death; it’s about prolonging healthy life and giving more people the chance to meet death on far better terms – – indeed, on their own terms. Quickly and painlessly. When they are ready.

Either by refusing the treatments and therapies at all for a prolong healthy life or accepting those interventions and then deciding to leave whenever the time is right, no one who has returned what they have been given should have to stay on this planet if he or she does not wish to do so. And we need to begin the process of developing the cultural, ethical, and legal principles that will allow that to happen.

Is Playing Pickleball Safe Now?

Is playing Pickleball less safe now than it was in the summer? Given the change in weather and new wave of Covid 19 infections, what should we be doing to ensure safe and healthy play?

Disclaimer: I am not a doctor, epidemiologist, scientist, government official, CDC employee or pandemic expert. The conclusions and opinions are mine based on limited information, data and just a few hours of thought and analysis. Like many other topics today, there is a lot of misinformation and this post is my personal effort to sort out my alternatives and plan of action.

Overview: There are approximately 2,300 members in the South Jersey Pickleball Group. Recently there were a few members that tested positive for coronavirus. These members had recently played at various pickleball venues and obviously this created some concerns within the pickleball community. While there have been reported incidents of coronavirus infections nationwide spreading at indoor pickleball facilities, there appears to be few, if any infection outbreaks of coronavirus from playing outdoors. 

The infection rates within the State of New Jersey and specifically Camden County have risen dramatically the past few weeks. In Camden County, more than 15,000 cases of infection have been reported since the start of the pandemic. This represents about 3% of the Camden County population. Gloucester County has approximately 7,200 cases, representing about 2.5% of their population.

If we use 3% as the mean, as many as 70 South Jersey Pickleball members could be projected to have already caught the coronavirus. So no one should be surprised in a group as large as ours, there may be some reported cases. (As an offset, most members of the South Jersey Pickleball group are obviously very health conscious and many are retired so they are not exposed to potential workplace initiated infections.)

Risk Management Considerations:

Many in our pickleball community are in a high risk age group (65+) related to complications from Coronavirus. Younger players generally have less to fear if infected but they still need to exert vigilance and prevention for themselves and when playing with or around older players. Older players too must be diligent when playing with or around younger players.

Exposure to many players. If you play golf or tennis, generally you play with three other people for the morning or session. Some Pickleball Meetups had 50 or more people signed up so this meant in a two or three hour period, you could be partnered or playing with 12-20 different people depending on the available players at your skill level. (See chart). If you play 3 or more times a week, you can be playing with 40 or more different people creating added potential exposure or risk.

Exposure to players who are visiting or returning from vacations from “hot infection” states. Pickleball players (usually) are a very friendly group. We don’t check IDs on the court. Hence we don’t quarantine players from Florida, South Carolina etc playing on South Jersey or local courts. Regrettably as I write, just about every state is a “hot infection” state.

Exposure to different pickleballs. There are those balls you play with each game and those balls you toss back to another court when their ball rolls on your court.

Recommendations:

These measures appear to be prudent given the colder weather and the rising rates of Coronavirus infections nationwide and within the South Jersey/Philadelphia area. Hopefully by Spring 2021, vaccines will have begun to be distributed and pickleballers can return to an almost normalized routine.

Play within small groups of players (4-8) to minimize exposure. Various groups are organizing and using the TeamReach app to schedule events. If, by chance, a player displays symptoms or tests positive, TeamReach can serve as a communication and tracking tool.

Ideally one should play with those who are responsible and considerate of the health and safety of other players. These also should be people who you can have fun and be social with.

Players who play exclusively outside may be safer to play with than players who have recently or are playing indoors.

If you are an older player, it may be safer to play with people within your own age group. Most younger players have families and children and are much less likely to be able to isolate due to career and family responsibilities.

Playing outdoors appears to be more safer (not foolproof) than playing indoors. If you are deciding to play indoors, make sure that the facility and employees are practicing the same due diligence and health risk mitigating efforts as you are.

Maintain social distancing and wear a mask while resting or waiting to play again. (I don’t think I have seen those precautions taken at all at any of the venues I have played. I think all of us were lulled by the great weather.)

Don’t handle someone else’s paddles. (This generally happens when moving paddles along a fence or queue to create space.)

If you are feeling sick or have a fever, don’t play!! (whether it’s outdoors or indoors). This is not the best time to try to play through an illness.

From Sgt. Phil Esterhaus (Hill Street Blues), one last piece of advice “Let’s be careful out there!”

Tuesday November 3, 2020

Author’s Note: Science fiction? Horror? Or Cautionary Tale? You the reader decide…

He awakened, startled by the noise outside. It was 3:00 AM. Normally he would be up and writing his first tweet. However no one wanted to hear from him anymore. Even the Fox Morning show was not taking his calls. Here it was the morning of a scheduled election day that was not going to take place. “Too dangerous” he argued and the election date was postponed. Plus his septuagenarian opposition candidate had contracted the virus and now was in serious condition. He wondered about the crowd outside – – it still sounded very loud and angry. Thankfully he was able to count on the military to place a perimeter around the White House grounds. That did not stop a few people from attempting to breach the White House grounds. Occasionally there was a sound of gunfire and the smell of tear gas. He remembered videos of the last days of Hitler hunkered down in his Berlin bunker while Russian troops closed in. It wasn’t tanks or troops he was avoiding but the utter catastrophe that was occurring during his watch. He was alone. His wife and young son sought refuge in a Caribbean island that had not been affected by the virus. 

How could things go so wrong and so quickly in nine months! He was assured by people in his administration that there was no huge threat to the American people. Regrettably those people were not scientists nor were they medical experts who could’ve provided the proper expertise and advice. His initial primary concern was the falling stock market and its effect on the economy and on his reelection chances. He now regretted the cuts to the budgets of the CDC and other medical projects. Testing for the virus had been delayed and many low income individuals with no health insurance could not afford the $3,000 charge and did not get tested. Maybe the Medicare for All was not such a bad idea?

The catastrophe started slow. He even bragged that this was all a hoax and that the virus would disappear shortly. However pockets of infection started to grow at a steady pace. Once infection pockets were found in large cities like New York, Chicago, Los Angeles and Atlanta, the virus spread rapidly. Just about every state with a large population center  was overwhelmed with sick and infected. The stock market mirrored the infection rate plaguing the country. The Dow dropped below 2500 and continues to decline. The Fed attempted to staunch the bleeding and even dropped to negative rates at his insistence but all it did was panic investors more. No one was worried about their 401Ks anymore.

He initially appointed his vice president to spearhead the effort to manage the crisis. But with each report of a 25,000 or more dying, he appointed new people starting with his son in law and then a Fox News personality to take over crisis management. In desperation he asked his daughter to take over but she also fled to an island resort not affected by the virus. Responsible people avoided him and his administration as much as they did the virus.

Being a germaphobe, he was always skittish around people with coughs and colds. He curtailed any outside campaigning or outside exposure when the rate of infections rose dramatically in the spring. No more MAGA rallies. No golf outings. He had found it hard to find people to play golf with when the infection rates spiked. Except for Lindsey. Even the summer national party conventions were cancelled for health concern reasons.

The infection rate overwhelmed hospitals and medical capabilities. Many doctors, first responders and nurses were among the first victims of the rising infection rate as protocols had not been adequately developed or communicated. Those doctors and health officials who did not die found themselves too sick to treat other patients. Infected people, usually the elderly, passed away in their homes. They received no medication and no treatment. He realized that he lost the country when even Fox News broadcast pictures of elderly people dying uncared in nursing homes.

For those who did not have the virus, life was very hard with plenty of disruptions. There were food shortages as many stores and groceries were closed. There was no gas for cars. Most civil and government services were suspended or terminated. No mail was being delivered. Law enforcement and the judicial system ground to a halt. Violent crime rose dramatically everywhere. Desperate people seeking food, medication and household supplies preyed on those neighbors who had them. Banks and the financial systems were at a standstill. ATMs did not dispense cash. The country was in financial, commercial and social gridlock.

City streets were largely empty. Those who were seen walking wore masks. Places where people tended to congregate socially were closed including churches, movie theaters, malls, restaurants and gyms. Neighbors stayed to themselves in their homes fearful to venture outdoors. Schools and universities closed in the Spring and remained closed. Unemployment exceeded Depression era levels. Manufacturing plants were shuttered. The service industry ground to a halt. No pizza deliveries. Fast food chains were dark. If you had problems with your internet or cable, there were no home repair calls.

There were no diversions to distract those who were still healthy from all the bad news. The World Series was completed overseas in Aruba. The college and professional football seasons had been cancelled. There was a limited Olympics in late summer but U.S. athletes were prohibited from entering Japan, the site of the games.  As a further insult, Mexico and Canada blocked their borders to prevent Americans from coming in. Countries around the world including China, Japan and South Korea did not allow flights emanating from the United States. Mexico was beefing up their borders to keep Americans out and planning to build a wall.

His poll numbers were in the low single digits. His businesses suffered too. His resorts and golf courses were closed. Diplomats and business people were no longer making any reservations at his hotels. It seemed the only business being done was by some of his prayer partners who were urgently requesting seed money through various media ads to prop up their flagging enterprises. A donation of $1,000 was guaranteed to protect you from the virus, or if you were infected, to survive it.

The Federal government was bankrupt, financially, morally and in operation. State and local governments were left to deal with the catastrophes. Some states also issued their own travel restrictions prohibiting citizens from “high risk” areas from coming into the state. There were countless stories of citizens and charities taking care of the sick and dying and attempting to rebuild. The virus adversely infected the American immune system  but did not destroy the American spirit.

He grimly understood that he did achieve one thing that many in the country had insisted upon. He leveled the playing field between rich and poor. The virus did not differentiate between those who had money or did not. Some of the rich tried to flee to other countries but found themselves turned away. He sighed. All of this was Obama’s fault. He did reach out to the former President but Obama did not take his call.

He realized that his aide and butler had not knocked on his bedroom door to deliver briefing papers that he rarely read and breakfast. No more McDonald meals as the local store was closed. He poked his head out his bedroom door and saw there was no activity, no one in sight, not even Secret Service. He turned on the TV but it was not working. He could not access his Twitter account either. Suddenly, the din from the crowd outside was being replaced with a rumble by the gates…

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