Month: February 2023

February 2023

By Richard Fleming

During my years in medical practice, one of the most common complaints shared by my older patients was stiff and painful joints and muscles. I tried to approach such problems with sympathy and concern. But I can now confidently state if I was still in practice today, I would approach these complaints with empathy and vehement affirmation. Oh my goodness.

Now that I am in my early 70s, my understanding of joint and muscle stiffness has advanced dramatically. Not because I have read more deeply in medical texts. My knowledge has expanded through personal experience.

Fortunately I do not have much arthritis, as far as I can tell. Unfortunately my knees tend to get stiff and painful. When going to the bathroom in the middle of the night – a possible topic for a future post – it sometimes feels like I’m walking on stilts. My right wrist has started protesting any attempts to embark on home repair projects. And in the mornings I now find I must put my pants on without bending at the waist. (Important disclaimer: if you do not face this problem yet, don’t attempt this activity at home. It puts you at high risk of falling.) My lower back simply refuses to bend until I have at least two cups of coffee.

Does any of this sound familiar?

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As humans age, our joints and muscles tend to become stiff and sore. This happens for various reasons. Arthritis – inflammation in the joints – is a common cause. But we can also develop stiffness and pain without arthritis. The tendons and ligaments which surround our joints grow less flexible as they age. Older muscles become infiltrated by increasing amounts of fat and a pigment of aging called lipofuscin, both of which limit muscle contraction. Muscle fibers shrink. Add these things together and what do you get? Stiff muscles and joints.

While stiffness is a near-universal component of growing old, we need not succumb to it. Useful methods can help counter this scourge. Using our muscles and flexing our joints frequently is important. Exercise helps. Regular stretching and walking can improve flexibility.

I’ve never been one for assuming awkward postures or posing like a clown, but I am told yoga is a useful technique for slowing down the aging of joints and muscles. Truth be told, yoga is on my bucket list. But it is down around #37 or so, below projects like cleaning the garage and doing paint touchups around the house. I may come to regret yoga’s low ranking and really should consider moving it up to the single-digit category.

Other useful measures are ice or heat. An interesting phenomenon is that some people do better with cold and others do better with warmth. What accounts for the difference? This is one of the great unsolved mysteries of aging. I hope some smart research team can obtain funding to investigate this important problem.

Of course, massage can be therapeutic. Massage helps not only stiff muscles but pretty much all other human ailments as well.

And a good night’s sleep never hurts, though for many that concept is, shall we say, a stretch goal.

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I do my best not to feel victimized by aging. Why should I resent seeing young people out running rapidly through the park? By moving more slowly, I get to see the birds and flowers they miss because they move too quickly. There is no reason for me to begrudge kids playing a vigorous game of tennis. I simply recall my own embarrassing efforts to play that game when I was their age, and I am suffused with feelings of contentment.

But – if I’m being honest – it is hard to avoid feeling a mite resentful at times about the creeping infirmities which accompany a maturing body. When I feel this way, I put myself on another time-out. I try to force myself to remember and then count my blessings. I tell myself that growing old is so much better than the alternative.

And I keep repeating this simple mantra: stiff happens.

My comments here are intended for folks experiencing the common stiffness and soreness of aging muscles. If you are having significant muscle or joint pains which are new or seem in any way unusual, please contact your doctor for evaluation.

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February 2023

By Richard Fleming

If you are tired of hearing about covid-19, I get it. I’m tired too. Isn’t three years of this pandemic enough? A brief look back into history justifies our frustration. The deadly 1918 influenza pandemic lasted only two years. Two! Going further back, the Plague of Justinian which killed millions lasted from 541-542. One year.

OK, I can hear my historian friends starting to grumble about selective facts and confirmation bias. I grant you the Black Plague lasted seven years. But it took place in the 1300’s, long before we had a scientific understanding of infectious diseases.

In these early years of the 21^st Century we understand a lot about viruses. We know how to reduce covid’s spread. We have effective therapeutics for those who become infected. Nonetheless the pandemic persists. It is too early to look away. Especially for us seniors. While mortality figures have dropped substantially, hundreds of people in the U.S. continue to die from covid every day. Thousands get sick enough to require hospitalization.

It is notable that the proportion of covid-19 deaths among seniors is higher now – in 2023 – than at any previous time during this pandemic. In the first year 80% of covid deaths occurred in those over age 65. Today it is 90%. And seniors are being hospitalized at four times the rate of the general population.

Black and Latino seniors experience even higher mortality. In California, for example, covid deaths among Black seniors are about 30% higher than would be expected if deaths occurred equally among seniors of all races. For Latinos, covid deaths are about 80% higher. These differences have nothing to do with biology. They are due to social and environmental factors. People of color have less access to healthcare services. Their work and living situations often put them at disproportionate risk of acquiring this virus. And informed, relevant communication to communities of color about prevention and treatment options has been inconsistent.

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Although opinions vary about many aspects of this pandemic, everyone agrees on one fact: covid hits the elderly the hardest.

Yet this basic truth has not led our society to follow simple, easy steps to counter the virus. A significant current of public opinion feels wearing a mask in public indoor spaces and staying updated on vaccines is asking too much. It is too big a burden.

Loud voices angrily denounce covid prevention measures. They shrilly push a political agenda, not public health policies. These voices mock expertise. Their subtext is clear: if covid is culling the herd, that’s not necessarily bad. After all, folks in their 70s, 80s, and 90s are close to dying anyway. Maybe the Social Security Trust Fund will last longer if we let more current recipients move on.

Thankfully, not everyone feels this way. But there is significant sentiment that the time for small sacrifices is over. Personal freedom and individual liberty trump community welfare. Especially the welfare of those who have lived in the community the longest.

Where does this leave us? With the clear understanding that when it comes to covid-19, boomers bear the biggest burden. And for many people this is just fine.

If I seem a tad irritated you are reading me correctly.

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I acknowledge that seniors bear some responsibility for the increased problems we face from the pandemic. We have not all stayed up-to-date with vaccines. Not all of us wear masks while shopping. We sometimes go to indoor gatherings where unmasked people are milling about in close quarters. We need to be more careful. We need to be more cautious.

But I also want to ask folks of all ages to be more careful. More cautious. And more compassionate.

I have always put a premium on empathy. It is one of the most beautiful human traits. I try to understand where other people are coming from. But I am befuddled by why so many people seem unwilling to take small steps to help protect others.

When I’m in our local grocery store, three years into this pandemic, roughly 75% of the seniors and 2% of the young people are masked. People of all ages are coughing into their hands, sneezing at their sleeves, and standing close together in the checkout lines. This creates a covid playground.

I do not spend much time on social media. But when I read comments about covid on FaceBook or NextDoor, many say something to the effect of, “Leave me alone. If you’re afraid of the virus, then you can wear a mask.”

I know of several people in my age group who were themselves very careful and took all the right precautions. But they acquired covid from young adult family members who probably caught the virus at a party or a bar. The older family members became very sick, and I know of one who died. Of course the young people felt horrible. But their empathy arrived a little late.

I wish everyone would understand that when it comes to a still-lethal virus spread easily by respiratory transmission, we are all in this together. No one is an island. We are a community. And as a community, are we willing to tolerate losing the equivalent of a plane load of seniors every day? Are these deaths an acceptable cost to preserve some tarnished liberty?

Is it unreasonable to ask folks at low risk of complications from covid to think about others? To consider the health and the lives of those at higher risk?

Do old people matter?

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