HOW OLD IS TOO OLD FOR A COLONOSCOPY ?

We live in an age in which health care spending has come under close scrutiny, and rightfully so.  But how will we decide such issues when dealing with the elderly.  What I would NOT want to see are decisions based on age alone.  There are protocols being generated by large groups of advisers suggesting that colonoscopies should not be performed on patients over the age of 75. 

I fear that such arbitrary declarations fail to consider the mental and physical status of any particular patient.  Patients vary enormously as they age.  Some are mentally and physically quite vibrant and functional well into their nineties.  Others suffer from such debilitating cardiovascular/pulmonary or cognitive disabilities in their forties or fifties that a colonoscopy would be inappropriate.

Allow me to offer one particular example which illustrates my point.  An 87 year old woman literally bounded into my office requesting a colonoscopy.  “My primary doctor detected an iron deficiency anemia in me and I believe I probably have colon cancer.  I need a colonoscopy”.  I was a bit taken aback by her forthright approach and obvious excellent physical and mental state of being.  “Besides, my sister had colon cancer.”  I performed the procedure and did, indeed, find a colon cancer.  A CT scan did not reveal evidence of metastases and we discussed a surgical option.  “I’m all for it”, she said “let’s go for it!”

I referred her to a local colo-rectal surgical group and spoke to the surgeon before her visit.  I alerted him to the fact that she was 87 but asked him to evaluate her on the basis of how she seemed to  him.  He agreed and soon scheduled her for surgery.  She did great and was out of the hospital in about four days.  There was no requirement for chemotherapy in her case.

So here was an individual patient who was clearly of such physical and cognitive functionality that her life expectancy might easily allow her to reach 100 with exceptional quality of life.  A colonoscopy in her made perfect sense and she has every expectation to life many more years as a result of what transpired subsequently. 

So, while motivated by a desire to reduce health care expenditures, let us be cognizant of the unique nature of each individual and avoid placing artificial limitations on testing based on age alone.

That would be age discrimination at its worst.

CONSIDERING D.N.R.– Do New “Facts” Change Anything?

The NYTimes features on ‘The New Old Age” are worthy of perusing.  In a recent piece by Judith Graham http://newoldage.blogs.nytimes.com/2013/03/14/healthy-rate-of-survival-for-elderly-saved-by-cpr/?src=recg&pagewanted there is a discussion regading new data on the outcomes of “code blue” resuscitation on patients 65 and older.  Such data seem to indicate that of the 18-20% who survive these efforts 58.5% are alive after one year.  Of this number 52% had moderate or severe neurologic damage.  The article seems to suggest that those who survive have reason for “hope”. But the author does acknowledge that there was no attempt to evaluate the quality of that life that was “saved”. 

There is no question that these end of life issues continue to be provocative and extremely controversial.  The article might lead one to be less likely to sign a D.N.R. form than previously. 

I believe the most reasonable approach (and one offered in this piece) is to realistically evaluate the quality of life we all experience on a periodic basis.  Why not make this an annual serious soul-searching event?

When cognitive decline reduces a once viable human being to a nonfunctioning one then why prolong this level of existence by means of cardiac resuscitation?  Would you want this state of existence for yourself?  But doesn’t this extend to physical suffering?  If a progressive neurological disorder renders someone all but helpless, should they not have some say in the prolongation of there life as well?  Should our goal be the number of years we or our loved-ones exist or their quality?

Again, we are dealing with the most difficult of life’s questions.  We need to continue to discuss them openly and frankly.  Will there ever be a template or algorithm that can or should be applied to everyone? Clearly not. But waiting to the moment of crisis or allowing family members to contravene our own wishes regading D.N.R. needs to be seriously addressed as well.

TRAVELING TO OUR “VACATION-MIND”

What is a vacation anyway? 

Can we find one through the pages of travel magazines, websites that portray locales with exotic beauty and escape from the chaos of our everyday lives?

Certainly our physical surroundings can contribute to a perception of change and a reduction in our day to day challenges of living. But if we truly believe a vacation from stress and adversity is a physical location, we are deluding ourselves.

Since all suffering and serenity arises from states of mind (of course influenced by life’s external events) the only true “vacation” can be found through mindful practices.  Meditation, yoga, prayer, exercise assist in clearing our mind of negative thoughts.  Being present in the moment, not attaching to thoughts or feelings of any kind, merely observing the content of our minds, allows us to reach a state of tranquility with is surprisingly restful. 

Of course we can do this when we travel.  The change in our physical location can assist us in altering our state of mind. But we can also bring our suffering with us by our thoughts and worries.  Likewise, we can achieve a sense of serenity without physically leaving our own homes. 

So learn how to find our “vacation-mind”  on a regular basis through practice and attention. It may save us some money as well.

 

COMPARE & DESPAIR — Why Comparing Your Life With Others Makes Little Sense

Compare and despair……. How much suffering has been engendered by envy over the lives of others around us?  It is barely ‘human’ to not observe the lives of friends, colleagues, relatives or bare acquaintances and not wish that some aspect of our lives were like theirs. 

Of course the absurdity of such a delusion becomes clear when we realize that the lives of others is a “package deal”.  It is not fair to just pick one aspect of someone’s life, then another aspect of someone else’s life etc. etc.  And, of course, there is the interior state of mind of that individual that we can never know.  A superficial evaluation of someone else’s life cannot possibly comprehend what goes on the emotional level.  Seemingly fabulous lives (to an outsider) may be filled with unexplainable pain and suffering when experienced from within. 

To Life, L’Chaim — revisited

The Hebrew toast “L’Chaim–to life”  is known to many from the Broadway show Fiddler On the Roof.  While having said it innumerable times during my life, I actually began to think about it in a new light.

It is interesting that the toast is “to life” and not “to a long life”, “a happy life”, “a successful life”, “a content life”, “a fulfilled life” etc., etc.   Why is that?  Did Jews not want those more favorable qualifiers for their lives? Of course not.  So why just “to life”?

Perhaps it has to do with acceptance rather than wishful thinking. Perhaps it reflects the group memory of persecution, destruction, harassment and genocide.  Yet despite all of this, life is felt to be a divine gift.

Perhaps it is a recognition that the bad times are opportunities for growth and transformation.  Perhaps it is an understanding that this “human experiment” is supposed to be difficult.  The mystics understood this.  The rest of us struggle with it on a daily basis.

So by simply stating, “l’chaim, to life”, we acknowledge the good with the bad,  the happy with the sad, all our triumphs and failures.  It is the entire package  called life that we celebrate when we toast each other. It is about pure acceptance and gratitude.

Embracing The Paradox of Joy & Suffering– Being Present in the Moment

My last posting has led me to continue to ponder the mystery– how do we live our lives in the face of all the suffering we see around us and which we experience in our lives?  How do we survive on the edge of chaos?

The irony is this– does this fear of the unknown diminish our ability to enjoy the blessings in our lives?  How do we accept the gifts of life and love that surround us while being in fear of the suffering that awaits us?  Those of us immersed in fear and negativity find our minds so overwhelmed that we pass beauty without seeing it.  We overlook gifts of gentleness and peace.

We are caught in a vortex of thoughts and feelings.  Many of us find ourselves paralyzed by the fear. We actually fear that we will not find our way out. This is a self-perpetuating cycle of suffering.  Not only are we suffering now for what has not occurred but our minds can’t function clearly enough to find solutions to our problems.

The answer lies in living within the now, the present moment.  We need to force ourselves to step out of our minds.  Here is the paradox–In order to make progress, to deal with our problems we must forget about them—at least for the moment.  By doing so we will learn to clear the chaos that produces anxiety and confused thinking.  Clearning our minds will actually allow them to function better.

Once again I find myself advocating for the practice of meditation.  It is the mechanism for developing our awareness.  It is training for being present in the moment.  It is the antidote for our mind’s internal battle. It reboots our minds.  It is an instant vacation.  It allows us to step out of the vortex of suffering and find peace.

When our minds return to our usual state of consciousness,  we may find  gifts of love and beauty previously  hidden in plain sight  are now visible. We may be shocked by how blinded we were to their presence.

And we will have a new perspective, a renewed confidence that we will be able to handle what comes our way. And this attitude will allow us to do just that.

Post – Sandy Holiday Party & Kabbalistic Themes

The staff from my surgicenter are getting together tonite for a belated holiday party.  As usual I will be asked to say a few words to the staff and their partners who will be there.  I hope that those in attendance will have had something to drink before I begin.  I don’t dislike offering an impromptu toast or speech but I know I will sound better if they have. 

I will keep it light.  I will offer my deepest appreciation for all their extraordinary  efforts during the storm, and the  loss of power and chaos that ensued. I will ask that while we are enjoying ourselves and celebrating our renewal that we not forget our friends and neighbors in the Garden State who are still suffeirng badly.  I will point out that the hotel in which we are standing was closed for many weeks because of damage. 

But  Kabbalistic themes are never far from my thoughts.   They deal with creation and destruction.  They speak of the myth of creation from the perspectives of the mystics who read the sacred writings with their own eyes.  They speak of the multiple universes that God created and destroyed before deciding that this one was “good”.  They write of the destruction of this universe soon after it was formed, of the tzimtzum, the chaos that followed when the divine energy could not be contained by matter and the vessels shattered.  Of the hidden sparks of divinity that surround us, are us.  Of the need to assist in the repair of this world.  Of our role in the process  by which tikkun operates.  Fixing, repairing, search and rescue, liberating holy sparks that lay covered by debris.  The debris is us, the physical world that can alternate between beauty and horrific ugliness.  Can be find the holy sparks amidst tragedy?  Can we ever raise a glass in celebration when the lifeless bodies of the innocent children of New Port have so recently re-joined the earth? 

All this is way too heavy for a holiday party. 

But destruction and renewal are a part of all of our lindividual ives, as well as the universe itself.  But finding joy amidst chaos is a human quality as well.   In our lives we bounce between joy and sadness. We are manic-depressives, all of us. Many of us have difficulty getting unstuck when the darkness is so overwhelming.  But we need to recognize this paradox, this ultimate mystery.

 In times of joy we shatter the glass to remind ourselves of destruction.  But we cannot allow joyous times to pass unappreciated.  They are rare and precious and they are to be acknowledged. 

When in the midst of the chaos we need to raise the vessel we have fixed  and  say “L’Chaim”– to life.

Beyond Election 2012 – Seeking a Political Party

Obama was not my man.

I am not a fan of redistributionist theory of economics. I believe that wealthy people pay more than their “fair share” already (statistics are clear on this point) but that tax loop holes should be remedied. I believe that the wealthy should be extremely charitable towards those who are in need but object to that role being played by the government. Private choice and private charities can work wonders to “re-distribute” resources.

While understanding that rampant capitalism is dangerous and self-serving, I find Obama’s lack of understanding how small business works appalling. This economy will never grow as long as small businessmen and women continue to be inundated by regulations and higher taxes. Economic uncertainty is the bane to any business plans for expansion and/or new hiring.

Obamacare itself adds such burdensome taxation that many small business will withdraw their offered health care programs and risk paying the penalties for doing so. I object to his re-creation of the entire health care system in a manner which adds layers of bureaucracy without doing anything to address quality of care. In particular his refusal to acknowledge the cost of defensive medicine secondary to lack of tort reform is disingenuous on his part.

On the other hand the Republican party’s social agenda bothers me tremendously. I cringe when I read their positions on a woman’s right to choice, objections to gay marriage, anti-scientific religious agenda such as teaching “creationism” as an alternative to evolution.

So you can see my conundrum–there is no party that reflects my core beliefs.

I also believe that I am not alone. There many of “us” out there–social progressives, economic conservatives. Perhaps I would have felt comfortable in a branch of the Republican party that no longer exists– “a New York Republican”. There are references to Jacob Javits, Nelson Rockefeller and others who were politically liberal in their thinking but more libertarian and pro-business when it came to government intervention and control over other sectors in our lives.

For close friends who grew up under Eastern European communism, the rhetoric of class envy and attacks on success in this country are deeply frightening. This country promises one thing only–opportunity. It cannot, nor should it ever, guarantee “success”. That is unreasonable and contrary to human nature. Correcting imbalances, encouraging minorities who do not have the personal connections and resources to succeed is a part of the American dream. That is something I wholeheartedly support. The regressive social/religious and moral agendas of a segment of the population do not belong in the platform of a major political party. Perhaps I should consider myself an Independent. Unfortunately, they rarely have much political clout. So I , as many others, remain a political anomaly.

My hope is that there will be some political party structure will represent my personal philosophy. Until then I will remain frustrated.

Neuroscience & Ethics – An Uncomfortable Mix

In a recent NY Times article William Egginton discusses the fascinating relationship between science and morality. In particular he references those whose political and personal moral agenda seek to make any abortion illegal, to request that neuroscientists explain when a human fetus first feels pain.

He refers to a 2005 review of clinical research conducted by the Journal of the AMA to conclude “evidence regarding the capacity for fetal pain is limited but indicates that fetal perception of pain is unlikely before the third trimester.” Egginton, a professor of humanities, expands the topic into one that has engaged philosophers for centuries–what constitutes “personhood”. Descartes wrote of the “reflective” nature of human consciousness found in adult humans as necessary for perceiving pain. While many have found fault with this notion (apparently he had no problem with experimentation on animals) it ultimately raises the question–should science be used to understand questions of morality anyway?

Egginton quotes Immanuel Kant who argued that science can tell us nothing about the nature of God, immortality of the soul, the origin of human freedom etc. He goes on to note “the basic liberties of Americans should not be dependent on the changing opinions of science.” What he is saying is that we need to respect the advances of science in an ongoing attempt to understand the physical world around us. Deep problems arise when science is then “used” to support moral, religious and political agendas.

Is it ironic that some of the same people who seek the assistance of science to declare that all abortion is murder of a sentient human being, deny the undeniable–that evolution is not a theory but the real nature of life on this planet.

To pick and choose how science supports ethical and moral beliefs opens a Pandora’s box which then taints the achievements and ongoing value of science itself.

The Karma of Hate – The Self-Destructive Force

I believe that we intuitively understand that individuals whose lives are consumed with hatred of others live shallow, pitiful and ultimately self-destructive ones.

History has shown that even societies whose past was notable for tremendous cultural and scientific progress can plummet to the depths suicidal self-annihilation when their fanatical goal is genocide–witness Nazi Germany in the 20th century.

Hatred is a karmic cancer whose victim is its perpetrator. It is a spiritual black hole that consumes those who are obsessed with it.

Unfortunately we can see the consequences of such attitudes in the many parts of the Muslim world today. Hatred of nonbelievers: of the West, of America and especially of Israel is such an all-consuming fact of life that there is energy for little else.

And what “else” is there? Everything!

How is it possible to develop a civil society based on principles of liberty and free expression (formerly a basic tenet of leftist doctrine) when religious fanaticism blocks any dissent? How can at least half of the population (women) be subjugated and regarded as chattel. Where is the energy to create works of art, of music, of philosophy, literature? And what about science and medicine? What about the development of advances that can help ALL humanity?

The irony is that the Muslim world was such a leader–in philosophy, art, science. That was about 500 years ago. But apparently such a worldly approach was compatible with its religious tenets then. Is it not true now, in the 21st century?

Yes, to my leftist friends–Israel is militarily superior to the Palestinians. And yes there are legitimate reasons for Palestinian frustration with their political conditions and standard of living.

Attacking their more powerful neighbor, knowing their own civilians will be killed when they hide their weapons among them is clearly self-destructive. And to my leftist friends–is hatred and targeting of civilians a strategy to laud? Is religious intolerance and genocidal rhetoric now a part of the world’s leftist creed?

The thrill of killing another human being is a spiritual poison–regardless of the impetus for doing so. Former prime minister Golda Meir is quoted as saying “there will not be peace between Israel and the Arabs (substitute Islam and the West) until Arab mothers love their children more than they hate us.”

It is a powerful yet sad statement. Of course Muslim mothers love their children. So why do they feed their children a diet of fanatical hatred?

Societies driven by hatred take on the karmic burden that individuals do–they will ultimately fail. They will succumb to the karmic poison, the darkest of energies known to the universe.