Toolbox: Communicating with the Medical World

Communication: understanding others and being understood is one of the most wonderful aspects of being human. A dog can't go in to the vet and calmly explain to the doctor that he has a burning pain in his back left toe (3rd from the right) and has been craving cat food. We humans are the ones with advanced language skills. Why then, is this so difficult?

Part of the problem is our brains have to translate the speech we hear into something of meaning and our brain translators are not much better than the online language translators on the internet. The difference is a computer cannot take facial expression, body language, and tone of voice into consideration. We, on the other hand, take all that and more into our language interpretation center where it is sifted through our experiences, our prejudices, and the traumatic time when we threw up in the middle of our third grade classroom.

I'm sure there are people who have no problem at all with communicating, whether it be with their families, coworkers, neighbors, pets, or any alien species who happen to be visiting. I am in awe of these people. Most of our attempts fall into one of these categories: a) I'm afraid I'll say something stupid  b) I'm sure I must have said something stupid  or c) as usual, I talked too much. These are exact quotes from friends after a recent social outing. 

And this is just in our everyday encounters. When we are trying to communicate our health challenges to our doctor or dentist or emergency room nurse, our ability to communicate effectively can make a huge difference. Before we even begin, our expectations and assumptions can create barriers. Are we going in assuming our doctor won't take time to listen? Or will talk down to us? Do we get intimidated by medical professionals? Do we trust our doctors? It's good to recognize the barriers we bring with us.

What do we want our doctors to know about us? What do doctors want us to know about them? I have compiled a basic list. From the doctor's side, it's a compilation from articles I've read and asking doctors.

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Patients

I am more than a bundle of symptoms - I am a whole person. I have a biography. I have interests and talents, family and friends. And a sense of humor.

How you see me today is how I am today.  This is so true with PD. If I'm having a good day, will the doctor believe me when I tell them of my challenges? If I'm having a bad day, will they think I'm always like this?

I don't need to be made perfect.  Let me know what can be helped and what can't. I know treatment doesn't take away 100% of my symptoms.

Do you realize you treat me differently depending on how well I am able to speak?  This is my pet peeve, but I realize it's also a natural reaction. If my speech is slurring or hesitant, my docs have talked down to me. It's subtle, but noticeable, and totally unintentional. If I can speak well, my docs speak to me more as an intelligent adult. Do I do this to other people? Something to think about. My first neurologist tended to speak down to me a lot. I was a bit of a mess while trying to get my meds stable. Another patient showed her my blog articles. Suddenly, her attitude toward me changed drastically and she treated me more like a peer. 

I want my doctor to respect me.   I know my body and, while I want to listen and trust my doctor's knowledge, if I tell my doc about a reaction to meds or that I don't want to try a certain treatment, I want them to listen to me and believe me. 

Doctors

I wish I had the time to really get to know each patient.  Doctors often have very large caseloads these days, not because they are greedy, but because a lot of people need to be seen. This is especially true with specialists.

If you aren't taking your medicine (or my advice), please tell me.  We can talk about it. How can our doctor know if we have the right medicine if we stop a particular drug because we didn't like the way it made us feel? If they think we're doing everything they told us to do, and it's not working, our docs might conclude we need stronger, more aggressive treatment. At a patient panel at our School of Pharmacy, all 5 of us patients on the panel admitted to not always taking our medication the way it was prescribed. Not necessarily bad, but absolutely we need to talk to our docs about it!

Pain is difficult to treat. Anxiety is difficult to treat. There isn't a magic medication.  It's easy to become addicted to drugs used for pain or anxiety. While drugs are often necessary, a good doctor will also help you find resources to learn tools for coping with pain and anxiety.

I want my patients to trust me.  Building trust can take time, especially if we have had negative experiences in the past with Dr. Payne and Dr. Hertz.  Remember, your doctor is a whole person, too, with their own interests and talents, their families and friends. Most doctors are passionate about their work and are there for you.

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Considering all this, how do we effectively communicate with our doctors and give them all the information they need? One way is to write everything down and be as organized as possible. If I can do it, anyone can. I'm organizationally challenged. The benefit is that your doctors will be impressed with just how organized you are and impressed because this saves them a lot of time. Conversely, trying to depend on our memory to report how we're doing can lead to finding this on our medical record: "Patient reports she has no cognitive issues, however..."

Before your appointment, write out your questions and concerns. Keep track of the symptoms that are bothering you so you can let the doctor know how often and when they happen, and whether there is any variation in the severity. Have the receptionist make a copy of this and attach it to the outside of your chart. This way, your doctor can read the details even before he/she comes in to see you. 

If you have a good friend or a family member who is willing to come, it's good to bring them along to be another set of ears. They can take notes and perhaps even think of questions you don't. 

Trust yourself! Even if we walk a little awkwardly and slur our speech, even if our face is a mask and shows little expression, even if we shake and our arms go every which way and we have a tendency to walk into walls, even with all our challenges, know that what you have to say is valuable and interesting. Try believing this, even for one appointment. If we believe it, others will, too.

Mrs. Reinhart Goes To Washington

It might look like I'm working, but in reality, I haven't been able to concentrate on doing much reading and studying today. Tomorrow morning, long before any sensible person is out of bed, I'll be on my way to the airport and off to Washington D.C. 

This has been planned for awhile. While I'd like to say I had very noble reasons for applying to review funding applications for clinical studies, the trip to DC was the real incentive. I love to travel. I love seeing new places and finding my way around a new city. I enjoy meeting and talking with people from all over the place. I love to travel. Because I am leaving at such an early hour, I'll get a chance to explore a little. Maybe I'll see the White House? I love to travel.

Maybe if I say it a few more times, I'll stop being nervous. I LOVE TO TRAVEL! 

It didn't work. This trip is just a little bit different from my usual travels. For one thing, Emma won't be coming with me. I'm going all by myself. Solo. No one to pick up my shoes for me when I almost leave them behind in security. When I arrive in DC, there won't be familiar Ronald McDonald House staff to greet me. I'll have to buy my own lunch and dinner.

It's a work trip, of course, and I have to be prepared to give my presentations on Thursday and Friday. Yes, I'm nervous. Not only will I not know anyone, but this is a PROFESSIONAL meeting. People are wearing "business casual" clothing. I finally consulted a former colleague and friend to guide me in finding something that didn't look like middle-aged retired kindergarten teacher. I can do this... and hopefully, not squirm my way through the meetings. The others on the panel will be scientists, doctors, and other experts. And me. What in God's name made me think I could do something like this? 

What if my Parkinson's and dystonia kick in big time? It does when I'm nervous. What if I start walking wonky, my balance is off, and I start slurring my words? What if they think I'm drunk? Okay - do I have my "I am not drunk" card with me? Check. 

So, yes, I'm nervous. Instead of reading and preparing, I've been panicking. I've been to the store twice already getting toothpaste, tooth brush, and deoderant. The hotel experience is one I haven't had in years. I couldn't remember what I needed to bring. Almost... I almost wrote a friend to ask whether I needed to bring soap and shampoo. How many pens do I need to bring? Will I need some paper? Where are the socks I had hanging on the clothesline? What if I run out of deoderant?

My family (Chris and Emma) gently reminded me that, though neither of them had ever been to DC, they were fairly certain I could find a store there. 

I'll be fine. I've got my clothes, my notebook, my computer, my phone, all the various cords that go with phone, computer, and scooter. I have "The Last of the Dragons" by E. Nesbit, my little book of Welsh phrases, and my knitting. I'll admit, the last three are security items. Don't laugh.

I'll be fine... as long as I remember my shoes after I go through security. 

Always Darkest before the Dawn

I got up growly today. Snarling at my husband, who dared to be still asleep in bed, blankets pulled up to his chin (God, he looked... happy... damn him), I lurched out to the kitchen and took my meds. How long will it take for them to take this time?

I'm retired. There is no earthly reason I have to be up by 6:30. It's way too early, but my legs decided to argue. If I didn't get up, they threatened to get out of bed without me. Hah. I'd like to see them try. Restless leg syndrome isn't for wimps. You have to be strong and not let your legs call the shots. Get up one day at 6:00 and the next thing you know, they'll have you getting up at 5 am and going on a 5 mile run before breakfast.

I managed to hold them off till I got sick of trying to hold them still, then I got up out of self defense. Fine. I'll get the animals fed, take the laundry off the clothesline, and make breakfast. Then, if the legs have moved enough and the meds have taken effect, maybe I can have a nap.

It's raining. Not a light quiet sprinkle, but a downpour trying to make up for the last drought.  I put on my boots, coat, and hat. I slipped and slid out to the chicken yard and barely managed to get the grain out without falling on my ass. The chickens refused to come out of their house. As I walked back, I saw a couple of squirrels happily devouring the expensive feed. I growled at them, but they continued eating. As for the soaking wet laundry, it could stay outside.

Back in the house, I started to heat water for tea and sat down at my computer to see the news of the day. I should know by now. Don't get your first peek at news for the day on the internet. The weird news floats to the top and I was greeted with:

"Nebraska Woman Sues All Homosexuals", "Obama plans to invade Texas, kidnap George W. Bush, and create a new kingdom of liberal darkness", "Anti-evolution Legislation Introduced in Alabama House", and "Chance of snow for Mother's Day"

It was enough to make me want to crawl back in bed and pull the covers over my head. My legs, however, were still restless and the feeling had drifted up to my arms and chest. I did a few stretches then got my cup of tea and tried to curl up on a soft chair.  Mmmm... the tea did wonders for me and I reminded myself it is always darkest before the dawn.  My craziest symptoms often come up just before the meds kick in and... yes... My muscles were starting to relax and I could breathe easier again.

The rest of me relaxed, too. I know our country is making progress, even though it often seems to take 2 steps back for every 3 steps forward. We're still making progress and, unfortunately, when progress becomes noticeable, it often comes with violent backlash from those who oppose it. I'm trying to stay positive, but it also takes work to continue taking those forward steps. We're doing what we can. We're getting more involved with city politics, which is where we can make a difference. In the coming weeks, we'll be helping to get signatures for a petition, going door to door handing out leaflets, and I will continue to carefully watch the actions of our local school board, which has become incredibly dysfunctional and disrespectful towards teachers and students. I'll also continue to speak out on behalf of my friends in the LGBTQ community, whose presence brings such beauty and richness to our world.

Okay, for now, it's time to take another deep breath, let my muscles finally relax, and... nap. If I'm to do all that work, I'm going to have to rest up. I curled up on the couch and was almost asleep when I heard my husband walk in the room. As I dozed off, I imagined him snarling at me. I had dared to go to sleep again, just as the day was getting started.

And I'm sure I looked happy.

A Magic Wand?

“As a first step, any ‘cure’ would have to stop the spread of the dysfunction in PD brains, so it would have to arrest progression. Brains do ‘heal’ through making new nerve cells and incorporating them into existing networks, but the healing process is slow. Potential ‘cures’ may include therapies that accelerate the healing processes, although it is likely that the first ‘cures’ would arrest progress and not reverse the disease or make symptoms go away entirely.”

— Dr. Rohit Dhall

I have lost track of the number of ways I've been told my Parkinson's disease could be cured. The stories generally come from well meaning friends or friends of friends about someone they know, or someone a friend of theirs knows who was cured of their Parkinson's disease by taking a certain supplement, or drinking an herbal tea or following a special diet. Often people are offended when I don't jump to try the new sure-cure they've suggested. After all, so-and-so tried it and they've been symptom free ever since!

When we go to our doctors, we tend to expect them to have miracle cures, too. Antibiotics were, and still are, miracle drugs, even as we know more about the downside of overusing them. Sinemet (carbodopa/levadopa) is a miracle drug for Parkinson's which has allowed those of us with PD to function. We've come so far with modern medicine, we've become impatient. We really want a magic wand hey presto throw your crutches down and dance kind of cure.

I would be happy with this first step, described to me by Dr. Rohit Dhall. This is enough for me to know. It's exciting to think there may be a time when PD will not be progressive. Even if it's not in my lifetime and it's not totally cured, halting the progression of the disease would be amazing. Levadopa, after all, was a throw your crutches down and dance kind of cure for the time. When it was first given to Parkinsonian patients in 1961, people who were bedridden were suddenly able to walk and run and even jump. (History of Parkinson's Disease)

Dr. Rohit Dhall is the Director of Clinical Studies and Movement Disorders Specialist at the Parkinson's Institute and Clinical Center in Sunnyvale, California. He recently took 45 minutes of his time, precious time to a busy neurologist, to talk with me on the phone about the issues of Parkinson's Dementia and Parkinson's Psychosis. During our conversation, I asked some questions about a cure. The answer he gave, which I have quoted at the beginning of this article, was reassuring to me.

Perhaps because he wasn't promising a miracle, magical cure, it sounded like it might actually happen some day. 

Am I Losing My Mind?

"In other words, Parkinson's may not be unique to me, but I am unique to my Parkinson's. I am not a collection of symptoms to be managed; I am a complex person, and I want caring physicians who see all of me and who are willing to walk down the path of Parkinson's with me. In my neurologist, of course, I want a doctor who understands Parkinson's inside and out, but I want him to understand me inside and out, too.

Thomas Graboys, MD from his book, "Life in Balance"

Before my diagnosis of Parkinson's disease, I was becoming anxious about my health. My balance was off in more ways than one. No one can think very clearly when they have significant health challenges that go for years with either no diagnosis or several diagnoses which the doctors won't agree on. The physical issues with balance, bradykinesia, and dystonia were just the tip of the iceberg. At best of times, we can't separate our illness from how the rest of our body and brain functions. If you've ever broken a toe, which is something quite minor in the scheme of things, you understand this.

Cognitive issues, like it or not, are a part of Parkinson's. When these cognitive issues become unrelenting and affect our daily lives - other than just when we're tired and meds have worn off (we all have off days) - it's time to check in with our doctor. Most of us have experienced the sadness of watching someone we love slowly lose their memory and cognitive abilities due to Alzheimer's or dementia. The estimates of how many people with PD will develop Parkinson's dementia vary greatly. I've seen figures anywhere from a conservative 20% to a frightening 80%. 

The percentage of people with Parkinson's psychosis is difficult to assess easily as well. Dr. Rohit Dhall from the Parkinson's Institute and Clinical Center in California, spoke to me on the phone. "About a third of (Parkinson's) patients can experience psychosis at some point," he said, " and maybe 15% will have profound psychosis requiring a low dose of an antipsychotic medication." 

He continued, "Our biggest fear is losing our minds. In general, People with Parkinson's remain sharp."

With psychosis, Dr. Dhall explained, the patient is out of touch with reality. This can include hallucinations (seeing, hearing, smelling, feeling, or tasting something which is not there), delusional thinking (false, firm beliefs - the house is not my house, the person here is not my spouse but rather an imposter, people are trying to poison me). Often, if there is a mild psychosis due to medication, the patient will retain their awareness of what is real and not real.  

When someone comes in to their clinic with psychotic behaviors, Dr. Dhall said they look first at their medications and make adjustments if need be. All the dopamine agonists (ie: Requip, Mirapex), levodopa, and some of the others can increase the likelihood of hallucinations. The doctors also look at the patient's history. Do they have an infection or other illness which could be causing this? How long have they had Parkinson's? Do they have Parkinson's Dementia?

Psychosis can come with the advancing disease as secondary to changes in the brain related to PD. Those who have cognitive challenges of Parkinson's Dementia are at greater risk. There are medications, however, some of the common drugs which treat psychosis in the general population will worsen PD symptoms. It can also take awhile to find the right combination of medications.  

When a medication is causing or exacerbating a psychosis, it seems reasonable to simply take the person off the drug. This isn't always practical and the patient and doctor have to weigh the benefits against the undesirable effects. In this case, it would be helpful to have a medication to help mitigate the effects of the PD meds without causing further nasty stuff. This is when my head starts to spin.

Remember the old carnival fun houses with, as Wikipedia says, "various devices designed to surprise, challenge, and amuse the visitor", often incorporating activities which distort reality (mirrors) or throw us off balance physically? I was never very fond of them. Looking back, it seems like my first years with PD, especially as my medications were constantly being adjusted, were much like being in one of these places. It wasn't all bad, just exhausting after awhile. 

I asked Dr. Dhall if there was anything we could do to lower our chance of getting PD Dementia or PD Psychosis. Fortunately, though there is nothing we can do to guarantee we won't have severe cognitive challenges, the standard recommedations for avoiding demetia are valid here. 

They are:
Take care of your heart health. Eat right and exercise. 
Exercise your mind with problem solving tasks and word retrieval games. If you are regularly engaged in exercising your brain, it will help. Be engaged in the community. When withdrawing from community work, some people decline more quickly.
Pay attention to mood. Mild depression will affect cognition, often because you give up quickly. 

Let's face it, we're all control freaks. It's engrained in our society right now. Not only are we supposed to pull ourselves up by our own bootstraps, we also must take charge of our life, be the change we want to see in the world, learn to dance in the rain, and always be positive. Our society still has to learn to accept and value times of weakness. 

This morning, I visited a lovely woman who has Alzheimer's disease. She couldn't remember her granddaughter or her son-in-law. She couldn't create full sentences or ideas. It didn't matter. I had heard she was a fighter and a feminist. When I said this to her, she straightened in her chair and said, "Yes!" And she let me know, in her halting, disjointed way, she wished she could still be out in the world doing things. "I love it," she said, smiling. 

Later, I wrote to her son, "When I get old, I hope I can be as delightful as your mom. I've experienced this with other people, but she was a reminder that, even though Alzheimer's can be very sad, SHE isn't. I'm sure there were times of real struggle and may still be, but her warmth shines through."

As Dr. Thomas Graboys said, as he was battling Parkinson's and Lewy Body Dementia, we're much more than just a collection of symptoms to be managed. 

A New Rating Scale For Parkinson's Disease

According to the “Classical PD Timeline: Onset to Death” chart I found on the website of the Rocky Mountain Movement Disorder Center, I'm in trouble. My clinical symptoms showed up 13 years ago, which means I am somewhere in between Hoehn & Yahr stage III (Poor Balance) and H & Y stage IV (Fall, Dependency, Cognitive Decline). The fact that I fell on Christmas eve while getting ready for family to come doesn't help.

While I understand this chart shows a common pattern of PD and is not meant to strictly show what an individual will go through, I also understand how easy it is to bypass the writing underneath the chart and just see the chart... like I did... and have that knee jerk (or dystonia jerk) “holy shit” reaction. (I eventually skimmed the article.)

When all is said, researched, and done, we still have to admit how much we don't know. My PD will do what it will do. I know if I exercise my body and my brain, eat right, and do my best to stay connected with my friends, family, and the community at large, I will do better than if I watch TV all day, eat junk food, and never see anyone. I also know this has less to do with PD than with LIFE in general. Duh.

Having said all this, I know I've gone through a lot of stages since my diagnosis. So many, I have come up with my own rating scale. I call it the Reinhart New Rating Scale for Parkinson's Disease. I'm sure others will find it extremely valuable and someone will insist on paying me lots of money to continue my research.

Here it is:

Stage 1: Parkinson's? Me?

This stage usually starts when you are diagnosed. It is generally accompanied by either screaming, swearing, or a blank stare.

Stage 2: No, thank you.

This isn't just denial, it's when you tell your doctor you're returning his/her diagnosis and you want your money back or possibly, “I'd like to trade it in for a bout of stomach flu and hemorrhoids.”

Stage 3: I'm going to do this right.

For some people, this means fighting it. They express this stage with: “I have PD, but PD doesn't have me.” Others (like me) decide to embrace their situation and become as positive as possible. This could be expressed as “I'm not going to fight this, I'm going to learn to live well with PD” meaning, “I'm going to learn how to slow down and eat well and exercise and keep active in the community and do everything I want to do which means I'm really in denial about having anything wrong with me in the first place.”

Stage 4: Pac-man Power Pellets

Otherwise known as Sinemet or Carbidopa-Levodopa. All of a sudden things are good. Wow. Life is almost back to normal... sort of. If I have more symptoms, the doc gives me more power pellets. Mmm, dopamine rush. It's much easier now to be positive about life, the universe, and everything.. and I don't even need marijuana.

Stage 5: Crash and Burn

Maybe a few people can be put on medication, have it work right the first time and be just fine. For the rest of us, it's like trying to get an old record player to work at the right speed with the right records. (Okay, between the Pac-man reference and vinyl records, have I dated myself?) Too much dopamine and I'm a 45 record playing on 78 speed. Too little and the speed goes down to 16 rpm or it stops altogether and the needle screeches off the record.

The crashing and burning comes from the reality of what happens at 78 speed, like obsessive compulsive stuff, and what happens at 16 speed, like severe depression.

Stage 6: How normal do I have to be?

This is the healthy fear (or terror, depending on what effects meds have on you) of changing medications, adding medications, or upping your dose.

Stage 7: Be positive? Fuck no.

Self explanatory. For the sake of our families and friends, we always hope this stage is short.

Stage 8: Do-over.

Let's go back to stage 3, but be more realistic about it.

Stage 9: Finding Grace

What happens when you realize these stages happen. You're not going be positive all the time, you're really going to have to slow down and it's okay. Life is good. It's okay. No, my PD isn't going to be controlled all the time and I'll have to make adjustments. It's still good. Amazingly, it's much easier to be positive more of the time when you don't put pressure on yourself to be positive all the time.

This is a rating scale I can understand. It's not perfect, some of us go back and forth between stages for years. I tend to shout, “DO-OVER!” on a regular basis.

It's okay because the grace is always there waiting for us.

“For to be poised against fatality, to meet adverse conditions gracefully, is more than simple endurance; it is an act of aggression, a positive triumph.”

— Thomas Mann

Keeping our Sense of Wonder - Knowing what we don't know

This week I joined a small group of people with movement disorders at the University of Colorado Health Sciences Center and we had the privilege, once again, of being interviewed by groups of 2nd year medical students. I've done this for five or six years now and I've come to appreciate what I learn as well as the opportunity to teach the medical community a little bit about the reality of living with a movement disorder.

Intended to be a learning experience for the students, I believe it's also important for the teachers - the experienced medical doctors who are in charge of preparing the next generation of health professionals. We expect the students to be impressed when they hear about the realities of living with a movement disorder, but we don't expect the doctors to react. They've heard it all before.

During the interviews, however, they are listening in a much different way - through the perspective of the students. The students take things slowly. They hesitate. They ask their questions and wait. They are not thinking of the five (or ten or fifteen) patients still to be seen. They aren't trying to put together a diagnosis as we are speaking. They don't have the same knowledge or experience as the doctors and they know it. 

Something magical often happens. The doctor hears, really hears and suddenly comprehends one of the challenges we go through as patients. The students responded with interest and sympathy when they heard how drug side effects caused serious problems for me for two years before anyone, including the neurologist, knew what was happening. The doctors reacted more strongly and responded with , "Wait, what was that?" and they began asking me questions about what they could have done differently. One year, the doctor turned pale and seemed to forget the students were in the room as she asked me question after question. 

They realized how much they didn't know and this, I believe, is the best lesson for the students.  

I had symptoms for 5 years before I was diagnosed with Parkinson's disease. Looking back, it's not the length of time which was so frustrating, it wasn't even the misdiagnoses. My PD presented itself in a way which differed from the classic symptoms. The frustrating times were when I had doctors who were so very, very sure of themselves.

It's a fine line, I know. Doctors need to be confident in their abilities, otherwise they would be second guessing themselves all the time - and that isn't healthy for them or their patients. Having the ability to say, "I don't know. I'll have to think about this and talk with some of my colleagues" when they have an unusual situation is reassuring, at least to me. 

It means they haven't lost their sense of wonder. It means they know there's a lot they don't know. These are the best doctors.

Learning How to Grow Older

As I watch my parents get older, there are so many things I think about. In fact, there are so many things, I have to keep lists. Most of this is purely practical: the paperwork I need to get done so they can move to their assisted living apartment, what they will need to bring with them, what are all those things they can't take with them and what will be do with them. That's a long enough list to last a few months right there. 

For better or for worse, we can't be only practical when it comes to our parents aging. There's a whole range of emotions and memories, as well. There's also some dirty laundry to deal with, even if it's just in my own mind, and it has to be sorted, cleaned, and hung out on the line to dry. 

It's also made me look at how I want to be as I get older. Do we have a choice?

It's debatable how much of our health is due to our lifestyle choices and how much is due to luck, karma, and good genes. Eating healthy and exercising is good, but then my grandmother ate lots of rich desserts and she lived to be 97.  My choice, my ideal, would be to live a full life and be able to say at the end, as my mother-in-law did, "It's been fun, hasn't it!"

What I've learned this summer is I don't ever want to resent being a year older. I'm not going to buy into the youth obsessed culture. I don't want to pretend I'm still 35. I'm not. I don't want to dye my hair or hesitate when someone asks my age. Why would I? Being 57 is cool! Each time in our life is unique and I'm enjoying my life right now.

Don't tell me I'm 57 years young. We wouldn't tell a child he is 10 years young. I'm getting older, not younger. All of me is getting older. I don't have the physical body of a teenager or young adult and, thankfully, I don't have the mind of a teenager, either. I wouldn't want it. A lot of work goes into learning and developing as an adult, and the work never stops. 

I don't want to fear getting older. I don't even want to fear getting very old. Many people don't make it that far. I'm not afraid of nursing homes. I worked in one. There's also the example of our former neighbor who, at the age of 92, met a lovely old lady in the nursing home where they both lived. They spent their days holding hands and talking to each other. No one else understood what they were saying, but they enjoyed every moment. I'd like that. If the other person was my husband getting very old with me, it would be even cooler.

The only thing that scares me about dementia and Alzheimer's is the possibility of becoming mean to people I care about. Even then, I know it's a phase which sometimes, but not always, accompanies these diseases and inevitably will disappear in the fog of memory loss. The memory loss doesn't worry me nearly as much. The heart often remembers, even if the brain doesn't. At least I believe this is true.

Ah, if I wasn't in the middle of taking care of my elderly parents, I wouldn't be spending time thinking of what it would be like to turn 85 or 90 years old. I've still got a long ways to go and I'm far too busy being 57 and spending time with my favorite 60 year old, 33 year old, 32 year old, 30 year old, 21 year old, 4 year old, 3 year old, and 1 year old.... not to mention my 85 and 90 year old parents.... and all those friends in between... to dwell on.. well, anything at the moment. 

So I'll just leave you with a few good quotes from some amazing women:

“Aging is not lost youth, but a new stage of opportunity and strength.”

— Betty Friedan

“At 20, we worry what others think of us. At 40, we don’t care what they think of us. At 60, we discover they haven’t been thinking of us at all.”

— Ann Landers

“The great thing about getting older is you don’t lose all the other ages you’ve been.”

— Madeleine L'Engle

“I’m a person who gets better with practice. Getting older is awesome because you get more practice.”

— Zooey Deschanel