Monthly Archives: June 2012

The dope on Dopamine

I just finished reading Kelly McGonigal‘s The Willpower InstinctIt is a fascinating look at the psychology and physiology behind our ability to control our actions. In the book talk below, McGonigal discusses some of the research covered in her book.

But it isn’t willpower I want to write about; it’s what I learned about DOPAMINE. Dopamine is the culprit behind folks with Parkinson’s Disease having movement and balance issues. More precisely, it is the lack of dopamine that poses the problem. Back in  May, 2007, when I first began blogging about the brain in order to learn about how it functions, I wrote a post about dopamine.

McGonigal has added to my understanding of dopamine. She describes the neurotransmitter as kicking in in anticipation of a reward. That reward can be anything that makes you feel good.

Dopamine tells the rest of the brain what to pay attention to and what to get our greedy little hands on. A dopamine rush doesn’t create happiness itself–the feeling is more like arousal. We feel alert, awake, and captivated. We recognize the possibility of feeling good and are willing to work for that feeling.

When there is insufficient dopamine, besides impacting movement and balance, the brain’s natural reward system feels a sense of apathy, according to McGonigal. She goes on to say that in Parkinson’s patients, while this state may pass for peacefulness, it is actually depression.

What further fascinated me was her explanation of the potential negative effects of dopamine drug therapy on people with Parkinson’s.

The standard treatment for Parkinson’s disease is a two-drug combo: L-dopa, which helps the brain make dopamine, and a dopamine agonist, which stimulates dopamine receptors in the brain to mimic the action of dopamine. When patients begin drug therapy, their brains are flooded with way more dopamine than they’ve seen in a long time. This relieves the main symptoms of the disease, but also creates new problems that no one expected.

Medical journals are full of case studies documenting the unintended side effects of these drugs.

McGonigal then describes one person who “developed insatiable [food] cravings”, another person who “developed a daily gambling habit”, and yet another who “all of sudden found himself afflicted with an increased appetite, a taste for alcohol, and what his wife called ‘an excessive sex urge’…All of these cases were completely resolved by taking the patients off the dopamine-enhancing drug.”

Essentially, it seems that as with much in life, there needs to be a balance in the amount of dopamine your brain processes.

For more on Parkinson’s and dopamine, see my previous posts:

How Elders Will Save the World

With age, comes wisdom.

Attribute to that line whatever you like. I choose to attribute it to the wisdom that comes from having lived a long enough time to be considered living in elderhood, that stage of life following adulthood. William Thomas, author of What are Old People For? How Elders Will Save the World, believes in and advocates for elderhood living environments intentionally designed to promote a sanctuary where elders thrive. These are not merely places where elders survive, but places where they can remain vibrant participants in their own lives and the lives of others, regardless of their physical or cognitive capabilities.

Thomas denotes several “Principles for Elderhood’s Sanctuary”:

  • Warm – radiating human warmth and developing “the practice of doing good deeds without the expectation of return”
  • Small – keep the scale small
  • Flat – keep the hierarchy flat
  • Rooted – have a “deeply rooted belief system”
  • Smart – use of technologies that support the well-being of elders and their care takers
  • Green – sustainable places that provide a “connection with the living world” through gardens

With the above principles in mind, Thomas developed The Green House Project, with implementation support from ncb Capital Impact and the Robert Wood Johnson Foundation. Below is a “documentary short” about the project.

John Zeisel is another author who has created a nursing home alternative. I have read his book, I’m Still Here, and blogged about him a few times, so was pleasantly surprised to see he was referenced by Thomas as a resource when Thomas was researching design possibilities for The Green House Project.

William Thomas goes on to paint a picture of elderhood where each person is able to give and receive loving care. He behooves us to reconsider the lives of the oldest of the old as another developmental phase in the life of a human being:

…to see old age as part of the ongoing miracle of human development. It offers a perspective that connects all elements of the human life span from birth to death.

Mostly what Thomas advocates for is a reenvisioning of the last phase of our lives with a return to respect for old age and the wonders it has to offer, and an acknowledgment that how we craft this last stage (including, but not limited to, physical buildings, guiding principles for care, opportunities for participation, equal respect for the care takers and the cared for) will make all the difference in how it is lived.

What are Old People For? How Elders Will Save the World

William Thomas is the most optimistic advocate for aging I have yet to encounter. He believes in the power of the oldest of the old, and has called that phase of our lives “elderhood”, the natural successor to adulthood.

Old age has richness and complexity that, when appreciated, provide a powerful counterweight to the measurable, progressive, steady decline in bodily functions. In old age, the body instructs the mind in patience and forbearance while the mind tutors the body in creativity and flexibility.

History & Culture of Aging

What Are Old People For? is Thomas’ treatise on old age, beginning with a brief history of the hunter-gatherers and continuing thru to old age’s transformation by modern culture. This was the first time I heard the word “senescence“, defined as “growing into old age”, as compared with adolescence, which is “growing into adulthood”.

The upper limit of longevity may be defined by human genetics, but the experience of living into old age is defined almost exclusively by the customs and mores of one’s culture. An individual’s ability to live a long and bountiful life depends, most of all, on society’s aptitude for making such a life possible.

If you take a look at the various media cultural artifacts (television, magazines, newspapers and the like), you cannot escape the many advertisements for anti-aging products and multiple medications, all being marketed to a very large baby boomer generation that has fully entered adulthood.

Not only are adults impacted by this swath of advertising, but there is a huge trickle down effect, whereupon youngsters and teenagers are inundated with messages about staying young. Modern culture does not embrace the distinctive lines of age – the wrinkles that appear as a banner to living long. There is a huge market for medicine and medical procedures designed to eradicate any banners of aging.

Long-Term Care Environments

From discussing culture, Thomas goes on to describe the “plagues of loneliness, helplessness, and boredom” that accompany oldsters who are relocated, by choice or against their will, to “long-term care environments”. Rather than sit by the sidelines, William Thomas and his wife, Judith Meyers-Thomas, have created an approach to eldercare living called The Eden Alternative. You can read more about it here or listen to this 2002 PBS NewsHour interview: Nursing Home Alternative.

Thomas quotes a passage from Erving Goffman’s 1961 book Asylums, where Goffman lists five traits that define a “total institution”. It is a scathing description that, as Thomas notes, can be equally applied to life in prisons, state psychiatric hospitals and concentration camps. Alas, concludes Thomas, this list is also applicable to our long-term care facilities.

While the intention of these organizations is clearly different from that of penitentiaries, they share a common, rigid division of people into the guardians and the guarded, the therapists and the sick, the staff and the residents.

My Dad lived in assisted living, followed by a nursing home, for a combined seven plus years. My Mom was hospitalized several times within the span of six months, followed by a three week stint in a rehab facility, followed by round-the-clock care at home for several weeks. I know first hand of what Thomas describes.

But all does not have to be glum! The full title of Thomas’ book is What are Old People For? How Elders Will Save the World. Stay tuned for that second part!

for more on William H Thomas:

Elderhood Rising: The Dawn of a New World Age

As I become more involved in the community of aging adults, including my own aging, I am determined to better understand the world of elderhood. From my experience, for the generation of my parents, those born between 1915 and 1930, old age has often been synonymous with illness, nursing homes, hospital stays, and, in too many instances, undignified end-of-life experiences.

William H. Thomas, M.D., has spent his career as a geriatrician trying to educate the world about having a “positive elderhood”, and in the process has helped create Eden Alternative, a living experience for elders that takes a rather different slant to what it means for older folks to live together. I first heard of William Thomas when viewing his TED Talk Elderhood Rising: The Dawn of a New World Age.

Yes, I know he has a semi-syncopated way of talking, but his message is well worth hearing, as he presents important and useful ideas to consider as you age and as your parents age.

 

I have since picked up his 2004 book, What are Old People For? How Elders Will Save the World, and that’s the topic of my next post or two.

Five Wishes (not what you might be expecting)

There is a hearty conversation going on around Michael Wolff’s A Life Worth Ending article in the May 28, 2012 issue of New York magazine. I have already commented once (you can see that in my previous Neurons Firing post) and just this morning added a second comment, which is copied below.

We first heard about Five Wishes from my brother-in-law and his wife, Pat. Pat happens to be a nurse practitioner and clinical coordinator in pediatrics at MIT, and is a former director of nursing at Children’s Hospital Boston. I point out her credentials by way of saying that a medical practitioner gave us our first copy of Five Wishes. I have since purchased additional copies to share with my brother and his wife.

Some form of health care proxy and living will is crucial for family members to have when they find themselves in the position of caring for not only an elderly family member, but for anyone in their family who is of age to be considered an independent adult. Rather than be put off by having conversations about end-of-life care, it is my hope that people will see these conversations as a way to more consciously provide the love, care, respect and dignity that hopefully accompanies the relationships between the cared-for and the caring-for.

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I previously commented about my Mom and her use of Compassion & Choices. Now am sharing about the organization Aging With Dignity – http://www.agingwithdignity.org/index.php – which provides a form called Five Wishes. This form helps people begin the conversations about their end-of-life wishes. When filled out, the form provides guidance to family, doctors and other medical personnel as to the wishes of the prospective patient. My husband and I are using this form, and I have ordered copies for my brother and his wife.

Regards, Laurie

Compassion and Courage

Timing is everything! Just yesterday I spent the bulk of the day with my Aunt (my Mom’s sister), and she gave me her May 28, 2012 issue of New York magazine. The cover highlights Michael Wolff’s article, A Life Worth Ending, which prompted me to high tail it to New York magainze’s website and add a comment to the already 370+. You can follow the comment stream here, and I’ve posted my initial comment below.

Oh, and why is timing everything? My Mom’s 83rd birthday would have been this coming Friday, June 8. My comment is a timely tribute to her courage.

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My 80 year old Aunt gave me her copy of the May 28 issue of New York magazine expressly so I would read this article. On the cover, my Aunt wrote “Don’t EVER let this happen to me“. She and my Mom have always held the philosophy that when your mind goes, you should go with it. They saw their own mother decline in a nursing home and vowed never, ever, would they follow that route.

My Aunt is still going strong, though not without bits and pieces of her body falling apart. My Mom died in October, 2010. And this is the part I hope readers of this article and these comments will take note of. Dying does not have to be an agonized, drawn out, horrific experience like the one that Van and her family is experiencing.

My Mom had a stroke in August, 2010, that left her paralyzed on her dominant right side. Unable to play her treasured piano (she had a masters in music composition), unable to use her valued computer to communicate with the world, and unable to care for herself with the basics of dressing and toileting, she invoked what she always said she would do if such a circumstance occurred. She contacted Compassion and Choices. http://www.compassionandchoicesofny.org/ Compassion and Choices is a phenomenal organization that exists to help people make quality of life decisions by offering them choices. My Mom opted for VSED, voluntarily stopping eating and drinking. She made this decision while perfectly competent, but even had she not been able to make this decision, it is one which she had shared with her family over and over for years, so we would have known what to do had she not been able to do it for herself.

VSED requires the participation of a doctor who will prescribe palliative care, which means medicine to alleviate pain and discomfort, and morphine towards the last day or two, and a round-the-clock aide to assist with diaper changing and other functions of care, but not of feeding, as no food or water are taken in during this time. It is a special person, indeed, who opts to provide aide care during this time – who can soothe and calm, clean and comfort. We had the benefit of such a person, thanks to a recommendation from our contact at Compassion and Choices.

My Mom had a soothing, almost spiritual final 11 days, filled with sunshine in her ground floor apartment, loving children around her and a compassionate aide to care for her. She died peacefully, on her own terms, in her own apartment, in her own way.

Respectfully,
Laurie B.