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Did you know that September was HealthyAging month AND Afib Month… Who knew and should we care?

To start out, to age in a healthy manner – you must be AWARE of your health.  According to the Heart Rhythm Society,  more than 2.5 million American adults and 4.5 million adults in the European Union are impacted by Atrial Fibrillation and that A Fib is responsible for 1/3 of the hospitalizations for disturbances in cardiac rhythm.

Knowing potential triggers (see below) is important and part of knowing how to live healthy.  Again, my husband is a good example and had many of the triggers that were cited in the article, What are the Triggers for Atrial Fibrillation (link below). 

Do you know your triggers and do you know the signs and symptoms of Atrial Fibrillation?

• Fatigue and illness
• Emotional triggers
• Hormones
• Exercise
• Medication
• Alcohol
• Caffeine
• Dehydration
• Outlook

Here is the link to the article titled “What are the Triggers for Atrial Fibrillation”

More to come on AFib, but always, if you have questions, feel fatigued, rapid heart beat, etc – please contact your physician.  AFib can lead to stroke – so pay attention to YOUR Health.

Hope you had a wonderful HealthyAging September!!!

How often do we say, I’ll do it later?   That could mean changing the batteries on your smoke detector, getting gas in your car or tending to your healthcare.  Wisdom says, if it only takes a short time, just do it and be done.

My husband is a great example of the “I’ll do it later” philosophy, and today was a good lesson.  Background: we moved approximately 500 miles from our previously home in Northern California about 1.5 years ago (we were commuting back and forth for approximately 4 years, while I kept my job up north and my husband worked part time there as well). We kept our health care providers and dentist that had treated us for the best part of 10 years.

With moves comes the usual disruptions: finding and establishing a relationship with a bank, locating your favorite restaurants, finding a good place to get your car serviced, and probably most important, identifying your medical and dental care providers.

We are both relatively healthy and in our 60’s, so what’s the hurry – no pressing issues.  We are good about our dental care, so that was an easy check (cleaning and some minor teeth repairs). Dermatologist was reasonably easy, we asked a neighbor who they went to and got an appointment in a short period of time (not my experience when living in Northern California, that was like getting an audience with the Pope.  So new dermatologist: my husband had a little “thing” on his shoulder – turned out to be melanoma.  Got that taken care of, now on the 6 month watch list. Check!!!

So what about the “general medical stuff”?  Well…. Finding a primary care provider is not so easy.  Their practices are full and getting an appointment is challenging. Getting all of your “stuff” from your previous care providers (your lab results, x-rays, etc.). That takes more time so ” I’ll do it later”.

Today is later!  My husband got his flu shot last week (good start, plus he had to for work), got pretty sick the day after – cold/flu symptoms and then really started feeling poorly through the weekend and into the workweek on Monday.  Symptoms: heart rate was erratic,  shortness of breath walking up the stairs, and generally “not feeling good.”

As all good healthcare people, we pulled out our tools.  First – check out the funky pulse rate with my Kardia, by AliveCor https://www.alivecor.com/  to get an EKG.  It’s an app with a bolt on device that is on the back of my phone (I have had problems with rapid heart rate while I run and I was trying to rule out SVT – but that has already been discussed in a previous blog).  Lo and behold – A Fib, with accompanying higher than normal blood pressure.

The dilemma is now – no primary care provider and no cardiologist.  Do you go to the emergency department or wait it out?  My husband called the cardiologist office where I was seen a bit ago.  As of this posting, we are still waiting for a “scheduled time” for an appointment.

Moral of the story… Don’t do it later.. do it now!  That is why houses burn down, cars run out of gas and people die. So here we wait – ED or appointment???

The Triathalon is now over.  The three of us who started together – finished together, as planned.  Two of us who have never done a triathlon (me and Steve) were a little unprepared for the swells (despite the ocean looking very flat and calm).  We had trained in the bay, but this was a bit different.  We were glad for the swim to be over, we didn’t have to be pulled out by the lifeguards and made it out of the water, as demonstrated in the picture – I’ll be prepared next time.

Alison and I at the beginning of th race

First leg (swimming) done.. Check

The three finishers, not too bad for the wear. By the way, Alison and I placed first in our respective age groups.

Coach Jim couldn’t take the disorganization at intesection between funning and finishing – He took the bull(horn) into his own hands

The learning from the triathlon and life in general:

• Stretch your comfort zone
• Try something you are afraid to do
• Don’t go for the perfect – getting a “b” is OK
• Have Fun!

By the way, Alison and I finished first in our age class…   I beat others in the 60-64 age class (and it was not an N of 1 in my category)… Woot!  I am ready for the next one.

Go out and try something you never thought you would do… Double dare you.

Have you heard this from friends and other retirees?  “I don’t understand why I keep gaining weight since I retired.  I have a very active social life”. It’s been proven than socialization is very important for cognitive health and general well-being as we retire.  However, be mindful that we don’t equate this socialization with a substitution for good healthy habits, like exercise and diet.  Those lunches and dinners out, not to mention the afternoon cocktails are all great for enjoying friends and each other – but try to add in some activity as well.

Here is a great quote from an article in Healthline titled What Really Matters in Life? Thoughts from People over 90.

“What motivates me? Doing work I love to do. I still work. Young people, kids (the smaller they are, the better), they motivate me. Don’t overeat; no snacking before bed. And go to the gym. I go Monday, Wednesday, and Friday — Saturday and Sunday, too.”   – Lyle Marty, age 93

Great Advice! My husband and I use to go to the gym (in a place we lived previously) at 5:30 am for a morning spin class before work – we were still in our late 40’s early 50’s.  In the gym were the spin class participants (maybe 10 of us on a good day) and a group of retirees.  These retirees met every day for at least an hour or more – they were there working out when we arrived for class and were still there after we were finished.  They worked out and then stayed and “socialized” over coffee when they were done.  This started out their day, both with exercise AND socialization.  Yeah for them!

How can you blend socialization with activity?  This might even give you a new circle of friends as well!!!  Think about it and give it a try…

 That is what Charlie use to say.  Charlie was an elderly gentleman that my mother in law use to take to the doctors and out to lunch.  This saying might be a bit extreme, but as we age, it seems like every time we turn around some area of our body is bruised and we don’t even know how it happened…  So why is this?  Why do we bruise?

Let’s first talk about our skin and its function.  We have three layers: epidermis, dermis and subcutaneous fat. Knowing what these layers do is important to un

derstanding bruising, etc.

• Epidermis
  • The skin’s top layer.
  • It’s primary functions are: making new skin cells and protecting your body.
• Dermis
  • The skin’s middle layer.
  • Is where the work happens
    • the sweat glands
    • nerve endings,
    • hair growth,
    • oil generation (more problematic for adolescents)
    • home of the blood vessels and capillaries
  • Subcutaneous fat
  • The bottom layer of skin
  • Attaches the dermis to our muscles and bones
  • The pathway for your blood vessels and nerve cells to the rest of your body from here.
  • Controlling your body temperature (that’s why those jackets come out even in warm weather as one ages)
  • Provides padding and protection from bumps/falls to your muscles and bones

As we age, our skin cells divide more slowly and skin begins to thin. Skin retains less moisture, causing it to become dry, scaly, and appear wrinkled. It loses its elasticity and instead of springing back, starts to sag. The skin’s ability to repair itself diminishes, and wounds are slower to heal. Blood vessels become more fragile.  Most bruises occur when those small blood vessels (capillaries) near the skin’s surface are broken (because they are so fragile). How often do we hit our arm or leg on something and we see those bruises?   Darn walls and coffee tables!

Effects of Medications

• Anti-coagulate medications: reduce your blood’s ability to clot, which allows more blood to leak out and cause a bigger bruise.
• . These include:
  • Aspirin and ibuprofen,
  • anticoagulant medications such as Coumadin® (warfarin), and
  • anti-platelet agents, like Plavix® (clopidogrel bisulfate).
• Antibiotics might also be associated with clotting problems.
• Antidepressants
• Topical and systemic corticosteroids — which can be used to treat various conditions, including allergies, asthma and eczema — cause your skin to thin, making it easier to bruise.
• Ginkgo – a dietary supplement that people may take for “energy”, has a blood-thinning effect. (Please be mindful of supplements, especially if taking other medications)

Always check with your physician and review your medications, their side effects, and potential interaction with one another.

Nutritional to strengthen blood vessels

Dietary bioflavonoids that contain rutin are believed to produce collagen and utilize vitamin C which some feel can help strengthen blood vessels and reduce bruising. Rutin can be found in apples, dark-colored berries (mulberries and cranberries), dark leafy greens, garlic, onions, buckwheat, most citrus, figs, and both black and green tea.

References:

Your skin and the layers of the skin

https://www.aad.org/public/kids/skin/the-layers-of-your-skin

General discussion about bruising

http://www.aplaceformom.com/senior-care-resources/articles/elderly-bruising

http://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/easy-bruising/art-20045762?pg=2

http://articles.mercola.com/sites/articles/archive/2015/05/11/bruising-easily.aspx

Rutin

http://www.healthline.com/health/potential-benefits-of-rutin#overview1

http://www.wow.com/wiki/Rutin?s_chn=86&s_pt=source2&s_gl=US&v_t=content

Last week was an interesting week for our #TriTraining Swim in the Bay.  Monday, our best excuse of our training:  A whale in our swim lane – yes the baby whale, separated from its pod was swimming along the So. Calif coast and in and out of smaller water ways.  The last I heard a group of divers escorted it back out to sea.  Unfortunately, the outlook for the young calf is not good.  We went back on Tuesday and had a successful swim.

Then we went out again and there was a submerged car in the water – initially we thought all of the activity was due to the whale returning.  But no, it was a stole car that was submerged in the water. Fortunately, there was no one in the car.

On Saturday, we had a wonderful surprise in our swim lane again. A dolphin calf accompanied by two older dolphins.  They were polite during their play by staying in their own swim lane and not ours (outside our buoys).   Watching them play in the water was just an amazing way to end the week.  Beautiful, sleek, and playful.

This is a true story!

Three of us (the tres amigos) who are training for the Long Beach Triathlon arrived at our regular swim site. We came upon a crowd of people lining the beaches, docks and bridge.  We had heard helicopters overhead earlier in the day, but assumed it was due to the solar eclipse – another excitement of the day.   There were tons of people watching a young juvenile whale that was separated from its pod and swimming in shallow waterways where it should not be swimming.  The whale was very close to shore, thus the lifeguards had everyone out of the water for their safety as well as the safety of the whale.

The Tres Amigos said – well, now that’s a great excuse to NOT swim.  …OK, plan B was to get up and swim at 7 am the next morning – which we did!!  Yeah for us.

See a brief clip of the whale below.   Really, it is not a Whales Tale… it was an actual Whale Tail.

https://twitter.com/i/web/status/899718982172889088

This past weekend I was shopping for Nike Free shoes to try for running.  I have noticed that my ankles are not very flexible.  I was listening to a running podcast where the speaker Jessica Leggio #runpainfree was talking about weak feet due to the structure of shoes that provide too much support and never allow your feet and ankles to strengthen.  Her recommendation was Nike Free 5.0 shoes. See link below to the podcast.

http://consciousrunner.com/tcr106-jessica-leggio-why-your-running-shoes-are-causing-your-injuries-what-to-do-about-it/

I got to thinking – Evolution generally occurs because of environmental changes, physical changes and need to adapt.  We as age, we humans need to adapt and change (evolve) as we will begin to live to over 100 years of age.  Yes, think about retiring at 60-65 yrs old and still having 40-45 years left to live.  How do we want to spend those 40- 45 years.   I digressed……

It’s a fact that as we age, our ankles stiffen and our flexibility decreases.  So, I was met by an “older” saleswoman who was very helpful in finding the shoes I was looking for.  She said she wore them and loved them because of their comfort and flexibility.  I told her I was getting them to strengthen my feet and ankles, because of their flexibility.  She sighed and said that she ran a bit – max 4 miles but she can’t run more than that because she is 65 and old. I replied really? I’m 63 and training for a mini triathalon and have a ½ marathon coming up in 2 weeks.  She looked amazed and said that she couldn’t do that “at her age”.

What does “I can’t do that at my age” really mean?  Is it because we are told that, or because we believe it to be so. By 2050, one out of five of us, almost two billion people, will be age 60 and up. Longevity is a fundamental hallmark of human progress. – Ashton Applewhite

It’s something to think about… Are we older people, not qualified for jobs that younger people have, should we sit at home and spend those 40 years watching TV and sitting and stiffening up?

It’s really your choice.

I encourage you to listen to Ashton Applewhite’s TED talk on Ageism – you will be amazed. Below is a link to the transcript.

https://www.ted.com/talks/ashton_applewhite_let_s_end_ageism/transcript

Note: Ashton Applewhite was named 2016 Influencer of the Year in Aging by PBS site NextAvenue  www.nextavenue.org

The Grapefruit diet is back, again.  It’s actually been around since the 1930’s – so Hollywood, this really isn’t so new.  Many of my friend think it is a great way to lose weight & get healthy… after all, it’s just food – right?

I hate to be the boo leader (the opposite of the cheerleader – and of course, we all love cheerleaders), but those who are taking medications for cholesterol, hypertension, etc., PAY CLOSE ATTENTION.  This is our age group – so we see these interactions more frequently because those in their 20’s and 30’s aren’t on many of the typical medications we take.

Grapefruit (Citrus x paradisi)  is a great refreshing food with lots of vitamin C, Vitamin A, antioxidants, and has a tangy-sweet sour flavor, but did you know that grapefruit is believed to interact with at least 85 drugs and  that number is climbing.

What exactly does “drug interaction” mean?

According to Wikipedia’s (https://en.wikipedia.org/wiki/Drug_interaction) definition:

“A drug interaction is a situation in which a substance (usually another drug) affects the activity of a drug when both are administered together. This action can be synergistic (when the drug’s effect is increased) or antagonistic (when the drug’s effect is decreased) or a new effect can be produced that neither produces on its own”.

Is it just the actual Grapefruit that can cause an interaction?

No, medications can interact with the fruit and the juice (frozen or otherwise). I know, all those wonderful salads with grapefruit, morning grapefruit, grapefruit in smoothies and of course lots of grapefruit if you are on “the diet”.

What can happen?

Drug levels may rise or fall, making them more or less potent and potentially leading to side effects (some can be quite serious).

What drugs does grapefruit interferes with?

• Some statin cholesterol medications (atorvastatin, lovastatin, simvastatin)
• Certain medicines that are used to stabilize heart rhythms (amiodarone, dronedarone)
• Certain high blood pressure medications called calcium channel blockers (nifedipine, verapamil, felodipine)
• Antihistamine called fexofenadine (Allegra)

• Kisqali, a new breast cancer treatment approved in March 2017, states it has specific drug-food interactions with both pomegranate and grapefruit juice. They recommend that patients avoid pomegranate or grapefruit and their juices while taking Kisqali as the combination may increase the amount of Kisqali in the blood, possibly causing worsened side effects.

Types of side effects (depending on the drug and the interaction) may include:

• abnormal heart rhythms,
• stomach bleeding,
• muscle breakdown and kidney damage,
• low blood pressure,
• difficult breathing,
• sedation,
• and dizziness.
• Remember, grapefruit is also high in potassium (so if you have kidney issues, you need to be aware).

Sorry, don’t mean to scare you and not all drugs in any one class of medications may have these interactions, but you should check.  Because you are your own Health Advocate – it’s your responsibility to check and not depend on your provider or pharmacist to inform you.  You can check sites for interactions of foods and other drugs (reference below), and avail yourself of the guidance and expertise of your healthcare provider and pharmacist, just don’t assume they know everything you eat and drink.

Check over the counter medications (ex: cold, allergy drugs), or herbal supplements (ginko) you use. There may be interactions you are not aware of.  Just because they are “natural” doesn’t mean they can’t cause harm.

How much grapefruit is too much?

One whole grapefruit or 200 milliliters of juice (less than one cup) can block the CYP3A4 enzymes and lead to toxic blood levels of a drug. For example, when a common blood pressure medicine felodipine (Plendil) is taken with grapefruit juice , blood levels of the drug can triple.

If you have been warned about a possible drug interaction with grapefruit, ask your healthcare provider to describe the possible side effect and learn how to recognize it.

Discuss all of your prescription, over-the-counter (OTC), and herbal medications with your healthcare provider every time a new drug is prescribed. Better safe than sorry.

Like grapefruit, pomegranate (people use this berry and its juice for health reasons) may have an effect on how drugs are metabolized (broken down and removed from the body) due to blocking of certain CYP enzymes – like CYP3A4 and 2C9.

Cytochrome P450 enzymes are essential for the metabolism of many medications. Although this class has more than 50 enzymes, six of them metabolize 90 percent of drugs, with the two most significant enzymes being CYP3A4 and CYP2D6.  (see website below for more information)

Theoretically, drugs that may have interactions with grapefruit juice may have interactions with pomegranate juice as they affect similar enzymes. Warfarin, some blood pressure or cholesterol medications, carbamazapepine, or other drugs that are broken down by CYP3A4 or 2C9 may also have interactions with pomegranate juice. Always have your pharmacist check for drug interactions anytime you start or even stop a medication, herb, or vitamin product. Be sure to tell your doctor if you regularly drink pomegranate juice, too.

Resources:  

Grapefruit drug interactions

https://www.drugs.com/slideshow/grapefruit-drug-interactions-1028

http://www.activebeat.com/diet-nutrition/6-health-reasons-to-beware-of-grapefruit/4/

Check your drug interactions

https://www.drugs.com/drug_interactions.php

CYP enzymes

http://www.aafp.org/afp/2007/0801/p391.html

Alison and I have different strengths (she in the water/bike, and me in running). Please understand that I am an older runner and was never an athlete growing up (unlike Alison).  Several times I have used Jeff Galloway’s method (run/walk) during my half marathons http://www.jeffgalloway.com/training/.  I find that when I am not well trained, this is a fantastic way to not get injured, finish the race and have a bit of gas left in the tank to take it home strong.  Alison and I use this for our runs (we monitor heart rate recovery and fatigue levels during these run/walks. It gets easier each time, right Alison?

So Alison adopted this technique for our open water swims.  Swim to a buoy, side stroke (the equivalent to the walk portion of Jeff’s technique) and then swim to the next buoy.  WOW!!! It worked and I felt much better after our last swim.  So this old technique for running is our new technique for swimming.

Just goes to show – transferable skills and techniques are often very helopful.

This is why a Tri is so much fun with a buddy – you learn different techniques and apply them as appropriate. It just take a different set of eyes!   Go us.

Here we are another week in.  I am learning how to get into my wetsuit easier (two choices Pam Olive Oil Spray or feet/hands in a plastic bag and SLIDE – any other suggestions?

The swim is getting a bit easier, but still not making the distance.  The crowd is staying motivated (easy to do in beautiful weather).  Getting in some more miles – oh yeah, I have that pesky 1/2 marathon at the end of August… Ha ha..

My trainer thinks that swimming has added to my fitness level and enthusiasm, I think that is partially true. I know for sure that this activity has kept me from going into the work ruminating rabbit hole.  My mind and body are tired and I don’t have time to think about those little things/people that bother me. My training buddy said to me, just remember in a year from now, those people will be just a fleeting memory… Good Advice as always..

Now, on with the training.

There is much written about the positive aspects of pet ownership as we age.  I am always so impressed by my 94 year old neighbor,who every morning walks the neighborhood with her small dog.  She suffers from COPD (so she is not able to walk and talk) and visual challenges.  She is fortunate to live in a neighborhood that is both safe and flat.

By my calculations, she probably gets in a good 1.5 miles during that walk and probably close to 4,000 steps. So if you are a 10,000 steps a day – a few trips around the block each day will be great for both you and your dog.  So much better than opening the door and letting them fend for themselves.

Also, don’t forget the flexibility of bending over to pick up what was left by your pooch. That’s why I am a huge advocate of dog ownership.  Cats are great and they will assist you in staying in your chair, while your pooch will help you with your steps.  It’s not for everyone, but something to think about.  My husband and I have met more friends because of our dog walking.  Don’t let your pet become a couch potato, #socialization.

See some fun references below:

https://www.caringvillage.com/2017/05/08/benefits-pets-aging-adults/

http://petsfortheelderly.org/research.html