Pumping Irony

Craig Cox, EL’s director of business operations and resident geezer, explores the joys and challenges of aging well.

Get Hip to a Healthcare Scam

Winter has arrived in full force around here, which means lots of snow, ice, and cold — a weather combo that produces a good deal of uncertain footing for walking commuters like myself. This point was driven home to me last Monday, when I strode a bit too confidently outside my office building on my way to the bank and crashed quite violently on my left hip. I regained my footing quickly and hobbled on more carefully. Then, walking back to the office, I promptly slipped and toppled onto the same hip once again.

A new colleague of mine, recently transplanted from the balmier climate of Washington, DC, observed that local drivers don’t seem to know how to navigate through the frictionless streets on her morning commute. I know she’s not exaggerating. We all seem to need to relearn how to drive every winter. I apparently need to relearn how to walk. (Small steps. . . .)

I made my way home without further difficulties and, despite the sore hip, headed over to Anderson School to join my old basketball buddies for the first game of the season. The court was a bit slick and, of course, at one point I tried to make a quick cut to the basket, slipped and landed — yes — on my tender left hip.

Nearly a week has passed since this series of events and, while my hip remains sore to the touch, it’s perfectly functional. I cranked through my morning workout today with no ill effects. But it does give me pause. More than 330,000 people (most around my age, I presume) will have their hips replaced next year, and I’d prefer to not be among that number.

It’s not just that I’d like to retain all my original body parts. The more I learn about how our healthcare system handles these sorts of procedures, the less I want to participate in the dysfunction. As Elizabeth Rosenthal recently reported in the New York Times, the U.S. hip-replacement industry is controlled by a cartel of five manufacturers that have been gouging hospitals, insurance companies — and patients — for years, and shows no sign of letting up.

The cost to manufacture a hip implant, according to Rosenthal, is about $350, yet the “list price” that a hospital pays for it can run as high as $7,500. When you add installation equipment, assorted fees, and the hospital markup, the cost to the patient can rise to nearly $40,000.

How is this possible? Here’s what Rosenthal found:

So why are implant list prices so high, and rising by more than 5 percent a year? In the United States, nearly all hip and knee implants — sterilized pieces of tooled metal, plastic or ceramics — are made by five companies, which some economists describe as a cartel. Manufacturers tweak old models and patent the changes as new products, with ever-bigger price tags.

Generic or foreign-made joint implants have been kept out of the United States by trade policy, patents and an expensive Food and Drug Administration approval process that deters start-ups from entering the market. The “companies defend this turf ferociously,” said Dr. Peter M. Cram, a physician at the University of Iowa medical school who studies the costs of health care.”

Plus, the manufacturers require that hospitals sign nondisclosure agreements, so they can’t compare pricing. “Manufacturers will tell you it’s R&D and liability that makes implants so expensive and that they have the only one like it,” Dr. Rory Wright, an orthopedist at the Orthopedic Hospital of Wisconsin, told Rosenthal. “They price this way because they can.”

Or, as Cram put it, “Why charge $1,000 for the implant in the U.S. when you can charge $14,000? How would you answer to your shareholders?

This sort of thinking speaks volumes about what is wrong with the American healthcare system, and it will remind me to walk more mindfully on my way to the office tomorrow.

Bowing to Reality

Two completely distinct occurrences in the past week crystallized for me why we can get so confused and unfocused about fitness.

Those who waste their valuable time reading these pages know that I’m currently pretending to train for the January 1 Commitment Day 5K and that my ambivalence about this preparation is directly related to my general ambivalence about running. So my heart was lifted when I stumbled upon a piece by Gretchen Reynolds in the New York Times highlighting new research from the National Walkers Health Study showing that walking — especially brisk walking — helped people live longer.

This, of course, is good news to ambivalent runners like myself, and it came to my attention the same day that our first major snowfall of the season forced me to leave my bicycle in the garage and hoof it to and from work. Not at a rapid clip, mind you — icy conditions call for mindful strides — but with enough exertion that I was ready to shed my jacket at the top of the hill.

Walking has a distinctly different effect on your body than does bicycling. Your calves loosen, hammies and quads catch a break, and your knees are bearing weight. All of which is good preparation, it seems to me, for a 5K jog around downtown Minneapolis in three weeks.

Just as I’m getting comfortable with the idea that all this snow will actually benefit my training regimen (such as it is), I get a note from Big D, convener of our winter basketball league, requesting my presence at tomorrow’s inaugural game. This, of course, will involve running — lots of it — but the sort of purposeful movement that suits my practical nature (if 60-year-olds stumbling around a basketball court can be called practical).

So, now it looks like I’ll be walking and running in the days leading up to my dreaded 5K. Not because I want to, but because I have to. I could call this a comprehensive, integrated training program, but that, of course, would be a lie. Let’s just call it bowing to reality.

Dare to Be Different

At summer camp back in my teen years, my camp counselor gathered us teenagers together in the cabin on our first night and asked us who we most admired. This was 1967, and most of my compatriots piped up to support the president, Lyndon Johnson, who at that time was under some public duress for his role in escalating the war in Vietnam. When the question came around to me, I admitted that I was most impressed with the courage of Muhammad Ali, who at the time had been stripped of his heavyweight boxing crown for refusing to be inducted into the military.

That drew some weird looks. But I was no dissident; three years later I was in the military myself, learning how to operate a teletype machine (?!?!) in Wichita Falls, Texas. But I often found myself back then — and now — challenging conventional wisdom, taking the path less taken.

And that hasn’t changed much in the intervening years. It’s interesting to me how this point of view affects my behavior today when it comes to health and fitness. Whenever I feel myself slacking off or mired in some sedentary rut, I can almost always get rolling again by reminding myself that most 62-year-olds aren’t swinging a kettlebell and cranking out 50 pushups every morning before pedaling a bicycle up a nasty incline to their place of work. I cling to the idea that I’m just a little bit different, and that’s enough motivation to keep me on track.

It also helps when I stumble upon new research that validates my view that the best way to stay healthy in your old age is to maintain a regular exercise regimen. The latest comes from the British Journal of Sports Medicine, which published a study last week showing that “regular physical activity boosted the likelihood of healthy ageing sevenfold compared with consistent inactivity.”

This study followed 3,500 Britons, with the average age of 64, for more than eight years. About one in 10 of the participants adopted an exercise regimen during the study period, while the rest didn’t change their sedentary behavior. The results? About four of 10 in the sedentary group had developed a long-term chronic disease, about one in five was diagnosed as depressed, a third suffered from some level of disability, and one in five was cognitively impaired. Those who remained physically active during the entire eight years of the study were seven times more likely to be healthy as those who stayed inactive.

One in 10 remained active. Challenging the cultural norm. Daring to be different. I’m with them.

Why Run Until You Have To?

It’s now about six weeks until the Commitment Day 5K, and I haven’t done any running to prepare for the event. You could call this an indication of sublime confidence or a disaster waiting to happen.

I don’t know that a 62-year-old guy has any business getting out of bed on New Year’s Day for anything but a hot cup of coffee and the morning paper, but I’ve got it into my head that clomping atop the frozen asphalt of downtown Minneapolis with a few thousand other ravaged souls on the calendar’s most grievous Morning After is kind of a test of my manhood. Especially when it’s my son, Mr. Parkour, who’s grading the test.

I’m not that competitive, but when MP stops by for dinner and mentions that he’s now cranking out 100 pushups every morning before breakfast as part of some obscure martial arts training regimen, you’ll find me soaked in sweat on the mat the next morning  trying to hit triple digits myself. It’s the principle of the thing.

Last year, we bundled up against the 4-below morning chill and set out from the Metrodome with the huddled masses, fully intent on strolling along with my EL colleagues. That lasted for about a minute, until MP broke into a trot and motioned for me to follow. A half-hour or so later, I was channeling my inner Usain Bolt, sprinting toward the finish line in my jeans and workboots.

I have completed exactly the number of training runs leading up to this year’s race as I did last year — that would be zero. I did spend 30 minutes on the Elliptical Death Machine at the gym a couple of weeks ago, just to show myself that I could. And I have thought once or twice about lacing up my sneakers and taking to the trail along the river a few blocks away from my house. Just for fun, mind you. And I do recall jogging across the street in front of my office on my way to lunch a couple of times last week, with no ill effects. So, I figure I’m good to go.

In other words, I’ve been thinking about what it might take to get ready to run the race. I just haven’t done it, because most runners train for races by running, which I’d rather avoid. It’s hard on the knees, for one thing, and it might be the most boring form of exercise ever developed. Every time I see a jogger, I want to hand them a basketball, so they could dribble it ahead of them. Work a little on their hand-eye coordination while they’re plodding along. Even a soccer ball would do. Give it a kick and run after it. Just seems more purposeful to me.

Besides, running is all about cardio, right? And there are all sorts of ways to build your cardio capacity without running. In fact, it’s becoming something of a trend among high-level runners, according to Olympic running coach Pete Rea. “From North Africa to Japan, many of the world’s best distance runners are now adding a variety of non-running, aerobically based exercise to improve their running performance,” Rea writes in a recent blog.

Among the most popular are stationary biking, our old friend the EDM, cross-country skiing, lap swimming, and walking. There’s also pool running (which doesn’t count as running because it sounds like fun) and a session or two on an anti-gravity treadmill (which just sounds scary).

This all make sense to me (except the anti-gravity thing), because I’ve always been of the opinion that any high-intensity exercise that gets you breathing hard — including strength training — is going to help you if, by chance, you someday have to break into a jog for some reason. So, I guess I’ll stay the course with my morning kettlebell workouts. Why run until you really have to?

A Big Pain

A couple of weeks ago, I tweaked a muscle in my lower back while flinging my kettlebell around and then wrenched it good a few days later while putting away our concrete birdbaths for the winter. It wasn’t too serious, just scary enough to convince me to leave my kettlebell alone for a while and ignore all other tasks that involve bending over.

This is how I handle pain: Slow down and let my body heal itself. There are other options, of course. A colleague of mine tends to reach for a couple of Advil when this sort of thing happens to him; other folks head to the doctor for some pain meds.

I’ve never suffered from chronic pain, so I’m not about to judge the actions of those who do, but I was struck by a recent article in The New Yorker that described the dramatic increase in the use — and abuse — of prescription pain-killers by outpatients. Celine Gounder, a physican and public-health specialist, writes that Americans now consume 99 percent of the hydrocodone on the world market, plus 80 percent of the oxycodone, and 65 percent of the hydromophone, and she asks, “How did doctors, who pledge to do no harm, let the use of prescription narcotics get so out of hand?”

The manufacturers of the narcotics played a major role, Gounder reports, aggressively marketing their drugs (Vicodin, Percocet, OxyContin, Dilaudid, and others) as an ongoing treatment option for neck and back pain, while also funding research to build scientific evidence for the efficacy of their drugs. But consumers have also been culpable. As Gounder puts it, “Many people believe in the power of modern medicine to cure illness, and bristle at the notion that pain is a fact of life. The promise of a set of medicines that could cure pain was appealing to many patients — and, with a customer-is-always-right mentality having pervaded the doctor’s office, patients were able to pressure physicians to satisfy their requests for the pain pills they’d begun hearing about.”

What most patients don’t want to hear is that prescription narcotics will eventually lose their power to mask the pain and that a combination of short-term pain medication with physical therapy, massage, acupuncture, and other alternatives is typically more effective. They just want to be able to pop a pill, and most doctors are more than willing to oblige them. “We are predisposed to say yes, even if we know it isn’t right,” Gounder writes. “Some of us just don’t want to take the extra time during a busy day to explain why that prescription for a narcotic isn’t a good idea. Some of us also use the promise of prescription narcotics to persuade patients to keep their medical appointments, or to take their other medication.”

This is a side of the healthcare debate that we seldom see. Doctors trying to do the right thing, but are hamstrung by a lack of time and energy as they try to placate patients who want simple solutions to their problems. It almost makes me want to make an appointment with my doc and let him tell me I don’t need no stinking pain pills and just lay off the kettlebell for a while. And I’d do it, too, if my back wasn’t feeling so much better.

Raise a Pint for Good Hydration

Twenty-five years ago, I spent a couple of delightful hours over lunch with the late Michael Jackson, who was at the time probably the foremost beer connoisseur in the world (and, I suspect, a much better interview than the old Jackson 5 refugee with whom he shared a name). We dined at some suburban steakhouse and quaffed a few pints of our new local microbrew while discussing the many virtues of various ales, lagers, stouts, and pilsners — not necessarily in that order.

Jackson was no beer snob. When I asked him about the differences between the exquisite European beers and America’s mass-produced brands, he was quick to laud Budweiser and the rest for their thirst-quenching qualities. “Those are lawn-mowing beers,” he said.

In the years since, I’ve had multiple opportunities to test that theory — often after a summer afternoon of yard work, but also following a good sweat-a-thon at the gym. In fact, it’s long been a tradition among my Monday night slow-old-guys basketball league that we reconnoiter at a local bar for a few cold ones after the game.

I’m not the sort to lose sleep over my choices of post-workout hydration (I don’t lose sleep over anything, actually). We drink plenty of water during the two hours we spend pounding up and down the hardwood, and I always figure fluids are fluids, when it comes to replacing all that sweat we generate.

And now I find out my (beer) gut instinct is correct. As Jen Miller reports in this New York Times piece, researchers at Griffith University in Queensland, Australia, have found that drinking beer helps you recover from a workout just as effectively as drinking water. The research team, led by Ben Desbrow, an associate professor in the school of public health, gave study participants one of four fluid replacements after their workout: light beer, light beer with added salt, standard beer, and standard beer with added salt.

(The salt-in-your-beer option reminded me of my late father, who always salted his beer after he got home after a hard day of — you guessed it — delivering beer all over St. Paul, especially in the summer.)

The verdict? Light beer with added salt offered the greatest rehydration benefits, Desbrow said. Stronger beer, he added, can further dehydrate your body after a workout. “The point is not to get nondrinkers to drink beer, he explained, “but to provide beer drinkers with a healthy alternative.”

Point taken, Mate. I’m not about to descend into the “lite” beer world, but it’s good to know that my thirst for a good lawn-mowing brew after working up a sweat isn’t going to derail my rehydration scheme. And when I sprinkle a bit of salt in my glass, it’ll remind me of my old man.

When Time Stands Still

We dialed our clocks back Saturday night, which left me happily ahead of the game all day on Sunday. Every time I looked up from whatever I was doing it seemed like no time had passed. It was like I had stopped aging for a day. Felt like I had unlimited free time, so much so that after raking leaves and caulking around the windows I climbed up on the garage and patched some holes in the roof. All before lunch time.

Einstein taught us that time is relative, and that sure seems to be the case sometimes. When I rolled out of bed this morning, for instance, yesterday’s extra hour had shrunk to something barely perceptible. I was once again aging at a normal rate — or as normal as a geezer like myself can expect.

This, of course, is all about perception. But it turns out that time is also relative inside your body, according to a recent UCLA study. Researchers there have found that some cells age at a different rate than others. As Melissa Healy notes in the Los Angeles Times, their new body clock “measures DNA methylation — the process by which genes are altered as the body’s cells differentiate and their genetic programs change to meet new demands.” And certain tissues routinely grow old more quickly than the body as a whole, leaving them vulnerable to cancer and other diseases.

A woman’s breast tissue, for example, typically is two or three years older than the chronological age of its owner, according to the UCLA study. And cells that have been invaded by cancer tumors were 12 years older, on average. On the other hand, cardiac muscle tends to look much younger than a person’s real age. That’s probably because the stem cells that help to ward off injury and disease tend to remain rather plentiful throughout one’s life.

This all makes some sense to me. Cells that are under attack are going to show their age. But I’m not at all sure I want to know how old my prostate is, or even the gray matter inside my skull. Those UCLA researchers believe that information could eventually help them determine whether “anti-aging measures” were working, but to my way of thinking, the only anti-aging measures that are worth the effort is a good morning workout — and maybe dialing back that clock every fall to enjoy the brief pleasures of a day that never ends.

Immunity and Exercise

I’ve been fighting some relentless cold bug for the past few weeks, it seems. Nothing serious, just feeling depleted. But it’s not getting better, and I woke up this morning wondering whether my immune system had taken the day off. On days like this, my body tells me to get more sleep and generally take it easy. Then I’ll go do some work in the yard or climb on my bike and feel recharged almost immediately — but only temporarily.

It’s a bit of a puzzle to me, this relationship between exercise and my immune system. Should I push through my exhaustion and force myself to work out in order to rev up my body’s defenses, or is it more prudent to spend the day on the couch with a purring cat and a good book? According to this 2009 study from the University of Illinois, it appears the answer is both yes and no.

Viruses like the one I suspect is knocking me down these days, trigger the production of what are called T1-helper cells as a first line of defense. These cells create inflammation in the body to fight off the virus. This is all fine, up to a point, but if that inflammation lingers too long, it can begin to do more harm than good. That’s when the immune system sends in reinforcements in the form of T2-helper cells, which are designed to cool the inflammation. In an ideal situation, this all happens seamlessly, and you soon start to feel better.

But if, like me, you’re battling some stubborn bug to a draw, the intensity and duration of your workout can tilt the balance of power. If you go too hard or too long, you may suppress the initial immune response and leave yourself open to a full-on viral invasion. And if you ignore exercise altogether, those T1 cells could hang around too long and begin to do some damage. Moderate exercise, on the other hand, can deliver those T2 cells at the appropriate time, bolstering your defenses and knocking out the virus.

That’s the idea, anyway. And it probably explains why my symptoms seemed to vanish this afternoon while I was raking leaves. I’ll take that to mean I was exerting myself just enough. But now, here I am slumped over a keyboard and longing for a nap. So what do I do? Climb on my bike? Crank out 30 pushups?

Maybe I need to ponder my options for a bit. On the couch. With a book. And where did that cat go?

My 5K Debate: Faith or Paranoia?

Last winter I was politely coerced into spending my New Year’s morning running 5 kilometers in the sub-zero haze of downtown Minneapolis as part of Life Time’s Commitment Day festivities. I’d never run a 5K before and haven’t run one since, despite several opportunities to do so in much warmer weather. So, when my fitness guru, SW, asked me last week how my 5K training was coming along, I was pretty much at a loss for words.

What I wanted to say was that I am a creature of habit and, while my son has convinced me to drag my butt out of my warm bed again on January 1 and chase him to the finish line, I’m not in the habit of training for anything — especially a 5K. After all, I cranked through my first and only “fun run” with no more preparation than I usually make before climbing on my bike and pedaling up the hill to the office every morning: make sure my shoes are tied and my fly is zipped.

But a new study from the Canadian Journal of Cardiology has me rethinking my cavalier attitude. Researchers at the institut universitaire de cardiologie et de pneumologie de Quebec found that poorly trained runners can suffer heart damage while running a marathon. In fact, more than half of the subjects tested experienced swelling and reduced blood flow in the heart. As Eric Larose, the study’s lead author, put it in a statement released by the university, “Although no permanent injury was observed in this group of runners, the findings suggest that there may be a minimum fitness level needed beyond which the heart can bounce back from the strain of training and running a long race.”

Now, my rational side tells me that jogging a 5K in 35 or 40 minutes is not the same as huffing non-stop for the six or so hours it would take me to travel 26.2 miles. My irrational side, however, conjures up images of ambulances, emergency rooms, and triple-bypass surgery. This would not be my preferred way to begin the new year.

The question, then, comes down to a debate between faith and paranoia. Am I confident enough in my fitness level to assume that I’ll cruise happily through that morning run without any real training, just as I did last year? Or am I courting disaster if I don’t climb on the dreadmill and begin to persuade my aging cardiovascular system that it’s up to the task?

At this point, I have to admit I’m more inclined toward the paranoid view. I haven’t done any running in recent memory and, while my morning workout gets my heart pumping pretty good, it’s not designed to test my endurance — or my creaky knees. So I guess I’ll have to lace up my sneakers and hit the (mechanical) road. What doesn’t kill you, after all, makes you stronger. Right?

Yet Another Fountain of Youth

Maybe it’s just me, but whenever I stumble upon a story touting the latest anti-aging research, I can’t look away. It’s like driving past a car accident. I just have to slow down and gawk. I can’t help myself. And I’ll bet I’m not alone. Who doesn’t want to learn the secret of a long (and presumably happy) life?

So, when I saw a piece in Science Daily touting the longevity-enhancing qualities of niacin, I was immediately transfixed. Not just because the Swiss researchers were more enamored with their findings than most gerontologists, but because what they were asserting was so counterintuitive.

It’s pretty much conventional wisdom among students of aging that the most pernicious enemy of longevity (at the cellular level, anyway; fractured hips are another thing altogether) are the pesky free radicals that damage healthy cells through a process called “oxidative stress.” Imagine the rusty remains of cars in a junkyard and you’ve pretty much captured the concept. It’s also been fairly widely accepted that consuming various types of antioxidants — the resveratrol in red wine being my personal favorite — can help keep your cells from gathering rust.

But these niacin boosters argue that our current infatuation with antioxidants is basically a bunch of hooey. “The claim that intake of antioxidants, especially in tablet form, promotes any aspect of human health lacks scientific support,” lead researcher Michael Ristow, a professor of energy metabolism at ETH Zurich, told Science Daily. And, he added, a little oxidative stress is actually a healthy thing.

That’s where niacin comes in. According to Ristow and his colleagues, a healthy dose of the B vitamin (B3 to be exact) will trick the body into believing it’s exercising, thus unleashing those free radicals in a “health-promoting” way. “Cells can cope well with oxidative stress and neutralize it,” Ristow said.

Hey, it works in roundworms: Ristow’s team found that the worms juiced up with niacin lived one-tenth longer than usual. That’s about three extra days for a worm that has to cram all of its life experiences into one short month, but imagine extending your lifespan by eight years or so just by ramping up your dosage of B3. The possibilities, as they say, are endless — just like the number of anti-aging studies.