Posts Tagged ‘aging’

Maintaining Masculinity With Aging

July 21, 2017

Andrew Siegel MD  7/21/17

“Time has a nasty way with human materials.”…Zadie Smith

“The reality of our bodies is that they are born and grow and in time suffer and decline.”  …Senator Ben Sasse

Bona Lane

No matter how old, most men wish to be able to travel down this road until their final breath.

Although the term masculinity may be better understood conceptually than described in words, it can be defined as possessing positive qualities traditionally associated with men: virility, drive, strength, vigor, resiliency, confidence, self-sufficiency, etc. Carried to an extreme, it can sometimes be associated with alpha behaviors including aggression, hyper-sexuality and supreme authority. Certainly, masculinity implies a certain “swagger” that clearly is unique from femininity. Sadly, aging and natural deterioration gradually rob men of many masculine attributes with the ultimate result–at some point in time–infirmity and frailty.

The Inevitable Loss of Horsepower

Our bodies-as-machines slowly lose their maximal horsepower and morph into less performative and functional machines.  The realities and challenges that accompany reaching senior years–the anatomical and functional deterioration that affect every organ system–are a direct blow to masculinity. A central premise of masculinity is having a strong and fit body; however, aging is at direct odds with masculinity because of the loss of bone and muscle mass, slower healing, accumulation of injuries and the occurrence of disease processes, resulting in declining strength and fitness.

All systems go to ground, as eventually we do. The senses–vision, hearing, taste, smell, touch–slowly rust away. Locomotion, nervous system, urinary system, bowel system, cognition and memory deteriorate. There is a good reason that athletes are considered “old” in their thirties. Rigidity of erections, the literal totem of masculinity, declines in proportion to age in years.

The silver lining is that although the degenerative process is inevitable and there will come a time when frailty will ensue, with the combination of strength training, cardiovascular conditioning, core and balance work, this process can be deferred substantially. Thinned bones, wasted muscles and hunched posture can be largely prevented by proactive and preemptive strikes against their onset.

I have an amazingly fit and cognitively intact 95-year-old patient who goes to the gym three times a week.  He lamented to me that because of an injury he was unable to work out for a few weeks and as a result he felt flabby and listless.

Retirement: Death with Benefits

At some point in the aging process, retirement from work becomes a reality for the vast majority of men.  Leaving work is one of the more challenging aspects of aging as our careers can often be considered “masculine” experiences from a primal perspective, since our roles as “hunter”—“warrior”—“gatherer” provide for our families.  Aside from financial resources, works provides benefits on so many levels—engendering a sense of usefulness and purpose, identity, dignity, self-worth, achievement, recognition, respect, (particularly self-respect), status and influence.  Furthermore, work also provides connection, collaboration and networking that are central to the human experience.  There is something special about having purpose and being productive, both of which give real meaning to one’s existence and help maintain vitality. This does not necessarily involve continuing to work full-time and compromising our fun and leisure activities, but rather achieving a healthy balance between work and play with part-time work, an encore career, volunteering, etc.

As a urologist with many years of clinical experience, I can attest to the fact that one of the shared attributes of my older patients who have aged well (Youthful Elderly Persons, a.k.a. Yeppies) is that they have NOT retired, often working well into their eighties and beyond.

Mitigate Risks

Typically associated with “masculinity” is risk-taking behavior.  Men are more likely than women to engage in activities such as smoking, heavy drinking, fast driving without seat belts, participating in sports with high injury rates, etc.  However, as we age, continued participation in such activities will not help the masculine cause, so at some point those who wish to maintain their masculinity will need to curtail unhealthy lifestyle activities and tailor sport participation in such a way as to maximize benefits, but minimize risks, for example, playing doubles tennis instead of singles.

Masculine to be Feminine

Masculinity often entails “alpha” behavior, which typically implies stoicism and self-reliance, in contrast to the female gender that is generally more emotive, communicative and willing to seek help from others. This translates to less preventive health care as men tend to be more reactive than proactive.  Furthermore, it generally leads to men having less meaningful and more superficial relationships than our female counterparts. This cool and independent alpha manner does not foster the skillset necessary to deal with many of the unpleasant circumstances that often accompany aging. It behooves men to seek preventive health care as well as nourish internal health by developing deeper and more meaningful relationships with our significant other, children, family and friends. We are a species who exists to coexist and connect and it is this social web that provides a safety net for us, valuable always, but particularly so when isolation, depression, fear, anxiety, etc., strike.

Bottom LineThe aging process gradually and insidiously erodes “masculinity.” Continuing to work in some capacity, working out regularity, working towards minimizing high-risk activities and maintaining a healthy lifestyle, and working “inwards”—fighting the culturally-based stoicism and self-reliance that runs counter to humans as highly social creatures–in concert can preserve “masculine capital” to an advanced age.  Although aging can be considered the “enemy” and will ultimately prevail, it is all about the possibilities as opposed to the limitations of the process.

Thank you to Rick Siegel–my brother–for suggesting an entry on this topic, based upon reading a Wall Street Journal article from 2/27/17: “Need To Redefine Masculinity As We Get Older” by Dana Wechsler Linden.

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health

Co-creator of the PelvicRx male pelvic floor muscle training DVD.

 

 

 

What To Expect of Your Erections As You Age…20’s, 30’s, 40’s and Beyond

December 26, 2015

Andrew Siegel,  MD  12/26/15

I have written more than 250 blogs, this being the overwhelming most popular one with 50,000 plus views in 2015.  I am therefore reposting this as an encore final entry of 2015. 

shutterstock_side view manjpeg

It is shocking how ill prepared we are for aging. Nobody informs us exactly what to expect with the process, so we just sit back and observe the changes as they unfold, dealing with them as best we can. Although educational books are available on many topics regarding other expected experiences, such as “What To Expect When You’re Expecting,” I have yet to see “The Manual of Man,” explaining the changes we might expect to experience as time goes on. Some day I wish to author a book like that, but for the time being I will blog on what to anticipate with male sexual function as time relentlessly marches on.

“But the wheel of time turns, inexorably. True rigidity becomes a distant memory; the refractory period of sexual indifference after climax increases; the days of coming are going. Sexually speaking, men drop out by the wayside. By 65, half of all men are, to use a sporting metaphor, out of the game; as are virtually all ten years later, without resort to chemical kick-starting.”

Tom Hickman, God’s Doodle: The Life and Times of the Penis

Aging can be unkind and Father Time does not spare your sexual function. Although erectile dysfunction (ED) is not inevitable, with each passing decade, there is an increasing prevalence of it. Present in some form in 40% of men by age 40 years, for each decade thereafter an additional 10% join the ED club. All aspects of sexuality decline, although libido (sexual interest and drive) suffers the least depreciation, leading to a swarm of men with eager “big heads” and apathetic “little heads,” a most frustrating combination indeed.

With aging often comes less sexual activity, and with less sexual activity often comes disuse atrophy, in which the penis actually becomes smaller. Additionally, with aging there is often weight gain, and with weight gain comes a generous fat distribution in the pubic area, which will make the penis appear shorter. With aging also comes scrotal laxity and testicles that hang down loosely, like the pendulous breasts of an older woman. Many of my older patients relate that when they sit on the toilet, their scrotum touches the toilet water. So, the penis shrinks and the testicles hang low like those of an old hound dog…Time and gravity can be cruel conspirators!

So, what can you expect of your sexual function as you age? I have broken this down by decade with the understanding that these are general trends and that you as an individual may well vary quite a bit from others in your age group, depending upon your genetics, lifestyle, luck and other factors. There are 30-year-old men who have sexual issues and 80-year-old men who are veritable “studs,” so age per se is not the ultimate factor.

You may wonder about the means by which I was able to craft this guide. I was able to do so through more than 25 years spent deep in the urology trenches, working the front line with thousands of patient interactions. My patients have been among my most important teachers and have given me a wealth of information that is not to be found in medical textbooks or journals, nor taught in medical school or during urology residency. Furthermore, I am a 50-something year-old man, keenly observant of the subtle changes that I have personally witnessed, but must report that I am still holding my own!

Age 18-30: Your sexual appetite is prodigious and sex often occupies the front burners of your mind. It requires very little stimulation to achieve an erection—even the wind blowing the right way might just be enough to stimulate a rigid, gravity-defying erection, pointing proudly at the heavens. The sight of an attractive woman, the smell of her perfume, merely the thought of her can arouse you fully. You get erections even when you don’t want them…if there was only a way to bank these for later in life!  You wake up in the middle of the night sporting a rigid erection. When you climax, the orgasm is intense and you are capable of ejaculating an impressive volume of semen forcefully with an arc-like trajectory, a virtual comet shooting across the horizon. When you arise in the morning from sleep, it is not just you that has arisen, but also your penis that has become erect in reflex response to your full bladder, which can make emptying your bladder quite the challenge, with the penis pointing up when you want to direct its aim down towards the toilet bowl.

It doesn’t get better than this…you are an invincible king… a professional athlete at the peak of his career! All right, maybe not invincible…you do have an Achilles heel…you may sometimes ejaculate prematurely because you are so hyper-excitable and sometimes in a new sexual situation you have performance anxiety, a mechanical failure brought on by the formidable mind-body correction, your all-powerful mind dooming the capabilities of your perfectly normal genital plumbing.

Age 30-40: Things start to change ever so slowly, perhaps even so gradually that you barely even notice them. Your sex drive remains vigorous, but it is not quite as obsessive and all consuming as it once was. You can still get quality erections, but they may not occur as spontaneously, as frequently and with such little provocation as they did in the past. You may require some touch stimulation to develop full rigidity. You still wake up in the middle of the night with an erection and experience “morning wood.” Ejaculations and orgasms are hardy, but you may notice some subtle differences, with your “rifle” being a little less powerful and of smaller caliber. The time it takes to achieve another erection after ejaculating increases. You are that athlete in the twilight of his career, seasoned and experienced, and the premature ejaculation of yonder years is much less frequent an occurrence.

Age 40-50: After age 40, changes become more obvious. You are still interested in sex, but not nearly with the passion you had two decades earlier. You can usually get a pretty good quality erection, but it now often requires tactile stimulation and the rock-star rigidity of years gone by gives way to a nicely firm penis, still suitable for penetration. The gravity-defying erections don’t have quite the angle they used to. At times you may lose the erection before the sexual act is completed. You notice that orgasms have lost some of their kick and ejaculation has become a bit feebler than previous. Getting a second erection after climax is not only difficult, but also may be something that you no longer have any interest in pursuing. All in all though, you still have some game left.

Age 50-60: Sex is still important to you and your desire is still there, but is typically diminished. Your erection can still be respectable and functional, but is not the majestic sight to behold that it once was, and touch is necessary for full arousal. Nighttime and morning erections become few and far between. The frequency of intercourse declines while the frequency of prematurely losing the erection before the sexual act is complete increases. Your orgasms are definitely different with less intensity of your climax, and at times, it feels like nothing much happened—more “firecracker” than “fireworks.” Ejaculation has become noticeably different—the volume of semen is diminished and you question why you are “drying up.” At ejaculation, the semen seems to dribble with less force and trajectory; your “high-caliber rifle” is now a “blunt-nosed handgun.” Getting a second erection after climax is difficult, and you have much more interest in going to sleep rather than pursuing a sexual encore. Sex is no longer a sport, but a recreational activity…sometimes just reserved for the weekends.

Age 60-70: “Sexagenarian” is bit of a misleading word…this is more apt a term for the 18-30 year-old group, because your sex life doesn’t compare to theirs…they are the athletes and you the spectators. Your testosterone level has plummeted over the decades, probably accounting for your diminished desire. Erections are still obtainable with some coaxing and coercion, but they are not five star erections, more like three stars, suitable for penetration, but not the flagpole of yonder years. They are less reliable, and at times your penis suffers with attention deficit disorder, unable to focus and losing its mojo prematurely, unable to complete the task at hand. Spontaneous erections, nighttime and early morning erections become rare occurrences. Climax is, well, not so climactic and explosive ejaculations are a matter of history. At times, you think you climaxed, but are unsure because the sensation was so un-sensational. Ejaculation may consist of a few drops of semen dribbling out of the end of the penis. Your “rifle” has now become a child’s plastic “water pistol.” Seconds?…thank you no …that is reserved for helpings on the dinner table! Sex is no longer a recreational activity, but an occasional amusement.

Age 70-80: When asked about his sexual function, my 70-something-year-old patient replied: “Retired…and I’m really upset that I’m not even upset.”

You may still have some remaining sexual desire left in you, but it’s a far cry from the fire in your groin you had when you were a younger man. With physical coaxing, your penis can at times be prodded to rise to the occasion, like a cobra responding to the beck and call of the flute of the snake charmer. The quality of your erections has noticeably dropped, with penile fullness without that rigidity that used to make penetration such a breeze. At times, the best that you can do is to obtain a partially inflated erection that cannot penetrate, despite pushing, shoving and manipulating every which way. Spontaneous erections have gone the way of the 8-track player. Thank goodness for your discovery that even a limp penis can be stimulated to orgasm, so it is still possible for you to experience sexual intimacy and climax, although the cli-“max” is more like a cli-“min.” That child’s “water pistol”…it’s barely got any water left in the chamber.

Age 80-90: You are now a member of a group that has an ever-increasing constituency—the ED club. Although you as an octogenarian may still be able to have sex, most of your brethren cannot; however, they remain appreciative that at least they still have their penises to use as spigots, allowing them to stand to urinate, a distinct competitive advantage over the womenfolk. (But even this plus is often compromised by the aging prostate gland, wrapped around the urinary channel like a boa constrictor, making urination a challenging chore.) Compounding the problem is that your spouse is no longer a spring chicken. Because she been post-menopausal for many years, she has a significantly reduced sex drive and vaginal dryness, making sex downright difficult, if not impossible. If you are able to have sex on your birthday and anniversary, you are doing much better than most. To quote one of my octogenarian patients in reference to his penis: “It’s like walking around with a dead fish.”

Age 90-100: To quote the comedian George Burns: “Sex at age 90 is like trying to shoot pool with a rope.” You are grateful to be alive and in the grand scheme of things, sex is low on the list of priorities. You can live vicariously through pleasant memories of your days of glory that are lodged deep in the recesses of your mind, as long as your memory holds out! Penis magic has gone the way of defeated phallus syndrome. So, when and if you get an erection, you never want to waste it!

Wishing you a healthy, peaceful, happy (and sexy) 2016,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. Coming soon is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Sexuality and Aging: Sex Dies Hard

September 5, 2015

Andrew Siegel, MD   9/5/15

Affectionate old couple with the wife holding on lovingly to the husband's face. Focus on the husband's eyes. Concept: Elderly love.

(Image attribution: Ian MacKenzie—Flickr– licensed under Creative Commons attribution 2.0 generic license)

“Sexy”—“desirable,” “seductive,” “alluring,” “sensual,” “erotic,” etc.—is a term applied primarily to attractive young people. As we age, we are somehow considered less “sexy”; however, at any age sexiness, sexuality and/or sex (call it what you will) is an important part of life for both women and men who desire closeness and intimacy that is often expressed through sexual means.

Many people have negative attitudes, prejudices and discomfort when considering the sexuality of older people, with a prevailing notion that older people should be asexual. Think about how biased and disparaging are the terms “dirty old man” and “cougar,” referring to older men and women, respectively, with healthy libidos. The thought of one’s parents having sex is disturbing and cringe-worthy for many. How about the notion of one’s grandparents sharing an intimate moment? Why is it so disconcerting to imagine the passionate coupling of aging bodies that have lost youthful suppleness? Why are the adjectives that often come to mind regarding elder sex “ugh”, “creepy,” “repulsive,” etc.?

When I asked my 16-year-old daughter to describe her thoughts on her parents having sex, her response was “disgusting.” When asked about her grandparents, she replied “gross.”

Sexuality is so much more than an act of physical pleasure. For men, it is emblematic of potency, virility, fertility, and masculine identity. For women, it represents femininity, desirability and vitality. For both genders, sex is an expression of physical and emotional intimacy, a means of communication and bonding that occurs in the context of skin-to-skin, face-time contact that gives rise to happiness, confidence, self-esteem and quality of life. In addition to sexual health being an important part of overall health, it also provides comfort, security and ritual that permeate positively into many other areas of our existence.

Time is relentless and the years creep by with great momentum until one day you are 50-years-old and you question how this is possible. However, no matter what our chronological age is, our drive, enthusiasm, spirit and need for physical and emotional and intimacy remain largely intact. Understandably, sex in the golden years is not always possible because of medical issues, absence of a partner or declining sexual interest. However, medical progress in the field of human sexuality has made it possible to maintain sexual activity until an advanced age.

Means Of Staying Sexually Active Until Old Age

First-line strategy is lifestyle “management” (healthy eating, maintaining a desirable weight, regular exercise, avoidance of stress, moderate alcohol intake, sufficient sleep, avoidance of tobacco, etc.). Physical interventions include pelvic floor muscle training and vibratory stimulation (useful for both genders) and the vacuum suction device. Pelvic floor muscle training improves the strength and endurance of the pelvic floor muscles—the “rigidity” muscles that surround the roots of the penis and the clitoris—enhancing penile and clitoral erections, pelvic blood flow and optimizing the muscles that engage at the time of orgasm. Vibratory stimulation triggers the reflex between the genitals and the spinal cord, enhancing genital blood flow and inducing contractions of the pelvic floor muscles. By stimulating this reflex and triggering nerve activity in the brain, spinal cord and peripheral nerves, vibratory stimulation is capable of inducing penile and clitoral erections and ejaculation/orgasm. The vacuum suction device—a.k.a., the penis pump—is a means of drawing blood into the penis to obtain an erection and enable sexual intercourse.

There are a host of pharmacological interventions available including hormone therapy–testosterone replacement therapy for men and estrogen replacement therapy for women. There are numerous oral medications for erectile dysfunction (ED) including Viagra, Levitra, Cialis and Stendra. Other alternatives for men with ED include urethral suppositories, penile injections and penile implants. Suppositories are pellets that are placed in the urethra that act to increase penile blood flow. Injections do the same, although they are injected directly into the erectile chambers. Penile implants are semi-rigid non-inflatable or hydraulic inflatable devices that are implanted surgically within the erectile chambers and can be deployed on demand to enable sexual intercourse.

Addyi (Flibanserin) is a new oral medication for diminished libido. It is currently being marketed largely to females, but is purportedly effective for both sexes. FDA approved on August 18, 2015, it is the first prescription for diminished sex drive, a drug that has been referred to as “pink Viagra.”

Despite all of the advances made in the field of sexual dysfunction, cost has become a major issue. On July 1, 2015, Medicare decreed that they would no longer pay for the vacuum suction device. For almost the past decade, Medicare has not covered the oral ED medications. They have become a very expensive commodity, averaging more than $35 per pill! Many private insurance companies are following suit, with little interest in financing the sex lives of those insured. Whether the government and private insurers should or should not underwrite the cost of maintaining sexual function is arguable. Certainly, as important as sex is, there are other health issues that are more pressing. However, no one can deny the importance of a healthy sex life as a means of maintaining wellness and quality of life.

Bottom Line: As one proceeds through life, he or she comes to the realization that their inner spirit and driving force remains intact, even though there are obvious age-related declines in their physical appearance and function. The notion that sexuality loses importance as we age is incorrect and antiquated. The common practice of sexual ageism should be abandoned. Being able to function sexually means so much more than the physical act of bodies coupling. Physical and emotional intimacy is ageless.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

What To Expect of Your Erections As You Age…20’s, 30’s, 40’s and Beyond

August 11, 2014

 

Andrew Siegel MD Blog # 167

 

3 screw icon square

 

It is shocking how ill prepared we are for aging. Nobody informs us exactly what to expect with the process, so we just sit back and observe the changes as they unfold, dealing with them as best we can. Although educational books are available on many topics regarding other expected experiences, such as “What To Expect When You’re Expecting,” I have yet to see “The Manual of Man,” explaining the changes we might expect to experience as time goes on. Some day I wish to author a book like that, but for the time being I will blog on what to anticipate with male sexual function as time relentlessly marches on.

 “But the wheel of time turns, inexorably. True rigidity becomes a distant memory; the refractory period of sexual indifference after climax increases; the days of coming are going. Sexually speaking, men drop out by the wayside. By 65, half of all men are, to use a sporting metaphor, out of the game; as are virtually all ten years later, without resort to chemical kick-starting.”

Tom Hickman God’s Doodle: The Life and Times of the Penis

Aging can be unkind and Father Time does not spare your sexual function. Although erectile dysfunction (ED) is not inevitable, with each passing decade, there is an increasing prevalence of it. Present in some form in 40% of men by age 40 years, for each decade thereafter an additional 10% join the ED club. All aspects of sexuality decline, although libido (sexual interest and drive) suffers the least depreciation, leading to a swarm of men with eager “big heads” and apathetic “little heads,” a most frustrating combination indeed. With aging often comes less sexual activity, and with less sexual activity often comes disuse atrophy, in which the penis actually becomes smaller.

Additionally, with aging there is often weight gain, and with weight gain comes a generous fat distribution in the pubic area, which will make the penis appear shorter. With aging also comes scrotal laxity and testicles that hang down loosely, like the pendulous breasts of an older woman. Many of my older patients relate that when they sit on the toilet, their scrotum touches the toilet water. So, the penis shrinks and the testicles hang low like those of an old hound dog…Time and gravity can be cruel conspirators!

So, what can you expect of your sexual function as you age? I have broken this down by decade with the understanding that these are general trends and that you as an individual may well vary quite a bit from others in your age group, depending upon your genetics, lifestyle, luck and other factors. There are 30- year old men who have sexual issues and 80-year old men who are veritable “studs,” so age per se is not the ultimate factor.

You may wonder about the means by which I was able to craft this guide. I was able to do so through more than 25 years spent deep in the urology trenches, working the front line with thousands of patient interactions. My patients have been among my most important teachers and have given me a wealth of information that is not to be found in medical textbooks or journals, nor taught in medical school or during urology residency. Furthermore, I am a 50-something year-old man, keenly observant of the subtle changes that I have personally witnessed, but must report that I am still holding my own!

Age 18-30: Your sexual appetite is prodigious and sex often occupies the front burners of your mind. It requires very little stimulation to achieve an erection—even the wind blowing the right way might just be enough to stimulate a rigid, gravity-defying erection, pointing proudly at the heavens. The sight of an attractive woman, the smell of her perfume, merely the thought of her can arouse you fully. You get erections even when you don’t want them…if there was only a way to bank these for later in life! You wake up in the middle of the night sporting a rigid erection. When you climax, the orgasm is intense and you are capable of ejaculating an impressive volume of semen forcefully with an arc-like trajectory, a virtual comet shooting across the horizon. When you arise in the morning from sleep, it is not just you that has arisen, but also your penis that has become erect in reflex response to your full bladder, which can make emptying your bladder quite the challenge, with the penis pointing up when you want to direct its aim down towards the toilet bowl. It doesn’t get better than this…you are an invincible king… a professional athlete at the peak of his career! All right, maybe not invincible…you do have an Achilles heel…you may sometimes ejaculate prematurely because you are so hyper-excitable and sometimes in a new sexual situation you have performance anxiety, a mechanical failure brought on by the formidable mind-body correction, your all-powerful mind dooming the capabilities of your perfectly normal genital plumbing.

Age 30-40: Things start to change ever so slowly, perhaps even so gradually that you barely even notice them. Your sex drive remains vigorous, but it is not quite as obsessive and all consuming as it once was. You can still get quality erections, but they may not occur as spontaneously, as frequently and with such little provocation as they did in the past. You may require some touch stimulation to develop full rigidity. You still wake up in the middle of the night with an erection and experience “morning wood.” Ejaculations and orgasms are hardy, but you may notice some subtle differences, with your “rifle” being a little less powerful and of smaller caliber. The time it takes to achieve another erection after ejaculating increases. You are that athlete in the twilight of his career, seasoned and experienced, and the premature ejaculation of yonder years is much less frequent an occurrence.

Age 40-50: After age 40, changes become more obvious. You are still interested in sex, but not nearly with the passion you had two decades earlier. You can usually get a pretty good quality erection, but it now often requires tactile stimulation and the rock-star rigidity of years gone by gives way to a nicely firm penis, still suitable for penetration. The gravity-defying erections don’t have quite the angle they used to. At times you may lose the erection before the sexual act is completed. You notice that orgasms have lost some of their kick and ejaculation has become a bit feebler than previous. Getting a second erection after climax is not only difficult, but also may be something that you no longer have any interest in pursuing. All in all though, you still have some game left.

Age 50-60: Sex is still important to you and your desire is still there, but is typically diminished. Your erection can still be respectable and functional, but is not the majestic sight to behold that it once was, and touch is necessary for full arousal. Nighttime and morning erections become few and far between. The frequency of intercourse declines while the frequency of prematurely losing the erection before the sexual act is complete increases. Your orgasms are definitely different with less intensity of your climax, and at times, it feels like nothing much happened—more “firecracker” than “fireworks.” Ejaculation has become noticeably different—the volume of semen is diminished and you question why you are “drying up.” At ejaculation, the semen seems to dribble with less force and trajectory; your “high-caliber rifle” is now a “blunt-nosed handgun.” Getting a second erection after climax is difficult, and you have much more interest in going to sleep rather than pursuing a sexual encore. Sex is no longer a sport, but a recreational activity…sometimes just reserved for the weekends.

Age 60-70: “Sexagenarian” is bit of a misleading word…this is more apt a term for the 18-30 year-old group, because your sex life doesn’t compare to theirs…they are the athletes and you the spectators. Your testosterone level has plummeted over the decades, probably accounting for your diminished desire. Erections are still obtainable with some coaxing and coercion, but they are not five star erections, more like three stars, suitable for penetration, but not the flagpole of yonder years. They are less reliable, and at times your penis suffers with attention deficit disorder, unable to focus and losing its mojo prematurely, unable to complete the task at hand. Spontaneous erections, nighttime, and early morning erections become rare occurrences. Climax is, well, not so climactic and explosive ejaculations are a matter of history. At times, you think you climaxed, but are unsure because the sensation was so un-sensational. Ejaculation may consist of a few drops of semen dribbling out of the end of the penis. Your “rifle” has now become a child’s plastic “water pistol.” Seconds?…thank you no …that is reserved for helpings on the dinner table! Sex is no longer a recreational activity, but an occasional amusement.

Age 70-80: When asked about his sexual function, my 70-something-year-old patient replied: “Retired…and I’m really upset that I’m not even upset.” You may still have some remaining sexual desire left in you, but it’s a far cry from the fire in your groin you had when you were a younger man. With physical coaxing, your penis can at times be prodded to rise to the occasion, like a cobra responding to the beck and call of the flute of the snake charmer. The quality of your erections has noticeably dropped, with penile fullness without that rigidity that used to make penetration such a breeze. At times, the best that you can do is to obtain a partially inflated erection that cannot penetrate, despite pushing, shoving and manipulating every which way. Spontaneous erections have gone the way of the 8-track player. Thank goodness for your discovery that even a limp penis can be stimulated to orgasm, so it is still possible for you to experience sexual intimacy and climax, although the cli-“max” is more like a cli-“min.” That child’s “water pistol”…it’s barely got any water left in the chamber.

Age 80-90: You are now a member of a group that has an ever-increasing constituency—the ED club. Although you as an octogenarian may still be able to have sex, most of your brethren cannot; however, they remain appreciative that at least they still have their penises to use as spigots, allowing them to stand to urinate, a distinct competitive advantage over the womenfolk. (But even this plus is often compromised by the aging prostate gland, wrapped around the urinary channel like a boa constrictor, making urination a challenging chore.) Compounding the problem is that your spouse is no longer a spring chicken. Because she been post-menopausal for many years, she has a significantly reduced sex drive and vaginal dryness, making sex downright difficult, if not impossible. If you are able to have sex on your birthday and anniversary, you are doing much better than most. To quote one of my octogenarian patients in reference to his penis: “It’s like walking around with a dead fish.”

Age 90-100: To quote the comedian George Burns: “Sex at age 90 is like trying to shoot pool with a rope.” You are grateful to be alive and in the grand scheme of things, sex is low on the list of priorities. You can live vicariously through pleasant memories of your days of glory that are lodged deep in the recesses of your mind, as long as your memory holds out! Penis magic has gone the way of defeated phallus syndrome. So, when and if you get an erection, you never want to waste it!

Stay tuned for my next blog, coming next week: The solution to age-related decline in sexual function: 10 Things You Can Do To Prevent a Limp Penis

Wishing you the best of health and erections that last a lifetime,

2014-04-23 20:16:29

      Andrew Siegel, M.D.

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: http://www.HealthDoc13.WordPress.com

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Getting Up At Night Gets Me Down: Nighttime Urinating

May 24, 2014

Blog #155

Getting up once to relieve your bladder during sleep hours is usually not particularly troublesome. However, when it happens two or more times, it can negatively impact one’s quality of life because of sleep disruption, daytime fatigue, an increased risk of fatigue-related accidents and an increased risk of fall-related nighttime injuries. Fatigue has a negative effect on just about everything, even influencing us to mindlessly eat.

Nocturia is the medical term for the need to awaken from sleep to urinate. One’s natural response is to think urinary bladder problem and seek a consultation with a urologist, the type of doctor who specializes in the urinary system. Although nocturia manifests itself via the bladder and much of the time is a urological issue, it is often not a bladderproblem. Rather, the kidneys are frequently culprits in contributing to the condition.

The kidneys are remarkable organs that can multitask like no other. They not only filter blood to remove waste products, but are also responsible for other vital body functions: They are in charge of maintaining the proper fluid volume within our blood stream. They regulate the levels of our electrolytes including sodium, potassium, chloride, etc. They keep our blood pH (indicator of acidity) at a precise level to maintain optimal function. They are key players in the regulation of blood pressure. Furthermore—and unbeknownst to many—they are responsible for the production of several important hormones: calcitrol (calcium regulation), erythropoietin (red blood cell production), and renin (blood pressure regulation). The kidneys regulate our blood volume by concentrating or diluting our urine depending on our state of hydration. When we are over-hydrated, the kidneys dilute the urine to rid our bodies of excess fluid, resulting in virtually clear urine. When we are dehydrated, the kidneys concentrate urine to preserve our fluid volume, resulting in very concentrated urine that can look as dark as apple cider.

Nocturia correlates with aging and the associated decline in kidney function and decreased ability to concentrate urine. Although having an enlarged prostate may certainly contribute to nocturia, it is obviously much more complicated than this since women do not have prostates and nocturia is equally prevalent in men and women. As simple as getting up at night to urinate sounds, it is actually a complex condition often based upon multiple factors that require careful evaluation in order to sort out and treat appropriately. When a urology consultation is sought, our goal is to distinguish between urological and non-urological causes for nighttime urinating. It often comes down to one of three factors: nighttime urine production by the kidneys; capacity of the urinary bladder; and sleep status. In the elderly population, excessive nighttime urine production is a factor almost 90% of the time.

Nocturia can ultimately be classified into one or more of 5 categories: global polyuria (making too much urine, day and night); nocturnal polyuria (making too much urine at night); reduced bladder capacity; sleep disorders; and circadian clock disorders (problems with our bio-rhythms). Global polyuria can result from excessive fluid intake from overenthusiastic drinking or from dehydration from poorly controlled diabetes mellitus (sugar diabetes). The pituitary gland within our brain manufactures an important hormone responsible for water regulation. This hormone is ADH—anti-diuretic hormone—and it works by giving the message to the kidneys to concentrate urine. Diabetes insipidus is a disease of either kidney origin—in which the kidneys do not respond to ADH—or pituitary origin—in which there is deficient secretion of ADH. In either case, lots of urine will be made, resulting in frequent urination, both daytime and nighttime. Medications including diuretics, SSRIs (selective serotonin reuptake inhibitors), calcium blockers, tetracycline and lithium may induce global polyuria.

Nocturnal polyuria may be on the basis of excessive fluid intake, especially diuretic beverages including caffeine and alcohol, a nocturnal defect in the secretion of ADH, and unresponsiveness of the kidneys to the action of ADH. Congestive heart failure, sleep apnea and kidney insufficiency may also play a role. Certain conditions result in accumulation of fluids in tissues of the body such as the legs (peripheral edema); when lying down to sleep, the fluid is no longer under the same pressures as determined by gravity, and returns to the intravascular (within the blood vessels) compartment. It is then subject to being released from the kidneys as urine. Such conditions include heart, kidney and liver impairment, nephrotic syndrome, malnutrition and venous stasis. Circadian clock disorders cause reduced ADH secretion or activity, resulting in dilute urine that causes nocturia.

Nocturia may also be caused by primary sleep disorders including insomnia, restless leg syndrome, narcolepsy, and arousal disorders (sleepwalking, nightmares, etc.)

There are numerous urological causes of reduced bladder capacity. Any abnormal process that occurs within the bladder can irritate its delicate lining, causing a reduced capacity: bladder infections, bladder stones, bladder cancer, bacterial cystitits, radiation cystitis, and interstitial cystitis. An overactive bladder—a bladder that “squeezes without its owner’s permission”—can cause nocturia. Some people have small bladder capacities on the basis of scarring, radiation, or other forms of damage. Prostate enlargement commonly gives rise to nocturia, as can many neurological diseases that often have profound effects on bladder function. Incomplete bladder emptying can give rise to frequent urination since the bladder is already starting out on a bias of being partially filled. This problem can occur with prostate enlargement, scar tissue in the urethra, neurologic issues, and bladder prolapse.

The principal diagnostic tool for nocturia is the frequency-volume chart (FVC), a simple test that can effectively guide diagnosis and treatment. This is a 24-hour record of the time of urination and volume of urination, requiring a clock, pencil, paper and measuring cup. Typical bladder capacity is 10–12 ounces with 4–6 urinations per day. Reduced bladder capacity is a condition in which frequent urination occurs with low bladder capacities, for example, 3–4 ounces per void. Global polyuria is a condition in which bladder volumes are full and appropriate and the frequency occurs both daytime and nighttime. Nocturnal polyuria is nocturnal urinary frequency with full and appropriate volumes, with daytime voiding patterns being normal.

Lifestyle modifications to improve nocturia include the following: preemptive voiding before bedtime, intentional nocturnal and late afternoon dehydration, salt restriction, dietary restriction of caffeine and alcohol, adjustment of medication timing, use of compression stockings with afternoon and evening leg elevation, and use of sleep medications as necessary.

Urological issues may need to be managed with medications that relax or shrink the prostate when the issue is prostate obstruction, and bladder relaxants for overactive bladder. For nocturnal polyuria, synthetic ADH (an orally disintegrating sublingual tablet) in dosages of 50-100 micrograms for men and 25 micrograms for women can be highly effective.

Bottom Line: Nocturia should be investigated to determine its cause, which may often in fact be related to conditions other than urinary tract issues. Nighttime urination is not only bothersome, but may also pose real health risks. Chronically disturbed sleep can lead to a host of collateral wellness issues.

Andrew Siegel, MD

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health; available in e-book (Kindle, iBooks, Nook) and coming soon in paperback.

www.MalePelvicFitness.com

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Prostate: Bigger Is Not Better

November 24, 2013

Blog #129

The following quote from Gabriel Garcia Marquez’s Love in the Time of Cholera colorfully sums up the aging prostate:

“He was the first man that Fermina Daza heard urinate. She heard him on their wedding night, while she lay prostrate with seasickness
in the stateroom on the ship that was carrying them to France, and
 the sound of his stallion’s stream seemed so potent, so replete with authority, that it increased her terror of the devastation to come. That memory often returned to her as the years weakened the stream, for she never could resign herself to his wetting the rim of the toilet bowl each time he used it. Dr. Urbino tried to convince her, with arguments readily understandable to anyone who wished to understand them, that the mishap was not repeated every day through carelessness on his part, as she insisted, but because of organic reasons: as a young man his stream was so defined and so direct that when he was at school he won contests for marksmanship in filling bottles, but with the ravages of age it was not only decreasing, it was also becoming oblique and scattered, and had at last turned into a fantastic fountain, impossible to control despite his many efforts to direct it. He would say: “The toilet must have been invented by someone who knew nothing about men.” He contributed to domestic peace with a quotidian act that was more humiliating than humble: he wiped the rim of the bowl with toilet paper each time he used it. She knew, but never said anything as long as the ammoniac fumes were not too strong in the bathroom, and then she proclaimed, as if she had uncovered a crime: “This stinks like a rabbit hutch.” On the eve of old age this physical difficulty inspired Dr. Urbino with the ultimate solution: he urinated sitting down, as she did, which kept the bowl clean and him in a state of grace.”

The prostate gland is that mysterious, deep-in-the-pelvis male reproductive organ that can be the source of so much trouble.  It functions to produce prostate fluid, a milky liquid that serves as a nutrient and energy vehicle for sperm. Similar to the breast in many respects, the prostate consists of numerous glands that produce this fluid and ducts that convey the fluid into the urinary channel. At the time of sexual climax, the smooth muscle within the prostate squeezes the fluid out of the glands through the prostate ducts into the urethra (urinary channel that runs from the bladder to the tip of the penis), where it mixes with secretions from the other male reproductive organs to form semen.

The prostate gland completely envelops the urethra, enabling its many ducts to drain into the urethra. However, this necessary anatomical relationship between the prostate and the urethra can potentially be the source of many issues for the aging male. In young men the prostate gland is the size of a walnut; under the influence of three factors—aging, genetics, and adequate levels of the male hormone testosterone—the prostate enlarges, one of the few organs that actually gets bigger with time when there is so much atrophy (shrinkage) and loss of tissue mass going on elsewhere.

Who Knew?  As we age our muscles atrophy, our bones lose mass, our height shrinks and our hairlines and gums recede.  So why is it that our prostates—strategically wrapped around our urinary channels—swell up?

Prostate enlargement can be very variable; it can grow even to the size of a large Florida grapefruit!  As the prostate enlarges, it often—but not always—squeezes the sector of the urethra that runs through it, making urination difficult and resulting in a number of annoying symptoms and sleep disturbance.   It is similar to a hand squeezing a garden hose that affects the flow through the hose. The situation can be anything from a tolerable nuisance to one that has a huge impact on one’s daily activities and quality of life.

The condition of prostate enlargement is known as BPH—benign prostate hyperplasia—one of the most common plagues of aging men. It is important to identify other conditions that can mimic BPH, including urinary infections, prostate cancer, urethral stricture (scar tissue causing obstruction), and impaired bladder contractility (a weak bladder muscle that does not squeeze adequately to empty the bladder).

Although larger prostates tend to cause more “crimping” of urine flow than smaller prostates, the relationship is imprecise and a small prostate can, in fact, cause more symptoms than a large prostate, much as a small hand squeezing a garden hose tightly may affect flow more than a larger hand squeezing gently. The factors of concern are precisely where in the prostate the enlargement is and how tight the squeeze is on the urethra. In other words, prostate enlargement in a location immediately adjacent to the urethra will cause more symptoms
 than prostate enlargement in a more peripheral location. Also, the prostate gland and the urethra contain a generous supply of muscle and, depending upon the muscle tone of the prostate, variable symptoms may result. In fact, the tone of the prostate smooth muscle can change from moment to moment depending upon one’s adrenaline (the stress hormone) level.

Typical symptoms of BPH include an urgency to urinate requiring hurrying to the bathroom that gives rise to frequent urinating day and night and sometimes even urinary leakage before arriving to the bathroom.  As a result of these “irritative” symptoms, some men have to plan their routine based upon the availability of bathrooms, sit on an aisle seat on airplanes and avoid engaging in activities that provide no bathroom access.  One symptom in particular, sleep-time urination—aka nocturia—is particularly irksome because it is sleep-disruptive and the resultant fatigue can make for a very unpleasant existence.

The other symptoms that develop as a result of BPH are “obstructive” as the prostate becomes “welded shut like a lug nut.”  These symptoms include a weak stream that is slow to start, a stopping and starting quality stream, prolonged time to empty, and at times, a stream that is virtually a gravity drip with no force.  One of my patients described the urinary intermittency as “peeing in chapters.”  Many men have to urinate a second or third time to try to empty completely, a task that is often impossible. There may be a good deal of dribbling after urination is completed, known as post-void dribbling.  At times, a man cannot urinate at all and ends up in the emergency room for relief of the problem by the placement of a catheter, a tube that goes in the penis to drain the bladder and bypass the blockage. BPH can be responsible for bleeding, infections, stone formation in the bladder, and on occasion, kidney failure.

Not all men with BPH need to be treated; in fact, many can be observed if the symptoms are tolerable. There are very effective medications for BPH, and surgery is used when appropriate. There are three types of medications used to manage BPH: those that relax the muscle tone of the prostate; others that actually shrink the enlarged prostate gland; and Cialis that has been FDA approved to be used on a daily basis to treat both erectile dysfunction as well as BPH.  There are numerous surgical means of alleviating obstruction and currently the most popular procedure uses laser energy to vaporize a channel through the obstructed prostate gland.

In terms of the three factors that drive prostate growth: aging, genetics and testosterone: There is nothing much we can do about aging; in fact, it is quite desirable to live a long and healthy life!  We cannot do a thing about our inherited genes.  Having adequate levels of testosterone is actually quite desirable in terms of our general health.

So what can we do to maintain prostate health? The short answer is that a healthy lifestyle can lessen one’s risk of BPH.  Regular exercising and maintaining a physically active existence results in increased blood flow to the pelvis, which is prostate-healthy as it reduces inflammation. Sympathetic nervous system tone tends to increase prostate smooth muscle tone, worsening the symptoms of BPH; exercise mitigates sympathetic tone.  Maintaining a healthy weight and avoiding abdominal obesity, will minimize inflammatory chemicals that can worsen BPH.   Vegetables are highly anti-inflammatory and consumption of those that are high in lutein, including kale, spinach, broccoli, and peas as well as those that are high in beta-carotene including carrots, sweet potatoes, and spinach can lower the risk of BPH.  

Bottom Line: BPH is a common problem as one ages, oftentimes negatively impacting quality of life.  There are medications as well as surgery that can help with this issue; however, a healthy lifestyle that includes exercise, avoidance of obesity, and a diet rich in vegetables can actually help lower the risk for developing bothersome prostate symptoms.

Ten Steps To A Healthy Prostate 1. Decrease the amount of animal fat in your diet 2. Eat less meat and dairy 3. Eat more fish 4. Eat more tomatoes 5. Increase the amount of soy in your diet 6. Eat more fruits, veggies, beans, cereals and whole grains 7. Drink a cup of green tea daily 8. Maintain a healthy weight 9. Exercise regularly 10. Manage stress

Andrew Siegel, M.D.

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Time Ticking

August 3, 2013

Andrew Siegel, MD   Blog #114

 

The following article appeared in the August 1 New York Times and was written by Steven Petrow. I found it to be a very sobering analysis of a subject that we just don’t like to think or talk about, and it very much reminded me of a post I did a few months ago, which is re-posted at the conclusion of the article.

 

“With every new silver hair sprouting from my scalp, I can’t help but think of the shortening arc ahead of me. Now in my mid-50s, for the first time I’m no longer looking up, over and beyond. Rather, my trajectory points downward at the approaching horizon. In this frame of mind, I recently found myself at DeathClock.com, the “Internet’s friendly” — if not scientific — “reminder that life is slipping away … second by second.” After I completed the short questionnaire, the Death Clock’s algorithm quickly did the math, concluding: “Your personal day of death is Wednesday, April 23, 2031.”

That’s a scant 18 years — although the clock gave it to me “in seconds left to live.” At the time, it was 563,037,386 … and counting down.

Old enough not to believe everything I read on the Web, I queried my doctor about my expected longevity. He quickly e-mailed back: “All things being equal, I believe your estimated survival time would be around 72 to 75. Good luck.”

Good luck? I spent a few moments processing the possible meanings behind “good luck” (none of them particularly appealing), realizing my good doctor had pretty much corroborated the Death Clock’s calculation, then sat there feeling sorry for myself, imagining the hourglass emptying. Then, not allowing myself to wallow one grain of sand longer, I decided to quit my day job.

Yes, just like that. Call me crazy. I worked as an editor and, ironically, my soon-to-be-former boss had once given me a copy of Malcolm Gladwell’s “Blink: The Power of Thinking Without Thinking,” suggesting I needed to act more on impulse than rationality. I had previously underlined this particular section: “Decisions made very quickly can be every bit as good as decisions made cautiously and deliberately.”

I’d long been toying with — even planning for — the day I’d quit. But so many fears had stood in my way, starting with the most basic: dollars and cents. Yes, my partner and I had downsized. Yes, I’d been squirreling away a rainy-day fund. And yes — and most significantly — I’d been talking regularly with my therapist not just about quitting, but about how to live a truly meaningful life. I knew it wasn’t sleeping my way through the workdays to get to the weekend.

Now a new fear – the ticktock of the clock — squashed the pecuniary one, and the decision to leave my job seemed like a Gladwell no-brainer.

Anyway, my plan wasn’t to spend the rest of my life traveling the world. First of all, that rainy-day fund isn’t that big. And as short as 18 years sounds, that’s a heck of a lot of days and weeks (and yes, seconds) not to fritter away. Rather, my plan was to do what I’d been doing in bits and pieces, in between jobs, on vacations, before the work day and after hours: Be a full-time writer.

Fortunately, I had some role models in making this leap. My friend Peter, 53, a documentarian, had left his full-time job 18 months earlier to take what he then called a sabbatical to write a play. He explained to me: “I realized it was a myth to think there would be a time when I don’t have any financial worries. If not now, when?” He then added that his 52-year-old best friend who died of a malignant brain tumor “was a very real accelerator of my decision.”

Similarly, my friend Tom, 56, told me over coffee he’d come to the realization, “I only have so many years left.” A photographer and writer, he’d recently stepped down from a university directorship after watching two of his closest friends die, “guys that I thought were bulletproof,” he explained. “I want to quit talking about doing my own work – and do my own work.”

The week after getting my doctor’s “good luck” e-mail, I gave notice. I told a good story but what I didn’t say was this: “I’ve got only one life to live, and if I don’t do it now, when?”

I couldn’t sleep the next few nights, the loud echoes of my naysayers circling through my head. But over the weeks that followed, things began to shift. I started to get new assignments and finished up a book proposal. I’d get up at 5 a.m. as excited as a kid on Christmas morning. I felt a new sense of ownership, joy and meaning to my days. This wasn’t my work, it was my life. And I didn’t just like it – I loved it.

Of course, I know I won’t spend the rest of my days in this state of euphoria. I will struggle with blank pages and intermittent paychecks. But I will appreciate each day more. I understand now what my friend Tom was telling me when he sent me a short passage from Wendell Berry’s novel “Jayber Crow,” in which the namesake main character reflects on the passage of time. “Back at the beginning, as I see now, my life was all time and almost no memory … And now, nearing the end, I see that my life is almost entirely memory and very little time.”

I know too well the feeling that my life is now more memory than future. As I finish these pages, I see that my clock is down two million seconds from when I started. Call me crazy, but I have to say I love the ticktock of the Death Clock. Without it, I might not be living.”

 

—————————————————————————————————

I am now just a few short years away from 60 (how is that possible?), inciting me to wax philosophical about the aging process.  The numbers are concrete and I view and interpret them through a surreal prism of disbelief and astonishment, still appearing reasonably young and internally feeling no different than 20 or 25 or 30. Factually, the average life expectancy for a male in the USA is 75.5 years.  So the truth of the matter is that if I am fortunate enough to achieve average longevity, I have already lived 75% of my life. And generally speaking, the last 25% of one’s life are not the best years in terms of one’s health, as I can attest to as a physician.

 

Somehow and some way, humans are imbued with a powerful mechanism of denial that allows us to isolate realities such as these and store them on some imaginary shelf, bottled in some imaginary can to be sequestered and quarantined and not to be contended with.  If we did not have this ability, the psychic pain would be unbearable and thanks to this artifice, we manage to endure emotional burdens. This allows me to proceed under the delusion that I am still “young” and have my whole life in front of me and I remain hopefully optimistic about what the future will bring, and my optimism is self-fulfilling.

 

I completed my fellowship at UCLA and continue to receive mailings and updates from this superb medical institution.  I just received their publication “Vital Signs,” which has a section for my demographic advertising their “Fifty Plus” program, which offers educational lectures, a walking program, information on community and health resources, membership amenities, a free community flu shot clinic, and special events. In the Spring 2013 edition, the following classes were offered: Senior

Scholars; Memory Training Course; Brain Boot Camp; Vision Problems in Older Adults; Health Maintenance and Disease Prevention; Tai Chi Workshop; Introduction to Dementia; Senior Health Fair; Vaginal and Bladder Mesh Surgery; and Dizziness. Oy Veh…woe is me!

 

The aging process is insidious. The years creep by, seemingly slowly at first; then, ever so gradually, the wheel of time starts to crank faster and faster with greater and greater momentum, until the weeks and months roll past at a dizzying and frightening warp speed. Before you know it, you are at the summit of the mountain, looking down at the back face or, for you golfers out there, you’re on the back nine.

 

The older one gets, the faster one’s perception of the passage of time. When I was a child, a single summer seemed to represent an eternity; now, in midlife, the summers blur by at a rate that challenges my sanity. Family events that are initially scheduled on the calendar for a few years from now seem to approach at an uncomfortably rapid pace and, suddenly, are here. Part of this may be explained on a strictly mathematical basis—for a five-year-old, one year represents 20% of his or her life, whereas for a 50-year-old, it represents a mere 2%. Another factor in the perception of time racing faster and faster is our pursuit of a career—being productive and busy does not necessarily lend itself to the awareness of time: time consciousness, if you will. Many of us are ever increasingly focused on our day-to-day activities, too caught up in maintaining our routines to take notice of the hours, weeks, and years speeding by.

 

The lightness of being is an additional factor contributing to the perception of the rapid passage of time—we float around the planet consumed by a variety of roles that we play, always in a hurry, constantly on the move, existing without giving a great deal of thought to actual existence—as a result, existence seems to lose its substance, weight, meaning, and time framework. We are so consumed by our numerous mundane daily destinations, working, traveling, living in our oftentimes insular circles, that we are remiss in attending to the real journey, the true process, life in its entirety. It is a Zen precept that life is to be found in the present moment, and not the future. Lack of focus on the here and now with too much attention to the next moment can be a factor in the perception of time passing at warp speed.

 

The bottom line is that the future is approaching in a fast and furious fashion and most of us hopefully desire to maximize our time—irrefutably one of our most precious commodities—that we spend occupying space on our planet. And we really do have precious little time here—to paraphrase Hart Crane: “Our earthly transit is a brief wink between eternity and eternity.” To quote Ben Stein, “Time is overwhelming, omnipotent, and ubiquitous in its power…it may never be conquered or defeated.”

 

As my former golf instructor-cum-philosopher Hank related to me, every opportunity we have to swing a golf club at a ball is a unique moment in space and time—a different day, a different course, a different ball, a different lie, a different mood, a different weather forecast—a moment that will happen once and only once and then will be gone forever. So, since you have one and only one chance at making the most of this unique slice (pardon the pun) of eternity, why not give it your all

and make it count to the best of your abilities. This concept is a useful metaphor when extended to life in general.

 

 So what is one to do in the face of this seemingly harsh reality? The answer is to appreciate every moment, put your best effort into every endeavor, and relish the journey because the inevitable destination for ALL of us is exactly the same. This is essentially an expansion of Tony Horton’s “BRING IT” concept (regarding exercise) to life overall.

 

“We see life through a screen of thoughts and concepts, and we mistake those for reality.  We get so caught up in this endless thought-stream that reality flies by unnoticed.  We spend our time engrossed in activity, caught up in an eternal pursuit of pleasure and gratification and eternal flight from pain and unpleasantness.  We spend all of our energies trying to make ourselves feel better, trying to bury our fears, endlessly seeking security.”

Bhante Henepola Gunaratana

 

“Life is a fatal adventure. It can only have one end.

So why not make it as far ranging and free as possible.”

Alexander Eliot (author/critic)

 

“We are living on borrowed time.”

Father Americo Salvi, my patient

“Do stuff. Be clenched, curious.  Not waiting for inspiration’s shove or society’s kiss on your forehead.  Pay attention.  It’s all about paying attention.  Attention is vitality.  It connects you with others.  It makes you eager.  Stay eager.”

Susan Sontag

“Don’t betray time with false urgencies.” 

Jack Kerouac

“For of all sad words of tongue or pen, the saddest are these—it might have been.”

John Whittier

“The miracle is not to walk on water.  The miracle is to walk on the green earth, dwelling deeply in the present moment and feeling truly alive.”

Thich Nhat Hanh

“Life moves pretty fast.  You don’t stop and look around once in a while,

you could miss it.”

Ferris Bueller

“Learn as if you were to live forever. Live as if you were to die tomorrow.”

Gandhi

 

“….Time is passing faster and faster every day.  Day to day I have to make all sorts of choices about what is good and important and fun, and then I have to live with the forfeiture of all the other options those choices foreclose.  And I’m starting to see how as time gains momentum my choices will narrow and their foreclosures multiply exponentially until I arrive at some point on some branch of all life’s sumptuous branching complexity at which I am finally locked in and stuck on one path and time speeds me through stages of stasis and atrophy and decay until I go down for the third time, all struggle for naught, drowned by time.  It is dreadful.  But since it’s my own choices that’ll lock me in, it seems unavoidable—if I want to be any kind of grownup, I have to make choices and regret foreclosures and try to live with them.”
David Foster Wallace

“The first half of life is orderly, a miracle of detailed harmonious unfolding” beginning with the embryo.  What comes after our reproductive years is “more like the random crumpling of what had been neatly folded origami, or the erosion of stone.  The withering of the roses in the bowl is as drunken and disorderly as their blossoming was regular and precise.”

Jonathon Weiner

 

“What surprises me most about humanity is man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

The Dalai Lama, when asked what surprised him most about humanity.

“Maybe it’s not metaphysics. Maybe it’s existential. I’m talking of the individual US citizen’s deep fear, the same basic fear that you and I have and that everybody has except nobody ever talks about except existentialists in convoluted French prose. Or Pascal. Our smallness, our insignificance and mortality, yours and mine, the thing that we all spend all our time not thinking about directly, that we are tiny and at the mercy of large forces and that time is always and that every day we’ve lost one more day that will never come back and our childhoods are over and our adolescence and the vigor of youth and soon our adulthood, that everything we see around us all the time is decaying and passing, it’s all passing away, and so are we, so am I, and given how fast the first forty two years have shot by it’s not going to be long before I too pass away, whoever imagined that there was a more truthful way to put it than “die,’ “pass away”, the very sound of it makes me feel the way I feel at dusk on a wintry Sunday—’

And not only that, but everybody who knows me or even knows I exist will die, and then everybody who knows those people, and might even conceivably have even heard of me will die, and so on, and the gravestones and monuments we spend money to have put in to make it sure we are remembered, these’ll last what—a hundred years? two hundred? – and they’ll crumble, and the grass and insects my decomposition will go to feed will die, and their offspring, or if I am cremated the trees that are nourished by my windblown ash will die or get cut down and decay, and my urn will decay, and before maybe three or four generations it will be like I never existed, not only will I have passed away but it will be like I was never here.

That everything is on fire, slow fire, and we’re all less than a million breaths away from an oblivion more total than we can even bring ourselves to even try to imagine, in fact probably that’s why the manic US obsession with production, produce, produce, impact the world, contribute, shape things, to help distract us from how little and totally insignificant and temporary we are.”

David Foster Wallace, from “The Pale King”

“Life is tough.  It takes a lot of your time, all your weekends, and what do you get at the end of it?  Death, a great reward.  I think that the life cycle is all backwards.  You should die first, get it out of the way.  Then you live twenty years in an old-age home.  You are kicked out when you are too young.  You get a gold watch, you go to work.  You work forty years until you’re young enough to enjoy your retirement.  You go to college, you party until you’re ready for high school.  You become a little kid, you play, you have no responsibilities, you become a little boy or girl, you go back into the womb,  you spend your last nine months floating.

 And you finish off as a gleam in someone’s eye.”

Jack Kornfeld
“Reverse Living”

Bottom Line: The reality is that the “end of the line” comes far too quickly. So, enjoy and protect in every way possible what you have today. Carpe Diem!

 

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.

Time Out

April 11, 2013

 

Andrew Siegel, MD  Blog #102

photo1

I am now just a few short years away from 60 (how is that possible?), inciting me to wax philosophical about the aging process.  The numbers are concrete and I view and interpret them through a surreal prism of disbelief and astonishment, still appearing reasonably young and internally feeling no different than 20 or 25 or 30. Factually, the average life expectancy for a male in the USA is 75.5 years.  So the truth of the matter is that if I am fortunate enough to achieve average longevity, I have already lived 75% of my life. And generally speaking, the last 25% of one’s life are not the best years in terms of one’s health, as I can attest to as a physician.

Somehow and some way, humans are imbued with a powerful mechanism of denial that allows us to isolate realities such as these and store them on some imaginary shelf, bottled in some imaginary can to be sequestered and quarantined and not to be contended with.  If we did not have this ability, the psychic pain would be unbearable and thanks to this artifice, we manage to endure emotional burdens. This allows me to proceed under the delusion that I am still “young” and have my whole life in front of me and I remain hopefully optimistic about what the future will bring, and my optimism is self-fulfilling.

I completed my fellowship at UCLA and continue to receive mailings and updates from this superb medical institution.  I just received their publication “Vital Signs,” which has a section for my demographic advertising their “Fifty Plus” program, which offers educational lectures, a walking program, information on community and health resources, membership amenities, a free community flu shot clinic, and special events. In the Spring 2013 edition, the following classes were offered: Senior

Scholars; Memory Training Course; Brain Boot Camp; Vision Problems in Older Adults; Health Maintenance and Disease Prevention; Tai Chi Workshop; Introduction to Dementia; Senior Health Fair; Vaginal and Bladder Mesh Surgery; and Dizziness. Oy Veh…woe is me!

The aging process is insidious. The years creep by, seemingly slowly at first; then, ever so gradually, the wheel of time starts to crank faster and faster with greater and greater momentum, until the weeks and months roll past at a dizzying and frightening warp speed. Before you know it, you are at the summit of the mountain, looking down at the back face or, for you golfers out there, you’re on the back nine.

The older one gets, the faster one’s perception of the passage of time. When I was a child, a single summer seemed to represent an eternity; now, in midlife, the summers blur by at a rate that challenges my sanity. Family events that are initially scheduled on the calendar for a few years from now seem to approach at an uncomfortably rapid pace and, suddenly, are here. Part of this may be explained on a strictly mathematical basis—for a five-year-old, one year represents 20% of his or her life, whereas for a 50-year-old, it represents a mere 2%. Another factor in the perception of time racing faster and faster is our pursuit of a career—being productive and busy does not necessarily lend itself to the awareness of time: time consciousness, if you will. Many of us are ever increasingly focused on our day-to-day activities, too caught up in maintaining our routines to take notice of the hours, weeks, and years speeding by.

The lightness of being is an additional factor contributing to the perception of the rapid passage of time—we float around the planet consumed by a variety of roles that we play, always in a hurry, constantly on the move, existing without giving a great deal of thought to actual existence—as a result, existence seems to lose its substance, weight, meaning, and time framework. We are so consumed by our numerous mundane daily destinations, working, traveling, living in our oftentimes insular circles, that we are remiss in attending to the real journey, the true process, life in its entirety. It is a Zen precept that life is to be found in the present moment, and not the future. Lack of focus on the here and now with too much attention to the next moment can be a factor in the perception of time passing at warp speed.

The bottom line is that the future is approaching in a fast and furious fashion and most of us hopefully desire to maximize our time—irrefutably one of our most precious commodities—that we spend occupying space on our planet. And we really do have precious little time here—to paraphrase Hart Crane: “Our earthly transit is a brief wink between eternity and eternity.” To quote Ben Stein, “Time is overwhelming, omnipotent, and ubiquitous in its power…it may never be conquered or defeated.”

As my former golf instructor-cum-philosopher Hank related to me, every opportunity we have to swing a golf club at a ball is a unique moment in space and time—a different day, a different course, a different ball, a different lie, a different mood, a different weather forecast—a moment that will happen once and only once and then will be gone forever. So, since you have one and only one chance at making the most of this unique slice (pardon the pun) of eternity, why not give it your all

and make it count to the best of your abilities. This concept is a useful metaphor when extended to life in general.

So what is one to do in the face of this seemingly harsh reality? The answer is to appreciate every moment, put your best effort into every endeavor, and relish the journey because the inevitable destination for ALL of us is exactly the same. This is essentially an expansion of Tony Horton’s “BRING IT” concept (regarding exercise) to life overall.

“We see life through a screen of thoughts and concepts, and we mistake those for reality.  We get so caught up in this endless thought-stream that reality flies by unnoticed.  We spend our time engrossed in activity, caught up in an eternal pursuit of pleasure and gratification and eternal flight from pain and unpleasantness.  We spend all of our energies trying to make ourselves feel better, trying to bury our fears, endlessly seeking security.”

Bhante Henepola Gunaratana

“Life is a fatal adventure. It can only have one end.

So why not make it as far ranging and free as possible.”

Alexander Eliot (author/critic)

“We are living on borrowed time.”

Father Americo Salvi, my patient

“Do stuff. Be clenched, curious.  Not waiting for inspiration’s shove or society’s kiss on your forehead.  Pay attention.  It’s all about paying attention.  Attention is vitality.  It connects you with others.  It makes you eager.  Stay eager.”

Susan Sontag

“Don’t betray time with false urgencies.” 

Jack Kerouac

“For of all sad words of tongue or pen, the saddest are these—it might have been.”

John Whittier

“The miracle is not to walk on water.  The miracle is to walk on the green earth, dwelling deeply in the present moment and feeling truly alive.”

Thich Nhat Hanh

“Life moves pretty fast.  You don’t stop and look around once in a while,

you could miss it.”

Ferris Bueller

“Learn as if you were to live forever. Live as if you were to die tomorrow.”

Gandhi

 

“….Time is passing faster and faster every day.  Day to day I have to make all sorts of choices about what is good and important and fun, and then I have to live with the forfeiture of all the other options those choices foreclose.  And I’m starting to see how as time gains momentum my choices will narrow and their foreclosures multiply exponentially until I arrive at some point on some branch of all life’s sumptuous branching complexity at which I am finally locked in and stuck on one path and time speeds me through stages of stasis and atrophy and decay until I go down for the third time, all struggle for naught, drowned by time.  It is dreadful.  But since it’s my own choices that’ll lock me in, it seems unavoidable—if I want to be any kind of grownup, I have to make choices and regret foreclosures and try to live with them.”
David Foster Wallace

“The first half of life is orderly, a miracle of detailed harmonious unfolding” beginning with the embryo.  What comes after our reproductive years is “more like the random crumpling of what had been neatly folded origami, or the erosion of stone.  The withering of the roses in the bowl is as drunken and disorderly as their blossoming was regular and precise.”

Jonathon Weiner

 

“What surprises me most about humanity is man. Because he sacrifices his health in order to make money. Then he sacrifices money to recuperate his health. And then he is so anxious about the future that he does not enjoy the present; the result being that he does not live in the present or the future; he lives as if he is never going to die, and then dies having never really lived.”

The Dalai Lama, when asked what surprised him most about humanity.

“Maybe it’s not metaphysics. Maybe it’s existential. I’m talking of the individual US citizen’s deep fear, the same basic fear that you and I have and that everybody has except nobody ever talks about except existentialists in convoluted French prose. Or Pascal. Our smallness, our insignificance and mortality, yours and mine, the thing that we all spend all our time not thinking about directly, that we are tiny and at the mercy of large forces and that time is always and that every day we’ve lost one more day that will never come back and our childhoods are over and our adolescence and the vigor of youth and soon our adulthood, that everything we see around us all the time is decaying and passing, it’s all passing away, and so are we, so am I, and given how fast the first forty two years have shot by it’s not going to be long before I too pass away, whoever imagined that there was a more truthful way to put it than “die,’ “pass away”, the very sound of it makes me feel the way I feel at dusk on a wintry Sunday—’

And not only that, but everybody who knows me or even knows I exist will die, and then everybody who knows those people, and might even conceivably have even heard of me will die, and so on, and the gravestones and monuments we spend money to have put in to make it sure we are remembered, these’ll last what—a hundred years? two hundred? – and they’ll crumble, and the grass and insects my decomposition will go to feed will die, and their offspring, or if I am cremated the trees that are nourished by my windblown ash will die or get cut down and decay, and my urn will decay, and before maybe three or four generations it will be like I never existed, not only will I have passed away but it will be like I was never here.

That everything is on fire, slow fire, and we’re all less than a million breaths away from an oblivion more total than we can even bring ourselves to even try to imagine, in fact probably that’s why the manic US obsession with production, produce, produce, impact the world, contribute, shape things, to help distract us from how little and totally insignificant and temporary we are.”

David Foster Wallace, from “The Pale King”

“Life is tough.  It takes a lot of your time, all your weekends, and what do you get at the end of it?  Death, a great reward.  I think that the life cycle is all backwards.  You should die first, get it out of the way.  Then you live twenty years in an old-age home.  You are kicked out when you are too young.  You get a gold watch, you go to work.  You work forty years until you’re young enough to enjoy your retirement.  You go to college, you party until you’re ready for high school.  You become a little kid, you play, you have no responsibilities, you become a little boy or girl, you go back into the womb,  you spend your last nine months floating.

 And you finish off as a gleam in someone’s eye.”

Jack Kornfeld
“Reverse Living”

Bottom Line: The reality is that the “end of the line” comes far too quickly. So, enjoy and protect in every way possible what you have today. Carpe Diem!

  

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.

Aging Young

September 17, 2011

With the occurrence of my birthday this past week and lots of birthdays of family members this month, I have been thinking about longevity, the aging process, and why—for so many of us—there is a glaring discrepancy between how old we are and how old we look.

Our collective longevity has improved dramatically over the past few centuries.  The 19th century was the Century of Hygiene (improved public health and sanitation saved more lives than any other cause), the 20th century was the Century of Medicine (vaccines, antibiotics, transfusions, chemotherapy, etc., helped contribute to longevity), and the 21st century will be the Century of Healthy Lifestyles—whereby longevity will be increased by reducing risky behaviors and making positive changes with regards to exercise and nutrition.

Aging is an inevitable occurrence, but how we age is within our control to a significant extent. We have it within our own power to maintain health, vitality, and quality longevity—to walk with a spring in our steps and to feel energized and content. Aging is, of course, a 100% fatal proposition, and the best recommendation to push the limit of it is to first do no harm by avoiding malignant behaviors. So the first general rule is active omission—avoid doing bad—do not eat excessively, stay away from harmful substances such as fast food, tobacco and drugs, be moderate when it comes to such things as alcohol and ultra-violet light exposure, minimize stress, etc. The second recommendation to push the limit of aging is active commission—do good—eat properly, exercise vigorously, get enough sleep, seek preventative maintenance, respect yourself, invest in yourself, engage in the fitness and health lifestyle, live well!

“You have to work on longevity…” “My ‘secret’ is that you have to plan for your life. You need to plant the seeds and cultivate them well. Then you can reap the bountiful harvest of health and longevity.” 

(Jack LaLanne, at age 92)

“The secret to aging well is simply living well.”

(A rabbi in his 80’s, who is a patient of mine)


Chronological age refers to how old you actually are (in years, months, days, etc.); physiological age refers to your functional age, the age at which your organ systems and other body parts are functioning.  There can be a great disconnect between chronological and functional ages—one can have a chronological age of 40 and a functional age of 30; or alternatively, someone may chronologically be age 40, yet have a functional age of 60. This disparity basically comes down to genetics and lifestyle. A desirable goal is to maintain a functional age that is as young as possible.

Through my interviews with many chronologically older adults who were physiologically much younger than their years of life would seemingly indicate, certain attributes of aging well and aging long became obvious:

  • An active, purposeful and meaningful existence—for many this means continuing to work in some capacity or involvement in other endeavors that create purpose
  • Ample exercise and physical activity
  • Mental engagement and commitment to interests and hobbies—reading, travel, games, art, music, crafts, pets
  • A healthy diet
  • Avoidance of self-abusive behavior—junk food, obesity, tobacco, excessive alcohol, excessive sun, excessive risks—an “everything in moderation” attitude
  • Close relationships with family and friends with sources of strength being a good social network and perhaps religious/spiritual pursuits; in particular, being in a good marriage seems to be a very important attribute of aging well
  • Optimistic and grateful attitude—cheery, happy and upbeat dispositions with a sense of hope about what the future will bring, a good sense of humor and the ability to deal positively with stress
  • The ability to adapt to loss or change
  • Good genes
  • The practice of preventative maintenance
  • Care about yourself, respect yourself and invest in yourself—live well

Andrew Siegel, M.D.

www.PromiscuousEating.com

If interested in a free electronic download of Finding Your Own Fountain of Youth: The Essential Guide to Health, Wellness, Fitness & Longevity, go to the Promiscuous Eating site and click on “links.”

Tempus Fugit (Time is flying)

September 3, 2011

Tempus Fugit

As another birthday rapidly approaches, I wax philosophical about the aging process. I will soon be 56, a not insignificant number of years now being well behind me.  The numbers do not lie, but the feeling is surreal in quality—how is this possible? I still look reasonable young (although the grays are coming in but good), and feel great, particularly invigorated at this particular moment after a two-hour bike ride with my wife on our tandem hybrid in preparation for the upcoming Bergen Bike Tour fundraiser.

The aging process is insidious. The years creep by, seemingly slowly at first; then, ever so gradually, the wheel of time starts to crank faster and faster with greater and greater momentum, until the weeks and months roll past at a dizzying and frightening warp speed. Before you know it, you are 50 years old and are at the summit of the mountain, looking down at the back face or, for you golfers out there, you’re on the back nine.

The older you get, the faster the perception of the passage of time gets. When I was a child, a single summer seemed to represent an eternity; now, in midlife, the summers blur by at a rate that challenges my sanity. Family events that are scheduled on the calendar for a few years from now seem to approach at an uncomfortably rapid pace and, suddenly, are here. Part of this may be explained on a strictly mathematical basis—for a five-year-old, one year represents 20% of his or her life, whereas for a 50- year-old, it represents a mere 2%.

The lightness of being is an additional factor facilitating the perception of the rapid passage of time—we float around the planet consumed by a variety of roles that we play, always in a hurry, constantly on the move, existing without giving a great deal of thought to actual existence—as a result, existence seems to lose its substance, weight, meaning, and time framework. We are so consumed by our numerous mundane daily destinations, working, traveling, living in our oftentimes insular circles, that we are remiss in attending to the real journey, the true process, life in its entirety. Our pursuit of a productive and busy career does not necessarily lend itself to the awareness of time: time consciousness, if you will. We are all ever increasingly focused on our day-to-day activities, too caught up in maintaining our routines to take notice of the hours, weeks, and years speeding by. It is a Zen precept that life is to be found in the present moment, and not the future. Lack of focus on the here and now with too much attention to the next moment can be a factor in the perception of time passing at warp speed.

The bottom line is that the future is approaching in a fast and furious fashion and most of us desire to maximize our time—one of our most precious commodities—that we spend occupying space on our planet. And we really do have precious little time here—to quote author/columnist Ben Stein paraphrasing Hart Crane: “Our earthly transit is a brief wink between eternity and eternity.” To further quote Ben Stein, “Time is overwhelming, omnipotent, and ubiquitous in its power…it may never be conquered or defeated.”

Stop for just a second or two to fully understand the notion that our time is truly limited, that the clock is ticking away relentlessly. So what is one to do in the face of this seemingly harsh reality? The only thing you can do is try to appreciate every moment, put your best effort into every endeavor, and relish the journey because the inevitable destination for ALL of us is exactly the same. This is essentially an expansion of Tony Horton’s “BRING IT” concept (regarding exercise) to life in general.

“Life is a fatal adventure. It can only have one end. So why not make it as far ranging and free as possible.” Alexander Eliot (author/critic)

“We are living on borrowed time.”  Father Americo Salvi, my patient

Our Mojo is Ageless

 “Age isn’t how old you are, but how old you feel.” Gabriel Garcia Marquez, Memories of My Melancholy Whores

 Our driving force and passion—spirit and vitality, if you will, is something that we are born with and generally never changes with the aging process. No joke! I’m, at my essence, just a 55-year-old kid with the same mental attitude, energy, and life force that I have had since childhood. When my twelve-year-old daughter inquisitively seeks advice from me, I answer her questions as best I can, but secretly feel like I am party to a grand charade— I am really an imposter—a poseur—a child in a man’s body, and at any time my duplicity will be unmasked. I honestly do not feel any different than I did when I was eighteen. The flame of joie-de-vivre, or lack thereof, that we are imbued with does not die or change as we age. Too many of us harbor a misconception that physical aging is associated with aging of mind and attitude. WRONG!! Questioning my own ninety-year-old grandfather, a Russian immigrant who was employed as a Brooklyn “seltzer man,” about this confirmed my already sneaking suspicions about this stability of passion. He conveyed to me that our drive, enthusiasm, and spirit are truly independent of chronological age.

“Never abandon the spirited fire of spontaneous, determined inspiration that sparks dreams into majestic conclusions, marvelous deeds, and spectacular endings.” Bernard Ficarra, M.D.

“You are old when you lose the capacity to dream and be creative.” Shlomo Raz, M.D.

Bottom line:  Time races on, seemingly faster and faster.  So eat well, stay fit, take good care of yourself, live well, be well, treat yourself well and enjoy what life has to offer.  As the cliché states, this is not a dress rehearsal nor is there a second act so…carpe diem (seize the day).

Happy Labor Day weekend and may our United States employment stagnation rapidly correct itself.

Andrew Siegel, M.D.

http://www.PromiscuousEating.com