Another really good book on ... aging

This is another book ‘review’ for my friends, family and colleagues by Daniel Levitin (neuroscientist and professional musician) aptly entitled for us “Successful aging:  a neuroscientist explores the power and potential of our lives”.  The title sounded, well … but it is extremely well researched, well written, thoughtful and impactful for our age group as we prepare for the next phase(s).  The tome presents the latest findings on psychology and neuroscience from a developmental perspective and sprinkles in many anecdotes from active elders from our generation, Joni Mitchell, Steven Stills, Paul Simon, Pablo Casals, Jane Fonda, Dalai Lama, along with many older researchers as well.  It's dense but readable.

 

I enclose the outline, healthy practices to maintain intelligence, a definition of wisdom, and his ‘prescription’ for keeping the mind going.

 

Contents

1.     Continually developing brain

a.     Personality, Memory (sense of you), Perception, Intelligence (problem-solving), Motivation, Social, Pain

2.     Choices we make

a.     Internal clock, Diet (brain food), Exercise, Sleep (memory consolidation)

3.     New longevity

a.     Living longer, Living smarter (cognitive enhancement), Living better (telomeres etc)

 

Health practices to main intelligence

C – curiosity

O – openness

A – associations – engage with others

C – conscientiousness – follow-through (he thinks this is tantamount)

H – healthy practices (diet, exercise, sleep etc)

 

Definition of wisdom

1.     Social decision-making ability and pragmatic knowledge of life

2.     Prosocial attitudes and behaviors

3.     Ability to maintain emotion homeostasis (tendency towards positive)

4.     A tendency toward reflection and self-understanding

5.     Acknowledgement of and coping effectively with uncertainty

6.     Valuing of relativism and tolerance

7.     Spirituality

8.     Openness to new experience

9.     A sense of humor

 

Rejuvenating your brain 

1.     Don’t stop being engaged in meaningful ‘work’.

2.     Look forward, not backwards.

3.     Exercise, preferably in nature.

4.     Embrace a moderated and healthy lifestyle.

5.     Keep your social circle exciting.

6.     Spend time with people younger than you.

7.     See your doctor regularly, not obsessively.

8.     Don’t think of yourself as old.

9.     Appreciate your cognitive strengths (pattern recognition, crystallized intelligence, wisdom, accumulated knowledge)

10.  Promote cognitive health through experiential learning (traveling, g’children, new activities and situations)

 

Live on, live well!

   

Oh Canada, On Wisconsin

From national anthem to university fight song it illustrates where I could-a-been, would-a-been, should-a-been this summer of COVID-19 … to where I am.  It's ground hog day in Middleton, waking up in the same place for months for the first time decades.  And for the first time in 14 years it appears that due to ban on non-essential travel, I won’t make it up to the kinder, gentler north!

Comparative COVID cases in British Columbia and Wisconsin (5+ million both).  I thought BC cases were poised to explode due direct China traffic and the nearby Washington outbreak.  I was wrong.  BC began at 2/3^rd the number of WI cases in March and have fallen to 1/14 – a completely flattened curve!!!   From Vancouver friends to NY Times accounts this is directly due the leadership by provincial health minister Dr. Bonnie Henry.  It’s more than her policies, it has been her daily televised communiques where she provides the numbers, educates, reassures, empathizes and stresses civic responsibility.  This approach has led to a high degree of compliance with masking, social distancing, and contact tracing.  And no surprise what competent female leader can accomplish in a crisis.

So instead of metro Vancouver which has been a combination of summer Chinese immersion and Tai Chi boot camp, I’m ensconced in a mostly medium-sized, white, midwestern town of 38,000 adjacent to scenic Madison, the home of University of Wisconsin, the State Capitol interspersed between four large lakes.  Everything is so convenient, nature conservancy in the back for hiking, groceries 200 feet, Asian food store 0.5 and Costco 1 mile distant.

It has allowed a big time climb back into road biking, in 20-40 mile stretches several times a week replete with 15+% hilly grades (Tour de France) by myself, with Steve, and neighbor Jeff.  One of the unexpected delights is the abundance of bike only paths and being able to reach country blacktop within 0.5 mile of home.  I’ve been humbled by having to walk up the last quarter of two exceedingly steep climbs – and just retooled my rear cassette to give me two extra gears to ascend to the very top!  My favorites passageways meander downhill through tree-covered S-curved arbors at 30 mph.

The landscape explored by bike provides rural views from the hilltops not scalloped by glaciers.  From atop, I can view verdant expanses in a mosaic of green (8 ft corn) in perfectly aligned rows topped with amber (corn tassels), dark green (clover or soy beans), light green (hay), brown (plowed dirt) over rolling terrain with aroma of … fresh manure.  These pastoral vistas are sprinkled with groves of trees, patches of forests, streams and ponds, and dairy farms with black and white Holsteins while reaching skyward with silos, church steeples and wind turbines.  And the bike path is lined by purple and yellow wildflowers and white Queen Anne's lace suspended above.     

Not being able to visit immediate family and Ben’s newbie Juna, I do have extended family here with Steve & Mary and three generations and the Chun Clan here.  Given the time we spent together up at Mary’s modernized ‘camp’ in northern Michigan with all-new indoor toilets and hot water (!) playing games, constructing a hunt for buried treasure, swimming and boating, Korben age 7 in a very touching request asked me if he could have a sleepover with me!  And interviewing two nonagenarians for 3-4 hours a week each has woven a rich tapestry for me that has revealed to me how multiple displacements during WWII (and air raids), women struggling in a man’s world, toggling between east (China) and west (Europe and America), and always adapting to changing circumstances led to wisdom and artistic brilliance respectively.

Am in the best physical shape in 20 years and my two remaining neurons are still firing. 

So despite the constraints, life is full.  And, I'm thankful. 

 

B.S.  (Book Script)

 One quick and relevant read is Robert Reich’s (Clinton’s Secretary of Labor) “The System:  Who rigged it.”  In a nutshell, he delineates three systemic changes wrought by Ronald Reagan in 1980 that has led to the dramatic economic inequality, hollowing of the middle class, extreme concentration of wealth and simply put oligarchy, over the past 40 years.  And, he doesn’t let complicit liberals off the hook either.

1)    The shift from corporate governance from stakeholder governance (that included employees and public interest) to pure shareholder interests (basically profits)

2)    The shift in bargaining power from large unions to giant corporations with consequent reduction in relative wages and concomitant 15-fold rise in CEO compensation

3)    The unleashing of financial power of Wall Street through deregulation leading to stagnant wages, financial crises plus what he termed “socialism for the rich (bank bailouts) and harsh capitalism for the rest”

We are no longer in Kansas …

So said Dorothy to Toto.  On Feb 29, the auspicious leap date on which Steve’s daughter got married, I told good friends that we were about to enter the twilight zone, never fully realizing the extent of what would unfold.  And so, where in the world in Carmen SD … B Li?  A reasonable question as I was in Middleton only 28% of 2019.  But, of course, the question is moot in this twisted, twilight zone!  Friends and relatives of friends were severely affected by COVID-19 in NJ and NY with two succumbing, NYC colleagues experiencing the unimaginable.    

Baby Juna

Most importantly, Theresa and Ben’s second daughter Juna arrived just a day late on July 9^th!  As her Montessori school closed, Ben got up to study (master’s) at 4 am, then took care of  Flora from 7 am, while Theresa worked from home, and then they flipped in the afternoon.  Flora enjoyed the close attention and continued her self-directed, Montessori-style puttering from one activity to the next.  She said “Happy Birthday, Yeye” (paternal gramp) last week!

Big Sis Flora

Jack & Memee

Naomi

Jack and Naomi’s public school amazingly transitioned to daily 40 min Zoom classes, including gym and music, yet despite that effort Rachel noted a decline in learning.  Like all families, she bore the brunt of maintaining school and piano discipline, nutritional and mental health.  After a big sigh of relief, she is taking both swimming at a nearby recreationalized pond.  Fast Naomi has been invited to play on a travel soccer squad a year up.  And Rachel compiled video clips into the most wonderful recorded birthday card from many of you!  Best ever.

And so we adapt.  Flightless since returning from NYC on March 17.  Auto trips only to Milwaukee and to Mary and Steve’s northern Michigan camp.  Constricted in-person social circle but expanded tele-reconnects with family, high school, college, residency mates, former colleagues/mentees/mentor (Memee 90+) and AsAm medical students. Less reading (Van Gogh, Bruce Lee bios), more watching.  But without sports ... unexpectedly enjoyed Chinese and Korean dynastic series, “Rise of the Phoenixes, Rookie Historian, Princess Weiyoung, Last day in Chang-An” with strong heroines but … 50-70+ episodes.  Limited to two meals/day to control weight without exercise facilities.  Tai Chi by tele-teaching by Master Tam in Vancouver.  In spring, hiking/bird watching in the nearby conservancy with Steve.  And summer, tennis with Steve, biking with Jeff, now up to 50-60 miles/week.  Virtual dating.  In a throwback, I picked up the guitar after 40+ years with arthritic hands.  JT, here I creak and croak again.

And so we learn.  The myth of American exceptionalism.  Watched “13^th Amendment, Just Mercy, I am not Your Negro” that connect dots between slavery, Jim Crow, mass incarceration, social inequality and contemporary lynching (by authorities).  Caste by Isabel Wilkerson argues that it goes beyond race to a fixed, socially-constructed caste system.  Watching PBS’s “Asian Americans” with former schoolmate talking heads, Helen Zia and Gordon Chang and “First Vote” with niece talking head (on anti-Asian racism*,**) Jennifer Ho who is the Director of the Center for Humanities and the Arts at the U. Colorado – so proud!   Learning that Asian American health providers and medical students have been sadly and ironically (while others are feted) targeted by anti-Asian racism. 

And so we retire.  One sleepless night, tossed and turned up the idea that I should be contributing something … telemedicine?  I got approval and funding from our national organization, and within 5 weeks Zoom-organized 23 faculty into a 6-hour Telehealth Webinar with 500+ registrants.  Most importantly found two faculty to lead continuing Telehealth projects.  Cyclic vomiting syndrome (yes Suzanne) keeps me up(chuck) to date with guideline revisions, chapters, talks and research mentoring.  APAMSA prepared for next steps with an 8-hour strategic retreat by Zoom.  And I am interviewing artist Margaret Chang (Hong Xian) to collect materials for a possible small biography.  Hmm, I seem to be working.

"Floating without end" by Hong Xian

As Lois said in her birthday greeting, “count your blessings, not your candles.”  Said perfectly.

So as life is placed on pause, take some time to glimpse inwards while reconnecting virtually outwards … here’s a Coke zero with a twist of lime toast to adaptability (and positive changes to come) … 

REQUEST YOUR MAIL-IN BALLOT

*https://journalofethics.ama-assn.org/podcast/ethics-talk-spread-anti-asian-racism-and-xenophobia-during-covid-19-pandemic (interview with the AMA)

**Anti-Asian Racism & COVID19.pptx (can ask me for it)

Coronaville – our new home

Whether you are on staywork, furlough, staycation, self-isolation or quarantine .. it’s no longer Margaritaville. Aunt Terri (Teri’s sister) asked me to share my recent experience and thoughts with you.  

I visited NYC for Asia Week (largest Asian Art fair in galleries and museums) 2½ weeks ago as I had the past four years.  Just as chaos was erupting heralded by the closure of major museums and Broadway.  Susan and I dropped into empty art galleries, one opened just for us after my call – the owner wore a mask.  On Saturday night, Broadway was unprecedently deserted, we along in usually full restaurant and one of a handful at an off-Broadway whodunit.  We took the emerging CoVID concern seriously but not fastidiously seriously.  For example, we elbow bumped instead of hugged, but didn’t distance or mask even though not yet recommended.  Ben called me repeatedly, “Dad you’ve got to get out of NYC, it will the next epicenter!” (before it became so) and shared articles (on community acquisition) as well as his frontline experience.  Somewhat reluctantly, I shortened my stay and returned to a less exposed Middleton, Midwest.  A few days later Susan alerted me that our mutual friends both tested positive, and that she had spent four hours with them before onset of symptoms and that I had been secondarily exposed.  I then went into self-quarantine for 2 weeks.  Fortunately, both of us … remained healthy.  We dodged a bazooka.

What did I learn?  Despite burdensome anticipation from an indirect CoVID contact, I was relieved to be alive, and well.  I indeed had not fully pondered the early on risk.  Were it not for Ben, I would not have altered plans.  He acted pointedly like a parent for which I am truly grateful and thank-full.  I am concomitantly humbled as parent and physician.

Like you at home, I’ve had a chance to speak with numerous family and friends in the US and Canada.  I have read many articles, heard presentations, spoken to my retired from CDC classmate, listened to overwhelmed front-line (including Ben) physicians, and carefully followed my two CoVID + friends.  After an interminable two weeks of fever, cough, shortness of breath, low oxygen levels, their course finally turned.  Like all of you, I still worry for others.  

A few numbers and observations I wanted to share.  Some may be helpful.

1)    Infectivity, compared to influenza.  While a single case of influenza (which I had this spring) is estimated to potentially infect 400 others over a 2-month period, a single case of CoVID could similarly infect 100,000!  Like a California wildfire, it only takes one (ironically even at a funeral) to ignite a whole city.  And, CoVID is 20X more likely to cause mortality than flu.

2)    Spread by whom.  No longer just travelers and the obviously infected, it is in the community even spread by the asymptomatic (except for loss of taste and smell) infected persons.  It is running silently and ubiquitously in our communities.  And, in the absence of herd (previous) immunity it can run rampant, via direct cough droplets, via indirect surfaces (20 hours), in the air (3 hours) and possibly stool.

3)    Who.  Although 80% of cases are mild or moderate, 20% require hospitalization and 5% need ventilators and are at a significant risk of dying.  Serious cases appear to require almost a month in the ICU (much longer than usual) and overwhelms critical care and supplies.  Besides the chronic disease risk factors (especially hypertension due to ACE2 receptor?), it has a predilection for males (70% fatalities) especially over 80 years.  Yet in is not only the elderly as 40% of NYC in-patients are < 50 years.  What is causing deaths not the virus so much as the body’s immune overresponse (cytokine storm = systemic inflammatory response syndrome SIRS) leading to adult respiratory distress syndrome and multisystem organ failure.  And, who wins, and more importantly, who loses ventilator lottery? 

4)    Social isolation and distancing.  The countries where they have stopped CoVID cold, including Taiwan, Singapore, and in South Korea, have done so early self-distancing and isolation and by extensive testing, tracking all contacts of positives, and quarantining.  We don’t have that capability.  However, this flattened curve doesn’t mean you won’t eventually acquire CoVID but avoiding a CoVID mushroom cloud will relieve an overladened medical system and provide a better chance for survival later on.

5)    Medications.  Hydrochloroquine antimalarials do show promise in trials (controlled study from Wuhan), but it may be even better when coupled with azithromycin (Z-pack).  Remedesivir a failed IV anti-Ebola agent shows promise and is currently in trials here.  Tocilizumab an IV anti-inflammatory agent in one case report calmed the cytokine storm.  A vaccine is at least a year away.

So friends and family, take care and be safe.  Follow the guidelines especially washing your hands anytime your go out or return with regular soap and water for 20 sec up to your wrists.  And, if you should get symptomatic – fever, cough, shortness of breath, muscle aches, headaches + loss of taste, diarrhea – please get tested if available and self-isolate.  

Equinox unseen

under Corona glare

daffodils arise 

Three non-fiction bestsellers

Three impactful bestsellers all came in concomitantly from my library request list in the last two weeks and are worth a mention as tasteful food for thought in this Chinese New Year of the Rat.  

Talking to Strangers:  What we should know about the people we don’t know [how our interactions with strangers often go wrong] – Malcolm Gladwell

This is another Gladwellian foray into the maze running behind curious human behavior.  This book is apropos now when the world feels irretrievably polarized as it tries to examine ways we misinterpret or fail to communicate with one another, especially strangers.  It begins with death of Sarah Bland after an undeserved traffic stop spirals out of control, extends to those of numerous unarmed African Americans in police encounters and traverses all the way to blind spots at the root of historical tragedies.  How did Fidel Castro fool the CIA for a generation? Why did Neville Chamberlain think he could trust Adolf Hitler?  Why are campus sexual assaults on the rise?  Then onto wide-ranging front-page incidents involving the deceptions of Bernie Madoff, the trial of Amanda Knox, and the child-abuse scandal involving coach Jerry Sandusky.

Gladwell argues that the flawed tools and strategies we use to make sense of people we don't know invites misunderstanding and conflict with profound unintended consequences.  One of the misperceptions is that we autonomically default to is taking strangers at their word so-called ‘default to truth’ which was at the heart of a CIA double agent, sexual abuse of gymnasts and the unwarranted trust of Hitler.  He explains other types of miscommunications, especially when strangers’ actions that do not conform to accepted norms (“transparency”) and when a failure to recognize a connection between behavior and external factors (“coupling” or context) allows us to radically misinterpret the intended action.

At times the book felt a little too facile, too sensational, but it did explain why the overextension of police policy of geographical profiling and using incidental (tail light) infractions to stop ‘suspicious’ citizens (with the hope of finding contraband) led to unfortunate interactions that resulted in too many unwarranted deaths.  Sobering.

Life span:  Why we age – and why we don’t have to.  David Sinclair PhD

When I first saw this title, I thought it must the hyperbole of the fountain of youth.  But, after reading it, I learned a lot about mechanisms and treatment of aging (especially sirtuin system), some of which … could be life changing now!  Dr. Sinclair is an eminent Harvard geneticist who studies aging and is a strong proponent of studying aging as a disease, that is the core malfunction that underlies specific diseases – cardiovascular, metabolic (diabetes), cancer and neurodegeneration (Alzheimer’s).  He maintains that if we fully understand the aging process, we will be able to circumvent or substantially delay many of the known diseases and experience a markedly enhanced quality of life.  It seemed fanciful at first glance, but he is quite convincing.  

Indeed, many of the key mechanisms have already been elucidated by his and other laboratories – in worms and rodents – and can extend lifespan by 5-20%.  The main one is the ancient sirtuin protein that toggles back and forth between fertility vs. repairing damage.  Resveratrol (red grapes/wine yea!) and nicotinamide mononucleotide stimulate sirtuin and delays aging – the latter even restores fertility in aged mice (grandma become new ma?).  Rapamycin inhibits mTOR (even given at the end of life) in simple cells and metformin activates AMPK (mimicking fasting) with reduced dementia, CV disease, cancer and frailty in 41,000 humans!  A second is epigenetic reprogramming – the Yamanaka (Nobelist) factors – which in simple systems can reverse cellular aging as if hitting a reset button.  BUT, as of yet there is no definitive evidence that these will work in us and long-term side effects are yet unknown.  But as we speak, human trials have just started but may be years to conclusion.  

Dr. Sinclair to his credit, discusses the demographic, nutritional, climatic, social and moral implications of these momentous possibilities.  He and others project that our grandchildren will on average live to 100 years and that people will have 3 careers, a main one, plus two others lasting until the age of 90.  Accordingly, I’m aspiring to be a 90 sprightly Walmart greeter!  I also much appreciated the extent to which he gave credit to others in the field and especially his laboratory post-docs.

Lastly, despite the unknown, he has hedged his bet and reveals what he is doing to improve his own odds of aging gracefully.  He emphasizes lifestyle modification – intermittent fasting, low protein, plant >animal protein, exercise and sleep which we have discussed.  All grandma’s advice.  But he also takes metformin, resveratrol (100s glasses of red wine worth/day) and nicotinamide mononucleotide, an active metabolite of vitamin B6.  

This was fascinating and thought provoking and for me a life changer to find what is known and what one can do potentially do now for oneself.  And I’m going to hedge my bet as well.

Range: Why generalists triumph in a specialized world.  David Epstein (sportswriter)

What's the most effective path to success?  Epstein begins with Tiger’s terrible twos when he already knew he was going to become a golfer and after racking up hour after hour of deliberate practice he outpaced everyone without such a head start.  It turns out, even among elite athletes, early specialization and focus is the exception not the rule.

Having exposure to multiple sports, multiple types of creative arts, multiple academic disciplines, multiple jobs appears to help in several ways.  It allows the child to trial and find a match, it provides a breadth of background which informs unique problems, and it allows the problem solver to draw analogies from a wide range of experiences.  For example, too often it is I have a hammer and there is a nail therefore I … yet the stent-hammering cardiologist continues on despite the equivalent outcome of conservative treatment.  In fact, grit may be overvalued in many who simply change instruments, fields, or jobs due in truth to trying to find a better match rather than from lack of persistence.  So, while experts argue that anyone who wants to excel in a sport, an instrument, or a field should start early, focus intensely, and practice deliberately, data suggests otherwise.

At first, I thought Epstein, an award-winning sportswriter, was selecting data, perhaps even outliers.  But as he reviewed life stories and group analyses of top achievers, he discovered that early specialization is the exception and broad exposure is more the rule.  In domain after domain, from elite (Roger Federer) athletes to artists (Van Gogh), musicians and composers, inventors (of Nintendo, glitter, Apple), forecasters, scientists and Nobel Laureates (Cajal), this pattern seems to hold true.  In a complex and rapidly evolving world, generalists, who typically find their path later than earlier, rather than specialists solve/discover/invent the big and difficult ones. By balancing different interests, they appear to be more mentally agile and more able to make connections (analogies) across fields that narrow specialists cannot see.  The most impactful inventors and Nobelists often cross domains rather than plunge into a single area alone.

This book is one of the most insightful books about learning that ever I’ve read and is relevant to our kids, especially grand kids, teachers, professors … mid-career change.  For our grand kids, having to figure out the hidden rule rather than simply memorizing the short cut, failing a test, quitting a sport or instrument and taking up another appears to be in the long-run the best way to learn.  I realized belatedly how my dilettante-ism (interest in humanities – religion, psychology, medical anthropology) enabled me to delve into grey areas of functional mind-body GI disorders, develop diversity curriculum and understand Asian American medical students.  I came to view Ben’s 7-year walk-about differently as an experimental, matching and maturing phase in which his sociology studies, experience with underserved, goal of social justice, and humanities coalesced into his unique career path.

a NY's or Chinese NY's post

When I reviewed my favorite memories of our condo overlooking the Milwaukee River – moving water soothing– I realized that Teri’s aesthetics and ergonomics (kitchen) were fully realized, something you who visited well appreciated.  Then, I realized that I had lived there longer by myself than with Teri – time slips away quietly and quickly.  

In January I downsized to one room of furniture and one 10x10’ storage and am renting temporarily in Madison to be close to my best friend Steve and mentor/friend Memée and their extended families.  A warm homecoming after 33 years away.

Over the past three years, a seasonal travel tempo has been established – so even while travelling 70% of the time, I am in a familiar and comforting rhythm.  Winter relief is a tour abroad (Kenya/Tanzania/ Netherlands), followed by Asia Week in NYC plus another spring break (DC and Vancouver).  May brings an annual reunion road trip through Iowa City (birthplace), Columbia MO, Lawrence KS (parents burial place).  July-Oct in Vancouver are consumed by daily Chen Tai Chi study/practice.  The fall season includes talks at the APAMSA and NASPGHAN conferences (+ Japan), an OSU football game (2 this year), a Tai Chi trip boot camp in Vancouver, topped off with Thanksgiving and Christmas alternating between Mendham and Denver.  The consistent joys in these journeys are family, old and new friends, great food and conversations, and sightseeing (art).

Highlights?  Ngorongoro Crater and the Serengeti with Steve’s extended family where we saw the free range Big 9 and learned abundantly about natural order, competition, evolution, survival, human incursion and the devastating effects of tropical infections and colonialism.  Interesting fact, Indian Asians comprise 7% of Kenyans yet control 60% of the economy not unlike the Chinese diaspora throughout SE Asia.  ‘Touching’ a Yuan Dynasty (1360s) Chao Mengfu painting in the Freer Gallery storage in DC about which father wrote a monograph.  White water rafting/camping for 5 days on the last undammed, pristine Salmon River in ID with Rachel’s family as she described ‘seeing nature through an 8 and 6 year-old eyes’ and as John captured ‘completely unplugged and totally connected to family and nature’.  And, little FLORA running and calling me Yeye (male-side grandpa). 

Rachel, John, Jack and Naomi continue to prosper in Mendham NJ, Rachel cooking instructing and catering and has the most organized household.  John is with a new generic pharma company and fortunately can work remotely.  Jack is thoughtful, warm and math savvy whereas whereas Naomi is now a speedster and soccer savvy.  Ben, Theresa, Flora (plus one coming) remain in Denver for another 1½ year, Ben completing his fellowship/master’s focusing on gun violence while Theresa works remotely at a Bay Area start-up.  Flora is a truly Montessori 16 month-old who feeds herself with a fork, and is verbal, signing and exacting about what she wants (and does not).

I feel fortunate to continue rich cultural experiences through traveling, art museums and galleries, artists, art historians, curators, eclectic reading (new high of 60 books) and series (Bosch, Mrs. Maisel).  I highly recommend Boon Joon Ho’s Parasite (Golden Globe foreign film winner) a complex comedy, thriller, tragedy and disquieting commentary on social inequity.  I continue to transform my self through Tai Chi (new muscle memory, improved proprioception & BP control), intermittent fasting, increased plant protein/less animal protein, antioxidants and mitochondrial supplements.  And I just began the ‘interesting’ process of internet dating after 45+ years.  

May we all share a healthy and fulfilling 2020 despite our aches and pains and the inhospitable atmospheric and geopolitical climate.  It is indeed wonderful to remain mobile in mind, body and of course bowels – my specific GI perspective.