aging – Page 2 – Jewish Independent

Jumping gene research

Dr. Gideon Rechavi, who founded Sheba Cancer Research Centre, was in Vancouver in January for an international conference at which he presented new findings on “jumping genes.” (photo from Sheba Cancer Research Centre)

Dr. Gideon Rechavi, who founded Sheba Cancer Research Centre, in Ramat Gan, Israel, was in Vancouver in January for an international conference on DNA and RNA methylation.*

“I described a new work we just published, regarding ‘jumping genes,’” he told the Independent about his presentation at the conference. “Forty-five percent of our genome, part of what people used to call ‘junk DNA,’ is composed of genes that can jump from one place to another.”

As far as what this means for the functioning of a body, he explained, “When they jump, they can activate genes and they can also inactivate genes, and it’s a random process. Actually, when I was PhD student in ’82 at the Weizmann Institute, I found the first example of such an event in mammals.” And, he added, “We were also the first to show the role of such events in cancer.”

Rechavi explained, “In cancer, there is a set of genes called oncogenes, genes that usually are normal genes in our genome but, when they are over-activated or activated in the wrong cell or at the wrong time, they can push the cell to proliferate and can cause cancer.”

Now, he said, many years later, using advanced technologies based on whole genome sequencing, they have found that, “in a variety of neurodevelopmental disorders, such as autism and Rett syndrome and similar diseases, there is a basic gene defect in the family or in the affected child. However, the clinical presentation can differ even between identical twins. Nobody understands why the same genome and the same genetic background will result in such a difference, one patient will be affected by epilepsy, the other one by autism or mental retardation.

“The mechanism that we show is that, in the brain, there is, normally, a constant level of jumping of such genes and, probably, it’s essential for diversity of neurons and brain plasticity and activity.”

This is happening all the time in neuronal stem cells, he said. “During the differentiation of neuronal stem cells … there is a very precise time window of 48 hours when such transposition events can take place. And, probably, it’s essential, because you find it in mice, in monkeys and in humans. However, in all the diseases that we are studying, there is over-activation of the mechanism, so you have many more jumping events.”

We have neuronal stem cells dividing in the brain our whole life, said Rechavi. “In the past, we used to think that all of the neurons are created during pregnancy or soon after, but now, in the last 20 years or so, we know there are also adult neuronal stem cells. When you do gymnastics or when you take Prozac, there are more neuronal stem cells. And, in these neuronal stem cells, these transposable elements – jumping genes – are jumping and probably contribute to brain function.”

The process seems to be quite regulated, he said. “The mechanism we suggest, we call it the ‘lightning rod’ mechanism or hypothesis.”

He explained, “The majority of jumping events occur in sequences in the genome where integration will not cause harm. So, in a normal level of jumping, we expect it will be beneficial, and the chance for damage is low. Although, if, in a variety of diseases, there is uncontrolled activation of this mechanism, so there are many more jumps, then it can saturate the lightning rod safeguard mechanism and then affect genes that are relevant to neuronal diseases, and we have a lot of examples where such things happened.”

To study this, said Rechavi, they sequenced the genomes of 100 samples, which included normal, diseased and control brain samples. “We were able to show that there is a particular normal level of transposition … and, then, over-activation, with many more transposition events, in the brains of disease-affected children.”

From these results, he said, we know that “the genes affected by such insertions from these transpositions, you see that many of them are relevant to neuronal functioning, neural development and a variety of neuronal disorders, such as autism and schizophrenia.”

By understanding the biochemical mechanism in these patients, what activates the jumping, “then you can intervene,” said Rechavi. For example, perhaps a drug could be developed that would decrease the level of transposition.

“This is the next step,” he said. “Now, we have several patients where we know the gene defect involved in the syndrome and, therefore, is involved in the enhanced transposition, so now we have to find a way to shut it off, to lower the activity.”

Rechavi said his lab is researching these jumping genes and their effects in both cancer and neuronal disorders, and that they are currently looking for funding to study the involvement of such genes in Alzheimer’s and in aging.

The purpose of the jumping genes is not certain. “What people suggest,” said Rechavi, “is that it has to do with diversity.” Recalling that it is a random process, he explained, “So, instead of having all the neurons in a particular part of the brain being identical, now you have diversity and probably the diversity increases the efficiency of the brain circuits, etc. It can also be relevant to plasticity. We know that specific brain regions can take over following damage or following a kind of environmental influence and change the activity and perform new activities. So, maybe the ability to create diversity in the brain is an advantage.

“A similar model has to do with the immune system,” he added. “With the immune system, we know that there are genetic mechanisms that increase diversity and, then, the cells of the immune system of an individual can respond to any virus and any bacteria.”

The main focus of his lab at Sheba Medical Centre, he said, is to find new genetic and epigenetic mechanisms, “and then to ask, what is their relevance to normal physiology and what’s their relevance to diseases. That’s how this story that started with cancer research turned out to be very relevant to neuronal disorders and psychiatric disorders.”

Rechavi said the phenomenon of jumping genes, or transposable elements, was first identified by American scientist Barbara McClintock (1902-1992) in experiments with maize. (She won the Nobel Prize in 1983 for this and other contributions to the study of genetics.) “She found it in maize,” he said. “We found it in mammals.”

Conferences like the one Rechavi was attending in Vancouver when he spoke to the Independent by phone Jan. 23 from his room at the Fairmont Hotel Vancouver, where the conference was being held, are useful for several reasons.

“Some people, after my talk, came and they wanted to collaborate, they want to learn the methodologies. Some people suggested samples we could analyze…. This is the basis for scientific collaboration, the main reason to do scientific meetings. You can read everything on the internet,” he said, “but when you discuss with people the findings and you drink coffee together and discuss the details, you can get new information, new non-published information, and also collaborations and friendships.”

Sheba Medical Centre doesn’t have many partnerships with Canadian institutions, said Rechavi. The centre’s main collaboration in Canada, he said, is with Toronto’s Hospital for Sick Children, especially in the field of brain tumours, because one of Rechavi’s former trainees, Dr. Uri Tabori, went to SickKids to study such tumours and stayed there.

Before obtaining his PhD at the Weizmann Institute of Science, in Rehovot, Rechavi earned his doctor of medicine at Tel Aviv University’s Sackler School of Medicine. He is a professor of hematology at Sackler School and heads the Cancer Research Centre at Sheba Medical Centre, the largest hospital in Israel, which serves as a university teaching hospital (affiliated with Sackler) and as a tertiary referral centre. He has published more than 450 scientific papers.

In addition to treating some 1.5 million patients annually, Sheba Medical Centre has 75 laboratories and more than 2,000 ongoing clinical trials; 30% of Israeli medical research is performed at Sheba, which files, on average, 15 biomedical patent applications per year.

In October 2017, Sheba Medical Centre inaugurated the Wohl Institute for Translational Medicine. The idea, said Rechavi, is to take the “findings emerging from basic research and try to translate it into taking care of patients; to better diagnose, to [develop] better treatments.”

* Methylation, explained Dr. Gideon Rechavi, “is the addition of a chemical group known as methyl on the four basic letters of the genetic material (DNA and RNA) to generate a new expanded ‘alphabet.’”

Victoria is alive and kicking!

Dulcinea Langfelder, being carried by Eric Gingras, in Victoria, which is at Massey Theatre for two shows only next week. (photo from Dulcinea Langfelder & Co.)

Victoria is coming to New Westminster next week for two shows only. Created and performed by Dulcinea Langfelder, a versatile dancer, multimedia performer and award-winning choreographer from Montreal, Victoria is about old age and young spirit, about laughter in the face of tragedy.

Langfelder started her life in New York. She studied ballet and pantomime, singing and acting. After a few years in Europe, including London and Paris, she moved to Montreal in 1978 to join La Troupe Omnibus. Since then, Montreal has been her home. In 1985, she founded her own company, Virtuous Circle Dance Theatre. In 1997, the company changed its name to Dulcinea Langfelder & Co.

Langfelder loves Montreal and can’t imagine living anywhere else. “The city is effervescent, young culturally compared to New York or Paris,” she said. “Fewer boundaries between categories, and close enough to New York to visit my mom. Why on earth would I want to live elsewhere?”

The same philosophy applies to her choreography and performing. Why on earth would she do anything else? “For the moment, I can still do what I love to do, and I believe that it’s important to see older people on stage. Art has always been the most effective way to influence our attitudes. Victoria gives voice to those who have ‘disappeared’ through aging – but we are still alive and kicking!”

Although it’s hard to pinpoint Victoria’s exact theatrical classification, Langfelder said, “It is a multidisciplinary and multimedia work for the stage. There really is no major discipline. I work with the elements on my palette: movement (I guess I do always put that one first), text, humour, dramatic – through line, projected imagery, music and a bit of puppetry. Everything is choreographed, not just the movement.”

The heroine, Victoria, is “a wheelchair-bound 90-year-old, suffering from the loss of memory, autonomy and just about everything else,” reads the press release. But Langfelder melds poignant and funny in this show of an elderly woman’s courage. Victoria premièred in 1999, and Langfelder told the Independent about its origins.

“In 1994, an actor friend of mine, Charles Fariala, who also worked as an orderly and knew that I have a penchant for tragicomedy, called me to say, ‘You must meet Victor, an old man in a wheelchair who’s lost his memory; sometimes I wonder if he’s just gaga or if he’s discovered Nirvana.’ I immediately responded, ‘We’ll call her Victoria!’ I was intrigued by the question: Where do we find our mental victory when we we’ve lost our physical power?”

Inspired by the concept, Fariala and Langfelder started working on the project. “Charles wrote pages of text, which I re-worked,” said Langfelder. “I also incorporated a lot of text that came from Angel Petrilli, a woman who became the principal model for the character, although there were other people as well, including my own father. But this piece is multidisciplinary and multimedia, so the ‘script’ is composed of text, choreography, song and projected imagery. It was written in concert with all of my collaborators; I created the choreography.”

One of the most unusual aspects of the show is that the protagonist is bound to her wheelchair. “It is hard to tame the wheelchair beast,” Langfelder admitted, “but fascinating for a mover!”

The show’s success and longevity – 18 years now – surprises even its creator. “I didn’t think it would fly at all, with such taboo subject matter,” she said. “But I discovered that audiences had been starving to have this conversation in a non-depressing way. While treating this subject as accurately as I can, Victoria is an uplifting piece, because there really are rich, poetic and hilarious moments when dealing with dementia and the end of life. We just underline those moments, without taking the subject matter lightly.”

Like every performer, Langfelder knows that art must change with time, that an actor should be flexible in her communication with different audiences. Victoria is no exception to this rule. “It changed a lot in the first years,” Langfelder explained, “then subtle changes. It adapted to different languages and cultures, though it clearly reminds us of what we have in common around the world. We’ve done this piece everywhere from Japan to Zimbabwe, in seven languages.”

One of the latest changes was adding another actress to play the title role. “I recently realized that this piece could live longer than I will,” said Langfelder. “I trained Anne Sabourin in the role. She plays Victoria in French.”

Langfelder herself plays Victoria in English in every show, in every country, and the reception has been overwhelmingly favourable, but that is not enough for the actress. “The Victoria project is about touring the piece for the general audience it was designed for,” she said. “Plus, we work hard to get those who can most benefit, and are the least likely to frequent the theatre: seniors and family/professional caregivers. The way we get them to the theatre, and Victoria can’t be done anywhere else, is that we go to them first. We offer workshops that answer their immediate needs, like non-verbal communication, movement for seniors and seminars on creativity, humour and dementia. Then we use the opportunity to make them understand that theatre can actually be useful, even more useful than workshops. We invite them to the theatre.”

Like her heroine, Langfelder meets her challenges with a smile. “I love making people laugh at difficult situations,” she said. “It makes me feel useful. My father’s last words to me, before his stroke, were in response to me complaining about my challenges. He said, ‘You mustn’t get discouraged, because what you do is so important! You put human dilemma on stage and allow us to laugh at it; what could be more important than that?’ I had just begun working on Victoria, and he never saw it. I become him when I play Victoria.”

Victoria is at the Massey Theatre in New Westminster on Oct. 27 and 28. For tickets, visit ticketsnw.ca or call 604-521-5050.

Olga Livshin is a Vancouver freelance writer. She can be reached at [email protected].

Celebrating the mundane

Why is it so bad to talk about the ordinaries of life? People often say the mundane is so boring, let’s talk about something exotic. Let’s gossip about somebody’s perversion. Isn’t there a scandal that’s just been discovered? Have you heard about the latest murder? Are the terrorists going to kill us all? Will they take over our world so that we will have to hide and practise our rituals in secret? Will our grandchildren ever get a paying job again? What’s the point of voting, they all tell us lies?

Turn down the TV, step away from the computer. Better still, turn them off! Don’t we wish it was that simple, but if we stop listening and are not active, isn’t what happens partly our fault?

I think I’d rather talk about how wonderful it is that the sun came out today. And this after many too many days of driving rain. If I organize my time correctly I will be able to sit on my balcony in the evening with a small glass of my favourite beverage, sending out smoke signals. We have had a late spring this year and the trees have been slow to leaf. I have a clear view of the water out by English Bay. It is too early in the season to see any sailboats. I have been rushing the season by stuffing the baskets around my balcony edge with colourful plants; red, yellow, blue, mauve and in-betweens. The dozens of tulips I planted last fall have let me down; lots of greenery, but only a handful of flowered heads.

It is not too early in the season for my blue plastic dragonfly to flutter with excitement as the sun pours over the balcony railing. I can feel the gentle blush of warmth on my skin if the breezes are not too vigorous. Sometimes I have to wear a leather jacket and a scarf to advance my challenge to the recalcitrant spring. I have cast off the rigours of a stuffy nose and a dry throat to insist on being in the pink of good health. We have even had a walk on the beach and ventured into Stanley Park to feed the ducks. We have abandoned the heat of the foreign and the exotic to embrace our ordinary life.

We are back to regular exercise at the community centre. Wasn’t it nice that people noticed we have been away and say they are happy to see us back? We are enjoying our regular shopping trips to the places we are used to. And dropping in on the new restaurants that have sprouted in our neighbourhood to vary our regular dietary habits. It was comforting to visit our doctors, dentists and pharmacists just to check in. And it was great to touch base with friends and family, finding occasions to meet and greet. In spite of technology that spans time and distance so effectively, even with those further away, somehow, people seem closer when we communicate with them from home. The ties that bind are so much stronger when we can see each other face-to-face.

For the next while, we will have gatherings bringing together family members and friends into our own locale, the ones not often in the same place at the same time. I look forward to these encounters. Life can be so fragile and we have had recent reminders of that reality. Sharing each other’s company in the flesh can be one of the rare pleasures we can enjoy in the peripatetic world we inhabit. I treasure each and every one of these opportunities. An appreciation of the passage of racing time gives these occasions added significance.

We ourselves will be traveling long distances soon to acknowledge important events in the lives of those near and dear. Travel is not what it once was, and is more of a challenge for us than it has been in the past. But the act of presence is important. Too often, for us, these days, it is about departing souls, so it is delicious when the trip is about new beginnings. And I will actually get to have all my children around me in one place. Wow!

I just had a birthday. I am too often careless about these times; I have had so many. It was heartening to have others make a fuss. And I got to have contact, and actually talk to, people it is often really difficult to reach in the ordinary course of life. I got to talk to some of my favourite people; that’s always a special pleasure. Appreciating how much of a treat it was for me makes me resolve to pay a lot more attention to this item in the lives of my friends and dear ones.

So here it is. We have spent all this time and space nattering on about so many mundane things. None of the topics has been about earth-shaking events. It does help soothe us, particularly when we have to go through some rough spots. You will have to judge whether it has been worthwhile. I think it has been.

I am looking forward to a sunny tomorrow.

Max Roytenberg is a Vancouver-based poet, writer and blogger. His recently published Hero in My Own Eyes: Tripping a Life Fantastic is available from Amazon and other online booksellers.

A technical love affair

I knew the printer wasn’t working when no typed pages flew out of its up-front opening where typed pages are supposed to fly out. Great! I spend a week feeding it $18 cartridges of yellow, magenta and black, and now that its appetite had been sated, no output. And, by the way, what marketing genius conceived of the scam where the color “black” demands yellow and magenta. It makes as much sense as filling your car with gas but the car won’t go unless you also buy a six pack of beer and two bags of potato chips.

Clearly, I needed a new printer. This clever machine announced its death in a dialect that even I understood. After some 10 years of service, it had gone to that junkyard in the sky where you could print black without magenta or yellow.

I needed a new printer. Even worse, I would have to properly introduce the printer to the computer. I’m a scribbler not an engineer. But then relief, as I thought of my great-grandchild in kindergarten. He was already 6 – he knew all about ’puters, as he called them. No, not a good idea – better my third-grade grandchild – much more experienced.

That thought cost me a quart of strawberry ripple ice cream, and alarm at his mature and loud vocabulary as failure followed failure. Then inspiration lightened the room as I thought of an engineering friend who loved key lime pie. My wife, who didn’t know a printer from a nuclear reactor either, had just made a key lime pie! What followed was the shortest marketing phone conversation on record.

“Henry, come on over and help me share a key lime pie.”

He came. Ate three pounds of key lime pie. We finished. The pie was as dead as the printer. Henry, though, full of pie, was – as I planned – in a jovial mood. I showed him around our house. And, somehow, we ended in the computer room.

“Hey Ted, the wire between the computer and printer isn’t connected.” (My third grader never noticed that! Public schools today are atrocious.) At this point, I hung my head and confessed the whole key lime pie inducement scheme. Nonetheless, my friend – what a friend! – jumped in the driver’s seat. He pushed buttons, tied wires, cursed, sweated. He condemned every printer you could imagine, as my chaste computer wouldn’t mate with the printer.

I didn’t get the whole picture but it had something to with it being a new printer and the ’puter having an old operating system. Such snobbery. It was age discrimination. That lousy printer should end up in court for rejecting the advances of my senior computer.

Not to worry, however. As in most fairytales – though this story is the absolute truth – we somehow found a happy ending. My friend, his forehead wet with frustration, mentioned that he saw another printer in my bedroom.

“Yeah, it’s an old one,” I said. “Somebody gave it to me.”

The word “old” rang in the room like a bell. His eyes lit up like he’d just drained a fifth of champagne.

“Go get it!” he screamed.

Sure enough, the old printer loved that old operating system. The two devices mated in front of our eyes. In fact, together they made this love story.

Ted Roberts is a freelance writer and humorist living in Huntsville, Ala. His website is wonderwordworks.com.

A leader by example

Janice Middleman, left, Rabbi Shaul Osadchey and Bobbie Osadchey, with Florence Middleman in the foreground. (photo from Rabbi Shaul Osadchey)

While it is becoming more commonplace to see people reach the age of 100 in fair health, it remains rare that an individual reaches the age of 110. So, Florence Middleman has beat the odds. And one person in particular has helped her achieve this milestone – her daughter, Janice Middleman.

Florence’s parents moved to eastern Canada at the turn of the last century. At the time, Alberta was vying to become a province. “They went east and recruited, and asked my grandparents and many others to be homesteaders,” said Janice. “As they stayed on the land a certain length of time and worked the land and raised animals, the land would become theirs.

“So, my grandparents came to Alberta and were homesteaders for quite awhile. It was during the dry-land period. There were many dust storms. At some point, they had to put the animals in the house and had to stay in the shelter on the hill they’d built for the animals – to protect themselves and the children from the dust storms.

“After a period of time, they moved to a small town near Edmonton, called Daysland. My grandfather, Max Goldberg, was a tailor. He made the red jackets for the Mounties, as well as everybody else’s clothes.

“My grandmother, Molly, was a midwife and spoke many languages. She delivered all the babies in the town and also accompanied the doctor on his rounds, as many people were immigrants who couldn’t speak English. She translated, so he could treat them.”

Florence was about 19 when the family moved to Edmonton and opened a store. She married Harry Middleman, who had moved from Montreal to Edmonton during the First World War. Janice was their only child.

The family moved to Calgary. While she lived in Toronto during her university years, Janice returned to Calgary afterward to be close to her parents. She took more university courses in Calgary.

When Harry passed away in 1985, Janice moved in with Florence. She found a flexible job she could do from home, while also caring for her mom, as there was no other family in the city.

Florence had four brothers who all passed away many years ago. Janice likes to describe her mom as having won the gene pool by living so long. “She’s got a tremendous spirit, plus the marvels of medicine as well,” said Janice.

Florence worked until the age of 68 as a librarian at an elementary school. She would have continued working and the library tried hard to keep her on, but, at the time, there was a law in place that you had to retire at the age of 65.

“When she did retire, she took a nap every day,” said Janice. “She has just a very, very good attitude. Besides working and helping to support our family, she volunteered at shul, Hadassah, the Red Cross and the Cancer Society – just to name a few.

“She had an interest in everybody, in Judaism, a belief in God, and kept a kosher home. She had an interest in the world. She appreciated everything and the beauty of nature, and appreciated children, animals and people in general. She still does.

“She always had a lot of friends. Regrettably, most of them are gone now, but she always had a lot of friends. She realized how important it was to give to the world. That’s also part of Judaism, to make the world a better place.”

When asked about her keen interest in child welfare and education, Florence said, “I worked at Glamorgan elementary school, including their library and the rest of the school, and bonded with the students. I was well liked by the children and got to know their likes and dislikes, their needs for education and their quality of life.

“One boy was Jewish and asked me if the library had any Jewish books. There were none in the library, so I brought some from home for him to read. He was very happy to have them.”

Janice added, “After that, my mother was very instrumental in inspiring the school to have multicultural books in their library. It spread to all the schools after that, a great deal due to her influence.”

Florence shared that some of her most-loved reading includes many “biographies, books on Judaism and prayer … biographies on artists, politicians like Abe Lincoln, history, art books, history of art, Canadian history, and all different countries.”

Janice noted, “She was and still is interested in countries and how they got where they are. She has a great love for literature, like Shakespeare, Dickens and William Blake. Also, my mother has written and continues to write our family history, as well as short stories and poetry.”

Florence had this to say about the most-treasured people in her life, such as her daughter, Janice: “I keep good people around me who care about other people, care about doing good works and doing good things in the world. My parents contributed greatly to the town of Daysland.”

As to whether she has any words of wisdom she would like to impart to readers, Florence said, “Keep on going. Surround yourself with good people who have good thoughts and care about their families, friends, the world, who care about contributing to the world and making it a better place and doing good work.

“Volunteer,” she added. “Give to charity when you can. Enjoy Judaism in any manner you are able. Give your time to your friends. Listen to them when they need you. Have a positive attitude. Be optimistic. Be grateful for what you have – your health, family, friends, home, food on the table and clothes on your back.

“Don’t think of the past or what you don’t have. Enjoy every moment, the moments you are in. Keep liking everyone. Don’t forget to thank people in your lives, in your family, and to appreciate everything you have.

“And take time to be good to yourself,” she concluded. “Take a nap every afternoon to refresh yourself. Be good to everyone. Be good to your family and friends. Don’t forget to thank God everyday for everything you have. Before Friday, during the week, don’t forget to be grateful to God and to everyone for everything in your life.”

Rebeca Kuropatwa is a Winnipeg freelance writer.

Benefits from finding your I

What was your growing-up story like? If we are fortunate, we are in a nurturing environment as we scramble to make some sense of the world around us, with little sense of who or what we are. We are all the sensations we react to, hunger, cold, heat, pain, pleasure, more instinctive than rational. When do we develop a sense of self, an idea of what it is we might want rather than what those around us might wish for us?

For me, the smoke began to clear by the time I was in Grade 5, about the age of 11 or 12. Suddenly, it seemed to me, I had a sense of self, and opinions about what was going on around me in the world. Not only that. The opinions of others were less important. I had begun reading voraciously, learning of a world that had a past that had shaped my present. My immigrant parents’ views had begun to disappear as reference points; my feeling was that I knew more about the real world we lived in than they could possibly understand.

By the time I was in my mid-teens, I felt I was fully in charge of my life. I was under the family roof, but the things going on in my head, the plans and actions I contemplated, were formulated and carried out with almost no reference to parental guidance. I generated the funds to permit me independent action from an early age. Was it just me? Was I the only one who was obnoxiously opinionated by the time he was a teenager? I was fortunate that my parents did not stand in my way. It doesn’t happen to everybody like that.

Gaining a consciousness of oneself as separate from those around us, with an independent will, especially, independent from those in positions of authority, is a big thing. The sense of being an independent identity may come long before we achieve independence, but it surely must come first. We may begin by feeling a rising sense of rebellion, exasperation with the lack of understanding by those around us. We may begin to object to decisions made for us, about us, without consultation. We may begin to object to rules of the game, which we find erroneous, obtuse, nonsensical or unjust. We may say nothing, but a knot of resistance, even anger, may begin to form. Our I begins to take shape. We may even be wrong, lacking all the information needed to make a correct decision. We learn to negotiate those things.

An independent will can form at any age. Sensitivity on the part of those in authority, inviting expressions of opinion, can stimulate development. An authoritarian environment can delay it. Doesn’t it take some people a long time to achieve a sense of I? One wonders at the history behind that. How much goes on in the mind as part of this process? How much conflict does it generate? How many experience damaging environments that prevent a proper development, haunting their adult lives. Don’t some people spend a lifetime in counseling working through their feelings? Don’t some people take pills to quiet the questions? We really have to work through this stuff to become happy campers, to make a success of what we hope to do in life. How many people do I know who, even in their 50s and 60s, are agonizing about relationships with parents that still leave them anxious, angry and confused about their self-worth? How can we successfully interact with a life partner with this monkey on our back?

Yet some of us who have lived through the worst seem to get through it relatively unscathed. Perhaps a parent or family member saved the day. Or they met the right person early on who got them on the right track. Or they just had the right stuff to see beyond the sickest parts of the people they were in forced contact with and sloughed it all off. What we do know is that a healthy sense of I, a healthy sense of self-worth, a positive self-image, is crucial to making it through to adulthood with some chance of happiness. With it, we can handle being knocked down a peg or two by the inevitable reverses we will face over the years. We can pick ourselves up, dust ourselves off and step back into the fray.

Max Roytenberg is a Vancouver-based poet, writer and blogger. His book Hero In My Own Eyes has just been published.

A forum on rethinking aging

Gyda Chud of Jewish Seniors Alliance with forum speaker Dan Levitt of Tabor Village. (photo by Binny Goldman)

On Sunday, Nov. 6, 175 people gathered at the Peretz Centre for Secular Jewish Culture for the Jewish Seniors Alliance of Greater Vancouver’s fall symposium, featuring Dan Levitt and his unique approach to residential living.

Ken Levitt, president of JSA, spoke briefly about the seniors organization, after which Gyda Chud, co-convener, greeted the crowd and introduced the Three Amigos, Yom Shamash, Ian St. Martin and Steve Glass, a musical trio who urged attendees to join in as they sang and played songs which included “Bei Mir Bistu Sheyn” – and Chud thanked the musicians with “bei undz bistu sheyn,” “in our eyes you are nice.”

Shanie Levin introduced Levitt.

“In continuing the theme of our Empowerment Series, ‘Thriving until 120,’ we have invited Dan Levitt, executive director of Tabor Village, an elder-care facility affiliated with Fraser Health Authority,” she said. “Levitt is also an adjunct professor in the gerontology department at Simon Fraser University, whose insights and leadership on seniors’ care are sought after in Canada, the U.S., Europe and Asia.”

Levitt challenges societal attitudes towards aging by introducing new approaches to residential living. The goal of his talk – Rethinking Aging: Not the Traditional Nursing Home Grandma Lives In – was to start a conversation that reframes elderhood as an exciting stage in human growth and development.

Levitt would like people to discard the stereotypes of aging that have been emphasized by the media. He wants people to remove the word “still” when praising someone who looks good at 75, to refrain from showing surprise at the ability of someone to work at 80, and for people to maintain high expectations as they age.

He cited an experiment in which each of the residents on the first floor of a seniors residence were given an African violet to water, while second-floor residents were told of a doll that was left in the care of the staff and that, together, they had to make sure it didn’t get lost. On follow up, it was discovered that those who were given the individual responsibility to care for the plants thrived, requiring less medication, and their moods were uplifted, whereas those with the collective responsibility did not fare as well.

Levitt said the idea of individual responsibility has been introduced at Tabor Village and the residents are flourishing, as they expect more of themselves and feel increased self-worth. Levitt mentioned one occasion, where a resident remembered her recipe for pancakes and proceeded to make pancakes from scratch for 20 diners. She then approached Levitt, saying: “You didn’t think I could do it, right?” He had to agree, as he looked around the spotless kitchen. She had not only cooked and served the food, she had cleaned up afterwards.

Statistics show that an average of nine medications are given to seniors in British Columbia. Some of these are chemical restraints – anti-psychotic medications – just to alter behavior and make the residents easier for staff to deal with.

One alternative method that has proven effective is music therapy, said Levitt. This therapy enables non-verbal residents to sing their thoughts when speech has failed.

Alive Inside is an experiment by Dan Cohen, which introduced iPods into a seniors home. Listening to the music, each with their own earphones, non-verbal residents experienced an unprecedented improvement. They readily responded to familiar music, singing along. Some were even able to hold a conversation afterward, saying the music gave them hope and happiness inside. Subsequently, a program called Music and Memory was instituted.

In addition, many residences have introduced computer classes, which benefit many residents.

Breaking old policies is indeed difficult but must be strived for, said Levitt. There are many books, videos and films on the subject of dementia and the stigma that is often associated with it. Still Alice and Glen Campbell: I’ll Be Me are two examples.

Levitt listed off some “super seniors”: one who had climbed Mount Kilimanjaro at age 90; another who golfed and had come close to beating the pros at age 90; and Olga Kotelko, who ran races, breaking records and winning medals into her 90s (she died in 2014).

There are many experimental and successful programs being carried out, said Levitt. One is Hogeweyk in Amsterdam, a village built and devoted to seniors with dementia. A small Ontario town, Penetanguishene, has recreated a village similar to Hogeweyk and relatives of the residents are reportedly pleased with how happy those living in this community are; residents are able to shop and walk to the market, for instance. In Florida, Miami Jewish Health Systems is seeking to create a similar program – Green House Project focuses on helping companies and individuals convert or build residential homes where every room would have a shower. These residences, which exist in several states in the United States, can provide a high level of care for those who do not wish to be in a nursing home.

Levitt ended his talk with a quote from Margaret Mead: “Never doubt that a small group of thoughtful, committed citizens can change the world. It is the only thing that ever has.”

Chud thanked Levitt for teaching the audience to think differently, and noted that the success of the event was made possible by the dedicated help of JSA’s office staff. A video taken by Karon and Stan Shear can be found at jsalliance.org.

Binny Goldman is a member of the Jewish Seniors Alliance of Greater Vancouver board.

Good news on Alzheimer’s

For the last three years, I have been researching, interviewing and writing articles for Senior Line, the magazine published three times a year by Jewish Seniors Alliance of Greater Vancouver. In that capacity, I read everything I can about dementia, especially Alzheimer’s disease, medical care for seniors and residential facilities for seniors.

A year ago, I succumbed and started paying for a digital subscription to the New York Times. Using their “alerts” system, my inbox is filled with relevant, current articles on these topics. I scour the media (Vancouver Sun, Zoomer Magazine, Jewish Independent, CBC News Network, CNN, documentary channels, movies portraying Alzheimer’s disease, and online newsletters from organizations such as CARP and COSCO) searching out information about these senior issues. I also began visiting the Louis Brier Home and Hospital regularly, interacting with people with dementia (with the assistance of Davka, my Standard Poodle).

Why was I obsessed with Alzheimer’s disease? The truth is that I was swimming in a turbulent sea of fear, dread and panic – analyzing every forgetful moment and constantly measuring my intellectual capacities, to be sure that I wasn’t “losing it.” This had been going on for the past five years.

My feelings and thought processes began to evolve as I gained knowledge and understanding of the causes, the progression of this condition and, of utmost importance, the changes in attitude towards the management of seniors residences and the programs offered to seniors with dementia. Most surprisingly, among the gloom and doom scenarios of “the grey tsunami” and “the stark demographic shift,” I began to understand that there is actually good news about dementia and Alzheimer’s disease. Yes, you heard me: good news!

Today, reaching the age of 100 is no longer shocking. I personally know three people who have reached that age. Seniors of my generation, and the Boomers and Zoomers, are living longer. Within this large cohort, dementia is a product of the natural aging process. The longer we live, the higher the probability of dementia. Is there anyone among you who wants to die at 65 or 71 (the risk of Alzheimer’s begins to increase dramatically at the age of 65)? Wouldn’t you rather live to 86 or 94? Of course! Well then, your chances of having dementia will increase.

At 77, I am more active and more productive than I have ever been. I know that, at any time, I may begin to deteriorate. The influence of genes is crucial: one grandmother had dementia, the other did not. My aunt has Alzheimer’s and, recently, a close relative was diagnosed with the early signs of the disease. I am shocked and saddened, but now I am able to accept the possibility, putting it in the context of the result of aging well and living longer.

What have I learned? Maria Shriver, in her Feb. 25 article on WebMD “We can handle the truth: the facts on Alzheimer’s,” writes “try to put your denial impulse aside and take a hard look at the truth about Alzheimer’s. Because the fear that causes you to deny things – like our risk of getting this mind-blowing disease – can actually be the motivator you need to stop ignoring the facts….” We know the risks and the consequences, but we are in denial and unprepared to deal with it – personally, financially and as a society. It seems that by pushing through my ignorance and my fear, I have come to a place of harsh reality and hope.

The intense desire for the discovery of a cure for dementia, or a preventive strategy for Alzheimer’s disease, is universal. Exciting research is happening in labs across the globe but, until a “miracle cure” is found, let us not refuse to act because there is no cure. Denial is the enemy of hope.

How much do you want to know about your risk of getting the disease? Here is a list of ways to learn more:

Review your family history with your doctor.
Review lifestyle factors like diet and exercise with your doctor.
Review your medical history with your doctor, including questions about brain trauma.
Take a genetic test to determine whether you have genes that raise your odds of getting the disease.
Get a brain scan to spot signs of the disease.

But, if you are like 41% of the people in the survey “Insight into Alzheimer’s Attitudes and Behaviors,” you have not – or are not willing to – take any of the proposed steps, according to a Feb. 25 article by Ashley Hayes on WebMD. Another 46% say they aren’t worried about getting Alzheimer’s in the future, mainly because they take care of their health and also because they can’t do anything about it. Thirty-four percent of respondents say they’re concerned about getting the disease in the future and, of those, 69% say they’re concerned because they don’t want to become a burden to their family, with 60% concerned because there’s no cure.

Michael Smith, MD, WebMD’s chief medical editor, states, “There is great concern about the impact of this disease, but denial, fear or other unknown factors seem to be preventing us from taking the necessary steps to prepare.”

People do not seem to realize that they can lower their risk. A few suggestions are offered: stay mentally or intellectually active, eat a healthy diet, take vitamins or supplements, exercise at least three times a week and stay socially active.

There is a positive link between physical exercise and brain health. There is a relationship between the foods, drugs, alcohol and nicotine we ingest and their impact on the brain. Hopefully, more informed, more realistic children will notice when a parent’s mental capacities are diminishing (if you haven’t), and they will get us to the physician or gerontologist early, wasting no time; perhaps to participate in a clinical trial or to get a new drug that could slow its progression. Plans must be made, contingency scenarios must be worked out. The best way to break through denial is to challenge it.

The good news

Dementia rates have been plunging. It took a few reports and more than a decade before many people believed it, but data from the United States and Europe are becoming hard to wave off. The latest report finds a 20% decline in dementia incidence per decade, starting in 1977.

A recent American study, for example, reports that the incidence among people over age 60 was 3.6 per 100 in the years 1986-1991 but, by the years 2004-2008, it had fallen to 2.0 per 100 over age 60. With more older people in the population every year, there may be more cases in total, but an individual’s chance of getting dementia has gotten lower and lower, as Gina Kolata reported in a July 8 New York Times article.

The psychological definition of “denial” is an unconscious defence mechanism characterized by refusal to acknowledge painful realities, thoughts or feelings. My anxiety, fear and dread have disappeared. I have faced the dreaded monster, I have embraced the enemy. I now visit with people suffering from Alzheimer’s. I have spoken to my children frankly about my wishes if I should become incapable of handling my affairs. I have decided where I wish to live if I must move into a seniors residence to receive care. I am aware of the newer approaches to residential care and housing arrangements. I have informed myself of the resources that my community can offer me.

Now, every day is an invitation to excel, to learn and to enjoy. I have become ambitious, physically stronger and more committed than ever to appreciate my good health and sense of well-being.

Dolores Luber, a retired psychotherapist and psychology teacher, is editor of Jewish Seniors Alliance’s Senior Line magazine and website (jsalliance.org). She blogs for yossilinks.com and write movie reviews for the Isaac Waldman Jewish Public Library website.

Between parent and child

When my father died in 2014, I was already familiar with the notion that mourning progresses in stages. These include denial, anger, grief, bargaining and, finally, acceptance, and they are widely recognized by the therapeutic professions.

Two years after my father died, however, I could make an argument for one more item in this neat list. This item is: paperwork. Paperwork that can take months or years to complete while other tasks are shelved, children get older and family relationships unravel.

And so it was that I didn’t really start grieving for my father until two years after his passing. This was the point at which I was finally able to look through my father’s archive. He had a wealth of his professional writing, as well as mementoes from his life in Israel – things I had never seen, never heard about, photos of people I didn’t recognize. Here, now, was another kind of loss: his memories, the languages he spoke, the cultural narrative of the Egyptian Jew who became the halutz (pioneer), the farmer and a soldier.

My grief was further complicated by my father himself: complex, secretive, angry, hard to fathom and even harder to love. But, as hard as it was to love him, it has been just as hard to let go of this contradictory, loving, gifted and extraordinary man, who spoke nonchalantly about his life being “nothing special,” while simultaneously and relentlessly craving recognition for his life’s work.

How was I to experience my grief, work through it in the tidy way suggested by the literature, without feeling like a hypocrite? Every time the sadness bubbled to the surface, another voice cried out, yes, but…. And yet, and yet, and yet.

My father loved trees. He loved the smell of them in Egypt. He loved planting them in Israel, shortly after its independence. After immigrating to England, he started a conservation charity to encourage children to do the same. He spoke fondly of his favorite plants, naming them with relish, acer palmatum, acacia, copper beech, pyracantha, weeping willow, honeysuckle. He talked about them the way other people talk about their friends, and his belongings reflected this after his death. One of his books was called Meetings with Remarkable Trees. It suited him. His meetings with remarkable trees had started when he was still a youngster.

It was also appropriate because, as straightforward as his relationship was with trees, his relationships with other people were confusing and painful. He was seldom content, often angry, and his brain was constantly besieged by business ideas, political observations and diatribes about the state of world affairs. I never saw him make a new friend. He called nobody from his old life and nobody called him. A staunch Zionist, he regarded orthodoxy with disdain. He refused to join the Jewish community and kept us apart from it, too.

But, when he was nurturing his plants, he was in touch with something sacred; this was his worship, his peace and his prayer. He could stand perfectly still, just watching the arc of the water landing on the dry earth, listening to the birds and the wind in the willow tree, utterly alone and completely at peace.

At other times, I tried to look after him. I tried to be his caregiver, his protector. So, with him gone, I felt myself to be – even with a multitude of other responsibilities – rather redundant.

By the spring of this year, I found an uncomplicated way that I could commune with my father: I nurtured my own garden. I thought of him as I watered, listening to the wind in the trees and watching the droplets creating rainbows. The water trickled down the spines of the squash leaves, pooling at the roots. I listened to the birds, felt the sun on my back, remembering the ice-cold glasses of water we’d enjoy together in the summer, the way he taught me to transplant trees, how I was always surprised by how much water he’d use. “Do you really need that much?” I’d ask.

He would collect seeds with a strange sort of compulsion, from public gardens, with no particular method – he would never store them properly or label them but there they were, stuffed in the bottoms of his pockets. Like me, now, collecting foxglove, chive, kale and garlic seeds for next year. Always thinking of the next harvest, another step toward self-sufficiency. “We made the desert bloom. We grew watermelons there.”

When I went to visit my mother this summer, I noticed that her own honeysuckle plant was growing wildly out of control. It had become so heavy that the lattice was falling off the wall of the house and it was beginning to encroach on other plants. The flowers were beautiful and the aroma intoxicating but, according to my mother, the vine was basically a weed. I offered to prune it back for her and was startled when she showed me how much could come off. Like a cautious hairdresser, I asked her, “Are you quite sure?” And she was. Besides, she told me, it would grow back in no time.

As I started to cut the branches, I realized that a good part of this monster was already dead. The branches overhead broke apart in my hands, dropping dry leaves in my hair. It was more than 30 degrees outside and, with older tools and a ladder pitching on the gravel, it was slow-going. I tried to avoid cutting live stems but soon grew too tired for mercy. I hacked at the convoluted, weedy vine and snapped the brittle trunk as perspiration ran into my eyes. As I did so, it occurred to me that something about the honeysuckle felt very familiar. In short, this tangled, complicated plant was very much like my father – extravagantly beautiful, complicated and with no respect for boundaries. One might almost say, parasitic.

And then I noticed what looked like a bundle of dry leaves tucked in the back. On closer inspection, I realized that it was an abandoned bird’s nest, carefully woven from the tiniest twigs with only the smallest space left to hold a few eggs. Right in the middle of that tangled mass of dead foliage, there was a sanctuary. Like our relationship – painful and nearly impossible to navigate but, at its heart, like that nest, there was something to treasure.

In the end, grief is not so much affixed to the image of the parent we have lost, or even the relationship we had. We are not grieving the relationship we could have had, either: we are acknowledging the gifts they did pass on.

My father, teaching me to cut and paste magazines; to write business letters with punchy opening lines; to edit my work, to edit it mercilessly until it was taut like a tightrope, without a single unnecessary word. Sure, he was a merciless critic, but this quality has served me well. Even as I revisit each sentence of this essay, it is an act of memory, a gesture of thanks to my father that I am so particular, so careful with my words and so determined that they should fall in, militarily, if possible, with my meaning.

In the end, this is how we find grace in grief when our relationship with the dead was challenging – toxic, even. We can choose how we remember, how we grieve and, ultimately, how we live, once our beloved relative is gone.

It is not simply an act of respect, this mourning. It is an act of gratitude, as we thank our lost ones for what they did give us, as we visit all of the unconditional love we can muster for that ancient connection, between parent and child.

Shula Klinger is an author, illustrator and journalist living in North Vancouver. Find out more at niftyscissors.com.

Expert on sundowning

Dr. Brian Goldman (photo from Brian Goldman)

While most people have heard of dementia, many of us won’t have heard the term sundowning before.

According to Dr. Brian Goldman, emergency physician at Mount Sinai Hospital in Toronto, sundowning is generally part and parcel with dementia of various kinds.

“Sundowning refers to a person who is sleepy during the day and very active at night,” he explained. “Almost as soon as the sun goes down, that’s when they become active. The activity can be not just when awake and walking about in an agitated or restless state.… For sundowning to have its maximum impact on the patient and others – the caregivers and care providers – you have to have dementia [as well].

“A person who is cognitively intact, who is simply sleeping during the day and being up all night, would have the cognitive reserve to be able to handle that. They might feel they have a problem, need to see a doctor, or they might rearrange their lives because, when everyone’s sleeping, they’re up, [but] they’d be able to cognitively make sense of it.”

Goldman explained dementia as “a chronic disorder caused by a brain disease or injury. It is characterized or marked by impaired cognition or thinking, memory and personality changes.”

Goldman – who grew up in Toronto’s North York, the heart of the Jewish community – said he is seeing more elderly people with dementia. Often he is one of the first people to notice the symptoms.

“As an emergency physician,” he said, “I would say that an increasing percentage of the patients I see in the emergency department are frail seniors. When I started out in the 1980s, we would see an occasional patient over the age 90, but now it’s commonplace.

“I have professional experience, but I also have personal experience. Both my parents have passed away in the last two years and they both reached frail senior years. My mother had dementia. My father did not.”

Why some dementia patients also suffer from sundowning while others do not, Goldman said, remains a mystery. As well, the number of people who suffer from this newly defined condition of sundowning is also unknown, with estimates ranging from as low as two to three percent of people with dementia up to more than 60%.

“It has been said that sundowning tends to occur when the person is in unfamiliar surroundings, though it can also occur in the home,” said Goldman. “It’s well known that some people with dementia have damage to the pathways to their brain that recognize light coming in through their eyes and stimulating a part of the brain called the pineal gland. The pineal gland secretes the hormone melatonin.”

Melatonin is secreted somewhere around 2 or 3 a.m. every morning. It resets your body’s circadian rhythm. If that pathway is disrupted, it makes sense that your sleep-wake cycles would be seriously disrupted.

Another theory is that people who sundown are dreaming vividly. They are flipping between the awake and dreaming states quickly and frequently. And, again, because they don’t have the cognitive reserve, they do not know if they are dreaming or awake.

There is not yet a lot known about sundowning and another phenomenon known as delirium.

According to Goldman, delirium is confusion associated with the activation of the fight or flight response along with symptoms that include tremors, shaking, a fast heart rate, sweating and dilated pupils. These symptoms are sometimes also referred to as “toxic delirium.” People with toxic delirium have a rapid, traumatic change in their demeanor. Triggers of toxic delirium are often fever, urinary infection, pneumonia, flu, or even a heart attack.

“You recognize it if you see a sudden change from what the person was doing a week ago,” explained Goldman. “They look sick, sweaty … something seriously wrong … and there is an underlying cause. Treat the cause and the toxic delirium goes away.

“Sundowning is a more chronic pattern that can go on for months. There is no vast dramatic change. The only change in pattern you might notice, wherein dad or mom wander off at night once a month, then it becomes once a week, then every night. It’s a gradual pattern.”

Ways to help this condition, according Goldman, include regularizing a sundowner’s routine: having meals at set times, a set time for exercise (but not at night), set times for bathing and toileting (like washing in the morning or before bed), and the like.

“The experts say that caffeine should be avoided,” he added. “You want people to walk. Walking is good for them. Visitors are good, but probably not close to the time they’re going to bed. Also, reduce noise from TVs and radios and address the lighting in the room, ensuring you don’t have harsh lighting that could cast disturbing shadows on the wall.”

Besides these steps and before turning to sleep medication, Goldman advised exploring some other preventive approaches. Light therapy has shown some promise, he said, affecting patients in a similar way as those with seasonal affective disorder. This involves getting special light-generating therapy units, which are available without a prescription and come with instructions on use.

When it comes to lost brain pathways, Goldman sees the technique as especially helpful when approached in a “use it or lose it” fashion. “If you want to build up a reserve, this might be a way of doing that, with year-round light therapy,” he said.

“Certainly, making them busier during the day with exercise and other stimulation is the way to go. Somebody with dementia wants adventures in the same way that everyone wants adventures, something new. Keeping to the same routine everyday is helpful for structure, but the novelty factor can be helpful as well.”

Goldman said these practices can offer some relief of the effects of dementia, including Alzheimer’s, the most common cause and form of dementia.

Rebeca Kuropatwa is a Winnipeg freelance writer.