Aging Gets Personal

Writing this blog has introduced me to a community (that’s you) with which I have shared a great deal of information, and from which I have learned more.  You have become dear to me.  Now I’ve been away for many weeks, away from my home (Philadelphia) and away from this blog.  I’ve been in California and Switzerland and (now) China.  Here are some snippets of what I’ve learned and what I’ve been thinking.


My mother was proud of me when I was a physicist, but since I took up the study of aging she only shakes her head and stops just short of calling my work immoral.  She has been a lifelong advocate for population control and family planning.  “There are already too many people in the world.  When people started living longer, the population started booming.”

She is 95, posts a living will on her refrigerator, in her purse and in her car.  She wears beaded jewelry that says, “Do Not Resuscitate”.  But when she had a stroke last month, a neighbor called 911, and the medics did what they are trained to do.  I spent several weeks by her bedside, and making arrangements for her rehabilitation and physical therapy.  Her mind and speech seem unaffected, but she sees it as a grave injustice that she is still alive.

This has been an opportunity for me to examine my attitudes toward death and the prejudices of my culture.  Still raw, I have only questions, not answers…

  • How can we reconcile Ecology’s iron law that there is no life without death with the foundational sentiment of all human morality that tells us every human life is sacred?
  • Is every experessed wish for death an expression of despair or depression?  Is it always a call for help, or is there ever a situation where we should honor a person’s wish to die?
  • If we honor and work toward fulfilling an individual’s wish for added years of life, should we equally honor another individual’s wish for a prompt and painless end?
  • If our culture embraces the legitimacy of a wish to die, how can we prevent the Vonnegut scenario: social pressure to commit suicide because someone is disabled or different or just because many people wish to get rid of him or because it is a burden to care for him?
  • What can we learn from the way death is regarded in other cultures?  When someone over 80 dies, the Chinese are prone to treat it as a rite of passage, rather than a cause for mourning.

My encounter with hospitals and insurance served to instantiate and reinforce my dim views of the American system.  Limitation of liability everywhere impedes effective care for individuals.  “What is covered” is more important than “what is best for the patient,” and coverage is maddeningly arbitrary and variable from one policy to the next. Doctors, by and large, are kindly with the best of intentions, but their brains are fried by quotas and schedules; they have no time to work with a patient, to listen to symptoms, to explore diagnostic possibilities and treatment options.  Most know less about diet, exercise and supplements than you do, dear reader.  Hospitals will do everything to keep the patient from dying on their watch, but nothing to put individuals under their care on a path to long-term health and wellbeing.

 

Back to Biology

While in California for my Mom, I had a chance to make three visits to colleagues in the biology of aging.

From Andy Mendelsohn, I learned that a stem cell can be made to differentiate into a particular kind of somatic cell by one or a few transcription factors. Furthermore, you don’t have to start with a stem cell; applying these same factors to a different kind of somatic cell re-directs it toward the target of the transcription factors.  For example, applying the nerve cell TFs to a skin cell can turn a skin cell into a nerve cell.  Andy raised the possibility that this re-programming process is rejuvenating.  What would happen if you applied the skin cell TFs to an old skin cell?  Would it become a young skin cell?  This is an area ripe for experiment!

Andy also reminded me of a topic I wrote about 4 years ago: the hypothalamus as an endocrine aging clock, and the role of inflammation in suppressing two anti-aging hormones, to wit, GnRH and NPY (gonadotropin-releasing hormone and neuropeptide Y).  If there is a centralized clock at the root of aging, the hypothalamus is currently our best candidate for its location [ref, ref].  Both these are small proteins.  NPY has a short residency time in the blood, and there is yet no practical way to increase its level, but GnRH is normally released in pulses, and might it might be easy to enhance these artificially; in fact, there are several synthetic variations of GnRH sold as drugs.  The fact that they suppress male sexuality is a deterrent to experimentation by most men.

I learned that Elissa Epel has begun a long-term project to collect and share data on lifestyle habits for health and longevity.  She plans to develop a cell phone app both to remind and encourage and also to record metabolic responses.  Users will be able to learn what is working for their own individual bodies, and to share information so that others can benefit from their experience.  For Epel as a researcher, the payoff is crowdsourced data from which to study correlates of good health and long life.  I signed up on the spot to be her statistician. TrackYourLyf.com is under development.

The third visit was with Mike and Irina Conboy – see below.

 

Geneva Symposium on Anti-aging Medicine

I was honored to be invited to a small symposium in Geneva last week, sponsored by the St Petersburg laboratory of Vladimir Anisimov and Vladimir Khavinson.  I spoke on my favorite topic these days: the potential value of quick-and-dirty screening for combinations of age treatments that might synergize to induce major increases in lifespan.  I proposed a medium-scale experiment with 1300 mice that would test all combinations of 3 treatments among a pre-selected universe of 15. This size of experiment seems to be a statistical sweet spot for combinatorics.

The most revealing talk from my vantage was Claudio Franceschi’s glimpse into broad effects of the gut microbiome, a topic which I’ve written about recently.  Diversity of our intestinal flora decreases with age.  Centenarians seem to have different microbiomes from the rest of us, with an enhanced role for allochtonous flora, which just means niche-adapted bacteria [ref].  We are used to thinking of allochtonous bacteria as associated with infections and pathology.  They prompt an inflammatory response in the host (that’s us) to a greater extent than other bacteria.  Why would there be more of these in centenarians?

There is a powerful interaction between the microbiome, the immune system, the endocrine system, and the central nervous system [ref].  Presently, high fiber diets are the only generally-agreed path toward healthy microbiomes.  Fecal transplants and probiotics are of uncertain value with respect to long-term health.  Here’s a paper from 6 years ago in which a particular strain of yoghurt bacteria (LKM512) was introduced into intestines of mice with dramatic effect on their mortality.  The field is developing rapidly now that people appreciate how important it is.

Given the sponsors of the one-day symposium, I was not surprised to see an emphasis on short peptides.  These are micro proteins, just 3 or 4 amino acids strung together, that have been studied in St Petersburg with remarkable results: extension of lifespan in mice, and halving the mortality rate among older experimental subjects who receive peptide supplements.  Why isn’t anyone trying to replicate these studies in the West?  Khavinson has leapt ahead to open a clinic in St Petersburg where various peptides are prescribed for various ailments, and one of the peptide docs has a satellite clinic in Italy.  I met an American doctor who runs a clinic in Alaska where you can buy oral versions of epitalon and other peptides from a British company.  But the British web site does not list chemical compositions of their brand-name peptides, and though Dr Lawrence is full of enthusiasm and anecdotes, there is no data nor plan to collect data on their effectiveness in humans.  To my mind, this is a case of commercialism leaving science behind.

Which brings me to one more topic…

 

Plasma Transfusions for Rejuvenation, Ready or Not

In the news this week is Ambrosia, Jesse Karmazin’s company which provides transfusions of blood plasma from young donors to old recipients, who pay about $8,000 for 1.5 liters of blood.  When I first spoke with Karmazin nearly two years ago, he told me he had analyzed Stanford Hospital data on hundreds of patients who had received transfusions for various reasons.  He made the remarkable claim that he was able to trace the source of the blood in these transfusions, and found that patients who had received transfusions from young donors had had lower mortality and significantly better outcomes than those who had been paired with older donors.  This is an impressive finding if true, but Karmazin refused to share his data with me, claiming “patient privacy”, even if all personal identifiers were redacted.  At the time, he said that his motivation was to boost research in the field, that plasma transfusions were already an approved procedure and needed no special FDA approval, and that he thought he could fund the project by charging costs to the experimental subjects.  When I exchanged emails with him this week, he said that the data generated by his company would be treated as “intellectual property” and not shared openly with the scientific community.

My opinion is that, based on mouse studies, plasma transfusions are a promising procedure, but we have yet to explore how much is needed, the frequency and severity of complications, what are the benefits and how long they last.  A medium-sized body has about 5 liters in circulation.  Is 1.5 enough to make a difference?  That these experiments will be done is a huge step forward, but the benefit depends on data that is made available to the scientific community.  If the result is dramatic age reversal, we will all know about it pronto.  But if (more likely) the result is nuanced, we might be starved for balanced information.

One other company experimenting with human subjects is Alkahest, founded by Tony Wyss-Coray of Stanford.  Alkahest has received approval to do a trial with early-stage Alzheimer’s patients, using 2 liters of blood from a young donor, spread over 4 weeks.  The endpoints they will be examining involve cognitive function.

Wyss-Coray has voiced scathing charges of irresponsibility against Ambrosia.  Meanwhile, Berkeley’s Irina Conboy (in a private conversation last month) has been highly critical of Alkahest.  It was Conboy who originally brought the idea of parabiosis experiments to a Stanford lab 15 years ago, where she and her husband Mike and Wyss-Coray and Amy Wagers (now at Harvard) were all students together.  She said that Alzheimer’s was the wrong target, that the amount of blood being provided would not be enough to make a difference, and that repeat transfusions exposed patients to the risk of anaphylactic shock if some patients’ immune response to the alien proteins got out of hand.

The Conboys have been working on isolating the active ingredients that make old blood harmful and young blood beneficial.  I asked how that work was progressing.  While they would not share details, they said that early hopes for a small, manageable number of active factors had not panned out.  They were hopeful, however, that all the necessary factors belong to a few major pathways, and that transcription factors could be identified that would selectively activate these pathways.  From a New Scientist article:

Older people who received transfusions of young blood plasma have shown improvements in biomarkers related to cancer, Alzheimer’s disease and heart disease. Since August 2016, Ambrosia has been transfusing people aged 35 and older with plasma – the liquid component of blood – taken from people aged between 16 and 25. So far, 70 people have been treated, all of whom paid Ambrosia to be included in the study. The first results come from blood tests conducted before and a month after plasma treatment, and imply young blood transfusions may reduce the risk of several major diseases associated with ageing.

None of the people in the study had cancer at the time of treatment, however the Ambrosia team looked at the levels of certain proteins called carcinoembryonic antigens. These chemicals are found in the blood of healthy people at low concentrations, but in larger amounts these antigens can be a sign of having cancer. The team detected that the levels of carcinoembryonic antigens fell by around 20 per cent in the blood of people who received the treatment. However, there was no control group or placebo treatment in the study, and it isn’t clear whether a 20 per cent reduction in these proteins is likely to affect someone’s chances of developing cancer.

The team also saw a 10 per cent fall in blood cholesterol levels. “That was a surprise.” This may help explain why a study by a different company last year found that heart health improved in old mice that were given blood from human teenagers. They also report a 20 per cent fall in the level of amyloids – a type of protein that forms sticky plaques in the brains of people with Alzheimer’s disease. One participant, a 55-year-old man with early onset Alzheimer’s, began to show improvements after one plasma treatment, and his doctors decided he could be allowed to drive a car again. An older woman with more advanced Alzheimer’s is reportedly showing slow improvements, but her results have not been as dramatic.

 

33 thoughts on “Aging Gets Personal

  1. Hi Josh,
    All this is stunning, incredibly important information. Thank you for the sheer generosity in sharing it so freely.
    Look forward to more!

  2. Josh, thank you so much for sharing, not only your brilliant thinking & hard work, but also your humanity. Your Mom’s scenario reminds me so much of the many strong-willed and eccentric women in my wife and my families. That generation has left us and we miss them terribly! I’m pleased to report that many of them, with the exception of my Mom(Taken in her 60s by breast cancer.), lived to around, or over, 100 years of age. Now that I am technically an old man and can see the final days ahead, I want to say that from my experience, nothing else is of more importance than love and forgiveness. I wish this for your Mom and all of her loved ones! Please keep up your courageous efforts!!

  3. Alteration of mTOR signaling occurs early in the progression of Alzheimer disease (AD): analysis of brain from subjects with pre-clinical AD, amnestic mild cognitive impairment and late-stage AD.
    Tramutola A et al
    J Neurochem. 2015 Jun;133(5):739-49.
    http://onlinelibrary.wiley.com/doi/10.1111/jnc.13037/epdf
    (Open source, freely available).
    If nothing else, the implication of this article at least are that the preventive measures (low-dose rapamycin?) for Alzheimer’s have to start EARLY.

    • Rapamycin has shown side effects – may be Inhibition of mTOR by protein restriction could be a better alternative? Personally I currently do not think mTOR Inhibition is the best anti-aging strategy – I am hoping the likes of Harold Katcher, Conboys, et al find a version of parabiosis and HPE that gives sustainable benefits. For me that is a more exciting approach. Inhibition of any kind is always at a cost. For example I don’t what would happen to weight training results with mTOR Inhibition.

  4. Jesse was originally challenged by Alkahest on patent grounds but used my paper (2013) to show that the idea of using blood or plasma to affect changes in the aging phenotype, particularly of stem or progenitor cells was in the published literature, so no doubt there’s bad blood between them. The ability to rejuvenate old cells (at least their nuclei), was first shown by JB Gurdon back in the sixties. More recent work using TF induction to pluripotence has demonstrated changes back to youthful phenotypes – as had the early, 2005, work of Conboy et al – which showed change of age-phenotype without any change of differentiated state – which is even more exciting. Also work with GnRH has already been used to extend the lives of mice (or rats, I don’t remember it’s in my 2015 CAS paper) – based on the hypothesis that GnRH was a cyclic signal to other subsidiary tissue-level clocks, and that restoring those levels would increase lifespan and they did get a considerable ~25% increase in lifespan. As I recall the really interesting thing is that the hypothalamus responded to signals of cellular stress in cutting down production of GnRH – so there was integration from the cellular level of the hierarchy right up to the organ-system level.
    This only emphasizes the concept that aging is not a cell-autonomous process, in mammals and in worms, genes in one tissue controls aging in other tissues. (DAF-2, expressed in the brain, controls the aging of intestinal cells, in the worm C. elegans.) Of course in humans, apart from neuronal control, it is the blood that transmits the humoral controls. I think not only is the humoral control system multi-component but very much tissue specific and dependent on relative concentrations rather than presence or absence and also has temporal components. By which I’m saying that I doubt the efforts of the Conboys will pay off, but there are other ways and at least they’re keeping their eyes on the ball – looking in the right direction instead of trying to have computers examine massive data, or placing mitochondrial genes in nuclei to save them from ROS monsters – or any of the fads based on aging ‘theories’.

  5. Rejuvenation of mouse muscle by injecting OSKM expressing plasmids.
    http://biorxiv.org/content/biorxiv/early/2017/01/18/101188.full.pdf
    I dont quite understand how bacterial plasmids can transfect in vivo eucaryotic cells, but they report an upregulation of the Yamanaka factors for 4 days, which is exactly the golden time constant as reported in the Belmonte study. No terratomas but rejuvenation.
    Could be translated to humans quite soon in theory?

    • A-ha! someone have been heeding my words carefully…

      @ Gabor
      If ribosomes can’t take them directly (how would they evade defenses?), then mitochondria can (called it :p)

  6. Your Mom’s sentiments echo those many reasonable and intelligent people. The questions you pose are not ones to be dismissed, nor are they easy to answer in a final way.

    If there are answers, I’d liken them to medicine, good scientific research, and evolution – an ever changing practice.

    • Your comments echo the by far most important concern: Increasing evolutionary pressure on such sensitive enough people in favor of the ones who could care less.

      The solution however has already been stated. Costly as it may be:

      “The Only Thing Necessary for the Triumph of Evil is that Good Men Do Nothing”

  7. If I were to live to be 100 years old, that would add to the overpopulation and would be selfish of me. If there were a legal age limit, it would be immoral, and unfair for those over the limit! So maybe the Chinese are right in restricting family size.

    • Enforced family planning is an idea that is ripe for abuse by even the most benign and democratic government. Nevertheless, I think it is a necessary step. If the community is to take responsibility for the health, education, and welfare of children, then there must be some sense of equity to see that right is not abused by families that have nine children, or by men who leave women pregnant and without support. The alternatives are worse. This is independent of the powerful global argument that the human population has caused the most devastating extinction on our planet in at least 65 million years.

    • Actually, the Chi-coms (chinese communists) are slowing phasing out the forced family planning laws. It has led to the death of far too many daughters since in Asian culture the male child is most prized. Pressure from the population has already doubled the child wuita from 1to 2. I live in Asia, btw. Cheers-

      • My comment was not a criticism of China but a suggestion that the idea of limiting family size is going to be necessary elsewhere. What China needs badly is to make less pollution of the air and reduce its carbon dioxide output to the atmosphere. And there are two other gases which China involuntarily “exports” Nitrous Dioxide N02 (also from cars) and methane NH4 (from animals), both of which are greatly contributing to global warming.

  8. Thanks Josh. I tend to agree with your mother. But then again it is the nature of life to push up against the limits that contain it. If the technologies that enable life extension also enable us to take better care of the ecology and each other then we have transcended the zero sum game as currently imposed. I have some hope we are heading in that direction as a system. New Battery technology and sea farming rather than over-fishing I think are the two things that could get us over the hump and create the resources to allow re-wilding.

    The best discussion of life as part of death I have read about is in Bill Moyer’s interviews with Joseph Campbell. I think the book of the interviews is called the Power of Myth.

    • I believe that most of the world’s problems can be solved with democracy. I believe democracy has been deeply subverted in America, where the people are peace-loving and environmentally conscious, while the government is constantly making wars and subsidizing fossil fuels.

      In my readings and research, I was surprised to discover that cold fusion is real. It has been dismissed by the scientific community because we don’t know how it works, and because it is not easy to reproduce. But there have been many credible reports of cold fusion, and it is our best hope for an environmentally benign source of energy.

  9. Thank you for the post Josh…Even tough I actively seek to avoid aging, I have thought about this issue for a long while.

    My own mother was trapped in abody for 10-15 years, which was broken in numerous ways. But for all that period medical staff at hospitals here in Oz refused to allow her to leave. And that meant much extra needless suffering.

    Life is a gift. But there will always for each of us, come a time to decide, “Yes it’s time give the gift back”.

    And it is a universal human right to make this decision… But at the moment some folks refuse to recognise it.

  10. Sounds like some interesting trips, along with a bit of a wake up call from good ol’ mom. Trips keep the mind young, and probably the body as eell. Taken out of our comfort zones as we are when we are young and learning, the system is more alert and aeake. Especially true if we need to try to learn a foriegn language to communicate.

    So aside from talking to your guru friends about ways being explored to extend life, the trips themselves probably did you the most good. This being said by an American that has been based in Cambodia for 20 years, and is writing this from Ecuador.

  11. The old Malthusian fears have been superceded by the new reality: in advanced (Western) civilizations, none, absent immigration (legal and illegal) have replacement rates of fertility. Among subpopulatiions, fertility is inversely correlated with intelligence, so your mother can drop her old-style overpopulation guilt. The opposite is the problem. So advances in longevity are no longer a population problem, although they might contribute to resource problems as fewer young people support a greater number of people kept “alive” through self-interested medical technology. I’d look into Bill Sardi’s work on longevity and into the caloric restriction effects demonstrated in monkeys and sirtuin activation from intermittent fasting. As for the vampire/plasma transfusion technology, a similar effect may arise in older individuals from the blood neogenesis that proceeds from the blood donation that you have already admirably covered.

  12. Overpopulation:
    I was under the impression population decline among non-immigrants is the norm for first-world countries in general. IIRC Japan is currently getting hit the hardest? I believe America owes waves of (younger) immigrants for preventing us from already being in the same boat.

    Anyway, as countries continue to develop this will likely effect all of them without the need for family planning. In the long run extending lifespans might result in overpopulation concerns (would ‘old’ people have more children if they had the time?), but I don’t see it as being an immediate issue. In the short run rejuvenation could even buy us more time (or solve completely) the coming “we need more young people to support all of these old people!” crisis.

    I’m not certainly not an expert in this area, however, so if any such folk are in the audience by all means weigh in here.

    Cultural Traditions:
    Are there any cultures that treat dying after age 40 as a rite of passage instead of something to be mourned? Traditional views on having to accept old age will probably cease to be widespread if it turns out we don’t actually have to accept it.

    On Desiring Death:
    How would living longer change this? There are people who desire to die already. There are already people that don’t want any trouble to be spent keeping them around. Would this number really increase if people lived longer? How often do middle-aged people have suicidal bouts (mid-life crisis and current cultural/economic woes aside)? Is there any reason to believe these thoughts and feelings are tied to a certain number of years instead of old-ness?

    Honoring Death:
    Is it right for someone to demand someone else suffer the emotional turmoil of taking a life? Or to demand the systematic issues of making it easier to disguise murder as suicide?

    It’s true that there are cases where the individual is physically incapable of killing themselves, and in those cases things get tricky. I don’t think life extension will make these situations more common, however – it might even make them less common.

    Expressed Wish For Death:
    Well, do we have any examples of people with wonderfully fulfilling lives, free of pain & suffering, that don’t feel guilty about anything.. wishing for death? I can’t think of any. Well, I guess some religious cultists? I wouldn’t really count those though. Are there any others?

    I suppose “feeling guilty” is not a cry for help, at least, although that need not be a permanent condition.

    Ecology’s Iron Law:
    There are already species that don’t age like we do, some of whom I learned about from you! Physical laws aren’t commandments maintained by a divine police force (I hope), they’re called laws because a massive pile of evidence has led us to be very, very confident that’s how the universe works. If we can overcome death then there was no iron law in the first place. We’d still be in caves if we assumed failure from the start.

    ——

    On the medical side of things:
    This served, to me, as a depressing reminder that industry’s effect on medicine is very much “better than nothing, but only relative to that” territory. It’s like watching a group trying to solve a jigsaw puzzle while mutually hoarding the pieces from each other. It’s a shame we can’t get enough grassroots support from the general public to promote more open research.

    ——

    Ah, on the fulfilling lives bit I meant in the present tense – not if they led such lives back in the day but those whose lives are currently unmarred by an inability to continue living the life they want to live / used to live.

    That said, I suppose the longer someone lives the more they will experience change and loss. Living longer will almost inevitably result in more change and loss being experienced, and that might not be for everyone. I think assuming that will be the case ahead of time is rather premature, though? Living longer would also give more time to come to terms with both of those things.

    • Read The Sixth Extinction, by Elizabeth Kolbert. The world has already begun ecological collapse such as we have not seen since the dinosaurs. It is already set in motion, but may take a century or two to unfold. We don’t know whether humans will be able to live in the impoverished ecology that will result.

      We do know that the earth will recover, and new species will evolve to replace the old. But this will take 1 – 10 million years.

      • Do you believe that God has patience to wait that long? At the present rate of pollution and green-house gas effects on climate warming, our species is due to become extinct in less than 100 years.

        • David, I know I won’t get the details straight because it has been a few years, but I hope this is generally accurate. In the early 70s, I want to say in ’74, I received a letter signed by Jacques Cousteau. In this letter, he suggested that the oceans were putrefying and mammalian life, including human life, would likely be extinct by 1990!! I’ve searched the net for the letter and, so far, to no avail.
          As was the case with the Malthusians, there appears to be so much missing in the analysis of these gloom and doomers.
          Are today’s Climate warming theorists yesterday’s Y2Kers?

          • What sort of an answer is that? In view of the probabilities of life on other planets being high and bearing in mind that our God is also their God (to the best of our knowledge), I have trouble in discerning why our earthly life can be sufficiently important to God that He will miraculously save it here on earth. Since He is eternal, the time speculation of how long till Man re-appears should not be seen as very important to Him, but why should He bother when so many other civilized planets support life? It would seem that our religious faith is badly limited to conditions here on the home planet.

          • Sorry, David; I would never assume to have an answer to such a huge question. I suspect an answer to such a question would depend largely on one’s theology and concept of time. To me, knowing the mind of God has created problems since Adam & Eve. My comment was solely an effort to recount a scenario which, like many others, has proven inaccurate. While your questions seem perfectly reasonable, I submit that we have to figure things for life on this planet before we can venture an understanding of others, at least if we expect any sense of accuracy.

            In my peculiar mind, the subject reminds me of this little tale:

            A man was talking to God one day, and he said, “God, I have always wanted to ask you this question.” He said, “God, from your perspective how long is a million years?”

            God said, “In my perspective, a million years is a second.”

            “Wow, a second!” He then said, “God, from your perspective, how much is a million dollars?”

            God said, “From my perspective, a million dollars is a penny.”

            “Man, that is unbelievable!” Then he said, “God, could I borrow a penny?”

            And God said, “Sure, just a second.”

  13. This is so true not only in America 🙁 My mom is dying from cancer these days and this was exactly what I was thinking: “Limitation of liability everywhere impedes effective care for individuals. “What is covered” is more important than “what is best for the patient,” and coverage is maddeningly arbitrary and variable from one policy to the next. Doctors, by and large, are kindly with the best of intentions, but their brains are fried by quotas and schedules; they have no time to work with a patient, to listen to symptoms, to explore diagnostic possibilities and treatment options. Most know less about diet, exercise and supplements than you do, dear reader. Hospitals will do everything to keep the patient from dying on their watch, but nothing to put individuals under their care on a path to long-term health and wellbeing.”

      • I meant that there are hospital rules imposed by their lawyers. These are supposed to be safety rules, but often they go too far. For example, getting up to walk was the most important thing for my mother’s recovery, but the hospital would not allow me to walk with her, so her walking was limited to 4 hours a week when a physical therapist was assigned. Another example, she was not allowed to drink water until they could get a speech therapist in to see her and certify that her swallowing was OK. Well, her swallowing was fine, but she was dehydrated for 3 days while we were waiting for a speech therapist over the weekend.

        • Josh,
          Such experiences with the medical establishment, my friends, family & I, have all had, too! It is so ironic, especially since we live in a city with the second highest per capita number of PhDs of any major metropolis in the country. These sorts of experiences are ones we would expect in a supposed ignorant population.
          Prayers and Blessings for your dear Mom and her family and friends during this difficult time.

  14. Glad to hear you were able to spend lots of time with your mom, Josh. The lack of such is certainly the cause of much obtuseness in our society.

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