Springtime and Play Time
I walked past the elementary school and saw the teachers taking the kids out of the class to explore the neighborhood. I remember the feeling that started to set in this time of year. The weather is getting nicer; The school year is coming to an end; And, I just wanted to get outside and play. In the springtime I am reminded of the need to take time out of my schedule to play.
Play time is not just a luxury. Recreation is an integral part of a healthy lifestyle. And, being able to play is one of the 10 steps to optimal aging with HIV. Playful activities can keep us socially involved as well as physically, intellectually, and creatively stimulated – all of which can counteract stagnation and increase adaptation at midlife and beyond.
There are many opportunities for finding play time:
Organized sports can be great forms of play, when they are not taken too seriously, and are not beyond your physical capabilities. When you are involved in a strenuous sport you get much needed exercise and increase your endorphins. In team sports, such as basketball, you stay connected to others. You can play golf alone or with friends. And, bowling is a lower energy sport that can still work up a sweat. Even if you are not an athlete, you can find a sport that isn’t too intimidating. Jogging, rowing, bicycling, and kayaking are all independent sports that have meditative qualities. Less conventional sports such as ballet, ballroom dance, fencing, and yoga are all forms of play. Games such as cards, scrabble, and board games have the same opportunities for competitive activity, intellectual challenge, and socialization without the strain of physical activity.
Creative activities can be done alone or with others. Making art, writing, woodworking, and gardening are all creative activities in which you participate in making something new. Do you enjoy listening to music? Dancing to rock and roll or drums? Cooking, needlework, collecting? You can take a class to learn a new hobby or skill. Join an improvisation group. Care for animals. Any of these activities can broaden your sense of creative play.
If you need help developing your ability just spend time with a child. My biggest pleasure is watching a child who has just opened a present make a toy out of the box it came it. You can invent play from your imagination, too.*
There are many social clubs for gay and HIV positive people that offer ongoing recreation activities. Check out the list of resources on this site to find an organization near you where you can participate in an event or join an ongoing program. You can also take a retreat with organized activities. Blogger, Mark S. King has compiled a list of vacations and retreats (some at low cost) for people living with HIV. Follow the link to learn more.
Now, I’m going to listen to my own advice and get outside to enjoy a bit of this day!
*excerpt from Aging with HIV: A Gay Man’s Guide
The Issue of Comorbidities
HIV, Aging and Cognitive Impairment
I’ve been spending some time lately on the relationship between cognitive impairment and older age in people living with HIV. The research is inconclusive. Recent findings suggest that there could be an increased risk for HIV-associated dementia and minor cognitive motor disorders in this population. However, as I pointed out in last week’s post, research in this area is new and the findings are complex. While older age may be a contributing factor in cognitive impairment, other issues to consider are: HIV itself, treatments for HIV, other age-related diseases and their treatments, as well as heredity and lifestyle.
A first step in optimizing your health is to identify the factors that you can control. In order to do that, older people living with HIV must consider the issue of co-morbid conditions.
Comorbidities and Cognition
Aging with HIV can create a complicated health-related picture. In addition to the effects of HIV itself, people taking medications to treat HIV and its symptoms may experience co-morbid conditions from those drugs, such as heart disease and diabetes.
This population also faces non-HIV- related illnesses common to older persons in the general population including: diabetes, hypertension, arthritis, and coronary artery disease. These comorbidities may affect HIV disease progression and may play a role in cognitive impairment.
Depression and other untreated mood disorders can also impact cognition and affect quality of life. In addition, alcohol and substance use can negatively affect one’s cognitive functioning.
Finally, illness can set in motion a negative feedback loop when physical limitations cause reductions in social involvement, depression and further complications of illness.
Developing an accurate picture of your health involves appreciating the complex and changing impact of HIV-disease progression, medications, mood, lifestyle and heredity. That means routine general health maintenance and appropriate diagnosis, treatment, and prevention of non-HIV-related medical and neuro-psychiatric conditions*
There is a great deal you can do to optimize your health outside of your doctor’s office. Your daily health care regimen can include activities that prevent, treat or modify the presence of comorbid conditions. Factor’s such as diet, exercise, participating in alternative therapies (such as meditation, acupuncture, yoga and massage), and maintaining an active social life have all been demonstrated to improve quality of life. Optimal aging with HIV involves working within your limitations to maximize your day-to-day life.
What one step can you take today to enhance your well-being?
*Goodkin, K. & Stoff, D., “Older Age and HIV Infection.” In Cohen M, Gorman J, eds. Comprehensive Textbook of AIDS Psychiatry. New York, NY: Oxford University Press, 2008, pp. 357-376.
AIDS Activism 101
I recently read a post by Mark S. King for his blog “My Fabulous Disease” that I thought would be especially relevant for people aging with HIV.
In it he gives an overview of the ADAP crisis that is going on across the US. He explains that there is growing concern that ADAP programs that provide access to HIV medications will be cut. He has video coverage of the “emergency summit” to discuss the growing ADAP crisis. And, he presents what we can do to make sure that people living with HIV can continue to receive their medications.
This issue is relevant to all people living with HIV and he offers clear guidance on how to get involved.
To read the post on how you can get involved, go to: http://marksking.com/my-fabulous-disease/aids-activism-101-steps-to-end-the-adap-crisis/
Activism and Aging with HIV
For many of you activism is not a new subject. AIDS activism may have been a part of your day-to-day life in the eighties and nineties. You may have even been a part of the gay rights movement of the seventies or earlier.
Is activism a part of your life today?
The men I interviewed for Aging with HIV: A Gay Man’s Guide answered this question in different ways. Some continued to participate in political and social groups and called themselves “activists.” Others were no longer as “out there” as they were ten and twenty years ago. They wrote letters, signed petitions on line, and supported organizations that shared their concerns. Some continued to read updates and were concerned, but no longer participated in causes.
Several felt alienated from activist organizations that, they felt were oriented toward younger people. Some had become fatigued from years of activism, and hopeless that they had any voice in creating change on a larger scale.
Why Get Involved?
Activism can offer many benefits to people in midlife and beyond. When you participate in social cause, you have the possibility to effect change on a larger scale. Activism also offers an opportunity for you to get out of yourself and to think about others. This is what developmental psychologist call generativity, and it is an significant aspect of continued personal growth at midlife. Getting involved also offers you opportunities to meet new people, stimulate your mind and broaden your social network.
There are many causes that you can get involved in. And, activism is only one level of involvement. Some of us work better on a smaller scale. Volunteering at a social service organization is a great way to get involved, feel like you are making a difference, and being part of something beyond yourself. Check out the resources page (see tabs above) to find an agency near your.
Resolutions Gone Awry
Its that time of year. The end of January. Snow is falling. (A lot of it in New York!) And, your New Year’s Resolutions are on the verge of becoming history.
This week I’d like to encourage you to reconsider those resolutions. Perhaps they need to be altered. But, it may not be time to put off those goals for New Year’s Eve 2012.
What do Resolutions have to do with Aging and HIV?
Living with HIV into midlife and beyond requires adaptation to a great deal of change. There have been changes to your body, career, family, your friendship networks, and to the world around you. Optimal aging with HIV involves flexibility as you develop new strategies to cope with aging. Often this means discarding old patterns that no longer work for you and beginning the difficult task of learning new ways to care for yourself.
You may have used the new year to reflect on what has and hasn’t worked for you in the past, and developed some ideas about what you want for yourself in the year ahead. You may have made an intention to change the way you eat, to exercise more, to address your drinking, to make new friends, to join an organization, to look for a new job, or get yourself out there in the dating world. You may even have come up with a plan to reach those goals.
Well, now is the time to review how that plan is going. If you are still on target, then read this post in order to help you look for warning signs that your resolution is going awry. But, if you are anything like me, your commitment to change is starting to waver, and you are at risk for giving up altogether. If that is the case, let me tell you about my New Year’s Resolution.
At the end of December I realized that I had been gaining weight. In fact, a step on the scale revealed that I was the heaviest I had ever been. So, I resolved to lose weight in the new year.
I had helped many others through similar challenges and knew what pitfalls to avoid. For example, I knew that I needed a reasonable goal. If I tried to lose too much, too quickly, I would just feel deprived and give up. So, I decided that I would set a goal of 1-2 lbs per week. I also knew that I should not only change my eating habits, but also increase my exercise, so I joined a gym.
Great plan. (Do you see where I’m going with this story?) Well, its the end of January, and as of yesterday I have lost 1 lb.
This is where I want to say, “what’s the point? My metabolism has slowed and no matter what I do, I won’t be able to lose that weight!”
But, since I’m writing this post to help you, I have to take the following advice:
Don’t Give Up!
When a plan doesn’t succeed, it just means there’s something wrong with the plan. In every failure there is a learning opportunity.
So, first, before you dismiss the commitment you made to yourself, remind yourself what you wanted to accomplish, and why.
Do your reasons to meet that goal still seem rational? Then, you have to find a way to make it work.
Next, assess the steps you took to meet that goal. Did you do what you said you were going to? If not, ask yourself, why you didn’t.
Maybe the goal makes sense, but the way you are going about it is faulty. For example, I could have joined a gym near my apartment. But I don’t get home until late every evening, and am usually too tired to exercise then. It would be better for me to find a gym near work, where I can go during a break in the day.
Once you know why your plan hasn’t worked, you can make changes to the plan and try again.
I often hear clients who have given up on their resolutions only to discover that the goal they set for themselves was unreachable. In my case, I set a very reasonable goal, but I got a cold and missed one week of exercise. I also didn’t consider that I would have to build my stamina slowly, having been away from the gym for some time. And, there was a learning curve, as far as my diet was concerned. It took me some time for me to learn what foods I could, and couldn’t eat, in order to stay on target for my weight goal.
Backing off is different from giving up. Its being honest with yourself about what you are, and are not, willing to do to accomplish your goal.
Ask for Help
There may be obstacles in your way that you are unaware of. If you have rethought your plan and are still getting nowhere, it may be time to get some help. Talk about your goals with a friend, your doctor or a counselor.
Change is hard. We develop patterns of taking care of ourselves and relating to others. Sometimes those rituals are deeply ingrained in our sense of ourselves, our memories of friends, and our families. Food, for me, is one of those issues. I still eat the same meal for breakfast that I did as a child. Changing my diet means changing my relationship to food, and that can have emotional meaning, as well.
Sometimes you just need a buddy. Share your resolution with a friend. (And, they can share theirs with you.) By including someone else in your plan, you have someone to support you, encourage you, and to hold you accountable when you want to give up.
On the resources link (above) there are a list of agencies that may be able to help you reach your goal.
I hope that this post helps you to recommit to your resolution, reassess your objectives, and get the help you need to achieve your goal. Please let me know if you set an intention for the new year, and how you are progressing on that goal.
The final post in December’s Self Care series is on staying connected.
The research demonstrates that having a rich social support network is integral to optimal aging with HIV. Having friends and family helps one to cope with some of the challenges of aging, and of living with HIV. The presence (or absence) of social support affects emotional and physical health. It is not merely the number of friends that matter, but how reliable they are in a variety of ways, and your satisfaction with these supports that matters.
But, many gay men have lost their entire friendship networks to the AIDS epidemic. Add to this the normal losses that occur with aging and we see that just as people need more support from friends and family to deal with the challenges of aging with HIV, they have fewer people in their life to rely upon.
The challenge at this stage of life is to maintain, reconnect, and rebuild social networks. There are many obstacles to rebuilding social networks. You must know yourself, what you like in a friend, and what you need in a friend (which are not always the same.) You also have to be willing to take a risk and even to experience the potential for more losses. A difficult challenge for people who have lost many friends in the past.
I’ve pulled a few suggestions on rebuilding social networks from Aging with HIV: A Gay Man’s Guide:
Renew old acquaintances. Contact friends from your past or deepen your involvement with extended family.
Seek out people with whom you have things in common. Join an organization. Many of the men I spoke with are in HIV or gay men’s support groups. But the options are as broad as your interests. Are you into doll collecting? Environmental issues? Chess? The Avengers? Macrobiotic cooking? Salsa dancing? There is a club for you. Look at your local gay community organization, AIDS service agency, newspaper, or on the web to find a group that fits your needs.
Talk to a stranger. Strike up a conversation with someone you see at the supermarket, in the building where you live, or the restaurant on the corner. If you don’t know what to say, ask a question. People love to talk about themselves.
Diversify your networks. Your friends should include people from different backgrounds. The wider and more varied your network, the greater your ability to manage what life throws at you. There may be straight, younger, or HIV-negative people in your life who would welcome the opportunity to develop a closer bond.
Don’t wait for people to contact you. If you want to talk to someone, pick up the phone (and leave a message at the beep). Every day. I don’t know anyone who can read minds. No one will know that you need help if you don’t ask for it.
Consider professional supports. You may feel more comfortable reaching out to a psychotherapist, pastoral counselor, or social worker than a friend when you are depressed or anxious.
Get a pet. Pets are great companions. And when you’re walking the dog, who knows who you might meet?
Pursue (or maintain) a romantic relationship. A stable marriage at age 50 is one of the predictors of healthy aging at age 75.
Use the Internet to cast a wider net. The Internet is not a replacement for human contact, but it can be an effective tool to rebuild your social network. Several aging organizations serving the lesbian, gay, bisexual, and transgender (LGBT) and HIV communities have resources on the web. Don’t be afraid to join Facebook, Twitter, or LinkedIn. They are great tools to stay in touch with people of all ages.
Form a reading group. At the end of the book I outline a strategy to use this book in a group setting. But you can form a reading group on any subject that interests you. Start advertising by word of mouth and then consider where you can post a flier or put in an ad to best reach like-minded people, such as your office or a local bookstore.
Just as a garden needs constant tending before your new plant can take root, you must nurture your relationships for them to mature. Keep showing up. Stay in regular contact with your friends. Time can weaken the bonds of friendship. Find ways to stay in touch, such as the telephone or Internet. Similarly, don’t allow arguments or miscommunication to jeopardize a good friendship. Try to work out your disagreements by talking to each other, or ask a friend or professional counselor to help you mediate the problem. Remember, maintaining friendships is as important as forming them.
The third post in the December Self-Care series is about staying fit. For me, the challenge of exercising is getting started. I never want to exercise, but I always feel better after. My strategy to compensate for my inertia is to include some form of physical activity into my weekly routine, that way I don’t have to think about it, I just do it.
The benefits of exercise are multi-fold. A balance of aerobic exercise, strength training, and stretching helps cardiovascular health while maintaining muscle mass, balance, and flexibility. Regular exercise is not only an integral part of physical health for people aging with HIV, but exercise can also help you reduce stress, manage anger, and improve your mood. In addition, there is evidence that regular physical exercise can actually forestall the onset of non-HIV-related dementia.
Calisthenics, rapid walking, jogging, dancing, and hiking are aerobic activities. Strength training––using weights or other forms of resistance––is increasingly found to be important for building muscle mass lost with aging. Stretching is an important part of any exercise routine, and it is especially important to increase flexibility as we age. Yoga is an ancient form of exercise involving the mastery of postures that increase flexibility and strength. I recently heard one yoga instructor refer to spinal flexibility as, “the fountain of youth.”
Your exercise routine should include aerobics, strength training and stretching. Exercise does not need to be strenuous. Start slow with achievable goals and respect your limits. You may want to consider getting started with a fitness professional. Before starting an exercise program be sure to discuss it with your doctor.
Next post: Staying Connected
In the second installment to the December’s Self-Care posts, I wanted to discuss healthy eating. Well, actually, I do not want to discuss healthy eating, because I have to admit to everyone that I have not been eating well lately. With the release of the book, the stress of the holidays, and my inclination to eat more than I should at this time of year, I have put on a few pounds. So, I need to revisit this topic for myself and will bring you along for the ride.
You may have already made adjustments to your diet to adapt to HIV-related changes in your metabolism and the effects of medication. Aging, too, creates shifts in our body, and as we age we need to alter our diets to compensate.
I consulted with Dr. James Schmidtberger, from the Leicht Clinic, an HIV-clinic in New York City to get some guidance on eating well and aging with HIV. He offered some general suggestions in order to get us started. He also suggested following up with a doctor or nutritionist to respond to changes in your specific physical condition.
Here is what he had to say:
When we age we lose muscle mass and require fewer calories daily. Uncontrolled HIV can accelerate the loss of muscle mass. If you are concerned about HIV wasting you may be tempted to overeat. Without adequate exercise, this may result in excess fat which raises the risk of developing (or worsening) other chronic conditions such as diabetes and heart disease. This is why nutrition and exercise are so important to help you maintain your muscle mass. Nutrition is particularly important if you have other medical problems (such as high blood pressure, high cholesterol, diabetes, or prediabetes) or lipodystrophy. A balanced diet is important to help your body fight HIV and control (or prevent) those other conditions.
A good place to start is to assess your overall dietary habits. In general, you want to eat a balanced diet with plenty of fresh fruits and vegetables. A good rule of thumb is called the “plate method.” This is a simple way to devise a healthy meal and is recommended by the American Diabetes Association. Take your dinner plate and divide it in half. Fill one half with nonstarchy vegetables (such as spinach, broccoli, cauliflower, greens, salad, tomato, cucumber). Divide the remaining half again into two quarters. Fill one quarter with starchy foods (such as rice, pasta, corn, peas, whole grain breads/cereals). Fill the remaining quarter with proteins (lean meats, skinless poultry, seafood, tofu, eggs). Add a glass of nonfat or 1% milk or yogurt and a piece of fresh fruit. You can bring the plate method to the breakfast, lunch, or dinner table.
Consider the following small modifications. If you eat too much, try to limit your portions. If you drink soda, switch to seltzer or diet sodas. Avoid fast food. Switch to healthy oils, olive oil or canola oil, and avoid food with trans fats.
Depending on your situation, your nutritional needs may differ. For example, if you are fighting an opportunistic infection, your calorie requirements may be higher than usual. If you have heart disease, diabetes, or other complications, you may have specific dietary restrictions. Ask about nutrition. You may also want to consult with a nutritionist to assess your dietary needs.
Next week’s blog: Staying Fit
A Good Night’s Sleep
As we’ve been discussing on this blog , aging with HIV involves adapting to a great deal of change. One aspect of optimal aging with HIV is re-evaluating your coping strategies, to make sure they are meeting your changing needs.
This month we will be discussing Self Care. December can be a stressful month and you may want to make sure that you are doing everything you can to take the best care of yourself that you can.
Developing healthy sleep habits is an integral part of self care.
There are several things in life that could impact your sleep. Changes in medication, physical changes that accompany aging, stress, and environmental changes can all affect your ability to get a good night’s rest. The following are some recommendations for getting a good night’s sleep taken from Aging with HIV: A Gay Man’s Guide.
Many people’s sleep habits interfere with getting a good night’s sleep. For example, eating or drinking in bed, reading/playing cards in bed, and falling asleep with the TV on for background noise are just a few. These practices train your body to be awake in bed. If you are having sleep problems, try retraining yourself: go to sleep and get up at the same time every day, remove the TV from the bedroom, make your bedroom quiet and dark (use blackout shades if necessary), do not read in bed, and do not eat or drink in bed. The bed should be only for sleep (and sex). Establish a prebedtime ritual, such as turning off the TV and computer at least 30–60 minutes before bedtime, changing out of your day clothes, and flossing and brushing your teeth, to prepare your body for sleep. When you feel tired, go to bed. If you cannot sleep after 20 minutes, get up and leave the bedroom, but don’t turn on the TV or computer. Wait until you feel tired and try again. If you continue to have trouble sleeping, you should bring it up with your doctor.
Next post: Eating Well.
Someone in AA recovery recently told me that alcoholism is a three-fold disease, “Thanksgiving, Christmas, and New Year’s.” The risk at this time of year is to turn to alcohol as a way to cope with stress. But, the holidays are not only challenging for alcoholics. They are wrapped up with intense meaning for many of us, and, it is difficult not to feel pressured at this time of year. The holidays can also stir up feelings of grief, sadness, and loneliness, and these feelings can be compounded when it seems that everyone else is having fun but you. And, moods can darken when the weather starts getting colder, and the days become shorter.
But, there are things we can do to take care of ourselves at this time of year. That is why for the month of December I will be dedicating my blogs to the subject of Self Care.
Self care can be both simple and difficult. A few activities may mean making only small adjustments to your daily routine. However, maintaining a regimen of self care can also feel like work. People can be surprised at the discipline it takes to take care of oneself.
Please feel free to add your thoughts at any time. I hope that this will spark a discussion about self care and aging with HIV.
Next post: Healthy Sleep Habits
There has been much discussion lately in the blog-o-sphere about accelerated aging among people living with HIV. The term “accelerated aging” refers to a collection of conditions (heart disease, bone loss, cancer and cognitive decline) that are more common in HIV-positive people in their 40s and early 50s, compared with HIV-negative people of the same age. There is a great deal of controversy about using this term given the lack of research in this area. Many argue that one cannot combine these conditions under the heading “aging.” Researchers are also unclear whether these conditions are a result of age, long-term HIV-infection, long-term use of highly active antiretroviral treatment (HAART), or the presence of other infections. The researcher, Dr. Charles Emlet, sums up the research on his blog and links to a POZ article on the subject.
In another related article, Medscape writer Bob Roehr, interviews Steven G. Deeks, MD, a professor of medicine in residence at the University of California, San Francisco (UCSF), and codirector of the Population and Clinical Sciences Core at the UCSF-GIVI Center for AIDS Research. In the interview Dr. Deeks discusses the controversial topic of accelerated aging. He focuses on chronic low-level inflammation demonstrated among people living with HIV taking HAART. He states that while the presence of elevated markers for inflammation is “well accepted” among scientists, the effect is “not particularly dramatic.” Dr. Deeks suggests that more research needs to be done on the relationship between chronic inflammation and CMV disease. He adds that inflammation levels are much higher in people who are untreated with HAART than in those who are treated. His recommendation – “For now, lifestyle changes such as diet and exercise may be the most useful interventions. They have demonstrated efficacy in dampening immune overactivation and restoring a more normal homeostasis.”
I am sure that there will be much more to say about this topic. Add your thoughts, personal reflections or research updates here or on the “community” page.