The Grumpy Doc – Page 6 – Grumpy opinions about everything.

Statute of Limitations

On October 16, 2023

It seems these days that everything in the newspaper (Yes, I still read a newspaper) has to do with some kind of legal issue. It is either the ongoing political and legal difficulties of Donald Trump and Hunter Biden or it’s the lawsuits that our governor Jim Justice is facing as result of his questionable business dealings.

There also are various criminal stories in the paper. These range from the trials of the January 6th insurrectionists to local drug related shootings here in Charleston.

I think the fascination with legal stories is that happy news is inherently boring, and we all want to read about scandal or intrigue, particularly when well known people are involved.

Occasionally, in both civil and criminal cases I have run across the term “statute of limitations”. I’ve never paid a lot of attention to that. I always assumed it was just a get out of jail free card for people who could keep their crimes hidden long enough.

A recent article about a criminal case discussed when to start the clock on the statute of limitations. That got me thinking about exactly what is a statute of limitations and how does it relate to both criminal and civil cases.

Let’s start first with the definition. Miriam Webster defines statute of limitations as: A statute assigning a certain time after which rights cannot be enforced by legal action or offenses cannot be punished.

OK, that sounds a lot like the aforementioned get out of jail free card. Everyone knows about Monopoly and the get out of jail free card. I always thought of it as a way to avoid punishment for a crime you had obviously committed. But after spending some time looking into it, it’s a lot more complicated than that.

A Very Short History

We’ll start with a little bit of the history of the statute of limitations. Recognize, of course, there is no single statute of limitations; it varies from country to country and from local jurisdiction to local jurisdiction and from civil to criminal cases. Some countries have no statute of limitations at all.

Unlike what I initially thought, the statute of limitations is not a creation of the modern legal system. It has been around as long as there have been codes of law.

Hammurabi’s Code (circa 1754 BCE) in Babylon and the Twelve Tablets (449 BCE) in Rome included provisions that established time limits for bringing legal claims. Medieval Europe had statues of limitations that developed as part of customary law to ensure that legal actions were brought while evidence and memories were still fresh. Many of these same issues were incorporated into English common law and were codified in the Statute of Limitations Act of 1623 in England. This established limitations for various types of actions such as indebtedness and trespass. It generally did not cover criminal cases, particularly if it was an offense against the crown. Statutes of limitations in those early times were much shorter than what we have now.

Civil Actions

We will look first at the statute of limitations as it applies to civil actions. There are two main reasons for restricting time limits for civil suits. First, to ensure that legal action is brought while evidence is readily available. Second, to ensure that minor legal grievances are not raised years later as a means of harassing the defendant.

A major provision of most statutes is tolling. Tolling is a suspension or extension of the statute of limitations in exceptional circumstances. These include when the plaintiff was a minor at the time of the offence or has filed a bankruptcy petition. This extends the statute of limitations until that condition has been resolved.

It’s important to recognize that the statute of limitations does not begin when a fraudulent event occurs. It begins when the fraud or injury is discovered. At times it may begin when the plaintiff should have known. This prevents the plaintiff from fraudulently claiming to have been unaware of the injury.

There is an exception to the tolling rule. It does not apply to mass media such as newspapers and the internet. The statute of limitations begins at the date of publication. The general assumption is that the plaintiff knew or should have known on the date of publication that there may have been injury.

A judge may decide that the plaintiff has waited too long to request an extension of the statute of limitations in civil cases. This is intended to prevent never-ending litigation.

Criminal cases

The statute of limitations in criminal cases is far more controversial. These literally may be the get out of jail free card. However, there’s a long-standing precedent of statute of limitations in criminal cases. Even the US military in the Uniform Code of Military Justice states that all charges, except those facing court martial on a capital charge, have a five year statute of limitations. A capital charge being one that carries a death penalty.

It is important to note that in almost every jurisdiction with a statute of limitations on criminal cases there is a specific exclusion. That is when the defendant is in a fugitive state or has actively attempted to cover up their crime. In these cases, the statute of limitations begins when the defendant is apprehended or when the crime is discovered.

There has been much revision of statutes of limitation in criminal cases in recent years. For serious cases such as murder, kidnapping, rape, and child abuse they have either been considerably extended or eliminated altogether. They remain in effect for minor transgressions such as vandalism, trespassing, and marijuana possession.

The main argument for maintaining a statute of limitations for minor criminal cases is that it prevents prosecutors years later going after a person for a relatively minor crime and thus tying up the legal system at a time when witnesses and evidence may no longer be available. Although, some prosecutors argue that they require the ability to pursue relatively minor crimes in order to investigate or prosecute more serious crimes committed by the same person.

Putting it all together

After having done some research, I have a better understanding of the statute of limitations. I think it’s generally useful in civil cases to prevent new suits being filed years after the alleged event. Lawsuits are rampant in our court system today and we need to avoid clogging up the system with frivolous cases.

However, I’m undecided on criminal cases. While I recognize that keeping your crimes secret does not allow the statute of limitations to run, I still have some problem with people being able to defend themselves by saying “Sorry it’s been too long”.

If the statute of limitations is limited to such minor things as jaywalking, shoplifting, vandalism or marijuana possession for personal use, I think that helps to avoid backing up the legal system. Personally, I don’t believe there should be a statute of limitations for serious crimes. Of course, that leads to another discussion of what constitutes a serious crime.

All comments on the statute of limitations are welcome. You may even encourage me to share my grumpy opinions on more controversial aspects of this topic. The Grumpy Doc is just glad that the statute of limitations applies to the stupid things he did in high school.

I Couldn’t Sleep At All Last Night -Bobby Lewis, Tossin’ and Turnin’

By John Turley

On October 1, 2023

In Medicine

Sleep Part 2

Several different processes fall into the broad category of sleep disorder. But first, we should understand a few things about what constitutes a sleep disorder.

Not everyone requires the same amount of sleep; children and adolescents require more sleep than adults. Once we reach adulthood, our individual need for sleep usually becomes fairly consistent for the remainder of our lives. However, the amount of sleep needed varies from person to person.
A common misconception is that we require less sleep as we age. It is true that older adults frequently get less sleep but it’s not necessarily because we require less. Admittedly there is some controversy among sleep specialists, but we shouldn’t dismiss the concerns of older people because we don’t think they need as much sleep as they used to.

To diagnosed as a sleep disorder, it must be a relatively long-term process. An occasional night of sleeplessness does not constitute a sleep disorder; there must be some impact on the waking hours. For example, a person who only sleeps 5 to 6 hours a night but never has any daytime sleepiness, fatigue, difficulty concentrating, or completing tasks probably does not have a sleep disorder. Another person who gets 7 to 8 hours of sleep a night but feels drowsy, is unable to concentrate on tasks and drifts off to sleep midafternoon may have a sleep disorder.

A sleep disorder is never diagnosed by the time spent in bed. It is diagnosed based on how a lack of sleep impacts daily life and ability to function at the desired level. It’s very common for people to overestimate the amount of time they are awake at night. A sleep disorder is something that requires careful investigation. It is important to contact your doctor for a definitive diagnosis.

If there is another reason for sleeplessness, then a sleep disorder diagnosis should not be made. Common causes of sleep disturbance are pain and environmental factors such as noise, bright lights, and temperature extremes. Rotating shift work is another common cause.

It is important to determine if the person reporting sleep problems has adequate opportunity to sleep. Family demands or work requirements may often limit the ability to get sufficient sleep. Additionally, some older men make frequent trips to the bathroom during the night, but this doesn’t necessarily constitute a sleep disorder.

To diagnose a sleep disorder, the patient must have had the opportunity for adequate sleep but is still suffering from the symptoms of sleep deprivation. The first step in evaluating a sleep disturbance is to identify and eliminate as many external factors as possible.

Sleep Apnea
Sleep apnea is perhaps the best known sleep disorder. There are two types of sleep apnea, the fairly common obstructive sleep apnea (OSA) and central sleep apnea. Central sleep apnea is extremely rare and well beyond what we’re talking about here.

Most OSA patients complain of daytime sleepiness. A patient’s bed partner may report loud snoring, gasping, or snorting, or the patient seeming to stop breathing while asleep. Not everyone who snores has OSA. While about 80 to 90% of people who have OSA snore, fewer than 50% of snorers have OSA.
If you are concerned that you may have OSA, talk to your doctor. It’s not something that can be diagnosed by you at home. Diagnosis requires a formal assessment.

Sleep apnea is treatable with the infamous CPAP machine. It isn’t generally considered to be curable although some people who have lost a significant amount of weight have been able to wean themselves from the CPAP machine.

Insomnia

Insomnia is one of those catchall medical terms that covers a variety of clinical situations. The broad definition of insomnia is difficulty sleeping. But that includes many causes, both those understood and those not well understood.

During a sleep assessment, it’s important to determine if it is chronic insomnia. That is a pattern of difficulty falling asleep or staying asleep that occurs at least three nights a week and lasts for at least three months. But that’s only the beginning, there are many unrelated factors that can cause chronic insomnia and there are also different types of insomnia that may be unrelated to any other factors.

Onset insomnia is difficulty falling asleep. The patient may be awake for very long periods, but once they fall asleep, they’re usually able to sleep for several hours. Unfortunately, they are usually awakened by the alarm clock before they have experienced adequate restorative sleep.

The other broad category is maintenance insomnia, the difficulty staying asleep. These patients often wake up in the middle of the night and are unable to return to sleep for several hours. Frequently they report falling back asleep just before the alarm goes off.

Some people have mixed insomnia. Sometimes they will have difficulty falling asleep and at others, staying asleep. Occasionally, they will suffer from both types on the same night, making for a very long night indeed.
Both types of insomnia can have similar underlying causes. Some of them fit in the broad category of comorbid insomnia, whether it’s a medical, psychiatric, or other problem. This can include depression, anxiety, or somatic disorders such as restless leg or chronic pain. Medical disorders include pulmonary disease, diabetes, and congestive heart failure. Treatment of the underlying medical condition is the key to dealing with these types of sleep disorders.

In a self-fulfilling cycle, some people suffer from insomnia because they worry about their inability to sleep.

Another type of sleep disturbance frequently included in the category of insomnia is disruption of the circadian rhythm. The circadian rhythm is the body’s internal clock. It is generally a 24-hour cycle that follows the light-dark cycle of the day. Major circadian disruptions include jet lag and intermittent shift work. The use of LED screens such as televisions, computers, and E readers exposes us to a large amount of blue light which may confuse our body’s circadian rhythm into thinking it is a daylight period. The many effects of disrupting the circadian rhythm are beyond the scope of this post, but if your circadian rhythm is interrupted it can affect your sleep, at least in the short term.

In Part 3 we will look at those things that may help you sleep.

A quote to end this post:
“I’ve always envied people who sleep easily. Their brains must be cleaner, the floorboards of the skull well swept, all the little monsters closed up in a steamer trunk at the foot of the bed.” – David Benioff, author, and TV producer

Hamilton And Lincoln Still Have Something To Tell US

By John Turley

On September 26, 2023

In Commentary, History

Objections and Answers respecting the Administration
of the Government

Alexander Hamilton 18 August 1792

“The truth unquestionably is, that the only path to a subversion of the republican system of the Country is, by flattering the prejudices of the people, and exciting their jealousies and apprehensions, to throw affairs into confusion, and bring on civil commotion…

When a man unprincipled in private life, desperate in his fortune, bold in his temper, possessed of considerable talents, having the advantage of military habits—despotic in his ordinary demeanour—known to have scoffed in private at the principles of liberty—when such a man is seen to mount the hobby horse of popularity—to join in the cry of danger to liberty—to take every opportunity of embarrassing the General Government & bringing it under suspicion—to flatter and fall in with all the non sense of the zealots of the day—It may justly be suspected that his object is to throw things into confusion that he may “ride the storm and direct the whirlwind.””

Speech to the Young Men’s Lyceum of Springfield

Abraham Lincoln 1838

Is it unreasonable then to expect, that some man possessed of the loftiest genius, coupled with ambition sufficient to push it to its utmost stretch, will at some time, spring up among us? And when such a one does, it will require the people to be united with each other, attached to the government and laws, and generally intelligent, to successfully frustrate his designs….

Distinction will be his paramount object, and although he would as willingly, perhaps more so, acquire it by doing good as harm; yet, that opportunity being past, and nothing left to be done in the way of building up, he would set boldly to the task of pulling down….

I first came across these quotations in an article by Jeffery Rosen published in the Wall Street Journal. The Grumpy Doc does not need to add anything further to them and will leave them for your thought and consideration.

50th Post

By John Turley

On September 12, 2023

In Commentary

When I started this blog over 2 1/2 years ago, I didn’t expect to reach 50 posts. I thought I would run out of ideas long before this. OK, I know some of you guys are saying I ran out ideas long ago, but I’m going to keep on with it anyway. The ideas all may not be new to you, but they’re new to me and I hope I can present you with a new twist on some of them.

I’ve learned a lot doing this blog. One of the things that I’ve learned is that I continue to have a fascination with trivia. I might be rich now if I weren’t so interested in things that have no monetary value. But that’s the way it is. I’ve always said that I am the master of useless information.

I really enjoy the research and the writing. Recently, I’ve been experimenting with artificial intelligence in the form of ChatGPT. It can certainly produce a lot of results in a short period of time. Unfortunately, it’s not always accurate. I found that names and quotations are frequently a little bit off. Occasionally, it seems that AI has just completely made up something and I find that I can’t verify it. I know there’s a concern that people will stop doing their own work and just produce an AI generated product. But at this time, I don’t feel AI is reliable enough for use as anything but a starting point for your own work.

One of the most significant things I’ve learned is that Margie is an excellent editor. I give her all my posts before I publish them. Her comments are always spot on and significantly improve my articles.

When I first started doing this, Margie and I decided I should avoid politics. With a few exceptions, I have done this. When I have ventured into the realm of politics those are the few times we disagreed about my posts. As usual, she is generally right.

I do this because I enjoy it. I hope you enjoy it as well. If there is anything in particular that you would like me to write about or to comment on, please let me know. Otherwise, my comments will be random as they occur to me.
Hopefully, I will last long enough to do another 50 or God forbid, another 100.

The Grumpy Doc thanks everyone who has been reading this blog. When someone tells me they read one of my posts it makes me very happy. Please know that you don’t have to agree with me. Disagreement and discussion can lead to growth on both sides. I hope you will respond on the website with any ideas you may have so that we can continue this journey together.

To Sleep, Perchance to Dream -Wm. Shakespeare, Hamlet

By John Turley

On September 2, 2023

In Commentary, Medicine

Sleep – Part I

The other night, about 3:00 AM I was lying in bed wide awake thinking about…. sleep. It’s natural to think about sleep when you’re having trouble doing it. I’ve had intermittent insomnia for my entire adult life. Sometimes I’ll go several days with not much more than two or three hours of sleep a night and then I’ll go several days where I can sleep six, seven or eight hours. I’m not sure what causes insomnia at one time but not another.

I’ve spent a lot of time thinking about sleep. Mostly, I think about why I can’t sleep and what I can do to get to sleep. I’ve read a lot about specific tips and techniques to improve sleep. I’ve tried many of the so-called “sleep hygiene” regimens. I’ve tried herbal preparations and prescription sleep medications. Lately I’ve been using a sleep mask with some positive results. I’m easily awakened, and it has helped with that.

But, with one of those middle of the night revelations, I realized that in all my years of thinking about sleep I’ve never really thought about what sleep is and why we need to do it. So, I’m going to embark on a three-part post about sleep. This is Part 1; it’s a look at what sleep is and why we do it. In Part 2 we’ll look at why we can’t sleep and the various things that cause us to lose sleep. Part 3 will be a survey of the many things available that may or may not help us to get that good night’s sleep.

What Is Sleep?

We will spend anywhere from 25 to 30% of our lives asleep so we really ought to have a better understanding of exactly what it is.
Merriam-Webster defines sleep as: The natural, easily reversible periodic state of many living things that is marked by the absence of wakefulness and by the loss of consciousness of one’s surroundings, is accompanied by a typical body posture (such as lying down with the eyes closed), the occurrence of dreaming, and changes in brain activity and physiological functioning….

As with many dictionary definitions my first response is “What?” So, let’s see if I can come up with something that’s a little more than a physical description of someone laying on the couch asleep.

Our bodies crave sleep just like they crave food. The major difference is your body can’t force you to eat but it can force you to sleep.

The reasons why we sleep and what happens during sleep are not completely understood. People used to believe that sleep was a passive activity when the brain and the body were dormant. But, according to sleep specialist and neurologist Dr. Mark Wu, MD “… it turns out that sleep is a period during which the brain is engaged in a number of activities necessary to life which are closely linked to the quality of life.”

Cycle of Sleep

Everyone’s heard of the sleep cycle so I’m just going to briefly touch on it here. There are two basic types of sleep. The first is non-REM sleep which also has three stages of its own and the second is the rapid eye movement (REM) sleep.

The three stages of non-REM are Stage 1 which is the transition into sleep and is relatively light. It is when brain waves begin to slow down. Stage 2 is the period just before you enter into deeper sleep when your heart rate and breathing slow, your muscles relax, your body temperature starts to drop, and eye movements stop. This is the stage where you spend most of your sleeping time. Stage 3 of non-REM sleep is the period of deep sleep that you need to feel refreshed in the morning. It occurs more during the first half of the night. Your heartbeat and breathing are slowed to their lowest level, and you are most relaxed. Brain waves are at their slowest.

REM sleep first occurs about 90 minutes after falling asleep. Your eyes move rapidly even though your eyelids are closed. Your brain waves are closer to those when you are awake. Breathing becomes faster and your heart rate and blood pressure increase. This is when most of your dreaming occurs. Although, some can occur during non-REM sleep periods. During REM sleep your arm and leg muscles may become temporarily paralyzed which prevents you from acting out your dreams. As you age, you spend less time in REM sleep.

What Happens When We Sleep?

If we’re going to spend this much time sleeping there must be some benefit to it, right? Surely it is not just a way to pass the time until we have something better to do.

There have been a lot of theories over the years about why we sleep. Some of the older ones include the adaptive or evolutionary theory that says animals sleep during periods of vulnerability, such as darkness, so that they won’t attract attention. However, this seems to be counterintuitive. During periods of vulnerability, I would certainly want to be most alert. Another theory is that of energy conservation. During periods of sleep the body has less need for energy and will not require food as often. For most of human history, and continually for the rest of the animal world, food is a scarce item and energy conservation is important to survival.

People have always recognized that somehow sleep helped rejuvenate us. Newer research points to this as probably the main reason why we sleep. Sleep helps clear the brain of waste products that accumulate when we are awake allowing it to function more efficiently.

Sleep also helps us consolidate the day’s memories. It facilitates the conversion of short term to long term memories so that they are more readily accessible. Sleep also improves alertness, concentration, and cognitive performance. This may be why some people recommend a good night’s sleep rather than an all-night cramming session prior to finals.

Sleep helps regulate various hormones that are responsible for appetite control, growth, and metabolism. Poor sleep can exacerbate physical problems such as diabetes, hypertension, and obesity. Sleep is essential to our immune function; prolonged periods of sleep deprivation put us at risk for opportunistic infections. Sleep is also important for our emotional well-being and for helping to prevent anxiety and depression.

I will finish this post with two quotes that I particularly like about why we sleep.

Sleep is an investment in the energy you need to be effective tomorrow.
-Tom Rath, American author and consultant

Sleep is the golden chain that ties health and our bodies together.
-Thomas Dekker, 17th Century English poet and playwright

Civil War Trivia

By John Turley

On August 26, 2023

In History

On January 12, 1864, President Lincoln went to Fort Stevens north of Washington, DC to observe military actions by the soldiers defending the capital against the Confederate cavalry of General Jubal Early. Lincoln became the only sitting United States President to come under direct fire from enemy troops. Reportedly, a young officer named Oliver Wendell Holmes (a future Supreme Court Justice) said to Lincoln “Get down you, damn fool”.

Ulysses S. Grant was the first army officer to hold the rank of Lieutenant General since George Washington.

One of General Grant’s ongoing problems was political generals. Because the army expanded so quickly, many people with little or no military experience were commissioned as officers because of political connections. Former senators, congressmen and governors frequently became generals. A number of these were placed in critical combat commands. Many of the early union setbacks can be partially attributed to the ineptitude of political generals who either were unable or unwilling to follow the orders of the professional army. (It must also be admitted that a few regular army generals were inept, but they were easier to set aside.) It wasn’t until late in the war that Grant finally had sufficient influence to be able to dismiss a number of these political generals.

Future Confederate General James Longstreet was a groomsman at the wedding of Ulysses and Julia Grant. He was a West Point friend of Grant’s and Julia’s cousin as well.

Lincoln first offered command of the Army of the Potomac to Robert E Lee. Lee refused, resigned his commission in the United States Army, and returned to Virginia where he swore allegiance to the Confederacy. The first official commander of the Army of the Potomac was General George B. McClellan. General Irwin McDowell commanded the union forces at the first battle of Bull Run, but those forces had not been designated as the Army of the Potomac at that time.

Lee was not the first choice for command of the army of Northern Virginia. The first commander of what would eventually become the army of Northern Virginia was General P. G. T. Beauregard. Interestingly, he also designed the Confederate battle flag which is today widely considered as the “Confederate flag”. It was designed because of the confusion between the Confederate national flag, the stars and bars, and the United States flag. General Beauregard relinquished command to General Joseph E. Johnston when his army was combined with Johnston’s larger army group. Lee did not become commander of the army of Northern Virginia until Johnston was wounded in battle and unable to continue.

The Civil War did not end with the surrender at Appomattox Courthouse on April 9, 1865. On April 26th, Joseph E. Johnston surrendered his larger army of 90,000 soldiers. On May 26th General Kirby Smith surrendered the Army of the Trans-Mississippi, the largest confederate force still operating on land. The last Confederate flag was lowered when the open ocean raider CSS Shenandoah surrendered to the British in Liverpool on November 6th. Interestingly, almost half of the Shenandoah ‘s victories over merchant ships occurred after the surrender at Appomattox.

The surrender at Appomattox Courthouse occurred in the home of Wilmer McLean. In one of those interesting coincidences of history, McLean originally lived near Manassas VA and his property was part of the battlefield of Bull Run. He moved to Appomattox Courthouse to try to get as far away from the fighting as he could.

At the beginning of the Civil War, Ulysses S. Grant was not even in the army. Initially, despite being a West Point graduate, he was refused a commission in the regular army and his first Civil War commission was in the militia.

Grant and wife were initially scheduled to be in the box with President and Mrs. Lincoln at Ford’s Theater on the night the President was assassinated. At the insistence of Julia, the Grants left Washington that afternoon. There’s been much speculation about why they did not attend the theater. Among the many reasons put forward are: Julia missed her children whom she had not seen for almost three months; Julia did not wish to spend time with Mrs. Lincoln whom she found disagreeable and with whom she had several contentious meetings; and one which seems most interesting, she was reported as being very worried about someone that she thought had been watching her all that day and she felt they needed to get away. The assassins did report that Grant had been one of their initial targets so this may be a true report.

Emancipation Proclamation only freed slaves in Confederate held territory. Slavery was not officially abolished in the entire United States until December 6, 1865, with the ratification of the 13th amendment.

Counting both northern and southern casualties, more Americans died in the Civil War than in all other American wars combined. The most recent estimate of the number of Civil War deaths on both sides is placed at about 750,000. Of that number, almost 2/3 died from disease.

At the end of the Civil War the United States had the largest army in the world. In 1860 the US Army had been about 16,000. At the end of the Civil War, it is estimated the army was slightly over one million. It is estimated that a total of about 2.6 million served in the US Army during the Civil War. There are no reliable estimates of the total number to have served in the Confederate Army.

Grant’s drinking was largely overstated. The stories of his dinking stem from a period, early in his career, when Grant was assigned to an isolated fort on the West Coast and his family remained on the East Coast. He suffered depression and loneliness. Throughout his life he had anxiety when separated from his family. While in the west, he began bouts of binge drinking. He missed his family to the point that he resigned from the army even though he had no job prospects at the time. There is very little report of any drinking by Grant’s following his return to the army during the Civil War, although rumors were plentiful. When given reports of supposed excessive drinking on Grant’s part, Lincoln is reported to have said “Find out what whiskey he drinks and send a case to all of my generals”.

Grant smoked up to 20 cigars a day and admirers from all over the country mailed him boxes of cigars. He eventually died of cancer of the throat and tongue.

The poet Walt Whitman worked as a volunteer in union hospitals.

Lew Wallace, author of Ben Hur, was a general in the Union Army. By most reports he was a better author than general.

The last verified Civil War veteran died in 1956. He was Albert Woolson who served in the Union Army as a drummer boy. There were three men who claimed to be Confederate veterans who lived longer than Woolson; however, one of those has been completely debunked and no confirmation of service of the other two has ever been found.

Persistence of Memory

By John Turley

On August 11, 2023

In Commentary, Medicine

I turned 75 this year and like many people my age I have started to worry about my memory. I’ve always had a good memory. I seldom had to write anything down and I almost never forgot anything. But that’s rapidly becoming a thing of the past. I try to tell myself it’s because I don’t need to remember things now. I have my phone with my calendar and my to-do list and my reminders all right there in my pocket. Things for which I once relied on my memory are now just a simple “buzz” away. As much as I try to tell myself that, I can’t really believe it. I’m afraid things are starting to slip away, and I worry just how far and how fast this will progress. I know from talking to others my age I am not the only one with this concern. But what exactly is memory? How does it work? And what can we do to prevent its decline, or even better to reverse it?

What is memory?
Marriam-Webster Dictionary defines memory as: “…the power or process of reproducing or recalling what has been learned and retained especially through associative mechanisms; the store of things learned and retained from an organism’s activity or experience as evidenced by modification of structure or behavior or by recall and recognition.” I hope that’s more enlightening for you than it is for me. While it may describe memory, it doesn’t really explain it.

I think that I like Salvador Dali’s approach to memory. In his famous painting shown above, The Persistence of Memory, we see the passage of time as it inexorably moves on but leaves persistence in our memory. But as we can see memory is fluid and it is malleable. While memory may persist, it is not unchanged. OK, that may sound like philosophical mumbo jumbo, but I just want to get across the idea that memory is not a concrete thing, and it is as much about perception as anything else.

Types of memory

One of the first things to recognize is that memory is not a single monolithic sense. There are many types of perceptions or abilities that are encompassed in the collective term memory.

The type of memory we use most frequently is working memory. This is where we store things for short-term use. It would include things such as remembering numbers to add in your head. You don’t need it for long term, but if you have problems with your working memory it can take you much longer to get things done such as balancing a check book, following directions or grocery shopping.

Episodic memory is how we recall past events, personal experiences, conversations, feelings, and emotions. If you’re struggling to recall recent events and activities, you may have a problem with your episodic memory. This is the type of memory loss that most people first worry about.

Semantic memory is what you use to recall the definitions of words, the names of objects and to recognize familiar faces. It’s not tied to any specific experience, but these are just things that you just know, such as your key is used to unlock your door or if you want a drink of water, you pour it into a glass. If you find yourself frequently struggling for the right words in a conversation you may be having problems with your semantic memory.

Our prospective memory is the way we remember future things. It’s how we keep track of appointments and obligations. If you find yourself forgetting that you have made plans or where you were supposed to be going you may have problems with your prospective memory. We most commonly experience this when we find we have walked into a room, and we can’t remember why we went there. (Unless it’s the bathroom; I always remember why I’m there.)

Is it dementia?

Of course, this is our greatest worry. I think many of us fear dementia more than we fear stroke, heart attack, or cancer. Memory loss is not always dementia; there is some natural degradation of memory as we get older. But what is age-appropriate memory loss and what are some of the more common and frequently reversible forms of memory losses, and how do we know it’s not dementia.

So, is it normal memory loss or not? It’s normal to forget the date but it is not normal to not know the month or the year. It is normal to have to search for the appropriate word at times. It is not normal to be unable to hold a conversation. It is normal to occasionally forget someone’s name. (By this standard I’ve been suffering from memory loss since I was about 20 years old.) It’s not normal to not recognize close friends or family members. It’s normal to forget where you put your car keys. It’s not normal to forget what they are used for.

The fact that you’re worrying about some of these mild memory problems is in itself good. It just means that you recognize your memory is not as sharp as it once was. Dementia is a sudden and rapid decline in cognitive ability. It is frequently recognized by everyone except its victim.

Other causes
But before you jump right to worrying about Alzheimer’s, there are several more common medical problems that can cause memory loss and confusion. Most of these are, at least partially, reversible.

One of the most common causes of confusion and memory loss in older adults is what we in the medical field call polypharmacy and what most people call over medication. Some of the most common medications that cause mental impairment are diphenhydramine (more commonly known as Benadryl), pain medications, sleeping pills, medications for dizziness or anxiety, as well as some Parkinson medications. Some side effects of all of these can mimic the symptoms of dementia. This is particularly true if any of these medications are mixed with alcohol. If you’re experiencing some episodes of confusion or memory impairment and you’re on a variety of medications, ask your doctor or pharmacist to review them for potential memory impact.

Other common causes of memory impairment in older adults are dehydration, lack of sleep and lack of exercise. It’s a common misconception that our need for sleep and exercise decreases as we get older. Simple exercises such as daily walking have been shown to increase brain health and memory. The positive effects of exercise appear almost immediately.

Undiagnosed anxiety or depression often can mimic memory loss and dementia. This even has a nice clinical sounding name as the pseudodementia of depression. Poorly controlled chronic diseases such as type 2 diabetes can cause chronic inflammation in the body which can lead to cognitive and memory impairment as well.

It’s also generally believed that poor nutrition can cause memory impairments and a Mediterranean style diet has been recommended as a way of protecting against cognitive decline.

What can I do?

If you have concerns about your memory, of course the first step is to consult your doctor. Ask them to look for and deal with any of those common causes listed above. Be prepared, they may ask you some embarrassing questions about your past. They don’t think you’re a bad person, the only effective way to evaluate problems is to ask the same questions of everyone.

So, from there we get on to what can be done for prevention.

Excessive alcohol use and cigarette smoking have both been shown to have a negative impact on memory and can speed cognitive decline. Try to decrease your alcohol intake to one or two drinks a day and your cigarette smoking to none. There is no safe level of cigarette use. Despite common belief, vaping isn’t safer than cigarette use. Although oral tobacco hasn’t been extensively studied as it relates to memory, in studies related to other diseases it has been shown to increase inflammation and microvascular disease, all of which are known to accelerate memory loss and even vascular dementia.

Plan and implement a regular exercise program. You don’t need to be a marathon runner or a gym rat, you just need to have a steady regular plan. Thirty minutes of moderate exercise four or five times a week will show great benefits. Make sure you don’t get overly aggressive at the beginning and injure yourself. Walking is perfectly adequate for most people and doesn’t put undue stress on your joints.

Sleep like your life depends on it. Set a regular bedtime and stick with it both on weekdays and weekends. Try to get up at the same time every day. Just remember that during normal sleep, memory and learning are consolidated and brain toxins are disposed of. Improved sleep can also help with weight management, blood pressure control and blood sugar control. (More on sleep in a later blog.)

Social interaction has been shown to be as important for preventing cognitive decline as anything else. Strong bonds between family and friends are important for a healthy life. Involvement in churches, social groups and civic organizations are all equally beneficial. People who are socially isolated tend to develop earlier and more rapid cognitive decline. Social engagement also reduces the likelihood of depression.

Activities that require mental engagement, particularly in a social setting, have been shown to delay the onset of cognitive decline and in some cases have even reversed some of the signs in people who have previously been socially isolated.

Activities such as reading, writing, puzzle solving, card games and learning new skills have been shown to delay cognitive decline. For example, one of the things that I have done to try to stay mentally active is starting this blog. Not only am I engaged in researching and writing articles, but I had to learn how to set up and manage a website. Also, I had to learn how to work with voice recognition software because I must admit I’m too old to learn how to type.

Can’t I just take a pill?

For as long as I can remember, the pill to cure or reverse dementia is being tested and will be released sometime soon (it always seems to be within the next year). Unfortunately, most of those have been a disappointment. There have been some medications that have been shown to slightly delay decline, but none have substantially reversed it. And none of these medications have, so far, shown to be superior to correcting polypharmacy, or underlying medical problems, and improving social interactions and mental activities.

The Grumpy Doc says the best way to keep your memory is to stay out there living your life and making new memories. Keep moving, keep thinking, and keep doing. And the next time you see me you can tell me all about it, even if it does take me a while to remember your name.

To Pay Or Not To Pay, That Is The Question.

By John Turley

On August 4, 2023

In Commentary

With apologies to William Shakespeare

I have been following the debate about student loan forgiveness with some interest. First of all, I don’t think there is any such thing as loan forgiveness. There’s only transference. The debt itself does not go away. Someone else is required to pay it.

Having said that, I understand the concerns of the students. They feel that they were sold a bill of goods. They were encouraged to accumulate significant debt for a degree that frequently has no value to them in the marketplace. How can they expect to repay a $50,000 student loan with whatever job they may possibly find with a degree in medieval English literature?

However, these people are intelligent otherwise they would not have been in college, and they would not have gotten a degree. They must have known that the likelihood their degree would provide them with employment sufficient to repay these massive loans was small. Additionally, they’re not the first generation to have found themselves in this dilemma. People my age, two generations prior to them, also found themselves with massive student debt and degrees with little market value. However, most persevered, and eventually paid off their debt

Those who repay their debts have little sympathy for people who wish to escape theirs, be it student loans, credit cards or taxes. The feeling is, you are responsible for your decisions, and you should pay the debts that you incurred.

There currently are programs that allow for some student loan forgiveness. These usually involve some type of service arrangement. Full disclosure, Uncle Sam paid for my undergraduate degree but in return he required six years of service in the United States Marine Corps. I received a loan forgiveness of $10,000 for my medical school expenses but I agreed to practice in West Virginia, an underserved area, for four years. (I’ve been practicing here for 29 years, so they got their money’s worth.) Older generations have more sympathy for student loan forgiveness if there is an obligation in return for that forgiveness.

I’d like to propose a middle ground. Have the government forgive all accrued interest for student loans while requiring the principle be repaid. This could be done without requiring any type of service commitment from the borrower. Additionally, provisions could be made for forgiveness of the principle in return for service that benefits the public in general. This could include such things as military service, teaching, public health service, law enforcement, and such things as foster care and youth programs. This would provide students with some relief from their high debts, and at the same time provide benefits to the country.

I’m not in favor of allowing people to completely escape their obligations but I recognize young people can easily be misled and should not be burdened at the beginning of their lives with unrepayable debt. At the same time, they should not be led to believe that they can escape all responsibilities by simply demanding that the government take care of them.

And that is my grumpy opinion.

In Search of a Bench

By John Turley

On July 28, 2023

In Commentary, Travel

Margie and I just returned from 10 days in Florida. We combined my SAR conference with a few days of vacation. We got to spend the vacation days with our grandson (and his parents, of course).

We took him for a day at Disney World and a day at Universal Studios. He had a great time and we enjoyed watching him have fun. But for us old folks, it was extremely hot. It was also a lot of walking. We consider ourselves doing well if we get in a mile and a half for a daily walk. At Disney we covered over 7 miles, which left us drained. For the next day at Universal we drafted his parents to go with us so they could do some of the high-speed keeping up with an active 11 year old. We only covered about four miles at Universal but that’s still more than our average.

There was one thing that caused us to tire out more than we should have. That’s the lack of any place to sit in either park. They must think all seniors will be in wheelchairs. What few benches we found were in the direct sun or were occupied. Any shaded place to sit almost inevitably required purchase of food or drink.

Neither Disney nor Universal can be considered senior friendly.

“Disney! Universal! If you want older folks to continue bringing their grandchildren to your parks and spending money, you need to be sensitive to our needs. We need some place to sit! In the shade! It’s the least you can do in return for our spending money at your parks.”

And that is my grumpy opinion!

Full disclosure: the bench shown above is not in either park…But Margie found it!

Merry Old England

By John Turley

On July 13, 2023

In Reminiscence, Travel

Decisions, Decisions
Margie and I got married in June of 1971. Shortly thereafter she received a check for her vested portion of retirement for two years of teaching. So, what should we do? Perhaps we should open a savings account. Or maybe, we could invest it.

Finally, starting a pattern that happily follows us through more than 50 years of marriage, we decided to take a trip. Since there was no internet, we went to a travel agent. We had to find a trip that would fit into the next seven weeks before the fall semester started. We were able to find a trip to the British Isles. It was high on Margie’s list because she’s always been fascinated with Stonehenge.

It was a long flight, though more comfortable than the flights now because the seats were larger and had more legroom. But still, that’s when we discovered Margie suffers significant west to east jet lag. Even now, we never plan anything for the first day of a trip to Europe. The transatlantic flights always seem to leave in the evening or early night. I suppose they think everyone will sleep on the way over. Since neither of us can sleep on the airplane, it’s directly to the hotel room for us.

England Swings (like a pendulum do)
Growing up in the 1960s we were heavily influenced by the British invasion beginning with The Beatles first US hit “I want To Hold Your Hand” in 1964. We couldn’t get enough of all things British, the music, the fashions, the haircuts and the slang. Mod was what the style was called, and Carnaby Street was the place to find it.

What a major disappointment! What had been the iconic epicenter of swinging London in the 1960s had become a tawdry, shabby looking street of overpriced gift stores and strung-out people by the 1970s. But it was still fun and there was more yet to see.

Fortunately, Carnaby St. wasn’t the only thing in London. Trafalgar Square, with the Nelson Monument, was a busy and fascinating place. We loved the Albert and Victoria Museum and the British Museum. I was especially fascinated with the Egyptian displays at the British Museum.

For me, a highlight of our visit to London was the changing of the guard at Buckingham Palace. While we were there, we got to see a rare occurrence. The Coldstream Guards (think the big bear skin hats) were being deployed to Northern Ireland and the Royal Marines were taking over responsibility for guarding the palace.

A few random thoughts on London: I was struck at how unimposing 10 Downing Street is compared to the White House. It’s just a townhouse in the middle of the block with the door right on the street. Although, I suppose the appropriate comparison is to Buckingham Palace. We were surprised to learn that Big Ben is not the name of the large clock tower, that’s the Westminster Tower. Big Ben is the name of the bell that chimes the hours. The London tube (subway) was easy to use, as were the buses. It wasn’t until several years later when we visited Paris that I realized the ease of use was because the schedules were printed in English. I think it’s just part of our natural American inclination that everyone should speak English.

Touching History
We planned our trip to Stonehenge. It’s interesting that at the time there were no scheduled tours from London to Stonehenge. We had to arrange for a train trip to Salisbury, the nearest town. We bought our ticket on a standard English train. We had a first class ticket which gave us a private compartment. It was what we would now think of as the “Harry Potter train”. But in those pre-Potter days we thought of it as the “Murder on the Orient Express” train. I kept waiting for Hercule Poirot to show up in our compartment.

When we arrived at Salisbury we stopped at a shop for tea and biscuits. We asked how to get to Stonehenge. They told us to catch a local bus. There was a bus route with a stop that was about 100 or so yards from Stonehenge.

Surprisingly, there was no visitor center or gift shop at Stonehenge. There was a small pull-off where a few cars could park, but mostly it was just an open area. We walked from the bus stop to Stonehenge and were able to walk right up to the monument. We could walk around and touch the individual stones and we could have climbed on them had we desired. It’s amazing to think that we were able to be right in the middle of it since now the whole area is cordoned off so you can’t approach it and must view it from a distance.

We were lucky to go there at a time when it was still approachable. I have always marveled that preindustrial people were able to move and manipulate these massive stones. (Perhaps aliens really were involved.)

Touring the Rest of England
After more than 50 years it’s hard for me to remember the exact itinerary of the remainder of our tour in England. There are a few things that come to mind. Every village has a church, and they are all old, and when we were on a tour bus it seemed like we visited every one of them. It was a bit too much for us 20-somethings.

We stopped at a pub one evening, I don’t remember where or what we ate but I do remember what we had to drink. I ordered an English beer; I was a little hesitant since they come warm. I discovered they brew them to be drunk warm, and it was good. But what isn’t made to be drunk warm is Coca-Cola. Margie ordered a coke, and they brought her a glass, warm and right out of the bottle. She asked for some ice and the bartender gave her that look like, “Bloody Yanks,” and then disappeared into the back with the glass. He came back after what must have been 10 minutes with the glass in hand and a single cube of ice floating in it. He set the glass down with a self-satisfied look and pointed to it as if to say, “Here’s your bloody ice.”

I was surprised at how extensive the Roman occupation of Britain was. I was equally surprised how much of their influence remains. The Romans brought road building, city planning and many of the crops that were staples in England through the Middle Ages. They also introduced the Christian religion. Even the word Britain is of Roman origin.

One last thought about England before we head north to Scotland. We were touring through an area called the Lake District; a beautiful area that, according to our bus driver, was the honeymoon district of England. We stopped in a small village that he said was the most fertile village in England. And I think he was telling the truth; I have never seen so many baby buggies in one place. Maybe there’s something in the water.

On to Scotland!