"I love grab bars even though I am not old," said my 60-year-old fiancé when we found our one-level condo, meant to be our forever home. I recoiled. 
It turns out I am not the only one hesitant to live in a home with chrome grab bars in the bathroom. In a 2021 Cleveland Clinic article, geriatric specialist Ami Hall reveals why people do not want grab bars. They are either in denial that they need them or "embarrassed and feel like there's [negative bias]."
The grab bar is a longstanding purposeful accessory, particularly in the bathroom. Often its necessity comes to light when a towel rack is used as a substitute, and an accident occursWondering if others feel the way I do about products to help with accessibility at home, I sought out advice from three occupational therapy colleagues who work directly with consumers who could benefit from mobility and safety devices: Daniel Elliot of Long Beach, New York, Director of Partnerships for Jukebox Health; Dr. Carol Siebert of Chapel Hill, North Carolina, owner of The Home Remedy; and Susanne Giannitti, of Norwalk, Connecticut, clinical lead on a subacute rehab unit at The Carolton Chronic and Convalescent Hospital. 
Although the client did not say anything about aging, Siebert sensed the bias. The real estate agent said the grab bar was "a desirable amenity." 
Over time, all have learned strategies to help consumers transcend [negative bias] and attitudinal barriers for the sake of safety and functionality.   
The Benefits of Grab Bars 
The grab bar is a longstanding purposeful accessory, particularly in the bathroom. Often its necessity comes to light when a towel rack is used as a substitute, and an accident occurs. Elliot points out that now many manufacturers have come out with colorful grab bars and others "that do not look like grab bars or are dual-purpose," such as toilet paper holders or towel rack grab bars that blend in while still serving their intended purpose.
Siebert once recommended a grab bar that matched the decor of a client's bathroom in a valuable historic house. The client first consulted her real estate agent to see if grab bars would affect her home's resale value. Although the client did not say anything about aging, Siebert sensed the bias. The real estate agent said the grab bar was "a desirable amenity." 
Bedside Commodes
Bedside commodes are often met with a negative bias, even though Medicare will cover the cost when deemed medically necessary. Inevitably some people acquiesce to its use usually out of absolute necessity, which is especially the case for those living alone.
Siebert shares a story she read in the "OT Practice" publication about Susan Bachner, an occupational therapist, and her client, a gentleman who needed a commode. With a home full of antiques, he was horrified when he saw the hospital-recommended titanium plastic commode. So, Bachner went to an antique store and bought him a wooden commode with a lid; it was converted into a commode using modernized components. 
On the outside, it looked like a wooden chest. Fashioned into a familiar container that fits the décor of his home reduced the negative bias and aligned with the aesthetic of this man's environment.
A Negative Bias Towards Walkers 
While a cane seems to be socially accepted, it is hard to de-stigmatize a walker — though often it is a better option for those with an unsteady gait or balance issues.
Giannitti says, "People who use the walker feel it makes them look the most disabled, especially if they were once ambulatory."
Siebert remembers her mother, who, in her late 80s, needed a walker for any distance. Despite her love for walking around her neighborhood, she stopped doing it because she did not want to use the walker. "Ultimately, I think it is a person's choice," says Siebert.
"If you think you aren't old, you are. Deal with it," my 95-year-old mother-in-law tells me. She is frustrated with some falls that she witnesses in the independent assisted living facility where she resides. She explains that a walker at her age symbolizes "one step down," another plateau of degradation. While she uses her walker because it makes her feel physically stable, many others of her age do not.
Despite her love for walking around her neighborhood, she stopped doing it because she did not want to use the walker.
On top of the social bias, there are architectural barriers to using a walker. In many homes, walkers and wheelchairs can be a tight fit in hallways and bathrooms. In addition, since some walkers do not have a carrier function, people may abandon their walkers when there is no way to bring an object, like a cup of coffee, from one room to another.
Additionally, Siebert explains that ramps at the front of houses are perceived negatively, almost advertising that a resident is vulnerable. Alternatives include a less conspicuous ramp at a rear entrance or re-grading the ground near the entrance to achieve a gently sloped pathway. This feature, with a durable top surface and landscaping, is attractive and avoids the negative bias of a ramp. In addition, the presence of at least one entry with no steps makes entry and exit easier for people of all ages and abilities.
Gradually Modifying Your Home 
Occupational therapists work to help clients accept the use of devices, typically a bittersweet and gradual process when resignation overcomes the feelings of indignation.
Michael Graves's architectural design team, known for modern design and functionality, recently introduced an innovative line of home health products, including chairs, walkers and raised toilet seats, for "aging adults and disabled people" through CVS. Following a spinal cord infection in 2003, Graves used a wheelchair until his death in 2015.
Though under the guise of universal design that is helpful for everyone, Giannitti says, "I can't emphasize enough how important the occupational therapist's role is to come and look at some of those things," if people are considering using them in their home. 
Elliot says the Michael Grave designs are "moving in the right direction," away from medical-looking accessories and offering products that appear more home-like.
Giannitti talks about the benefit of aging "gradually." Home modifications are a more straightforward process if gradually you find a different way to do things rather than having to make an immediate adjustment due to the sudden onset of a disease or disability.
My fiancé is now my husband; we have been in our condo for ten years and the grab bars I initially disliked are now a comfort when I feel tired or off. We are beginning to realize that being able to live out our lives here will require a healthy dose of personal compromise on what we want to do, how we want to live and the devices and support we may need to accomplish that.  


How I Learned to Love My Grab Bars

Laura Neikrug

"Aside from a house and a car, fixing my teeth would be the most expensive purchase of my life."The day before my 62nd birthday, I got braces on my teeth. Not the wire-and-metal-stud variety I might have had 50 years ago, but clear "aligners" that I thought would be inconspicuous. 
My smile had always bothered me, but I had given up the thought of straightening my teeth decades earlier, when an orthodontist said I needed surgery to fix my underbite. At the prospect of having my jaw wired shut for six weeks I thought, "I don't look that bad." So, I dropped the idea. 
Why revisit it now? My crowded teeth were difficult to floss, and my top teeth seemed to be getting more crooked, which is possible, as teeth can shift over time. For years I smiled for photos with my mouth closed.  
For years I smiled for photos with my mouth closed.
Hearing my concerns, my dental hygienist suggested I consult an orthodontist.  
I was skeptical, expecting to hear, again, that I'd need surgery or that my three remaining wisdom teeth would have to be pulled to make room in my mouth. Either of these suggestions would have ended my quest for straight teeth. 
Aside from traditional wire braces, newer options include wire-and-porcelain braces and devices that fit behind the teeth to be invisible. After taking impressions, photographs, and a 360-degree scan of my jaw, Dr. F said I was a candidate for clear aligners, which fit over the teeth and work by slowly pushing them into position. I'd still have an underbite, but my teeth would be straighter, no surgery or extractions required.   
Too Old?
A few weeks later, after consulting with the company that makes the custom aligners, Dr. F showed me a video simulation of how she expected my teeth to move. It looked like magic — albeit high-priced magic. Aside from a house and a car, fixing my teeth would be the most expensive purchase of my life.  
Family and friends encouraged me to do it, but I had to wonder: Wasn't I too old for this? 
"Oh, I have patients in their 80s," Dr. F said.  
The American Association of Orthodontists estimates that one in three orthodontic patients are adults, and a 2022 survey of AAO's nearly 10,000 members showed, on average, a 19% increase in patients over 50 since 2018. Overall, the survey data suggest there are as many as 270,000 orthodontic patients aged 50 or older in the U.S. and Canada, according to Melissa Palmer of the AAO. 
I had to wonder: Wasn't I too old for this? 
Why this surge of interest in straight teeth? Vanity drove my decision, but in an email, Myron Guymon, DDS, MS, president of the AAO, said improved function and stability are other important reasons to pursue orthodontic treatment. Straight teeth are easier to clean, which helps us maintain good oral health. "A well-aligned bite and straight teeth may help to decrease future dental problems," he said. 
Soon after starting the process, I learned it is not as magical and inconspicuous as I thought. First, Dr. F bonded tiny "attachments" made of composite dental resin to some of my teeth to anchor the aligners. I would need 36 sets of upper and lower aligners, changing them every two weeks over at least 18 months as my teeth shifted.  
'Was It Worth It?'
Teeth move more slowly in adults than in adolescents, but they begin moving soon after pressure is applied. Until settled in their new position, they'll move back just as quickly, so the aligners must be worn 20 to 22 hours per day. Formed from clear plastic, they stain easily and are not strong enough to withstand the pressure of chewing. I was told to remove them to eat or drink anything other than water. 
That leaves only two to four hours per day for meals, or even less, considering the brushing and flossing needed before re-inserting the aligners. Good-bye to a second cup of coffee in the morning or lingering over a glass of wine in the evening. 
Not knowing how I'd survive a year and a half of this, I joined a couple of online support groups, one of which, with 1,000 members, is specifically for people over 50. Visiting these groups, I'm often greeted by a screen-filling photo of teeth. Many people post success stories, but just as many have problems that they highlight with circles and arrows on their pictures. 
As I approach the end of my treatment friends ask, 'Was it worth it? '
Older adults are more prone to gum disease than younger patients, and they may have crowns, bridges or dental implants that can complicate treatment, said Guymon. Good communication between patients and their dental providers is essential. For example, as my bite changed, an existing crown began preventing other teeth from closing together properly. Fixing the problem required a visit to a prosthodontist, who "polished" off a tiny fraction of the offending part of the crown. 
For people using clear aligners, it is not unusual to need "refinements," meaning the initial treatment didn't do the trick, so an additional batch of aligners is needed — adding to the treatment time. Also common is interproximal reduction (IPR), which is a process of filing away a hair's-width of enamel to make space between teeth. Everyone in the support group said it was no big deal, but I felt like Dr. F was sawing away with the dental floss equivalent of sandpaper.  
Two years in, I now wear aligners only at night, but I still have metal hooks on a few teeth, to which I attach tiny rubber bands meant to pull a couple of stubborn pre-molars into their final position.  
As I approach the end of my treatment friends ask, "Was it worth it?"
Like most challenges, this one was toughest at the beginning. And in a sense, it will never end, because anyone who gets braces — of any kind, at any age — needs to wear a retainer at night for the remainder of their days, lest those formerly crooked teeth return to their old positions.  
Overall, I am grateful to have an orthodontist who was honest about what could be achieved. My teeth are still not perfect, and I've had to adjust to my new bite, but for the first time as an adult, I'm learning to smile and laugh while showing my teeth.  


Braces at 62? It's True.

Patricia McTiernan

I was lying in bed, upset that my breakthrough COVID-19 left Christmas in tatters. Granted, things felt topsy-turvy. But when Facebook Messenger flashed with a "Friend Request," my feeling was part surprise, part uncertainty. 
"Cannot believe this! You look BEAUTIFUL, healthy & happy!" wrote J., my elementary school neighbor in West Los Angeles, using heart emojis.
Clicking on her profile, I could see the young girl I'd once known in photos of an attractive brunette, now a Dallas mom of two. Her feed was full of quotes from the Dalai Lama. J. appeared a perfect model citizen — but she had been my personal monster, a master of bullying.
We grew up a block apart, running between my yellow home and her Tudor charmer many times a day to listen to records, play Twister, or compare whose fridge contained junk food. I knew her parents and brother as well as I knew my own family.
I can't recall the day I went to school and J. would no longer let me sit with friends. I was cast out, but kids rallied around J. 
Until everything changed. J. lead a pack of girls; I was happy to be included. It was a respite from my house, where my divorced mom welcomed a boyfriend who was staying indefinitely.
I can't recall the day I went to school and J. would no longer let me sit with friends. I was cast out, but kids rallied around J. I was followed home, kids chasing me on foot while others threw eggs and sped away on banana-seat bicycles. I had zero friends; not one kid dared talk to me.
Class was agony, as I waited for the next nasty note, delivered to my desk by a smirking girl in ponytails tied with red ribbons. Maybe the ribbons were yellow? Memories are sporadic; they flash with holes in them, like a film strip nibbled by mice.
Lunch was the worst. J. organized singalongs, injecting my name and the fact I was short into unflattering songs. I found a storage shed to cower behind. 
One thing I recall? The principal saying she couldn't help. Back before participation trophies, getting bullied was your fault. I was guilty of being weak; that was the message I internalized.
My parents put me in private school, a financial sacrifice. Years passed. I avoided J.'s house. When I got my learner's permit, I used three streets away to practice driving, never hers.
Why Victims Can't Just "Move On" After Abuse
By the time J. found me on social media, this seemed like ancient history. I'd been to therapy, was married and raising three daughters in a house with a picket fence. I'd moved on, right? Maybe J. and I would turn out to be friends.
Except, I started having weird dreams. In one, a woman in a Mardi Gras mask menaced my kids. As I lay there sick, flashbacks flooded me. Or were they hallucinations of COVID-induced fever? I saw J. walking toward me, smiling. People were around, but nobody noticed when her grin turned menacing. 
I was annoyed with myself: Here I was in my cozy house, decorated for the holidays, afraid of phantoms.
May is Mental Health Awareness month, and it comes as a revelation how far from alone I am in experiencing a terrible childhood event. 
Some 20% of students ages 12-18 report being bullying in the past year, per 2021 government statistics. 2018 numbers from Pew Research clocked the number of teens harassed online at 59%.
Until I spoke with experts, I never realized my reaction when my tormentor returned, and the characteristics I developed following childhood trauma (known as an adverse childhood experience, or ACE), follow patterns. 
"I get emails [from victims] daily," said Dr. Dorothy L. Espelage, a William C. Friday Distinguished Professor of Education at the University of North Carolina at Chapel Hill, whose expertise in bullying has been brought to members of Congress, and philanthropists like Mackenzie Scott.
"It becomes part of who you are," said Espelage, who herself survived abuse growing up. "There's always this facade you feel you're putting on for the world." 
I realized how right she was — in spite of accomplishments, I doubt myself, and the validity of my perceptions.
This is typical: The sense of trust children need in the adults around them, to keep them safe, does not hold after suffering through something like the overwhelming persecution J. visited on me. 
I also have anxiety, common in the adult child of such challenges. Studies indicate PTSD can be present in victims of bullying up to 40 years later.
"Trauma can't override your life, but it will be with you forever. There's strength in [surviving] that experience."
"Scientists are finally realizing you can't wish away trauma. The idea of, 'Pull yourself up, the past is in the past' doesn't work," added Espelage, whose dedicated UNC research lab addresses violence prevention in schools. "These are permanent parts of your personality you have to find a way to use [positively]."
This is certainly not the message people heard back when the self-help community pushed the notion that anyone can completely transform. Or maybe I just wasn't ready to consider that this episode, rarely discussed in friendships forged in adulthood, had become part of the fabric of my life.
With bullying on social media grabbing headlines, and celebrities such as Monica Lewinsky and Britney Spears being reexamined as victims of sexism and media bashing, it might have occurred sooner that J.'s behavior was nothing to dismiss.
One Supportive Person Can Lessen Impact of Bullying 
Society might be having overdue conversations about mental health, but child psychiatrist Dr. Christine M. Crawford of Boston University School of Medicine and associate director of the National Alliance on Mental Illness (NAMI), added that such talk has not amounted to better outcomes for a vulnerable student facing more powerful peers, like I did. Disturbingly, breaking headlines are full of horrifying recent attacks and teens dying by suicide, allegedly prompted by harassment at school and online.
Bullying is a group phenomena, added Crawford, and teens and tweens need their cohorts; they join in because they think there's no choice. 
"There's a growth in cyberbullying, especially since the pandemic," she said. "Kids five to eleven are showing higher rates of depression and anxiety, especially in communities of color."
Before it sounds too hopeless, experts noted the growing normalization of psychiatry and therapy in the quest for improved mental health means things are slowly going in the right direction.
Not only are more people aware of self-care, but it's no longer in fashion to dismiss someone's childhood as a mere excuse for their struggles. Luckily, today's teachers are better schooled than they were in my time about the importance of creating a community of upstanders (someone who intervenes when they see bullying) who will push back against antisocial behavior.
Research shows even one supportive friend or adult can greatly lessen the impact of bullying. Additionally, diagnostic methods to pinpoint personality disorders have improved, meaning people lashing out at others for their own psychological reasons are able to get help sooner.
Even so, Espelage suggested that in my shoes, she might spend more time, not less, mourning the me that might have been if not for J. 
"What would you be like if you hadn't been turned on in fifth grade?" Espelage asked. "Because no therapy, no acupuncture, will wish it away. Trauma can't override your life, but it will be with you forever. There's strength in [surviving] that experience."
The mental health professionals must be right, because now I'm not so eager to answer J.'s Facebook Message. I feel a not-unhealthy sense of righteous anger about my past struggles, now that I better understand how deeply bullying affected me.
My tormentor seems reformed, sure, but I wonder if her kids know the truth about her own childhood. My urge to offer her absolution was trying to prove I'm "over" it. I'm not. 
Just like the answer to exactly when I'll feel better, I'm leaving J.'s communication unanswered.


My Fifth-Grade Tormentor Found Me on Facebook and It Brought Up Past Trauma

Rachel Spalding

"Seventy to eighty percent of adults will have back pain at some point in their lives," Dr. Deborah A. Venesy, staff physician at the Cleveland Clinic's Center for Spine Health, says.
"Some common reasons for back pain include mechanical low back pain (due to the daily things we do, repetitive bending, twisting, and lifting), muscle strain/sprain, herniated discs, and vertebral compression fracture as a result of osteoporosis," she explains.
Core strengthening exercises are important to reducing back pain. A stronger core helps the spine tolerate things like slouching on a couch or sitting hunched over a computerOther rare causes include "infection, inflammatory arthritis, cancer, or other non-spine related causes like kidney stones, endometriosis, and stomach issues like stomach or peptic ulcer."
Salvador Portugal, DO (doctor of osteopathic medicine), a physiatrist and medical director of sports medicine rehabilitation at the NYU Grossman School of Medicine in New York City, stresses that "low back pain is more common than neck pain or midback pain."
Even though back pain is familiar, the exact cause is unknown, and while many people will visit their primary care physician if they have back pain, seeing a physiatrist is also an option.
But First, What Is a Physiatrist?
Physiatrists treat back and neck pain, hip and knee arthritis, sports injuries, and other musculoskeletal conditions and injuries. While many people haven't heard of physiatrists, they may have heard of sports medicine doctors.
Many physiatrists are sports medicine physicians.
"Both physiatrists and sports medicine physicians treat similar conditions related to musculoskeletal injuries. However, sports medicine specialists have additional training after residency in sports-related injury management, and many physiatrists are sports medicine physicians," Venesy explains. Likewise, sports medicine physicians may have a background in family medicine or physical medicine and rehabilitation.
Seeking Pain Relief
Elizabeth Santos, 49, who lives in New York City, developed lower back pain in the summer this year. She says she'd never had back pain before but is pretty sure the cause was lifting a heavy cinder block. She took over-the-counter pain medicine, visited a chiropractor for six weeks, and went for some massages, but nothing helped.
"I'd never heard of a physiatrist before." 
She called NYU Langone Health in Manhattan for help finding a doctor and was referred to a physiatrist. "I'd never heard of a physiatrist before," she says. 
"The doctor did some tests, including x-rays, and recommended an MRI, but my health insurance would not approve an MRI until I received six weeks of physical therapy," Santos says. Unfortunately, the PT didn't relieve the pain, and she is scheduled for an MRI.
The physiatrist prescribed anti-inflammatory medicine and a muscle relaxer, which she said hasn't helped with the pain. Once she gets the results of the MRI, she will revisit the doctor so he can make a diagnosis and treatment plan. In the meantime, she takes her meds and alternates between using ice and heat.
Where Do Physiatrists Work?
"We are a very team-oriented specialty," Venesy says. Physiatrists work with orthopedists, neurologists, neurosurgeons, and primary care physicians (family practice and internal medicine doctors). Physiatrists do not perform surgery but can refer their patients to orthopedic doctors if surgery is indicated.
Physiatrists work in private practice, inpatient rehab centers, hospitals, skilled nursing facilities, pediatric and cancer hospitals, and multi-specialty groups, among other places.
The first visit to a physiatrist is much the same as the first visit to any doctor, Venesy says. After the doctor gets the patient's medical history and the reason for the visit, they ask how the problem affects the patient at home or work. 
Next, the physiatrist will review the patient's medications and electronic health record, any imaging reports, perform a physical examination, and provide a diagnosis and a care plan.
"We may order additional tests such as advanced imaging (MRI, x-rays, CT scan), lab work, or EMG (electromyography)," Venesy explains. A physiatrist may also suggest exercises, prescribe medications, and refer the patient for PT (physical therapy), OT (occupational therapy), speech therapy, or acupuncture. They may also prescribe spine PT and aquatic physical therapy for back pain.
Team Up with Your Doctor
During an office visit, tell the doctor your primary concern and bring a list of questions. It's helpful to get any imaging on a CD so the doctor can review it with you.
"Work with your doctor and be involved," Portugal stresses. "Partnering with a physiatrist and playing an active role in treatment greatly reduces a patient's risk of developing chronic low back pain and may reduce the risk of needing surgical intervention in some cases."
Age Affects Back Pain
The discs (mainly water) between the vertebra dry out as we get older, and we can develop arthritis of the small joints that help us bend forward and backward (lumbar facet joints). Moreover, patients over 70 or 80 may develop stenosis (narrowing of the canal where the nerves travel), known as lumbar canal stenosis. 
Along with exercise, guided imagery and meditation for chronic pain management can be helpful.
"Folks present leg pain, numbness, or heaviness in the legs when walking for some time (not so much back pain), and these symptoms resolve with sitting," Venesy explains. Another issue is that older women have a higher risk for compression fractures related to osteoporosis.
Regarding prevention, it is necessary to address "modifiable risk factors through eating a healthy diet, living an active lifestyle, avoiding smoking, and seeking a mental health professional if one is experiencing symptoms of anxiety and depression," Portugal says. "A sedentary lifestyle, obesity, smoking, depression, and anxiety are associated with a higher risk of chronic low back pain."
Further, the American College of Sports Medicine recommends at least 150 minutes of moderate-intensity exercise each week, which may reduce the risk of developing many chronic medical conditions, including low back pain," Portugal adds.
Venesy recommends cardio exercise (walking, cycling, elliptical, water aerobics, jogging, dance, etc.), core strengthening, and stretching. "Core strengthening is the most important so that our spine can tolerate the things we do daily (like slouching on a couch or sitting hunched over a computer)."
"We are made to move, and I love to tell patients, "motion is lotion!" Venesy says. "Get up and move – if you are sitting at your desk and on the computer, get up every hour or so. Exercise is key."
Recent Advancements in Treating Back Pain
Portugal reports that radiofrequency ablation (RFA) is a non-operative technique that can reduce lower back pain "in well-selected patients with confirmed facet joint-mediated pain." Likewise, orthobiologics, including platelet-rich plasma, "may have a role in addressing lower back pain due to degenerative or age-related changes in the spine," he adds.
Venesy says that along with "exercise, exercise, exercise," guided imagery and meditation for chronic pain management can be helpful, as well as spine injections for facet arthritis. 


Should You See a Physiatrist for Your Back Pain?

Debbie L. Miller

It's a Sunday afternoon in 1977 and my 10-year old self is with my father in the basement helping with a repair project. Blue Maxwell House coffee cans line the wall, filled with useful metal bits and a hurricane glass sits next to its kerosene base on a bookshelf. 
We stand next to the furnace that rumbles now and then, our heads bent over the open jaws of the vise. My father demonstrates how to twiddle the handle to push the opposing blocks of metal closer and closer to the piece of wood, pressing it snug.
Tools used to fix the wiggly bridge"Hand me a nail." he says. I hand him a nail. "Hand me the hammer." I hand him the hammer. The afternoon proceeds in this manner, serious and scripted. Did I ever ask to use the hammer myself? Did he ever offer? I can't be sure. I'd like to give him that possibility. Maybe I wasn't that interested in hammers or nails. I just wanted to be there with my dad, doing something simple and right. 
Did I ever ask to use the hammer myself? Did he ever offer? I can't be sure. 
Years later, as a frugal feminist, my tool-deprivation and secondary role irked me. Why was it that all the guys took 'shop' in middle school and I took 'home-ec?' Why was it that I saw myself only in the helper and cleaner-upper role on those Sunday basement afternoons?  
Here I was paying people to fix my stuff. And I was outsourcing joy — earned by problem-solving and fixing with my own wits and hands.
A Light Bulb Went Off
In my early 50s all that ended along with my marriage when I had to replace a recessed light. "I can do that," I thought. I took the bulb to the hardware store and found its twin. At home, no matter how many YouTube videos I watched, the new bulb would not fit.  
A catty voice in my head said: "How long does it take a divorced woman to change a lightbulb...?"  A different voice countered, "What would you say to a friend?" and answered, "Go to the hardware store and ask the experts."
My local ACE hardware is a mix of country store and bougie boutique. Antique baseball bats line the walls and I covet their $26 art-deco nightlights. Within 5 seconds of entering you'll hear: "Can I help you find something m'am?" At the key counter I found Johnny ("How can I help you?"), a Midwestern gentleman with rimless spectacles and a kindly, curious nature. 
I told him my story and asked, "Do you know how to fix this?" He said, "No, I don't. But I bet together we can figure it out."
Years of expecting expertise in others and denying my own responsibility and power dissolved with Johnny's words. We inspected the metal collar; we gazed at the bulb. My hands discovered that if I held the collar base and squeezed the pins on the side and he put the bulb in, the satisfying click happened. A design flaw! Only larger hands could do both tasks at once. 
Meeting a Patient and Kind Teacher 
Soon after, I lucked into a patient and kind teacher in the world of fixing and making. We met at a local dance. His top hat, bespoke patterned coat, gray cargo shorts and white knee-high shrimper's boots caught my eye. I asked, as we danced (he mysteriously graceful in his rubber boots) "Are you an artist?" He gazed distantly and said, "It's more complicated than that." 
Wiggly bridge opening, 2019Over tea the next day he said he works summers at various dance and family camps; one in the Catskills where he is rebuilding a suspended bridge. Would I like to join him for a week of music, dancing and bridge-repair? A day later, after googling the heck out of him, I said, why yes, yes I would.
He picked me up in his Honda Odyssey, the back seats removed, the floor a collage of carpet remnants, coils of thick rope, hacksaw blades, socket wrenches, drift punches, a level; though at the time I didn't know their names. At night he threw down faded cushions from his 1968 VW bus, fell asleep and snored. I lay there at the rest-stop and listened to the hum of 18-wheelers idling nearby and in the glare of the lights wondered and smiled at what I was doing with my "one wild and precious life." 
Getting to Work 
On that first morning at camp we approached a red shed in a green field where a few sheep nibbled nonchalantly. I envied their ease. I dreaded the first impression as the only woman in the shop with the young guys in their day-glo T-shirts and Timberland boots. The hard-rock oldies on the radio and the scent of sawdust felt familiar. 
The guys were sunny and more interested in their show-and-tell and jokey ribbing than in me. My friend put me to work in the shelter of a 1956 Rockwell drill press with a simple task: drill holes in the stanchions that would hold the hand-ropes. 
A soothing rhythm developed as my fingers set the plastic ratchet clamps to hold the wood and slowly lowered the drill bit as wood particles flurried away. The repetition relaxed and satisfied. I could focus on one thing. That thing was do-able. It didn't involve complex emotions or unpredictable scenarios. It wasn't gendered or hard or something held by a priesthood. 
Wiggly bridge opening, 2019Soon the movement of clamp to wood, metal bit to wood became one graceful action. My fingertips found a spiky edge where the drill bit broke through. For every problem there was a tool to solve it —hello, Shinto wood rasp! I enjoyed the rasp's toothy grasp on the wood and smoothing effect. "We're not making furniture here," my teacher chided.  
As on all bridges in folk tales, I wrestled. My impatient desire to prove a point to myself and resentment of gendered expertise conflicted with the slow pace and the fact I was a novice with a guy who knew more than I did. And like most work, it wasn't all exciting power-tool wielding action. There were simple repetitive tasks, like gooping anti-seize paste onto every bolt on the bridge, or tying clove hitches over and over.  
I returned to humility and gratitude. Given the major shifts in my life, where else would I rather be than here, being of use, on a wiggly cable bridge looking out over a clear pond with mist rising off of it and a thick margin of wild green in the distance? 
Building Connections 
Like the nursery rhyme "This is the House that Jack Built" I understood that every part of what I was doing held a future human relationship. If the stanchion can't be built, then the hand-rope won't support the children's hands. If the children's hands won't be supported, they can't cross the bridge. If the children can't cross the bridge, the connection between the old camp and the new camp will be lost; the bridge will exist only in memory. 
When you pick up a tool, you animate it with your energy and your intention. My mentor said, "People say, "Man, I can knock that out in an hour! Your volunteer is gonna take 6 hours to put those rivets in." And I say, "yeah, but when she walks by those rivets later, she's gonna feel they're hers."  
In that moment I felt that in fixing material objects, the world is made well in some small way, and something inside is fixed too. 
That light in my kitchen became a symbol of my ability to take care of myself and to collaborate with others. It sparked a belief in my ability to problem-solve and use tools. Working on the bridge became proof that in the aftermath of emotional discord and weariness, self-renewal was possible.
For the first time in 10 years, the "wiggly bridge" of camp lore came to life. My mad hatter showed up in magenta Alice-in-Wonderland leggings, a burgundy brocade coat and his signature top hat. He lined up the children, "Youngest to oldest! Two by two!" between pips of his whistle. 
The children's hands held the guide-ropes I had pulled through the stanchions. Their hesitant steps became confident as they giggled at the bridge's bounce and sway. My teacher merrily tapped planks of the bridge with his black umbrella as he led the parade. 
I leaned against a tree and watched as the children and mothers crossed the bridge, serenaded by fiddles, guitars and song. In that moment I felt that in fixing material objects, the world is made well in some small way, and something inside is fixed too. 


If I Had a Hammer

Moira Bucciarelli

Improv made me a better person.
By that, I mean the study of improvisational performance — and I’m only stretching the truth a little bit.
When I moved to Chicago from my hometown of Detroit at 30, I looked forward to immersing myself in the city’s cultural scene. I was particularly excited about becoming a regular audience member at The Second City Theater, an international mecca for improvisational comedy. I was even more excited about taking improv classes there. What surprised me was how the fundamental lessons of improvisational performance eventually figured into my world view and day-to-day life.
The Improv HQ
For the uninitiated, Second City (and its predecessor, The Compass Players) has been the launching pad for generations of actors, writers, comedians and directors since the 1950s. Its alumni include everyone from Mike Nichols and Elaine May in the early Compass days, to Joan Rivers, Ed Asner, Gilda Radner, Stephen Colbert and many more too numerous to mention. TV shows (notably Saturday Night Live) and film producers regularly scout and recruit talent from Second City, and it remains the foundation for Chicago’s thriving improv community.
I began my journey as one of the few students over 30 in my Improv 101 class, but that didn’t dampen my enthusiasm. The buzz of being in that theater and hanging out with fellow improv nerds, even if it meant being the old(er) man in the class, was more than worth it.
Learning to Say 'Yes, And...'
I quickly discovered that there were actual lessons to learn — that one didn’t just suddenly step into the spotlight and deliver a priceless moment of high comedy. Improv is a team exercise, and I was one among many who endured an instructor’s verbal smackdown whenever we placed our egos above the needs of the scene and our fellow performers.
At Second City, as in the world of improv in general, the No. 1 Rule is “Yes, And...” Conversely, “No, But...” is strong discouraged. The reason is simple: “Yes, And...” confirms the validity of whatever precedes it, while “No, But...” denies it and often kills the momentum of an improvised scene.
The classic example: You say, “Well, here we are in Spain.” Then I say, “No, we’re not. We’re in Idaho.” I may get a cheap laugh, but I’ve also undermined you as my stage partner and placed my trustworthiness in question. Trust is key when you’re working without a net, on a bare stage with maybe a chair, a willing partner or two and the thread an idea.
In those days, Second City had three class levels — it has since added many more specialty courses and seminars — and I blazed through them all in quick succession. I then hit the improv comedy class circuit, seeking every opportunity to learn, hang with the improv nerds and perform whenever and wherever possible, no easy feat in a city filled with aspiring actors, writers and comics. I wisely kept my day job as a PR guy.
My travels eventually brought me to the ImprovOlympic (now iO) and the legendary improv guru Del Close — mentor to John Belushi, Bill Murray, Tina Fey, Amy Poehler and countless others. Close was a fierce advocate for “Truth in Comedy,” (not coincidentally the title of an improv manual he co-wrote) which meant that every moment on stage, no matter how bizarre, had to contain some element of truth. He drove his students to focus on intuitive thinking, listening skills, continuity, characterization, and, most importantly, teamwork.
Close suffered no fools: To make him laugh was a genuine delight, while any false note onstage earned his unfiltered rage, and it was not pretty. Having experienced both ends of the Del Close continuum, I much preferred the delight.
Applying What I Learned in Improv
My improv experiences took place in the 1980s and early '90s, and after a few years, that interest ran its course. My journey had taken me through stage shows, a few comedy videos and a small, non-speaking role in a John Goodman film. I’d seen several talented classmates graduate from the Second City mainstage to sitcoms, films and, more recently, TV shows including Mad Men and Veep. In my case, Saturday Night Live never called. Life moved on.
But the lessons I’d learned from Second City and Del Close remained.
I began using those lessons to train high-profile PR clients in the basics of good communication for media interviews: Pay attention. Speak up when it’s your turn, surrender the floor when it’s not. Don’t deny the reality of the moment. Be Present.
My experience with character work helped me create an array of press personalities that my clients would likely encounter on multi-city media tours. I put them through their paces in mock interviews with a collection of chatty, oddball, egocentric and/or clueless reporters. Laughs shared, lessons learned.
I wasn’t the first “genius” to figure out that improv has wider implications beyond the stage. Several enterprising companies, including Second City itself, are finding success with an “improv for business” curriculum designed to help corporations develop strong work teams and expand creative thinking. (As Next Avenue has written, Second City is now using improv to help caregivers get better at what they do.)
I eventually realized improv’s lessons are applicable to anyone in any stage of life, whether your “audience” is a condo association subcommittee, your softball team or the person across the table. These eight simple rules of engagement are often lost in a world of tweets and multi-tasking, but they still work and I've compiled them here:
8 Great Improv Life Lessons
Always work at the top of your intelligence. Avoid clichés and lazy thinking.Think "Yes, And..." instead of "No, But..." Negativity and denial slow or stop your momentum.Know when to make yourself the center of attention, and when to give it to someone else.Don't be afraid to fail; it’s the effort that counts.Live in the moment; respond to what's happening now.In any conversation, focus on listening to what the other person is saying instead of what you want to say next.Serve the needs of your partner, team or the situation, rather than your ego.Do your best, learn from your mistakes and move on.

How to 'Improv' Your Way Through Life

Chuck Otto

"Some of the women I interviewed felt there was a definite connection between their coming out and menopause, whether or not they thought they might have been attracted to women earlier."I was at dinner one winter evening with seven friends. All of us had gone through or were in the midst of going through our menopause. Outdoors, the temperature was a brisk 32 degrees. Yet as I looked around the table in the restaurant, I had to laugh. 
Most women begin this journey from menstruation, to perimenopause, and then to menopause in their mid-forties.
Jane wore a tank top and constantly mopped her face. Marie kept her winter jacket on, zipped up to her neck. I wore a heavy sweater. The rest were clothed somewhere in between. Other than Jane, who complained that it was too hot, we were all comfortable — for the moment.
Most women begin this journey from menstruation, to perimenopause, and then to menopause in their mid-forties. With menopause comes new physical and emotional symptoms. Hot flashes or cold chills, mood swings, crankiness, feelings of sadness or anxiety are just some of the changes that might manifest themselves at this time. Trouble concentrating or feelings of fatigue are others.
Menopause and Women's Sex Drive
Stephanie Faubion, medical director of the North American Menopause Society and director of Mayo Clinic Center for Women's Health says, "Some women also experience lower sexual desire, primarily due to the lack of estrogen. There is a shift from a more spontaneous desire pattern to a more responsive sexual desire pattern where [given the] right place, right time, right partner, right situation, the woman is willing to be sexual, but she may not have spontaneous sexual thoughts or fantasies."
While it is natural for some menopausal women to lack sexual drive and it is true that dryness can make sex uncomfortable (although there are remedies for that), some women, like Evelyn, who had not been keen on having sex with her husband for years, and had been faking headaches, said, "Menopause was a good excuse to cease sexual activities completely. I no longer had to fake headaches."
During menopause, it became obvious to some women that they were in stuck places.
Some women, like Margaret, whose stories are included in the book "M-Boldened: Menopause Conversations We All Need to Have," edited by Caroline Harris, saw menopause as a sign that they were no longer a full woman. 
Margaret said, "I knew exactly when I had my last period. It was heavier than any period I had ever had. For one split second I felt bad. I could never have another baby. I felt like I had lost the ability to feel like a real woman. I felt as though sexually I was facing an end."
Others, in good relationships, noted an increase in sexual activity as, no longer fearful of unwanted pregnancies, they felt freer to enjoy sex.
During menopause, it became obvious to some women that they were in stuck places. They spoke of the chaos and confusion in their lives at that time: from kids leaving home to older parents needing care, and all had retirement looming ahead. While some took up new hobbies, others felt an overwhelming need to make more drastic changes: returning to school, finding more challenging jobs, leaving their marriages.
While some women found little, or no correlation between their sexual desires and menopause, others who left unsatisfying marriages found more compatible mates. And some ended up having better sex than ever before.
Coming Out and Menopause
Some of the women I interviewed for my book, "Married Women Who Love Women and More," felt there was a definite connection between their coming out and menopause, whether or not they thought they might have been attracted to women earlier. Those who had been married wondered if there had been signs they'd just ignored while busy doing what they were supposed to be doing as wives and mothers. They wondered if they had been playing a role while raising their children.
Maria realized that she was attracted to women when she returned to college. She said, "My husband and I had focused on our careers and raising two kids together. Who had time to think of anything else? Then I took a women's study course and my mind seemed to open up. I fell in love with my professor and realized I wanted to be with women."
For Rebecca, menopause and gayness came about almost simultaneously. "I thought it was menopause that was causing me to feel attracted to women. I think that had a lot to do with me waking up to who I authentically was."
The main thing I've learned about menopause is that it is consistently inconsistent.
Betsy said, "I suppressed my attraction to women for three decades until I decided — after 30 years of marriage, a year and half after the hysterectomy that triggered the start of menopause, that I did not want to do that any longer. After more than a year of therapy, I now have a girlfriend. I hope to preserve my marriage and maintain my relationship with my girlfriend forever. She and my husband have met and like each other but my relationship with each of them is separate. We are navigating our situation better than most."
Weight gain, which frequently happens during menopause, hampered the sexual enjoyment for some because cultural ideals equate being thin with being desirable. Some of the women who identified as lesbian or bisexual, however, seemed to be less concerned with their body images, as they were less affected by heterosexual ideals of what a woman should look like.
Joanna said, "Deep inside I've known and had these feelings my whole life. I crushed on and obsessed about girls, and later about women until I finally broke the closet door down. That said, menopause hasn't diminished (maybe enhanced?) my sex drive. My first relationship with another woman was after I began my menopause at 55."
The main thing I've learned about menopause is that it is consistently inconsistent. Very few women shared identical stories. The luckier ones said, "it was easy," or, "nothing really exceptional." Several said, "My period just stopped."
Women in menopause were once expected to be irritable, tired, depressed or all three and we fed into that ageist culture. Fortunately our beliefs have shifted dramatically. We are now seeing more media coverage of strong, energetic menopausal women. We are looking younger and sexier and are changing our cultural negativity about aging and menopause.


'When I Realized I Was Gay, Menopause Arrived.' Was There a Connection?

Carren Strock

In the fall of 2020, I was playing tennis with my pal Vini, just volleying casually without keeping score. Now and then, he would belt a shot well beyond my reach, and I would sprint after it. Only on this day, after three or four such tries in a row, I was gasping harder than usual.
"Let's take a break," I told Vini.
"I'd led a lucky life, luckier than most. If I died now, I'd have no right – none whatsoever – to feel cheated. I could, in effect, live with dying."Perhaps, at age 68, I had let myself get slightly out of shape and just needed to whip myself together.
Feeling winded in the middle of our hour-long sessions had never forced me to take a break. I had trained my whole adult life as a recreational athlete to keep going without letup, even if exhausted from my exertions, and was conditioned to catch my breath eventually. But this experience was different from anything I had ever known before.
So began the most significant health scare of my life. But I mentioned nothing about it to Elvira, my wife of 41 years.
I thought little of the incident at the time. Maybe, I reasoned, my stamina that day happened to be down a few quarts. Perhaps, at age 68, I had let myself get slightly out of shape and just needed to whip myself together. Then again, maybe, just maybe – though I never acknowledged it to myself – I had some kind of an issue with my heart.
A Persistent Problem 
Over the next few months, the problem persisted. In early 2021, I went for a jog around our neighborhood. Toward the end, I ran up an extremely steep hill, easily 100 yards long. I reached the top, panting loudly but also dizzy. I never got dizzy for any reason. I chalked the episode up as a fluke.
But then, a week later, it happened again, only worse. I ran up another hill, almost as steep, and had to stop in my tracks before getting to the top. I was dizzier than the previous time, so much so that for a second, I felt tempted to reach out to a parking meter to brace myself in case I blacked out and toppled over.
Clearly, something was wrong. But again, I set aside these inconvenient worries. I was just getting older. Stuff tended to happen. Maybe I would deal with it later. Again, nary a word to Elvira.
Then again, maybe, just maybe – though I never acknowledged it to myself – I had some kind of an issue with my heart.
Then came my final warning sign. I got into a three-on-three, half-court basketball game on a schoolyard playground nearby. About 20 minutes in, my lungs billowing away, I ran out of energy and grew dizzy. And, right then and there, in the middle of this competition, I stopped playing. Cold. I'd played hoops for 61 years, but this was a first for me. 
I should have quit the game on the spot. But pride – and the forces of denial and delusion – prevailed. So, I resumed playing. Indeed, I rationalized, I could finish the game before I keeled over dead. Still, I now knew, with a dawning sense of certainty, that I should see a doctor sooner rather than later.
Once more, I said nothing about any of this to Elvira. What if these symptoms turned out to be nothing serious? Why concern her unnecessarily? Whenever she asked me how I was doing, I would tell her I was doing okay.
Facing Serious Obstacles 
Besides, we faced another equally serious obstacle. Elvira was living in Italy while I lived in New York City, and I planned to move there as soon as possible. The coronavirus pandemic was hurtling along at full tilt, Italy its original epicenter, New York City its second. Elvira already had her hands full, keeping our family – our son and daughter, granddaughter and son-in-law – safe from the virus.
Hospitals worldwide were overrun with dying patients. Patients were delaying and canceling elective procedures and screenings left and right. How could I seek medical attention now? So, I opted, at least for the moment, to forgo a visit to my primary care doctor.
Meanwhile, I at least had the common sense to stop exerting myself as much. I avoided any activity that might leave me breathless and dizzy. I could have researched my symptoms online but decided against it. Whatever I learned would be less than definitive, mere diagnostic guesswork. Besides, did I want to know?
No. Not really.
A few weeks later, I came to my senses. I saw my physician and told him about my concerns. He referred me to my cardiologist, who subjected me to an electrocardiogram and detected an abnormal rhythm in my heart. He told me he needed to investigate further and strapped an electrocardiogram to my arm, connected to electrodes pasted across my chest, so that he could monitor my heart activity for 24 hours and evaluate the results.
Dealing With My Heart Issue 
The upshot was that I was suffering from atrial flutter, a cousin to atrial fibrillation, though less severe. My heart was beating arrhythmically, one minute fast, the next slowly, due to a defect in electrical conduction. It was unlikely to pose any immediate danger, but it was hardly nothing. Long-term, it represented a clear-cut threat. At some point, it could trigger a heart attack or stroke.
I was advised to undergo a procedure called catheter ablation. It would be minimally invasive, involving a small incision in my groin that would enable a wire to be threaded through to my heart to correct the arrhythmia. I was told the procedure was effective 95% of the time and was scheduled for surgery at Mount Sinai Hospital in New York City.
Again, I told Elvira about none of this – nothing about my breathlessness or my dizziness, nothing about seeing a cardiologist, nor his diagnosis and my upcoming procedure. I had good reason to hold off, I felt. I wanted to get all the facts nailed down first and leave nothing open to surmisal or speculation. As I've learned, sometimes, in marriage, we have to keep secrets and tell lies for the good of both parties. This happened to be one of those times.
I could die. I could suffer a stroke or sudden cardiac arrest on the operating table. And what then?
But now, in a video call, I told Elvira. And she took it, as she takes most news, more or less in stride. She accepted my reassurances that I would be okay at face value, just as I expected she would.
"I can come back to New York to be with you," Elvira said.
This was no small offer. Elvira hated to fly in airplanes. She dreaded every flight and stayed nervous from takeoff to landing. Flying to New York City to be with me also meant she would be leaving behind our daughter, granddaughter and son-in-law, all still quarantined in the strictest of lockdowns. Offering to fly across the Atlantic Ocean during a once-in-a-generation pandemic to be at my side touched me as profoundly as when she accepted my marriage proposal.
"No," I said. "No need."
The date for my surgery loomed large, and I tried my utmost to maintain a modicum of equanimity. These were reputable physicians at a world-class institution. The procedure was well-established as the gold standard. I was in otherwise excellent physical condition. What could possibly go wrong?
But, of course, anything could. The procedure could go awry. It had happened. I was scared. I could die. I could suffer a stroke or sudden cardiac arrest on the operating table. And what then?
Reflecting on Our Life Together 
I contemplated my mortality more gravely than I ever had done before. Everything would end for me. And why now? Round and round my head, this question went. Here I was on the cusp of starting a new life in Italy, reuniting with my family, only to be cut short. I would be gone, never to live in our new house, never again to be a husband, a father, a grandfather, much less a friend, colleague or neighbor.
With this new understanding of my life, a peace came over me, a peace such as I had never felt before, a peace that I now knew would see me through.
But I never said so to Elvira in any of our video calls. I was here and she was over there. Why complicate our complications? Instead, I told her I would leave the hospital all right. Again, I kept my secrets and told my lies. Specific stuff is, for the moment, best left unsaid.
But as I agonized, I reflected on my life, the whole of it. And I recognized, with a brilliant new and transcendent clarity, that I had led a good and more fulfilling life than I could ever have imagined or expected. 
Elvira and I had lived together since 1977 with no lapse in love, fidelity or faith in each other. We had raised a son and a daughter, both now decent, humane, intelligent, funny and beautiful adults. We had our miraculous granddaughter, Lucia Antonia. I had arrived at age 68 in otherwise above-average health. Even my career had proven to be a moderate success.
I'd led a lucky life, luckier than most. If I died now, I'd have no right – none whatsoever – to feel cheated. I could, in effect, live with dying. Besides, I had no control over any of it now. The anesthesiologist would knock me out, and the surgeon would do his stuff. It would be what it would be, and whatever was going to happen would happen, and I would just have to accept the outcome.
And just then, with this new understanding of my life, a peace came over me, a peace such as I had never felt before, a peace that I now knew would see me through.
The procedure went perfectly. I was in and out of the hospital within about 30 hours. The surgeon gave me a before-and-after presentation to demonstrate his success. He showed me one graph with spikes and dips showing my heart beating erratically and another with it beating smoothly.
My heart was fixed. I was good to go. Italy awaited. Three months later, my family met me at the airport in Rome.


Atrial Fibrillation: A Love Story

Bob Brody

The founder of the first sleep and dream research lab at the University of Manitoba and a retired psychology professor, David Koulack is documenting his health journey through occasional posts on Next Avenue.Recently, I received a letter informing me of an upcoming appointment for an MRI at the Health Sciences Centre in Winnipeg.
"How come?" I asked my son Joshua. "I had an MRI only a few months ago."
"To see if you've gotten any worse," he said.
David Koulack, photographed by his son Daniel His reply probably told me more than I wanted to know, but it also got me thinking about the recent past, the present and the future.
It's been several weeks since I got my first vaccination for COVID-19, but the process of getting it gave me another perspective on my situation.
As for me, in spite of my mild cognitive impairment, I was doing just fine and I was doing it on my own. 
The vaccination site was at the Civic Centre which was crowded with people my age — 82-year-olds — but what was striking was that many of those people were in wheelchairs or using a walker or, at the very least, were accompanied by an attendant. But as for me, in spite of my mild cognitive impairment, I was doing just fine and I was doing it on my own.
And, as an added bonus, while waiting for the vaccination, and afterward for 15 minutes to make sure that there were no ill-effects from the vaccine, several of us became friends with each other. We joked around, talked about our lives, the strangeness of the situation and the world in general.
In short, we talked about the sorts of things we would have been talking about in the outside world if we had actually been able to spend time with other people, something that was going to happen now that we would be immune, or so I thought.
But of course, that wasn't to be the case. Vaccine or not, we are still advised to keep our distance from others, even after the second shot, because there are new COVID-19 variants on the scene.
Making Our Home Safer 
Another recent event was that I had an important meeting with an occupational therapist. Her job, it was explained to me, was to make our home as safe as possible for older people and especially, I guess, for an older person with "the shaky wakeys" (how I describe the way my condition makes me feel).
The appointment started in the bathroom where she prescribed two vertical bars on the bathtub wall — one next to the shower to aid in stepping into the tub and one on the far wall to hold on to while the shower was going.
The OT also recommended adding a railing adjacent to the steps going down to the basement from the main floor and other railings to be attached to the walls beside the steps leading to the second floor. 
"And," she added while demonstrating the instability of an iron banister on the second floor, "this needs to be replaced by a sturdier wood structure."

There were also a number of loose rugs on the second floor that she felt should either be removed or secured to the floor with rubber backing or two-sided tape.
And then coming back downstairs, she checked our bedroom, where she quickly focused in on our dog Mabel's bed.
"This has got to go," she said. "It's a hazard."
David Koulack's dog, MabelI have a vivid image of the moment she said that. She was in the room standing on Mabel's bed, if you can believe that, and Mabel and I were at the door. Was Mabel's brushing against me just happenstance or a message of some sort?
Staying Active With New Endeavors
When I looked down at Mabel, I was certain it was the latter. Propriety demanded that neither of us make a comment, but I did bend down and stroke Mabel in a manner that made it clear that she and I would discuss this later.
"Listen," the occupational therapist said as she handed me her card before making her way to the door, "if you have any questions about what we've talked about or any other changes you'd like to make, don't hesitate to give me a call."
My thanks were heartfelt. Her suggestions were really helpful and I had every intention of implementing almost all of them. "Except for the last one," Mabel said, and maybe she was right.
Life couldn't come to a halt because of the "shaky wakeys" or the pandemic, for that matter. 
As it turns out, we're going to have to wait a bit for the work to be done because the guy who has helped us out with all sorts of alterations and fixes in the past is, as usual, very busy.
But that's okay, summer is here and there all kinds of things I can do, like helping my wife Barbara with her garden, not to mention managing my tomatoes and cucumbers and, of course, getting outside and walking as much as possible with Mabel.
One of the things we particularly like to do is to go to the nearby Little Mountain Park. There, Barbara and I can spend an hour or so walking on the many pathways while Mabel spends the time charging through the woods going after all sorts of game that she never manages to capture. What fun that was for all of us. 
But, unfortunately, the last time we went was not without its consequences.
The next morning, Mabel had a limp. The vet's diagnosis was arthritis, so now she's on medication and, while she still likes running around, the truth is she'd rather hang out in the garden or just go for our regular walks.
The garden outside their homeThere had to be more than this. Life couldn't come to a halt because of the "shaky wakeys" or the pandemic, for that matter. And that's where our friend and neighbor Bill happened along. 
"I'm going down to the Assiniboine River on Thursday at one o'clock to start cleaning up all the debris that people have discarded down there," he said. "You want to join me?"
"You bet," I told him.
And that week we began what will be a long-term project. Something I realized I had seen someone doing on his own when we first moved to our Riverbend neighborhood. Where was the man now? I wished that I'd spoken to him then, that I could have told him we were going to be carrying on his legacy.
And there's something else: our neighbors are threatening to join us. Maybe this is the beginning of something new — people helping nature to restore itself.


Daily Life With Mild Cognitive Impairment: Making Adjustments at Home

David Koulack

When my husband, David, passed away in April after a short battle with pancreatic cancer, my adult sons, Chris and Nick, and daughter-in-law, Mackenzie, knew just how to remember him. We rolled up our sleeves and, in my case, pant leg and got tribute tattoos.
69% of tattooed adults said they got theirs in memory of someone else, according to a 2023 Pew Research survey.Honoring a loved one who has died is one of the top motivators for getting inked. According to a 2023 Pew Research survey, 69% of tattooed adults said they got theirs in honor of someone else.
"A lot of people want to cherish someone that they had in their life," says Nadia Alpirez, shop manager for Canvas Tattoo & Art Gallery in Charlotte, North Carolina, the studio where Nick and I got our tattoos. "They want that reminder."
The type of person who gets a tribute tattoo is pretty universal, adds Alpirez. "Some people who are older have it as their first tattoo," she says. "Others add it to their [existing tattoo] sleeve. It's something that speaks to everyone."
Choosing a Design
Deciding on a design for a memorial tattoo is highly personal. My family and I each got an otter tattoo. Otters have held a special place in our hearts, symbolizing resilience and companionship. Each of our otters, however, is different. Mine is holding a pink Gerbera daisy, which is the type of flower I carried in my wedding bouquet. Christopher's has a purple tie in honor of pancreatic cancer awareness. Mackenzie's includes a Narcissus, the birth flower of the month David was born. And Nick's shows two otters together in the water, representing a never-ending bond.
Stephanie Vozza's tattooAlpirez says she's seen people choose all kinds of designs for tribute tattoos. "Sometimes it's the person's name or initials," she says. "Or it can be a phrase. I've also seen people pick something to remember where they met or hung out, such as a lake house. I saw one person who got a duck because they called [their loved one] 'Ducky.'"
The only type of design Alpirez cautions against is a portrait of the person who passed. "It can be heartwrenching to have that constant reminder," she says. "We will second guess it with them a little bit. We love when the tattoo is light with positivity, instead."
Mental Health Benefits
Surprisingly, getting a tribute tattoo can be healing, helping mourners manage their grief and keeping the memory of a loved one alive, mental health professionals say.
"Grief is arduous and can sometimes bring up conflicting emotions; parts of us that want to find peace and acceptance with our 'new reality,' and other parts of us that desperately want to remain connected to the person we have lost," says Alison Stone, a New York City-based therapist. "Memorial tattoos can be a way to help us feel that we are permanently maintaining and honoring that connection to a loved one, which is a valuable part of the grieving and healing process."
Surprisingly, getting a tribute tattoo can be healing.
Rose Bleiweis, a Silver Spring, Maryland-based therapist, agrees: "Tribute tattoos are something to hold on to," she says. "They come from a sensory perspective, but also from a processing perspective. They help the brain to have something to associate with that individual. Our body is personal to us, and by getting a tattoo, it also personalizes your connection."
Tattoos may also help in terms of getting to the acceptance stage, says Bleiweis. "Acceptance doesn't mean feeling good about what happened," she says. "Acceptance means living our lives knowing that it's still going to affect us, but we're living our lives regardless. I believe that people can get there quicker if they have this visual reminder when they need it."
Timing Concerns
Standard advice when you lose a spouse or other significant person is not to make any big decisions in the first year. Deciding to get a tattoo may fall into that for some people, says Bleiweis.
"As long as you're making a mindful decision and you feel like it's going to help your grieving journey, absolutely do it."
"I think that's a personal decision," she says. "As long as you're making a mindful decision and you feel like it's going to help your grieving journey, absolutely do it. But if it's something that feels like a result of an immediate emotion that hasn't really been talked through, you may want to run it by someone in your support network."
Stone agrees: "In some ways I think it is helpful to guard against impulsiveness or doing something we might later regret," she says. "However, getting a memorial tattoo can also feel like a part of the grieving process, and I don't think there is a hard and fast time frame for that."
A Shared Memory
Getting tattooed with others is a bonding experience. Alpirez says she sees several clients come in with friends and family. "I love seeing the moral support," she says. "And some people get matching tattoos."
When Nick and I got ours, we didn't know what to expect. It was extra meaningful to do it together, and it's a moment I'll never forget. We planned our day around the experience. Nick is the king of research, and he got us snacks and water in case we felt lightheaded. We also went through the initial stages of the healing process together, helping each other care for our freshly tattooed skin.
The person isn't just in your heart; now you have something visual to cherish that represents them and your time together.
Chris and Mackenzie live in Grand Rapids, Michigan. I went with them when they got theirs and even added a second tattoo of my husband's handwriting to my wrist. "It becomes a connection that you are doing something together as a way to remember this person," says Bleiweis. "Whenever you look at it, you'll remember the person who died and the person you went with. It's a bond with your husband and your family."
Memorial tattoos can be a beautiful experience. The person isn't just in your heart; now you have something visual to cherish that represents them and your time together. They may not be with you physically, but you carry them with you as you move forward.


Always In My Heart (And on My Ankle)

Stephanie Vozza

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