Cheryl told me I looked like I’d aged 15 years after my accident. While she admits I’ve gotten almost all of those years back, I started wondering just how we calculate perceived age with what we see in a person. Since my skin didn’t wrinkle or hair turn totally white overnight, there must be other cues she was picking up on. In my case, I think it was my weight loss, reduced ability to move, and various medical accoutrements I had: trach, feeding tube, O2, etc.
So that got me to thinking about ways in which we “get old”, and I came up with three general categories. They are: things which happen naturally to everybody, causing visual and functional changes which we all share on a pretty standard timetable; degenerative diseases which are mainly preventable, but definitely slow us down and change us; and a generalized slowing in our bodies’ healing processes, which have cumulative and at times, sudden, effects.
Now, those of you who do not think of yourselves as “old” (and that would be all of you, I suspect), may not want to hear about any of this, as you don’t plan on getting “old”, but, believe me, in my time on earth, and in my profession as a physician, I have yet to see someone who is not physically changing everyday, year, decade. Changing in ways that ultimately get labeled “aging” or “old”. We fear less the things we examine closely (except for that ugly creature which kept going after Sigourney Weaver), so I’m going to forge ahead anyway.
First, it happens to all of us. Maybe the first two signs are presbyopia and loss of hair color. By age 40, the lens in our eye has lost at least 50% of its elasticity, and it becomes almost impossible to focus clearly on close up objects. This starts insidiously, further afield at first, so most of us can still read a book or magazine by squinting. But eventually, only an artificial, external lens (reading glasses) will do the trick. Except, of course, for those of us blessed with severe myopia – near-sightedness. We have secret Superman vision. When I take of my glasses, I can see things close up in perfect clarity, and magnified. Dealing with tiny screws and hidden splinters becomes a specialty, as long as they’re within 7 inches; any farther away, and life’s a big blur.
So reading glasses and hair dyes are a standard introduction into aging. We grumble, and sometimes try to avoid the issues, but in the end, embrace it as sort of a parallel puberty. Getting just the right touch of grey at the temples (for men), or looking over skinny glasses with a glower allow us a measure of apparent wisdom, and propel us into a new role: the adult supervisor.
There are other universal changes which we use to define “older”. Internally, our bodies are doing things a bit differently. For instance, men see a gradual drop in our gender specific hormone, testosterone. And women see a precipitous fall at about age 51 in theirs – estrogen. Again, we can try to fight to effects, but it is as if our bodies are programmed to operate differently over time, like the difference, say, between and 8 year old and a 16 year old. Pharmaceutical solutions may retard or reduce some of the effects, but never as fully as one’s own natural, youthful sex steroid, and sometimes with negative effects (like cancer).
The end results of things like natural skin and hair color changes, hormone depletion, loss of bone in the spine (reducing one’s height) and effects of things some of us do to try and overcome evidence of bodily changes, make us look and act different at age 57 then 27. But it’s a slow process, never catching one by surprise. And there are things we can do – sort of a sleight of hand – to draw attention away. Make-up, the right clothing artfully deployed with color conscious choices, weight management … all of these may make us feel better about how we look, but carry their own set of codes for who is older, and who isn’t.
Some of us, unfortunately, have further burdens layered onto the aging process. Weight gain, diabetes, osteo-arthritis of the hips and knees, heart disease, degenerative neurological processes – the list is endless. They all alter not only how we look, but very often how we move. One’s gait becomes stiffer, one’s actions truncated or labored. The wheezing, shuffling, corpulent, red-faced 57 year old carries an extra wardrobe of aging signs at all times. And can look or act so much older than one not so encumbered.
Like the universal attributes of aging, those with “disease” labels can be attacked, but rarely overcome. And the very process of battle – side effects of medication or surgery – sometimes create stigmata all its own.
Overlapping this category and the next is the special case of cancer. This can strike at any age, of course, but becomes generally more common the older we get. And various types of cancer are more or less debilitating and dangerous both in their effects, and the results of treatment. But as a general rule, cancer is a sign of aging, one of those degenerative diseases which strikes more and more often the older we become.
But cancer is also a sign of the third category, retarded healing. Fundamentally, cancer is an alteration of DNA’s ability to repair itself. As we accumulate insults and traumas through life, healing becomes critical to simple maintenance. A ten year-old coming home with a skinned knee needs only a kiss on the owie and a couple of days for the scar to simply disappear under a fun scab to pick at. For me, a scrape on my skin can leave a mark for months. And for my mother, in her last few years, I used to dread any barked shin, which might actually never heal over, so low were her dermatological recuperative powers by that point.
These little, insidious traumas which heal more and more slowly create a cumulative portfolio of half-healed scars, both external and internal, which eventually mark us all. Big traumas, like cancer or an accident, can cause a stair step in one’s perceived age. And this is what I fear most from my own recent trauma. I am seeing healing happen in many places proceeding on its own, now slowed, timetable. The bones and muscles came back first – x-rays and the weight room tell me that. My several spots of serious road rash have now started turning white, from their earlier pink, evidence that blood vessels are shrinking down, no longer needed to bring repair teams in to work every day. My neck is not so stiff anymore, my swallowing keeps getting better, and I will even have more teeth some day soon.
But I think I’ve gained two new signs of being “old”, all at once, from my crash into that truck. First, my crushed larynx gives me a permanent sound of gravel and hoarseness, which more often creeps up slowly over decades. (Compare Gov. Jerry Brown of the 70’s to the current incarnation.) And my arms – my arms went from being 55 year old guns to 70 year old pipe cleaners overnight, and just don’t seem inclined to get any bigger or stronger.
I’m visiting a physiatrist in two days, and intend to ask her if there is any reason to believe that new neural connections can grow around the deadened cells in my spinal cord. And if so, is there anything to be done to prevent the potential loss of muscle tissue while we’re waiting for that regeneration to occur. Update next week.
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BTW, this is my 200th post in Triblog, something I’m a little bit proud of. I hope I get to 400 a little bit sooner, though. It’s taken me since Oct., 2008 to hit the double century mark.
Very interesting piece, Al.