Skin ulcers of the lower legs become more common with age for a variety of reasons. The most common ulcers develop when the veins that return blood from the legs deteriorate.

Because blood in the leg veins must run uphill to return to the heart, leg veins come equipped with valves to keep blood from being pulled back down by gravity.

Some people inherit fewer valves or valves that give out early. Valves can be damaged by injury, blood clots (venous thrombosis) or vein inflammation (phlebitis.)

Calf muscles also aid return of blood from the legs. Their contraction squeezes the veins. Injury, immobility or just plain inactivity can impair the leg vein function.

When blood pools in the veins, it backs up blood in the capillaries, the smallest blood vessels that ultimately feed into the veins. Stretching the capillaries damages their walls, releasing substances that cause inflammation.

This damages the skin of the lower legs.

The most common location is near the ankle, especially just above the medial malleolus (the inner ankle bone). At first, the ankles swell. The swelling generally decreases overnight when the patient lies flat, only to progressively worsen over the course of the day. The skin stretches, and develops a rash similar to eczema with redness, dryness, and scaling. The legs often ache. Over time, pigments leaking from the pooled blood discolor and darken the skin. Eventually the skin breaks down to form an irregular shallow ulcer.

Once an ulcer appears, treatment involves compression, leg elevation, dressings, medication, and sometimes surgery. Compression reduces pain and swelling, enhances return of blood from the veins, and hastens ulcer healing. Compression may be elastic, inelastic or mechanical.

Elastic compression conforms to leg size and therefore is effective during both rest and activity. Either stretchable bandages (ace wraps) or compression stockings can be used. Compression stockings are superior because they are capable of applying higher pressure and can be graded to apply the highest pressure near the ankle with decreasing pressure toward the knee and thigh.

Inelastic compression consists of bandages, like an Unna boot, that don’t stretch. While not as effective as elastic compression, there are times when, as a doctor, I find it helpful. The Unna boot is one brand of inelastic compression dressing made of moist gauze impregnated with zinc oxide. The doctor applies it, and it hardens (not as much as a cast) and stays in place until removed several days later.

For the patient who can’t — or won’t — apply compression stockings, it jumpstarts the healing process and ensures that the patient is actually complying with the doctor’s recommendation. But they’re messy, and if the ulcer is draining a lot, they can smell.

Mechanical pressure devices encircle the legs. A pump inflates and deflates them to provide a pumping action. They are expensive and cumbersome and so are used for bedridden patients who can’t tolerate other compression methods.

Leg elevation means getting the legs above the level of the heart. Ideally this happens three to four times daily for 30 minutes at a stretch. That’s not always possible especially for working people. Even lesser degrees of leg elevation speed ulcer healing, and reduce swelling.

There are dozens — if not hundreds — of types of dressings to choose from: hydrocolloids , hydrogels, foams, pastes, and more. But so far studies have not proven any one dressing superior to others. So the best choice is something that isn’t too expensive, is easy to use, and preferred by the patient or doctor.

Infected venous ulcers require antibiotics by mouth. For ulcers without infection, oral antibiotics don’t hasten healing. There is limited evidence for the usefulness of topical antibiotics. In any case, leg elevation, appropriate dressings, and leg compression are the first line treatments.

Large or stubborn venous stasis ulcers sometimes require skin grafting. Fortunately this is rarely needed. There is a role of surgery to treat venous insufficiency to reduce the risk of recurrent venous stasis ulcers.

The financial cost of venous stasis ulcers is huge because nearly 1 percent of the population is affected. The estimated price tag is $2 billion per year in he United States.

If you have leg concerns that may be related to poor vein function, ask your doctor whether you might benefit from compression stockings, vein surgery, or other preventive measures.

And if you do develop an ulcer, get treatment right away. Small problems are easier to fix than big ones.

By Lou Sorendo

For Dr. Samuel Paris, the phrase “going the distance” embodies his lifetime creed.

Paris, 72, is a family practitioner with North Medical Family Physicians in Liverpool. While he certainly goes the distance for his patients, he has also gone the distance in over 300 marathons.

And there is no slowing down this quick-witted Syracuse native who earned his medical degree in 1967 at the University of California at Irvine and has been practicing for 43 years.

Paris said the major threats facing Americans today are cardiovascular disease and cancer. Not far behind are problems associated with out-of-shape and overweight people, conditions that commonly lead to diabetes.

“My job is mainly defense. My defense is so good that it’s offensive,” he said.

“I believe in life after death and I also believe in life after birth,” he said.

“I want to take good care of my people so they don’t end up in the hospital, in a box or cremated,” he quipped. “Then I work on how they should be living.”

Paris advocates the formula put forth by Hippocrates, who said the secret to good health is a balance of adequate diet, rest and exercise.

“He said it in Greek, so a lot of people probably didn’t understand him,” Paris said.

“Their’s is no magic thing,” he added.

Paris complained that people put too much food and supplements into their bodies.

He said patients often complain that they would rather treat themselves through natural means. Paris counters by saying medicine is more effective, particularly in situations such as controlling high cholesterol. “With medicine, you can clean out your arteries in a month or two,” he said. “With diet and exercise, which a lot of people probably won’t do, it probably takes three years to do that. And that’s if you lose 50 pounds and exercise a minimum of six hours a week.”

He said when he does visit urgent care or the emergency room, the majority of people there are not adhering to the right balance of diet, rest and exercise.
Paris compares notes with Dr. Walter Bortz, who has written and spoken extensively about fitness and aging. Bortz ran the Boston Marathon this year at 80, his 40th marathon in the last 40 years.

His books include “We Live too Short and Die too Long,” “Dare to be 100” and “Living Longer for Dummies.”

Born to practice—Paris’ pat answer when asked what he wanted to be at the tender age of 5 was a doctor.

He enjoyed and respected his own family doctor, and said he was “horrified” to discover he would not be the one to remove his appendix at age 11.

When he attended medical school in California, he enjoyed every service he engaged in.

The family doctors in California at that time did surgery too, which captured Paris’ attention.

“Family doctors take care of acute and comprehensive medical care. They try to be all things for all people,” he said.

Paris devoted himself to the “one doctor for one family” philosophy. When he first started his practice, he stressed the importance of dealing with families because he wanted to touch on all aspects of medicine, from pediatrics to gerontology.

He has always been attracted to acute medicine, and thrives in the urgent care environment. He used to work in the emergency room and attend to obstetrics, but age and a back injury stopped him from delivering babies back in the late 1980s. He delivered over 2,000 babies.

“I like everything about medicine. There isn’t one thing that I don’t like,” he said.

Back in the day, it was common for Paris to work 100 hours a week. Now, that number has shrunk to 50.

He does make himself available to his own patients, and proudly proclaims that two of his patients are 100 years old.

His oldest patient lived to 105. “God did that, not me,” he said. When his oldest patient got into a fender bender at age 102, it was suggested that he hang up the car keys.

“He probably resented that until the day he died,” Paris said.

Marathon man—Paris participated in track and cross-country in high school and college and said he enjoyed the competition. His passion for running carried over into his adult life.

Paris’ brother died of a heart attack at age 44. “It’s probably one of the things that influenced me to continue running and working with heart patients,” Paris said. He took care of his brother’s three children until his sister-in-law remarried.

While he has run over 300 marathons, he has also integrated his passion for running into his medical practice.

“I started treating overweight men in their 40s and 50s who had experienced heart attacks, and asked myself why,” he said.

Paris then took a page out of Dr. Terry Cavanaugh’s book. Cavanaugh operated a cardiac rehab center in Toronto at the time and trained people who had suffered heart attacks to run marathons.

“I just copied him,” he said.

“I had 50 people who had bonafide heart attacks and trained them to run marathons,” Paris said.

It started when Paris was treating a man in his mid-50s who had had a heart attack. He saw him in the coronary care unit at a hospital and shared a copy of Cavanaugh’s book, “The Healthy Heart Program.”

“I said, ‘Read this if you want, and don’t be down and depressed, because I’ll have you running a marathon in one year.’ He said, ‘You’re on, doc.’”

Paris employed his own cardiac rehab program and after 13 months, had the man running the Marine Corps Marathon.

Paris ran with him, and made sure he had a stethoscope under his sweats along with a healthy dose of adrenaline in case anything wrong happened.

One of Cavanaugh’s charges survived five heart attacks. He is still alive today, and actually beat Paris’ time during the last marathon they competed in together.
Paris took five members of Cavanaugh’s vaunted “World’s Sickest Track Team” and ran the Boston Marathon with them. They all made it between 3:30 and 3:45, remarkably fast times that caused some consternation among healthcare professionals who were in attendance.

Benefits of running—“It gives you a high,” Paris said in regards to the benefits of running. “It releases endorphins, so that’s less tranquilizers you have to put in people.”

Paris just recently was running six miles a day with a 23-year-old Le Moyne College student. “It makes me feel good and young,” he said.

He said if a person gets their legs in shape, “the rest of the body will follow.”

He once read a letter in the New England Journal of Medicine that stated people attending the Olympics in the stands die at the same age as those who participated in the Games. However, a rebuttal letter stated in the next issue that if you looked at the participants in the 10-kilometer run and marathon, they seemed to live six to seven years longer than the people in the stands or the other participants.

Paris once ran the Boston Marathon when it was 100 degrees at the starting line. He finished just 20 minutes behind the winner.

How did Paris master such an endurance test?

“It’s the same thing as working 100 hours a week,” he said.

He competes in the Boston Marathon through the American Medical Athletic Association.

One of his notable accomplishments was participating in an invitational run which started at the Liberty Bell in Philadelphia and ended at Convention Hall on the Board Walk in Atlantic City. The run was 60 miles and took nine hours for Paris to complete.

He was the youngest 40-year-old-plus competitor to complete the run, only stopping to hydrate and urinate while running on the New Jersey Turnpike.
The North Syracuse resident said the key to preparing for a marathon is motivation, the same kind of motivation that has made him a cancer survivor.

Paris has battled both prostate and esophageal cancer.

“I really have to practice what I preach,” he said.

Paris comes from a family that has been stricken by heart disease. “Very few of my people made it into their 70s,” he said. “We don’t have longevity.”

Paris was told by doctors when he was sick that if he had not trained as a runner and built his lung capacity, he would probably not have survived his ordeal.

“They didn’t think I would make it. The doctor gave me lousy odds,” he said jokingly.

After surgery, however, he was determined to jump back in the race.

“I had all these freaking tubes, and when I was walking with the nurse, she couldn’t keep up with me,” he said.

He was also told after back surgery to correct a pair of ruptured discs that he would never run again. Again, he proved the doctors wrong by being motivated enough to overcome obstacles.

The golden years—At 72, Paris said he feels the “heat is off” as far as expectations are concerned on the marathon circuit.

“I finally realize that I can’t do what I used to do, and that is run an average of eight-minute miles,” he said.

Instead, he is content with running a 10-to-12-minute mile pace and finishing the 26.2-mile challenge.

While he intended to slow his pace at the last Boston Marathon he ran, a nasty spill and a muscle pull hobbled him on the course. Despite the bleeding gash and limp, he managed to avoid being pulled from the course and finished.

Does that deter the veteran marathoner?

“Next year, I will probably go a little faster,” he said.

“Everybody has a little touch of competition and an ego,” he said.

He also tells his patients to set a goal of finishing, even if they have to stop and walk to get there.

Paris cautioned that running seven days a week increases the chances of injury. Going five or six days is safer from a health standpoint, he noted.

He noted that one surgeon general suggested exercising an hour for five days a week.

“Anything is better than nothing,” he said.

He gets a kick out of people who insist they are in shape because they play basketball once a week.

“Those are the guys I worry about. They go out on the court and drop dead,” he said.

Paris said, “You don’t play anything to get in shape. You have to get in shape to play,” he said.

Lifelines:

Birth date: Dec. 27, 1937
Birthplace: Syracuse
Current residence: North Syracuse
Education: Bachelor’s degree, Le Moyne College; master’s degree, Syracuse University; degree in medical technology, University of Southern California; medical degree, University of California at Irvine
Affiliations: American Medical Athletic Association; American Medical Association; American Academy of Family Physicians; diplomate, The National Family Medicine Board; Society of Teachers of Family Medicine
Personal: Married to Susie with 10 children, three of which are stepchildren and two of which are adopted.
Hobbies: jitterbug dancing.

The success of Living Proof Longevity Centre (LPLC) is a prime example of men and women’s desire to manage actively their own aging process. Since 2000, physicians Mark McConn and Susan Merola-McConn have specialized in anti-aging and preventative medicine in a boutique medical practice located at Northeast Medical Center in Fayetteville. The practice, a division of North Medical, P.C., provides primary care as well.

With the average life expectancy now estimated at 75.8 years, anti-aging medicine is the recipient of a consumer-driven demand this country has never before experienced. More and more people recognize the value in age management — being able to affect your own aging process in a positive manner through what are now widely considered mainstream techniques and medical procedures. Many of the insights of anti-aging pioneering researchers and clinicians have become accepted scientific fact.

According to Susan Merola-McConn (Sue, as she is fondly referred to at the practice): “People realize our current U.S. health care system is based solely on treating diseases and that to live a longer, healthier life they are going to have to become proactive at preventing the disease in the first place. Our services are preventative and wellness-based and we teach our patients that aging is actually a treatable condition. We encourage our patients to laugh away the aging process and it’s easy when they feel good.”

Living Proof Longevity Centre starts with the metabolic approach to nutrition, diet, exercise and vitamin and anti-oxidant supplements and works in conjunction with the doctors’ bio-identical hormone replacement therapy expertise. The results can be significant changes in a patient’s biochemistry that helps them experience improved general health, overall moods, skin texture, and energy levels. “Our anti-aging commitment is not a fountain of youth, but it allows us to design a complex, personalized approach to each and every patient that walks through our doors at the Centre,” noted McConn.

“Dr. Sue’s holistic approach—mind, body, and spirit—truly makes a difference in my life. Thanks to balance between good nutrition, a combination of hormones compiled specifically for me, and a positive mind-set, I am living better than I have in years,” said Betsy Bedigian, 55, of Baldwinsville, a patient at Living Proof for over 10 years.

Elizabeth Mallory, 56, of Camillus, a patient of Living Proof for more than five years, says she understands exactly what that approach means. “I came to Dr. Sue for a weight loss program not realizing that it was only a small part of what I could do to impact my overall well being. Through a deliberate and personalized approach, I worked with the team to begin hormone replacement therapy, aesthetic, bariatric and Medifast services. And I have truly never felt better.”

Today, each American spends more on health care than anyone else does in the world and yet we are not much healthier as a people. Living Proof Longevity Centre believes that anti-aging medicine is the most important new health care model this country has ever seen. Their goal is not simply to prolong your years but to ensure that those years are healthy, happy and full of laughter.

For more information, call (315) 329-4975 or visit www.livingproofmd.com.

By Mary Beth Roach

Years before TV’s mega-hit “Dancing With The Stars” was even a twinkle, Donna Natale O’Neil, Dennis Deland and Geno Aureli were offering dance instruction in Central New York. And while the three instructors credit the popular show for an increased interest in ballroom dancing across all age groups, many of their students say it was a long-time desire to dance and the opportunity for fun and exercise that inspired them to kick up their heels and enroll in classes.

Suzy Tankersley, 60, of Syracuse, has always enjoyed dancing, so her husband, Clint, 61, gave her three dance lessons for Christmas a few years ago. He figured that the lessons might satisfy her desire to dance.
What Clint didn’t figure on, however, was that he would enjoy it as much as she does. They’ve been taking classes at O’Neil’s Puttin’ on the Ritz, located at Driver’s Village in Cicero, for more than two years now, and they have found it not only to be good exercise, but they’ve been able to create new friendships.

And although Suzy jokes that “it’s harder than it looks,” her smile as she glides across the floor belies her comment.

“It’s a better workout than you think, without dripping sweat,” according to O’Neil.

To stay on their toes, many take what they’ve learned each week to any number of dances offered throughout the Syracuse area.

Gerry Youngs, who assists Deland with instruction at the OCM BOCES location in Liverpool with Walt Medicis Associates, will often attend dances outside of class, and will dance for two to three hours.
“You’ll get a good workout — a lot of cardio,” the Cato resident said. “You can work at it as hard as you want.”

Because people can so easily adjust the pace at which they want to dance, it is a great activity for those age 50 and older, said National Dance Association’s Marian Simpson in an article titled “Let’s Dance To Health” that appears on AARP.org.

“Dancing can give you a great mind-body workout,” the story reads. “Researchers are learning that regular physical activity in general can help keep your body, including your brain, healthy as you age. Exercise increases the level of brain chemicals that encourage nerve cells to grow. And dancing that requires you to remember dance steps and sequences boosts brain power by improving memory skills.”
Local instructors agree.

“The learning process is a significant mental challenge,” said Aureli, who runs All for the Love of Dancing. “When they make the decision to learn to dance, they have to learn to move and use their bodies in new ways. Correct posture, proper dance position, the many and varied foot patterns, arm and head styling, learning to lead or to follow and add in the fact that it all changes from dance to dance and you can see that there is plenty of room for mental exercise!”

Deland said that in his class they learn the steps, and from there, the students can create their own patterns, which, he said, means they have to think ahead.

But the benefits go well beyond the physical and mental aspects. The students emphasized that they enjoy the opportunity to meet new people and to do something as a couple.

“This is something you can do together for the rest of your lives,” said Kennatta O’Brien, 55, of Syracuse, who attends classes at Puttin’ on the Ritz, with her friend, Ron Adams, 60, of Parish.

While helping each other through cross-body positions or outside under-arm turns, students and instructors will chat while “cha-chaing” or swap stories while doing the samba. The easy camaraderie among the students creates a comfortable and enjoyable setting for them to learn.

“I kind of feel like a social director,” quipped O’Neil, adding that it’s important to her for the students to get to know each other, to make new friends.

Toward the end, she hosts barbecues for the students, dances with live bands about six times a year for both students and the general public in the Court at Driver’s Village, and CD dances in her studio every few weeks.

Aureli and his wife host an open ballroom dance on the first and third Saturday of every month, and on any given night, half of those in attendance are seniors, he said.

Do you think you have two left feet? Convinced you won’t like it? Instructors and students alike say these are not reasons to sit the dance out.

There is a fear factor, Aureli admitted, but it is “very do-able. Don’t ever feel you can’t do this.”

“Non-dancers can dance,” O’Brien said, and all those interviewed agree that dancing is a learned skill.

And Deland was one of those who decided before he even started that he wasn’t going to like it. But he was mistaken, he said, adding that he felt that he belonged immediately, and after a relatively short period of time, he became an instructor.

And even if you don’t have a dance partner, join in anyway, people interviewed for this story said.

It didn’t stop Harriette Taylor, 55, of Phoenix, who likes to dance so much she attends the classes at Puttin’ on the Ritz by herself. And some of the instruction at the BOCES program is structured so that the partners rotate, leaving no one out for very long.

And Dennis Goodrich, 55, of Geddes, takes a weekly class with his wife, Linda, at Puttin’ on the Ritz, but sometimes he’ll come solo for another class so he can memorize the patterns and get a step up on his ability to lead.

And some have even found romance along with the dance.

Deland said that a few of his students have fallen in love and gotten married. And now, they were well prepared to dance at their wedding.

Rosie Ryan’s got the right idea.

“Get out and do something,” she said, during a lesson with Aureli. And Rosie practices what she preaches. The 66-year-old Minoa resident walks four miles every other day and had taken line dancing for four years before starting with Aureli’s class.

“Give it a try,” she added.

But in women, doctors and bystanders should be paying attention to something else, says Lynda Lisabeth, researcher in the department of neurology at the University of Michigan Health System.

“What we’re finding is that women experience what is considered non-traditional symptoms,” said Lisabeth, who presented research findings on acute stroke symptoms at the 2009 International Stroke Conference this spring. “The non-traditional symptom that stood out was altered mental status, meaning confusion, disorientation or a loss of consciousness.”

Symptoms such as sudden numbness of the face, arm or leg are a warning sign of what’s happening in the body during a stroke, which is a loss of blood supply to the brain because of a blocked or ruptured artery.
While larger scale studies focusing on stroke in women are warranted, the gender differences U-M researchers identified may contribute to delay in treatment for women and could signal a need to change public health campaigns, Lisabeth says.

The U-M study examined ischemic strokes, the kind experienced by 80 percent of stroke victims, and transient ischemic attack, called mini-strokes because symptoms go away quickly. Researchers examined the cases of 461 men and women and classified their symptoms as either traditional or non-traditional.
Altered mental status was the most common non-traditional symptom and it was more likely to be reported in women, the study showed. Researchers do not know why women’s symptoms were different.

But the differences in symptoms may have consequences if slow recognition of stroke signs cause a delay in treatment, the researcher says.

“The only treatment that is currently FDA approved in the United States for stroke is tPA (tissue plasminogen activator), or what we call a clot-busting drug,” Lisabeth says. “To administer tPA, people with stroke have to get to the hospital within three hours of symptom onset. So any delay on the part of actually getting to the hospital or delays once at the hospital could literally mean the difference between getting the therapy, or not getting the therapy.”

Each year 800,000 Americans experience a stroke. Hispanic Americans and African Americans have a greater risk having a stroke, and to die from it. Intensive rehabilitation can help some overcome loss of function, but stroke remains a leading cause of disability. It is the third leading cause of death.
Men have an increased risk of stroke across most age groups. But in the oldest age groups, women’s risk is higher, and since women live longer than men, women actually have an increased lifetime risk for stroke.

By Laura Thompson

I don’t consider myself easily overlooked. I am, after all, six feet tall, and roughly 180 well distributed pounds. While this height isn’t as unusual as it used to be in a woman, it’s still significant height when compared to the general population.

I also am a charismatic person, or so I’ve repeatedly been told. When I walk into a room, you know someone’s there.

Given this, why do I suddenly feel invisible when I’m walking through a store, waiting in a line or trying to get my waiters attention?

Don’t get me wrong. I’m a realist and know that while I ‘m still a good looking woman, the old gray mare ain’t what she used to be. I don’t bemoan the lack of sexually-driven attention I used to draw. I actually welcome its absence, after a long day in the sun. It’s refreshing not to be fending off every Tom, Dick, and Harry with a little romance on their minds.

However, I still would like the normal attention and respect any customer should get.

I’m in my bank. Waiting patiently — too patiently — for the bank teller to notice me standing in place, while she gossips with her co-worker. She suddenly snaps to attention when a handsome male enters the line behind me. I get it. It’s OK to let the old white woman wait, but not the good-looking man behind her. From her forced smile to her curt responses, I’m clear she’s just getting me out the way so she can wait on the customer behind me.

I’m in a big-box department store, waiting in line to return an item. The next available customer service clerk looks right at me — I am not making this up — and turning to two young men who have just arrived, asks them, “Can I help you?”

I’m grocery shopping, and the store is filled with younger women pushing fully loaded shopping carts around. Around everything but me. They cheerfully — and repeatedly — ram their shopping carts into me, over me, at me. I’m suddenly walking through a hazardous bumper car course. They don’t apologize. They don’t seem to even see me. Given their youthfulness, I find this hard to comprehend.

Is Generation Next suffering from mass myopia?

In the same grocery store, the male cashier barely glances at me, and gives me less than the time of the day. By the book, and barely, is his attitude. His eyes never meet mine, and his attention is already fixed on the next customer.

I’m in a restaurant. I need an additional condiment. I shall die and go to diners’ hell before I successfully attract the attention of my waiter. I sigh, and consign myself to a less than perfect meal.

’ve somehow become invisible.

I don’t know all the whys and wherefores pertinent to my sudden invisibility. I can play analyst at large, and surmise that it has to do with my aging. I’m older, and therefore unimportant. I have reached my middle years, and now may be ignored or completely overlooked.

After all, no one expects me to complain about it.

I have, over the years, heard similar complaints from older friends. Experiencing it first hand is still a real wake up call. Common courtesy and good business practices suggest this is not a smart course of action for anyone wanting my dollars. And I say, from here on out, ignore me at your peril.

I can’t speak for all women my age, and that won’t stop me from trying. I’ve had enough! My pockets are still deep, and my spending habits matter. If my bank can’t hire tellers who see me—regardless of my age or gender—then I’m taking my business elsewhere. If the big box retailer can’t teach the basics of customer service to its clerks, then I can spend my healthy green at yet another. I will never again spend my time nor money in that restaurant where I went invisible. I will speak up, to all those shopping mama’s intent on crushing me with their carts.

I will not be invisible.

I will insist on my place in line. I will speak up when I get less than good customer service. I will not take it anymore—and quite frankly, I wish you wouldn’t either.

I have used this statistic before, and I give it to you again. There are 77 million of us out there, gradually growing older. If we got together on this one, we could turn it around, and quickly. There’s power in unity; if every older person refused to become invisible, we wouldn’t. It’s that old Boomer magic the numbers, people, the sheer magnitude of our numbers.

So stand with me on this one.

Speak up the next time the world treats you as if you don’t matter, as if you’ve become invisible. Don’t let yourself be cut off in line. Don’t wait because someone else thinks you can. Insist on the service you used to get, and still deserve. Make it clear to businesses, and their employees, that money is an equal opportunity tool—and you’ll spend yours where you get the most respect and best service. Businesses where you matter, where you are still seen.

Power to the people! Even to the older ones. No, let me revise that. Especially to the older ones.

Laura Thompson is an occasional contributor to 55PLUS. She’s in her 50s.