October 13, 2025

Dateline – Playa Conchal, Costa Rica

I’ve looked at the various off site excursiont that are offered and most of them strike me as being rehashes of things I did this past week (often in the same places) so rather than go trekking off, I think my best use of the next couple of days is a combination of thinking and drinking, writing and citing, and snoozing and choosing. I don’t get a lot of times to completely unwind in life and there are worse places to do it then a resort on the Pacific Ocean in the tropics in company with the birds and the strange rodents, and the iguanas. One very large and venerable iguana is, I swear, trying to make friends as he appears out of a tree and saunters my direction every time I’m in the pool area. He’s probably looking for something to eat but I am mindful of the multitude of ‘Don’t Feed the Animals’ signs posted everywhere.

The weather pattern is holding stable. The sun was out and it was a glorious and clear morning so I got up, had some breakfast with a mimosa, and headed to the beach, plunging into the Pacific. The surf was a bit stronger than I expected so I didn’t venture out too far. There was also a major drop off about ten yards out from shore. I am a reasonable swimmer (all Seattle raised children learn to swim early as self preservation – most social gatherings in the summer revolve around water activities) but am out of practice and not as young as I was so I pay fairly close attention to waves and tides and currents. (Having a father who is a physical oceanographer also gave me a very healthy respect for the power of water). After a few hours, I switched back to the pool and my iguana friend, had lunch, another drink (or two) and relaxed in general for the afternoon. The clouds rolled in around two in the afternoon but, for once, the rains held off until about dinner time so it was possible to remain in the pool area until it was time for a mocha and eventually dinner.

As I don’t have much else to report in regards to travel, I’m going to fill out this entry with something I’ve been working on for a while and which I think I’ve finally got nearly right. Feedback is welcome. I therefore present: Dr. D’s Ten Commandments of Aging Successfully.

Dr. D’s Ten Commandments of Successful Aging

1. Thou Shalt Choose Thy Parents Carefully

You’re never going to be any better than the physiognomy and physiology allotted to you by your genetic makeup. We are all given gifts by our parents. Some of them are positive, some are negative. The trick is to figure out which combination you inherited and play to its strengths.

2. Thou Shalt Heed the Lessons of Thy Mother

Most of us were raised with a maternal figure who attempted to teach us the basics of healthy living. Eat a balanced diet. Get some sleep. Go outside and play. Get some exercise. Turn off the TV. Read a book. Those truisms, passed down by mothers since time immemorial exist for good reason. They are the building blocks of successful adulthood and aging. Think back on them and incorporate them into your living patterns.

3. Thou Shalt Not Fall

There is nothing that will change the life and function of an aging adult for the worse faster than a bad fall and injury. We lose our ability to balance on two feet as we age for a whole host of reasons and our vanity often keeps us from taking the steps necessary to do the simple things necessary for fall prevention. As I say to my patients repeatedly: Floor hard! Fall bad! Use stick!

4. Thou Shalt Treat Medications with Proper Respect

Our culture assigns a great deal of the magic of the healing process to the physical object of the pill and therefore we believe that if one is good, five is somehow better. Practitioners are seduced by this thinking as well and are very good at adding medication but not good at stopping medication that may no longer be appropriate or useful. The best way to think about medicines is that they are controlled doses of poisons – substances which when taken into the body cause a physiologic alteration.

5. Thou Shalt Live with Moderation

We live in a culture of excess. Super size it! All you can eat! Get the biggest house you can afford! As we age, those trends can trap us in patterns which make the compromises necessary for successful aging harder to implement. Also, life’s little pleasures are usually fine in small to moderate doses but when we go full steam ahead, we can get ourselves in trouble.

6. Thou Shalt Treat Healthcare Professionals as Partners

Doctors and other practitioners aren’t there to tell you what to do. They are there to share their expert knowledge gained from education and experience and proffer advice. They don’t go home with you and they can’t make you change behavior in any way. Only you can do that. At the same time, while they can’t tell you what to do, don’t try to tell them what to do. You don’t have the knowledge base they have no matter how much Googling you’ve done. Work together.

7. Thou Shalt Prepare for Change and Accept It

We are all aware that a 5-year-old, a 15-year-old, and a 25-year-old are all very different from each other in function and physical being. The differences between a 65-year-old, a 75-year-old, and an 85-year-old are nearly as great but we don’t culturally understand that in the same way. If you try to create a static life in which nothing changes, the mismatch between your body and function and that life will get exponentially greater as the decades advance and will create innumerable issues for you and your family. Understand that life is change and go with it.

8. Thou Shalt Hold a Sense of Wonder and Optimism

When social scientists have looked at populations that have aged successfully into the 10th decade and beyond, they have tried to find the common factors that allow one to achieve the century mark. Almost everything falls out with statistical analysis with the exception of one thing. A sense of looking forward to the future rather than dwelling in the past. Always focus on what you can do rather than what you can no longer do due to the inevitable changes of aging.

9. Thou Shalt Make Health Decisions For You, Not Others

You are a unique individual. You understand better than anyone else what is right for you; whether that’s living patterns, medical treatment options, or what sort of symptom burden is tolerable. When faced with choices, and often in aging there are no good choices, just choices, make them based on what it right for you. Don’t try to second guess what would be better for a spouse or for children and grandchildren. As a corollary to this, begin conversations regarding personal wishes long before such conversations are necessary. There’s a campaign called ‘Let’s Talk Turkey for Thanksgiving’ which encourages older adults to initiate conversations regarding morbidity and mortality when the whole family is present and Thanksgiving is often one of those rare times.

10. Thou Shalt Trust in Luck

What will happen to each and every one of us as we age is going to be a combination of genetics, life choices, and sheer dumb luck. Always trust that luck will be on your side. Expect the best, prepare for the worst, and take what comes.