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AMD in Challenging Times: Tips for Living Well and Coping

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Featuring

Dierdre Johnston

Deirdre Johnston, M.D., M.B. B.CH. B.A.O.

Assistant Professor of Psychiatry and Behavioral Sciences at Johns Hopkins Hospital

Dr. Johnston discusses the impact that age-related vision diseases have on older adults and common challenges that older adults face living alone. Dr. Deirdre Johnston also addressed the depression and anger that people face when dealing with an age-related vision disease and steps to take when facing those emotions.

 

  • Please note: This Chat may have been edited for clarity and brevity. 

    MICHAEL BUCKLEY: Good afternoon. I’m Michael Buckley with the BrightFocus Foundation, and welcome to today’s BrightFocus Chat, “AMD in Challenging Times: Tips for Living Well and Coping.” If today is your first time on a BrightFocus Chat, welcome. This is background; BrightFocus funds some of the top researchers in the world trying to find cures for macular degeneration, glaucoma, and Alzheimer’s. We’d like to share the latest news from these scientists with families that are impacted by these diseases. That’s why our website, www.BrightFocus.org, has a lot of free publications and resources, and we also have today’s BrightFocus Chat, which is a way of hearing directly from some of the leading experts related to vision health and aging.  

    Now, I’d like to tell you who we have with us today. It’s a returning guest. We’re very fortunate to have Dr. Deirdre Johnston. She’s a geriatric psychiatrist at Johns Hopkins University in Baltimore, and Dr. Johnston helps lead a number of programs that are aimed to help older adults remain in their community for as long as possible and to be happy and safe and thriving living in their own home. She has been helping lead a number of programs in the city of Baltimore to do that, and she’s also been a part of a big research project at BrightFocus Foundation to that end. She’s with us today because these are obviously very challenging times for people of all ages and all across the country, but I think particularly for people who are impacted by age-related vision disease, such as macular degeneration and glaucoma. We were very fortunate that Dr. Johnston agreed to return to the BrightFocus Chat. With that, Dr. Johnston, thank you very much for coming back today. 

    DR. DEIRDRE JOHNSTON: You’re very welcome. I’m delighted to be here. Thank you for inviting me. 

    MICHAEL BUCKLEY: I’m sure all of us are curious about a wonderful accent that you have. I was wondering if you could tell us about where you grew up, and how did you get into such a valuable line of work? 

    DR. DEIRDRE JOHNSTON: So, I grew up in the West of Ireland, and my mother was a district public health nurse. She had patients … most of her patients she visited at home, and lots of them were older adults, and so when I was a child, I would often follow her on her rounds. I’d go with her and meet her patients. She would make sure they all had their medications and give diabetics their insulin, etc., but she’d also make sure that they had fresh food and address any other issues that might cause problems for them, and then she’d sit and have tea with them and chat with them, and this was really lovely for me as a child. I loved meeting her patients and hearing their stories, especially people who had lived long lives—they had the best stories. So, my mom [inaudible] very well, and her visits meant a lot to them because she kept them well at home, and that’s where they wanted to be; and a lot of them were dealing with all kinds of challenges, but they were at home. So, it occurred to me even as a child that seeing patients in their homes was a better way to take care of older adults, especially through [inaudible] sensory and mobility and cognitive challenges. And because I like their stories, that ended up with me choosing geriatric psychiatry as a career because not only is it all about the medical stuff, it’s also about the patients’ stories.  

    MICHAEL BUCKLEY: That’s very interesting that what you found growing up in Ireland, I think, is still true today here in the U.S. In your work and the different programs you lead in the city of Baltimore, are there common typical problems or challenges that older adults face who wish to remain in their home? 

    DR. DEIRDRE JOHNSTON: Well, there are many. I like to emphasize that aging isn’t all bad. You know, sometimes it’s tempting to see the challenges before we see the … before we see the benefits. And, you know, as older adults … as we age, we develop more insights into things, and we have a lot more experience to draw on … that we tend to be resilient. If we make it into our older years, we tend to be pretty resilient. So, that’s the positive, and some of us get there with all kinds of problems to deal with, but we get there. So, some of the things that people struggle with … you know, our bodies age, and they change, and things crop up. We’re like any aging—and I include myself in this—we’re like any aging machine. Things break and go wrong, and it needs maintenance and tuning more often, but chronic health conditions are … you know, there’s very … there are very few people in their 80s—70s even—who don’t have one chronic health condition. Some people have several. Many of my patients have several. Many of the patients that I see in their homes have several, and they’re continuing to function. And then, you know, social isolation can be an issue, and that can be actually made worse by sensory problems. Sometimes visual and auditory problems can worsen social … it can worsen the loneliness that comes with social isolation, and those issues can also lead to medication errors and to falls and being unable to keep the environment cleared for many reasons. There are many reasons why people might not be able to take care of their environment. Sometimes people don’t have the physical capacity to do it; sometimes people don’t know that things need to change a little bit so that you can stay safe. Yeah. 

    MICHAEL BUCKLEY: I think it’s really interesting to talk about the connections between a lot of these challenges. Through your work and what we do at BrightFocus is working on both vision and Alzheimer’s issues. Is there a connection between vision loss and dementia? Does one … does one exacerbate the other in either direction—vision loss and dementia? 

    DR. DEIRDRE JOHNSTON: Yeah, there is a relationship between the two, and what we know is that there’s a slightly increased risk of dementia with impairment in one sensory modality. The risk actually increases with the number of sensory impairments. But there’s also evidence that if you identify the problem and manage it—if you identify and manage the sensory impairment early—that can actually mitigate the increased risk of dementia. It can actually soften the blow, as it were, and maintain function for longer. And really, I think that the common factor in both impaired vision and hearing is under-stimulation and isolation and reduced physical activity. All of these things are known to accelerate cognitive decline, so you need to stimulate your brain in order to keep it working. If you don’t, it slows down and gets less sharp, so you have to adopt lifestyle changes to address these risk factors, and that can actually help your cognitive health and maximize your function and quality of life; and I know it’s not easy, but we can do it. 

    MICHAEL BUCKLEY: Yeah, that’s interesting. In your work in the programs that you’re a part of in Baltimore, such as MIND at Home and others, are there common steps or themes that help people be able to remain in their home and in their community? 

    DR. DEIRDRE JOHNSTON: Well, it always helps to have support, and sometimes people are fortunate in that they have family members that are there in the background that can … and also in contact with them regularly. There’s also … social connectedness is actually a big thing. Staying in touch with friends and family, even by phone, can actually help a person feel connected and function better. I had a 102-year-old patient—have her; she’s still alive. She’s 102, she’s got real mobility problems—but she calls and talks to her friends and relatives every day. She has a list of people she calls every day, and she chats to them. And she can’t leave her apartment, and she has multiple health problems, but she’s in contact with people every day, and she’s very alert; and I think that’s the thing that is actually keeping her alert: that she’s making the effort to reach out to people and talk to them. But that’s really one thing you can do. 

    MICHAEL BUCKLEY: That’s really admirable. Great advice always. And kind of to that point, Dr. Johnston, we just got a question related to the person you just mentioned. The listener says, “How do I deal with the depression and anger that comes from having trouble seeing things?” How does that … do you see that in your practice? 

    DR. DEIRDRE JOHNSTON: Yeah, I do, and dealing with any new challenge as you age, it doesn’t get easier, and it is common to feel defeated and to feel angry that you’re having to deal with this. And it’s kind of a normal reaction, really, to finding yourself facing something really tough. Through no fault of your own, these things could happen. And you can use a lot of energy being angry, and you can also suffer from clinical depression, which is treatable, actually, so if … and there’s indicators of clinical depression. It’s not just like being sad or upset—there’s a whole … there’s a pattern to clinical depression that we recognize, and we treat it, and there is treatment for it. So, if you’re feeling so depressed that you can’t function, then it is a good idea to talk to your doctor about that because that can be treated. Now, part of getting … part of dealing with depression is actually doing some of the things that I mentioned, like reaching out and staying in contact with people. Dealing with anger is a challenge, and sometimes the anger gets better if the depression is treated. Different people have different ways of dealing with things, but some people, instead of letting themselves get sad or depressed, they get angry, so it could be in the same spectrum.  

    However, there are strategies you can use to help you manage your feelings about your situation, and … you know, I’m pretty skeptical about … about things that I’m told are out there that can help people; I have to see the evidence. But it turns out there’s a non-medical … there’s a non-medical thing you can do, and it’s a practice you can do that can be very helpful to manage those feelings. And people who get into the habit of using this do it every day, and they report that it is very helpful, and the research that’s been done on it also confirms that it does help. So, it’s called mindfulness, and maybe some of you are familiar with mindfulness practice. So, I would strongly encourage anybody who’s struggling to deal with the feelings they have associated with this situation to look into mindfulness, and you can do guided mindfulness practice by following along an auditory … there are apps you can download. There are tapes you can get, and the guide will take you through the exercises to do daily to help you get control of your feelings and to help you feel better. And it gives you a tool you can use when you start to feel that things are just getting to be too much. So, there is a … there is a publication about that. There’s a … the leading practitioner is a man called Jon Kabat-Zinn, actually, and he has a number of publications, so if you’re looking for something to read about it, I would start there. There’s more, but I would start there, and I can give Michael that information for you if you want it. 

    MICHAEL BUCKLEY: That would be great, and we’ll have that here for folks who have questions. And Dr. Johnston, staying on that theme of mental health and anxiety, as you know, older adults with macular degeneration and glaucoma need to be, for the most part, on a pretty regimented schedule of doctor … in-office doctor visits and treatments. How … do you have advice for people that want to do the best they can for their vision health but parallel to that also have a lot of concerns over the last 2 years about the pandemic and maybe public transportation or being in a medical office building? Any recommendations for our listeners about balancing those two things: wanting to do the right thing for their vision health but also hearing 2 years of public messaging about a contagious disease? 

    DR. DEIRDRE JOHNSTON: It’s been a pretty scary couple of years for a lot of people, particularly if you had a health challenges to begin with. I remember when it all started, and we were trying to figure out: What on earth are we going to do? How are we going to make sure we take care of our patients? How are we going to see them, and what is the safe thing to do? And, of course, I had been doing telemedicine already, so I was able to start doing telemedicine right away, as many people did—as many providers did. So, it’s … you know, the decision to come in and see your doctor is a decision. Am I going to be more at risk? Am I going to be safer at home than I am in the doctor’s office? So, the telemedicine did help with that somewhat. There are some [inaudible] where you have to go into the doctor’s office that cannot be done by telemedicine, and you know, there are many treatments that people have to get, particularly with macular degeneration, that you have to go in in-person. Now, all providers have to follow a pretty strict protocol to minimize the risk of transmitting the virus, and I think you could always ask your doctor’s office what they … what they do, what’s required of them, and how they … how they make sure that they maintain their patients’ safety. They will tell you that. They will describe to you what they’re supposed to do. And it has eased up a little bit lately, and as long as you’ve been vaccinated and had your booster, you’re actually very much protected. It’s safer going now to your doctor and safer being around people. I wouldn’t go to any parties myself at the moment, but it is safer for us now. 

    MICHAEL BUCKLEY: That’s very reassuring advice. I know that at Johns Hopkins you’re involved with efforts to make sure that residents in the city of Baltimore and elsewhere get the services they need. I mean, what are you seeing in the last year or two about older adults, particularly maybe those with vision issues, getting help with transportation or maybe their caregiver’s getting some respite care or getting food, groceries, and meals? What are … how would you describe that … I don’t know, the current state of those challenges from your experience? 

    DR. DEIRDRE JOHNSTON: Yeah, some people have been very creative, and families have stepped up, you know? I have many patients who have not set foot outside their door for the past 2 years unless they absolutely had to, and their families have been bringing them what they need, and for them, that’s working out quite well. And actually, some of them are quite happy talking to me from their homes and not having to go out. Others miss being able to get out. Some people used to like to go to senior centers and other activities or to the Y or their gym. That was hard for people to do, you know, during the pandemic, but that’s starting to resume again. There is … there is a difference between what … everybody’s a little bit different, and everybody’s resources are a bit different, and there are some people who are more isolated than others because their families live at a distance or maybe they don’t have any close family members. It’s been … it’s been quite difficult for that group of people. And then, there are people, of course, who maybe can’t afford to get extra support for themselves, and that’s been a challenge for those people as well. There aren’t a lot of really consistent resources for people who have … who have need for support in their homes, and that’s one of the things we’re working on at Hopkins, is to build programs that help people who are older and in need of support to help them stay well. There aren’t enough of those programs around, but hopefully, there will be more in the future.  

    MICHAEL BUCKLEY: I agree. It’s tremendously valuable. In your experience over the last 2 years with the families you work with in Baltimore, how has the pandemic affected people’s mental health among older adults and those that may have some health conditions? How are your clients doing? 

    DR. DEIRDRE JOHNSTON: Yeah, that’s interesting. Like I said, I have some people who, actually, it didn’t adversely affect their mental health. They’ve managed to … they’ve managed to get through it, and without any recurrence of their anxiety or their depression, and those were people that tended to have more social support and were less isolated. Now, I have other patients, however, who had maybe underlying anxiety or maybe were somewhat more isolated or their situations were more challenging or unsteady, and they had more difficulty. I did have some people who developed an escalation of their anxiety and some people whose depression came back—actually, some people who became depressed after being treated for COVID, so that turns out to be one of the things that we’re seeing, which is another good reason to get vaccinated to prevent … to prevent yourself from catching it. So, people are amazingly resilient, really. For the most part, they have found ways to get through it without … without their depression coming back, but there are those who have more trouble. Yeah. 

    MICHAEL BUCKLEY: Dr. Johnston, on that point about mental health, we have a listener that is wondering: Why does anxiety seem to come in waves, sort of the good days and bad days? What accounts for those peaks and valleys? 

    DR. DEIRDRE JOHNSTON: Well, again, this varies from one person to another. If a person has an anxiety disorder, particularly lately, the anxiety isn’t far from the surface, and it doesn’t take much to tip you into that anxious state. Again, that’s one of those situations where it’s a good idea to look into mindfulness practice because that can help you manage that anxiety. But some people don’t experience a whole lot of anxiety at baseline—that’s just their personality. And some people have anxious personality types, and some actually have anxiety disorders. Anxiety can be a prominent part of depression, for instance, but that doesn’t usually come in waves; that’s usually fairly continuous if it’s a chemical depression. But even with a clinically diagnosable anxiety disorder, it can wax and wane, depending on the circumstances. I think, that’s as good an answer as I can give you without knowing the particulars. 

    MICHAEL BUCKLEY: On the issues of anxiety and depression, we know that sometimes that leads people to smoke or drink or use controlled substances in excess. But we also know that for macular degeneration and glaucoma and dementia, smoking is one of the greatest risk factors for your vision health and for your brain health. I was just wondering, in your experience, particularly during the stress of the pandemic, what do you … what are your experiences in trying to help people stop smoking not only just to protect their overall health but particularly for their vision health? What do you see in your experience? 

    DR. DEIRDRE JOHNSTON: Actually, that’s a very important topic. Substance and alcohol use has become an, actually, increased public health issue over the course of the pandemic because there is evidence that people are drinking more, they’re smoking more, and the stress of the pandemic—the isolation, the boredom, all of that—has led people to increase their consumption of substances that aren’t good for them. Not everybody but people who may be susceptible … have suffered in this way. I do work with people of chronic mental illness in the community as well, and we have a program going for the patients that attend our clinic—our community psychiatry clinic—to address smoking, and it’s a smoking cessation program, and we’ve been able to enroll many of our chronically mentally ill patients who actually have a very hard time giving up smoking. We’ve been actually making progress and getting them on smoking cessation programs and helping them … helping them getting off cigarettes, even during the pandemic. It says a lot for their motivation, and it says a lot for how connected they feel to our doctors and teams that are taking care of them, and it says a lot for their … their just determination, really, to be well despite everything that’s going on. So, for older people, smoking is more hazardous, of course, and for people with chronic health conditions that are adversely affected by smoking, it really is very harmful. But you know all that. Smoking cessation programs are effective. They work, and if you want to stop smoking, talk to your doctor about a smoking cessation program. There are various things that can be done, including medications that can be prescribed to help you stop smoking. 

    MICHAEL BUCKLEY: Congratulations on that accomplishment. That really, I think … really changing people’s lives. We’ve got another question about … related to mental health during the pandemic and just people living with low vision. Loneliness. Do you think that’s inevitable for people with … that are older or living by themselves or have vision challenges? Do you have any advice to combat that—to form or maintain connections with family and friends? 

    DR. DEIRDRE JOHNSTON: Yeah, it’s a thing that can happen to anybody, you know. Maybe you haven’t been well for a while. You drop some of your social activities, and it becomes more difficult to get to them—there may be physical barriers—and it can become a real effort to try to keep up with the things that prevent loneliness. So, yes. There are things you can do. You can find yourself actually depressed and lonely. I mean, loneliness can lead to depression in some cases. Sometimes, however, the other applies—people who are feeling depressed don’t feel like socializing. But that is something that needs to be addressed because social isolation isn’t good for anybody, and even though it may take more of an effort to reach out to people that you care about and friends that you may not have talked to for a while, it is worth your while to reach out and stay connected to people. Make new friends. I mentioned, I think earlier—or maybe I didn’t—but my mother-in-law is 93, and she is going strong, and her … what she says … her advice is, “Make friends that are younger than you, and then when you’re older friends pass away, you still have friends—you still have your young friends—and stay connected.” Even just for … just coffee or a phone call, a chat, you can … family updates or stories or books you might be listening to or reading, all of those things you can do these days with technology; it can help us.  

    I’m not recommending social media. That is one way people stay in contact and find people out there. Social media can be very toxic, and unless you’re in a group that focuses on a specific interest that’s non-contentious—and there are a lot of contentious interests out there that people are getting immersed in, and it’s really bad for their mental health—but some people like to crochet, for instance, and that would be a social media group you might … if you’re going to do social media, that would be the one to pick. Don’t get down the rabbit hole of all the other things you can get involved in. But stay using the media that we have available to us now to stay in touch with people who matter to you—the people in your life who matter to you—that will keep you healthy, and you’ll probably help them as well. 

    MICHAEL BUCKLEY: I see that. My mother lives alone in a rural part of the country with cold weather, and yeah, you’re exactly right. I can tell when she has been able to get together with people, either virtually or in person, and I can tell when that’s not happening. So, that’s tremendous advice. So, you talk about how to work through these loneliness challenges, and you certainly gave good advice about the smoking. I think one of the things that I hear in a common thread is resilience, and we’ve heard a lot about resilience in the last couple of years, and I think it’s one of those terms that you hear all the time, but people don’t exactly know what it means, or you know what it means, but it’s easier said than done. I mean, what do you see in your experience about … what is resilience and how does somebody get it and live it out? I would just address the topic for people. 

    DR. DEIRDRE JOHNSTON: Yeah, there are a lot of different definitions of resilience. You know, you’re right. It’s hard to know what’s meant by it. The one I like is “acceptance of reality, a sense of purpose, and flexible thinking.” And if you think about the three elements of that definition, those are tools you can use. Those are things that can guide you to developing resilience—recognizing the reality and accepting it—and that, again, goes back to the anger. Instead of being angry at it, finding a sense of purpose. Finding your sense of purpose again if you’ve lost something that was important to you, then finding meaning in your life again and making that a goal, and then keeping your thinking flexible. That’s one of the things that happens to people sometimes if they get sick or as maybe they get a bit older, a bit more isolated, they tend to get a little bit stuck in their thinking. One of the key things that can help you stay well and adapt is to be prepared to be flexible in your thinking. And as we get older, we do tend to … things become familiar. We don’t have to figure too much out anymore because it’s all familiar to us, and it tends to get comfortable, you know? But then things pop up that require flexibility in us, and it takes a conscious effort to recognize that you’re in a situation that requires you to take a different approach, to be open to a different way of addressing this situation, and it’s in your best interest to actually follow that recommendation and to learn to develop some flexible thinking and develop that muscle for flexible thinking. And you’ll feel— 

    MICHAEL BUCKLEY: That’s really important. I think when you mention that, honestly—admitting and accepting adversity and resilience and flexible thinking—to me, that brings to mind driving. In your experience in the community, how do you see driving—or more specifically stopping driving—affecting people’s sense of self-confidence and independence and resilience. It’s got to be a tough topic.  

    DR. DEIRDRE JOHNSTON: That really is a tough one, and it’s one of the things that I know people get angry about when they’re told they can’t drive anymore, and it is a terrible [inaudible] to know that you can’t … you know, you’re not going to be able to drive. How do you do the things that you normally used to do? How do you stay in contact with people? How do you stay independent? And it really is … it’s a big [inaudible]. However, again, it’s better to stop driving, of course, before something bad happens—it’s to be proactive rather than reactive—and this is, again, an example of flexible thinking: being willing to think a little bit differently than you usually do and be proactive and protect yourself from the adverse consequences of making unwise decisions about driving. But another … there’s a story I have about one of my patients. He called me one day. He haven’t been driving for a while, and he had a number of issues and impaired vision and couldn’t really drive, and he was in a nice retirement community. But he discovered … he had a smartphone, and he discovered an app that’s similar to Uber or Lyft. I don’t know if people are familiar with those but they’re great … they really are a great way of getting around. He found one that actually was … the app was simplified so that a person who wasn’t familiar with technology—and he was about 95—a person who wasn’t familiar with technology could use it. And he wanted to tell me that he had gotten this ride for himself. He went down to see a part of town that had all been renovated recently. He went and had lunch at a restaurant that had just opened there, and he used the app to call his ride to bring him home, and he was absolutely thrilled with this. And, of course, he had his phone with him, so if he got lost or anything happened … if somebody knew where he was, they could locate him through the phone. But he was absolutely delighted with this independence and made the most of it after that.  

    MICHAEL BUCKLEY: That’s great. What an inspiring story. I think the last question on that, on this whole topic of resilience: How do things like sleep and diet and exercise either help or hurt someone’s ability to be resilient during the pandemic and living with low vision? How do those factors interact? 

    DR. DEIRDRE JOHNSTON: All of those things are interconnected. Exercise is really important. You have to keep moving. Your body kind of seizes up, really, if you don’t keep moving, and we all know that if you’ve been sitting for a while and you stand up, everything’s stiff. You get out of bed in the morning and everything’s stiff. The temptation is to kind of give in to that, and just, “Oh gosh, it hurts to do that; I’m not going to do it.” And really, what you have to do when you feel that stiffness and the slowing down and your joints are a bit stiff when you haven’t moved for a bit is to get up and move because that keeps your body healthy, it protects your cardiovascular health, it protects your brain health, and it also protects your mood. It helps you stay well, and it helps you sleep better. So, sleep and exercise are very interconnected, and there’s a lot of evidence that getting more regular exercise as you age helps minimize cognitive impairment and helps maintain function for longer. So, I tell all my patients: get off the couch, walk around. Even if you’re sitting on the couch all day watching television, get up every 20 minutes and move. And it’s been hard to go outside, you know, with everything that’s going on, and people … there’s actually evidence that people have become more, what we call, deconditioned—weakened physically—by having sat at home for the last couple of years and not being able to go out and do the things they used to do. So, you really have to make a conscious effort to get yourself up and moving, and you don’t have to run a marathon; just get up and move. Obviously, if you can go for a walk, that’s even better, as you can go for a regular walk every day, and that is an opportunity to have social … a social event because you can go for a walk with other people, and that’s a two-fer.  

    The other thing is that sleep is really important, and some people get in the habit of maybe watching TV late at night or being on their iPad or their iPhone or whatever before bed, and even with impaired vision, those screens can interfere with your sleep/wake cycles, so you’re better off to stay away from them and have a quiet bedtime routine away from screens and relaxing an hour or so before you go to bed. There is evidence that sleep and cognitive function are interconnected, and in fact, it’s been discovered that while you sleep your brain actually is working. It’s clearing out toxic byproducts of neurotransmitters that are broken down, and it actually is thought to maybe reduce some of the amyloids that can build up when people develop dementia. So, getting some sleep … it’s not a luxury to sleep, but it feels like it sometimes if you don’t sleep well, but it’s a necessity. So, if you’re sleeping poorly, the key is to have a structured daytime routine. Get some daylight—even if you have impaired vision, get some daylight—because the daylight can actually help set your circadian clock, so to speak, and can help you sleep better. And the exercise will help you sleep better.  

    Now, food … they say food is medicine, and I agree. Again, it’s been hard for some people to maintain healthy diets because it might be hard to keep fresh food in the house if they can’t get out, and that’s a real issue for a lot of people. I would say avoid fast food as much as you can. Try to learn what you can about foods to … foods you enjoy that are good for you, and I totally am opposed to diets and all that sort of stuff. I think that … and I also think that it’s awful to feel deprived. So, doctors often tell you, you need to lose weight, you need to avoid this, avoid that. And what I prefer to think about is, “Okay, what can I eat that I like that won’t hurt me?” And, you know, you’d be surprised. There’s a lot of stuff out there. There’s a whole other … there’s a whole other topic that I think is worth pursuing. But you could change your taste for food as well. You can change … you can change your palate to finding foods that you actually didn’t think were so nice that actually maybe aren’t so bad after all and that you actually quite like. And I’m not talking about eating celery sticks or carrot sticks all day, you know? There’s a long way between carrot sticks and a McDonald’s cheeseburger, you know? You know what I mean? So, it’s worth searching for that. 

    MICHAEL BUCKLEY: I appreciate that. Dr. Johnston, as always, it’s just so rewarding to talk with you. These topics are so important, and you’ve given us a lot of really good specific advice. I just wanted to conclude today by asking you: Are there any great lessons you’ve learned over your career or one recurring piece of advice you’d like all of us to know? I was wondering if you could just, sort of, conclude with some overarching advice to wrap up today’s conversation. 

    DR. DEIRDRE JOHNSTON: You know, I think people are often more resilient than they give themselves credit for, and people can often change in ways they didn’t think they could. So, the piece of advice I would give would be to keep moving; keep learning; keep your brain open, keep it open to ideas and flexible; and keep engaging with activities and with other people in whatever way you can. And lastly, avoid smoking, and don’t drink to excess and other substances as well. Take care of yourself. 

    MICHAEL BUCKLEY: Thank you. This has been a great conversation, Dr. Johnston. I appreciate you taking the time to be with us today, and it’s great to hear about work that you’re doing in Baltimore; and I think a lot of that work and your observations and lessons apply to people all over the country. It’s been really good to hear that.  

    Again, on behalf of BrightFocus and all the listeners, I just want to thank you for not only for what you do but for taking the time share it with us today. 

    DR. DEIRDRE JOHNSTON: You’re very welcome, Michael. Thank you so much for inviting me. 

    MICHAEL BUCKLEY: On behalf of BrightFocus Foundation, this concludes today’s BrightFocus Chat. Thank you very much for being with us today. Goodbye.

This program is supported in part by educational grants from NovartisGenentech, Delta Gamma Foundation, Apellis, and Alexion.

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