Bob Cayne's  WHY IS THAT?​ Archive



                                                             DNR IS IN OUR DNA
June 16, 2018  When you drive to work or the store or where ever, after you reach your destination, have you wondered how you got there? You forgot because you were on ‘automatic pilot.’
A while back I sat at a red light admiring the scenery, maybe daydreaming. When the light turned green I just sat there––I drew a blank, forgot where I was headed.
Maybe I forgot to aim when I left home.
I’m convinced that Do Not Remember (DNR) is part of our DNA.
I’ve spent decades drawing blanks and it has nothing to do with dementia, a very serious subject. I always snap back from my foolish actions. Dementia patients do not.
I have a theory: Scientists know our DNA contains DNR but they won’t tell us. And it increases as we age. In time, it takes over––just ask grandpa
After the red light thing happened I laughed. It was no big deal I was headed for the barbershop. I only get a haircut every five or six weeks so I gave myself a pass. 
Editor’s note: He has gone to same barbershop since 2005.
I even turned left out of my driveway when I should have turned right that day. My absentmindedness varies.
Give me a break I’m between social security and death. My DNR dates back to my teens. I was fourteen years old. I loaded a toothbrush with Brylcreem. OK, I wasn’t paying attention that time, but it might qualify as an early warning.
I walk into rooms and wonder why I’m there. I’ve even lost track on my way to a room. 
Cooking is a passion of mine but it loses its luster when I stare blankly at the refrigerator’s contents because I can’t remember what I'm looking for.

One final theory: Excessive DNR leads to fake hearing loss. Your spouse yells, “Where are you going?” You pretend you didn’t hear her because you don’t know. Or you fake it because the last time she asked you answered, “To the basement,” and she came back with, “You’re going the wrong way.”
Sometimes you just can’t win.


THE JOY OF SILENCE

June 1, 2018
“How wonderful it is to be silent with someone.” – Kurt Tucholsky
“Button your lip!” - My Dad
We have funny ways of remembering things. The first quote reminded me how satisfying quiet times are. Then the second quote (which after decades remains a lesson to be learned) came to mind.
That aside, the joy of sitting silently with someone you love and admire ranks among the top-ten joys of my life and is the reason for this column. There is immense comfort when I look across the room and see my better half quietly engrossed in a book or working on her laptop. The image never loses its luster. We can be engaged in different activities yet an unspoken bond permeates the room.
How many people are lucky enough to have a similar experience? The complicated world we live in makes a quiet oasis all but nonexistent. Take heart if you are caught up in the swirl, be patient, the golden years will reward you. That’s my vantage point.
Aches and pains aside, the greatest luxury of retirement is togetherness. Surprisingly sharing a box of Kleenex is pretty good, too. It is okay to cry. We cry together wiping away tears of pride, sadness and sentimentality––scarcely uttering a word. Our strength of union is that strong. We watch Undercover Boss just to get to the end. Our tears flow because the employees get unexpected rewards. After that we turn on Curb Your Enthusiasm and scream with laughter.
It’s amazing how much passion, wisdom and understanding a lifetime brings. We have incredible conversations, lest I’ve led you to believe otherwise. We are partners in every sense of the word.
We rarely go more than a matter of minutes without smiling, giggling or laughing out loud. I covered that in last week’s column: Laughter is the Best Medicine. A sense of humor beats anything Walgreens dispenses.
Ah, the joys of togetherness. You’ll know you’ve arrived when your heart rate quickens.


                                         LAUGHTER IS THE BEST MEDICINE
May 26, 2018 A sense of humor is better than anything Walgreens can dispense. 100 percent guaranty. Just hang a TV screen over the prescription counter showing a George Carlin comedy routine and see how many customers forget they’re there to pick up a prescription.
It’s amazing how a little amusement can reduce stress, fight depression and adjust attitudes. You have to wonder if the FDA has researched the soothing effect of a good punch line.
We are daily victims of morbid news, utter chaos and vicious backbiting. I buck all that by hunting for humorous nuggets–they are my focus. If somebody says, “You make me laugh,” it’s like being awarded a bronze star.
When the chips are down laughter trumps medicine. One time in pre-op before a serious operation my surgeon was late so I spent the time bantering with the nurses and orderlies. A lady in the next cubicle overheard our conversation and said, “That man must be frightened, he never stops talking.” Heck, I was having fun. Before long the surgeon breezed in, handed me a clipboard and said, “Sign this so I can prove I didn‘t drag you in from the street.” Everybody laughed. Then he asked if I was ready to go into surgery and I nodded yes. “OK, he said, “the nurses will wheel you to the operating room and I’ll go oil the chainsaw.”
How’s that for relieving tension? An injection from the anesthesiologist helped, as well.
Speaking of anesthesiologists, on another occasion they wheeled me into surgery and I couldn’t believe what I saw. I was in a rather small room lined with metal shelving. My immediate reaction was, “Good grief, are you operating on me in a cheesy storage room?” That’s all I remember. The anesthesiologist had me off the air like I’d been tasered.
Medical professionals are under the gun to limit the amount of time they spend with patients because the administrative burden takes up two-thirds of their time. But many are good conversationalists and you will find they often have a good sense of humor. So try to engage your doctors with relaxed dialog. The time spent may be worthwhile.
If you’re at a loss for a conversation starter, tell your doctor you have a good stock tip: Buy American Thermometer. It’s selling for 54, but if you stick it up your butt it’ll go to 98.6. ​


HEY, THE STONES ARE BACK AGAIN

May 18, 2018  If you have Ticketmaster on the phone, hang up. This isn’t about a rock group coming to town although it does involve screaming, writhing and acting like a maniac.
The headline should read: WHAT LOOKS LIKE GRAVEL, FEELS LIKE BOULDERS AND HURTS LIKE HELL?

The answer: kidney stones. If you’ve had them you know what I mean.
Kidney stone attacks come on as abruptly as a pie in the face … but lower. I was walking to my car on a lovely summer day when I felt like I’d been stabbed in the abdomen. My first thought was appendicitis; the pain was on the right side. I called our family doctor and explained what happened. He said, “Appendicitis comes on slowly, you have a kidney stone. Go to the emergency room.” 
That was 40 years ago. There was one stone, it was small and I was able to pass it at the hospital. Since then I‘ve manufactured enough gravel to pave a driveway. Mine come in bunches so passing them is out of the question the screaming would go on for hours. I opt for immediate relief.
Kidney stones are jagged little rascals––often calcium-based. They are painful when they move or block a passage. If a stone sits quietly in a kidney it poses little, if any problem, but once it enters the ureter on its way to the bladder, brace yourself.
An outpatient surgical process called lithotripsy that uses ultrasound shock waves blasts kidney stones into small particles. One surgeon gave a few to me in a pill bottle as a parting gift in post-op.
There are other procedures to remove stones using instruments and telescopes. Sometimes stents are used to dilate the ureter to help urine pass. The stent is removed during an office visit by the surgeon without sedation. So there is no earthly reason to discuss the process here.
Women say the pain is worse than giving birth. Men are positiveit’s more painful. May you never know the difference.


THE BIG BOX EFFECT

May 11, 2018 Recently I had an appointment with my ear, nose and throat specialist to cauterize a chronic nosebleed. He was particularly chatty as we waited for the numbing agent in my nostrils to take effect. He talked about his thriving practice in a rural setting back east and how his specialty training had served families across three generations.
I imagined him cauterizing a kid’s bloody nose, curing a sinus infection or surgically repairing a deviated septum as the child entered adulthood and eventually treating the next generation. His pride of accomplishment and affection for his patients was indisputable.
Then his tone changed. “One day,” he said, “a health insurance company began calling on large companies in the area and offered their employees reduced-premium health insurance.” The only catch was the providers who accepted the insurance were on a proprietary list. “And I wasn’t one of them.”
On one hand the insurance company thrived by cherry-picking big businesses. Hundreds of employees benefitted from lower premiums. On the other hand before long the doctor’s practice was on the ropes. 
His story seemed to parallel that of a big box store appearing on the scene to the detriment of mom and pop retailers who are forced out of business.
“Can you imagine the decision my wife and I had to make?” he asked. His medical practice was riddled by the exodus––so much so that they decided to sell the practice and move their family across the country. Unfortunately that isn’t as easy as it might seem. “Years ago there were young doctors eager to buy a practice. Now potential buyers are scarce. They point to a chair and say, ‘I’ll give you twenty dollars for that.‘ Besides, my equipment was 15 years old and the cost of crating and shipping it wasn’t practical.”
The doctor and his wife had been to Arizona and the idea of living where the sun shines abundantly put a positive spin on the relocation process. Besides, greater Phoenix is rife with sinus and nasal conditions. I’m a prime example.
So here he is, well established in north Scottsdale and eager to tell his story. He goes back east for a week every few months to help take care of patients and extend friendships. That, too, is a good thing.
Before leaving I asked, “Are your children happy about the move?” He grinned. “We can’t get them out of the pool.” All’s well that ends well.


GREEN FOREVER

May 4, 2018  Some of my older friends (those between social security and death) frequently obsess about the finality of life. Such was the case during a social lunch with Gloria (not her real name).
Gloria and I were chitchatting, catching up about this and that and solving the world’s problems. The conversation was as far from discussing death arrangements as one can get when Gloria came out of left field with, “ What do you think about ‘green’ funerals?”
I pinched my nose to block a swig of iced tea that was on its way out.
“I’ve never heard the term,” I said wiping my face. “What’s a ‘green’ funeral?”
“You may not realize this,” she said, “but ordinary American burials involve chemicals like embalming fluids that end up in the ground. Green or natural funerals are environmentally friendly.”
I get queasy about morbid discussions, especially while dining and it made the sauce on my pizza taste like it came from a lab. I quickly changed the subject. “You’ve given me a homework assignment,” I said, “I’ll read up on green funerals. By the way, how is your salad?”
“Quite green,” she replied and we had a good laugh.
A good bit of my psychology career was spent in palliative care, yet the green burial subject never came up. Gloria gave me new information to consider.
I learned that green burials conserve natural resources, reduce carbon emissions, preserve and restore habitats. Each year traditional burials include 20 million feet of wood, 4 million gallons of embalming fluids, 1.6 million tons of reinforced concrete, 17,000 tons of copper and bronze and 64,500 tons of steel. 
Good grief. Who would have imagined that?
The Green Burial Council, a nonprofit, encourages environmentally sustainable death care and 54 percent of Americans have expressed interest in exploring green funeral options and their lower costs.
There are other ways to preserve a body such as dry ice or a nontoxic agent, but the most environmentally conscious move is to pass on embalming altogether.
I believe in donating one’s body to science and medical research. Give hope to future generations. There is a no cost program for final arrangements. For more information visit www.sciencecare.com


WHAT'S YOUR GOAL?

April 28, 2018 Do you set goals? Not goals to eliminate negative thoughts, feelings or life situations. I’m talking about realistic goals. For example, a goal to relieve stress by improving the way you respond to negative situations and events.
If you aren’t goal oriented think about stress management… way you can reduce stress.
Begin by confining yourself to today’s problems. Adding infinite battles from yesterday or speculating about tomorrow complicates life.
Evaluate the tension in your body. Check your posture. Do you feel tension? Rotate your neck, flex your shoulders and check your back.
Tension stems from exhaustion. Neither your mind nor body can relax. You may be disheartened by the truth, frustrated at a circumstance or overwhelmed by what lies ahead. You may be overthinking things you should have done. Mental exhaustion creates anxiety. Before long your body feels like an ironing board … a folded iron board.
So change the way you respond to things. Down shift your mind; get it out of overdrive. Instead of struggling and resisting change set goals to achieve peaceful acceptance. Remember, psychological problems are at the root of physical problems. Relax. Take a soothing hot bath; get a massage do a few exercises to get the kinks out. Pretend your body is a noodle. 
Wouldn’t it be nice to wake up in the morning with a smile? Happy about the things you were thankful for when you went to bed? Be appreciative for your health, family, friends and your home. In times of uncertainty keep the basics in perspective. You are alive. You are loved. You can breathe.
Every thing is relative. Let your enthusiasm rise from the doldrums. Be appreciative. 
Feel like that and your friends might think you are wealthy and privileged. 


                                       IF YOU CHANGE NOTHING, NOTHING WILL CHANGE
​April 21, 2018 I’ve known intelligent, successful people who say they are uncomfortable, always searching for something new: a new relationship, a better income opportunity or a distant place to relocate. But when the ideal opportunity surfaces––it’s there for the taking––they stall, afraid the change may be painful, cause rejection, or lead to failure. They turn their backs on the possibility of comfort and happiness and continue having pipedreams. People do it everyday. 
Please, avoid such a rut.
There are always positive change opportunities, but for many of us change represents uncertainty that leads to insecurity and fear. Change isn’t easy to deal with, but it’s something to embrace openly. Put on a smile, even if it’s forced, put your head down and plow forward.  
We desire change as much as we fear it. We say things like, “I’m unhappy in my marriage, but I'm afraid of being alone.” Or, “I’m sick of spending my days in a corporate cubicle, but I make decent money.” Or, “I can’t stand home ownership, it’s the pits, blah, blah, blah.” You get the idea. 
So we resist change and wind up stagnant, holding on to what a vibrant future begs us to release. Change is part of life. Whether you like it or not, some change happens with or without your approval (death, divorce, or disability). Life has a way of forcing us to change.
Here are signs that it’s time to ditch the rut:
When you find yourself romanticizing about the past to escape the present. 
When you feel numb because you’ve lost passion and motivation. 
When you resist good opportunities out of fear. 
When your current situation doesn’t support your growth potential. 
When you lie to yourself and others to avoid the truth. 
When your relationship feels superficial. 
If you settle for less than you deserve, repeat this mantra: 
‘I do not settle; I am worthy of my desires.’ 


FIRST RESPONDERS

April 13, 2018 Tragedy struck one night on a hazardous Arizona highway. A woman’s car was hit almost head-on by a SUV. She grabbed the steering wheel and braced for the impact when her car crashed into the mountainside. The SUV carrying a young family of five on their way to the Grand Canyon flipped on its side slid over the cliff and plunged more than 500 feet.
The woman couldn’t recall any of the events for several days. She didn’t remember the first responders who arrived in near-record time, the ambulance ride to the emergency room or being hospitalized for over a week with a severe concussion and broken bones. She had no idea who contacted her family or how they happened to be with her at the hospital. “Who were those responders?” she wept and expressed her gratitude when told of their dedication to medical emergencies.
Medical Emergencies cover a lot of ground from bee stings to trauma cases, childbirth to cardiology. The emergency medical technicians (EMTs) and paramedics who are dispatched to answer 911 calls are an incredible breed.
These front-line people provide immediate care. They are capable of caring for and resuscitating patients going into cardiac arrest, saving people from burning buildings, car wrecks, terrorist attacks, shootings, stabbings, domestic assault, strokes, seizures, overdoses, immobilizing injured people and, yes, even dog bites. First responders deserve a medal for versatility, if nothing else.
Paramedic is the highest level of EMT certification. They perform advanced life support (ALS). They administer IV fluids, injections and medications, and perform advanced respiratory procedures. They are also skilled in basic EMT functions: treating wounds, performing CPR, delivering babies, performing patient assessments and inform hospitals of patients’ conditions.
Rescue teams usually have a paramedic as the lead member since they have the most training and decision making power. Their leadership skills include the ability to perform complex life-saving functions in extremely stressful crisis situations.
In many cases the team also sees if the spouse or children need assistance and notifies family members. In celebrity situations they protect the patient’s privacy.
First responders are physically fit. While EMTs don’t have to bench press a Chevrolet, they do have to lift and transfer patients to a stretcher and control defiant patients. 
Today’s column is a thank you note to first responders who work day and night, weekends and holidays. Your proficiency and dedication, often times your anonymity, is warmly appreciated.

​​

BRACE YOURSELF

April 6, 2018 Okay, I admit today’s subject is delicate––even the photo is a turnoff––but listen up. If the ailment doesn’t apply to you I’ll bet dollars to donuts that people close to you cope with it.
Is this about Inflammatory Bowel Disease (IBD)?
Yes, I was diagnosed with Crohn’s Disease in 1989. I’ve lived with it for 29 years. I can tell you the closest parking space to the men's room at every Arizona resort, and I only patronize the best.
IBD is no laughing matter, certainly not at first. Tell your primary care doctor that porcelain is your best friend and you’ll be referred to a gastroenterologist who will run a TV camera up your keister and call it a colonoscopy. In 1989 they didn’t sedate me like they do now so I watched a monitor as the camera snaked through what seemed like the I-5 and CA-163 interchange. Or maybe I was watching the Travel Channel.
A word about preparation––it’s okay to joke about these things because laughter beats anything Walgreens dispenses. Well, except the stuff you use to “prepare.” The day before the procedure you clear the runway by drinking a cocktail manufactured by a company that makes incendiary bombs and await the result. The team of chemists who concocted the recipe included an element of suspense: nothing happens right away. That’s just enough time to grab an armload of reading materials since you’ll ride the porcelain for two hours. I passed cotton candy that I ate at the circus when I was a kid.
Now, all of the above aside, if you have IBD symptoms you will know you are ill. The toilet paper in the suitcase photo will only last a week, and you’d be anemic. A routine colonoscopy for people over age 50 also screens for colorectal cancer. If you have the dreaded disease how would you know? Colorectal cancer is the second most common cancer and cause of cancer deaths in the U.S. Catch it early before it spreads. Detection and treatment is important.
Trust me, the colonoscopy part is a cinch. You will be sedated. One anesthesiologist said, “Count backward from 10,” and I was off the air by 7. The hospital gown is the only bad part. Pre op looks like Gucci’s hosting a trunk show for their Exposure Collection.
Now, please roll over on your left side. 


WHO'S IN CHARGE? YOUR MIND OR YOUR BRAIN?

March 31, 2018 If you follow postings at www.letsfaceit.care you’ve probably seen links to brain research stories that include photos and drawings. Your brain is a physical entity and the center of your nervous system.
Then there is your mind. No pictures or diagrams here, nothing to see––just the moods, emotions, instincts and judgments that you experience all of which control your brain. Your mind is the court of last resort––the final word.
Having said that (not a good way to begin a sentence) your mind is capable of lying to you. It may make excuses and at times try to convince you not to take actions that are in your best interest. In other words, your mind may prevent positive changes from taking place.
Your mind wants you to be comfortable and when we stretch our comfort zone too far or too long it tries desperately to get us back to ground zero––at any cost.
Here are three ways your mind acts as a deterrent:
“Marie Osmond lost 46 pounds. Hey, it’s easy, she has people cooking for her and money to buy diet food.” This kind of mindset creates a negative thought about something positive.
"Life is supposed to be easier and enjoyed more." Of course life should be enjoyed. But sitting on the couch all day eating Fritos is lazy behavior. The path of least resistance is usually the path of least reward.
"I’ll get to it later." Care to bet? You can always do it later, but your later self will feel exactly the same way. Think about it: Why will you be more disciplined then?  You know you won’t be.
The good news is your mind has extraordinary positive effects on your brain when they compliment each other––like when you do something creatively or have an idea that turns out to be productive. As Nike says, “Just do it.”
Keep a pad and pencil on the nightstand. You might get a brainstorm at 3:00AM. Or would it be a mindstorm?


SHOULD GOLDEN AGERS WEAR FITNESS TRACKERS?

March 23, 2018 Today’s topic is: Should Golden A Wear Fitness Trackers? Admittedly a weird spectacle, if ever there was one.
Editor’s note: He’s an octogenarian, and he wears one.
In the old days I thought the watch I’d worn for 40 years was everything I’d ever need. But you can’t beat a Garmin Vivosmart HR’s razzle-dazzle features like heart-rate monitoring, step counting, stairs climbed, sleep tracking, inactivity alerts, weather forecasts and music controls.
Right off the bat the sleep tracker came in handy. I sleep, nap and nod almost continuously. My Garmin needs a Tesla battery just to stay charged. When I’m off the air the four-hour tracker looks like a flat line. It doesn’t blip when I get up to pee, which is a problem.
The step tracker feature comes in handy because it “dynamically adjusts your goals based on your achievements.” I already know my goals: 37 steps to the refrigerator and 45 steps to bathroom. Multiply those by 6 times and you have my daily goal. But I do other stuff, too––like grocery shopping. I was disappointed the day I walked up and down every aisle to get extra credit and found out that steps are measured by arm swings. I was holding on to the cart.
There’s a stairs climbed feature but I don’t use it. Are you kidding me? I live on the first floor. I get the GOAL signal by stepping up a curb.
The Garmin is waterproof to 50 meters––overkill for a guy who avoids puddles––but I do wear it in the shower. Who knew I’d be able to tell time when I wash my knees? The first couple weeks I kept hearing music in the living room when I left the shower; iTunes was playing on my iPhone. I was stumped because I don’t listen to music on my phone. The user manual doesn’t cover melodic showering, so that didn’t help. It turned out that my tracker and iPhone are synced. As shower water hit the tracker it advanced the features and once in a while it turned on the iPhone’s iTunes feature. You can disable the feature but if you sing in the shower it comes in handy.
All things considered, I say phooey to naysayers who think golden agers wearing fitness trackers look silly. Oh, there might be a few snickers at the physical therapy gym, but so what?
By the way, upgrade if Garmin comes up with a shuffle tracker. How handy would that be at night? 


THE GOOD OLD DAYS

March 16, 2018 I’m long enough in the tooth to compare the medical profession decades ago when I was a snot-nose kid to what it has morphed into today.
EDITOR’S NOTE: The following has nothing to do with senility, but we’re not entirely sure.
Things change rapidly. In my lifetime the black Ford sedan with running boards and big white sidewall tires that took our family on weekend picnics turned out to be the prototype of a rocket that takes nut cases to Mars. Granted, going to Mars is no picnic, but you get the idea. Over time, little things get complicated.
Our family doctor, B.A. Temple, MD, we called him Doc, handled everything. If you busted a finger, had an ache, affliction or disease he was your guy. He’d open the examining room door; approach me and say and “Well, let’s see if you’re worth saving.” If he looked puzzled, and he rarely did, you were sunk.
If Doc Temple was around today he’d cure nagging problems with ‘green pills’ that he kept in a gallon jar. “Those suckers,” as he liked to say, “can do anything except kill rats and prevent childbirth.” At the end of an appointment he handed me an envelop of green pills. I suspect he gave them to people who were just there to pay a bill.
I miss Doc. Recently while engrossed in an interesting book I discovered that I exhale when I turn the page. Grab a novel and try it, you’ll see. Then again, maybe you won’t. It’s barely audible unless you hear a wheezing sound in the back of your throat, like I did.
The book was about cops, detectives and forensic specialists in a frantic crime scene investigation and I was really into it when when I had a coughing jag and lost focus.
Doc Temple’s not around. I wasn’t sure what to do. Should I check to see what’s in the medicine cabinet? Do a Google search? Call my primary care doctor and wait a week for an appointment? Call a specialist and if so, which one? Go to urgent care or the emergency room? Dial 911?
I’m a one-stop shopping guy so I went to the nearest hospital’s emergency room. After a chest x-ray, EKG and other testing the diagnosis was acute bronchitis with bronchospasm. I’ll give 8-5 odds that the AMA waited till George Carlin died before hanging that tag on a hacking cough. Carlin would do a 20-minute routine and we’d be rolling in the aisles.
Meanwhile, Doc Temple would have said I have “the crud” and knocked it out with green pills and a bottle of his ‘white lightning’ cough syrup. The emergency physician prescribed a synthetic corticosteroid drug and an albuterol inhaler.


CONFUSED OR AGITATED?

March 10, 2018 Agitation. Confusion. Imagining things. Do any of those words strike a familiar note?
They are common symptoms of dementia. They are also signs of delirium, a dangerous but treatable condition.
If you care for an older adult recognize the difference: Delirium is a medical emergency that needs immediate evaluation and care.
Not all healthcare workers are familiar with delirium symptoms. As a family member you may be the first to spot the problem.
At first glance there are similarities.
Delirium patients may be agitated––even paranoid––due to confusion and hallucinations. They may also be quiet and withdrawn, or dazed. Some patients may have ‘mixed delirium’ rapidly switching from dazed to upset or euphoric, and back again.
There is a telltale difference between the two conditions. Dementia develops and worsens over months or years. Full-blown delirium episodes are abrupt––they are apparent in a matter of hours or days. Delirium has red flags: a rapid onset of symptoms, an abrupt change in behavior or frequent changes in mood.
Whatever the new behavior, there are noticeable changes that include confusion, memory lapses, anxiety or lethargy, garbled speech and a seeming inability to pay attention to what’s happening.
The exact cause of delirium isn’t known. What doctors know, based on their own observations and patient cases, is this: severe or chronic medical conditions can trigger delirium. Medication, changes in diet and infection may increase risk of a delirious episode.
In older adults, urinary tract infections, fevers, dehydration, poor nutrition, pain, metabolic imbalances, alcohol, exposure to toxic substances, extreme stress and sleep deprivation may be the culprits.
Holiday activities can result in confusion. Gatherings, unusual visits, travel, stress, missed medication, even food allergies. Holidays are often such a departure from the norm that we find them exciting, rewarding and motivational. Then we reach our sixth decade and it is best to begin a transition. We may not be able to do everything we used to do.
Think about your capabilities. Establish a safe zone. Then embrace the best things in life that are available to you.


                                                             THE DREADED HOSPITAL GOWN
March 2, 2018  HuffPost: “On January 11, 2018, officials at a Maryland hospital were investigating the situation of a discharged patient captured on video incoherently wandering a frigid street in only a hospital gown and socks, as several people in uniforms looked the other way.”
Naturally, I watched the video.
A therapist saw workers wheel a female patient out of the hospital and leave her at a bus stop. A bus stop!
It’s hard to imagine the indignity the poor lady went through. I blush when a medical procedure begins with, “The opening goes in the back.” They have to pry me out of the dressing room.
Are wide-open gowns all they make? Does my ass have to be on display before, during and after a procedure? Where is the fashion industry when we need them?
I examined the situation, as a public service.
Patient gowns are a $76 million business. They cost $2 to $3 each. Who would have guessed? You’d think they’d be under a dollar. The twill-tape tie must run the price up.
There have been several upgrade attempts. The College of Textiles at North Carolina University took a shot at it. They plowed through a $263k grant and spent two years fumbling around. Meanwhile, gowns where I live in Arizona still have a bay window.
Hackensack University Medical Center went for broke. They hired Nicole Miller to fix the rear view problem. That gave me hope. I delayed an MRI in case her design makes it to Phoenix.
Amid a rising tide of patient complaints Cleveland Clinic CEO Toby Cosgrove commissioned Diane von Furstenberg who submitted a wrap design with a full drawstring and snaps down the sides that offer patients “full coverage in the front and back.” Ta-da.
That gave me even more reason to anticipate a concealed future.
But none caught national attention because designer solutions are expensive. The medical community refuses to pony up to protect our dignity. Really? Like charging $35 for an aspirin isn’t enough to cover the added cost?
At least imaging venues don’t marble benches. Otherwise it would sound like an audience applauding.
For $263,000 couldn’t they just move the opening to the side?

                                                             

                                                     HOW SAFE IS YOUR SCHOOL?
February 22, 2018  Looking for answers on what needs to be done to secure our students in the wake of the Parkland, Florida tragedy? Look no further than the Lakota Local School District in Cincinnati, Ohio.
In an open letter to the Lakota Community, Superintendent Matthew J. Miller talked about safety initiatives that have been implemented in recent years to protect the students and staff.
“Some aspects of our district safety plan are visible to the public, while others are not,” he said. The schools have safe and secure entrances. There are strict procedures regarding how visitors are admitted. Lakota increased the number of uniformed members of the Butler County Sheriff’s Office and the West Chester Police Department. Their visible presence allows them to build relationships with the students and become another trusted adult to confide in.
They continue to investigate and introduce new protocols––several that will be announced in the coming weeks. Staff and student training takes place all year long––natural disaster drill for fires or tornadoes. Lakota uses ALICE (Alert, Lockdown, Inform, Counter, Evacuate) training about what to do in the event of an intruder.
Students’ health and well-being is part of safety and security. Lakota pays attention to social and emotional needs by continually expanding mental health services. Their partnership with Mindpeace, a non-profit advocate for access to high-quality mental healthcare is in place in high schools and will be in junior highs next year.
Grant Us Hope is another Lakota partnership. Hope Squads, peer-to-peer suicide prevention groups encourage students to “see something, say something” when concerns arise about fellow students. The concept is tested regularly regarding questionable social media posts and is encouraged through the Text-a-Tip program in partnership with local law enforcement.
“The work never stops and safety plans are never finalized,” Superintendent Miller said. “Safety protocols are reviewed regularly by a district safety team which consists of district administrators, all of our School Resource Officers, a member of our school board and representatives from our local law enforcement agencies.”
Lakota’s safe education practices might be worth national attention.


WHO ARE YOU?

February 17, 2018 Who are you? How well do you understand your character, feelings, motives and desires? I’m asking because if you want to better understand others, you must first understand yourself.
Get to know the different parts of your own personality, your tendencies and patterns. That’s called emotional intelligence; it helps you navigate relationships and the way you connect with others.
Self-awareness improves your ability to infer the mental states of others, a skill known as ‘theory of mind’ or empathy. Self-awareness and empathy are intimately connected. Once you are aware of what makes you who you are, you can understand differences between yourself and others and what makes them tick.
Not surprisingly, both self-awareness and empathy are considered to be two of the main pillars behind emotional intelligence. Empathy is technically other-awareness––the counterpart to self-awareness.
Empathy is not just about the ways you are similar to others, but how you are very different. It’s impossible to empathize if you think everyone is like you. If you don’t understand another perspective you project your perspective onto them.
If something is unimportant to you, closeness to a pet, for example, it will be difficult to have empathy for a person who has lost a pet. You may feel sorry for your friend’s sorrow but empathy isn’t in the mix.
You hear peoples say, “I feel your pain” when they try to empathize. But if they haven’t been in the same situation they can’t feel the pain. Sympathy is different than empathy.
Here are 5 effective ways to begin improving your self-awareness. Practice them often, even in the car:
Meditation
Personality Quizzes (on-line everywhere)
Contemplation 
Roleplaying
Talk Less Listen More (really)

DAILY ACHES AND PAINS

February 11, 2018  Daily aches and pains are part of growing old, but I needn’t be reminded of my advanced age. It’s not necessary to ask me if my favorite movie is The Great Train Robbery.
I play competitive bridge with golden agers who pass time discussing their medical problems and emergency room experiences. They told me about cataracts before I had them, trifocals before I needed them and a handicap-parking permit before I wanted one. What’s next, comparing bypass scars?
Once in a while I run into a crony at the supermarket or on the street and get a blank stare. I might say, “Hi, I’m Bob Cayne, you were at my bridge table last Wednesday. Nice to see you.” It usually triggers a smile and a LOUD response, “BOB CAYNE, I REMEMBER BOB CAYNE.” That means the old geezer is congratulating himself; he remembered me.
I had lunch with three friends not long ago. The waitress brought lunch and said, “Jim?”
My friend raised his hand and said, “Over here.”
I told him, “No, she said Jim–you’re Tim.”
Speaking of lunch, a noontime conversation was mostly small talk until the food arrived. After a few bites Wally, an elderly gent, wiped his chin and said, “I’m doing something interesting.”
“Tell me about it,” I said.
“I’m taking falling lessons.”
I look at the humorous side of growing old. We kid each other about things like hip replacement surgery, memory lapses, and so forth. My late friend, Dick, who I knew for many years played golf regularly into his 70s. But his game deteriorated, it wasn’t like he thought it should be, so he decided to seek help. He asked the club pro if he could schedule a lesson. The pro asked, “A half hour or an hour?”
Dick said, “My attention span is about as long as that of a two-year old. Anything over five-minutes is a waste of time. I’d forget what you taught me.”
He thought for a moment and asked, “How about a series of 12 five-minute lessons? I’ll pay you for an hour.”
The pro agreed, and it worked. Dick’s game improved.​


                                                        SO HOW WAS YOUR WEEK?
​February 4, 2018  The 2018 Waste Management Phoenix Open began on Wednesday with a 24-year old nitwit, naked as a jaybird, streaking a fairway. Then it got really crazy.
Why? Everybody contributes to the spectacle. Waste Management the title sponsor, TPC Scottsdale, the PGA Tour, the host Phoenix Thunderbirds, the players, the spectators, the …
Well, everybody. That’s why it’s the highest attended tournament on the PGA Tour––and it keeps growing.
Most Tour events are a snooze compared to what goes on every February in Scottsdale, Arizona; once again we saw why.
The gates opened before dawn at 7:00 AM. And the crowds surged through like they heard a starter’s gun. They raced en masse to the par-3 16th hole … about a mile away. It’s like strolling is a felony. The Thunderbirds Launched a Breakfast Club for them this year that included a disc jockey and breakfast burritos.
By 7:30 the general admission stands were bulging with humanity. Not quite everybody was there. Check the concession stand lines and you’d think they were giving away money. The lines were that long.
The 16th hole, surrounded by corporate boxes three stories high, accommodates 20,000 people. And it was jammed every day. You won’t find that anywhere else.
719,179 people turned out for this year’s tournament eclipsing last year’s record of 665,434. Saturday’s crowd of 216,818 made golf history. Any questions?
The gate receipts have yet to be counted but so far the Phoenix Thunderbirds have distributed more than $120 million to local charities.
Most of the players enjoy the week as a change of pace. They get heckled for poor shots and the crowd roars for birdies and eagles. What would you expect, it’s the greatest party on Tour.
So how was your week?


                                                                  WE HAVE OUR OWN SUPER BOWL
January 26, 2018  Welcome to the biggest keg party in the southwest conveniently located at the TPC Scottsdale. Talk about a perfect way to prepare for the Super Bowl.
In Scottsdale, before we make popcorn, tap a keg and tape our ankles for the Super Bowl we watch the “Greenest Show on Grass” the Waste Management Phoenix Open.
If you think a Brady-to-Gronkoski TD pass is exciting, watch 20,000 people go nuts over a Phil Mickelson tee shot and you’ll come out of your seat. That’s right, 20,000 beer-slamming fans fill the grandstand surrounding one hole, a par-3. The setup resembles a mini-football stadium.

Forget about polite fingertip golf gallery applause, the mob responds to golf shots like they stuck their finger in a light socket. When a rowdy gallery gulps beer under the broiling Arizona sun, a “Quiet Please” sign is a waste of time––proof that silence is not required at golf tournaments. They hoot enthusiastically as players emerge from a tunnel under the stands leading from the 15th-hole.
USGA-ish behavior doesn’t apply here. This is the rock concert of golf tournaments. The mania makes Ohio State-Michigan, World Cup Soccer and March Madness seem like a lawn party.
In spite of all that…
Guess how Waste Management handled the debris that 665,434 people left behind last year? (By the way, that set a new PGA Tour record.)
Waste Management left the venue spotless. Just like they have since they took over as title sponsor nine years ago. They replaced garbage cans with compost and recycling containers and solar-powered compactors. They recycled, composted, re-used or converted to energy more than 1,700 tons of waste. Not a speck wound up in a landfill.
The Waste Management Phoenix Open is a showcase for recycling. Even the signs on the golf course are re-used from year to year. Waste Management leads by example hoping to inspire golf fans to go green.
“Learn it here, use it everywhere” is the motto.
That’s quite a challenge since attendees range from regular golf fans to corporate hosts and their guests plus the beer-stained tee-shirt crowd and stiletto-heeled honeys stalked by Oakley-wearing bronzed wolves.
Nevertheless, Waste Management and recycling prevail. Compare that to the aftermath at the Super Bowl.


IT'S FLU SEASON

 January 19, 2018  It’s flu season and it’s bad. According to the Centers for Disease Controlevery part of the continental U.S. shows “widespread” flu activity. You’d think traffic would be minimal with all the people out sick, but here in Arizona the winter tourists are like locusts. Flu shots east of Mississippi must be 100-proof.
I should go to the doctor but I’m waiting for the fire department to hose down his waiting room. You can hear wheezing and hacking from the parking lot. Patients wear surgical masks and use their own pens–to sign in.
There was a TV program about Wrigley Field that showed a guy power-washing restrooms with a giant hose after a ballgame. The nozzle must have been set on ‘blast’ because it threatened germs, bacteria and everything else including the wall tile. Fortunately, the toilets were bolted down. The guy is missing an opportunity. He should buy a fire engine and hose down medical waiting rooms. Shark Tank’s billionaires would claw each other to get a hunk of him. Mark Cuban would have him hosing down cabs, busses, trains and planes.
A study released yesterday in the Proceedings of the National Academy of Sciences says “we may pass the flu on to others just by breathing.”

Uh oh, now it’s not safe to avoid people who are wheezing, hacking and coughing. We have to avoid people who are exhaling. Mark Cuban may alter his course and search for an inventor who can design a forehead fan that blows contamination away from your face.
In the case of the college crowd, iPhones with built in fans oughta do the trick.
Most experts say the thing to do is stay home and avoid contact with other people. That’s why I’m on my stomach typing this under the bedspread.                                          
       


SPREADING YOUR WINGS

January 12, 2018 The training wheels were off. The first 10-feet were iffy as the handlebars did figure eights searching for a groove. My father loped along with a firm grasp on the seat. He urged, "Pedal faster!"
The faster I pedaled, the steadier the ride. I sailed along nearing what felt like the sound barrier. “Way to go, dad, way to go.”
Oops, no answer. He quit a dozen houses back. It was a solo mission.
I never looked back.
You’ve gone through a similar experience, haven’t you?
Once you get up enough speed to feel the wind in your face you have your first taste of freedom.
You thought your parents lost their minds when they said you were too big for training wheels. You saw your bike and panicked. They had been removed, probably while you slept. 
You went on to ride a bike without training wheels, drive a car, swim across a lake, graduate college, find a job, get married, buy a house and have kids.
Yes you did.
If you have doubts about what lies ahead rest assured, you can do it.
You’ve done it before and you can do it again.
Onward! ​


                                            PONDERING IS NOT A FELONY
January 5, 2018  Are there times when your life changed? Small, gradual changes may not be memorable, but think about the sudden, abrupt ones. When you encountered a startling situation did you take a step back? Did you evaluate what just happened? Some major events are dramatic and hard-to-swallow. It takes time to digest them. Take the time.
My patients say they try to stay busy––they go out of their way to avoid thinking about the problem whether it involves work, personal life or something else. I ask, “Why didn’t you give yourself permission to sit and think?”
Pondering a problem is not a felony. It’s a valuable resource that should never be viewed as negative or depressing.
Gain a new perspective on your life. Private moments lead to a healthy, fulfilled mind. The bigger the event, the more time it takes. Days and weeks, even years may be necessary before you can satisfactorily bring about closure. 
Digesting big events varies from person to person. Some turn to creativity––they write, listen to music, or paint––they get involved with things that quiet their minds. Others immerse themselves in work. Some even avoid work by traveling to faraway resorts. Do whatever puts you in a thoughtful, introspective state. Go for a walk or sit in the sun. Bottom line: find a way to let go.
Important: don’t let your mind wander. It will go so far astray that the experience will be far from pleasant and less than enjoyable. Just ponder the circumstances without being judgmental or guarded about your internal state.
Honesty and clarity are the keys to resolution.
By the way, not all thoughts need be taken seriously. Our minds are designed to create and imagine many ideas and possibilities. Haven't you jumped from one thought to another without rhyme or reason? The thought process lets your mind play instead of judging you personally. Negative thoughts don’t mean you’re an inherently bad person. The most positive minds experience their fair share of negativity. 

                                                                                

                                                                             ​​JUST PUT ME UP ON A LIFT
​December 29, 2017  Our car went in for regular maintenance recently. The windshield sticker said it was due at 10,300 miles. I mentioned to the service agent that a dashboard alert said three tires had low air pressure and guessed that the change in temperature from summer to fall had something to do with it. He said he'd check it out.
I asked what service would cost. “15,000 mile maintenance is $250,” he said. 
My voice leapt an octave, “Nice try,” I said, "the speedometer reads 10,300 miles.”
“Yes, but …”
I interrupted. “So how much is regular maintenance?”
“$36.50.”
“Just do the regular stuff. Nothing else.”
I retired to the customer lounge for a donut, fruit salad and the morning paper, courtesy of the dealership. When the car was ready I paid the tab and happily motored away.
Wait, that part’s not true. The dealership gave the car a bath and it looked pretty spiffy until the heavens opened up in the parking lot. I wouldn’t say it happened fast, but the rain beat the automatic door lock and 'fasten seat belt' beep.
On the way home, waiting at a red light, the same dashboard tire alert caught my eye. It was back, blocking the other instrument readouts pending further action by the service department.
I’m telling you all this because a while back I was an emergency room patient and it’s apparent that a trip to the hospital is like taking your car to a mechanic. Whichever the case, check your bank balance before they start running tests.
The minute you arrive you’re at their mercy. The mechanic takes your keys. The hospital takes your clothes. Either way you’re not going anywhere. The good news is you can wander around and kick tires in the showroom; that beats being bedridden counting ceiling tiles in the emergency room.
In each situation, after you explain why you are there the attendant says, “We need to run a few tests.” That means, “No matter what we find, we’ll make it sound like we have to call in specialists and, of course, amputate your wallet.”
Memo to self: Check available credit before surrendering car keys or clothing. Prepare for the worst. If the attendant begins to hem and haw brace yourself. That’s a prelude to, “We’ll have to keep your car (or body) overnight.”
Worthwhile tip: make sure your financial planner is on speed dial.

                                                                                                           

                                                                                                YOU CAN DO IT
December 22, 2017   Oh, how I remember the terror I faced and my sweaty hands. I wasn’t sure I could do it.
The first 10-feet were iffy. The handlebars zigzagged like windshield wipers until I found a confident rhythm. No training wheels this time, they were gone but dad loped along with a firm grasp on the seat as he urged me on., "Pedal faster! Pedal faster," he rasped breathlessly
And the faster I pedaled, the steadier the ride. As I closed in on what felt like the sound barrier I hollered, “Way to go, dad, way to go.”
Oops, no answer. He ran out of breath a dozen houses back. It was my solo mission.
I’ve never looked back.
You’ve gone through a similar experience, haven’t you?
Once you felt the wind in your face. Once you saw the beauty of the landscape unfold you were tasting the sweetness of freedom.
You'll never go back, either. You thought your parents lost their minds when they said you were too big for training wheels. You saw your bike reduced to two wheels and panicked. The training wheels had been removed, probably while you slept. 
You didn't think you could ride a bike without training wheels, swim across a lake, drive a car or graduate college with honors, get married, buy a house and have kids.
But you did.
So, if you have doubts about what lies ahead rest assured, you can do it.
You’ve done it before; you can do it again.
You've faced obstacles and overcome them.
Onward!

                                                                                   DECISIONS, DECISIONS
                                                             “We create our fate every day we live.” Henry Miller
December 15, 2017  Your fate is determined by your attitude. Think about that. The things around you are neutral––until you give them meaning. The way you assess a given situation–the questions you ask yourself–controls your mood and drives your destiny.
You decide your course. For example:
• I was amazed at the way the principals of a company treat their employees. That’s what made me decide to join them.
• I liked her the moment we met, but something didn’t seem right­­­­­. I followed my instincts.
• I used to raise my voice in situations like this. Then I changed my approach, toned things down and became a better communicator.
Being in the ‘right place’ at the right time can be a secret to success. Success leads to happiness, but it’s up to you to recognize opportunities and take advantage of them.
Ask yourself, “What do I really want?” Have a vision. Realize that the ‘right place’ is other than the four walls you reside in. Why be housebound, get out in the fresh air and experience life. Try new things without fear of failure. You might get lucky when you least expect it. How, you ask? Chances are luck will find you.
Adopt a positive attitude; change your demeanor and perspective. That will help move you forward. Shed negativity you haven’t been able to control.
Here's a powerful question to ask yourself, use it as an attitude adjustment when necessary: Who would I be and what opportunities would be available to me if I unload nagging thoughts that keep me up at night?
Worrying can be poison. If you think it prevents bad things from happening you are kidding yourself. Quite the opposite, worrying strips you of joy and contentment. It prevents you from doing productive things. It saps your imagination and leads to ulcers.
Seek piece of mind. Come to peace with problematic thoughts. Learn to be happy where you are––both physically and emotionally. Be grateful for what you have.
Years ago I asked a lady how she could be so calm. “Things get easier once you understand what’s not meant for you,” she said. “I learned to accept reality and realized that wasting energy over impossibilities is mere fantasy.”
How true. Reality trumps fiction, every time.

                                                                                                        

                                                                                    THE DOCTOR'S OFFICE
December 8, 2015   I don’t know about you, but I feel like invoicing my doctor for time wasted before I even make an appointment.
Medical offices are inefficient, so we should charge an inconvenience fee. Hand an invoice to the receptionist as you check in and say, “Here’s my estimated inconvenience bill based on the amount of time I wasted during previous visits. I’ll adjust it if my blood boils in the waiting room, examining room ... or while I’m practicing self-defense among sneezing, wheezing patients in the reception area.”
If a Southwest Airlines Boeing 737 carrying 175 passengers goes from Cleveland to Denver on time why can’t my doctor go from room to room on schedule? Why don’t medical schools include punctuality courses? I’m pretty sure nursing schools teach students to slap a blood pressure cuff on patients before they have a chance to sit down. I bet they even have time trials. If blood pressure tests were left to doctors––when mine finally shows up––my systolic reading would have a comma in it.
One time my ear, nose and throat guy arrived just as the nurse said, “The doctor will be in shortly.” I took his picture by the clock. It’s in my wallet––next to a shot of my primary care guy dressed like Fonzie on Halloween.
Editorial pause: Yes, that’s true, on Halloween my primary care physician wore a black, leather jacket, black boots and had his greased-hair spiked. That same day (honest) at a physical therapy appointment, my therapist walked in wearing a tutu.
I’ve spent decades in examining rooms staring at posters, wondering if my intestines really look like that. My urologist has the best posters, male and female. I like to take inventory of the Q-tips, tongue depressors and cotton balls in case there’s something worth snitching. You can’t go wrong with latex gloves––one size fits all.
If I’m stranded in the examining room long enough I check out the electronic equipment and wonder if any will be used on me. I mean, what kind of illness calls for that long hose? Oh, what’s in all the squeeze bottles?
The scariest piece of equipment is the eye refraction contraption, the one where you put your chin in an indentation and lean forward. The doctor is on the other side holding his breath so you can’t tell he had onions for lunch. One time we were face-to-face holding our breath in dead silence for the longest time until I whispered, “I’ve had wives I haven’t been this close to.”
Speaking of eye doctors, before my first appointment with a retina specialist I read his impressive biography: Harvard Medical School, law degree with honors on a Rhodes Scholarship. We were face-to-face at the refraction contraption and I blurted out, “Wow, this is exciting, after decades a lawyer’s finally looking me in the eye.”
Hey, did you notice I didn’t mention the usual vintage, dog-eared magazine selection? Not to mention the scale results (c’mon, deduct the 10-pounds of clothes I’m wearing).

                                                                                                        

                                                                              THE SELFIE PHOTO ALBUM
November 30, 2017  Email from a friend vacationing in Paris:
Hey, check this: a picture I took with the Eiffel Tower sitting on my right shoulder. Neat, huh?
Here’s my favorite: I’m face down at the pool with the Arc de Triomphe balanced on my ass. Check back for new pictures tomorrow. I’ll be in London staging a shot of Big Ben coming out of my shorts.
C’mon.
What gives with the selfie craze? Extending an arm was the way Nazis saluted. That is until iPhone users did it and aimed backwards. Photography used to be an art form then Apple fucked it up.
People document every move they make. Like I care where they are? Do I give a rat’s ass that Lindsay Lohan passed out in a club with my buddy next to her on the floor playing paparazzi?
Thinking about it makes me crazy. One day in Ft. Lauderdale I took my iPhone to the beach (just to see if it would skip like a stone). The next day, I added $42.66 a month to my cell bill for an iPhone X.
Then I checked into therapy.
In addition to getting an attitude adjustment, my shrink, who is a part-time venture capitalist, came up with a landslide business opportunity. We started a new business: Selfie Photo Albums.
Selfie Photo Albums take the guesswork out of what to do with the shit in your camera. Save and protect those valuable action shots in an authentic naugahyde selfie album, made from the hides of farm-raised female naugas.
Portrait or landscape Selfie Photo Albums Fit ‘Em All. Panoramic shots, too.
You get preprinted tabs so you can file pictures by category:
People crammed together in theater aisles
Celebrities holding my camera
Celebrities who seem pissed off
Shit eating grins
Shots by people with 50” sleeves
Guess who she is
Weird hairdos
People who smile with spinach teeth
Booger noses
Wrinkles galore
Squinters
Flash or No Flash, take the quiz
                                                                            
Today only. Rare cell phone special:
                                                                                           FOR SALE: iPhone
                                                                                   Never held at arm’s length
                                                                            Certificate of authenticity included
                                                                                         $2,999, or best offer

                                                                                                           

                                                        IT’S ALWAYS AN INSIDE JOB
November 23, 2017  When I write about self-esteem, readers ask if they can boost the self-esteem of someone they love.
That’s a tough subject, but it's not mission impossible. The thing is: self-esteem is the way we feel about ourselves.
It’s always an inside job.
Nevertheless, aiding and abetting isn’t a felony. So …
… be supportive. Listen closely; understand why your friend scowls at the mirror while brushing their teeth.
Tell him/her you like what you see, always have … and why. Describe their valuable traits (there must be some if you have a true friendship) and express each characteristic directly.
Do it often and in person.
Don’t get into their careers, education or things like that (lousy performance reports or failing grades could be touchy subjects). There may be problems you don’t know about.
Let your friend vent about failure or lack of self-esteem without commenting or interrupting. Just listen. You aren’t a mechanic trying to determine why an engine sputters. 
Focus on the way you see your friend as a person. Explain how much you value their friendship. Bring up times and events from the past that were mutually enjoyable or beneficial––even ones that are memorable for all the wrong reasons. You might both break into laughter over them––after years pass we see things in a different light.
Know how your own self-esteem works. Then, if asked perhaps you can share a tip or two. 
Share how you coped with a situation similar to theirs.
Constructive comments about mutual situations are good.
Keep this in mind: what was good for you may not be the solution. But it may be an option to consider.
If none of the above seems appropriate, just listen quietly. Sometimes that’s all a person needs.
It’s always an inside job don’t make it about you.