Alexa Fleckenstein M.D.

A few weeks ago I had chosen this title for a blog entry because I wanted to tell (again!) how short and precious life is. Then I had no inkling that my friend Hazel Rowley would die in New York on March 1st, unexpectedly. Hazel was a fellow writer and biographer. Only last fall, her new Roosevelt biography had come out: “Franklin and Eleanor” - a book that I couldn’t put down, reading till late in the night. In November, on her birthday, I met her for the last time. She was full of sparkle and wit, and doubts and insecurities, and dazzling intelligence; nobody would have foreseen her sudden death. When I asked her if she was planning another couple’s book (before “Eleanor and Franklin” she had done Sartre and de Beauvoir in “Tête à Tête”, she laughed and said that she was done probing deeply into the relationships of people. She had found lasting love and felt secure in it, ready to probe other issues. She said the McCarthy era interested her. The period between book projects is always a brittle time for a writer. In short order, the love fell apart, a resistant bug settled on her heart, little pieces of the infectious growth broke lose, settling in her brain, and putting her into a coma, from which she, mercifully, never awoke – Hazel Rowley would not have wanted to live with half a brain. Born in London, raised in Australia and England, she roamed the world – in Paris she lived for nearly two years - before settling in New York early in the millennium. When Hazel was young, Simone de Beauvoir had become her hero: a woman who wrote about women’s disadvantages in a male world, and who opened new paths for women of our generation; Hazel wanted to be where Simone de Beauvoir was: an woman writer, and an equal partner in a lasting relationship. Christina Stead was Hazel Rowley’s first subject. Stead had made child abuse the subject of an autobiographical novel – in 1940! Christina Stead was a fellow Australian; her American publishers famously – or notoriously – made her set her novel “The Man Who Loved Children” in America. Hazel felt kinship to her lonely compatriot, a writer, a woman with a complicated love life, a woman often on the edge of society. And a woman who carved out for herself an independent literary existence – even before de Beauvoir. Hazel’s second biography took on the black author of “Native Son,” Richard Wright, who in his life found no real home and only scattered success, ending up (and dying) in Paris, much too young. This is the only book by Hazel Rowley I haven’t yet read; I assume it was Simone de Beauvoir who directed Hazel to this American expatriate writer in whom de Beauvoir was greatly interested. But think: A young, rather unknown Australian white woman writing about an American black man – how dare she?! Paris is also the setting of Hazel Rowley’s third book “Tête-à-tête”, the book about Sartre and de Beauvoir’s relationship. The two famous writers don’t get away scotch-free – this reader felt rather repulsed by their sexual predatory shenanigans. But as Simone de Beauvoir had been the one who showed us that traditional women’s roles were not written in stone, Hazel Rowley wanted to know if promiscuous sexuality would be worthwhile and livable - if you ask me: no - exploring the Sartre/de Beauvoir relationship objectively, without taking sides. Her new book “Franklin and Eleanor,” probed another famous relationship. To me the book seemed especially timely, because the Roosevelt’s Great Depression and the present Great Recession share some commonalities, which takes the book to a higher level than even “just” being about male-female relationships. Eleanor Roosevelt had built a public and private life for which she had no role models – she did it with what was given her: her wit, her caring, her curiosity. Neither Simone nor Eleanor were abstract feminists or men haters. On the contrary, men were invited into their lives. But they never gave up being a person and pursuing their own goals in life. At her memorial in New York recently, so many people spoke eloquently about Hazel’s wonderful, bright presence – she had nothing lukewarm about her. Unable to speak in tongues myself, I played “Songs Without Words” by Mendelssohn for Hazel – badly, as always – but she would have wanted me not to chicken out. Hazel had many more books in her, it was so clear – how I wish she had more time! Read More 

As a physician I sometimes make observations that strike me as plausible – but I don’t have the wherewithal or time to scientifically check on them. Writing a blog might be one method to test an idea, and find out if others made similar observations. So, here is my first one, pertaining to urge incontinence. Wikipedia defines urge incontinence as “involuntary loss of urine occurring for no apparent reason while suddenly feeling the need or urge to urinate.” What really happens is the patient makes it to the stall but then goes before she has a chance to pull down her pants. Or she hears water tinkling, and tinkles herself. The two other forms of urinary incontinence are stress incontinence and overflow incontinence. Stress incontinence comes from weak pelvic floor muscles – when you sneeze or run or laugh, you suddenly can’t hold your urine. Overflow incontinence is a constant dribbling of urine – as if the faucet can’t be shut off. All three forms are common in people of a certain age – therefore the hilarious TV ads for adult diapers. But according to my patients, incontinence is no laughing matter. People thus afflicted (women are in the majority here, probably because of what childbirth can do to one’s organs) are on the constant lookout for the nearest restroom. The interesting part of Wikipedia’s definition of urge incontinence is “for no apparent reason.” Urge incontinence has been linked to stroke, Alzheimer’s, spina bifida, multiple sclerosis (MS), Parkinson’s – they all can lead to urge incontinence. All are neurogenic causes (stemming from the brain and the nerves) – we lump them in one group, but still they are poorly understood. And then there is “idiopathic” urge incontinence. Idiopathic means: Doctors have no clue at all. But they think it has to do with local inflammation around the bladder. Years ago a patient with urge incontinence told me that she could make the urge disappear (at least long enough to make it to the bathroom), if she stretched her neck. For a while I was not sure if any sudden distraction – like clapping your hands or hopping up and down – would do the same. But lately I returned to my first hypothesis, namely that the stretching of the neck works best. Because I have observed that the condition occurs more often in people with less than stellar posture, especially the ones whose head is slightly bent most of the time. Standing tall and erect, at least for a moment, seems to release the urge. As for the mechanism – are certain spinal nerve fibers pinched when the head is bent? We need more research on that. Poor posture is more common in people with gluten intolerance and food allergies – it seems as if they don’t have the muscular strength to keep their heads straight on their shoulders – perhaps on the basis of poorly functioning mitochondria (this is all speculation on my part; I would be happily disproved). If urge incontinence is your problem, try this out – nod a bit, stretch your neck - and write me if it works for you! Perhaps one day a peer-reviewed study will be done. Read More