June 2021 OutreachNC

JUNE 2021 - 1

Feature Intro: Hearing Loss: The Silent Epidemic part 2

J U N E 2 0 2 1

Welcome back to our exploration of hearing loss. In last month’s feature, we learned how to identify and treat hearing loss. This month we dig deeper into coping with hearing loss. We also help caregivers and loved ones understand how they can help someone with hearing loss through better communication, understanding and patience. Finally, we dig into the experience of hearing loss among our veteran population, which has unique experiences with loss due to job exposure and combat roles. We also provide a list of the latest technology available for treating loss and a list of resources for further research.

Whew. That was a lot! Let’s get started…..

How Can I Cope with Hearing Loss?

Coping with hearing loss is an important part of achieving the best quality of life possible. The first steps include identifying loss and treating it.

Prevention is a key component of treatment, to avoid future loss. But even with treatment and prevention, new coping skills can be beneficial in simply dealing with current hearing loss. If you are living with hearing loss, learning to cope with the new normal can be empowering and lessen frustrations and feelings of isolation.

continued page 4

CONTENTS

ASK THE EXPERT: ALZHEIMER’S BOOKS FEATURE: HEARING LOSS - PART 2 IN VERSE: ON THE PENICK TRIP TO THE ZOO Q&A: CARING HEARTS FOR CANINES

LETTER FROM THE EDITOR

Amy Phariss, Editor-in-Chief, OutreachNC | editor@outreachnc.com

JUNE 2021 - 2 Welcome to June!

We officially begin summer in the coming weeks; though the weather around the Sandhills seems to think summer is in full swing. We won’t complain.

Rather, we’ll sit on our porches and watch the mornings and evenings unfold in birdsong, gorgeous sunsets and sunrises and the comings and goings of those we love.

This month, ONC honors our animal friends in our annual pet issue. We hear from Jennifer Johnston Chopping of Caring Hearts for Canines, a local dog rescue committed to fostering and rehoming dogs in need. Chopping helps us explore what to do when we can no longer care for our pets, which is a reality many of us face.

Our feature this month is part two of our article on hearing loss. We explore how to cope with hearing loss, from both an individual as well as family/ caregiver perspective. We also look at new technology and how hearing loss affects the veteran community.

We have the honor of hearing of a trip to the beloved NC Zoo from Barbara Stoughton through her poem “On the Penick Village Trip to the Zoo.” In Ask the Expert, Amy Natt offers up a reading list for anyone interested in learning about Alzheimer’s Disease. The list is a great starting point for learning.

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ASK THE EXPERT: ALZHEIMER’S BOOKS

Amy Natt, MS, CMC, CSA | amyn@agingoutreachservices.com

JUNE 2021 - 3 My mom was recently diagnosed with Alzheimer’s Disease. I am looking for a few recommendations for books I might read to help me understand how I can best help her through this.

Receiving a diagnosis is often just the first step in a long journey. It is a great idea to start gathering information and resources to further your understanding of the disease process and the impact it will have on the entire family. Some of these books may be good to share with your mom, but keep in mind, too much information at one time might feel overwhelming.

I would suggest ordering a few books and pacing yourself. In addition to books, there are also a lot of online resources, as well as support groups. These support groups are often open to adult children and can be very beneficial for both learning and sharing resources. I have always found that it really helps to be around people who are dealing with a similar experience. While everyone’s journey with Alzheimer’s is unique, you will find some commonality. Some support groups remain virtual, while others are resuming in person meetings. Two great places to start are the National Alzheimer’s Association https://www.alz.org/ and the Dementia Alliance of North Carolina https://dementianc.org/.

These will provide you with resources, guides and support group information. AOS and Friends Care is another resource that can provide some guidance and resources https://aosfcare.org/.

Now, to answer your original question, here are some books I would recommend. All of the links can be found on the AOS and Friends Care web site referenced above.

1. Living Your Best with Early-State Alzheimer’s

by Lisa Snyder, is one of my favorite books to use in support groups. This is written for the person who has been diagnosed and contains personal stories and tips for coping with specific challenges. I would recommend this for you and your mom.

2. The Alzheimers Action Plan by P. Murali Doraiswamy, was first published in 2008 but remains a staple resource. This book does a good job describing the different stages and provides examples to help apply the information presented. There is also a “Top 40 Questions and Answers” section that provides great information. This is an excellent resource for an adult child or spouse.

3. The Other Side of Alzheimer’s by Martha-Lee B. Ellis, was written by a spouse of someone with Alzheimer’s and focuses on the changes to the marital relationship. It discusses the physical, mental and emotional challenges, with some humor mixed in. If your mom is married, this would be a great book for her spouse. It is excellent for someone dealing with a new diagnosis.

4. A Dignified Life: The Best Friends ™ Approach to Alzheimer’s Care: A Guide for Care Partners (2012) by Virginia Bell, focuses on finding positive ways to interact with your loved one living with Alzheimer’s Disease. The book provides usable tips, therapeutic activities, and advice for caregivers. It is a universal program that focuses on helping the individual maintain a connection to their world.

5. The Emotional Journey of the Alzheimer’s Family

by Robert B. Santulli, focuses on the emotional journey of the family. It is a very straight forward book, sharing the struggles and triumphs families often encounter.

There are a lot of available resources and books on this topic. Some of them, like The 36-Hour Day, are more advanced and can be an overwhelming place to start. The books listed above should get you started. Just remember that you are on a journey as well. Educating yourself and finding a local support network is a great start.

JUNE 2021 - 4

HEARING LOSS

the silent epidemic-part 2

by Amy Phariss

continued from page 1 Tips for coping with hearing loss include: • Tell your friends, family and colleagues of the hearing loss.

• Make sure you’re positioned for optimal hearing; turn to face someone who is talking.

• Avoid trying to talk with someone in another room or even across the room.

• Choose your setting wisely. Try having conversations in quiet places without background noise or distractions.

• Ask others to speak clearly rather than to speak louder.

• Use the best assisted hearing device for the setting. Many devices can help tune out or block background noise that interferes with conversations.

• Relax and slow down. Hearing loss often includes ringing in the ears (tinnitus) and ear pain. Slowing down and using relaxation techniques can help you deal with the pain and actually decrease spikes in pain.

JUNE 2021 - 5 • Know your triggers. For tinnitus and ear pain, dietary and lifestyle factors may trigger a spike or increase pain. Keeping a journal can be beneficial in identifying triggers and avoiding them.

• Seek support through groups and community activities. See our list of Resources on pg. 7 for a good start.

HOW CAN LOVED ONES SUPPORT SOMEONE WITH HEARING LOSS? If you have a loved one experiencing hearing loss, communication can feel frustrating at times. You may struggle to know exactly how to respond.

Should you raise your voice, or is that rude? Should you acknowledge the hearing loss, or will that hurt a friend’s pride? You might wonder: What can I do to help my loved one hear better so we can communicate better?

Hearing loss experts and specialists suggest the following supports: • Identify and have the hearing loss assessed.

Helping a loved one make an appointment is a great sign of support.

• Be patient. Someone with hearing loss isn’t trying to be “difficult.” Hearing loss is a complicated issue with emotional and physical responses. Hard of Hearing Specialist Jennifer Cabe says, “I know it can be frustrating for both the family member and the caregiver and the person with the hearing loss, but patience will go a long way.”

• Don’t yell. Hearing loss isn’t always about volume. Often those who experience hearing loss complain about sounds being muffled more than volume. Cabe suggests rephrasing or reworking a statement if someone with hearing loss is struggling to understand.

• Face the person. Facing the person with hearing loss helps them know you are speaking to them and allows the person to see your face and read your facial cues.

• Remember lighting. Cabe reminds caregivers

and loves ones, “Make sure you have plenty of light so the person can see you clearly. Don’t stand in front of the window. That will make you look dark to that person.”

• Don’t be offended. Someone with hearing loss isn’t ignoring you or failing to listen by choice. Don’t take it personally but try, instead, to find ways to engage with your loved one so communication is enhanced. Also, many people do not want to wear assistive technology (such as hearing aids) due to vanity reasons.

They may feel it makes them look “old” or different. Try to be understanding of these feelings and appreciate how the person feels and the fears related to these concerns.

• Honor the individual. How a person addresses hearing loss is an individual decision and process. As Cabe notes, “Hearing loss is not a standard experience for everyone.”

• Assist someone with help finding financial support for hearing aids. There are programs throughout North Carolina to help obtain hearing aids and other assistive devices if the financial cost is a hardship. Financial assistance is available for other assistive devices and the cost of an exam by an audiologist.

WHAT ARE SOME OF THE NEW OR MOST EFFECTIVE TECHNOLOGIES AVAILABLE TO HELP ADDRESS HEARING LOSS? After the printing of the first part of our article on hearing loss, we heard from many of you regarding how hearing loss has impacted your lives. Some of you experience hearing loss yourselves, and some of you care for a loved one living with hearing loss. Through personal research and experience, you have provided ONC readers with a list of what has worked best for you in terms of the latest technology, gadgets, devices and more. We appreciate all of your suggestions and feedback.

Hearing from those of you who have been there and done that helps give readers the most current, reliable and tested suggestions for utilizing technology for living with hearing loss.

JUNE 2021 - 6 The following are examples of both new and triedand-true technology for living with hearing loss: 1. Hearing aids. Many of you told us hearing aids are now tiny and can be much more personalized. John Barrett of AOS and Friends Care shared an exciting new development in hearing aids: they’ll soon be available overthe-counter (OTC). According to the National Institutes of Health, OTC hearing aids are “intended to help adults who believe they have mild-to-moderate hearing loss.” The FDA is working hard to ensure they become available soon. Also, OTC hearing aids are not for everyone, such as those with significant loss.

2. Wireless Hearing Systems – ONC reader Myron Dice uses a wireless hearing system named Roger to help when he needs to listen to those sitting nearby. Dice says hearing aids often pick up background noise, making hearing difficult in group settings. Dice says, “I pick up the background noise before I pick up the voices. My experience is that hearing aids only minimally limit background noise. The most effective solution for me has been using Roger, which directs the sound.” Roger Select ™ is an adaptive microphone specifically designed for conversations that occur in group settings or where background noise is an issue. Dice says he puts his Roger on the table, and the device focuses on whomever is speaking and is able to adapt to different voices/speakers. This cuts down on background noise significantly.

For more about the Roger Select ™ and the new Roger On ™, visit www.phonak.com.

3. Captioned Telephones – Dice also uses a caption-enabled telephone, which he used during our conversation. A captioned telephone utilizes a screen (much like that of an iPad) to show users a text version of what is being said in the conversation. The screen is large enough for text to be seen clearly. For more information about captioned telephones visit www.captel.com or call 800-233-9130.

4. Smart Phones – as Richard Watkins, Jr. of the NC Department of Health and Human Services notes, smart phones and tablets are actually creating more equal communication among all groups of people. For people with hearing loss,

texting can be a great form of communication.

Watkins says, “Today we have so many new technologies. In the past, many of us were vain about using “different” technology than the majority population. Now, we can use the same technology such as Smartwatch, Smartphone, Wireless Doorbell like Ring, etc. Technology is creating more equity between the Hearing world and the Deaf world.”

5. Induction Loop Systems – some churches and other community buildings/venues may install an induction loop system (also known as a hearing loop system) to help produce clearer sounds and less background noise. The system is wireless device technology that works with T-coil equipped hearing aids and cochlear implants. For those who love attending church or other organized events, hearing loop systems can have a huge impact on quality of life outside the home. For more information, visit www. hearingloopsystems.com.

There are plenty of other gadgets and technology available to help those who are hard of hearing hear better, more clearly and with less obstruction.

The technology is always improving and changing, which means better quality, easier access and improved results for everyone.

HEARING LOSS & MILITARY VETERANS Hearing loss disproportionately affects military veterans, due to the nature of their work, which often places them in close proximity to extremely loud noises. Think of refueling a jet, long days at the rifle range, working with explosives and actual combat. For veterans returning from combat, for example, blast exposure is directly related to increased vulnerability to hearing loss. Each of these jobs (and others) puts soldiers at risk for hearing loss. According to Sean Baker, Veterans Liaison with the NC Department of Health and Human Services, veterans are 30% more likely to have hearing loss or tinnitus. When we add combat experience to this equation, the numbers get even higher. Baker notes that among veterans with combat experience, the number with hearing loss rises to 60%.

For veterans (like nonveterans), the statistics also differ among genders. According to the Centers

JUNE 2021 - 7 for Disease Control and Prevention (2020), “Male veterans were significantly less likely to have excellent or good hearing than nonveterans (72.9% compared with 84.1%), and significantly more likely to have a little or moderate trouble hearing (23.2% compared with 13.6%), as well as more likely to have a lot of hearing difficulty or to be deaf (3.9% compared with 2.4%).” Male veterans aged 45-64 and 65-74 were more likely to have hearing problems than their nonveteran counterparts.

In addition to the unique experience of military training and combat exposure, the military culture itself can sometimes be a barrier for veterans with hearing loss. Some people have difficulty accepting hearing loss as part of their lives, and veterans can be especially sensitive to how it may impact careers, how it may be perceived at work and in the military community and how hearing loss may be perceived as a weakness. In a culture that values physical strength and endurance, any threat to that strength can be problematic. For some veterans, the stigma associated with hearing loss during their service extends to their lives even in retirement.

According to Baker, military culture often promotes the idea of being indestructible. This idea can extend beyond the borders of military bases, affecting veterans’ perspectives of themselves and possible issues affecting health. The first step in addressing hearing loss is identifying the issue and seeking treatment. For some veterans, this is the hardest part. As Baker notes, veterans don’t always link hearing loss to overall health. Hearing loss, as we’ve explored, impacts many other aspects of physical health and is linked to vision and balance issues, all of which are linked to the body’s sensory system. As Baker says,

“The slow-moving threat is allowed to progress until one day they can’t ignore it.”

Reaching out and connecting with veterans is key in helping identify possible hearing loss, seek treatment for loss and cope with living with hearing loss. Depending on how veterans receive information, reaching out through conversations among trusted friends can be especially helpful.

Many veterans, according to Baker, trust fellow soldiers, so organizations such as the VFW can be great places to provide information. For other

Resources Many resources exist for those living with hearing loss.

Resources can help connect you or a loved one with direct access to technology, medical care or support groups. Understanding not only hearing loss itself but also the resources available is key in living and thriving with the sensory limitations of hearing loss.

Here is a list of resources you may find helpful. It’s a good start but not at all exhaustive. Keep researching, digging and asking others about the resources they find most helpful!

CapTel Captioned Telephones CapTel provides telephones for hearing loss and much more.

You can reach them at 800-233-9130 for more information about captioned telephones. https://www.captel.com Communication Services for the Deaf and Hard of Hearing For assistance in understanding communication services to assist those with hearing loss, visit http://www.csdhh.org Hearing Loss Association of America To find a local chapter, visit https://www.hearingloss.org/chapters-state-orgs/finda-chapter/ NIOSH Sound Level Meter App This app helps identify and measure noise levels in environments to help identify when ear protection may be necessary or if the environment is unsafe for hearing. https://apps.apple.com/us/app/niosh-sound-levelmeter/id1096545820 North Carolina Health & Human Services Division of Services for the Deaf and Hard of Hearing For a list of regional centers for the Division of Services for the Deaf and Hard of Hearing, visit: https://www.ncdhhs.gov/assistance/hearing-loss/ regional-centers-for-the-deaf-hard-of-hearing The Beltone Hearing Care Foundation The Beltone Hearing Care Foundation is a 501(c) (3), this charitable organization donates hearing instruments to those in need, who may otherwise not be able to access or afford assistance. https://www.beltonecarolina.com

JUNE 2021 - 8 not linear. However, if taken, they can help life with hearing loss improve dramatically. For loved ones and caregivers, supporting those with hearing loss is an important element in creating an environment in which a loved one may thrive. For those living with hearing loss, understanding not only the loss itself but the many options for treating and coping with hearing loss is key in living well with limited hearing.

soldiers, social media is the way information is consumed. Like the general population itself, taking a multi-pronged approach to addressing hearing loss is key. Finally, Baker suggests providers (doctors, hearing specialists, etc.) work to understand military culture, which is often a big part of a veteran’s worldview and identity. In better understanding this culture (which is unique and multi-faceted), providers can better connect with and help veterans who experience hearing loss.

ONC thanks the many experts, readers and staff who contributed to this article and helped us understand hearing loss in a broader though more personal context. Thank you to Sean Baker, Veterans Liaison for the NC Department of Health and Human Services Division of Services for the Deaf and Hard of Hearing, who helped illuminate the veteran experience and understand how we as a community can reach everyone.

For all of the many living with hearing loss, the steps to successful intervention remain the same: • Identify the loss • Seek assessment • Apply treatment • Learn to Cope • Continue to thrive These steps may not be easy, and they’re certainly

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JUNE 2021 - 9

IN VERSE: ON THE PENICK VILLAGE TRIP TO THE ZOO Barbara Stoughton

Today we visit the contented creatures.

All the animals seem at ease, Out in their fields in a breeze.

The giraffe glided gracefully past.

The mother chimpanzee cuddled her baby, dear.

The red-river hog happily rooted about In the dry leaves.

The huge brown elephants followed a path up To the pool. The panther slept in his den.

The polar bear tossed his big red ball about.

In the shade, gazelles lounged comfortably.

And the rhinoceros lumbered about Unthreateningly.

Two wild geese with a snarl or a hiss Had a picnic lunch with us.

The lion sprawled out upon the grass.

He was sound asleep.

The ostrich pranced across the grass.

While the zebra raced away, so fast.

The tall giraffe has yellow ochre spots Lined in white as he glides across The land, tall as trees.

He gives a little whistle cry as if to Call the others to follow.

And there were three others behind.

Oh, to see such grace across the earth And to feel the peace and gracefulness Which unknowingly the animals had shared With us. Thus, a happy day at the N.C. Zoo we had spent, For their peace on earth the animals to us had lent.

­

Q&A - CARING HEARTS FOR CANINES

JUNE 2021 - 10 In the month of June, ONC celebrates pets. Our animal companions offer love, support, humor and much more in our daily lives. As we age, or as our life circumstances change, we sometimes have to shift in how we care for our pets. Sometimes, through death or illness, we can’t care for our beloved pets any longer. We spoke with Jennifer Johnston Chopping of Caring Hearts for Canines, an Moore County-based dog rescue, about what to do when caring for our pets is beyond our capacity.

ONC: How many animals do you see needing a home or being displaced because owners either become too ill to care for pets or because owners pass away? Is this an issue for pet owners we’re not fully aware of?

Jennifer Johnston Chopping: Caring Hearts has been contacted on several occasions to take a pet when their owner has passed away.

ONC: What can pet owners do to anticipate a pet’s needs if, for example, they have an upcoming surgery or might require rehabilitation care?

JJC: Often times you can find a boarding facility that may be willing to give a discounted rate to help someone that will be in the hospital or having surgery. Sometimes a rescue may have an open foster who would be willing to keep a dog until the owner is able to care for the dog again.

ONC: If a family finds itself needing to rehome a pet due to a death in the family, what is the first step in starting that process? Do people immediately think of shelters when there are other options?

JJC: We have found that often family members are not able to keep the pet from the deceased person, so they reach out to no kill shelters or non-profit rescues to take the animal in.

JUNE 2021 - 11

Pumpkin Peanut Butter Dog Treats

ONC: Do you have any tips for family or friends who find themselves caring for pets while someone is recovering from illness or after a death?

JJC: The best thing to do is to help provide the pet with a new “normal.” Pets often grieve and may possibly become anxious/worried because their owner passes away and they don’t understand what is happening.

ONC: Finally, what can owners do if they find themselves unable to care for a dog as they age? Is it best to rehome a pet? Should an owner hire a pet sitter or dog walker?

JJC: I always encourage people to try their best to keep a pet but if it is not possible, we recommend finding them a new home suitable for their needs or reaching out to a rescue that will find their pet a new home.

Many of us want to donate or support local rescues but are unsure what is needed.

Here is Chopping’s list of most-needed supplies: Peanut Butter

These easy, three-ingredient pumpkin peanut butter dog treats are pup-approved!

Prep Time: 5 mins Cook Time: 35 mins Total Time: 40 mins Ingredients • 1 cup whole wheat flour • 1/3 cup peanut butter (make sure it doesn’t contain xylitol; this is toxic to pets!)

• 1/2 cup pumpkin puree Instructions 1. Preheat the oven to 350 degrees F. 2. Add all ingredients to a large bowl and mix together.

3. Place a sheet of parchment paper on your counter.

Place the dough on the parchment paper and add another sheet on top. Using a rolling pin, roll until desired thickness. Mine were about 1/4 inch thick.

4. Remove the top sheet of parchment paper. Cut the dough into sizes appropriate for your pet using a cookie cutter or knife. Place the pieces on a nonstick or foillined baking sheet.

Bleach Laundry Detergent Wet Food (cat and dog)

5. Bake for about 20 to 35 minutes depending on the thickness used and the desired crunchiness of the treats. 20 minutes will yield soft baked treats and 35 minutes will be more crunchy. |

Cat Food Dog Treats Cat Treats

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Credit: Cardamom & Coconut https://cardamomandcoconut.com/pumpkin-peanutbutter-dog-treats/

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All funds raised will go toward AOS & Friends Care direct care recipient requests, programs, and community education/awareness efforts targeting older adults, with an emphasis on Alzheimer’s and Dementia. |

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Mums will be available on October 14, 2021.

AOS & Friends Care was incorporated and approved by the IRS as a 501(c)(3) tax exempt nonprofit in 2015. Our Mission is to raise awareness and provide direct care and community support to older adults, with a focus on those with dementia.

ORDER ONLINE at www.mumsformemory.org For more information: EMAIL info@aosfcare.org ALL DONATIONS ARE TAX-DEDUCTIBLE. |

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For your donation of $25, we will purchase a mum in honor or memory of a loved one, local care facility, caregiver or front-line worker. ™

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JUNE 2021 - 12

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4 SIGNS YOU MAY NEED A CAPTIONED TELEPHONE 1 2

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Caller voices seem quiet or muffled, even at max volume.

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You struggle to catch every word over the phone.

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You avoid making phone calls.

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305 Page Road | Pinehurst, NC FEDERAL LAW PROHIBITS ANYONE BUT REGISTERED USERS WITH HEARING LOSS FROM USING INTERNET PROTOCOL (IP) CAPTIONED TELEPHONES WITH THE CAPTIONS TURNED ON. IP Captioned Telephone Service may use a live operator. The operator generates captions of what the other party to the call says. These captions are then sent to your phone. There is a cost for each minute of captions generated, paid from a federally administered fund. No cost is passed on to the CapTel user for using the service. CapTel is a registered trademark of Ultratec, Inc. NC Department of Health and Human Services • Division of Services for the Deaf and Hard of Hearing • ncdhhs.gov/divisions/dsdhh • NCDHHS is an equal opportunity employer and provider. • 04/2021

JUNE 2021 - 13

GRAY MATTER GAMES

ACROSS 1. Western blue flag, e.g.

5. Abstinences from food 10. ___ gin fizz 14. Fashion 15. Bar order, with “the” 16. Part of BYO 17. Oil source 18. Asian shrub yielding flaxlike fiber 19. Caution 20. Church of England archbishops 23. Ring bearer, maybe 24. Beauty 25. Semiquaver (2 wds) 32. Electrical unit 33. Knocked off, in a way 34. Clear, as a disk 36. Boxer’s stat 39. “___ Maria” 40. Cantankerous

41. American symbol 42. Caddie’s bagful 44. Athletic supporter?

45. Dust catcher (2 wds) 49. Go after, in a way 50. “___ any drop to drink”: Coleridge 51. Inequality 58. Band member 59. A Judd 60. Amorphous mass 62. “Beowulf,” e.g.

63. British ___ 64. Breezy 65. Home, informally 66. Agreeing (with) 67. “The ___ Ranger” DOWN 1. Babysitter’s handful 2. Be itinerant 3. Doing nothing 4. Pliable plastic explosive

5.

Public uproars 6. “By yesterday!”

7. Clash of heavyweights 8. Detective, at times 9. Santa’s rig 10. Buttonwood 11. Advance 12. “ One of ___” (Willa Cather novel) 13. “ ... ___ he drove out of sight” 21. Backstabber 22. Article of faith 25. Bundle

26. Candidate’s concern 27. Carry away, in a way 28. “Well, I ___!”

29. Like some jackets, fabric 30. Spoonful, say 31. Banana oil, e.g.

32. Bauxite, e.g.

35. Artist’s asset 37. O ne who shows impressive excellence 38. In a lather (2 wds) 43. Break of dawn

46. Rupture 47. Boozehound 48. ___ customs 51. Copy 52. Bird venerated by ancient Egyptians 53. Brewer’s equipment 54. Game on horseback 55. Black cat, maybe 56. Assortment 57. Norse goddess of fate 58. Big ___ Conference 61. “Ciao!”

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JUNE 2021 - 15

Spring is on the Way and

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