February 28, 2014

Around Cape Horn, #4: Regent vs. Holland America -- My Verdict

My home around the Cape Horn: the Zaandam

Sailing on cruise ships is new to me. An inveterate independent traveler, I used to sneer at people who vacationed this way. Now I’m one of them.

I made a fortunate choice for my first cruise last June -- Vancouver, British Columbia to Fairbanks, Alaska. It was terrific, with exciting and fun shore excursions: flying over the mountains in a small plane, landing on a glacier for a walk, boating out to a bird-covered island. And I made a good choice of cruise line – Regent. It has a deserved reputation as being high priced and high quality.

I booked Regent again last summer for a Venice-to-Barcelona excursion with four generations of Schappis. I wasn’t too happy with that cruise; it seemed almost sacrilegious to spend day after day pretending you’ve seen Rome, Florence, and Barcelona after racing around on a bus for five hours with a guide.

That experience led me to conclude that cruises just weren’t meant for me, and that I should abandon the idea of cruising around South Amerca to escape DC's winter and visit a part of the world I'd never seen.

Luckily, I got several messages from friends -- whose judgments I respect -- urging me to give this cruise a try. Someone with lots of cruise experience suggested Holland America Line (HAL). Always willing to try something new, I booked a HAL cruise from Valparaiso, Chile to Buenos Aires, Argentina.

This morning I woke up after 6am to hear the cruise director announce we were reaching the point on Cape Horn where we would cross from the Pacific Ocean into the Atlantic. Now it’s north towards home . . . well, at least toward Buenos Aires, where I’ll spend a couple of days before heading back to Washington.

February 27, 2014

Less is More: A Doctor Recalls Her Father's Death

Surer than ever that “less is more,” I’ve written often about the risks posed by taking new drugs and undergoing medical treatments, especially for seniors. Certain that – for me, anyway -- quality of life trumps everything else, I’ve underscored the importance of communicating our wishes – no extraordinary, life-prolonging efforts, please! – to our families and healthcare providers. I’ve included tips from professionals on how to initiate those important and difficult end-of-life discussions.

Here’s a very brief post from Dr. Ana Pujols McKee – published online by the Journal of the American Medical Association -- about her own father’s last days. I hope that lots of seniors, their families, and their doctors saw it.

# # # # # # #

Taking Care of My Parents
My father died the day after Christmas. I think he waited so he would not ruin Christmas for the rest of us. That would have been consistent with his considerate nature. Six months earlier, we were able to relocate him to the same city where both my sister and I live. He lived with her, and during that time, he received excellent care. His physicians and nurses understood his goals of care and what mattered to him most. They communicated with each other as well as with my father and members of our family. His care was both appropriate and coordinated to the very end.

February 26, 2014

Around Cape Horn, #3: Holland America's War on Germs Gives Me an Idea....

On my two Regent cruises last year, I was impressed by their effort to suppress onboard sickness by positioning hand-sanitizing machines around the ship. Holland America has done the same on the MS Zaandam:

Holland America takes it one step further. As you exit any rest room, a sign on the door makes this request:

February 25, 2014

U.S. Healthcare: How We Stack Up

Most everyone I know agrees on something: -- the U.S. healthcare system is a mess..

Sadly, there's nothing close to agreement on how to fix it.

Recently, the World Health Organization (WHO) released some figures -- using a broad range of healthcare indicators -- that show how America compares with 16 other countries around the world. The results aren’t impressive; it's unsettling to imagine our rankings if the WHO had included ALL countries.

Those other 16 represent a pretty good mix geographically, economically, culturally: Afghanistan, Algeria, Australia, Canada, China, Colombia, France, Germany, Ghana, India, Japan, Mexico, Mongolia, Russia, Singapore, United Kingdom, United States.

Here are the categories for which the WHO provided rankings:

February 24, 2014

Around Cape Horn, #2: Santiago in the Aubrey Hotel

My last post -- Friday's -- clearly reflected jet lag and other stress-makers. I had spent Tuesday spaced out in my Santiago hotel. I wrote that sad story on Wednesday evening, after I'd boarded the ship. It's Sunday morning now.

Thursday -- the first full day at sea -- provided a good opportunity to rest and recover from the long journey south. Friday, during our first port call, we took a bus tour of the Chilean countryside. We saw an impressive snow-capped volcano and enjoyed a lake cruise.

On Saturday, we toured the unspoiled countryside of northern Patagonia by bus. Today we're sailing through Chilean fjords. Photos and details to come.

So . . . how am I feeling? Great. How is the cruise shaping up? It looks like it could equal or surpass my cruise to Alaska last year.

Now, back to the start of the trip.

February 21, 2014

Around Cape Horn, #1: Screw-Ups by MS Outlook, LAN Airlines and Yours Truly Almost Ended this Trip Before It Began

I’ve been looking forward to this cruise around South America. It was set to start this past Monday with a flight from Washington to Miami, then a connecting flight to Santiago, Chile, where I was booked into a hotel before the Holland America cruise ship departed on Wednesday from nearby Valparaiso.

I’ve always prided myself on my trip planning and organizing skills. Now I’m not so sure. Witness these events:

1)  I always save crucial vacation emails to a “current trip” folder in Microsoft Outlook. But several weeks ago, Outlook decided to freeze all my folders with saved emails. Since I couldn't seem to fix the problem on my own, I hired a computer geek. In short order, he worked his magic -- by making all my frozen files disappear completely! Not the solution I was looking for.

2)  Fortunately, I had printed out a few crucial emails, including the final page of my purchase agreement for airline tickets, which showed the flight itinerary. The email from LAN (the Chilean airline several friends had recommended) showed that the initial flight to Miami left at 11:05am Monday from Washington National Airport. (Most people use its new name, "Reagan National Airport." I don’t.) My housemate Nimesh planned to drive me to the airport. On Sunday, I decided to check-in online and get my boarding passes. The internet process didn't work, so I called LAN. More confusion, more wasted time, and NO check-in or boarding pass. I noticed that LAN was using American Airlines for the segment TO Miami, so I called them. I soon discovered that my flight was departing from Baltimore-Washington Airport, not National. Good thing I checked a day ahead, or this whole adventure might have ended before I left home.

February 20, 2014

Top Five Regrets of Dying People

Call me weird: I don’t mind talking about death and dying. In fact, I’m convinced it’s something a lot more of us should do.

I’m happy with the life I’m living. I also want to be sure I get – as much as I can control it, anyway – the death I want.

I'm sure I can do more, but I’ve made certain my family, my healthcare team, my domestic partners, and my estate executor clearly understand what I want and DO NOT WANT at the end. It is the quality of my life that matters – my happiness, my contentment, my pleasure in family and friends – and NOT the length of my days on the planet.

I’ve offered tips on how to initiate those important, emotional, and – for most people – difficult conversations about end-of-life. I shudder to imagine my family, tortured by questions about my care while I’m still “alive” but not able to counsel them.

Trolling the internet, I found an interesting article on AARP’s website by Bronnie Ware. A palliative care worker for many years – she helps people who have returned home to die (where most of us want to die) -- Bonnie describes the five most common regrets she hears people discuss during the time she shares with them – typically the last three to 12 weeks of their lives.

She even wrote a book – The Top Five Regrets of the Dying: A Life Transformed by the Dearly Departing, now available in 27 different languages -- about her observations. Here is that short list. We all might be well advised --in the time that remains – to take a good look.

February 19, 2014

Tremor-Reducing Spoon: New Mealtime Independence for People with Parkinson's and Essential Tremor?

A new spoon with electronic sensors might be a real dinner-table boon to people with the tremors that accompany Parkinson’s disease (PD) or “essential tremor” (ET).

Developed by California-based Lift Labs, the smartspoon counteracts the user’s trembling by moving the head of the spoon – with nano-second swiftness – in the opposite direction. BINGO. Increased steadiness.

Here's what it looks like:

People with Parkinson’s (PWPs) can manage tremor with medication, but results are – like the disease – highly idiosyncratic. Even if a small percentage of PWPs find help using the new electronic spoon, that’s a lot of reclaimed independence, and a hefty reduction in caregiver hours.

February 18, 2014

Can Deep Brain Stimulation Improve Memory?

Deep brain stimulation (DBS) may well provide a particular kind of memory boost.

If additional testing confirms that connection, DBS would have an entirely new application, particularly for people with Alzheimer’s. Now, it’s used to control the tremors that often accompany Parkinson’s disease, and to treat the symptoms of obsessive-compulsive disorder and other mental disorders, like depression.

The February 8 edition of the New England Journal of Medicine reported the results of the very small but intriguing study. Doctors implanted electrodes into the brains of seven patients with seizure disorder epilepsy, in order to pinpoint the exact origin of their convulsions.

Researchers then observed the seven play a video game in which the patients assumed the role of cab drivers in a virtual city, picking up cyber passengers and delivering them to one of six shops. The make-believe cabbies drove around the cyber city, figuring out where the shops were.

Occasionally, as they got the lay of the land, they received five-second jolts of DBS to the entohinal cortex – a part of the brain considered key to transforming daily experience into lasting memories. As they learned three of the six imaginary locations, study participants received DBS. When they learned the other three locations, they did not.

Here’s the interesting part: if they got zapped while they learned a particular location, they were more likely to remember it later.

February 14, 2014

Salutogenesis Factor #6: My Relationships

People Need People . . . at Least I Do

Watching Barbra make that grand entrance, I thought: "Wouldn't it be nice if I could make an equally grand exit" . . . confirming the "drama queen!" comment I sometimes hear from one of my nearest and dearest. I won't leave the stage singing and dancing; I could never do either. But a little warm applause would be nice, as long as it isn't the "glad to see you go" kind.

Today's post wraps up the salutogenesis series I began a couple weeks ago, in which I've reviewed the many positive elements that keep me reasonably healthy and happy as I approach my 85th birthday in May. Thinking about the importance of my relationships feels like a good place to end the series.

February 13, 2014

Salutogenesis Factor #5: Meditation -- Two Ways

Meditation My Way
My favorite hour of the day now comes in the darkness of early morning, around three or four o'clock. That's when I do my own combination of light exercises and mindfulness meditation. 

I explained yesterday that I make up the exercises as I go. The same holds true for meditation: I do it -- like Frank -- my way. 

Once -- after my middle-of-the-night bathroom visits -- I'd sit in a straight-backed chair and do a standard version of meditation. It worked for a while. Now, I sit in the chair one day and lie on the floor the next, combining my ever-changing program of exercise and meditation. 

This free-form program has made my very-early-morning sessions a time of bliss. Creative ideas for blog posts come to me, and so do solutions to problems that have been troubling me.

February 12, 2014

Salutogenesis Factor #4: Exercise

What Will My Last Ten Years Look Like?
I doubt I'll last 10 years. I wouldn't want to last that long if the quality of my life resembled what you see in the right hand panel of this Canadian government video.

Importance of Exercise
Yesterday in my diet discussion, I mentioned the open letter from leading doctors in Great Britain to the Health Secretary. That letter cited a comprehensive study that offered five simple rules to dramatically reduce the risk of dementia, heart disease, diabetes, and other serious health problems:
  1. Don't smoke.
  2. Follow a healthy diet such as the Mediterranean diet.
  3. Have a low alcohol intake.
  4. Maintain a low body weight.
  5. Exercise.
According to the study, people who adhered to four of the five guidelines slashed their risk of dementia and cognitive decline by at least 60 percent. They were 70 percent less likely to develop diabetes, heart disease, and stroke  . . . compared to people who ignored all the rules. 

Of the five, exercise made the biggest difference.

February 11, 2014

Salutogenesis Factor #3 -- Mediterranean Diet

Working on this blog for over four years, I've read many studies about dealing with diseases, including my two: Parkinson's and prostate cancer. Those findings invariably suggest that there are TWO things within our power to prevent, treat, even cure those diseases: diet and exercise. I'll talk about diet today and exercise tomorrow.

The media health gurus pitch one new diet fad after another. Even respected medical authorities sometimes recommend diets that require following formulas that require tracking fats, proteins, carbohydrates, etc. I could never do that.

I'm pleased about the emerging consensus: what's best for us is the Mediterranean diet. This regimen focuses on increasing intake of fruits, vegetables, whole grains, pasta and fish, eating products made from vegetable and plant oils, and eating less meat.

February 10, 2014

Salutogenesis Factor #2g: My Home-Sweet-Home Family

Last but certainly not least on my list of families that have enhanced my well-being are my current housemates and treasured companions, Nimesh and Bhawana. Here we are at their marriage in Kathmandu in March, 2012:

And back home a few months later:

Family History
My many trips to Nepal always started and ended in Kathmandu. Every day there, I'd go to my favorite bookstore in the heart of Thamel for my International Herald Tribune. Nimesh's dad owned the store, and everybody in the family worked there from time to time. I soon became friends with the whole family.

February 7, 2014

Watching Rahel Grow Up in Pokhara and Here

with Rahel in "John's room" at the Pokhara house

I love my three grandchildren. I'm fortunate they all reside in the Washington-Baltimore area and are part of my life today. When they were growing up, I didn't actually live in the same house with them. But I've had that experience with Rahel, the son of Laxmi and Ramesh.  

Rahel was born November 2, 2004 -- right in the middle of my Nepal years (2001-2009). During that time, I visited Nepal twice a year, and spent at least two weeks every year living with the family in their Pokhara house. I've always had trouble relating to young children. With Rahel, it was impossible NOT to relate. 

I could go on and on about this terrific kid. Instead, I'll let these pictures do the talking.

February 6, 2014

Salutogenesis Factor #2f: My Pokhara Family

Here's my Pokhara family: Laxmi, Ramesh, their son Rahel, and me:

Pokhara: Paradise on Earth
I enjoyed the capital Kathmandu during that first trip in February, 2001, but I fell in love with Pokhara -- a short flight from Kathmandu, or a long, adventurous five-hour-drive. 

February 3, 2014

Will Oncologists Lead the Way to Single-Payer Healthcare?

In an editorial last week, oncologists Ray Derasga, MD and Lawrence Einhorn, MD explained their “moral and ethical obligation” to advocate for single-payer, universal healthcare.

Their call-to-action faces odds many would consider insurmountable. There’s no political hot potato hotter than healthcare, and the private, for-profit providers – to say nothing of Big Pharma – have deep pockets and powerful lobbies to make their case for maintaining the status quo.

There is also strong opposition to any notion that smacks of “socialized medicine.”

Still, the two doctors made their pitch: "Because the [Affordable Care Act] will fail to remedy the problems of the uninsured, the underinsured, rising costs, and growing corporate control over care giving, we cannot in good conscience stand by and remain silent. Life is short, especially for some patients with cancer; they need help now."

Derasga and Einhorn laid out the improvements they think a new, single-payer system would bring:
  • Reduced administrative costs, which currently account for almost a third of healthcare expenditures
  • Eliminating many bankruptcies attributable to healthcare costs, which accounted for more than 60% of family bankruptcies identified in a 2009 report
  • Improved health, as indicated by evidence that being uninsured increases the mortality hazard by 40%
  • Building on an existing structure, noting that about 60% of all healthcare in the U.S. is publicly funded
  • Implementation of proven cost-containment strategies, which are absent from the ACA
  • Improving quality of care and outcomes by increasing access to care
  • Reverse the trend toward for-profit, investor-owned healthcare plans
  • Preserve physician's income potential, as judged by experience with the Canadian healthcare system