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What Are Your Priorities?

My best friend and I, 1973

A dear friend died recently. Her husband fired up their gas grill for a leisurely summer dinner. A freak accident led to a house fire. She was trapped inside, and died as a result. He is struggling to survive. The house is gone. My heart is heavy.

She was an amazing person and an important part of my life. Her death spurs me to look inward. What is important? Do I spend enough time with my loved ones? When I do, am I kind? Do I tell them I love them? Do I have any unresolved issues with anyone that I need to clear up? Is there anyone I’ve been meaning to contact, but put off until tomorrow, followed by many more tomorrows?

Behind all these questions is the ever-present reality that life is short and there is no do-over. I will never get another opportunity to have lunch with my friend. Death will continue to remove loved ones from my life, and ultimately will take me. As the poet Mary Oliver wrote, “Doesn’t everything die at last, and too soon? Tell me, what is it you plan to do with your one wild and precious life?” (from The Summer Day)

Time with friends isn’t just about having fun. It is also about improving health. Studies have repeatedly shown the health benefits of social relations. Friends help us feel better and live longer. People who exercise with a partner or in groups report reduced pain when compared to those who exercise alone.

Family is important, but friends usually make us feel good without adding a layer of stress. We may love our family, but we don’t choose them. We select our friends because they have qualities that we share. A good friendship is a bond like no other.

A few days after my friend died, I contacted my best friend and invited her to visit. She arrives in August. My heart already feels lighter.  I don’t know what I will do with my one wild and precious life, but part of it involves kayaking and hiking with my best friend. What do you plan to do with your one wild and precious life?

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Regular readers may notice that I am not blogging about hepatitis C much these days. Here are the reasons for this:

  • I have a blog on Hepmag.com that is devoted to hepatitis C.
  • Health is a total package. I am constantly looking for ways to stay healthy or be healthier. Words are bursting out of my head, and my blog seems like a good place to put them.
  • Every healthy choice helps us manage hepatitis C.

Health never goes out of fashion. When I look at people in their nineties and hundreds who are still active, it motivates me. But some days I falter. It’s raining or I’d rather catch up on paperwork. When it comes to excuses, I doubt I am alone. This is another reason I am blogging about health.

Health care costs are rising, and my health insurance has a high deductible. The best health insurance plan includes self-care. Using sunscreen properly is considerably better than dealing with melanoma. Not having to go to the doctor fits well in my budget.

If you want to read more about hepatitis C, visit my blog on Hepmag.com. Hope I see you here and there. And if there is anything in particular that you want me to write about, let me know. I hope we’ll be growing old together; really old and really healthy.

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The Truth Can Be Heavy

I care about truth not for truth’s sake but for my own.” ~ Samuel Butler

The Truth Can Be Heavy

Truth can be weighty

I love the truth when it is comfortable. However, when honesty reveals an uncomfortable fact, I am not truth’s biggest fan. Lately, I’ve been holding on to denial, trying to ignore the clear fact that if I eat too much I will gain weight. Or if I don’t walk every day, I will feel tired and not sleep as well at night. If I don’t do strength training exercises, I will get weaker. And if I don’t meditate, I will feel stressed.

It all seems so simple. Confronted with these obvious truths, one can only ask, why wouldn’t I want to do the things that make me feel better? I don’t know the answer. I have some theories. I also have plenty of excuses.

My current theory is that when I am stressed, I pick the activity that I think matters to me most. It isn’t always the task that gives me the most, but it is the activity I derive the most satisfaction from. For instance, watching an episode of Masterpiece Theater provides much more pleasure than meditation. Writing feels better than doing sit-ups.

The problem with choosing items that bring immediate pleasure is that they can sometimes also bring long terms problems. Sitting is associated with many health problems including diabetes, arthritis, weight gain and a shorter life span. These consequences are painful.

I could go on about this, but if I do, it means I sit more. So on that note, I am going for a walk…

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Helping Your Brain

Last week, I blogged about forgetfulness. This week, I provide some tips on how to keep your brain healthy. Just because memory decline is natural does not mean we can’t help slow down the process. The brain is like a muscle in that if you don’t use it you lose it. An active brain can grow new cells and work more effectively.

Here are some ways to keep your brain healthy:

  • Be physically active on a daily basis. A combination of stretching, strength training, and aerobic activity is an ideal approach.
  • Eat a nutritious diet. Fruits and vegetables, along with other high-value nutritional foods can provide nourishment for our brains. Do not skip meals.
  • Drink enough water.
  • Manage stress. Meditation and relaxation techniques can help us to think more clearly.
  • Avoid alcohol and other substance use.
  • Get sufficient sleep. The average adult needs 7 to 9 hours of sleep a night.
  • Breathe. Oxygen is essential to our brains.
  • Stay mentally active.

How do we stay mentally active? Here are some tips:

  • Read more or listen to audio books.
  • Do puzzles and brainteasers.
  • Learn new things, particularly drawing or painting.
  • Go to lectures, plays, museums, or concerts.
  • Cut down or eliminate T.V. watching.
  • Take up a musical instrument.
  • Maintain social and family connections.
  • Study a new language.
  • Find a hobby.
  • Play games.
  • Learn to juggle.
  • Take adult education classes.
  • Learn to dance.
  • Deliberately shake up your routine. Rearrange your furniture, drive a different route to familiar places, or wear your watch on your other wrist.

As for forgetfulness, there are techniques that can be used to help us improve our memory. Libraries usually have books on memory improvement. A few suggestions:

  • Organize yourself.
  • Create habits and routines.
  • Write things down and keep your lists in the same place.
  • Do one task at a time, rather than multi-tasking.
  • Pay attention to what you want to remember.
  • Visualize what you want to recall.
  • Use repetition to fasten something into your memory bank.
  • To remember long lists, create a story or connections between items.

You can use memory devices, also called mnemonics to aid memory. A classic mnemonic is “My Very Educated Mother Just Served Us Nine Pickles” (the first letter of each word is also the first letter of the planets in our solar system – Mercury, Venus, Earth, etc) or “Thirty days has September, April, June, and November. When short February’s done, all the rest have 31” (used to remember how many days are in each month).

Various supplements are being tested for memory enhancement capabilities. Ginkgo biloba, choline, lecithin and vitamins B, C, E are probably the most well-known.  There is still nothing conclusive about choline, lecithin, or vitamins B and C. The research on vitamin E has only been conducted on dementia patients and more research needs to be done before coming to any conclusions. Lemon balm is being researched for a number of properties, including memory enhancement. This herb can be infused as a tea. Steep 3 teaspoons of dried lemon balm leaves in 2 cups of boiled water for about 5 minutes. Strain the leaves out before drinking. Add honey if you like.

There is not much research on Ginkgo biloba, but what does exist is somewhat encouraging. If you want to try Ginkgo biloba, talk to your doctor. A typical adult dosage for memory enhancement is 80 mg 3 times daily of 50:1 standardized leaf extract. Ginkgo seeds are toxic and can be fatal if swallowed. Pregnant and nursing mothers and children should not take ginkgo. Patients with cirrhosis should also refrain from taking herbs. Common adverse reactions to ginkgo are headache, dizziness, flatulence, upset stomach, heart palpitations, rash and allergic reactions. Seizures and bleeding problems have been reported but are rare. Discontinue ginkgo and all supplements a week prior to any medical procedure. The following drug interactions have been noted: Trazodone, Monoamine oxidase inhibitors; Anticoagulants / Antiplatelets; Insulin; Antipsychotics / Prochlorperazine; Cytochrome P450. Gingko may alter coagulation lab tests.

Personally, I don’t find any benefits from supplements. However, exercise, good sleep and a healthy diet help my memory and brain function. I remember more things during my walk than any other time, so if you try walking, take paper and pencil with you. You’ll be surprised what you recall.

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Have you ever misplaced something, searched for the item and in the middle of the search, forgot what you are looking for? If so, welcome to the club. Misplacing objects, forgetting things, occasionally driving and realizing you forgot where you were headed, and putting the milk in the cupboard, are common and frustrating experiences. These occurrences become more frequent as we age.

If you are the type of person who has been blessed with a good memory, this change can be extremely disconcerting. The “A” word leaps to mind (Alzheimer’s), followed by other worst fears, such as brain tumors, strokes, and various neurological impairments.

What was I saying? Oh, yes, I was talking about memory loss. With age, forgetfulness generally increases, while ability to concentrate decreases. It affects nearly everyone, except for my husband. Pay attention to your peers and you will notice that others are experiencing memory loss, particularly with name recall. A typical conversation while discussing a movie with my friends goes something like this: “It was a great movie and it had So and So in it. I can’t remember his name, but I know you will know exactly who I mean.  He’s been in a lot of movies, but I can’t think of a single title right now. He starred in that movie opposite What’s Her Name.” If I am lucky, the other person may be able to fill in the blanks, but usually my friends are just as forgetful as I am.

The average adult brain is made up of over 100 billion nerve cells. We used to think that the brain stopped developing when we were young, but we now know that we can continue to develop our minds at least into our 70’s and that there is no age limit on learning new things. We learn more slowly as we age. Comprehension and reaction times slow. Multi-tasking becomes more difficult as we grow older. Short-term memory suffers far more quickly than long-term memory. Remembering who the U.S. President was in 1970 but not being able to recall what one had for lunch today is common for the aging brain.

Despite all this reassurance, we still wonder if something is wrong.  How do we know when to be concerned? Here are some possible early indications of Alzheimer’s or other cognitive abnormalities:

  • Repeatedly asking the same question after it has been answered.
  • Inability to complete familiar tasks.
  • Increasingly showing poor judgment.
  • Decline in the ability to think abstractly.
  • Changes in personality and mood with no apparent cause.

In short, it is normal to forget how to add, but abnormal to be confused about the concept of numbers. It is alright to forget where you put your keys; forgetting what your keys do is cause for concern.

There are many treatable conditions that can cause cognitive impairment, so it is important to obtain a good medical evaluation before jumping to conclusions. Hearing loss, sleep problems, thyroid disease, psychiatric disorders, stress, vitamin deficiency, alcohol, and drugs are just a few factors that can have an impact on our ability to think, communicate, and function effectively. Always talk to your medical provider about changes in your health.

If you are forgetful, go easy on yourself. However, if you forget an anniversary or a loved one’s birthday they will probably scold you. Stay positive and maintain a sense of humor. Remember being happy is much more important than remembering where you put your keys.

Next week I will provide some tips on how to keep your brain healthy (if I remember to).

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Of all the forms of inequality, injustice in health care is the most shocking and inhumane. ~Martin Luther King, Jr.

Martin Luther King, Jr.

Years back, the Los Angeles police department videotaped ambulance companies leaving ill patients in Skid Row. A representative from the ambulance company reported that hospital officials ask them to do this on a regular basis. Many of the patients who were dumped were homeless. A local council member spotted an obviously sick patient, dressed in a hospital gown, pushing a walker down the streets.

The violation of patients’ rights is an indefensible reality. When we are sick, we are vulnerable. It is a basic human need to expect others to care for us when we are ill. However, these are expectations that are not always met. Sometimes the people we trust our health with, do not live up to this trust.

How should you expect to be treated by your medical provider? What are your rights? There is not a simple answer to this question. In 1997, President Clinton appointed a commission to develop a plan to protect medical consumers. Since 2001, there have been a number of bipartisan attempts to pass legislation that would provide greater protection for patients.  To date, no federal Patients’ Bill of Rights has passed the legislative and executive process.

Patients do have some protection. Nurses, physicians, and surgeons have codes of ethics to follow. Patients have very clear rights when using hospitals and skilled nursing facilities. Some states, such as California and New York, have based Patients’ Rights Bills. Various professional organizations prescribe patients’ rights, such as the American Psychiatric Association and the Joint Commission on Accreditation of Healthcare Organizations.

Before any surgical procedure, you should be informed about the risks prior to consenting to the procedure. This is known as informed consent. All the risks should be listed, even if they are unlikely to occur. It may be frightening to read this information, so ask the doctor or nurse to be specific about the risk. For instance, it is scary to read that one of the risks of liver biopsy is death. However, when told that this occurs in 3 out of 10,000 procedures, this risk does not seem as frightening. If you are healthy, had the necessary lab work, and have an experienced physician, this risk is even less.

Patients have clear rights regarding the handling of healthcare information. Under the Health Insurance Portability and Accountability Act (HIPAA), you have the right to privacy and access to your medical information. You have the right to be notified when your information is being shared, to whom it is being shared with and in certain cases, the power to decide if the information may be shared. You have the right to make corrections to your medical information and to file complaints if any of these rights are violated.

If you participate in any clinical research, your rights are highly protected. Before a clinical trial can begin, it must meet the strict set of standards required by the U.S. Food and Drug Administration (FDA). Additionally, an independent review board must approve every trial before human subjects can be enrolled. This board is comprised of people from many disciplines – doctors, scientists, pharmacists, nurses, and non-scientist community representatives such as attorneys, clergy or lay people. Clinical trials are reviewed throughout the course of the study, and all people associated with the trial are required to keep records long after the study has ended. Participants must be informed of their rights, including the right to drop out of a study for any reason without influencing their subsequent medical care.

If you feel your rights have been violated, there is always recourse. Talk to your insurance company, state insurance commissioner, medical society, or hospital ombudsperson. Keep talking until you get your concerns addresses.

 

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