Having a choice

There was a nice opinion piece in our local paper. It inspired me to write a letter to the editor, entitled "Have that dying wishes conversation today." What do you think? Ready to start a conversation?

How we eat

How we eat has become a great subject in the media. Is it true? Is it all hype? And how long have we been discussing our diets? How many people have said, "I am on a diet"? And what does that mean?

I read an article on Medscape by Threapleton, et al. about dietary fiber intake that correlates an increased fiber intake to a decreased risk of heart disease.(To see these articles, register for a free account.) It is a scholarly article with a review of 22 different studies. If you wade through the graphs and statistics, their conclusion says "A significantly lower risk of 9% was seen for both CVD [cardiovascular disease] and CHD [coronary heart disease]with every additional 7 g/day of total fibre consumed." What this means is that if you can increase the fiber in your diet, you will probably decrease your risk of heart disease. When you break it down to what we eat, 7 grams of fiber can be added by a portion of whole grains plus beans, or two to four servings of fruit and vegetables a day. The grocery store signs saying "5 a day" in the produce section are referring to just that.

There are other "special diets" in the media: the paleo diet, the Mediterranean diet, the vegan diet. This Medscape article by Scherer has a great summary of them. The current favorite of the media is the Mediterranean diet: a diet that uses olive oil, plant-based food, whole grains, fish, and scarcely any red meat. It also stresses daily physical activity, and is similar to the American Heart Association's recommended diet for decreasing the risk of heart disease.

Dr. Perlmutter's book, Grain Brain: The Surprising Truth About Wheat, Carbs, and Sugar - Your Brain's Silent Killers, is covered in this Medscape article. He is promoting a very low carbohydrate diet without gluten to decrease the risk of dementia. He has some scientific evidence, but many detractors who don't quite believe it, and it is the exact opposite of the Mediterranean diet.

The dietary advice is bombarding us. Even the bag of walnuts I opened this morning says "Scientific evidence suggests but does not prove that eating 1.5 ounces per day of most nuts, as part of a diet low in saturated fats and cholesterol may reduce the risk of heart disease. So which diet should we follow? I  follow a diet that makes sense for me. First I look at my personal health risks, based on my family history and current health factors. Then I consider what I enjoy eating. To me, it is important not to deny ourselves based on some associations of food with disease. I eat steel cut oats with walnuts for breakfast because my cholesterol is borderline high, but also because I really enjoy the taste and texture. Every now and then, I even eat cake, red meat, or potato chips. It is hard to follow an extreme diet, and still have it be a balanced diet. Eating is one of the enjoyments in life. And every one of these diets also includes exercise, good for the brain and the heart!

Transitions

"I am so stressed out!" is a phrase I have used many times, and I have heard everyone I know say it. What does that mean? There is actually a scale to measure how many life-changing events we have, and a measure of how much it could affect our health. For example, divorce has 73 life change units, marriage has 50, retirement has 45, and even Christmas has 12. The problem for our health status is when we have multiple stressors. Many people have stress of some sort, but as long as the life change units total up to less than 150, it will not affect our health. If it is over 300, it will definitely affect our health.So if my spouse dies and I move, I retire, lose my sister, have a car accident and injury, and my daughter gets ill, all in one year, then I have a score over 300, and I am at great risk for illness.

Fortunately, I usually have one or two stressors at a time. This past year I changed my line of work, and refinanced my home. Everything else in my life remained fairly constant, and I did not feel stressed. I think we feel less stressed when we identify these points in our life as transitions. There are many transitions that are generally considered positive, such as getting married, having a baby, buying a new house, or retiring. Sometimes those transitions are not smooth and not easy. That is why they are also listed on the stress scale.

Realizing that we are going through a transition is the most important part of doing it graciously. Hopefully, we will come out on the other side as a better person. In my work as a midwife, I helped many women through that transition to being a mother. Many of them prepared for the event with reading books and the Internet, but they also needed some reassurance and a helping hand. The transition that we all go through as adults when we lose our parents is hard, but we will survive it, and become stronger.

Relationships also go through transitions, and it is important to the health of the relationship to give it some attention. It is not always easy to move from a courtship to a committed dating couple, and then to living together or getting married. Sometimes we need help, and it is crucial to get that help before that relationship falls apart. That help can come from a quiet cup of coffee with a friend or a sister, or sometimes from a counselor. The point is, if you are stressed, can you do something about it? Or do you just need a helpinghand to come through that necessary transition graciously?
 

Everything can change in an instant

A recent column in our newspaper gave me some food for thought. It talks about a man who was on a flight which was forced to land on the Hudson River. It is a good example of how things can change in an instant, and the thoughts that go through our heads during those seconds that seem like hours. Some things become so much clearer under that microscope of impending death. Our priorities in life jump to the top of the pile of thoughts.

Ten years ago, my car skidded on a curvy road, and all of a sudden, it turned in a complete circle and  then flipped over completely. While this was happening, my thoughts were racing. My brain was yelling, "I am not ready to die! I still have some important work to do! It is not time yet!" Fortunately, a nice bank of dirt stopped my car, I was wearing my seat belt, and I was able to climb out of my car without help. That brush with death re-focused my efforts to get that work done, but it also made me decide what was important.

We have all heard the phrase, "Carpe diem", or "Seize the day." To me, this means living every day to the fullest extent possible. It means making time to nurture myself, and balancing all the demands on my time, like work, family, exercise, and housework, with some time to relax and read a good book. As a "boomer" getting older, I know that I might have twenty to thirty more years to live, or maybe not. So I am developing my own "bucket list" that includes some travel. Since I am seizing the day, I will not wait until I retire to make that happen. I will travel a little bit every year.And I will stop to watch the birds a few minutes every day. Carpe diem.

No one wants to think about dying, much less talk about it. Putting off the conversation means that we never talk about it. So many people do not die the way they want. Consider this fact: Seventy percent of people want to die at home, but seventy percent die in the hospital, according to The Conversation Project. These pictures reminded me of some of the differences between the home and the hospital. Everyone should have that choice, but sometimes a person with a terminal condition cannot speak for themselves, and they have never expressed their desires to family members.

No one wants to burden their family members with making decisions for them. Unfortunately, when decisions need to be made in the intensive care unit about withdrawal or withholding of treatment, studies suggest that less than 5% of patients are able to participate in the decision-making process. Almost all states have a legal form that a  person can fill out to express their wishes, and name a medical power of attorney. In fact, The Conversation Project reports that 82% of people say it is important to put their wishes in writing, but only 23 % have an advanced directive or Living Will.

Why can't we talk about death? It is not a disease that we catch by talking about it. As Alexandra Drane pointed out, "Talking about sex won't make you pregnant and talking about death won't kill you." Maybe we just need to change our perspective. Aren't we really talking about how we want to live up until the moment we die?

It seems like there are a few important events in our life: marriages, births, and deaths. We all prepare for births and marriages for months in advance, hire wedding planners and doulas, and have long discussions with various family members about our choices. The only thing about end-of-life decisions is that the date is unknown, though it is inevitable. With the uncertainty of when it will happen, it seems like we ought to be prepared.

I am spending a few days in beautiful snowy mountains. Our host shared his story of the miracles of modern medicine. He had open heart surgery to replace a valve. Because of complications during the surgery, he was in a coma after the surgery. Tests showed that he still had brain activity, and he was in good health before the surgery. Fortunately, his advanced directive guided his wife in what they should do next. He was in a coma for four days before he awoke. He also had suffered a small stroke after the surgery. Now, after some physical therapy, he is living a normal life, full of activity, like Nordic skiing. His medical care helped him survive the complications of surgery, and his advanced directive guided the medical team and his wife to continue life support, because he did not have severe brain damage.

On the other hand, another friend (that I will call Jane) shared the story of her mother’s death last year. Jane’s mother, at an advanced age, developed a terminal disease. She ended her days in the hospital, unable to breathe on her own. She was on a ventilator for ten days before she died. Jane now realizes how unnecessary and traumatic it was for her mother and the whole family. She has two siblings and it was very difficult for them to make decisions about her mother’s care. Their mother had no advanced directive, and they did not know what she wanted to do. There was no hope that she would get better. Jane really felt that her mother should have let them know what she wanted before the family had to make end-of-life decisions. Leaving your family to make these decisions can be very cruel. Advanced directives are only used when you are unable to make your own decisions, and they clarify your wishes for your loved ones.