Life certainly gets busy sometimes. I am working full-time again and sometimes it seems impossible to find time to cook and especially to write in my blog. Unfortunately, cooking at home is still the healthiest way to eat. So I try to plan a week's meals, and go to the grocery store with a list so I have the ingredients I need.

I am also getting a box of fresh local produce delivered to my door once a week by The Farm Table. They even have recipes for all the interesting veggies they put in my box. It forces me to cook good vegetables almost every day. And they are sending many greens that are either not readily available in the grocery store, cost too much, or look too wilted.

So I have been doing some research on the greens and learning which ones are good raw in salads. Kale is my new favorite lettuce. This article comparing greens is amazing! Have you ever tried greens in your smoothie? Also amazing!

If you look further back in my blog, you will see that I wrote about stress. Sometimes we do not even realize how stressed we are until we consciously do something designed to relieve stress. That is what vacations are all about. We take a vacation, get on an airplane, and go somewhere where relaxation is a major activity. Have you ever returned home and realized how quickly we jump back into the same state of stress? Why can't we take care of ourselves a little bit of every day?
So I will make a valiant effort this time to do some of the same activities when I get home: get a massage, do some Yoga, take an herbal bath, read a book just for enjoyment, sit on my front porch and watch the arrival of spring. We don't have to wait for vacation to take a few minutes every day for ourselves. It is perfectly okay to DO NOTHING for a few minutes, and open our minds to random thoughts, that can become inspirations. And it is necessary for our mental rejuvenation. Our brains get tired of all the mundane details we remember every day. We need relaxation to refresh our brains. I think we would all be smarter for it, and probably nicer.

I have been urging everyone to write an advanced directive, but recently, I realized that it is hard to have it with you when you need it. Whenever you are admitted to a hospital, even for outpatient surgery, they ask if you have an advanced directive. How many of us can remember to bring it with us? And of course if you have an accident, you certainly don't have it with you. Thus far I have found two ways to store it on the internet. One website, My Directives, will guide you through writing one that is compatible with state guidelines. Then you can print out a card and carry it with you, so any hospital could access that record of your advanced directive.

There is also a Virginia Registry that will store your advanced directive. You can download a form, fill it out, and then save it in the Virginia Registry. Many people think you need an attorney for an advanced directive, but Virginia has made it easy to use a form and register it. If you know what you want, fill in the form, sign and date it and have two witnesses sign it. You do not need a notary or an attorney. If you are not sure about what you want, call me. I can explain what therms mean, and help you look at your own values, so you can verbalize your desires.

"Can't we have lunch instead?" is the response one daughter gave, when her mother brought up the conversation about end-of-life care. Recently, I brought up the topic at my relatives' house. Fortunately, I plunged ahead with the topic for at least 5 minutes, before someone said, "Can we talk about something more pleasant now?" It might be easier to talk about sex!!
Ellen Goodman, a writer for the Washington Post, co-founded The Conversation Project which provides a starter kit to help people get going on this conversation. They commissioned a survey, and found that 9 in 10 Americans think it is important to discuss end-of-life care wishes, but less than 3 in 10 have actually done so. Many people say it is too soon to talk about it, but it is "too soon until it is too late."

Transitions with our parents

Humor is good medicine.This is a great cartoon that will make you
laugh.The amazing thing is that it is so true for all of us. Trying to discuss end-of-life decisions, seeing our parents in declining health, dealing with the death of one parent, and moving a parent to assisted living are all hard for all of us.If we can laugh about it, it might make it a little easier.

Aging gracefully

Here's to growing older! A friend in his eighties says, "Growing old is not for the faint-hearted." I just read a piece in the New Yorker by Roger Angell, now in his eighties. Since growing older is inevitable, let's embrace it.

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.

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.