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.

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!