Tightened Airline Security Guarantees Rise in Stress Levels

Get ready for this: random wanding of hitherto unexamined body parts; syringe searches; interminable landing-pattern hours spent with hands in full view and no foreign objects in your lap — including that good book you were about to finish. This is what Umar Farouk Abdulmutallab has brought us, but it’s not all his fault. It has simply, quietly, come to this.

In the wake of the terrorism attempt Friday on a Northwest Airlines flight, federal officials on Saturday imposed new restrictions on travelers that could lengthen lines at airports and limit the ability of international passengers to move about an airplane.

The government was vague about the steps it was taking, saying that it wanted the security experience to be “unpredictable” and that passengers would not find the same measures at every airport — a prospect that may upset airlines and travelers alike.

But several airlines released detailed information about the restrictions, saying that passengers on international flights coming to the United States will apparently have to remain in their seats for the last hour of a flight without any personal items on their laps. It was not clear how often the rule would affect domestic flights.

Airline travel has traveled a long route from the days of white-gloved passengers (remember legroom?) and spiffy stewardesses asking if you’d like coffee, tea or milk. Most of us can recall the unlamented lunches and snacks on trays — although the salad dressing was spicy and the ice cream was good. Almost everyone can remember getting on a plane without first removing your shoes. And although we now stock 3-ounce containers of everything cosmetic and medicinal under the sun, everyone can recall, with a little effort, the day when you could bring a bottle of water from home in your purse.

All of the changes have now become routine, and hardly worth a grumble. Routine is reassuring. New ones will slide into the mix eventually. But it’s that “unpredictable” business that distresses more than a few of us.

The homeland security secretary, Janet Napolitano, said in a statement Saturday that new measures were ‘designed to be unpredictable, so passengers should not expect to see the same thing everywhere.’ She said passengers should proceed with their holiday plans and ‘as always, be observant and aware of their surroundings and report any suspicious behavior or activity to law enforcement officials.’

Here we are, with the back-zip boots, the 3-ounce plastic containers, the 10-minute book and the anticipation of no bathroom privileges on 90-minute flights, and we’re supposed to remain observant while expecting not to know what to expect?

Thanks a lot, Umar.

New Restrictions Quickly Added for Air Passengers – NYTimes.com.

The cost of trying to live forever

Why is this not an encouraging word? In a front page article, part of a Months to Live series,  New York Times writer Reed Abelson leads with a glimpse into the Ronald Reagan U.C.L.A. Medical Center, a top-rated academic hospital noted for extensive, aggressive end-of-life care (and very high costs):

‘If you come into this hospital, we’re not going to let you die,’ said Dr. David T. Feinberg, the hospital system’s chief executive.

Feinberg’s commitment to “success” might be admirable, but the statement is patently false; people die at U.C.L.A. Medical Center. This is what people do: we die. Until this culture gets its act together on that subject our health care system — whatever the reform bill eventually looks like — will continue to flounder.

Difficult as it is to talk dollars when you’re talking lives, the issue of cost has to be factored in. There are only so many dollars, and there are countless lives needing care those dollars can buy: infants, children, young adults, boomers, elderly. In each of those care-needing groups, some die.  Feinberg’s philosophy somewhere has to encounter reality.

…that ethos (keep testing, treating, keeping alive no matter what) has made the medical center a prime target for critics in the Obama administration and elsewhere who talk about how much money the nation wastes on needless tests and futile procedures. They like to note that U.C.L.A. is perennially near the top of widely cited data, compiled by researchers at Dartmouth, ranking medical centers that spend the most on end-of-life care but seem to have no better results than hospitals spending much less.

Listening to the critics, Dr. J. Thomas Rosenthal, the chief medical officer of the U.C.L.A. Health System, says his hospital has started re-examining its high-intensity approach to medicine. But the more U.C.L.A.’s doctors study the issue, the more they recognize a difficult truth: It can be hard, sometimes impossible, to know which critically ill patients will benefit and which will not.

That distinction tends to get lost in the Dartmouth end-of-life analysis, which considers only the costs of treating patients who have died. Remarkably, it pays no attention to the ones who survive.

No one, not the doctors, not the patients, not the best crystal ball reader around can guarantee that this patient will die or that patient will live. If there is a good chance a patient will survive — and it would be nice to add “with a reasonable quality of life” here — everything possible, and affordable, certainly should be done. Abelson’s carefully balanced article details the arguments for going to extraordinary lengths to save lives, as well as the arguments to draw the line on end-of-life expenses.

According to Dartmouth, Medicare pays about $50,000 during a patient’s last six months of care by U.C.L.A., where patients may be seen by dozens of different specialists and spend weeks in the hospital before they die.

By contrast, the figure is about $25,000 at the Mayo Clinic in Rochester, Minn., where doctors closely coordinate care, are slow to bring in specialists and aim to avoid expensive treatments that offer little or no benefit to a patient.

“One of them costs twice as much as the other, and I can tell you that we have no idea what we’re getting in exchange for the extra $25,000 a year at U.C.L.A. Medical,” Peter R. Orszag, the White House budget director and a disciple of the Dartmouth data, has noted. “We can no longer afford an overall health care system in which the thought is more is always better, because it’s not.”

By some estimates, the country could save $700 billion a year if hospitals like U.C.L.A. behaved more like Mayo. High medical bills for Medicare patients’ final year of life account for about a quarter of the program’s total spending.

So…. to spend that $25,000/$50,000 or not to spend? Unless we the people somehow face the reality that living forever is not a human option, the dilemma will continue.

The benefits of coming to terms with non-optional dying could be huge. We could focus on quality living. On palliative care and hospice care and end-of-life peace and comfort. Advances in palliative care now make it possible for most of us to spend final months at home (or in special hospital rooms), in comfort, surrounded by loved ones; given the choice, would you prefer a few weeks or months in a bright-lit sterile room with a lot of tubes and wires keeping you alive? U.C.L.A. now offers the choice of palliative care. Not everyone in charge, however, is convinced.

Dr. Bruce Ferrell, who helps lead the palliative care program, recalls a patient two years ago who got a liver transplant but developed serious complications afterward and remained in the hospital for a year. “He had never, ever been told that he would have to live with a ventilator and dialysis,” Dr. Ferrell said. “He was never told that this is as good as it’s going to get.”

Dr. Ferrell talked with the patient about whether he might want to leave the intensive-care unit to go home and receive hospice care. But when the surgeon overseeing the case found out, he was furious.

“We do not use the h-word” — hospice — “on my patients,” the surgeon told Dr. Ferrell. “Don’t ever come back.”

The patient chose to leave.

But lately, Dr. Ferrell says, more of the transplant surgeons appreciate the value of what he is trying to do.

“We’re not the bad guys,” he said. “We offer options.”

We the people would do well to quit being the bad guys. To quit behaving as if death were always preventable. We could learn about the options to spending all those thousands of dollars on exhaustive, often futile treatment. We could talk about what we would or would not want for ourselves, write things down, make choices.

If more of us would do that for ourselves, the House and Senate wouldn’t have such a time trying to do it for us.

Taking on MoveOn

I am a certified MoveOn supporter. Though I had to opt out of the e-feeds because my Inbox overfloweth, I have sent money, forwarded news, heeded their messages.

But enough is enough. They are pushing for measures we should have, but won’t get today. I am coming down on the side of those who say just get us a bill. In the words of Washington Post editorial writer E. J. Dionne — in a column today aptly titled Don’t scream: organize:

Instead of trying to derail the process – exactly what conservative opponents want to do – those on the left dissatisfied with the Senate bill should focus their efforts over the next few weeks on getting as many fixes into it as they can.

What we have in the Senate bill is a mishmash of stuff we didn’t want, along with the absence of stuff we did. Ridiculous obstacles to a woman’s right to choose to have an abortion — write two checks every month just so Ben Nelson can get benefits in perpetuity for Nebraska and maybe we’ll satisfy the U.S. Conference of Catholic Bishops in the bargain? — piled on top of other obstacles for the poor and benefits for the rich (read: Big Pharma.) But come on, folks, it’s a bill. If we get a bill, it can be improved. If we fail, it’ll be another generation of a punitive, non-working “system” of health care before we get this far again. By then there will be other Joe Liebermans eager to grab the spotlight and claim the power to derail every other beneficial detail. I’ll be dead, but I plan to haunt you.

Dionne points out that the House bill is superior, the two bills will now have to be reconciled, and there will be future opportunities to build on this beginning.

Enactment of a single bill will not mark the end of the struggle. It will open a series of new opportunities. It’s a lot easier to improve a system premised on the idea that everyone should have health coverage than to create such a system in the first place. Better to take a victory and build on it than to label victory as defeat.

Successful political movements prosper on the confidence that they can sustain themselves over time so they can finish tomorrow what they start today. At this moment, rage is understandable, but hope is what’s necessary.

Progressives – don’t scream: organize.

Needless pain, senseless dying

His wife is dying. If she’s lucky, she will be dead before you read this. If he has his way, she will hang on — for what purpose I am not sure, since she is now barely conscious and in terrible pain — but, in his words, she is “not ready to close the curtain.” He cannot bring himself to say the D-word out loud.

Joe — not his real name — called me last night. I am not sure for what purpose the call was either, except he’s quite understandably angry and I was a handy person to be angry with for a while. His wife was a supporter of an organization I serve, as a board member and a one-on-one client volunteer. Compassion and Choices N.CA is a chapter of the national Compassion and Choices nonprofit organization. We advocate for everyone’s right to a humane and compassionate death, which Cathy — not her real name — is not having. We also advocate for changing the laws that ban physician aid in dying, and the right of a terminally ill, mentally competent adult to hasten his or her own dying if living a few more days or weeks becomes unbearable. Cathy’s life is past unbearable by now.

After suffering for several months with back pain, trying chiropractic sessions and over-the-counter medications, Cathy wound up in an emergency room in mid-November, almost accidentally having an MRI that showed the tumors throughout her body. Lung cancer had metastasized to her brain, spine and almost everywhere else. THIS IS A GOOD TIME TO CALL HOSPICE. Joe encouraged Cathy to fight on. She is in terrible pain, and worse than the pain, Joe says, is the difficulty she has breathing, which keeps her from sleeping because she feels like she’s drowning — “but she doesn’t scream out, exactly…” he said. I wonder how heroic she must need to be for him. She is down to 89 pounds.

As gently as possible, I suggested he call one of several excellent local hospice organizations which I’d earlier mentioned to Cathy’s friend who connected us. As a matter of fact, Joe said, he had already called one of them, they’d been over, he was impressed with them. I was almost beginning to breathe myself when he added that he still wanted to talk with the other I had mentioned (Big mistake. Why did I do that?) and had made an appointment with them to come after the weekend. I suggested they would not mind coming on a weekend.

Denial is a perfectly legal way to deal with things, but it should have its limits. If your spouse, partner, child, friend or parent is terminally ill and in unremitting pain, hospice can be the kindest word you have ever spoken. Hospice care IS NOT about “giving up,” or about dying. It is about comfort, pain management, living, peace. It is entirely possible to sign up for hospice care, change your mind and start some newly-discovered intervention later if one should be found. Probably at some point, you will say the D-word out loud. It won’t kill you.

Joe and Cathy are highly educated, financially well off, widely known and admired. He spoke of moving her to their second home nearby where she could enjoy the ocean, and perhaps take time “to say goodbye to her friends when she feels a little better.”

Should Catholic Bishops Determine U.S.Health Policy?

Why do these two sentences, in a report by New York Times health writers Robert Pear and David M. Herszenhorn which appears in today’s San Francisco Chronicle, send chills down my spine?

Nelson (Sen. Ben Nelson, D-Nebraska) and the U.S. Conference of Catholic Bishops , said Thursday that they could not accept Casey’s (Sen Bob Casey, D-Pa) initial proposal, in part because they saw money from the government and premiums as fungible.

Cardinal Daniel DiNardo, the archbishop of Galveston-Houston and chairman of the bishops’ anti-abortion committee said, ‘We continue to oppose, and urge others to oppose, the Senate bill unless and until this fundamental failure is remedied.’

A more recent report on NYTimes.com says Nelson will now support the bill, since it includes tighter restrictions on abortion coverage. I assume if it’s okay with Senator Nelson it’s okay with USCCB.

In the mid-1970s I had a friend I will call Sara, a 19-year-old single mom working hard to raise an infant daughter, who found herself pregnant with a probably defective potential baby. She saw no way to care for her existing child without a job — the pregnancy would cost her her job — let alone care for an unplanned and unwanted new child with special needs. Her church gave her no choice. She managed to have an abortion in fairly sterile circumstances, but because she was part of a small Catholic congregation she remained terrified for years afterward that she would be found out and condemned to hell. I remember thinking how sad it was that she could not seek comfort and support from her close-knit faith community.

I am fine with Sara’s beliefs and honor her for that struggle. I am not fine with having the U.S. Conference of Catholic Bishops determine health policy for all of us. And I wonder how many Saras will be denied proper care because the USCCB believes that some embryonic cells are more important than the right of a woman to control her own body. It remains to be seen if the bill passes, and what sliver of abortion coverage survives, but the tragedies of back-alley abortions, which I know from personal experiences and which the bishops cannot even begin to fathom, are quite likely to return.

What happened to that quaint notion of separation of church and state?

Birds, Bees and Cell phones

Richard Fagerlund is a man you can trust. Politicians, bankers, automotive industry executives… you can’t always be sure; but you ask a question of Richard Fagerlund and you’re going to get a straightforward answer. He gets a lot of questions. Fagerlund, AKA The Bugman, is a syndicated columnist, author and entomologist who has been involved with pests and pesticides for about four decades. He fields questions, in a column (Ask The Bugman) with a large and trusting audience, about pesky flies and persistent termites and uninvited bedbugs and more. He will tell you how to get rid of them, but you still get the feeling he would never squash one with malice, or consider one less worthy than humankind. He opposes cruelty in any form, to animals of any size.

Thus, when the issue of honey bees (good) v electromagnetic radiation (potentially evil) was raised, it was no surprise that The Bugman would come down firmly on the side of the bees. Turns out, this might be an issue with broad implications for us all. A reader asked The Bugman, several days ago, about a report that cell phones are a cause of colony collapse disorder in honeybees. (Honeybees do more than make honey. Think oranges, lemons and blackberries for starters.)

It is my contention that the main cause of colony collapse disorder in honeybees is from pesticides. Another reason for the population decline in honeybees is believed to be electromagnetic radiation that is emitted from cell phones and wireless towers. According to an article published in the Times of India, a study in Kerala found that cell phone towers caused a rapid decline in their honeybee population and that they could cause a complete collapse of the bee population in 10 years. Dr. Sainuddin Pattazhy, who conducted the study, concluded that the electromagnetic waves from the towers shorted out the navigational abilities of the worker bees so they couldn’t find their way back to their hive after collecting pollen.

A study conducted at Landau University in Germany showed that when cell phones were placed near hives, the bees wouldn’t return to them. Scientists believe the radiation generated by the cell phones was enough to interfere with the bees’ communication system, which are movement patterns, with their hives.

I doubted the contention that cell phones were detrimental to bees when I first heard it. But studies have shown that the electromagnetic fields have an impact on other species as well, including migratory birds that lose their orientation in the radiation.

If the electromagnetic radiation can affect birds, then there is no doubt in my mind it can affect insects as well, including honeybees. We also need to be concerned about our own species. At one time we were convinced that cigarette smoking was harmless. We were wrong with cigarettes, and we need to look carefully at electromagnetic radiation.

The writer of this space, a chain smoker for 20+ years (thankfully long past) and currently a city walker regularly threatened with sudden death by cell phone wielding drivers, comes down firmly on the side of The Bugman and the bees.

Cell phones’ waves found to disorient honeybees.

Get smarter before the New Year? Sure you can

Scientific proof is limited. But this space, in the interest of staving off dementia while smartening up the general population, has been investigating recent reports on benefits of brain exercise. (One recent report in this space said crossword puzzles aren’t any big brain deal, which is mildly contradicted by the report below, which proves one cannot believe everything one reads online. Still… evidence is coming in.)

Doing crossword puzzles, reading, and playing cards daily may delay the rapid memory decline that occurs if people develop dementia, according to a U.S. study.

Researchers from New York’s Albert Einstein College of Medicine spent five years following 488 people aged 75 to 85 who did not have dementia at the start of the study.

Participants were tracked for how often they engaged in six endeavors: reading, writing, doing crossword puzzles, playing board or card games, having group discussions and playing music. Almost 1/4 of them developed dementia (that’s the bad news) during the study period. But the more engagement, the slower the decline.

Denise Park, PhD, founder of the Center for Vital Longevity at the University of Texas and a panelist on the recent brain fitness segment of PBS’ Life (Part 2) series, argued against crossword puzzles in this space (Can You Beef Up Your Brain, 12-09-09.) The social component (think tackling a new dance step) of brain exercise, she and many others maintain, is critical. Or the multi-layered element involved in learning to play a musical instrument or taking up photography — Park believes those sorts of endeavors will always beat crossword puzzles and solitary computer games.

Now comes Kathryn Bresnik of ProProfs.com. Bresnik isn’t quite ready to assert that you can improve your cognitive function right this minute by playing online brain games, but she cites a recent report (by Mary Brophy Marcus in USA Today) that the movement is gaining traction:

Computer games have been inching their way into the medical world over the last few years and though your local hospital may not become a mini-arcade, experts say patients can expect to see more gaming in medical settings in the years to come, especially brain games.

That report covered a recent Games for Health Conference in Boston, which for the first time featured a day of sessions specifically focused on gaming and cognitive health, and presentations by researchers from such mildly disparate sites as Massachusetts Institute of Technology and Warner Brothers Interactive Entertainment. (Pick which to believe.)

For the past two days, since being alerted to ProProfs.com, I have been sneaking over to their game page, doing things like the Family Word Search or the Quick Calculate math one. Being an admitted novice to computer games, I found it pretty nifty to have that little voice telling me That. Is. Correct. when I did something right, and presenting instant tallies of time and scores.

So, okay, I haven’t made it into the top 50 for this week, and the games I chose are probably designed for 7th graders rather than 70-somethings. But here’s the thing: Every day, my scores are just a tiny bit better. This seems proof, albeit slightly anecdotal, that I am getting smarter. You may want to give it a try. If I can get smart enough to embed the game that the site tells me I can embed into a blog, it will be done at a later date, and perhaps we can poll True/Slant readers for increased cognitive function.

One caveat: While you are doing computer games, you cannot be doing dishes. Or writing blogs, for that matter. Smartness has its price.

via A crossword puzzle a day may delay dementia – Aging- msnbc.com.

Stress, sorrow and depression – – the dark side of the holidays

Win McNamee/Getty
Win McNamee/Getty

The photo on the front page of the Sunday New York Times tells the ultimate underside to holiday joy: a young woman, Sarah Walton, with her arms around the tombstone of her husband. The scene is in Arlington cemetery; the simple stone reads LTC James J. Walton and lists the parameters of his brief life, 1967-2008.

In households and hotel rooms everywhere, sadness and loss color the holidays gray. Most of the sadness is of a far lesser sort than that of the grieving widow, but just as real: relationships gone sour, bills that can’t be paid, health that can’t be restored — or the old, familiar pains of too many demands and too little time.

At my San Francisco church, a ‘Blue Christmas’ service was started four years ago by Associate Pastor Catherine Oliver, designed for those who struggle under the weight of everyone else’s festive spirits. Some of the faces she sees are familiar, but many belong to strangers seeking comfort or relief. This year, Oliver reports, attendance was not notably higher — “but there were more men.”

Acknowledging the stress and depression that so often accompany the Thanksgiving-to-New Year’s Day season, the Mayo Clinic recently posted a few tips to help bring a little peace and joy into the season. They are summarized here, in categories found to be common.

First, Mayo Clinic recommends, recognize holiday triggers so you can disarm them before meltdown occurs. Most common among these are:

Relationships. Relationships can cause turmoil, conflict or stress at any time, but tensions are often heightened during the holidays. Family misunderstandings and conflicts can intensify — especially if you’re thrust together for several days. On the other hand, facing the holidays without a loved one can be tough and leave you feeling lonely and sad.

Finances. With the added expenses of gifts, travel, food and entertainment, the holidays can put a strain on your budget — and your peace of mind. Not to mention that overspending now can mean financial worries for months to come.

Physical demands. Even die-hard holiday enthusiasts may find that the extra shopping and socializing can leave them wiped out. Being exhausted increases your stress, creating a vicious cycle. Exercise and sleep — good antidotes for stress and fatigue — may take a back seat to chores and errands. To top it off, burning the wick at both ends makes you more susceptible to colds and other unwelcome guests.

The good news is that even with the worst of causes, holiday blues can be lessened. Most effectively by following a few good recommendations such as these:

Acknowledge your feelings. If someone close to you has recently died or you can’t be with loved ones, realize that it’s normal to feel sadness and grief. It’s OK to take time to cry or express your feelings. You can’t force yourself to be happy just because it’s the holiday season.

Reach out. If you feel lonely or isolated, seek out community, religious or other social events. They can offer support and companionship. Volunteering your time to help others also is a good way to lift your spirits and broaden your friendships.

Be realistic. The holidays don’t have to be perfect or just like last year. As families change and grow, traditions and rituals often change as well. Choose a few to hold on to, and be open to creating new ones. For example, if your adult children can’t come to your house, find new ways to celebrate together, such as sharing pictures, emails or videotapes.

Set aside differences. Try to accept family members and friends as they are, even if they don’t live up to all your expectations. Set aside grievances until a more appropriate time for discussion. And be understanding if others get upset or distressed when something goes awry. Chances are they’re feeling the effects of holiday stress and depression too.

Stick to a budget. Before you go gift and food shopping, decide how much money you can afford to spend. Then stick to your budget. Don’t try to buy happiness with an avalanche of gifts. Try these alternatives: Donate to a charity in someone’s name, give homemade gifts or start a family gift exchange.

Plan ahead. Set aside specific days for shopping, baking, visiting friends and other activities. Plan your menus and then make your shopping list. That’ll help prevent last-minute scrambling to buy forgotten ingredients. And make sure to line up help for party prep and cleanup.

Learn to say no. Saying yes when you should say no can leave you feeling resentful and overwhelmed. Friends and colleagues will understand if you can’t participate in every project or activity. If it’s not possible to say no when your boss asks you to work overtime, try to remove something else from your agenda to make up for the lost time.

Don’t abandon healthy habits. Don’t let the holidays become a free-for-all. Overindulgence only adds to your stress and guilt. Have a healthy snack before holiday parties so that you don’t go overboard on sweets, cheese or drinks. Continue to get plenty of sleep and physical activity.

Take a breather. Make some time for yourself. Spending just 15 minutes alone, without distractions, may refresh you enough to handle everything you need to do. Take a walk at night and stargaze. Listen to soothing music. Find something that reduces stress by clearing your mind, slowing your breathing and restoring inner calm.

Seek professional help if you need it. Despite your best efforts, you may find yourself feeling persistently sad or anxious, plagued by physical complaints, unable to sleep, irritable and hopeless, and unable to face routine chores. If these feelings last for a while, talk to your doctor or a mental health professional.

None of the above can bring back a loved one, or make a new job appear. But perhaps they can help you through to a better and brighter New Year.

Stress, depression and the holidays: 10 tips for coping – MayoClinic.com.

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