Sunday, April 5, 2020

Quarantine Daze

Grass is growing in Piazza Navona
It’s been a little more than three weeks since my last post, and now half the world has joined in the COVID19 quarantine protocol: stay home; wear a mask and gloves; wash your hands; don’t touch your face; disinfect everything. As the coronavirus hit countries in waves, so too did the harsh reality of the major disruption, despair, and sorrow it brings. Fortunately for us, Rome and its environs have been spared the devastating death toll in northern Italy, and as of today there are 2,340 positive patients; in the region of Lazio there have been 212 deaths due to coronavirus and its complications. 

Meanwhile, my mother has been making slow and steady progress in her recovery. It’s most easily measured in things like what she is able to do once a week with a physical therapist. Last week, it was managing to stand up from the wheelchair and hold onto the bed frame for as much as two minutes at a time, for a total of six times. This week, she held
Helping Maureen in PT
onto her rollator and walked several steps, first in her bedroom, then in the kitchen, also for a total of six times. This required a team of helpers that physically and emotionally supported her trajectory across the floor. She has also been using a mechanical pedaling bike out on the terrace for half an hour a day, helped by the patient nurses who guide her weaker left foot and encourage her to keep going.
Daily pedaling outside
Improvement is also noticeable in her transition from sippy cup to glass, and in the number of hours she can tolerate being out of bed either in the wheelchair or electric recliner. She’s easily managing 4-5 hours, some days even more than 6, with an hour outside in the afternoon sun on good days. 

We are fortunate that we continue to have excellent nursing care in afternoons and nights, although two of our regular nurses have been reassigned to COVID19 patients in hospitals. It breaks my heart to know they are putting themselves at risk of grave illness, but I also tell myself that those patients deserve and need the very best care to recover, and good nurses are their first line of defense in fighting the virus. 

Like others managing the quarantine, I pass the time
Yummy muffins
cooking, and even baking, and have discovered my gluten free banana chocolate chip oat muffins are quite popular with the nurses (muffins are just catching on in Italy). I got two Ottolenghi cookbooks from my sister, and with friends in California and one in New Zealand we share photos and recipe experiments in a WhatsApp group. I try to give Maureen tasty, easy to eat food, and balance her diet with fresh market vegetables, beef and chicken in small portions, and rice or potatoes. I make a fruit puree with apples, pears, ginger, honey and spices that she loves as a snack. Eating requires a lot of focus for her, as she carefully chews slowly to be sure everything in her mouth is safe to swallow, and sometimes if her eyes close and she gets sleepy she needs to be reminded to stay awake and alert. I leave much of the task of feeding her to my helpers as I’m usually still in the kitchen working on meal preparation. So far she has had minimal digestive issues and all her tests point to no more problems with diverticulitis or bleeding. I still make sure she has a daily probiotic VSL3 mixed in her morning brew with aloe and fresh orange juice.

For me one of the most remarkable things is that all of her medication with the exception of her asthma inhalers has changed. In addition to stopping the Alzheimer medications of donepezil and memantine, she is not taking previous blood pressure medications or montelukast for asthma. She takes a daily diuretic, Lasix, a beta blocker for her heart, an anticoagulant, and a blood pressure medicine. Her kidney function has improved, her blood pressure is stable, and her heart and lungs are working fine. There has been some notable decline in terms of Alzheimer’s symptoms, but some improvements as well, so it’s hard to say what will be the lasting effect of both her health trauma and suspending the two medications. To help her sleep, and to calm the agitation she experiences in the middle of the night, we use a low dose of Lexotan (we tried Xanax, but it didn’t work) in combination with natural sleep aids valerian and melatonin. 
Mimi helps me with my ankle magnet therapy,
now dubbed Mimimagnetoterapia

Like others looking for creative ways to pass the time at home, we listen to a lot of different music throughout the day: Yo-Yo Ma’s Bach recording;  Frank Sinatra from the late 40s-early 50s with the swinging Harry James Orchestra; Ella Fitzgerald’s live concert in Rome recording; Morabeza, a new recording by Italian singer Tosca (and we have tickets to hear her live in Rome in mid-May); in the evening to wind down, Stan Getz, Bill Evans, or Oscar Peterson. We also tried a collage activity exploring concepts of isolated, tangential, and overlapping led online by our artist and teacher friend Barbara Ellmann, offered through Lincoln Center’s education program, and hung our collages
My collage had a Roman theme
on the wall across from Maureen’s bed. We avoid the news now, and prefer concerts or classic films, limiting TV watching to less than an hour or two a day. There’s always daily chores and now we’re starting some spring cleaning and closet reorganization projects too. 

I know I am blessed to be spared the common hardships of the quarantine in that I don’t have to work from home and schedule online meetings or classes, I don’t have to homeschool any children, I am not ill, and I can get whatever food and medicine we need with relatively little effort and low risk of infection. Even my gyrotonics teacher is offering free classes through Skype, so I’m getting my weekly exercise. But I am blessed in another way, that fellow caretakers will probably recognize. I am used to this feeling of staying close to home, attending to domestic chores, slowly feeling the passing of time, because my mother is my number one priority. It’s been three years. I can handle whatever quarantine time is still to come. Every day with Maureen is precious. 

Friday, March 13, 2020

Life During Wartime

“This ain’t no party, this ain’t no disco, this ain’t no fooling around” – Talking Heads

If you are one of those people who still thinks the COVID-19 virus is unlikely to change your life, think again. We are witnessing the worst-case scenario of a global war against a highly contagious virus that requires all of us to do our part to contain its spread, particularly to the most vulnerable among us. Here in Italy as of today there are more than 15,000 known cases of the Corona virus, 11,000 of which happened just last week. 
From New York Times March 13, 2020

Hospitals in the north where the spread began are overwhelmed, desperately seeking to create intensive care beds for the overflow of dying patients. This New York Times piece (no paywall on Corona news) provides a grim glimpse into the future scenarios likely to expand globally.

Italy has now taken the most drastic measure of putting the country on pause – no school, no work, no play – and is using celebrities and doctors to spread the #IoRestoACasa message that staying put, in the safety of one’s home, is the best way to contain the spread of disease. Now only supermarkets and smaller food stores plus pharmacies are open, and you have to wait your turn to get in. When I ventured out to the pharmacy yesterday, there were about ten people waiting not in line, but with the required meters between them, each new arrival confirming who was the last person so as to keep track of turns. This sort of civility is rare in Italy where cutting in line, especially at airports, is more the norm. Masks and gloves are everywhere, and supplies of hand sanitizer seem to have run out.

Against this surreal backdrop, my life as a caregiver goes on with the daily joys of watching my mother get better and better with each day. Even her bloodwork yesterday shows dramatic improvements in the worrisome numbers. When we first got the hammock-like lifting machine to transfer her from bed to reclining electric armchair, she actually loved the whole experience, and stayed in the chair for 30 minutes. Just yesterday she stayed for three full hours, eating dinner in the chair, and during her physical therapy session managing to stand three times holding on to the bed frame while we supported her on either side. For the first time we saw her move her feet on her own, taking little steps as we pushed the armchair into position, and turning her ankles in circles to stretch the muscles. This morning I left her room for a few minutes and returned to find her sitting up, legs hanging down the side of the bed, torso up, with only the yoga belt barrier I put in place as support for her hands. She is ready to, as she says, “get out of here.”

Also remarkable is the dramatic difference between her speech when she is lying in bed compared to when she’s sitting up in the chair. Moans and groans turn into full-blown phrases of thoughts her brain has been likely storing up for eventual use. Her physical therapist recommended putting
Maureen loves the armchair
objects she enjoys out on a table in front of her, so I got out her box of costume jewelry necklaces and bracelets, and she reached forward with delight, holding each one as we talked with her and had much more meaningful social interaction than when we are leaning over her in bed, taking her blood pressure or helping her to eat and drink something.

I shudder to think how all of this would have been different if we had decided to put her in an ambulance and take her to the Umberto I hospital when she first had the crisis after her colonoscopy and endoscopy hospitalization. I doubt she could have survived. Alzheimer’s patients are particularly prone to terrible disorientation and panic attacks in hospital settings, and she would have increased her risk of exposure to germs, bacteria, and of course, the COVID-19 virus. With her weakened lungs and heart, she wouldn’t have had a chance.

So please, take this pandemic seriously. For you, for your loved ones, and for those who are most vulnerable. They need you.

Sunday, March 1, 2020

Nursing Back to Health

Nurses, like teachers, are some of the hardest working, underpaid, under appreciated professionals and they are on the front lines of health care with the most direct contact with patients. Here in Rome, just as in New York, they come from countries across the globe, many hoping to earn enough to help family members they left behind. Their hours and shifts are crazy, well beyond a straight 12 hours, and often requiring being awake all night.

My mother came home from the hospital on February 13th, and all was going pretty well until a few days later when she became bedridden. Her doctor came for a visit when a nurse was here and they determined she needed a catheter, so I raced to the open pharmacy to get supplies and after a tortuous few minutes it was in and there were within minutes two full liters of urine filling up the bag. Apparently the bloating resulting from the endoscopy and colonoscopy perhaps coupled with side effects of anesthesia caused her bladder to back up, which might also explain her high creatinine level above 3. It was touch and go for the next several days, requiring sleepless nights, gas pain, difficulty breathing, anxiety and delirium. I feel as though I have jet lag from a trip to Los Angeles for about two weeks now, and I am definitely feeling that I am too old for this.

I have learned a lot about nursing and caring for an elderly bedridden patient in the past weeks. The doctor has been in constant contact through messages and took a one-problem-at-a-time approach, so first we worked to stabilize lung edema issues using intervals of oxygen, the diuretic drug Lasix, and extra inhalers beyond the ones my mother usually has for asthma. Then once her breathing improved, we shifted our focus to her heart, slightly modifying the medication regime (she had still suspended many of her previous medications) and taking her blood pressure regularly. I kept charts of all the data including what she ate and drank and anything else noteworthy. Once I became incapacitated by sleep deprivation, I hired night nurses so that even though I woke up regularly anyway, I was sleeping in my bed more than I had been in the makeshift one next to my mother.

This all paid off and slowly but surely, we turned a corner and she seemed out of immediate danger. Her bloodwork numbers were going in the right direction. We had avoided an ambulance and hospitalization through teamwork and good communication, and Maureen’s ability to fight the impulse to give up. Every day she ate more, gained strength, was more present and herself, giving sweet hand caresses to the faces of those caring for her, winking, smiling, sometimes even singing. Frank Sinatra is an excellent healer. There were also battles to move her body, when she would threaten with fists clenched, “I’ll kill you!” but once in a comfortable position she settled right back down.

I worked in the kitchen and in my shopping to make smooth, easy food taste good, while following dietary guidelines for kidney problems and diverticulitis. Squash, carrot, and sweet potato soup. Omelets with cheddar cheese. Lemon flavored meatballs. Juice mixes with the sweetest fresh oranges and pure aloe plus her usual morning probiotic. Hot Irish tea with milk and sugar. Creamy yogurt in her favorite flavors. Cooked pears and apples pureed with banana. Lots and lots of zucchini minus seeds drowning in delicious olive oil. Thank God for soft sippy cups that made drinking in the inclined hospital bed we rented possible with little mess.

Finally, four days ago, my warm and creative physical therapist agreed to work with Maureen and see if we could get her to sit up on the edge of the bed with her feet down. Since it was close to our regular happy hour time, I told her she could even enjoy a few sips of wine if she’d try to do it, and we put on some upbeat jazz music. We slowly progressed from massage, to movement, to pillow readjustments, to a three-person (assisted by the nurse moving pillows) maneuver that slid her into position with an armchair pillow rest cradling her back. For the first time in over a week she had a different perspective out her bedroom window, and she seemed surprised to see it. I gave her the promised sips of wine, I cried, composed myself, took a picture to send my sister, and just marveled at what all that hard work had produced.

In addition to learning to do belly injections the right way with no pain and no black and blue mark, to change a really messy diaper (double gloves!) without taking forever, to treat bed sores (a rotation of three products seems to work best) and foot blisters, to get creative with pillows of all shapes and sizes, to administer oxygen with a patient determined to remove it, to change and reposition my mother all by myself (THAT was hard but now I’m a pro), to manage a catheter, and to not lose my patience every time I had to get back up just after falling asleep (I really understand those new mothers who look at their newborns in exasperation), I learned that I had to also administer some self-care. I thought about that airplane safety rule about putting on your oxygen mask before helping someone beside you. So I returned to doing my gyrotonic exercise hour with my teacher, crying with joy at my ability to do the familiar movements after my ankle surgery. I made a point of shopping at my favorite market, and chatting as I always do with the vendors I have befriended who make this chore so pleasant. I didn’t try to do everything, and trusted that Irene and Arianna were perfectly capable of being in charge of things too. I took time to make myself some comfort food, to watch my favorite Italian show, to even have my weekend martini.

And finally, blissfully, I got some badly needed sleep.

Saturday, February 15, 2020

Hospitalization and Frailty

Maureen in the afternoon sun

Aside from the two times she gave birth, my mother has never had to stay in a hospital. She has had cataract surgery, Mohs surgery for skin cancers, and she has been treated in an emergency room and in an urgent care facility, but as of this week, she has never been hospitalized overnight for illness. Now that she has Alzheimer’s, I have dreaded the possibility of having to either call an ambulance, or admit her to a hospital, as I feared the resulting anxiety and disorientation would be more debilitating than whatever affliction might befall her. So last weekend when she began to have serious rectal bleeding, I made a round of phone calls and found that my anesthesia doctor from my recent ankle surgery was also practicing geriatric medicine and could do a house call that same afternoon. Imagine that! 

He immediately had me suspend four of her medications. Two were her Alzheimer’s medications, donepezil and memantine, here in Italy known as Aricept and Ebixa. For some time I had suspected they were doing more damage than good. In fact I recently read that memantine and donepezil should not be taken together, and not by patients with heart conditions. My mother has both high blood pressure and a heart arrhythmia. Donepezil is also bad for people with asthma, which my mother has had all her life. The other drug was warfarin, which thins the blood to presumably prevent strokes and heart attacks, but it carries a risky potential for causing internal bleeding. We agreed that hospitalization was not yet necessary, and might make matters worse for her. When her symptoms persisted the next day, he had her admitted to a private hospital not far from where we live.

Her hemoglobin was dangerously low, so she was given blood and plasma transfusions in order to prepare her for a diagnostic endoscopy and colonoscopy the following day. Thankfully with the help of some fantastic nurses, I got her through the prep and we had generally good news from the procedures: no tumors, no hemorrhoids, no need for any surgery. However, she had diverticulitis, and the working hypothesis was that her worsening anemia coupled with the impact of that cocktail of medications caused internal bleeding that eventually led to the hemorrhaging. Luckily a careful diet can help the intestinal healing, and now we will work to figure out how to improve her heart and lung health. 

I imagine readers of this blog are well aware of the dubious results of these two widely prescribed Alzheimer’s medications, and of the many undesirable side effects. Dr. Dale Bredesen whose work I have previously written about, posted on his Facebook page about a year ago about a meta analysis:
a recent study showed that patients treated with standard Alzheimer’s drugs donepezil (Aricept) or memantine (Namenda) actually declined more rapidly than those who were not treated with those drugs (Kennedy et al., JAMA Network Open. 2018;1(7):e184080. doi:10.1001/jamanetworkopen.2018.4080

What may be less understood by caretakers and even medical professionals is how the frailty of old age can mean unseen vulnerability that is not diagnosed with typical bloodwork and routine doctor visits. I think of myself as a pretty well-informed caretaker, someone who has done a lot of reading about Alzheimer’s, but I did not go to medical school, so I put a great deal of trust in doctors. When I saw symptoms like nighttime coughing, complaints of feeling cold, rising creatinine levels, increased sleepiness, breathlessness with fatigue, I did not pursue the possible reasons, even though I wondered about the medicines that negatively impacted kidney function. My mother’s doctor most recently diagnosed a flair up of asthma and prescribed prednisone, and it reassured me the chest x-ray showed no change from the previous one and therefore she felt the heart was not to blame for her symptoms. In retrospect, I am shocked that a simple online search turned up the fact that iron-deficiency anemia (which my mother has been taking iron supplements for since late fall) is almost always due to blood loss, and a simple test can determine if there is blood in the stomach or bowels. 

Lessons learned the hard way always leave a residue of guilt. I am grateful for the happy outcome of the procedure, for a trustworthy and competent doctor and his colleagues at the hospital, and for a mother who is a stubborn warrior and even in her most distressed state was willing to fight through it. I am more skeptical than before all this happened about the medical establishment, which seems even more dysfunctional than the really messed up field of education that has been my life's work. I see disturbing parallels. We know from replicable and reliable research that these medications are not working and are even dangerous, yet millions continue to take them in the hope they'll do something for their loved ones. We know that the toxic testing culture taking over educational settings is not improving learning outcomes and is actually harmful to students and teachers, yet we persist in ranking, sorting, praising and publicly humiliating people. We have a long way to go. We're not getting younger, and most of us are not getting healthier. Or for that matter, smarter. 

Saturday, December 28, 2019

When the Caretaker Needs Care

Yes, that's my left foot.

About two weeks ago, after a lovely visit with friends and hot chocolate with whipped cream in a coffee bar, I slipped in dog shit and broke my left ankle. I was alone, in the dark, on a wide street with no other pedestrians around to notice my predicament. My high tolerance for pain enabled me to get up, walk two blocks to my car (stopping at a street fountain to wash the shit off my hand) and drive home using the clutch. Thinking it was only sprained, I wrapped the ankle, took some Advil, and had a bit of wine.

Three days later I realized I needed x-rays, and they revealed broken bones on the inside and outside of my ankle, requiring surgery. I knew I was going to have to pay for private service since I don’t have Italian health care set up yet (and probably would not do this sort of surgery in a public hospital anyway) but I needed to get it done quickly and with a minimal hospital stay. Luckily our doctor’s office came to the rescue with a very experienced American orthopedic surgeon specialized in hand and foot surgery and she got me into a private Catholic hospital close to home. I had
After surgery
the surgery the next day and spent only that night in the hospital. In another few days I get to switch from a cast to a boot and my healing is progressing nicely so far, plus I’m down to only using Advil for pain. Big sigh of relief, right?

Not quite. If I didn’t have two fantastic women who help me manage things at home, who know and understand my mother and her needs, and who were willing to take turns staying overnight so we had constant coverage, I don’t know what I would have done. In part you just don’t realize how much you do as a caretaker until you can’t do it anymore. You cannot even take something out of the fridge and get it to the counter when you have to walk with crutches.

For some time my mother had refused to let me order her a rolling walker with a seat for when she was tired of pushing it around. Now I realized I had to get one as I couldn’t risk her falling, and I decided I also needed a stool with wheels to roll around, at least in the kitchen. I also went online to buy cat litter, and stock up on grocery items that are heavy to carry. We tried ordering home
Better stick with Italian food.
delivery from a local restaurant for the first time and were disappointed by mediocre poke bowls. Our helpers managed all the rest and so we got through these two weeks with only one slow-motion late night fall as my mother was heading to bed.

We also had our Roman friends come to the rescue with a Sunday afternoon visit and a Christmas lunch feast, picking up our spirits considerably. My sister and her family cheered us on through FaceTime calls and it made them not seem so far away. Even though my mother would regularly forget what had happened to me, she started to catch on when she would see the cast on my foot, and her patience and concern has been of great comfort.

Now that I am facing the grim reality of not being able to drive or walk without crutches for weeks, not to mention months of physical therapy, I realize that the hard part is probably yet to come. I don’t know what it will be like for us to be constantly in each other’s company at home, to not go out to eat, or just for a drive or an errand. We’ll have to take taxis for important things like doctor appointments and blood tests (coming up in January) and I guess just learn to manage as best we can.

The research on the toll caretaking takes suggests that it’s not enough to carve out a bit of down time, to relax and take a break. I thought my twice weekly gyrotonic exercise classes were my sanctuary, keeping me fit in body and mind. I learned to do more than errands while my helpers were with my mother, to go for walks, to see an exhibit, or shopping. I was even plotting to take my laptop to a café one afternoon and work on the young adult novel I am writing, which seemed truly luxurious. For now, that will all have to wait. I have to focus on healing, and getting through the tough weeks ahead.

Sunday, May 26, 2019

A Rainy Sunday

It’s rare to have a string of rainy days in Rome, but that is what was in the forecast this weekend. Because it is my father’s birthday on Monday we decided to do what we did last year and go to mass at the church where my parents got married in 1960, San Giovanni a Porta Latina. We easily parked outside the church and sat in the same place we did before, and the children’s choir was just as sweet as we remembered. I even took the same panoramic view of the interior with my mother sitting to the left as I had last time. 

Our moods lifted by the beauty of the church and the familiar mass and music, we drove to the nearby neighborhood of Ostiense to have brunch at our beloved Marigold (I previously wrote about our first lunch at this wonderful new restaurant run by a husband and wife team). We got there just in time to score a spot at the long central table on the end. We got to chat again with both Sofie and Domenico, even though it got very busy, and had our brunch favorites,
eggs benedict and avocado toast, while enjoying the pleasurable vibe of the international clientele. We bought some chocolate chip cookies, seeded rye bread, and granola to take home in a new blue Marigold tote bag.

The rain let up as we made our way back to the car, and driving along the Tiber we admired the green sycamore trees and the familiar buildings as we drove back north towards home. Then my mother wondered if our florist might be open, so we turned right at the piazza and sure enough his stand was full of buckets of pink peonies and potted hydrangeas.
As he wrapped our flowers he gave some extra fully opened short stem peonies to my mother for free, because that’s just the kind of wonderful generous man he is, and she delighted in arranging them when we got home. Usually our flower market day is Tuesday, but it’s also nice to have fresh flowers on a rainy Sunday just as Tuesday’s peonies were starting to fade. 

Then we napped. Some days it is the simple pleasures that bring the most profound feelings of gratitude. 

Saturday, April 13, 2019

Thinking About Health

Seven years ago today I was released from the hospital after a three-week stay. If you have ever been in the hospital, you know that is a long time. I had perforated my appendix while in Italy but thought I had a bad stomach flu. I miraculously flew home, stayed in bed for a day, and then was so ill I had to be taken to the hospital in an ambulance. I was in full sepsis, kidney failure, the works. Antibiotics saved my life, plus an awesome team of nurses and doctors (in that order). This experience changed my life. I am certain that is true for anyone who fought a serious illness, or who continues to battle diseases both visible and invisible. Now that I am a full time caretaker for my mother and have been doing research on Alzheimer’s, I have a few thoughts to share on this anniversary.

Doctors can only do so much
Medical training is rigorous, competitive, and not for the faint of heart. It requires massive amounts of memorization, ongoing test taking and certification, long hours of practical experience which involves extended sleep deprivation, and undoubtedly causes considerable stress. Doctors have to make life and death decisions, sometimes in a moment of crisis, sometimes after careful research and consideration of all options. They make mistakes, and while most of us can agree that learning from mistakes is a part of life, for doctors, they may come with the burden of guilt, of fear, even sorrow.

These demands have led to extreme specialization, so it is increasingly rare to find an internist or general practitioner who has the knowledge and experience to see the big picture of a patient’s health, regardless of age, gender, and medical history. You see more and more that doctors will tell patients they must see yet another specialist. Each of these specialists is trained to prescribe medication, sometimes on a short term basis, but more often indefinitely. Having read the fine print on many types of prescription medications, I am willing to bet that most specialists cannot remember drug interactions except for common ones, and so they rely on computer programs to cross-check, but computer programs are not infallible, nor do they necessarily keep up with the latest research, which in turn can’t keep up with extant empirical evidence. Plus most side effects do not affect all patients in the same way. That’s why drug commercials have to say all the potential side effects as quickly as possible, to make us believe that those bad things won’t happen to us if we take the medicine.

When medicine can’t cure what ails us, doctors prescribe surgery. Surgeons can do amazing things, sometimes without having to cut open our bodies. My four hour surgery to clean up the mess of my perforated appendix (and remove my gallbladder) was done through a single incision in my belly button. I have no scars to show for my ordeal. All my scars are internal. That’s right, sepsis leaves a trail of adhesions throughout the abdomen, and even laparoscopic surgery causes scar tissue to form internally. Did anyone explain this to me? Of course not. I had to ask my surgeon about symptoms before finding out this lasting side effect, and on my own, had to learn about massage and exercise that keeps me from having any intestinal blockages and keeps my organs from getting stuck in scar tissue. My surgeon did tell me that unfortunately more surgery means more adhesions.

Now sometimes doctors need the help of psychologists to diagnose illness. In the case of various forms of dementia, neurologists usually have some simple-to-administer surveys and tasks that can assist in early diagnosis. In my mother’s case, this survey was farmed out to a young office assistant. My mother, insulted by the simplicity of the questions and the age of the young girl trying to figure out if she was having comprehension problems (which she was probably quite aware of and had been trying to hide and compensate for them for some time), refused to complete the test. I had to sympathize. What was the neurologist thinking? That he didn’t have the time or inclination to do those surveys with elder patients. But was he aware of how easily that eroded the patient-doctor trust that was the basis for his practice? Similarly I learned more about my heart and high cholesterol from the technician doing my exams than from my primary care doctor.

Nutrition is the first line of defense against disease
You are what you eat, how many times have we heard that advice and ignored it? Now the diet fads have cool-sounding labels like keto and paleo, and for those who need their healthy “food” on the go, we have $12 juice drinks made to order if you live in an urban environment where there are enough paying customers to keep such a place in business. Even though there is growing consensus that sugar is the most evil ingredient in our diets, American supermarkets continue to be palaces to mass-produced high sugar content food and drinks.

Grilled asparagus with agretti and chopped egg
We are lucky. Here in Rome fresh produce is abundantly available, and vendors do their utmost to make it easy for home cooks. You are craving mixed roasted vegetables? Buy a bag for caponata and all you do is drizzle some olive oil, add salt and seasonings and stick it in the oven. You need a hearty soup? Grab the minestrone mix, add water and rice, pasta, or potatoes and lunch is ready in no time. Even the artichokes are trimmed and ready to go in the pan when you get home. I regularly buy 5 kilos at a time of organic beef in various cuts through a friend who runs this as a side business. At Friday’s open air market I get seafood so fresh it came out of the sea the day before. The whole chicken from my butcher comes from the Tuscan countryside and cooks up to be juicy, tender, and full of flavor I didn’t know chickens could have. Our eggs (which we eat every day) are bright yellow and delicious no matter how we cook them, but they do make the fluffiest omelets and soufflés I have ever had.

This Mediterranean diet is delicious, full of variety, and does not lead to weight gain. All of our blood work shows that our health has improved in the last 18 months. Our eating habits have changed without causing us to despair or develop cravings for junk food. We don’t have intestinal issues or heartburn. We both take probiotics and supplements that I believe enhance the health benefits of this way of eating. In all my encounters with doctors, only two have discussed nutrition. One was my mother’s eye doctor here in Rome, who discussed the right supplements for eye health (for both of us) and for her macular degeneration. The other was my surgeon who said taking probiotics “wouldn’t hurt” and told me about his friend Dr. Peter Attia, whose writing has taught me a great deal about nutrition, health, and cholesterol. The only other times doctors mention nutrition is when doctors see my high cholesterol levels they tell me to avoid fat, beef, and eggs. That is old, old science, but it continues to persist in the profession.

We still don’t know much about the brain
Increasingly the medical profession is paying more attention to the role stress plays in developing disease, perhaps more so in cardiology where the links between stress and heart disease are most obvious. I am convinced my problems seven years ago were caused by stress, so pervasive and severe that even my weekly yoga practice wasn’t helping. Academics are typically perceived as having a “cushy” work life, with self-regulated working hours and a light teaching load. A recent heartbreaking profile of the late Dr. Thea Hunter brings into sharp focus how dramatic changes in higher education including labor practices have led to exploitation and work loads of adjunct, untenured, and junior faculty members that go far beyond common understandings of stress-inducing.

What decades of Alzheimer’s research has yielded in terms of treatment are drugs that work on slowing the growth of synapse-destroying plaques and tangles in the brain, with no clear cause, prevention or cure for this growing disease in sight. In Dr. Dale Bredesen’s research, he lays out the case
From The End of Alzherimer's (2017)
against the mainstream dogma that Alzheimer’s is a single disease characterized by the excess production of amyloid-beta plaques. “Our research on the different biochemical profiles of people with Alzheimer’s has made it clear that these three readily distinguishable subtypes are each driven by different biochemical processes. Each one requires a different treatment. Treating them all the same way is as naïve as treating every infection with the same antibiotic.” (p. 9) Bredesen goes on to explain that these subtypes, identified alone or in combination with each other, are risks for brain function decline: “inflammation/infection, insulin resistance, hormone and supportive nutrient depletion, toxin exposure, and the replacement and protection of lost or dysfunctional brain connections (synapses).” (p. 17) Standard one-size-fits-all treatments are destined to fail in these manifestations of degenerative neurological disease.

One truism that helps me on my quest to better understand issues of health and well-being, particularly in order to be the best caretaker for my mother that I can possibly be, is that the more you know, the more ignorant you feel. I do not want to leave the impression that I have little faith in the medical profession. My life was saved by people at the hospital, who kept careful watch over me for three whole weeks, and by my doctors who followed up with me in the years that followed.
The biggest lesson I learned was to listen to my body, to pay attention, to slow down and rest, to put good wholesome food in my mouth, to find ways to exercise that brought me energy as well as pleasure, and made my body feel better. If that sounds hard, it is. Kind of a lifelong mission actually, but well worth the effort.