Living life, facing death-a review of A Beginner’s Guide to the End

Even as a physician, I was surprised at the claim that only 10% to 20% of us will die without warning. The rest of us will know we have something that will likely take our life. And even if we don’t, we all know we will die eventually, although we tend to think and act as if it’s a well kept secret, and maybe it is.

A Beginner’s Guide to the End

Practical Advice for Living Life and Facing Death

by B.J. Miller, M.D. and Shoshana Berger

This book’s tag line sums up the content of this book perfectly. I have reviewed other books about death on this blog; they were more biographical, philosophical, and spiritual and touched less on the practical. This book is on the other end of the spectrum; more practical, but also philosophical ,and spiritual. ( And I mean spiritual in a broad sense, not necessarily religious.)

The book begins with a brief biographical section where each author shares their reason for writing a book about death. Dr. Miller, a palliative care physician, had a life-threatening injury. He writes,

I got close enough to see something of death and come back from the ledge, only to realize that it’s in and around us all the time.

Ms. Berger, an editorial director, took care of her dying father. She wrote,

I remember those years as being full of anxiety and grief but also as a time of drawing closer.

an illustration from the book

How the book unfolds

The book consists of 5 sections that mimic the progression from life to illness to death. Even as a physician, I was surprised at the claim that only 10% to 20% of us will die without warning. The rest of us will know we have something that will likely take our life. And even if we don’t, we all know we will die eventually, although we tend to think and act as if it’s a well kept secret, and maybe it is.

The sections are as follows

  • PLANNING AHEAD
  • DEALING WITH ILLNESS
  • HELP ALONG THE WAY
  • WHEN DEATH IS CLOSE
  • AFTER

Although you could read the book straight through, you might want to skip to sections you need at whatever stage you are in. Chapter titles clearly tell you what to expect from their content. Here are some examples-

  • Yes, There’s Paperwork.
  • Can I Afford to Die?
  • I’m Sick
  • Love, Sex, and Relationships
  • Hospital Hacks
  • Care for the Caregiver
  • It’s Your Body and Your Funeral
  • Grief
  • How to write a Eulogy and an Obituary
  • Celebrating a Life

There are no photographs, charts, graphs, or info graphics, but scattered throughout are illustrative sketches that convey helpful information in a non threatening way. I have used some screenshots of a few of them to illustrate this post.

The authors conclude the book with Last Words, Acknowledgments, Resources (an extensive list), Notes, and Index.

Read this book

As much as I hope you don’t need it right now, unfortunately you do need it right now. So whatever stage of living, or dying, you or a loved one may be in, you will find something helpful here.

Find the book at your local library like I did, or get it from one of these book sellers; this would be a good book to keep on hand. (These affiliate links pay a commission to support this blog, while you pay nothing extra. )

Bestsellers at eBooks.com! Support Independent Bookstores - Visit IndieBound.org
Dr. Miller’s TED talk on WHAT REALLY MATTERS AT THE END OF LIFE

Here is another post from this blog about the dying experience

What books teach us about dying

an excerpt-

I reviewed these books  because understanding how other people and their families have faced death may relieve our dread, anxiety, or fear  about dying and death. Often it is not death itself that we fear but the dying process -the pain , disability, dependence, isolation, unfulfilled dreams.

In an essay  for JAMA, Dr. Zachary Sager, a geriatric and palliative care physician in Boston Massachusetts, described his response to  working with dying patients-

“I witnessed how people could be simultaneously resilient and fragile. I was moved by the connectedness between individuals.

I accept that death offers not only the expected reflection on life and mourning but an opportunity for a unique form of growth and healing. ”

The books I reviewed share  common themes, and events yet are each unique as are the people in them who demonstrate both resilience and fragility.

sharing the HEART of life and death

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

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Hell and Back-a breast cancer story

Hell & Back is a memoir by pediatric ENT (ear, nose, throat) physician Tali Lando Aronoff, M.D. who finds her perfect life upended in ways she never imagined would happen to her.


The sorrows of death compassed me, and the pains of hell gat hold upon me: I found trouble and sorrow.


Psalm 116:3, KJV, public domain


Wife and mother

Just based on the title, you know this isn’t a happy story.

The main character, Tali, seems to have the perfect life. She is a pregnant young woman with a husband who adores her and two beautiful children. They have good jobs, a nice house, a nanny who is good with the kids. She has a loving and supportive extended family.

Then her father is diagnosed with an incurable brain tumor. She develops life threatening preeclampsia. She has an emergency caesarean section, delivering her baby prematurely.

Then she finds a lump in her breast. It is cancer- that has already spread.

Oh, did I tell you she is a physician with a busy surgical practice?

Hell & Back: Wife & Mother, Doctor & Patient, Dragon Slayer

by Tali Lando Aronoff, M.D.

Hell & Back is not a novel. It is a memoir by pediatric ENT (ear, nose, throat) physician Tali Lando Aronoff, M.D. who finds her perfect life upended in ways she never imagined would happen to her.

(By way of disclosure, I have never met Dr. Aronoff. After reading about her, I asked for a complimentary copy (PDF) of her book in exchange for a review. This blog post has affiliate links which will help fund this blog if a purchase is made. )

Doctor and patient

A physician’s illness can be awkward, both for us and for those who take care of us. Other doctors may assume we know more about our diseases than we do and fail to give us the same information they would give to “real” patients. We, on the other hand, often try to help them out by diagnosing ourselves, or minimizing our symptoms because we don’t want to bother them, or seem like complainers. Either approach impacts our care negatively.

But being a physician can be an advantage and it certainly was for Dr. Aronoff since she had friends who specialized in breast surgery, oncology (cancer), radiation therapy, and plastic surgery, all of which she would need. Recently out of training,  they had the most up to date knowledge in their fields. They helped her get to the right doctors, including getting appointments quickly.

But being a physician didn’t spare Dr. Aronoff pain from her mastectomy and the expanders (used to make room for eventual breast reconstruction). She still had to cope with  the debilitating side effects of chemo- fatigue, nausea,appetite loss, and hair loss- all the while caring for 3 small children.

A physician’s friends and family may assume that because we are healers, we are brave, strong, and can take care of ourselves. Dr. Aronoff found her closest friends understanding and supportive, and many went above and beyond, driving her to appointments, taking her kids to activities, and bringing meals.

“The naked truth”

When she lost her hair, she tried wearing wigs and found them uncomfortable so opted for scarves instead. This made her illness obvious, so when she went out in public people noticed her. She described becoming a “Synagogue Celebrity”, with people in her community posting sightings of her on Twitter because she “looked so good”.


“I smiled at praises..inside though, I was slipping, retreating into myself. But I didn’t dare let them see. With time and practice, I learned to navigate and embrace the dichotomy. I realized that projecting courage may not reveal the whole truth, but it’s not always a lie either.
Eventually, as the months passed, I regained my courage, I still had fight in me. So, I saved the naked truth for a handful of my trusted few.”

Daughter and doctor


Dr. Aronoff shared a poignant yet humorous moment celebrating Chanukah with her extended family while in the middle of chemotherapy that made her nauseated and weak.  She knew this would be the last time they would celebrate with her father, who had a terminal malignant brain tumor, so she made the 3 hour car trip to her parents’ home.


“In the glow of candlelight, I watched my father from the corner of my eye, burning his image onto my brain. I knew in my gut it would be the last year we’d celebrate together. We sang the ancient chant Hanerot Halalu about the miracle of the small jug of oil that burned for eight days. My family sure as hell needed some miracles these days too.”  

When the evening was over, they loaded the kids into the car for the long ride home.


“Alex (her husband) and I smiled at each other optimistically, anticipating a smooth ride back home with sleeping children. I hugged everyone goodbye and kissed my father lightly on the cheek. And just when I thought I was in the clear…(her daughter) Scarlett leaned over and vomited all over me!”


Who should read this book and why

Despite pieces of levity, this book is serious and hard hitting at times. Dr. Aronoff does not mince words, nor does she shy away from frank talk about intimate issues and raw emotions. If 4-letter words offend you, you may not want to read this book.

Dr. Aronoff’s book outlines the basics of diagnosis, staging, and treatment of breast cancer but I don’t think she intends it as a definitive patient guide. She does not imply that her experience is what other breast cancer patients should expect; rather she emphasizes that every patient’s journey may be different.

If you have had breast cancer, you may or may not identify with her experience. If you have not had cancer, her experience may motivate you to get a screening mammogram, explore your genetic risk, and consider what you can change in your lifestyle to decrease your  risk of getting breast cancer. (I’ll include some references for this at the end.)

“Dragon Slayer”

I won’t leave you hanging; this story has a happy ending. Dr. Aronoff is now disease free, and back working at her practice.She is a “survivor” but the threat of a recurrence will always loom over her. She may never know for sure if she is “cured”.

I invite you to visit her website to see photos of her before, during, and after treatment, and to read a sample chapter of her book.

Interlude-Women’s Cancer Stories

Dr. Eleonora Teplinsky talked to Dr. Aronoff for her podcast series Interlude. Listen to the interview at the above links.

Check out these breast cancer resources

Breast cancer screening

Understanding your breast cancer risk


Breast cancer is not exclusively a women’s disease, it happens to men also.

Risk factors for breast cancer in men

The Susan G. Komen Foundation offers this printable resource

Coping with a Breast Cancer Diagnosis


Informacion en espanol- Cáncer de mama

Shop To Fight Breast Cancer! Every Purchase Helps Give Free Hospital Mammograms To Women In Need!

(This post contains affiliate links which, by paying a commission if used for a purchase, help fund this blog. )

sharing the HEART of health

Again thanks to Dr. Aronoff for giving me her book and sharing her story with all of us. I think we all have learned something that might help us or someone we know.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

True health stories-3 medical memoirs that share the HEART of health

I think the best medical books are those about real people who face real health challenges that are often life changing or even life threatening. There is nothing like experiencing a serious illness or injury to make you an expert about it.

I read lots of books for my own pleasure and to review for this blog. Although health/medicine can be a genre in itself, many different types of books and media can illustrate medical science.

Some are fiction including drama, comedy, and often science fiction. One I have reviewed here is

Say Goodbye for Now.

SAY GOODBYE FOR NOW- A Novel
SAY GOODBYE FOR NOW by Catherine Ryan Hyde

Most however are non-fiction. One in this category that I reviewed relates medical history.

Pandemic by Sonia Shah
PANDEMIC BY SONIA SHAH

Pandemic

Medical writers often explain medical conditions, offer information on treatment options, give advice, and encourage healthy habits. One of these is

Mind Over Meds

MIND OVER MEDS- book cover
MIND OVER MEDS BY ANDREW WEIL, MD

But as helpful and interesting as these are, I think the best medical books are those about real people who face real health challenges that are often life changing or even life threatening. There is nothing like experiencing a serious illness or injury to make you an expert about it.

And when the person with the problem writes or tells the story, we don’t just learn about it, we feel the emotions it provokes also.

Share your story

I have reviewed several of these “medical memoirs” here and will likely continue to do so. In a way, we are all living our own health journeys and many of you could offer reflections on how you and your family deal with your unique medical challenges.

If you are willing to share the perspectives you have gained through a health issue or medical experience, contact me; I would love to read it, and maybe share it here with my other readers. Your remarks may remain anonymous if you prefer.

Explore these “medical memoirs” with me.

The Best of Us

A Memoir

by Joyce Maynard

Ms. Maynard’s story opened with a  failed marriage/bad divorce saga with adult children torn between the two parents, persistent anger and bitterness, and attempts to ease the pain with a series of bad choices in lovers. Equally sad was her telling of a complicated  and ultimately failed adoption attempt.

Finally she and we can breath a sigh of relief when she meets a man and seems to have found true love at last. But that comes to an abrupt halt when he is diagnosed with cancer.

From then on she poignantly describes a life turned upside down as she enters new territory as a caregiver. As she relates how their lives changed, we the readers are changed also, learning to recognize what is truly important in life. As Ms. Maynard  writes,

“success, money, beauty, passion, adventure, possessions- have become immaterial. Breathing would be enough.”

Read this book if you want your assumptions about life and death to be challenged and changed. You may read an excerpt at this link

The Best of Us-Chapter 1

Tears of Salt

A Doctor’s Story

by Pietro Bartolo; Lidia Tilotta

Dr. Pietro Bartolo practices medicine on the tiny Italian island of Lampedusa, in the Mediterranean Sea. Lampedusa, known for its friendly people, sunny skies, pristine beaches, and turquoise waters famous for fishing, seems an idyllic place to live, work, and visit.

But for the past 20 years, Dr.Bartolo has cared for not just residents and tourists, but for hundreds of refugees- people who risk their lives crossing the Mediterranean from northern Africa, fleeing poverty and political unrest. The lucky ones land on shore injured and sick. The unlucky ones wash ashore dead, having died en route or drowning after falling from a capsized or wrecked boat, sometimes only a few feet from shore.

In this memoir, Dr. Bartolo shares the stories of many of these people, giving them the names and faces that we don’t see watching news stories about the refugee crisis. He also shares his own life story of growing up on the island, leaving for medical school, and returning to raise a family and to practice medicine.

Dr. Bartolo’s story was also told in the documentary film FIRE AT SEA

He never expected to become the front-line help for hundreds of desperate people. With no specific training on how to manage an avalanche of desperate, sick, and injured refugees, and with little resources, he manages to put together a system for triaging, evaluating, and treating these people, then sending them on for more advanced medical care or to immigration centers in Europe.

For the less fortunate, he serves as medical examiner, to determine the cause of death for those who do not make it to Lampedusa alive; sometimes taking body parts to extract DNA to identify them, so families can be notified. He states he has never grown comfortable to this aspect of his job.

As a physician myself, I marvel at Dr. Bartolo’s caring and commitment to people who will never be able to repay him for his sacrifice. He approaches his work as a mission of mercy, and treats every person with the utmost respect, no matter their circumstance. Some of the people he treats become almost like family; he has even tried to adopt a couple of orphaned children but cannot due to legalities.

Dr. Bartolo’s story reads like a conversation. I think you will like him, and admire him for his dedication and selfless service.  His life should encourage all of us to consider what we can each do to lessen someone else’s suffering.

Follow this link to my review of

Love conquers fear-a memoir of hope

The Napalm Girl’s Journey through the Horrors of War to Faith, Forgiveness and Peace

I received a free digital or paper copy of these books in return for posting a frank review on my blog and/or social media.

Get books here and support Watercress Words

Check your local library or book stores for these books, or consider these affiliate links, through which purchases help support this blog.

 

eBooks.com - books at affordable prices 160x600
Support Independent Bookstores - Visit IndieBound.org

Amazon and Kindle Books

Amazon Medical Books
Amazon Health Fitness and Dieting Kindle eBooks he Literacy Site

explore the HEART of health with me

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn, links are on the left side bar here and the Home page. Thanks so much.

Please follow me on social media (links in the side bar). I look forward to sharing more information and inspiration to transform your health journey.

                              Dr. Aletha 

How common meds can hurt your skin

Medications, both prescription and over the counter, can relieve symptoms, hasten healing, and save lives. Even so, adverse reactions are always a risk with any drug. Some of these adverse reactions can involve the skin.

In a previous post I told you how smoking and sunlight affect our skin- premature aging, dryness, and increased risk of skin cancer. Here is a link for you to review or read if you missed it.

How smoking and sun affect your skin’s look and feel

Layers of the Skin diagram

Here is a review of the skin’s layers

Medications and skin -help and harm

In this post I’ll talk about ways medications can adversely affect skin health.

Medications, both prescription and over the counter, can relieve symptoms, hasten healing, and save lives. Even so, adverse reactions are always a risk with any drug. Some of these adverse reactions can involve the skin.

So it is vital that patients and doctors avoid unnecessary or inappropriate use of medications.

Sun sensitivity due to medication

As mentioned in the previous post , some medications can make your skin more sensitive to sun exposure, called drug-induced photosensitivity.

Any drug can cause a reaction, even if you have taken it before without a problem. Some of the more common “skin reaction drugs” include

  • Anti-inflammatory medications, the NSAIDs
  • Psychiatric medications
  • Chemotherapy drugs
  • Blood pressure lowering meds
  • Antibiotics
  • Statins-cholesterol lowering drugs

Reactions can vary from scaly rashes, blisters, redness, dryness, itching, to severe eruptions all over the body that can be painful and occasionally life threatening.

This is what your skin looks like under a powerful microscope.

Melasma-drug induced skin color change

Melasma (muh-LAZ-muh) is a common skin problem. It causes brown to gray-brown patches, usually on the face. It is much more common in women, probably because it is triggered by female hormones, so it often starts in pregnancy. Women of color are also more susceptible.

Photo by Pixabay on Pexels.com

Melasma can be caused by

  • Sun exposure
  • Hormone medications-birth control pills, post -menopause hormonal therapy

Here is an excellent discussion and photos of melasma from the American Academy of Dermatology

Use antibiotics wisely for your skin’s sake

Probably the most common drugs that cause a rash or other adverse effects are antibiotics, probably because they are used so often. A

Antibiotics such as penicillin, amoxicillin, sulfa, tetracycline, and ciprofloxacin can cause several skin reactions .

  • urticaria, also known as hives
  • photosensitivity, mentioned above
  • a scaley rash that may peel off
  • a measles-like rash, called morbiliform
  • blisters

So doctors prescribe antibiotics only for infections that are serious enough that the risk of adverse reaction is worth the possible benefit.

Colds,  flu, and bronchitis are caused by viruses and don’t respond to antibiotics. Even sinus and ear infections don’t always need an antibiotic to resolve. Please don’t pressure your doctor for an antibiotic when you don’t need it. Read more about antibiotic misuse at my previous post

How to navigate the antibiotic highway

6 smart facts about antibiotic use
graphic created by the Centers for Disease Control, http://www.cdc.gov

The American Academy of Dermatology shares

10 skin care secrets for healthier skin

What you should and shouldn’t do now

Please understand I am not saying we should never use these medications as sometimes they are the best choice for our overall health. You should be aware of the potential for reactions and report them promptly to your doctor if they occur.

If you are taking any of the drugs listed here, do not stop without talking to your doctor.

Coming soon-more skin care tips

In a future post I’ll look at common skin injuries and how to help injured skin heal.

Thanks for joining me to explore skin problems and the HEART of health. Even if it’s winter where you live, don’t forgo sunscreen; the sun doesn’t take a holiday from damaging skin.

Please share this post and follow Watercress Words where we explore and share the HEART of health.

                              Dr. Aletha 

a cute monkey checks out his face in a mirrow
We all care about our appearance, including this cute monkey. Photo by Andre Mouton on Pexels.com

A time to be born, and a time to die-what books teach us about dying

The books I reviewed share  common themes, and events yet are each unique as are the people in them who demonstrate both resilience and fragility. 

There is a time for everything,
    and a season for every activity under the heavens:

    a time to be born and a time to die,

Ecclesiastes 3, NIV

Holy Bible, New International Version®, NIV® Copyright ©1973, 1978, 1984, 2011 by Biblica, Inc.® Used by permission. All rights reserved worldwide.

Birth and death are the only medical events that all humans share. We can anticipate and celebrate the births of other people but not our own.

However we all can anticipate our own death although most of the time we don’t want to.  Unless we deal with a chronic life threatening disease or  are  diagnosed with a terminal illness, or thrust into a life-threatening situation such as combat or a natural disaster,  most of us don’t consider  about how or when we will die. But in truth we all will die.

I have reviewed several books about death here . Not because I  wanted to write about death but because several good books deal with death sensitively and thoughtfully.

Books about death are sometimes written by a person who is facing death. Relatives write after a loved one dies- a child ,a spouse ,a parent. The motivation for writing these books varies as does the motivation for reading them.

I reviewed these books  because by understanding how other people and their families have faced death it may relieve our dread, anxiety, or fear  about dying and death. Often it is not death itself that we  fear but the dying process -the pain , disability, dependence, isolation, unfulfilled dreams.

In an essay  for JAMA, Dr. Zachary Sager, a geriatric and palliative care physician in Boston Massachusetts, described his response to  working with dying patients-

“I witnessed how people could be simultaneously resilient and fragile. I was moved by the connectedness between individuals.

I accept that death offers not only the expected reflection on life and mourning but an opportunity for a unique form of growth and healing. ”

The books I reviewed share  common themes, and events yet are each unique as are the people in them who demonstrate both resilience and fragility.

I am posting excerpts from my reviews with a link to the entire piece. I welcome and encourage your comments about these books as well as any about how you  have navigated death in your family.

A 90 year old woman says “yes” to life

Driving Miss Norma tells the story of Norma Bauerschmidt, a WWII WAVE veteran, wife, and mother. She was still in good health at 90 years of age, until she was diagnosed with cancer.

Her doctor recommended surgery to be followed by chemotherapy, and warned her the treatment and recovery would be long and difficult. She told him no, she would rather “hit the road” with her son and daughter-in-law and enjoy her life, seeing and doing things she had not had a chance to do before. And her doctor agreed, saying that is just what he would do.

Driving Miss Norma - a book cover

Tim, her son, and Ramie, his wife, had already been living a nomadic life, travelling the country with their standard poodle Ringo in an Airstream travel  trailer they parked in campgrounds and  Walmart parking lots. They enjoyed travelling, seeing new places, meeting new people. They wondered how adding a 90 year old woman to their wandering lifestyle would work.

Driving Miss Norma- a book review

A young mother who chose life

A few months after their baby Indiana’s birth, Joey  faced the recurrence of cervical cancer diagnosed and treated years before. Despite more surgery, radiation and chemo the cancer persisted until further treatments were futile and and likely to cause more suffering. Joey decided to leave their Nashville farm,her horses, chickens and gardens, to move home to Indiana to spend her remaining time with her extended family.

To Joey, With Love

Faced with the persistence of the cancer

“Joey decided to come home-not to die, but to live.”

To Joey, With Love- a movie review

A physician who faces his own mortality

Dr. Paul Kalanithi was a 36-year-old resident physician who had, as he wrote, “reached the mountaintop” of anticipating a promising career as a neurosurgeon and neuroscientist. He had a loving wife, a supportive family and professors who respected his knowledge and skill. He seemed destined to be sought after, well paid, productive, successful, and  famous.

WHEN BREATH BECOMES AIR- a book

(note: a neurosurgeon treats  brain, spinal cord and nerve  diseases such as brain tumors that can be cured or improved with surgery,)

Unfortunately, “the culmination of decades of striving evaporated” when he was diagnosed with an aggressive form of lung cancer for which the prognosis was bleak, even with treatment. He was admitted to the very hospital where he trained as a neurosurgery resident, now  to learn what it is like to be a patient with a potentially terminal illness.

When Breath Becomes Air- reflections from Dr. Lucy Kalanithi

Thank you for joining me to remember and honor Norma, Joey, and Paul. I appreciate their families’ generosity in sharing their stories and the HEART of health.

Dr. Aletha stethoscope with a heart

How smoking and sun affect your skin’s look and feel

You can buy products to maintain youthful skin, restore youthfulness to aged skin, remove blemishes, lighten/brighten/darken skin, minimize or eliminate wrinkles, and tighten sagging or puffy skin. But as effective as these are, they work better on skin that is already healthy.

Skin health and beauty- big business

Browse social media or news sites online and you notice skin health and appearance is a priority for most people. Sales for skin care and appearance products and services is a multi-billion dollar industry. If you’re on social media, you’ve probably seen posts from friends who are involved in direct selling companies for skin care, maybe you are also.

(By way of disclosure, I am a consultant for a direct selling company offering skincare products and makeup but won’t discuss any of those products in this post. However there will be other affiliate links through which this blog can earn a commission if you make a purchase through them.)

As a family physician, I treat skin problems frequently. Some of these are primary skin problems, but some are the result of lifestyle habits, other medical conditions, and even medical treatments. While some of these may be unavoidable, others are preventable.

This post will look at two avoidable risks to skin health and appearance-smoking and ultraviolet light. 

HOW SMOKING AND SUN AFFECT YOUR SKIN'S LOOK AND FEEL

Skin Deep- cells and layers

First let’s take a deeper look at our skin, it’s more complex than you may realize. It has two layers-

the top layer, the epidermis

the lower layer, the dermis

Layers of the Skin diagram

The layers of the skin (epidermis and dermis), as well as an inset with a close-up view of the types of cells in the skin (squamous cells, basal cells, and melanocytes). Source: National Cancer Institute Creator: Don Bliss (Illustrator) This image is in the public domain and can be freely reused. Please credit the source and, where possible, the creator listed above.

Skin disease and trauma involve damage to one or both layers of the skin- the dermis or epidermis, or to the individual cells- squamous cells, basal cells, or the melanocytes-the cells with pigment that give our skin color.

Cancers can develop in any cell of the skin. Melanoma is cancer of the melanocytes.

(This photo is for illustration only and should not be used to diagnose a skin lesion. See a physician if you have a skin lesion that concerns you. )

photo of melanoma skin cancer

a melanoma skin lesion-Source: National Cancer Institute Creator: Unknown Photographer- This image is in the public domain and can be freely reused. Please credit the source

Smoking

I’ve previously discussed 7 reasons to be smoke free. One of those is skin health.

By decreasing circulation, smoking robs skin of nourishment and oxygen; this weakens skin , making it susceptible to infection, cancer, and aging.

Skin experts wrote in the Journal of Dermatological Science

“Smoking is associated with many dermatological (skin) conditions, including

  • poor wound healing,
  • premature skin aging,
  • squamous cell carcinoma and melanoma,(cancers)
  • acne,
  • psoriasis, and
  • hair loss

Tobacco’s effect on  skin appearance include

  • Facial wrinkles and furrows (eg, crows’ feet at corners of the eyes,  smoker’s lines around lips)
  • Baggy eyelids and slack jawline
  • Uneven skin coloring: grayish, yellow with prominent blood vessels (telangiectasia)
  • Dry, coarse skin.

Long term, the skin of a 40-year-old heavy smoker will resemble that of non-smoking 70-year-old. !

Other potential hazards from tobacco use include

  • increased risk for bacterial, yeast, and viral skin infections
  • impaired circulation increasing the risk of frostbite, Raynaud’s syndrome, and blood clots (thrombosis)
  • thrush and gingivitis

DermNet NZ offers this gallery of photos illustrating these ways tobacco use can damage our skin.       ALERT: These photos are graphic.

No Smoking sign with pumpkins

Ask your doctor about safe and effective ways to help you stop smoking.

Ultraviolet light

Basking in sunlight may enhance our mood, but too much of it can damage our skin.

The signs of photo-aging are obvious to physicians-

  • yellowing or sallowing of the skin complexion
  • dry and rough texture with wrinkling,
  • unevenly pigmented skin tone with dilated blood vessels.
  • stretched out
  • easy bruising

Visit this link from the Canadian Dermatology Association to see what photoaged skin looks like

Photoaging

Photoaging is premature aging of the skin caused by repeated exposure to ultraviolet radiation (UV), primarily from the sun but also from artificial UV sources, such as tanning beds. Besides aging, excess sun exposure can cause

  • Burns
  • Rash due to increased sun sensitivity when taking certain medications
  • Cancers- skin cancers are the most common type of cancer.

How to limit UV light exposure 

  • Use a broad spectrum sunscreen, SPF 15 or higher
  • Wear hats, sunglasses, sun protective clothing
  • Avoid sun exposure, especially from 10 am to 4 pm
  • No tanning bed use.

Learn more about the effects of sun exposure from familydoctor.org at this link.

What sun exposure does to our skin.

In future posts, I’ll talk more about what hurts our skin, and what helps our skin.

As always, I appreciate your time and interest in exploring and sharing the HEART of health with me. And I would especially appreciate if you will share this post wherever you hang out.

Thanks!

Dr. Aletha

a cute monkey checks out his face in a mirrow

We all care about our appearance, including this cute monkey. Photo by Andre Mouton on Pexels.com

How to stop motion sickness and enjoy a cruise to Alaska

Fear of motion sickness causes people to forgo activities like airplane travel, boating, amusement park rides, and car trips. But sometimes these activities are unavoidable or people just want to enjoy them.

A comment prompted this  post to follow up my recent post about cruising

Safe and healthy cruising-keys to an enjoyable vacation

The conversation went like this:

Rhonda Gales (@RhondaGales) blogger at Mother 2 Mother 

Your photos are great! I want to do a cruise to Alaska next year, but I’m a little leery. The last cruise that I took, I was sea sick the entire cruise. Any advice on how to avoid it this time, and thanks for sharing on Sunday’s Best.

Dr. Aletha

Thanks Rhonda we’ve also cruised to Alaska, it was beautiful. You might look for a facility offering desensitization training for motion sickness. Otherwise drugs work but can cause unpleasant side effects. Talk to your doctor.

Rhonda

Thanks for your advice. Would love to see pictures of your Alaska Cruise. This post was quite popular with my readers.

white and yellow roller coaster
Photo by Min An on Pexels.com

What is motion sickness?

Motion sickness is the unpleasant sensation of motion, either with or without motion actually occurring. Those of us prone to it wonder why some people seek out experiences  like roller coasters.  Symptoms include

  • sweating
  • nausea with or without vomiting
  • dizziness
  • imbalance
  • general unwell feeling

Fear of motion sickness causes people to forgo activities like airplane travel, boating, amusement park rides, and car trips. But sometimes these activities are unavoidable or people just want to enjoy them.

 

Cruising Alaska’s Inside Passage

 

 

How to stop motion sickness and enjoy a cruise to Alaska-watercresswords.com

 

 

Preventing motion sickness

If you don’t want to completely forgo activities that might cause motion sickness, manipulating the situation to minimize or change the motion can help.

Sitting toward the front of a vehicle and facing forward will help.

  • Airplanes- sit over the wings
  • Boat- sit level with the water facing the waves
  • Bus/Van/Car- nearest the front
  • Train- lowest level

Use your eyes

  • Don’t read
  • Focus on the horizon if possible.
  • Keep eyes closed (especially if not able to see the horizon) and/or wear sunglasses.

Maintain general wellness

  • Be rested, sleep if possible
  • Stay hydrated, eat lightly
  • Avoid alcohol
  • Keep the environment  well ventilated, avoid strong smells
  • Listen to soothing music
a seaplane with a cruise ship in the background
No roads lead into Juneau, the capital of Alaska , so people there depend on boats and airplanes.

Using medications for motion sickness

One option is to use medication, either for prevention or to treat the symptoms once they occur (not as effective.)

Prevention- using the patch

There are herbal patches  but this one is  prescription only, and most likely to be effective.

Transdermal Scopolamine patch (Transderm-Scop)

  1. Apply behind one ear at least 4 hours before travel
  2. Replace patch every 72 hours

 

man and woman standing next to a helicopter on a glacier
When our cruise ship stopped at Juneau, we took a helicopter ride over a glacier-and then landed on it.

 

 

 

 

Other prescription medication

Promethazine (Phenergan) for nausea and vomiting

woman walking over icy terrain near a mountain
exploring the surface of a glacier

 

 

 

Available OTC- over the counter

(These affiliate links are for information only and are not a recommendation to use unless advised by your personal physician.)

 

 

 

 

a village by the shore flanked by mountains, Alaska
Sailing through Alaska’s Inside Passage, we were never far from breathtaking scenery.

Habituation and Desensitization

The more I travel , the less likely I am to suffer motion sickness without using drugs.  I use the tips above- I don’t read in the car, I sit in the front of a bus. If an airplane encounters turbulence, I lean back, close my eyes, and direct the cool air toward me. I have gradually become habituated to motion, although I still do not ride roller coasters.

There are programs available to desensitize people to motion; the military uses these since pilots and sailors will constantly be exposed to motion and must be able to function.

A former NASA flight surgeon  and fighter pilot developed such a method, naming  it after himself. Dr. Sam Puma developed the Puma Method. 

“The PUMA METHOD consists of a series of simple yet very effective warm-up and conditioning exercises.

These exercises raise your tolerance level to a variety of motion sickness producing activities such as reading in a moving vehicle, riding in a small boat or cruise ship, or flying in an airplane. This process is called habituation.

The exercises use your body’s own habituation mechanism to prevent motion sickness. You don’t need any drugs, so there are no negative side effects.”

(quote from the website)

(This is an affiliate link to  the product. Otherwise, I have no personal, professional, or financial connection to Dr. Puma or the Puma Method.)

 

 

 

 

a street in Ketchikan Alaska with a sign-The Salmon Capital of the World
Fortunately for us, we love to eat salmon.

Motion Sickness Treatment Makes Waves

This article from Scientific American explains how NASA and the U.S. Navy are finding new ways to help everyone overcome motion sickness.

“Researchers  and those who work with pilots and the military’s most frequent flyers, are especially keen to find better ways to treat motion sickness. And the many civilians who face nausea in cars, planes, boats or even the tamest amusement park rides would welcome a cure without the common side effects of current medications, such as sleepiness, or the questionable efficacy of alternative treatments, such as pressure bracelets.

The path to those ends remains bumpy and filled with more than a few green faces, but new research is closer to finding the best treatments to keep both side effects and lunch down.”

 

The food as well as the dining service was always excellent, and one of our favorite parts of the cruise.

 

 

If you didn’t visit it already, you may want to read my previous post-

Safe and healthy cruising-keys to an enjoyable vacation

 

 

Travel comments please

Please share your cruise experiences, good or bad.  How have you coped with motion sickness on any trip? I may share some of your insights in a future post.

 

boats in a harbor with a mountain in the distance

 

 

 

Please visit my page

Healthy and Helpful Resources

 

And learn how you can help

Share the HEART of health

 

Thanks for exploring the HEART of health on a cruise ship with me. Please share this post and follow Watercress Words.

Dr. Aletha 

woman standing by pink flowers
At our final stop , Victoria, Vancouver Island, touring Butchart Gardens. Yes, an Alaskan cruise stops in Canada.

How to dress for an Alaskan cruise

Blogger Cathy Lawdanski offers these tips on what to pack for an Alaskan cruise, which is not as easy as packing for a warm weather cruise. Read her helpful tips based on her experience at this link.

Here’s what you should know about what to wear on Alaskan Cruises