Don’t let the medical industry own your death

When my grandmother was diagnosed with pancreatic cancer, we were all told to come visit immediately. By the time I got there, they had already given her a dose of chemotherapy. I was furious. Why do you give a dying 80 year old person a dose of chemotherapy? She never got out of bed again.

I could not understand why the doctors had given her the option of chemotherapy. She wasn’t expected to live more than a few weeks with or without it.

My family explained that this was my grandmother’s choice. She wanted the chemo. She wanted any chance she had to live longer. I was delighted she wanted to fight. And I selfishly wanted to be able to hang out with her during her final days.

What I didn’t understand at the time was that doctors have as hard a time as the rest of us talking about death. They probably have an even harder time “giving up” and accepting that there’s not really anything medicine can do to cure someone. Informative doctors want to give you all the choices and explaining the reality of your situation is hard. Maybe they did explain to my grandmother that the chemo wouldn’t prolong her life much, maybe they explained her quality of life would decrease and maybe she wan’t able to hear them because she wasn’t ready to give up on any chance no matter how small.

Reading Atul Gawande’s Being Mortal gave me a lot more insight and understanding into both our society’s way of handling death. He said we’ve given our end of life process to medicine. And doctors are not trained to understand what a patient most wants (like the ability to continue to eat chocolate or talk to your grandkids) but rather to either try to extend their life or to give them all the medical options without helping them weigh what those options mean within their choices. We are letting the medical field decide how we will live our last days. They may be able to help, but they are not in the business of figuring out how you want to live and then facilitating that. Instead they tell you what medical options you have and try to do the most they can to prolong your life even at the expense of comfort or quality of life. And there’s rarely a time when doctors can’t do something more. They can insert feeding tubes, try experimental drugs, remove parts of tumors, but those things might not always help you live the life you want.

Atul Gawande’s message really resonated with me when — while reading his book! — I called an ambulance for someone who didn’t want one. They clearly said they did not want an ambulance and did not want to go to the emergency room. I could not in good conscious not call an ambulance. They weren’t in a position to stop me from calling one, so I called for one but it weighed on me. I was reading a book about how we should be able to choose the medical care we want and I clearly went against someone’s wishes. Atul Gawande says this is a natural conflict, “We want autonomy for ourselves and safety for those we love.” (In my defense, I did not think they were capable in that moment to evaluate whether they needed an ambulance or not. One of my friends suggested just waiting until the person passes out and then its complied consent. I figured that was even worse. Looking forward, if someone you know is likely to be in that position, ask them their wishes ahead of time. Unfortunately, we don’t usually have that option until someone is clearly ill.)

“We want autonomy for ourselves and safety for those we love.” — Atul Gawande

He recommended this set of questions for helping people decide on treatment options:

What is your understanding of the situation and its potential outcomes?
What are your fears and what are your hopes?
What are the trade-offs you are willing to make and not willing to make?
And what is the course of action that best serves this understanding?

An example of a trade-off might be, are you willing to risk being in a wheel chair in order to get rid of some of the pain? Are you willing to lose your sense of taste to see if this chemotherapy will work?

In particular, I thought his trick of asking “what’s the longest anyone has lived with this treatment” instead of “how long do you expect me to live” was a very good one. He said “Sixty-three percent of doctors overestimated their patient’s survival time. Just 17 percent underestimated it. The average estimate was 530 percent too high. And the better the doctors knew their patients, the more likely they were to err.”

Throughout the book, Atul Gawande used very personal examples of family members and friends who were faced with difficult end of life decisions. He described cases where he thought he could have done better and cases where he helped people make the right decisions. The best, most difficult ones seemed to be the ones that didn’t pursue every chance medicine could offer.

As for my grandmother, we brought her home and worked with hospice. She died in her own bedroom surrounded by all her children and grandchildren. While I’m sure she was not ready to go, I’m sure that’s how she would have chosen to go.

I recommend reading Atul Gawande’s Being Mortal.

Originally published on Medium.

10 thoughts inspired by Always Hungry?

First published on Medium.

Always Hungry? by David Ludwig is yet another diet book but one written by a respected doctor specializing in obesity in children. I really enjoyed several articles about Dr Ludwig and his ideas, so I was expecting something more from the book but all I got additional was lots of recipes.

  1. Dr Ludwig, like many others, blames sugar and refined grains for many of our health problems. I like how he explained it and provided supporting science and studies, but if this is why you are reading the book, I recommend Good Calories, Bad Calories by Gary Taubes. Dr Ludwig does do a good job of explaining inflammation, blood sugar and fat storage in a way that people without medical backgrounds might understand.
  2. I love his point that the process of getting fat makes you eat more, not the other way around.
  3. I hate reading cook books on the Kindle. Actually, I just hate reading cook books. I think you should search for recipes or ideas for recipes, not read them.
  4. The advice for how to eat healthy seems pretty consistent these days — avoid processed foods, refined grains and sugar — and just as hard to follow.
  5. He focused more on waist size than weight and only recommended weighing yourself once a week as opposed to most people’s recommendation to weigh yourself daily.
  6. His supporting quotes and stories were all about people who had lost 5–20 pounds instead of the tons of weight most diet books claim.
  7. New studies seem to be consistently saying that exercise is good but exercise makes you eat more, not less. I really wonder what we’ll be saying a decade from now.
  8. He doesn’t really talk about overweight kids at all in spite of his background.
  9. If I could not eat carbs, I’m sure I would lose weight. I would also be really sick of eggs and chicken and meat. And while I like vegetables and fruit, I just can’t imagine them replacing pasta.
  10. Unlike Atkins, Dr. Ludwig recommends lots of fruits and vegetables and eventually some grains and carbs.

What did you end up thinking about as you read the book or these points?

Book Review: The FastDiet, Not my kind of book

While the diet and the ideas behind The FastDiet are pretty intriguing, the book doesn’t add a lot of value.

I was expecting something like Good Calories, Bad Calories. Something with a bit of research and data behind it. Instead you get a brief overview of the diet with a few pointers to studies, a few quotes from doctors at longevity institutes and then lots of advice for how to eat 500-600 calories on the fasting days. Not worth the $9.67 I paid for it.

I also checked out their website which has a brief overview of the diet, but no pointers to any studies.

The diet in summary:

  • Eat normally 5 days a week.
  • “Fast” on two non consecutive days. “Fasting” means eating 500-600 calories preferably in 2 meals spaced widely apart.

Their theory is two fold:

  • Your body evolved under situations that required “fasting” and during those times it spent its energy on repairing itself. So fasting will cause your cells to regenerate, decreasing all sorts of bad things like high cholesterol, cancer and signs of aging.
  • You’ll eat less, so you’ll lose weight. They quoted a study that said people eat more the day following a “fasting” day, but it was less than 125% more, not double what they would have eaten normally.

In addition to the proposed health benefits of the diet, they advocate that it’s much easier to follow than most other diets like low calorie or low carb. I do agree with them on that. I think it’s easier not to eat for two days a week than it is to count calories every day but they did not have any studies to support that.

Most of the evidence in the book was the authors’ own experiences, quotes from a few doctors at longevity institutes, pointers to a few studies and a bunch of letters with anecdotal evidence.

The diet is an interesting idea, but the book doesn’t do much more than explain the diet and the authors’ theories.

Too skinny and too fat: what happened to normal?

Photo by Camera baba' aka Udit Kulshrestha

You hear a lot about how the media potrays super-skinny models and they make poor role models for young women.

Today I turned on the TV and there was a cartoon with an obese girl in it. Interesting, I thought, they’re trying to portray reality. Then I noticed that every other character had a waist the size of their arm. (Literally, I paused and checked. The male characters had muscular arms and so had slightly bigger waists. The girls all had thin arms and ridiculously thin waists.) So there were a whole bunch of super skinny characters plus one obese girl and one obese boy.

What kind of body image message is that sending?

Book Review: Food Rules

Food Rules by Michael Pollen is a good summary of many of his other books. It’s a set of 63 rules with a bit of explanation per rule. If you’ve never read any of his books, I’d probably recommend The Omnivore’s Dilemma, but if you’ve already read one or if you are just looking for a shorter read, Food Rules was good.

Some of the rules I liked were:

  • If you aren’t willing to eat an apple, you’re not hungry.
  • Eat no food whose ingredients you wouldn’t have at home.
  • Snacks should be unprocessed plant foods.

(Not that I am currently following any of these rules!)

I also liked these reminders:

  • Eat until not hungry, not until full.
  • Put your fork down between bites.
  • Use smaller plates and glasses.
  • Eat at the table, and only eat when you are eating.
  • Cook your own junk food. (How often would you eat french fries if you had to cook them?)

Food Rules: An Eater’s Manual was an entertaining and thoughtful read. It didn’t feel worth buying to me because it was so short so I’d recommend checking it out of the library. I got my copy through Paperbackswap and have already sent it on to somebody else.

Why our insurance costs so much

Our insurance costs so much because the insurance company pays way more than you or I would pay.

I recently went to see a chiropractor.

I was informed that the chiropractor’s appointment would be $45 if I paid in cash.  The sign on the door said a massage was $70. (The doctor prescribed the massage.) Or they could bill my insurance company and they could not guarantee the prices in that case. Thinking I’d save some paperwork, I said please bill my insurance company. They billed my insurance company $144.60 for that chiropractor’s appointment (321% more than they were willing to accept in cash) and $180 for the massage! Who in the world would pay $180 for an hour massage??

Of course, the insurance company didn’t pay that, they paid their agreed up on rate of $65.12 for the chiropractor and $113.92 for the massage. The massage was actually billed as “physical therapy” which I think is also wrong. (In case you are curious, my portions of what the insurance company paid were $26.05 and $45.57 respectively.) The going rate around here for an hour massage is $50-60. And my insurance company paid $114!!

Cash amount Amount billed to insurance Insurance Paid
Chiropractor $45 $145 $65
Massage $60 $180 $114

So I called the chiropractor’s office to complain that they were overcharging my insurance company and they claimed that the state of Colorado sets those prices. They can charge me whatever they want if I pay cash, but if they charge the insurance company, they have to use the codes and prices set by the State of Colorado. However, the insurance company then pays whatever rate the doctor’s office and the insurance company agreed upon when they signed their initial agreement.

This is just wrong. The doctor’s office is getting $113.92 for a 60 minute massage that they were willing to give to me for $70. I can only assume the insurance company agreed to that amount because they either don’t know any better or they are passing on those costs to me or the company backing my insurance.

I survived 30 days without sweets

A month ago I set a goal for myself: no sweets nor alcohol for 30 days. In this post I'm primarily going to discuss the sweets part. I'll address the alcohol part in another post.

IStock_000011166708XSmallHow did I do? I did excellent sticking to my goal. (That doesn't mean I felt excellent just that I stuck to my goal well.) I did quit the alcohol part on day 25 for Superbowl weekend. But I didn't have any sweets, not even a bite of birthday cake, for the entire 30 days.

Best side effect? The whole family is eating better. I have been buying a bunch of fruit to take care of sweet cravings and the whole family has been loving it. We've discovered that our 3 year old will eat all of his dinner, including spinach salad and broccoli, just to get an apple or some grapes!

Did you feel different? Not really. I was really hoping that I'd feel different, i.e. better, if I ate less sweets. Other than craving sweets every day, for the most part I felt the same. With one exception – on day 3 I felt miserable. My whole body ached. I have no idea if that was from giving up sweets or alcohol or if I had a one day flu. Thank goodness it was over in a day.

Did you ever get over craving sweets? Not really, I had one day where I did not crave sweets – day 12. It lasted only a day. And the last week was better – I didn't crave sweets, I just really wanted some. It makes me think I'm still addicted and perhaps I should continue with the no sweets for a while longer.

How did you cope with the cravings? I ate a ton of fruit for the first 5 days. After that I just ignored them. (Or complained about them on identica, twitter and Facebook. 🙂 I also drank a lot of carbonated water.

Were you hungry? I was very hungry the first 5 days and then again on days 21 and 22. Unusually hungry. Other than that, I think I was less hungry than normal.

I was surprised to discover that it is possible to not be hungry between meals. I always thought people were really hungry between meals but just holding out for the next meal time. It was a new thing for me to be able to go from breakfast to lunch and from lunch to dinner without snacking. I don't think I've done that in several years.

Did your energy levels change? My initial response would be no. But I think my running suffered a bit. And at bedtime I was more than ready for bed. Nothing I can prove though.

Did you lose a lot of weight? I lost 4 pounds. As I wasn't doing it to lose weight, I ate whenever I was hungry. The problem (or advantage) is that most of the snacks I enjoy are sweet, so often nothing appealed to me. I think I ate a lot more at meal times but snacked less.

Did you exercise? I did my normal exercise which is running 1-3 miles a day.

What qualifies as a sweet? Candy bars, cookies, anything with chocolate in it, cookies, flavored yoghurt, chocolate chips, pudding, … I interchanged saying I gave up sweets and saying I gave up chocolate. To me a sweet isn't worth eating if it doesn't have chocolate in it. Except maybe marzipan. And even marzipan is better with chocolate.

Did you give up bread, rice or pasta? No, I did not give up bread, rice or pasta. I did not have any of the yummy cinnamon bread we had though. I thought the added sugar on top turned it into a sweet. And I didn't make any banana bread during this time as I consider it a sweet too.

How many sweets do you normally eat? I estimate about 600 calories a day. But I never really counted.

How come you don't talk about the alcohol? I didn't crave wine or beer. I craved sweets. I only really missed alcohol when I was having food I thought would be better with a drink, like beer with pizza or red wine with pasta. And even that went away after a while. The second time I had a pub hamburger without a beer, I decided maybe it was ok that way. I do have some insights about the alcohol though that I'll share in another post.

What's next? I think I'm going to continue to try to eat less sweets. Maybe not no sweets, just less sweets. I don't know what that looks like yet. And I will start drinking wine again with my pasta.

What was the hardest moment? I'm not sure if it was not eating sweets while sitting at home by myself or if it was the cooler full of ice cream bars that they wheeled into a conference room and left right next to me … on day 30. I couldn't think of any way to take an ice cream bar to keep in my room until day 31!

What have been your experiences giving up sweets?

Book Review: Survival of the Sickest

I really enjoyed reading Survival of the Sickest: A Medical Maverick Discovers Why We Need Disease. Dr. Maolem explains how the diseases we suffer from have helped us survive in the past. For example, people with hemochromatosis were more likely to survive the plague. (Bacteria needs iron to survive and while people with hemochromatosis have lots of iron in their blood, they don't have any in their macrophages.) They died early due to their disease but after their child bearing years so the disease, and its advantages and disadvantages, were passed along.

He theorizes that diabetes might have helped people survive a mini ice age – sugar lowered the freezing temperature of blood.

Like good teachers, Dr. Maolem and his co-author Jonathan Prince use a lot of interesting anecdotes and facts to make the material easy to relate to and memorable. (Did you know Inuit hunters can raise the temperature of the skin on their hands from freezing to fifty degrees in minutes? And do so periodically when they are outside?)

You may or may not end up agreeing with all of Dr. Maolem's theories, but if you like understanding why and how the human body and evolution work, you'll probably enjoy Survival of the Sickest.


So today I decided to quit (or at least seriously cut back on) caffeine, artificial sweeteners, alcohol and carbs. So you can blame any behavior you don’t like on that – for a couple of days anyway. (And if you see me drinking a diet coke, please remind me that I’m cutting back!)

On that note, a new study (yet another study) shows that consuming fructose actually changes the way our bodies process sugar. Fructose is mostly commonly consumed as high fructose corn syrup that is added to just about every packaged food.

The researchers found that lipogenesis, the process by which sugars are
turned into body fat, increased significantly when as little as half
the glucose was replaced with fructose. Fructose given at breakfast
also changed the way the body handled the food eaten at lunch. After
fructose consumption, the liver increased the storage of lunch fats
that might have been used for other purposes.

I don’t think they’ve figured it out yet, but I think it’s fascinating that the calories in, calories out model is finally being challenged.