Grateful for the little (and big) things

I recently returned from a vacation in the Bahamas – my husband and I spent six days on the island of Exuma to celebrate our 20th wedding anniversary. There is nothing like visiting a foreign country to help provide some perspective on your everyday blessings. In the spirit of Thanksgiving, I thought I would share some of my takeaways from our trip.

First, I have to say that Exuma is probably THE most beautiful place on Earth I have visited (so far). One of the reasons we chose to go there was to meet a “bucket list” goal of experiencing crystal clear Caribbean water. We were not disappointed (see photos below). Exuma is known for its beaches and for the spectacular variation in the color of the water depending on the depth of the sea. The pictures almost don’t do it justice. And each beach we visited had something unique to offer, whether it was sea creatures (swimming pigs, stingrays, dolphins and sea turtles) or sand bars at low tide that allow you to walk about a half mile into the sea without the water getting above your knees.

We soon found out though that beyond the beauty of the island, there was not much else to experience. This particular island in the Bahamas is relatively underdeveloped compared to the more well-known ones like New Providence Island (Nassau) and Grand Bahama Island (Freeport). Despite having modern technology such as cellular service and internet, some basic infrastructure was lacking – like decent roads and public transportation. There were no big box stores or chain restaurants. Outside of the two all-inclusive resorts, it was primarily small, family-owned business and restaurants, many of which only accepted cash. It was an eye-opening experience for me, particularly because I did not do much research ahead of time to understand the nature of our destination. However, within a day or two, I found myself experiencing a profound sense of gratitude for what now seemed like luxuries back home.

Roads and transportation

We chose to rent a home rather than stay at a resort as we wanted peace and quiet and privacy. However, this meant we needed transportation to get around the island, so we chose to rent a car. The car rental and driving around the island were probably two of the most stressful parts of the trip. The Honda Civic we were given was an older model apparently shipped straight from Japan given that the GPS was all in Japanese (and thus useless to us in navigating our way around the island). The seat belts did not work properly – the belt remained slack after you buckled it, so I kept my fingers crossed each time we ventured out that we would not be in a situation where we needed them. The steering wheel is on the right side of the car as they drive on the opposite (left) side of the road than the US. And then there were the roads…

The car rental employee warned us about the potholes, most of which are on the shoulder of the road. We paid for the insurance on the rental car, but we were told upfront that it did not cover tires – and we soon learned why. Due to the potholes on the shoulders, everyone hugs the middle of the road (and there really is only one main road up and down the entire island). On our very first ride from the airport to the rental home, we unfortunately hit two or three potholes in an effort to avoid hitting the car barreling down the center of the road. The next morning on our way up to our boat excursion, we hit one more and sure enough, a half mile later we were forced to pull over with a flat tire – and a bent rim. I’ll spare you the details of dealing with roadside assistance (a very nice gentleman in a minivan filled with spare tires) other than to say that we did make it to our excursion on time, which we appreciated.

Given the nature of the roads, we made the decision to avoid driving after dark, which limited our ability to venture out in the evenings to eat out or experience the island nightlife. This was a little disappointing, but the whole white-knuckle driving experience during our stay really made me appreciate the safety and comfort of the cars we currently drive AND the quality and safety of the roads we traverse every day here at home. I’ll think twice before complaining about the minor pothole on my commute knowing it could be a whole lot worse.

Bountiful food choices: blessing or burden?

Food is often a central part of our vacations. My husband and I love to dine out and experience the flavors of the local cuisine. Given this trip was to celebrate a major milestone in our relationship, I was looking forward to being wined and dined – and not having to cook dinner every night. You can imagine my disappointment when I soon realized this was not to be the case. We quickly learned there were no high-end restaurants on the island (outside of the resorts and those were for guests only). We found ourselves at the local market, stocking up on some basic staples to get us through the week. Given our reluctance to drive at night, we cooked dinner in every night – and kept it simple with things like pasta or sausage, peas and rice (we did infuse some local flavors by trying pigeon peas in coconut milk with said sausage and rice – it was quite tasty!). And my husband stepped up to cook most of the meals, giving me a break from my normal duties back home (thank you, Chris).

What struck me most about the food though was the limited choices in the local markets. As I mentioned previously, there were no supermarket chains – just mom and pop stores that were probably a tenth of the size of your local grocery store. The fresh produce consisted of one side of a short aisle and I couldn’t even find something as basic as garlic. I think there were maybe two or three fruit options and one type of lettuce. In the canned and boxed goods, there were maybe two brands of pasta and just a handful of varieties, primarily spaghetti. In the dairy aisle, there were one or two choices for items like milk, eggs and cheese – and forget about finding dairy-free alternatives.

After I got over the initial shock of the shopping experience here versus back home, I noticed a different feeling arise – it was almost a sense of relief at the lack of choices and how much simpler that made the task of grocery shopping. We were in and out of the store in less than half the time it normally takes me to shop back home. You may be familiar with the concept of the Paradox of Choice put forth by Barry Schwartz – the idea that “choice overload” can make you question the decisions you make before you even make them and in the long run, can lead to decision-making paralysis. This idea hit me square in the face as I was walking through the store. On one hand, I truly felt fortunate to have the choices we do in the United States, whether it’s food, cars, clothing, or electronics. But I also couldn’t help but think about how all of those choices often make life more complicated than it needs to be. Fewer options makes life simpler in a number of ways.

Il bel far niente (“the beauty of doing nothing”)

As I noted earlier, it only took a few days into our trip to realize that there wasn’t much to do in Exuma other than hang out on the beach or visit different islands and beaches via boat (either private rental or paid excursion). My husband and I are not the type to spend all day lounging on the beach. And we knocked out the most popular excursion (swimming with the pigs) on our second day so by day three, I was beginning to think our trip was three days too long. We were fortunate to have internet at our accommodations, but I found myself glued to my phone, checking email, social media and the news back home. This was NOT how I wanted to spend my vacation.

I was faced with the harsh reality – I had forgotten how to be bored. It made me think of one of my favorite quotes from Eat, Pray, Love, when Elizabeth Gilbert was introduced to the Italian expression “il bel far niente” – the beauty of doing nothing. In the hustle and bustle of our everyday life, I seemed to have forgotten that, in many ways, the whole purpose of a vacation is to do just that: nothing. This was our time to relax, to forget about calendars and agendas and deadlines. We could embrace “island time” and just let the day unfold as we wanted it to. It took another day for this notion to completely sink in, but we did our best to adopt this approach for the remainder of the trip – whether it was reading out on the veranda overlooking the beautiful blue sea or hopping a water taxi to Stocking Island to experience the Atlantic Ocean side as well as the famous Sunday BBQ buffet at the Chat ‘n’ Chill. By the end of the trip, I found that I kind of liked not having anything to do.

Even though this may not have been my favorite vacation destination, I am truly grateful to have experienced such a beautiful piece of this planet. And I am most appreciative for the reminder to not take the little or big things in my life for granted.

May you have a peaceful and Happy Thanksgiving!

Breast Cancer Awareness Month

Each October, I usually share a little blurb in my newsletter to remind readers about National Breast Cancer Awareness Month and the importance of screening and early detection. I was content to leave it at that until two recent events prompted the desire to share more information: the announcement from Beyoncé’s father, Mathew Knowles, that he had been diagnosed with breast cancer and the news that a dear family member is experiencing a recurrence of her breast cancer after being in remission for about 10 years.

Men and Breast Cancer

According to the CDC, about 2,200 cases of breast cancer in men are diagnosed in the US each year – compared to about 245,000 cases in women. So, although breast cancer occurs mainly in women, men can get it, too. Many people do not realize that men have breast tissue and that they can develop breast cancer.

Men have much less breast tissue compared to women and thus, are not routinely screened for breast cancer. Breast cancer screening is only recommended for some men at higher than average risk due to:

  • an inherited gene mutation (either they have the BRCA2 or BRCA1 gene mutation themselves or an immediate family member has the mutation), or
  • a strong family history of breast cancer, such as a mother and/or sister diagnosed at age 40 or younger

For these men, screening may increase the chances that breast cancer is found early, when the chances for survival are highest. The National Comprehensive Cancer Network (NCCN) recommends men at higher risk for breast cancer, starting at age 35:

  • have a clinical breast exam every year
  • learn how to do breast self-exam

Men at higher risk for breast cancer should also be aware of the warning signs of breast cancer, including:

  • a lump, hard knot or thickening in the breast, chest or underarm area (usually painless, but may be tender)
  • any change in the size or shape of the breast
  • dimpling, puckering or redness of the skin of the breast
  • itchy, scaly sore or rash on the nipple
  • pulling in of the nipple (inverted nipple) or other parts of the breast
  • nipple discharge (rare)

Any man noticing these signs or other changes in his breasts or nipples should see a health care provider right away. Mathew Knowles said he noticed a recurring dot of blood on his shirts and his wife saw the same on their bed sheets. Fortunately, he contacted his doctor, was diagnosed quickly and underwent treatment immediately. He emphasized the importance of early detection to increase the chances of survival.

Click here to learn more about male breast cancer – and ladies, please share this information with the men in your life.

Women and Breast Cancer

Unfortunately, despite all of the advances of modern medicine, there is no sure way to prevent breast cancer – or its recurrence. Therefore, emphasis is still placed on understanding the risk factors and promoting screening and early detection.

There are some risk factors that are out of your control, such as being female and getting older (it’s more common in women 55 years and older). You are also more at risk if there is a family history of breast cancer or if you have an inherited mutation in the BRCA1 or BRCA2 gene. However, there are other lifestyle-related risk factors which you can modify to help lower the risk of developing breast cancer. I thought it would be helpful to highlight some of the ways you can do so, including:

  • Maintain a healthy weight – being overweight or obese after menopause increases breast cancer risk. Having more fat tissue after menopause can raise estrogen levels and increase your chance of getting breast cancer. Also, women who are overweight tend to have higher blood insulin levels, which have been linked to some cancers, including breast cancer.
  • Exercise regularly – evidence is growing that regular physical activity reduces breast cancer risk, especially in post-menopausal women. The current recommendation is that adults get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity (or a combination of these) each week, preferably spread throughout the week.
  • If you drink, limit alcohol to no more than one drink per day – drinking alcohol has been linked to an increased risk of breast cancer. The risk increases with the amount of alcohol consumed. Alcohol is also linked to an increased risk of other types of cancer.

Understanding and modifying your behavior-based risk factors is important, but at the end of the day, finding breast cancer early and seeking treatment immediately are the most important strategies to prevent deaths from breast cancer. Getting regular screening tests is the most reliable way to find breast cancer early. For women of average risk for breast cancer, the gold standard for screening is the mammogram, which is a low-dose x-ray of the breast. A mammogram can often find breast changes that could be cancer years before physical symptoms develop. Women at high risk for breast cancer are often urged to undergo a breast MRI as well as a mammogram. An MRI uses magnets and radio waves to take pictures of the breast.

At this time, there are some differences in the breast cancer screening guidelines recommended by some of the leading organizations, such as the American Cancer Society and the US Preventive Services Task Force. Therefore, it is best to talk to your health care provider about the most appropriate  screening options for you.

Finally, I think its important to end with a note about breast exams. For years, women were urged to perform monthly breast self-exams. Recent studies have not shown a clear benefit of regular physical breast exams done by either a health professional (clinical breast exams) or by women themselves. Unfortunately, there is very little evidence that these tests help find breast cancer early when women also get screening mammograms. However, women are still encouraged to be familiar with how their breasts normally look and feel and to report any changes to a health care provider right away. All of the women I know who were diagnosed with breast cancer felt something in their breast that prompted them to seek further testing. That’s enough to make me continue with regular self-breast exams.

E-Cigs: Let’s Clear the Air

Given that you can’t turn on the news or browse the internet these days without seeing stories about recent health concerns related to e-cigarettes or vaping, I thought it was worth taking a moment to share the latest report and recommendations based on what public health experts know so far.

To recap: various local, state and national public health partners, including the CDC and the FDA, are currently investigating a multistate outbreak of lung injury associated with e-cigarette product use. As of September 24th, there have been 805 cases of lung injury reported from 46 states and 1 US territory. Twelve deaths have been confirmed in 10 states; however, I woke up this morning to read that there has been a new death reported in my own state of North Carolina that is believed to meet the case definition so that number will likely increase.

This is what we know so far:

  • Individuals have experienced severe respiratory symptoms, including cough and shortness of breath, as well as fever, fatigue, chest pain, nausea, vomiting and diarrhea. Most of the patients have been hospitalized and have required respiratory support.
  • Most of the reported cases involve males between the ages of 18 and 34.
  • All reported cases have a history of e-cigarette product use or vaping.
  • Most patients have reported a history of using e-cigarette products containing THC, the chemical responsible for most of marijuana’s psychological effects. Many reported using products with both THC and nicotine. Some have reported the use of e-cigarette products containing only nicotine.

Perhaps the most troubling part of all this is what the experts don’t yet know: the specific cause of these lung injuries. The investigation has not identified any single e-cigarette or vaping product or substance (including devices, liquids, refill pods, and/or cartridges) that is linked to all cases. Based on what is known so far, there is no consistent evidence of an infectious cause. Therefore, the suspected cause is a chemical exposure. For this reason, as the investigation continues, the CDC has released the following recommendations:

  • Given the health risks, consider refraining from using e-cigarette or vaping products.
  • If you are an adult who used e-cigarettes containing nicotine to quit cigarette smoking, do not return to smoking cigarettes.
  • If you have recently used an e-cigarette or vaping product and experience symptoms like those reported in this outbreak, see a healthcare provider as soon as possible.
  • Do not buy e-cigarette or vaping products off the street, and do not modify or add any substances to these products that are not intended by the manufacturer.

As a general reminder, youth, young adults and pregnant women should all refrain from using e-cigarette products regardless of the latest concerns. And any adults who do not currently use tobacco products should not start using e-cigarette products.

From the time that e-cigarettes entered the market back in the early 2000s, public health experts emphasized the fact that we just didn’t know enough about the potential short- and long-term effects on health to determine whether they were a safer alternative to traditional tobacco cigarettes. I think what we are seeing now is every public health professional’s nightmare – that these products are indeed not safe and are responsible for unnecessary and avoidable illnesses and deaths.

The good news is we are starting to see action at the national level. The commissioner of the FDA admitted to Congress that the agency “should have acted sooner” to regulate e-cigarettes, and they are finalizing policies that will increase enforcement and potentially remove products from the market. Several large retailers such as Walmart announced they will no longer sell e-cigarettes in their stores. Major media companies including CNN, CBS, Viacom, and WarnerMedia all said they will stop running e-cigarette advertisements on their networks. In response, Juul, the largest e-cigarette maker in the US, announced it too would cease all of its print, broadcast, and digital advertising. And in even bigger news, Juul recently announced that its CEO Kevin Burns was stepping down, no doubt as a result of the intense criticism and investigation the company has been under regarding its marketing techniques, such as using social media influencers to illegally target children.

Although I wish 800+ individuals did not have to suffer illness and death in order for our leaders to be spurred into action, I am encouraged that steps are finally being taken to address the issue of e-cigarettes at the national level. For those of you who may be users of these products, I hope that you will seize this moment as an opportunity to quit for good. Click here for information and resources available to help you on the journey to finally being free of all tobacco and nicotine products.