Undoing The Damage Of Life’s Hard Knocks
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Sometimes, What Doesn’t Kill Us Makes Us Insecure
We’ve written before about Complex PTSD, which is much more common than the more popularly understood kind:
Given that C-PTSD affects so many people (around 1 in 5, but really, do read the article above! It explains it better than we have room to repeat today), it seems like a good idea to share tips for managing it.
(Last time, we took all the space for explaining it, so we just linked to some external resources at the end)
What happened to you?
PTSD has (as a necessity, as part of its diagnostic criteria) a clear event that caused it, which makes the above question easy to answer.
C-PTSD often takes more examination to figure out what tapestry of circumstances (and likely but not necessarily: treatment by other people) caused it.
Often it will feel like “but it can’t be that; that’s not that bad”, or “everyone has things like that” (in which case, you’re probably one of the one in five).
The deeper questions
Start by asking yourself: what are you most afraid of, and why? What are you most ashamed of? What do you fear that other people might say about you?
Often there is a core pattern of insecurity that can be summed up in a simple, harmful, I-message, e.g:
- I am a bad person
- I am unloveable
- I am a fake
- I am easy to hurt
- I cannot keep my loved ones safe
…and so forth.
For a bigger list of common insecurities to see what resonates, check out:
Basic Fears/Insecurities, And Their Corresponding Needs/Desires
Find where they came from
You probably learned bad beliefs, and consequently bad coping strategies, because of bad circumstances, and/or bad advice.
- When a parent exclaimed in anger about how stupid you are
- When a partner exclaimed in frustration that always mess everything up
- When an employer told you you weren’t good enough
…or maybe they told you one thing, and showed you the opposite. Or maybe it was entirely non-verbal circumstances:
- When you gambled on a good idea and lost everything
- When you tried so hard at some important endeavour and failed
- When you thought someone could be trusted, and learned the hard way that you were wrong
These are “life’s difficult bits”, but when we’ve lived through a whole stack of them, it’s less like a single shattering hammer-blow of PTSD, and more like the consistent non-stop tap tap tap that ends up doing just as much damage in the long run.
Resolve them
That may sound a bit like a “and quickly create world peace” level of task, but we have tools:
Ask yourself: what if…
…it had been different? Take some time and indulge in a full-blown fantasy of a life that was better. Explore it. How would those different life lessons, different messages, have impacted who you are, your personality, your behaviour?
This is useful, because the brain is famously bad at telling real memories from false ones. Consciously, you’ll know that one was an exploratory fantasy, but to your brain, it’s still doing the appropriate rewiring. So, little by little, neuroplasticity will do its thing.
Tell yourself a better lie
We borrowed this one from the title of a very good book which we’ve reviewed previously.
This idea is not about self-delusion, but rather that we already express our own experiences as a sort of narrative, and that narrative tends to contain value judgements that are often not useful, e.g. “I am stupid”, “I am useless”, and all the other insecurities we mentioned earlier. Some simple examples might be:
- “I had a terrible childhood” → “I have come so far”
- “I should have known better” → “I am wiser now”
- “I have lost so much” → “I have experienced so much”
So, replacing that self-talk can go a long way to re-writing how secure we feel, and therefore how much trauma-response (ideally: none!) we have to stimuli that are not really as threatening as we sometimes feel they are (a hallmark of PTSD in general).
Here’s a guide to more ways:
How To Get Your Brain On A More Positive Track (Without Toxic Positivity)
Take care!
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21 Most Beneficial Polyphenols & What Foods Have Them
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We often write about polyphenols here at 10almonds; sometimes mentioning that a certain food is good because it has them, or else occasionally an entire article about a particular polyphenol. But what about a birds-eye view of polyphenols as a whole?
Well, there are many, but we’ve picked 21 particularly beneficial for human health, and what foods contain them.
We’ll be working from this fantastic database, by the way:
❝Phenol-Explorer is the first comprehensive database on polyphenol content in foods. The database contains more than 35,000 content values for 500 different polyphenols in over 400 foods. These data are derived from the systematic collection of more than 60,000 original content values found in more than 1,300 scientific publications. Each of these publications has been critically evaluated before inclusion in the database. The whole data on the polyphenol composition of foods is available for download.❞
Source: Phenol-Explorer.EU | Database on polyphenol content in foods
We use this database at least several times per week while writing 10almonds; it’s a truly invaluable resource!
However, 500 is a lot, so here’s a rundown of 21 especially impactful ones; we’ve sorted them per the categories used in the explorer, and in some cases we’ve aggregated several very similar polyphenols typically found together in the same foods, into one item (so for example we just list “quercetin” instead of quercetin 3-O-rutinoside + quercetin 4′-O-glucoside + quercetin 3,4′-O-diglucoside, etc etc). We’ve also broadly grouped some particularly populous ones such as “anthocyanins”, “catechins”, and so forth.
Without further ado, here’s what you ideally want to be getting plenty of in your diet:
Flavonoids
- Quercetin
- Foods: onions, apples, berries, kale, broccoli, capers.
- Benefits: anti-inflammatory, reduces allergy symptoms, supports heart and brain health, and may lower blood pressure.
- See also: Fight Inflammation & Protect Your Brain, With Quercetin
- Kaempferol
- Foods: spinach, kale, tea (green and black), capers, brussels sprouts.
- Benefits: antioxidant, may reduce the risk of cancer, supports cardiovascular health, and has anti-inflammatory properties.
- Epigallocatechin gallate (EGCG)
- Foods: green tea, matcha.
- Benefits: potent antioxidant, promotes weight loss, supports brain health, and may reduce the risk of heart disease.
- Anthocyanins
- Foods: blueberries, blackberries, raspberries, red cabbage, cherries.
- Benefits: improve brain health, support eye health, and reduce the risk of cardiovascular diseases.
- Apigenin
- Foods: parsley, celery, chamomile tea.
- Benefits: anti-inflammatory, reduces anxiety, and supports brain and immune system health.
- Luteolin
- Foods: peppers, thyme, celery, carrots.
- Benefits: anti-inflammatory, supports brain health, and may help reduce the growth of cancer cells.
- Catechins (aside from EGCG)
- Foods: green tea, dark chocolate, apples
- Benefits: boosts metabolism, supports cardiovascular health, and reduces oxidative stress.
- Hesperidin
- Foods: oranges, lemons, limes, grapefruits.
- Benefits: supports vascular health, reduces inflammation, and may help manage diabetes.
- Naringenin
- Foods: oranges, grapefruits, tomatoes.
- Benefits: antioxidant, supports liver health, and may improve cholesterol levels.
For more on epigallocatechin gallate and other catechins, see: Which Tea Is Best, By Science?
Phenolic Acids
- Chlorogenic acid
- Foods: coffee, artichokes, apples, pears.
- Benefits: supports weight management, improves blood sugar regulation, and reduces inflammation.
- See also: Green Coffee Bean Extract: Coffee Benefits Without The Coffee?
- Caffeic acid
- Foods: coffee, thyme, sage, basil.
- Benefits: antioxidant, anti-inflammatory, and supports skin health.
- See also: The Bitter Truth About Coffee (or is it?)
- Ferulic acid
- Foods: whole grains, rice bran, oats, flaxseeds, spinach.
- Benefits: protects skin from UV damage, reduces inflammation, and supports cardiovascular health.
- Gallic acid
- Foods: green tea, berries, walnuts.
- Benefits: antioxidant, may reduce the risk of cancer, and supports brain health.
Stilbenes
- Resveratrol
- Foods: red currants, blueberries, peanuts.
- Benefits: anti-aging properties, supports heart health, and reduces inflammation.
- See also: Resveratrol & Healthy Aging ← and no, you can’t usefully get it from red wine; here’s why!
Lignans
- Secoisolariciresinol
- Foods: flaxseeds, sesame seeds, whole grains.
- Benefits: supports hormone balance, reduces the risk of hormone-related cancers, and promotes gut health.
- Matairesinol
- Foods: rye, oats, barley, sesame seeds.
- Benefits: hormonal support, antioxidant, and may reduce the risk of cardiovascular diseases.
See also: Sprout Your Seeds, Grains, Beans, Etc ← for maximum nutritional availability!
Tannins
- Ellagic acid
- Foods: pomegranates, raspberries, walnuts.
- Benefits: anti-cancer properties, supports skin health, and reduces inflammation.
- Proanthocyanidins
- Foods: cranberries, apples, grapes, dark chocolate.
- Benefits: supports urinary tract health, reduces inflammation, and improves blood vessel health.
See also: Enjoy Bitter Foods For Your Heart & Brain
Curcuminoids
- Curcumin
- Foods: turmeric.
- Benefits: potent anti-inflammatory, supports joint health, and may reduce the risk of chronic diseases.
- See also: Why Curcumin (Turmeric) Is Worth Its Weight In Gold
Isoflavones
- Genistein
- Foods: soybeans, chickpeas.
- Benefits: supports bone health, reduces the risk of hormone-related cancers, and promotes heart health.
- Daidzein
- Foods: soybeans, legumes.
- Benefits: hormonal balance, supports bone health, and may help alleviate menopausal symptoms.
See also: What Does “Balance Your Hormones” Even Mean?
Well, that’s a lot of things to remember!
If you want to make it easier for yourself, you can simply make sure to get at least 30 different kinds of plant into your diet per week, and by doing so, statistically, you should cover most of these!
Read more: What’s Your Plant Diversity Score?
Alternatively, for a middle-ground approach of targetting 16 most polyphenol delivering foods, check out this super-dense arrangement:
Mediterranean Diet… In A Pill? ← it’s about plant extracts from 16 specific foods, and the polyphenols they deliver
Enjoy!
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As Nuns Disappear, Many Catholic Hospitals Look More Like Megacorporations
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ST. LOUIS — Inside the more than 600 Catholic hospitals across the country, not a single nun can be found occupying a chief executive suite, according to the Catholic Health Association.
Nuns founded and led those hospitals in a mission to treat sick and poor people, but some were also shrewd business leaders. Sister Irene Kraus, a former chief executive of Daughters of Charity National Health System, was famous for coining the phrase “no margin, no mission.” It means hospitals must succeed — generating enough revenue to exceed expenses — to fulfill their original mission.
The Catholic Church still governs the care that can be delivered to millions in those hospitals each year, using religious directives to ban abortions and limit contraceptives, in vitro fertilization, and medical aid in dying.
But over time, that focus on margins led the hospitals to transform into behemoths that operate for-profit subsidiaries and pay their executives millions, according to hospital tax filings. These institutions, some of which are for-profit companies, now look more like other megacorporations than like the charities for the destitute of yesteryear.
The absence of nuns in the top roles raises the question, said M. Therese Lysaught, a Catholic moral theologist and professor at Loyola University Chicago: “What does it mean to be a Catholic hospital when the enterprise has been so deeply commodified?”
The St. Louis area serves as the de facto capital of Catholic hospital systems. Three of the largest are headquartered here, along with the Catholic hospital lobbying arm. Catholicism is deeply rooted in the region’s culture. During Pope John Paul II’s only U.S. stop in 1999, he led Mass downtown in a packed stadium of more than 100,000 people.
For a quarter century, Sister Mary Jean Ryan led SSM Health, one of those giant systems centered on St. Louis. Now retired, the 86-year-old said she was one of the last nuns in the nation to lead a Catholic hospital system.
Ryan grew up Catholic in Wisconsin and joined a convent while in nursing school in the 1960s, surprising her family. She admired the nuns she worked alongside and felt they were living out a higher purpose.
“They were very impressive,” she said. “Not that I necessarily liked all of them.”
Indeed, the nuns running hospitals defied the simplistic image often ascribed to them, wrote John Fialka in his book “Sisters: Catholic Nuns and the Making of America.”
“Their contributions to American culture are not small,” he wrote. “Ambitious women who had the skills and the stamina to build and run large institutions found the convent to be the first and, for a long time, the only outlet for their talents.”
This was certainly true for Ryan, who climbed the ranks, working her way from nurse to chief executive of SSM Health, which today has hospitals in Illinois, Missouri, Oklahoma, and Wisconsin.
The system was founded more than a century ago when five German nuns arrived in St. Louis with $5. Smallpox swept through the city and the Sisters of St. Mary walked the streets offering free care to the sick.
Their early foray grew into one of the largest Catholic health systems in the country, with annual revenue exceeding $10 billion, according to its 2023 audited financial report. SSM Health treats patients in 23 hospitals and co-owns a for-profit pharmacy benefit manager, Navitus, that coordinates prescriptions for 14 million people.
But Ryan, like many nuns in leadership roles in recent decades, found herself confronted with an existential crisis. As fewer women became nuns, she had to ensure the system’s future without them.
When Ron Levy, who is Jewish, started at SSM as an administrator, he declined to lead a prayer in a meeting, Ryan recounted in her book, “On Becoming Exceptional.”
“Ron, I’m not asking you to be Catholic,” she recalled telling him. “And I know you’ve only been here two weeks. So, if you’d like to make it three, I suggest you be prepared to pray the next time you’re asked.”
Levy went on to serve SSM for more than 30 years — praying from then on, Ryan wrote.
In Catholic hospitals, meetings are still likely to start with a prayer. Crucifixes often adorn buildings and patient rooms. Mission statements on the walls of SSM facilities remind patients: “We reveal the healing presence of God.”
Above all else, the Catholic faith calls on its hospitals to treat everyone regardless of race, religion, or ability to pay, said Diarmuid Rooney, a vice president of the Catholic Health Association. No nuns run the trade group’s member hospitals, according to the lobbying group. But the mission that compelled the nuns is “what compels us now,” Rooney said. “It’s not just words on a wall.”
The Catholic Health Association urges its hospitals to evaluate themselves every three years on whether they’re living up to Catholic teachings. It created a tool that weighs seven criteria, including how a hospital acts as an extension of the church and cares for poor and marginalized patients.
“We’re not relying on hearsay that the Catholic identity is alive and well in our facilities and hospitals,” Rooney said. “We can actually see on a scale where they are at.”
The association does not share the results with the public.
At SSM Health, “our Catholic identity is deeply and structurally ingrained” even with no nun at the helm, spokesperson Patrick Kampert said. The system reports to two boards. One functions as a typical business board of directors while the other ensures the system abides by the rules of the Catholic Church. The church requires the majority of that nine-member board to be Catholic. Three nuns currently serve on it; one is the chair.
Separately, SSM also is required to file an annual report with the Vatican detailing the ways, Kampert said, “we deepen our Catholic identity and further the healing ministry of Jesus.” SSM declined to provide copies of those reports.
From a business perspective, though, it’s hard to distinguish a Catholic hospital system like SSM from a secular one, said Ruth Hollenbeck, a former Anthem insurance executive who retired in 2018 after negotiating Missouri hospital contracts. In the contracts, she said, the difference amounted to a single paragraph stating that Catholic hospitals wouldn’t do anything contrary to the church’s directives.
To retain tax-exempt status under Internal Revenue Service rules, all nonprofit hospitals must provide a “benefit” to their communities such as free or reduced-price care for patients with low incomes. But the IRS provides a broad definition of what constitutes a community benefit, which gives hospitals wide latitude to justify not needing to pay taxes.
On average, the nation’s nonprofit hospitals reported that 15.5% of their total annual expenses were for community benefits in 2020, the latest figure available from the American Hospital Association.
SSM Health, including all of its subsidiaries, spent proportionately far less than the association’s average for individual hospitals, allocating roughly the same share of its annual expenses to community efforts over three years: 5.1% in 2020, 4.5% in 2021, and 4.9% in 2022, according to a KFF Health News analysis of its most recent publicly available IRS filings and audited financial statements.
A separate analysis from the Lown Institute think tank placed five Catholic systems — including the St. Louis region’s Ascension — on its list of the 10 health systems with the largest “fair share” deficits, which means receiving more in tax breaks than what they spent on the community. And Lown said three St. Louis-area Catholic health systems — Ascension, SSM Health, and Mercy — had fair share deficits of $614 million, $235 million, and $92 million, respectively, in the 2021 fiscal year.
Ascension, Mercy, and SSM disputed Lown’s methodology, arguing it doesn’t take into account the gap between the payments they receive for Medicaid patients and the cost of delivering their care. The IRS filings do.
But, Kampert said, many of the benefits SSM provides aren’t reflected in its IRS filings either. The forms reflect “very simplistic calculations” and do not accurately represent the health system’s true impact on the community, he said.
Today, SSM Health is led by longtime business executive Laura Kaiser. Her compensation in 2022 totaled $8.4 million, including deferred payments, according to its IRS filing. Kampert defended the amount as necessary “to retain and attract the most qualified” candidate.
By contrast, SSM never paid Ryan a salary, giving instead an annual contribution to her convent of less than $2 million a year, according to some tax filings from her long tenure. “I didn’t join the convent to earn money,” Ryan said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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What are ‘Ozempic babies’? Can the drug really increase your chance of pregnancy?
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Hundreds of thousands of people worldwide are taking drugs like Ozempic to lose weight. But what do we actually know about them? This month, The Conversation’s experts explore their rise, impact and potential consequences.
We’ve heard a lot about the impacts of Ozempic recently, from rapid weight loss and lowered blood pressure, to persistent vomiting and “Ozempic face”.
Now we’re seeing a rise in stories about “Ozempic babies”, where women who use drugs like Ozempic (semaglutide) report unexpected pregnancies.
But does semaglutide (also sold as Wegovy) improve fertility? And if so, how? Here’s what we know so far.
Remind me, what is Ozempic?
Ozempic and related drugs (glucagon-like peptide-1 receptor agonists or GLP-1-RAs) were developed to help control blood glucose levels in people with type 2 diabetes.
But the reason for Ozempic’s huge popularity worldwide is that it promotes weight loss by slowing stomach emptying and reducing appetite.
Ozempic is prescribed in Australia as a diabetes treatment. It’s not currently approved to treat obesity but some doctors prescribe it “off label” to help people lose weight. Wegovy (a higher dose of semaglutide) is approved for use in Australia to treat obesity but it’s not yet available.
How does obesity affect fertility?
Obesity affects the fine-tuned hormonal balance that regulates the menstrual cycle.
Women with a body mass index (BMI) above 27 are three times more likely than women in the normal weight range to be unable to conceive because they are less likely to ovulate.
The metabolic conditions of type 2 diabetes and polycystic ovary syndrome (PCOS) are both linked to obesity and fertility difficulties.
Women with type 2 diabetes are more likely than other women to have obesity and to experience fertility difficulties and miscarriage.
Similarly, women with PCOS are more likely to have obesity and trouble conceiving than other women because of hormonal imbalances that cause irregular menstrual cycles.
In men, obesity, diabetes and metabolic syndrome (a cluster of conditions that increase the risk of heart disease and stroke) have negative effects on fertility.
Low testosterone levels caused by obesity or type 2 diabetes can affect the quality of sperm.
So how might Ozempic affect fertility?
Weight loss is recommended for people with obesity to reduce the risk of health problems. As weight loss can improve menstrual irregularities, it may also increase the chance of pregnancy in women with obesity.
This is why weight loss and metabolic improvement are the most likely reasons why women who use Ozempic report unexpected pregnancies.
But unexpected pregnancies have also been reported by women who use Ozempic and the contraceptive pill. This has led some experts to suggest that some GLP-1-RAs might affect the absorption of the pill and make it less effective. However, it’s uncertain whether there is a connection between Ozempic and contraceptive failure.
Some women have reported getting pregnant while taking the contraceptive pill and Ozempic. Cottonbro Studio/Pexels In men with type 2 diabetes, obesity and low testosterone, drugs like Ozempic have shown promising results for weight loss and increasing testosterone levels.
Avoid Ozempic if you’re trying to conceive
It’s unclear if semaglutide can be harmful in pregnancy. But data from animal studies suggest it should not be used in pregnancy due to potential risks of fetal abnormalities.
That’s why the Therapeutic Goods Administration recommends women of childbearing potential use contraception when taking semaglutide.
Similarly, PCOS guidelines state health professionals should ensure women with PCOS who use Ozempic have effective contraception.
Guidelines recommended stopping semaglutide at least two months before planning pregnancy.
For women who use Ozempic to manage diabetes, it’s important to seek advice on other options to control blood glucose levels when trying for pregnancy.
What if you get pregnant while taking Ozempic?
For those who conceive while using Ozempic, deciding what to do can be difficult. This decision may be even more complicated considering the unknown potential effects of the drug on the fetus.
While there is little scientific data available, the findings of an observational study of pregnant women with type 2 diabetes who were on diabetes medication, including GLP-1-RAs, are reassuring. This study did not indicate a large increased risk of major congenital malformations in the babies born.
Women considering or currently using semaglutide before, during, or after pregnancy should consult with a health provider about how to best manage their condition.
When pregnancies are planned, women can take steps to improve their baby’s health, such as taking folic acid before conception to reduce the risk of neural tube defects, and stopping smoking and consuming alcohol.
While unexpected pregnancies and “Ozempic babies” may be welcomed, their mothers have not had the opportunity to take these steps and give them the best start in life.
Read the other articles in The Conversation’s Ozempic series here.
Karin Hammarberg, Senior Research Fellow, Global and Women’s Health, School of Public Health & Preventive Medicine, Monash University and Robert Norman, Emeritus Professor of Reproductive and Periconceptual Medicine, The Robinson Research Institute, University of Adelaide
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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He Fell Ill on a Cruise. Before He Boarded the Rescue Boat, They Handed Him the Bill.
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Vincent Wasney and his fiancée, Sarah Eberlein, had never visited the ocean. They’d never even been on a plane. But when they bought their first home in Saginaw, Michigan, in 2018, their real estate agent gifted them tickets for a Royal Caribbean cruise.
After two years of delays due to the coronavirus pandemic, they set sail in December 2022.
The couple chose a cruise destined for the Bahamas in part because it included a trip to CocoCay, a private island accessible to Royal Caribbean passengers that featured a water park, balloon rides, and an excursion swimming with pigs.
It was on that day on CocoCay when Wasney, 31, started feeling off, he said.
The next morning, as the couple made plans in their cabin for the last full day of the trip, Wasney made a pained noise. Eberlein saw him having a seizure in bed, with blood coming out of his mouth from biting his tongue. She opened their door to find help and happened upon another guest, who roused his wife, an emergency room physician.
Wasney was able to climb into a wheelchair brought by the ship’s medical crew to take him down to the medical facility, where he was given anticonvulsants and fluids and monitored before being released.
Wasney had had seizures in the past, starting about 10 years ago, but it had been a while since his last one. Imaging back then showed no tumors, and doctors concluded he was likely epileptic, he said. He took medicine initially, but after two years without another seizure, he said, his doctors took him off the medicine to avoid liver damage.
Wasney had a second seizure on the ship a few hours later, back in his cabin. This time he stopped breathing, and Eberlein remembered his lips being so purple, they almost looked black. Again, she ran to find help but, in her haste, locked herself out. By the time the ship’s medical team got into the cabin, Wasney was breathing again but had broken blood vessels along his chest and neck that he later said resembled tiger stripes.
Wasney was in the ship’s medical center when he had a third seizure — a grand mal, which typically causes a loss of consciousness and violent muscle contractions. By then, the ship was close enough to port that Wasney could be evacuated by rescue boat. He was put on a stretcher to be lowered by ropes off the side of the ship, with Eberlein climbing down a rope ladder to join him.
But before they disembarked, the bill came.
The Patient: Vincent Wasney, 31, who was uninsured at the time.
Medical Services: General and enhanced observation, a blood test, anticonvulsant medicine, and a fee for services performed outside the medical facility.
Service Provider: Independence of the Seas Medical Center, the on-ship medical facility on the cruise ship operated by Royal Caribbean International.
Total Bill: $2,500.22.
What Gives: As part of Royal Caribbean’s guest terms, cruise passengers “agree to pay in full” all expenses incurred on board by the end of the cruise, including those related to medical care. In addition, Royal Caribbean does not accept “land-based” health insurance plans.
Wasney said he was surprised to learn that, along with other charges like wireless internet, Royal Caribbean required he pay his medical bills before exiting the ship — even though he was being evacuated urgently.
“Are we being held hostage at this point?” Eberlein remembered asking. “Because, obviously, if he’s had three seizures in 10 hours, it’s an issue.”
Wasney said he has little memory of being on the ship after his first seizure — seizures often leave victims groggy and disoriented for a few hours afterward.
But he certainly remembers being shown a bill, the bulk of which was the $2,500.22 in medical charges, while waiting for the rescue boat.
Still groggy, Wasney recalled saying he couldn’t afford that and a cruise employee responding: “How much can you pay?”
They drained their bank accounts, including money saved for their next house payment, and maxed out Wasney’s credit card but were still about $1,000 short, he said.
Ultimately, they were allowed to leave the ship. He later learned his card was overdrafted to cover the shortfall, he said.
Royal Caribbean International did not respond to multiple inquiries from KFF Health News.
Once on land, in Florida, Wasney was taken by ambulance to the emergency room at Broward Health Medical Center in Fort Lauderdale, where he incurred thousands of dollars more in medical expenses.
He still isn’t entirely sure what caused the seizures.
On the ship he was told it could have been extreme dehydration — and he said he does remember being extra thirsty on CocoCay. He also has mused whether trying escargot for the first time the night before could have played a role. Eberlein’s mother is convinced the episode was connected to swimming with pigs, he said. And not to be discounted, Eberlein accidentally broke a pocket mirror three days before their trip.
Wasney, who works in a stone shop, was uninsured when they set sail. He said that one month before they embarked on their voyage, he finally felt he could afford the health plan offered through his employer and signed up, but the plan didn’t start until January 2023, after their return.
They also lacked travel insurance. As inexperienced travelers, Wasney said, they thought it was for lost luggage and canceled trips, not unexpected medical expenses. And because the cruise was a gift, they were never prompted to buy coverage, which often happens when tickets are purchased.
The Resolution: Wasney said the couple returned to Saginaw with essentially no money in their bank account, several thousand dollars of medical debt, and no idea how they would cover their mortgage payment. Because he was uninsured at the time of the cruise, Wasney did not try to collect reimbursement for the cruise bill from his new health plan when his coverage began weeks later.
The couple set up payment plans to cover the medical bills for Wasney’s care after leaving the ship: one each with two doctors he saw at Broward Health, who billed separately from the hospital, and one with the ambulance company. He also made payments on a bill with Broward Health itself. Those plans do not charge interest.
But Broward Health said Wasney missed two payments to the hospital, and that bill was ultimately sent to collections.
In a statement, Broward Health spokesperson Nina Levine said Wasney’s bill was reduced by 73% because he was uninsured.
“We do everything in our power to provide the best care with the least financial impact, but also cannot stress enough the importance of taking advantage of private and Affordable Care Act health insurance plans, as well as travel insurance, to lower risks associated with unplanned medical issues,” she said.
The couple was able to make their house payment with $2,690 they raised through a GoFundMe campaign that Wasney set up. Wasney said a lot of that help came from family as well as friends he met playing disc golf, a sport he picked up during the pandemic.
“A bunch of people came through for us,” Wasney said, still moved to tears by the generosity. “But there’s still the hospital bill.”
The Takeaway: Billing practices differ by cruise line, but Joe Scott, chair of the cruise ship medicine section of the American College of Emergency Physicians, said medical charges are typically added to a cruise passenger’s onboard account, which must be paid before leaving the ship. Individuals can then submit receipts to their insurers for possible reimbursement.
More from Bill of the Month
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He recommended that those planning to take a cruise purchase travel insurance that specifically covers their trips. “This will facilitate reimbursement if they do incur charges and potentially cover a costly medical evacuation if needed,” Scott said.
Royal Caribbean suggests that passengers who receive onboard care submit their paid bills to their health insurer for possible reimbursement. Many health plans do not cover medical services received on cruise ships, however. Medicare will sometimes cover medically necessary health care services on cruise ships, but not if the ship is more than six hours away from a U.S. port.
Travel insurance can be designed to address lots of out-of-town mishaps, like lost baggage or even transportation and lodging for a loved one to visit if a traveler is hospitalized.
Travel medical insurance, as well as plans that offer “emergency evacuation and repatriation,” are two types that can specifically assist with medical emergencies. Such plans can be purchased individually. Credit cards may offer travel medical insurance among their benefits, as well.
But travel insurance plans come with limitations. For instance, they may not cover care associated with preexisting conditions or what the plans consider “risky” activities, such as rock climbing. Some plans also require that travelers file first with their primary health insurance before seeking reimbursement from travel insurance.
As with other insurance, be sure to read the fine print and understand how reimbursement works.
Wasney said that’s what they plan to do before their next Royal Caribbean cruise. They’d like to go back to the Bahamas on basically the same trip, he said — there’s a lot about CocoCay they didn’t get to explore.
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Safe Effective Sleep Aids For Seniors
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Safe Efective Sleep Aids For Seniors
Choosing a safe, effective sleep aid can be difficult, especially as we get older. Take for example this research review, which practically says, when it comes to drugs, “Nope nope nope nope nope, definitely not, we don’t know, wow no, useful in one (1) circumstance only, definitely not, fine if you must”:
Review of Safety and Efficacy of Sleep Medicines in Older Adults
Let’s break it down…
What’s not so great
Tranquilizers aren’t very healthy ways to get to sleep, and are generally only well-used as a last resort. The most common of these are benzodiazepines, which is the general family of drugs with names usually ending in –azepam and –azolam.
Their downsides are many, but perhaps their biggest is their tendency to induce tolerance, dependence, and addiction.
Non-benzo hypnotics aren’t fabulous either. Z-drugs such as zolpidem tartrate (popularly known by the brand name Ambien, amongst others), comes with warnings that it shouldn’t be prescribed if you have sleep apnea (i.e., one of the most common causes of insomnia), and should be used only with caution in patients who have depression or are elderly, as it may cause protracted daytime sedation and/or ataxia.
See also: Benzodiazepine and z-drug withdrawal
(and here’s a user-friendly US-based resource for benzodiazepine addiction specifically)
Antihistamines are commonly sold as over-the-counter sleep aids, because they can cause drowsiness, but a) they often don’t b) they may reduce your immune response that you may actually need for something. They’re still a lot safer than tranquilizers, though.
What about cannabis products?
We wrote about some of the myths and realities of cannabis use yesterday, but it does have some medical uses beyond pain relief, and use as a sleep aid is one of them—but there’s another caveat.
How it works: CBD, and especially THC, reduces REM sleep, causing you to spend longer in deep sleep. Deep sleep is more restorative and restful. And, if part of your sleep problem was nightmares, they can only occur during REM sleep, so you’ll be skipping those, too. However, REM sleep is also necessary for good brain health, and missing too much of it will result in cognitive impairment.
Opting for a CBD product that doesn’t contain THC may improve sleep with less (in fact, no known) risk of long-term impairment.
See: Cannabis, Cannabinoids, and Sleep: a Review of the Literature
Melatonin: a powerful helper with a good safety profile
We did a main feature on this recently, so we won’t take up too much space here, but suffice it to say: melatonin is our body’s own natural sleep hormone, and our body is good at scrubbing it when we see white/blue light (so, look at such if you feel groggy upon awakening, and it should clear up quickly), so that and its very short elimination half-life again make it quite safe.
Unlike tranquilizers, we don’t develop a tolerance to it, let alone dependence or addiction, and unlike cannabis, it doesn’t produce long-term adverse effects (after all, our brains are supposed to have melatonin in them every night). You can read our previous main feature (including a link to get melatonin, if you want) here:
Melatonin: A Safe Natural Sleep Supplement
Herbal options: which really work?
Valerian? Probably not, but it seems safe to try. Data on this is very inconsistent, and many studies supporting it had poor methodology. Shinjyo et al. also hypothesized that the inconsistency may be due to the highly variable quality of the supplements, and lack of regulation, as they are provided “based on traditional use only”.
Chamomile? Given the fame of chamomile tea as a soothing, relaxing bedtime drink, there’s surprisingly little research out there for this specifically (as opposed to other medicinal features of chamomile, of which there are plenty).
But here’s one study that found it helped significantly:
The effects of chamomile extract on sleep quality among elderly people: A clinical trial
Unlike valerian, which is often sold as tablets, chamomile is most often sold as a herbal preparation for making chamomile tea, so the quality is probably quite consistent. You can also easily grow your own in most places!
Technological interventions
We may not have sci-fi style regeneration alcoves just yet, but white noise machines, or better yet, pink noise machines, help:
White Noise Is Good; Pink Noise Is Better
Note: the noise machine can be a literal physical device purchased to do that (most often sold as for babies, but babies aren’t the only ones who need to sleep!), but it can also just be your phone playing an appropriate audio file (there are apps available) or YouTube video.
We reviewed some sleep apps; you might like those too:
The Head-To-Head Of Google and Apple’s Top Apps For Getting Your Head Down
Enjoy, and rest well!
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From straight to curly, thick to thin: here’s how hormones and chemotherapy can change your hair
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Head hair comes in many colours, shapes and sizes, and hairstyles are often an expression of personal style or cultural identity.
Many different genes determine our hair texture, thickness and colour. But some people’s hair changes around the time of puberty, pregnancy or after chemotherapy.
So, what can cause hair to become curlier, thicker, thinner or grey?
Curly or straight? How hair follicle shape plays a role
Hair is made of keratin, a strong and insoluble protein. Each hair strand grows from its own hair follicle that extends deep into the skin.
Curly hair forms due to asymmetry of both the hair follicle and the keratin in the hair.
Follicles that produce curly hair are asymmetrical and curved and lie at an angle to the surface of the skin. This kinks the hair as it first grows.
The asymmetry of the hair follicle also causes the keratin to bunch up on one side of the hair strand. This pulls parts of the hair strand closer together into a curl, which maintains the curl as the hair continues to grow.
Follicles that are symmetrical, round and perpendicular to the skin surface produce straight hair.
Each hair strand grows from its own hair follicle.
Mosterpiece/ShutterstockLife changes, hair changes
Our hair undergoes repeated cycles throughout life, with different stages of growth and loss.
Each hair follicle contains stem cells, which multiply and grow into a hair strand.
Head hairs spend most of their time in the growth phase, which can last for several years. This is why head hair can grow so long.
Let’s look at the life of a single hair strand. After the growth phase is a transitional phase of about two weeks, where the hair strand stops growing. This is followed by a resting phase where the hair remains in the follicle for a few months before it naturally falls out.
The hair follicle remains in the skin and the stems cells grow a new hair to repeat the cycle.
Each hair on the scalp is replaced every three to five years.
Each hair on the scalp is replaced every three to five years.
Just Life/ShutterstockHormone changes during and after pregnancy alter the usual hair cycle
Many women notice their hair is thicker during pregnancy.
During pregnancy, high levels of oestrogen, progesterone and prolactin prolong the resting phase of the hair cycle. This means the hair stays in the hair follicle for longer, with less hair loss.
A drop in hormones a few months after delivery causes increased hair loss. This is due to all the hairs that remained in the resting phase during pregnancy falling out in a fairly synchronised way.
Hair can change around puberty, pregnancy or after chemotherapy
This is related to the genetics of hair shape, which is an example of incomplete dominance.
Incomplete dominance is when there is a middle version of a trait. For hair, we have curly hair and straight hair genes. But when someone has one curly hair gene and one straight hair gene, they can have wavy hair.
Hormonal changes that occur around puberty and pregnancy can affect the function of genes. This can cause the curly hair gene of someone with wavy hair to become more active. This can change their hair from wavy to curly.
Researchers have identified that activating specific genes can change hair in pigs from straight to curly.
Chemotherapy has very visible effects on hair. Chemotherapy kills rapidly dividing cells, including hair follicles, which causes hair loss. Chemotherapy can also have genetic effects that influence hair follicle shape. This can cause hair to regrow with a different shape for the first few cycles of hair regrowth.
Your hair can change at different stages of your life.
Igor Ivakhno/ShutterstockHormonal changes as we age also affect our hair
Throughout life, thyroid hormones are essential for production of keratin. Low levels of thyroid hormones can cause dry and brittle hair.
Oestrogen and androgens also regulate hair growth and loss, particularly as we age.
Balding in males is due to higher levels of androgens. In particular, high dihydrotestosterone (sometimes shortened to DHT), which is produced in the body from testosterone, has a role in male pattern baldness.
Some women experience female pattern hair loss. This is caused by a combination of genetic factors plus lower levels of oestrogen and higher androgens after menopause. The hair follicles become smaller and smaller until they no longer produce hairs.
Reduced function of the cells that produce melanin (the pigment that gives our hair colour) is what causes greying.
Theresa Larkin, Associate professor of Medical Sciences, University of Wollongong
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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