Managing Your Mortality

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When Planning Is a Matter of Life and Death

Barring medical marvels as yet unrevealed, we are all going to die. We try to keep ourselves and our loved ones in good health, but it’s important to be prepared for the eventuality of death.

While this is not a cheerful topic, considering these things in advance can help us manage a very difficult thing, when the time comes.

We’ve put this under “Psychology Sunday” as it pertains to processing our own mortality, and managing our own experiences and the subsequent grief that our death may invoke in our loved ones.

We’ll also be looking at some of the medical considerations around end-of-life care, though.

Organizational considerations

It’s generally considered good to make preparations in advance. Write (or update) a Will, tie up any loose ends, decide on funerary preferences, perhaps even make arrangements with pre-funding. Life insurance, something difficult to get at a good rate towards the likely end of one’s life, is better sorted out sooner rather than later, too.

Beyond bureaucracy

What’s important to you, to have done before you die? It could be a bucket list, or it could just be to finish writing that book. It could be to heal a family rift, or to tell someone how you feel.

It could be more general, less concrete: perhaps to spend more time with your family, or to engage more with a spiritual practice that’s important to you.

Perhaps you want to do what you can to offset the grief of those you’ll leave behind; to make sure there are happy memories, or to make any requests of how they might remember you.

Lest this latter seem selfish: after a loved one dies, those who are left behind are often given to wonder: what would they have wanted? If you tell them now, they’ll know, and can be comforted and reassured by that.

This could range from “bright colors at my funeral, please” to “you have my blessing to remarry if you want to” to “I will now tell you the secret recipe for my famous bouillabaisse, for you to pass down in turn”.

End-of-life care

Increasingly few people die at home.

  • Sometimes it will be a matter of fighting tooth-and-nail to beat a said-to-be-terminal illness, and thus expiring in hospital after a long battle.
  • Sometimes it will be a matter of gradually winding down in a nursing home, receiving medical support to the end.
  • Sometimes, on the other hand, people will prefer to return home, and do so.

Whatever your preferences, planning for them in advance is sensible—especially as money may be a factor later.

Not to go too much back to bureaucracy, but you might also want to consider a Living Will, to be enacted in the case that cognitive decline means you cannot advocate for yourself later.

Laws vary from place to place, so you’ll want to discuss this with a lawyer, but to give an idea of the kinds of things to consider:

National Institute on Aging: Preparing A Living Will

Palliative care

Palliative care is a subcategory of end-of-life care, and is what occurs when no further attempts are made to extend life, and instead, the only remaining goal is to reduce suffering.

In the case of some diseases including cancer, this may mean coming off treatments that have unpleasant side-effects, and retaining—or commencing—pain-relief treatments that may, as a side-effect, shorten life.

Euthanasia

Legality of euthanasia varies from place to place, and in some times and places, palliative care itself has been considered a form of “passive euthanasia”, that is to say, not taking an active step to end life, but abstaining from a treatment that prolongs it.

Clearer forms of passive euthanasia include stopping taking a medication without which one categorically will die, or turning off a life support machine.

Active euthanasia, taking a positive action to end life, is legal in some places and the means varies, but an overdose of barbiturates is an example; one goes to sleep and does not wake up.

It’s not the only method, though; options include benzodiazepines, and opioids, amongst others:

Efficacy and safety of drugs used for assisted dying

Unspoken euthanasia

An important thing to be aware of (whatever your views on euthanasia) is the principle of double-effect… And how it comes to play in palliative care more often than most people think.

Say a person is dying of cancer. They opt for palliative care; they desist in any further cancer treatments, and take medication for the pain. Morphine is common. Morphine also shortens life.

It’s common for such a patient to have a degree of control over their own medication, however, after a certain point, they will no longer be in sufficient condition to do so.

After this point, it is very common for caregivers (be they medical professionals or family members) to give more morphine—for the purpose of reducing suffering, of course, not to kill them.

In practical terms, this often means that the patient will die quite promptly afterwards. This is one of the reasons why, after sometimes a long-drawn-out period of “this person is dying”, healthcare workers can be very accurate about “it’s going to be in the next couple of days”.

The take-away from this section is: if you would like for this to not happen to you or your loved one, you need to be aware of this practice in advance, because while it’s not the kind of thing that tends to make its way into written hospital/hospice policies, it is very widespread and normalized in the industry on a human level.

Further reading: Goods, causes and intentions: problems with applying the doctrine of double effect to palliative sedation

One last thing…

Planning around our own mortality is never a task that seems pressing, until it’s too late. We recommend doing it anyway, without putting it off, because we can never know what’s around the corner.

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  • SuperLife – by Darin Olien

    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.

    We mostly know more or less what we’re supposed to be doing, at least to a basic level, when it comes to diet and exercise. So why don’t we do it?

    Where Darin Olien excels in this one is making healthy living—mostly the dietary aspects thereof—not just simple, but also easy.

    He gives principles we can apply rather than having to memorize lots of information… And his “this will generally be better than that” format also means that the feeling is one of reducing harm, increasing benefits, without needing to get absolutist about anything. And that, too, makes healthy living easier.

    The book also covers some areas that a lot of books of this genre don’t—such as blood oxygenation, and maintenance of healthy pH levels—and aspects such as those are elements that help this book to stand out too.

    Don’t be put off and think this is a dry science textbook, though—it’s not. In fact, the tone is light and the style is easy-reading throughout.

    Bottom line: if you want to take an easy, casual, but scientifically robust approach to tweaking your health for the better, this book will enable you to do that.

    Click here to check out SuperLife and start upgrading your health!

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  • Half Of Americans Over 50 Have Hemorrhoids, But They Can Be Prevented!

    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.

    It’s Q&A Day at 10almonds!

    Have a question or a request? We love to hear from you!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝Hello. I was hoping you could give some useful tips about how to avoid a painful ailment that has affected Ernest Hemingway, Karl Marx, David Livingstone, Napoleon, Marilyn Monroe, King Alfred, and Martin Luther, and, I confess, me from time to time … namely, hemorrhoids. Help!❞

    Firstly: that list could be a lot longer! We don’t have global stats, but in the US for example, half of adults over 50 have hemorrhoids.

    So, you’re certainly not alone. People just don’t talk about it.

    But, there are preventative things you can do:

    Fiber, fiber, fiber. See also:

    Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)

    Hydrate, hydrate, hydrate.

    This one’s simple enough. If you are dehydrated, constipation is more likely, and with it, hemorrhoids.

    Watch your meds…

    Some medications can cause constipation—painkillers containing codeine are a common culprit, for example.

    When you go, go!

    Not only can prolonged straining promote hemorrhoids, but also (if you’ll pardon the phrasing—there’s only so delicately we can say this) simply sitting with things partway “open” down there is not good for its health; things can quickly become irritated, and that can lead to hemorrhoids.

    So: when you go, go. Leave your phone in another room!

    Wash—but carefully.

    Beyond your normal showering/bathing routine, a bidet is a great option for keeping things happy down there, if you have that option available to you.

    However, if you have hemorrhoids, don’t use soap, as this can cause irritation and make it worse.

    Warm water is fine, as is a salt bath, and pat dry and/or use gentle wet-wipes rather than rougher paper.

    You can follow up with a hemorrhoid cream of your choice (or hydrocortisone, unless that’s contraindicated by another condition you have)

    Know when to seek help

    Hemorrhoids will usually go away by themselves if not exacerbated. But if it’s getting unduly difficult, and/or you’re bleeding down there, it’s time to see a doctor.

    Note on bleeding: even if you’re 100% sure you have hemorrhoids, there are still other reasons you could be bleeding, and so it needs checking out.

    Hemorrhoid treatment, if needed, will vary depending on severity. Beyond creams and lotions, there are other options that are less fun but sometimes necessary, including injections, electrotherapy, banding, or surgery.

    Take care!

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  • Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer – by Dr. Patrick Walsh & Janet Farrar Worthington

    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.

    Prostate cancer is not glamorous or fun, and neither is this book.

    Nevertheless, it’s a disease that affects 12% of men in general, and 60% of men aged 60+, with that percentage climbing every year after that.

    So, if you have a prostate or love someone who has one, this book is worthwhile reading—yes, even as a preventative.

    Like many cancers, prostate cancer is easy to treat if caught very early, becomes harder to treat as it goes, and almost impossible to cure if it gets as far as metastasis (i.e., it spread). Like all cancers, it’s better off avoided entirely if possible.

    This book covers all the stages:

    • How to avoid it
    • How to check for it
    • How to “nip it in the bud”
    • Why some might want to delay treatment (!)
    • What options are available afterwards

    This latter is quite extensive, and covers not just surgery, but radiation, thermo- or cryoablation, and hormone therapy.

    And as for surgery, not just “remove the tumor”, but other options like radical prostatectomy, and even orchiectomy. Not many men will choose to have their testicles removed to stop them from feeding the prostate, but the point is that this book is comprehensive.

    It’s asking whenever possible “is there another option?” and exploring all options, with information and without judgment, at each stage.

    The writing style (likely co-author Worthington’s influence; she is an award-winning science-writer) is very “for the layman”, and that’s really helpful in demystifying a lot of what can be quite opaque in the field of oncology.

    Bottom line: absolutely not an enjoyable read, but a potentially lifesaving one, especially given the odds we mentioned up top.

    Click here to check out Dr. Patrick Walsh’s Guide To Surviving Prostate Cancer, and be prepared!

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Related Posts

  • Imposter Syndrome (and why almost everyone has it)
  • The Brain-Gut Highway: A Two-Way Street

    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.

    The Brain-Gut Two-Way Highway

    This is Dr. Emeran Mayer. He has the rather niche dual specialty of being a gastroenterologist and a neurologist. He has published over 353 peer reviewed scientific articles, and he’s a professor in the Departments of Medicine, Physiology, and Psychiatry at UCLA. Much of his work has been pioneering medical research into gut-brain interactions.

    We know the brain and gut are connected. What else does he want us to know?

    First, that it is a two-way interaction. It’s about 90% “gut tells the brain things”, but it’s also 10% “brain tells the gut things”, and that 10% can make more like a 20% difference, if for example we look at the swing between “brain using that 10% communication to tell gut to do things worse” or “brain using that 10% communication to tell gut to do things better”, vs the midpoint null hypothesis of “what the gut would be doing with no direction from the brain”.

    For example, if we are experiencing unmanaged chronic stress, that is going to tell our gut to do things that had an evolutionary advantage 20,000–200,000 years ago. Those things will not help us now. We do not need cortisol highs and adrenal dumping because we ate a piece of bread while stressed.

    Read more (by Dr. Mayer): The Stress That Evolution Has Not Prepared Us For

    With this in mind, if we want to look after our gut, then we can start before we even put anything in our mouths. Dr. Mayer recommends managing stress, anxiety, and depression from the head downwards as well as from the gut upwards.

    Here’s what we at 10almonds have written previously on how to manage those things:

    Do eat for gut health! Yes, even if…

    Unsurprisingly, Dr. Mayer advocates for a gut-friendly, anti-inflammatory diet. We’ve written about these things before:

    …but there’s just one problem:

    For some people, such as with IBS, Crohn’s, and colitis, the Mediterranean diet that we (10almonds and Dr. Mayer) generally advocate for, is inaccessible. If you (if you have those conditions) eat as we describe, a combination of the fiber in many vegetables and the FODMAPs* in many fruits, will give you a very bad time indeed.

    *Fermentable Oligo-, Di-, Monosaccharides And Polyols

    Dr. Mayer has the answer to this riddle, and he’s not just guessing; he and his team did science to it. In a study with hundreds of participants, he measured what happened with adherence (or not) to the Mediterranean diet (or modified Mediterranean diet) (or not), in participants with IBS (or not).

    The results and conclusions from that study included:

    ❝Among IBS participants, a higher consumption of fruits, vegetables, sugar, and butter was associated with a greater severity of IBS symptoms. Multivariate analysis identified several Mediterranean Diet foods to be associated with increased IBS symptoms.

    A higher adherence to symptom-modified Mediterranean Diet was associated with a lower abundance of potentially harmful Faecalitalea, Streptococcus, and Intestinibacter, and higher abundance of potentially beneficial Holdemanella from the Firmicutes phylum.

    A standard Mediterranean Diet was not associated with IBS symptom severity, although certain Mediterranean Diet foods were associated with increased IBS symptoms. Our study suggests that standard Mediterranean Diet may not be suitable for all patients with IBS and likely needs to be personalized in those with increased symptoms.❞

    In graphical form:

    And if you’d like to read more about this (along with more details on which specific foods to include or exclude to get these results), you can do so…

    Want to know more?

    Dr. Mayer offers many resources, including a blog, books, recipes, podcasts, and even a YouTube channel:

    Don’t Forget…

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  • Statins: His & Hers?

    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.

    The Hidden Complexities of Statins and Cardiovascular Disease (CVD)

    This is Dr. Barbara Roberts. She’s a cardiologist and the Director of the Women’s Cardiac Center at one of the Brown University Medical School teaching hospitals. She’s an Associate Clinical Professor of Medicine and takes care of patients, teaches medical students, and does clinical research. She specializes in gender-specific aspects of heart disease, and in heart disease prevention.

    We previously reviewed Dr. Barbara Roberts’ excellent book “The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs”. It prompted some requests to do a main feature about Statins, so we’re doing it today. It’s under the auspices of “Expert Insights” as we’ll be drawing almost entirely from Dr. Roberts’ work.

    So, what are the risks of statins?

    According to Dr. Roberts, one of the biggest risks is not just drug side-effects or anything like that, but rather, what they simply won’t treat. This is because statins will lower LDL (bad) cholesterol levels, without necessarily treating the underlying cause.

    Imagine you got Covid, and it’s one of the earlier strains that’s more likely deadly than “merely” debilitating.

    You’re coughing and your throat feels like you gargled glass.

    Your doctor gives you a miracle cough medicine that stops your coughing and makes your throat feel much better.

    (Then a few weeks later, you die, because this did absolutely nothing for the underlying problem)

    You see the problem?

    Are there problematic side-effects too, though?

    There can be. But of course, all drugs can have side effects! So that’s not necessarily news, but what’s relevant here is the kind of track these side-effects can lead one down.

    For example, Dr. Roberts cites a case in which a woman’s LDL levels were high and she was prescribed simvastatin (Zocor), 20mg/day. Here’s what happened, in sequence:

    1. She started getting panic attacks. So, her doctor prescribed her sertraline (Zoloft) (a very common SSRI antidepressant) and when that didn’t fix it, paroxetine (Paxil). This didn’t work either… because the problem was not actually her mental health. The panic attacks got worse…
    2. Then, while exercising, she started noticing progressive arm and leg weakness. Her doctor finally took her off the simvastatin, and temporarily switched to ezetimibe (Zetia), a less powerful nonstatin drug that blocks cholesterol absorption, which change eased her arm and leg problem.
    3. As the Zetia was a stopgap measure, the doctor put her on atorvastatin (Lipitor). Now she got episodes of severe chest pressure, and a skyrocketing heart rate. She also got tremors and lost her body temperature regulation.
    4. So the doctor stopped the atorvastatin and tried rosovastatin (Crestor), on which she now suffered exhaustion (we’re not surprised, by this point) and muscle pains in her arms and chest.
    5. So the doctor stopped the rosovastatin and tried lovastatin (Mevacor), and now she had the same symptoms as before, plus light-headedness.
    6. So the doctor stopped the lovastatin and tried fluvastatin (Lescol). Same thing happened.
    7. So he stopped the fluvastatin and tried pravastatin (Pravachol), without improvement.
    8. So finally he took her off all these statins because the high LDL was less deleterious to her life than all these things.
    9. She did her own research, and went back to the doctor to ask for cholestyramine (Questran), which is a bile acid sequestrent and nothing to do with statins. She also asked for a long-acting niacin. In high doses, niacin (one of the B-vitamins) raises HDL (good) cholesterol, lowers LDL, and lowers tryglycerides.
    10. Her own non-statin self-prescription (with her doctor’s signature) worked, and she went back to her life, her work, and took up running.

    Quite a treatment journey! Want to know more about the option that actually worked?

    Read: Bile Acid Resins or Sequestrants

    What are the gender differences you/she mentioned?

    Actually mostly sex differences, since this appears to be hormonal (which means that if your hormones change, so will your risk). A lot of this is still pending more research—basically it’s a similar problem in heart disease to one we’ve previously talked about with regard to diabetes. Diabetes disproportionately affects black people, while diabetes research disproportionately focuses on white people.

    In this case, most heart disease research has focused on men, with women often not merely going unresearched, but also often undiagnosed and untreated until it’s too late. And the treatments, if prescribed? Assumed to be the same as for men.

    Dr. Roberts tells of how medicine is taught:

    ❝When I was in medical school, my professors took the “bikini approach” to women’s health: women’s health meant breasts and reproductive organs. Otherwise the prototypical patient was presented as a man.❞

    There has been some research done with statins and women, though! Just, still not a lot. But we do know for example that some statins can be especially useful for treating women’s atherosclerosis—with a 50% success rate, rather than 31% for men.

    For lowering LDL itself, however, it can work but is generally not so hot in women.

    Fun fact:

    In men:

    • High total cholesterol
    • High non-HDL cholesterol
    • High LDL cholesterol
    • Low HDL cholesterol

    …are all significantly associated with an increased risk of death from CVD.

    In women:

    …levels of LDL cholesterol even more than 190 were associated with only a small, statistically insignificant increased risk of dying from CVD.

    So…

    The fact that women derive less benefit from a medicine that mainly lowers LDL cholesterol, may be because elevated LDL cholesterol is less harmful to women than it is to men.

    And also: Treatment and Response to Statins: Gender-related Differences

    And for that matter: Women Versus Men: Is There Equal Benefit and Safety from Statins?*

    Definitely a case where Betteridge’s Law of Headlines applies!

    What should women do to avoid dying of CVD, then?

    First, quick reminder of our general disclaimer: we can’t give medical advice and nothing here comprises such. However… One particularly relevant thing we found illuminating in Dr. Roberts’ work was this observation:

    The metabolic syndrome is diagnosed if you have three (or more) out of five of the following:

    1. Abdominal obesity (waist >35″ if a woman or >40″ if a man)
    2. Fasting blood sugars of 100mg/dl or more
    3. Fasting triglycerides of 150mg/dl or more
    4. Blood pressure of 130/85 or higher
    5. HDL <50 if a woman or <40 if a man

    And yet… because these things can be addressed with exercise and a healthy diet, which neither pharmaceutical companies nor insurance companies have a particular stake in, there’s a lot of focus instead on LDL levels (since there are a flock of statins that can be sold be lower them)… Which, Dr. Roberts says, is not nearly as critical for women.

    So women end up getting prescribed statins that cause panic attacks and all those things we mentioned earlier… To lower our LDL, which isn’t nearly as big a factor as the other things.

    In summary:

    Statins do have their place, especially for men. They can, however, mask underlying problems that need treatment—which becomes counterproductive.

    When it comes to women, statins are—in broad terms—statistically not as good. They are a little more likely to be helpful specifically in cases of atherosclerosis, whereby they have a 50/50 chance of helping.

    For women in particular, it may be worthwhile looking into alternative non-statin drugs, and, for everyone: diet and exercise.

    Further reading: How Can I Safely Come Off Statins?

    Don’t Forget…

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  • Cauliflower vs Carrot – Which is Healthier?

    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.

    Our Verdict

    When comparing cauliflower to carrot, we picked the cauliflower.

    Why?

    In terms of macros, cauliflower has nearly 2x the protein while carrot has nearly 2x the carbs and slightly more fiber; we’re calling it a tie in this category.

    When it comes to vitamins, cauliflower has more of vitamins B2, B5, B6, B9, C, K, and choline, while carrot has more of vitamins A, B1, B3, and E. Thus, a 7:4 win for cauliflower here.

    In the category of minerals, cauliflower has more iron, magnesium, manganese, phosphorus, selenium, and zinc, while carrot has more calcium, copper, and potassium. So, a 6:3 win for cauliflower here.

    In short, for overall nutritional density, adding up the sections makes for a clear win for cauliflower, but of course, enjoy either or (preferably) both; diversity is good!

    Want to learn more?

    You might like to read:

    What’s Your Plant Diversity Score?

    Take care!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

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