Paris in spring, Bali in winter. How ‘bucket lists’ help cancer patients handle life and death
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In the 2007 film The Bucket List Jack Nicholson and Morgan Freeman play two main characters who respond to their terminal cancer diagnoses by rejecting experimental treatment. Instead, they go on a range of energetic, overseas escapades.
Since then, the term “bucket list” – a list of experiences or achievements to complete before you “kick the bucket” or die – has become common.
You can read articles listing the seven cities you must visit before you die or the 100 Australian bucket-list travel experiences. https://www.youtube.com/embed/UvdTpywTmQg?wmode=transparent&start=0
But there is a more serious side to the idea behind bucket lists. One of the key forms of suffering at the end of life is regret for things left unsaid or undone. So bucket lists can serve as a form of insurance against this potential regret.
The bucket-list search for adventure, memories and meaning takes on a life of its own with a diagnosis of life-limiting illness.
In a study published this week, we spoke to 54 people living with cancer, and 28 of their friends and family. For many, a key bucket list item was travel.
Why is travel so important?
There are lots of reasons why travel plays such a central role in our ideas about a “life well-lived”. Travel is often linked to important life transitions: the youthful gap year, the journey to self-discovery in the 2010 film Eat Pray Love, or the popular figure of the “grey nomad”.
The significance of travel is not merely in the destination, nor even in the journey. For many people, planning the travel is just as important. A cancer diagnosis affects people’s sense of control over their future, throwing into question their ability to write their own life story or plan their travel dreams.
Mark, the recently retired husband of a woman with cancer, told us about their stalled travel plans:
We’re just in that part of our lives where we were going to jump in the caravan and do the big trip and all this sort of thing, and now [our plans are] on blocks in the shed.
For others, a cancer diagnosis brought an urgent need to “tick things off” their bucket list. Asha, a woman living with breast cancer, told us she’d always been driven to “get things done” but the cancer diagnosis made this worse:
So, I had to do all the travel, I had to empty my bucket list now, which has kind of driven my partner round the bend.
People’s travel dreams ranged from whale watching in Queensland to seeing polar bears in the Arctic, and from driving a caravan across the Nullarbor Plain to skiing in Switzerland.
Nadia, who was 38 years old when we spoke to her, said travelling with her family had made important memories and given her a sense of vitality, despite her health struggles. She told us how being diagnosed with cancer had given her the chance to live her life at a younger age, rather than waiting for retirement:
In the last three years, I think I’ve lived more than a lot of 80-year-olds.
But travel is expensive
Of course, travel is expensive. It’s not by chance Nicholson’s character in The Bucket List is a billionaire.
Some people we spoke to had emptied their savings, assuming they would no longer need to provide for aged care or retirement. Others had used insurance payouts or charity to make their bucket-list dreams come true.
But not everyone can do this. Jim, a 60-year-old whose wife had been diagnosed with cancer, told us:
We’ve actually bought a new car and [been] talking about getting a new caravan […] But I’ve got to work. It’d be nice if there was a little money tree out the back but never mind.
Not everyone’s bucket list items were expensive. Some chose to spend more time with loved ones, take up a new hobby or get a pet.
Our study showed making plans to tick items off a list can give people a sense of self-determination and hope for the future. It was a way of exerting control in the face of an illness that can leave people feeling powerless. Asha said:
This disease is not going to control me. I am not going to sit still and do nothing. I want to go travel.
Something we ‘ought’ to do?
Bucket lists are also a symptom of a broader culture that emphasises conspicuous consumption and productivity, even into the end of life.
Indeed, people told us travelling could be exhausting, expensive and stressful, especially when they’re also living with the symptoms and side effects of treatment. Nevertheless, they felt travel was something they “ought” to do.
Travel can be deeply meaningful, as our study found. But a life well-lived need not be extravagant or adventurous. Finding what is meaningful is a deeply personal journey.
Names of study participants mentioned in this article are pseudonyms.
Leah Williams Veazey, ARC DECRA Research Fellow, University of Sydney; Alex Broom, Professor of Sociology & Director, Sydney Centre for Healthy Societies, University of Sydney, and Katherine Kenny, ARC DECRA Senior Research Fellow, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Can Home Tests Replace Check-Ups?
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
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
❝I recently hit 65 and try to get regular check-ups, but do you think home testing can be as reliable as a doctor visit? I try to keep as informed as I can and am a big believer in taking responsibility for my own health if I can, but I don’t want to miss something important either. Best as a supplemental thing, perhaps?❞
Depends what’s being tested! And your level of technical knowledge, though there’s always something to be said for ongoing learning.
- If you’re talking blood tests, urine tests, etc per at-home test kits that get sent off to a lab, then provided they’re well-sourced (and executed correctly by you), they should be as accurate as what a doctor will give, since they are basically doing the same thing (taking a sample and sending it off to a lab).
- If you’re talking about checking for lumps etc, then a dual approach is best: check yourself at home as often as you feel is reasonable (with once per month being advised at a minimum, especially if you’re aware of an extra risk factor for you) and check-ups with the doctor per their recommendations.
- If you’re talking about general vitals (blood pressure, heart rate, heart rate variability, VO₂ max, etc), then provided you have a reliable way of testing them, then doing them very frequently at home, to get the best “big picture” view. In contrast, getting them done once a year at your doctor’s could result in a misleading result, if you just ate something different that day or had a stressful morning, for example.
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Spiced Fruit & Nut Chutney
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‘Tis the season to make the chutney that will then be aged chutney when you want it later! And unlike supermarket varieties with their ingredients list that goes “Sugar, spirit vinegar, inverted glucose-fructose syrup,” this one has an array of health-giving fruits and nuts (just omit the nuts if you or someone you may want to give this to has an allergy), and really nothing bad in here at all. And of course, tasty healthful spices!
You will need
- 2 red onions, chopped
- 1½ cups dried apricots, chopped
- 1½ cups dried figs, chopped
- 1 cup raisins
- ½ cup apple cider vinegar
- ½ cup slivered almonds
- ½ lime, chopped and deseeded
- ¼ bulb garlic, chopped
- 1 hot pepper, chopped (your choice what kind; omit if you don’t like heat at all; multiply if you want more heat)
- 2 tablespoons honey or maple syrup (omit for a less sweet chutney; there is sweetness in the dried fruits already, after all)
- 1 tbsp freshly grated ginger
- 2 tsp sweet cinnamon
- 1 tsp nutmeg
- 1 tsp black pepper
- ½ teaspoon allspice
- ½ MSG or 1 tsp low-sodium salt
- Extra virgin olive oil
Method
(we suggest you read everything at least once before doing anything)
1) Heat some oil in a heavy-based pan that will be large enough for all ingredients to go into eventually. Fry the onions on a gentle heat for around 15 minutes. We don’t need to caramelize them yet (this will happen with time), but we do want them soft and sweet already.
2) Add the ginger, garlic, and chili, and stir in well.
3) When the onions start to brown, add the fruit and stir well to mix thoroughly.
4) Add the honey or maple syrup (if using), and the vinegar; add the remaining spices/seasonings, so everything is in there now except the almonds.
5) Cook gently for another 30 minutes while stirring. At some point it’ll become thick and sticky; add a little water as necessary. You don’t want to drown it, but you do want it to stay moist. It’ll probably take only a few tablespoons of added water in total, but add them one at a time and stir in before judging whether more is needed. By the end of the 30 minutes, it should be more solid, to the point it can stand up by itself.
6) Add the almonds, stir to combine, and leave to cool. Put it in jars until you need it (or perhaps give it as gifts).
Alternative method: if you don’t want to be standing at a stove stirring for about an hour in total, you can use a slow cooker / crock pot instead. Put the same ingredients in the same order, but don’t stir them, just leave them in layers (this is because of the pattern of heat distribution; it’ll be hotter at the bottom, so the things that need to be more cooked should be there, and the design means they won’t burn) for about two hours, then stir well to mix thoroughly, and leave it for another hour or two, before turning it off to let it cool. Put it in jars until you need it (or perhaps give it as gifts).
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Top 8 Fruits That Prevent & Kill Cancer ← figs and apricots appear here
- Apricots vs Peaches – Which is Healthier? ← have a guess
- Almonds vs Walnuts – Which is Healthier? ← almonds won, but walnuts were close and would also work in this recipe
- Pistachios vs Almonds – Which is Healthier? ← almonds won, but pistachios were close and would also work in this recipe
- Our Top 5 Spices: How Much Is Enough For Benefits? ← we scored 4/5 today!
Take care!
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In Praise Of Walking – by Dr. Shane O’Mara
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At 10almonds we talk often of the health benefits of walking, so what’s new here?
As the subtitle suggests: a new scientific exploration!
Dr. Shane O’Mara is a professor of experimental brain research—and a keen walker. Combining his profession and his passion, he offers us a uniquely well-grounded perspective.
While the writing style is very readable, there’s a lot of science referenced here, with many studies cited. We love that!
We begin our journey by learning what we have in common with sea squirts, and what we have different from all other apes. What we can learn from other humans, from toddlers to supercentenarians.
As one might expect from a professor of experimental brain research, we learn a lot more about what walking does for our brain, than for the rest of our body. We’ve previously talked about walking and cardiovascular health, and brown adipose tissue, and benefits to the immune system, but this book remains steadfastly focused on the brain.
Which just goes to show, what a lot there is to say for the science-based benefits to our brain health, both neurologically and psychologically!
One of the things at which Dr. O’Mara excels that this reviewer hasn’t seen someone do so well before, is neatly tie together the appropriate “why” and “how” to each “what” of the brain-benefits of walking. Not just that walking boosts mood or creativity or problem-solving, say, but why and how it does so.
Often, understanding that can be the difference between being motivated to actually do it or not!
Bottom line: if there’s a book that’ll get you lacing up your walking shoes, this’ll be the one.
Click here to check out “In Praise of Walking” on Amazon, and start reaping the benefits!
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Evidence doesn’t support spinal cord stimulators for chronic back pain – and they could cause harm
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In an episode of ABC’s Four Corners this week, the use of spinal cord stimulators for chronic back pain was brought into question.
Spinal cord stimulators are devices implanted surgically which deliver electric impulses directly to the spinal cord. They’ve been used to treat people with chronic pain since the 1960s.
Their design has changed significantly over time. Early models required an external generator and invasive surgery to implant them. Current devices are fully implantable, rechargeable and can deliver a variety of electrical signals.
However, despite their long history, rigorous experimental research to test the effectiveness of spinal cord stimulators has only been conducted this century. The findings don’t support their use for treating chronic pain. In fact, data points to a significant risk of harm.
What does the evidence say?
One of the first studies used to support the effectiveness of spinal cord stimulators was published in 2005. This study looked at patients who didn’t get relief from initial spinal surgery and compared implantation of a spinal cord stimulator to a repeat of the spinal surgery.
Although it found spinal cord stimulation was the more effective intervention for chronic back pain, the fact this study compared the device to something that had already failed once is an obvious limitation.
Later studies provided more useful evidence. They compared spinal cord stimulation to non-surgical treatments or placebo devices (for example, deactivated spinal cord stimulators).
A 2023 Cochrane review of the published comparative studies found nearly all studies were restricted to short-term outcomes (weeks). And while some studies appeared to show better pain relief with active spinal cord stimulation, the benefits were small, and the evidence was uncertain.
Only one high-quality study compared spinal cord stimulation to placebo up to six months, and it showed no benefit. The review concluded the data doesn’t support the use of spinal cord stimulation for people with back pain.
What about the harms?
The experimental studies often had small numbers of participants, making any estimate of the harms of spinal cord stimulation difficult. So we need to look to other sources.
A review of adverse events reported to Australia’s Therapeutic Goods Administration found the harms can be serious. Of the 520 events reported between 2012 and 2019, 79% were considered “severe” and 13% were “life threatening”.
We don’t know exactly how many spinal cord stimulators were implanted during this period, however this surgery is done reasonably widely in Australia, particularly in the private and workers compensation sectors. In 2023, health insurance data showed more than 1,300 spinal cord stimulator procedures were carried out around the country.
In the review, around half the reported harms were due to a malfunction of the device itself (for example, fracture of the electrical lead, or the lead moved to the wrong spot in the body). The other half involved declines in people’s health such as unexplained increased pain, infection, and tears in the lining around the spinal cord.
More than 80% of the harms required at least one surgery to correct the problem. The same study reported four out of every ten spinal cord stimulators implanted were being removed.
Chronic back pain can be debilitating. CGN089/Shutterstock High costs
The cost here is considerable, with the devices alone costing tens of thousands of dollars. Adding associated hospital and medical costs, the total cost for a single procedure averages more than $A50,000. With many patients undergoing multiple repeat procedures, it’s not unusual for costs to be measured in hundreds of thousands of dollars.
Rebates from Medicare, private health funds and other insurance schemes may go towards this total, along with out-of-pocket contributions.
Insurers are uncertain of the effectiveness of spinal cord stimulators, but because their implantation is listed on the Medicare Benefits Schedule and the devices are approved for reimbursement by the government, insurers are forced to fund their use.
Industry influence
If the evidence suggests no sustained benefit over placebo, the harms are significant and the cost is high, why are spinal cord stimulators being used so commonly in Australia? In New Zealand, for example, the devices are rarely used.
Doctors who implant spinal cord stimulators in Australia are well remunerated and funding arrangements are different in New Zealand. But the main reason behind the lack of use in New Zealand is because pain specialists there are not convinced of their effectiveness.
In Australia and elsewhere, the use of spinal cord stimulators is heavily promoted by the pain specialists who implant them, and the device manufacturers, often in unison. The tactics used by the spinal cord stimulator device industry to protect profits have been compared to tactics used by the tobacco industry.
A 2023 paper describes these tactics which include flooding the scientific literature with industry-funded research, undermining unfavourable independent research, and attacking the credibility of those who raise concerns about the devices.
It’s not all bad news
Many who suffer from chronic pain may feel disillusioned after watching the Four Corners report. But it’s not all bad news. Australia happens to be home to some of the world’s top back pain researchers who are working on safe, effective therapies.
New approaches such as sensorimotor retraining, which includes reassurance and encouragement to increase patients’ activity levels, cognitive functional therapy, which targets unhelpful pain-related thinking and behaviour, and old approaches such as exercise, have recently shown benefits in robust clinical research.
If we were to remove funding for expensive, harmful and ineffective treatments, more funding could be directed towards effective ones.
Ian Harris, Professor of Orthopaedic Surgery, UNSW Sydney; Adrian C Traeger, Research Fellow, Institute for Musculoskeletal Health, University of Sydney, and Caitlin Jones, Postdoctoral Research Associate in Musculoskeletal Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Red Lentils vs Green Lentils – Which is Healthier?
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Our Verdict
When comparing red lentils to green lentils, we picked the green.
Why?
Yes, they’re both great. But there are some clear distinctions!
First, know: red lentils are, secretly, hulled brown lentils. Brown lentils are similar to green lentils, just a little less popular and with (very) slightly lower nutritional values, as a rule.
By hulling the lentils, the first thing that needs mentioning is that they lose some of their fiber, since this is what was removed. While we’re talking macros, this does mean that red lentils have proportionally more protein, because of the fiber weight lost. However, because green lentils are still a good source of protein, we think the fat that green lentils have much more fiber is a point in their favor.
In terms of micronutrients, they’re quite similar in vitamins (mostly B-vitamins, of which, mostly folate / vitamin B9), and when it comes to minerals, they’re similarly good sources of iron, but green lentils contain more magnesium and potassium.
Green lentils also contain more antixoidants.
All in all, they both continue to be very respectable parts of anyone’s diet—but in a head-to-head, green lentils do come out on top (unless you want to prioritize slightly higher protein above everything else, in which case, red).
Want to get some in? Here are the specific products we featured today:
Enjoy!
Want to learn more?
You might like to read:
- Why You’re Probably Not Getting Enough Fiber (And How To Fix It)
- Eat More (Of This) For Lower Blood Pressure ← incidentally, the potassium content of green lentils also helps minimize the harm done by sodium in one’s diet
Take care!
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Lower Cholesterol Naturally
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Lower Cholesterol, Without Statins
We’ll start this off by saying that lowering cholesterol might not, in fact, be critical or even especially helpful for everyone, especially in the case of women. We covered this more in our article about statins:
…which was largely informed by the wealth of data in this book:
The Truth About Statins – by Dr. Barbara H. Roberts
…which in turn, may in fact put a lot of people off statins. We’re not here to tell you don’t use them—they may indeed be useful or even critical for some people, as Dr. Roberts herself also makes makes clear. But rather, we always recommend learning as much as possible about what’s going on, to be able to make the most informed choices when it comes to what often might be literally life-and-death decisions.
On which note, if anyone would like a quick refresher on cholesterol, what it actually is (in its various forms) and what it does, why we need it, the problems it can cause anyway, then here you go:
Now, with all that in mind, we’re going to assume that you, dear reader, would like to know:
- how to lower your LDL cholesterol, and/or
- how to maintain a safe LDL cholesterol level
Because, while the jury’s out on the dangers of high LDL levels for women in particular, it’s clear that for pretty much everyone, maintaining them within well-established safe zones won’t hurt.
Here’s how:
Relax
Or rather, manage your stress. This doesn’t just reduce your acute risk of a heart attack, it also improves your blood metrics along the way, and yes, that includes not just blood pressure and blood sugars, but even triglycerides! Here’s the science for that, complete with numbers:
What are the effects of psychological stress and physical work on blood lipid profiles?
With that in mind, here’s…
How To Manage Chronic Stress (Even While Chronically Stressed)
Not chemically “relaxed”, though
While relaxing is important, drinking alcohol and smoking are unequivocally bad for pretty much everything, and this includes cholesterol levels:
Can We Drink To Good Health? ← this also covers popular beliefs about red wine and heart health, and the answer is no, we cannot
As for smoking, it is good to quit as soon as possible, unless your doctor specifically advises you otherwise (there are occasional situations where something else needs to be dealt with first, but not as many some might like to believe):
Addiction Myths That Are Hard To Quit
If you’re wondering about cannabis (CBD and/or THC), then we’d love to tell you about the effect these things have on heart health in general and cholesterol levels in particular, but the science is far too young (mostly because of the historic, and in some places contemporary, illegality cramping the research), and we could only find small, dubious, mutually contradictory studies so far. So the honest answer is: science doesn’t know this one, yet.
Exercise… But don’t worry, you can still stay relaxed
When it comes to heart health, the most important thing is keeping moving, so getting in those famous 150 minutes per week of moderate exercise is critical, and getting more is ideal.
240 minutes per week is a neat 40 minutes per day, by the way and is very attainable (this writer lives a 20-minute walk away from where she does her daily grocery shopping, thus making for a daily 40-minute round trip, not counting the actual shopping).
See: The Doctor Who Wants Us To Exercise Less, And Move More
If walking is for some reason not practical for you, here’s a whole list of fun options that don’t feel like exercise but are:
Manage your hormones
This one is mostly for menopausal women, though some people with atypical hormonal situations may find it applicable too.
Estrogen protects the heart… Until it doesn’t:
See also: World Menopause Day: Menopause & Cardiovascular Disease Risk
Here’s a great introduction to sorting it out, if necessary:
Dr. Jen Gunter: What You Should Have Been Told About Menopause Beforehand
Eat a heart-healthy diet
Shocking nobody, but it has to be said, for the sake of being methodical. So, what does that look like?
What Matters Most For Your Heart? Eat More (Of This) For Lower Blood Pressure
(it’s fiber in the #1 spot, but there’s a list of most important things there, that’s worth checking out and comparing it to what you habitually eat)
You can also check out the DASH (Dietary Approaches to Stop Hypertension) edition of the Mediterranean diet, here:
Four Ways To Upgrade The Mediterranean Diet
As for saturated fat (and especially trans-fats), the basic answer is to keep them to minimal, but there is room for nuance with saturated fats at least:
Can Saturated Fats Be Healthy?
And lastly, do make sure to get enough omega 3 fatty-acids:
What Omega-3s Really Do For Us
And enjoy plant sterols and stanols! This would need a whole list of their own, so here you go:
Take These To Lower Cholesterol! (Statin Alternatives)
Take care!
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