Paddleboarding in Hawaii: Who Cares About Surf

FIFTY years ago the Waikiki beach boys were the suntanned demigods of Honolulu’s palm-fringed shores. After the first major resort — the Moana Hotel, now the Moana Surfrider — opened in 1901, organized beach service began on Waikiki. The beach boys came to act as instructors, lifeguards and entertainers, spreading the gospel of surfing to dreamy-eyed tourists of all ages.

They also pioneered the art of stand-up paddleboarding — also known as stand-up paddle surfing or beach-boy surfing — now all the rage among fitness enthusiasts and practiced from Cape Cod to Cape Town.

In San Francisco, where I live and surf, there’s almost always a stand-up paddleboarder in the lineup on any given morning. On days when there aren’t many waves, I envy the cruise-y ease of the paddleboarder as he maneuvers through flat water, getting exercise all the while. On a recent trip to Honolulu I decided to try stand-up paddleboarding in its birthplace.

First, I sought inspiration in the archives of the venerable Bishop Museum, founded in 1889 in honor of Princess Bernice Pauahi Bishop, the last descendant of the royal Kamehameha family. The museum has a renowned collection of natural and cultural artifacts from Hawaii and the Pacific Islands. Surfboards were once exclusively the province of royalty; the museum’s holdings include 19th-century wooden boards that belonged to chiefs and princesses, as well as other models that were used by the legendary surfer Duke Kahanamoku and first introduced at Waikiki.

The Waikiki beach boys began using outrigger canoe paddles with surfboards in the 1960s, as a way to keep an eye on their tourist charges and to get better pictures as the beginners made their first attempts at wave riding. Ask locals about stand-up paddleboarding, and many will reminisce about the first time they saw someone do it.

“I remember this one guy, he wore a construction helmet and had a cigar clamped in his teeth,” Charles Myers, an archivist at the Bishop Museum, told me as he brought out vintage black-and-white photos of Waikiki. “He used a paddle and stood up on this big, floaty tandem board to see above the water when he was teaching people to surf.”

As I examined photographs of fit young men surfing, swimming and paddling canoes — and even giving ukulele lessons to women on the beach — I thought of the tradition of the “waterman,” the athletic and aesthetic ideal to which ancient Hawaiian men aspired. The beach boys, the modern epitome of watermen, found joy in every kind of water sport and helped to popularize surfing as we know it.

One of the most famous was George Freeth, an accomplished swimmer and lifeguard who was the subject of a profile by Jack London in 1907. Freeth, who moved to California and became known as a pioneer of modern surfing, was awarded a Congressional medal for rescuing several fishermen during a treacherous storm in 1908.

What began as a matter of practicality for the beach boys started popping up in its modern form as a full-fledged sport in the past 5 to 10 years; there are now stand-up paddleboarding competitions all over the world, from flat-water races on rivers and lakes to big-wave ocean contests. Since the boards are large and stable in flat water, they are easy to use.

Hotels around Honolulu have capitalized on the craze; many now offer stand-up paddleboarding lessons. For my maiden voyage I ventured into the calm turquoise lagoon at the Kahala Hotel & Resort, which looks out at the Diamond Head and Koko Head craters.

The afternoon sun glinted off the water as I stood uncertainly in the warm shallows with the relevant equipment — thick 10-foot board, long, angled paddle — I’d just rented from Kahala’s beach shack. The attendant reassured me that there was nothing to it.

“Hop on the board, start on your knees and try paddling from that stance first,” he instructed, mimicking the motions as he talked. “Keep the flat of the paddle to the back when you stroke. Then try standing up, keeping your weight to the center of the board and legs slightly apart.” He paused. “That’s it.”

Oh, and one last bit of advice.

“You might want to stay away from the waves for now,” he called as I began to paddle away. “And fall shallow!”

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The Falcon: A Jazz Haven in a Hudson Valley Hamlet

THE pianist Fred Hersch seemed right at home here one recent Saturday night, onstage at the Falcon, a perfectly unlikely jazz haven in this Hudson Valley hamlet. Leading a trio, he mingled standards and originals, including a graceful waltz with the appropriate title “Snow Is Falling.” The standing-room crowd, a few hundred strong, was lavish with its applause, never more so than when Mr. Hersch made a brief acknowledgment: “I just want to congratulate Tony for putting this place together.”

Tony is Tony Falco, an environmental scientist who has spent the last decade presenting jazz concerts in a barnlike structure he built behind his house. Over the years the intimacy of the setting and the hospitality of Mr. Falco and his family have brought a revolving roll call of top jazz talent to this town 70 miles north of Manhattan.

“It’s a really special place,” Kevin Hays, another acclaimed pianist, said of the Falcon, where he will appear with a trio on April 2. “The audiences are always great: quiet and respectful, even though it’s a very relaxed vibe, with kids often running around.”

I began hearing about the Falcon four or five years ago, from musicians who had played there. It sounded like a model of small but sturdy local activity, in a community far (but not too far) from the feverish metabolism of the city. Yet Mr. Falco’s operation isn’t on the radar of the average New York jazz fan; why would it be, with so many options closer to home? (Mr. Hersch, who played a week at the Village Vanguard in January, is scheduled to perform at the Weill Recital Hall on March 31.)

One recent development should add some incentive for out-of-towners: last fall Mr. Falco moved the Falcon from his backyard to larger accommodations on Route 9W, the town’s main drag. The handsomely renovated room, in what was once a 19th-century button factory, more than doubled his seating capacity, while easing tensions with his neighbors.

Since opening the day after Thanksgiving, the Falcon has settled into a steadier rhythm than ever before, with shows every Friday and Saturday. A liquor license came through in late January, and the kitchen began turning out light dinner fare. In theory, a visit to the club could form the cultural centerpiece of a restorative Hudson Valley weekend.

I set out to test that theory along with my wife, Ashley Lederer, who has grown warily accustomed to my idea of a weekend getaway. (I review pop and jazz for The New York Times; she harbors the humane conviction that a weekend should feel different than the rest of the week, and that a getaway involves getting away.) The good news is that we enjoyed Mr. Hersch’s two sets, with the bassist Larry Grenadier and the drummer Richie Barshay, at least as much as we would have in the city. Even better news: The weekend really did feel like a mini-vacation.

It began with a roadside stop at the workshop of Bruce Bayard, also known by the name of his trademark creation, Chainsaw Bear. Since 1993 Mr. Bayard has been using chainsaws to carve three-foot-high wood sculptures, specializing in grizzlies but also producing made-to-order sea captains and cigar-store Indians. He warmly welcomed a pair of unexpected visitors, sharing some tips about the area, starting with the Falcon.

The Hudson Valley is known for its agriculture, and the town of Marlborough, which includes the farming hamlets of Marlboro and Milton, fits the bill. Most of the area’s orchards and farms have yet to reopen for the season; Meet Me in Marlborough, a cooperative of farmers and businesses, oversees orchard and farm tours. Our visit, in February, was poorly timed for agritourism, but we did stop at two wineries, encountering a study in contrasts as well as a sampling of local flavor.

Benmarl Winery at Slate Hill Vineyards in Marlboro, which holds the claim to America’s oldest vineyard, wears its heritage with pride. Though no longer owned by the storied winemaker Mark Miller, who died in 2008, its cellar still holds some of his vintages, their labels dust caked and faded. A $6 six-flight tasting yielded some pleasant surprises, including a baco noir and a de Chaunac, hybrid varieties common to the Hudson Valley, as well as a crisply balanced Riesling. (As a bonus we were offered a dram of Clinton Vineyards cassis, which had a bouquet strikingly redolent of a bloody mary but the musky taste of black currant.)

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From Frozen Vines In Ontario, a Sweet Specialty: Ice Wine

Steve Pfost for The New York TimesDan Stouck, center, was among the volunteers picking grapes recently at Malivoire Wine Company in Beamsville, Ontario.

Beamsville, Ontario

The grapes are pressed shortly after being picked, releasing sweet, concentrated juices.

IT is 14 degrees above zero as a group of wine lovers converges in a vineyard on the Niagara Peninsula. Frosty bundles of Riesling grapes hang on rows of vines in the pale, gathering daylight. A storm the night before has left behind six inches of fresh snow.

Perfect conditions, the winemaker Shiraz Mottiar declares, for picking the frozen grapes that he will soon transform into Canada’s specialty, ice wine, for his employer, Malivoire Wine Company. By law, Canadian ice-wine makers cannot call their product by that name unless it is made from grapes picked off the vine at or below -8 Celsius (17.6 degrees Fahrenheit). So far, so good. Mr. Mottiar is confident that the temperature will hold, at least for a few hours, and instructs the group to get to work. What is ideal for the harvest, though, is not so great for human extremities.

“My feet are very cold now,” said Peter Scott, who woke up at 4:45 a.m. to make the hour-and-10-minute drive from Toronto with his wife, Jessica Dolman. This is the fourth year of picking for the couple, who, like the other 25 or so loyal Malivoire customers bending intently over their work, are not paid for their labor. They will, however, receive a free bottle of ice wine with their names listed among the workers on the 2010 vintage label. After the harvest they’ll also be invited back inside the winery, where the proprietor, Martin Malivoire, has been preparing vats of hot chocolate and chili spiked with ice wine.

“The whole experience is very addictive,” Ms. Dolman said.

Among devotees in North America, this stretch of flat farmland bordered by Lake Ontario to the north and Lake Erie to the south is ground zero for indulging a taste for ice wine, a sweet wine that is often paired with dessert, rich cheeses and foie gras. Canada vies with Germany for the title of world’s largest producer of ice wine — some years, because of inconsistent weather, Germany’s crop is small or nonexistent. (Austria, Switzerland and New York’s Finger Lakes are among the many areas that also make ice wine.)

More than 75 percent of all the ice wine in Canada comes from Ontario. (The remainder is made in regions like southern Quebec and the Okanagan Valley in British Columbia.) Unlike more temperate parts of the world, Canada has consistently cold winters, which guarantee an annual crop of frozen grapes. Still, ice wine represents just a small percentage of wine being produced here. It’s expensive to make: a ton of grapes yields only one-sixth the amount of ice wine as table wine — hence its nickname, liquid gold — and its prices start at $50 for a half-bottle. Leaving grapes on the vine long past normal fall harvest also is risky.

“There are all kinds of hazards,” said Norman D. Beal, a former oil trader who in 2000 turned a decrepit barn into an opulent tasting room at his Peninsula Ridge Estates Winery on a hill in Beamsville. “There are the birds, mildew, all kinds of diseases.” That’s in addition to the vagaries of the weather, including rain, hail, ice storms and midwinter thaws.

Extreme wine making, as some call ice-wine production, calls for extreme wine touring. In winter that means lots of layers, and maybe a face mask with an opening big enough for sipping. The trade-offs: there’s plenty of room to belly up to the tasting bars, and it’s easier to get a table at one of the region’s many fine restaurants.

Each tasting inevitably leads to a game of identifying classic ice-wine flavors: lychee nut, caramel, toffee, strawberry jam, crème brûlée, burnt orange, citrus, tropical fruit. Then what follows is a discussion of the improbable alchemy that goes into producing a drink that is said to have been created by mistake in a German vineyard in 1794.

Ice-wine makers here like to leave the grapes on the vine through a series of mild freezes and thaws instead of picking at the first opportunity. That process produces the right balance of sweetness, acidity and the nuanced flavors that separate great ice wine from something that is cloyingly sweet.

“You’re always watching the sugar and acid levels,” Mr. Mottiar said. “Once they peak, then you pick and press.” The ice-wine harvest usually doesn’t occur until well into December, and in some years it has stretched into February.

When the frozen grapes are pressed at just the right temperature, usually immediately after picking, the water is crystallized, and the juice that remains consists of the most exquisitely concentrated sugars and flavors.

Correction: An earlier version of a photo caption on this article misspelled the name of the town where volunteers were picking grapes. As correctly noted elsewhere in the article, it is Beamsville, not Bearnsville.

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Breaking Ground: Sound-View Homes in North Carolina’s Waterfront

WHERE Merry Hill, N.C.

AMENITIES A completed 18-hole golf course and a planned marina, among others.

PRICES Home sites start at $125,000, and furnished cottages start at $475,000, including lots.

STATUS Three homes have been completed so far; more are now under construction. Work on a clubhouse with a pool is expected to begin this spring.

DEVELOPER IMI, based in Greenville, S.C.

CONTACT (877) 847-3727 or scotchhallpreserve.com.

DETAILS The development’s site is dotted with ponds and includes three miles of shoreline, part of which belongs to the vast Albemarle Sound estuary in North Carolina, a section of the Intracoastal Waterway. Lately, to capitalize on the popularity of the nearby Outer Banks archipelago, a large area that includes land on the sound has been labeled “the Inner Banks” by developers and others hoping to attract crowds of travelers and second-home hunters. Scotch Hall Preserve, one such new development, is on a cape about a two-hour drive from the Outer Banks. It covers 900 acres, and there are plans for 450 home sites, with 119 lots and 10 cottages in its first phase. The home sites range from around one-quarter acre to over an acre each. The company is also offering furnished cottages of roughly 2,500 square feet to be built on lots clustered near the center of the community. A private golf course with a number of waterfront holes that was designed by Arnold Palmer opened for play in mid-2008. The marina is to have 107 slips, and there will be dining areas in both the main clubhouse and in a golf clubhouse building. Other planned amenities include a shooting and hunting club on adjacent land, a children’s activity center and a program of outdoor activities like fishing.

Breaking Ground covers projects, planned or under construction, that include weekend or vacation homes.

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Well: Safety: Smoke in Nonsmoking Hotel Rooms

Jim Wilson/The New York Times A no-smoking sign in a hotel room in Honolulu.

Staying in a nonsmoking room in a hotel that allows smoking elsewhere does not prevent exposure to tobacco smoke, a new study reports.

Writing in Tobacco Control, researchers examined a sample of 10 hotels with complete smoking bans and 30 with designated smoking rooms. They analyzed air and surfaces for tobacco smoke pollutants, took finger wipe samples to measure the presence of tobacco carcinogens, and tested the urine of nonsmoking occupants after they had stayed in the rooms.

Some nonsmoking rooms were quite low in pollutants. But at their worst, levels of tobacco air pollutants were almost five times as high in nonsmoking rooms as they were in rooms of nonsmoking hotels, and pollution of surfaces was up to 25 times as high. In some cases, nonsmokers who stayed in nonsmoking rooms had signs of nicotine exposure in their urine that were more than twice as high as those of nonsmokers who stayed in nonsmoking hotels.

Only four states — Indiana, Michigan, North Dakota and Vermont — completely prohibit smoking in hotels, and designated smoking rooms do not work, according to the lead author, Georg E. Matt, a professor of psychology at San Diego State University.

“Smokers leave a legacy behind that they cannot control,” he said. “The physical reservoirs — in the fabrics, the blankets, the upholstery, the drywall — are very deep, and you can’t just take them out.”

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Ask Well: Coated vs. Uncoated Aspirin

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Ask Well May 17, 2013, 10:29 am Ask Well: Coated vs. Uncoated Aspirin

By ANAHAD O'CONNORQCan I split or crush aspirin so its coating does not prevent me from fully metabolizing it?A recent story in The Times reported that it may be the coating, rather than “aspirin resistance,” that prevents people from taking full advantage of aspirin’s benefits. Uncoated aspirin is hard to find.Asked by Bruce Cleary • 378 votes

A

If you take coated aspirin and have concerns about its absorption, you are better off crushing the tablets than splitting them. Crushing them does a better job of dispersing and removing the coating, said Dr. Garret FitzGerald, chairman of pharmacology at the University of Pennsylvania.

Dr. FitzGerald was one of the authors of a recent study, published in the journal Circulation and reported in The Times, that showed that the idea of aspirin resistance is essentially a myth. The research found that in people who appear to be immune to aspirin’s blood-thinning effects, it is the coating that interfered with the drug’s absorption, and not any resistance to the drug itself.

The results suggested that in roughly a third of people taking aspirin on a given day, “enough aspirin hasn’t been absorbed to affect platelets, and the assumption is made that they are aspirin-resistant,” he said. When uncoated aspirin is used, he said, this diagnosis disappears.

Still, Dr. FitzGerald said, if you’ve been taking coated aspirin daily for the prevention of heart attacks, it would be a mistake to assume you’re getting no benefit from it. Some of the drug is released and, over time, would build up to have “an indistinguishable effect” on platelets from that of regular aspirin.

The rationale for the coating on aspirin is that it protects the stomach against bleeding. But that benefit has never been borne out in research, he said. So the message of his study is that there is no reason to pay extra for coated aspirin when the uncoated tablets — usually generic — are cheaper.

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Well: Cracking Down on Drinking and Driving

“It’s better not to drink and drive, but if you do, keep it under 0.05.” So rhymed William N. Plymat, an Iowa insurance company president and former Prohibitionist who became one of the earliest anti-drunken driving activists in the 1950s.

Mr. Plymat’s plea remains timely, with a revived plan by the National Transportation Safety Board, an independent federal agency charged with investigating transportation-related crashes, to lower the legal blood alcohol concentration to 0.05 percent. The safety board’s report, “Reaching Zero: Actions to Eliminate Alcohol-Impaired Driving,” was released on Tuesday.

The United States has long lagged behind most other countries, which have blood alcohol limits of 0.05 percent or lower. The time has finally come to put Mr. Plymat’s plan into action.

Drunken driving raised few hackles in the mid-20th century. Two decades out of Prohibition, Americans — and alcohol manufacturers — were more likely to extol the virtues of drinking as opposed to warning of its dangers. This mind-set extended to drunken driving, which resulted in relatively few successful prosecutions, even in instances where people were injured or killed. Law enforcement officials told grieving relatives that their loved ones had been “in the wrong place at the wrong time.”

But with the growth of the interstate highway system and proliferation of cars, it became harder to turn away, especially once the Department of Transportation reported in 1968 that up to 25,000 Americans died annually because of drunken driving. By the 1980s, thanks to organizations like Remove Intoxicated Drivers and Mothers Against Drunk Driving, angry citizens, many of whom had lost loved ones in alcohol-related crashes, pushed the issue front and center. States passed over 700 new anti-drunken driving laws between 1981 and 1986 alone, tightening loopholes and strengthening penalties. By 2004, all 50 states had lowered their legal blood alcohol level, which had been as high as 0.15 percent, to the current level of 0.08 percent.

Meanwhile, drunken driving control had become a success story. Annual deaths, now termed “alcohol-impaired-driver-related crashes,” had declined from 25,000 to under 10,000 by 2011.

But can we do better? The safety board’s report says yes, arguing that “success in addressing this safety issue has plateaued.” It points to the fact that one-third of highway deaths are still alcohol-related, and that known effective strategies for lowering injuries and deaths because of drunken driving are underutilized.

In this spirit, the safety board is calling for universal use of ignition interlocks, in which drivers must blow into a breathalyzer with a zero alcohol level in order to start their cars, for all convicted drunk drivers. It also wants broader use of roadblocks, in which police stop random cars and test certain drivers for alcohol, another proven means of deterring drunken driving.

Yet the recommendation most likely to raise hackles is the call for a 0.05 percent blood alcohol level, roughly equal to two bottles of beer, two glasses of wine or two shots of liquor on an empty stomach over an hour — with the caveat that everyone metabolizes alcohol differently.

The notion of having a couple of drinks, often termed “social drinking,” has rarely been the target of government officials, who have reasonably focused on the binge drinkers and chronic alcoholics who drive with especially high blood alcohol levels and are responsible for a vast majority of drunken driving deaths.

But what if we could save another 500 to 750 lives a year by lowering the acceptable blood alcohol level to 0.05 percent? Based on data from other countries that have gone to 0.05 percent, Robert Voas and James C. Fell of the Pacific Institute for Research and Evaluation believe that this is possible, both by discouraging social drinking and driving and creating a “general deterrent effect” among the whole population.

The backlash to the N.T.S.B.’s proposal is predictable. The beverage and hospitality industries, which make money from alcohol, will argue that such a restrictive law will deprive Americans of the pleasurable experience of enjoying a drink or two with one’s meal. Libertarians will decry the new proposal as “neo-Prohibitionist,” another example of the “nanny state” depriving us of our basic liberties.

But here are a few reasons that 0.05 percent makes sense. First, almost everyone is impaired at that blood level, with reductions in performance in areas such as braking, steering, lane changing and judgment. Do you want these people coming at you on the road?

Second, it takes some work to get to 0.05 percent. It is overwhelmingly more likely to happen if someone is trying to get buzzed as opposed to having a couple of drinks over a leisurely dinner.

Third, portable breathalyzers are easily available and relatively cheap. If you are out drinking, check your level before you get in the car and, if you are at 0.05 percent or higher, sit back down, eat something and recheck yourself in an hour. It’s not that much of an imposition if lives are at stake.

Or, better yet, arrange in advance for a designated driver. That’s another underutilized strategy that has been around for decades.

Dr. Barron H. Lerner, a professor of medicine at New York University School of Medicine, is the author of “One for the Road: Drunk Driving Since 1900.”

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18 and Under: Poverty as a Childhood Disease

Getty Images Dr. Perri Klass on family health.

Poverty is an exam room familiar. From Bellevue Hospital in New York to the neighborhood health center in Boston where I used to work, poverty has filtered through many of my interactions with parents and their children.

I ask about sleeping arrangements. Mother, father, older child and new baby live in one bedroom that they’re renting in an apartment, worrying that if the baby cries too much, they’ll be asked to leave.

I encourage an overweight 9-year-old who loves karate, and his mother says, “We had to stop; too expensive.” I talk to a new mother who is going back to work too soon, leaving her baby with the cheapest sitter she can find.

Is your housing situation secure? Can you afford groceries? Do you go with the cheapest fast food? Can you get the prescription filled? Raising children in poverty means that everything is more complicated.

Me, I’m one generation out. My mother will tell you about her Depression childhood, the social worker who checked the family’s pots to see whether they were secretly able to afford meat, the landlord who put the furniture out on the street. It wasn’t character-building or noble, she says. It was soul-destroying, grinding and cruel.

And it’s even crueller, now that social mobility has decreased and children who grow up poor are more likely to stay poor.

At the annual meeting of the Pediatric Academic Societies last week, there was a new call for pediatricians to address childhood poverty as a national problem, rather than wrestling with its consequences case by case in the exam room.

Poverty damages children’s dispositions and blunts their brains. We’ve seen articles about the language deficit in poorer homes and the gaps in school achievement. These remind us that — more so than in my mother’s generation — poverty in this country is now likely to define many children’s life trajectories in the harshest terms: poor academic achievement, high dropout rates, and health problems from obesity and diabetes to heart disease, substance abuse and mental illness.

Recently, there has been a lot of focus on the idea of toxic stress, in which a young child’s body and brain may be damaged by too much exposure to so-called stress hormones, like cortisol and norepinephrine. When this level of stress is experienced at an early age, and without sufficient protection, it may actually reset the neurological and hormonal systems, permanently affecting children’s brains and even, we are learning, their genes.

Toxic stress is the heavy hand of early poverty, scripting a child’s life not in the Horatio Alger scenario of determination and drive, but in the patterns of disappointment and deprivation that shape a life of limitations.

At the meeting, my colleague Dr. Benard P. Dreyer, professor of pediatrics at New York University and a past president of the Academic Pediatric Association, called on pediatricians to take on poverty as a serious underlying threat to children’s health. He was prompted, he told me later, by the widening disparities between rich and poor, and the gathering weight of evidence about the importance of early childhood, and the ways that deprivation and stress in the early years of life can reduce the chances of educational and life success.

“After the first three, four, five years of life, if you have neglected that child’s brain development, you can’t go back,” he said. In the middle of the 20th century, our society made a decision to take care of the elderly, once the poorest demographic group in the United States. Now, with Medicare and Social Security, only 9 percent of older people live in poverty. Children are now our poorest group, with almost 25 percent of children under 5 living below the federal poverty level.

When Tony Blair became prime minister of Britain, amid growing socioeconomic disparities, he made it a national goal to cut child poverty in half in 10 years. It took a coalition of political support and a combination of measures that increased income, especially in families with young children (minimum wage, paid maternity and paternity leaves, tax credits), and better services — especially universal preschool programs. By 2010, reducing child poverty had become a goal across the British political spectrum, and child poverty had fallen to 10.6 percent of children below the absolute poverty line (similar to the measure used in the United States), down from 26.1 percent in 1999.

“Poor families who benefited from the reform were able to spend more money on items for children: books and toys, children’s clothing and footwear, fresh fruits and vegetables,” said Jane Waldfogel, a professor of social work at Columbia who has studied the British war on childhood poverty.

Dr. Dreyer said: “Income matters. You get people above the poverty level, and they actually are better parents. It’s critical to get people out of poverty, but in addition our focus has to be on also giving families supports for other aspects of their lives — parenting, interventions in primary care, universal preschool.”

At the Pediatric Academic Societies meeting, the most unexpected speaker — to a room full of pediatricians — was Robert H. Dugger, managing partner of Hanover Investment Group, who made the economic case for investing in young children. “History shows that productivity increases when people are able to access their rights to life, liberty and the pursuit of happiness,” Mr. Dugger told me. “There is no economic recovery strategy stronger than committing to early childhood and K-through-12 investment.”

Think for a moment of poverty as a disease, thwarting growth and development, robbing children of the healthy, happy futures they might otherwise expect. In the exam room, we try to mitigate the pain and suffering that are its pernicious symptoms. But our patients’ well-being depends on more, on public health measures and prevention that lift the darkness so all children can grow toward the light.

This post has been revised to reflect the following correction:

Correction: May 17, 2013

The 18 and Under column on Tuesday, about the lasting effects of living in poverty in early childhood, misstated the academic position held by Jane Waldfogel, who has studied British efforts to reduce the rate of childhood poverty. Dr. Waldfogel is a professor of social work at Columbia University, not a sociologist there.

Dr. Perri Klass on family health.

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Recipes for Health: Focaccia With Sweet Onion and Caper Topping — Recipes for Health

1 recipe Whole-Wheat Focaccia

2 tablespoons extra virgin olive oil

2 large spring onions or white onions (1 1/2 pounds)

Salt to taste

2 tablespoons capers, rinsed and coarsely chopped

2 teaspoons fresh thyme leaves

2 garlic cloves, minced (optional)

Freshly ground pepper

1. Mix the focaccia dough as directed and set in a warm spot to rise.

2. Meanwhile, prepare the onion filling. Heat the olive oil over medium heat in a large, heavy lidded skillet. Add the onions and cook, stirring, until they soften, about 5 minutes. Add a generous pinch of salt, the capers, thyme and garlic, and turn the heat to low. Cover and simmer gently, stirring often, for 30 to 40 minutes, until the onions have cooked down and are very soft and lightly colored but not browned. They should taste sweet. Season to taste with salt and pepper and remove from the heat.

3. When the focaccia dough has risen, shape as directed into 1 large focaccia or 2 smaller focacce. Cover with a damp cloth and let rise in a warm spot for 30 minutes while you preheat the oven to 425 degrees, preferably with a baking stone in it.

4. Dimple the dough with your fingertips and spread the onion mixture over the top in an even layer. Drizzle with olive oil. Bake, setting the pan on top of the baking stone (if using), for 20 to 25 minutes, until the bread is deep golden brown and bits of the onion topping are browned. Let rest for at least 10 minutes before serving, or allow to cool completely.

Yield: 1 large focaccia or 2 smaller focacce, 12 to 15 servings

Advance preparation: The onion topping will keep in the refrigerator for 3 days. You can make the dough and place it in a plastic bag in the refrigerator for up to 2 days. Remove from the bag and bring to room temperature before proceeding. The bread should be eaten or frozen within a couple of days.

Nutritional information per slice (12 slices): 208 calories; 6 grams fat; 1 gram saturated fat; 1 gram polyunsaturated fat; 4 grams monounsaturated fat; 0 milligrams cholesterol; 34 grams carbohydrates; 4 grams dietary fiber; 383 milligrams sodium (does not include salt to taste); 5 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Recipes for Health: Focaccia With Cauliflower and Sage — Recipes for Health

1 recipe Whole-Wheat Focaccia

1 pound cauliflower (1 small head or 1/2 large), cut into florets, stems trimmed

Salt and freshly ground pepper to taste

2 tablespoons extra virgin olive oil

30 to 40 fresh sage leaves (depending on the size)

1. Mix up the focaccia dough as directed and set in a warm spot to rise.

2. Meanwhile, bring a large pot of water to a boil and salt generously. Add the cauliflower and blanch for 2 minutes. Transfer to a bowl of cold water, then drain and pat dry. Cut the florets into small pieces and toss in a large bowl with 2 tablespoons olive oil and salt and freshly ground pepper.

3. When the focaccia dough has risen, shape as directed into 1 large focaccia or 2 smaller focacce. Cover with a damp cloth and let rise in a warm spot for 30 minutes while you preheat the oven to 425 degrees, preferably with a baking stone in it.

4. Dimple the dough with your fingertips and arrange the sage leaves, then the cauliflower on top. Drizzle with olive oil. Bake, setting the pan on top of the baking stone (if using), for 25 minutes, until the bread is deep golden brown and the cauliflower lightly colored in spots. Let rest for at least 10 minutes before serving, or allow to cool completely.

Yield: 1 large focaccia or 2 smaller focacce, 12 to 15 servings

Advance preparation: The blanched cauliflower will keep in the refrigerator for 3 days. You can make the dough and place it in a plastic bag in the refrigerator for up to 2 days. Remove from the bag and bring to room temperature before proceeding. The bread should be eaten or frozen within a couple of days.

Variation: Add 2 to 3 ounces (1/2 to 3/4 cup) Gorgonzola or 1 to 2 ounces freshly grated Parmesan. Bake the focaccia without the cheese for 15 minutes, then sprinkle on the cheese and bake another 10 minutes.

Nutritional information per slice (12 slices): 194 calories; 6 grams fat; 1 gram saturated fat; 1 gram polyunsaturated fat; 4 grams monounsaturated fat; 0 milligrams cholesterol; 30 grams carbohydrates; 4 grams dietary fiber; 353 milligrams sodium (does not include salt to taste); 5 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Well: Regimens: LDL Cholesterol Levels Stop Decline

Average levels of LDL, the so-called bad cholesterol, declined significantly in Americans from 2001 to 2008, but have remained steady ever since. No one knows why.

Using the database of a medical testing company, researchers checked LDL values in the blood of almost 105 million men and women age 18 and older. After adjusting for age, they found that average LDL declined steadily at a rate of 2.05 milligrams per deciliter per year, to 104.7 in 2008 from 120 in 2001.

But the study, published in the May issue of PLoS One, found that over the next three years, there was almost no change, with levels in 2011 averaging 104.3. A reading under 100 is generally considered healthy, but some experts recommend getting to 70 or below, especially for people with heart disease.

The scientists offer three possible explanations. The recession that began in 2008 may have made people stop seeing doctors or buying cholesterol-lowering statins; the benefits of taking the drugs reached their maximum; or increasing obesity began to overwhelm the drugs’ beneficial effects.

“We’ve raised a red flag that something dramatic happened,” said the lead author, Dr. Harvey W. Kaufman, senior medical director at Quest Diagnostics, a medical testing company. “We laid out some theories, and it’s now up to investigators to determine why.”

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Dannon Cuts Sugar, Carefully, in Children’s Yogurt

Its Danimals Smoothies, a line of yogurt drinks in Technicolor packaging for the pint-size set, have gotten a little bit healthier. Since February, Dannon has been selling the smoothies with 25 percent less sugar. And hardly anyone seems to have noticed — just as Dannon had hoped.

Deciding not to trumpet a healthier-for-you move might be puzzling at first, until you consider this: “One thing I have learned is that the main driver of yogurt sales above all is taste,” said Sergio Fuster, senior vice president for marketing at Dannon. “You do not want to send any signal to the consumer that might lead her to believe the taste has changed because she will simply pick up another yogurt — and it may not be ours.”

The margin for error in the realm of taste is small. A mistake could be financially deadly.

Yogurt sales are among the fastest-growing of all food products as a wave of new brands challenges the shelf space allotted to more traditional ones like Dannon, Yoplait and Stonyfield. And Chobani, which is posting sales of more than $1 billion less than 10 years after it was founded, and the other upstarts are aggressively promoting their products for children.

Dannon clearly regards its decision to make such a big reduction in the product’s sugar content — to 10 grams, from 14 — as a way to get ahead in the game. The only indication is in the fine print on the nutrition label, which shows its sugar content is slightly lower than for similar products by its competitors.

“Kids are not into nutrition profiles, but moms are,” Mr. Fuster said. “We want to shift the discussion away from the quantity of calories, although they are impacted with this change, to talking about the quality of the calories in yogurt, like how much protein it delivers.”

Kathleen M. Zelman, a registered dietitian who is director of nutrition for WebMD, took a look at the nutrition labels for the product before and after sugar was cut and said it was a step in the right direction, though she wished it delivered more protein.

“There’s no nutritional payback from sugar, so any time you can cut it and still enjoy nutritional goodness like that found in yogurt, I’m thrilled,” Ms. Zelman said. “There’s a lot of pressure on sugar these days because of the obesity trends, not that I’m saying it’s the culprit, but we eat too many calories in general and it’s easy to overconsume sugar calories.”

Dannon has reduced sugar in a handful of products before, but never by more than 5 to 10 percent. Reductions of that size merely require subtracting sweetener in small amounts.

But when the company was looking for ways to underscore its commitment to enhancing the healthiness of its products, it decided it needed to do something more dramatic. “We set a target of 25 percent, even though a lot of people said that was too much,” said Thierry Saint-Denis, director of research and development at Dannon.

Reducing sugar by 5 percent is relatively simple, Mr. Saint-Denis said, because milk and other components in yogurt can mask the missing sweetness. Such a change has little impact on yogurt’s viscosity and other characteristics.

But eliminating one-quarter of the sweeteners has much bigger consequences, wreaking havoc not only on taste but on texture, acidity and other aspects. “We decided to do it because it would force us to do something we had never done if we were to meet that target,” Mr. Saint-Denis said.

To explain the complex science of ingredient mix, Mr. Saint-Denis did a little demonstration at the company’s American headquarters in White Plains, involving cups of two different unsweetened yogurts and big syringes filled with liquid sweetener. At the start, one yogurt was tart and acidic, the other more bland — and it quickly became clear that it would take markedly less sugar syrup to arrive at a sweet taste with the bland flavor than with the tart and acidic one. So one crucial factor to less sugar is lower acidity.

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Urban Athlete: Exercise Class, Obedience Not Required

DOGS may be our best friends, but that doesn’t necessarily make them the easiest exercise partners. The fitness trainer Angi Aramburu thinks otherwise, though, and this spring she started Go Fetch Run, an exercise class in which owners and their dogs can work out and play together.

On a recent Monday evening a small group of people gathered with leashes in hand at the 15th Street entrance to Prospect Park in Brooklyn. As the sun was starting to set, Ms. Aramburu led them on a jog into the park, past the blooming magnolias.

After spending an uneventful day indoors, the four dogs in attendance were gung ho, tails wagging, though compliance was another matter. As they trotted along, Ms. Aramburu, carrying a large bag of props, had them stop to practice sitting and staying. Oppa, a rambunctious 2-year-old Labrador-terrier mix who established herself as the class clown, remained standing, seeming to shake her head “no,” turning her nose up at a cookie bribe.

The group arrived at a grassy clearing next to the main road where runners and cyclists steadily flowed past. The humans began a cardio warm-up that included jump squats, while the dogs stood by, sussing out the smells. Then Millie, a 6-year-old flat-coated retriever, grabbed the leash from her owner and made a run for it, prompting a chase.

Next there were power skips, forward walking lunges with kicks and a bear crawl — the owners going back and forth between pylons with the dogs at their sides. Then everyone was sent on the first of many trips sprinting up a nearby hill, where all did 10 push-ups or jumping jacks before returning, humans and dogs both catching their breath.

Ms. Aramburu, 37, who has a Chihuahua and two small children, said she always had difficulty balancing her own need for exercise with that of her dog. But after joining and eventually becoming an instructor with Stroller Strides, an exercise class held in the park for parents with their babies, she hit on the idea. “I thought, you could do this with your dog,” she said.

She put together a 60-minute cross-training sequence that integrates cardio, strength, balance and agility. (She also created a 5K running program.) The idea, she explained, is to tire out the dogs, both mentally and physically. “A tired dog is a good dog,” she said.

This kind of activity is just what Michelle Herman, a nurse who lives in Park Slope, Brooklyn, needed for her mischievous, high-energy 2-year-old Labrador-collie mix, Eliot, who was showing signs of progress in this, his third class. As for Ms. Herman, 50, the workout was challenging, she said, but doing it with her companion was motivating.

“Exercising with my dog is so much more fun than doing it by myself,” she said.

The highlight of the session was an owner-dog obstacle course that included jumping over a pole and through a hoop, zigzagging across pylons, crawling through a tunnel and hopping over a rope ladder. Once everyone got the hang of it, the dogs and their masters seemed to have a ball.

Later, as the owners did abdominal exercises in a circle, Oppa broke away, ran up to the top of the hill and then barreled down full-throttle toward the group. The other dogs nearly joined in the uprising, going into a momentary frenzy before order was quickly restored.

By the end of class, the dogs were all quite subdued. Millie was lounging at the feet of her owner, Frances Largeman-Roth, 39, a cookbook author and dietitian who lives nearby. She said Millie hadn’t been getting enough exercise lately, and since the dog was competing with two small children for attention, had been experiencing some neglect.

“She loved that I was spending time alone with her,” Ms. Largeman-Roth said. “This showed me that I can actually get a good workout and hang with the dog at the same time.”

Go Fetch Run’s cross-training classes are offered four times a week at Prospect Park, Brooklyn, with a free trial class; gofetchrun.com.

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Recipes for Health: Focaccia With Tomato Sauce and Green Garlic — Recipes for Health

1 recipe Whole-Wheat Focaccia

1 tablespoon extra virgin olive oil

1 bulb green garlic, papery outer layers removed, thinly sliced, or 2 garlic cloves, minced

1 14-ounce can diced tomatoes, preferably fire-roasted, with juice

Salt to taste

2 teaspoons fresh thyme leaves

Freshly ground pepper

2 ounces fresh mozzarella (optional)

1. Mix up the focaccia dough as directed and set in a warm spot to rise.

2. Meanwhile, make the tomato-garlic topping. Heat the olive oil over medium heat in a medium saucepan or skillet and add the garlic. Cook, stirring, until it begins to smell fragrant, 30 seconds to a minute, and add the tomatoes and salt to taste. Cook, stirring often, for about 10 minutes, until the tomatoes have cooked down slightly to a fragrant sauce. Stir in the thyme. Taste and adjust salt, and add pepper. Remove from the heat. For a smooth sauce, blend with an immersion blender or pulse in a food processor.

3. When the focaccia dough has risen, shape as directed into 1 large focaccia or 2 smaller focacce. Cover with a damp cloth and let rise in a warm spot for 30 minutes while you preheat the oven to 425 degrees, preferably with a baking stone in it.

4. Dimple the dough with your fingertips and spread the tomato sauce over the top in an even layer. Drizzle with olive oil. Bake, setting the pan on top of the baking stone (if using), for 25 minutes, until the bread is deep golden brown. If using the mozzarella, tear it into small shreds. Bake the focaccia for 15 minutes, pull it from the oven and quickly scatter the mozzarella over the focaccia, then return to the oven for 10 minutes. Let rest for at least 10 minutes before serving, or allow to cool completely.

Yield: 1 large focaccia or 2 smaller focacce, 12 to 15 servings

Advance preparation: The tomato topping will keep in the refrigerator for 3 days. You can make the dough and place it in a plastic bag in the refrigerator for up to 2 days. Remove from the bag and bring to room temperature before proceeding. The bread should be eaten or frozen within a couple of days.

Nutritional information per slice (12 slices): 186 calories; 5 grams fat; 1 gram saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 31 grams carbohydrates; 3 grams dietary fiber; 423 milligrams sodium (does not include salt to taste); 5 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Well: Childbirth: Flu Linked to Bipolar Disorder

Flu infection during pregnancy may increase the risk for bipolar disorder in the child, according to a new report.

Previous studies have found an association between flu infection and schizophrenia, but this one, published online in JAMA Psychiatry, is the first to find a connection with bipolar disorder.

From 1959 through 1966, researchers recruited more than 19,000 pregnant women enrolled in a large health insurance program in California, collecting data on influenza infection from just before conception until delivery. Using various techniques, they tracked down cases of bipolar disorder among the offspring from 1981 to 2010 and found 92 cases of documented illness and 722 matched controls, a sample size the authors acknowledge is not large.

After controlling for maternal age, race, educational level, gestational age at birth and maternal psychiatric disorders, they found that people whose mothers had the flu during pregnancy had quadruple the risk for bipolar disorder as adults.

“Pregnant women should not be alarmed,” said the senior author, Dr. Alan S. Brown, a professor of psychiatry and epidemiology at Columbia. “Bipolar disorder occurs in only 1 percent of the population. But this is another piece of knowledge indicating that pregnant mothers and women planning a pregnancy should consider getting a flu shot.”

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The Consumer: Doctors’ Lucrative Industry Ties

Viktor Koen

Dr. Alfred J. Tria is the chief of orthopedic surgery at St. Peter’s University Hospital, a 478-bed facility in New Brunswick, N.J., and to the medical technology company Smith & Nephew, his good word is worth a million bucks. Well, $940,857, to be precise.

That’s how much the company paid Dr. Tria in fees for promoting its products and training doctors in Asia to use them from 2009 to 2011, according to disclosures required by the state of Massachusetts, where Dr. Tria is licensed. In 2010, Dr. Tria earned $421,905 from private industry — more than any other Massachusetts-licensed physician that year.

Dr. Tria may be an outlier, but gifts and payments to physicians from drug and medical device companies have been rampant in medicine for decades. Over a two-and-a-half-year period, device and drug companies shelled out over $76 million just to physicians licensed in Massachusetts, according to a study published online this month in The New England Journal of Medicine. That amount does not include outlays of less than $50, which are exempt from disclosure.

The companies treat doctors to dinner, pay them to attend lectures, and underwrite conferences and continuing medical education courses. Asked whether such payments could pose a conflict of interest for physicians, Dr. Tria said, “It’s a legitimate concern.”

A spokesman for St. Peter’s said Dr. Tria had disclosed his financial relationships with industry to the hospital and refused to elaborate on the hospital’s policy.

Information about these sorts of payments to physicians is available for the first time now in a handful of states that have passed laws requiring corporations to disclose payments to health providers. Next year, the data should be available nationwide when the federal Physician Payment Sunshine Act goes into effect. Corporations were supposed to start collecting the information last year.

“For many decades, we had no information — these were closely held industry secrets,” said Susan Chimonas, of Columbia University, who has researched industry payments to physicians. “We are just starting to get a sense of how much money companies are spending on the marketing and consulting arrangements.”

The data will be a treasure trove for researchers. For patients, the question is what to make of this information and whether to seek it out when choosing a physician or making an important medical decision. Orthopedic surgeons, cardiologists and psychiatrists received the most lucrative payments, the new study found. Primary care physicians — such as internists and pediatricians — were least likely to receive payments.

In Massachusetts, companies are required only to broadly categorize the purpose of the payments, and nearly 90 percent of them were described as “compensation for bona fide services.” Dr. Aaron S. Kesselheim, an assistant professor at Harvard and the lead author of the new study, says that though the reported information can be vague, it can still be useful.

“It’s another piece of data for patients to examine as they consider treatment options,” he said. “If they go to an orthopedic surgeon who recommends a knee transplant, and they go to another who recommends watching and physical therapy, it might be interesting for the patient to wonder to what extent those two physicians have relationships with industry.”

The question may also be appropriate if a physician changes a patient’s prescription for no apparent reason, or prescribes a new or more expensive drug instead an older, tried-and-true alternative, said Dr. Joseph S. Ross, an internist and assistant professor of medicine at Yale.

“We know physicians are more likely to overprescribe or potentially prescribe inappropriately when they have a financial relationship with industry,” Dr. Ross said. His own research has found that many physicians do not think there is anything inappropriate about industry gifts as long as they’re not too lavish.

The size of the gift is not a determinant of its influence, experts say. Even a small gift can generate positive feelings and influence attitudes and behavior. “I don’t think doctors ever set out to make decisions that are not in the best interest of their patients,” said Dr. Deborah R. Korenstein, associate professor at Mount Sinai and a co-author of the study by Dr. Ross.

“But there are subconscious influences that people can’t control, and that’s why patients, and doctors, need to be concerned,” she said.

A paper Dr. Korenstein published in 2011 found that more than a dozen expert panels that developed national clinical practice guidelines for managing diabetes and high cholesterol were dominated by physicians with financial conflicts of interest — that is, they were receiving payments from companies with an interest in how these diseases are managed.

Physicians often do not realize that they are being manipulated when drug companies offer to pay them consulting fees — for example, for listening to pharmaceutical representatives describe new medications and evaluating their performance. The real purpose “is just to get the doctor to listen to the reps over and over again,” said Dr. Adriane Fugh-Berman, director of PharmedOut, a project at Georgetown University Medical Center that focuses on the influence of drug company marketing.

Dr. Fugh-Berman advises patients to avoid physicians who see drug reps and dispense samples. “Ask, ‘Could I have a tried-and-true drug?’ ‘Could I have a generic version?’ ”

Although many schools and hospitals have adopted new policies that guide interactions with industry, they exempt physicians who are not staff employees and do not restrict the doctors’ income. Tufts University Medical Center adopted a policy in 2010 that required physicians to get approval and review if they were paid more than $25,000 in a year by a private company. But a Tufts associate professor, Dr. Yoav Golan, an infectious disease specialist, was paid $340,754 by drug companies in 2011, including $100,000 from Forest Laboratories, $73,918 from Merck and $42,109 from Pfizer, according to disclosures filed in Massachusetts.

A Tufts spokeswoman, Julie Jette, said the payments were approved by the university. “The policy wasn’t intended to be a cap,” she said. Dr. Golan did not respond to an e-mail requesting comment.

Dr. Chimonas said she would encourage physicians and their professional groups “to think about how all the information that is coming out is going to be interpreted or understood by the public.”

“It’s so important for patients to be able to trust their physicians,” she said.

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Really?: The Claim: Never Go Grocery Shopping on an Empty Stomach

THE FACTS:

Anahad O’Connor tackles health myths.

Most people know the age-old diet advice about grocery shopping when you are hungry: You are more likely to buy fattening, unhealthy foods. So avoid it.

But the weight loss maxims found in diet books do not always hold up in the real world. So two researchers at Cornell University recently devised an experiment that put this notion to the test.

The study, published in JAMA Internal Medicine, was carried out in two phases. In the first, 68 men and women were brought into a lab on two separate days after having been told not to eat for five hours. Then they were allowed to “shop” for food in a simulated grocery store, which offered low-calorie options like fruits, vegetables and chicken breasts, as well as higher-calorie junk foods.

Before shopping, half of the subjects were given a snack. Both groups ultimately purchased a similar number of items, but those who shopped while hungry picked the highest-calorie foods.

In the second phase of the study, the researchers followed 82 actual shoppers in a grocery store. Once again, they found that people shopping at times when they were most likely to be hungry opted for the foods that were more calorically dense.

In an accompanying editorial, Dr. Rita F. Redberg, a cardiologist, said the findings provided scientific support for common-sense advice.

“I think all diet guides include the advice to ‘never go grocery shopping when you are hungry,’ ” she wrote, “and when I had young children, I added ‘and never with young children’ – because either of these factors seem to lead to less wise food choices.”

THE BOTTOM LINE:

Shopping for groceries on an empty stomach does in fact influence food choices.

Anahad O'Connor tackles health myths.

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Well: Seeking Calm on the Cancer Ward

Darren Hauck for The New York Times On the shores of Lake Michigan.

When people choose to have their leukemia treated aggressively, it’s a big commitment, more so than for almost any other cancer.

With this therapy — three days of the drug daunorubicin, which comes in a reddish color so distinctive that one of my patients, a former chemist, used it in his professional life as a dye for plastics, and seven days of the drug cytarabine, which is infused continuously over 168 hours — we offer them the chance to be cured of a disease moving like wildfire with a stiff breeze behind it at the height of drought.

The offer can be seen as a Faustian bargain, though. In return comes the very real possibility of dying from our treatment, along with immersion into a kind of purgatory of a hospital stay lasting four to six weeks. We joke with our patients that we love boring — it is, in fact, a medical ideal that our patients complain of nothing more than ennui on a daily basis. But the psychological mettle it takes to endure this experience is remarkable, and there’s little that can prepare a person for it.

We make our rounds as a group — nurses, physician assistants, residents, a fellow, a pharmacist, a case manager, me and occasionally additional observers. It can be quite absurd, really, this thundering herd walking slowly down the hallway of the leukemia unit, stopping at each doorway. A few weeks ago, when I was attending on the leukemia service, we came to our eighth patient of 25, a 72-year-old man whose leukemia persisted despite our first round of chemotherapy, so we gave him more. It was now his 36th day in the hospital, and his blood counts showed no signs of recovery, a wasteland of emptiness.

A few of us walked into his room, where his wife sat in a chair by his bed, reading. She looked up and gave us a half-smirk as we glanced over at him. His sheets were pulled completely over his head and then tucked underneath it, creating the image of a starched white cocoon.

“Don’t mind him. He always sleeps like that,” she said. “On the ship, the couch where he rested was directly under a vent, and this was the only way he could ever grab any shut-eye.” He stirred and pulled the sheets down, squinting against the room’s lights.

He was captain of a barge that traversed the Great Lakes, hauling iron ore for the steel mills, back when steel mills were still open and the Steinbrenners controlled a lot of this commerce. He steered these massive vessels from the back (“aft,” he liked to remind us landlubbers), staring out across the two football fields of their length.

“He’d be gone from March through October,” his wife said. “I was one of the lake widows!” She laughed, but stopped herself quickly, realizing the nickname threatened to become a reality. “But I knew what I was getting myself into. His father was a ship captain, too, so my mother-in-law sat me down before our wedding day to prepare me.”

I asked what it was like to go eight months without seeing each other.

“I missed her, but we’d meet up every month or two,” my patient chimed in, now awake.

“I would track the ship,” his wife added. “I knew what day they would set out from Duluth and approximately when they’d be getting into Chicago. So I’d pile the kids into the car and we’d go see him. We’d have 24 hours as a family, but if we were lucky, and there was a maintenance issue on the ship, sometimes we’d get 36.” She smiled at the memory. “But mostly, there was a lot of waiting.”

My patient said: “It got better when the kids went off to college. Then she could join me on the ship for two weeks at a time.” He gestured to a photograph on his wall, of the sun rising over a body of water in a cloudless sky. “It was beautiful, really, seeing that every day.”

“Beautiful,” his wife echoed. Everyone in the room was still, thinking about the expanse of water, the miles he had already covered and what lay ahead.

“So, I guess there’s no change in my blood counts?” my patient asked.

“Nope, not yet,” I answered. “But they could improve any day now.”

“It’s O.K.,” he said. “We’re not in a hurry. We’ll see you tomorrow.”

His wife waved goodbye and went back to her book as we left his room, the waters calm, the air without breeze.

Dr. Mikkael Sekeres is director of the leukemia program at the Cleveland Clinic.

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Well: Pickle Recipes for Health

Andrew Scrivani for The New York Times Pickled radishes.Martha Rose Shulman on healthful cooking.

Barbecue season is just around the corner, which means that it’s time to break out the Mason jars and make some crisp, briny pickles to accompany your smoky sandwiches and slaw. But why should pickling be relegated to cucumbers alone? In this week’s Recipes for Health, Martha Rose Shulman writes:

Pickled vegetables make great snacks and hors d’oeuvres. They look beautiful on a platter. They’re also good with a sandwich or with cottage cheese, a quick and easy way to make vegetables part of your lunch.

Here are five recipes for pickling less conventional vegetables.

Chard Stem Pickles: Pickling is a great thing to do with leftover chard stalks. Red chard or a mix of rainbow chard stalks are especially pretty if you serve them within a few days of pickling.

Spring Carrot Pickles With Caraway: Multicolored carrots make for particularly beautiful pickles.

Pickled Beets With Caraway: These are great for nibbling, but they also make a delicious tangy slaw.

Pickled Cauliflower With Hot Pepper and Cumin: This piquant refrigerator pickle tastes even better after a long brine.

Pickled Baby Turnips or Radishes: The natural pungency of turnips contrasts beautifully with the vinegary brine.

Martha Rose Shulman on healthful cooking.

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Hard Cases: The Traps of Treating Pain

Wesley Bedrosian Dr. Abigail Zuger on the everyday ethical issues doctors face.

I hadn’t seen Larry in a dozen years when he reappeared in my office a few months ago, grinning. We were both grinning. I always liked Larry, even though he was a bit of a hustler, a little erratic in his appointments, a persistent dabbler in a variety of illegal substances. But he was always careful to avoid the hard stuff; he said he had a bad problem as a teenager and was going to stay out of trouble.

It was to stay out of trouble that he left town all those years ago, and now he was back, grayer and thinner but still smiling. Then he pulled out a list of the medications he needed, and we both stopped smiling.

According to Larry’s list, he was now taking giant quantities of one of the most addictive painkillers around, an immensely popular black-market drug most doctors automatically avoid prescribing except under the most exceptional circumstances.

“I got a bad back now, Doc,” Larry said.

Doctors hate pain. Let me count the ways. We hate it because we are (mostly) kindhearted and hate to see people suffer. We hate it because it is invisible, cannot be measured or monitored, and varies wildly and unpredictably from person to person. We hate it because it can drag us closer to the perilous zones of illegal practice than any other complaint.

And we hate it most of all because unless we specifically seek out training in how to manage pain, we get virtually none at all, and wind up flying over all kinds of scary territory absolutely solo, without a map or a net.

The events of the last few decades haven’t helped much. First came a consumer-driven “pain power” movement — justified, for the most part — pointing out that pain was wildly undertreated by most doctors. And then, more recently, came the new statistics on the widespread abuse of prescription narcotics, which now saturate street corner markets everywhere and cause more overdose fatalities than heroin and cocaine combined.

In other words, we are now cautioned in the strongest possible terms against giving too little medication and too much, being too free and too parsimonious, underprescribing to the right people and overprescribing to the wrong. Most official guidelines and policy statements, even fuller than usual of vacuous general principles, aren’t of much help in figuring how to do any of this.

One of the most accurate, articulate and heartfelt reflections on the situation was written a few years ago in Archives of Internal Medicine by Dr. Mitchell Katz, who now directs the Los Angeles County health department. Dr. Katz described his slow disillusionment with the standard approach to pain control, which involves escalating from nonnarcotic to narcotic medication, then prescribing as much as needed to eradicate the pain, while deploying measures like written contracts, pill counts and urine tests to make sure the patient is taking it all as prescribed.

It is awfully hard to take that road without turning into the patient’s parole officer. And so, Dr. Katz suggested, how about a regulatory body establishing a reasonable cap for narcotic dosing, at least for people without malignant diseases who are likely to be taking them long-term? Also, how about formally acknowledging that sometimes pain cannot be entirely eradicated? “Leaning how to cope with pain can be more empowering for patients than trying to find a pill to completely eliminate it,” he wrote.

Clearly Larry’s last doctor wasn’t buying into these sentiments, given the quantities of medication Larry was asking for — assuming there actually was a previous doctor in Larry’s life. All I had for evidence was a list, in Larry’s handwriting. The pills themselves, the bottles? “They got stolen off me on the bus here,” Larry said.

When was that?

“Last month,” Larry said.

Ultimately, all careful nomograms fall aside in the face of the particular patient. I was lucky enough to know Larry pretty well, although in some ways that only made things more difficult. I knew he was a decent and intelligent guy, with a pretty sophisticated understanding of his own problems and a hard time keeping straight. I also knew he was clearly walking with the careful “don’t touch me” gait of someone with a really bad back.

And Larry, of course, knew me well, too — well enough not to be surprised when I sent him off with a sheaf of referrals to evaluate his back, a weaker, nonnarcotic pain reliever, and not a single one of the requested pills. He just smiled and said, “I knew you wouldn’t give them to me.”

These decisions are always harder than hard; you have nothing but instinct and experience to guide you, and you never know if you’ve done the right thing. I think about Larry periodically, but I haven’t seen him since.

Dr. Abigail Zuger on the everyday ethical issues doctors face.

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Recipes for Health: Focaccia With Tomatoes and Rosemary — Recipes for Health

2 teaspoons (8 grams) active dry yeast

1 teaspoon (5 grams) sugar

1 1/2 cups lukewarm water

2 tablespoons (25 grams) olive oil, plus an additional 2 tablespoons (25 grams) for drizzling

250 grams (approximately 2 cups) whole-wheat flour

200 to 220 grams (approximately 1 2/3 to 1 3/4 cups) unbleached all-purpose flour or bread flour, plus additional as needed for kneading

1 3/4 teaspoons (13 grams) salt

3/4 pound Roma tomatoes

Coarse salt and freshly ground pepper to taste

1 to 2 tablespoons chopped fresh rosemary (to taste)

1. In the bowl of a standing mixer, or in a large bowl, dissolve the yeast and sugar in the water. Add the olive oil, whole-wheat flour, 200 grams of the all-purpose flour and salt and mix together briefly using the paddle attachment. Change to the dough hook and beat for 8 to 10 minutes at medium speed, adding flour as necessary. The dough should eventually form a ball around the dough hook and slap against the sides of the bowl as the mixer turns; it will be sticky. Remove from the bowl, flour your hands and knead for a minute on a lightly floured surface, and shape into a ball.

2. If kneading the dough by hand, dissolve the yeast in the water with the sugar as directed. Stir in the olive oil, whole-wheat flour, salt and all-purpose flour by the half-cup, until the dough can be scraped out onto a floured work surface. Knead, adding flour as necessary, for 10 minutes, until the dough is elastic and smooth. Shape into a ball.

3. Clean and dry your bowl and oil lightly with olive oil. Place the dough in it, rounded side down first, then rounded side up. Cover tightly with plastic and let rise in a warm spot for 1 1/2 to 2 hours, or in the refrigerator for 4 to 8 hours, until doubled.

4. Punch down the dough. Cover with lightly oiled plastic and let the dough rest for 15 minutes.

5. Preheat the oven to 425 degrees, preferably with a baking stone in it. Line a sheet pan with parchment and oil generously. Roll or press out the dough into a rectangle the size of the sheet pan or just slightly smaller. To do this efficiently, roll or press out the dough, stop and wait 5 minutes for the gluten to relax, then roll or press out again, and repeat until the dough reaches the right size. Cover with a damp towel and let rest for 30 minutes. Just before baking, use your fingertips to dimple the dough all over.

6. Cut the tomatoes into rounds and place on top of the focaccia. Sprinkle with coarse salt and the rosemary. Drizzle a tablespoon or two of olive oil over all.

7. Bake, setting the pan on top of the baking stone (if using), for 20 to 25 minutes, until the bread is deep golden brown. Let rest for at least 10 minutes before serving, or allow to cool completely.

Note: You can divide the dough in half and make 2 smaller focacce that would fit 14-inch pizza pans.

Yield: 1 large focaccia or 2 smaller focacce, 12 to 15 pieces.

Advance preparation: You can make the dough through Step 4 and place it in a plastic bag in the refrigerator for up to 2 days. Remove from the bag and bring to room temperature before proceeding. The bread should be eaten or frozen within a couple of days.

Nutritional information per slice (12 slices): 180 calories; 5 grams fat; 1 gram saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 0 milligrams cholesterol; 29 grams carbohydrates; 3 grams dietary fiber; 343 milligrams sodium (does not include salt to taste); 5 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Well: My Stroke of Luck

A stroke in 2011 landed the writer in the hospital.

Twenty-two months ago, I interrupted my nonstop reporting about paths toward a sustainable future for our species to focus on sustaining myself. The hiatus was not by choice, but was mandated by a stroke — the out-of-the-blue variant, the rare kind of “brain attack” (the term preferred by some neurologists) that is most often seen in otherwise healthy, youngish middle-aged people.

It’s Fourth of July weekend, 2011 — a beautiful, if hot, morning for a run in the Hudson Valley woods with my son Daniel, back from brief service in the Israeli army. I’m eager to be pushed hard. I’m not even a lapsed middle-aged athlete; I’m truly negligent when it comes to exercise.

We’re jogging up a steep path, and my breathing gets deeper and faster. At a particularly tough turn, I pause, hands on knees.

“Come on, keep it up, Dad.”

I’m panting but don’t want to disappoint. We press on. But I stop again, this time insisting that Daniel run ahead. I rest in the mottled shade and sunlight of the woods until he returns. Then I realize that through my left eye, the world appears paisley — as if I were looking through a patterned curtain. Something is really wrong.

We make it back to the car. Daniel takes the wheel. Back home, I take a shower, thinking that cooling off will help.

For the first time, a thought flickers. Could this be a stroke? Almost unconsciously, I take half a dozen baby aspirin. I know enough about aspirin’s blood-thinning properties to think this can’t hurt.

I call my doctor’s office and the receptionist says I should go to the emergency room.

We head to the hospital. Although it’s a designated stroke center, there is no stroke neurologist around on this holiday weekend. A CT scan shows nothing. Vitals are normal. But I realize something is still wrong when I get an eye test in a hallway. I can see the letters on the eye chart, but not the hand of the nurse pointing to a particular row.

Also, my pupils are different sizes, a condition that I later learn is called Horner syndrome and can presage a stroke.

Nonetheless, the hospital plans to release me. I push back, recalling that months earlier my doctor, as a midlife precaution, had recommended ultrasound scans of my carotid arteries to be sure there wasn’t any buildup of plaque. Maybe they should try this?

Preparations are made for an ultrasound of my arteries. But the technician holding a gel-covered probe against my neck has a puzzled look. She can’t find my left internal carotid artery. She asks for a second opinion.

I vividly recall hearing the words, “There’s no flow in your carotid artery.”

My first reaction: How can that be the case while I’m sitting here conscious and listening to you?

I would later learn that my left internal carotid artery had no flow because of what is known as a “spontaneous dissection.” The artery lining had peeled away and blocked the vessel.

This kind of injury can result from certain yoga moves, painting the ceiling, tipping your head back for that soothing shampoo at a salon, possibly a chiropractor visit (research is equivocal), even a coughing fit. Or, evidently, a tough run on a hot day.

In hindsight, all I can think about is the doctors’ mantra about stroke: “Time is brain.” More accurately: Time wasted is brain lost. It seems to me the hospital staff ramped down their concern about my case just when they should have been swinging into high gear. The ultrasound, at least, confirms there is a serious problem.

The doctors arrange a transfer to a bigger regional hospital. My wife, who had been at a job interview, has caught up with me, and we have an ambulance-and-Prius parade to Westchester Medical Center.

I haven’t had a stroke yet; stroke is loss of brain function. But it is coming. At the hospital, there are more tests and tubes. Finally, I get intravenous heparin to prevent blood clots, but probably too late.

Seeing the Damage

I’m sent to the neurology ward, which is a deeply unsettling experience from the start. The man in the bed next to mine, an actor with an aneurysm, alternates between saying he’s dying and calling nurses to insist that he needs to leave to get to the set of “Boardwalk Empire.” Late that night, I fall asleep to the moaning and howling of an unseen old woman down the hall.

If you can avoid the neurology ward, do so.

An M.R.I. scan shows the area of neuron death after the stroke.

Sometime that night, blood clots break away from the damaged artery lining and flow up the middle cerebral artery into my brain. I awake to a bad headache, a throbbing left eye socket and the realization that three fingers of my right hand aren’t working.

Now M.R.I. scans do show damage. I’ve had a stroke. I learn I have to remain in the hospital for a week as I’m put on warfarin, a blood thinner also used as rat poison.

A week in the hospital. What to do?

Blog, of course. I hunt and peck, writing a post for my blog, Dot Earth, on the need to sustain your health if your broader goal is sustaining a thriving planet. I also get focused on building stroke awareness on Twitter.

Don’t stress your carotid arteries if you like your brain and the things it does for you.

— Andy Revkin (@Revkin) July 3, 2011

Tapping on my laptop with unfamiliar fingers, I learn that stroke kills 130,000 Americans a year and is the leading cause of disability. Horner syndrome, I find, is often the first sign of carotid dissection. Recent studies have found the mean age of stroke occurrence is declining, with 19 percent of strokes in people younger than 55. Some stroke specialists who have studied misdiagnosis in stroke victims younger than 50 have proposed a push for “young stroke awareness” in staff in hospital emergency departments. The American Academy of Neurology has created a task force on stroke in young adults.

And I learn of a solution for hospitals, like the one in my suburb, when they have no stroke specialists on duty: telemedicine.

Through something like Skype on steroids, any stroke specialist could provide virtual care in any emergency room. The technology is most developed in places like Arizona, where it connects big urban teaching hospitals to dispersed rural health care centers that will never have a stroke neurologist. Most of the signs of stroke are visual, meaning an expert diagnosis and swift application of the right medication are possible without laying on hands.

I interview Dr. Yulun Wang twice, first using his technology — with me at a Long Island hospital and Wang in Santa Barbara — and then when I visit his company, InTouch Health, a few months later. Here’s Dr. Wang describing these tools and the hurdles to wider adoption of the technology:

The merits of telemedicine seem utterly obvious, but I learn that Medicare and insurers don’t reimburse for this sort of care, with a few exceptions, because the doctor is not physically at the bedside.

Well, there was no living, breathing stroke specialist at my bedside to bill in those first vital hours. Give me a virtual doctor any day.

There are other impediments to what’s called telestroke technology, including licensing roadblocks preventing doctors from practicing across state borders.

You can learn more about research showing the cost-effectiveness of telemedicine for stroke and the hurdles to its adoption in my Skype chat with Dr. Bart Demaerschalk, the director of the Mayo Clinic Telestroke Program in Arizona and an author of an important 2012 paper on telestroke cost-effectiveness.

New Chance, New Vows

After my week in the hospital, I dive into my physical and occupational therapy. I also make lots of vows.

¶ I vow to write a hard-hitting print article about stroke care.

¶ My wife gives me a card for a personal trainer. I start working out.

¶ In the interest of not torturing my neck, I vow no more red-eye flights.

¶ I’ve played guitar since I was 17, but never with much discipline. I start doing scales.

So how am I doing? I’ve stuck with almost none of those commitments.

Run-ins with the reaper cut in two directions. Part of you swears to slow down, to smell the roses, to get closer to loved ones. But part of you — me, anyway — says life is short and tenuous. Get everything done now!

I posted 322 times to Dot Earth in 2012. The flow of news on my beat pushed my stroke article to the far back burner. My workout routine and guitar scales faded. I’ve taken several red-eyes, with more coming. I’m on the run, in many ways, more than ever.

But I am humbled by one thing that I learned. I was pretty smug, once I recovered, about having scarfed down those aspirin early on. Experts tell me that act probably did mitigate the effects of my stroke. (My fingers and vision are fine.)

In my later research, however, I realized that if I’d had a bleeding stroke, the kind that almost killed Jill Bolte Taylor — the neuroscientist who wrote “My Stroke of Insight” — the aspirin might’ve killed me. Roughly 1 in 10 strokes are of the bleeding variety.

So yes, this was my stroke of luck. As it turns out, luck played a bigger role in my being here today than I’d like to admit.

View the original article here

Well: Sports Injuries and Athletic Shoes

Brian Harkin for The New York Times The right shoes can be important for avoiding injury on the playing field.Gretchen Reynolds on the science of fitness.

Sometimes innovative science requires innovative machinery, like a moveable, four-legged robotic sled that can wear shoes, a contraption recently developed and deployed by researchers at the University of Calgary to test whether grippy athletic shoes affect injury risk.

It’s well known, of course, that shoe traction influences athletic performance, especially in sports that involve sprinting or cutting, meaning abrupt rapid shifts in direction. In broad terms, more traction leads to better results.

In a 2009 study of soccer players and their footwear, for instance, researchers tested the players’ forward sprinting and sideways cutting speed while the players wore their normal soccer shoes, and again after the shoes’ cleats had been shaved down in length by 50 percent and then by 100 percent, meaning they were flat against the outsole. While wearing the shortened cleats, the players had less traction on the field and were significantly slower moving forward or sideways.

But these and similar studies did not establish whether more shoe traction is always desirable or if there is such a thing as too much stickiness in a shoe.

Athletic shoes have two primary types of traction. One keeps you sticking to the ground as you move forward. The other, called rotational traction, kicks in when you move sideways or shift direction. The amounts of each type of traction depend on a shoe’s outsole material and on whether it has cleats and, if so, how many, their size and shape, and how they are positioned.

For some time, most researchers have believed that forward-related traction does not have much effect on injury risk, while rotational traction does.

But that idea had been difficult to test in real-world situations. For one thing, researchers can’t ethically shave down cleats or otherwise alter shoe traction and ask players to don them and helpfully go out and hurt themselves.

And logistically, it’s easier to measure shoe traction in a lab than on a playing field.

But researchers at the Human Performance Lab at the University of Calgary wanted to see whether different degrees of traction would affect whether players got hurt in real playing conditions. So they created their shoe-wearing robotic tester. Mounted on rails, it can move either forward or sideways on a field at whatever speed the researchers choose, while its “feet” stay in contact with the ground and various sensors determine forward and rotational traction.

With this robot tester at the ready, the researchers recruited hundreds of local high school football players and borrowed their shoes. They fitted each shoe onto the robot tester and determined its unique forward and sideways traction.

The various shoes varied widely in terms of traction, says John W. Wannop, the University of Calgary kinesiologist who led the study.

The scientists then returned the shoes to the players and asked each team’s trainer to track all non-contact leg injuries throughout the season. This experiment was repeated for two more years, during which time the playing fields were switched from grass surfaces to artificial turf. At the end of the three seasons, the scientists compared traction levels and injury reports.

Many of the players had experienced ankle, knee and ligament injuries that didn’t involve contact. This was, after all, football. But the incidence was highest and the severity of the injuries greatest among those players whose shoes provided the most rotational traction. At the same time, the players whose shoes had provided the most forward traction developed fewest injuries.

This finding was unexpected, Dr. Wannop says, because it had been thought that any shoe with high forward-motion traction would also automatically have high rotational traction, and so would increase injury risk. But this was not the case; some shoes gripped as players ran forward but didn’t stick when they cut sideways.

Those shoes were the safest.

Playing surface, meanwhile, had almost no effect on injury risk. Injury rates were similar on grass and artificial turf, whatever shoes the players wore.

What these findings mean in practical terms, Dr. Wannop says, is that for the ideal mix of athletic performance and reduced injury risk in sports, a shoe should have “high translational traction values and relatively low rotational traction values.”

Good luck, however, finding precisely that shoe. Companies don’t advertise shoes’ traction values and probably can’t, Dr. Wannop says, since they will vary, depending on your body size and movement patterns and on such ephemera as the muddiness or dryness of a field or trail on any given day.

Still, there are some broad guidelines to consider when purchasing athletic shoes, especially for team sports like football, soccer or basketball, Dr. Wannop says. Avoid models with multiple large, toothy cleats or rubbery nodules along the outside of the sole, he advises, since they can create too much rotational traction. Look instead for groupings of shorter cleats in the forefoot, which can provide reliable forward-oriented traction.

Most important, try the shoes before buying, if at all possible. Ask the salesperson if you can go outside while wearing them. Find some grass and sprint, halt, pivot and cut. If your foot slips when you move forward or noticeably sticks when you pivot, Dr. Wannop says, try another pair. You might want to stick to your exercise regimen, but you don’t want to be stuck to the ground.

Gretchen Reynolds on the science of fitness.

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Well: Life, Interrupted: Getting Away

Seamus McKiernan The writer on her first big trip since her diagnosis with leukemia two years ago.

Like a lot of other cancer patients lying in hospital beds or in chemotherapy suites, I have spent a fair amount of time fantasizing about jetting off to a tropical island. A certain part of me knew that the fantasy was really about escaping my disease, but even so, I made a pastime of watching planes in the sky and dreaming of white, sandy beaches.

Suleika Jaouad writes about her experiences as a young adult with cancer.

One of the hardest parts about developing leukemia at age 22 was how restrictive it was: My treatments left me highly susceptible to infection and with limited mobility. Airplanes were strictly off limits. Even a trip to my neighborhood bodega required a protective face mask and plastic gloves to shield me from germs. Extended stays in the oncology ward were especially difficult, because travel was so closely tied to my identity.

When I was growing up, traveling was my family’s modus operandi. Between the ages of 4 and 18, I attended six different schools on three different continents. In the world of expat children, there are roughly four types of “brats”: business, military, foreign service and “other.” I guess you could say that my younger brother, Adam, and I fit into the last of these. Our family was constantly moving among New York, Switzerland (where my mother is from) and Tunisia (my father’s homeland). My mother, an artist, and my father, a professor of foreign literature, often had to pick up and move for new work.

It wasn’t always easy, but I learned to love moving around. I quickly learned to be an expert at being the new kid on the block. Traveling gave me the opportunity to reinvent myself. You can imagine my excitement when, one year after my bone marrow transplant and two years after my cancer diagnosis, my doctors gave me permission to take my first big trip since cancer. Freedom, finally!

That’s how I found myself standing in line at Kennedy Airport last week holding an international boarding pass. After looking at dozens of pictures of exotic islands online, I had chosen the island of Capri in Italy as my destination. With its breathtaking coastal views and Mediterranean climate, it seemed like the perfect escape.

More than the destination itself, I was looking forward, for one week anyway, to being just Suleika, and not Suleika the Cancer Patient. I could have fooled most people. If you didn’t notice the catheter scars on my chest, or the slight bulge of a central line implanted below my collarbone, or the oversize pill case in my purse, I looked like a healthy young woman with a short hairdo that came across as more punky than post-chemo. In a strange way I was the new kid again. (Well, except to my boyfriend, Seamus, who was by my side during the trip and was probably worried more often than not.)

The anonymity that came with traveling was thrilling, and it was a welcome relief that no one would be bringing up the C-word. But even though I was anonymous to others, it became all too obvious to me that this wasn’t like the trips I’d taken in the past. And it didn’t have to do with the latitude and the longitude of where I was. My body wasn’t in the kind of shape to travel that it used to be. Despite the beautiful views, walking around the island was exhausting. The water was warm, but I hadn’t swum in two years – a few strokes and I was done. Foods may have been exotic, but they were mostly off limits to me. I had to stay away from the mouthwatering caprese salads for fear that the fresh tomatoes and basil leaves might carry bacteria harmful to my compromised immune system. By Day 3, I had come down with a cold. I spent the last few days under a parasol sipping hot ginger tea and blowing my nose every few minutes.

Don’t get me wrong. I still got a little time in the sun, a break from the chemo suite and my daily gelato (or three). All in all, I just feel fortunate to have been able to make the trip. But it wasn’t the escape that I had fantasized about. I wasn’t able to totally get away from Suleika the Cancer Patient, but maybe that wasn’t all bad. I missed my family, whom I’ve grown so close to since my diagnosis, and I looked forward to seeing my friends, many of whom are in cancer treatment just like me. For the first time in my life I wanted to go home – a concept that had always seemed so foreign to me growing up.

Suleika Jaouad (pronounced su-LAKE-uh ja-WAD) is a 24-year-old writer who lives in New York City. Her column, “Life, Interrupted,” chronicling her experiences as a young woman with cancer, appears regularly on Well. Follow her updates on Twitter or Facebook.

Suleika Jaouad writes about her experiences as a young adult with cancer.

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