The spirit of unity is essential to the way forward, not only on the islands, but for the global community. On this point, getting our COVID vaccinations is akin to doing our part for climate change.
My mom just passed away. I’d been caring for her around the clock in home hospice for close to a month. Three weeks before I arrived, she was discharged from the hospital following a two-week stay for COVID. Although her death certificate says that she died from cardio-pulmonary arrest, she would almost certainly be here today if not for the COVID.
As the COVID pandemic rages, sadly, many survivors do not fully recover.
Hawaii-grown Team Merlin is among 10 finalists out of nearly 1,000 entrants in the XPRIZE Foundation’s $1 Million Next-Gen Mask Challenge for young innovators age 15-24.
This year will be one of broad, gradual recovery, but there is a fierce gantlet yet to be run.
We continue to seek vibrant health and freedom from suffering for ourselves, our loved ones and our community. Are you ready for another boost of inspiration? Again, this year, the Hawaii Book and Music Festival, offers two full days of dynamic panels in its Wellness track. Enjoy dynamic dialogues among prominent authors, community leaders, meditators, politicians, health providers, entrepreneurs and medical researchers. Gain valuable insights and guidance during these 13 fascinating panels.
10am- Marijuana/Cannabis Gateway or Gatekeeper? Hawaii has recently legalized dispensaries for medical marijuana. What is the evidence behind medical use? What is the status of efforts to legalize recreational use in Hawaii? Is marijuana a gateway drug that leads to opiate use or a gatekeeper, guarding against more dangerous drugs reducing violent crime?
11am – Haumea: Transforming the Health of Hawaiian Women and Empowering Wahine Well-being. This OHA report seeks to provide a comprehensive wahine perspective on the historic role of wahine in the traditional era, and of wahine wellbeing today, including as many wahine voices as possible, including the contributors presenting the work at this panel.
Noon – Hawaii Homelessness Status Report: A panel led by Lt. Gov. Josh Green addresses our collective responsibility for solving the suffering of the Hawaii homeless. It is the result of health and wealth disparities, mental illness and drug addiction. What efforts are afoot and what is working?
1pm- Housing is Healthcare: Studies have shown that housing for the homeless lowers their healthcare costs. Might Hawaii offer an emerging model for the nation? Learn about a recent trip to DC by Dr. Josh Green, our Lieutenant Governor.
2pm- Sleep Apnea, Insomnia and Deprivation: We spend one third of our time in pursuit of nourishing sleep, often to no avail. What is sleep apnea, how is it damaging and how can it be identified and managed? Does screen time drive insomnia? What happens when we undersleep because we overwork?
3pm Death with Dignity: Does death with dignity mean the black pill? What factors drove the new bill just promulgated? Are people taking advantage of it? Is it really necessary or are there better means to dying well? Can conscious dying be facilitated by palliative care, hospice and spiritual support?
4pm- Regenerative Medicine: Can we now turn back the clock on aging? How far have we come towards repairing damaged or aged tissues with stem cells? Will it be possible to avoid the need for so many joint replacements?
11am- Vaping – Health Impacts and Behavioral Trends: Is vaping better than smoking tobacco? Does it still pose a cancer risk? It may help people to stop smoking — but does it also get them started? Is it healthier to vape marijuana than to smoke it?
Noon- Bruised by Social Media: You’ve captured an awesome moment. It goes viral, but – what? – thousands scoff, some begin to bully, a couple start to stalk. How do we prepare for a negative response or worse, or… no response at all to our precious post?
1pm- Teenage Depression and Suicide: Social media can bring us together as one, enable a global dialogue, isolate us or crush our spirit. In a world with increasing wealth disparities, we risk becoming isolated, disenfranchised and deflated.
2pm- Millennial Work/Life Balance: As the gig economy expands and the 8-5 job becomes less common, how do millennials find a healthy rhythm? Does this lifestyle engender an enhanced sense of freedom or a scattered, never-ending grind?|
3pm- Nutrition and Cancer: Certain foods increase specific cancer risks. Listen to the evidence from Cancer Center researchers and learn how simple dietary changes can help prevent cancer and enhance longevity.
4pm- Naturopathic Medicine in Modern Healthcare: As Hawaii approaches universal healthcare, naturopathic medicine is integral to disease prevention and optimal health. Naturopathic physicians contribute to lowering total costs and closing the gap on health disparities. Learn how these physicians are impacting care on the islands and their increasing insurance coverage. Gain insights on the treatment of digestive issues, women’s health, palliative cancer care and heavy metals.
The Hawaii Book and Music Festival draws as many as 20,000 participants each year. Check out the Wellness in Hawaii track as an opportunity for healing in paradise:
Hawai‘i Book & Music Festival
Wellness In Hawaii 10 a.m.-5 p.m. Saturday, Sunday May 4-5
Wellness Pavilion, Civic Grounds at Honolulu Hale
Free Admission, and free parking in municipal parking next to the site
See wwwhawaiibookandmusicfestival.com/schedule
Among the landmark issues affecting the health of the blue planet in 2019 is whether the fracking boom will be leveraged to develop sustainable energy resources for the long run. The trajectory of climate change depends on it. The ability of the United States to increase oil production by approximately 1 million barrels per day during the past several years — causing it now to exceed the production of Russia and even Saudi Arabia — has given an economic boon to the nation, dropped the price of oil and reshuffled geopolitical priorities. This window of opportunity must be put to good use.
As the United States rapidly approaches energy independence, the critical, strategic role once played by the Middle East as a source of crude oil has waned. OPEC’s recent decision to maintain production levels allowing oil prices to slide was motivated by the fact that cheap oil will improve global demand and modestly slow increases in the rate of U.S. production year on year.
OPEC’s alternative — to drop production and raise prices in the near term — would only have accelerated the increase in American oil production and resulted in both reduced global demand and a smaller market share for OPEC. The debate is how low prices can go before fracking becomes unprofitable.
Although it costs more than simple drilling, technology continues to improve. There is a range in the cost of production depending on geology, the quality of what is being extracted and distance from distribution networks. However, even in North Dakota’s Bakken shale region, by some estimates, the break-even point is now under $42 per barrel.
In addition to crude oil, fracking also produces immense volumes of natural gas. When burned, natural gas is cleaner and releases fewer greenhouse gases but it is still not a sustainable fuel and, like crude, is still a cause of global warming. The fracking process uses large amounts of fresh water and often occurs in places where the water table is limited. When mixed with chemicals to crack open the earth’s crust, it also carries the possibility of contaminating groundwater deep beneath the surface. The potential for geological instability is a further concern.
The two principle beneficiaries of cheap oil are the U.S. and, especially, China. By contrast, Venezuela, Iran and Russia are among the most vulnerable. A sustained, severe drop in oil prices could result in substantial instability that is hard to predict.
In any case, progress toward international agreement on global reduction of greenhouse emissions is moving ahead slowly. As part of an agreement with Xi Jinping of China in November, President Obama announced that the United States would emit 26 to 28 percent less carbon in 2025 compared with 2005 levels. In turn, China pledged to reach peak carbon emissions no later than 2030 by investing in clean energy sources, like solar power and windmills, that would account for 20 percent of China’s total energy production by that time.
The United Nations Climate Change Conference last month in Lima resulted in modest incremental progress, but the greatest challenge continues to be the divide between wealthy, developed nations and the more populous developing economies.
The next one will be held in Paris this year. The conference objective is to achieve a legally binding and universal agreement on climate, from every nation. A tall order.
Back at home an early debate is heating up on the proposed $4.3 billion acquisition of Hawaiian Electric Industries by NextEra. The press release reads, “Nation’s leading clean energy company to support Hawaii in achieving a more affordable clean energy future,” but some are not so sure.
In any case, the respite in oil prices and America’s fast-approaching energy independence is an opportunity to transition to more affordable, sustainable and renewable energy. It must not be squandered. Profits must be directed toward research and development and robust government incentives that result in a smarter, smaller carbon footprint.
To employ a lifestyle that ensures a healthy weight, it is essential to drill down and understand the details of a caloric profit and loss statement. Countless patients complain to their health care providers that they watch what they eat and get plenty of exercise but can’t seem to take off the extra pounds. Once the provider determines through laboratory testing that there is no medical reason for weight gain, such as an underactive thyroid, the therapeutic relationship can reach an uncomfortable impasse.
Failure to lose excess weight in the face of a reasonably healthy diet and regular exercise often comes from overestimating how many calories are burned by physical activity and underestimating how many calories are in those little tasty rewards for good behavior. To lose 1 pound per week, one simply needs to reduce their steady-state intake by 500 calories per day. Here are some foods that can be left off the table to get there: two Spam Musubi (506 calories), 1 cup of macaroni/ potato salad (509 calories), 1 cup of oxtail soup (458 calories), one lau lau (414 calories) or one Big Mac (550 calories).
In contrast, calories burned during a given activity depend on one’s current weight, height, age, gender and other individual characteristics. Still, the average person burns about the same amount of energy while watching television as when sleeping and only slightly more when sitting at a desk. Roughly 500 calories are burned during a decent night’s sleep. On the other end of the spectrum, scuba diving can burn as much as 900 calories per hour depending on how cold the water is, while moving along on a stand-up paddleboard will average roughly 500 per hour. Swimming draws roughly the same as does mountain biking or a strong-paced hike up Koko Head. Yoga can also burn up to 500 calories per hour when practiced full tilt.
While diet and physical activity are both essential to maintaining a healthy weight, to pay for one slip of the tongue can take a huge physical effort. Unless you are fully ready to hustle up Koko Head right after lunch, don’t eat that second lau lau. Let it slide only a few times and be ready to carry around an extra pound next time you take the hike. Call my CPA if you don’t believe me.
Hawaii should not have passed a law to condone actively facilitating death. During this legislative session a Pandora’s box was opened for medically assisted death in the form of House Bill 2739. It passed through the Legislature with only cursory debate, and this week Gov. David Ige signed HB 2739 into law.
No one has the right or the capacity to judge which patients should die and when. Neither a panel of physicians, nor lawyers, nor community members, nor clergy. We still struggle even to aptly build a public rail. There remain myriad human frailties: arrogance, jealousy, greed, prejudice, misogyny, racism, xenophobia. The human condition is rife with hidden agendas and secondary gains which will be unleashed by HB 2739.
Any law for medically assisted death places the people of Hawaii at risk for the slippery slope. Facilitated death could be encouraged not only to relieve human suffering, but also by economic motivations. Consider the recent announcement that Berkshire Hathaway, JP Morgan and Amazon are teaming up to create their own health care system. Walmart just announced its interest in acquiring Humana. The primary responsibility of publicly traded companies is to their shareholders, not to their would-be patients.
Society is vulnerable to mind-bending as the result of data profiling and social media. Will we be encouraged to end it all if we have outlived our usefulness? It certainly would improve health care budgets if benefits were curtailed by medically assisted death for seniors and those with chronic disease. Perhaps the gravely ill who are undocumented, destitute or uninsured will one day be more aggressively offered a facilitated death.
Many proponents of this bill are motivated by fear of loss of self-control and pain. Some argue that “it’s my life. I want to chose my own exit and don’t want to suffer.” We have come to expect immediate gratification, ready distraction and to avoid suffering at any cost. As I’ve written previously, today’s culture is removed from death, hence people fear it and desire instant access to turn off the life-switch.
As distinct from the traditional Polynesian voyagers who held a deeply connected view of the world, a GPS mindset leaves us isolated. We resist change, but how often have we trusted only to later feel betrayed? How often have we mistrusted only to build trust over time?
I have treated countless patients who thought living was pointless, but with thyroid hormones re-balanced, antidepressants on board, a new job or relationship, suddenly life was now bright again. With breakthroughs in health care including cancer, a facilitated death could occur when a cure is around the corner. To truly fathom the nature of dynamic change is to be reluctant to facilitate an untimely death, an action that cannot be re-traded. Rather, death should be allowed to happen in its own time.
But, what if a loved one is riddled with painful metastatic cancer or breathless from congestive heart failure? As a physician, my consistent experience is that the right dosing and combination of medications is highly effective at alleviating both pain and anxiety at the end of life. As death draws near, first eating, then drinking naturally stop. At that point death is just days away, and there is no need to rush it.
The majority of health providers report that they will opt out, leaving prescriptions to a few practitioners who might offer them liberally. Even with a take-back provision, lethal prescriptions will fall into the wrong hands and be used for suicide or homicide. It’s not a question of “if,” but “when and how many.”
Meanwhile, Hawaii combats extensive diversion of controlled substances while our teen suicide rate is nearly twice the national average. What’s more is that in Hawaii treatment for mental illness is limited, and even nationwide only 4 percent of those who request medication to die are assessed for depression. How tragic, the thought of mistakenly facilitating death in one with a treatable mental illness. “Counseling” is not a fail-safe.
To be sure, we must be more measured in choosing interventional care if there is little chance for quality of life, and more prepared to withdraw care that extends life artificially, but we should not engage in suicide, medically assisted or otherwise.
Tips: The first ingredient to success is to set goals that are realistic and achievable. They must be not only humanly possible, but also logistically feasible. Does it fit in the schedule? How long is the drive?
Next, add a pinch of joy. Goals should be enjoyable, not simply chores to be tackled because it’s the right thing to do.
Third, build support. Is the ohana on board? Solid support, whether it is a weight-loss challenge among co-workers, a workout partner or a skillful coach, is huge. I’ve been doing martial arts in the evening for many years. My family believes it keeps me sane. Although I know I am missed, the support is there. Finally, set a combination of short-term and long-term goals.
Here are some suggestions for the Wealth of Health:
No amount of exercise will make up for a consistently unhealthy diet, especially in the absence of portion control. Start with those green vegetables and, if unaccustomed to fresh salads and raw greens, steam them lightly, Be sure to consume lean protein regularly, and easy on the carbs. Go for local, organic and non-GMO. If possible, get to the farmers market and make eye contact with the person who grew the food you will eat. Pick a vice and cut it back. Give up some sodas, smokes or a scoop of rice. Consider setting some goals about what comes out of the mouth as well. Negative chatter can be incredibly habitual. It has the potential to put us in the position of victims or victimizers and tends to detract from our mental health and human relationships and has no upside in business. The people I know well who make it a practice of not talking stink, regardless of the situation, seem to live in a better place. Still, there is no replacement for straight talk or for sharing what we truly feel. Suppression breeds illness as well.
Don’t forget, the mouth and nose are also for breathing. Notice that when we are angry or fearful, we tend not to exhale fully. Likewise, when people are emotionally down, their inhalation tends to be shallow. Consider taking five minutes each day to sit and reflect on the breath. Just notice the pattern. Guaranteed, this will cultivate the wealth of health.
When Americans think exercise we think “cardio” and “resistance” training. For cardio the best case is to get the heart rate up with a good sweat six days per week. Twenty minutes three times per week is the minimum. If you are overweight or over 40 and have not done much exercise, first get medical clearance to avoid a heart attack out of the gates. For resistance training, most people think weights, which is fine if the technique is solid. Swimming is terrific especially for those who, because of joint problems, need a low-impact activity.
Flexibility training is the essential third leg of the exercise tripod. Most of us spend a few minutes limbering up before a run or a weightlifting session but don’t take the flexibility training as seriously. It deserves equal time. Yoga is hard to beat if taught by a well-trained teacher, and almost anyone can enjoy it. Be more cautious with the big yoga chains that have commoditized the ancient art. Yoga is especially important for those who play sports that use one arm or that require the body to twist in the same direction each time such as golf, tennis or baseball. Manakai o Malama continuously sees joint injuries and sprains among those who have omitted flexibility training for too long. The determined streak that drives us to keep breaking our personal records for time or weight is a blast, but there comes a time in life when it is more important to stay physically healthy and pain-free for the long run. We see countless people in the clinic who, if they could go back in time, would let go of the personal record, to avoid lifelong pain or disability.
Cultivate the mind: Perspective is everything. I like to fish. It struck me once after pulling a big bull mahi onboard that for one person catching a fish is a legal way to kill, while the next person is harvesting a sacred life to feed the family. OK. Maybe most guys are, like, just fishing. The point is that perspective is everything, but there is a tendency to be so habituated, so close to it that we fail to recognize what really drives our actions. Taking just a few minutes each day to reflect, observe and reaffirm our New Year’s resolutions is worth a million bucks.