Today Fox News ran the story in the video above about how Obamacare will destroy marriage for the middle class because its means-testing requirements will force millions of couples to choose between marriage and health insurance. That’s because married couples who file joint federal tax returns will be means-tested by their combined income, but unmarried couples filing separately will not. Since marriage is optional, but Obamacare is mandatory, most unmarried middle class couples will have to forego marriage to afford their Obamacare. Obamacare may even force millions of couples to divorce.

The poor, the disabled and the elderly who need long term nursing home care already know how means-tested health insurance discourages marriages or forces divorces thanks to Medicaid. (One of the toughest things estate attorneys have to tell their married clients is that they should divorce promptly if one of them may need nursing home care in order to protect the spouse who is still able to live independently from being left destitute by Medicaid’s means tests.)

I pointed out that Obamacare will destroy marriage for everyone on March 24, 2010, the day after Obama signed Obamacare into law.

If the National Organization for Marriage really cared about protecting marriage, Obamacare is the asteroid that is going to make it all but extinct. If NOM’s true purpose were to protect marriage, it would be fighting the things that truly threaten it.

Dear Attila is musing tonight on why people become overweight and proposes two explanations. I agree with her, but want to add a third — sleep deprivation. Luckily, the Los Angeles Times published a story this week explaining, “Lack of sleep contributing to obesity” (boldfacing mine):

“You’re fighting against the tide to lose weight when you’re sleep-deprived,” said Dr. Amy Aronsky, medical director of The Center for Sleep Disorders in Portland, Ore., and a board certified sleep specialist. “Good sleep is as important as a good diet and exercise when it comes to weight loss.”

Where’s the link between sleep and obesity?

Hormones are the likely culprits. Normal adults need seven to nine hours of sleep per night, particularly deep sleep and REM (dream) sleep, Aronsky said. When we don’t get the good quality and proper quantity of sleep, hormone levels are altered, plus we wake up feeling unrested.

Some people are genetically programmed to need just five or six hours of sleep per night to be healthy, but that’s a tiny portion of the population, said sleep expert Dr. Michael Decker, associate professor at Georgia State University and spokesman for the American Academy of Sleep Medicine. Children ages 2 to 3 need 10 to 12 hours of sleep per night, while children ages 5 to 10 need 9 1/2 to 11 hours, Decker added.

Studies have shown that when sleep is restricted, the hormone ghrelin increases and the hormone leptin decreases. Ghrelin tells our brain that we’re hungry, while leptin tells it we’ve eaten enough.

Average leptin levels decreased 18 percent when sleep was restricted to four hours per night over two nights, according to a study published in the journal Sleep Medicine by Dr. Eve Van Cauter, Average ghrelin levels increased 28 percent when sleep was restricted.

In other words, when we don’t get enough sleep we feel hungry, even if we’ve eaten enough.

In another Van Cauter study, healthy young volunteers showed signs of prediabetes when they were restricted to four hours of sleep for six nights in a row.

The stress hormone cortisol also surges when we’re sleep-deprived. When that happens, we crave high-fat, high-carbohydrate foods (“comfort foods”) to increase our serotonin levels to calm down, said Dr. Michael Breus, author of “The Sleep Doctor’s Diet Plan.”

Other studies consistently show that adults sleeping fewer than six hours a night increase their likelihood for becoming overweight or obese — even when exercising and eating right, Decker said. Among adults ages 32 to 49, those averaging five hours of sleep were twice as likely to be obese after nine years compared with those averaging seven hours.

The news for kids is just as alarming. A study of 8,234 children (starting at age 38 weeks) found that the odds of being obese by age 7 increased 50 percent for children averaging fewer than 10 1/2 hours of sleep. Another study found that 58 percent of obese kids averaged fewer than eight hours of sleep, while just 11 percent of non-obese kids averaged fewer than eight hours of sleep.

By coincidence, I’ve been MIA this week due to sleep deprivation. To help out a friend, from Sunday night to Tuesday afternoon, I battled with iTunes and an iPad, and just as I was recovering from that, my beloved big grey cat, Beauregard, was sick Friday night and I was up with him into the wee hours. The veterinarian treated his dehydration with IV fluids Saturday morning, and took a blood sample, but we won’t have the results until Tuesday. Beauregard did not perk up from the steroid shot and is still lethargic and not eating or drinking, so my heart is aching at the possibility of losing him.

My own quest to lose weight is going well. It also is becoming more comfortable — I credit a more active application of the principles of ayurveda and some ayurvedic supplements that I began to use in May. And that brings up another element to consider regarding weight control: ayurveda discerns 10 mind-body types, with the three dominated by kapha dosha having the characteristic of putting on weight easily and needing to exercise regularly to maintain a healthy weight.

P.S.

If you have a comment that hasn’t been approved, it’s because I haven’t looked at the comments since last Sunday. The subject of gay equality can attract toxic comments and I need to be well-rested to respond to them courteously.

This video is neuroanatomist Dr. Jill Bolte Taylor‘s talk at the TED conference on Feb. 27, 2008, on her experience of a hemorrhagic stroke in 1996. You may relate better to some posts I’m planning if you have listened to this speech first. I plan to refer to it when I write about my own experience of working since April 2003 to recover from hypoxic brain injury and regain executive function, my weight loss program and the process of gaining higher states of consciousness (which really and truly exist).

I’ve struggled with whether to tell my story because it is so very painful for me to write about. I would prefer to be telling it after having reached the goals I’ve set for myself. But some of my dear gentle regular commenters are asking me about it now, one or two because they have similar challenges. I am concerned about what could happen to them if I delay. Nearly all the family members, friends and acquaintances I’ve spoken to after I recognized their symptoms of sleep apnea got tested and treated and were joyful about how much better they felt. One, however, a fit ex-Marine, did not and died in his sleep at the age of 49. So, since lives are at stake, it seems better to trust that if some people are asking for my story now, then now is the time to tell it. Let it begin as a journey story.

P.S.

The experience Dr. Taylor refers to in her talk as “La-la Land” is pure bliss consciousness. I will be explaining in future posts how to have it without the risk and inconvenience of a brain injury. In fact, the technology for culturing the brain’s ability to maintain the experience of pure bliss consciousness at all times, waking and sleeping, is what I’ve been using to heal. As I’ll explain, Dr. Taylor’s story has given me a better intuitive model for how it works.

Note: Another version of this piece is posted at RightNetwork. My agreement with them is that I can cross-post the pieces I write for them here after four or five days. However, it was so significantly re-written that I am posting my original piece tonight. It is NOT about de-cluttering — it is about exactly what it says: if you find that you clutter and can’t keep your environment orderly and clean, it could be a symptom of a health problem and your life may be at risk.

Here is what I originally wrote:

If your environment is cluttered, whether at home or work or both, the worse your problem is, the more you need to look at your health as its cause. The good news is that when you feel better, you will have the energy and organizing power you need to clear your clutter and make your environment glow with orderliness and well-being.

The first things to look at are your exercise and sleep habits. Aerobic exercise – even brisk walking – for at least 20 minutes helps your body clean house at the cellular level because it increases your circulation. It’s like the cells are better able to throw out their garbage when the blood is circulating more rapidly, probably for the same reason that a quick-moving stream of water washes things away, while water that is slow-moving, or stagnant, does not. Somehow that seems to translate from the micro level to the macro level. My own experience is that 20 minutes of aerobic exercise gives me two or three days of being able to tackle clutter more effectively. However, it took three or four months of exercising regularly for me to notice this benefit because I was so out of shape when I started. So don’t be discouraged if it takes awhile before you really experience the de-cluttering benefits of exercising.

Another part of your daily routine to look at if you are a clutterer is how much sleep you are getting. If you aren’t sleeping as much as you need to in order to wake up feeling refreshed, you won’t have the clarity to make all the decisions necessary for keeping your environment in order. You won’t have all the energy you need, either. Plus, you might see pounds pile on as you eat more calories than you need to get the energy you should have gotten from a good night’s sleep. To learn how to pay off your sleep debt and establish good sleep habits – called “sleep hygiene” – try the “Three-Week Sleep Camp” program, which you can do in your own home, in The Promise of Sleep, by Dr. William Dement, one of the pioneers of sleep medicine.

In addition to improving your exercise and sleep habits – or if you find you can’t because you just don’t feel well enough – three signs that you may have health problems you need to address to stop cluttering are as follows: waking up still feeling tired, daytime sleepiness and feeling sluggish mentally and physically. While sleep deprivation alone can make you feel sluggish, it doesn’t hurt to see your doctor to rule out a thyroid disorder. The blood test to check whether your thyroid is not producing enough thyroid hormones is called the “TSH” test. It actually measures the hormone from the pituitary gland that regulates the thyroid gland. If you need to start taking thyroid medication, it may take a few months to find the right dose, but you’ll be amazed at how much better you feel. You’ll regain the energy and mental clarity you need to clear your clutter.

However, if you still feel lethargic and sleepy even if your thyroid is fine or your thyroid medication is at the correct dose, you may have a sleep disorder. Don’t expect your primary care physician to understand sleep disorders – sleep medicine is so new that you really need to see a sleep specialist to determine if your symptoms are due to a sleep disorder, and if so, ensure it is correctly diagnosed and treated.

One of the common sleep disorders that can be associated with cluttering is obstructive sleep apnea (OSA). In OSA, the airway collapses when you are sleeping so little or no air gets to your lungs. However, your brain still tells your body to breathe – breathing against a sealed airway puts enormous strain on your heart and lungs, which is exhausting. Then, when your blood oxygen falls to a certain point, your brain sends a signal to wake up – at least enough to open your airway. What OSA sounds like is at least 10 seconds to a couple of minutes of silence, followed by an explosive snore as the airway opens. OSA is a potentially deadly condition because severe exhaustion, a normal dose of a painkiller or normal consumption of an alcoholic beverage can dull the brain so much it can’t send the signal to wake up.

While the daytime sleepiness associated with untreated obstructive sleep apnea will rob you of the energy and clarity you need to enjoy life and keep your home clutter-free, sleep deprivation isn’t the only problem caused by OSA that can lead to cluttering. OSA also causes oxygen deprivation during the periods that the airway is collapsed. A person with OSA may not be getting air for up to 40 percent of the time he or she is asleep. This can cause damage to the part of your brain responsible for executive function – see here and here – which you need to have in good shape to be able to keep everything in your life in order. Since current research suggests executive function damage due to sleep apnea is resistant to treatment, it seems better to be safe than sorry and consult a sleep doctor if you really just can’t seem to keep your environment in order.

"Mike and Molly" is a new hit romantic comedy on CBS. The title characters are played by Billy Gardell and Melissa McCarthy.

What could go wrong?

The link goes to a reaction piece by my dear friend, Jenny Lawson, at Ask The Bloggess, who links the post at the fashion magazine Marie Claire by Maura Kelly about the new TV show Mike and Molly. I encourage you to read both. Jenny points out that Ms. Kelly is an anorexic, which is an eating disorder that has severe dysmorphia as a symptom. This means Ms. Kelly is unable to control her anxiety that her body is defective. For anorexics, this results in the perception of being fat, regardless of how emaciated they may be, and obsessive dieting, exercise, vomiting and laxative abuse. It’s hard to imagine a subject on which anorexics would be LESS qualified to write than body image.

Ms. Kelly’s anorexia is quite severe judging from the fact that she has weighed less than 70 pounds more than once as an adult. Her advice to the obese on how easy it is to lose weight is comparable to all the advice she certainly received that she could conquer her anorexia if she just ate a little more — here, have a cookie, it’s so yummy, you’ll love it! — which clearly she has been unable to do, even when her emaciation was life-threatening. (Force-feeding an anorexic doesn’t work, either — it has a lot in common with putting your head in the mouth of a psychotic tiger on PCP. Neither one of them takes it very well.)

In an update in which Ms. Kelly apologizes for hurting people while pretty much standing her ground defiantly on the actual hurtful points, she defines morbid obesity as being 100 percent over your ideal weight. I find myself wondering if her own dysmorphia caused her to exaggerate this definition. The actual definition of morbid obesity is being more than 20 percent over your ideal weight.

I had an anorexic lesbian partner for about two years when I was in college. I also got to know her mother, who never allowed my partner to develop her inner self — which is what I believe is the underlying cause of anorexia. I had to learn a lot about anorexia in order to heal myself from these two very destructive women. To the people wishing Ms. Kelly in hell, I assure you she is already there.

P.S.

Since June I’ve lost over 27 pounds. Another time I’ll write about why I got fat and what I have had to do — and am doing — to recover my health and lose weight.

Maggie Byrd this morning, 9/19/10, from a cell phone photo from her sister -- she's on 100 percent oxygen now but her lungs can't manage to take it in so her blood oxygen percentage levels dropped to the 80's around dawn.

Maggie’s sister called me around 6:30 am to tell me that she and Maggie’s brother had been called and told that Maggie does not have much longer to live. They had gone to their respective homes for the weekend on Friday afternoon to get chores done, based on assurances from the doctors that Maggie seemed stable and they would call immediately if that changed. They had made the two-hour drive back to Lexington to be with her before calling me. This is my death vigil post for Maggie. Please pray for Maggie to feel loved, forgiving and forgiven, divinely protected, divinely guided and to be blessed in every way for her highest good now and always.

Maggie got a CT scan on Thursday to see why she was having hallucinations and check on her heart and lungs. The CT ruled out physical causes for the hallucinations and the doctors did not say they are a symptom of dying in addition to being a side effect of chemo — if hallucinations like Maggie’s even ARE ever a side effect of chemo. However, the lung scan showed Maggie had pneumonia, so she was started on IV antibiotics. She also got a Dobhoff feeding tube, which is a type of naso-gastric tube. That is, it goes through the nose and esophagus to the stomach. (Other types of feeding tube require a brief surgical procedure to create a hole through the abdomen into the stomach.)

Maggie weighs 98 pounds now — which reminds me that I should have mentioned a week ago that she had developed considerable edema from being on IV fluids, which were prescribed for reasons including the fact that she had no desire to drink or eat and therefore was not doing either. When your body is shutting down as part of the dying process, it can’t process food or drink and therefore you are not hungry or thirsty. In that situation, if you are forced to eat or drink anyway, you will vomit. Also in that situation, when you vomit you are likely to choke and aspirate your vomit, simply because you are weak, have poor coordination on account of being weak and because you are lying down. Aspirating liquids or solids into your lungs leads to aspiration pneumonia. This is why your advanced directive allows you to refuse food and fluids at the end of life and why those wishes are followed in hospice care.

Anyhoo, thanks to the edema from not being able to process the IV fluids, Maggie weighed 122 pounds last weekend. The edema was squeezing her heart and lungs — did I not mention edema does that and it’s uncomfortable and frightening? — so Maggie was started on lasix, a diuretic. She lost 24 pounds in three or four days. That’s three gallons of fluid — a gallon of water weighs 8.3454 pounds.

Maggie also received a very frank lecture mid-week from a doctor regarding her final wishes about CPR and ventilation (intubation and connection to a breathing machine called a ventilator). The doctor explained that when CPR is performed properly, it breaks ribs, even in healthy people with strong bones. Maggie is frail and her rib cage would be crushed by CPR. CPR and defibrillation — which someone who’s had it told me feels like a mule kick in the chest — under ideal conditions fail completely most of the time and when they succeed frequently leaves the patient brain-damaged or in a vegetative state. The doctor also told Maggie that in her condition, if she needs ventilation, it will not give her a bridge back to life. Maggie decided against CPR and ventilation.

Maggie’s sister told me that Maggie had a visit mid-week from a group of doctors that left her and her nurse astonished and asking, “What just happened?” That’s because after days of hallucinating, as soon as Maggie saw the doctors in their white coats, she became oriented and lucid and was able to converse with them. As soon as they were out of the door, Maggie was back to her hallucinations and lethargy. So the doctors saw Maggie in a completely different state than anyone else attending her.

On Friday, before Maggie’s sister and brother left, Maggie got a session with a physical therapist to see about getting her strong enough to walk. Maggie is very emaciated and has no muscle tone. (The emaciation of her buttocks led to a pressure sore there.) However, after tearing out her IVs and chemo port on Wednesday — because she was determined to get up and go — I think it was an occupational therapist who came up with a solution for Maggie’s restlessness and gesturing at tasks visible only to her: a large apron with lots of buttons, zippers and different textures. Maggie found it very satisfying. (I guessing an OT came up with this because hands are their domain.)

Last night dear Mark Koenig asked me how I know that some people’s end of life experience can be angry and frightening. The answer is that that is how my mother passed, although I was able to lift a great deal of her anger, fear and pain while surrounding her with friends and family members who loved her and got to say so when she could appreciate it. So in the end her passing was peaceful. Margaret’s passing was peaceful all the way through, probably due to both of our personalities.

At the very end, I tell my dying loved ones that they are having the experience of dying, so they know what is happening. I tell them that their guardian angels and angels of love and healing are with them and will take them to heaven when it is their time, so that they feel there’s a proper procedure for their passing that is being followed so they can feel safe about it.

I told Maggie’s sister to tell Maggie that she is dying, and that we love her, the kitties love her and her guardian angels and the Angel of Love and Jesus are with her and will take her to heaven when she is ready to go. Maggie’s sister said she would tell her.

Maggie, I send you my love and gratitude for all the good things you have done for me, Margaret and my family. I forgive everything that needs to be forgiven and I pray you forgive me for everything that needs to be forgiven. You have had a life to be proud of. Your guardian angels, the Angel of Love and Jesus are with you to take you to heaven when you are ready to go. You are safe and loved. May God bless your soul in every way forever and ever. Amen.

Yes, you DO swing from tears to laughter unpredictably when a loved one is dying. Why do you ask?

Click for a profound and touching video correlating the lyrics of “What Sarah Said” by the indie rock group, Death Cab for Cutie, with the experience of a person at the very end of life made by a palliative care doctor. It will make you a better, stronger and more courageous person.

Love is the main job you do for someone in the last days of their life — just being at their side, lifting pain and fear, meeting the needs of the moment so your loved one remains empowered, radiating love, creating safety. It doesn’t feel like you are doing anything, and yet you are doing everything.

I’ve been providing end-of-life care for my loved ones for most of the last 10 years. Hospice care did so much to improve the end-of-life experience for my late life partner and my mother that my father had me make arrangements so that he can have it, too, when his time comes. (New gentle readers: my father is 94 and has congestive heart failure. I live with him and take care of him.)

How to make end-of-life care choices is something I will be writing about in an e-book, but today I came across a piece from The New Yorker by general surgeon Atul Gawande describing how he learned about what hospice care could do for his patients who were approaching the end of their lives that I think is excellent and worth reading. The only bit that I think will stick with most conservatives is his remarks detailing how the “death panels,” which were stripped from Obamacare would both prolong lives and greatly reduce medical costs. Actually, the death panels are still there because it is their job to ration care — he means the discussion that was mandated about end-of-life care choices.

Frankly, given the attitudes of the people in charge of implementing Obamacare, I think it is appropriate to reject the belief that their intentions would be wholesome for both the individual and society. This is tragic — as you will see — because compensating doctors for the conversations required in making end-of-life care choices AND making it easier to have the option of hospice care and acute care at the same time really would improve the quality of life at its end, give a lot of dying people both more and better quality time AND save trainloads of money.

Here’s a sample:

Outside [after my first visit accompanying a hospice nurse at a patient's home], I confessed that I was confused by what Creed [the hospice home healthcare nurse] was doing. A lot of it seemed to be about extending Cox’s life. Wasn’t the goal of hospice to let nature take its course?

“That’s not the goal,” Creed said. The difference between standard medical care and hospice is not the difference between treating and doing nothing, she explained. The difference was in your priorities. In ordinary medicine, the goal is to extend life. We’ll sacrifice the quality of your existence now—by performing surgery, providing chemotherapy, putting you in intensive care—for the chance of gaining time later. Hospice deploys nurses, doctors, and social workers to help people with a fatal illness have the fullest possible lives right now. That means focussing on objectives like freedom from pain and discomfort, or maintaining mental awareness for as long as possible, or getting out with family once in a while. Hospice and palliative-care specialists aren’t much concerned about whether that makes people’s lives longer or shorter.

Like many people, I had believed that hospice care hastens death, because patients forgo hospital treatments and are allowed high-dose narcotics to combat pain. But studies suggest otherwise. In one, researchers followed 4,493 Medicare patients with either terminal cancer or congestive heart failure. They found no difference in survival time between hospice and non-hospice patients with breast cancer, prostate cancer, and colon cancer. Curiously, hospice care seemed to extend survival for some patients; those with pancreatic cancer gained an average of three weeks, those with lung cancer gained six weeks, and those with congestive heart failure gained three months. The lesson seems almost Zen: you live longer only when you stop trying to live longer. When Cox was transferred to hospice care, her doctors thought that she wouldn’t live much longer than a few weeks. With the supportive hospice therapy she received, she had already lived for a year.