cruising in the caribbean

Cruise ship - Radiance of the Seas by blmiers2, on Flickr
Creative Commons Attribution-Noncommercial-Share Alike 2.0 Generic License  by  blmiers2 

We are seniors. We have been for awhile. And taking cruises is something seniors do. In the winter, many of those seniors go cruising in the Caribbean, where the weather is warm and shopping is duty free.

I had been fascinated by the idea of taking a cruise long before I joined the ranks of seniors. I first wanted to take a cruise since before I joined the ranks of teenagers, in the days of that TV classic from the late 50’s, The Gale Storm Show: Oh Susannah. Finally, last month, my husband and I headed off for ten days on a cruise involving stops at six islands interspersed with three days at sea. I was so excited.

We were with two of my cousins and their husbands and were joined for evening meals and many other events by a couple my cousins had met before who have enough nights of sailing with the cruise line we were on to be five-star passengers. The six of them had been on many cruises before. But we were newcomers. There were so many things we didn’t know, even though my cousins and their husbands tried to fill us in.

Maybe the fact that we didn’t have to do our own research was part of our difficulties. My cousin’s husband had checked out the price, the route, and the time of the year, concluding that the price was great, the route would take us to lovely ports, and the time of year would guarantee us pleasant weather. He was right, but that wasn’t enough for our first cruise.

Here is what we learned from our experience.

  • Be prepared to experience motion sickness. No matter how big those ships are, the bow will be bobbing along in the water at some point and that motion can be difficult to adjust to. It is no surprise that the dining rooms are at the back of the ship, where the motion isn’t quite as extreme. Bring motion sickness medicines along. There will be some available on the ship, too, but those shops are like mom-and-pop shops everywhere, limited in what they offer and the prices are high.
  • Start from somewhere close to home. Our ten-day cruise originated on the east coast. We live on the west coast. So our first travel day was consumed just getting across country. And our first flight was delayed by hours because of mechanical problems, putting us at risk of not making our connection or arriving on time, not the carefree beginning to our vacation we had hoped for. And the return trip was even more stressful.
  • Start with a short cruise. This may seem counter-intuitive since it will cost a packet of money for a vacation and longer vacations always seem better than short ones. But we both concluded we should have tried a five-day, not a ten-day, cruise for our first one. Had we not been on the ship for so long, we would likely have enjoyed all of our cruise, instead of just the first half. That’s because. . .
  • Cruise ships are confined and confining places where it is difficult to get away from anything unpleasant. And what was unpleasant for us was the viral infections we both picked up. For the final five days of the cruise, we couldn’t take part in many of the activities we had been looking forward to because our coughing disrupted those around us. In addition, the virus robbed the food – the exquisitely prepared and oh, so plentiful food – of its flavor.
  • Remember that not everything comes with the cost of the room. Meals are included – and as I had expected, there was plenty of food at all the hours we were awake. But everything else beyond food comes with a price tag. It isn’t that the prices were all high – drinks were about what we pay for them back home. But we don’t go out to have cocktails ten nights in a row back home. On the ship, that’s what we all did. And the Love Boat series that included Dr. Bricker as one of the main characters never prepared us for the cost involved in visiting the ship’s medical center. For what we paid for our medical bills – thanks to my PSVT episode – we could have brought along another passenger or taken another shorter cruise. And it happened on the fifth day – what would have been our departure day had we opted for a shorter cruise.
  • Be aware that people on cruises – both passengers who have been on them before and the staff – speak a different language. We didn’t know what the Lido deck meant. Everyone else knew that was the top deck where the buffet and the swimming pools were. I checked what I thought was the right box on the form to arrange for our disembarkation but when we were advised to be ready to leave the ship at 7:30 a.m. while our flight out of town wasn’t until 5:00 p.m., I thought they had made a mistake. When I called to ask why we had been told to be ready to leave so early, the helpful man at the other end of the phone explained, seemingly with great pleasure, that we had been approved for the Luggage Direct program. I had no idea what that meant except that it required us to leave much earlier than we wanted to. We didn’t know the difference between Expedited Departure and Luggage Direct, so we showed up to disembark with the wrong group. I thought a 7:30 a.m. departure time was pretty darn expedited, but we had to wait for the expedited departure folks to leave first. Once we figured out the language of cruises, I realized that what people told us was accurate, but it was as if they had been throwing Finnish words into the middle of English sentences.
  • No matter what clothes you bring along, you’ll need different ones. I had bought three pairs of walking shoes to be sure I had good ones for walking around in port. The first pair bruised the top of my foot before I even set foot on the ship. The second one had decorative holes along the top – I thought it would be good to have shoes that could breathe. Each edge was the source for rubbing my toes, resulting in blisters. Thankfully I bought a pair of walking shoes on the ship – at a lower cost than any of the pairs I brought with me – that served for part of the time. I had to buy another pair when the blisters on my toes made it clear I was not going to make it back to the ship if I didn’t get out of that pair. And I hadn’t brought along dressy shoes for the three formal evenings. I made do with the third pair of walking shoes that could pass for ballet slippers.
  • Be prepared to pony up plenty of money for anything off the island. Sure, it was possible to just walk off the ship and walk around town – each port offering essentially the same shops, all duty free, all offering goods I don’t need and wouldn’t use – but anything beyond that came with price tags per person in excess of a couple of hundred dollars. The one excursion my two cousins and I took together was a slightly lower price and I can’t imagine that any of the other offerings could have topped it. We went zip lining across the jungle canopy of the Dominican Republic.
  • Check for where the smokers spend their time. On our ship, smoking was permitted around the outdoor swimming pool on the Lido deck – at the back of the ship – and on the verandas of the staterooms. Unfortunately, the couple in the stateroom just forward of ours were smokers. Every time we opened the door to spend time on our veranda, we heard one of them open their door. And then the smoke wafted from their veranda to ours. I wish we had asked to swap staterooms with them on the first day. I didn’t think of that until the end of the cruise.
  • Are we sorry we went on the cruise? Not at all. It was a wonderful opportunity to reunite with my cousins and their husbands. And we met other great people as well. Besides, it was on my bucket list.

    Will we go on another cruise? Maybe. But unless taking a cruise is the only way to get somewhere we really want to go, I think we’ll opt for an all-inclusive package where we can stay in one place or go out somewhere else as we want to, not according to the ship’s schedule.

hospice

The one statement I have heard about hospice again and again is that people wish they had contacted hospice sooner. I wasn’t sure how someone would know that sooner was the right time, so I wondered what that meant, until our family finally had the experience of watching – and experiencing – what hospice can do to make the last days, weeks, even months or more, of someone’s life as pain free, comfortable and fulfilling as possible.

When my baby brother was diagnosed with leukemia in August 2010, we learned that if he didn’t undergo chemotherapy right away, he would likely live only one to two months. When his remission lasted only two weeks, we learned that we would have to wait to see how quickly his strength recovered to know whether he could undergo a second round. Within just a few more weeks we learned that there wasn’t anything more that the doctors could do for him. We talked with his doctor about hospice care as an option, but he slipped away before we could take any action, seven weeks after his diagnosis.

Then in August 2011, when it was clear that my dad would not be able to return to his apartment and we moved him into the long-term care section of a nursing home, one of the emergency room doctors who treated Dad on a recent trip there told us that at some point there would be nothing more that they could do for Dad. When that happened, hospice would be an alternative we should explore.

So we contacted Hospice of the Red River Valley. One of the RNs met with several of us to talk about what hospice could do for Dad – and for the rest of us – and what they couldn’t do. For us, the most attractive service was that hospice would take over as Dad’s primary medical advocate. Instead of my brother and his wife being called to decide if Dad should be sent to the emergency room to have blood drawn or urine samples taken when the nursing home staff were concerned that his blood sugar level was too high or when his behavior made them suspect he had a bladder infection, hospice would send an RN to Dad to take those samples, eliminating both the cost of the ambulance rides between the nursing home and the hospital as well as the confusion those trips caused Dad. But she warned us that it wasn’t automatic that Dad would be accepted for hospice care. She would have to assess him and it would be the medical director of Hospice who would decide if he fell within the guidelines.

After talking with us, she talked with Dad, explaining that she represented an organization that could provide him with additional help while he was in the nursing home, services beyond what the nursing home could provide. Those services included a team of people he could contact for help – an RN, a social worker, a chaplain – in addition to volunteer visitors who would come to visit him, to play cards with him, to read to him. Dad had a couple of questions including just what it would cost. He was surprised when she said that Medicare would cover 100% of the costs. After answering his questions, she asked if Dad would welcome these services. He said he would so she asked him some questions and took some measurements for the assessment.

At that point, the hospice medical director determined that Dad hadn’t yet reached the point that hospice would be the right option. It wasn’t an unhappy conclusion because it meant that those who are in a better position to forecast the future believed that Dad’s health was better than we thought. But more importantly, because of the consultation, we had an excellent understanding of what hospice could do when the time did come.

Then, when Dad had his fifth stroke and his short-term memory became impaired, we knew that the time was right for raising the issue of hospice care again. This time, the medical director agreed that Dad’s condition was within the guidelines. One of the first steps was to stop many of the medications with side effects that negatively impacted Dad’s quality of life. Orders were written that permitted the nursing staff at the nursing home to provide pain management medications to Dad on an as-needed basis. An RN, a social worker, and a chaplain began visiting Dad each week. And occasionally a volunteer, usually a student from one of the local colleges, would visit to play cards or just talk with Dad.

In the final weeks of Dad’s life, calls from hospice staff to my sister-in-law, an RN herself and therefore our translator in all things medical, ensured that we all knew when his health was failing more quickly, allowing us all to make appropriate plans to be with Dad and one another.

Before, I had thought that being under hospice care meant there was no hope. And that meant for family members, considering hospice was something to avoid. And that explains why people often said they wished they had considered hospice sooner. But now I know that I was wrong. Hospice care provides hope. Talking about hospice care, setting up a consultation with hospice providers should not be avoided, even if it seems too soon. We did and that made all the difference in getting Dad under hospice care at the right time.

Take time to learn about hospice now, before you think you will need it.

bliss point?

I used to be able to eat anything I wanted when I wanted to. Every now and then, I read some promise that I can do so again by following just one wierd trick. I know that isn’t going to work. Nothing is ever that easy. But I love to find evidence that weight gain isn’t my fault. Like this article describing the bliss point that food labs and scientists seek.

http://www.nextavenue.org/blog/why-were-addicted-unhealthy-snacks

An excerpt:

We’re fundamentally responsible for our own decisions, healthy or not. But in ways many of us don’t appreciate, the companies that produce our favorite snacks are using science and a deep knowledge of our vulnerabilities to get us to eat more than we intend, sometimes even fooling us into thinking we’re making healthy decisions.

I am looking for solutions, not shortcuts. And since I was recently advised that my blood sugar and A1C tests split on whether I meet the diagnosis for diabetes – my blood sugar levels are too high, but my A1C test is below the threshold – eating right and getting exercise every day is more important.

My nutritionist advised that the exercise doesn’t have to be sweat-inducing in intensity, so I can live with her advice that I get in at least 30 minutes a day. But turning down all the food temptations is a much bigger challenge. It isn’t just that I have a loving husband who feels it is his job to offer me something he knows I like several times a day. It is that developing a habit takes consistent effort. Some resources say that consistent effort must continue for at least three to four weeks. I can see that developing the habit of doing something new, like getting at least 30 minutes of exercise each day will take a month or more to form. But getting rid of a habit – like eating whatever I like when someone offers it to me – isn’t so easy to get rid of.

So I did more research. According to PsyBlog, the much touted 21-28 day timeframe is much underestimated. In a study that followed individuals who attempted to establish a new simple habit – drinking a glass of water each day – the average length of time required was 66 days. That’s the average. In some cases it took as long as 254 days for the behavior to become automatic, i.e., for someone to perform the action without thinking about it. That same study had a kernel of good news, however, in that skipping a day now and then didn’t appear to be detrimental in the long run. I will keep that in mind so that if I slip up one day and don’t get that 30-minute walk in, or accept that one treat out of the half-dozen my husband has offered me, I can stave off the feeling of guilt or failure.

My nutritionist told me the story of one of her patients who arrived for the first session seriously overweight and then arrived one year later having lost much of that excess weight and much better blood sugar test results. She asked the patient how she had done it. The response was that she followed the nutritionist-provided diet six days a week and then on the seventh day she took her mother out for dinner and had whatever she wanted to eat. That plan gave her something to look forward to each week, a reward for sticking with the plan the rest of the week. That’s a success story I can emulate.