Monday, December 20, 2010

Cholesterol

I feel a bit like the Grinch raising health issues around Christmas time when hedonism is how we celebrate.  Who wants their Christmas parade to be rained on by a natural health zealot?  Too bad though...

High cholesterol can contribute to heart attacks, strokes, and vascular dementia.  

Bringing cholesterol under control is not a function of reversing your physical deficiency for statin drugs, much as conventional doctors push those at people.  Bringing cholesterol down involves (in order of importance): 

  1. Controlling stress
  2. Reducing simple sugars and starch
  3. Exercise
  4. Diet
Sadly, conventional medicine reverses the order and wants you to alter your diet, whereupon when that doesn't do enough of the job they offer the drugs that kill off your liver so your bad heart doesn't get you.  This is a sad state of affairs!

Control your stress as much as possible.  The body recruits cholesterol -- i.e. stimulates your liver to make more cholesterol -- to make stress hormones.  Reduce stress, increase stress coping and the demand for those stress hormones declines and cholesterol goes down.  Exercise goes a long way in helping the body cope more efficiently with stress!

High glucose and sugar levels prime the cholesterol pathways and sugar rattles through biochemical pathways in your body to create higher triglycerides, which in turn get cranked over into cholesterol as a fat storage process.  Reduce sugar intake and amazingly the cholesterol numbers will drop.

Exercise works because of the stress coping connection I just mentioned, but it also alters the cholesterol makeup.  There is good and bad cholesterol -- cholesterol that sticks to vessels as opposed to cholesterol that carries fats, etc. back to the liver for processing.  Exercise increases the good cholesterol.

Diet only controls about 20% of the total cholesterol.  This means you can eliminate all cholesterol from your diet and your total cholesterol will only come down 20%.  If you are just slightly over then, diet change will help.  Most are not in the slightly over category.

Herbal/natural supplements for reducing cholesterol include: plant sterols, guggulipids, and fiber.  I have seen a number of patients completely drop their very high cholesterol numbers doing nothing but go on very high fiber diets.  So, bottom line here is:  nobody should really NEED a statin medication of any kind for high cholesterol when all of these effective alternatives exist!

Friday, December 17, 2010

The Sin of Gluttony

The second deadly sin is Gluttony.  

In the words of nineteenth-century Russian Bishop Ignatius Brianchaninov:
Wise temperance of the stomach is a door to all the virtues. Restrain the stomach, and you will enter Paradise. But if you please and pamper your stomach, you will hurl yourself over the precipice of bodily impurity, into the fire of wrath and fury, you will coarsen and darken your mind, and in this way you will ruin your powers of attention and self-control, your sobriety and vigilance.


Okay there is no way to mask this, so I will just come right out with it up front -- this post is intended to raise a lot of guilt.  If it raises your awareness to others' plight, then the world is a tiny bit improved.  If it inspires you to contribute to the aid of someone hungry or in need, then it helps even more.  If it inspires you to make some dietary changes from the guilty conscience I hope this unleashes, then your health will only improve from those changes as well!


I am bothered by how eating and drinking is required to have a "proper," "fun," holiday.  We live in a country (the USA - apologies to those readers from other countries) where upwards of 45% of the population is overweight.  This implies that the majority of Americans are getting all the food they need every day.  So when we pull up the plight of those living in Haiti or Ghana or Nicaragua and realize we have a "holiday" in the food department EVERY day, adding even MORE food to our celebrations seems wrong ethically. 

I can't even count the number of Thanksgivings, Christmases, and New Year's Days that I found myself "hurled over the precipice" and struggling with the bloated sloth and the mental darkness of a brain reeling from too many carbs and calories.  If I/we weren't also doing it half the week all the time, it might be "special," but as it is now, with the world hurting and hungry, it's simply obnoxious insensitive behavior.  To say nothing of the health effects.


Sugar kills immune system function for six hours after ingesting very small amounts.  The wrong fats clog arteries and veins.  The excess calories put on lots of pounds that reduce metabolism, slow down physical activity, and put undue stress on knees, ankles, and hips.  The majority of us need simpler, lower calorie diets.  Perhaps the more amazing celebration to have at holidays is a focus on the importance of the people we love and their health, and to take a break from the typical three meals and four snacks a day to eat LESS on holidays.  Perhaps greater thanksgiving would be realized if food were not the priority and people were?


So heading into Christmas I have these few suggestions to offer in some way to assuage the guilt I hope I've stimulated:


  • Visit www.kiva.org.  There is a link to the top left of this post along with just one of thousands of people in developing countries who could use just a $25 loan from you.  The cost of a very good meal out can make such a difference in someone's life!  Kiva is an amazing organization and you aren't donating $25 (or more) and writing it off.  That money comes back when their loan is paid and you get to choose AGAIN (and again) who to help next with that $25 (plus earned interest.)  If's VERY fun and terribly satisfying to watch their progress!
  • Eat less, but prepare food more!  Stop taking the easy Costco, microwaved, prepared food route to your meal.  The actual preparation of food should engage one's creative side and senses, and when done with others encourages cooperation and conversation.  These virtues feed far more than tummies.
  • Start "tweaking" recipes.  Play with reducing the sugar and the fat, while increasing the fiber, protein and vegetables in your recipes.  If you've ever noticed how food that is "good for you" tastes lousy, stubbornly adhere to the belief this does NOT have to be so and work to find the secrets for GOOD HEALTHY food!  Remember even if the recipe "flops dismally" that food represents MORE life sustenance than two-thirds of the world is getting for their meal.
  • Eat lightly then take a brisk walk and count the many, many blessings that flood our lives.
  • Remember your manners and politeness.  My mom and dad had a rule that reaching for food across the table was only permitted if one foot remained on the floor at all times.  This is a grossly minimalist approach to table manners, but thank yous and pleases really DO carry a positive energy that reflects gratitude and appreciation back to the Goodness of All Things!
 Prepare well in these last seven days before Christmas and with luck you will find some new traditions that come back year after year, as well as avoid the "fire, wrath, and fury" of gluttony.

Monday, December 13, 2010

Spiritual Journeying

Spiritual health is substantially more nebulous than physical health, and there are many for whom it is so nebulous that they do not ever consider their spirits to have anything to do with life, much less health.  Tomorrow is my father's birthday, he would be 89.  He was a man of a quiet and very deep faith.  I remember him vividly sitting at the table reading his devotions and Bible every morning before going to work.  He was a lot like his mother in that he just lived his faith, he didn't push it at you.  I remember saying to him once when I was a teenager - "I don't think I believe in God."  His words have carried me through four and a half decades since -- "Mark, I don't know that I can prove God exists to you, but I know this much: my life is better for having believed and even if I get to the end of my life and find there was nothing to it, I will still see God as having made me a better person."

Spiritual health can be measured, I think, in terms of how optimistic and trusting you are.  One of my favorite definitions of faith is that it is the belief that the universe is kindly intentioned toward you, even when evidence points to the contrary.  There are larger dimensions to human existence (and health) than simply skin and bones.  In The Message, Eugene Peterson translates Philippians 4:8 this way:
"Summing it all up,friends, I'd say you'll do best by filling your minds and meditating on things true, noble, reputable, authentic, compelling, gracious -- the best, not the worst; the beautiful, not the ugly; things to praise, not things to curse." 

There are a host of spiritual values including compassion, humility, forgiveness, patience, gentleness, and kindness -- all of them powerful medicine that heals us individually from the inside, as well as healing for a world that is sick in too many places.

Thursday, December 9, 2010

Anger

I have been thinking quite a bit about anger and it's impact on mental, emotional, and physical health. In the crowded culture in which we live anger poses a double problem.  First, with so many different ways that we interact there are bound to be multiple exposures to things that can make us angry.  But the second problem is that in our culture anger is not very well accepted or received.  Most of us probably experience some kind of anger and most of us play polite and rarely "go off on" someone, especially if they are not related to us.

Anger is a powerful emotion.  It is quite easy for anger to kick in the adrenal's fight-flight reaction -- our blood pressure rises, heart rates increase, the mouth dries out, muscles tighten, eyes dilate, breathing increases, and digestion comes to a screeching halt.  Staying angry for a long period of time can create substantial wear and tear on us physically.  Anger is a central emotion contributing to the negative effects of stress.

Anger is a secondary emotion.  This means that anger occurs as a response to some other emotion.  The primary emotion that gives rise to anger is usually hurt or suffering, although fear is also common.  Hurt feelings generate a lot of anger.  We live in a society that seems to find a great deal of pleasure out of hurting others' feelings as a humor artform.  With the laughter that comes from some slam or insult, anger arises; but because others are laughing at our expense, we often have little we can do or say.  So anger stays bottled up inside.  Refusing to participate in rude and/or insulting humor certainly could make the world a better place in which to live.

There are a number of ways to handle anger.  It's often best and easiest to try and evaluate what the hurt or fear was that caused us to get angry.  This is the classic "count to ten" approach.  Once you know why you're angry, then speak to the person who may have caused the hurt or fear about that, rather than exploding about how angry you were.  Anger often begets anger.  An excellent resource I came across in a bookstore just by accident (serendipity?) is a book entitled simply Anger, by Thich Nhat Hanh.  I have been using the breathing technique taught in this book for a month or more now and find that it's helping me to stay centered and grounded in many different circumstances, not solely with anger.  Breathing is so important, and it definitely helps to calm down all the physical responses to strong emotion, as well as calming the mind and spirit as well.  I encourage you to try it, I think you'll find it helpful in your life journey as well.

Wednesday, December 8, 2010

Aspirin Cuts Cancer Risk?

The Associated Press yesterday reported on a health study from England that looked at the risks of developing cancer among users of low-dose aspirin (75 mg) therapy for cardiovascular disease.  The estimated risk for cancer in the groups taking the aspirin was lower than those not taking aspirin.  There was 20% lower incidence of dying from lung and prostate cancer, and 35% lower from gastrointestinal cancers.  The study did not include enough women to make the same estimation among women on breast cancer.

To my way of thinking this study confirms what David Servan-Schreiber argues in Anti-Cancer; A New Way of Life.  In this absolutely fantastic book about how to prevent cancer he argues that cancers fuel themselves by acquiring use of the body's inflammation responses.  So, it would make total sense that taking a small amount of aspirin, an anti-inflammatory, would impair cancer growth.  If the cancer cells' growth can be impaired long enough, the body's immune system has a chance to eliminated those rogue cells before they can become full blown tumors.  This is what is going on in everyone's body all the time.

Now, let me hasten to say -- aspirin is a common over-the-counter drug that most all of us have used, but there are some pretty substantial side effects possible from taking aspirin.  Side-effect risk, even with low dose aspirin, includes severe gastric bleeding and significant reductions in blood clotting.  So why take the chance of that? Rather than use aspirin long-term, why not go with natural anti-inflammatories that do not have these side effects?  Two of these supplements are turmeric and fish oil/flax oil.  Both of these can have the same anti-inflammatory effect as low dose aspirin.

Thursday, September 30, 2010

Breast Cancer Awareness Month

Every October the media turns attention to breast cancer awareness. The awareness seems to encompass mainly the claimed necessity for women to get a mammogram. Mammograms have been portrayed as the preventive screening tool needed to save every woman's life. The recommendations on when to start mammograms or how often to have them done has varied over the years.

For all the years I've been in clinical practice I've recommended against getting mammograms. Mammograms are X-rays. X-rays are radiation. Radiation causes cancer. Using repeated doses of radiation to find cancer seems like a perfect self-fulfilling prophecy. While we are hitting women's breasts every year with radiation the manufacturer's of the X-ray equipment, clinics, radiologists, surgeons... all get a lot of money. They've claimed early diagnosis will reduce deaths from breast cancer, yet breast cancer mortality has remained pretty stable through all the years mammograms have been done.

Now, in a recent study done in Sweden most of my beliefs have been vindicated. The study found it would take 2500 women being screened annually for ten years to save one woman's life from breast cancer. Mammography may only reduce deaths from breast cancer by two percent rather than the 25 percent that has been claimed previously. (Mammograms Offer Limited Help -- Msnbc)

The feelings about mammograms can run strong. There are a few women who had breast cancer diagnosed on the basis of the mammogram they received. They are justified in believing strongly in the power of mammograms. Probably far more women have been frightened and biopsied on the basis of false positives, and others have had breast cancer missed by false negatives.

The problems with mammograms -- the false positives, the false negatives, the radiation exposure, the discomfort of the test -- don't take away from the reality that 192,000 new cases of breast cancer are expected to be diagnosed in the United States in the next year. Ignoring all screening because of mammogram problems don't help women with cancer brewing in their breasts. Early detection is vital in every type of cancer. Thermography is one alternative test that is suitable for screening purposes. It involves no radiation and is quite non-invasive. Self-exams and clinical exams are still worthwhile screening tools. Dietary changes, supplements weight management, and exercise can reduce breast cancer risks.

Thursday, June 10, 2010

The Air We Breathe

Clean Air -- an odd concept in a way. We assume it, take it for granted; it's invisible, odorless, and can't be felt, except when it's moving. It is so much a part of daily existence that most of us hardly give it notice, and yet, it's a mandatory essential part of staying alive. Cut it off for even five minutes and you're in fatal trouble. Clean air supplies not only the oxygen we need, but apart from that obvious dimension, breathing accomplishes two other vital functions. Breathing clean air is important in regulating our body's acid-base balance, as well as being a crucial pathway for detoxification. Breathing is one of the four toxin elimination pathways the body uses to cleanse itself.

So, good health relies heavily on clean air and a vital breathing mechanism. Urban environments pose particular health challenges to our good health. Urban environments contain much higher levels of contaminants and toxins in the air we breathe. While exercising is an important health thing to do for oneself, at least half of the benefit from exercising is from the increased circulation of clean air through our lungs and bodies. When I'm walking or jogging along a busy street I always get creeped out by the question that pops up in my head: "How much carbon monoxide and carbon emissions am I breathing from all these cars going by?" Even the air inside our homes, offices, or schools can be suspect, what with the large number of chemicals present in floor and wall coverings, furniture, construction materials, and central heating/air conditioning systems. The impact on one's breathing from just these sources can be substantial. That said, who in their right mind would then ADD to it by smoking -- a practice I still see being done with alarming frequency!

Lest you think that moving to a less developed nation solves the problem, it doesn't. Consider how in the developing world cooking frequently occurs over an open fire inside whatever structure is being used for a house. The concentrated second-hand smoke from cook fires creates a large public health issue where the incidence of pneumonia, chronic obstructive pulmonary diseases, and lung cancer tend to run very high. So, the poorest of the world's poor get slammed with these devastating illnesses where there is poor health care. Add to it that the average family in Guatemala, for instance, spends up to a third of their income for firewood. So, they make themselves poorer only to give themselves serious pulmonary disease.

What can you do?
Sadly, in our urban American environment there isn't a lot -- other than to be conscious of where you are and what is going on around you from a pollution aspect -- most importantly when exercising. Supporting clean air regulations at every level of government is another consideration.

In developing countries -- one organization, Ahuyu.org, is working to supply poor peasants in Guatemala with fuel efficient cook stoves. These cook stoves cut down on the amount of firewood needed (reducing deforestation and leaving more disposable income available), and improves air quality (improving health.)

Tuesday, June 8, 2010

Global Partnerships

Two things have recently come together for me. First, I checked the world map of who all has been reading this blog and was totally stunned that rather than a bunch of local people, there were far many more of you from all around the world reading my occasional missives. So, a belated welcome to all of you reading this from the Philippines, India, Japan, Europe, as well as the eastern USA. The second thing that has come to me is the world of micro-lending and in particular Global Partners (www.globalpartners.org) and Kiva (www.kiva.org).

Global Partners are doing a phenomenal thing loaning small amounts of money to Central and South American business people living under the poverty line. I am struck by the transformation of lives this brings. An aspect I had not really thought about was that women around the world are prone to cervical cancer. In addition to small business loans, Global Partners are allowing the use of their network to bring cervical and breast cancer screening tools to women caught in poverty.

Cervical cancer is probably the most easily detected and addressed of all cancers. It is clearly associated with the presence of the HPV virus. There is really very little excuse for cervical cancer taking a woman's life due to the susceptibility of the HPV virus to a number of natural vitamins, minerals, and herbs. Even if the natural treatments fail, there are fairly simple (though not necessarily comfortable) surgical procedures that eliminate this type of cancer. So my advice here is if you are female or know someone close to you who is female, wherever you live, get a PAP smear done.

Friday, April 2, 2010

Reservatrol

So am sitting here on Good Friday and thinking about the Syrah wine I'm drinking and as I'm swirling it in my mouth, it caused me to reflect on the properties of reservatrol.

Reservatrol is most readily extracted from the skins of red grapes used in wine making. It has gotten the most attention on TV news programs for it's properties that have shown it to be useful in longevity and in cancer prevention. It has a slightly better track record on reducing cancer risk, than on reducing wrinkles or extending one's life. It is an excellent anti-oxidant, which probably attributes for most of it's positive health benefit(s).

Reservatrol comes in supplement form, but one can also get it from red wines and grape juice. Studies show that MUCH HIGHER blood concentrations can be achieved by swishing it in your mouth and letting it absorb from there, than running it through the digestive system where most of it gets broken down and split into ineffective constituent parts.

Stay Healthy and Keep Swishing,

Mark

Thursday, April 1, 2010

Anti-Cancer Kill-a-Cell-athon

April 18th eat three anti-cancer foods and kill cancer cells through food and natural substances. Join the facebook online event at:

http://www.facebook.com/?ref=home#!/Anticancer

Wednesday, March 31, 2010

Antibiotic Resistant Infections

Boy! What having spent a month in a hospital ICU unit does for one's perspective on medicine! First Living Wills, now I want to talk a bit about antibiotic resistant infections.

First, I do not want to generate germophobia or an obsession with bacteria. There are two facts to keep foremost in one's mind as you read the rest of this blog entry: 1) Antibiotic resistant strains of bacteria are still pretty rare in the normal environment -- our bodies/homes/workplaces/churches; and 2) There are GOOD bacteria which do daily battle with the bad ones, so don't lump them all together.

So, with that fact in front, what is an antibiotic resistant bacteria? It is a specially mutated bacterial species that has evolved, which is resistant or impervious to certain antibiotics that have commonly been used to kill them. The most widely heard about is MRSA - methicillin-resistant staphylococcus aureus. This is a Staph infection caused by a particular staph bacteria that cannot be effectively treated using the antibiotic methicillin, other penicillins, and even a few other forms of antibiotics. This makes it much harder to treat, as the numbers of antibiotics that will work are limited (and growing smaller over time.) MRSA is not the only bacterial strain that has antibiotic resistance. Other resistant strains have appeared in the strep family, the tuberculosis family, and the enterococcus family.

For the most part, the people getting infected include those in hospitals, nursing homes, group quarters, and those who are immune compromised. You get immune compromised from certain illnesses (like HIV), or from some drug regimens (like used to prevent organ rejection, or chemotherapy), or from severe physical and emotional stress (like from a major surgery.) In the world of microbiology, there are always exceptions; one of the growing exceptions is that while this list accounted for 100% of the "super bug infections" once upon a time -- there are growing signs that these bacteria have escaped and are showing up more in the general population as well.

This escape is a scary prospect to everyone. What IF most or all bacteria develop resistance to all our antibiotics? We are then suddenly plunged back into the pre-20th century years where the effective treatments of infections were not as simple as we have lived with over the last eighty years (Penicillin was discovered in 1928). I am, however, not as worried or scared as a lot of doctors/health professionals seem to be, and here is why.

Speaking ONLY of the general, healthy population -- even in the era before antibiotics, more people lived than died. Before antibiotics there were still treatments for infection. Naturopathic medicine still uses many of these treatments, and have added some others as well. There are any number of herbal substances that have infection-fighting powers. Herbs fight infections on two fronts. Some can stimulate immune system function. Echinacea, for instance, increases the CD4 Killer Cells in the white blood cells to seek out and destroy foreign attackers -- both bacterial and viral. The second front herbs work on is as direct killers of microbes. Garlic, is an excellent example of a plant medicine that kills bacteria on contact. Garlic extracts are being used against MRSA very effectively! Vinegar and hydrogen peroxide kill bacteria directly. The best news of all is that these natural substances have been around for, all practical purposes to our discussion, as long as bacteria have been in existence; and the bacteria have not developed resistance to any of them. Why this is, nobody knows. But, this means that natural medicines still work, even against MRSA and the others! Do they work as quickly? Do they work as effectively? Truthfully, probably not -- but they are an essential presence to be getting used in ANY infection - whether it is being treated with antibiotics or not.

Finally, I want to throw in a word about using probiotics for strengthening immunity. Probiotics are the "good" bacteria (e.g. lactobacillus and acidophilus to name a couple of hundreds of kinds.) We all have them residing within us and on our skin surfaces. These good strains of bacteria set up a microbiological environment where pathological bacteria have to fight and compete to gain a foothold. Good strains of bacteria do "friendly" training simulations for the immune system to keep it tuned and vigilant. Fermented foods (e.g. yogurt, sauerkraut, kimchee) and probiotic supplements are excellent sources of probiotics that will aid in keeping your immune system resistant to antibiotic resistant, as well as other nasty kinds of infections.

Stay Healthy!!

Monday, March 22, 2010

The Hardest Side of Medicine

One of the hardest sides of medicine is when it turns to pallative care turns to dying. Dying is not something to which most doctors take kindly. In fact, most of us go into the profession to thwart death and misery. So, approaching the topic is very difficult for everyone, but a recent experience I had with the dying of one of my most special patients raised a very large issue that is hardly ever discussed, but which tears at the souls of everyone in a family. The forms for Living Wills and Powers of Attorney for Health Care are ones that most patients are left with on their own to flounder. Sure, a hospital will likely hand you a folder or a form and have you fill it out, if you do not already have one, but what you are signing; and what you are asking member(s) of your family to undertake on your behalf is huge. These decisions need to be entered into with a lot of forethought and discussion with the very ones who will be potentially taking charge of your health care decisions should you become incapacitated. The decisions are intensely personal, tremendously spiritual, and steeped heavily in one's moral and ethical values. The decisions, when they are called upon to be made, are likely going to have to be made under some of the most intense hospital conditions and time crunches human beings will ever endure. Furthermore, given that hospitals and the majority of hospital doctors and staffs are intense-duty bound to war with death like desperate troops battling hand-to-hand for the last foothold of a strategic island, THEIR pressure to make THEIR decisions quickly will often involve a lobby, the likes of which Congress has never known.

We tend to think of a Living Will in a skip-ahead way. I mean by that, we tend to look at Living Wills as though we are already at the end point and have been there for weeks or months with tubes and machines. It's fairly easy for us to put ourselves in this end scene and make decisions based on that image. What is not realized is that nobody goes instantly from calmly talking to one another in one moment to intubated for a month in the next. In between will be the "slippery slope." Further, making choices to remove "life-saving tools" is vastly different from not starting them in the first place. Both eventualities should be thought through.

The first question to come to grips with is: how DO you feel about dying? It has always struck me as a bit bizarre that Christians, who proclaim the resurrection and eternal life, can also be the ones MOST intensely attached to "life at all costs." What constitutes a life? Is the relatively simple act of breathing and heart beating what life is? Or, does life involve more, like consciousness, interaction, movement, vocation....? If all life has is breathing, then preserving that includes a particular set of steps on that pathway. If life involves lots more than that another course is required.

The next question is what constitutes "playing God," or put in a non-religious vernacular, what constitutes murder? Is murder withholding "life giving or sustaining possibilities"? Is murder withdrawing "life sustaining techniques" that are not actually making progress in saving that life?

Armed with answers to those two very hard questions, you are then ready to tackle the same conversation with those you would choose to be making those decisions for you. Do they understand your perspective? Can they abide by your understandings and beliefs?

The trouble typically starts when 911 is called to an emergency or when you are checking into a hospital with some significant health problem. Those moments are like entering the starting blocks of a Grand Slalom ski downhill. You will potentially find yourself being swept down the slope. "Standards of care" issued by all-knowing medical teams will dictate the twists and turns. Each significant junction they will need to collect an "informed consent" either from you or the one to which you have given power of attorney. That signature either keeps the race going, or stops it in it's tracks. WHERE in "the race" do you want the towel thrown, where or when do you want it to stop? The time to make the decision to sign will be very short and the hospital staff are typically super-charged ready to go to the next part of the race. Putting the brakes on and saying "No," at any point is going to take tremendous resolve not only to stand up to the hospital staff, but to know the decision is very possibly one that could cost your life.

I'm hoping that if you've read this far you now have had the experience of a light bulb going off in your head. Any one of us is a street intersection away, or a heart attack away, from landing in the ER. Do you even want to cross the threshold of the hospital door? Who do you have to make your decisions for you? What decisions do you want made? Having the conversation before hand will undoubtedly aid the process should it take place at some point for you. Put your choices in writing! It's an intense, scary, and tremendously painful time. Having had the conversations before events ever happen won't take the intensity or the fears away, but it will help everyone feel a little more sure that you received the dignity you desired at that awful moment in your life.