Dieting and such

Here's a theory: skip focusing on which diet is best and start focusing on changing eating habits.

This translates to stop focusing on what we eat and getting the balanced diet and change to focus on how we can get people to make healthier food decisions. Are we eating because we are stressed? Do we have bad habits related to the drive through where we make a quick stop on the way home and eat the food in the car?

Researchers look at all sorts of diets - Paleo, Atkins, Weight Watchers - and compare them all. The FDA issues the nutrition pyramid which is now a plate. But does anyone stop and look at the eating habits we have developed and why we have them?

We live in a world full of light this and fat free that and a widening population. Why?

I used to work with a woman who was a fairly healthy eater at work. She did not snack, she didn't go out for donuts. But she was quite large. I never really figured out why.

Then I went on a business trip with her and  she insisted we stop at the grocery store on the way to the hotel so she could get some stuff for her room. I was happy to go and get some seltzer (my secret addiction). She bought a couple boxes of crackers and cookies - for a three day business conference. I think she went out and made another grocery run later on. I think she was an evening snacker - hence her hefty weight.

So why does a normal, bright, well educated person, sit and eat for hours at night by themselves? That is the question to answer.

If you watch the greater loser shows, people talk about their bad eating habits and are taught how to eat healthy -  no soda, no drive through, healthy snacking. They also get exercise and lose weight. But they change their eating habits. Maybe they eat more salads and fewer french fries but often these shows are accompanied by tears and emotional breakthroughs as well.

I know my weight stems from three issues I have.

1. At my job, there are more snacks than any place I have ever worked and the kitchen is right next to my office.
2. I snack after dinner which I shouldn't do. (Why did I eat that granola bar after dinner last night? I didn't have dessert is my justification and I wanted something crunchy. But I didn't need it.)
3. Sometimes I eat when I am not hungry because I am bored, stressed or in pain.

So if I can get rid of those habits, I can lose weight. I have been working on them, my weight is going in the right direction. The funny thing is I am still eating desserts sometimes and normal food. I didn't switch what I eat. I switched when I eat. My goal is to modify my eating habits so I can get to and maintain a healthy weight but still enjoy eating. I will no live on lite versions of crappy prepared food.

Maybe that's what researchers need to figure out so other people can more easily lose weight.

Today I am a normal person

First I overslept (but still have time to blog - a tiny bit). I forgot to take all my pills last night so I have to figure out which ones I should take this morning vs which ones I should skip but I have to wait 1-3 hours before I can take any of them after my synthroid. That was after I put my pill box back together after dumping three days worth on the floor and having to sort them all out again. I think I am still missing two pills but as long as the cat doesn't eat them I can cope.

I wanted to leave for work early  but that doesn't look like its happening. I have showered. I have not eaten breakfast - I will do that when I arrive at work. I did make lunch for both of us. I have not yet brushed my teeth or my hair but my gym bag is packed.

Last night I was running around the back yard in my PJs at 10 pm with a flashlight looking for the damn cat who got out the basement door. This  morning I get an email from my next door neighbor that she has a raccoon on her back porch. I would generally not worry about the raccoon but since my cat is 18 years old, blind, deaf, and can't smell, he wouldn't know a raccoon until he walked right up to it.

Damn. I am now really late. Off I go as a normal person.... or as normal as I can ever be.

Test Dilemma

This week a new recommendation came out that people at high risk for lung cancer - particularly current or previous heavy smokers - should be screened for lung cancer with CT scans. This is another way that cancer can be detected at an earlier more treatable stage.

'Great,' we say. On the surface this seems like a good idea - catch a cancer early on and save more lives. Advanced testing options which have become relatively more accessible and affordable over the years have opened up testing options for millions.

But, and there is a big fat BUT here, does the additional screening add false positives which equal expense and stress for the patient? This is the same argument for women who have had breast cancer that they all should have MRIs in addition to mammograms each year to screen for recurrence.

All this wonderful new testing does great things. They find things that are something 'bad' and catch it early. They also find things that are big enough to see but too small to do anything about. And where does that leave the patient?

Medical advances are great but sometimes the advances exceed the capabilities that are required to diagnose and treat the findings.

This does not even touch on the issue of over testing and the emotional toll. Whether a positive or negative result, the testing experience is an emotional roller coaster ride for the patients. False positives and false negatives are realities in the results. Non test is 100% fallible so these do take place.

Me, personally, I am a big fan of the lets waiting and watching at this point. Unless I have symptoms I am not bounding off to see the doctor. I don't want more tests. I am happy this way.

Life in cancer land

Life in cancer land is never normal. Every little thingy becomes suspicious and requires further testing. It doesn't matter if it has any relation to previous ailments or is new or not but you always get the 'because of your history we need to be sure...' line.

I was talking with a friend about it this morning. There is a nasty level in the diagnostic process that is called 'big enough to see but too small to do anything about it'. It is almost as bad as the 'there are too many thingies to think about surgery' but not really.

Basically its a sh*thole that cancer people live in suspended animation for days, weeks, months or even years. Going from scan to scan and living with a constant level of scanxiety.

Finally the outcome becomes one of two options:

• It grew big enough to deal with it some how - surgery, radiation, etc.
• It was decided it is stable and will require future supervision but less frequently.

Personally I have a bunch of the second option - tested beyond belief and now we are hoping they are stable and checking less frequently. But they all started as something that was big enough to see but too small to do anything about which was  no fun.

And how does the cancer person adapt to this not so happy roller coaster? Well that is the question of the year. You can try to sleep at night and the little 'what if' gremlins start dancing around your head. Or you can ignore it but sometimes a sinking feeling shows up in the pit of your stomach.

That is the real cancer roller coaster or how life in cancer land really is. In case you were wondering.

Friendships and Cancer or other Ailments

This is an ever popular topic in the cancer blogsphere - friends and cancer (or other ailments). More specifically the friends who either:

• run for the  hills
• become a doctor instantly and tell you what treatment you need
• think you will be dead in a month

But then there are the real friends who stick around when you are coping and help as they can.

AARP suggests saying a heartfelt 'I'm sorry' upon hearing someone is ill. I'm not so sure I would appreciate that as much as something more along the lines of 'well that really sucks'. But their other suggestions are good.

Then there is 'A Field Guide to the Wildlife of Cancer' which narrows down the categories to:

• Preachers
• Clueless
• Angels
• Bolters
• Fellow Travelers

I find there are too many preachers, clueless, and bolters out there. And far too many fellow travelers as well, but that's a different post.It doesn't matter if its cancer you are talking about, this applies to just about any serious life changing ailment.

Some times I get so tired of some people I stop telling them about my ailments or newest medical adventure because its just stressful to keep hearing the same crap from the preachers, clueless, and bolters (if you can find them).

Am I supposed to be stressed?

I am really not stressed about my big needle adventure this morning. Am I supposed to be? I am very much looking forward to pain relief. I hate/dislike needles themselves.

But I have been through this procedure three times already so I  know what is expected. I have had probably six or seven other back injections as well. The last time I was there, the nurses all thought they knew me.

Well I will enjoy not being stressed. I am hungry of course but will have to wait to eat - no solid food after midnight.  And I could use some water - no liquids for two hours prior to arrival.

Upon my return, I will take a nap with an ice pack (and a cat who likes to snuggle). If/when I wake up, I might:

• fold some laundry.
• convince my husband its his turn to make dinner
• prepare for a meeting I am having here tomorrow (which means I need to tidy the dining room).
• And possibly go to the bookstore with my husband.

Of all those, my husband cooking dinner would be nice but tidying the dining room and living room before my meeting is important. I should probably also even look at my notes.

Damn, that meeting could stress me  out if I'm not careful.

Basic screening tests take on a new meaning after cancer

Most people, by this I mean people who have never had cancer, go to the doctor for check ups and get sent for tests and don't think twice. They get nice negative results sent to them in the mail and they don't think twice about it.

Throw in a few cancer diagnoses, and any screening test takes an ominous turn. Of course any screening test will show that you are doomed. There is  no way you will ever get a clean result again. One test will lead to another which will lead to another which will lead to another and then surgery, chemo, and more and more and more.

Or so the little voices in your head tell you.

It is perfectly acceptable to have little voices in your head after cancer.

Its when they take over all rational thought that you really are screwed. This is why we have psychiatrists, psychologists, and anti-depressants to keep us sane.

However our screening tests still can drive us crazy.

Blah, blah, blah - with your medical history we have to be sure

Yesterday I had my annual physical. Or Woman Wellness Exam or whatever the correct term is for it these days.

It did start off interestingly while I was waiting to check in at the desk, there was a woman who was being told she can't call the doctor's office every day making demands, should go back to her psychiatrist, and perhaps become an inpatient at a psychiatric facility. We'll just say that I was very happy that was not me. My health/mental stability is not that bad.

My primary care, who I like, just had a baby and is out for the summer on maternity leave so I met with her nurse practitioner who was one I had not met before. She was very nice and very thorough in her questioning after she let me go through my list of questions. We talked about my ganglion cyst which makes my wrist hurt, we talked about my arthritis, we talked about back pain, car accident, back procedures, previous surgeries, my general health, how much I exercise, and more. Then she examined me and thought I was pretty normal (wow!).

I left with two to-do items - one is a cholesterol blood test which can be done the next time I have blood work done - every two months for rheumatoid, every six months for thyroid - so whenever the next one rolls around.

The other is a much bigger test (where I might feel a 'little pinch') that she wants done in the next two weeks. I can understand wanting the test but I didn't realize she considered it to be more urgent. That part I don't like. I'm not looking forward to the test itself but really dislike it when I have tests which must be done right away.

Grrr.... All the little 'what if' voices in your head start to kick in when I have 'urgent' tests.

It is scheduled for July 5 - which is fine because we had no plans to go away for the weekend - which is 2 1/2 weeks. I have no idea why it is so urgent. But of course I get to stress about it. I will take my avoidance mode until then and discuss it in more detail when I feel like it.

Unplugging

It is the easiest way to fill in free time these days. Go online, watch TV, read your ereader, text/call on your smart phone. I know I do it.

I come home from work and am exhausted so I sit down on the couch, turn on the DVR and watch one of my many recorded shows, sometimes I even play games on my ereader at the same time or text on my phone. Three pieces of technology at one time.

I go to the gym to destress and exercise and either bring my mp3 player or my ereader and watch TV while listening to music or read during commercials. I grab my ereader for waiting in doctors office where I used to bring a book. My husband one time laughed at my in the car as I juggled my cell phone, GPS, and ereader all at once on my lap.

In the morning we automatically turn on the television to get caught up on the news and I boot up my laptop to catch up on blogging, email, facebok, twitter, and anything else that crosses my mind.

How much technology is too much? That's too much.

I want to step away from technology. I spend too much time on the computer, ereader, DVR, phone, GPS, and TV.

I am working on changing my ways. I am back to reading more books in book format. I actually went to the library this week and took out four books. I have read most of one already (and then I got an email that books I was waiting for are now available so I downloaded three more on my ereader.)


So, I pull out my knitting and sit and enjoy it without the TV on the in the background. I read books with no noise going on. I 'forget' to bring my cell phone places. I leave technology behind. And I find I like it that way. I will do more of it.

Warning - I have been thinking!

I'm sorry I don't mean to do that, think that is, very often. It often gets me into trouble in one way or another.

I wrote a post the other day about how time flies and how I am coping better these days - or so it seems. Being sensitive and thoughtful (hah!) I decided it was time for some inner-contemplation on my developing coping skills.

First, am I any healthier than I was six years ago? Absolutely not. I have so many new ailments that are the chronic kind that follow me around wherever I go, I think I have lost count. I definitely have many more doctors and doctor appointments (these seem to go hand in hand) than six years ago.

I have many more surgical scars. I have the kind of scars where they went back in a second time to make sure the scar is going to stick around a long time. I have had the kind of surgery which left not one but four scars. I am going to start playing connect the dots with my scars and see what I can draw...

Back to coping, I have come up with a couple little reasons and a couple bigger reasons.

On the little reasons, I see a monthly therapist. I didn't start therapy until I was going through radiation. I did go to support groups but therapy might have helped me sooner.

I also believe in 'better living through chemistry' where I take an antidepressant daily because as my therapist puts it "I am in constant mourning for my health". This might not be a problem if my doctors stopped finding new ailments.Maybe if I stopped going to see my doctors they would stop finding new ailments.... No bad idea.

Bigger reasons why I think I am doing better. First of all for over the past two years, I have been going to the gym regularly. I used to belong to a gym where I would walk on the treadmill and look at all the other equipment and never know how to use it and I went for daily walks. I broke down a couple of years ago and joined the expensive gym for dilapidated people where they have worked with me.

Now even though my health has clearly gone down hill, I am physically in better shape with muscles and things like that. I have retained a fair amount of flexibility and have a good sense of balance so I feel less clumsy. All this makes me feel 'healthy'. I can pick things up without straining. I don't feel like I am going to trip over myself.

Finally, I think my coping skills have improved. I don't let myself get all worked up over the little things any more. Life is too short to let the little things bug me. I save that for stupid customer service people or bad drivers on the highway. Most of the rest of it, I have learned to let it run off my back. I mean I have heard more medical ailments, there are not that many new ones left that might scare me at this point.

Just or the hell of it last week I decided to see if anyone would offer me life insurance at this point. The answer I have found is not for 'any reasonable amount of money'. So maybe I am seeing the humor in things as well. That is coping too. And thinking...

Rheumatoid treatment options

When I was diagnosed with rheumatoid last fall, I was already fairly aware of treatment options as my mother has had RA since 1989. The current theory for treatment is to hit it fast and early to slow progression and joint deformities.

I was immediately put on plaquenile and prednisone. Plaquenile is an old drug from the 1930s or so and has successfully been proven to treat RA but it is slow working - months to have an effect - so usually prednisone is given for a brief period of time to get the swelling and  pain down faster. That was bad news for me because I turned out to be allergic to both.

I was then put on methotrexate orally and after three months, was upped to the maximum oral dose but still not much progress against RA. Then after another three months, I was switched to injectable methotrexate which is not my favorite thing. This seems to be causing a few problems in reacting to the injection and I have been concerned about my options.

I go to my new rheumatologist in July to talk options. I have limited options because all those lovely new biologic drugs like Enbrel and Humira that are advertised on TV are not for me because they don't like giving them to people who have had cancer. (There's a choice - living in pain or cancer.) There is one new option that has only been out for a short time that might be a possibility but it is very expensive.

So while I have been over thinking this whole thing and spending all too much time consulting with the evil Dr. Google I just learned about a new study that says that the older drugs - methotrexate, plaquenile and another drug that I have not been put on are proving just as effective as the new and expensive ones that I can't take. And they cost a lot left. The article also notes that between 20-40% of patients do not react to methotrexate. So maybe I am not alone.

Now I am going to stop over thinking this, step away from Dr. Google and wait until I see my rheumatologist next month.

Avoidance mode

Yesterday at work was the monthly sales meeting day which means it was chaotic from time to time. I was feeling relatively antisocial for some reason. I couldn't decide why. Then I realized its because of my stupid medical appointments tomorrow which are putting me in avoidance mode.

Nothing like one bad mammogram to make you dread them for the rest of your life. But that is tomorrow. This is today. I will go to work today and then the gym and continue to avoid it all day and all of tomorrow as well.

Stressed? Not me. Ha!

That was a bad day!

I don't like needles. You might have heard this from me before. I was very clear with my oncologist when I was diagnosed that it was not an option for me to self inject. Ever. Last week I was told that my RA is not responding to oral treatment so I need to switch to injections. I was a bit stressed.

I had no idea how stressed I was. Tuesday night I took an ativan so that I would be able to sleep and reduce some stress. Yesterday morning we had the teaching lesson with the nurse to learn how to self inject.

I woke up with hives, a knot in my stomach, and extreme stress. Hives? That was a bit extreme. I have only had hives from allergic reactions before. I might have been a bit whiney as well. Only a slim possibility of that. I even took  half an ativan to help me cope.

My husband went with me as he was the mere 'learnee' and I was the mere patient in this. We got there on time and had to sit in the waiting room where my husband's hand got a bit squished (only a tiny bit). And we waited. So I stressed some more. 

Finally the nurse came to get us. I was very nervous and told the nurse - there is no point in being nervous if you can't tell everyone about it. She said it was good to be nervous as that meant I cared about my health and was taking it seriously which is a good thing. It may have been a good thing but it didn't make it easier.

My husband learned out to put on the gloves, swab off my skin, fill the needle, etc. I got to ask stupid questions and be an idiot because I was nervous. I even cowered when the put the fake fat pad against my arm for my husband to pretend to inject me. I cowered again when he really did inject me.

There was a little pinch and it did burn a little. But I survived. I think.

I left to go to work and my husband went to his other doctor appointment. My stomach started to unclench. My hives itched a little less. But I felt better. It was over. Until next week when we go through it again with out a nurse to help. Crap.

Misconceptions about breast cancer risk

Last night we had dinner with a friend who's mother had breast cancer more than 15 years ago. She was talking about her concern about getting breast cancer. I think both her grandmothers and a couple aunts had breast cancer. Several of them had bilateral mastectomies. This is dating back decades to the 1970s and earlier.

She has not been tested for the BRCA genes because it would require her mother to be tested and she didn't want to put her mother through that. That was probably 15 years ago and she hadn't asked since. She was very concerned and sounded like she was sure she would get breast cancer.

I asked her a couple questions. What stage cancer did all her relatives have? She had no idea. She thought they were relatively advanced because of the bilateral mastectomies. But those were done in the 1970s when more radical surgery prevailed.

I also said that the BRCA genes only account for 5-10% of all breast cancers. But I did suggest that even though she was told years ago that she would have to have her mother get tested for the BRCA gene first, maybe times had changed and she could be tested now. She is going to ask her doctor about that now.

Her other comment was that there is cancer on both sides of her family and both her parents had cancer which further reinforced her thought that she would definitely get cancer. 

I was somewhat surprised at her misconceptions that she was sure she would get cancer because of her family history. Yes she is probably at higher risk than the average population of getting cancer. But there is  no reason to think she definitely will get cancer. And with regular mammograms and annual physicals, anything would probably be caught early.

I think this is a case of her mind getting ahead of reality. You start thinking well everyone else got cancer so I will too and I'll die some kind of horrible death as a result. I hope I was able to reassure her that she is doing the right thing and cancer is not a certainty for her.

Playing Hooky

Yesterday I posted about my crappy week. It got even better. After working until 230, I rushed to a dr apt and then rushed home to a meeting that last until after 6, and then got THE call. 730am on Wednesday 4/24 we will get a lesson on delivering medication subcutaneously. What that means, they will expect me to stab myself with a needle. I will need an ativan for that.

The news this morning is all about the shootouts overnight to track down the Marathon bombing suspects. One is dead, one is on the run, police officers are dead. These guys are armed and dangerous. The subway and bus system is shut down city wide. Some towns people are being told not to leave their homes as cars are not allowed on the street. They are looking for a suspect and more explosive devices... Great.

Last weekend, a friend asked me if I wanted to play hooky for a day. We selected today. I had no idea last weekend how much I would appreciate a day of hooky. I can't wait.

In a few minutes I will go to the gym and work off some stress. Then I will go to a dr apt and then meet my friend. We will zip up to a small city on the ocean and enjoy the day - we are supposed to hit 70 - and have some lunch, maybe a little shopping, who knows. I need to get away and avoid all this.

I hope this is all over by the time we get home so life can resume some normalcy.

This has been a bad week

This has not been a good week for me and a lot of other people. First off all, the marathon bombing on Monday turned lives upside down. And it seems to be the only thing on network television these days. All my regular shows I record so I don't have to stay up late, have been superseded by more news coverage showing the same things over and over again.

I have a very busy schedule this week. I had a meeting after work Tuesday that went relatively well. I met with my boss at the job I am leaving to talk about transition and was pleasantly surprised to find out they have two replacements for me - which is good for them and makes it easier for me to train people instead of leaving lots of notes.

Yesterday I went to work where there has been a fair amount of stress going on as well. Also, I was out last week so we can just say I have piles of things to do. Then I had an appointment with the nurse practitioner in rheumatology. I had hoped for a quick appointment and a quick trip to the gym before getting my hair cut.

Instead I had a 45 minute wait to see the nurse practitioner - stuck in a waiting room with a giant flat screen tv focused on the bombings and then the federal court house had a scare and was evacuated so all the newscasters could do was conjecture about what was going on and patients and medical staff, kept asking questions. I could not ignore it.

Finally I met with the nurse practitioner and we talked about my tiny medical history before the bad news started. Methatrexate is not working well for me. I can't take the biologics that are TNFs - tumor necrosing factors. This means I will never be able to Humira, Enbrel, and that whole class of drugs.

There are still options available for me that are not the big names but they all involve needles. I have a real problem with needles. My husband said he would help. We will go meet with a nurse and get instructions at some point. (And then he told me last night he didn't really like needles either - I don't think he has a choice in this because I am not sure I can give myself injections.) But that will be next week and I am not worrying about it today.

The one advantage to injecting methotrexate instead of taking it orally is that it is easier on your digestive system. This is good because last night after taking my pills, including my weekly dose of methotrexate, my stomach turned into a giant knot and caused a lot of pain. So I ended my crappy day in the bathroom in a lot of pain.

I just have to get through today and then tomorrow I am going to play hooky with a friend. I need a day off.

A doctor question.

Here is an interesting question. A woman wants additional treatment for her husband who is failing rapidly from cancer. She thinks there must be something more that can be done. But the doctor knows there isn't really anything left to prolong his life.

I am sure oncologists and other doctors are put into this position by well meaning family members countless times. There is a point where the treatment of the patient extends to the family members, especially the primary caregivers. They do not want to lose their loved one and are grasping at straws for anything to save their life.  

The article I liked to is from the physician's point of view - what should they do? Where do they draw the line? How do they keep the patient as comfortable as possible and keep the family members happy?

It is a tough question. I would not have to be the one to have to answer this. I can also see me being the one grasping at straws and asking the doctor isn't there something else to try?

PTSD and cancer diagnoses

I honestly do not believe they needed a study for this one but did so now they can say its true. A recent study examined women diagnosed with breast cancer from 2006-2010 and found that 23% reported PTSD symptoms shortly after diagnosis. This rate was higher for Black, Asian  or under 50 women and apparently the symptoms decline over time.

My comments (because I had to have an opinion) are that:

• I do not think it is isolated to breast cancer patients. I think its probably across all cancer diagnoses and they just have not done a study yet to prove it.
• I think the people who say they did not have PTSD were still stressed. A cancer diagnosis is not something you can bury inside you and not react. 
• Although the symptoms may fade over time, the person with the diagnosis has to learn to cope with the ongoing fears of cancer's return for life.

Ask anyone who has had a cancer diagnosis and talk to them about the stress of diagnosis and fear of recurrence or new diagnosis, and they can tell you without the need for a study. 

The medical roller coaster is not just about cancer

I admit I have been struggling in some ways for the past few months in terms of that lovely medical roller coaster. So often I think of the medical roller coaster as being focused on cancer - because cancer has such a 'fatal' 'terminal' 'deadly' 'life changing' connotation. I think 'life changing' is the best term here. A cancer diagnosis is life changing.

But also other diagnoses are also life changing. Like rheumatoid arthritis and fibromyalgia. When you are diagnosed with cancer, you usually look the same on the outside unless in active treatment. You do your thing - work, exercise, socialize - and have a life.

But with rheumatoid and fibromyalgia, you look mostly the same, might be moving a lot slower and hobbling around. But you are on the same damn medical roller coaster for a life long adventure.

The ways to calm down the medical roller coaster include knowledge, self education, exercise, and maybe even blogging.

I am coping with the medical roller coaster and I think I have been handling it worse than usual these days. I need to get my ailments under control both physically and mentally. I'm a work in progress here.

Time to take a break from Dr. Google

Dr. Google can kill us all off in our heads in a matter of seconds or minutes (depending on the speed of your internet provider). I have new ailments that I have been asking Dr. Google about. I also have continued to ask Dr Google about my other ailments. I have totally grossed out myself and made myself decide I will end up in chronic pain in a wheelchair in a matter of weeks.

I am not showing your actual links because that would mean finding the disgusting things again and going through it all so you will have to suffer with my descriptions.

• I found a picture of a woman with uncontrolled lymphedema in her arm. On one side she looked light a normal slight build, slender woman. On the other, her arm looked like it belonged to someone weighing about 400 lbs. 
• Then I found some pictures of what rheumatoid can do to one's feet since my feet really hurt recently. They showed all these x-rays of feet wit plates in them, turned up toes, collapsed arches, etc. 
• Then I found pictures of flesh eaten through to bone by rheumatoid.
• Then I found articles on the latest conflicting research on breast cancer screening and its value for older women.
• Then I found a comment page on people coping with fibromyalgia
• Then I found a list of sayings by people on 'you know when you have rheumatoid...' and realized I could agree with all of them.
• And more.

The more ailments you have the faster and easier you can kill yourself off.I need to step away from Dr. Google (and I need a trip to a Caribbean beach). But getting away from Dr. Google is easier and cheaper.