Without further ado, here are my 2011 rankings:

Best to Worst Airline Rankings

• Delta
• Kingfisher
• Alitalia
• Jet Airways
• Iberia
• Swiss
• British Airways
• Malev
• SN Brussels
• American
• EL AL

Best Airline: Delta

Why Delta?  Two reasons set Delta above the rest of airline carriers:

1)    Excellent frequent flier program.  If you fly as much as I do, being able to earn miles or upgrades in a generous, hassle-free manner is reason enough to fly Delta.  They constantly enticed me with bonuses during the year that made it very easy to reach the top elite status and rewarded me handsomely once reaching.

2)    Excellent customer service.  Delta demonstrates that it values its customers. After a couple of unforeseen incidents with Delta flights (as happens with all carriers), we received immediate letters of apology as well as monetary compensation.  In certain instances they went above the call of duty to make sure we were properly satisfied.

Worst Airlines:  American and EL AL

Why American?  With its next to the bottom rating, American Airlines may seem a surprising choice, but here’s why this airline ranked so low:

1)    Poor customer service.  My opinion of American’s customer service dropped tremendously in the past year.  Perhaps their loss of customer focus coincides with the company going into bankruptcy.  Frankly, the most caring people I’ve met recently at American are the sky caps who work at their airports.  Other than that from check-in agents ate their Flagship Counter to the Admirals Club their level of service on and off the aircraft declined tremendously in 2011.   You’ll be seeing much less of me on their aircraft in 2012.

2)    Poor aircraft quality.  I’ve noticed a dramatic decrease in the quality of the company’s aircraft.  In the past month alone I was on two aircraft (transatlantic) in which video systems didn’t work and with seats that wouldn’t recline (in business class mind you).   The flight attendants were able to do very little but furthermore their customer service could do no more thana right a standard apology letter (not even directly addressing the issue).

Why EL AL?  What a disappointment!  The reasons are many:

1)     Frequently lost or damaged luggage. I’ve lost luggage on EL AL flights on numerous occasions in 2011.  Never have I been offered so much as even a toothbrush.  (As a matter of fact, it was stated by their less than friendly customer service agent  that they wouldn’t provide one, and we should be lucky that they would deliver it.)  Lost luggage has sometimes arrived days later, damaged at that with EL AL willing to take (rather I should say deny) any responsibility.

2)    Poor customer service.  When incidents such as lost or damaged luggage occur, there seems to be no one with whom to speak about the problem.  Months after an incident, compensation is still not received.  When something goes wrong, there’s a tendency to blame “security” and if that doesn’t work it’s always the passenger’s fault!  At EL AL the “customer is always wrong”. For 2011 EL AL truly has earned the reputation as the worst customer service around.

3)    Poor employee attitudes.  It’s not just responses to customer service incidents that highlight this problem.  EL AL employees seem to treat customers as cattle, rather than people. There’s no recognition – I’ve heard in all cabins on EL AL (yes even in first class) passengers referred to as seat numbers rather than by name.

When I flew EL AL in 2011 I was made to feel that they think they are doing me a favor by letting me fly, even when I’m sitting in business or first class.   The attitude is pretty amazing.  Let’s face it:  as much as airfare costs, people like to feel a bit pampered – or at least respected — when they fly.

To be fair, here are the rules I’ve given myself: My rankings focus only on airlines with which I personally flew in 2011, and only airlines with which I had at least two flights were included in the ranking list. I had at least eight flights each on three of the airlines which anchored the top and bottom of my listings – Delta, American, and EL AL, so I felt particularly comfortable in rating them.  (Because I didn’t have at least two flights on any Asian carriers, these airlines were omitted from the rankings, but I suspect that they would have received top scores if they had been eligible for inclusion.)

As a business person in the travel industry, I may be more sensitive than most to the airline that either goes the extra mile (no pun intended) or treats me with less than the utmost courtesy.  But success in the travel industry is based primarily on people’s perception of their customer service and how they are treated during a travel experience.  The 2011 best and worst airlines may have some lessons for all of us about how to do – or not do—business.  Let’s see who may care as we enter 2012.

Earlier this year, I experienced a sudden pulmonary embolism (PE), from which I am still recovering.  Having been extremely healthy all my life and a very active person, I was not prepared for becoming a temporary semi-invalid.  Part of my journey to recovery has been to learn all I can about the condition, so that I can have the best recovery possible and also educate other people about my own experiences. In this final article I wish to give a “shout out” and thanks to the hundreds of friends who rushed to my side and stood by me (literally) and via email and phone (got your messages even though I never answered the phone) and of course to Carol (who made sure we got the keys to the house) and to my children – Adina, Ilan, Gilad and Dafna who each have contributed to my recovery but more important to my education of Life with a PE and PE with Life!

My Story

As I’ve mentioned previously, having a pulmonary embolism was a complete surprise to me, because I am a freak of preventive medicine and was told I was in such good health.  Even with the benefit of hindsight, I find few of the risk factors associated with PE on my personal check list.  Because I don’t plan to become another statistic, I am committed to doing everything I can, however, to reduce the chance of suffering another and potential more damaging pulmonary embolism and also to educate as many people as possible about PE.  And so I have developed my own prevention plan, of sorts:

• Continue to follow healthy diet and exercise program. Now that I’m clear to resume all normal activities, I’m going to pick up the pace again at the gym (OK, I’m pushing myself already – perhaps more than I should – but I’m determined).
• Exercise increased travel precautions.  Airline travel is the linchpin of my business endeavors, so discontinuing extended travel is not an option.  However, I can make my travel safer by doing more in-seat stretching exercises and walk-around breaks.  I’m also going to break down and start wearing compression socks (CONFIDENTIAL) to decrease the potential for blood pooling in my legs (please don’t try and get a peak as they’re really quite nasty).  I’m going to drink even more fluids in-flight (and do my best to stay away from Diet Coke and no it’s not an opportunity for Pepsi to step in)). -
• Obtain comprehensive health assessment.  After having made inaccurate assumptions about my health risks before, I am averse to future surprises.  I’m currently undergoing a complete battery of all kinds of medical tests.  I find myself wondering if what happened was a possible warning sign for something else that is awry with my health.  Just knowing other potential health vulnerabilities will allow me to expand my own health promotion program to address any other relevant risk factors.
• Practice (a little more) moderation in my schedule.  An 18-hour work day sounds extreme to someone who doesn’t have my particular personality, metabolism, and joy in what I do.  But even cutting back a few hours per day will create less wear and tear on all my body’s resources.  Learning the fine art of relaxation may be a challenge, but I’m willing to give it a try!

So that’s my own plan.  Lesson learned:  be prepared.  What do the experts tell us that you can apply to your own health promotion and disease prevention plan?

Reducing Risks of Prolonged Inactivity

You can reduce the overall risk of pulmonary embolism to practicing habits that will reduce the likelihood of having blood clots form in your legs.  The single most common cause of deep vein thrombosis is prolonged inactivity – often associated with surgery, bedrest, or travel.  Follow these guidelines to lower your own risk:

• Avoid long periods of inactivityat work– If your job involves sitting at a desk, get up at least every hour or so and take a stretch break.  Flex your feet and legs, using the following exercise:  Point your toes up toward your head.  Feel your calves stretch.  Hold, then relax.  Repeat this frequently.
• Taking reasonable travel precautions – If you’re on an extended car trip, take at least hourly stretch breaks.  On plane rides, get up at least hourly to stretch or walk the aisle.  Practice your leg stretching exercises, as described above, as you sit.  If you are at high risk for PEs, use compression stockings or socks when you travel.  Always drink plenty of fluids to avoid dehydration, but stay away from alcohol or caffeine.  Wear loose-fitting clothes that don’t constrict your waist or legs.
• Taking reasonable post-surgical or bedrest precautions – Try to get up out of bed and begin moving as soon as allowed after surgery or an illness.  If you’re confined to bed, do the above leg exercises to keep your blood circulating.

Reducing Lifestyle Risks

Smoking, overeating, and leading a sedentary life are manageable risk factors associated with increased incidence of pulmonary embolism.  All three factors are also associated with a variety of other health risks, including heart disease.  For the best cardio-pulmonary health promotion, try to follow as many of these guidelines as possible:

• Eat a reasonable, low-fat diet;
• Avoid any use of tobacco;
• Drink moderately, if at all;
• Get 30 minutes to one hour of exercise at least 3-4 times per week;
• Avoid use of hormones found in birth control pills or hormone replacement therapy, unless they are prescribed to reduce other health risks.

Following Physician Advice

If there’s ever a time to listen to your doctor, this is it.  After a PE, you’re likely to be on a regimen of blood thinners for several months.  In order to get maximum benefit, it’s critical to take them as prescribed and follow up with blood work and physician appointments.

Listen to your physician’s advice about when to return to work, as well as other precautions you may need to follow, depending upon your own particular situation.

Conclusion

Over the past six weeks many of you have endured my writings about MY LIFE WITH PE.  In doing this writing I’ve had only one goal – TO TRY AND PREVENT JUST ONE PERSON FROM ENCOUNTERING A PE.  For those that have passed on any or all of the writingsIthank you and trust that the one person will be saved without any of us ever knowing and in doing so making thousands aware of this deadly killer.

As I stated at the beginning of this article series, the end of my story has not yet been written.  And neither has yours.  While no one knows for sure what the future holds for any of us, we can take the saying that “knowledge is power” and apply it to our personal healthcare.

It’s never too early to take an inventory of your own health and the lifestyle practices that inform it.  Waiting until a health crisis to take action is the least effective way of promoting your physical health and well-being.

I hope you’ll take some of my own lessons learned to heart (and to health):

• Pulmonary embolism (or insert your own choice of “disease of the day” here) can happen to anybody.  None of us are immune.
• Knowing the signs and symptoms of PE or any health problem for which you may be at risk, is critical, as timing is everything.
• Knowing your own degree of risk is crucial.  Feeling healthy does not give you immunity.
• Listen to what your body is telling you.  With medical providers, become a vocal health advocate for yourself, as you’re the expert, too.
• Healing takes time, and recovery is a process, not just an outcome.
• Be pro-active with your health. Choose the ounce of prevention any time.

And if you have travel insurance – Israeli or otherwise, don’t wait until you’re in the ER to determine whether it’s comprehensive.

Most people are not diagnosed with Pulmonary Embolism until autopsied.  I cannot tell you how many times I heard the word “lucky” when I was hospitalized.   Starting with the attending EER Physician who’s words I continue to hear – “You beat this one by 3 hours” and the assortment of doctors and nurses would come into my room and see me, sitting up reading, or perhaps blogging, all with a smile (often a painful one) on my face and some energy I had pre-PE and ask, “are you the patient?” as if someone else would willingly impersonate me at a time like that.  I was well aware of the severity of what I went through, but I WENT through it…time to move on.  I am literally a survivor and am trying to appreciate life differently now.  Whether you are a survivor, as well, have questions, or are a caregiver or support someone who has experienced a PE, feel free to comment.  There are times I will also need reassurance.  After all, recovery is a process and of course some days will be better than others.  I will surely look forward to your comments, especially then.

Those of you that know me — whether for 48 years or for 48 minutes – were probably shocked with the openness of my first article and that I continued to tell the story in the subsequent five.  As a very private individual I can say it wasn’t easy but I felt that it must be done

Finally, enjoy each second that life has to offer – whether it’s working, traveling, family time, or embellishing and furthering your faith.   Each second is truly precious.

Good luck on your own health journey, and wish me the best in mine, as my (NOT SO patient) recovery continues.Now, back to the private life.

Earlier this year, I experienced a sudden pulmonary embolism (PE), from which I am still recovering.  Having been extremely healthy all my life and a very active person, I was not prepared for becoming a temporary semi-invalid.  Part of my journey to recovery has been to learn all I can about the condition, so that I can have the best recovery possible and also educate other people about my own experiences.

My Story

Approximately six weeks after my hospital stay, I am clearly still healing and not fully recovered (thank G-d it’s not the way feel –  it’s just what I’ve been told).  For someone who has always enjoyed excellent health, this is a new and somewhat disconcerting place in which to find myself.  I continue to experience some difficulty minor breathing as well as pain in my leg (particularly at the gym which I’m not stopping and when sitting still for long periods of time –  like 15 minutes).  It’s anticipated that I’ll remain on Coumadin for at least six months – likely a year.

My lifestyle has always been enjoyable to me, but very fast-paced.  I have been accustomed to often working 18-hour days, flying all over the globe, multi-tasking and relishing every minute of it.  And yes, I must admit that I continued to try and work from my hospital bed (NOTE TO SELF – If needing to go to a hospital again check for WIFI availability) . Now I must await my doctor’s permission for me to resume a “completely normal lifestyle,” although I know that will mean taking scrupulous travel precautions and reducing my work schedule by a few hours per day.

Lesson (being) learned:  You don’t just “bounce back” from a major pulmonary embolism.  Now is the time for me to practice patience.  And gratitude (and more gratitude)!

Hospital Convalescence

Before you’re discharged from the hospital, your recovery plan is already beginning.  The medical staff will establish targets that must be reached before discharge can be considered.  They include:

• Having at least 72 hours of warfarin and/or heparin treatment;
• Having a therapeutic or close to therapeutic level of warfarin blood thinner;
• Having no signs of internal bleeding;
• Having no worsening of symptoms;
• Having strong vital signs and good pulse and blood pressure;
• Having no residual clots that pose a danger;
• Having sufficient heart health;
• Having good oxygen saturation in the bloodstream.

A follow-up appointment should be scheduled with either your primary care physician or a hematologist.  While you are on blood thinners, you will need to be seen regularly by your physician and receive frequent blood tests (non stop pricking and black and blue arms – so much for the summer tan lines – I have blood lines)  to check your levels.

Be assertive in your discussions with your physician.  Get clear instructions about what you can and cannot do once you are discharged, what preventive practices you should follow to reduce future risk, and what symptoms you should expect vs. those that may indicate a problem.

After Discharge: What to Expect

The single most important point you can remember is that everyone’s recovery is unique (and although I try – it’s not easy).  The speed and ease of a person’s recovery depends upon the degree of lung damage that was experienced, the presence or absence of other underlying medical conditions, the individual’s overall health, and the severity of the PE attack itself.  That’s why it’s so important to have frank discussion with your medical provider, so that you have realistic expectations about your recovery.

Some individuals are back at work within a week after hospital discharge, while others report significant residual problems a year or more after the pulmonary embolism episode.  By listening to what both your physician and your body tell you, you’ll be able to heal at the pace that is right for you.

Another important point that must be made: about half of all people who have one pulmonary embolism episode will experience future episodes.  This is not pointed out for the purpose of being pessimistic, but to stress the importance of having a good convalescence, followed by future preventive actions (which we’ll discuss later).

There are common residual symptoms which post-PE patients tend to experience.  They are often milder versions of the symptoms of a pulmonary embolism itself, which can be frightening if you don’t know what to expect.  Some of these symptoms include:

• Fatigue
• Breathing difficulties; e.g., shortness of breath
• Anxiety and/or depression
• Increased heart rate
• Chest pains

In the weeks and months after a pulmonary embolism, your body is using a lot of energy to heal both your lungs and your heart.  It’s understandable (to those who didn’t experience the PE) that you’ll feel more fatigued.  You’ll also probably find that you get sick more easily, as your resistance is down.  And experiencing milder versions of your initial symptoms is not uncommon.  You may also experience symptoms associated with your use of blood thinners.  The illness will also take a toll on your emotions.  You may feel like a ticking time bomb, waiting for the next clot to appear.  Or you may experience depression related to loss of control of your life and the self-perception of being an invalid.

Keep recovery symptoms in perspective, but discuss each of them with your doctor.  If any of them are severe or increase in intensity, it’s worth a trip to the emergency room.  Staff can check to see if any new clots have formed.

This may sound simplistic, but it’s important to take care of yourself.  While you need more rest, you also want to have enough physical activity to keep from being too inactive (a risk factor!).  Talk with your doctor about a gradual exercise program.  Make sure you get plenty of sleep, eat healthily, and try to keep as stress-free as possible (easier said than done).  Some individuals have found that a mild anti-anxiety medication helps.  For others, taking walks, listening to music, or learning meditation exercises may do the trick.  As a person accustomed to working up to 18 hours per day, I find this next recommendation difficult – but allow yourself extended sick leave from your work if that is what is needed to speed your recovery.

The good news is I’m told(and counting on) that after weeks or months of gradual recovery, most residual symptoms do subside or go away altogether.

Earlier this year, I experienced a sudden pulmonary embolism (PE), from which I am still recovering.  Having been extremely healthy all my life and a very active person, I was not prepared for becoming a temporary semi-invalid.  Part of my journey to recovery has been to learn all I can about the condition, so that I can have the best recovery possible and also educate other people about my own experiences.

My Story

After a week of ignoring my gradually worsening symptoms, Ilan(my son) took me (in reality forced me and in doing so saved my life) to the ER at the hospital (South Nassau Community Hospital – Oceanside, NY) I somehow had the presence of mind to recommend (from the choices which popped up on the GPS).  When I arrived at the ER, I was thinking peripherally about my health insurance.  I have Israeli insurance and I found myself wondering if this was the smartest choice – would I enter the ER door and have it cost me my life savings? But if I didn’t enter, would this mistake cost me my life?

After a few minutes of this cost-benefit analysis (isn’t the bottom line what it’s all about?), the doors to the ER swung open, and I was taken into the inner sanctum of probes, pricks, scans, and the always enjoyable peeing in a cup (the competitive soul I am I was hoping to get an “A”).  After a round of X-rays, I was told that they couldn’t find anything, and they debated about sending me home (actually the “A” was not wanted – I wanted to Fail at this point so I would understand the pain)

Thank G-d my instincts kicked in:  I told the attending PA that, while I didn’t normally frequent emergency rooms, nor was I a medical genius, I knew that something was wrong.  And now that I was here (and had worked through my financial misgivings!), they had better find what was wrong and fix it.   So they ordered a CT scan.  Lo and behold, they found three blood clots by my lung.  At 2:30 in the morning of June 27^th, 2011, I was admitted to the hospital – exactly 48 years and one week since the last time I was a hospital patient.

As for treatment, I was placed on a regimen ofHeparin to thin my blood and dissolve the clots.  They also tried to keep me comfortable with pain killers, but I’m usually a stickler about not taking medication.  The pain was so unbearable that I did succumb to taking the medication on two occasions.  I remained in the hospital for eight days, and didn’t require additional treatment other than the blood thinners (ultimately was weaned off Heparin to Coumadin which I can continue to take).

Lesson learned:  It’s important to listen to what your body is trying to tell you and get medical help.  The fact that I was insistent about the need for thorough testing led to the critical finding that ultimately saved my life (although Ilan who took me and Carol who encouraged him to do so are the ones who really save my life).

Obtaining a Diagnosis

Because many of the symptoms of a pulmonary embolism may resemble those of a heart attack, panic attack, or respiratory problem such as pneumonia, making an initial diagnosis can be a process of ruling out other problems.  A preliminary physical exam and medical history can help identify if you are at high risk for pulmonary embolism.  If your risk factors are high, the next step is to have testing done to look for blood clots or to rule out other possible disorders.

Some of the most common procedures to detect a PE include blood tests to check electrolytes and blood counts, electrocardiograms, spiral CT scans, MRIs, ultrasound, pulmonary angiograms, and venous Doppler checks on legs (where clots usually first form).

Treatment Methods

In the great majority of cases, the primary treatment regimen is a course of anticoagulant drugs, often referred to as blood thinners.  While they don’t actually thin the blood, they do help reduce the formation of new clots and stop existing clots from growing.  The treatment program often begins with an initial injection of heparin, a fast-acting blood thinner.  This medication is often followed by a type of warfarin, such as Coumadin, that is taken orally.  Once an individual is placed on warfarin, the course of treatment usually lasts several months.

When you’re on a schedule of blood thinners, it’s important to exercise precautions to prevent bleeding problems.  During a course of warfarin treatment, you’ll also be advised to obtain regular blood tests.

Luckily, most existing clots will usually dissolve on their own. For severe and life-threatening clots, other methods may be used, however.  A thrombolytic or clot-dissolving drug can quickly break up large clots, but the risk of serious bleeding is increased.

Another option for breaking up a large clot in the lung is through the use of a flexible tube or catheter threaded through the blood vessels. It can break up the clot with a few artful maneuvers.

For individuals who can’t take blood thinners or don’t respond to them sufficiently, a vein filter can be surgically placed in the inferior vena cava – the large vein that leads from the legs up to the right side of the heart.  Because deep vein thrombosis is the single greatest cause of pulmonary embolisms, having a filter in place to block moving clots can protect the cardio-pulmonary system and significantly reduce the incidence of PE reoccurrence.

Earlier this year, I experienced a sudden pulmonary embolism (PE), from which I am still recovering.  Having been extremely healthy all my life and a very active person, I was not prepared for becoming a temporary semi-invalid.  Part of my journey to recovery has been to learn all I can about the condition, so that I can have the best recovery possible and also educate other people about my own experiences.

My Story

The excellent health I have always experienced was the proverbial blessing and curse in my experience with having a pulmonary embolism (PE).  According to my doctors (and friends who are wanna be doctors and perhaps everything I’ve managed to find on the WWW), the fact that I was in physically good shape certainly aided in my survival, and I trust it continues to aid in my overall recovery.  However, my history of having great health and being physically fit lulled me into a state of denial about the very real medical crisis that was unfolding in my own body.  Because I was not very familiar with the symptoms of pulmonary embolism, I continued to attribute my growing problems to everything from stress to exhaustion – until my body sent me signals that couldn’t be denied.

When I say excellent health, it’s no exaggeration.  I had never been hospitalized since my birth 48 years ago. I strove to keep myself in good shape, working out at the gym 6-7 days each week (if you’re there chances are I’ve seen you), taking stairs instead of elevators, walking instead of driving and keeping physically active.  I never smoked, used drugs, or drank (except for the more than occasional Diet Coke – although tye attending ER physicians didn’t believe me — almost had to call friends to verify this fact), and used almost no medication in my lifetime.  I even obtained an MPH and an MBA with a focus on Health Administration, so I certainly knew the general do’s and don’ts of promoting good health.

In retrospect, the one risk factor that stands out for me is related to my work in the travel industry.  I spend hundreds of hours per year in overseas flights.  The so-called “economy class syndrome” of cramped seating quarters is a major culprit in clot formation (see below).  But I estimated that I upgraded at least 80% of my flights this past year with frequent flier miles, in order to take care of myself.  (I’ve idly pondered the chances of finding an attorney who could get my miles back from the airlines!)

Lesson learned:  Just because your health is good, it doesn’t mean that you’re not at risk for a PE.  Understanding your own risk factors can help you better recognize your own degree of risk.

Causes of Pulmonary Embolism

The large majority of pulmonary embolisms are caused by a blood clot or as in my case a series of clots creating a sudden blockage of an artery in the lung.  In most cases, the blood clot originated in the veins of the legs, broke loose, and traveled through the circulatory system to lodge in the lung.   Individuals who form blood clots in the deep veins of their legs may have a condition known as deep vein thrombosis or DVT.  Therefore, the single greatest cause of a PE is the presence of DVT.

However, a pulmonary embolism can be caused by a blockage created by something other than a blood clot, such as: fat from the marrow of a broken bone, tumors, air bubbles, and even amniotic fluid.

Risk Factors

Because the overwhelming majority of PE incidents are related to blood clots, particularly those in the deep veins of the legs, a look at risk factors should focus most on those elements most associated with such clots.  Avariety of factors can influence one’s risk, ranging from ones that are completely outside an individual’s control to those associated with lifestyle choices.

The most significant risk factors associated with both DVT and pulmonary embolisms are:

• Prolonged immobility – Blood clots are more likely to form in the legs during periods of greater inactivity.  If you have recently experienced extended bed rest or travel, you may be at greater risk.  Many PE episodes occur during recuperation from illness or injury or after a long plane or car trip.
• Medications – Taking birth control pills or hormone replacement therapy medications increase the risk of clotting.
• Diseases or disorders – Cancer, heart failure, stroke, and severe infections are all associated with increased risks of abnormal clotting.  Certain cancers, for example, can increase levels of substances in the blood stream that increase clotting, and chemotherapy itself can increase the risk.
• Surgery – Recent surgery involving the legs, hips, brain, or abdomen are associated with increased risk.  Hip and knee replacement surgeries are particular culprits, as they may release tissue debris into the bloodstream during bone prepping.
• Family history/genetics – Some individuals inherit a tendency to form clots too quickly.  Your family’s medical history is a significant factor in determining your own risk.
• History of recent pregnancy and childbirth—A baby’s weight pressing down in the pelvic veins can create pooling of the mother’s blood return and increase the incidence of clotting.
• Age–Older adults are at greater risk of forming blood clots, particularly above the age of 70.  Valve malfunctions, dehydration, and age-related medical conditions are all  contributing problems.
• Lifestyle issues – Individuals who smoke, are sedentary, or are obese have increased risk of pulmonary embolisms.  High blood pressure is an associated risk factor.

In another upcoming article, we’ll take a look at how some of these risk factors can be reduced or even prevented, but for now, it’s important to know your risk factors as a predictive or diagnostic tool.  The more you know your own risks, the more likely you’ll be to take appropriate action.

Earlier this year, I experienced a sudden pulmonary embolism (PE), from which I am still recovering.  Having been extremely healthy all my life and a very active person, I was not prepared for becoming a temporary semi-invalid.  Part of my journey to recovery has been to learn all I can about the condition, so that I can have the best recovery possible and also educate other people about my own experiences.

My Story

In my own case, I began experiencing pain and difficulty breathing almost a week before I was diagnosed.  At a Bat Mitzvah party given by friends, I noticed that I wasn’t able to dance the way I normally could.  I chalked this fact up to the fact that it was my birthday.  At the ripe old age of 48, I was either having psychological twinges or age was truly catching up with me.  I continued on with my usual schedule throughout the week, making excuses for the fact that I wasn’t feeling great at all; e.g., I was just stressed because summer is the busiest time of my year for work and knew that in 3 weeks time the pressure would let up. I traveled to New York with Dafna on Monday night and somehow managed to work despite the continual (and increasing) pain. Later in the week I made a presentation at my former synagogue in North Woodmere (NY), and when done I honestly couldn’t remember a word I had said – but somehow I got through.

By Saturday night I was feeling even worse, but attributed it to exhaustion due to missing my Shabbatafternoon nap, which helps compensate for getting only 4-5 hours sleep per night otherwise.I told Gilad that I really needed to get a good night’s sleep as I was wiped. On Sunday morning I continued to feel queasy and weak but went to the gym for my normal workout.  (I’m a pro at denial, apparently!)  But I was only able to complete about a third of what I normally do.  All day – while seeing groups off for the summer at the airport –  I felt weak and “out of it,” and found myself sitting down frequently to rest – something I never do.

That evening I went to dinner with my father-in-law and company along with Ilan and Dafna.  About an hour after we arrived, the pain became unbearable and un-ignorable.  It was truly like no other pain I’d ever experienced before.  Ilan insisted on taking me to the hospital, and by this time I was unable to argue (although I did try).  I had an obligation to “Roast” a friend (at was called the “2^nd Annual Stuart Katz Memorial Roast – did someone know something I didn’t?) and said after that was done I’d go to bed early – but my body (and Ilan – who proceed to Carol for consultation) knew better.

The fact that I tried to soldier on for a week while my body was telling me something was going seriously wrong put me in greater danger.  I was later told by the attending Emergency Room staff that I was literally within hours of death by the time I arrived at the ER.

Lesson learned:  Being able to recognize the signs and symptoms of a pulmonary embolism is critical, as timing can be everything in preventing serious damage or death.  Many people ignore symptoms until they are too late.  The death rate from a PE is still significantly high, largely because of delays in obtaining treatment.  Personally and most importantly – listen to your children and loved ones when you yourself won’t listen to your body.

Primary Symptoms

Depending upon the size of the clot, how much of your lung has been compromised, and your overall general health, your PE symptoms may vary significantly.  Obviously, individuals who have an underlying heart or lung disease are likely to experience more intense symptoms and be more at risk for severe lung or heart tissue damage or even death.

For most people, the most common symptoms are:

• Shortness of breath.  Regardless of whether you’re sitting quietly or being normally active, a sudden, unexplained feeling of breathlessness is a hallmark sign of pulmonary embolism.
• Cough.  In the absence of related symptoms, the onset of coughing is another common sign.  The coughing may produce sputum or mucus that is foamy and pink due to the presence of blood.
• Chest pain.  This symptom often causes an individual to feel that he or she is having a heart attack.  The pain is sudden and sharp, and usually worsens if one tries to cough, bend, breathe deeply, or eat.

Any of these symptoms is cause for alarm, but the presence of all three is a major indication that you are experiencing a pulmonary embolism.  If so, seek medical help immediately!

Associated Symptoms

In addition to the classic triad of primary symptoms listed above, there are other symptoms commonly associated with a pulmonary embolism that are frequently described as being similar to the sensation of a panic attack.  They may include the following:

• Rapid or irregular heartbeat
• Excessive sweating
• Feeling of being about to faint or being lightheaded
• Increased heart rate or palpitations
• Feelings of anxiety

If you have not been diagnosed as having panic attacks and you have any of the other acute symptoms such as shortness of breath, coughing, or chest pains, you shouldn’t attribute symptoms to “nerves.”  Get an expert opinion to rule out something much more serious.

Some individual also experience other unusual symptoms such as:

• Wheezing
• Bluish-tinged skin
• Weak pulse
• Swelling in the legs

Remember that pulmonary embolisms can occur in people who are otherwise quite healthy, so don’t ignore these symptoms, particularly if you experience primary symptoms and/or a cluster of several other symptoms.

What do tennis star Serena Williams, news broadcaster David Bloom, and TV pitchman Billy Mays all have in common?  They were all victims of a pulmonary embolism, and the latter two individuals died from it.  Pulmonary embolisms strike individuals of every age, health condition, and livelihood.  No one is immune from this often silent killer, to which about 15% of all sudden deaths are attributed.

Pulmonary Embolism Defined

A pulmonary embolism (PE) occurs when an artery in a lung becomes blocked by some material, usually a blood clot.  The most common cause of a pulmonary embolism is the movement into the bloodstream of a blood clot that has formed in the deep veins of the legs.  The tendency to form blood clots there is known as deep vein thrombosis (DVT).

The effects of a pulmonary embolism vary considerably, depending upon the size of the blockage and the length of time in which blood supply was restricted.  A large clot that completely stops blood flow to the lung can be quite deadly.  But even among survivors, no one escapes completely unscathed.

Small clots may have lesser residual effects, but recovery can take anywhere from weeks to months or years.  Lasting damage to both the lungs and heart may occur.  Lung tissue that is served by any blocked artery is damaged or destroyed, reducing overall lung capacity.  Pulmonary embolism can also cause a condition known as pulmonary hypertension.  Because the blood pressure in the lungs may become too high due to obstructions, it can “wear out” a portion of the heart.

Each year approximately 300,000 Americans are diagnosed with the condition, and an estimated 3-4 times as many individuals have the condition without receiving a diagnosis.  Worldwide estimates are difficult to assess, as diagnosis can only be definitive with the right diagnostic tools.  A death from pulmonary embolism is commonly reflected as a broader cardio-pulmonary problem.

And why are these facts and figures so important to me?  Because I quite unexpectedly joined the ranks of Williams, Bloom and Mays, and countless thousands of other individuals.  On June 26, 2011, when I should have been “roasting” my good friend Ben Rosenberg, I was diagnosed with pulmonary embolism, and almost became a sudden death statistic.

My Story

My profile is not the typical one for someone who just suffered a major health crisis – and perhaps that’s the whole point.  Judge for yourself:

Having just turned 48 (I know some thought I was older and others I was younger – but this is the age on my driver’s license), I had never had a major medical problem in my entire life.  My only trips to hospitals were to visit ailing friends or relatives.  I worked out rigorously and religiously 6 days per week, and enjoyed a full and happy life.  My career in the travel field, presiding over several travel companies has afforded  me the opportunity to fly frequently to countries all around the world, explore new cultures, and meet interesting people.  With one foot in the United States and the other at home in Israel, I had far-flung family, friends, and business associates who daily enriched my life.

I’m also a family man, soon to be celebrating 25 years of marriage to Carol, and proud father to Adina, Gilad, Ilan, and Dafna. On the day I was hospitalized, one of my daughters, Adina, was just heading off to Canada to work in Camp Moshava, and I was feeling particularly proud.  Ilan, who literally saved my life by taking me (making me go) to the ER – was in New York enjoying his final day before heading to work at a camp for children with Special Needs.  Gilad was in New York working for the summer and on this very day volunteering for (US) Customs and Border Patrol – and was at my side each and every day while in the hospital and Dafna was taking a breather from an unbelievable academic school-year before returning home for her continued summer adventures.  Like Carol and myself, all of our children have been active in volunteer work. Our family also takes great pride inactive expression of our Jewish faith, enjoying everything from affiliation with our synagogue community to hosting kosher travel tours around the world and of course at home in Israel.

So that is me before the moment of crisis:  a healthy, happy man, content with his family, his work, and his faith – secure in the knowledge of his good health and a bright future.And then the pain comes.  The days of hospitalization.The weeks stretching into months of recuperation.

Lesson learned:  It CAN happen to me, or to anyone.

In the series of articles to follow, I’d like to walk you through some of my own experiences with pulmonary embolism, as I share with you some important facts about:

• Signs and symptoms;
• Causes and risk factors;
• Diagnosis and treatment;
• Recovery; and
• Prevention

From my own experiences, I know that my lack of knowledge about the condition, combined with my denial about the signs my body was giving me, brought me to a medical crisis that came all too close to being fatal.  While normally reticent about my personal life, I hope that by sharing my own experiences and feelings, I may help someone else to avoid becoming a statistic.

If you don’t believe it can happen to you, neither did I!  So I hope you’ll join me on this story of lessons learned, of a sudden loss of health, and a still gradual recovery.  The end of my story isn’t even written yet, but with my strong faith and incredible support system I believe it will end with my health fully restored.

I hope you will take this journey with me.

I’m thinking about Romania as a possibility this year.  It’s certainly a country with a rich Jewish heritage, as well as a beautiful countryside to revisit.

Jewish History in Romania

The first Jewish settlers were believed to have arrived in Romania thousands of years ago, as part of Roman legions invading the region.  Then during the Middle Ages, immigrants settled in parts of Romania, followed by larger numbers from Spain after its expulsion of the Jews in 1492.  By the 16^th century, the Romanian Jewish community had evolved into a relatively large and prosperous group, and by the 1920s, almost 800,000 Jews lived in Romania.  After the later turmoil of the 20t h century, from the Holocaust to the Communist reign, the Jewish population decreased significantly  Only an estimated 9,000 – 15,000 Jews call Romania home today.  But in today’s Romania, you can still see traces of its proud Jewish heritage.  Nearly 100 well-maintained synagogues dot the countryside, along with more than 800 Jewish cemeteries.  I’d like to celebrate a Jewish festival day in a country which so tenaciously holds on to its heritage.

Today’s Jewish Community

Encouragingly, about half of the synagogues are in regular use.  Romanian anti-Semitism appears to be at an ebb, and the country’s relationship with Israel is stable.  Signs that the community is holding to its roots include Sunday morning programs on Jewish subjects, centers for historical studies, and Talmud Torah classes for youth.  Bucharest’s Jewish community is quite active, and there are outposts of Jewish culture scattered throughout the country.  As one measure of its stability, 10 different kosher canteens are in operation by various communities, and three ritual providers make kosher meat available.  The current resurgence in religious practice also is an encouragement to me as I consider a return visit to Romania.

Sightseeing in Romania

As a seasoned traveler, I would be less than honest if I didn’t admit that the pull of Romania is not just a religious one.  I always welcome any reason to spend time in a country with which I’m less familiar.  From my brief time there, I know what treasures Romania has to offer to a curious tourist.  Here are just a few of the sights on my must-see list:

• In Bucharest, the Choral Temple, built in 1857, features Moorish turrets and lavish interiors.  It’s the largest active synagogue in Bucharest today.  I’d also like to stop by the Museum of the History of the Jewish Community, which features books and artwork by Romanian Jews.
• In Islai, I plan to visit the National Theatre, decorated in French-eclectic style and featuring a renowned auditorium with excellent acoustics. I must re-visit the Great Synagogue of Iasi, the oldest surviving prayer house in Romania and second oldest synagogue in all of Europe.
• In Brasov, the Council Square is worth a stop.  Build by the Saxons with massive stone walls and bastions, it’s reputed to be the spot where the Pied Piper led away the children of Hamlin.  The Bran Castle, infamously known as Dracula’s Castle is also located in this Transylvanian mountain city.
• Piatra Neamt, situated in the Carpathian foothills, is home to the Ba’al Shem Tov Synagogue, a wooden structure built in 1766.

A Romanian Shavout Celebration

But the centerpiece of this trip must be an authentic Romanian celebration of Shavout.  I’m still learning about some of the rituals and customs. Somehow I’ve become most fixated on the foods!  I know that the typical palacsinta tortes (blintzes) are made in Romania with a mixture of mushrooms, lemon, dills, and cheese.  They also serve their mamaliga (polenta) with white cornmeal, to signify purity.  Given the diverse backgrounds of Romanian Jews, the cuisine is quite eclectic.

Most of all, I hope to attend prayer services at one of the historical Romanian synagogues.  And I’m practicing the Romanian version of the blessing that is said when the Shavuot candles are lit:

“Burikh Atu A-d-y-n-o-y E-l-o-y-h-a-y-n-I Melekh Hu-Oylum Asher Kiddshuni Be-Mitsvoysoyv Ve-Tsivuni Lehadlik Nayr Shel Yoym Toyv.

Burkh Atu A-d-o-y-n-o-y E-l-o-y-h-a-y-n-I Melekh Hu-Oylum She-Hekheyuni Ve-Kiyyemuni Ve-Higgiuni La-Zzman Ha-Zze.”

If you have any other suggestions for how I can enjoy Shavout in Romania, please let me know.

Sure Shabbat anywhere in the world is special.  It is Shabbat, after all, isn’t it?  But, how about enjoying the Sabbath in an exotic locale like India’s Pushkar?

Yeah, I thought you’d like that idea.

Pushkar is not only sacred on Shabbat, but a sacred pilgrimage site (one of five) for devout Hindus.  It’s one of the oldest cities in the country, dating back more than 60,000 years.

Throughout Puskhar’s long history (and its designation as a holy site) many Hindu temples were built.  Too bad during Muslim conquests many of them were destroyed; but many were rebuilt in the subsequent years.  One of the most famous is the Brahma Temple, a 14^th century building.

A few other temples to see while you’re out in the area are the Sri Sawai Bhoj Temple, the Varaha Temple of Rangji, and the most visited Varah Temple–dedicated to the god Vishnu.

Stroll along Pushkar Lake, considered a holy lake when a lotus was dropped Brahma’s hand personally.

Yet, as exciting as Shabbat in Pushkar is, it gets better.  How?  The Pushkar Fair is a famous 5-day Camel Festival every November; which brings more than a quarter of a million of visitors a year to see it.  At first glance you might just think its one big camel market, where thousands of camels are sold (or traded).

But, it is the way they’re traded & sold that makes this out of the ordinary.  They’re all decked out wearing silver and beads, jingling and jangling while they walk.  Even the camels’ noses are pierced.

Mostly this festival takes place in November, but it’s possible for it to fall in October as it falls according to the moon calendar.  The festival kicks off with a camel race, with music and shopping going on throughout the entire festival.  Competitions (like who’s got the longest moustache) and art & sport exhibitions take place, also.

Alongside the sacred Pushkar Lake, women set up stalls selling their wares of jewelry, fabric, and other bric-a-brac; all the while, men are still off selling or trading the ornately decorated camels.

Come to think of it, with that many people coming to Pushkar is it really a hidden gem?  I don’t care, but I do know I’ll be there in November for the Camel Festival.  Won’t you?