Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

Saturday, July 15, 2017

Abbronzatissima: Notes on the Allure of the Suntan in Italy


Baked In


Italians flock to the sea every summer starting in August and return in early September sporting dark tans. Sunbathing is baked in their DNA. Can you blame them? That Italy is surrounded by so much sea by my reckoning must compel Italians to seek it out ritualistically every summer, a ritual bordering on obligation.

Italians and tanning. The two words just seem to go together. 

It is well-documented that the allure of the tan follows changing notions of beauty (e.g., see references below). For most of human history when we have cared about what we looked like, light skin was considered more desirable. And today, there are many parts of the world where this is still true, typically in places where people with darker skin want to look lighter. Coco Channel is credited in Western culture with seeding the desirability of a tan in the 1920s. It just took a while longer before the idea took hold in Italy. The Italian economic boom of the 1950s, brought more money and more leisure time to Italians. What better way to enjoy that money and time then to vacation at the sea and to show your conspicuous leisure than by returning with a deep tan.

You may be wondering if there are other places Italians go on vacation. Yes, of course there are, but it's the beach vacation we hear about the most.

Data from Istat reveals that 57 million Italians traveled in 2015, and about 50% had as a destination the ocean or a cruise, 26% the mountains, and 28% a city. (Total percentage greater than 100% is due to multiple destinations or trips.) Furthermore, in 2015 the percentage of total travel, 42.5%, occurred during the summer. The tradition of taking vacation during Ferragosto (mid-August) is still strong in Italy.

Every morning between July and September, we sit in our local café and listen. The subject of vacations, beaches, and tans are always a topic of conversation.  It’s roundly noted if someone from the neighborhood should walk in sporting a caramel-colored tan – usually smartly paired with white linen for maximum impact. The brown one is expected to tell all: who, what, when, where, and how. Besides talking about the best way to sunbathe - prendere il sole in Italian - the account is not complete without a few horror stories about crowded beaches and chance encounters.  I’m not saying this doesn’t happen in the United States, just that it seems to be more common and noticeable in Italy.

If a stranger enters the café sporting a chocolate-brown tan (Dutch processed?), heads turn, and tongues wag. The locals want to know from where cometh that fabulous tan, but restrain themselves until after the person has left. There is protocol after all.

The sense of pride emanating from the owner of a dark leathery-brown tan is palpable as well as the awe from those looking at it. Untanned skin just doesn’t evoke the same response.

In late spring, Italians who can get a jump start on their tans at the sea, do so. Those that can’t might visit a tanning salon, which are more common in Italy than I had ever imagined. Then, in the late summer and early fall, Italians start lamenting the loss of their tans. Again, those that are able, might sneak in a weekend getaway to a beach. And those that can’t, might prolong their tan artificially. It’s all in the name of the “bella figura” and “good health”, both illusions that actually don’t have much to do with the color of your skin.

So White


Our first summer here was a bit of a shock for me. I felt for the first time a sort of color discrimination when I was confronted with the exclamation: “You are so white!” I’m not talking about having heard it just once; I’m talking about many times. My whiteness, or lack of a tan, was a subject of many conversations.

Now we are in our second summer in Bergamo. We just returned from the north (Copenhagen and Stockholm) and the first words out of a friend’s mouth when I walked into the café was: “You are still so white!” Even if that friend was born in a different country and doesn’t have the baked in Italian DNA, the cultural significance of the tan has nonetheless infiltrated her thinking.

I admit it: I put on sunscreen to protect my face, neck and forearms, but rarely on my legs. And, I admit it’s for health and vanity. While I like the idea of reducing my risk of skin cancer, it's more important to avoid that burnt, crinkly-looking neck and décolletage when I’m older. I’ve already taken enough sun damage from when I was a kid with years of blistering summer burns and peels.

Paradoxically, people here often say I look younger than my age and ask “Why is your skin so nice?” I used to explain about my precautions in the sun, but it ended up being a buzzkill for most conversations. Now, I’ve taken to just saying “thank you, I don't know.” I have to work hard to hold my tongue when the question-cum-complement comes from a sun-tanned smoker.

Lest you think I have never been to an Italian beach in summer, rest assured I have. We went last summer in August and sampled a few beaches in Puglia. We enjoyed our little ol' pale selves with sun hats and SPF 30. We were focused on swimming and enjoying the water, not lying on the beach. We frequented swimming spots that were secluded and well out of sight of the beaches for hire and their endless rows of lettini e ombrelloni. Now, the question is: were we avoiding the crowds or were we too embarrassed to show our white bodies?

Just the other day, we hiked the Resegone mountain near Lecco. As we approached the high point of the mountain, Punta Cermenati, we encountered two Italian men. They had taken off all their hiking gear and with just skimpy shorts they were lounging at the peak and soaking up the sun. We approached timidly with our Tilley hats, sunglasses,  and our skin as covered as much as we could bear to block the sun. (By the way, nothing says FOREIGNER in Italy like a Tilley hat. I don't give a damn because those hats are so useful.)

In 2008, four young Roma (Romani) girls went for a swim on a beach near Pozzuoli, Naples and got in trouble. Two of the children were saved and two drowned, 11 and 12 years old. The bodies of the two victims remained on the beach for an hour before they could be removed. The driver of the emergency services was reported to have been struck by the indifference of the people on the beach as he collected the bodies. La Repubblica reported that the people on the beach continued to eat and sunbathe as if nothing happened:"i bagnanti hanno continuato a pranzare e a prendere il sole, come se nulla fosse successo." The reportage of the time indicated that the indifference was due to ill will between Roma people and Italians. Just perhaps, the reporting overlooked the simple fact that to leave the beach or otherwise be disturbed by the events would cost valuable time in the sun.

Music to Tan By


Summer songs, like all songs really, deal with the universal theme of love: lost, found, or rediscovered. But what about summer songs dealing with the beach and tanning? If we could devise a theme-o-meter for songs, would we notice trends in songs mentioning tanning corresponding to societal views of tanning? I was wondering about this earlier this summer when I started catching strains of the classic Italian summer song “Abbronzatissima”.

Casual Reader Exercise: From a representative number of Italian songs from 1950 to 2000, catalog songs by major and minor themes, and list all keywords words used. Then, search for repeated themes and keyword frequency. If applicable, plot themes and keywords in time similar to Google Books Ngram Viewer.
Aside: There is a project called Building a Corpus of American Song Lyrics that proposes doing exactly this for American music. We could not find a similar effort for Italian music, but we did find a limited effort to create an archive of some pop music between approximately 1950 and 1990.
Though the Google Books Ngram Viewer isn’t for music, we can see how often the words abbronzatura, tintarella (two terms used meaning tan) appeared in Italian books between 1900 and 2000. Here’s the similar query for tan (with inflections) in American English books for the same time period. The searches show something similar: that mentions of the words grow somewhat linearly in the 1940s, 1950s, and 1960s, and then exponentially in the 1970s, finally tapering off in the 1990s. I wonder if the tapering has to do with the advances in understanding the effects of too much sun exposure.

Until a corpus of Italian songs is available for us to search and resolve the burning question of beaches and suntans in Italian pop music, we will leave you with a few of our favorite 1960s summer songs to tan by. (I'm kind of stuck in that era of Italian music. In the café we frequent, there is an older gentleman, Lino, who remembers these songs and others from the 1960s. Often, we can be heard singing together.)


Album cover for Abbronzatissima.Album cover for Stesso spiaggia, stesso mareAlbum cover for Sapore di sale.Album cover for Tintarella di luna.Album cover for Sei diventa nera.
Album covers for Italian summer songs from left to right: "Abbronzatissima", "Stessa spiaggia, stesso mare", "Sapore di sale", "Tintarella di luna", and "Sei diventa nera".

“Abbronzatissima” (1963) – Edward Vianello
[video] Abbronzatissima roughly translates to “little tanned girl”. Besides being a catchy song (in Italian the word is tormentone) with the way Vianello rolls his r’s (“la erre bella marcata”), it also has the telling line:

“Quando il viso tuo nerissimo
tornerà di nuovo pallido,
questi giorni in riva al mar
non potrò dimenticar.”

These lines translate to “when your dark face turns pale again, I will not forget these days by the seashore.” (Nera or black here should be interpreted as dark.) The lines above remind us that going on vacation to the sea often involves a romance. The perfect summer romance and the perfect summer tan.

“Stessa spiaggia, stessa mare” (1963) - Piero Focaccia
[video] Another hit from 1963. In this song, Focaccia sounds like a bratty ten-year old taunting us over and over with “the same beach, the same sea”. In the song, he’s hoping to rekindle last summer’s love.

“Sapori di sale” (1963) - Gino Paoli
[video] And another hit from 1963. What was up with that year? You’ve got to love the black and white video for this classic song from Paoli, which is all about the taste of the sea, salty lips, and lazy days in the sun. This was one of the very first Italian songs that stuck in my head such that I can almost recall all the lyrics from memory.

“Tintarella di Luna” (1960) - Mina
[video] In this song, Mina takes a different tact by getting a tan (tintarella) by the light of the moon. I like to imagine that she was reacting to the suntan craze and picked this song, originally written for another group, as a statement, but that's probably false. More likely, Mina picked the song because she thought it would be a great hit, and hit it was: it became her big breakthrough. A few lines from the song:

“Tintarella di luna,
tintarella color latte…
e se c’è la luna piena
tu diventi candida.”

These lines translate to “suntan from the moon, suntan milky colored, if there is a full moon you will become pure white”. A goth suntan?

“Sei diventata nera” (1964) - Los Marcellos Ferial
[video] I think this song might have well been an early rally call to alert us about tanning dependence. The singer seems to poke fun at his tan-obsessed girlfriend who only wants to impress the folks back home.
“Con gli occhi socchiusi
tu pensi soltanto
a quando gli amici
rimasti in città
tornando dalla tua villeggiatura
diranno tutti che tu
Sei diventata
nera nera nera.”

These lines translate to “with your eyes closed you think only of when you return from your holiday and your friends, who stayed in the city will say how dark you've become”.

References


Wikipedia


Websites



Books

Tuesday, September 15, 2015

Hindsight

The fluorescent yellow and lime green walls of a Mexican restaurant in Ellensburg are forever etched in my mind. It’s mid-May 2015, and Mark and I are there on our way to officiate a wedding in Central Washington. While we wait for our food to arrive, we talk about what could go wrong in front of the 150 guests, and that I keep seeing little black spots in the periphery of my vision. We joke that the restaurant is full of flies, and we laugh it off as a case of overworked eyes. We tuck into our tacos, not understanding the warning sign that -- in hindsight -- seems as obvious as the glaring wall colors.

Early one morning a week after the wedding, I am standing in front of the bathroom mirror. My vision has steadily deteriorated to the point where I struggle to use a computer or read. In the gray light, I do something I've never done before: I check one eye at a time. I learn that what I thought was a general vision problem is really a problem with my left eye. Staring at my reflection with just my left eye, the right side of me disappears into a gray blob. Part of me is not there.

I mope around the house with my new discovery, but take no action. Mark though isn't having any of it; he sets up an appointment for a checkup with our optometrist. On the ship of my health, I'm not the captain, more a helpless deckhand. Writing this now, I want to reach back in time and slap myself.

The day of the checkup and the following ones blurred together in a series of doctors, waiting rooms, and dread as my eyesight worsened and we did not know the cause or what to do.

On a Tuesday afternoon in early June, we are with Dr. Doan, a short, confident UW Eye Institute fellow. She specializes in diseases of the retina. The exam room is midnight blue, full of expensive equipment and a large model of an eye. Dr. Doan jumps around the room in her white coat getting me ready for an exam.

"Look to the right buddy," Dr. Doan says as she stares into my eyes with one her instruments. She calls me "buddy" and shoots from the hip. She uses the eye model to give Mark and I a 101-intro to the world inside our eyes, introducing terms like macula, fovea, and cone cells. 

I've come to believe that learning new vocabulary in a medical setting is rarely a good thing.

Dr. Doan describes the macula -- the prime real estate of the eye as she calls it -- as resembling an open book viewed from its bottom or top edge. The two sides of the macular book curve up and fall into the binding crevice. The area around the crevice is the fovea, which contains cone cells responsible for sharp central vision. My left eye looks like a book that someone left out in the rain, warped and wrinkled, not smooth and not functioning fully.

Left: An open book. Center: Cross section of inflamed macular area. Right: Retina with lesions.
An open bookCross section of inflamed macular area.Retina with lesions

Looking at a three-dimensional scan of my left eye, Dr. Doan delivers the news in a matter of fact way, as if she were perusing a menu: my cone cells are gone and are never coming back. A sick feeling wells up in my stomach, similar to the one several minutes later when she inserts a needle into my left eye to deliver antiviral medicine directly to my warped book.

Dr. Doan tells us a much as she knows. The black spots -- my flies on the wall in the restaurant -- are floaters, which are often immune cells clumped together, my body protecting against an invader. The damaged area of my left eye is the ground zero of the invasion. Dr. Doan can see the battlefield, but she doesn't know who the invader is. She is puzzled and curious, a detective at heart. She talks about what we can rule in and rule out. Even more sobering is her focus on "saving" my right eye. I feel more desperate than ever to find out what my immune system is battling inside my eye and to not lose any more vision. Why did I wait so long?
~~~

The detective calls two days later. She has an answer. The blood work she ordered revealed that we are dealing with toxoplasmosis. Toxoplasmosis is a parasitic disease caused by the single-celled organism Toxoplasma gondii. The etymology of the name gives clues to its look and history; toxoplasma refers to the crescent-shaped form of the cells, and gondii refers to the gundi rodent in which the parasite was first identified over 100 years ago.

Most people know toxoplasmosis as the pregnant-women-shouldn't-clean-cat-litter-boxes disease. The prevalence of toxoplasmosis in the U.S. is between 20 and 30 percent, with most cases being asymptomatic. Unfortunately, mine isn't.

I've been immunosuppressed and living on the edge for years dealing with ulcerative colitis. Onboarding this parasite, along with a host of other problems, has always been a possibility. I mistook my luck up to this point for invincibility perhaps. If I got something, I reasoned, I could beat it with modern medicine. Dumb luck or not careful enough, I ingested the parasite's cysts and didn't understand the symptoms until too late. Dr. Doan says my case is atypical, but that doesn't make me feel any better.

The treatments I've had up to the diagnosis focused on a viral cause. Toxoplasmosis is a parasite and doesn't respond to antiviral drugs. So I find myself once more on my back looking up and watching Dr. Doan bearing down with a needle, this time full of an antibiotic for my embattled eye. After she is done, I'm sweaty and white as a ghost. "Breathe buddy, breathe," she says. 

~~~

Since the toxoplasmosis attack, my change in vision dictates that I slow down and rethink daily activities like cutting fruit for breakfast, walking, working in the yard, and reading. The future includes long-term antibiotics, regular visits to check my eyes, protecting my good eye, and getting to know what to look for in the next possible outbreak. Yes, the parasite hunkers down, quiescent, in the scars bordering the battlefield and waits. No one knows what will trigger the parasite to resurrect itself and attack again.

Through it all, I'm puzzled why I waited so long to act. In fact, I didn't act at all. It was Mark who did, making the initial appointment that started the process of healing, or, more aptly, stemming the tide.

When I got the diagnosis, my engineering instinct kicked in to analyze sequences of events, assign probabilities, and counter-productively, assign blame. Did I prioritize my health too low? Did my doctors warn me enough about being immunosuppressed? Is there a flaw in my prioritization of what's important in life? Was I not educated enough to recognize the signs? Was I too cocky about my health?

I was mired in hindsight. As the urge to rewind the tape and replay the events fades, acceptance and foresight slowly replaces hindsight. I mentally prepare for a relapse of toxoplasmosis or threats from other serious infections such as from listeria or tuberculosis. I rehearse advice I've noticed I now give freely to others, which is this: don't wait to ask when it comes to something about your health.

When I wake in the morning now, I instinctively test my eyes. In my left eye, the gray spot shows up, fuzzy and dead center. Has it grown? Is my right eye okay? In the seconds it takes to run through these tests, a compressed version of those uncertain months -- from noticing the problem to halting its advance – passes through my mind. It’s but a glance in the rear-view mirror because my eyes are now squarely on the road ahead.

Tuesday, September 1, 2015

Amsler Grids

Isn't it funny how something you never heard of before can suddenly become a big part of your everyday life? That's what happened to me with Amsler grids.

It started on a warm Thursday morning, May 28, 2015. I was finishing up with my optometrist -- the first stop in a long journey to discover why I was losing vision. My optometrist was puzzled and referred me to a retinal specialist.  As I got ready to leave the office, his white-jacketed assistant handed me a few sheets of paper containing Amsler grids. I stared at them for moment before realizing their purpose.

Named in honor of the Swiss ophthalmologist Marc Amsler (1891 - 1968), the eponymous grids test defects in vision, in particular, macular degeneration. The macula of your retina is responsible for central, high-resolution vision. Macular problems manifest themselves as warped or missing Amsler grid lines. To use an Amsler grid, you stare at it with one eye. If the grid lines misbehave and don't intersect at right angles, then you’ve got a problem.

Marc Amsler
A handful of doctors’ visits after my first encounter with Amsler grids, I learned that I had contracted toxoplasmosis in my left eye. My body mounted a fight and retinal cells in my macula were the collateral damage. If I had known about Amsler grids, would I have caught my vision problem earlier? Possibly. Detecting eye loss problems early is what the Amsler grids were designed to do.

On an Amsler grid, my vision loss manifests itself as a gray hole in the grid with minimal warping. The missing vision is in the space from the center of my left eye to my nose. My brain does the best it can without the information from the missing retina cells, hence a gray spot.

An Amsler grid is simply a sheet of graph paper. That's not to downplay the time Amsler likely spent testing and arriving at this simple diagnostic test. The genius of the Amsler grid is that it turns the subjective into objective. How you use it is what matters. The grid reminds me that checking my eyes is important: every day and everywhere. I see Amsler grids in mullions on windows and doors, stripes on walls, and fences. Even a telephone pole can work as a simple Amsler test.

Now that I know about Amsler grids, I routinely pull out a fresh grid and check my vision, sketching the contours of the missing vision. Looking at grid results over time helps me keep track of what my vision is doing. If the warping changes or grows, then it may be that the toxoplasmosis parasite has awoken and is on the move.

The Ophthalmology Hall of Fame biography suggests that Amsler may have been inspired to create the grid by fellow Swiss ophthalmologist Edmund Landolt (1846 - 1926). However, the biography doesn't give much more detail on how Amsler arrived at the grids. Likely, the complete story rests in private notes and correspondence somewhere, out of sight. All I have for now is the image of Amsler accompanying the biography. In the photo, bow tie askew and wearing a white lab jacket, Dr. Amsler smiles at us from the past. I imagine him saying, "Did you check your eyes today?"

Results of Amsler grid tests showing loss of left eyesight.