The Travel Heart Attack.

La Dolce Vita – the sweet life.  Just as James Gandolfini was beginning to enjoy his sentimental journey back to his ancestral roots in Italy, he died presumably of a heart attack.  His 13 year old son, Michael, found him in the bathroom of their hotel in Rome – apparently in cardiac arrest.  He died as medical people worked to save his life.  Why would this happen while he was supposedly relaxing on vacation?  According to one study I’ve read, the travel heart attack is not an unusual phenomenon and happens during the first two days of travel. Part of the cause may be jet lag as the body’s defenses are reduced but there is no conclusive evidence. A similar situation can arise during moving as well.  Anticipation of something new, a new home or life in a different country and the stress of preparation can combine to create rare challenges for the body.

Gandolfini suffered from a few risk factors: obesity, smoking and a fondness for alcohol.   He apparently had not had much medical guidance about his incipient heart problems, his weight nor his destructive habits.  If he had a calcium scan of his heart -- it might have uncovered problems which he could have taken precautions about.  Combine these with a disruption in the pattern of life -- skipping meals or medications, a change of climate, air quality, food intake and overdoing exercise (climbing stairs) after leading a sedentary life, and you are courting disaster.  The physical and emotional demands of travel can take a heavy toll.  Many of us tend to go on extreme diets prior to travel.  We buy new pieces for our travel wardrobe in order to look good as opposed to a desire to be comfortable. Where long flights are involved we change our schedule of eating, sleeping, exercising and taking medications.  Lack of sleep can be detrimental to our health by lowering our immune system and mental alertness. Often we see items on a menu which are tempting – we combine foods and alcohol.  According to news reports Mr. Gandolfini enjoyed two pina coladas with four extra shots of rum mixed with beer during his final dinner.  He ordered a large serving of rich foie gras followed by two orders of fried prawns with mayonnaise and chili sauce.  It’s possible that the meal was simply too much food and too rich, especially when combined with the alcohol.  He was a smoker and may have chosen the dining patio of his hotel in order to smoke.

The previous evening he and his son had dined al fresco at a restaurant in the Trastevere (across the Tiber) called Sabatini.  The problem with dining in that part of Rome is that there are no vehicles permitted in the area and diners have a tendency to linger too long and drink too much or walk too far before hailing a cab or reaching public transportation.  Some tourists think they can handle walking vast distances in Rome without tiring.  I once asked the restaurant to call a taxi and waited more than one hour in the piazza for the cab to arrive.  This restaurant has a huge patio which spills out into the piazza of Santa Maria in Trastevere.  Here, Mr. Gandolfini drank Campari and soda followed by red wine with his meal.  This is an engaging neighborhood mainly inhabited by blue collar workers who own motorcycles.  Being a salt of the earth type, Gandolfini was probably drawn to this particular neighborhood to be part of a group he truly identified with.

The most sensible way to enjoy a vacation is to follow a few simple rules.  Have a medical checkup prior to travel.  Don’t go on a drastic diet before your trip.  Pack and wear comfortable clothes and shoes without overloading your suitcase.  Do your homework by reading and researching your destination so you can be organized.  Make a list of priorities including places you want to visit, restaurants you want to try.  Get a street map and circle your hotel -- write the name and address of your hotel on it.  Don’t try to see too much or cover too much on any given day.  Don’t overeat and drinkplenty of bottled water to keep yourself hydrated.  Make time each day for a power nap of a half-hour.  Check with your concierge and ask questions before setting out for any monument, volcano, beach, museum, you-name-it. Take it easy, sit and enjoy the scenery.  You don’t need to be doing something every minute.  Avoid stress, relax and enjoy yourself.  Watch your alcohol and food intake.  Don’t put too much dolce in your Dolce Vita.