Eradicating Alzheimer's disease - if not now, when?

Are you hoping to live to at least age 85? If so, there's good news and bad news.

• The bad news - If you turn 85 in the next ten years or so, you'll have about a 50% chance of getting Alzheimer's disease.
• The good news - Researchers have never been closer to finding a cure.
• The unfortunate news - Alzheimer's research is inadequately funded.
• The hopeful news - Last February a bill was introduced in the U.S. Senate that would commit adequate personnel and resources to fighting this disease.
• The frustrating news - The bill went immediately to committee, which means it is competing with thousands of other bills for attention. Most bills die in committee.
• The scary news - The Alzheimer's Association projects that the number of people affected with the disease will increase by 50% over the next 20 years; by 40 years from now, it will have doubled or even tripled.

For me, Alzheimer's has a human face. The pictures on the left show my mother as a bride, a mother, a grandmother, and a great-grandmother. She died at age 85, a few weeks after the last picture was taken, after living for about six years with Alzheimer's. My father died four months earlier, the week before his 85th birthday, with the same disease. My mother-in-law suffered increasingly for about 10 years before dying with Alzheimer's at age 86.

I, for one, want to get this bill out of committee and onto the Senate floor immediately.

No time to waste
 We have no time to waste, say Sandra Day O'Connor, Stanley Prusiner, and Ken Dychtwald in "The Age of Alzheimer's," an op-ed piece in yesterday's New York Times:

Starting on Jan. 1, our 79-million-strong baby boom generation will be turning 65 at the rate of one every eight seconds. That means more than 10,000 people per day, or more than four million per year, for the next 19 years facing an increased risk of Alzheimer’s.

The authors argue that ignoring the oncoming wave of people with Alzheimer's is going to cost the government (and individual families) huge amounts of money. Adequately funding research, by contrast, could save trillions of dollars in Alzheimer's-related care by relegating "Alzheimer's to the list of former diseases like typhoid, polio, and many childhood cancers." Eventually Alzheimer's will be conquered - but "unless we get to work now, any breakthrough will come too late to benefit the baby boomers."

As a 62-year-old boomer myself, I would like to see this disease wiped out soon - not only for my sake, but also for the sake of my husband, children, and grandchildren.

Alzheimer's is a terrible disease. It isn't just Grandma getting pleasantly vague. As Alzheimer's progresses, a person no longer knows where she is or what she is doing there. She doesn't recognize friends, family members, or - eventually - even herself. Her emotions rage out of control. She may leave the house and wander strange neighborhoods, gather small objects and redistribute them throughout the house, forget what she is cooking and start small fires. She may become paranoid or even violent. And because she knows something is terribly wrong but she doesn't know how to get help, she is often depressed, angry, or frightened.

Some of my friends believe that the government should stay out of health care. Good health habits and private funding, they have told me, should suffice, and families should take care of their own. In dealing with Alzheimer's, however, those solutions are inadequate.

There is currently no way to prevent Alzheimer's. My parents, who both died with Alzheimer's,  did not get it because of bad habits. They ate a mostly vegetarian diet and never drank alcohol or smoked. They exercised regularly, walking three miles most days. They were sociable people who spent lots of time with friends. They were people of faith. They were well educated. They read books. My father even wrote books. The thing is, you can do everything on those how-to-prevent-Alzheimer's lists and still get Alzheimer's.

Few families are equipped to take care of a person in the middle or later stages of Alzheimer's. I wanted to take care of my parents myself, but Alzheimer's is not like other debilitating illnesses. People with Alzheimer's are a danger to themselves and to others 24/7. One daughter with two sick parents is not up to the task. One elderly father-in-law with one sick wife eventually needs help. Nursing homes can't do a good job on their own either. But a good nursing home or board-and-care home, working in cooperation with caring family members, can at least keep the patient clean, fed, safe, and somewhat socialized.

Unless one is very rich or dies very quickly, private funds will not cover the cost of necessary Alzheimer's care. Many families can't afford any paid help. If the wage-earners must continue working, they may have to leave Mom at home alone, hoping she won't get lost, set the house on fire, or break a hip. Middle-aged and older daughters often quit their jobs to care for an ailing parent, thus reducing their own retirement savings and Social Security benefits and making it more likely that their children will have to do the same for them.

My parents were fortunate - they had private insurance, including nursing-home insurance. Those funds, together with Medicare, Social Security, and their life savings, barely paid for their combined total of seven years of care, even though they received quite basic services in a nursing home that charged comparatively modest rates. (If a family wants to keep the patient at home and hire helpers, the cost is far higher.) If my parents had lived just a few months longer, I would have had to apply for public aid for them, in spite of their lifetime of frugality, saving, and wise decisions.

But there is reason to hope that one day Alzheimer's disease will be eliminated!

Researchers in the private sector are making tremendous strides toward eradicating this disease. A lot more funding is needed, however - not just for patient care (though that need is growing at an alarming rate), but especially for research so that patient care will no longer be necessary.

O'Connor, Prusiner, and Dychtwald compare Alzheimer's research today with AIDS research 25 years ago:

In the mid-1980s, when our country finally made a commitment to fight AIDS, it took roughly 10 years of sustained investment (and about $10 billion) to create the antiretroviral therapies that made AIDS a manageable disease. These medicines also added $1.4 trillion to the American economy. The National Institutes of Health still spend about $3 billion a year on AIDS research, while Alzheimer’s, with five times as many victims, receives a mere $469 million. 

That means we are spending 32 times as much on each person with AIDS as on each person with Alzheimer's, and with demonstrably good results - people with AIDS are living longer, and more money has been injected  into the U.S. economy. We were wise to commit to fighting AIDS. Now it's time - past time - to commit to fighting Alzheimer's as well.

What we can do today
If you've read this far, you probably have a personal interest in wiping out or containing Alzheimer's disease. Perhaps you already donate to the Alzheimer's Association. Consider contacting one or both of your senators as well. If one of them is among the 23 on the Health, Education, Labor, and Pensions committee where the National Alzheimer's Project Act is languishing, urge him or her to recommend its passage to the full Senate. If your senators are not on the committee, encourage them to schmooze with those who are. Here's what I've written to Senator Dick Durbin. If you wish to borrow any of my words when writing to your senators, feel free. You can find an easy-to-use e-mail form for contacting your senators here.

Dear Senator Durbin:

I'm writing in support of S 3036, the National Alzheimer's Project Act, which was introduced to the Senate last February 24, read twice, and referred to the Senate Committee on Health, Education, Labor, and Pensions.

Finding a cure for Alzheimer's disease would save untold billions of federal, state, and private dollars over the next 40 years as we boomers age and decline.

Without a strong federal commitment to eradicating the disease, however, a cure is unlikely to be developed before millions of people suffer and billions of dollars are spent, all unnecessarily.

I realize that you are not on the committee that is supposed to be studying this bill, but you know the people who are. You have consistently supported legislation that improves health and helps the needy. As an aging boomer and the daughter of two parents who died with Alzheimer's disease, I hope you will be able to influence your Senate colleagues to get S 3036 out of committee and to get moving on a strong national commitment to eradicate this tragic disease.

Respectfully yours,
LaVonne Neff

ALMOST FRENCH by Sarah Turnbull - and other books by people who straddle two cultures

Sarah Turnbull's Almost French is neither new (copyright 2002) nor unique, but it's an excellent example of a genre that never fails to attract me.

The set-up: an English-speaking writer falls in love with a foreign place or person, usually non-English speaking. Often impulsively, the English-speaker leaves home and moves to a country whose customs are quite different from his or her own.

At first the writer is thrilled and dazzled. Then reality sets in, and he or she discovers how very different the two cultures are. Food usually plays a major role in the story, as - often - does home purchase and repair.

Inevitably, the displaced Anglophone writes a memoir.

Well, it worked for Peter Mayle, an English marketer whose steady stream of books beginning with A Year in Provence set high standards for the genre. It also works for Sarah Turnbull, an Australian journalist who, entranced by a Frenchman she met in Romania, goes to Paris to visit him for a month. That was in 1994, and, as far as I know, she is still there.

One reason these two authors succeed at this genre is that neither is a navel-gazer. They write about their experiences, to be sure, but their focus is on France - the rural south for Mayle, contemporary Paris for Turnbull. Her life as an ex-pat is often lonely. Because at first she does not understand the French language, social customs, dress codes, family traditions, bureaucracy, or ways of getting around red tape, she is frequently frustrated.

At the same time, she loves "the heart-stopping beauty of Paris," its "history and tradition, passion and beauty, art and inspiration - everything that makes France a measure of civilized life." More prosaically, she also loves her sixth-floor walk-up apartment, good coffee and croissants, and even the neighborhood drunks who show "the rich diversity of life within a small circumference." She has a love-hate relationship with France, she confesses, "but it's charged with so much mystery, longing and that French specialty - séduction - that we can't resist coming back for more."

Nor can I resist coming back for more books about people who follow their dreams and become ex-pats in countries they will never quite understand. This is probably because I've had a taste of the ex-pat experience myself: as a teenager, I studied for a year in France, and in middle age, I worked for a British company. My best friend in grade school moved to Florence nearly 40 years ago and has lived there ever since. One daughter has studied and lived in Bogotà and Taipei; the other daughter has studied in Munich and Salzberg. A granddaughter is hoping to study in China year after next. My husband and I occasionally talk about retiring, at least for a year or two, in a foreign country (aren't new experiences supposed to keep brain cells young?). Given the current high price of the Euro, however, it probably won't be France or Italy.

Meanwhile, I love to read about people who straddle two cultures. Here's a list of other bicultural memoirs I've enjoyed.

• Bryson, Bill. Notes from a Small Island. Bryson, an American, lived for 20 years in the U.K. with his British wife. Here he describes his farewell tour before moving back to the U.S.
• Child, Julia. My Life in France. Love, food, France, and the indomitable Julia Child. What could be better?
• De Blasi, Marlena. The Lady in the Palazzo and various other memoirs about an American woman in Italy. Lavish, sensual, self-absorbed.
• Gopnik, Adam. Paris to the Moon. New Yorker essayist takes family to live in Paris for five years. Excellent and often very funny reportage.
• Keenan, Brigid. Diplomatic Baggage. Hilarious tales by a diplomat's wife who has been an ex-pat on several continents.
• Lenard, Yvone. The Magic of Provence.  Lenard, a French ex-pat who spent most of her adult life in California, writes about moving back to France. Instead of struggling for years (like most authors in this genre) to restore an old house, she and her husband simply hire a contractor and go back to California. When they return, their house is all ready for them. Now that is magic.
• Mayes, Frances. Under the Tuscan Sun and Bella Tuscany. Mayes is an American woman in Italy and Mayles is a British man in France, but otherwise their stories are similar.
• Robb, Peter. Midnight in Sicily. Robb, an Australian, lived in Sicily for 14 years. Here he looks at Sicilian food, history, politics, and organized crime. Among other things.
• Sanders, Michael S. From Here You Can't See Paris. An American spends a year writing about a village and its restaurant in rural southwestern France.
• Simeti, Mary Taylor. On Persephone's Island. American-born Simeti, now in her 70s, married an Italian professor in 1964 and still lives in Sicily. This now-classic ex-pat memoir was first published in 1986.

The estrogen bogeyman - why not to panic

Today's news brings yet another scare for women of a certain age. "Breast Cancer Seen as Riskier with Hormone," trumpets the oddly worded headline in this morning's New York Times, which summarizes the JAMA findings also released today.

No, this isn't old news, though it's based on the Women's Health Initiative study that was stopped several years ago because the estrogen-using participants kept coming down with dread diseases. Long-term results have recently been analyzed, and women who take Prempro are clearly at greater risk than women who do not.

But the headlines are misleading for several reasons.

First, the WHI studied only one form of estrogen--and it's the one most likely to cause problems. The WHI studied women using conjugated equine estrogens. These are laboratory produced hormones that are not biologically identical to the hormones produced in a woman's body. Premarin is based on the estrogens found in PREgnant MAres' uRINe, some of which are much more potent than human estrogens. It is somehow unsurprising to learn that long-term use of substances that do not naturally occur in the human body may have deleterious side effects.

Second, estrogen is probably not the culprit in increased breast-cancer risks anyway (though it may increase other risks). According to the National Institutes of Health, the risk does not apply to hysterectomized women who take only estrogen, not estrogen plus some form of progesterone. Since about 1/3 of all American women will have had a hysterectomy by age 60, that's a fair number of women who can apparently take estrogen without raising their risk of breast cancer - and who may need to do so, since they have lost their natural source of the hormone.

Third, biologically appropriate hormones are under-researched. Bioidentical hormones, though synthesized from plant sources, are "identical in molecular structure to the hormones women make in their bodies" (see this explanation and list of bioidentical hormone medications). Reputable studies of bioidentical hormones, however, are hard to find, and to my knowledge no longitudinal study comparable to the WHI study of Premarin and Prempro has ever been made. Are these hormones safer than hormones that do not match those our bodies naturally produce? A lot of women think so, but we don't know yet.

So what is a woman to do?

Well, if we don't need hormone replacement therapy, we certainly shouldn't use it. If we need it for hot flashes only, we should quit using it periodically to see if the need has passed. But if for some reason we need to use HRT for many years, we don't need to panic. Every medicine has potential side effects, and some risks are worth running.

To minimize the risks, we can look for hormone formulations that mimic human hormones. We can look for delivery methods, such as the patch, that appear to be safer than HRT in pill form. We can monitor those body parts that our HRT use may be slightly endangering.

And just maybe we need to consider our mortality. I'm not going to live forever. I can't avoid every possible risk. Even if I were able to give up absolutely everything that's bad for me, would I really be better off? Would I live longer, or would it just seem longer? Would I be healthier, or would I worry myself to death?

"If it feels good, do it," we boomers liked to say when we were young and immortal. Well, maybe that's not an entirely helpful philosophy. And yet feeling bad so as to avoid a very small risk may not be such a great philosophy either.

Several years ago I was explaining to a middle-aged doctor why I hoped she would prescribe an estradiol patch for me. "I have to tell you about all the potential problems," she told me. "But if anyone wants to take away my estrogen, they'll have to pry it out of my cold, dead hands."

THE CHARMING QUIRKS OF OTHERS by Alexander McCall Smith

If you're not already a McCall Smith fan, The Charming Quirks of Others - book 7 in the Isabel Dalhousie series - may not be the place to start. Most readers get hooked on the No. 1 Ladies' Detective Agency series (now up to 11 titles) before moving on to the first book about Isabel, The Sunday Philosophy Club, though the Dalhousie series is also a fine introduction to the man who surely must be Scotland's most prolific writer.

But if, like me, you're a confirmed McCall Smith devotee, you know without my telling you that, with his newest book, you're in for another evening or two of reading that's as comforting as a mug of hot chocolate.

Isabel, the kindly, rich, slightly snoopy, and incessantly worrying Edinburgh ethicist, has several things to think about. Will she be able to purchase the Raeburn portrait of her ancestors? How will she, as editor of the Review of Applied Ethics, deal with a presumptuous author she strongly dislikes? Can she - should she - help a woman she barely knows find out who has written an anonymous letter, and why? Has her niece, Cat, finally found a decent boyfriend? Is her fiancé, Jamie, having an affair?

The interwoven stories are fun - McCall Smith is a very funny writer. And Isabel's constant musings are delightful and, sometimes, thought provoking - McCall Smith is also a professional philosopher. Listen to Isabel thinking about why we are interested in genealogy, for instance:

Blood links, she thought; that was what it was about. However tenuous such links were, people regarded them as standing between themselves and the void of human impermanence. For ultimately we were all insignificant tenants of this earth, temporary bearers of a genetic message that could so easily disappear. We had not always been here, and there was not reason to suppose that we always would be. And yet we found such thoughts uncomfortable, and did not like to think them. So we clung to the straws of identity; these, at least, made us feel a little more permanent.

I love McCall Smith's storytelling and philosophizing, but even more I love his kindness. His characters are often odd and bumbling, but they mean well. They care for one another. They believe in forgiveness. They know how to love.

Isabel and Jamie, for example, having picnicked on Scotch egg pie and cucumber sandwiches, are now lazily talking. "You're very kind," Isabel says.

"Because I love you so much," he said. "That is why I like to be kind to you."

"And that is why I shall bring you all the flowers of the mountain," said Isabel. "For the self-same reason."

She went on to say something else, but Jamie found his attention drifting. He was feeling sleepy, for it was warm, and he could lie there for ever, he thought, listening to the sound of Isabel's voice, in the way one listens to the conversations of birds, or the sound of a waterfall descending the side of a Scottish mountain; sounds for which we cannot come up with a meaning, but which we love dearly and with all our heart, and loving anything with all your heart always brings understanding, in time.

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To read my reviews of other McCall Smith books, click here and then click on the titles that interest you.

Dear Candidate: Would you mind talking about your goals?

It's midterm election time. How are you going to vote? Well, it's obvious, isn't it? Your side - whichever it is - is the only one that will save America from utter financial and moral collapse. The other side - whichever it is - is full of liars and hypocrites controlled by unscrupulous cabals who, for financial reasons, are willing to ruin the common man. And woman.

I am so tired of political invective. I have come close to unfriending some very nice people on Facebook because they are always saying nasty things about the only party of truth and light, i.e., the one I favor. (Though nasty internet comments are certainly not limited to discussions of politics: I just read through a long list of vicious personal attacks that had to do with the genetics of an Airedale terrier.)

Can we for a moment lay aside our overweening sense of personal righteousness and talk reasonably about goals?

Politics is a process of people working together to achieve goals that are good for everybody. Often we agree on the goals, though we disagree violently about how to achieve them. For example, I imagine we all think that if Great-Grandmother develops Alzheimer's disease and becomes difficult to care for, she should not be left in the street to fend for herself. We probably agree that all children who have the capacity to read and write should be taught to do so. The vast majority of us think it's a good idea for a large country like ours to have an interstate highway system. Nearly all of us would like to live in an economy where jobs are plentiful and wages are adequate.

Where we disagree, of course, is how to achieve our goals, and a two- or multi-party system can stimulate our thinking by challenging our presuppositions and enlarging the range of options we consider. It's hard to believe, but several decades ago Democrats and Republicans often discussed issues respectfully and worked together to arrive at solutions. The Internet would allow us to do this again, if only we would stop calling names.

How are you going to vote in November? How about setting party labels aside and asking some goal-oriented questions of your candidates? And since many candidates are good at spinning their answers, how about setting campaign rhetoric aside and looking at what your candidates have actually accomplished in each area?

Here are ten goals that are important to me, with questions I need to consider:

1. Which candidate's policies are more likely to help people escape from poverty? (I put this in first place because I am a Christian, and the ethical issue that receives the most space in the Bible is concern for the poor. I believe each party has a valid contribution to make to this issue, and I'd like to see both parties make it one of their major goals.)
2. Whose policies are more likely to create long-term jobs?
3. Whose policies will have a better effect on public health?
4. Whose ideas are more likely to provide high-quality education for children of all socioeconomic levels?
5. Whose ideas will better help us restore our decaying infrastructure?
6. Who is more likely to handle finances responsibly, keeping budgets balanced and planning for the future?
7. Who is more likely to show responsibility for the environment, keeping in mind not only our present needs but also the needs of generations to come?
8. Who is least likely to bow to the special interests that are financing his or her campaign? Who is least likely to be influenced by lobbyists? For that matter, which special interests are behind which candidates? (Open Secrets is a nonpartisan site that will help you follow the money that is following your candidates.)
9. Who is more likely to make accurate public statements? (Fact Check is a nonpartisan site that helps to sort out fact from fiction.) Note: It is possible to make an inaccurate statement without lying, but you probably don't want either a liar or an ignorant person representing you.
10. Who has the better understanding of the common good - that is, that society depends on our working together, especially to help those who can't help themselves and to build that which we can't build alone - and not just on our getting the best possible deal for our individual selves?

I don't believe either party has a corner on morality, justice, truth, intelligence, or good will. There are a few people of integrity and a lot of scoundrels leading both parties. I'd like to see us stop bickering about means and get to the important questions - what are we trying to accomplish in our towns, counties, states, and nation? And how can we work together to reach those goals?

THE REVERSAL by Michael Connelly

Michael Connelly's newest book, The Reversal, is hot off the press, and—no surprise—it's another stunner. Jason Jessup is about to be retried after serving 24 years for murdering a 12-year-old girl. DNA traces taken from the body, it turns out, did not belong to him, and now the public is clamoring for his exoneration. LAPD Detective Hieronymus Bosch and attorney Michael Haller are convinced, however, that Jessup is guilty as charged—and extremely dangerous.

That's the first paragraph of my review, "Beyond Hardboiled: Michael Connelly's Dark but Hopeful World," in today's online edition of Books and Culture.

To read more about Connelly's 22nd crime novel, or to learn why it's OK for people with literary tastes to read this bestselling author, or for ideas on where to plunge in to his prodigious oeuvre - click the link.

Related post: I reviewed The Lincoln Lawyer (Connelly's 16th novel) here.

Which party is more likely to be in bed with Wall Street? or, A plague on both your houses

Are Barack Obama's policies ruining business? Some of my Republican friends think so. So I was interested to learn about financial reporter Charles Gasparino's newly published book, Bought and Paid For: The Unholy Alliance Between Barack Obama and Wall Street. I haven't read the book, and I'm neither analyzing nor recommending it. Its thesis interests me, however. A few lines from Amazon's product review show where it's going:

Gasparino draws on interviews with dozens of key CEOs and political players to trace the roots of Wall Street's twisted love affair with one of the most liberal presidents in American history. He shows how, for decades, big banks and big business have colluded with big government, thereby laying the groundwork for today's shady dealings, and how the same bankers Obama now publicly reprimands have supported him--not because he promises change, but because he promises business.

That's scary, especially when read alongside a recent New York Times article about Republican Congressman John Boehner, likely to be the next Speaker of the House. In "A GOP Leader Tightly Bound to Lobbyists", Eric Lipton writes that Boehner

maintains especially tight ties with a circle of lobbyists and former aides representing some of the nation’s biggest businesses, including Goldman Sachs, Google, Citigroup, R. J. Reynolds, MillerCoors and UPS.They have contributed hundreds of thousands of dollars to his campaigns, provided him with rides on their corporate jets, socialized with him at luxury golf resorts and waterfront bashes and are now leading fund-raising efforts for his Boehner for Speaker campaign, which is soliciting checks of up to $37,800 each, the maximum allowed.

So who's helping business more, Democrats or Republicans? Seems to me that elected representatives of both parties need to wear the full-disclosure T-shirts I recommended last month.

Perhaps the answer is found not in PAC donations and lobbyists' influence, but in how individual states are faring. If a state is hospitable to business, won't that result in improved finances, better incomes, lower unemployment? And if so, shouldn't a state's political leanings have something to do with its financial soundness?

Yesterday the website 24/7 Wall Street published "The Best and Worst Run States in America: A Survey of All Fifty." The report's authors noted that "well-run states have a great deal in common with well-run corporations. Books are kept balanced. Investment is prudent. Debt is sustainable. Innovation is prized. Workers are well-chosen and well-trained. Executives are picked based on merit and not 'politics.'” Taking data from a host of surveys, they came up with a formula that ranked each state "giving weight to metrics that are most important to prudent governance."

In a wonky mood, I made myself an Excel chart showing the states' ranks. I then added columns listing each state's choice of presidential candidate in 2008, the party affiliation of each state's governor, and the party affiliations of each state's two senators. What I found is that a well-run state can be Democratic, Republican, or a mix. So can a poorly run state. Though it appears that Democrats may have a slight edge over Republicans in good governance, we who live in Illinois--solidly Democratic and #43 on the list--must be careful about throwing stones.

Next month's primary elections will likely shift power in the direction of the Republican party. Will a Republican win rescue business from destruction at the hands of Democrats?--or, looked at another way, will it sell a defenseless populace to greedy Wall Street types?

The answer to both questions is that the elections will probably make little difference, since Democrats seem to be in bed with business just as much as Republicans are. Will a power shift help to put the states on a more solid financial footing? Again, probably not, since party affiliation doesn't seem to have a lot to do with a state's financial soundness.

“We basically have two bankrupt parties bankrupting the country,” says Stanford University political scientist Larry Diamond. Thomas Friedman quotes him in a recent op-ed piece, "Third Party Rising." Here is Friedman's proposal:

We need a third party on the stage of the next presidential debate to look Americans in the eye and say: “These two parties are lying to you. They can’t tell you the truth because they are each trapped in decades of special interests. I am not going to tell you what you want to hear. I am going to tell you what you need to hear if we want to be the world’s leaders, not the new Romans.

Hear, hear.

LET'S TAKE THE LONG WAY HOME by Gail Caldwell

One of my favorite memoirs is Caroline Knapp's Pack of Two: The Intricate Bond Between People and Dogs. It's also one of my favorite books about dogs, because Knapp, who knew how memoir should be written, tells us as much about dogs as about herself. The book is not self-indulgent, even though Lucille, her rescued German shepherd mix, in turn helped her come to terms with a series of devastating losses.

Pack of Two was published in 1998. In 2002, Knapp was diagnosed with lung cancer. Less than two months later, she died. She was 42 years old.

Gail Caldwell was Knapp's best friend. A memoirist and Pulitzer Prize-winning book critic, she and Knapp met at a literary gathering, but they bonded several years later near a duck pond where they had brought their rambunctious dogs. Both women enjoyed rowing and swimming. Both were recovering alcoholics. Both were driven introverts. They could talk for hours.

Let's Take the Long Way Home is the story of their friendship, their dogs, their personal struggles, and - eventually - Knapp's death. It is a nostalgic book, as memoirs often are, but it is not a downer. I recommend it to other bookish, dog-loving introverts who care deeply about their friends.