Before You Give the Clot-Buster: One New Question We Need to Ask

For years, when evaluating a patient for thrombolytic therapy, emergency clinicians have been trained to ask about blood thinners. There is now another medication history we need to know.

“Does this patient receive an infusion for Alzheimer’s disease?”

That seemingly small question may have major implications for emergency stroke care—and potentially for other emergencies in which thrombolytics are considered.

Infographic about considerations for administering thrombolytics in patients with Alzheimer’s disease, featuring details on anti-amyloid therapies and clinical scenarios.

A new generation of Alzheimer’s treatments

Two newer medications, lecanemab (Leqembi) and donanemab (Kisunla), are monoclonal antibodies used to slow the progression of early Alzheimer’s disease. Rather than simply treating symptoms, these drugs target amyloid in the brain and help the body remove it. Impact of Anti-amyloid therapie…

That is an exciting development in Alzheimer’s treatment.

But it creates a new challenge for emergency medicine.

Amyloid doesn’t accumulate only in brain tissue. It can also deposit within the walls of cerebral blood vessels—a condition known as cerebral amyloid angiopathy. Impact of Anti-amyloid therapie…

As anti-amyloid antibodies help clear amyloid, some patients develop ARIA: Amyloid-Related Imaging Abnormalities.

There are two major types:

ARIA-E involves edema or fluid leakage.

ARIA-H involves hemorrhage, including microhemorrhages and other bleeding-related changes.

Most ARIA is asymptomatic, but symptomatic patients may develop headache, confusion, seizures or focal neurologic deficits—the last of which can look remarkably like an acute ischemic stroke. Impact of Anti-amyloid therapie… Impact of Anti-amyloid therapie…

And that creates a potentially dangerous dilemma.

When ARIA looks like a stroke

Imagine this:

A 78-year-old man with Alzheimer’s develops sudden left-sided weakness. His last-known-well was 90 minutes ago. His NIH Stroke Scale score is 8. His noncontrast head CT shows no hemorrhage.

The team prepares tenecteplase (TNK).

Then his wife casually mentions:

“He gets an infusion every month for Alzheimer’s.”

Does that change anything?

It should at least make us stop and investigate. Impact of Anti-amyloid therapie…

Patients receiving anti-amyloid therapy may have underlying cerebral vascular changes that aren’t apparent on a routine noncontrast CT. ARIA is evaluated with MRI, and administering a thrombolytic to a patient with vulnerable cerebral vasculature may increase the risk of catastrophic intracranial hemorrhage. Fatal hemorrhages following thrombolysis have been reported in patients receiving anti-amyloid therapy. Impact of Anti-amyloid therapie… Impact of Anti-amyloid therapie…

Close-up portrait of an elderly man with white hair and a slight smile, wearing a checked shirt.

So are thrombolytics contraindicated?

This is where things get complicated.

There is not yet one universally adopted protocol. Recommendations differ, and practices can vary between institutions and even clinicians.

The American Heart Association Stroke Council has advised avoiding thrombolytics in patients receiving anti-amyloid immunotherapy until safety data are available. Published appropriate-use recommendations for donanemab recommend against IV thrombolysis without a pretreatment MRI unequivocally excluding ARIA. FDA guidance also emphasizes considering whether focal neurologic symptoms could actually represent ARIA-E before thrombolytic treatment. Impact of Anti-amyloid therapie…

That doesn’t mean we stop treating stroke.

It means we need to know who is receiving these drugs before making a time-critical reperfusion decision.

Mechanical thrombectomy may still be an option for appropriate patients. Neurology consultation, review of previous imaging and, when appropriate and feasible, rapid MRI may become increasingly important pieces of the emergency stroke pathway. Impact of Anti-amyloid therapie…

This isn’t only a stroke issue

Thrombolytics aren’t exclusive to stroke.

Consider a patient with a STEMI presenting somewhere without immediate PCI capability. Or a patient in shock from a massive pulmonary embolism.

Systemic thrombolysis may enter the discussion in either situation.

The indication is different, but the patient’s brain is the same brain.

The possibility of vulnerable cerebral vasculature and intracranial hemorrhage doesn’t disappear simply because we’re giving the thrombolytic for a heart attack or pulmonary embolism instead of a stroke. Impact of Anti-amyloid therapie…

The practical takeaway

We have spent decades teaching clinicians to look for anticoagulants before giving thrombolytics.

Now we need to recognize another category of patient: someone who may have unusually fragile cerebral vasculature because of Alzheimer’s disease and anti-amyloid treatment. Impact of Anti-amyloid therapie…

For EMS and emergency clinicians, the medication history needs to evolve accordingly.

When an older patient with Alzheimer’s or cognitive impairment presents with a possible stroke—or another condition in which thrombolysis may be considered—ask specifically:

  • Do they receive an infusion for Alzheimer’s disease?
  • Is it lecanemab/Leqembi or donanemab/Kisunla?
  • When was the last infusion?
  • Have they previously had ARIA?
  • Is prior MRI imaging available?
  • Has Neurology been involved before thrombolysis is given?

My ED checklist also includes considering alternative reperfusion options and documenting the risk-benefit discussion. Impact of Anti-amyloid therapie…

This information needs to be identified before the patient reaches the point of a thrombolytic decision whenever possible. That means educating not only emergency physicians, but also dispatchers, EMS clinicians, nurses, neurologists, cardiologists, radiologists—and patients and caregivers themselves.

A young woman and an elderly woman standing together on a beach, looking at the ocean. The elderly woman has short grey hair and is wearing a striped shirt, while the young woman is in a gray t-shirt and blue jeans. They are embracing each other, sharing a moment of connection.

One question worth remembering

Anti-amyloid medications represent an important advance in Alzheimer’s treatment. But as these therapies become more common, their effects will increasingly intersect with emergency care.

We don’t need every EMS clinician or emergency physician to become an expert in Alzheimer’s immunotherapy.

We do need them to recognize the medications.

So the next time you’re evaluating a patient with Alzheimer’s disease for thrombolytic therapy, don’t stop after asking about Eliquis, Xarelto or warfarin.

Ask about the Alzheimer’s infusion.

That one piece of medication history could fundamentally change the next decision you make.

~Steph

Infographic discussing considerations for administering clot-busting drugs in Alzheimer's patients, featuring information on new anti-amyloid therapies, their mechanisms, and associated risks.

Switzerland Day 17: Chocolate, Chocolate…and More Chocolate

This morning we packed up our chalet—another Airbnb win—and somehow managed to squeeze ourselves and all of our luggage back into the Hyundai Santa Fe. I’m still not entirely convinced the laws of physics weren’t temporarily suspended.

Before this trip, the one thing Lidia repeatedly said she wanted to do in Switzerland was tour a chocolate factory. She’s a bit of a chocoholic, so visiting Maison Cailler was at the very top of her Swiss bucket list. Fortunately, it was perfectly positioned to break up our drive from Les Collons to the Zurich airport.

Admission to the tour is 17 CHF (about $21 USD) for adults, 7 CHF (about $9 USD) for children ages 6–17, and free for children under 5—a pretty reasonable price considering how much chocolate was waiting for us at the end.

Chocolate replica of Maison Cailler

The museum itself is exceptionally well done. Upon entering, you’re handed an audio guide in the language of your choice. As you move through the exhibits, you simply hold it to your ear and tap it against each display to hear the next chapter of the story. Rather than listening to a generic narrator, you hear from the people actually involved in making the chocolate—from machine operators and chocolatiers to the artisans who still hand-decorate many of the confections.

The tour begins thousands of years ago with the Aztecs, who considered cacao a sacred gift from the gods. Their chocolate looked nothing like the sweet treat we know today. It was a bitter, frothy drink flavored with spices and reserved primarily for nobility and warriors. In the early 1500s, the Spanish conquistador Hernán Cortés brought cacao back to Europe after encountering it in the Americas. Once Europeans began adding sugar, cinnamon, and vanilla, chocolate quickly became a luxury enjoyed by royalty across the continent.

One of eight sequential rooms

The Swiss entered the story much later—but completely changed it. During the 1800s, Swiss chocolatiers transformed chocolate from an occasional luxury into the smooth, creamy confection we know today. Daniel Peter developed milk chocolate using condensed milk created by his neighbor, Henri Nestlé, while Rodolphe Lindt invented the conching process that gives chocolate its silky texture. François-Louis Cailler, the founder of Maison Cailler, was one of Switzerland’s chocolate pioneers, opening the country’s first mechanized chocolate factory and helping establish Switzerland’s worldwide reputation for producing exceptional chocolate.

Chocolate sculpture

After the educational portion of the tour, the real fun began.

Your admission ticket includes unlimited chocolate samples.

There is only one rule: you have to eat them there. No stuffing handfuls into your purse. No filling your pockets. No strategically loading up your backpack.

(I’m looking at you, Amir.)

#1BigSister and I attacked the tasting room together. We started responsibly with small rectangles of white chocolate before moving on to creamy milk chocolate squares, hazelnut-filled logs, and adorable milk chocolate cups filled with white chocolate. Somewhere around that point, I realized I had reached my chocolate limit—a sentence I never imagined I’d say. I found myself desperately wishing for a cold glass of milk and actually saying, “No thanks,” to more chocolate. There simply wasn’t enough room left to give the dark chocolate the attention it deserved.

As if unlimited chocolate tasting wasn’t enough, the tour conveniently ends inside the enormous chocolate store.

Amir grabbed a shopping basket and immediately began filling it with such enthusiasm that it looked like he was competing in one of those game shows where contestants have 60 seconds to throw as much as possible into their cart. Chocolate bars. Truffles. Gift boxes. Assorted pralines. If it contained chocolate, it somehow found its way into the basket.

Needless to say, we may have picked up a few gifts for a few special people back home in Virginia.

…assuming Amir doesn’t eat them before we get there.

Supermarket Sweep of Chocolate

We hit a bit of traffic after the chocolate factory on our way to Zurich. One fender bender involving a car and a camper van added about an hour to our drive. Fortunately, we had bananas in the car to keep everyone from getting too hangry, and they bought us just enough patience to make it into the city.

Is there anything left in the store?

For dinner, we set our sights on Hiltl, the world’s oldest continually operating vegetarian restaurant, as a nod to #1BigSister. She had been incredibly patient this trip. Spain is a paradise for meat lovers—jamón, chorizo, and every variety of sausage imaginable—but not exactly a vegetarian’s dream. She’s eaten more pasta with red sauce over the past two weeks than she probably cares to see again. Switzerland hasn’t been much easier, so tonight was her night.

Hiltl Vegetarian Buffet in Zürich

The restaurant was heaven for her. The all-vegetarian buffet featured cuisine from around the world: Japanese udon noodles, tofu curry, falafel, vegan chicken nuggets, French fries, grilled vegetables, fresh fruit, desserts, and countless other dishes. There had to be over a hundred options. The concept was simple—you filled your plate, took it to the register, and paid by weight.

Hiltl Vegetarian Buffet in Zürich

We were a little nervous the kids would enthusiastically pile their plates high only to leave most of it behind, but much to our surprise, every one of them cleaned their plate. Everyone was impressed by how convincing the vegetarian chicken nuggets were. We capped off dinner by sharing a dessert plate before making our way to the hotel.

Hiltl Vegetarian Buffet in Zürich

Tonight we checked into the Holiday Inn Express near the airport, and I have to say, it’s probably the nicest Holiday Inn Express I’ve ever stayed in. Over the years, I’ve accumulated quite a stash of IHG points from staying at the Holiday Inn Express in South Hill while working shifts at VCU Health Community Memorial Hospital. Those points paid for all three of our rooms tonight, making the stay completely free.

The hospitality was exceptional. At check-in they welcomed us with complimentary beers, hot chocolate, Coke Zero, and what seemed like an endless supply of Swiss chocolate. Check-in was effortless, and after a long day of driving, that was exactly what we needed.

Breakfast is included tomorrow morning, although with a 4:00 a.m. wake-up and a 4:30 departure, I’m not sure we’ll be eating much. We’ll certainly take advantage of the coffee. From Zurich we’ll fly to Brussels, then onward to Dulles before making the final drive back to Richmond. Travel days home are always long. Between the time change, customs, baggage claim, and then several more hours on I-95, it’s a marathon. Thankfully, we were able to book lay-flat business class seats for the overnight flight, which should hopefully allow us to arrive with at least a little sleep under our belts.

Cailler Chocolate Museum & Factory

Switzerland has been a fascinating country. More than once I found myself asking ChatGPT to explain some aspect of Swiss culture, beginning with the language. Switzerland has four national languages—German, French, Italian, and Romansh—and the country’s commitment to neutrality extends beyond international politics. Even domestically, they work hard not to favor one linguistic or cultural group over another. I even learned why Switzerland’s internet domain is “.ch” instead of something like “.sw.” It comes from the country’s Latin name, Confoederatio Helvetica, avoiding preference for any one of the country’s major languages.

Nighttime at Les Collons

The scenery here has been breathtaking. Everything seems to function with remarkable efficiency. At times, the people have seemed a bit reserved, although that’s probably an unfair comparison after spending nearly two weeks in Spain being welcomed as family by Lidia’s parents, relatives, and lifelong friends. Switzerland, in its own way, has been incredibly family-friendly. There are activities everywhere for children, transportation is seamless, everything feels clean and organized, and traveling here with three kids has been far less stressful than I expected.

I’m looking forward to tomorrow’s flight home. Airplanes have always been a place of reflection for me. There’s something about being suspended somewhere between one place and another that makes it easier to process everything you’ve experienced. Every vacation has a re-entry period, but after an 18-day adventure through Spain and Switzerland, stepping back into everyday life will feel especially strange. Fortunately, I have at least a day or two before returning to work, giving me time to unpack, catch my breath, organize the house, and ease back into reality.

I may write a short post tomorrow about the trip home, although travel days rarely make for particularly exciting reading. Before we wrap up this adventure, though, I want to thank a few people.

First, Amir deserves enormous credit. He was the principal architect of this entire trip, handling nearly all of the flights, almost all of the lodging, the rental cars, and the endless logistics required to move six people through two countries over eighteen days. Trips like this don’t just happen. They require months of planning, flexibility, spreadsheets, patience, and countless hours behind the scenes. He created something truly special for all of us, and these are memories our children will carry with them for the rest of their lives.

Second, thank you to Lidia and her family and friends in Autol. They welcomed us with open arms and treated us like family from the moment we arrived. They shared their homes, their meals, their traditions, their stories, and their culture. They taught us about Rioja wines, mushroom farming, village festivals, and the rhythm of everyday life in northern Spain. They gave us an authentic experience that no guidebook, tour company, or hotel ever could.

And finally, thank you to everyone who’s followed along with these daily posts. I originally started writing them simply so our family would remember the little moments years from now, but knowing so many of you have been reading along has made it even more enjoyable.

Now, if you’ll excuse me, I have #1LittleSister to wrestle into bed before our 4:00 a.m. alarm goes off.

Thanks for coming along on this adventure. Until the next one.

~Steph

Guest Post: Switzerland through the eyes of Evie

Today we got to Switzerland 🇨🇭 and I was so surprised when I figured out how cold it was compared to Spain 🇪🇸. At the airport we got 54€ at McDonald’s?!? We just got two large fries 🍟 and two large chicken nuggets 🐔. 

Free fries! 🍟

When we got to the cabin we quickly found the bedrooms and decided who would sleep 💤 where. Lidia went insane when she saw the hot tub 🛁. For some reason there was two chess boards,one big one small. 

At the end of the day we went to a pizzeria and there was a mini playground 🛝 for the kids. It is kinda confusing because some people speak English and some people speak Spanish and some people speak French and many others. 

I was going to do this post of 1 day, but I didn’t have time.however, we went ziplining on the tallest zipline in the world. 

Me getting ready to zip

I have like ABSOLUTELY NO IDEA HOW MANY CHAIRLIFTS WE WENT ON. It took a long time to get to the top of the mountain,but we had to wear GIGANTIC backpacks that only held 1 thing!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

At the end of the day,(4pm) we were going to go on the chairlift AGAIN TWICE but the person that ran the lift said that if we went up,we would have to not go back down on the lift. We were so glad he had told us,otherwise we’d have been stuck. 

We will be sad to go home but we have had so much fun. 

~Evie

Switzerland Day 16: Touching the Sky at Mont Fort

Today was all about going up.

Our destination was Mont Fort, one of the highest lift-accessible viewpoints in Switzerland, sitting at 3,330 meters (10,925 feet) above sea level. Getting there was an adventure in itself, requiring three different ski lifts.

Our three-part route in green

We started in Siviez (1,730 m) on a classic four-person chairlift to Tortin (2,050 m). From there, we boarded a large gondola—big enough not only for passengers but also strollers, dogs, and mountain bikes—which carried us to Col des Gentianes (2,950 m). The final leg was a smaller gondola climbing to the summit of Mont Fort.

Team Girls!

Of the three lifts, the old-fashioned chairlift was my favorite. Being out in the open, you could feel the cool alpine air, hear the rushing streams below, listen to cowbells echoing across the valley, and even catch conversations from hikers passing underneath. It was the longest ride and gave us plenty of time to soak it all in.

At one point we floated over a pasture full of cows, where two enormous bulls were locked in a battle while one particularly unlucky cow did her best to stay well out of the way. Nature’s version of reality television.

Cows with bells battle

One thing Switzerland does exceptionally well is efficiency. We bought our lift tickets once at the base, then simply scanned them at automated turnstiles before each lift. Every transfer was seamless.

Riding in the larger of the two Gondolas

Before boarding the final gondola, Lidia, #1BigSister, and I stopped to collect our zipline equipment. #1BigBrother and #1LittleSister were too young to participate, and Amir graciously volunteered to stay with them while the three of us tackled what had become the biggest adventure of the trip.

The Mont 4 Zipline claims several world records depending on how they’re measured, but what makes it unique is that it begins at one of the highest starting elevations of any zipline in the world. Watching people launch from the gondola below was intimidating enough that I briefly considered backing out. But I knew this was probably my one and only opportunity to do something like this, and I would regret letting fear win.

#1BigSister gets prepped

Before our scheduled launch, Amir wisely insisted we make time for the observation deck at the summit.

I’m so glad he did.

From the top, you can see the Matterhorn, Mont Blanc, the Grand Combin, and countless other Alpine peaks stretching in every direction. It is one of those places where photos simply cannot capture the scale.

The summit itself feels almost extraterrestrial.

View from the summit of Mont Font

The closest comparison I can make is that it felt like walking on the moon. There is almost no vegetation. Just rock, ice, glaciers, and patches of snow. Every now and then a lone butterfly would flutter by, leaving me wondering how on earth it had made its way to nearly 11,000 feet.

Adding to the surreal experience was the full-service (fairly fancy) restaurant perched near the summit. People casually enjoyed fondue, white wine, and long conversations while surrounded by a landscape that looked more like another planet than Earth. I couldn’t help wondering how they managed to get all the supplies up there. Gondola? Helicopter? Either way, it was impressive.

Fondue and wine at the summit

Then it was time.

Lidia went first.

#1BigSister followed.

I was last.

Lidia readies herself

I had planned to capture all three launches using my Meta glasses. Unfortunately, I couldn’t hear the recording chime over the wind. Instead of starting new videos, I accidentally stopped previous recordings and completely missed their launches.

Thankfully, by the time it was my turn, I had finally figured it out and managed to record my own ride.

The initial drop off the tower is over almost instantly before gravity takes over. Within seconds you’re flying at speeds approaching 60 mph (100 km/h). I quickly understood why they recommend long pants and a jacket. Even on a warm day, the wind at that speed is surprisingly cold.

They also provide goggles if you don’t have sunglasses because opening your eyes at those speeds isn’t easy. And if you make the mistake of opening your mouth, your cheeks inflate like a squirrel storing acorns for winter.

Zip line overlook

On previous adventures—whether ziplining at Camp Seafarer or paragliding in Costa Rica—I had been brave enough to strike the dramatic “starfish” pose with my arms spread wide.

Not today.

Today I held onto those straps for dear life.

The arrival was wonderfully anticlimactic. The braking system automatically slows you before you reach the landing platform, making for a smooth, gentle finish.

What surprised me most was how peaceful it was.

From below, it looks terrifying.

From the line itself, it feels surprisingly serene.

I’m incredibly glad I took the leap.

Afterward, the rest of the family rode the gondolas down to meet us. Our plan had been to celebrate with burgers at the restaurant beside the zipline station, but it happened to be closed. So we descended one gondola ride to Tortin, where we found a wonderful Italian restaurant serving pizza, lasagna, soup, sandwiches, beer, cider, and wine. Pizza is always a safe bet with our crew, and the attached playground made it an even bigger success.

The moon?

One thing we’ve noticed throughout Switzerland is that restaurants frequently include playgrounds, trampolines, or inflatable bounce houses. Families are clearly expected to linger.

Italian café at Tortin

At the same time, we’ve also noticed a cultural difference compared with Spain and Italy. In Spain and Italy, when one of our kids accidentally bumped into someone, it almost always led to smiles, funny faces, or affectionate interactions. Here in Switzerland, we’ve had several encounters where adults—particularly older adults—seemed noticeably less tolerant of even minor accidental bumps, including one on today’s gondola ride. It’s certainly not everyone, but it has been a noticeable contrast. Thankfully, the incredible playgrounds have more than made up for it from the kids’ perspective.

Cow counting from the lift

The drive back to our chalet was every bit as spectacular as the journey up.

Amir asked me to film a time-lapse as we descended the endless switchbacks. The winding mountain roads reminded both of us of driving through Crete several years ago. Amir has handled every mile of driving on this trip, and today he admitted these were the most challenging mountain roads he has ever driven. Coming from him, that got my attention. If he posts the finished time-lapse, I’ll come back and add it here because it’s worth seeing.

After our enormous Italian lunch, none of us were especially hungry for dinner. We simply picked at leftover cheese, sausage, bread, yogurt, and whatever else remained in the refrigerator at the chalet.

Tomorrow we leave the mountains behind.

We’ll pack up and begin making our way toward Zurich for the flight home, with one final stop planned at a Swiss chocolate factory along the way.

Gondola up to Mont Fort

Before this trip, I assumed that after more than two weeks away I’d be counting the hours until we got home. We usually travel for only ten to twelve days, and this has been our longest family vacation ever.

Surprisingly, I don’t feel ready for it to end.

I think I easily have another few days of adventure left in me.

But tonight the plan is simple: one last soak in the hot tub, finish the laundry, pack the suitcases, and get a good night’s sleep before one final Swiss adventure awaits.

~Steph

Switzerland Day 15: Underground Lakes, Medieval Castles, and Sticker Shock

Today began underground.

Our first stop was the Lac Souterrain de Saint-Léonard, the largest navigable underground lake in Europe. If you’re planning a visit, reserve your tickets in advance. The boats have limited seating, tours often sell out, and with timed entry, there was virtually no waiting once we arrived.

The tour itself lasts about 30 minutes. We had dressed in layers after reading that the cave stays cool year-round, and we were glad we did. The contrast from the summer heat outside was immediate.

Our guide was just 17 years old and effortlessly conducted the tour in French, German, and English. What an impressive young man. Switzerland’s multilingual culture was on full display.

Our rower and tour guide

The underground lake stretches roughly 300 meters (about 1,000 feet) and was discovered in 1943 by Swiss speleologist Jean-Jacques Pittard. At the time, the water level was too high for boats to navigate the cave. Then, in 1946, an earthquake created cracks in the cave floor, lowering the water level just enough to allow small boats to pass. Sometimes nature rewrites the tourist guidebook.

Before leaving, we wandered through the gift shop, which was surprisingly charming and definitely worth a quick look.

From Saint-Léonard, it was just a 15-minute drive to Sion, a beautiful valley town watched over by two historic landmarks perched on neighboring hills.

Château de Tourbillon

On one hill stands Château de Tourbillon, a fortified castle built between 1297 and 1308 by the bishops of Sion. Originally constructed as both a military stronghold and the bishop’s residence, it commanded sweeping views of the Rhône Valley and served as a powerful symbol of the church’s authority. Although much of the castle was destroyed in a devastating fire in 1788, its stone ruins remain remarkably impressive, and ongoing restoration continues to preserve this piece of Swiss history.

Basilique de Valère in the distance

Across the valley sits the Basilique de Valère, built between approximately 1100 and 1130. More fortress than church in appearance, the basilica served both religious and defensive purposes during the Middle Ages. It is home to one of the oldest playable pipe organs in the world, dating back to the 15th century, and has been an important pilgrimage site for centuries. Walking through its ancient stone walls, it’s impossible not to imagine the generations who climbed the same path long before us.

Inside the basilica

Amir was determined to tackle the climb to Tourbillon Castle despite the 90-degree heat and the altitude. The rest of us were a bit less ambitious. We settled into a café where the kids enjoyed ice cream while Lidia and I cooled off with Aperol Spritzes.

Not sorry

Eventually, Lidia and #1 Big Brother decided they wanted to join Amir after all. As Lidia wisely pointed out, she may never have another chance to visit this place. Opportunities like this aren’t meant to be watched from a café.

View of the valley from Château de Tourbillon

Meanwhile, the two girls and I finished our treats and opted for the gentler climb to Valère Basilica instead. With more shade and a slightly more forgiving ascent, it felt like the right choice for us.

As always, the climb proved worthwhile. Whether you conquer the castle or the basilica, the reward is the same: panoramic views of the valley, vineyards stretching into the distance, and the satisfaction of knowing you earned them. Everyone returned with huge smiles—and, of course, enough photos to prove their accomplishment.

On the drive home, we stopped at the grocery store to pick up dinner. One thing we’ve learned quickly is that Switzerland is breathtaking… and breathtakingly expensive. After paying 25 CHF (about $30) for each of two small plates of plain penne with tomato sauce for the kids at lunch, we unanimously decided tonight would be a home-cooked meal.

Town of Sion, Switzerland

Amir fired up the outdoor grill, cooking two kinds of Swiss sausage, chicken satay, and a spread of delicious sides. We finished dinner with chocolate biscuits from the chocolate factory we’ll be touring before we leave—a little preview of what’s to come.

Tomorrow promises another adventure as we head to Mont Fort to ride one of the world’s longest and highest zip lines. At nearly 0.87 miles long and speeds approaching 60 mph, it should be equal parts breathtaking and terrifying.

I’ll let you know which one wins.

~Steph