You…to the Rescue

Is there someone whom you have become accustomed to seeing on a daily basis?  What would you think if one day they weren’t there? And then a second day passes without seeing them…what would you do? 

A pizza delivery driver in Tennessee made headlines recently when she went the extra mile by checking on a regular customer whom she had not heard from in several days.  She made a visit to her elderly customer’s home and when the door went unanswered, she called the police for assistance.  When they entered the home, they found the elderly woman had fallen a few days before and could not reach a phone to call for help.  The pizza delivery driver earned well-deserved attention as a community hero – as one who cared enough about an elderly customer to take action. 

Many elderly and disabled people live alone and rely on the kindness of relative strangers for day-to-day contact:  their mail carrier, the newspaper delivery person, or the volunteer who arrives with their daily meals.  Some of us make it a routine part of our day to call and check on another who lives alone.  And of course there have been similar instances when an everyday hero saved a life by being observant and taking action when they suspected something was wrong.

What if the elderly or disabled individual does not have day-to-day contact with anyone?  There are other life-saving options, including life-alert systems that can be worn as a bracelet or necklace and easily activated if a crisis occurs and phone contact is not possible.  There are also service agencies that can be hired to make daily phone contact; they use a predetermined protocol if the individual does not answer the phone.  More information on these systems may be found at your region’s Area on Aging or senior center.    

If you know of an elderly, ill, or disabled individual who lives alone, what warning signs should alert you?  Generally, the trouble signs are an absence of activity or a break in routine: you fail to see the person, calls or doors go unanswered, and their homes show no sign of activity.  Calling police for assistance is the wisest approach before you attempt to enter the home.

When Doctors Lie

Doctors and other health professionals should never lie.

We accept that as an almost sacred truth.  But reality suggests something quite different.  Doctors lying to patients – either by commission or omission – is both more common and more “ethically gray” than we might think. 

Sometimes, doctors lie out of a sense of altruism or patient protection.  They believe they need to shield a patient from hard truths, particularly if the patient is dying.  Sometimes, the doctor – accustomed to seeking a cure – is simply unable to accept that a condition is incurable, or that additional treatment won’t make a difference.

Sometimes, doctors lie for their own motives.  They may be seeking loopholes in the informed consent laws, or they may want to get patients to agree to a course of treatment that would be conducive to insurance reimbursement.

Some patients ask their doctors to lie.  They may want an HIV diagnosis left off their records (including their death certificate).  They may not want a doctor to report that an injury was the result of a DUI.  They may ask the doctor to change the date of a diagnosis to avoid pre-existing condition insurance traps.

Some families ask doctors to lie to patients (their loved ones).  They believe that Mom is too frightened or feeble to handle her diagnosis. 

Some doctors lie because the issues are ethically and morally complex.  A doctor may feel he needs to assure a patient that he’s chosen a great surgeon, despite knowing that the surgeon has a past history of substance abuse.

Are there occasions when a doctor should lie?  Or when an incomplete disclosure might be justified?  When a doctor is simply uncertain of a patient’s prognosis, should that be part of full disclosure?  More important:  who should decide the answer to these questions?

There are no simple answers because no two patients or families are the same.  Yet the enormous weight of evidence suggests that medical lies have harmful and often uncontrollable consequences.  When doctors decide to protect a patient, they may run afoul of the law (in not reporting true circumstances) or – more likely – they rob a patient of the autonomy to determine the right course of action for his life.  Doctors who protect patients from the severity of their own conditions -- even at a family’s impassioned requests – are denying the patient the opportunity to make important decisions about his treatment and his quality of life.  Far too often, this results in aggressive, prolonged, and ultimately counterproductive treatments simply because no one has compassionately and forthrightly spoken with the patient.  Even patient denial is not sufficient cause for lying (denial of the severity of a medical condition is often an early phase of coping).

It is also true that most medical training does not sufficiently help doctors and healthcare professionals communicate hard and sensitive truths to patients and their families.  It is hard to assess what a patient can emotionally bear; some of the strongest patients crumble at the prospect of surgery.  But emotional assessment is as essential to medical treatment as physical assessment.  Both are the physician’s responsibility.

If you suspect that a physician is not being fully honest with your loved one, there are a few steps you can take:

• Talk to your loved one and gently assess how much he really knows.  Many patients know far more about their conditions – and far earlier – than we (or their physicians) think.  On the other hand, no matter how much you know and love your parent, spouse, or sibling, their preferences, not yours, must be respected.  If a patient steadfastly refuses to hear the truth, that is something you must respect.  Be aware that your loved one’s views may change as a condition worsens, which is why continuing, clear communication is so necessary.
• Talk to the doctor.  Respectfully voice your concerns and your experience with what your loved one has indicated they know…or want to know. Listen to his response; he and your loved one may have had a discussion before this time concerning how to deal with specific situations.  Also, the doctor-patient relationship is a protected one unless the patient (your loved one) has signed a release that the person they have specified may be informed of the particulars of their condition.
• If you make no headway with the physician, speak to a nurse, social worker, caseworker, or hospital administrator.  Express your concerns clearly and respectfully and ask them to intercede. Be aware that the burden of proof is yours – proof that the patient wants to know the truth about his condition, and proof that the doctor has not been fully disclosing.

Deadly ‘Little’ Lies

Most healthcare professionals and experienced caregivers know that patients lie.  They may “embellish” the facts; leave out a detail or two; or “forget” some inconvenient truth.  They may lie about how much they smoke, drink, eat, or exercise.  They may lie about how faithfully they take their medication.  They may lie about symptoms or problems they are experiencing.

A recent Johns Hopkins study demonstrated the gap between what patients say and what they do. When patients with breathing problems were given specially monitored inhalers, 73 percent of them claimed to be using the inhalers three times a day, but only 15 percent of them did.   

Many patients lie without intending to, consciously at least.  They may not see an “omission” as dangerous because they figure it is a detail too small to mention.  Or they may be on their best behavior – reducing alcohol intake, taking their meds, exercising – in the days before a doctor’s appointment, convinced that they’ve been on their best behavior.

Even small “omissions” of details can have devastating consequences, however, leading to delayed or wrong diagnoses, too many or too few medical tests, dangerous intermingling of medications, and potentially deadly results.

With all this at stake, why would our loved ones lie to those charged with protecting their health?

• Shame.  They may feel embarrassed about how much or how little they eat.  They may be embarrassed to admit they are taking a tranquilizer. 
• Denial.  They may not even admit to themselves they drink as much as they do. Or that they are having anxiety attacks.
• Guilt.  They know they are supposed to be walking every day, and they haven’t been.  They know the danger of smoking – yet they can’t kick the habit.
• Desire to be a “good” patient.  They don’t want to complain, or admit that a treatment regime is not working.  They don’t want to waste the doctor’s time – or yours -- by appearing to have more problems.
• Fear of offending the caregiver.  They don’t want to admit it hurts when you lift them, or that the home-health arrangements you’ve made aren’t working.
• Fear of losing insurance coverage.  Some patients will mask symptoms, or pretend to be following orders for fear that the insurer will deny them coverage.
• Fear of their physician or caregiver.  If a physician or caregiver is harsh or judgmental, the patient may react by concealing information or giving the answers they believe will result in positive reactions.
• Protecting family members.  Patients – particularly children and the elderly – may lie about bruises or weight loss to cover family or caregiver abuse issues.

What can you do if you suspect a loved one is concealing important medical information? 

• Monitor what you observe about how well your loved one is following medical instructions.  Don’t accuse without educated observation.
• Talk to your loved one about your concerns, without casting judgment.  Accusing your husband of lying about his smoking is unlikely to improve the situation.  Asking nonjudgmental questions with a measured tone will lead to a better exchange.
• Talk about the importance of telling the truth – and the consequences for not doing so.  “If we don’t tell the doctor you are taking Xanax, he might prescribe medication that will have a terrible side effect on you.”
• Assure your loved that there is nothing he or she can tell a physician, nurse, or healthcare professional that will be offensive or inappropriate.  The physician is not insulted to hear that the patient has not been following instructions, or offended to hear that pain has returned. 
• Be loving and supportive.  Statements like “I will help you explain what you are feeling,” or “I will help the doctor understand why this is a problem for you” can pave the way for more honest exchanges.

Is it ethical to intervene with the physician, nurse, or professional caregiver and “tell the truth” if you loved one isn’t?

• Not without telling your loved one your intention first.  “Dad, if you don’t tell Dr. Stevens that you are still experiencing leg pains, he cannot help you, and I love you so much that I’ll tell him.”  If you let your loved one know what you’ve observed and why full information-sharing is essential, this conversation will go better.

• Not in a way that humiliates or casts judgment on your loved one or the healthcare professional.  “Dad is lying about his drinking again,” will not improve the situation, nor will “Dad is afraid of you, Dr. Johnson.”  If you are caring for an adult loved one, you must recognize (as hard as it is) that he is ultimately in charge of his own life; infantilizing them will not result in better health outcomes. 
• Absolutely yes, when the loved one in question is a dependent child or whenever concealing a medical situation will result in imminent danger. 

 

The situation may be more easily handled if you have a private conversation with the physician or a member of his/her staff beforehand.  You might want to suggest that your loved one fears “wasting” the doctor’s time, suggest what types of questions may elicit more truthful responses, or explain the need for your loved one to have a better discussion of consequences.

If your loved one is consistently withholding information from a physician, the relationship will not work for either of them. It may be time to seek a new physician or to talk to a nurse, social worker, home health aide, or caseworker who may be able to mediate between the two.

The Power of Protein

Many caregivers often ask me as why their loved one is not getting stronger, why they are so tired all the time, and why their wounds are not healing.

While there may be many reasons and physicians should be consulted when these concerns persist, one common cause of these complaints is a dietary deficiency.  When individuals are recovering they often have poor appetites so they choose to eat small amounts of food, miss meals or choose foods with limited nutritional value. Many will choose toast and tea, or crackers and cookies and juice as their daily sustenance. 

What is most often missing is protein, an essential building block for our bodies.

Protein is crucial for our bodies to function no matter our age.

What do proteins do for our bodies?

• They are essential for building and repair of body tissues
• They are vital for the proper function of enzymes, hormones, and many immune molecules are proteins
• They enable essential body processes such as water balancing, nutrient transport, and muscle contractions.
• They are a source of energy and strength
• They help keep skin, hair, and nails healthy
• They are absolutely crucial for overall good health.

What can happen when there is not enough protein in our body for an extended period of time?

• Our muscles lose their elasticity and deteriorate, we feel weak and sluggish
• Our immune system weakens and we become more susceptible to infections

• Our wounds take longer to heal
• Our blood sugars fall, our cholesterol rises, anemia occurs
• Our blood pressure falls, our circulation falters, water retention occurs
• Our vision fails, our nervous system weakens
• Our stomach can develop ulcers, constipation occurs
• Our liver and kidneys also can be permanently injured.  

What are good sources of protein?

• Meat: Chicken, turkey, beef, veal, lamb, pork and venison all contains significant amounts of proteins. Beef products and dark poultry meats are higher in fat.

• Fish and Seafood: These products are one of the best protein sources and are usually lower in fat. Salmon contains somewhat high quantity of fats but it is known for providing essential omega-3 fatty acids, which are beneficial for heart.

• Dairy Products: Milk, yogurt, cream, cottage cheese and other cheeses are rich sources of proteins. They also provide calcium and essential vitamins. They help keep teeth and bones strong and prevent osteoporosis. If you select skim or low-fat dairy products, they are helpful for weight loss and have a lower fat content too.

• Eggs: Normal healthy adults are advised to eat an egg daily. They are an excellent source of proteins.

• Legumes/Beans and Nuts: These are the best source of proteins for the vegetarians. ½ cup of beans consists of proteins equivalent to that of 3 ounces of broiled steak. Beans are also loaded with high amounts of fibers.  Cashews, almonds, lima beans, lentils, red kidney beans and tofu are rich in proteins.

The caregiver’s dilemma is often related to how to improve their loved ones food intake. Small frequent meals are a good choice with selections that are healthy and protein rich.

Here are just a few suggestions: 

• Add a small handful of cheese to a serving of scrambled eggs, top a cup of chili with some cheddar cheese, or include a piece of cheese on a sandwich
• Combine a chopped hard boiled egg with tuna or chicken salad
• Serve cottage cheese with fruit
• Provide peanut butter or cheese with an apple, make a snack of peanut butter and jelly on crackers, or a daily dose of a chocolate covered peanut butter cup
• Snack on nuts, especially  walnuts and almonds
• Supplement a favorite beverage with a scoop of protein powder or serve an already prepared supplemental drink.

  

Send me your ideas for adding proteins to your loved one’s diets.

The Spice of Life

We all look for ways to spice up our cooking, to add variety to everyday meals.  Seasoning your foods with herbs and spices may also help to decrease the amount of salt, fat and sugar you use without sacrificing flavor.  Adding spices to your meals not only enhances the flavors of foods, recent research suggests that it may also help fight disease.

Allspice, cinnamon, and cloves have considerably more antioxidants than blueberries.  A tablespoon of oregano is comparable to an apple in antioxidant power.  New studies at the University of Georgia are demonstrating that many other common spices have the ability to neutralize inflammatory responses that contribute to cardiovascular disease. 

Other spices have shown potential in disease prevention, too. Turmeric and sage are being studied for their ability to improve brain function.  Chili pepper is being researched for potential weight control by increasing metabolism and decreasing appetites.  It is important to remember that these spices are still in the preliminary research stage. 

Cinnamon – for most of us a kitchen staple -- has been in the news recently for its ability to improve our health in a variety of ways:

• Some research has shown that blood sugars may be controlled for those with type 2 diabetes simply by adding cassia cinnamon to a daily regime.  Cinnamon can also interact with other dietary supplements in lowering blood sugar levels.  It is very important to monitor blood sugar levels closely if adding cinnamon to a daily regime.
• Cholesterol and triglycerides levels were lowered with as little as ½ teaspoon of cinnamon a day, studies have demonstrated, but caution should be taken not to overdo it -- too much of a good thing can irritate lips and mouths and high quantities can harm the liver.
• Additional research at Wheeling Jesuit University has noted that cinnamon may boost your memory and brainpower.

Cinnamon as a treatment is not recommended for children, pregnant or breastfeeding women, and those with hormone-dependent cancers like breast cancer.  The use of any spice in more than usual amounts (sprinkled on toast or added to a latte) should be discussed with a physician to avoid interactions with other medications being taken.

Adding these spices will liven up your menus and may improve your health.  So spice it up!   

 

How Sweet It is

Many of us are moving away from chemically-laden products and back to more natural substances. The cure for many ills may be right on your kitchen shelf:  thick, rich, golden honey.  The healing powers of honey have been recorded since ancient times.  Egyptians used the thick syrup to heal their wounds and to preserve their dead.  Honey is frequently mentioned in the Bible; it was referred to as a wholesome food, a helpful medicine, an ingredient of delicious drinks, an appropriate gift and a valued possession.   

Yet only recently has science been able to prove the benefits of honey.

But all honey is not created equal.  The honey that has been approved in current studies for the healing of burns, chronic wounds and chronic sinusitis infections is Manuka and Sidr honey.  Manuka honey is from the manuka bush, also known as the “tea tree bush” from Australia and New Zealand (priced online at $36/17 ounces).  Sidr honey comes from the Sidr tree in Yemen; the tree is referred to in religious texts as sacred.  It is one of the world’s most expensive honeys (priced online at $30/5 ounces).  The use of any of the honeys should be discussed with your physician.

• These honeys have been found to have antibacterial/antibiotic properties.  The FDA has approved a seaweed and Manuka honey-infused bandage named “Medihoney” for the healing of chronic wounds and burns (priced online at $50/10 dressings and $22/1.5 ounce of ointment). 

• The same honeys have been proven effective in treating chronic sinusitis by destroying the bacteria that can cause the condition, according to a University of Ottawa study.  These honeys have also been shown to be highly effective on drug-resistant strains of bacteria.  We can hope that the results of the University of Ottawa study will soon lead to a convenient treatment for sufferers.    

Our grandmothers have made their own homemade cough syrup for generations; honey often combined with lemon, ginger or whiskey to soothe coughs.  Another study has proven that Grandma was right:  honey is better at controlling coughs and promoting  sleep than over-the-counter preparations.

Move over dark chocolate and blueberries!  Honey also boosts antioxidants, the body’s natural defense against disease, especially heart disease and cancers.   Scientists at the University of Illinois have discovered that honey contains the some disease fighters as fruits, vegetables, tea and olive oil.  While honey cannot be consumed in the same amounts as fruits and vegetables, it can be substituted for other sugars to satisfy your sweet tooth.  Add a spoonful of honey to your cup of tea instead of sugar, or spread honey on your toast instead of jelly.  Just remember:  the darker the honey the higher the amount of antioxidants.  Buckwheat honey is 3 times higher in antioxidants than Acacia honey. Sunflower and Tupelo honey are also good choices and available in most grocery stores.

Honey has also been proclaimed (but not yet substantiated) as a cure for hangovers and insomnia; lowering weight and  LDL (bad cholesterol) levels;  remedying bad breath, sore throats, a myriad of digestive problems, dry skin, facial scrubs and even athlete’s foot!

As sweet as this news may be, please use caution:  honey should never be given to infants less than one year old because their digestive systems are immature and its use can cause illness or even death.

Dangerous Disposal

What do you do with medications when they are no longer needed?

One thing you should not do is flush them down the toilet or wash them down the drain.

Recent studies have demonstrated that medications are polluting our water systems and causing health hazards to others, especially our children.  The better choice is to mix them with used coffee grounds or used cat litter and dispose of them in your trash. You do not need to cut up the pills or break up capsules before disposing of them.

That solution works well for pills and liquids, but not for patches that are applied to the skin.  Most of the active ingredients have been absorbed by the skin when the patch is used as prescribed, but if the patch is removed prematurely there is still medication between the transparent layers that can be absorbed by others if not properly discarded.   These patches should be cut up before discarding them in your trash.  Always wear gloves when cutting patches to avoid contact and absorption with the gel-like medication.

Needles and syringes can be disposed of in red “needle” boxes provided by your health care provider or in thick plastic containers or laundry or dishwasher soap containers.  When the red needle boxes are full, they should be given back to the home care/hospice nurse or healthcare provider for proper disposal.  If you are using a household container, the entire container (with needles and syringes secured inside) may be discarded in your regular trash. You do not need to recap the needles.

Just as you store the medications in a safe place where a child or pet could not get them, the disposed medications and needles should also be kept safely away from children and pets.         

Elder Abuse, Continued

In my decades of caregiving experience, among the saddest situations are those times when I have suspected elder abuse.   The stresses of caregiving can be tremendous.  These stresses are magnified when the needy loved one is elderly, progressively weakening and totally dependent – or when the caregiver is struggling emotionally him or herself.   The incidents of elderly abuse are often hidden from public view, ignored as a shameful secret, or concealed as a private family matter.  The abused elderly so often have no advocates, constituency, or public voice.   But silence is deadly.  The two examples I share (real names protected) underscore why it is so vital that we care for each other, support each other and guide each other to appropriate resources when the burden of caregiving becomes too heavy.  

Betty, an elderly woman, was now living with her daughter.  She was no longer well enough to live independently.  Every weekday, Betty was left alone with instructions to stay in her room while her daughter went to work – with no food or liquids left for her so she couldn’t make a mess that would need to be cleaned up.  Betty’s isolation was reprieved once a week when Julia, an elderly friend from her church, would visit for the afternoon; her friend would help her   freshen up.  Julia also would bring a special lunchtime treat for them to share.  Julia was very sad to see what was happening because she, herself, enjoyed a wonderful life, living with her daughter and her daughter’s family.  Julia was afraid to say anything to anyone for fear Betty would no longer be removed from her daughter’s home -- then where would she go?

Ruth was angry.  Her husband had had a massive stroke about a year ago and she was tired of caring for him.  She refused to discuss the option of placement for respite or long term care because she wasn’t going to spend that kind of money!  John was powerless to say or do anything for himself; he was totally dependent on Ruth. On each visit, he was found bathed and dressed, medications given on schedule and meals nutritious but the mood of the household was hostile.  The one day, the aide came to help John with his bath and noted fresh bruises on his back and legs.  John could not speak for himself, so Ruth was gently asked what had caused these bruises.  She denied being aware of them.  The following week more bruises appeared.  Again, she denied being aware of them.  Suspicion grew among the staff visiting the home and adult protective services were notified by the agency.  It was discovered that Ruth was hitting John to dispel her anger.   Their marriage had not been happy; John had often been physically abusive to her during their relationship but she had stayed because there were two children to raise.  Finally, she felt she could release the demons she had carried for decades.  John was placed in a facility and Ruth was directed to therapy. 

The Silent Epidemic

Elder abuse is a crime. It is often overlooked, undisclosed or unrecognized, and it receives far less public attention than other kinds of abuse. An estimated 1.5 to 2.5 million elderly Americans have been injured, exploited or otherwise mistreated by someone on whom they depend for care. It is believed that less than one case in 14 is reported to a public agency.

There are five categories of elder abuse and mistreatment:

Physical abuse, or mistreatment, is defined as the willful, non-accidental use of force to inflict pain, injury or unreasonable confinement; it typically includes hitting, slapping, beating, pushing, punching, shoving, shaking, kicking, pinching and burning.

Neglectful actions can be intentional or unintentional; they include lack of adequate nutrition, personal care, medications, medical attention or a safe place to live.

Emotional abuse inflicts psychological pain and distress, it is an intentional infliction by verbal or nonverbal behavior; examples include name-calling, unkind remarks made within earshot of the elderly person, threatening, insulting, humiliating, ignoring, isolating and excluding the individual from activities.

Financial abuse occurs when someone forces the individual to sell personal belongings or property or to change wills or other legal documents, steals money, possessions, or withholds money needed for daily expenses.

Sexual abuse is nonconsensual sexual contact; it includes unwanted touching, rape, coerced nudity and sexual photography or videos.

Here are some general warning signs:

• Previous incidents of abuse on the part of the caregiver or family members

• History of alcoholism or drug abuse by the caregiver

• Caregiver refuses to allow the individual to speak for themselves or without the caregiver presence

• Obvious lack of assistance by the caregiver

• Aggressive behavior by the caregiver, such as threats, insults of harassment, pushing, hitting

• Obvious indifference toward the older adult by the caregiver (withholding food, hygiene, medication)

• Inappropriate and uncontrollable anger (rage) toward the older adult by the caregiver

Others often feel uncomfortable or frightened to approach the caregiver. Just as with other types of abuse, most states have mandatory reporting laws regarding suspected elder mistreatment. The following are methods of reporting suspected abuse:

• If immediate danger is suspected, call 911.

• Contact Adult Protective Services for assistance

• Health care providers need to notify their immediate supervisor of their suspicions

A Letter to You

The health care reform laws will be focusing strongly on preventative care for Medicare recipients. Annual visits to your PCP and screenings for breast and colon cancer will no longer have deductibles.


Health problems can occur for any of us at any time, but prevention, early detection and treatment are key to maintaining good health and preventing complications that can occur even with the simplest problems. Many Medicare receipents will soon be receiving a reminder of the importance of preventive care when their primary care physicians send them a letter similar to the one below. If you receive this letter, please take the time to complete the form and call to schedule an appointment for yourself and your loved one.


“DEAR __________:


Your health concerns and questions are important to me.


But, if you don’t ask, I may not know that you have a concern or question. If you are not comfortable asking me a question, you can put it in writing.


Be sure to give your written concerns to me or my nurse at the beginning of the exam. We can then talk about your questions or concerns and take any necessary steps.


Call today to make your appointment.”


The letter may also include several questions similar to those listed below:

1. How can I prevent falling? (The reason for this question is that while there are many potential causes for falling; in the elderly population falls are common and may lead to injuries, decline in function and even death).


2. How can I treat or manage bladder problems? (The rationale for this question is that these problems can lead to more serious problems such as urinary tract infections, skin breakdown and falls).


3. Do I need to be tested for Osteoporosis? (The importance here is that this condition can cause fragility of the bones and may ultimately result in bone fractures and poor healing especially in post-menopausal women- the testing required is painless and quick)


4. How much exercise should I be getting? (Prevention is the focus her and exercise can prevent problems as well as maintain good health, it can be as non-stressful as walking 20-30 minutes a day to more strenuous activities that you enjoy- ask if there are any restrictions that would prevent you from participating in the activity you have chosen.


5. Do I need the flu and pneumonia vaccines? (Prevention of the flu is key to preventing complications that afflict many seniors if the get the “bug”. Flu shots are especially recommended for adults 50 years and older, residents of nursing homes and long-term care facilities, adults with chronic medical conditions such as diabetes, heart disease, or other health disorders, anyone with a compromised immune system due to HIV disease or medications such as chemotherapy, health-care workers involved in direct patient care and healthy adults and children who live with or care for anyone with a medical condition that could put them at higher risk for flu complications).


6. What preventive or screening tests should I have? (Another benefit to the annual visit to your PCP is learning what screenings are recommended for those with chronic conditions such as diabetes and heart disease to prevent complications).


(Here is your opportunity to ask your doctor the questions you have regarding your own health concerns).

7.__________________________________________________________________

8.__________________________________________________________________

9.__________________________________________________________________

10.________________________________________________________________”

Check It Out

How often should we get “routine” medical screenings? The answer always depends on your age and personal and family medical histories, but here are some general guidelines to follow:


• Blood pressure check: every regular physician visit
• Cholesterol test: starting at 20, every 5 years.
• Blood glucose (sugar) test: starting at age 45, every 3 years.
• Colon screening: starting at 50, every 1-10 years, depending on the type of test.
• Pap test: once a year for women 20-30; for those 30 and beyond, once every 1-3 years.
• Prostate screening: starting at age 50, ask your physician for his recommendation.
• Clinical breast exam and mammography: until age 40, every 3 years, then yearly

Well-Care

Our current system of health care often places more focus on “illness-care” than wellness. Each of us can be part of the change that makes prevention the center of attention in our country.

Heart and lung disease, cancer and stroke are the leading causes of death in the United States. Diabetes is another disease that affects millions. America ranks third in the world for those afflicted with diabetes and it myriad complications. This is one area where we surely do not want to become number one in the world.

Healthy eating, exercise, health promotion programs (smoking cessation, weight-loss, and exercise) are crucial important aspects for good health.

Wellness also includes proactive medical care. Visiting your primary care doctor on a regular basis may help prevent problems. Early detection and treatment is very important. As we age we need to visit our doctors at least once a year, and maybe more frequently to stay healthy.

A consistent focus on “well-care” may help each of us avoid the more burdensome focus on “illness-care.”

Arresting Events

For most of the country, this winter has been brutal – ice, heavy snows, winds, and low temperatures. Extreme activity, like shoveling, in extreme temperatures are one cause of sudden cardiac arrest, a dramatic drop in blood pressure that causes an individual to collapse and lose consciousness. Sudden cardiac arrest is different from a heart attack, but can be every bit as life-threatening. It can be caused by a fast or slow heart rate.


While sudden onset arrest can be caused by extreme activity, it can occur even when we are at rest. The symptoms can include dizziness, light-headedness, chest pains, and shortness of breath.


Risk factors include those normally associated with heart disease: family history, smoking, obesity, physical inactivity, high blood pressure, or high cholesterol.


Immediate treatment by returning the heart rate to normal levels is essential. Normal treatments include CPR, or a shock to the heart by defibrillation.


Make a commitment during February to be kind to your heart. Learn all that you can about preventing and treating heart disease.

After the Final Moments

My work with hospice has always been highly dynamic – no two individuals, caregivers, homes, or end-of-life experiences were ever the same. I have been at the side of many individuals and their caregivers in the last moments of life. My words and actions varied according to the needs of the individuals, but my concerns were always for those left behind. Sometimes, I said very little; at other times those conversations lasted for hours. I have held many hands and shared many hugs, and I’ve also respected the family’s preference for no human contact. In all cases, I made every attempt not to leave the caregiver alone when I was leaving the home. I left them with my phone number to use as needed in those first weeks after their loss. In today’s post, I offer some insights drawn from two personal experiences. I encourage you to share your own insights, and I will post them.



I met Joe and his wife only once before his death. They were arguing over his wanting to drive into town and called hospice to mediate the situation, which was easily remedied. Then just a few weeks later, I received the call late one night that Joe was close to death and immediately headed to their home. When I arrived, he was taking his last breaths with only his wife and sister at his bedside. They asked that I lead them in pray before anything else was done. We were of different faiths but there we stood holding each others hands, reciting The Lord’s Prayer. The feelings we shared were so intense that it wasn’t until the last words were being said that I realized more voices had joined ours. I turned around to find their very small three-room home crowded with dozens of people; family, friends and neighbors. I found comfort not only in the time we shared that night but also in the awareness that Joe’s wife and sister would have support in their time of mourning.



I had been in and out of John and Louise’s home numerous times over the last months of John’s life, his decline was slow but steady and we had time to prepare for his death. The final call came in the very early hours of the morning and I left my home for theirs. When I arrived, Louise, his wife of many decades and his children were there and had been with him in his last hours. I offered my condolences and held Louise for some time because we had become close. She then helped me to bathe John one last time as we waited for the funeral home to arrive. When they got there, the family did not want to be present as John left his home for the last time. Louise came to me and asked if I would stay at his side. She said they trusted that I would protect him on his final departure from his beloved home. That was a very easy request to honor, and I was privileged to do so.


The Caregiver's Caregiver@ www.caregiver2caregiver.blogspot.com

Mourning With Those Who Mourn

“It is better to go to the house of mourning, than to go to the house of feasting: for that is the end of all men; and the living will lay it to his heart.” (Ecclesiastes 7:2)



A good friend is nearing the final days of life, and we don’t know what to say; another friend is taking care of a loved one who is near death, and we don’t know whether we should intrude upon their privacy in these final days; a family has experienced a tragic and unexpected death and we are at a loss for how to be of comfort.



What to say? What to do? How to console others during inconsolable times? These are the most difficult and most human questions we can face. The difficulty of knowing how to be of comfort or they fear of saying or doing the wrong thing may prevent some of us from reaching out to friends who are experiencing serious illness, who are in the final stages of life, or who are supporting loved ones as they die.



There is no rulebook or etiquette guide to precisely navigate these tender moments. There is no standard set of phrases or gestures that will make everything better. But there are things we can do to bring comfort to those who are suffering. Please consider:



• The Greek word for comfort is parakaleo, which means “to call to the side of” or “to call near.” This ancient meaning suggests that comfort entails physical presence and proximity. You need not fear visiting those who are gravely ill, or their caregivers. Visits are often a tremendous comfort for the family; your physical presence in itself can be the most important source of support. Your visit need not be long to make a difference. This is true even when it does not appear that the person who is ill is aware of your presence; remember that hearing is often the very last sense to fade. It may be wisest to call ahead; if you do, be sure the family knows you will not stay long and are willing to help with whatever they need.


• Simplicity is better than extravagance. As an individual approaches the final days of life, she and her family actually require very little in the way of material things. Large floral displays, robes, blankets, books, magazines – these things are now probably past their usefulness. You need not fear coming empty-handed; if you feel you must bring something to the home make it something small and simple, unless the family has asked for something specific.


• Be prepared to allow silence. Out of nervousness or awkwardness, we sometimes seek to fill every moment with unnecessary words. Sometimes the most comforting thing you can do is to sit with an exhausted caregiver and rub her shoulders, or sit at the bedside of a dying friend and hold her hand. Follow the family’s behavior and preferences; some families use the final hours of a loved one’s life sharing reminiscences, praying aloud, or singing. Others take turns saying words of endearment and farewell. But a great many families simply keep a silent and loving vigil.


• Greeting cards, prayer cards, or inspirational cards can be a form of our “presence” when the miles separate us. I know of a case where a woman dying of breast cancer was comforted at least twice a week by beautiful (and often humorous) cards a friend sent from across the country. Even when the dying woman’s eyesight failed her, family members cheered her (and themselves) by reading these cards and their personal messages of love.



• Speak from the heart, without speaking volumes. Whether you are offering words of comfort in person or via cards, letters, or even email, your heartfelt feelings and shared remembrances are worth more than all the stock greeting-card phrases combined. Sometimes a simple statement like, “Oh how I love your father,” is quite enough to a grieving daughter or son, just as the promise that the family is in your daily prayers can bring comfort. Avoid phrases that may be intended to bring comfort but seldom do, such as “At least she is no longer suffering” or “we all knew her death was coming.”



• Daily acts of grace can bring tremendous comfort. A man I know stopped by the home of a dying friend every morning on his way to work, bringing fresh juice for the family. He stayed only seconds, bidding all hello, never expecting anyone to alter their routines to accommodate his visits. Yet these daily drop-ins became a comforting routine to the family at a time of deep stress and anxiety. It made them feel less isolated and less alone. His regular visits also inspired other friends and neighbors to understand that it was “okay” for them to visit as well.



• Do what is required or needed, even if it falls outside your comfort zone. If we say we want to be of help to the family, we must sincerely seek to be of help. Some of us aren’t comfortable praying in public, singing out loud, or hugging. Significant numbers of us are uneasy about going into hospitals, hospices, or the rooms of the dying. Comforting others is rarely scheduled at our convenience and it almost always requires us to give from deep within ourselves. When we do, we find that we grow from the experience. When family members ask for specific kinds of help, we need to respond without judgment or questioning. The family may ask for help with funeral planning, for example, even while their loved one is still alive. Don’t balk or shy away, or pretend as if funeral plans are premature. My sister recounts when a good friend had only hours to live; her friend’s husband called my sister at work to ask her to hurry over and to please bring “white cheese” for the out-of-town guests who would soon be arriving for the funeral. My sister’s response was to log off her computer, get in her car, quickly pick up the cheese, and get to their home. She was grateful that the family had given her a purpose and a way to be of help.



• Don’t minimize the situation or attempt to make it “all better.” Recognize that the individual and his family are experiencing the end of a life. Just as we would not ignore the birth of an infant, we should not ignore the fact that someone is dying. It is better to be silent and supportive than to offer pat statements of optimism. “Where there is life there is always hope” is a true statement, but it has its appropriate time and place.



• Require nothing in return. In states of exhaustion, distress, shock, or deep mourning, families may scarcely be able to hold conversations or acknowledge your kindness. They may not even notice that you brought donuts and coffee, or that you raked the leaves. Understand that the blessings you derive from comforting those in need do not come in the form of thank you notes or effusive gratitude. The comforter’s true blessings always come from a higher source.

Cold Comfort Care

A cold or flu can make any of us feel miserable; while prevention is the best medicine any of us can “catch the bug.” Those bothersome symptoms of cold and flu are actually ways that our bodies are trying to fight these infections: fever is one way our body tries to kill the infection (germ-killing proteins in the body move faster and more effectively in a hot environment) and coughing is another way the body rids itself of germs that the thick mucus can carry to the lungs.


Many of us need relief from the symptoms but do not like to take over-the-counter medications for cold and flu symptoms; the side effects may be bothersome or there may be a risk of interaction with our prescription medication. Here are a few home remedies for you and your loved one that just might help you feel better:


• Stay warm and rested. Staying warm and rested helps the body focus on the battle the infection places on the body. Get comfortable under a blanket and take a break.


• Drink hot liquids. Hot liquids help relieve nasal congestion, prevent dehydration and soothe inflamed membranes in your nose and throat. If you are so congested at night and cannot sleep, try a cup of hot tea, add a teaspoon of honey, and if appropriate to your health and religious practices, add an one ounce of whisky or bourbon (but limit this concoction to one cup as too much alcohol can inflame the membranes).


• Sleep with an extra pillow under your head. Elevating your head helps to relieve congested nasal passages.


• Blow your nose often. Blow your nose when you have a cold, rather than sniffling the mucus back into your head. But when you blow your nose too hard, it can send the mucus back into your ear canals, causing an ear ache. The best way is to press a finger over one nostril while you blow gently to clear the other.


• Clear your stuffy nose with warm salt water. Salt water rinsing helps to break up nasal congestion and get rid of viruses and bacteria from your nose. Mix ¼ tsp of salt and ¼ tsp of baking soda in 8 ounces of warm water. Use a bulb syringe to squirt this mixture into a nostril, apply pressure to the other nostril to close it while squirting the fluid in. Let it drain, repeat 2-3 times then treat the other nostril. You can also try using a netty pot, commonly available in most drugstores or health stores.


• Gargle. Gargling brings temporary relief to a sore throat by moistening it. Mix ½ tsp of salt in 8 ounces warm water until dissolved, gargle 3-4 times a day.


• Take a hot shower- Steamy showers moisturize your nasal passages and help you to relax. If dizziness is a problem, run the steamy shower but sit on a chair nearby and sponge bathe.


• Apply a salve under your nose. Applying a small amount under your nose can help to open your nasal passages and relieve irritated skin under your nose. Menthol, eucalyptus and camphor all have a mild numbing effect that soothes raw and tender skin.


• Apply hot or cold packs around your congested sinuses- Applying either will work so it is your preference. Place a damp washcloth in your microwave for 45 seconds to warm it up (test the temperature before applying the warm pack to those tender areas under your eyes or forehead) or use a frozen bag of vegetables for a cold pack.


• Eat infection-fighting foods, such as:

o Bananas, which help soothe upset stomachs
o Bell peppers and oranges, which are loaded with Vitamin C
o Blueberries, which help control diarrhea and may also help lower fevers and help with body aches and pains
o Chili peppers, which open sinus passages and break up mucus in the lungs
o Mustard and horse radish, which help break up mucus in the air passages
o Onions, which reportedly clear bronchitis and other infections
o Rice, which helps curb diarrhea
o Tea (black and green but not herbals), which are professed to have antibiotic and anti-diarrhea effects


Remember:


o Wash your hands frequently with soap and water or the use of an alcohol-based hand sanitizer
o Sneeze or cough into your elbow area rather than your hand to control spreading germs.
o Discard used tissue or replace handkerchiefs often.
o Antibiotics are not effective in treating viruses and should only be used for bacterial infections.


If at any time you feel the symptoms are severe or worsening, call your doctor.

Super Bowl, Super Bloat?

Super Bowl XLV might be a good or painful memory everywhere except your waistline. This American sports ritual has become a national excuse for indulgence – and indulge we do. Current estimates suggest that Americans spend $50 million on food during the four days prior to game day, including 51.7 million cases of beer; 14,500 tons of chips; and 8 million pounds of guacamole. Domino’s Pizza alone delivers 1.5 million pies that day.


Small wonder, then, that on Super Bowl Monday 6% of working Americans call in sick and antacid sales increase by 20%.


If your Super Bowl celebration led to post-bowl bloat, it’s time to get back into the heart-healthy game. Here are a few simple tips for doing so:


• Switch to lean meats and poultry (pork chops, turkey, chicken, sirloin) and prepare them without their skins. Grill, bake or broil instead of frying … and use spices, not fats or trans-fats, to bring out the flavor.
• Switch to fat-free, 1%, or low-fat dairy products. You’ll be surprised how quickly your taste buds adapt.
• Cut back on beverages and foods with added sugars (sucrose, glucose, fructose, maltose, and corn syrups).
• Cut back on sodium. Salt-free seasonings are delicious and available everywhere.
• Select frozen foods over canned foods. If you need to use up those canned vegetables, drain and rinse them well before preparing.
• Get smart about label reading. Products “free” of a harmful nutrient are the best possible choices; “very low” or “low” contain more of the nutrient; and “reduced” products contain only 25% less of the harmful nutrient than the standard version of the product.

Winter 'Warming', Part 3

Keeping your loved one and yourself safe and warm during the winter months takes additional special precautions. About 500 Americans die from accidental carbon monoxide poisoning each year and the majority of these incidents occur during the winter months. Many more may feel sick; symptoms of mild acute poisoning include headaches, dizzyness and nausea during the winter because of low-level exposure to carbon monoxide. Poorly maintained furnaces are one reason; this can be remedied by yearly inspections of your home’s furnace. Starting automobiles in attached garages without adequate ventilation is another cause; this, too, can be avoided by fully opening garage doors before you turn on the ignition. Purchasing a carbon monoxide alarm can help prevent these accidental deaths. Many of these devices are now a combination of smoke and carbon monoxide alarms. These alarms make great (and reasonably priced) gifts too.

Winter 'Warming' Part 2

Deaths and hospitalizations for heart disease and stroke increase more than 50% in winter. Why? Most people blame holiday stress, cold weather and the exertion of snow shoveling, but according to experts there are other reasons too. The short days and long nights are thought to throw heart-related hormones out of whack. Keeping resolutions to exercise and exercising with gusto may be overtaxing to hearts comfortable with sedentary lifestyles. Before beginning any exercise program it is very important to be evaluated by a physician.


A new theory suggests a link between heart disease, strokes, and the flu. The plaque that builds up in artery walls tend to become inflamed when a viral infection attacks the body, then making it more likely to rupture and cause a heart attack or stroke.


Exactly if or how the flu shot may protect against first heart attack and stroke is not clear yet. In studies it has been demonstrated that the earlier in the flu season that participants got the flu shot, the lower their risk for first heart attack or stroke. While the study showed that earlier is better, it is never too late to get the flu shot. (The pneumonia vaccine, however, did not provide protection against heart disease)

Winter 'Warming' Part 1

Older people are especially susceptible to hypothermia and frostbite because their bodies don't adjust as well to cold weather. Hypothermia and frostbite can occur when we are over-exposed to cold air, water, wind, or rain and may occur even in relatively mild weather.


Wet clothing is a common cause of hypothermia because it reduces body heat. Besides impairing judgment, alcohol opens up (dilates) blood vessels beneath the skin, which creates a dangerously misleading sensation of warmth even as body heat escapes. What are the symptoms of hypothermia?


Early symptoms include:

• Severe shivering.
• Cold, pale, or blue-gray skin.
• Lack of interest or concern (apathy).
• Poor judgment.
• Mild unsteadiness in balance or walking.
• Slurred speech.
• Numb hands and fingers and difficulty performing tasks.


Late symptoms include:

• The trunk of the body is cold to the touch.
• Muscles become stiff.
• Slow pulse.
• Breathing that is shallow and slower.
• Weakness or sleepiness.
• Confusion.
• Loss of consciousness
• Cessation of shivering if body temperature drops below 90F.


Treatment depends on the severity of the hypothermia. Treatment of mild hypothermia includes getting out of the cold or wet environment, and slowly re-warming the body using warm blankets, heaters, and hot water bottles. Moderate to severe hypothermia generally is treated in the hospital, where health professionals can give warmed intravenous fluids and warm, moist oxygen in addition to other treatments to warm the core body temperature.


Frostnip is a mild form of frostbite; although it is uncomfortable, it doesn't damage skin. Frostbite occurs when tissues freeze. This condition happens when you are exposed to temperatures below the freezing point of skin. The nose, cheeks, ears, fingers, and toes are most commonly affected. Everyone is susceptible to these conditions, even people who have been living in cold climates for most of their lives.


Signs of frostnip include:

• Pale skin
• Numbness
• Tingling in the affected area


In superficial frostbite, the symptoms worsen and burning or itching may also occur. The regions appear white and frozen, but if pressed they retain some resistance. Medical evaluation is vital; a doctor must be able to see and feel the affected area. The best treatment if these symptoms are experienced is to slowly re-warm the affected areas.


Both frostnip and frostbite can be avoided by dressing warmly and covering exposed areas with hats, ear muffs, and gloves. Avoid prolonged periods outdoors and excessive intake of alcohol in outdoor settings.

Heart Signs

At our own risk, too many of us buy into the Hollywood notion of a heart attack:  sudden, severe, unmistakably serious pain.   While some heart attacks are sudden and intense, most are not.  Generally, heart attacks start slowly, with pain or discomfort so mild that people aren’t really sure if something is actually wrong … with pain that goes away … with pain nowhere near the chest region … and with symptoms that are just plain weird.  Consequently, many of us ignore heart warning signs and wait too long to get help. 

What are some signs that a heart attack might be happening?

·         Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain.
 

·         Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, across the shoulders or stomach.
 

·         Shortness of breath. May occur with or without chest discomfort.
 

·         Other signs. These may include breaking out in a cold sweat, nausea, or lightheadedness. 

If you or someone you love is experiencing these symptoms, take action.  Don’t ignore them, minimize them, or rationalize them away.  Better to overly cautious than too late.