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How to Talk to Someone Who is Dying

how to talk to someone who is dyingWhen someone has received a terminal diagnosis, it’s a sensitive and traumatic time for them. Our words and actions at this point carry great weight. While it would be nice to believe that there’s no wrong thing to say and it’s the thought that counts, those close to the dying can make the experience easier or harder for them depending on what they say. If your loved one has recently received the bad news, look to them for clues about what to say and do. Don’t be surprised if they in fact don’t want to talk at all. People facing their own passing are often relieved to not have others say anything – though they are also glad to know that they can reach out if they choose to do so. Do your best to respect what they want, but find ways to make it clear that you’re willing to offer a listening ear when they need it. Rather than fretting about what to say and whether it’s the “right thing,” put your energy into listening to and observing your loved one. Whatever you do, avoid grand platitudes about fate or God’s will. These won’t make the person feel better, and may even make them feel that they are at fault for their illness in some way. Don’t tell your loved one that they’ll be OK – both you and they know that this isn’t really true. Don’t try to praise them by telling them how strong they are – at this time they may not feel very strong. Instead, they need to be allowed to acknowledge their fears. Find ways to emphasize that you love them and that you’re there to help them in the way they need. Do your best to make this time pleasant and comfortable for them. This is one exception to the advice to let your loved one guide you – as far as comfort goes you should take the lead. This is the time for random acts of kindness like making them breakfast or doing their laundry for them. They may be too preoccupied to ask for help with these everyday tasks. Make sure that you follow through on any offers you make. What gift do you give someone who doesn’t have many days left in the physical world? The gift of your time. Even sitting quietly with your loved one can be valuable to them. It sends the message that you’re there for them and that you’re willing to support them in their struggles.
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Guide to Buying Medication Online

guide to online pharmaciesMany of us are doing more and more online shopping, and so inevitably we wonder if we should buy medication online too. Beyond the simple convenience, the cost savings are certainly tempting, especially when dealing with an expensive chronic condition. However, the world of online prescription drugs is one that needs to be navigated with caution. Counterfeit medicine is abundant, and the old saying that “if it seems too good to be true, it probably is” was never more apt. There are both legitimate and illegitimate online pharmacies, and the trick to buying medicine online successfully is to be able to tell the difference. By taking the time to gain a little knowledge, you too can be an informed consumer and avoid getting burned. Here are signs of a reputable and safe online pharmacy:
  • They require that you submit a prescription from your doctor. Usually they will ask for this by mail. If they allow you to send a fax or a scanned copy, they should then check with your doctor to make sure that the prescription is legitimate. Avoid sites that will send you medicine just on the basis of a questionnaire, without requiring you to visit your doctor.
  • They should also require that you fill out a detailed profile that includes your medical history.
  • You should be able to speak to a licensed pharmacist who can answer any questions you might have.
  • The pharmacy should be located in the United States. Many online pharmcies are located abroad. The prices may be cheap, but as much as 40% of the medicine in these countries is counterfeit, so you’re much more likely to not get what you paid for, or even something that’s safe to consume.
  • You can easily find and understand the website’s various policies regarding privacy, shipping, and payment.
Officials recommend that you only use sites that have accreditation from an organization called Verified Internet Pharmacy Practice Sites (VIPPS). This insures that the company has gone through a rigorous review process and on-site inspection. You can find a list of pharmacies that have achieved this accreditation at the National Association of Boards of Pharmacy. When your order arrives, make sure that all the information on the label is correct, including your name and the name of the medication. Make sure that the dosage you’ve been given matches what the doctor ordered. Also keep an eye out for packaging that seems to be tampered with. If this is a medication you’ve taken before, compare its color, shape, and size with what you’ve taken previously. Do you see, taste, or smell any differences? You should also be able to easily verify that the medicine has not expired. If you have any doubt about what you’ve received, don’t take the medication until you’ve spoken with your doctor or pharmacist. This may be a hassle that negates the convenience of online shopping, but it’s much easier than making a mistake that could be costly or lead to further health problems.
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Should Your Parent See a Geriatric Specialist?

should you see geriatric specialistYour loved one has multiple doctors already. Do they really need to add one more to the list? This post is designed to help you decide whether your loved one should consider seeing a geriatric specialist. A geriatric specialist provides comprehensive care for the elderly. They’ve completed their residency in Family or Internal Medicine, and have one or two years additional training in the various issues – physical, mental, and social – that affect this age group. There are several benefits to seeing a geriatric specialist. Seniors sometimes experience illnesses differently than younger adults, and so it helps for them to work with a doctor who understands their specific situation. Geriatric specialists are especially well-equipped to understand the particular complexity of senior health issues, which are typically caused by multiple factors. For example, they can examine a senior’s prescription drug regimine and make sure that they’re not over-medicated. They will also be familiar with the particular resources available to help your loved one in your specific local area. Whether or not a senior should see a geriatric specialist depends on their particular situation. After all, seniors themselves are different: one 80 year-old may be active with minimal health problems, while another may be struggling with serious health conditions. Geriatric specialists tend to step in when an individual’s health problems become complicated. It’s recommended that all seniors consider a visit when they turn 65, and highly recommended for those seniors who are in some way impaired, who have multiple medical problems, who are experiencing cognitive decline or dementia, or whose family members are struggling with caregiving. If you do decide to take your loved one to see a geriatric specialist, the initial assessment will take several hours. You’ll be given a detailed questionairre to fill out that your loved one will most likely need help with. Make sure you bring a list of all medications, hearing aids and dentures, eyeglass prescriptions, and information about other doctors your loved on is seeing or has seen recently. The following elements make up a typical assessment:
  • Complete physical exam
  • Detailed medical history
  • List of medications and their purpose
  • Dental exam
  • Hearing and vision tests
  • Pain level analysis
  • Cognitive evaluation
  • Osteoporosis screening
  • Dietary analysis and advice
  • Meeting with a social worker
  • Discussion with family members
Rather than being “just another doctor” a geriatric specialist can help you with managing the extensive medical care your loved one is already receiving. Many seniors and their caregivers find these physician’s particular expertise helpful.
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Is Dementia Genetic?

is dementia hereditaryIf you’re diagnosed with a disease, often one of your biggest worries is whether or not it’s hereditary. Will you pass it on to your children and grandchildren? Or those who are watching their parents struggle with a disease wonder, “Will this be me one day?” Dementia is no exception. The good news is that in most cases, dementia is not a hereditary disease. However, this does vary depending on the type of dementia, and it may be that the inherited nature of dementia is too convoluted for researchers to fully understand it yet.  Genetics is complicated, after all. We can see this with more basic traits: even if both parents have brown eyes, their child’s eyes might turn out to be blue. Or a trait like height may be influenced by several different genes. Alzheimer’s disease is usually not inherited, though if someone in your family has had the disease there’s a slightly greater chance that you’ll have it too. Early onset Alzheimer’s is one specific form that does tend to occur within families – though this version of the disease is more rare. Huntington’s disease, on the other hand, is clearly hereditary, and it’s a little known fact that this is a form of dementia. Other types of dementia that run in families include fronto-temporal dementias: as many as 50% of those cases seem to be hereditary. While genetics has its influence, our environment and our lifestyle have perhaps an equally powerful role. Since families share similar ways of living, it can be difficult to sort out what happens due to genetics and what happens due to environment. If you’re worried about you or someone you love developing dementia, rather than look at family history you may find more connections by considering the following:
  • Women are more likely to develop Alzheimer’s disease than men are.
  • Researchers have determined that diseases of the heart, blood, or arteries are linked with an increased chance of dementia. This includes heart attacks, high blood pressure and cholesterol levels, and especially strokes.
  • Those who have a history of depression are more likely to develop dementia.
  • Repeated or severe head injuries are also a risk factor.
If you have concerns that you or a loved one will inherit a form of dementia, talk to your doctor. They can provide guidance about how likely it is that your form of dementia is inherited, and can give you guidance about whether a step like genetic testing and counseling might be worth it.
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Caring for Aging In-Laws

caregiving for in-lawsYou expect to have to care for your own parents in their old age, but often times we find ourselves caring for our in-laws too. For many this isn’t a problem, as they’re your spouse’s parents and part of your family. But sometimes, this situation presents issues when we have conflicts with our in-laws. It’s also not unheard of for someone to be caring for their former spouse’s parents, even when they’re no longer married to that person. Then things become a little more complicated. Though gender roles are changing in contemporary life, it’s often women who find themselves in this situation. Sometimes their partner is helpful and supportive, but too often this isn’t the case. Men aren’t used to taking on nurturing roles like this and tending to someone physically. They may manage their parents’ finances or help with more manly tasks like mowing the lawn if his parents still live in their own home. And of course he calls the shots for the big decisions. But the women in his life end up taking on the responsibility for tasks like preparing meals and bathing – and this role is not always welcome on the part of the woman. If you find yourself in this situation, try appealing to your spouse’s desire to be a good caretaker. Once their parents have passed away, many children regret not doing more for them while they were still alive. Remind him that he’ll want to be proud of what he’s done for them. You’ll also want to remind him that doing so-called “feminine” tasks doesn’t make him less of a man – he’s getting hung up on stereotypes. If you work, you can also make it clear that you have just as much of a right to spend time on your career as he does. You have your other obligations too. In the end, you need to decide how much care you’re willing to take on, and then leave it to your spouse to handle things from there. Set strong, clear boundaries: ultimately his parents are his responsibility. Of course, if you’re married, you’ll need to take the health of your relationship into account with any decision you make. However, if you’re divorced, you have no obligation, though some women feel they should care for their former in-laws because they are, after all, their children’s grandparents. But the key point to remember is that you are in charge of your contribution.
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All About Lewy Body Dementia

lewy body dementiaLewy body dementia is a particular form of dementia, characterized by abnormal brain cells called Lewy bodies. The disease gets its unusual name from its discoverer, Dr. Levi of Germany, who uncovered the disease in 1912. “Levi” was changed to “Lewy” in the English translation. Lewy body dementia is one of the most common forms of dementia, occurring in 15% or more of all cases. However, the general public and even some health professionals are not as familiar with the disease as they are with better-known dementias like Alzheimer’s. Researchers at this time don’t know why Lewy bodies form. They are made up of alpha-synuclein protein, which is also connected to Parkinson’s disease and other disorders. Indeed, Parkinson’s disease patients and Lewy Body dementia sufferers display similar symptoms, especially in later stages of the disease. Lewy bodies collect in the nuclei of the neurons that help manage motor control and memory. They can accumulate by themselves, but they also sometimes appear in the brains of those with Alzheimer’s. Because it is easily confused with similar diseases, Lewy Body dementia is under-diagnosed. However, seeking a diagnosis is critical, as it can lead to proper care that will make a real difference in quality of life and the length of time the patient is able to maintain their independence. Unlike Alzheimer’s, in which the disease eventually kills most of the victim’s neurons, in Lewy Body dementia the patient only loses 10 to 15% of neurons, though other areas of the brain are damaged as well. Lewy Body dementia tends to affect different areas of the brain than Alzheimer’s does. The disease interferes with language, memory, and higher-level mental functions. Lewy body dementia also often occurs in connection with anxiety and depression. As with other forms of dementia, there is no cure currently available. Doctors will prescribe various medications to treat the different symptoms, however. Drugs like rivastigmine and donepezil are used to treat cognitive problems, and may also help with motor control and psychiatric issues. Motor control can also be helped by levodopa. Drugs that treat hallucinations however usually are not used since there’s the possibility they could make motor control issues worse. The life expectancy for someone with the disease is about eight years. Lewy body dementia is an area of active government-funded research, with the immediate goal of better understanding what causes the disease. Scientists hope to eventually discover ways to treat it, prevent it and cure it.
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Five Myths About Alzheimer’s Disease

mythsThere are many misconceptions out there about Alzheimer’s. Below are some of the most common, along with explanations about what the real deal is. There are cures that will stop the development of Alzheimer’s. Unfortunately, at this time there is no cure for Alzheimer’s disease, and no way to halt its progress. However, there are drugs that will, temporarily, pause the deterioration of or even improve cognitive skills and memory. But they only, for a period of time, treat the symptoms and not the disease itself. These drugs only work for some people, so there’s no guarantee that they can help your loved one. These drugs include cholinesterase inhibtors like Aricept and Exelon, and memantine (also known as Namenda). Cholinesterase inhibitors are used in the earlier stages of Alzheimer’s, and memantine is prescribed later on. The aspartame in artificial sweeteners contributes to memory loss. Aspartame is an artificial sweetener approved by the FDA in 1996. It is made by combining two proteins, phenylalanine and aspartic acid, with methanol, a chemical found in various plant foods. The studies that have been done on this issue so far have yielded no evidence of a connection between memory loss and aspartame. The use of aluminum in cooking or with food can cause Alzheimer’s. Current studies do not show that eliminating aluminum, such as that in pots and pans and soda cans, reduces one’s chances of getting Alzheimer’s disease. The jury is still out on aluminum’s relationship to the disease, but scientists generally think that it is unlikely that it has any significant effect. Alzheimer’s disease can be caused by a head injury. This one is partially true: researchers have proven that having a severe head injury with loss of consciousness during one’s life will increase the chances that the individual will get Alzheimer’s disease. However, researchers don’t yet understand why this occurs and what is happening in the brain during these incidents that leads to Alzheimer’s. Alzheimer’s disease won’t kill you. Alzheimer’s is, in fact, a fatal disease. It first destroys brain cells that assist with memory functions, but over time the damage will spread to parts of the brain that control essential bodily functions. It can be hard to attribute death to Alzheimer’s disease, however. Many Alzheimer’s patients, due to their age, are experiencing a number of health issues. It is likely that several different problems contribute to the actual cause of death.
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Senior Day Trip Idea: Visit the Zoo

senior day trip to the zooWe think of zoos as a classic class trip for children–but seniors can enjoy them too! Taking your loved one to visit a zoo, possibly with the extended family in tow, can be a great way to create togetherness and provide a stimulating activity for your loved one. In southern California we have some of the best zoos and aquariums in the nation, so this can make a great local day trip. Interaction with animals is beneficial both for seniors and their stressed caregivers. Research has shown that this activity contributes to lower blood pressure and makes people feel happier. The increased chance of social interaction that happens during a zoo visit, whether the senior is part of a group or just visiting with one caregiver, also has positive effects such as reducing the chance of depression. Your loved one will even get more exercise than they do when they stay at home. For various reasons, seniors are often not able to have pets. This can be a difficult restriction to live with for those who are lifelong animal lovers. But regular zoo visits allow these seniors to experience the benefits of animal interaction. Those who have Alzheimer’s disease or other forms of dementia can specifically benefit from zoo visits, as this environment can trigger happy childhood memories. Be sure to plan your trip carefully, as that will help the day go smoothly and minimize stress for both of you. Schedule your trip for a day when the weather will be good. You’ll want to arrive close to opening time, when the zoo will be less crowded. Discuss with your loved one what exhibits they want to see, and get a map of the zoo beforehand so that you can plan the best route for seeing everything on your list. That way you won’t get lost or waste time backtracking once you’re there. When you’re at the zoo, don’t be afraid to ask for help. The staff regularly deal with various people with disabilities and know ways to help your loved one get the most out of their visit. Zoos often offer priority seating during events for those with mobility or vision issues. Special audio assistance devices can also be arranged. And be aware that many zoos offer senior discounts or other special deals for the elderly. A trip to the zoo can be a fun diversion for both seniors and caregivers, breaking up the monotony of the day-to-day.
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How to Maintain a Positive Attitude

caregiving positive attitudeThrough our communication with others and with ourselves, we create reality. Does that sound a little new age to you? Think about it. Everyone has a friend whose negative attitude makes them difficult to be around because you in turn start to feel more pessimistic. Or, on the other end of the scale, there are enthusiastic people who leave us feeling more energized. It’s a basic fact that the people around us influence what we think and feel. And this is true not just for our friends and family, but for ourselves as well. What we think and say to ourselves can change our lives. Examine your own thoughts about caring for your loved one. If you say to yourself, “This is a hard situation” you’ll experience it as being unpleasant. Try telling yourself, “This situation is a challenge” instead. Can you see how that might change how you look at things a little? Challenge implies that this is something you can overcome, and that will make you stronger as you deal with it. Watch how you discuss the events in your life, both what you tell others and what you tell yourself. Our words not only describe our feelings, but also create what we feel. Here are a few other tips for keeping a positive attitude:
  • Express thanks at the end of each day. Take some time to look back over your day and think about the things that went right. Even if you had a truly lousy day, you probably still have a roof over your head, food to eat, friends and family members you love, and a life in one of the wealthiest countries in the world. You can always find something to be grateful for.
  • Commit a random act of kindness. This can be one of the best ways to make yourself feel better and adjust your mood. Try bringing your mother flowers, giving a neighbor a small present, or paying for the person behind you in the drive-through. We usually think that to feel good we need to do things for ourselves, but doing things for others can have a powerful impact.
  • Take a minute to appreciate nature. Even if it’s just a small park or your backyard garden, there’s probably some place close by where you can go for a few minutes to clear your head and be in the moment. You don’t need to hike out into the wilderness. Just take a few minutes to admire the beauty of the world around you. Consider it a mini-vacation.
All of the above isn’t to say that you should never complain – to keep your frustrations bottled up inside clearly isn’t healthy. But be careful not to get carried away when you do indulge in venting. You may want to set a time limit for airing your greivances, and then when you’re done make a point of reminding yourself of the big picture. Caring for your loved one can be aggravating, but you are doing your best to make sure that they’re healthy and comfortable. Revisit your reasons for taking on these responsibilities in the first place. In this way you can connect to the deeper meaning of caring for someone you love, which is a deeper happiness that goes beyond day-to-day annoyances.
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How to Lower Medical Expenses

reducing medical billsHealth care bills are notoriously confusing. Of course, Medicare all by itself is a maze, but beyond that there’s also the out-of-pocket expenses that Medicare doesn’t cover. These can be a significant financial obligation: almost $200,000 for a married couple over the course of their retirement according to one estimate. Here are some steps you can take to try to make these expenses more manageable. 1. Use in-network providers Whenever possible, use in-network providers for all your care. This can lower your bill tremendously, as in-network providers have previously negotiated what they’ll charge with your insurance company. Take the time to sit down with your plan to understand what is covered and what isn’t. This can result in significant savings, both immediately for particular medical events and over time. 2. Examine your bill closely Whenever we get a bill, many of us will quickly write a check out of habit, wanting to be prompt and on top of these sort of things. However, it’s worth taking the time to go over medical bills line-by-line, as they frequently contain errors and services that you or your loved one didn’t receive (as often as 80% of the time!). This is the time to be a pain and question anything you don’t understand: don’t pay until you’re confident about what you’re paying for. You’ll also want to verify the basics, such as your name, address and date of service. You may be surprised at how often it’s worth it and that being thorough leads to savings. Plus, it’s a much better idea to do this up front. If you discover an error later, it may be very difficult to get a refund from the provider after you’ve paid. Unfortunately, they’ll tend to be more responsive when they’re eager to get the matter resolved and have your payment in hand. 3. Verify that the bill has been adjusted for insurance payment One important item to note when reviewing your bill is whether the different line items have been adjusted to reflect the insurance rates. If you don’t see this, insurance was not applied. You should contact the office right away to make sure they run the charges through your insurance first. 4. Check the bill against your EOB You should never pay a medical bill without getting an EOB from your insurance company first. This document will verify what you’re supposed to pay. This is an important step for eliminating possible errors. Be wary if the bill arrives much sooner than the EOB does–this means that the medical provider has not received payment from your insurance company yet. 5. Be proactive Don’t just let errors slide–contact both your insurance company and the provider to resolve billing issues. Often it will be important to be persistent: sadly, larger companies will try to win in these disputes by ignoring you sometimes. At the same time, make sure you keep the lines of communication open with all parties. If you are waiting to hear from your insurance company before you pay the doctor, let their office know what the delay is. Otherwise, they may be very quick to assume that you’re trying to dodge the bill and send the account to collections. This will be counterproductive, resulting in more unnecessary charges and time spent resolving the issue. 6. Negotiate Even if you don’t have insurance, you can try asking providers if they’ll charge you the same rate they charge insurance companies. Also, if a bill is more than you can afford right away, see if the provider will lower it in exchange for faster payment. You can also try asking for financial assistance. Some providers will let you pay in interest-free installments or work out some other reasonable arrangement. They would much rather get the bill paid than have you feel the situation is hopeless and ignore it.
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