tag:blogger.com,1999:blog-22590868781653329592024-03-20T02:08:22.999-04:00Nursing Resources LLCAnonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.comBlogger12125tag:blogger.com,1999:blog-2259086878165332959.post-2543933067045529562016-04-20T09:27:00.003-04:002016-04-20T09:27:55.190-04:00End of Life Conversations: Have You Had Yours?<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
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<span style="color: #262626; font-family: Merriweather; font-size: 14.0pt; mso-bidi-font-family: Merriweather;">A large majority of the
doctors (roughly 75 percent) believe it’s their responsibility to initiate
the end-of-life conversations, however, less than one-third have received
training on how to do so effectively with their patients and patients’ family
members.<span style="mso-spacerun: yes;"> </span>This is important for several
reasons. At the end of life we<span style="mso-spacerun: yes;"> </span>waste a
great deal of resources by not educating and talking about<span style="mso-spacerun: yes;"> </span>the end of life.<span style="mso-spacerun: yes;"> </span>Annually we waste $210 billion on unwanted,
unnecessary and non-beneficial healthcare services.<o:p></o:p></span></div>
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<span style="color: #262626; font-family: Merriweather; font-size: 14.0pt; mso-bidi-font-family: Merriweather;">80 percent of people believe
it’s important to create advance directives, but less than 25% have actually
done so, and only 7% with their doctor’s help. Seventy-five percent of the
doctors say the conversations, which are often held in a hospital or other
healthcare facility, are initiated because Medicare reimburses for advanced-care
planning. However, only approximately 14 percent of the doctors report having
to bill </span><a href="http://www.medicaldaily.com/us-health-care-system-doing-disservice-end-life-care-high-costs-and-instability-303854"><span style="color: #262626; font-family: Merriweather; font-size: 14.0pt; mso-bidi-font-family: Merriweather; text-decoration: none; text-underline: none;">Medicare-eligible
patients</span></a><span style="color: #262626; font-family: Merriweather; font-size: 14.0pt; mso-bidi-font-family: Merriweather;"> for having the conversations.
Despite the fact that end-of-life talks are covered by insurance for elderly
patients, which removes financial hurdles, doctors still find it
difficult to overcome the discomfort of talking about death. More than that,
most electronic paperwork systems are so antiquated, doctors report there’s no
place to include their patients’ end-of-life preferences in their file.<o:p></o:p></span></div>
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<a href="http://www.medicaldaily.com/examining-end-life-care-patients-under-40-er-icu-services-accessed-more-often-young-342138"><span style="color: #262626; font-family: Merriweather; font-size: 14.0pt; mso-bidi-font-family: Merriweather; text-decoration: none; text-underline: none;">End-of-life
conversations</span></a><span style="color: #262626; font-family: Merriweather; font-size: 14.0pt; mso-bidi-font-family: Merriweather;"> not only help ensure a
patient the specific type of treatment they want once they may no longer be
able to articulate their desires, but they also save costs associated
with treating someone medically who doesn’t want to prolong life. Without “the
talk,” doctors and possibly even family members would be left in the dark on
how their loved one wishes to proceed when they are critically ill and dying.<o:p></o:p></span></div>
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<span style="color: #262626; font-family: Merriweather; font-size: 14.0pt; mso-bidi-font-family: Merriweather;">Adapted from Medical Daily
2016</span><o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com1tag:blogger.com,1999:blog-2259086878165332959.post-26793767181375351762016-03-24T16:22:00.001-04:002016-03-24T16:22:55.558-04:00Wow! this has been pretty busy so far this year! I have been helping out Compassion and Choices to do some talks about the importance of a specific Living Will WITH a choice of a good Surrogate who can speak for you if you are unable to. I gave a presentation at the Herald Tribune in Sarasota FL a couple weeks ago. For my talk I emphasized this and explained that after one becomes incapacitated, it is too late. I also told the group that lying in an ICU bed is NOT desirable. Do you know why?<br />
<br />
First, the longer you are in the hospital, especially the ICU, the bigger chance you will develop an infection. Maybe someone does not wash their hands. Maybe you are just so sick you cannot fight off the bugs brought to your bedside. Second, we now know that even after the short time of 48 hours, people are likely to develop Post-Intensive Care Syndrome (PICS). What is PICS? It is where you get out of the hospital, and now have post-traumatic stress disorder (PTSD)...yes! Just like our Servicemen and women get! And also, you are likely to develop Alzheimers-like symptoms where you are unable to remember and think clearly. Many people who have been seriously ill in the ICU never go back to work because of these things. Third: Do you have any idea what kind of costs you will be racking up lying in that bed? Just consider: an ICU bed (just the bed, no meds, no treatments, X-rays or ANYTHING else!!!) costs about $7000.00 per day. Multiply by a week or 2! Yes, you might be lucky to have insurance that covers 80% of those costs, but YOU will need to cover the rest. How many people have $50,000. or more of disposable income to pay the remainder? Not many.<br />
<br />
So, advice, needless to say is to talk with your family. Think about: What is valuable to me? Would I be happy to never golf again? What about never playing bridge? What about never being able to hold my grandkids? What about never eating normally again? These are your values. You should think about theses things so YOU can make your own choices and consider your values. Today is a good day to start!<br />
<br />Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com0tag:blogger.com,1999:blog-2259086878165332959.post-91552002204569731192016-02-08T09:34:00.000-05:002016-02-08T09:34:08.540-05:00Confusion Between Palliative Care and Hospice Care<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #1a1a1a; font-family: Arial; mso-bidi-font-weight: bold;">Last week I was caring for an 84 year-old gentleman who had been battling
colon cancer at home.<span style="mso-spacerun: yes;"> </span>His condition
worsened and he ended up in our ICU after having major abdominal surgery.<span style="mso-spacerun: yes;"> </span>He had never had palliative care, which would
have been a benefit since, at his age, he was unlikely to recover to his
previous level of function.<span style="mso-spacerun: yes;"> </span>Now that he
was even more deconditioned, it was appropriate to discuss palliative care for
him.<span style="mso-spacerun: yes;"> </span>I found this article, written by an
Emergency Physician in California which helps clarify supportive care at the
end of life.<span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<b><span style="color: #1a1a1a; font-family: Verdana; mso-bidi-font-family: Verdana;">Clearing palliative care confusion</span></b><span style="font-family: Verdana; mso-bidi-font-family: Verdana;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-left: .5in; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; tab-stops: 11.0pt .5in; text-autospace: none; text-indent: -.5in;">
<!--[if !supportLists]--><span style="font-family: Arial; font-size: 10.0pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">•<span style="font: 7.0pt "Times New Roman";"> </span></span></span><!--[endif]--><a href="http://www.goldenstatenewspapers.com/press_banner/clearing-palliative-care-confusion/article_09630e2e-cc7b-11e5-afa7-9791c0ae1d85.html?mode=story"><b><span style="color: #262626; font-family: Arial; font-size: 10.0pt; text-decoration: none; text-underline: none;">Story
</span></b></a><span style="font-family: Arial; font-size: 10.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="color: #535353; font-family: Arial; font-size: 11.0pt;">Posted: Friday, February 5, 2016 6:40 pm<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<b><span style="color: #535353; font-family: Arial; font-size: 11.0pt;">By Terry Hollenbeck MD<o:p></o:p></span></b></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: Arial;">There seems to be some
confusion when it comes to understanding the difference between palliative care
and hospice. They are both distinctive medical disciplines and often work
together.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: Arial;">Hospice care comes into
play when a patient has a terminal illness and all treatment options have been
exhausted. It is really for those who have been determined to be in their last
six months of life. The goal of hospice care is not to cure the underlying disease
but to support the quality of life. Hospice care maximizes comfort for
terminally ill patients while also addressing physical, social and spiritual
needs.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: Arial;">Hospice care is most
commonly provided at a patient's home, with a family member typically serving
as the primary caregiver, but, it is often available in facilities. The hospice
care team is usually available 24 hours a day, seven days a week.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: Arial;">Palliative care is medical
care based on the goal to relieve pain and suffering, reduce symptoms, ease
stress, and mainly to improve a patient's quality of life during a serious
illness and is not limited to end of life issues. People who are actively being
treated for a disease can receive palliative care at any stage of their illness
whereas hospice is thought of as end of life care.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<br /></div>
<div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: Arial;">This is an important
distinction because many people think of palliative care as end of life care.
The palliative care team works closely with the patient's primary treating
physician in caring for the patient. While the patient's treating physicians
may be trying to prolong life, palliative care's goal is to <u>maximize quality
of life</u>. <o:p></o:p></span></div>
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<div class="MsoNormal">
<span style="font-family: Arial;">Identifying and managing
pain is one of the main priorities of any palliative care program. Palliative
care also seeks to improve many other troublesome sources of physical
discomfort such as shortness of breath, constipation, and insomnia.</span><o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com0tag:blogger.com,1999:blog-2259086878165332959.post-76005428660988990262016-01-04T14:22:00.001-05:002016-01-04T14:22:29.407-05:00Happy New Year! <div class="MsoNormal">
Happy New Year!<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Here we are already in 2016!<span style="mso-spacerun: yes;">
</span>Time flies, and we are yes, admit it! One year older!<span style="mso-spacerun: yes;"> </span>So I reflect on some very positive things
from 2015:<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As I mentioned before, I was invited to present a talk at
the World Nursing Conference in Dubai.<span style="mso-spacerun: yes;">
</span>It was very interesting, for one, to be half way around the world!<span style="mso-spacerun: yes;"> </span>And also in a completely different
culture!<span style="mso-spacerun: yes;"> </span>As nurses, we all have many of
the same concerns for better healthcare and improved lives of those we care
for.<span style="mso-spacerun: yes;"> </span>And as such I am thinking that it
is never too soon to think about whether we have had those discussions with our
family members about our wishes should a catastrophic event or illness occur.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB_l8a0QhKDIRgyqFqduVVs7VZ5NAfbRtHrEEzKA2CPNb07BKyQIdCTb_VmzG8yRo1u-9GOno7W51AxKCtGReufNIzKp8uhJ96RPvBfcgRDpRTLJ0iXZ4a5SIRYQZNouQG2i0ChaaAc_g/s1600/Nursing+conf+Dubai.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="190" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB_l8a0QhKDIRgyqFqduVVs7VZ5NAfbRtHrEEzKA2CPNb07BKyQIdCTb_VmzG8yRo1u-9GOno7W51AxKCtGReufNIzKp8uhJ96RPvBfcgRDpRTLJ0iXZ4a5SIRYQZNouQG2i0ChaaAc_g/s200/Nursing+conf+Dubai.jpg" width="200" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I recently did a talk at our local library in Michigan about
considering your wishes if something occurs, and what to consider and why. Keep in mind that we always think ‘It won’t
happen to me,’ or ‘I’m too young to consider what I’d want if I cannot continue
the life I have now.’ But it is NEVER
too soon to think and talk about these topics, as hard as it may be.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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<div class="MsoNormal">
You do not want to have these things happen and you have not
discussed your thoughts and wishes with anyone.<span style="mso-spacerun: yes;">
</span>Trust me, it is something I see very often at my hospital.<span style="mso-spacerun: yes;"> </span>And it is too late of you cannot
communicate.<span style="mso-spacerun: yes;"> </span>So please, think about
this, read some of the questions I have here on the website and<span style="mso-spacerun: yes;"> </span>ask a healthcare professional or your doctor
to help you understand.<o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com0tag:blogger.com,1999:blog-2259086878165332959.post-27056406361305824902015-11-18T13:16:00.001-05:002015-11-18T13:16:53.888-05:00Have you Thought about 'What If?'<div class="MsoNormal">
I recently had a social event along with<span style="mso-spacerun: yes;"> </span>my neighbors. We got around to talking about
‘What If’ scenarios because we were discussing our age.<span style="mso-spacerun: yes;"> </span>It seems everyone thinks nothing is going to
ever happen to them that is bad unless we are very old.<span style="mso-spacerun: yes;"> </span>Of course, bad things happen to good people
every day.<span style="mso-spacerun: yes;"> </span>I mentioned to my neighbor.
’If only we had a crystal ball!’<span style="mso-spacerun: yes;"> </span>Well,
we don’t.<span style="mso-spacerun: yes;"> </span>I asked if they had a Living
Will, or as some call it, ‘Durable Power of Attorney.’<span style="mso-spacerun: yes;"> </span>My friend said, well, it’s terrible!<span style="mso-spacerun: yes;"> </span>We don’t even have a will!’<span style="mso-spacerun: yes;"> </span>Of course, we all believe nothing ever will
happen to us so we put off these things. And we take life for granted! And...we're busy.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I asked her, ‘What if your husband here got into a serious
car accident and was paralyzed, needed to breathe on a ventilator for life and
get fed with a feeding tube?’<span style="mso-spacerun: yes;"> </span>She
shuddered and said she didn’t like talking about it. I also asked: ‘What if he
was comatose in an ICU and was not likely to survive, would he want to continue
to live, even though we may have no idea the pain he might be in?’<span style="mso-spacerun: yes;"> </span>This seemed to give them food for
thought.<span style="mso-spacerun: yes;"> </span>Well, they are not alone.<span style="mso-spacerun: yes;"> </span>Her husband acknowledged that these
discussions are probably valuable to have.<span style="mso-spacerun: yes;">
</span>I supported him on that thought.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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<div class="MsoNormal">
So if you have not given thought to things like these, today
is a good day to start thinking about it.<span style="mso-spacerun: yes;">
</span>Think about this:<span style="mso-spacerun: yes;"> </span>You are the
patient in the bed, in pain,<span style="mso-spacerun: yes;"> </span>not likely
to survive, and you cannot tell anyone.<span style="mso-spacerun: yes;">
</span>Nor have you ever talked about these things to any of your family.<span style="mso-spacerun: yes;"> </span>You think it can’t happen to you?<span style="mso-spacerun: yes;"> </span>It happens every day to good people.<span style="mso-spacerun: yes;"> </span>Think about it.<span style="mso-spacerun: yes;"> </span>Talk about it.<o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com0tag:blogger.com,1999:blog-2259086878165332959.post-34992342065101082102015-11-07T10:39:00.001-05:002015-11-07T10:39:41.361-05:00<div class="MsoNormal">
Wow!<span style="mso-spacerun: yes;"> </span>It’s been a
while! I am still busy practicing at the hospital, learning and observing.<span style="mso-spacerun: yes;"> </span>One of my goals each day I work is to chat
with the family of my patient and understand what they and their family member
really wants.<span style="mso-spacerun: yes;"> </span>Often I am dealing with elderly
patients.<span style="mso-spacerun: yes;"> </span>I know we all think we’ll live
forever, but like a machine after many years, we wear out.<span style="mso-spacerun: yes;"> </span>Even though we have many tools we can use to
help people get better, or get ‘over the hump’ of surgery, sometimes it is just
too much for us.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
So what should the considerations be then?<span style="mso-spacerun: yes;"> </span>First and foremost, there should be little or
no pain and suffering.<span style="mso-spacerun: yes;"> </span>Problem is, we
cannot often talk with those that are seriously ill.<span style="mso-spacerun: yes;"> </span>They can’t tell us they are in pain.<span style="mso-spacerun: yes;"> </span>So that’s all the more reason why we should
think it through and consider the reality of the situation.<span style="mso-spacerun: yes;"> </span>This is where an expert Advocate comes
in.<span style="mso-spacerun: yes;"> </span>This is where we should talk about
end of life comfort, or the possibility of recovery.<span style="mso-spacerun: yes;"> </span>Frank discussions of medical possibilities,
or none is paramount here.<span style="mso-spacerun: yes;"> </span>So talk about
‘What if” scenarios with your family.<span style="mso-spacerun: yes;"> </span>It
is difficult, but important.<span style="mso-spacerun: yes;"> </span>Would you
want to be in pain, unable to recover but unable to tell anyone?<o:p></o:p></div>
<div class="MsoNormal">
I’m also delighted to mention I have been invited to speak
at the World Conference on Nursing in Dubai this month!<o:p></o:p></div>
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Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com0tag:blogger.com,1999:blog-2259086878165332959.post-28949660942711254382015-04-17T12:39:00.001-04:002015-04-17T12:39:31.008-04:00<div class="MsoNormal">
Have you had conversations with your family about your
end-of-life wishes?<span style="mso-spacerun: yes;"> </span>Dying with dignity
is a part of life well lived.<span style="mso-spacerun: yes;"> </span>Most
seriously ill patients are unable to express their wishes and also are unable
to communicate any suffering at the end of life.<span style="mso-spacerun: yes;"> </span>In more than 88% of doctor-patient- family
conferences during serious illness, there was no conversation about the
patient’s own values and wishes. (Critical Care Medicine April 2015). <o:p></o:p></div>
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<br /></div>
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Decisions about using life support (breathing machines,
dialysis, transfusions etc) usually hinge on trade-offs between the length and
quality of life.<span style="mso-spacerun: yes;"> </span>And they are influenced
on the person’s understanding of their expected level of function, independence
and comfort.<span style="mso-spacerun: yes;"> </span>But most people who are
critically ill are incapacitated and therefore the family members try to make
the decisions for them.<span style="mso-spacerun: yes;"> </span>So does your
family REALLY understand what you would want?<span style="mso-spacerun: yes;">
</span>And do you understand the implications of the life-support treatments? <o:p></o:p></div>
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<div class="MsoNormal">
You can be comfortable and have your wishes carried out but
only if you take the right steps now.<span style="mso-spacerun: yes;">
</span>Talk with your family.<span style="mso-spacerun: yes;"> </span>We all
will die, but some of us will have a plan in place to die in comfort.<span style="mso-spacerun: yes;"> </span>You can too!<o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com0tag:blogger.com,1999:blog-2259086878165332959.post-31349315556607082682015-03-12T11:13:00.001-04:002015-03-12T11:13:08.820-04:00Well, to follow up, My aunt was seen in a major medical center hospital (read University hospital). They correctly diagnosed her with a very fast heart rate which was causing the loss of consciousness (something I had also determined as a diagnosis myself.) She is now on the correct meds to slow her heart rate and has had no incidences since!<br />
<br />
So this is important. I can't even count how many times people tell me their MD, who is a part of the 200 bed local hospital, is "world renowned" in cardiology, or lung disease, or kidneys, or whatever. The way you <u>become</u> world renowned is to work in a large university-affiliated teaching hospital (for years!) and continue to do research and publish the results. Small local hospitals do not require their MDs to read a medical journal let alone do research and let the world know what they found by publishing. So, no that doctor may be world renowned, in their head. <br />
<br />
So it pays to be suspicious. You ask why? Well, let's put it simply: if you bought a Ferrari, or a Lexus even, would you bring it to Joe-Bob's car fixing shack for repairs???? I highly doubt it. But yet, we will blindly trust any doctor and not even ask appropriate questions prior to major procedures!! <br />
<br />
I tell my clients to ask some simple, direct questions such as "What is the recovery period?" "Will I be active enough after the surgery to return home? Or will I need extended rehab in a nursing home?" What if this doctor's complication rate is off the charts? Do you think they are going to share that info? When was the last time they read a journal citing that this procedure was state-of-the-art and currently evidenced-based? When they cannot answer these questions readily...get another opinion!<br />
<br />
Just some food for thought. It's your body, spouse, friend, family member. Are you really looking out after yourself or your loved one? Or are you blindly trusting that this is for sure the honest truth? Yes it might be. Or...maybe NOT! We can help!Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com0tag:blogger.com,1999:blog-2259086878165332959.post-46544456473691725442014-12-08T12:25:00.001-05:002014-12-08T12:25:46.104-05:00<div class="MsoNormal">
The other day, I was speaking to my elderly Aunt.<span style="mso-spacerun: yes;"> </span>She was telling me that she found herself
fainting for no reason.<span style="mso-spacerun: yes;"> </span>She told me one
day she woke up on the kitchen floor.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I was alarmed.<span style="mso-spacerun: yes;"> </span>I
asked if she told her doctor, and she did.<span style="mso-spacerun: yes;">
</span>He had her undergo many tests but found no reason for the sudden loss of
consciousness.<span style="mso-spacerun: yes;"> </span>Now, this is not normal
and these symptoms have meaning.<span style="mso-spacerun: yes;"> </span>My
conclusion was either a cardiac problem or something like a stroke.<span style="mso-spacerun: yes;"> </span>She told me she had no problems after she
fainted.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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Of course., since I am the family Advocate, especially for
health-related issues, I urged her to seek a second opinion at a large
University center, where they would have more specific diagnostic tests.<span style="mso-spacerun: yes;"> </span>I searched and gave her some physician names
to call and set up appointments.<span style="mso-spacerun: yes;"> </span>She was
very thankful, but this is what I do.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I cannot sit by and just blindly trust anything a doctor is
saying.<span style="mso-spacerun: yes;"> </span>These statements need to backed up
by evidence-based medicine and research.<span style="mso-spacerun: yes;">
</span>Only then can we make decisions and proceed or elect to wait and
see.<span style="mso-spacerun: yes;"> </span>I told my Aunt, ‘The worst case
scenario would be that<span style="mso-spacerun: yes;"> </span>you suffer a big
stroke and end up in a nursing home the rest of your life.’<span style="mso-spacerun: yes;"> </span>That was appalling to her and I think that
caused her to rethink the potential severity of these symptoms.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
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But the best I can do, as head of Family Medical Advocate is
to BE that expert advocate and help people make informed choices.<span style="mso-spacerun: yes;"> </span>I am waiting to see what happens next.<o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com0tag:blogger.com,1999:blog-2259086878165332959.post-90548673458203086162014-10-03T14:40:00.002-04:002014-10-03T14:40:29.845-04:00What Do You Think?<br />
<br />
I recently read an article about discussions about 'What If?' situations and discussion about what your wishes will be at the end of your life. It was interesting! <span style="background-color: white; color: #444444; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px;">The Institute of Medicine came out with </span><a href="http://www.iom.edu/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx" style="background-color: white; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px; padding-right: 0px; text-decoration: none;" target="_blank"><span style="color: black;">a 500-page</span></a><a href="http://www.iom.edu/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx" style="background-color: white; color: #334e91; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px; padding-right: 0px; text-decoration: none;" target="_blank"> </a><span style="color: black;"><a href="http://www.iom.edu/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx" style="background-color: white; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px; padding-right: 0px; text-decoration: none;" target="_blank">report</a><span style="background-color: white; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px;"> </span></span><span style="background-color: white; color: #444444; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px;">earlier this week urging more conversations and action surrounding end-of-life care.</span><br />
<span style="background-color: white; color: #444444; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px;">The Institute of Medicines (IOM) </span><span style="background-color: white; color: #444444; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px;">“Dying in America” report says Americans should start having end-of-life conversations much earlier, even when a teenager gets their first driver’s license at 16.</span><span style="background-color: white; color: #444444; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px;"> </span><br />
<span style="background-color: white; color: #444444; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px;"><br /></span>
<div style="background-color: white; border: 0px; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px; outline: 0px; padding: 0px 20px 20px 0px; vertical-align: baseline;">
<span style="color: #444444;">Oregon has been out front of other states in this area, </span><a href="http://pubads.g.doubleclick.net/pagead/adview?ai=Bf-A4jOsuVKyOJdCAwgHvtoBAiefLugUAAAAQASCpltofOABYmZfpiK4BYMnWwImQpOgPsgETd3d3LmJpempvdXJuYWxzLmNvbboBCWdmcF9pbWFnZcgBCdoBdGh0dHA6Ly93d3cuYml6am91cm5hbHMuY29tL3BvcnRsYW5kL2Jsb2cvaGVhbHRoLWNhcmUtaW5jLzIwMTQvMDkvd2h5LWFuLW9oc3UtcHJvZi1zdHJvbmdseS1zdXBwb3J0cy1lbmQtb2YtbGlmZS5odG1smALohAHAAgLgAgDqAhYvNDYzNS9iemoucG9ydGxhbmQvb29w-AKE0h6QA-ADmAPgA6gDAeAEAZIFCwgHEAEYASDBmegYkgULCAcQARgBIJmd6hiSBQsIBxABGAEgufn8GKAGIA&sigh=T1_AcsjqBqo&adurl=http://pagead2.googlesyndication.com/pagead/imgad?id=CICAgKCNn-yIxgEQARgBMggPKtH7CIiUnA%26t%3D10%26cT%3Dhttp%253A//bizjournals.com%26l%3Dhttp%253A//www.bizjournals.com/portland/blog/health-care-inc/2014/06/ohsu-study-why-some-oregon-patients-get-their-last.html%253Fpage%253Dall" style="padding-right: 0px; text-decoration: none;" target="_blank"><span style="color: black;">with a program developed in 1991</span></a><span style="color: #444444;"> to ensure the wishes of those with advanced illness or frailty are followed. Called "Physicians Order for Life-Sustaining Treatment", the form allows people to express their wishes about the level of care they receive. “It is a tool that would help any of the problems they’re discussing,” she said.</span></div>
<div style="background-color: white; border: 0px; color: #444444; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px; outline: 0px; padding: 0px 20px 20px 0px; vertical-align: baseline;">
Most Americans haven’t documented their wishes for end-of-life care. A national survey in 2013 found that fewer than 30 percent have done so!! The report also found gaps in the health care system for patients at the end of life including very few doctors specializing in palliative care and inadequate support for dying patients.</div>
<div style="background-color: white; border: 0px; color: #444444; font-family: 'Helvetica Neue', Helvetica, Arial, sans-serif; font-size: 14px; line-height: 20px; outline: 0px; padding: 0px 20px 20px 0px; vertical-align: baseline;">
We never want to have these discussions..After all, we are having a great time living today, right? But in a split second, you can be clinging to life and unable to express if you are in severe pain or what you want to do. Once you end up in the ER, the Healthcare Team has one focus: To try to save your life...at ANY cost and ANY quality. After the ER, you end up with a situation that, if not properly discussed and written down can be something your would never agree to. Asking the right questions, and thinking hard and long about what you really want can make all the difference...for you AND your family.</div>
Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com0tag:blogger.com,1999:blog-2259086878165332959.post-62853493502579473402014-09-02T14:58:00.000-04:002014-09-02T14:58:23.531-04:00Can You Imagine?<br />
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Each day that I work,
I am realizing that despite all our plans and hopes to have a wonderful
long life, sometimes, (it seems often
for me) life throws a big curveball to many good people. This week and last, I cared for 2 people
that had just been diagnosed with Lou Gerhigs disease or ALS. Now, this is not your run-of-the-mill
disease. The fact that both of these
people had just been told they had a terminal disease…well, it broke my heart,
and I know it was a terrible parcel of news for both of them. Just think:
What if you’d been told you have a disease that has no treatment and no
cure?<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
But still, this is real, and they need to know that they
will be comfortable until the end. As a professional, I suggested that they talk with our Palliative Care Team to find out how they could help alleviate the symptoms and keep them comfortable. I sat
with both of them, and we discussed this and why it would be of help. And at
the end, they could transition into Hospice, so that they did not suffer with breathing difficulties. Since we cannot change the disease why not
help them to pick options now so that they, and their families know who to call
for assistance? We should be able to
direct a good death as well as a good life.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
These are real-life examples of the fact that we cannot
control or predict our future. And it
also reminds me that planning for the end in a very specific way can create at
least some piece of mind. So I encourage
you to sit down and discuss What ifs? with your family. Be open and honest and consider that we may
be the next one that gets the bad news…or the one that ends up seriously ill or
injured in an ICU. None of this is nice
to discuss, but it is reality.<o:p></o:p></div>
<!--EndFragment-->Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com0tag:blogger.com,1999:blog-2259086878165332959.post-14412426179176169872014-09-02T12:09:00.001-04:002014-09-02T12:09:11.685-04:00Plan Ahead for Getting Older and the Potential for Continuing CareWhen do you think you will start to need help with simple activities of
daily living? What if you are hospitalized and cannot go back to your
home? Wouldn’t you want to choose where to live instead of your
children (if you have some)?<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-m2_7kvKKGcc/VADV1U2vSMI/AAAAAAAAAMQ/tpFLAVnLlrg/s1600/home_consult_pic2.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="200" src="http://4.bp.blogspot.com/-m2_7kvKKGcc/VADV1U2vSMI/AAAAAAAAAMQ/tpFLAVnLlrg/s1600/home_consult_pic2.jpg" width="195" /></a></div>
We all want to maintain control of our lives. We want to stay where we
are, and this works well as long as we can take care of ourselves. Once
we cannot, we will have to depend on others. This is one way to ensure
that if and when you are unable to live alone, you can have made this
decision and feel confident about it. We should think about this in
advance, and consider how we will transition into another living
environment.<br />
<br />
An easy way to evaluate how well your home would work for you should you
become disabled is to look around your home now. Can a walker or a
wheelchair get into the bathroom? Can you get into the shower if you
cannot get over the side of the bathtub? Could a wheelchair get through
the doors of your home? Many homes have door frames that are less than
30 inches wide. Not enough to accommodate a wheelchair. Do you have
to go up steps to get into the house or go up to the bedroom?<br />
<br />
All of these questions can shed light on whether or not you can
reasonably continue in your own home if you need help. There are
several facilities that you could live in, from a continuing care
retirement community (CCRC) to assisted living. Both offer
housekeeping, laundry, meals, entertainment and activities. Many
assisted living communities allow the residents to live privately in an
apartment, but also may offer skilled nursing should you need it for
short periods of time.<br />
<br />
The time to consider, evaluate, look around and choose is while you can.
After you have experienced a serious medical event you may not be in
any shape to make your own plans. You can find out more information at
the caregiving resource center: <a href="http://www.carf.org/">www.CARF.org</a>.
Anonymoushttp://www.blogger.com/profile/00742903845371998658noreply@blogger.com0