The Heartwarming Story of an Elderly Widower’s Heartbreaking Song

Watch the video here: https://vimeo.com/70426141

When Fred Stobaugh’s wife Lorraine passed away earlier this year, he felt he needed to say goodbye one last time.

“She gave me 75 years of her life,” said Stobaugh, recalling “the prettiest girl I ever saw.”

Like many a heartbroken men before him, the 96-year-old sat down to write his “Sweet Lorraine” a song, but after coming up with the lyrics, the melody, and everything in between, he realized he lacked the musical talent to bring his eulogy to life.

Enter Green Shoe Studio.

The Illinois-based music production outfit just so happened to be running an online singer-songwriter competition aimed at discovering unsung talent, and Fred just so happened to come across an ad for the competition in his local paper.

Not being entirely familiar with the concept of email, Fred instead went the old-fashion route and sent Green Shoe an honest-to-goodness letter with his hopes and dreams tucked inside.

Touched by the story, the studio agreed to fill in the gaps for Fred, and turn the tune in his head into a professionally produced track.

The entire process was captured on film for the short documentary A Letter from Fred — “a poignant story of life, love and music.”

Source: Gawker. By Neetzan Zimmerman

Caregivers’ reading list: Tips, guidance and humor

Great article in San Diego Union-Tribune by Michele Parente 

Most family caregivers know there aren’t enough hours in the day to get everything done on their to-do list. So why would a caregiver with some down time pick up a book — on caregiving?

Because maybe when you put the book down, you might be smarter, calmer or even in a better mood.

Take, for example, “How to Care for Aging Parents: A One-Stop Resource for All Your Medical, Financial, Housing, and Emotional Issues,” by Virginia Morris. Now in its third edition, “How to Care for Aging Parents” has earned accolades usually reserved for the bestseller list. (“The bible of eldercare,” said ABC World News, while The Washington Post called it, “A compassionate guide of encyclopedic proportion.”)

The book provides concise, authoritative information on everything from preventing elder fraud to a primer on the different stages of Alzheimer’s disease and the essentials of Medicare parts A and B.

There’s also the personal, but no less informative, “Passages in Caregiving: Turning Chaos into Confidence,” by mega-selling “Passages” author Gail Sheehy. The writer uses her experience caring for her husband, the late magazine editor Clay Felker, as a springboard to delve into — and try to make sense of — the healthcare system, the dearth of support for family caregivers, and the impact of a loved one’s death and its aftermath.

As Sheehy leads readers on this journey, she offers both practical and spirit-lifting advice.

Then there’s the crowded genre of caregiver memoirs which read more like journals and collections of poignant and profound moments that result in “ah-ha” moments. Some contain poetry, others capture the humor that inevitably surfaces amid the pressures of caregiving. Many can bring you to tears.

The book jacket of “My Life Rearranged: Musings of an Alzheimer’s Caregiver,” by Cardiff author Susan Miller, says the book “will tug at your heart, touch your soul, inspire you, and help you believe in your capabilities.”

“The book just flowed out of me and it felt like it was something I was supposed to be doing,” Miller told the Union-Tribune recently. “In the beginning, it was just for me, but I later came to understand the impact it could have on caregivers. It is my way of giving back and giving thanks that I could see the journey through to the end, and find tomorrow.”

Former Carlsbad resident Jerry Bridge — a motivational speaker and comedian — also thought his experience, which he got through with a combination of therapy, faith, journaling and a sense of humor, could be the basis of a book. From that, came “Who Cares? The Give and Take of Family Caregiving.”

Bridge told the Union-Tribune in 2015 that he wanted “Who Cares” to help other caregivers sort through the emotions and day-to-day challenges of their role as well as prepare for the end-of-life stage.

“Some people will have it more difficult than me and some not as difficult,” he said. “It’s just a way to help people not feel alone and … help people laugh and cry.”

An informal search of Amazon turned up warehouses-worth of caregiving books, some put out by large publishing houses, others self published. There is value in even older, out-of-print volumes which can offer universal advice and timeless encouragement. Among the 4,000-plus available on Amazon, we’re citing a micro-sampling below.

Some of the titles can be found at public libraries or on the shelves at caregiver-centric organizations such as the Southern Caregiver Resource Center and the Sharp Senior Resource Centers. Others can also be purchased directly from the authors, including Miller (Caregiverbooks@gmail.com) and Bridge (jerrybridge.com/books)

  • “The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss,” by Nancy L. Mace and Peter V. Rabins. Considered essential, trusted reading for anyone caring for someone with dementia. Every aspect of the disease is covered in easy-to-understand language.
  • “Dementia Sucks: A Caregiver’s Journey with Lessons Learned,” by Tracey S. Lawrence. Think caring for your father and then your mother for 12 years, handling all of their financial, health and daily living concerns, can’t be side-splitting? Read on: “ ‘Not buying it, huh?’ My mother acknowledged her assertion that the woman she pointed out at the rehab center as being her dead husband was a bit of a stretch. But this was the kind of conversation I had with Mom as her cognitive abilities declined and her psychosis fully bloomed.” The true, heart-wrenching, and yet hilarious stories at the center of “Dementia Sucks” were borne of a journal and blog that author Lawrence kept as her mother transformed from classic Jewish mother, to mildly forgetful Floridian grandma, to geriatric delinquent removed by police for knife-play at a rehabilitation facility. Really.
  • “The Complete Eldercare Planner: Where to Start, Which Questions to Ask and How to Find Help,” by Joy Loverde. This respected, comprehensive road map to caregiving is also a useful workbook, with multiple checklists and an extensive document locator.
  • “Eldercare for Dummies,” by Rachelle Zukerman. If ever a book title conveyed how caregiving can throw even the savviest person for a loop, this is it. Written in the consumer-friendly format that the “Dummies” franchise is known for, this guide will take you through problem areas you might not even know is a problem yet.

Read more: http://www.sandiegouniontribune.com/caregiver/sd-me-cargiver-reading-list-20180606-story.html 

Happy Holidays from Team Starlight

Here is wishing you Happy Holidays and Merry Christmas. We look forward to a fantastic 2018.

Starlight-team-Christmas-2017-cropped

 

Why It’s Okay to Fire Your Doctor

Finding a primary care doctor who makes you feel heard, responds to your questions and understands your concerns is not easy. And if you’re lucky enough to find a physician who suits your needs, it’s not always guaranteed that the doctor will do so as long as you need.

When a doctor stops meeting your standards of care, the conundrum becomes: Do I wait it out, avoid hard feelings and give it a chance, potentially wasting time, money and effort? Or do I move on and see if I can find better care from another doctor?

Fire Your Doctor? Many Do

Former health care journalist Bob Brody grappled with this challenge in a recent New York Times piece. Brody wrote that his trusted doctor of more than 20 years became less thorough in his questioning and examinations and began looking at his computer screen far more than Brody during appointments. Brody said the physician gave increasingly more referrals out to other doctors, more dense medical articles for him to read and more prescriptions without evidence showing the need.

Brody was left feeling unheard, and he’s not alone. In his article, he pointed to a 2001 Journal of Family Practice study showing that one-fifth of patients left their primary care doctors voluntarily over a three-year period.

Dr. Danielle Ofri, an associate professor of medicine at NYU,  told Brody that in an attempt to avoid medical risks, it’s on trend for doctors to prescribe medications and refer patients to specialists by default. And Dr. Russell Phillips, director of the Center for Primary Care at Harvard Medical School, validated Brody’s qualm that doctors are spending more time looking at screens than their patients — a topic Next Avenue has previously explored.

Brody’s tough decision was ultimately made simple when he learned that his doctor retired. He had no choice but to seek out a new physician. Not everyone has that fortune.

Putting You First

In thinking about whether to start seeing a new doctor, ask yourself if your physician listens to you and understands what you want. If you’re consistently feeling ignored or misunderstood, allow yourself to prioritize your health above your doctor’s feelings and consider making a change.

To start off on the right foot with a new doctor, read up on getting more time with your physician, standing up for yourself at a doctor’s appointment and steering your health care in the right direction.

By Grace Birnstengel

The Biggest Estate Planning Mistake People Make

If you are like most people, when you hear the words “estate planning,” you probably think of writing a will, to explain who will get what you own when you die. The problem is, a will has little or nothing to do with you. It’s all about planning for someone else. In reality, estate planning is about much more than writing a will; it’s also about taking care of you while you are alive, should you become incapacitated and unable to make your own decisions.

What follows is a rundown of the key disability documents to complete as part of your estate planning, even before writing a will. Although their names vary from state-to-state, the following are essential “me first” documents.

An Advanced Health Care Directive, sometimes called a Medical Power of Attorney  This document lets you choose who will make decisions about your health care if you become too ill or injured to make them yourself. This person is referred to as your health care agent.

Living Will  A living will spells out the kinds of medical care and treatment you do and don’t want to receive if you are close to death and there is no hope of your recovery. Your health care agent will have the power to make sure your wishes are complied with. In some states, a living will is part of an Advanced Health Care Directive; in others, they are two separate documents.

A living will also spares your family members from having to second guess your desires and can help avoid emotionally difficult fights among your loved ones over what to do (or not do). Worst case scenario: Without a living will (and a Medical Power of Attorney), decisions about your end-of-life care could end up in the hands of a judge who knows nothing about you, and your loved ones could be completely shut out of the judge’s deliberations.

A Durable Power of Attorney If you become incapacitated, your bills still must be paid, your investments managed and so on. A Durable Power of Attorney helps ensure that during your incapacitation there will be someone to manage your finances. This individual, your agent, will be able to write checks, deposit and withdraw money from your accounts on your behalf and speak with your financial advisers, among other things. Be sure to pick as your financial agent someone you trust and who will act in your best financial interest.

Don’t confuse a Durable Power of Attorney with a Power of Attorney. The latter ceases to be legally valid as soon as you become incapacitated. You need a Durable Power of Attorney

A caveat: Despite the importance of a Durable Power of Attorney, many financial institutions and real estate title companies don’t like them. They worry the document may have been revoked by its creator and replaced with a different one and that the individual claiming to be your financial agent may be trying to steal money from you. So it may be difficult for your financial agent to use your Durable Power of Attorney.

The more recent the power of attorney, the more likely it will be honored, but this varies from state-to-state. Also, financial institutions and title companies have their own criteria for when they will accept a Power of Attorney document.

Before you prepare yours, find out the criteria of your financial institutions and real estate title companies. Also, check with the companies that hold your retirement accounts to see if they have their own Power of Attorney forms; aif they do, use theirs.

A Revocable Living Trust To avoid problems with Powers of Attorney, some people set up a revocable living trust, which essentially acts like a super power of attorney. Financial institutions are legally obligated to comply with their terms. Generally,a revocable living trust is most appropriate for estates worth more than $1 million.

When you set up a revocable living trust, you transfer your assets to the trust and designate yourself as trustee. This way, you can continue to manage and benefit from those assets as you did before they were in the trust. If you can no longer act as the trustee because you become incapacitated, the individual you designated as your successor trustee manages the trust. Most people choose their spouse or partner, a close relative or a trusted friend.

A living trust doesn’t eliminate the need for a Durable Power of Attorney, however. You’ll still need that document to identify the person you want to manage your retirement accounts, like your 401(k) and your IRAs, because these kinds of accounts cannot be transferred into a living trust.

A HIPAA Release HIPAA is the acronym for the federal Health Insurance Portability and Accountability Act. Doctors may prefer, or require, you to give them written permission to share or discuss your health information with family members and friends involved in your care or payment for your care. But HIPAA does not require you give your health provider written permission; you may want to ask about your provider’s requirements, says the federal Office of Civil Rights.

An Organ Donation Authorization You may want to donate your organs when you die so someone can benefit from them. If so, make your wishes known on your driver’s license or register with an organ bank or with your hospital. Be sure to make your family and your health care agent aware of your wishes.

By Brad Wiewel

Brad Wiewel is a Texas estate planning attorney who teaches in the University of Texas CFP training program, and has taught continuing education classes to CPAs at St. Edward’s University
This post was published on Next Avenue

10 scary scams targeting seniors and how to avoid them

By Clark.com staff, July 4, 2017
Crimes against the elderly continue to skyrocket each year, as criminals continue to find more ways to carry out both new and old scams.

In fact, seniors lose billions of dollars a year to home repair scams, investment scams, IRS scams and various other cons targeting older people.

Elderly people are targets for criminals for a variety reasons, and as their family members and friends, it’s our job to help protect them from potential scams.

So in order to help you protect your loved ones, here’s what you need to know about some of the most common types of scams targeting seniors and how to avoid them.

Who criminals are targeting

Con artists are particularly fond of elderly widows. The scam is to find those who may be lonely or infirm, and slowly shower them with attention and small gifts in order to gain their confidence.

How you can help protect older people in your life

If you have elderly friends or relatives, you need to stay involved in their lives. Be nosy! Visit them. To someone who is alone a lot, just your presence brings them joy. It may seem dull at times, but never forget, someday you will be in their shoes.

With families together during the holidays, it’s a great time to check in on what’s going on in a parent or other older family member or friend’s life, including their finances.

Do you have siblings? Some families find it’s a good plan to divide up responsibilities when you have elderly parents — one kid takes them shopping, another entertains them, and a third handles money issues. Regardless of how it’s handled, be aware and be present in the financial lives of your elders.

That can mean being a second signature on a checkbook, or an authorized person on a checking account. Know about the investments they have. Remember, be nosy! You don’t want to find out your parents are destitute because you were looking the other way.

As you monitor your parent or other older person’s financial life, it’s important to be aware of some common scams and to talk to your loved ones about how they can avoid being scammed.

According to the National Council on Aging (NCOA), here are the top 10 financial scams that are wreaking havoc in the lives of seniors.

Top 10 financial scams targeting seniors

1. Medicare/health insurance fraud

PROBLEM: Scammers have targeted seniors for numerous ripoffs surrounding the Affordable Care Act and Medicare enrollment. Since every U.S. citizen over the age of 65 qualifies for Medicare benefits, seniors are an easy target for medical scams, because criminals don’t have to do any research around their insurance provider.

Many of these scams operate via door-to-door or over-the-phone solicitations by someone claiming to be a Medicare representative. Here are some ways to spot a medical scam targeting a senior:

Being told you need a new Medicare card and have to divulge your Social Security number.
Being told you need new supplemental policies.
Being asked to pay a $100 fee for help navigating the new Obamacare landscape.
SOLUTION: When in doubt, just hang up the phone or shut the door on the person trying to get money from you.

2. Counterfeit prescription drugs

PROBLEM: Many older people may be looking for cheaper drug alternatives as a way to save money on a fixed income. The problem is that scammers prey on this vulnerability of wanting to save.

The Internet is the most common way criminals operate these scams — offering ‘better prices’ on specialized medication, which can not only be fake, but also end up being harmful to the person if they take an unknown substance.

SOLUTION: Be very cautious when ordering medication online and make sure to talk to your loved ones about the dangers of doing so. Here are more tips about what to look for when buying medications online. Also, check out these 4 ways to save money on prescriptions.

3. Funeral & cemetery scams

PROBLEM: Funeral and cemetery scams have been around for years. The FBI warns about two main types that are targeted toward seniors:

Criminals will read obituaries and either call or attend the funeral service of someone they don’t know just to take advantage of someone there who’s grieving. The scammer will then claim the deceased had an outstanding debt with them in an effort to get money from relatives to ‘settle’ that fake debt.

Unfortunately, there are dishonest funeral homes out there that prey on grieving families by capitalizing on their unfamiliarity with the cost of funeral services in order to get more money from them. How it often works is someone at the funeral home adds unnecessary charges by insisting on extra features, such as the most expensive casket.

SOLUTION: Do some research before agreeing to anything suggested by the funeral home. Also, if your elderly loved one has a friend or other family member pass away, make sure to check on them and monitor their finances to make sure they don’t fall victim to a scam like this.

4. Fake anti-aging products

PROBLEM: If you watch a lot of late night TV, which seniors often do, you’ll notice all the commercials about products that claim to be the perfect solution to signs of aging or other unwanted physical changes.

According to the NCOA, seniors often feel the need to look younger in order to keep up in social circles or to fill some other void in their life. This leads them to seek out new treatments, medications and other remedies — making them vulnerable to scammers who capitalize on this demand. These scams operate in a variety of ways, including offering very expensive treatments that turn out to be harmful or very expensive homeopathic remedies that actually do nothing (except take your money).

SOLUTION: When monitoring your loved one’s finances, look for purchases of these types of remedies or treatments, which you may also find when you visit their home. Talk to them about the dangers of these products, and also just increasing the frequency of your visits may help them avoid these situations.

Read more: Beware of anti-wrinkle cream ‘free’ trial offer

5. Phone scams

PROBLEM: Scammers use several types of phone scams to prey on seniors. Here are a few to watch out for:

IRS phone scam
Caller ID spoofing: Criminals make the name of your bank pop up on the caller ID
Calling back an unknown number
SOLUTION: Here are a few ways to avoid phone scams:

Never call back an unknown number.
Know the IRS will never contact you by phone or email, only by U.S. mail.
Read more: How to protect your elderly loved ones from being scammed

6. Internet fraud

PROBLEM: Microsoft has put out special consumer alerts to warn about bogus computer security engineers making cold calls to convince people their computers are at risk for a security threat.

The phonies offer a free security check over the phone in an effort to get you to give them remote access to your computer for a supposed diagnosis and fix. Once they have remote access, they will download software to your computer that basically allows them to steal money from your accounts.

A Microsoft survey conducted in the English-speaking world (this is not just limited to the United States) found that 15% of people have gotten a call from these scammers at one time or another.

Eight in 10 of those who allowed remote access of their computers had money stolen. One in five became identity theft victims. Finally, more than half of all people who allowed remote access got hit with viruses that fouled up their computers. Very often, the cost of repair was greater than the money stolen.

SOLUTION: Microsoft offers a few recommendations to stay out of harm’s way. First, be suspicious of unsolicited calls from supposed computer security experts. Second, don’t visit any sites or install software recommended by unsolicited callers.

BONUS TIP: Seniors often fall victim to a variety of Internet scams, including fake virus protection pop-ups and fake emails. Warn your loved one about the dangers of clicking on any unknown links or emails. Do not click on any link in any email you were not expecting. If there’s a question and you think there’s a legitimate message or notification intended for you, go directly to the official website of whatever business it is and check for any notifications there. Also, you can protect their computer by downloading virus and malware protection software on it yourself.

7. Investment/timeshare schemes

PROBLEM: Buying a timeshare is bad enough of a ripoff. But imagine getting ripped off twice or three times by crooks promising to help you resell your timeshare!

The crooks typically ask for money upfront for advertising, title searches, and other administrative fees. You may even be told you’ll get your money back if your timeshare isn’t sold in 90 days. That’s a big, fat lie. You won’t get anything back except a lighter wallet.

SOLUTION: Here’s the real truth. Anyone promising you more than a few pennies on the dollar of what you paid is lying. Remember, salespeople should receive commissions at the time of the sale, not a second before.

8. Homeowner/reverse mortgage scams

Homeowner scams

PROBLEM: Seniors who live alone in their own homes are cautioned to be wary of ‘woodchucks’ — fake home contractors who gain their confidence and then charge huge amounts of money for unnecessary work.

These con men usually have some level of handyman skills and will start the relationship by offering to do a benign job such as gutter cleaning. But after they finish that job, they’ll find other imaginary problems — such as a roof or chimney repair — and convince seniors to fork over thousands of dollars.

Woodchucks also love to target people who have failing memories. In some of their most disgusting offenses, they’ll even drive old women to banks and get them to cash bogus checks before disappearing with the funds.

Police expect the woodchuck phenomenon to worsen. After all, we’re an aging population and we no longer live geographically close to our families as we did a few generations ago.

SOLUTION: Pick up the phone and call your aging relatives — or go visit them — to make sure they’re not falling prey to woodchucks. Be nosy if you’re worried that their money may be in danger. With a parent, there’ll be a natural inclination for them to not want to talk to you about money. But you’ve got to be pushy.

Mortgage/reverse mortgage scams

PROBLEM: According to the NCOA, scammers are preying on senior homeowners by offering a property assessment on the value of their home. They find the public information on the home, and then send the homeowner an official looking letter that offers to assess the value of the home for a fee. This is of course just a ruse to get that ‘fee’ money.

As reverse mortgages have increased in popularity, scammers are taking advantage of seniors with fake offers. According to the NCOA, ‘unsecured reverse mortgages can lead property owners to lose their homes when the perpetrators offer money or a free house somewhere else in exchange for the title to the property.’

SOLUTION: Monitor all of your loved one’s important financial and asset information closely. If you are worried they could fall victim to a scam like this, you may need to take control of their power to make decisions involving their finances, investments, assets etc.

Read more: Pros and cons of reverse mortgages for seniors

9. Sweepstakes & lottery scams

PROBLEM: Seniors get a call saying they’ve won a lottery or sweepstakes of some kind, but they need to either pay money or divulge sensitive account information to claim the winnings.

With the lottery scams, a senior’s savings are not eroded all at once. Once they take the bait and send some money in, they’re put on the sucker list. That marks them to receive future calls or solicitations about other alleged lottery winnings. It’s known as a ‘reload scam,’ and it can play out in areas other than just fake lottery winnings.

Another way these scams unfold is a criminal will send the person a fake check to deposit, and during the period it takes for the check to get rejected, the scammer collects money from the senior for ‘fees’ or ‘taxes’ on the supposed prize. Then they’re out of that money, and of course, no money is deposited from that fake check.

SOLUTION: Warn your loved ones about these scams and that they should NEVER hand over money for a ‘prize’ or to anyone that they (or you) do not know.

10. The grandparent scam

PROBLEM: Crooks call senior citizens and impersonate their adult grandchildren in order to hit them up for money. Here’s how a typical conversation might go:

The phone rings and the senior picks up…

Scamster: (in a low tone) Grandma?

Senior: Is that you, Jimmy?

Scamster: Yes, it’s me and I’m in trouble. I’m in jail. I need you to wire money so I can get out.

The typical take on this scam is anywhere between $3,000 and $4,000. There’s even a ‘reload’ on this one. If the scamster gets money, they’ll have another person call up impersonating a police officer and ask for additional funds in order for their grandchild to be released. They claim there are extra charges for property damage. Once the money is taken, you’ll never see it again.

SOLUTION: Never give out personal info over the phone or send money to unknown sources through a wire service.

The Potentially Deadly Condition That May Follow a Hospital Stay

Venous thromboembolism (VTE) might be the most serious condition you’ve never heard of.

The disease starts with a blood clot, or thrombosis, that forms in a deep vein in the leg (or, less frequently, the arm). This clot is known as deep vein thrombosis. If the clot breaks off, travels through the bloodstream and lodges in a lung, it’s called a pulmonary embolism and in about a quarter of such cases causes sudden death.

Together, deep vein thrombosis and pulmonary embolism are known as VTE, a dangerous and deadly combination that can strike anyone, but is particularly problematic for those over 60 who have experienced hospital stays and/or surgeries.

Although some VTE cases are unprovoked (caused by genetic mutations that affect clotting factors in the blood or family history), many others are preventable. That’s according to Jack Ansell, an internationally recognized expert in the field of hematology and thrombosis and a member of the scientific board of the National Blood Clot Alliance.

Since about two-thirds of blood clots occur as a result of hospitalization or after hospitalization, Ansell says that many cases of VTE can be prevented if patients are proactive.

“When you enter the hospital for surgery, ask your doctor, ‘What are you going to do to prevent a blood clot in my leg?’” says Ansell. “More and more doctors are aware of the problem and are using anticoagulant therapies to prevent blood clots.”

VTE: An Underappreciated Disease

While the precise number of people affected by VTE is unknown, as many as 900,000 people could be impacted each year in the U.S., according to a report published by the Centers for Disease Control and Prevention. Up to 100,000 Americans die of VTE annually; 10 to 30 percent of them within a month of diagnosis.

A report by the World Thrombosis Day Steering Committee on common problems that stem from hospital stays found that VTE was the leading cause of death and disability in low- and middle-income countries and was the second leading cause of death in high-income countries. And while VTE per se is not listed as a leading cause of death in the U.S., Ansell cites it as an underlying specific cause of death in many cases of cancer, heart or other types of fatalities.

Despite this, awareness of VTE is woefully low, according to a 2014 global study in the Journal of Thrombosis and Haemostasis. It showed that fewer people were aware of thrombosis, deep vein thrombosis and pulmonary embolism than those aware of heart attack and stroke and health conditions such as hypertension, breast cancer, prostate cancer and AIDS. Less than half of respondents knew that blood clots were preventable or that they were associated with cancer (16 percent), hospitalization (25 percent) and surgery (36 percent).

“In the long term, we will see more cases because it is more common in older folks and the population is certainly aging,” says Gary Raskob, professor of epidemiology and dean of public health at the University of Oklahoma.

Tracking the Disease

“Blood clots work as a defense mechanism to prevent us from bleeding to death if we cut ourselves,” says Raskob, who serves as the head of World Thrombosis Day on Oct. 13, an event designed to heighten awareness of VTE. “What we’re talking about are the formation of clots inside blood vessels or veins when they shouldn’t form.”

Symptoms of deep vein thrombosis include swelling in one leg, pain or tenderness; reddish or bluish skin discoloration and warmth. Pulmonary embolism can cause sudden shortness of breath, chest pain that may get worse with deep breaths, rapid heart rate, an unexplained cough and light-headedness.

Anyone experiencing these symptoms should call his or her doctor right away or call 911 to get to an emergency room, where an ultrasound can determine the presence of a clot.

Risk Factors for Blood Clots

Three prime factors contribute to blood clot formation: “Immobility, which causes blood to pool in the veins; problems with proteins in the blood that balance bleeding and clotting and damage to a vein or blood vessel caused by injury or surgery can all spur unwanted blood clots in veins,” says Raskob, “If any two of these factors are in play, you can be in danger of developing a clot.”

In addition to hospital stays, there are a number of risk factors for developing VTE, including surgical procedures — particularly knee and hip replacements.

“After surgery you need to heal the wound and the body can’t say, ‘Put a clot here where the surgeon cut and not in the vein,’” says Raskob. “In addition, there could be damage to the vein during surgery, such as in hip replacement, where surgeons may manipulate your vein, causing it to get bent or twisted, causing a clot.”

Cancer and cancer treatments can also cause clot formation, says Raskob. They upset the delicate balance between coagulation factors that promote bleeding and those that promote clotting.

Other risk factors include taking estrogen or estrogen-blocking drugs like tamoxifen; long car rides or plane rides, family history and genetic mutations that predispose blood to clotting.

But sometimes, clots can be unprovoked, says Elaine Chiang, a hematologist at Penn Medicine. “If a person develops a clot with no risk factors, that is more concerning,” says Chiang, since they are at a higher risk for additional clots.

Although VTE is not really a “lifestyle” disease, experts suggest moving around every two or three hours if you’ve been sitting in a car, plane or train, maintaining a healthy weight and quitting or avoiding smoking.

Anti-Coagulant Therapies

Treatment for VTE often involves blood thinners. While older anti-coagulants required frequent tests to check if dosages were in a therapeutic range, newer drugs are more predictable and have fewer dietary restrictions, says Chiang.

“Once you have a clot, it’s important to see a hematologist — a doctor specializing in thrombosis and clotting disorders,” says Chiang. Having a blood clot is not a one and done issue, she notes. “We need to evaluate if blood thinners are doing their job and if they need to be adjusted down the road,” says Chiang.

She adds thats there are implications for family members as well. “Make sure family members tell physicians that they are related to someone who has a blood clot,” Chiang says. “If they plan for surgery or pregnancy, they need to know if there are special considerations to be made.”

The Potentially Deadly Condition That May Follow a Hospital Stay

It happens more often to people over 60, and airline travel is another risk factor

Venous thromboembolism (VTE) might be the most serious condition you’ve never heard of.

The disease starts with a blood clot, or thrombosis, that forms in a deep vein in the leg (or, less frequently, the arm). This clot is known as deep vein thrombosis. If the clot breaks off, travels through the bloodstream and lodges in a lung, it’s called a pulmonary embolism and in about a quarter of such cases causes sudden death.

Together, deep vein thrombosis and pulmonary embolism are known as VTE, a dangerous and deadly combination that can strike anyone, but is particularly problematic for those over 60 who have experienced hospital stays and/or surgeries.

Although some VTE cases are unprovoked (caused by genetic mutations that affect clotting factors in the blood or family history), many others are preventable. That’s according to Jack Ansell, an internationally recognized expert in the field of hematology and thrombosis and a member of the scientific board of the National Blood Clot Alliance.

Since about two-thirds of blood clots occur as a result of hospitalization or after hospitalization, Ansell says that many cases of VTE can be prevented if patients are proactive.

“When you enter the hospital for surgery, ask your doctor, ‘What are you going to do to prevent a blood clot in my leg?’” says Ansell. “More and more doctors are aware of the problem and are using anticoagulant therapies to prevent blood clots.”

VTE: An Underappreciated Disease

While the precise number of people affected by VTE is unknown, as many as 900,000 people could be impacted each year in the U.S., according to a report published by the Centers for Disease Control and Prevention. Up to 100,000 Americans die of VTE annually; 10 to 30 percent of them within a month of diagnosis.

report by the World Thrombosis Day Steering Committee on common problems that stem from hospital stays found that VTE was the leading cause of death and disability in low- and middle-income countries and was the second leading cause of death in high-income countries. And while VTE per se is not listed as a leading cause of death in the U.S., Ansell cites it as an underlying specific cause of death in many cases of cancer, heart or other types of fatalities.

Despite this, awareness of VTE is woefully low, according to a 2014 global study in the Journal of Thrombosis and Haemostasis. It showed that fewer people were aware of thrombosis, deep vein thrombosis and pulmonary embolism than those aware of heart attack and stroke and health conditions such as hypertension, breast cancer, prostate cancer and AIDS. Less than half of respondents knew that blood clots were preventable or that they were associated with cancer (16 percent), hospitalization (25 percent) and surgery (36 percent).

“In the long term, we will see more cases because it is more common in older folks and the population is certainly aging,” says Gary Raskob, professor of epidemiology and dean of public health at the University of Oklahoma.

Tracking the Disease

“Blood clots work as a defense mechanism to prevent us from bleeding to death if we cut ourselves,” says Raskob, who serves as the head of World Thrombosis Day on Oct. 13, an event designed to heighten awareness of VTE. “What we’re talking about are the formation of clots inside blood vessels or veins when they shouldn’t form.”

Symptoms of deep vein thrombosis include swelling in one leg, pain or tenderness; reddish or bluish skin discoloration and warmth. Pulmonary embolism can cause sudden shortness of breath, chest pain that may get worse with deep breaths, rapid heart rate, an unexplained cough and light-headedness.

Anyone experiencing these symptoms should call his or her doctor right away or call 911 to get to an emergency room, where an ultrasound can determine the presence of a clot.

Risk Factors for Blood Clots

Three prime factors contribute to blood clot formation: “Immobility, which causes blood to pool in the veins; problems with proteins in the blood that balance bleeding and clotting and damage to a vein or blood vessel caused by injury or surgery can all spur unwanted blood clots in veins,” says Raskob, “If any two of these factors are in play, you can be in danger of developing a clot.”

In addition to hospital stays, there are a number of risk factors for developing VTE, including surgical procedures — particularly knee and hip replacements.

“After surgery you need to heal the wound and the body can’t say, ‘Put a clot here where the surgeon cut and not in the vein,’” says Raskob. “In addition, there could be damage to the vein during surgery, such as in hip replacement, where surgeons may manipulate your vein, causing it to get bent or twisted, causing a clot.”

Cancer and cancer treatments can also cause clot formation, says Raskob. They upset the delicate balance between coagulation factors that promote bleeding and those that promote clotting.

Other risk factors include taking estrogen or estrogen-blocking drugs like tamoxifen; long car rides or plane rides, family history and genetic mutations that predispose blood to clotting.

But sometimes, clots can be unprovoked, says Elaine Chiang, a hematologist at Penn Medicine. “If a person develops a clot with no risk factors, that is more concerning,” says Chiang, since they are at a higher risk for additional clots.

Although VTE is not really a “lifestyle” disease, experts suggest moving around every two or three hours if you’ve been sitting in a car, plane or train, maintaining a healthy weight and quitting or avoiding smoking.

Anti-Coagulant Therapies

Treatment for VTE often involves blood thinners. While older anti-coagulants required frequent tests to check if dosages were in a therapeutic range, newer drugs are more predictable and have fewer dietary restrictions, says Chiang.

“Once you have a clot, it’s important to see a hematologist — a doctor specializing in thrombosis and clotting disorders,” says Chiang. Having a blood clot is not a one and done issue, she notes. “We need to evaluate if blood thinners are doing their job and if they need to be adjusted down the road,” says Chiang.

She adds thatsthere are implications for family members as well. “Make sure family members tell physicians that they are related to someone who has a blood clot,” Chiang says. “If they plan for surgery or pregnancy, they need to know if there are special considerations to be made.”

“The Potentially Deadly Post-Surgery Condition.” Next Avenue, 22 Aug. 2017, www.nextavenue.org/vte-condition-hospital/?hide_newsletter=true&utm_source=Next%2BAvenue%2BEmail%2BNewsletter&utm_campaign=a75faa1231-08_17_2017_Thursday_Newsletter&utm_medium=email&utm_term=0_056a405b5a-a75faa1231-164939389&mc_cid=a75faa1231&mc_eid=8e7e577d68. Accessed 12 Sept. 2017.

Caregiver Burnout: What It Means and How to Cope

Know the signs that you need a break — for your health and your loved one’s

  • By Gina Roberts-Grey

(This article appeared previously on Caring.com.)

Caregiving can bring many positives into your life — but it can also take a toll, both physically and emotionally. Without finding a balance between caring for your loved one and maintaining your own mental, physical and emotional health, you’re at risk of developing what’s known as caregiver burnout.

“Feeling exhausted, unmotivated, constantly frustrated and forgetful, as well as having problems at work or with relationships, are all signs of caregiver burnout,” says Kimberly Hershenson, a New York-based therapist specializing in anxiety and depression.

Caregiver burnout can not only interfere with your ability to care for your loved one, it’s a leading contributor to placement of that person in a nursing home. It’s also risky to your own health, raising the risk of chronic depression, hypertension, diabetes, stroke and premature death.

“It is important to have life balance between caring for loved ones and caring for yourself,” says Hershenson. It helps to know the signs that you need a break, and what to do if you’re close to depleting your emotional, mental and physical reserves.

Spotting the Signs of Caregiver Burnout

Caregiver burnout is mental, emotional and physical exhaustion that may develop through the responsibilities of supporting and caring for another individual. “Caregivers often focus so intently on the needs of the individual receiving care that they may neglect their own health and wellness,” says Darren Sush, a licensed clinical psychologist and board-certified behavior analyst in Los Angeles.

As this lack of self-care persists, along with the ongoing obligations of providing care for a loved one, caregivers’ exhaustion often intensifies, impacting different aspects of their lives as well as their effectiveness and compassion as a caregiver.

Sush says that burnout may be easily misunderstood as simply feeling overly tired or even occasionally exhausted. “Unfortunately, while being tired can often be resolved by taking a break, getting a little more sleep or actively trying to relax, burnout is more often less easily relieved. Individuals who experience caregiver burnout, tend to face an all encompassing fatigue that impacts multiple areas of their lives,” he says.

Caregiver burnout can happen to anyone who is providing care for another person, whether it’s hands-on care, is only occasional, from a distance, or even at the “managerial” level, says Zina Paris, associate director of clinical services at Alzheimer’s Greater Los Angeles, a local nonprofit that helps families affected by Alzheimer’s and other dementias.

“It happens when you feel that the experience of caregiving is overwhelming and that you do not have the support — physically, mentally, emotionally, financially — that you need in order to successfully care for the person and to take care of yourself adequately at the same time,” says Paris.

Very often, caregivers can find themselves accustomed to the routine stress, worry and discomfort that come with providing care for a loved one. And as a result, Sush says you may not acknowledge warning signs of your own needs for gaining support.

Signs of Caregiver Burnout

Those signs include:

  • You no longer find pleasure in things you once found enjoyable, or you have no motivation to participate in previously enjoyed activities
  • Friends and family have expressed concerns about your well-being
  • You’re getting negative feedback at work
  • You’re having problems with your spouse
  • You experience intense and recurrent feelings of anger, sadness, worry or fear
  • You have difficulty concentrating, trouble sleeping, notice drastic weight changes (significant gain or loss), or unexplained health problems
  • You find yourself using a substance to cope with, manage or suppress uncomfortable or painful feelings.

Sush notes that there are also signals caregivers should know that indicate they’re at risk for developing caregiver burnout in the near future. These include:

  • Regular thoughts of anger or resentment toward the person you’re caring for
  • Irritation toward others who aren’t helping with your loved one’s care
  • Isolating yourself from people who aren’t involved in providing care to the person
  • Consistently arriving late to appointments or to visiting the person receiving care, or often leaving early

Combating Burnout

If you notice these signs in your own life, it’s time to take action.

Enlisting the help of a therapist is one option. “That provides a safe, sympathetic and constructive environment where caregivers can express their wants and needs,” says Sush.

Having a supportive community also helps. “Making a connection, such as with friends, family, or support groups, where you can freely share your thoughts and feelings, can be exceptionally important,” he adds. “While there is not necessarily a right or wrong way to get the help you need, it is important to acknowledge when you do need help.”

Here are some other expert strategies to help you cope with caregiver burnout:

Embrace gratitude. Make a daily gratitude list by writing down 10 things you’re grateful for. This could include anything from your family, legs to walk on or even a TV show you find entertaining. Focusing on what is good in your life as opposed to what is going wrong with your loved one’s health helps relieve stress.

Read affirmations every morning. “Starting your day with positivity kickstarts your day on the right foot,” says Hershenson.

Start the day with you. Hershenson says having a morning routine with time to yourself (going to the gym, having your daily coffee while reading the newspaper or stretching for 10 minutes) is crucial to fending off mental stress and fatigue.

Practice acceptance. Make a list of what you can control in the situation (getting enough sleep, eating well) and what you can’t control (your loved one’s health). Focus on what you can control to make changes where needed and try to accept the things that are out of your control.

Paris notes that while the advice to “take a break” may sound cliché, it is repeated for a reason.

“Self-care needs to be a top priority when caring for another person, otherwise neither the caregiver or the one receiving care will thrive,” she says. “This means finding a way to take short respite from caregiving on a consistent basis.”

Caregiver Burnout: What It Means and How to Cope. (2017, June 28). Retrieved August 30, 2017, from http://www.nextavenue.org/caregiver-burnout/?utm_source=Next%2BAvenue%2BEmail%2BNewsletter&utm_campaign=d8aba6fdc2-08_10_2017_Thursday_Newsletter&utm_medium=email&utm_term=0_056a405b5a-d8aba6fdc2-164939389&mc_cid=d8aba6fdc2&mc_eid=8e7e577d68

5 Myths About Obsessive-Compulsive Disorder

When people learn that I am a psychiatrist who has spent the last 20 years studying obsessive-compulsive disorder (OCD) at Columbia University Medical Center, I get various reactions.

They include jokes (“Hey, we could really use you in my family”) and minimization (“We all have some OCD, right?”) that unwittingly trivialize the suffering of my patients.

These patients include: the mother tortured by intrusive thoughts about hurting her children; the grown son who calls his elderly mother weekly but has not visited her in years because he has intrusive sexual and violent images about her; the lawyer whose “just right” obsessions made her unable to meet deadlines and the teacher with such severe contamination fears that he washes with bleach each night.

People with OCD often avoid situations that trigger their obsessions or compulsions.

In the last few decades, we’ve learned a lot about OCD. It’s time to dispense with some common myths. (Some of the details of examples below have been changed to protect patients’ privacy.) Here are five big ones:

Myth No. 1: OCD is rare.

Two of every 100 Americans will suffer from OCD in their lifetime. This means that OCD is twice as common as schizophrenia. Unfortunately, OCD usually starts early (half of all cases start by age 18; a quarter begin before 14), and its course is often chronic. Thus, OCD is not rare.

Moreover, once OCD develops, one can wrestle with it for a lifetime, as many of my patients have.

Myth No. 2: We all have OCD.

Yes, we all have occasional intrusive thoughts (e.g., did I just say the wrong thing?). Many endorse some type of ritual or repetitive behavior (such as double-checking to make sure the door is locked). Most of us also have habits (like taking the same route to work). Some of us are very rigid in our views and perfectionistic. This is not OCD.

OCD is a specific illness characterized by obsessions (repetitive thoughts, images or urges) that generates significant distress and by compulsions (repetitive thoughts or acts) that the person feels driven to perform. To be OCD, these symptoms must cause impairment and be highly distressing and time-consuming (taking up more than an hour a day). Many OCD patients obsess and ritualize on and off all day.

Although most people with OCD have both obsessions and compulsions, the specific content can vary between individuals. The result is that different patients can have very different symptoms.

Some common themes include: intrusive thoughts about harm with checking rituals (like the mother); taboo (usually sexual, religious or violent) thoughts (like the son); concerns about symmetry and exactness with ordering and arranging behaviors (like the lawyer) and obsessions about contamination with washing rituals (like the teacher). Note: Hoarding behaviors can also occur as part of the compulsions of OCD, but if the primary problem is difficulty discarding, this is now diagnosed as Hoarding Disorder.

Yet the OCD devil is in the details.

For example, I once worked with a man whose contamination concerns were focused not on an illness but on the state of California; as a result, he forbade anything with the word California in his house and he once forced his entire family to move after receiving mail from a California address.

Importantly, not all repetitive thoughts or behaviors are OCD. For example, people with depression can ruminate, those with generalized anxiety disorder can incessantly worry and people with trichotillomania can repeatedly pull their hair. The point is that we do not all have OCD. Some people do, and they suffer.

Myth No. 3: OCD is helpful.

The data show that OCD impairs functioning across many different domains, including worklife, social relationships and family. OCD is impairing because of its relatively early onset, its typically chronic course and the likelihood that most people with OCD will have moderate to severe symptoms.

When beset by hours of obsessions and compulsions each day, it is hard to perform at your best at work, socializing is difficult and family life is turned upside-down.

People with OCD also often avoid situations that trigger their obsessions or compulsions. For example, the mother I mentioned forbade her children to join her in the kitchen (fearful she would harm them with the cutting knives), the teacher never invited anyone to his home and the lawyer eventually lost her job.

Imagine having to move your entire family if you got mail from California.

The bottom line is that OCD interferes with life and can cause people to miss important milestones, such as graduating from high school or college, leaving home, marrying and having children and advancing in your worklife. The disability can accrue over time and be devastating.

Myth No. 4: OCD is “made up.”

The brain underlies our behavior, including abnormal behaviors like obsessions and compulsions. Dysfunction in specific brain circuits has been linked to obsessions and compulsions. The data come from: imaging studies comparing the brains of people with OCD to those without OCD; case studies of new-onset OCD in people following acute brain lesions and studies that disrupted specific brain circuits in animals and produced repetitive behaviors that could be “treated” using the same medications that work in people with OCD.

Of course, how the brain develops this dysfunction is a different question. Like most medical illnesses, OCD is likely to have multiple causes that play out across development and range from genes that increase risk for the illness to environmental triggers.

Myth No. 5: OCD is untreatable.

There are two effective treatments for OCD: medications called serotonin reuptake inhibitors (like Prozac, Zoloft and their siblings) and a specific form of cognitive-behavioral therapy (CBT) that includes exposure and ritual prevention. Either alone or in combination, these treatments help up to half of patients keep their symptoms to a minimum within eight to 12 weeks, even in adults who have been ill for decades.

Very intensive CBT protocols — daily sessions or residential programs — can achieve results even more quickly. This offers incredible hope.

“It’s Time to Stop These 5 Myths About Obsessive-Compulsive Disorder.” Next Avenue. N.p., 19 July 2016. Web. 11 Aug. 2017.