Saturday, December 31, 2011

Dilemma: Your opinion whether it’s been asked for or not

Think of a good friend, or family member and asks yourself how you would respond if they asked for your opinion on something they just purchased. Chances are you would probably be fairly honest in your reply. Now think of this same person. They have a very serious health crises and they ask you “Do you think I should have treatment?”

Reverse the process and think about the times you’ve asked others for their input? Did you want an honest answer or were you just wanting them to collaborate what you were already thinking or planning to do?

There are multiple things that come into play when we ask for input or our advice is being sought. A lot of the responses come down to the people involved, the situation and the level of honesty in the relationship.

I’ve had reason to belabor these questions because of several recent situations where people are asking friends, family and the occasional provider, about how they should be managing their health care. There is no simple answer when someone asks if they should continue treatment, have surgery, opt for hospice, move to assisted living or enter a clinical trial. These are major life altering choices and so it is important to weigh your answers carefully.

When faced with such a question(s), consider the following:

• For people with chronic and life threatening conditions, the provider will expect the person and/or family to make the choices and decisions about type of care and treatment and when and when not. If a person is dealing with pain, metastases disease, malnutrition, dementia or anything else that may alter their thinking, they may be in a very difficult position to make such choices. These are very challenging situations. If a friend or family member asks your opinion, help facilitate discussion by responding honestly, recognizing that they, more than anyone else, has to live with the consequences of the decision.

• Sometimes people will ask not only for opinions but also make requests of you, which are illegal. It could be a matter of obtaining medical marijuana, which may be illegal in your state. Over the years, I’ve known many people who have said that if they became too ill, senile or are in considerable pain, they want their family to terminate their lives or they will do it themselves. These are definite ethical issues, which need to be weighed on a case-by-case basis. Below are resources that might be helpful:

Resolving an Ethical Dilemma

Top 50 Medical Ethics Blogs

Medical Futility Blog: Has an excellent list of links on medical ethics.

• What weight might your response carry in their eyes? In other words, do they consider you a valued and trusted person whose advice they have sought before?

• What about the situation where you see a good friend/family member who is in real trouble with their health care? They may not be asking for your advice, but you also don’t want to stand by and watch them damage themselves. When or do you intervene? This can be an incredibly difficult situation. Step one is to let them know of your concern. If they respond negatively, your options are limited. Again, what is your relationship to the person? If there are people closer to them, such as a spouse, partner, parent or adult child, talk to them. They may share similar concerns and together you may be able to come up with strategies to intervene. If you are the caregiver, and have permission from the patient to speak with the provider, talk to them. Even if you don’t have permission to talk with the provider, you can contact them and relay your concerns, basically having a one-way conversation. If you truly believe that this person is a danger to self or others, you can call adult protective services and report the situation.

Wednesday, December 28, 2011

Take a Break: Solve the Mystery

Minute mysteries come in all shapes and sizes. You can download the Sleuth App for your iPhone or try out some of the links below:

Mystery Digest: This site contains two minutes mysteries to solve and a whole lot more.

5 Minute Mystery

One Minute Mysteries: These are really easy

5 Minute Mysteries Old Time Radio Shows

If you like medical mysteries, once a month (or so) the Well blog of the New York Times provides case information and you can figure out the diagnosis.

Saturday, December 24, 2011

Go-Go Eating /Exercise and Stress

This post is dedicated to Mark, who specifically requested information for those over 55 who need to exercise and how to eat healthy when they are constantly on the go.

To the first request, the Feb. 10, 2011 post covers exercise. But as to eating, well that’s a bit more complex.

Since it’s Christmas Eve, and this blog’s focus is on chronic conditions, a quick reminder that in this time of excess food and drink, what you put in your body can impact how you handle medications, how you feel and how you heal. For example, eating cranberries can increase the effectiveness of coumadin (Warfarin). Dark chocolate contains theobromine, which is also a diuretic, and can decrease the effect of sleep medication or increase blood pressure. Mixing alcohol with medications is a bad idea as it can block the effect of some medications, increase gastrointestinal bleeding and so forth.

There is no time like the present to think about how you use food to celebrate events, holidays etc. Think about options other than food, e.g. in honor of your new promotion, great test results, birth of a grandchild you go to see a play instead of having a big dinner.

Since chronic conditions very significantly, I’m the last person to tell you what foods to eat or even when, as medication schedules and interactions with certain foods are real issues for many. Clearly, it is important to check with your medical provider, as well as a dietician about what’s right for you. Also, organizations focusing on your condition will include diet programs and suggestions. However, most important is paying attention to your body.

Another resource to consider is the Diet & Nutrition section of the University of Minnesota’s “Taking Charge of Your Health.” Note that as research is published on nutrition, exercise and other topics relating to chronic conditions, I post them to the Healing Whole Facebook page.

I digress. Mark’s specific request was how to eat healthy when you have little time to shop, are in the car a large part of the day, and since we live in a rural area, when shopping options are limited. So to that request, here are some very doable suggestions, even for someone who is on the go as much as Mark:

Plan meals in advance and shop accordingly. Not much on meal planning? Check out Meal Planning 101.

Use your local CSA (community supported agriculture): A farmer offers a certain number of "shares" to the public. Typically the share consists of a box of vegetables, but other farm products may be included. Interested consumers purchase a share (aka a "membership" or a "subscription") and in return receive a box (bag, basket) of seasonal produce each week throughout the farming season. If you don’t know where your local CSA might be, check Local Harvest. There are almost two million farms in the USA, so there is bound to be one close to you. Have a last minute Christmas gift to purchase? Why not a share or a partial share at your local CSA.

• Shop Locally: Farmers’ Markets abound. Check your local newspaper for dates, time and location or use one of the apps-Locavore or Ample Harvest. While this is a great way to get locally grown produce and meats, as well as support your local farmer, it’s a good time to socialize with others in your community.

Prepare snacks in advance. If you know you’ll be traveling quite a bit in the coming week, or you have a variety of medical appointments, prepare five days of healthy snacks on Sunday night. You can do this while watching the football game. Such items may include: almonds and cranberries (a portion size is generally twenty almonds and a 1/4 cup of cranberries-check label for serving information). Other ideas for healthy snacking:

Snacks: How they fit into your weight loss plan from Mayo Clinic

The Best Healthy Snacks in Your Supermarket: 24 snack ideas to satisfy your cravings from WebMD

The Healthy Snacks Blog

Cook once, eat two or more times: When you do have the time to cook, prepare enough for the freezer. That way on days you are very busy, it’s a simple matter of heating up a meal.

Use a crock-pot: Slow and low is the way to go! I use mine at least two or more times a week. Put it on before you leave for work and when you return enjoy a wonderful home cooked meal. So if you aren’t familiar with this magical device (you can pick them up for cheap at your local thrift store), check out the Food Networks Eleven Tips for Slow Cooker Meals.

Crock-pots aren’t just for making stews. I make beans, soups, sauces, jelly and much more in mine. You can easily adapt favorite recipes, but if you want something new, check out the following:

Best Crockpot Recipes

Crock Pot Recipes from

Easy Vegetarian Slow Cooker Recipes

Buy in season and freeze: Frozen fruits and vegetables keep very well. On the subject of freezing, if you live alone, there are now many single serving choices for frozen vegetables.

Restaurants are an option. You can eat quite healthy even at fast food restaurants. Use the USDA’s Healthy Restaurant Eating guide to help you make choices that are healthy. And yes there is an App for that. Try Weight Watchers Mobile is also another option. Of course there is the ever popular Eat This, Not That.

While Mark and I discussed various strategies for eating and exercising, one of our colleagues mentioned that he found the most helpful thing for him, more than exercise and eating, was managing his stress. I realize that this is one topic that I discuss frequently (each Wednesday is “take a break” day) but have never dealt with in-depth. A post for January for sure. In the mean time, check out the following links, which do address holiday stress.

Holiday Songs Can be good Reminders for People With Chronic Conditions

Holidays: Over Do the Laughter and Under Do the Stress

A Merry Christmas to all and a special greeting to Mark and those working in FAR today and tomorrow.

Wednesday, December 21, 2011

Take a Break: Celebrate the “Other” Holidays

December is awash with holidays, but this week marks several that are often over looked in the mad dash of Christmas. In fact, the real “reason for the season” is Winter Solstice, which takes place on Dec. 22. Marking the shortest day in the Northern Hemisphere, my husband refers to this as the first day of summer. Given that it’s close to the single digits where I live, as I write this, that’s a very welcome idea.

A historical review shows that Christmas grew out of Solstice traditions. In 46 BC, Julius Caesar, in his Julian calendar, established Dec. 25 as winter solstice for Europe. The Emperor Aurelian selected Dec. 25 as Sol Invictus or the birthday of the “Invincible Sun” in the third century as part of the Roman Winter Solstice celebrations, Saturnalia. Prior to Sol Invictus, Dec. 25 was the birthday of the Persian hero and sun god Mithra. In 273, the Christian Church adopted this same day to represent the birth of Christ. Interestingly, January 6, known as Epiphany or feast of the Magi (three kings), was originally an Egyptian date for the winter Solstice.

Some ideas for celebrating winter solstice can be found at the following links:

Celebrating Winter Solstice

Dream Catcher Native Flutes Ron Allen-6 Winter Solstice

Newgrange Winter Solstice in Ireland

Christmas, Yule and the Winter Solstice from Mysterious Britain & Ireland

Since this festival is all about the sun, make some sun ornaments to hang around your house or tree. You can make them out of clay; paper Mache or whatever strikes your fancy. Sun catchers are easy to make. Use a small ornament and hang it in your window so that it reflects the sun. It can be a simple piece of glass, such as a pendant from an old chandelier, or something more elaborate made of beads.

Dec. 20 is the first night of Chanukah. This eight-day festival of light begins on the eve of the 25th of the Jewish month Kislev. It commemorates the rededication of the Holy Temple in Jerusalem at the time of the Maccabean Revolt of the 2nd century BX. Learn more about this celebration.

December 23 is Festivus. Recently, I watched a snippet of the Seinfeld episode featuring George’s father Frank:

Frank Costanza: "Many Christmases ago, I went to buy a doll for my son. I reached for the last one they had, but so did another man. As I rained blows upon him, I realized there had to be another way."

Cosmo Kramer: "What happened to the doll?"

Frank Costanza: "It was destroyed. But out of that a new holiday was born: a Festivus for the rest of us!

It made me laugh out loud. So while this post is about celebrating lesser-honored December holidays, it’s also about doing something that makes you laugh and celebrate.

Not familiar with Festivus? "The Strike" episode of Seinfeld featured George’s Dad explaining how to celebrate the holiday season without commercialism and religious aspects. As celebrated by the Castanza family, Festivus includes such practices as the “Airing of Grievances” during the Festivus meal, whereby each person tells everyone else all the ways they have disappointed him or her over the past year. There is also the Festivus pole”-an aluminum pole unadorned, and “Feats of Strength.”

To learn more about Festivus and how it’s celebrated, start by watching clips of the Seinfeld Festivus episode, then check out some of the links below:

Festivus Song

Practical tools for Festivus: Feats of Strength Challenge Card and Airing of Grievances Worksheet

Festivus Web

Friday, December 16, 2011

Messin’ with Meds

The holidays are a time when people forget to take meds or call in a refill because their normal routine is interrupted by parties, guests, travel etc. However, I’ve had a very recent reminder of what happens when you don’t take meds as prescribed.

The situation was not unusual. In order to save money, the person was taking their medication once every three days and not daily as prescribed. Thinking the medication wasn’t working, the medical provider ordered a lot more tests, which ultimately resulted in higher medical costs. However, the patient paid the highest price, as symptoms were not controlled effectively and became progressively worse over a six-month period.

People “mess” with their medications by doing the following:

• Not taking them because they: forget, have side effects, can afford them, feel better, or don’t have symptoms

• Taking them for a reason other than there intended purpose.

• Sharing them with a friend or family member.

Some simple solutions for taking medications as prescribed:
• Use a “friend with a pen” at medical appointments. Have them write down what the provider says about the medication, how to take it, possible side effects. The research shows that patients have a much better visit when they have someone with them. Read more about the importance of a health advocate.

• Ask the provider about the cost of the medication being prescribed. Be clear if you don’t think you can afford it. Ask for samples, as well as generic alternatives. The latter are often a lower priced option. Ask if the company has some type of program to help those who have difficulties paying for it. Check out the following sites for additional resources:
- Prescription Assistance Program
- Free Medicine Program
- Needy Meds
- Rx Assist
Tricare Senior Pharmacy For uniformed services beneficiaries 65 years of age or older.

• Understand the how and when to take the medication-e.g.when is the best time to take it; should it be taken on an empty stomach or with food; are there certain medications, supplements or food that shouldn’t be taken while on the medication; what happens if you miss a dose.

• Some drugs aren’t easy to take, such as interferon for hepatitis. Pharmaceutical companies will often set up programs to help patients with adherence. Inquire if such a program is available for a medication that is being prescribed.

• Ask for a clear explanation of why the drug is being prescribed and what the consequences are if you don’t take it.

• Discuss possible side effects.

• Talk to the pharmacist about any questions you might have. They can often provide helpful tips about taking the meds, such as whether a tablet can be broken in half; where to store it (medication cabinets in bathrooms are often not a good location because of humidity)

• Use the same pharmacy if possible and take advantage of automatic refill prescription programs.

• Use reminder devices such as a pill caddy, which organizes medications in a variety of ways-daily, weekly and by time of day. There are a lot of varieties out there so shop around for one that you think will work for you.

For more information on this topic, go to Medications Made Easier

Wednesday, December 14, 2011

Take a Break: Create and Be Inspired by Fibonacci

Named for the mathematician Leonardo of Pisa, who was known as Fibonacci, his number sequences is o, 1, 1, 2, 3, 5, 8, 13, 21, 34, 55 …Each subsequent number is the sum of the previous two. What is amazing about this sequence is that it occurs throughout nature, art, music, literature (it’s the code broken by Sophie in The DaVinci Code) and of course mathematics.

If you count the number of petals in flowers, nearly all will be a number in the Fibonacci sequence-an iris has 3, buttercup 5, delphinium 8, and ragwort 13. For more examples, watch Fibonacci Numbers-Numbers in Nature.

The ratio between successive Fibonacci numbers approximates the “golden mean,” also known as the Golden Ratio, Divine Proportion or Phi 1.618. This ratio has been used for centuries. The first use may have been by the Egyptians when they designed the pyramid.

I’m particularly interested in the Fibonacci sequence as I’m trying to make jewelry based on it. So today’s “take a break” is having fun with Fibonacci. Enjoy some of the following:

Fibonacci Puzzles

Unfold the Golden Rectangle

Creating the Fibonacci Musical Scale for Piano

Fibonacci’s Chinese Calendar

Saturday, December 10, 2011

Living as if we might die tomorrow: Does it work?

Attending Catholic School, the nuns would say things like, “When you go to bed tonight, pretend it’s your coffin,” or “How would you change your life if you new you’d die tomorrow?” The right answer was to change nothing as you were living the perfect Catholic life.

Last week a friend Facebooked an article, “Top 5 Regrets of The Dying,” whose author had worked for many years in palliative care. Having witnessed many people closing out their lives, I would agree with this author’s selection: live a life true to myself and not others expectations; not work so hard; the courage to express feelings; staying in touch with friends; let your self be happier.

Since my colleague and friend Kathy, she’s the other half of Chronic Conditions Information Network, and I have often discussed aspects of this, I forwarded the article to her with the following note, Saw this article today and it certainly reflects what I've seen. So the question in my mind is can we really live like we're about to die in the next few weeks for years on end? While I try to practice happiness and recognize the critical need of friends and community, and to really nurture those that I love, there are some very practical issues-like making a living-that aren't necessarily there for those that are about to exit. Puzzling thoughts.

Her reply was spot on, and probably the best response I’ve read to the adage “Live as if you die tomorrow.” You ask a very good question, and the answer is no, we can't. The last few weeks or months of one's life allows one to have those kinds of reflections and take the liberty of acting on them, since there is literally no time left to put it off. I think that all the messages in that article are valid and worthy of acting on in small ways, but you can't do it full time.

I speak from experience. Because of all the deaths and losses in my family, we were raised to live every day to its fullest, give to and love the other as if it were his or her last day on earth, and to be grateful simply to be alive. They are good concepts, noble messages, and engender a kind of fullness of experience that I appreciate having had.

There is, however, a dark side to it that can be very destructive and hard to lighten. The energy that sustains that approach to living is fueled by a strong current of anxiety, fear of loss, and pessimism about the future. There is little room for attending to the relative minutia of getting along in the real world and taking care of one's own needs. In the face of impending death, career planning and goal setting for one's own future seems trite. In fact, everything that is not life or death seems trite. It is a huge burden to assume.

Kathy’s last paragraph was an “I get it” moment. It helped me understand some of my own negative thoughts and actions. Instead of dwelling on the fact that we all come with an expiration date, and I could be gone tomorrow, a healthier approach is living a mindful life where one is present for it.

It is interesting that in the past few months I have though about life expectancy from the vantage point that I’m not financially prepared for old age. That’s been an eye opener for me to realize that I do need to be a lot more mindful of how I earn a living.

Thanks Kathy for your insightful words. Even though Kathy is a nurse by training, she is an amazing artist. Check out her website Fraglets and scroll through her “ Where in the World are Fraglets” section as her art hangs in some pretty amazing places, like MOMA in San Francisco, the Louvre in Paris and anywhere there is a scrap of metal.

Wednesday, December 7, 2011

Take a Break: Create Green and Memorable Gifts

This past Saturday, I blogged about balancing giving and receiving this holiday season. Following with the “giving” theme, today’s “take a break” is about making gifts that have meaning, are affordable and help the planet.

Green Cleaning Products: While no one needs the harsh chemicals used in household cleaning, it’s even more true for those living with a chronic condition. Study after study has shown how household cleaners can make people sick, cause asthma flare ups etc.

A simple, but very welcome gift, are cleaning products that you make yourself. Pick up some squirt bottles from the Dollar Store, or recycle ones you may already have. Make simple labels for each bottle, that include directions for use as well as the recipe for remaking when empty.

The basics are generally things you have in your house- baking soda, white vinegar, lemon juice, salt, washing soda, liquid soap. You can make a simple all-purpose cleaner by combining 1/2 cup vinegar, 1/4 cup baking soda and 1/2 gallon water (8 cups). Mix, pour into containers and use. You can add a few drops of essential oils.

Want to get rid of the bleach? Use 2 cups of water, 3 Tablespoons of liquid soap and 20-30 drops of tea tree oil. You can make your own Oxi Clean solution. It’s just hydrogen peroxide (1 cup) and washing soda (2 tablespoons-note this is not the same as baking soda). Pour the hydrogen peroxide into the spray bottle, add the washing soda. Let it sit for a day. Give it a gentle shake before each use and use as you would oxi clean.

Check out the following links for recipes:

Green Cleaning from Pink Pistachio
Non Toxic Home Cleaning from Eartheasy
The Easiest Green Cleaning Recipes You Can Make at Home

The Dollar Store is a good place to also pick up cleaning clothes. Microfiber ones can reduce your cleaning time.

Give Experiences They’ll Enjoy and Remember: Research shows that experiences bring about more happiness than things. Below are some ideas to consider:
• Tickets to a sporting, concert, play or some other event.

• A weekend get a way, a day at a spa, a massage

• Membership to museums, public TV or radio, community garden , local historical society etc.

• Fees for a special class or workshops, such as car mechanics for dummies, beginning piano, yoga class etc. All the better if you have a special skill that you are willing to share.

• If you have a special skill that you are willing to share via a workshop, pick the date, make up invitations and send. While it’s nice to try and coordinate everyone’s schedule, it’s going to be a lot easier if you pick the date and time and limit the size of your “class” to what you can realistically manage.

Food: Known the person’s taste and special needs (e.g. salt restricted, gluten free etc.) and make or purchase wholesome food accordingly. If you can afford a “fruit of the month” program great, but you can also achieve the same thing by doing something like making soup the first Monday of the first three months of the new year. As much as people like sweets, there is enough of it around to rot everyone’s teeth.

Go Junking: We use to call going to second hand stores, yard sales and the occasional antique dealer, “going junking.” We would paw through a lot of items before we found “treasurers. “Pick up items that will either amuse your friends and family or is part of a collection they may have.

Natural gifts: I happen to love stones, so I enjoy it when friends return from vacations and bring me items they found on the beach. Consequently, I have a lovely collection of beach stones. Consider what's in your natural environment that may appeal to a friend.

Saturday, December 3, 2011

Balancing Giving and Receiving This Holiday Season

We’ve all been raised with the idea it is better to give then to receive and where this is most exemplified is during the Holidays. “What do you mean you aren’t going to go to your parents (who live 300 miles away) for Christmas? How can you be so selfish?” “It’s the perfect present for Jack (substitute any name). You can always put it on plastic.”

I’ve done a variety of posts on this topic. However, at this time of year, we all need the reminder to try and achieve some sort of balance in this season of excess.

The fact is, when you are dealing with a chronic disease, you don’t always have the energy to travel or party or have the money to pay for expensive presents. At the same time, you may have to heavily depend on others to help you with the basics of daily living, such as getting to doctor’s appointments, grocery shopping, child care etc. If you are a caregiver, you may be so depleted from giving that the idea of “holiday giving” is more than you can stand

We need to keep a balance of giving and receiving. It can’t go all one way. We only need to look outside our window to get the picture. At this time of year, when we have just celebrated the bounty of harvest, the ground now lays quiet. Living in snow country, it is if the land is tucked in for a long much needed sleep. It is it’s time for the earth to recharge so that in the spring it can once again bloom and provide.

Consider the following:

Watch for warning signs that you are out of balance. These can include: feelings of being very anxious and tense (clenched jaws); a flare in symptoms; complaining; feeling listless and not wanting to do anything.

Identify yourself: Are you a constant giver? (No rationalizations about why you give too much). If so, be willing to receive. Are you a constant taker? If so, start giving of yourself. For tips on balancing giving and receiving, read January’s post on this topic.

Read previous holiday posts:
Holiday Songs Can be good Reminders for People With Chronic Conditions

Holidays: Over Do the Laughter and Under Do the Stress

• Do what you can realistically do. The idea of sacrificing yourself for others is not a good idea.

• Use this time to let people know how special they are to you with meaningful gifts that do not deplete your income. Check out the following posts for ideas and suggestions:

Balancing Giving and Receiving: Includes ideas on giving when you are relying on others for help and assistance

Holiday Gifts for People with chronic disease

Unique Gifts for Hospital Patients

The Best and Worst Holiday Gifts for People with Cancer

Keep the joy alive by reminding yourself daily of what you have to be grateful for and brings you joy. They can be as simple as watching snowfall, the smell of baking cookies or a fresh cut pine tree or the smile of appreciation from someone you helped.

Take a Break. Every Wednesday is “take a break day.” If you don’t care for this particular weeks “break,” try the archive section, which includes hundreds of ideas.