Dr. Mauk’s Boomer Blog

/Dr. Mauk's Boomer Blog

Each week, Dr. Mauk shares thoughts relevant to Baby Boomers that are aimed to educate and amuse.

End of Life: Palliative Care and Hospice

 

The human survival instinct is strong and our spirits are made to embrace life. But what happens when your loved one is diagnosed with a terminal illness that has no cure? How do you reconcile the certain death of your spouse, parent, or child? Where can you turn when death is close or imminent?

We are fortunate to live in a society that supports excellent care for those who are coming towards the end of their life. As difficult as this journey is for persons and their family members, the appropriate level of service can provide the needed care and comfort to make the end of life a time of peace and reflection rather than pain and suffering.

Two major services are readily available to bring comfort and promote quality of life even until the end of life. These are palliative care and hospice.

Palliative care is a consultative service for those with life-limiting illnesses who may not yet meet the criteria for hospice or who do not wish to enter hospice yet. The focus of palliative care is comfort and symptom management, but patients may still continue treatments such as radiation, chemotherapy, dialysis, home health, or other therapy.  Palliative services can be provided in the acute hospital setting, in the home, or in a long-term care facility. A new program called PRIME (Progressive Illness Management Expertise) by AseraCare, focuses on symptom management, goals of care planning, medication management, and transition management. PRIME provides palliative care through nurse practitioners and social workers who coordinate care with your regular medical providers. For persons with serious chronic illnesses who experience recurring rehospitalizations, palliative care management can provide care coordination and smooth transitions to other settings, including hospice, at the appropriate time.

Hospice is a supportive and comprehensive service for those who are dying. The National Hospice and Palliative Care Organization states that the foundation of hospice and palliative care is the belief that “each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so”. Generally, to qualify for hospice a patient is expected to live 6 months or less. Hospice uses an interdisciplinary team of physicians, nurses, social workers, home health aides, chaplains, bereavement counselors, trained volunteers and others to provide comfort and support to the dying patient and family. These services are covered by Medicare, Medicaid, and most private and commercial insurances. Hospice care can be provided wherever a patient lives, with 24-hour on-call availability.

End of life decisions are often difficult for families to discuss, but palliative care and hospice programs provide the help that is needed to have these conversations. Their aim is to help provide quality of life until death, helping people “live until they die”. If your loved one may qualify for assistance, don’t delay in seeking this support. It may be the best way you can help your family member have a peaceful end of life.

 

 

 

 

 

By |2019-06-15T16:52:10-05:00June 19th, 2019|Dr. Mauk's Boomer Blog, News Posts|Comments Off on End of Life: Palliative Care and Hospice

Sometimes We Just Need a Little Grace

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This is my dog. Her name is Grace. We fondly call her Gracie.

Gracie is a miniature pinscher, born just over 9 years ago, the last of a six-puppy litter. She was barely 3 inches long at birth and a third the size of the other puppies. We doubted she would survive. Her mother rejected her and tried to throw her out of “the nest” because she was different than the other puppies.

But my children and I believed in Gracie’s survival. We fed her by hand with an eyedropper as we cradled her in our palms, and we gave her the love and nurture she didn’t get from her own family of dogs. I had to lay her mother on my lap so that Gracie could be nursed apart from the others. When she was too weak to nurse, the kids and I took shifts to feed her around the clock and speak encouraging words of survival to her. Soon she became the strongest and most dominant of the pack, although still the smallest. She could fend off her five littermates from the food bowl with a fierce growl and scary glance. And Gracie repaid our faith in her will to live by returning the care and comfort she received from us with a lifetime of love and companionship.

Now that she is an older adult dog, she shows those signs of aging that we all do: gray hair, hearing loss, cataracts, stiff joints, and some excess weight around the middle. But like so many of us Baby Boomer humans, Gracie has the heart and soul of her younger years. She will still chase a chipmunk, but no longer catches it. She can still jump around with excitement, but then promptly falls asleep on the couch. Even in her old age, she continues to teach us about another kind of grace.

When I return from a business trip, Gracie is the first to greet me. Long before my husband or kids make it to the door, she hears my footsteps and comes running. You would think I was the most important person on earth as she jumps and whines and licks me, climbing in my lap for some affection. She makes me feel like a queen. It doesn’t matter to Gracie if I am in a grumpy mood, if I’m overweight, or if my hair is gray. She doesn’t care if I’m smart or not, or if others find me attractive. I am her person! She loves me the same in the morning, noon, or night and she never holds a grudge. In fact, I think that my dog seems to know more about unconditional love than many people do. She doesn’t hold my faults against me and she loves me just the way I am. She always shows it no matter what else has happened in the day. Gracie is the one at my feet in every room of the house. She sleeps next to me when I watch TV. She follows me everywhere. She is always at the door to protect me from strangers. She would give her life for mine in an instant if she could, and without a thought for herself. I sometimes find myself wishing that I had her strength of character.

It is a wonder to me that an ordinary, common, little runt of a dog without the powers of human reasoning could possess qualities that we so seldom see in people. The judgment and unforgiveness of others, sometimes even among our own families, is outshone by the loyalty and companionship that little Grace gives me every day.

So, maybe today we can learn a lesson from the simplest of God’s creatures. Show your enthusiasm for life and each other. Be a loyal companion. Take time to show affection. Miss each other terribly when you are apart. Be happy when you are together again. Forget past mistakes and harsh words. Practice forgiveness. And above all, love unconditionally.

By |2019-06-15T16:51:06-05:00June 17th, 2019|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Sometimes We Just Need a Little Grace

Total Knee Replacement

plastic model of a knee replacement

Background

Similar to hip replacement, knee replacement is done when a person is experiencing decreased range of motion, trouble walking or climbing stairs, and increased degeneration of the joint so as to impair quality of life. This most often occurs as a result of arthritis.

Treatment

Total knee replacement (TKR) surgery involves resurfacing or removing the distal portion of the femur that articulates with the end of the shin bone. The prosthesis consists of metal and plastic or similar materials that are cemented onto the newly resurfaced areas of the articulating bones. Although often done under general anesthetic, this surgery can also be performed under spinal anesthesia. Sometimes blood loss is significant, so patients may be asked to donate their own blood ahead of time to be given back to them in the event it is needed. In addition, a growing trend is toward bilateral knee replacement in those persons requiring both knees to be surgically repaired. The benefits of this are the one-time operative anesthetic and room costs, and many physicians feel recovery from bilateral replacement is similar to single replacement. However, the pain and lack of mobility, as well as the significant increase in the assistance needed after surgery when a bilateral replacement is done, may make this less than ideal for older patients. Surgical procedures for TKR have not evolved quite as rapidly as total hip arthroplasty.

Discomfort after knee surgery is generally severe in the first few days. Complications after surgery may occur, including pain, infection, and blood clots. Patients may use cold packs on the operative area and take pain and sleeping medications as ordered. In addition, alternative therapies such as guided imagery have been shown to help with pain management (Posadzi & Ernst, 2011). Many joint replacement patients feel a loss of control and independence.

Therapy will begin immediately in the acute care hospital. Although weight bearing does not usually occur until 24 hours after surgery, sitting in a chair and using a continuous passive motion machine (CPM) (if ordered), will ease recovery. The use of a CPM is generally based on the surgeon’s preference. There is research to support it, as well as studies indicating that walking soon after surgery has an equal effect and makes the CPM unnecessary. However, in cases of an older person who may not have the mobility skills initially after surgery that a younger person would, a CPM may be beneficial to keep the joint flexible and decrease pain.

Dr. Zann (2005) indicated that “patients undergoing total knee replacement do not achieve their maximum improvement until 2–4 years” (p. 1). This is attributed to the lack of muscular structures that surround and protect the knee and the need for the ligaments and tendons to adapt to the indwelling prosthesis. Recovery times vary and depend upon a number of variables, including the patient’s overall health, age, other preexisting health issues, and motivation. Patients report that the new knee joint never feels normal even years after the surgery, but that they experience an increase in function and generally much less pain than before.

Patients should be educated about signs and symptoms of infection, care of the surgical site (if staples are still present), pain management, and expectations for recovery. A range of motion from 0–90 degrees is the very minimum needed for normal functioning. Normal knee flexion is 140 degrees, but few older persons would get this amount of flexion after surgery, and may not have had full flexion even prior to the operation. After discharge, a walker is usually used in the first few weeks, followed by light activities 6 weeks after surgery. In addition, the patient’s spouse may experience feelings of being overwhelmed due to role transitions that occur after surgery and during the recovery period (Walker, 2012 ). Newer knee prosthetics are still going strong for the majority of patients 15 years after surgery.

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For more information on Knee Replacement, visit the AAOS Website:
http://orthoinfo.aaos.org/topic.cfm?topic=a00389

Download this care page as a PDF: Knee Replacement
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By |2019-06-15T16:50:39-05:00June 16th, 2019|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Total Knee Replacement

Guest Blog: Budgeting for Seniors and Those on Fixed Incomes

Most seniors have a fixed, limited income. Even though it may not seem like a whole lot, there are ways to budget and make the fixed income work to your advantage. After all, you know exactly how much money you are going to get each month. You don’t have to worry about losing a job, or not getting a paycheck. Most of the time the money comes in on a predictable date and this is very advantageous because you know exactly when the money is going to get replenished.

Now to the budgeting. Most seniors have essentials such as paying for medications, food, rent and mortgage, transportation and of course incidentals. Figure out how much you have available after your rent/mortgage expense, medication expense, transportation expense and this is the amount you have for food and incidentals. Going out to eat can be a major expense so staying in might be a good idea for some.
Additionally, if you have money left over at the end of the month, you can save up for a vacation, or a one off purchase.

If you have debt, negotiating the interest rate with the bank or credit card company can save a lot of money. Monitoring utility usage and minimizing utility usage can also lead to a big savings. Leaving on the air conditioning or heat during the day when you aren’t home tends to add up over time. Even though this may amount to 50-100.00 per month, over the course of the year this equates to thousands of dollars.

It’s also worth mentioning that not all insurance premiums are created equal. Some people are unknowingly paying for services outside of Medicare that they may not need. Likewise, for those on an extremely reduced fixed income, it could be worth looking into Medicaid in your state. Each state has different rules, but here is a nationwide guide to Medicaid, which can help pay for regular medical expenses and long term care.

The last piece of advice is to track your not-so-necessary purchases. Write down each time you purchase something that is not essential and you will most likely be surprised. If you are not careful, a large amount of your budget could be going to non-essentials. Whether you use a pen and paper, or are using budgeting software, it is a good idea to keep track of all expenses. Click the lick to see a handy budget sheet created by AARP. This minimizes surprises and will lead to a much easier time getting to the next month’s income check.

Jacob Edward is the manager of Senior Planning in Phoenix Arizona. Jacob founded Senior Planning in 2007 and has helped many Arizona seniors and their families navigate the process of long-term care planning.

By |2019-06-14T10:59:13-05:00June 14th, 2019|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: Budgeting for Seniors and Those on Fixed Incomes