Photo by: graur razvan ionut / FreeDigitalPhotos.net

When you are in the midst of a busy holiday season, getting enough sleep is something that can be hard to obtain. Yet for others, this is a year round problem if they have sleep apnea. It has been estimated that this condition, where a person has episodes of stopped breathing during sleep, affects about 18 million Americans (1 in 15 people) yearly. Not only does it contribute to daytime drowsiness and lack of energy, but could be potentially dangerous and affect ones health. Many suffer from this condition without even knowing it.

I once had a patient who had uncontrolled high blood pressure, and even though he was taking his medications the way his doctor told him, it was always too high. One weekend, his sister and her family came into town and stayed with him. It wasn’t until his younger nephew told him the next day that he snored so loudly it nearly scared him, that he went to get it checked. Eventually it was discovered he had obstructive sleep apnea (OSA), and now that he uses a CPAP machine at night, his quality of sleep improved along with his blood pressure.

Months later I told a girlfriend his story when we went on a trip together and I found her snoring to be disturbing. After having a sleep study done, she too found out she had sleep apnea and wears the CPAP at night. She recently told me she now gets the best sleep ever. Although snoring does not mean a person has this condition, speak to your doctor about your sleep patterns and your energy during the day. If you believe you or someone you know may have this, have it checked out. Good sleep is something we all need! Be well.

photo by Maggie Smith

Arthritis affects the joints and muscles of the body and can affect people at different ages and stages of their life. It limits a person’s mobility and creates an emotional toll from losing the ability of fully participating in the things once enjoyed. It is this aspect of the illness that can cause another problem and is one of the hardest to deal with — depression. At times putting feelings of loss and hopelessness into words is difficult, and having others understand what you are going through can be one of the greatest challenges.

Recently, a patient spoke to me of the emotional roller-coaster ride this illness was taking on him. Not only was the pain intolerable at times, but he stated he was becoming very depressed because of it, causing him to dwell more on his illness and what he could no longer do. When he was speaking to me, I thought of the problems my grandfather had to face with his rheumatoid arthritis. As far as I could see as a child, it only affected his knees causing him to walk with a cane. Some days he was fine, but on others he was downright miserable and I would try to help him as best as a child could. Yet now that I am older and thinking of what my patient was telling me, I wondered how much more the pain had affected my grandfather’s mood, and if he too was somehow suffering with depression. For my patient, he is about to start going to a pain clinic, and is also thinking about counseling to help with the feeling of helplessness and loss he sometimes encounters.

Studies have now shown that treating depression can very well help with the symptoms and problems with arthritis. Whether a person is treated with medication or psychotherapy, it not only helps with the symptoms of depression, but also the symptoms of arthritis. By treating one issue can help with the other. Is this something you or someone you know has had to deal with? And if so, was there a treatment that helped? Share with us your stories, and be well.

If you are not familiar with Pat Summit, she is widely considered the most successful college basketball coach of all time. Her recognition is well deserved after coaching Tennessee University’s women’s basketball team to a record eight national championships and more than 1,000 wins.

Sally Jenkins of the Washington Post writes:

“Denial was followed by anger. For the first few weeks, Summitt would barely even discuss the subject. She told her doctors, ‘You don’t know me. You don’t know what I’m capable of.’ Finally, Summitt realized she would have to accept the diagnosis. ‘I can’t change it,’ she says. After a pause, she adds, ‘But I can try to do something about it.’”

Summit has made it clear that she will continue to coach despite being diagnosed with early onset Alzheimer’s. I believe Summit’s desire to continue leading her team outshines all her previous accomplishments since she is now one of the public faces of a disease that affects millions of Americans.

Dementia is a progressive disease that causes a loss of brain function, which can result in memory loss and problems with concentration and decision-making. Alzheimer’s Disease is believed to be the most common form of dementia.

Over the years, a number of my seniors who have been diagnosed with dementia have been able to lead productive lives. What is their secret? All of them have had a good support network, which included a combination of caregivers and medical staff. In my next post I’ll lay out a few helpful ways to build a support network after a Alzheimer’s diagnosis.

Are you or someone you know living with Alzheimer’s or a form of dementia? If so, I urge you to take a look at our resource page, Living With Alzheimer’s Disease, which provides helpful tips for managing the disease.

Have a peaceful week.

On the other end of the spectum however, is anorexia nervosa. Anorexia is simply a loss of appetite, yet anorexia nervosa is a disorder characterized by a fear of becoming fat, leading to a refusal of eating food, or at least eating enough for a person to remain healthy. Even though many cases are seen in adolescence, it has been found in children as young as seven. This (and other eating disorders) have a physical, behavioral and emotional component. Some symptoms to look for in those with anorexia include the following:

• being 15% below ideal weight
• fear of becoming overweight even though they may be normal weight for their age and height
• a distorted body image
• unusual avoidance of food, monitoring what is being eaten or eating in very small amounts
• excessive exercising
• menstrual cycle may be irregular or stop (missing at least three in a row)
• frequently feeling cold
• dry skin, thinning hair

Where children are concerned, it’s especially difficult to determine if the child is just a “fussy eater”, or perhaps just going through a growth spurt. Yet if you suspect your child or someone you know may be anorexic, it is important to speak to the parent and/or pediatrician right away. Sometimes a parent may suspect, but are not sure until someone else observes signs that there may be a problem too. If it’s discovered a child does have a problem, professional treatment may include a medical doctor, nutritionist as well as a psychotherapist. For more information about anorexia nervosa, contact the National Association of Anorexia Nervosa and Associated Disorders.

1) Avoid walking between 10 a.m. to 2 p.m. — generally the hottest time of the day.

2) Begin your daily walk at a slower pace to prevent exhaustion and retreat to a cool place if you start to feel uncomfortable.

3) Wear light colored and loose fitting clothing.

4) Drink plenty of non-alcoholic fluids to remain adequately hydrated and pack a bottle of water when you head outdoors.

5) Consult your physician on the amount of liquid you should consume if you are on a fluid-restricted diet.

Take a look at VNSNY’s guide to hot weather safety and the Center for Disease Control and Prevention’s guide to heat related illnesses to learn more about how to keep safe this summer.

Stay safe and cool!

Photo by Salvatore Vuono

In today’s New York Times, there is a wonderful article about a 38-year-old man who suffered a brain hemorrhage and whose wife agreed to donate his organs. In total, EIGHT people were given hope because of Julio and Mirtala Garcia’s selflessness. Mrs. Garcia met with five of the recipients last week and the reporter, Denise Grady, was there.

The article is beautiful not just for its writing and the way it combines medical information with personal and specific detail, but because we get a sense of the love Mirtala had for Julio. “What would he have wanted?” she was asked. “He would have wanted to help people,” was her response.

The article places in stark language the importance of organ donation and the way in which humans become interconnected by the experience. It conveys this message in a way that no well-intentioned blog possibly could.

Please read the whole story and discuss it with the people you love. After you hug and kiss them for no apparent reason, of course.

I feel it’s crucial to have advanced directives, including a living will and a durable power of attorney or health care proxy in place, should my mother require hospitalization. It will take me some time to travel to her in such an occurrence. Knowing that a health care proxy is in place would ease my mind that her wishes are being followed if she cannot speak for herself.

It eases my mother’s mind, too.

On a recent visit to Ohio, near the one-year anniversary of my father’s death, I cautiously broached the topic with her.

We were at a lovely diner full of lush, green plants. The sun was shining through the window. We had just finished our chicken dumpling soups. It was our last day together and I had just helped her with her taxes earlier in the day—for the first time, she would be filing as a single person.

I figured if we were on a roll organizing her financial matters I may as well keep along those lines of open communication.

“Mom,” I said, “I’m sure you’ve heard about a Living Will and Durable Power of Attorney.” (In Ohio, we use the term Durable Power of Attorney as opposed to Health Care Proxy, which is what we say in New York. They mean the same thing.)

“Do you mean for my finances?” she asked, “because I’ve been thinking about that.”

“A Durable Power of Attorney is a person who can make medical decisions for you in the event that you cannot do so for yourself,” I replied. “ That person is someone who can follow your wishes. Someone who can speak for you.”

“Yeah, I’ve been thinking about that, too. I have papers about that from when I had my knee surgery,” she said.

“Mom, I just think it may be a good idea to think about those papers again, if you feel comfortable.”

My mom expressed her preference to  initiate the process, as it would make her feel relieved knowing that me or my brother have the authority to carry out her wishes.

As we moved on to our main lunch dish we continued to talk about the advanced directives. She even began to talk about her considerations for pre-funeral planning, as well as how she would like to organize finances for the future. The initial topic she proposed above. She guided the rest of the discussion on her own.

I sometimes wonder if it’s actually the adult child who has reluctance to discuss these matters as opposed to the senior parent. It’s not easy hearing your healthy adult parent mention her own funeral wishes, but it also has a sense of decompression. The “talk” relieves all this perceived built-up pressure imagined in one’s mind. It wasn’t as difficult as I thought it would be. In fact, it has given us a clearer path to more honest, direct communication regarding important issues in our lives.

My mom now feels taken care of by her family. Her children know what she wants. My brother and I feel at ease because we understand her wishes in advance, as opposed to the worry of fumbling through difficult decisions in a time of crisis.

You can initiate advanced directives, living wills and health care proxy forms on your own in my many states via internet-available forms, but please ensure they are appropriate sites. Talk to a physician or health care professional if you are not sure. You may even want to ask your physician if he or she carries living will documents at the office. Be aware that each state’s documents are different and that you may need to have a witnesses or a notary public present at the signing of the documents.

Here are some more links regarding the topic of advanced directives:

AARP’s Advanced Directives Article

The US Living Will Registry

As my colleague, Paula Wilson, mentioned at the close of her blog. Advanced directives are not only important for the elderly, but for each and every one of us.

One way to accomplish this is to have an advanced directive. Advance directives are legal documents that convey to others what your medical decisions are, should you be unable to make the decisions for yourself. Examples of advanced directives include: Living Will (PDF), or Health Care Proxy (PDF). The requirements for these documents may vary by state, but it’s always a good idea to at least have a Health Care Proxy or Living Will in place to give guidance to health care providers.

Living Will:

• Indicates which life-saving procedures you do and do not want performed under various circumstances — it may be more detailed than a health care proxy
• A Living Will is used when a person is unable to make decisions for him or herself.

It is probably good to have both types of documents. Starting the conversation about something most of us want to avoid is important. This is the talk I had with a friend a few years ago, and she has discussed with me what she would and would not want done. I am glad she feels that I am someone who will honor her wishes if and when the time comes. Now, to fill out my own paperwork…..