Rodger Marion

Marcos Caliente – An enchanted chili created by Marvin Niebuhr, who is one of those isolated, rural artists with an eye on the inner spaces

I’m burrowing through the August 2013 issue of Texas Monthly thinking about writers.

Earlier this week I read in the newspaper about John Graves moving on at 92. Graves lived in Glen Rose and was a well known writer about Texas rural life. His Goodbye to a River is considered a classic and his other books, for example: Hard Scrabble: Observations on a Patch of Land and From a Limestone Ledge, leave a legacy of insightful observations about Texas, conservation and nature.

Benjamin Sáenz is another Texas writer and poet from a later generation. He’s almost 59, a professor at UTEP and lives in El Paso.  He writes about growing up in West Texas and New Mexico but mostly he writes about growing up inside, the process whereby we learn about ourselves.

Artists (writers and poets and painters and anyone else who goes off alone to explore) put into expression (words, pictures)  what we all experience but often cannot quite grasp. It is the artist who while questing through his own awareness often sees those insights that we all know lie at the root of our behavior and dreams.

The cool thing about this process is that it is a skill that stays with artists all their lives. And while Ludwig van Beethoven wrote wonderful music when he was deaf, for most of us staying creative is linked to staying healthy. As providers of health services, we can make a contribution to art too. When we work to create efficient, coordinated health services for all people, especially isolated, rural folks, we add to our library of human understanding by enabling people to have the energy and freedom to look inside and tell us what they find there.

Join us for a real-time discussion about ideas raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag

References

Balli, C. The Passion of Benjamin Sáenz. Texas Monthly, August 2013. http://www.texasmonthly.com/story/the-messy-visionary-passionate-life-of-benjamin-s%C3%A1enz (This is not the whole article but just a stub to serve as a source).

Holley, J. Goodbye to a writer; John Graves dead at 92. Houston Chronicle, August 2, 2013. http://www.chron.com/news/houston-texas/houston/article/Goodbye-to-a-writer-John-Graves-dead-at-92-4698127.php

Image Source: http://flimflamlab.blogspot.com/2009/10/marcos-returns.html

You know the song – “The Gambler” (written by Don Schlitz and made famous by Kenny Rodgers).

You got to know when to hold ‘em Know when to fold ‘em Know when to walk away Know when to run Your never count your money When you’re sitting at the table There’ll be time enough for counting When the dealin’s done

But my favorite line is: “Every Gambler knows that the secret to survivin’ is knowing what to throw away, and knowing what to keep” and that “the best you can hope for is to die in your sleep.”

For those in old age, gambling could be a way of life whether sitting at the poker table or sitting in a wheelchair at the neighborhood nursing home.  Some say the gambler depicted in the song was lucky.  It is implies that he dies in his sleep.  And that for many old folks with a terminal illness who unexpectedly pass in the night that could be a blessing.

Has the gambler broken even?  Has he finished his last hand and feels it is time to walk away from the table?  In aging this bring up profound questions of death and dying.  Ethical concerns, like the decision for aggressive treatment or to sign a DNR (Do Not Resuscitate order).  Or when to seek care or when to give up.  I bring this up because some in the field of Gerontology and Geriatrics spend a lot of time examining the choices older folks need to make, or are faced with, as they age.  In old age, do you get that hip replacement and say “he died with two good hips.”  It may be a good idea if it improves function, relieves pain and helps you get around.  But is it a good idea for such a surgery at age 95?  Do you resist any medical intervention when you clearly need the EMS to come and take you to the hospital?  Do you keep playing a losing hand or fold ‘em in hopes of a better day?

What often happens is the need to prioritize.  In the study of Geriatric Medicine, those who know, such as Geriatricians, will weigh the options of care between what can actually do the most good for the older patient and what will adversely affect their quality of life.  That is not an easy thing to figure out.  And there are some of the best Geriatricians in the country who will tell you, “when faced with a difficult medical decision for my patients, I am often still rather confused and unsure of what exactly is the best course of action.”

Now I am not a Geriatrician, but I know several who are and they will probably tell you that unless you know what you are doing, you may very well do more harm than good when trying to provide care for an older person.  This is because it is so damn difficult.  There are so many variables to consider besides age.  What are the patient’s wishes?  What are other medical conditions that may or may not also need some intervention?  What medications should they be on or off to make any hope of recovery effective?  What kind of support do they have to sustain independent living after a major intervention? What does the family say and want? On and on and on.  Many may try to be too aggressive in their treatment and really mess up a patient’s quality of life.  The key is education – learning what needs to be done to come up with the best results – and like being dealt a good hand, a little bit of luck.

And remember – no matter how much you trust your opposition – always cut the cards.

Reference

http://en.wikipedia.org/wiki/The_Gambler_(song)

The Guest Blogger this week is Tony DiNuzzo, Ph.D. He is the Director of the East Texas Geriatric Education Center/Consortium

Join us for a real-time discussion about ideas raised by this essay on
Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for
details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Everyone tells you that you need to have a will. That way both your relatives and the courts will know what you wanted done with all your stuff. As we get older the need for a will usually becomes fairly obvious and it’s a good wellness behavior to “get one’s affairs in order.”

Wills relate to the disposition of physical assets (“stuff”). Lawyers generally advise against including personal opinions (as in “My lousy, good-for-nothing brother-in-law gets…”) and philosophical observations (as in “”My higher powers have directed me to dispose of my assets… “).

But you say “I have all this super useful wisdom to pass along? What did I do?” The answer lies an another form of a will: an Ethical Will. This is a document that you write and in it you put your wisdom and history… any and all things that you want your descendants to know. It’s not a legal document nor is it a memoir.

Beth LaMie defines it thus, “An ethical will, also called a legacy letter, is a document written to pass on important considerations, such as experiences, values, wisdom, and blessings, to loved ones. An ethical will can be shared with family members or friends either at the time it is written, or preserved to be read after the author’s death. Originated as the Jewish tradition of passing down values orally, ethical wills have been around for over 3,500 years.”

Ethical wills in Biblical times were oral stories told at one’s bed side. Later they were a paper-based document. These days your ethical will could be an online blog, a YouTube video, or perhaps the next new digital thing. A 3D hologram perhaps.

Andrew Weil writes, “I can think of no better way to end this book than to recommend that you undertake the composition of an ethical will. No matter how old you are, it can be an exercise that will take stock of your life experience and distill from it the values and wisdom that you have gained. You can then put the document aside, read it over as the years pass, and revise it from time to time as you see fit. Certainly, an ethical will can be a wonderful gift to leave to your family at the end of your life, but I think its main purpose is what it can give you in the midst of life.”

Resources

• A National Public Radio program dealing with ethical wills: http://www.npr.org/templates/story/story.php?storyId=3166037
• Examples of ethical wills can be read here: http://celebrationsoflife.net/ethicalwills
• A template for writing an ethical will can be found at http://bethlamie.com/ethical-wills.html (This web site is a commercial one but the information is freely provided).
• A web site where people write and share their life stories: http://www.storyofmylife.com

Reference

Weil, A. Healthy Aging: A Lifelong Guide to Your Physical and Spiritual Well-Being. Random House of Canada, Mississauga, ON, 2005, p. 298.

Join us for a real-time discussion about ideas raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

We had a number of guests to dinner for the Fourth of July celebration yesterday. One of our guests, an older, retired man, had had a lung transplant. He reported how well his new lungs worked and how marvelous it was that medicine could give him such a new lease on life.

His story got me to wondering about the issue of limiting treatment options due to considerations such as age, productivity, ROI, etc. I found a related article by Andre & Velasquez (1990) that began with a quote by Euripides from about 500 B.C.E.

I hate the men who would prolong their lives
By foods and drinks and charms of magic art
Perverting nature’s course to keep off death
They ought, when they no longer serve the land
To quit this life, and clear the way for youth.

It often surfaces that in order to provide affordable care for everyone perhaps the options need to be limited, or given finite resources, choices must be made as to who gets what’s available. This is of course a very sticky wicket.

Ethicist Daniel Callahan wrote a book, Setting Limits, about limiting health care for people over 70 based on the premise that they had lived long enough and it was best to provide for palliative care but not expensive, life prolonging procedures. This position has been very controversial to say the least.

Callahan has focused on the cost of care, citing ever more expensive health care options that provide ever smaller increments of increased life span. Recently, he was quoted as saying, “Our whole health care system is based on a witch’s brew of sacrosanct doctor-patient autonomy, a fear of threats to innovation, corporate and (sometimes) physician profit-making, and a belief that, because life is of infinite value, it is morally obnoxious to put a price tag on it… Cost is a symptom of a deeper problem. We have an ‘infinite progress’ model. Nothing is ever good enough. The standard of care is raised higher and higher – but death always wins.” (Baker, 2009)

Callahan is nearly 80 now and has not voluntarily passed up expensive medical help with his personal health issues and this is not surprising. The issue of “affording health care” is based on a notion of lack, that there is not enough to go around and that somehow we must ration it, lest we run out. I don’t think this is the case.

On Wednesday, we can discuss this area and I excerpted a few quotes from Andre & Velasquez (1990) that appear to be good discussion starters:

“If our aim is to use costly resources more effectively, then we ought to deny treatment to all patients whose prognosis indicates a short life span, chronic illness, or little likely improvement in the quality of life, rather than denying treatment simply on the basis of age.”

It is argued that… “providing benefits to one group means unfairly taking them away from members of the other group. But, this is mistaken. We don’t claim that it is unjust to spend more educational dollars on children than on adults. Similarly, it is not unjust to spend more medical dollars on the aged than on the young, so long as every individual has the same access to medical care over a lifetime.”

“To claim that the elderly’s right to health care must be restricted because they have achieved a “natural life span” — that they have no life goals or possibilities — is simply erroneous. In fact, their major life achievements may still be ahead of them.”

References

1. Andre, C & Velasquez, M. Aged-Based Health Care Rationing. Issues in Ethics, Vol 3, Num 3, Summer 1990, Markkula Center for Applied Ethics, Santa Clara University, http://www.scu.edu/ethics/publications/iie/v3n3/age.html.
2. Baker, B. Ethicist Callahan: ‘Set Limits’ On Health Care. Kaiser Health News, 12-10-2009, http://www.kaiserhealthnews.org/checking-in-with/daniel-callahan-limits-on-health-care.aspx.
3. Callahan, D. Setting Limits: Medical Goals in an Aging Society. New York: Simon and Schuster, 1987 (http://books.google.com/books/about/Setting_Limits.html?id=NH1T-sVvEw4C).

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Image Source: Identity and Ration Books. Image licensed under Creative Commons by Wolfiewolf on Flickr

At the two year mark of this experiment in social media (our blog, Facebook, web site, virtual discussion), I want to divert from talking about the rural elderly and muse a bit about information technology.

Each year the EDUCAUSE Review (a magazine for academic IT geeks) identifies the current top-ten IT issues. Number 7 is relevant to our activities in the ETGEC/C: Determining the role of online learning and developing a sustainable strategy for that role (Grajek et al., 2013).

The ETGEC is not a face-to-face endeavor. It has always been clear to me that because our project is scattered across half of Texas, it is the various online activities that are really our major points of contact. We are seeking to use online resources in the two ways that David Brooks identifies as the major functions of the university (Brooks, 2013): providing technical knowledge and practical knowledge.

Technical knowledge is the facts and rules about things and practical knowledge is how and when to apply technical knowledge to solve problems or accomplish goals.  We are using the web site as a source of technical knowledge and the blog and virtual discussions as a path to practical knowledge. Facebook is sort of a glue that helps link the others together.

The reception to two years of blogging and almost a year of the virtual discussion has been lukewarm to say the least. The participation in Second Life has been particularly limited. I wonder why and I wonder what other options are available to us?

I also wonder if there is a geek/non-geek divide in technology adoption. The same issue of EDUCAUSE has a superb article on how geeks and non-geeks can learn to get along (Glen & McManus, 2013).  Just the thought, brings back memories of the musical Oklahoma!

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

References

1. Brooks, D. The Practical University. NY Times Opinion Pages, April 4, 2013, http://www.nytimes.com/2013/04/05/opinion/Brooks-The-Practical-University.html.
2. Glen, P & McManus, M. Geeks and non-geeks: From contraxions to collaboration in higher education. EDUCAUSE Review, May/June 2013, 48, 3, 20-29.
3. Grajek, S. et al. Top-ten IT issues, 2013: Welcome to the connected age. EDUCAUSE Review, May/June 2013, 48, 3, 30-57. Top 10 website: http://www.educause.edu/ITissues
4. Magna Theatre Corporation. Oklahoma! (1955). http://www.imdb.com/title/tt0048445. Reference is to the song, The Farmer and the Cowman (1943) by Richard Rodgers and Oscar Hammerstein II.

Image Source

Still from The Farmer and the Cowman dance sequence from Rodgers & Hammerstein’s Oklahoma! with the 1998 London cast, http://youtu.be/IjVQqGlj4A8.

Too many choices

I frequently encounter elders and their family members who have been misinformed about services and programs available to the elderly.  Example: An elder or family member inquires about services that will help the elder remain independent and in their residence. I frequently find that the elder is likely eligible for Community Care Attendant (CCA) services, formerly known as Provider Services, and a referral to the Department of Aging and Disabled Services (DADS) is made.  Later, I find out that the elder did not pursue this because of fear that the State of Texas could take their home.  While estate recovery provisions do apply to CCA services there are exemptions and legal ways to protect the homestead.

I get most frustrated when a spouse informs me that they have depleted their savings paying for the patient’s skilled nursing facility care.  Here information has been withheld, likely unintentionally, and the spouse was unaware of rules regarding help through Medicaid with costs for Skilled Nursing Facility care while the patient rehabilitates from a medical condition.

How can we better inform people before they find themselves in a situation that requires care they cannot afford where there might be programs to help?

———————

Our Guest Blogger this week is Adele Herzfeld, who is a Senior Social Worker in the UTMB Geriatric Clinics.

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag

Image by Jack Atley of Bloomberg News illustrating a New York Times article by Alina Tugend, Too Many Choices: A Problem That Can Paralyze. Posted 2-26-2010 at http://www.nytimes.com/2010/02/27/your-money/27shortcuts.html?_r=0

“An 80-year-old Japanese man who began the year with his fourth heart operation became the oldest conqueror of Mount Everest on Thursday, a feat he called ‘the world’s best feeling’ even with an 81-year-old Nepalese climber not far behind him. Yuichiro Miura, a former extreme skier who also climbed the 8,850-meter (29,035-foot) peak when he was 70 and 75, reached the summit at 9:05 a.m. local time, according to a Nepalese mountaineering official and Miura’s Tokyo-based support team.” (Gurubacharya, 2013)

Miura is being closely followed by Nepal’s Min Bahadur Sherchan, who is 81 years old and expects to also reach the summit in a few weeks.

These are remarkable feats for two men in their 80s. I feel fairly proud of myself when I hike up the hill from my mail box, so getting to the top of Mount Everest has got to be quite an accomplishment.

Everyday humans are discovering wider horizons and defining themselves in new ways. I decided not to expand this blog and find additional examples of older people pushing the conventional assumptions about aging, but to pause in remembrance, as they do in the tales of heroic quests.

Please, simply consider this one achievement and take a moment to celebrate it and to ponder the great potentials we all hold within.

Reference

Gurubacharya, B. Japanese man, 80, oldest to top Everest, for now. Austin American Statesman, May 23, 2013. http://www.statesman.com/ap/ap/top-news/japanese-climber-80-becomes-oldest-atop-everest/nXzkr

Image

The photo was taken with a telephoto lens from an altitude of 5,550 meters (18,208 feet). It is not clear which of the climbers in the photo is Miura. (AP Photo/Kyodo News)

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Hume Cronyn and Jessica Tandy in Cocoon

At the Super Bowl one of the fancy commercials was about a group of elderly people out for a wild night on the town.

Taco bell released the commercial on YouTube hoping it would go viral. According to Time Magazine by the day after the Super Bowl 2013 it had been viewed about 1.2 million times and shared 130,000 times (Sanburn, 2013). So, I guess it did.

Why did Taco Bell make this commercial? From their web site, “‘There’s a common misconception that to appeal to Millennials you have to show Millennials.  The reality is to appeal to them you simply need to entertain and engage them.  And that’s what this entire integrated effort does,’ said Mike Sheldon, CEO of Deutsch LA.  Sheldon continues, ‘We’ve all had an epic night out on the town followed by a trip to Taco Bell. Viva Young is a surprising and fresh way to remind people of that.'”

So it’s not a commercial made to appeal to the older generation, nor an homage to how the elderly can still be a part of mainstream life, no, it’s marketing to twenty year olds.

Now, I do admit to finding the commercial amusing, but a few questions do come to mind:

• Was this something older people would enjoy watching?
• Did it help to improve the image of growing older in America?
• Is it respectful of older people?
• Does it mask some deeper rejection of the idea of growing older, mature and wise?

The commercial also reminds me of the film Cocoon. In that film a group of old people swim in a pool that makes them vigorous and vital again. Cocoon makes two points. First, it’s always good to be healthy, strong and seek new adventures. Second, the true meaning of life may come from following the seasons of life.

References

1. Cocoon (film). Internet Movie Database: http://www.imdb.com/title/tt0088933
2. Live Mas/Viva Young (commercial): a52: https://vimeo.com/58518122
3. Sanburn, J. Time, Business & Money, Feb. 04, 2013.  http://business.time.com/2013/02/05/super-bowl-2013s-6-most-shared-commercials-and-why-they-went-viral/slide/6-taco-bells-viva-young/#ixzz2StcM2v4Z
4. Super Bowl web site: http://www.nfl.com/superbowl/47
5. Taco Bell web site: http://www.tacobell.com/Company/newsreleases/SUPER_BOWL_Sneak_Peek+

Image source: http://hippierefugee.blogspot.com/2012/12/cocoon-return_11.html

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

I recently came across an article on “6 predictions for our digital future” written by CNN’s Doug Gross. It outlined the predictions made by Google chairman, Eric Schmidt,  in a new book “The New Digital Age: Reshaping the Future of People, Nations and Business,”  The article and book centered on what the “world will be like when everyone on Earth is connected digitally.”  It is Mr. Schmidt’s belief that this will happen by the end of the current decade.

That is only 7 years away, folks.  So, I ask – are you and everyone you know ready to be connected digitally, if you aren’t already.

Around the same time I was listening to John Mellencamp’s song “Peaceful World” and the line… “If you’re not part of the future, then get out of the way.”

I saw some new threads begin to intertwine between these two thoughts – “the future is digital and if you’re not part of it, then should you get out of the way?”  And what exactly does that mean as we age? Will playing bridge be done using Skype or will we start playing digital bingo?  Ok, maybe those stereotypes of what older folks like to do will have faded by then.  But what about the reality of aging and the issues we may face as we age? Fixed income? Changing physical and mental health? Loss of friends and family?  You have to wonder how the expected and increasing fast pace of living in a digital world will effect quality of life of an older adult who wants to relax and enjoy the fruits of retirement.  Is slowing down the expected path as we age and that if it doesn’t fit in a digital world? Or will embracing the digital world add untold joys to post-retirement lifestyles?

I remember about 15 years ago, offering computer classes at the local senior center and the absolute look of amazement on the faces of seniors fascinated by what they saw and could do on a PC. Of course, there were those who grumbled and would predict, “all this computer stuff will never catch on.”  Well, I guess we know that hasn’t exactly been the case.

So I try to think how I might face a digital world in the next 10 years.  I used to think it would be no problem keeping up with the latest technological trends and gadgets.  I bought a laptop, joined Facebook, got the latest iPhone, I’m good at texting, know how to Skype and can hold my own with videoconferencing at work.  But I haven’t embraced Twitter, E-bay nor do I have wireless Internet service or cable TV.  I use an amplified antenna to get local TV stations since I don’t like cable companies.  So I feel a little behind in some things and once you fall behind, at the pace of new technology, catching up may be impossible – and expensive.

So the next question for myself is – how much does it matter if I “don’t keep up” with all this technology?  Will it affect my longevity?  My quality of life? Will my friends abandon me if I don’t know the latest in tech?  Will I be able to continue to communicate with the world?  With my kids as they become more techno savvy?  Generally, I hope we will do the best we can, get into what is comfortable – separate the “wheat from the chafe” kind of attitude.  Maybe we will continue to know when something is important to pursue, learn and enhance it with all our aging wisdom.  I don’t think the goal of aging is to keep up with the latest trends or even to establish new ones.  I hope the goal will be to stay happy and healthy with whatever we undertake and make it a part of improving ourselves, our minds, bodies, and relationships – if we chose it to be.

References

• Gross, D. Google chairman: 6 predictions for our digital future. CNN Tech, posted 4-24-2013, http://www.cnn.com/2013/04/23/tech/web/eric-schmidt-google-book/index.html
• Schmidt, E & Cohen, J. The New Digital Age. Alfred A. Knopf, NY, 2013. http://www.newdigitalage.com

The Guest Blogger this week is Tony DiNuzzo, Ph.D., Director, ETGEC-C, UTMB Sealy Center on Aging.

Image Source: “Commander Cody and his Lost Planet Airmen” album cover. https://www.asme.org/kb/news—articles/articles/technology-and-society/engineering-rock-star

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Last month I was at the Annual Herbal Forum at Round Top. This is a gathering of people, from across Texas, who grow and use herbs in cooking and for health benefits. I use herbs in cooking but there is a very long tradition for the beneficial uses of herbs for curing aliments, preventing illness and maintaining wellness. I’m going to spend an occasional week, here and there, on exploring an herb or two as they relate to the rural elderly.

The use of herbs and plants in healing and wellness is the oldest approach in medicine. Early people discovered that leaves, bark, sap and other parts of plants helped in healing cuts and curing maladies. The average person today would not recognize the “pharmacy” of the 17th century which was filled with dried plants and other natural items which were ground into the various medicinal powders. As medicine evolved,  practitioners developed purified chemicals and the use of prepared pills became our common mode. Today, there is a gulf of perception between a bottle of aspirin and a box of peppermint leaves, but both are used to reduce the discomfort of a headache.

Three assertions. First, we may generally acknowledged that the use of homemade remedies and herbs is more common in rural communities and among the older population who may be more familiar with local traditions of self-care. Second, the validity of a herb for any particular use usually lacks a systematic history of clinical trials to verify its utility and effectiveness. Third, modern health care providers have been slow to return to using herbs because of concerns about the difficulty in predicting exactly how a natural product may effect a patient.

A consequence of these assertions is that often patients use herbs to treat themselves and others and if the health care provider is not aware of this, his/her treatments may interact negatively with what the patient is doing. Thus, it behooves care providers to be aware of herbal health practices,  find out if patents are using them and plan their interventions accordingly.

This can get complicated. For example, Echinacea is commonly used as a preventative measure for colds or as an intervention to reduce the severity of a cold. However, there are two varieties of Echinacea and each has somewhat different properties and uses (Brinker, 2013). The article by Brinker reviews historical uses and clinical trials with Echinacea angustifola root extracts and Echinacea purpurea fresh plant extracts. They each may be useful in helping resolve different health issues, but there is also overlap between the varieties and varying levels of effectiveness depending on the exact source and processing. Thus, the modern care provider needs not only to find out what his/her patients are doing for self-care, but he/she needs to be aware of subtle differences between varieties of the same thing.

Reference

Brinker, F. Echinacea: Differences Matter. HerbalGram, February/April 2013, issue 97, pp 46-57. The HerbalGram is a journal published by the American Botanical Council (www.herbalgram.org) which is a good source for herbal and botanical information.

Image Source: http://www.bitlessbridle.co.uk

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Do you have experience with diagnostic error?  Have you ever brought your car or computer to be fixed and you get it back and it seems like the problem starts happening again after a few days?  You have probably encountered diagnostic error with numerous patients and you (and they) may have never known.  Diagnostic error can include over-diagnosis, misdiagnosis, missed diagnosis, or severely delayed diagnosis.

If you are a person who provides diagnoses, chances are you have been part of a diagnostic error and not even known it.  Consider trying to track your diagnostic accuracy to see how well you are actually treating your patients.  Try a follow-up phone call and simply ask them if they think you identified their root problem. Also, consider these diagnosis myths as you take a good look at your own practice.

If you are not responsible for diagnosing, tell your patients about the potential problem and consider advocating for them… especially the ones who have been led to believe “it’s all in their head.”

Diagnosis Myths from a Patient’s Perspective

• “No news is good news” – make sure you follow-up with lab results.
• “The more tests I have, the better accuracy of my diagnosis” – explain why this isn’t always the case.
• “My doctors are talking to one another” – remind your patients of their role in their health care coordination.

Diagnostic Myths from a Provider’s Perspective

• “I don’t have any diagnostic error problems” – take a closer look.
• “Reimbursement doesn’t change my behavior” – take a closer look again.
• “I always do a complete differential diagnosis” – are you sure?

It’s always good to take a look at our practice and make sure we are providing the best possible diagnostic care for our patients.  Are you?

Our Guest Blogger this week is Meredith Masel, PhD, MSW, Oliver Center for Patient Safety & Quality Healthcare

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag

Image source: http://en.wikipedia.org/wiki/File:Good_the_bad_and_the_ugly_poster.jpg

Upon admission to hospital Mrs. Murphy, age 81, lays down comfortable in bed and is reluctant to get up.  “I am in the hospital because I am ill and I need to stay in bed and be cared for,” she says.  “I need to rest and regain my strength and get well.”

The myth that bed rest is good for you is strongly ingrained in our society.  A study BY Hirshch (1990) on patients over the age of 74 noted that  by the second day of admission statistically significant deterioration had occurred in “individual scores for mobility, transfer, toileting, feeding and grooming.

Many older adults become dependent in one or more activities of daily living (ADLs: dressing, bathing, transferring, eating, toileting) when hospitalized and their prognosis after discharge is poor.

A study by Boyd and Landefeld (2008) showed that at 12 months after discharge, of those discharged with new or additional ADL disability, 41.3% died, 28.6% were alive but had not recovered to baseline function, and 30.1% were at baseline function. Hospitalization and bed rest superimpose factors such as enforced immobilization, dehydration, accelerated bone and muscle loss, urinary incontinence and sensory deprivation. Any of these factors may begin the downward cascade into a state of irreversible functional decline.

The factors that contribute to a cascade to dependency are identifiable and can be avoided. Health care providers need to encourage mobility and independence be teaching their patients about the detrimental effects of bed rest.  The Bed is not your patients friend.

Look at the patient lying in bed
What a pathetic picture he makes
The blood clotting in his veins
The lime draining from his bones
The scybala stacking up in his colon
The flesh rotting from his sweat
The urine leaking from his distended bladder
And the spirit evaporating from his soul

Poem by Richard Asher, MD

Our guest blogger this week is Bronia Michejenko, RN, MSN, GNP, BC.

References

Boyd. C., Landefeld. C. Counsell S., Pammer.  R.  (2008) Recovery of activities of daily living in older adults after hospitalization for acute medical illness. J Am Geriatr Soc., 2008, 56(12), 2171–2179.

Hirsch. C. (1990). The natural history of functional mobility in hospitalized older patients. J. Am Geriatr. Soc., 38(12), 1296-1303.

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

Longtime football coach and UT icon Darrell K. Royal died awhile back at age 88.  He died from complications due to cardiovascular disease and was dealing with Alzheimer’s disease.

In an editorial, the Austin American Statesman said about Royal’s disease and death that, “It was not right and it was not fair.”

Now, I do understand anger and support one’s right to get really mad when life hands us something we decide is awful. However, once our feelings are explored and expressed, what is the best long term way to respond to life’s dilemmas?

I support research dealing with the management and elimination of Alzheimer’s disease (and cardiovascular disease for that matter), but how does “rightness” and “fairness” fit into our response to disease? We don’t arrive in these lives with any sort of guarantee or predetermined plan (or for Calvinists, at least no one ever tells us the plan in advance). To quote an overused phrase: It is what it is.

That brings up another issue I have with language. Why do people “fight” cancer with all their energy and hopes. We are always reading, “He put up a valiant fight against cancer.” One could take a more gentle approach and see illness has an opportunity or at the least as simply an event in our lives. Why not say, “Yesterday it rained, today I had a heart attack. Regardless my life goes on and I can love every moment.”

I made a film that touches this issue. It’s called “Healer” and it explores alternative ways of looking at life and disease. It’s fiction so don’t try to make it apply to reality. Also, I apologize as it’s not a freebie unless you are an Amazon Prime subscriber, but it’s worth the $1.99 rental fee. Find it at http://tinyurl.com/cxhxzw8

A classic take on the fairness of it all is this book, “When Bad Things Happen to Good People” by Harold Kushner.

References

Austin American Statesman (Editorial), For Coach, let’s take on Alzheimer’s. Tuesday, November 13, 2012, page A8.

Flores, D. UT legend Royal was always ‘Coach’ to former Longhorns. KENS5.com, November 13, 2012, http://www.kens5.com/news/Texas-legend-Royal-was-always-Coach-to-former-Longhorns-great-Nobis-179059891.html.

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.

It’s coming up on ten years since my father died at age 93. The years have mellowed my memories somewhat but still and overall he and I never shared the best of relationships. He always had these crazy expectations for me to follow in his footsteps and accomplish even greater and more significant things but he also always had low expectations at the same time. It put me in the most peculiar “no win” situation my whole life. I agonized over it for years and I’m convinced that he never gave the issue a serious thought.

Just before he passed away I visited him around Christmas. He was in good spirits and apparent health and we parted on very benevolent terms and he expressed a gratitude that I’d rarely seen before. A few weeks later he became ill and quickly passed away and, while I was there at his death, we never spoke again.

I’ve always been surprised at that moment of insight on his part and how profoundly that small communication touched me and my wife and one of my sons, who were also there. That insight has prompted me to consider fully the value of gratitude and expressing that gratitude towards one’s family. Too many people tell me that their relationships with their parents were awful and how it was never resolved or healed. And in too many of those situations the resistance to change lies with the parent not the child.

So how does an elderly parent become aware enough to look inside and figure out how to mend fences with their adult offspring?  I found two resources on the web that offer insight if not answers.

The first is Next Avenue which is a product of PBS and offers daily compilations’ of lifestyle stories for adults. One article was specific to today’s issue: How to Heal a Rift With Your Adult Child by Erica Manfred (Link is below).

Another source of advice from seniors (not just about them) is the Legacy Project developed by Karl Pillemer at Cornell University. His site says, “The Legacy Project has systematically collected practical advice from over 1500 older Americans who have lived through extraordinary experiences and historical events. They offer tips on surviving and thriving despite the challenges we all encounter.”

Being proactive is one key. I can see how in myself (to some extent, perhaps in theory) I am aware of the need to do this now and I have not built vast relationship barriers with my two middle-aged sons, so I expect I’ll maintain good relationships with them for the duration. My Dad never quite got it until that moment at like 11:57 p.m. on his life clock.

However, I feel he did get it at the end and salvation is only needed once.

Resources:

Manfred, E. How to Heal a Rift With Your Adult Child, January 16, 2013, http://www.nextavenue.org/article/2012-07/how-heal-rift-your-adult-child.

Legacy Project, advice from elders: http://legacyproject.human.cornell.edu/2012/02/avoiding-and-healing-estrangement-from-a-child

Image: This photo appears in several places on the web but I could not find its source.

Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.