Commonly Asked Questions -- Archived Articles
What is an Intervention?
“What can we do?” “How can we help?” “I’m so worried about her” “He won’t listen”
Families call and ask us what they can do to urge a loved one to seek help for an alcohol or drug problem. They often relate stories about the many times they have had a “talk” with their loved one, expressed their concern, tried to cajole, bribe, blame, shame and entice their loved one to get help….to no avail. Chemical dependency is a chronic disease that will only get worse without interruption and change: planning an Intervention can be the only way to break through the denial and urge them to get help….now!
An Intervention is a structured process motivated by care and concern, lead by a trained professional called an “Interventionist” or a two person team of Interventionists. The family meets with the Interventionist and relates the relevant current information, history and details. A suggested list of effective participants is composed and reviewed. The Interventionist selects the most appropriate four or five participants during the meeting with the family members. A practice session is conducted so participants have ample opportunity to become comfortable with the process. The date and location of the Intervention is set with a plan in place for an appropriate treatment resource to be ready to accept the patient as soon as possible after the Intervention.
Sometimes an “Executive Intervention” is the best approach for an Intervention. Many times an individual’s problems with alcohol or drugs have been noted in their workplace: performance, attendance, reliability, work product quality. Some employers may consider the employee so valuable they would like to retain them if the productivity could return. Some employers have policies allowing a leave of absence or sick leave to seek treatment. Employers that are aware of the problem and supportive of treatment can be a VERY POWERFUL ally in the process. In selected cases, the Intervention can be conducted right at the workplace rather than the home.
The Intervention itself is a respectful presentation of the concrete observations of each participant with the Interventionist present to guide the process. There is no shouting, badgering or haranguing. Participants relate their observations and express their desire for the individual to seek professional help for their chemical dependency.
Some families have said they feel they are betraying the addict or “letting the cat out of the bag” if they plan an Intervention and reveal the facts of the situation. Truth be told, the secrets and “discretion” many families have used in the past can prevent the addict from seeing the full reality of the disease and recognizing the need for help. This step could be the most loving thing a family can do to help their loved one.
The disease always gets worse and does NOT go away on its own.
Risky, yes….but the risk of doing nothing is greater.
We believe so strongly in the power of Intervention we have a page dedicated to the topic. Please visit Intervention - A Way To Help for a more thorough discussion of the process.
Tell me more about a Substance Abuse Assessment
A Substance Abuse Assessment is completed in a confidential, personal interview of one to two hours in length. The results of the assessment are used to help determine if a person’s use of alcohol and/or drugs meet the criteria for chemical dependency or abuse. Some individuals seek this service as an honest opportunity to explore their use and consider changes in their lives. Often the assessment is undertaken at the urging of family members concerned about their loved one’s use of alcohol or drugs.
The assessment is a non-judgmental, objective process with a professional trained in the Substance Abuse field conducting the interview. Information is gathered regarding current and past patterns in the use of drugs and/or alcohol .We explore any impact on the person’s health, employment, social and family function, finances and legal situation as well as any family history contribution. Every individual is different but common themes are present in chemically dependent individuals. A trained professional can weave the complex threads.
After the formal assessment is completed there is ample opportunity to discuss the results, implications and recommendations. There may be suggestions for changes to consider, literature to read, educational programs or formal treatment services. Some individuals use the results to move towards a more healthy direction and make life changes.
Kathryn and Tina hold professional credentials in the Substance Abuse field and we have the needed expertise and experience to perform Substance Abuse Assessments. We invite you to browse our pages on Addiction, Mental Health and Interventions for more information.
We can provide our services in the home setting if it is difficult to get to one of our offices.
Alcohol and Seniors
Do you know that the response to drinking alcohol can change as we grow older? We have all seen the recent articles on the health benefits of alcohol but rarely do we see the cautions that are the flip side. The way we metabolize alcohol differently as we age can create a situation where a senior may find they become more intoxicated than expected, a potentially deadly combination with driving. Alcohol interacts with MANY medications, this could cause the medication to be ineffective, produce unexpected side effects or cause new medical problems! Chronic medical conditions can be affected by alcohol intake; diabetes, heart disease, high blood pressure to name a few.
Older women have special considerations. Women metabolize alcohol in a different manner from men; this can result in more potential health risks for women who drink, regardless of age. Add the extra risks associated with aging and there is a “double whammy” for women.
Some seniors start drinking more after they move into the retirement phase of life. Boredom, social isolation and grief can contribute to increases in alcohol consumption. This can become a problem for some folks.
There’s a lot to think about.
When you visit your doctor tell him or her if you drink and if so, how much. If you drink, ask about guidelines for safety and health. Bring a list of all your medications, including vitamins or supplements, and review the effect of alcohol consumption on each so you and your doctor can make the best possible decisions for your individual circumstances.
We provide assessment and evaluation services with the special considerations for seniors in mind. Please browse our
Just for Seniors page for additional information.
Oh those Medicaid Applications! Oh the Disability Application!
How about the Virginia Medicaid application... 14 pages at last count.
Social Security Disability Applications that grow additional forms after submission.
Private disability policy claim applications.
Applications for State and Local benefit programs.
The list is long, the applications are longer.
Do you know the first step in any application process is to fill it out as accurately and completely as possible? Incomplete applications can result in rejection and return before the merits of your case have ever been reviewed. This can delay determinations and delay your qualification to receive benefits to which you may be entitled. Completing the application within the time frame requested is also important.
First step is to review the application and gather all the information you will need. For example: do you need to provide copies of bank statements or CERTIFIED copies of bank statements? It makes
a difference. Do you need a CERTIFIED copy of a birth certificate or just a copy?
If you are applying for Social Security Disability make sure you complete the questions as asked. Your answers should reflect how your disability has affected your everyday life. “Describe what you do from the time you wake up until the time you go to bed” should result in a detailed answer, more than “I watch
TV all day”. What time do you get up, do you fix a meal, take medications on a schedule, read, watch
TV, go to a regularly scheduled medical appointment, fix food for
the kids when they get home, sleep in the afternoon??
“List the places you go on a regular basis”, maybe you’re so ill you don’t go anywhere but to the doctor appointments
-- put it down, explain what you do.
Many times questions are repetitive. Answer each time as completely as possible. The easy way would be to answer “See above” or “See question 3”.
Avoid this and just…answer the question again.
If you feel you need to provide additional details about an answer or it is a complex answer you can usually attach a separate sheet with your explanation. Be as detailed as possible! Often, the answers you provide result in additional questionnaires requesting even more detail on a particular topic. Sit down and complete them
-- they are important to your case and part of your submission. Break it up into small steps and set aside some time each day to work on your answers with the completion date deadline in mind.
Social Security allows you to appoint a representative to assist in the application process and to communicate with them on your behalf. Maybe you should consider asking a trusted friend or family member to help you?
If you are so sick you find it impossible to get out easily, ask if the agency can provide some accommodation for you. Maybe they can do more by mail, maybe require fewer personal visits? If you don’t ask, they can’t help.
It’s a time consuming process to complete applications but you’ll stand a better chance of a fair hearing if the agency or company has all the information needed
to review your case.
We can provide assistance with completion of applications. We can’t manufacture information for you and we have no “secret recipe” for guaranteed approval, but we can help you make sure your application is as complete as possible and that’s always the first step.
What is “coordination of care” and why is it important?
In the medical system the term “coordination of care” refers to the way medical providers SHOULD share information about your medical care with one another. This is a cooperative process with the goal of bringing together your many different medical services and providers into a unified plan of care to treat or manage your illness. It’s a roadmap of your care, if you will. Without coordination of care you’re on your own to travel the road, alone!
Let’s say you have been diagnosed with a chronic illness like diabetes and you have a foot sore that’s not healing. Your doctor decides you should see three specialists and get some tests in the next month. As you see each specialist he/she does an exam, tells you the findings (which you may not even understand), maybe even prescribes some new medication? At the end of the month you’ve seen everyone and had your tests done.
Have the doctors talked to one another? Have they exchanged reports about their findings? Does EACH ONE know the new medications you’re now on? Have they agreed on a course of action for you? Has one doctor reviewed all the information and explained it to you? If these things happened…that’s “coordination of care” in action. If this did not happen maybe you were in charge of all this? Yikes, that’s a lot to do and remember and you didn’t even realize you were in charge or you would have taken notes.
Many folks ASSUME this coordination is going on in the background … that could be a mistake. Doctors know that coordinated care is the logical, beneficial approach. Everyone shares the information and joins in the medical plan for you. The problem is time. It takes extra time to make follow up calls, check to see if a report arrived, review the reports, review the medications, make another appointment with you. You don’t want your medical concerns to “fall through the cracks”.
We specialize in coordination of care. We make sure everyone
is in the loop about your care. We make sure the new report gets to
your doctor for review. We can call to clarify which test the doctor wants you to have and when. We will attend your doctor appointments with you, help to interpret medical language, make sure a thorough medication review is completed and make sure you have all your questions answered before we leave. Please visit our
Care Management page for a more comprehensive description of the services we can provide to you.
I’ve tried to stop drinking on my own, again and again. How can I get help to stop for good?
When we hear this our first recommendation is a thorough assessment. There is no easy recipe that fits everyone. What and how much do you drink, how often and for how long have you been drinking? Medical conditions? Family support? Do you have a job? Your age and gender, what have you tried to help you quit in the past? Many, many more elements are involved. We use professional guidelines to match the best available treatment options to the individual and their situation.
Our first concern is medical complications. Some folks may go into withdrawal if they stop drinking abruptly
-- this can be life threatening. “Detox”, short for “detoxification”, is a service that provides a safe environment to withdraw from alcohol. Sometimes this is in a hospital, sometimes not. Not everyone needs this but it’s important to determine if you do because it needs to be the first step.
Recommending a particular treatment approach for you depends on many factors such as your current medical status, mental health status, relapse potential and recovery environment to name a few.
Available treatment options may be local or distant, public or private, evenings, daytime, residential…or a combination of all.
You can see this is a complex process that should be trusted to experienced professionals. We use the nationally recognized standards and guidelines for patient placement set forth by the APA (American Psychological Association) to assure you of an objective recommendation. We provide our assessment and referral services using our professional skills and our intimate knowledge of available treatment programs to craft an INDIVIDUALIZED recommendation that will give you the best opportunity to accomplish your goal of sobriety.
Alcohol and Women, more dangerous than you may think.
Alcohol affects women differently than men. Heavy drinking is MUCH more risky for women. Women absorb and metabolize alcohol in a different way than men; this can result in higher concentrations of alcohol in the blood after consuming equal amounts of alcohol. This leaves more of the toxic and damaging elements circulating for a longer period of time in women. Since the body and brain are exposed to the direct effects of the alcohol and its toxic byproducts for a longer period of time….. the health risks are higher. The more you drink, and the more often you drink…the higher the risks.
Alcohol abuse and dependency in women has been linked to cardiovascular disease, diseases of the digestive tract including the liver, some cancers and brain damage. Current scientific study includes the examination of gender differences that indicate women alcoholics may suffer more brain damage than men who drink the same amount for the same amount of time. Since the toxic alcohol byproducts are present longer in women, it also takes longer for women to recover from the effects of alcohol. After three months of abstinence, studies have shown that women score lower on brain function tests than men.
Women seem to develop alcohol abuse related illnesses sooner than men. For example, the effects of alcohol on the liver are more severe for women and they develop alcoholic liver disease and cirrhosis of the liver earlier than men with similar drinking histories. This makes sense since the alcohol toxins circulate longer in women. There may even be additional factors at work that have not yet been identified.
Women who drink alcohol during pregnancy have special considerations. When you take a drink…so does the baby. Fetal Alcohol Syndrome (FAS) is one example of a condition directly related to alcohol consumption during pregnancy. FAS is a lifelong condition that causes physical and mental disabilities in children. No one knows if there is a “safe” drinking level in pregnancy so most doctors now advise pregnant women to abstain from drinking while pregnant. Many doctors also advise women to abstain from alcohol if they are trying to become pregnant.
Women who drink could have an important additional risk related to impaired judgment while under the influence…the danger of becoming a victim of violence or sexual assault.
As you can see, there are many considerations for women who drink. If you are concerned about your own drinking, or concerned about someone you love, we’re ready to help. We are experienced, female professionals with the knowledge to help you evaluate your alcohol use and discuss changes.
Sexual Addiction
Note: The descriptions I have noted below are from the work of Patrick Carnes, PhD., one of this country’s foremost experts on the dynamics of sexual addiction. Directly quoted material is taken from his book Out of the Shadows, 2nd edition, Hazelden Foundation, Center City, Minn. 1994.
Have you ever heard of the term “sexual addiction?” Ever wondered what it involves?
My first exposure to the concept of sexual addiction occurred several years ago, when I was working with a recovering alcoholic. He explained to me in our introductory assessment session he had noticed that since he had become sober that his interest and preoccupation with most things sexual were becoming more intrusive in his daily life. That was something I had never heard of, and certainly had never had any training on. So, out of curiosity and a desire to explore this dynamic more thoroughly, I signed up to attend a workshop given by Dr. Patrick Carnes (see Note above). I learned a lot that day and have since seen more clients who seem to develop a second compulsive disorder after their first one is under control. Since that time Dr. Carnes has led an effort in research and exposure to this problem, and has proposed that a new category be added to Vol. 5 of our Diagnostic and Statistical Manual of Mental Disorders, published by The American Psychological Association, called Interactive Addictive Syndrome.
I will highlight for you a few concepts to consider if you wonder if you or someone you care about may be heading down this path.
1. Level One Addiction: (page 36). “Many addicts believe they can control their behavior since it is not constant. The problem for the Level One addict is that they can RATIONALIZE their behaviors.” Rationalization is a way to say that “it isn’t really that bad.”
2. Level Two Addiction: (pages 36-45). “Behaviors in this level are sufficiently intrusive to warrant stiff legal sanctions.” All of these behaviors point to the preoccupation the addict has with increasingly dangerous behavior; all of the actions listed below can be prosecuted in court if the perpetrator is caught.
- Exhibitionism: attaining sexual gratification by exhibiting and attracting attention to the genitals.
- Voyeurism: attaining sexual gratification by looking at sexual objects or acts, especially secretly.
- Voyeur-Exhibitionism: masturbating while watching sexually provocative people or behaviors.
- Indecent calls and liberties: making sexually suggestive phone calls or inappropriately touching someone.
3. Level Three Addiction: (pages 45-51).
- Child molestation and incest: sexual contact with an underage child, who may either be related or not related to the perpetrator.
- Rape and Violence: forcing someone to have sexual relations against her will or combined with violent fantasies.
“Rape out of anger, passion or lawlessness does not constitute addiction.” Rape, in and of itself, is a crime involving control of another that is expressed in a sexual way. This alone does not meet the diagnostic criteria for a sexual addiction.
Corollaries of the Levels of Addiction (pages 51-60).
(Assumptions we can make)
Dr. Carnes says that:
- “The sexual addiction of each level is painful.”
- "The deviant’s behavior does not necessarily indicate the presence of addiction.” (Specific criteria have to be met to warrant this diagnosis.)
- “All three levels of addiction transcend personality, gender, and socio-economic status.”
- “Sexual behaviors within and between levels reinforce one another.”
- “Sexual behavior in each level is connected with behavior due to other kinds of addiction.” (For example, a workaholic may justify his sexual compulsion as a “reward” for working hard, or, Dr. Carnes’ research has shown that gambling and prostitution are often an irresistible combination.)
Is there help? Is there hope?
“The sexual addict has to face the fact of his or her own sexuality. The question emerges for addicts as to how they determine when their sexual behavior is addictive.” (page 158).
“The following formula is suggested as a guideline. Signs of compulsive sexuality are when the behavior can be described as follows:
“The SAFE Formula”
- “It is a Secret. Anything that cannot pass public scrutiny will create the shame of a double life."
- "It is Abusive to self or others. Anything that is exploitive or harmful to others or degrades oneself will activate the addictive system."
- "It is used to avoid or is a source of painful Feelings. If sexuality is used to alter moods or results in painful mood shifts, it is clearly part of the addictive process."
- "It is Empty of a caring, committed relationship. Fundamental to the whole concept of addiction and recovery is the healthy dimension of human relationships. The addict runs a great risk by being sexual outside of a committed relationship.”
Dr. Carnes recommends a Twelve Step Program to address the issue of sexual addiction.
Being willing to face the problem head-on and consider a path to spiritual growth can lead an addict from the depths of despair to the joys of living an HONEST life, based on personal responsibility.
At Medical Advocates of Virginia one of our professionals can answer your questions or provide a confidential, state-of-the-art assessment.
Compulsive Gambling
Based on the work of Robert L. Custer
Like any other compulsive disorder, gambling shares the same escalation in risk taking. The gambler gets hooked on the way he feels after winning, only to be followed by the slow decline into the despair of losing, and being unable to rationalize his behavior anymore. But instead of taking a step back and looking at the problem logically, the person is now hooked on these original feelings and cannot stop. So he tricks himself into thinking that if he could just hit that one big jackpot he could make everything right again. This sounds good, and temporarily reduces the anxiety he feels about losses and debts he may be accumulating. Eventually he develops a harmful dependency on the original feelings. Until something happens that creates panic, the problem escalates.
Caught in this dynamic, the compulsive gambler experiences greater and greater consequences: legal problems, damaged or severed relationships, use of alcohol or drugs to escape bad feelings, suicidal thoughts or attempts. A final crisis can lead to the admission of DEFEAT. Then and only then does the gambler seek help.
Just what is considered trauma? And how does it apply to PTSD (Posttraumatic Stress Disorder)?
Today, a trauma is defined as whatever an individual considers to be traumatic. In other words, it doesn’t have to be a hurricane, a flood, or an automobile accident. It is now defined as any situation or event that bothers somebody for more than 30 days, creating a variety of predictable symptoms. It is the perception of the person experiencing the event that counts!
People who are at risk for developing PTSD could be anyone who has been victimized or WITNESSED a violent act, or who has been exposed repeatedly to life-threatening situations. Below are just a few of the usual situations that can create lasting symptoms:
- Domestic violence.
- Rape or sexual assault.
- Physical assault, such as a mugging.
- Random violent acts such as a person going into a school or office to shoot several people or family members.
- Veterans who have experienced combat.
- Disaster survivors such as the massive tidal wave in Asia.
The symptoms we watch for are hypervigilance, avoidance of certain places, re-living the event in flashbacks or nightmares. Sometimes the person knows why they are having these symptoms and sometimes they don’t. The reason: our natural survival instinct protects us by shutting the terror out and preventing us from remembering the entire incident. The problem comes when a person is “triggered” by a similar place, smell, feeling, body sensation, or person. People often say they feel like they are “crazy” because they can’t figure out why they feel so bad when they KNOW that they are in no imminent danger. It is not uncommon for depression and anxiety disorders or panic attacks to accompany these “triggers.”
The good news is that help is available.
The Traumatic Incident Reduction (TIR) model has been shown to provide relief to many of those with trauma experiences and/or PTSD. TIR is a one-on-one, non-hypnotic, client-centered approach. This approach is also
client directed: this means you decide what issues
you would like addressed. Specially skilled facilitators design and employ a series of procedures related to the event(s) of concern. Facilitators do not interrupt or offer opinions; the client reports the results of the procedures and their sense of change, improvement or relief. TIR facilitators believe YOU ARE THE EXPERT ON YOUR OWN EXPERIENCES and can arrive at your own conclusions if provided a safe environment and a skilled facilitator. The TIR model can guide you back to wellness.
Kathryn McCormack-Chen, LCSW, RN is a facilitator and trainer for the Traumatic Incident Reduction Association and has experience using TIR procedures with PTSD clients. Her experiences using TIR with 9/11 survivors has been published in Beyond Trauma: Conversations on Traumatic Incident Reduction by Victor R. Volkman, Loving Healing Press, Ann Arbor, MI, 2004.
You can find a TIR facilitator in your area by consulting the Traumatic Incident Reduction Association web site. This site has a wealth of information on the approach.
Please browse our Mental Health web page for contact information if you, or someone you love, is unable to move beyond past events.
How do I know if it’s a good treatment program?
Medical Advocates of Virginia provides consultation services to professionals and families seeking appropriate treatment referrals for substance abuse, eating disorders, compulsive gambling and sex addiction. Our research and recommendations are provided as part of our services for families in the Intervention planning stages. However, we can also provide our professional expertise to others seeking this information.
We maintain professional contacts with many local and nationally recognized treatment providers and keep abreast of trends and changes in the treatment industry. The choice of a particular program for an individual is always based on a thorough assessment of the individual’s needs. There are, however, several general questions to be posed to any potential treatment provider such as:
- Does the program hold a license in their state to provide treatment services?
- Have they been cited for any license violations?
- Are they accredited by a recognized accreditation body?
- What credentials and special qualifications are held by the staff?
- If they provide medical services, are the doctors credentialed and trained in addiction medicine or another relevant discipline?
- Do they provide any special services such as mental health care?
- Do they have expertise with a particular population? Adults only? Seniors? Women? Adolescents?
- Do they have insurance contracts or self pay/sliding scale options available?
- What kind of reputation does the program hold in the field?
- How is the program structured?
- What are the specific therapeutic activities of their patients?
The answer to each question can generate another series of questions to clarify information. This can be a difficult task for anyone unfamiliar with the specific language used in the treatment field. Inpatient, outpatient, IOP, partial hospitalization, social detox, medical detox… all these terms have specific meaning in the treatment field. There’s a lot to know.
Beware of claims of “success rates”. It takes professional knowledge to interpret these claims for accuracy. Did they call 5 of their last 200 substance abuse patients and ask them questions over the phone? If all 5 reported they were sober does this mean they have a high success rate? Is it valid….. who knows? Can it be verified…. who knows?
Web searches for addiction treatment are popular. We have seen many sites that have an appealing web site yet they are short on the “meat” of treatment. If you have done your own research on possible treatment programs, we can review your findings with you.
Professional involvement is an essential component of matching an individual’s needs with the most beneficial approach. Please feel free to contact us to discuss how we can help you or someone you love formulate a plan of action. You can call or email us to set up an appointment, your contact and information will be kept strictly confidential.
Are you caught in the addict’s spiral? Does this sound familiar?
You’ve been promised over and over again that this will be the last time you need to:
- lend money
- call the boss to excuse an absence
- fix a legal problem
- make excuses for his/her behavior
- lie about the alcohol or drug use
- assume family responsibilities
Have you been rescuing your addict over and over again without seeing any positive changes? Are you exhausted by your efforts to “fix” the problem? Do you feel like you’re banging your head against a wall? Maybe a different approach is in order?
Families of addicts often find themselves involved in efforts to try to “fix” their loved one by doing these types of things repeatedly. These are normal family responses to a problem within the family. Imagine a family member has broken their leg. While recuperating the family gives special attention and treatment to this person. Help getting to the doctor’s office, maybe a loan while they are unable to work. The injury is short lived, the person heals and gets back in the swing of life and the family no longer needs to provide those special attentions. Families usually apply the same principles to their addict when the addict starts experiencing some of the negative consequences of their addiction. Families can get drawn into the addiction spiral and repeat the same series of actions but find nothing changes. What many do not realize is that these “helping” efforts can actually prevent the addict from seeing the reality of their situation and the need to change. In the language of Al-Anon these actions could be called enabling. Enabling shields the addict from the natural consequences of their behavior. If jobs are lost due to the addiction yet the family constantly lends money …why should the addict change? How will they be able to recognize the impact of their addiction if every time there is a problem someone takes care of it?
We have helped many families take a step back, look at what they’ve been doing in the past, get professional input and craft a better direction for their energy. Maybe an Intervention is needed? Maybe the family needs to agree on a unified approach? Al-Anon self help groups can provide support while learning new ways to respond. We are here to help you and your family turn your efforts into more productive actions. Remember: if nothing changes …. nothing changes. Please call or email us for a confidential appointment to discuss your concerns.
How can I be my own medical advocate?
Some of you may have heard a commercial on the radio for Syms Department stores, which says “an educated consumer is our best customer.” Well, believe it or not, all of us who seek medical care need to be “educated consumers.” We need to give up our old notions of thinking that our doctors are all total experts on everything that is wrong with us, and that we might waste their time if we ask questions about our medical problems.
So, to help you be educated consumers, we have a few tips for you:
- When you have a scheduled medical appointment be sure to write down any questions you may have about your symptoms, and be sure to note when any of your symptoms have changed ( Worse? Better? Fewer symptoms? More symptoms?).
- Be sure to always take an updated list of medications, including over the counter supplements you may be taking, with you. Many doctors ask you this question each time you have an appointment, so have your updated list with you.
- Do some homework if you have a new disease or symptoms. The internet can be a good source of GENERAL information, but don’t consider everything you read as gospel. We all should have some knowledge about our medical conditions, and learning about what to expect can help reduce anxiety and know what may happen in the future. Knowing about our medical conditions can help us to decide which options are available, and help us make decisions if our doctor gives us a choice of treatment options. If you are not an educated consumer in this instance you may end up on some medication or engage in some treatment that you really didn’t prefer in the first place!! Contrary to old beliefs, doctors appreciate it when we know something about our conditions!!
- STAY AWAY from buying “remedies” over the internet or in the drug store. These products can be both dangerous and/or counterproductive because they often have not been tested by the FDA, and also may have ingredients that may interfere with your current medication. They also may cause a change in the symptoms you already have. Any product that promises a cure or guarantees a particular result should be looked at with skepticism. Before taking any new product always contact your doctor to discuss what you may want to take.
- Always read the information that comes with each prescription, especially the side effects and that new little thing they have added recently that tells us what the medication looks like (color, shape, and size). Pharmacists can make mistakes, too, and educating yourself about what is in each container is important.
- Try to use the same drug store for all of your prescriptions. They have the ability to alert you if you have a new prescription that may be harmful if mixed with your other medications.
- Lastly, don’t be afraid to call your doctor if your symptoms aren’t being relieved with any medication that you have been prescribed.
Please call or email us for more information.
Have “The Conversation” before a crisis
We have had many families call us for assistance in the midst of a crisis regarding their older loved one. A fall has resulted in a serious injury, mental confusion has resulted in an accident, a medical condition has become more complex, a scary event has happened. What we often hear is: “It’s finally happened” or “We’ve been expecting this”.
When we ask about the history we are often told of concerns that have existed for a long time but have been unspoken. Family members have spoken to one another but have been afraid to approach the topic and express their concerns to their loved one. The topic is emotionally charged. How will Mom respond? How can you voice your concerns respectfully? Where do you start? How do you start? This is scary territory for many.
When a crisis occurs decisions must be made quickly. Unfortunately, the options can be limited if prompt placements are needed or help in the home is needed immediately. Financial decisions may have to be made urgently, without any preplanning. In the midst of a crisis it’s difficult to review choices with a clear mind.
With these factors in mind, it makes sense to think about and discuss these tough subjects in advance, if possible. A family meeting can open the lines of communication, permit a thorough exchange of concerns and assist in formulating a plan for the future. Advance discussions present an opportunity to address a variety of topics:
- Preferences for care at home vs. alternative settings
- Financial planning for asset conservation
- Legal issues
- Medical concerns
- Protecting safety
- Preserving independence
- Planning for the “what-ifs”
- Enlisting professional care management
We are happy to provide our professional care management services under any circumstances but we encourage you to think in advance…have “The Conversation” with your loved one before there is a crisis. We can meet with your family to discuss how to respectfully approach this subject with your loved one. If you’ve had “The Conversation”, we can help you explore options and plan for the future.
Coming home from the hospital…YIPPEE or YIKES!
An upcoming discharge of a loved one from the hospital can be an exciting event or a scary event. Hospital stays seem to be shorter and shorter. Hospital patients are often discharged with considerable recovery still ahead of them. If the hospital staff is suggesting your loved one will be discharged to home you need to advocate for yourself, your loved one and your family to be part of the decision process.
Hospitals use a variety of factors when determining if home is the “best” recommendation for care after discharge.
- Is the home environment safe for this patient?
- Can the needs of the patient be met at home?
- Can the patient care for themselves or is there a caregiver available in the home?
- Does the family caregiver have the skills to provide the needed care and supervision?
- Can professional home health staff be provided if needed?
- Is there an alternative if home is not appropriate?
If the hospital is recommending a discharge to home you need to get accurate information from the hospital staff.
- Do they expect you and/or family members to be the caregiver(s)?
- What specific tasks will you need to perform as caregiver?
- Will skilled professionals be available or scheduled to come to the home?
- Are there resources/programs to help offset the cost of care in the home?
- Will medical equipment, like a wheelchair or oxygen machine be needed?
You must give careful thought to these important considerations and be honest in your interactions with the hospital staff. You must be realistic in deciding if you can do what will be needed. Maybe you have a full time job and you can’t be at home in the day. Maybe you have a back condition and can’t lift someone into a wheelchair. Maybe you fumble with Band-Aids never mind a Tegaderm window dressing. Every situation is different.
Many families simply say they will do whatever is needed and never really think about the tasks until the patient gets home. They often find they are over their heads and beyond their capabilities. Your honest input can help the hospital explore alternatives if home discharge is not realistic. Sometimes a brief stay in a nursing home or other facility can provide a safe “bridge” to home. This can allow your loved one to continue recovery in a supportive environment and get them back home in a more stable condition.
We are available as medical advocates for you and your loved one. We can help you decide if a discharge to home is a reasonable goal, explore intermediate settings if needed or craft a return-to-home plan that is safe and realistic. We work with trusted area professionals that provide a variety of services so you can welcome your loved one home, with confidence.
What should I do if I want to prevent or treat Osteoporosis?
Osteoporosis, as indicated in the previous article, simply means “porous bones.” This is a condition that can happen to both men and women, but is most common in post-menopausal women. In fact, the majority of bone loss occurs in the first seven years after menopause. This makes it important to try to prevent the damage before it can occur.
Here are a few basic things one can do to help reduce the risk:
- Weight-bearing exercise: helps maintain bone density (thickness) and strengthen supporting muscles.
- Get plenty of sunshine: helps the body absorb Vitamin D and keeps bones strong. Supplements can help if you feel your diet is not rich enough in this vitamin.
- Be sure your diet is rich in Calcium: keeps bones strong and promotes new bone development. Over-the-counter supplements can help if you feel your diet is not rich enough in foods containing calcium.
Unfortunately, many people are not diagnosed with osteoporosis (or its precursor osteopenia) until they have a bone fracture. One can start treating the condition then, but it is better to try to prevent its occurrence whenever possible. For many years the medical community recommended that women take hormone replacement therapy (HRT), because the risk of osteoporosis increases as women lose estrogen when menopause occurs. Today that option is not always recommended, and anyone interested in this treatment should talk at length with their doctor, as the risks often outweigh the benefits of this kind of treatment.
There are several drugs that can treat osteoporosis. Some are over-the-counter (OTC) products such as Caltrate, and can be found at your local pharmacy. It is important to note, however, that when taking calcium supplements that one needs to take magnesium as well. The recommended ratio is Calcium 2:1 with Magnesium being half the amount of Calcium. These supplements also include Vitamin D. Warning: If you have a history of kidney stones you must not take Calcium Carbonate. So read the labels carefully when choosing a product. Some of the prescription drugs available are Boniva, Fosamax, Actonel, Evista and a nasal spray called Miacalcin. Reclast, a very costly preparation, is an intravenous drug that is given once yearly. Your doctor will be able to help you choose the product that is right for you.
These are the things your doctor needs to consider when helping you choose the medication that best suits your needs:
- Your risk factors for developing osteoporosis: (Asian heritage, small stature, family history, age at menopause).
- The degree of bone loss you already have: a DEXA scan can help determine this. One should be done before full menopause is apparent; then subsequent ones can be done to measure changes once medications have been started.
- Your fracture history or risk of fracture.
- Other diseases or medications you may be taking.
- Cost, convenience, and side effects.
For women who would like to prevent menopausal symptoms from occurring there are several books available that addresses lifestyle changes and diet.
The One Minute Adult Medical History
It’s a good idea to have a very brief medical history you can provide to your doctors. This can be especially useful if you have to see multiple doctors. A summary can provide the most basic information and allow the doctor to ask more detailed questions if needed. You can write it on an index card to keep for your reference. Remember, this is intended to be a brief summary so you have the “highlights” of important information. It is not a substitute for a comprehensive history but it’s a good starting point for any physician.
- Drug allergies
- Past reactions to drugs
- Current medications, including over-the-counter medications
- Medical, psychiatric illnesses
- Surgeries, hospitalizations, significant injuries
- Immunizations
- Tobacco, alcohol, drug use
- Reproductive status for females: last menstrual period, pregnancies, last pelvic exam
- Occupational hazards, chemical exposures
You can carry this information in your wallet. It’s a good way to help you remember important points about your medical history. You can expand on any aspects of the information if needed or asked.
I have used a similar system for cancer patients that have frequent trips to the hospital ER. Again, a BRIEF, one page description of the very basic information. I have found the ER staff quite grateful to have a brief summary available to get an overall view of the case, link with the Oncologist and begin to provide the needed services.
- Type of cancer, location(s)
- Date of diagnosis
- Name and phone number of Oncologist
- Treatment received:
- chemo drugs and dates
- radiation dosage, sites and dates
- surgery dates
- Past significant side effects
- Current situation that brings you to the Emergency Room
What is Caregiver Stress? Part 1
So sleepy you can hardly keep your eyes open?
So exhausted you can’t think straight?
Does your brain feel like mush?
Caregiver stress, also called caregiver fatigue, is a very real risk if you are a caregiver for someone with a chronic illness. Family caregivers can “burnout” from the pressures of providing care. Some folks feel overwhelmed by their responsibility, some are filled with concerns about proper care techniques, and many suffer from their own stress related health problems. Caregiver stress can develop over time. Perhaps your loved one’s needs were small and quite manageable when you first became the caregiver. But, over time, your loved one’s needs may have grown and you find yourself frazzled.
Signs of caregiver fatigue can include:
- Anger at the person who is sick
- Isolation from others
- Reduction in outside activities
- Difficulty with concentration
- Depression and feelings of hopelessness
- Exhaustion
- Sleeplessness
- Health problems
If you experience any of the symptoms above, you may be suffering from caregiver stress. It is clear that these types of symptoms have a negative effect on your own health and well being. However, keep in mind they could also have an impact on your ability to provide good care. For example, if you are not getting enough sleep it can be very difficult to manage medications correctly. If you are fatigued, you could risk injuring yourself helping to move someone. If you develop health problems, who will take care of you? We know that caregivers that get a regular break…provide better care.
The first step is recognizing caregiver fatigue. Next month we will have some concrete suggestions to address caregiver fatigue and help you find a balance between your own health needs and care for a loved one.
We are at your service to discuss caregiver fatigue and strategies to reduce your stress.
What is Caregiver Stress? Part 2
Last month we described some of the symptoms of caregiver stress, also called caregiver fatigue. There may be strategies you can implement to help relieve some of the stress associated with being a caregiver for a loved one. The goal is to provide the right balance between your needs and the needs of your loved one.
Is there a respite care program that could help you? Respite care is a term used for short term help so you can take a break. Some assisted living facilities allow short stays of a month, a week or even just a weekend. Some home health care agencies can make a respite care plan so professionals are in the home to allow caregivers to take a needed break.
Are there community resources and programs available? Could your loved one qualify for a day center program? There is a careful screening process for prospective participants for these programs; staff needs to make sure your loved one’s needs can be met appropriately. Many day centers offer great opportunities for social activities, meals, hobbies, trips, all under professional supervision.
Is there a support group for you in the community? Contact your community service agencies, local hospitals, professionals in the field to explore support group opportunities. Sharing your experience and learning from others in a similar situation can provide perspective.
Ask friends and family to help you. When folks offer to help in some way, respond “Yes” and work out a reasonable plan.
Follow the basics: get your rest, exercise, eat well balanced meals, find some time for enjoyable activities. If you are not feeling well, visit your physician for a check up. Be sure to tell your doctor about your caregiving commitment.
Give yourself credit for what you’ve been doing, and give yourself permission to seek help.
Consider using the services of a professional Case Manager. The oversight, coordination, guidance and expertise of a professional Case Manager can provide a fresh set of eyes on a situation and provide an objective assessment with recommendations.
Medical Advocates of Virginia can work with you and your family to create a reasonable, workable plan to address your caregiving situation and reduce your stress.
Adult Day Programs
Last month’s article on caregiver stress mentioned adult day care centers as a possible source for you to explore for care for your senior. You will need to look at various aspects of a program to see if it will meet the particular needs of your loved one. You should thoroughly examine the program before you sign up for any service. Some basic information you need to collect includes:
Initial contact information:
Who runs the program: private, public, partnership
Eligibility requirements: age, income, residency
Level of physical/mental impairment accepted
Staff qualifications and expertise.
Is it licensed by the state or is there an oversight body involved?
Do they meet fire, safety and health code requirements?
Days and hours of operation
Fees for services
You need to explore what services are offered:
Transportation to and from the facility
Socialization opportunities
Meals, including special diet needs
Nursing staff for medical oversight and monitoring
Recreation activities consistent with an individual’s ability and interests
Assistance with toileting, if needed
Make a personal visit:
Does it pass the “sniff test”?
Is the atmosphere cheery and inviting?
Is there ample lighting?
Are exits clearly marked and uncluttered?
Do the doorways, tables and bathrooms accommodate folks in wheelchairs and walkers?
Are the staff members actively interacting with attendees?
Do the participants appear content and cared for?
There is a lot of homework for you to do in order to find the right program. Depending on your location you may not have a choice of programs to evaluate. It’s vital you make sure the needs of your loved one can be met appropriately and safely. We are available to help you sort through your options and assist you in finding the right match of services.
Do you take oral blood thinners?
Blood thinning drugs, also known as anti-coagulants, are used to prevent blood clots. You may know the oral version of the drug under the names of Coumadin or warfarin. The blood is not actually made “thinner” using these drugs; it simply takes longer to form a clot by changing the amounts of clotting factors present in the blood. Blood clots can be life threatening if one lodges in a major vessel. These drugs are prescribed for a variety of conditions. Blood thinners are often used after major surgery like joint replacement. This is generally a short term use of the drug, when the risk for developing a clot is reduced the drug is discontinued. These drugs are also used for long term maintenance for some patients with heart conditions, heart valve replacements and stroke risks.
Blood thinners also require careful attention to diet and drug interactions. Foods high in Vitamin K like broccoli, cauliflower and brussel sprouts can change the way the medicine works. Aspirin, or any drug that contains aspirin, should be generally avoided. Aspirin acts as a blood thinner so you could get too much “thinning effect” if you combine aspirin and a blood thinner. If you observe a change in stool color, contact your physician right away. Dark stool could be a sign of bleeding. You can have internal bleeding without any other symptoms that might make you suspicious. Always read your label, observe the warnings and ask your doctor if you are not clear about the directions.
If you take blood thinners, you know how vigilant the doctors must be to make sure you are getting the desired effect. Doctors aim for a specific amount of the drug to be present in your body…neither too much, nor too little. Too much increases your risks of excessive bleeding, too little increases your risk of a clot. This precision requires frequent blood tests and frequent adjustments in your dose to maintain the therapeutic amount in your body. It’s important to follow your doctor’s directions for testing and dosage adjustments. Some folks experience wide variability in the concentration of the drug in spite of frequent testing and adjusting; it’s just the way their bodies work.
Drug companies are searching for more “user friendly” drugs to reduce the risks of clots. Drugs that would be more predictable and require less frequent testing and monitoring would be welcomed by doctors and patients. The FDA is reviewing the applications of several drug makers seeking approval of their new drugs. It would be expected that any new drug introduced would be more expensive than the present drug in use. They could, however, provide a significant benefit for a select group of patients. According to the Centers for Disease Control and Prevention (CDC), problems with warfarin are a frequent reason for emergency room visits by older adults…that reflects how hard it can be to get the precise amount of the drug in your body correct. New drugs could prevent some of these visits. These drugs are on the horizon. If/when new drugs are approved, a track record of use and results will be the best way to judge if it might be a drug for your doctor to consider for you. The risks and benefits must always be weighed.
Posttraumatic Stress Disorder and Older Veterans: Powerful New Tool called Traumatic Incident Reduction (TIR) can Help
by Kathryn McCormack-Chen, LCSW, Advanced TIR Facilitator/Trainer
While researching this article about Posttraumatic Stress and Older Veterans I came across this article which describes the extent of this problem in great detail. The main points of the article are highlighted for you. The technique mentioned in the title is called Traumatic Incident Reduction (TIR), and is one of the four power therapies designed to give symptomatic relief in a brief period of time. This technique is a one-on-one, non-hypnotic, guided imagery technique, and is centered on both a person’s level of distress and current interest in resolving a single trauma or a series of traumas. Veterans are excellent candidates for these procedures, and there are facilitators all over the world. I am one of those advanced facilitators, and am located in Fairfax and Loudoun Counties. Visit the Traumatic Incident Reduction Association website for more information on facilitators.
- PTSD has been recognized since wars began to be recorded.
- Other terms used were “combat fatigue” or “battle stress.”
- Veterans from WWII and Korea faced a very different war experience than the Viet Nam veterans, namely that the Viet Nam vet was sent to war alone, and not with the unit he/she trained with, was not given a clear mission, was plagued by political inconsistencies regarding the war itself and its usefulness, and most especially, they were spit on and regarded as traitors to the public when they came home. Many Viet Nam vets received no help whatsoever when they returned home, and many suicides resulted. Fortunately, the WWII and Korean vets were thought of as heroes, defending freedom and sacrifice for country.
- Suicide rates, homelessness, and substance abuse were rampant in the Viet Nam vet population.
- Feelings of stress, fear, anger, grief and horror after a traumatic event, or series of traumatic events are normal. When not given relief or opportunity to resume control these feelings intensify.
- When this stress lasts for more than 30 days and has certain symptoms it becomes PTSD. These symptoms can occur when a person did something horrific, witnessed something horrific, or survived something horrific when others did not. Symptoms of PTSD:
- Numbing
- Recurring, intrusive thoughts about the event(s)
- Recurrent dreams about the event(s)
- Intense psychological stress when any reminder “trigger” occurs when one is safe
- Persistent avoidance of stimuli related to the trauma
- Memory loss of aspects of the trauma
- Feelings of detachment from others
- Inability to show affection
- Sense of “impending doom”
- Sleep problems
- Uncontrolled rage
- Difficulty concentrating
- Hypervigilance-always looking for something that could be dangerous
- Exaggerated startle response
How to Get Help
- If reluctant to seek professional help, find a group of vets who will be good listeners.
- Contact the Dept. of Veterans Affairs Vet Centers - not always a popular choice for the Viet Nam vet.
- Learn about specialized therapies like Traumatic Incident Reduction that can greatly reduce and even eliminate the lingering effects of traumas.
- Visit the Traumatic Incident Reduction Association website.
- Read the National Center for PTSD FactSheet "PTSD and Older Veterans".
Drug storage and disposal tips: Cool, Dry, Dark
How you store your medicine really does matter. Do you have bottles stored in the bathroom cabinet? This can be the worst place in your house to store medicine. Why? Moisture is the enemy of most pill or tablet medicines. Excess moisture could degrade the drug and potentially make it less effective or, possibly, dangerous. Excessive heat can also cause medicine to degrade. Sounds like a bathroom to me. The same caution applies to using the refrigerator or a place in the kitchen near the sink. The moisture is the problem. A cool, dry, dark place is the best choice for storage. Someplace like a bedroom drawer would be a better choice than the bathroom or kitchen. Direct sunlight can also degrade medicine faster than expected.
Drug manufacturers test the storage life of medicine and create expiration dates using ideal storage conditions: Cool, dry, dark. You do read the expiration dates, don’t you? When drugs are manufactured, they keep their safety and strength for only a certain amount of time. The chemical composition starts to change slowly. The expiration date is the time when the manufacturer expects the slow change to be great enough that the drug may not work as intended. Again, the expected life of the drug is based on ideal storage conditions. If you store in any other conditions the medicine could deteriorate faster than the expiration date. There are some medicines that must be refrigerated so make sure you read the label for guidance. Don’t ever mix different drugs in the same container; there could be an interaction between the various ingredients.
You should regularly inspect your medicines. If you notice any of the following please check with your doctor or pharmacist for advice.
- Expiration date has passed
- Changes in color
- Changes in consistency, like a crumbly texture to pills
- Any unusual smell, especially an ammonia type smell in pills
- Cloudiness in liquids that were once clear
- Any separation in liquid medicine or a film on the top
- Tubes that have become hard or cracked
Safe disposal of drugs is an area of concern for many folks. The FDA offers advice to consumers on proper disposal. The old universal advice to flush drugs down the toilet has changed. A link to the FDA consumer advice is here: How to Dispose of Unused Medicines.
Safe disposal instructions are usually included in the patient insert, if you get this with your prescription. Another resource is your pharmacy -- check to see if they participate in a safe disposal program. Many pharmacies will accept expired drugs and dispose of them appropriately. More and more pharmacies are offering this service to their customers as well as the general public.
As always, check with your physician if you have any questions about your drugs. It’s always best to be safe.
Do You Know about the Dangers of Interactions Between Alcohol and Medications?
As the general population ages and life span continues to increase, concern about interactions between alcohol and medications has become more important. The elderly population accounts for one third of all prescribed medications in the United States. Additionally, on average, this population is using at least two over the counter medications or supplements that may contribute to dangerous drug interactions.
The primary consideration for seniors is related to the physiological changes that occur as we age. Two physiological changes in particular contribute to drug interactions or to the increased effect from the use of alcohol or other medications.
As we age our muscle mass decreases and total body water tends to decrease. This change can affect the concentration of water soluble drugs. This means the effects of the drugs can change even if the doses have not changed. For example, alcohol is a water soluble drug and if there is less water in the body the concentration of alcohol in the body could be higher than someone expected. This could mean that an older person could find they become more intoxicated than expected when they consume alcohol.
As our muscle mass decreases, our total body fat tends to increase. This increase in body fat means if a medication is stored in fat then it could take longer for the medicine to leave the body. This is especially true for many tranquilizers. This means the effect of the drug could last much longer in a senior than in a younger person.
As if this wasn’t already complicated enough, there is “synergy”. This means when mixing medications (including alcohol) the effect of the combination is greater than the effects of the individual drugs. In other words 2 + 2 = 6. For example, if an individual were using alcohol, taking a sedating over the counter medication such as Benadryl, and taking another sedating medication like a tranquilizer the level of sedation and/or appearance of intoxication could be far greater than expected.
There are some steps you can take to avoid problems related to medication interactions. You can strive to have one physician controlling all medications. If this is not realistic, make sure that all prescribing physicians are familiar with all medications being taken including over the counter medications. Make sure to ask to ask your doctor about interactions between drugs and alcohol. Since the kidneys and liver are active in metabolizing drugs, be sure to tell your doctor if you have problems with either of these organ systems. Your pharmacist can also be a resource for answers about drug interactions. If you or a family member is concerned about the possibility of drug or alcohol related problems for yourself or a loved one, please feel free to contact us by email or call 703-734-8760. We are here to help.
It may not be dementia. Vitamin B12 deficiency can cause the same symptoms
Remember when your grandmother used to put her gloves on once a month and go see her doctor for a Vitamin B12 shot? How silly, I recall thinking... but now I know why it was a good thing. Vitamin B12 deficiency can cause symptoms that mimic those of dementia.
Another word for Vitamin B12 deficiency is “pernicious anemia.” And the foods people used to eat regularly then would insure that they had an adequate supply. But today most of us do not eat liver, and many elderly people do not consistently eat balanced meals.
Case in point: A 72 year-old man was a daily runner. He was on one of his daily runs and became confused and disoriented. He was taken to the emergency room, and because of his age, the doctors thought he had had a stroke or some other neurological problem. But by taking an accurate history they discovered that this man was a vegetarian, and ordered the standard blood tests to look for any vitamin deficiencies. His Vitamin B12 level was much too low, and once he changed his diet to account for this deficiency his confusion cleared up.
Recommended daily requirement: 2-10mcg/day
Foods rich in Vitamin B12: liver and kidneys have the highest concentration; foods with moderate concentration include milk, muscle meats and fish.
Always tell your doctor that you are a vegetarian. Maybe you will be going for a Vitamin B12 shot monthly, too!
