Aging: Life Can Change in an Instant. Are We Prepared? cont. 7 “To-Do’s”

RHW’s wife, in essence, had neither control nor a Plan B.  She stepped back, relying on her husband’s good judgment, accepting the fact that he was going to consult one other specialist, then proceed as he thought best. All worked out well, but not without stress and worry. A pre-thought-out/pre-discussed plan for such emergencies would have–no doubt– made decisions easier.

Perhaps businesses do better in this regard when they require employees’ emergency information and keep it on file. A friend’s sister, (a widow on Medicare) had a seizure while at work. Her first ever seizure. 911 was called immediately and she was taken to the nearest hospital for stabilization and evaluation.

What about her emergency information? She listed just one person to call in an emergency. A MISTAKE– list at least 3 people if possible. 1st person was her adult son, a teacher. He couldn’t be reached–his class was on a field trip, scheduled to return after school hours. Her granddaughter (from another country) was in the US for the summer, working nearby; she was young; clueless about making health care decisions. The initial major decision: which (of 3) hospitals’ neurological centers should her grandmother be taken to. Evidently 911 responders made the decision. Several hours later the adult son made the decision to have his mother  transferred to a different hospital for further treatment. It was a good decision, made under tough circumstances.

7 “To-Do’s” can help us prepare as well as possible 

1.  Make time to sit down with aging parents, discuss and prioritize whom to put on an emergency contact list, their relationship or reason for being on the list. Include a person knowledgeable about healthcare management in the event others on the list aren’t available. Know what hospital(s) they prefer–or their doctors are affiliated with–should there be an emergency.

2. Make the contact list (3 people). Keep it in an easy-to-find place. 

3. Two additional lists–medications (dosage and frequency) as well as list of allergies and medical issues–keep with the contact list.

4. If parents have a Do Not Resuscitate (DNR) directive, it’s essential that 911 responders (if called) have–or can easily find– the DNR (otherwise they must do all they can to save a life).

5.  When elders have a good mind and want to participate in–or dictate– actions taken for their care, we need to ask ourselves “what’s the goal” (as did RHW’s wife); then decide how involved we need to be.

6. For elders still working, it’s important that their emergency contact information at work stays updated.

7. US News’ Best Hospitals yearly publication in July is an invaluable resource and good conversation-starter. This link from CBS News about the 2013-2014 publication contains a video with excellent additional advice–including having an “electronic healthcare buddy.” Don’t miss it. 

Yet, with our busy lives, will we set aside time for the 7 to-do’s? We know, intellectually, that being prepared saves time. In our situations it can help parents age well–or at least better–and save us some additional stress

Aging Parents: Making Major Decisions–Think: Doctors, Life-saving/changing Surgery

How Do We Make the Best Choice?

We make many choices throughout our lives, granted some much more important than others. But how do we know we’re making a really good choice–or the best choice–when major health matters are involved?

I posted a few years ago a relative’s stage 3-4 colon cancer and efforts to get him to leave the comfort of his home town and go to Sloan-Kettering in NYC, where the country’s leading colon cancer surgeon was at the time. His heart (and wife) were urging stay home for the surgery. But a science researcher relative demanded he go to NY–regardless of disruption to his and his family’s routine and any other inconvenience.  Bottom line: Head ruled heart. His surgery at Sloan-Kettering was much lengthier–more complicated–than first imagined, but the team there was well equipped to handle it.  He lived to see his daughter married, the birth of his first grandchild–and he’s still alive today. A good choice. And his insurance took care of almost everything.

I think about the countless choices teenagers need to make during that period of their lives. As counselors we try to instill good decision-making skills so they know how to make good choices, and think twice when a strong pull towards “heart over head,” “a friend said…,” “everyone’s doing it,” I just don’t know how to decide” etc. become a reason or default reason for their choice.

Identifying then prioritizing options, along with the rationale for those options, is productive and instructive.  And when time is involved (ie. for surgery, rehabilitation, recuperation), doesn’t it make sense to get the most out of that time….meaning using the best health professional–because the “cure” involves the same amount of time–more or less– whether its results are very productive or barely productive. (Next finding out what medical insurance qualifies no doubt gets added to the  priorities/options mix.)

Choice of a surgeon after Sr. Advisor R broke her hip at age 97, was left up to her doctor. He selected one who had “good hands,” “could get in and out quickly” thereby reducing trauma and blood loss in an elderly person, which he thought extremely important. This meant “very experienced” which was a requirement for the surgeon and the physical therapists in the rehab center she was transferred to. (Result: she did great as you know from reading the broken hip posts.)

“Very experienced” and “an excellent success rate,” were the criteria when Dad underwent 5 bypasses many year ago. Bypass surgery was relatively new at the time and we learned (upon questioning) it was important that the surgeon did what amounted to a bypass a day (not counting weekends)–in other words, was doing this almost daily (at a time when only a small number of heart surgeons could make that claim).

The internet makes it possible to locate “the best.” And at leading medical centers (although probably not as warm and cozy as the hometown hospital) there may be residences provided for families while a loved one is having a procedure. (MD Anderson and Sloan-Kettering, for example, provide this.) Also check the US News Top Hospitals 2012-2013 in the Blogs and Sites I Like tab above.

How to find top hospitals? Using prostate cancer for the model, I googled:
1. “best prostate cancer hospital;” this site looked interesting: http://prostatecancerinfolink.net/2011/07/22/top-hospitals-for-cancer-and-for-urology/.
2.  I decided to follow Johns Hopkins: http://urology.jhu.edu and clicking “About Us” learned it was the #1 Cancer Center from 1991-2011
3.  I clicked this Johns Hopkins site, wanting more information: http://www.hopkinsmedicine.org/kimmel_cancer_center/centers/prostate_cancer/prostate_multi_d_clinic.html.
4. And I remembered something about a Charlie Rose interview on prostate cancer so googled that and found this excellent, informative video of Charlie Rose interviewing a renowned Johns Hopkins surgeon: http://urology.jhu.edu/prostate/videoWalsh.php

While it takes time, feeling I had some command of what was involved by seeking “the best” was the best. I was no longer basically clueless and dependent on others because I wouldn’t even know the questions to ask. And asking the right questions can lead us to the best answers as we continue to help parents age well.

Related:
A long post (concerns various cancers), disconcerting at times, but very informative and worthwhile about “the best”– how to select them, when one definitely needs them, with statistical comparisons. http://www.thedailybeast.com/newsweek/2009/10/16/what-you-don-t-know-might-kill-you.htm

 

Helping Aging Parents Find “Best” Hospitals

When  there’s a serious medical emergency it’s probably safe to say few aging parents live near a hospital specializing in whatever caused the emergency.  Most of us–even those living near aging parents–don’t know the particular specialties at hospitals located nearby. A sudden emergency may leave little time to do the homework.

Three no-doubt-common scenarios follow, involving different situations and actions taken.  All happened in my family; all caused great concern; all turned out well.  All present strategies to help parents continue to age well.

#1.  Mother’s stroke experience: initially memorable for the emotional stress; equally memorable for the relief and sense of some control we felt once we found out–and got her to a place– where she could obtain appropriate treatment.

It began with phone call. Parents in California for the winter. Mother’s speech sounded “funny.”  Phoned my brother with concerns and a plea to fly to California immediately if possible (he was moving into a new home that day).  He got there quickly, phoned saying Mother was on her way to the hospital. I should fly out asap.

When I arrived at Mother’s bedside her speech was still garbled. Dinner was on a tray. She was eating the food with her hands. I’ve forgotten other details. A  terrific nurse updated me and said Mother’s physician would be in the next morning with test results. We learned they had limited the “damage;” there was nothing more they could do. Mother could go home later that day or the next with a caregiver, or go to a nursing home.  Dad would be unable to manage her care alone…a nursing home would be inevitable at some point.

I needed time to think.  Decided not to get a caregiver for that day.  Knew Mother would be safe overnight at the hospital.  I called a NY friend knowledgeable about medicine.  After some research, he phoned back. He said get her out of that hospital, which lacked neurology expertise, and to a neurologist at UCLA asap, and gave me a phone number. With great difficulty I got an out-patient appointment for the next day.

The next morning we picked Mother up at the hospital and drove to UCLA with films and reports. UCLA had newer technology.  New films were taken. The extent of the damage was clearly pin-pointed and Mother was given different medications, a prescription for physical therapy, and an appointment to return in a month.

There have been many advances in stroke treatment since.  I know Mother benefited from some because the neurologist said some were not widely used yet.  I also know a month later the improvement was so dramatic most people wouldn’t have known she’d had a stroke. Nor did she have any further strokes.
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#2.  A family member, also living in the west, was diagnosed with advanced colon cancer there. Treatment was about to begin. “Not there,” said my husband, who wanted to check Sloan-Kettering and knew we could be supportive if the family member came back.  Indeed Sloan-Kettering had top colon cancer people. Convincing someone to come all the way to NY, however, isn’t easy.  It’s easier when offered as “leaving no stone unturned”–making the trip to get a second opinion. That works.

While chronic health issues complicated things, Sloan-Kettering took charge: a top oncologist; an 8+ hour difficult surgery performed by a top surgeon (who had done complicated surgeries countless times); a while to recuperate in NY.  Instructions for additional “whatever” were given to the doctors in the west. Routine check-up visits show the surgery was a success.  Note: insurance often covers most everything done in hospitals.

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#3. Then there was Dad’s heart event in California shortly after his 76th birthday.  At the movies he began feeling dizzy, went to the theater lobby and sat down on the floor.  Someone came over to see if he was alright.  He wasn’t; his blood pressure was low. Paramedics were called. He was taken to the hospital where his internist practiced.  While it wasn’t the right hospital for my mother, it had a first-rate heart team whose surgeon did heart surgery on a former president several years later.  Dad had 5 bypasses on a Friday and went home the following Wednesday.  He aged well, lived to be 94, and his death was not heart-related.

So how do we generalize? When helping aging parents is a part of our life and our parents live long enough, the odds of serious medical problems necessitating hospitalization are great. Getting them to a hospital with the appropriate experienced specialists can increase the odds for a successful result that helps parents continue to age well…and medical insurance may make it more affordable than one might think.