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Statin Facts And Dementia Risk? – Published July 17, 2018

This report is not a substitute for medical advice and treatment. Never diagnose or treat yourself or a family member. See your doctor. Use your voice. Ask questions and share prescription concerns, if any, with your physician. 

Recently, whether enjoying conversation in a social setting or small talk among acquaintances (including the recent friendly exchange with a car salesperson during a vehicle test drive!) the subject about statin drugs and its increased risk of dementia frequently comes up. Knowing enough people who are on statin drugs, I decided to research this topic to unveil the facts and connection between memory loss and cholesterol lowering prescription drugs. Do statins cause memory loss? Read below for information about statins and why the short answer to this question is “NO”.

What are statins and when are they prescribed?

Statins are prescription drugs that can lower cholesterol in patients who have been diagnosed with heart disease, at high risk of a heart attack/stroke or whose cholesterol levels (results shown from a blood test) are higher than the norm of below 200 mg/dL, combined LDL and HDL. Prescription statins block the production of cholesterol in the liver, can flush cholesterol already formed within artery walls and reduce blood vessel inflammation lowering risk of blood clots.

LDL (Low-density lipoprotein) is the bad cholesterol that sticks to artery walls contributing to blockage (heart attacks) and clots (strokes). The ideal level is below 130 mg/dl and for those who have suffered a heart attack or stroke, the recommendation is to keep LDL below 100 mg/dl. High risk for heart attack or stroke? Your physician may be looking for LDL below 70 mg/dl.

HDL (high-density lipoproteins) is the good cholesterol that acts as a garbage collector, carrying cholesterol from all parts of your body to dispose/process through your liver. A good HDL level is 60 mg/dl or higher. An HDL level that is 40 mg/dl or less is consider low. Medical and environmental factors can negatively impact HDL levels, such as smoking, obesity, Diabetes II and inflammation. High alcohol consumption especially hard liquor, dessert liquors, mixed drinks high in sugar, beer, and excess wine, can have negative effects; “drinking more than what is considered moderate (daily women 1 glass and men 2 glasses), however, has an opposite effect, because it can raise both cholesterol and triglyceride levels.” Can Drinking Alcohol Affect Your Cholesterol Levels? Healthline

To keep HDL high, choose foods with unsaturated fats, low carbs and low sugar and enjoy a healthy lifestyle that reflects regular exercise, moderate alcohol consumption and smoke free. 11 Foods To Increase Your HDL, Healthline, offers great suggestions. There are some prescribed medications that can effect and lower good cholesterol so especially be mindful of your diet if taking these drugs.

Medication that can effect/decrease HDL…Beta blockers, a type of blood pressure medicine, Anabolic steroids, including testosterone, a male hormone Progestins, which are female hormones that are in some birth control pills and Hormone replacement therapy, Benzodiazepines, sedatives that are often used for anxiety and insomnia. HDL The Good Cholesterol, Medline Plus.

Statins are available in fat-soluble or water-soluble. Noted below is a list of such statin prescriptions available in the USA. How are they different? In a study conducted between the two types of statins… No difference was observed between various clinical coronary artery disease settings. Fats Vs Water Soluble Statins by Gerti Tashko, MD.  

Lipid Statins (fat-soluble) pass through the liver with a greater chance of being absorbed in muscle tissue. There is, therefore, an increased risk of liver damage as well as muscle and joint aches with fat-soluble statins.

Lipid Statins/Fat Soluble – pass through the liver

  • Atorvastatin (Lipitor) – most potent of statins
  • Lovastatin (Altoprev)
  • Pitavastatin (Livalo)
  • Pravastatin (Pravachol)

Hydrophilic/Water Soluble – pass through the body and not the liver

  • Rosuvastatin (Crestor)
  • Simvastatin (Zocor)

Side effects: headaches, nausea, and muscle and joint aches. More serious side effects include: increase blood sugar/diabetes 2, muscle cell damage, cognitive memory loss, liver damage.

What is the connection between statins and cognitive memory loss?

As a result of reports from some consumers claiming cognitive memory loss while taking statins, the FDA (2012) required all statin drug labels to include a warning about the risk of memory problems with short-term statin use. Studies conducted (as shown in the quotes below) reveal no direct link between memory loss and statin use. Other considerations could effect memory, such as; patient age, drug interactions, quantity of daily prescription drugs taken and perhaps taking some prescription drugs that are in fact linked to higher dementia risk reported by conducted studies. If you or a family member of whom you advocate are experiencing noticeable loss in memory, speak to your physician.

A study conducted out of John Hopkins in 2013, Statin Medications May Prevent Dementia and Memory Loss With Longer Use, While Not Posing Any Short-Term Cognition Problems,  concluded “no threat to short-term memory, and that they may even protect against dementia when taken for more than one year.” The study also reveals…”In contrast, they say that when the drugs are taken for more than one year, the risk of dementia is reduced by 29 percent.”

While statin users have reported memory loss to the FDA, studies haven’t found evidence to support these claims. Research has actually suggested the opposite — that statins may help prevent Alzheimer’s disease and other forms of dementia. Healthline, Statins and Memory Loss: Is There A Link? 

Conclusion –  In patients without baseline cognitive dysfunction, short-term data are most compatible with no adverse effect of statins on cognition, and long-term data may support a beneficial role for statins in the prevention of dementia. Mayo Clinic Proceedings, November 2013

How can a statin actually decease the risk of memory loss? Dementia/cognitive memory loss can be the result of blockages in small blood vessels that could prevent blood flow and oxygen to certain areas of the brain. The effect of statins to reduce plaque and inflammation would therefore remove blockages and increase blood flow, reducing memory loss risk. John Hopkins, Statin Medications May Prevent Dementia and Memory Loss With Longer Use, While Not Posing Any Short-Term Cognition Problems

Although memory loss/confusion warnings are listed on the label of statin drugs, studies conducted to date do not support a higher risk of dementia when taking these drugs. The next time you attend a social gathering or are talking with an acquaintance and the concern about statins and memory loss comes up, you have some facts to share. Eliminate fears and enjoy the party!!

Next week’s blog post will discuss common prescription drugs that have been associated with higher risk of memory loss. The drug listing has been compiled after conducted studies and conclusion of risk factors.

Resources

 

Gut Health and Antibiotics…what you might want to know – Published July 10, 2018

This report is not a substitute for medical advice and treatment. Never diagnose or treat yourself or a family member. See your doctor. Use your voice. Ask questions and share prescription concerns, if any, with your physician. 

The purpose of this blog post is to reveal the reality of antibiotic overuse and misuse. This writing is to also encourage communication with your doctor when antibiotics are prescribed to you or the family member you advocate/share in health care responsibility.

Recently someone dear to me, “Barbara” was tested for a UTI. Barbara did not have UTI symptoms. Her bladder, however, appeared to be on a nighttime schedule with the inability to urinate during the day. The initial urinalysis revealed bacteria in the urine and her doctor insisted she be put on antibiotics ASAP, that day.

On the surface, following through with the physician’s request may appear as the only and best option for the patient. However, digging dipper, this was not the case. Barbara recently had C-DIFF (C. difficile/C-DIFF is a toxin-producing bacteria that causes antibiotic-associated colitis, Mayo Clinic…Antibiotic Associated Diarrheafollowing surgery, which extended her stay at a skilled nursing facility by 3 weeks. She experienced horrific symptoms of both, C-DIFF and the necessary antibiotic treatment. There is a HIGH probability of C-DIFF reoccurring when a patient is prescribed antibiotics, in this case treating a possible UTI. Question to the doctor…Knowing Barbara had C-DIFF a few months ago, can we wait for the full culture results before considering antibiotics??” It is not uncommon for some bacteria to appear in urine, especially in the population 75 years old+. The doctor agreed, stating, “I think that it’s reasonable to wait until the cultures come back, but it looks like a real infection based on the cell counts.” Three days later the culture results indicate…NO UTI.  The doctor emailed…The final urine cultures are back and surprisingly did not grow out any specific bacteria. So I would not give her the antibiotics. I would continue to monitor her symptoms. I would only recheck her urine if she is having symptoms.” If Barbara had a reoccurrence of C-DIFF, a high risk “serious symptom infection” possibly triggered by taking the prescribed antibiotic, she would have had to leave the comfort and familiarity of assisted living (very contagious). The C-DIFF treatment administered would have required admittance to either a hospital or skilled nursing facility, in contact isolation. Life would not have been pleasant for Barbara or her family, the aftermath of being treated for a UTI she didn’t have.

A key lesson from Barbara’s experience, communicate with your doctor. Express concerns by using your voice and take ownership to know options in order to make wise decisions for you and your family. The following shares antibiotic facts, its impact on the elderly and what you can do nutritionally to be “gut healthy” reducing side effects from antibiotics as well as some non-antibiotic drugs, to help prevent superbugs and antibiotic resistance (CDC: About Antimicrobial Resistance).

Full Culture Results 

Whenever possible and with physician agreement, request a full culture before taking prescribed antibiotics.

Antibiotics –How They Work, Classifications, When Administered 

Antibiotics are pharmaceutical prescribed medications administered to heal or slow down the growth of bacteria resulting in infections. Click this link for a complete antibiotic guide and their use…Antibiotics Guide, Medically reviewed on Aug 23, 2016 by L. Anderson, PharmD.

Antibiotics are known by these classes: Penicillins, Tetracyclines, Cephalosporins, Quinolones, Lincomycins, Masrolides, Sulfonamides, Glycopeptides, Aminoglycosides, Carbapenems.

Antibiotics are used to treat these top 10 common infections: Acne, bronchitis, Conjunctivitis (Pink Eye), Otitis Media (Ear Infection), Sexually Transmitted Diseases (STD’s), Skin or Soft Tissue Infections, Streptococcal Pharyngitis (Strep Throat), Traveler’s Diarrhea, Upper Respiratory Tract Infection, Urinary Tract Infection (UTI).

Additional details and supporting information can also be found at… Antibiotics: All You Need to Know by Medical News Today, By Christian Nordqvist, Jan. 2017. Article highlights…

  • Alexander Fleming discovered penicillin, the first natural antibiotic, in 1928.
  • Antibiotics cannot fight viral infections.
  • Fleming predicted the rise of antibiotic resistance we see today.
  • If antibiotics are overused or used incorrectly, there is a risk that the bacteria will become resistant
  • Antibiotics either kill bacteria or slow its growth.
  • Side effects can include diarrhea and feeling sick.
  • In some cases, antibiotics may be given to prevent rather than treat an infection, as might be the case before surgery. This is called ‘prophylactic’ use of antibiotics. They are commonly used before bowel and orthopedic surgery.

Before bacteria can multiply and cause symptoms, the body’s immune system can usually kill them. Our white blood cells attack harmful bacteria and, even if symptoms do occur, our immune system can usually cope and fight off the infection. 

Antibiotic Side effects and FDA Warnings

What are common antibiotic side effects?

Common side effects of antibiotics include rash, soft stools, diarrhea, upset stomach, fungal (yeast) infections (like thrush). Contact your doctor immediately if  you are experiencing; severe allergic reaction that includes difficulty breathing, facial swelling (lips, tongue, throat, face), severe watery or bloody diarrhea or stomach cramps, vaginal yeast infection with white discharge and severe itching, mouth sores or white patches in mouth or on tongue. Common Side Effects from Antibiotics, and Allergies and Reactions Medically reviewed on Mar 5, 2017 by L. Anderson, PharmD.

Your intestines contain about 100 trillion bacterial cells and up to 2,000 different kinds of bacteria, many of which help protect your body from infection. When you take an antibiotic to treat an infection, these drugs tend to destroy some of the normal, helpful bacteria in addition to the bacteria causing the infection. Without enough healthy bacteria to keep it in check, C. difficile can quickly grow out of control. The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins, penicillins and clindamycinC. Difficile Infection by Mayo Clinic

Which Antibiotics Are Most Associated with Causing Clostridium Difficile Diarrhea? On the basis of the available data, clindamycin should absolutely be avoided among patients who are at risk for C difficile infection, particularly in elderly patients and those with frequent antibiotic exposure or hospitalizations. Given the available data, it’s clear that clindamycin is a well-deserving candidate of its boxed warning specifically for C difficile risk. Box Warning can be read by clicking this LINK.

Clindamycin is prescribed most often to treat medical conditions as listed in …What Conditions Does Clindamycin Hcl treat?  Other options that have a reduced risk of triggering C-difficile?

For community-acquired pneumonia, it has been suggested that a tetracycline may be substituted in place of azithromycin (or another macrolide) among elderly patients at higher risk for C difficile infection. In fact, data suggests that tetracyclines may NOT increase risk of C difficile infection at all, with a non-significant odd ratio of 0.9 versus no antibiotic exposure.
 
In patients hospitalized with severe infections who require anti-Pseudomonal coverage, the available data suggests that penicillins (such as piperacillin/tazobactam) may have a lower risk of C difficile infection versus cephalosporins (such as cefepime) or carbapenems (such as meropenem). While this risk is certainly relevant to the selection of antimicrobials, local resistance patterns should also be considered when selecting an agent.
 
Knowledge of high-risk and lower-risk antibiotics for C difficile infection is important, particularly in patients who are already at a higher risk for C difficile infection, such as elderly patients. Avoidance of these high-risk antibiotics when other first-line alternatives exist in certain patient populations should be an antimicrobial stewardship intervention for pharmacists to reduce the risk of C difficile infection both in the inpatient and outpatient settings.

Antibiotic Warnings

Fluoroquinolones are antibiotics that kill or stop the growth of bacteria. While these drugs are effective in treating serious bacterial infections, an FDA safety review found that both oral and injectable fluroquinolones are associated with disabling side effects involving tendons, muscles, joints, nerves and the central nervous system. These side effects can occur hours to weeks after exposure to fluoroquinolones and may potentially be permanent.

Types of Fluoroquinolones that are FDA approved but which fall into this warning include levofloxacin (Levaquin), ciprofloxacin (Cipro), ciprofloxacin extended-release tablets, moxifloxacin (Avelox), ofloxacin and gemifloxacin (Factive). FDA updates warnings for fluoroquinolone antibiotics

Non-Antibiotic Drugs and Similar Antibiotic Side Effects

Antibiotics are known to trigger digestive issues and diarrhea, eliminating both the good and bad bacteria in our guts. There are also prescription non-antibiotic drugs that share similar harsh gut symptoms (as antibiotics) such as anti-diabetics (metformin), proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDS) and atypical antipsychotics (AAPs). Use the hyperlinks to see the listing of medications that fall within each category.

Non-antibiotics with antibiotic effects – Some non-antibiotic drugs have been associated with changes in gut microbiome composition, but the extent of this phenomenon is unknown. Athanasios Typas and colleagues screened more than 1,000 marketed drugs and observed that a quarter of them inhibited the growth of at least one bacterial strain in vitro. Scrutiny of previous human cohort studies showed that human-targeted drugs with anticommensal activity have antibiotic-like side effects in humans. The new data provide a resource for future drug-therapy research.  Extensive impact of non-antibiotic drugs on human gut bacteria, Published: 19 March 2018

The Elderly and Antibiotics 

UTIs are known to be common among the elderly and often the symptoms are not as visible making it difficult to know when a UTI exists. However, there appears to be a growing problem with over prescribed use of antibiotics especially for UTIs.

Consensus guidelines have been published to assist clinicians with diagnosis and treatment of urinary tract infection; however, a single evidence-based approach to diagnosis of urinary tract infection does not exist. In the absence of a gold standard definition of urinary tract infection that clinicians agree upon, overtreatment with antibiotics for suspected urinary tract infection remains a significant problem, and leads to a variety of negative consequences including the development of multidrug-resistant organisms. Urinary tract infection in older adults, NCBI 

The elderly are prone to UTIs and other infections but are they being treated more often than not when an infection is actually not present? Antibiotics do not treat frequent urination nor does this infer a UTI. Antibiotics can cause serious symptoms in elderly, weakening those that are already frail; fever, rash, diarrhea, nausea, vomiting, headache, tendon ruptures, and nerve damage. Information above about clindamycin specifically refers to the elderly, along with alternative options for infection treatment.

Elderly have an increased risk to antibiotic resistant bacteria, superbugs. 

Antibiotics may help “drug-resistant” bacteria grow, causing illnesses that are harder to cure and more costly to treat. Your doctor may have to try several antibiotics for treatment. This increases the risk of complications. The resistant bacteria can also be highly contagious/passed on to caregivers, family members and others. Antibiotics for urinary tract infections in older people When you need them—and when you don’t 

A study conducted by The Ottawa Hospital Regional Geriatric Program of Eastern Ontario Geriatric Refresher Day, Rosemary Zvor, Antimicrobial Pharmacy Specialist, (Research on Elder infections with charts zvonar_use_of_antibiotics) found an increase exposure within the healthcare system, antimicrobials, along with decreased immune system and functional status resulting in poor hygiene, as well as the increase use of invasive devices and close contact with other residents and medical staff that could be carriers.

Some antibiotics carry specific risks to the elderly. The article Adverse effects of Antibiotics in the Geriatric Patient Population lists precautions to consider, which you might share the elderly patient’s physician, of whom you advocate.

“Elderly patients have several unique issues related to antibiotic therapy. In addition to age-associated physiological changes and drug-drug interactions, adverse drug reactions are also a noteworthy concern specific to this population. 

  • Aminoglycosides-renal and auditory toxicity 
  • Trimethoprim and sulfamethoxazole-induced hyperkalemia and blood dyscrasias
  • Fluoroquinolone-related seizures and QT prolongation 
  • Doxycycline-related esophageal ulcerations & strictures 
  • Acute liver injury secondary to prolonged amoxicillin/clavulanate therapy”

Antibiotics – Impact On Brain Function 

This article, Link Between Antibiotics and Delirium Strengthened by Tim Newman, February 18, 2016, Medical News Today, explores an interesting discovery that “antibiotics are known to cause neurological issues in some cases, but the interaction has not attracted much study in the past.” Among the neurologic issues is delirium, which can include hallucinations, agitation and confusion, especially among the elderly. Since infection and antibiotics both can trigger delirium, more work and research is needed to measure and understand this relationship but something to discuss with physicians. Delirium can increase the risk of death in critical care cases.

“The antibiotics react not only against the bacteria but also have ‘off-target’ effects by interfering with normal signaling within the brain. Different antibiotics affect the brain differently, hence causing varying patterns of toxicity.”

“Dr. Shamik Bhattacharyya, of Harvard Medical School and Brigham and Women’s Hospital in Boston, MA, conducted a retrospective review using historical patient data. He found that links between antibiotics and delirium might be stronger than previously thought.”

Cranberry Supplements – Heal Or Prevent UTIs?

The Mayo clinic gives good advice about cranberry and UTI prevention in the article… Urinary Tract Infection (UTI)

“Many people drink cranberry juice to prevent UTIs. There’s some indication that cranberry products, in either juice or tablet form, may have infection-fighting properties. Researchers continue to study the ability of cranberry juice to prevent UTIs, but results are not conclusive. If you enjoy drinking cranberry juice and feel it helps you prevent UTIs, there’s little harm in it, but watch the calories. For most people, drinking cranberry juice is safe, but some people report an upset stomach or diarrhea. However, don’t drink cranberry juice if you’re taking blood-thinning medication, such as warfarin.”

Good Gut Health! Building a good gut…prebiotics and probiotic rich foods.

Be proactive and select foods that are high in probiotics and prebiotics for good gut health. The more good bacteria in your gut the less chance of bad bacteria that can cause irritating digestive system issues or trigger uncomfortable symptoms often experienced with autoimmune disorders such as Crohn’s, ulcerative colitis as well as irritable bowel syndrome. Can you take a probiotic supplement? Yes. Supplements, however, are not FDA regulated and you can’t be certain that what is listed on the label is actually in the capsule. I choose to follow wise advice given many years ago when I attend a Celiac Disease conference led by Dr. Peter Green. He shared that the body better absorbs whole foods rich in vitamins, minerals and in this case probiotics and prebiotics rather than taking capsules. If you eat right and skip processed foods, you won’t need to spend the extra dollars on supplements. As we get older and appetites wane, supplements may be needed and this is a conversation reserved to take place with your doctor or a clinical certified nutritionist. Also, probiotic dietary supplements may not be safe, as noted in What are Probiotics?, which may pose risks if you…

  • Get infections often
  • Have a weakened immune system
  • Are allergic or sensitive to the sources of the probiotics (dairy, for example)

What are prebiotics? 

Prebiotics, simply put, are food for probiotics. “They’re necessary in order for the good flora to flourish,” says Kristi King, R.D., a spokeswoman for the Academy of Nutrition and Dietetics. 6 Foods That Are Good for Gut Health 

Prebiotics encourage the growth of good and healthy bacteria in your gut. Prebiotic foods include fruits and vegetables that are loaded with complex carbohydrates, fiber and resistant starch that pass through the digestive system, which feed good bacteria and other micorbes. Prebiotic foods include: legumes such as chickpeas, lentils, navy beans; raspberries and blackberries; barley, bran and bulgar (being gluten free I search for whole grain gluten-free breads). 6 Foods That Are Good for Gut Health, Consumer Reports

The lining of your gut, like every surface of your body, is covered in microscopic creatures, mostly bacteria. These organisms create a micro-ecosystem called the microbiome. And though we don’t really notice it’s there, it plays an oversized role in your health and can even affect your mood and behaviorPrebiotics, probiotics and your health

Vegetables offer the best impact for your gut when uncooked to preserve fiber. Cooking transforms the fiber, lowering fiber content. Prebiotic Food List

What are probiotics? 

Probiotics are live culture bacteria which are found in foods or supplements that promote microorganisms for our guts known to benefit our health, body and brain. Probiotics could also benefit immune function and suggested as an aid for digestive issues, reducing the risk of diarrhea with antibiotic use, lessens risk of C-DIFF infection, and aids in food poisoning and stomach virus. Yogurt, such as non-flavored Greek yogurt, is a great source of probiotics and contains on average per serving 100 million probiotics. Simple… eat a serving of yogurt per day! Some yogurts are marked specifically to contain probiotics, such as Activa. Watch sugar levels in fruit flavored yogurts. Other fermented food products known to contain probiotics; kefer, sauerkraut, tempeh, kimchi, miso, kombucha, pickles, traditional buttermilk, nato and certain cheeses. Click Probiotic Food List for information on probiotic rich foods. Some fermented foods do have gluten, so for GF readers…read the labels.

NOTE: Kombucha bottles are not always well labeled to instruct recommended use, at least on the bottle I purchased. Internet checking I’ve seen serving recommendations at 4 oz and not to be consumed daily. The health benefits claimed have not been proven. Many brands contain alcohol and caffeine since it is fermented tea, therefore not for CHILDREN. There have been resulting health issues reported, such as liver damage, and the recommendation is to purchase from reputable sources and pass on homemade Kombucha. Not all Kombucha is created equal so if specifically looking for the benefits of probiotic and live cultures, look for labels with these ingredients noted. Some Kombucha can be high in sugar or use alternative sweeteners such as stevia. Check the label and choose those low in natural sugar. This video by Dr. Oz that aired Feb 2018 is a great resource about Kombucha in a comparison study to other food products rich in probiotics, titled, The Hype Behind Probiotics and Gut FoodsAnother good resource…What is kombucha tea? Does it have any health benefits? Mayo Clinic, Answers from Brent A. Bauer, M.D.

Conclusion 

Antibiotics rank as one of the greatest discoveries of our time, healing bacterial infections and saving lives. Fast forward 90 years and we are the generation experiencing repercussions of antibiotic overuse and misuse, especially within the elder populous leading to severe side effects, life threatening antibiotic resistant bacteria and superbugs. Failing to complete prescribed antibiotics and its dose recommendation, taking the wrong antibiotics for the wrong infection, borrowing another’s medication when feeling ill, or being prescribed antibiotics when an infection doesn’t exist, can lead to unwelcomed side affects and serious health issues. What can you do? Prepare now and be gut healthy choosing foods naturally rich in prebiotics and probiotics. Communicate prescription concerns with your healthcare provider and explore alternative options when possible. Use your voice and be an advocate for elderly family members. Antibiotic drugs can still be effective and the preferred drug to treat bacterial infections. The responsibility lies with you to know the facts, use your voice, and be proactive by feeding your gut well!

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Living Your story

This past week, in my private Facebook page, I posted a daily quote about gratitude. Life is not perfect and gratefulness sharpens a focus on blessings. Such gratitude reminds me of the gift of life and the people who bring beauty to it. I find this especially beneficial during the week leading to my birthday, which offers an opportunity to adjust my perspective to focus on what is right with the world. This gratitude exercise has encouraged the desire to know my story, a process of which I thought would be a great share with Modify readers. If we know our story and are able to articulate it well, we have a better grip on “self-confidence” to be who we are, comfortable in our own skin in order to live intentionally. Otherwise, we can feel like drifters across the sea of life, allowing shifting winds to set our sail. This post will share how to define your story by becoming well acquainted with who you are, embracing natural giftedness and communicating your story that includes gratefulness. If we know our life story, we can live it!

Creating and telling a story that resonates also helps us believe in ourselves.What is your story? HBR – Herminia Ibarra Kent Lineback JANUARY 2005 ISSUE

Defining Your Story – Getting Acquainted With Yourself

accept-no-ones-definition-of-your-life-define-yourselfThe first step… to define your story is to define YOU. The most difficult part of this first step is to guard against accepting a definition others assume of you that may not align with your thoughts of self, plans to be a better you or the reality of who you really are. This statement goes both ways…those who may critically judge you and those who may overly praise you. The focus here is articulating a personal, deeply introspective, perspective of SELF.

The second step…honestly identify positive behaviors/actions that support the first step as well as negative behaviors that do not validate the person you are or striving to be. “Is the story we are telling ourselves match the story others are witnessing.”Life’s Stories, The Atlantic

The third step…further explore those negative behaviors/actions, which are not mirroring the essence of the person you believe or want yourself to be. This step is about making necessary changes in order to be authentic. We may think incongruent actions are not a big deal, yet they are visible and the message the world receives and reflects back to you appears as… Do as I say and not as I do, which doesn’t bode well for shaping a person of integrity to yourself.

Using the Life-Scope

Does your story say you have suffered loss or been hurt so deeply that you will never get over it? Or does your story say, “Life is hard sometimes, but I am resourceful, not to mention still breathing, and I have free choice and the ability to change patterns that don’t work for me.” Defining Yourself: What’s your life story? 

Experiences… shape us, teach us, and guide us. Experiences are our credentials when fullsizeoutput_4db9
properly channeled. Throughout life we have those significant experiences that greatly impact… to strengthen or break us. Experiences that strengthen build character, kindness and compassion, victory over our circumstances. The Oyster and the Pearl is a perfect analogy shared recently by a friend of mine in bible study about the irritating grain of sand that the oyster uses to create a stunning pearl. Experiences that break accumulate anger and form a thick root of bitterness, greatly impacting a story’s sentiment, reflecting a victim instead of a victor. Don’t we all want to be victors in our story?? Which life experiences, both good and not so good, have shaped the person you defined in step one? Take a moment and be grateful for your life experiences, especially those that have been hard and hurtful. Try and see how challenging times and perhaps difficult people allowed you to rise above, step by step, modeling a person of strength and perseverance. Take time to reflect on these experiences and release any bitterness that may still be tied to a difficult situation or person(s) to move forward.

Victors produce choices and don’t live in regret over what might have been or what happened yesterday. Victims obsess on past failures and hurts, feeding a growing cancer of bitterness. As bitterness grows, the obsession with the past dominates and the ability to make choices in the present fades. Victims lose the potential to generate success.Victors and Victims…Are you being held back by a victim mentality? By K. R. Harrison.

Embracing YOUR Giftedness

Make a careful exploration of who you are and the work you have been given, and then sink yourself into that. Don’t be impressed with yourself. Don’t compare yourself with others. Each of you must take responsibility for doing the creative best you can with your own life. Galatians 6:4-5 The Bible – The Message

Photo Your Story.jpegWe are all born with natural gifts. Unfortunately, it is human nature that we don’t always follow through with the giftedness we have and often times work hard to attain the gifts others possess. Deep joy and life fulfillment come from nurturing the gifts given to us as our birthright. There are many surveys that reveal natural gifts through algorithm assessments. However, that pure blissful feeling of joy is an accurate indication when we accomplish certain tasks or lose track of time fully absorbed in a project or working and serving alongside others. And, the value of this giftedness and JOY most certainly is not limited to monetary rewards or income status. The responsibility lies with you to disengage from “noise” that might lead you to believe otherwise. Successfully using natural giftedness can be accomplished through employment or volunteer work or BOTH. Value is measured by thriving through personal joy and happiness and being a positive influence to those around you. The following are some simple questions that can guide you to living life on purpose and not by accident.

What you are is God’s gift to you; what you do with yourself is your gift to God. Danish Proverb shared in The Purpose Driven Life by Rick Warren.  

  • What do I enjoy doing the most? The least?
  • What do I feel I’m best at? Not very good at? Do other people see me the same way?
  • When did I experience pure joy from the fruits of my labor?
  • When do I feel I’m of most value?
  • What brings me sadness? What brings me frustration?
  • What makes me feel triumph? What makes me feel defeat?
  • What do I need to feel balanced? If feeling deprived, even when using our natural skills and talents, we can be robbed of joy. Example…I need minimum 8 hours of sleep, exercise 3 x per week, and prayer time, which must be scheduled in my calendar.
  • Is there any trait(s) I’m currently refusing to accept about myself?
  • If I can change anything about my life what would it be?
  • Describe my ideal life 5 years from now, what I would like to be doing, where I’ll be living and who are the people that will be in my life?
  • Where can I improve…words and actions?
  • A question to those of whom you respect and know well…What do you feel is one of my strengths and one of my weaknesses?

After identifying your natural skills and talents, explore the many ways they can be used in various environments, experimenting to find your deepest joy. Be creative and be open to all avenues of application! Expect that your plans may be met with naysayers, opposition, discouragement, and perhaps also unexpected circumstances that could circumvent short-term goals. Therefore, when making plans to use these gifts in a new and different way in your life, be careful with whom you share your story. As I have quoted in previous postings, my favorite quote by Eleanor Roosevelt, “No one can make you feel inferior without your consent.” Don’t consent. Trust is earned. Know with confidence those within your circle of relationships who are encouragers and qualified to offer solid, constructive and respected advice.

 “A life story is written in chalk, not ink, and it can be changed. “You’re both the narrator and the main character of your story,” Adler says. “That can sometimes be a revelation—‘Oh, I’m not just living out this story, I am actually in charge of this story.” Life’s Stories, The Atlantic 

Always let kindness be reflected in your story. And, if this is not the case for you, take time to find out why. Difficult people are often a reflection of their own insecurities and unhappiness. Is this the storyline you want?

Your own capacity for kindness. It can be hard to feel gratitude for the people in your life at times when you feel hurt, betrayed, or abandoned by them. People can be cruel, and often there is little we can do about it. But we can control our own behavior. We can choose to treat others with kindness, to be the person who brightens someone else’s day or eases their pain. This capacity for kindness is a valuable gift for others, but also for ourselves—research shows that giving compassion and support to others (link is external) can increase our own happiness too.  10 Things You Can Be Thankful For No Matter What Is Going OnPsychology Today

Fully applying your natural skills and talents will shape an authentic story, mirroring in life the totality of your person. Your story is complete when the essence of who you are is able to shine through. The natural giftedness that shapes you becomes like vivid images/illustrations to your story or the seasoning that flavors you to be exceptional!

Sharing your story

Sharing your story is meant to empower others and to continue to empower yourself. Your story can be modified to your audience, for example, to those you are meeting for the first time (getting acquainted) compared to those you have known for many years, where a solid bridge of trust has been constructed. What is most important about your story… is the impact it has on you, living it out consistently and sharing it to inspire others

This is where control comes into play. You must decide the information you share and who you share this information with. In telling these pieces, be certain to take ownership. If you want your story to have significance, do not shy away from what you share out of fear of being judged. Instead take complete power over your story. There are pieces of your story that you may not want to share, but figure out how to share them in a manner that is constructive and if nothing else, will inspire those around you. Defining Your Story, The Only One Worth Telling by Tim Mousseau

Are you ready to create your story and share it? Knowing your story feeds meaning to your life. Your story should be unique to reflect the essence of YOU and your life mission. Our lives reflect the sum of our core beliefs and best intentions to enjoy a full and joy-filled life. What we perceive through the lens of gratitude will fill our story with grace, love, and all that is beautiful. We are to guard against becoming the sum of other people; their passions, judgments, struggles, and weaknesses. Identify and embrace giftedness, which brings a vibrant energy to your story. And, share your story to be inspired and to inspire others to create and share their own!

Resources

Additional Resources

 

 

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Triage for the Caregiver – Published April 17, 2018

 The capacity to care is the thing that gives life its deepest significance and meaning.                                    Pablo Casals, World-Renowned Cellist

Longer life expectancy means we are becoming a triple-decker sandwich generation, caring for kids or grandkids, helping aging parents as well as managing our own life and medical needs, while often times maintaining a two-income household. Overwhelming! Frequently, we become victims believing the only choice is to make it all work. Stress can be incredible when striving to please everyone and be that perfect caregiver. Elderly parent care can include: medical advocacy, managing financial affairs, shopping and household duties, transportation to personal care appointments and running errands. Sometimes moving a family member home is the best choice but can be daunting managing one’s own personal life and existing responsibilities/relationships. Caregiving can also include attending to ill or disabled children (young or adult) or grandparents assuming responsibility to care for grandkids when adult children are a two-income household. Wherever you may fit in the caregiving category, and whether you are single, married, employed or not, you are juggling care and responsibilities of another and may be placing all or part of your life on hold to make caregiving work. This article offers suggestions on how to survive the role of caregiving without ultimately sacrificing one’s own health and well-being.

“When done in the right way, caring for a loved one can bring pleasure—to both you, the caregiver, and to the person you’re caring for. Being calm and relaxed and taking the time each day to really connect with the person you’re caring for can release hormones that boost your mood, reduce stress, and trigger biological changes that improve your physical health. And it has the same effect on your loved one, too.” Family Caregiving, Helpguide.org

Healthy Boundaries

Every caregiver deserves a cushion to refresh mentally and physically. And, those being cared for need a cushion, too! Sometimes a misconstrued belief convinces both the caregiver and the care receiver it’s best to depend on maintaining status quo, care as always managed in the past. This idea can lead to guilty feelings, straining relationships and blocking the caregiver(s) from reaching out for help and delegating responsibilities.

“If the caregiver is worn down or frustrated or responding to guilt, they are not providing the very best care that they could to their loved one. Those emotions drag us down,” explains Deborah Ford, in practice with Agape Home Care in Williamsburg, Virginia. How to Set Boundaries as a Caregiver, Caring.com

Trying to tackle it all, being available 24/7, is an unrealistic sacrifice that ultimately works to everyone’s disadvantage. Establishing healthy boundaries does not require justification or approval from anyone other than what works best for the caregiver(s), the care receiver, and communicating when help is needed for cover. It’s important to encourage the care receiver to also participate in decision making, when feasible, engaging with suitable choices to build confidence. Although best intentions, family members hoarding choices/decisions can inadvertently lead the patient to survival in a vacuum of despair, isolated by limitations. And, experiencing life on the sidelines can be a fast path to depression. Below is a list of healthy boundaries to consider.

This seems obvious on the surface but you’d be surprised how many of us behave as if we must respond to every demand with an outpouring of our time and energy. I’ve noticed my own tendency to turn requests into objects of resentment because I immediately assume each one is a “should do.”….But then, rather than an email saying, “I can’t do that,” I wondered: what if I sent an email that said, “Here’s what I can do (instead).” The Five Lessons in Setting Boundaries That Every Caregiver Must Learn, Huffington Post

General Boundaries

  • Schedule your day(s) off. This could be one full day per week or more, if you are able. Being available 24/7 is not healthy for anyone.
  • Triage requests received from the person needing care, medical staff and family members. Immediate responses are usually not necessary.
  • Block time each day for caregiving, time for yourself, as well as time for others. Let friends and family know your schedule, such as…I’m available after 4PM. Maintaining your own social network is needed and healthy.
  • Take urgent calls. Incoming doctor calls (set a unique ringtone) take priority and having to return them is not easy; navigating voicemail, long hold times and often playing phone tag. If others know in advance why you are taking a call, (in the middle of a meeting, family time/dinner, or social event) you won’t feel rude doing so and they will (hopefully) understand, without the need for justification.
  • Phone calls, not anticipated, can go to voice-mail. It’s not necessary to pick up every incoming call. Messages will be on voicemail to respond, when you are able, by return call or perhaps sending a text or email.
  • Say “no”. Your full availability before caregiving may not be feasible now. Accept this and others will, too. Overcommitting will eventually affect you, emotionally and physically.
  • Sleep…be consistent with a schedule. Well rested will serve you well and provide needed patience, a caregiving requirement.
  • Exercise… provides needed endorphins that clear the mind and reduce stress. A rigorous daily scheduled walk is just as good as a gym workout. Keep it up!
  • Embrace that you are WORTHY to have boundaries. Don’t be tempted to justify downtime and don’t be swayed to do so based on a comparison of responsibilities. The Five Lessons in Setting Boundaries That Every Caregiver Must Learn, Huffington Post says that being is more important than doing. Resist the temptation to feel...“I’ve often felt that I need to do more in order to make up for something I feel is lacking in who I am. That if I do more that’ll help everyone get past the general concern they all must have about my worthiness.”
  • Manage stress in ways that work best for you. Kaiser Permanente offers solid recommendations in this posted article…Stress Management.

Boundaries That Divide and Conquer

  • Identify all caregiving needs and responsibilities.
  • Identify what you are able to cover and what you can delegate.
  • Identify suitable choices and tasks the care receiver can have ownership. Relieves the caregiver of some tasks and inspires the care receiver with an “I can” attitude.
  • Match responsibilities to family members’ time and abilities and friends offering to help...medical advocate/coordinator, banking and bill paying, financial investments, home/real estate, grocery shopping and meal planning, transportation and general errands.
  • Connect with local community resources.

Seek personal referrals to local community services. Often times medical groups work with social services who can offer resources for home care, transportation services (providing transport to and from errands and medical appointments) as well as to community centers for social interaction. Always check current reviews. Well rated a few years ago may not be well rated today. I’ve identified a few outdated resources while being a caregiver. Share findings, especially to the social worker to update printed resources. Offering such feedback is graciously welcomed! My favorite transportation resource is Get Up and Go through the Peninsula Jewish Community Center.

Time Saving Boundaries

  • Mail order prescriptions is easy! Avoid driving to a pharmacy and long lines.
  • Email medical staff for non-emergency medical communications through protected online healthcare portals. Email directly connects to medical staff and avoids long phone hold times and the need to leave lengthy voicemail messages. I have found emails are forwarded to covering medical personnel if the email recipient is out of office. Email is also ideal to include photos of suspicious skin issues, healing wounds or other pertinent health concerns.
  • Request phone medical appointments instead of office visits, which can often suffice for follow-up exams. If needed, during the call, physician can suggest and schedule an office visit.
  • Text message medical staff if permissible (HIPAA concerns), especially great when communicating with medical coordinators, physical therapists and occupational therapists managing appointments. Huge time saver!!
  • Seek in-home nursing if offered by your medical group to avoid medical office visits for in-person routine follow-up checks.
  • Refuse automatic appointment scheduling, if this does not work for you. It is frustrating to receive a notice about a follow-up office appointment that isn’t feasible and calling the medical office (HOLD time) is the only way to reschedule. An 8AM appointment for someone in their 80’s and your commute is an hour away? You can request another time!! I share from experience.
  • Forward mail to avoid accumulation before you or a family member can get to the mailbox. This is also a time saver for the family member paying bills.
  • Paperless, if feasible, for all bills and monthly statements. Considering online auto bill payment, too.
  • Set up online ordering and delivery such as Amazon Prime Account for shopping, including groceries. Most grocery stores also provide online accounts and grocery delivery. HUGE time saver!!

Communication Boundaries

  • Use an online shared organizer, such as HUB, sharing calendars, lists, tasks, etc, with all those involved in caregiving duties, which prevents additional coordination/communications, overscheduling and efforts being duplicated.
  • Use an online meal organizer for extended families, friends, church groups and neighbors who want to help and prepared meals are needed. Meal Train is a great online resource.
  • Group text or email is ideal to communicate needs and updates to family sharing in caregiving. Text is best for urgent and brief notes. Email is ideal for lengthly updates and to file pertinent information in email folders for easy access, when needed.
  • Use an online connection portal, such as Caring Bridge, to keep all family and friends up-to-date at the same time, when dealing with a chronic health journey.
  • Be transparent with family members involved with caregiving. What one family may know the other may be seeking an answer. Avoid unnecessary duplication and communicate what you are working to solve/know… so everyone is aware.

It is far too easy for a caregiver(s) to neglect personal needs and existing relationships. Guard against feeling stressed and succumbing to a feeling of obligation and guilt, which can lead to unrealistic expectations. Be aware of extreme fatigue, which can skew reality when overshadowed by false perceptions, leading to bitterness and resentment damaging to relationships. Managing your emotional and physical needs, is, your responsibility. Establish boundaries to shape a healthy team instead of being or feeling like a solo act, wherever you may fit in the caregiving category. Find time to honestly assess what you can and cannot do. Reach out for help. Delegate where possible. Include the care receiver to cover suitable responsibilities, which will inspire and build confidence. Respect everyone’s time and contribution, including your own. We can all be effective caregivers and still live life joyfully. Communicating needs and seeking outside resources offers the opportunity to spend quality time with those in care. TRIAGE yourself! Be an effective caregiver and give yourself permission to take care of your needs, too.

Resources

 

 

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Planning Pain…what you should know – Published March 20, 2018

Planning is a fundamental part of our culture, from identifying pre-schools for our infants (often at the time of birth!) to preparing kids for high school and college years before admission. We plan for emergencies as discussed in the blog, “Must Have Unexpected Plan” and provide instructions for when we pass away, shared in the blog “Your Living Trust…details you need to know”. New Year goals help us to plan to live better lives as explained in “Target Change”. Yet, there are some areas that we don’t plan, and maybe it’s because we are not aware that we can. One area that often goes unplanned…pain management in unexpected emergency situations. The inspiration to write this blog comes from a recent experience with a family member requiring surgery to repair a fall fracture. The focus was on, “fix it” and a discussion about pain management following surgery was not. This blog will share the importance of having pain management discussions now, for you and those family members you advocate, so you might have a voice in choosing pain meds and being aware of potential side effects. Before an emergency event takes place know all pain management options. Controlling pain should be individualized to the patient’s age, sensitivity levels, health status and other drugs currently taking. Doctors work best when we give them needed information to effectively treat the patient, be it family members or ourselves. Making pharmaceutical decisions based on another person’s success can be dangerous to your loved ones, and to you.

“It is much more important to know what sort of patient has a disease than what sort of disease a patient has? William Osler

Plan Ahead – Physician Discussion

Falls and emergency medical situations happen suddenly, without warning. Here are some questions you can discuss with your physician. Often pain management conversations take place prior to a planned surgery and therefore, I feel, it might also be a good idea to have such discussions ahead of an unexpected emergency.

Questions To Review With Your Physician

Contact your/loved one’s family practice doctor to discuss pain management options in the event there could be a future situation/need.

  1. What pain medications are typically administered following emergency need and/or surgery? Dose?
  2. Length of expected duration on such pain meds?
  3. Can my family member(s)/I request a very minimum dose first and increase only as needed?
  4. What are all the side effects known for this/these drugs?
  5. Can this drug(s) be stopped immediately or is there a tapering off process?
  6. After no longer taking the drug(s), how long do these drug(s) remain in the body? And, what types of withdrawal symptoms, if any, can be expected?
  7. What signs might I expect that would indicate a family member or myself could be having a serious reaction and therefore the need to stop the administered pain medication?
  8. Whom would I immediately notify about this reaction in order to cease taking the pain medication? Would this medication then have to be removed from my pharmaceutical/drug listing? Who would have that authority?
  9. I do not want any form of Opioids. Other options in place of Opioids?
  10. Can age and overall health contribute to the effects of drugs? What long term effects could these drugs have on young children following my child’s surgery? Or the elderly who are frail? Other options with less risks?

The goal from this discussion is to have a written statement sharing your pain management preferences that could be placed alongside a HealthCare Directive, for easy access in the event of an emergency. It might also be something you give to your family practice doctor to add to medical records.

Pain Management Drugs

Before you are administered pain medication, you should be asked about your level of pain. Years ago I remember patients, when asked this question, were given a pain chart. Recently, I haven’t seen this chart and in fact, it took me a while to find one online. The chart illustrated below is found in the article, ZERO PAIN, for your reference.pain_chart

Opioids – Oxycodone (eg, OxyContin®, Percocet®), Hydrocodone (eg, Vicodin®, Lortab®), Hydromorphone (eg, Dilaudid®), Merperidine (Demerol®), Morphine (similar to heroin) Codeine, Fentanyl, Methadone – These are narcotics, which block pain signals from reaching the brain and can affect the whole body (systemic). According to “Technology Versus Pain: Targeted Drug Delivery And Electrical Stimulation – An Alternative to Systemic Opioids” Dr. Lawrence Poree, MD, MPH, PhD, Department of Anesthesia, UCSF,  shares that only 1/100th to 1/300th of the amount of oral pain medication actually gets to the place we need it. The remainder of the drug goes elsewhere throughout the body causing problems such as sedation, confusion, constipation, nausea, vomiting, etc. For this reason, higher doses could be needed to manage pain. And, often times combination drug pain therapy is necessary, as well. Opioids are highly addictive and recent news has been reporting an OPIOID epidemic in our country. Dr. Poree notes that in 2011 prescription drug overdose killed more people than auto accidents. “…each day 44 people die from opioid overdoses and 80 percent of those deaths are unintentional.” The following article is another great resource about Opioids…

Five Tips for Pain Management with Opioids: What You Need to Know About Common Prescription Medications by American Society of Anesthesiologists, 3.14.16

Non-Opioids – Aspirin, Ibuprofen (eg, Advil®, Motrin®), Naproxen (eg, Aleve®, Naprosyn®) Acetaminophen (eg, Tylenol®, Q-Pap®) Anti-inflammatory drugs (NSAIDs), Advil® and Aleve® that are anti-inflammatory and acetaminophen to manage mild to moderate pain. These pain management options can also affect the whole body (systemic) since they do not target/isolate the area of pain. They are not addictive. Internal bleeding/ulcers are a concern when elderly take these medications over a prolonged period of time.

Future of Pain Management

Pain management could be at the precipice of significant change. The video presentation Technology Versus Pain: Targeted Drug Delivery And Electrical Stimulation – An Alternative to Systemic Opioids, referenced earlier, was presented February 2016, by Dr. Lawrence Poree, MD, MPH, PhD, UCSF. Very interesting and informative about the history of and problems we face today with pain management along with technological advances regarding Neuromodulation, current alternative to and future advances in pain management, especially chronic pain.

Zero Pain, June 7, 2017, Mission Magazine, Univeristy of Texas Health Science Center at San Antonio

“All we have now are centrally acting opioid painkillers—fentanyl, hydrocodone and others—which has led to an epidemic of abuse and overdoses,” Dr. Shapiro said. “These medications don’t stop the pain signal but instead cover up the sensation in the brain, which frequently leads to devastating addiction. We want to treat pain at the source, at the sensory neuron, so that the pain signal never gets started in the first place, or if it does get started, doesn’t lead to this vicious cycle of pain and addiction.”

Pain Management and the Elderly

As we grow older we at greater risk to sensitivity and side effects of pain medications as well as to anxiety reducing drugs such as atypical antipsychotics – Risperdal, Seroquel, Geodon, Zyprexa as well as Atavin, Ambilify, etc. These anti-depressant drugs can be administered when hospital and skilled nursing facility patients show signs of frustration and depression, often a result of pain and rehab stress. What works OK for some may have serious adverse side effects on others, whether in different age groups, health status, or the interaction with drugs currently prescribed. Why? Because, how we metabolize drugs determine their effectiveness or … toxicity. Why are elderly (especially if inactive) as well as those with multiple health issues at higher risks of narcotic drug side effects?

According to NCBI Resources Opiates and elderly: Use and side effects, June 2008

“The increasing use of opiates for pain management by healthcare practitioners requires that those prescribing opioids be aware of the special considerations for treating the elderly.”

“With aging, there are changes in body composition: increase in adipose tissue, decrease in lean body mass and decrease in total body water. These changes can affect drug distribution. Therefore, lipophilic drugs tend to have greater volume of distribution, and it can take more time to be eliminated from the body (Linnebur et al 2005). Aging can also bring reduction in hepatic blood flow and volume which can decrease metabolism of drugs.” (Tegeder et al 1999AGS 2006).

MSD Manual Professional Version, Drug Metabolism,  explains…

“Some patients metabolize a drug so rapidly that therapeutically effective blood and tissue concentrations are not reached; in others, metabolism may be so slow that usual doses have toxic effects. Individual drug metabolism rates are influenced by genetic factors, coexisting disorders (particularly chronic liver disorders and advanced heart failure), and drug interactions (especially those involving induction or inhibition of metabolism).”

Too often I have heard the terms delirium and sundowners applied to elderly who are experiencing confusion. I can’t help but wonder if it’s the drugs administered when hospitalized that are actually the root cause, or at the least, considerably contributing to “confusion” and not simply a default reaction to feeling disorientated in an unfamiliar place such as a hospital or skilled nursing facility? In my own experience I witnessed an an individual under anxiety medication and OxyCODONE suffering confusion and hallucinations, which was diagnosed as Delirium. Yet, once taken off these meds, Delirium vanished and the patient resumed her standard of mental clarity after a few days, still at the same healthcare facility. Questions…

  1. Since elderly and inactive patients metabolize drugs at a much slower rate, could there be an accumulation effect leading to toxicity of anti-depressant drugs and narcotic pain medications?
  2. Could possible toxic levels be responsible for triggering Delirium and therefore, not simply the result of feeling disorientated in unfamiliar surroundings?
  3. If (1) and (2) above could be true, what are other options for safely managing elderly anxiety, depression and pain? Suffering hallucinations is a horrific experience. The memory of those hallucinations linger after the episodes are over!
  4. Is it possible to have a trained geriatric specialist (PA, NP, or Nurse) at physician family practice offices, considering our growing baby boomer generation is quickly populating this age group, to guide all elderly patients in best care and pharmaceutical options?

What happened to Geriatric Care? The quotes above by NCBI Resources and MSD make it quite clear; drugs are processed slower/differently because of the physiology of elderly patients. Perhaps a form of Geriatric Care should return to Healthcare, providing specific professional guidance and insight to aging patients and their family.

What I Discovered

  • If there is a reaction from pain medication, request it be removed. It’s important to minimize withdrawal side effects. Check if gradual removal is needed or if the medication can be stopped immediately. Only a doctor can remove a medication on a medical record.
  • Anti-depression drugs such as Ativan or Ambilify can be used to treat anxiety in emergency care and post-surgery recovery. Know drug side effects and red flags to notify healthcare workers. Short term, these drugs can be effective and beneficial. Long term (more than 2 weeks) can present serious side effects best known in advance. Every patient is different and may experience different reactions. I know someone who is so sensitive to medication she experienced the most uncommon side effects, immediately with Ativan. Benefit vs risks should always be considered…with a physician.
  • Important next step…Medications triggering side effects that are taken off a medical care chart must also be added to the “allergic” list or DO NOT ADMINISTER list. Do not assume this is automatically done. Only a doctor has this authority and best you request. If this step is not carried out and the drug remains on the patient pharmaceutical list, it can be prescribed again. Follow through with your doctor as well as visiting your online medical portal pharmaceutical listing, if you have one.
  • All drugs have some form of side affects. It is important to review benefits vs risks… with your physician, to guide decisions. Internet search should only be used as a guide for questions you can prepare in advance to discuss with your doctor.

This blog post is really more about questions rather than providing answers. I, and perhaps you as well, feel the need to be informed about pain management options, to plan your healthcare future. If we are not in a position to make these decisions, then someone else will. Would you prefer more control over what goes into your body and knowing the potential side effects? Hopefully this post will encourage you to meet with your family practice doctor (or PA, NP, attending nurse) to initiate a conversation about pain management… a good introduction to being actively involved in your healthcare and those you advocate. As the saying goes, every journey begins with a single step. When are you planning to take yours?

Resources

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Who Knew? You Decide! – Published February 20, 2018

A few years ago I discovered wax melts and the amazing aroma from these “fire safe” and beautiful warmers. After purchasing three wax melt units, I placed them strategically throughout my home to optimize seasonal fragrances. Many scents have been enjoyed from spring fresh, summer floral, fall cozy spice to winter pines!!! Although the home always had an incredible seasonal scent, fast forward 2 1/2 years and I’m beginning to have concerns. Is there a possible connection to health issues tracing back to the time we began using, almost daily, scented wax melts and candles? My husband and I, both, have had occasional coughing, sore dry throats, headaches, fatigue, followed by daily morning congestion and most concerning, my husband’s heartbeat irregularity, which eventually led to an **Atrial Fibrillation (AFib) diagnosis. During the past 3 weeks I began searching scientific studies about the safety of home air fresheners, specifically scented wax melts and candles. At that time we also stopped using these air fresheners in our home and soon began to notice a remarkable difference in our overall wellbeing. Coughing and clearing throats slowly ceased. Congestion has cleared. My husband hasn’t had a headache. And most amazing, he hasn’t had ANY AFib occurrences. Coincidence? Did the accumulation of daily use contribute to our symptoms? The following shares some interesting findings to equip you with information about synthetic fragrance and wax products, paraffin and soy. If you are currently using these products, you can then decide whether or not to continue. Home air fresheners, wax melts, scented candles, and/or plug-ins, daily use, could especially effect elderly, small children and infants.

Key Definitions

Click this HYPERLINKED PDF before you continue… Key Definitions – Who Knew_ You Decide! – 

Concerns

#1 Concern –Ingredients are not listed on wax melt and candle labels. Reviewing all products I have on hand, only one company provided an ingredient list, which was vague at best…Wax, Fragrance, UV Stabilizer and Dye. Air Fresheners, candles and wax melts are regulated by The Consumer Product Safety Commission (not the FDA) and ingredients on labels are not required. FDA Regulations states “Other products using essential oils, candles and air fresheners aren’t regulated by the FDA. The Consumer Product Safety Commission is responsible for keeping the industry safe and honest.”

#2 ConcernSynthetic Fragrance is used in many home products such as spray air fresheners, plug-ins, candle wax melts, scented candles, car fresheners, to personal care products, household cleaning products and laundry detergents. Such fragrances are made of synthetic oils in order to offer a wide variety of scents at a much cheaper price point. Synthetic fragrance can be toxic. In a study conducted by Atm.Environ.552012257 (conclusion page 7), scented candles surpassed the toxicity rate of the unscented paraffin based products. “The study of emissions among scented candles concluded the fragrance had more to contribute to toxic emissions than the paraffin wax.” If given a choice, lighting an unscented paraffin candle might be the better option! Synthetic fragrance oils use styrene and Phthalates. Dr. Axe, Dangers of Synthetic Scents …notes the following. This article also includes a comprehensive listing of products that include synthetic fragrance oils, toxic chemicals used, and its potential health impact.

“Sadly, styrene is just one of many ingredients linked to cancer being used to create artificial fragrance. Phthalates are another group of chemicals often disguised as “fragrance.” They are connected to cancer, endocrine disruption as well as developmental and reproductive toxicity. These dangerous synthetics are already banned from cosmetics in the European Union, but are still quite common in products produced and sold in the United States. Phthalates often hide under the “fragrance” ingredient, but they can also appear on ingredient lists as phthalate, DEP, DBP, and DEHP. Be sure to avoid all of those. Dangers of synthetic scents include cancer, asthma, kidney Damage and more.”

#3 Concern – Essential oils, although recommended over synthetic fragrances, can also trigger reactions. Surprisingly…”Oxidized lavender oil showed among the highest frequencies of contact allergy to studied essential oils.”Medical Journal  Essential oils come with warnings about recommended use and storage. And, not all essential oils are created equal, having different purity levels. Before using these oils in your home, whether in candles or by popular diffusers, do your research and perhaps consult with your physician. Some scents are particularly harmful to pets, as noted in Are Essential Oils Harmful to Cats and Dogs? by Amanda Carrozza. This article provides a helpful toxicity list along with a warning about using diffusers, which could be overwhelming to pets having a higher sensitivity to smell. Essential Oil Safety (and Are Essential Oil Diffusers Safe?)  is another good resource reviewing essential oils and their safe use.

#4 Concern – Heat changes the chemical composition of oils, synthetic fragrance and essential oils, and it is not advisable because of potentially toxic particle matter that can be emitted in the air and inhaled. Particulate Matter (PM) (pollution) is a complex mixture of extremely small particles and liquid droplets that get into the air. Once inhaled, these particles can affect the heart and lungs and cause serious health effects.

#5 Concern – Paraffin wax is predominately used in candles and wax melts, especially those that are bargain priced! Paraffin is a by-product of petroleum and found that paraffin-based candles — the most popular kind — emitted toxic chemicals like toluene and benzene. The sources below provide; a history of paraffin wax, its raw material make-up, and the chemicals used in wax products such as candles and wax melts.

#6 Concern – Study Conclusions

Product Material Quality

Emissions Of Air Pollutants From Scented Candles Burning In A Test Chamber Atmospheric Environment, Volume 55, August 2012, Pages 257-262 “It has been found that BTEX and PAHs emission factors show large differences among different candles, possibly due to the raw paraffinic material used, while aldehydes emission factors seem more related to the presence of additives.”

Emission Of Air Pollutants From Burning Candles with Different Composition in Indoor Environments, March 2014, Volume 21, Issue 6, pp 4320–4330 “In this regard, the purity of the raw materials and additives used can play a key role. Consequently, in this work emission factors for some polycyclic aromatic hydrocarbons, aromatic species, short-chain aldehydes and particulate matter have been determined for container candles constituted by different paraffin waxes burning in a test chamber. It has been found that wax quality strongly influences the air pollutant emissions.”

Heat and Smoldering – National Service Center for Environmental Publications (NSCEP), Fine Particle Matter Emissions From Candles “Most tests revealed low PM emission rate except two, in which excessive sooting occurred and the PM concentration approached 1000 J.Lg/m3 with six and nine burning wicks, respectively. Wax breakthrough significantly increased the PM emission rate. Smoldering generated more fine PM than several hours of normal burning, causing very high concentrations in a short period of time, which raises concern over potentially acute health effects, especially for children and the elderly.”

Frequency of Use – Emission of Air Pollutants from Burning Candles with Different Composition in Indoor Environments, Atm.Environ.552012257… “Burning of candles in indoor environments can release a large number of toxic chemicals, including acetaldehyde, formaldehyde, acrolein, and polycyclic aromatic hydrocarbons (Lau et al., 1997; USEPA, 2001; Lee and Wang, 2006; Orecchio, 2011). It is believed that regular burning of several candles in indoor environments can expose people to harmful amounts of organic chemicals (USEPA, 2001).”

Synthetic Fragrances – Emission of Air Pollutants from Burning Candles with Different Composition in Indoor Environments, Atm.Environ.552012257 “It has been found that the BTEX and PAHs emission factors show large differences in similar candles without any clear correlations. On the other hand, aldehydes emission factors are quite similar for all the candles, leading to the conclusion that such emissions are mainly related to the presence of a fragrance rather than to the other candle parameters. This has been confirmed by the experiments carried out using candles made by pure paraffin, where almost no emissions of aldehydes have been found. Moreover, a data scattering among the three paraffins investigated even larger than that found for the scented candles is evident for BTEX and PAHs emission factors. This seems to indicate that the kind of raw material rather than the additives determines BTEX and PAH emissions.”

Studies That Refute Health Concerns

In a study titled, Human health risk evaluation of selected VOC, SVOC and particulate emissions from scented candlesevaluated consumer health risks with candle emissions measuring particle matter and their thresholds of toxicity. The conclusion was that under normal conditions the use of scented candles do not pose known health risks to the consumer. I have found that studies which support the use of scented candles also indicate use in well ventilated areas, assume candles are not used by consumers on a daily basis, and consumers are not exposed to candle emissions 24 hours each day.

Consumer Frequency and Exposure – Human health risk evaluation of selected VOC, SVOC and particulate emissions from scented candles,“Despite this overall favorable first tier assessment, it remains important to provide a more realistic understanding of potential consumer exposures. Typically, candles are not used by consumers on a daily basis. Neither are consumers exposed to candle emissions for 24 h each day. Modeling of potential consumer exposures to a group of surrogate compounds including formaldehyde, benzene, limonene and particulate matter using consumer research based habits and practice information revealed consumer exposures that were approximately 10 times below those values derived under the overly conservative standard assumptions which were used in the first Tier. Accordingly, all measured compound emissions including indoor or ambient air quality guideline values or established toxicity thresholds (see Table 10). On the basis of this investigation, it was concluded that under normal and foreseeable use conditions, the use of scented candles does not pose a safety concern to the consumer.”

Negating Health Risks – Report on the Ökometric Wax and Emissions Study  “A new, internationally funded study on candle emissions has confirmed that well-made candles of all major wax types exhibit the same clean burning behavior, and pose no discernible risks to human health or indoor air quality.”

Allergic Reactions and Sensitivity National Candle Association FAQ – “Although millions of Americans regularly use scented candles without any negative effects, it is always possible that a particular fragrance might trigger a negative reaction in sensitive individuals. Individuals with known sensitivities to specific fragrances may want to avoid candles of those scents. In addition, consumers should remember to burn all candles, whether scented or unscented, in a well-ventilated area.”   

This post simply scratches the surface of all the sources available that shed light on this debated topic about the possible health implications with air fresheners using synthetic fragrances along with a variety of wax types and quality. After much work on this post I’m left with some remaining questions…

  • Chemicals heated by warmers or flame (candle)…is there an increased toxicity level and health risk from the change in oil composition, which we could be inhaling as Particulate Matter (PM)?
  • Is it possible PM toxin levels increase when wax color dyes are combined and burned with synthetic fragrances (candle and wax melts)?
  • Has a study been conducted on the accumulation effect, using these products frequently over a period of time and its health impact? (See blog article Medical Mayhem, 6.20.17…my reaction to fish oil supplement. Even though the manufacturer eventually assured me that the wheat ingredient was within FDA requirements, I still became very ill after 30 days, from the accumulation effect of daily intake.)
  • National Candle Association recommendation is for use in well ventilated areas, but there is no indication why ventilation is required if the product has been tested safe? (The labels on a few of my candles indicate…”avoid drafty areas.”
  • Normal use is often recommended in studies that refute health risk claims. What is normal use and if the product has been tested safe then why is there a “use” restriction?
  • Labeling on the products I own do not include frequency use recommendations or instruction for use in well ventilated areas. If these recommendations are so important for health safety, shouldn’t they be printed on product labels?

Who knew the amount of studies conducted and articles published (internet accessible), discussing and debating home air fresheners and potential health risks! Always, I am a firm believer, if something doesn’t make you feel well…then stop. My husband and I now feel great being an air freshener free home. The faux candles we have will suffice for ambiance. This past weekend (outdoor temperatures being a balmy 55-60 degrees) we opened windows to fragrance our home…with fresh air! When you can experience a remarkable difference in how you physically feel by staying clear of chemical based products, this becomes a debate you clearly WIN! If an ingredient list is not included on your air freshener product, you may want to pass on the purchase, not knowing what chemicals might be lurking in the product itself. Many studies conducted to-date arrive at different conclusions about the toxicity of synthetic fragrances and waxes. Take control, be informed, and make your own decisions on what is best for you and your family. You decide!

**I do not claim nor is there any scientific proof that specifically links air fresheners/scented wax melts and candles to being the root cause of AFib. What we do know is that once these products were no longer used in our home, there has not been an incident of AFib. The question is, can daily exposure to toxic substances identified in the studies of synthetic fragrances and waxes, referenced in this post, be contributing factors that trigger AFib events; BTEX (Benzene, Toluene, Ethylbenzene, Xylene), PAHS (Polycyclic Aromatic Hydrocarbons), Aldehydes (Formaldehyde and Acrolein) and VOC (Volatile Organic Compounds)? A study posted by the American Journal of Cardiologists concludes that acute exposure to air pollution, can acutely trigger AFib.  Acute exposure to air pollution triggers AFib.

Resources

 

 

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When To Call It?…making decisions during a health crisis – Published February 13, 2018

The New Year began with an adrenaline rush and not the preferred kind! Monday, January 5th, waking up to the start of the official New Year workweek, Marsha and her husband, Jack, enjoyed their morning routine of freshly brewed coffee while discussing current news and work related business. All seemed to be typical and uneventful. An hour later the ambiance in their home became tense. Jack confesses he has been having chest pains since 5 AM and the discomfort is getting worse. Breathing has become more difficult accompanied by a feeling of nausea and dizziness. He recently had a full physical and heart check and everything was great. What to do?? Planning for an emergency is not on most people’s radar. We all like to believe the sudden onset of concerning symptoms shouldn’t happen to those who are health proactive, have routine medical checks and are not at the age to be affected by such emergencies. This couple admits to being awestruck…do we push the emergency button (911), drive to the ER, or call our family practice doctor?? Let’s look at what the experts advise when a health emergency is in progress.

Emergency 101, When to call 911, offers an excellent guide. This is a great resource to print out and keep someplace handy for all those living in the home (children included) to know and understand. HR departments within companies should have something similar available to employees, visible and easily accessible throughout the office. This article defines a medical emergency as follows:

“A medical emergency is an event that you reasonably believe threatens your or someone else’s life or limb in such a manner that immediate medical care is needed to prevent death or serious impairment of health. A medical emergency includes severe pain, bad injury, a serious illness, or a medical condition that is quickly getting much worse.”

So often, to avoid embarrassment if the concern is ultimately nothing serious, people justify symptoms and avoid calling 911. Well, I would much rather deal with embarrassment than death or physical implications or a lengthy recovery time by waiting too long! It is important to know that when the 911 call is made, dispatch will ask questions to assess the medical emergency, taking the pressure off you, offering wise advice with next steps if paramedics are necessary. The arriving paramedics will also assess the emergency. Non-responsive, chest pains, difficulty breathing, profuse bleeding or severe allergic reactions are reasons to call 911, which often leads to paramedics bringing the patient to the ER.

Before paramedics arrive if the emergency is at a residence location, unlock your front door and place all pets in a safe place (another room with the door closed or the backyard) to avoid interferences. Either have a list handy of all current medications including vitamins and herbal treatments the patient is taking or place all bottles on the counter. Immediately notify EMTs of any allergies. They will need to know this information. Medical Emergency? Help the EMTs Help You as well as Insider’s Guide to the Emergency Room offer great advice. And, stay calm. If you are calm, the patient being attended to will also be calm (if conscious) and therefore share with greater accuracy symptoms and timing of what transpired. The paramedic team will then be able to better assess what is going on with the patient for proper treatment, quickly and thoroughly. If you struggle with calm in such a situation, let the patient and paramedics know you are leaving the room so the team can do their job and where you will be for questions and update status. Marsha took this approach and a paramedic knocked on her bedroom door to ask further questions, share the initial assessment and to let her know which ER Jack was being taken. The main highway was closed that morning and therefore side roads had to be taken. Knowing this greatly troubled Marsha. One of the paramedics gave needed assurance…”once in the ambulance he will get all the emergency care he needs while en-route.” The message here is to know the paramedics will provide necessary medical care in the ambulance, like a mobile mini ER, and also prepare the hospital medical staff for the patient’s arrival.

Before heading to the ER, be sure you have a copy of the HIPAA Release and Authorization Form. If you don’t currently have this document, you can print out this page by clicking, HIPAA Release and Authorization Form. If you also don’t have an Advance Healthcare Directive, contact your estate planning attorney or visit the Everplans website, which offers a wealth of information. The American Bar Association provides an informative overview, Myths and Facts About Health Care Advance Directives.  Additional resources can be found on my blog post Must Have “Unexpected” Plan, May 30, 2017. To have quick access to your HIPAA form and health directives, you might consider the following.

  • Best case is to bring copies of these signed forms to your local hospital to scan into their database in advance, where it needs to be.
  • Your physicians should also have a copy on file.
  • Another idea is to scan the Heath Directive and HIPAA signed form and email it to yourself. Save in a “Medical Emergency” email folder. When needed, wherever you might be, you can retrieve the document easily at any medical facility.

As you get ready to go to the ER, be sure to have the patient’s medical insurance card and drivers license (state ID card), if the patient left without this information. Suggest you also pack your (and the patient’s) cell phone and charger as well as a few power bars or fruit and bottled water, as you could be facing a very long day or night. If possible, consider having a friend drive. Even if you feel fine to drive on your own, the focus might be on the patient and not the road, overcome with all the “what ifs”. Marsha was fortunate a friend was already waiting for her when paramedics left and another friend, in the medical profession, was at the hospital when she arrived.

Patience is a virtue and you will need lots of patience. ER visits are usually long, whether the patient arrives by vehicle or ambulance. Consider waiting time to be seen, patient prep, evaluation, tests scheduled and results reviewed for a diagnosis. HIPAA doesn’t allow walking around the ER where patients are located, for privacy reasons, so you can’t pace the halls. ER room etiquette is required. 50 Secrets the Emergency Room Staff Won’t Tell You by Readers Digest will fill you in on the dos and don’ts of being at the Emergency.  It’s important to communicate accurately and with clarity, either on behalf of the patient or by the patient directly, to the attending ER physician and nurses. They cannot, otherwise, guess your symptoms or discern treatment and next steps when facts are left out or perhaps, embellished facts added in. Before you are discharged, if you are not admitted, the following is a summary of questions from the article, An Insider’s Guide to the Emergency Room, that is helpful.

  • Ask for contact numbers in case you feel worse later.
  • Review symptoms that would require heading back to the ER that you should know in advance.
  • Review the discharge paperwork and at-home care instructions and do ask questions, if you have any.
  • Ask about the medication you might be prescribed. How long to be on the medicine? What are the possible side effects? Will it interfere with other drugs, herbal treatments, and/or vitamins?
  • Ask about activities that you might need to avoid?
  • Follow up? When and with whom? Do you make the appointment or did the ER physician already contact the follow-up physician, and the name and contact information of this physician.

Emergency services are in place for true emergencies. The following from Do You Practice Proper Emergency Room Etiquette outlines considerations when a health issue arises that does not involve heart/chest pains, difficulty breathing, unstoppable bleeding, severe allergic reactions, or a severed or severely fractured limb.

  • Contact your primary care office, physician or local hospital advice line and discuss the situation if possible.
  • Utilize urgent care facilities or walk-in clinics for non-emergent situations.
  • Keep up with preventative care (such as physicals, shots and vaccinations, and annual screenings) to prevent necessity of emergent care.
  • Discuss care plans with your doctor and be well educated about any and all of your chronic conditions to reduce chances of requiring emergency care.

In the case of this couple, the emergency room visit ended well. It was not a heart attack, although symptoms led first responders to feel that it could be. The source of the problem remains unknown awaiting results from further follow up tests. It appears, however, symptoms may have been triggered by a severe reaction to a recently prescribed medication. This whole incident also could have been a heart issue, regardless of age or physical fitness. When symptoms match professional advice to call 911, this is when to call it! Many of us are guilty of being our own specialist when it comes to making decisions about our body. Don’t be this person. Be informed and prepared to make the best emergency decisions for you, and also for your family, friends or work colleagues. You never know when you’ll be in the position to take such a lead that could save someone’s life, including your own.

Note: This is a true story that happened January 5, 2018 and shared with permission. Names have been changed to follow HIPAAprivacy requirements.

Resources

Chasing Lost Mail…what you can do! – Published January 23, 2018

Chasing lost mail _edited-1

Mailing carefully selected gifts or greeting cards with personal notes for delivery to those we care about is something most all of us do at some point during the year, especially during the holidays. Companies depend on mail services to conduct business from sending corporate documents to fulfilling customer online and phone ordering. Even though we may consider ourselves to be a “paperless” generation, USPS alone reports 2015 revenue of 68.8 billion with 154.2 billion of processed mail, which proves our dependence on a trustworthy mail service. Not all mail, however, reach intended destinations. This past December I personally heard about a number of mailed packages missing, even with tracking numbers. These lost parcels represent service through USPS, UPS and FedX. It didn’t matter which service carrier was used. Packages went missing. After doing an internet search, missing and lost mail appears to be more common than I thought.

In fiscal year (FY) 2014, the MRC received 88 million items and processed 12 million of those valued at $25 or more. It returned 2.5 million items to customers — a resolution rate of 21 percent of researched items, or 3 percent of total incoming items. Office of Inspector General 

Reading this post you might also be nodding your head “yes”, having experienced lost mail this past year, especially over the holidays. One of my packages mailed on December 8th become MIA when tracking stopped a few days later. The package was finally located January 5th and redirected to the Mail Recovery Center (MRC) in Atlanta, Georgia. MRC is the USPS lost and found center hoping to reunite package with intended recipient.  Tracking a lost package is frustrating especially when having to endure excruciating on holdfrustration-clipart-frustration-clipart-287x187 waiting time to speak with a customer service representative and the end result…hearing what you already know! This post explores how a package can get lost and what we can all do to minimize the risk of lost letters and packages through the mail system.

How did the letter/package get lost?

damaged-box shipping
After speaking with USPS 3 times (average hold time being 1 hour!) listed below are some common reasons parcels can get lost.

  • Damaged package by USPS machines or personnel and the label becomes illegible or separated from the package.
  • The parcel box wasn’t sturdy to handle travel.
  • Letter or parcel slipped behind USPS machinery.
  • Address error made it undeliverable.
  • Intended recipient moved without leaving a forwarding address.

Ideas to reduce the risk of lost mail? 

  • Double check recipient current address. Nine digit zip code search, Click Here.
  • Place a clearly instructed note in the package indicating sender and recipient name, address, and contact information. Placing the note inside a zip lock bag for extra protection would be ideal. If the package label is damaged, the information needed to redirect the package is provided should the box be unintentionally ripped open or opened by mail carrier personnel/inspectors.
  • Invest in a new box instead of reusing a box to be sure it is sturdy. Use packaging well boxed shipping box brown-027_2048x2048tape to be SURE the box (bottom and top) is well taped and secure, including all the corners. The tape should be flat and not protruding beyond any corners that might easily get caught in machinery.
  • If reusing a box, remove all previous labels and black out with a permanent marker any pre-existing bar codes that often are on the sides and bottom of a box.
  • BOLD PRINT in clear visible font the addresses (return and send to) and fully clear tape the labels on the parcel or use a bold marker and write addresses on the box itself, clearly. Place clear package tape over the handwritten SEND TO address and RETURN address. This water proofs the ink and may prevent the risk of paper tear, damaging the entire label.
  • If the value of the parcel is over $25, avoid ground shipment and consider sending priority mail, signature required or registered and insure the contents. The more paper tracking on your package the easier it will be to locate if lost.
  • All sensitive documents, monetary contents or special non – replaceable items, send overnight or two day, fully insured, signature required or registered mail. Avoid mailing cash.
  • Follow the tracking of your parcel and if, after a few days, you don’t receive a tracking status update, contact your local carrier immediately.

What to do if your parcel is indeed lost?

  • Create an online account through the carrier of your lost parcel be it USPS, FEDX or UPS, or other carrier, if you haven’t already done so.
  • File an online missing mail claim through “search request” then contact your local mail carrier service by phone or in person for next steps they would recommend. Below are hyperlinked carrier online resources. When a search request claim is made and also when you connect with your local post office, ask for update notifications through text and email.

USPS,  FEDX,  UPS

  • If the package has been routed to USPS Mail Recovery Center, it will join many other parcels deemed “dead mail” because the sender and recipient address information has been destroyed. How could the tracking number be in tact and yet the address label missing? Good question and no one I spoke with could give me an answer. It has been over 10 days since my package was routed to MRC and although I check tracking status daily, receipt at MRC has yet to be confirmed. Once checked in at MRC, it is my understanding it will be inspected by a qualified USPS inspector who will login the tracking number and at that time my missing package claim will meet with my lost package. The inspector will then match content description to what is in the box. If the descriptions match, they will follow the mailing instruction on the missing package claim and forward the box. This process could take anywhere from 4-6 weeks, or longer.

Can parcels be a victim of carrier theft?

Yes, although not a significant factor in lost parcels at USPS. When there is suspicion of theft by USPS personnel they are, apparently, quickly discovered and criminal charges are filed. According to the USPS Office of Inspector Attorney General

It is the job of OIG special agents to identify dishonest employees and take proper investigative steps to have them prosecuted and removed from the Postal Service. During the reporting period from October 2014 through September 2015, OIG special agents conducted 1,607 internal mail theft investigations, resulting in 493 arrests, 1,220 administrative actions, and approximately $478,000 in monetary benefit for the Postal Service.

The risk of mail delivery mishaps still exists even with modern technology increasing the efficiency of postal operations. Moving forward the question I ask myself as I get ready to ship another package…”What can I do differently to reduce the risk of a lost package?” Following suggested ideas noted above is on my TO DO LIST before I head to the post office. My hope is that the US Postal Service and all mail carrier services will also strive to continuously improve internal operations. Regardless of how paperless we become, we will always need to depend on mail delivery services.

Resources

Your Living Trust…details you need to know – Published January 16, 2018

Modify - Trusting Your Living Trust

Many of us have Living Trusts to protect assets, which, upon our death are then inherited and able to pass directly to heirs instead of requiring a lengthy and costly probate process. The protection that a Living Trust provides, however, depends on your diligence, feeding (funding) into it all assets accumulated through the years. Most often homes are the largest asset in a Living Trust and yet, they can be inadvertently left out.

Recently a friend and her family were caught by surprise after the mom passed away. Believing all financial affairs were in order through the family Living Trust, they discovered the home was not included (funded) as an asset. This fact became known during the home sale, which invalidated the real estate transaction. The family sought legal counsel with the understanding that California probate might be inevitable. Probate could take anywhere from 3-8% of trust assets in fees and accumulating costs as well as up to a year or longer to settle. Why was the residential property left out of the trust?? After sharing this experience with her friend who was convinced her own home was definitely in Living Trust, both were surprised to find it is not! What can you do to protect your family assets? The following explains the purpose and process of a Living Trust, reveals common circumstances preventing property from being in a trust and shares how to determine if property(s) assets are funded and next steps if, perhaps, not.

This blog post is not intended to provide legal counsel. The information shared below is to encourage you to pursue professional legal guidance in your residing state to ensure your assets are protected.

A Living Trust is a contract between the trustmaker (a person who created the trust instrument also known as a settlor, grantor, or trustor) and the trustee(s) who hold and manage property for the benefit of named beneficiaries. A Living Trust includes a set of directions for asset management if the trustmaker is deemed mentally unstable or for asset distribution upon death. Revocable trusts can be changed without beneficiary approval and irrevocable trusts require notification and approval from the trustee(s) and beneficiaries. Trusts are funded by transferring title of assets to the trust. An estate attorney in your state will qualify your need for a Living Trust. Living Trust, Chapter 5, American Bar Association

When is property(s) inadvertently not funded (not included as an asset) in a Living Trust?

  • Forgot to include property/home residence in the Living Trust and therefore the title to the property wasn’t changed. This can easily happen when a) living in an existing home while a Living Trust is being created and b) first time homebuyer while having an existing Living Trust.
  • Purchasing a new home and assume since prior home was in the Living Trust, the new residence automatically will be, too. A deed for title transfer to the Living Trust will be needed or the new home will not be funded to the trust.
  • Refinancing home mortgage requires the property first be removed from the Living Trust. After refinancing is complete, a Deed for title transfer back to the Living Trust is needed or property will not be funded back to the trust.
  • Trustee passes away before the property is funded to the Living Trust.
  • Incomplete paper work that did not successfully complete title change.

Not sure about property(s) title or discover property(s) is not in your Living Trust?

  • Check your property tax statement. Does the title reflect the name of the Living Trust?
  • Review your Living Trust. Is your property(s) listed as an asset in the legal document? And, if property was purchased before your Living Trust was created, do you have the Transfer Deeds and Preliminary Change of Ownership Reports (PCOR) verifying property funded to the Living Trust?
  • Contact your estate-planning attorney ASAP for legal guidance to verify that property is funded as an asset in the Living Trust and next steps, if it is not.
  • California Residents ONLY – If you are a beneficiary and upon death of the trustmaker/trustee(s) discover property was not funded in the Living Trust, legal counsel might suggest filing a Heggstad Petition preventing costly and lengthy probate by proving trustmaker intent. A judge’s favorable ruling of the Heggstad Petition would allow property to be a covered asset in the Living Trust. California is the only state to offer a Heggstad Petition. The probate legal process of other states, from what I can discern simply from online research, is not as complicated, costly or time consuming as California and therefore something like a Heggstad Petition is considered not necessary.

Filing a Heggstad Petition

A Huge Change In Trust Funding Implications and Heggstad Petitions

While researching this topic about Living Trusts I discovered that when moving out of state, legal counsel should review your pre-existing Living Trust. Certain circumstances such as moving from a community property state to a common-law state may require revisions or a new Will/Living Trust and Health Directive(s) created in your current residential state. Community property states include; Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington and Wisconsin. Alaska is known as an opt-in community property state. Having moved out of California a few years ago, I’ll need to schedule a meeting with a local estate-planning lawyer!

“Finally, though a living trust you write while living in one state remains valid if you move to another, it’s a good idea to check with a lawyer familiar with the statutes of your new state to see whether the trust should be revised to account for differences in the law, especially if you’re moving from a community property state to a common-law state or vice-versa.” Living Trust, Chapter 5, American Bar Association, bottom of page 6

Whether you have a Living Trust and/or are beneficiaries in a family trust, to protect property assets and avoid probate check that all intended assets are funded and seek legal counsel if you have any doubts. Simple and proactive steps you take today will prevent unwanted surprises during those emotionally difficult times when a loved one passes away. A successful Living Trust depends on you to provide the care and attention it needs by being diligent and feeding (funding) assets into the trust when accumulated. If you want peace of mind, be this person!

Resources

How Much Does it Cost to Settle a Trust After the Trustmaker Dies? The Balance, by Julie Garber, Updated October 9, 2017

Living Trust, Chapter 5 American Bar Association About Living Trusts,The Denver Post, April 3, 2011

Do You Live In A Community Property Stateby Lisa C. Johnson, Esq.
Freelance writer

Planning For A Healthy New Year? READ those labels! – Published November 28, 2017

Approaching the New Year in just 6 weeks, this is the time many set healthy habit goals to prepare for the coming year. Often this includes exercise either at the gym, home or outdoors and better eating habits along with purchasing vitamins and supplements. Before you head out to fill your cabinet with bottles of tablets and packets, here are some facts you should know.

“Dietary Supplements can be beneficial to your health — but taking supplements can also involve health risks. The U.S. Food and Drug Administration (FDA) does not have the authority to review dietary supplement products for safety and effectiveness before they are marketed.” Food and Drug Administration

Vitamins and supplements can pose a danger and be toxic. PLEASE refer to your physician or a licensed certified nutritionist before taking any vitamins and supplements. The reason your friends, family members, coworkers and acquaintances might be taking certain supplements should not be your reason. If someone is trying to convince you to take or buy a supplement pack and discourages you from talking with your physician or nutritionist, this is a great reason to say NO, THANK YOU. Especially, be very careful taking supplement products that promote weight loss or are used to build muscle. A recent article in the Wall Street Journal, New Evidence for Critics of Weight-Loss and Sport Supplements warns about liver damage and states…

“Dietary supplements make lots of claims and consumers often believe them: The booming U.S. industry has grown from $9 billion in sales in 2007 to $15 billion this year, according to Euromonitor International, a market research firm. But a new study gives ammunition to critics of the supplements and their potential health risks. The study found two banned stimulants and two previously unknown and little-studied substances in six weight-loss and sports supplementssold in the U.S. The researchers defined “banned” as “ingredients for which the U.S. Food and Drug Administration had taken enforcement action to remove from dietary supplements prior to August 2016 (when the samples were purchased).”

Often, the vitamins you are already getting through food may be providing the essential vitamins you need. “But the combination of whole foods, supplements, and fortified foods raises safety concerns with experts. Eating fortified foods while also taking supplements can cause a person’s diet to exceed safe upper levels and potentially lead to a toxic buildup.” Webmd Only a physician and/or licensed certified nutritionist, often through the results of blood tests, can accurately discern what vitamins and minerals you might be lacking. Also, some supplements already contain vitamins other than the primary name listed on the label. It is very important you read the ingredient labels and small print before adding to your daily intake, to avoid duplicity. Here are a few examples.

I was taking ZINC as a supplement tablet. Then I started taking Ocuvite for eye health. I realized after reading the ingredient label, Ocuvite already has 40 mg of Zinc. I was exceeding Zinc daily recommendations and didn’t realize this for a few weeks. WebMD indicates the side effects of Zinc here.

Another situation came up where an individual I know began taking an IRON AID daily tablet. Within a week symptoms of delirium, rash, stomach issues suddenly came about. After reviewing all medications including supplements, discovered the IRON AID included 400 mcg of Folic Acid, which is not good when already taking a daily Folic Acid supplement of 1000 mcg. Toxic level of Folic Acid is noted at 1200 mcg daily and this individual was consuming 1400 mcg daily. Once taken off Folic Acid all symptoms disappeared within a week. Click here about Folic Acid and its side effects.

Below is a listing of common vitamins and toxic side effects possible (taken from the noted hyperlinked “article here” resources) when exceeding the recommended maximum amounts. New findings also suggest that the body doesn’t always flush out the excess of water-soluble vitamins. Therefore, even water-soluble vitamins pose a toxic risk when exceeding recommended amounts. In addition to these risks, taking vitamins/supplements may interfere with prescription medicine including over-the-counter blood thinners.

Almost 60,000 instances of vitamin toxicity are reported annually to US poison control centers. According to National Health and Nutrition Examination Survey (NHANES) data, in 2003–2006 33% of the United States population aged 1 year and older took a multivitamin supplement in a given month.  In a 2009 survey, 56% of US consumers said they take vitamins or supplements, with 44% saying they take them daily.   Vitamin Toxicity, December 21, 2016

Vitamin A – “Acute symptoms drowsiness – irritability, abdominal pain, nausea, vomiting, increased brain pressure. Chronic – blurry vision & changes, swelling and pain of bones, poor appetite, dizziness, nausea and vomiting, sensitivity to sunlight, dry rough skin, itchy peeling skin, cracked finger nails, cracked skin around mouth, mouth ulcers, yellow skin, hair loss, respiratory infection, confusion.” Article here.

Vitamin B Family

B1 – “Blue colored lips, chest pain, feeling short of breath; black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds, nausea, tight feeling in your throat, sweating, feeling warm, mild rash or itching, feeling restless, or tenderness or a hard lump where a thiamine injection was given.” Article here.

B2 – “Sun-induced eye damage, itching or numbing sensations, and orange-tinted urine.” Article here.

B6 – “Nerve damage, decreased sensation to touch, temperature, and vibration, loss of balance or coordination, numbness in your feet or around your mouth, clumsiness in your hands, or feeling tired, nausea, headache, drowsiness, mild numbness or tinkling.” Article here. 

B12 – “Restenosis (reoccurrence of narrowing of a blood vessel) after stent placement, high blood pressure, acne, rash, itchy or burning skin, pink or red skin discoloration, facial flushing, urine discoloration, numbness, nausea, difficulty swallowing, diarrhea, increase in blood volume and red blood cells, low potassium levels, gout flare-up.”    Article here.

Vitamin C – “Diarrhea nausea vomiting heartburn abdominal bloating and cramps headache insomnia kidney stones.” Article here.

Vitamin D – “Buildup of calcium in your blood (hypercalcemia), which can cause poor appetite, nausea and vomiting. Weakness, frequent urination and kidney problems also may occur.” Article here.

Vitamin E – “If you have a condition such as heart disease or diabetes, do not take doses of 400 IU/day or more. Some research suggests that high doses might increase the chance of death and possibly cause other serious side effects. The higher the dose, the greater the risk of serious side effects. There is some concern that vitamin E might increase the chance of having a serious stroke called hemorrhagic stroke, which is bleeding into the brain. Some research shows that taking vitamin E in doses of 300-800 IU each day might increase the chance of this kind of stroke by 22%. However, in contrast, vitamin E might decrease the chance of having a less severe stroke called an ischemic stroke.” Article here.

Iron – “Symptoms of an iron overdose include nausea, diarrhea, black stools, vomiting blood, a metallic taste in your mouth, stomach pain, fever and headache, which sometimes but not always occur within an hour of taking too many iron supplements. If you don’t get treatment, more severe overdose symptoms may include dizziness, chills, drowsiness, and pale or flushed skin, fast or weak pulse and low blood pressure.” Article here. 

Folic Acid – “Less serious side effects include digestive problems, nausea, loss of appetite, bloating, gas, a bitter or unpleasant taste in the mouth, sleep disturbances, depression, excessive excitement, irritability and a zinc deficiency. More severe signs include psychotic behavior, numbness or tingling, mouth pain, weakness, trouble concentrating, confusion, fatigue and even seizures. An allergic reaction to folic acid may cause wheezing, swelling of the face and throat or a skin rash.” Article here.

Magnesium – “Doses less than 350 mg daily are safe for most adults. When taken in very large amounts, magnesium is POSSIBLY UNSAFE. Large doses might cause too much magnesium to build up in the body, causing serious side effects including an irregular heartbeat, low blood pressure, confusion, slowed breathing, coma, and death.” Article here. 

Do older and inactive individuals require less vitamins? Well, this is not actually the case. As we grow older we tend to consume less calories, which means less food and therefore less vitamins from the foods we eat. This would indicate vitamin supplements may be needed. This article explains…Nutrition Over 70; A guide to Senior Dietary Needs. Published findings and talking with friends and family, however, ARE NOT to replace conversations about vitamins and supplements with a physician or their referral to a licensed and certified nutritionist.

There are no health risks when the body absorbs vitamins through a balanced diet of whole and natural foods. There is, however, a greater risk of toxicity from vitamins through dietary supplements and fortified foods. Best way to plan for the New Year…make an appointment with your General Practitioner, if you haven’t already. Discuss your physical fitness goals and review your everyday eating habits along with vitamin and supplement needs. AND, READ THOSE LABELS! Just because a bottle labels a certain vitamin doesn’t mean it doesn’t also contain other vitamins. Duplicity of vitamins can be toxic!

Additional Resources

What are the Most Toxic Vitamins? by LAURA KENNY

 

Color Your Communications! – Published October 31, 2017

A number of years ago I began managing my mother’s medical care. When I moved out-of-state in 2014, online communications with medical staff was an easy solution for healthcare management. Processing and managing prescriptions and vitamin supplements – far more challenging.  This published post shares a simple idea for managing prescriptions if you live miles away or in another state, yet continue to maintain responsibility for assisting parents, extended family members, or friends.

Whenever possible, the first suggestion is to participate in prescription mail order. This allows the patient (in many cases) to get a 90 day supply of ongoing prescriptions compared to a 30 day supply. Less ordering simplifies prescription management. Second, have a plan in place to monitor prescriptions running low as the care receiver may not always tell you prior to a dwindled down supply. This could include calendaring when to reorder and/or asking if the prescription/vitamin supplement is running low. Problems come into play when elderly vision is poor (even with glasses), which makes reading small print on glossy labels very difficult. If the care receiver has been diagnosed with low vision impairment, reading prescription and supplement labels is impossible. Often times my mom would call and request a refill but couldn’t read the name of the medication on the bottle. Asking for a reorder of the “large white pills” doesn’t suffice when most all the pills are white and size is subjective. This dilemma has led to color coding prescription and vitamin supplement bottles with stickers, using different shapes to accomodate many bottles.

Instructions for Color Coding

  1. Inventory prescriptions and supplements to determine quantity of bottles that require color coding.
  2. Purchase stickers, making sure the colors are distinguishable for the care receiver. Example – using both light pink and standard pink might be difficult to discern. Purchase different shape stickers, such as dots and stars, if working with many bottles. Although not shown in the blog photo, all prescriptions could be stars and the supplements could have color dots or vice-versa.
  3. It’s CRITICAL to place the color stickers on the BOTTOM of bottles because most bottle caps are universal. A serious problem could ensue if the wrong color coded cap got on prescription bottle.
  4. Create a color coded chart and be sure one copy is at the home of the care receiver. Keep a hard copy at your home for quick reference and distribute to others who might need this information, perhaps emailing as an attachment for recipients to save as a computer copy. This hyperlinked PDF, Prescriptions and Vitamins w.RX# – color coded,is an example of such a chart. Place the chart so it is visible in the care receivers home, serving a dual purpose to provide vital information in the event paramedics are called, for their quick emergency care response.

Refill Solution 

When medication or supplements are running low the care receiver simply calls you (texts or emails) and requests, “reorder the orange label” or “reorder the blue star”. When refill bottles arrive, if the care receiver is not able or you don’t reside locally to place color stickers on the bottles, have someone you trust do this for you. When visiting the care receiver it is always a good idea to check all medications and supplements to be sure the color stickers align with the color chart.

Managing healthcare for aging parents, family members, or friends has its challenges, especially when living at a distance. Workable and safe solutions can make life easier on everyone. Color your communications and see how this effective and efficient solution modifies your ability to be a dependable and trusting caregiver to those you love.

Resources

Amazon.com color stickers available:

 

 

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Patient Beware Update – Published October 23, 2017

This article is an update to the published blog, Patient Beware, posted on May 11, 2017 explaining the Medicare issues that arise when a patient is admitted to the hospital “under observation”.

“While under observation, patients can be liable for substantial hospital bills, and Medicare will not pay for subsequent nursing home care unless a person has spent three consecutive days in the hospital as an inpatient.” New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage

A new law came into affect this past March 2017, which requires WRITTEN notice by hospitals to patients admitted under observation for more than 24 hours.Medicare Outpatient Observation Notice (MOON)

“The new notice drafted by Medicare officials must be provided after the patient has received observation care for 24 hours and no later than 36 hours. Although there’s a space for patients or their representatives to sign it “to show you received and understand this notice,” the instructions for providers say signing is optional. By law, hospitals now must tell Medicare patients when care is ‘observation’ only – March 9, 2017.

The hyperlinked article above does a great job explaining the law and patient rights.

At the time a patient is admitted to a room, the patient and family member advocates have a right to know status; inpatient or observation and why. As noted above, written notice is legally required if the patient receives observation services beyond 24 hours.

A recent experience prompted this post writing because of confusion around whom to ask about admittance status and the appropriate words to use when asking. This is a true story. Patient identity is being protected.

After this law had been in affect for 5 months, an individual was hospitalized and admitted to the ER for chest pains in August 2017. Given a thorough check along with a number of tests, the ER doctor determined this person should be admitted. After assigned a room, a family member spoke with the attending nurse and asked, “Is admittance inpatient or under observation?” The nurse replied, inpatient. The question was asked again, to be certain, and the attending nurse this time replied, “I assure you, this patient has been admitted and given this room as an inpatient and not under observation.”

The following day the patient was discharged and the Patient Care Coordinator (PCC) requested papers to be signed. These papers noted, “admitted under observation”, and the patient could be liable for additional fees for medical exams, tests, x-rays, medications, etc., that may not be covered under Medicare because of observation status. The PCC could not disclose the $$$ amount of additional fees, if any, and stated that patient services received would be reviewed and fees determined by the hospital’s accounting department. Here is the problem. The attending nurse assured patient and family the prior day about inpatient status. Now patient and family member are preparing for discharge under observation and without knowledge of costs incurred. Unsettling for sure!

The family member questioned the PCC about this misunderstanding; however, the coordinator makes it clear that admittance according to hospital records was not “inpatient”. The PCC asks, “Did the nurse use the word patient or inpatient, because only the word inpatient refers to hospital admittance. Just saying patient refers to observation status.” When a family member is in the hospital with angst running high and nerves frayed, have we really come to that point of having to wordsmith conversations with hospital staff?? It appears so!

The PCC then states to the family member that the attending nurse was not the right person to ask about admittance status. The family member should have spoken with the doctor or the PCC and not nursing staff. Below are my two responses to this statement:

  1. If someone on staff assures you of admittance status, especially the attending nurse, what reason would you have to seek an answer from anyone else?
  2. It IS the responsibility of hospital management to advise/train employees to discern questions they can answer and questions that must be referred to appropriate hospital staff. This is NOT the responsibility of the patient and/or their family members.

Even though a law is in affect regarding required communication protocol when patients are admitted to the hospital, this doesn’t mean it will be followed. Patient and family members, therefore, need to be vigilant.

What you need to know

New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage discusses the legal requirement that patients be given verbal notification about their observation status followed by written notice using the Medicare form MOON if the patient is receiving such services exceeding 24 hours. MOON requires all hospitals (as of March 8, 2017) to also explain WHY the patient is receiving care under observation and not as inpatient, along with charges Medicare may not cover once the patient is discharged. The form is available in English – CMS-10611 MOON_v508 and SPANISH – CMS-10611 MOON Spanish_LARGEPRINTv508 . Also see MOON-FAQs, an informative document for review.

Anytime you (or a family member) are sent to the ER and referred to a hospital room, ask the hospital doctor or PCC about admittance status. Any other hospital staff may not be authorized or able to provide accurate information.

If you/family member are being held under observation, also ask those authorized; length of anticipated hospital stay, specifically why observation and not inpatient and additional costs, if any, that Medicare (or medical insurance) won’t cover. Even through the Moon Form is not required until observation status exceeds 24 hours, the patient has the right to know this information verbally at the time a hospital room is assigned.

“When patients are too sick to go home but not sick enough to be admitted, observation care gives doctors time to figure out what’s wrong. It is considered an outpatient service, like a doctor’s visit. Unless their care falls under a new Medicare bundled-payment category, observation patients pay a share of the cost of each test, treatment or other services.” By law, hospitals now must tell Medicare patients when care is ‘observation’ only– March 9, 2017. 

If already diagnosed at the ER, it would appear observation is not necessary. So, why wouldn’t the patient be admitted as an inpatient? Typically, only a doctor can explain this and request inpatient status for the patient. Speak to your doctor, especially if diagnosed at the ER with an anticipated stay greater than 24 hours. It appears patients most vulnerable to HUGE out of pocket expenses are those admitted under observation who require nursing rehab care when discharged. If you are hospitalized, suggest having a family member or trusted friend with you when asking these questions and signing any paperwork.

How did it end for the patient whose story is shared above? Discharged by the 24 hour mark. Did not require nursing home, rehab or assisted living services. The family member signed the discharge papers noting next to the signature, that the patient and family member were assured inpatient admittance, therefore, additional fees or charges, if any, resulting from observation status are not to be the patient’s responsibility. Thankfully, no additional fees were invoiced to the patient.

We don’t know what we don’t know until we experience it first hand or through the experience of others. The purpose of this blog is to SHARE information, especially on important issues that can negatively impact someone’s life. Be prepared and know about patient’s rights whether coverage is through Medicare or individual health care plans. What you learn now will save you time and money later, especially when spending quality patient time with family is your top priority. Let’s all be informed and share these posts with those you know – Patient Beware and Patient Beware Update.

Resources

  1. Medicare Outpatient Observation Notice (MOON)
  2. New Medicare Law to Notify Patients of Loophole in Nursing Home Coverage
  3. New Medicare Law To Notify Nursing Home Coverage NY TIMES …
  4. Are You In The Hospital Or Not? AARP 

 

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#3 Cultural Fit – Discovering Your Cultural Fit – Published October 3, 2017

Whether you are currently employed or a candidate job searching, it’s easy to fall into the trap of “just wanting a job and one that pays well”, as the primary goal. Making sure that the company cultural fit is a match for you, however, can be critical for your long-term career aspirations and success.

Today, companies look for skill and experience as well as how employees and candidates fit their company culture. When hiring, Cultural Fit Interview Questions by Workable.com, provides an excellent summary PDF for employers to understand cultural match. And, as this article notes, “Candidates also have a say in whether they’ll fit well with your company.” For this reason, applicants should understand the cultural fit that best meets their needs in order to thrive. Therefore, Cultural Fit Interview Questions is an effective tool for candidates, too. In addition, a list of questions are noted below for job seekers, whether currently employed and feel as if you are swimming in static waters or for those unemployed and actively interviewing; workforce veteran or college grad. After working through the lists, job seekers will hopefully come away with a good grasp about corporate culture, style and fit.

Once you have concluded the personality of the company and how they “roll”, make a decision if the company is a match for you and stick with it. Not every item on your list will be checked, so know where you are willing to make compromises. Make sure you are comfortable with your future team and your direct report is excited to have you on-board. Anything less is a red flag!

How should you respond if a job is offered and you are filled with uncertainty and you notice red flags? Bring up your concerns. How much of your concern is angst and how many apprehensions are valid, which hopefully can be worked through? Having said this, I know someone who had a number of concerns joining a company based on a level of discomfort and red flags. After discussing these concerns with a few employees, this individual was assured worries were unfounded. But, the executive director’s excitement did not appear to be authentic. The job lasted 29 days. Like a marriage, people show their best before the “ceremony” and any quirks become magnified after the honeymoon is over. Every situation is different and I share this story because the last thing anyone wants… a job that requires constantly having to look over the shoulder sensing that “something” is just not right! This then becomes a working environment not conducive to success, blocking the ability for anyone to thrive; the employee, team, department and company.

If you are employed and suddenly terminated without explanation and specifics, other than being told “not a cultural fit”, there can be an overwhelming feeling of injustice and mistreatment leading to suspicion of unlawful termination. At this point there might not be an opportunity to filter through work emails and forward accolades to your personal email. You could be immediately cutoff from the company server if working from home or escorted out of the office by security. It’s in the best interest of every employee to FORWARD emails to a personal account and SAVE all positive correspondence and performance reviews. Journaling direct report meetings and conversations is a good idea, as well. To pursue legal steps you may need all relevant documentation to prove unlawful termination.

How to identify corporate personal bias? Suspicion happens most often when the culture of a company is not documented and executive leadership can’t explain why someone is not a cultural fit, either passed up for hire or an employee is terminated suddenly. “It is an incredibly vague term and it’s a vague term often based on gut instinct,” says Wharton management professor Katherine Klein, Vice Dean of the Wharton Social Impact Initiative. “The biggest problem is that while we invoke cultural fit as a reason to hire someone, it is far more common to use it to not hire someone.  People can’t tell you what aspect of the culture they are worried about.” Is Cultural Fit a Qualification for Hiring or a Disguise for Bias? 

An employee wrongfully terminated can independently seek legal counsel or file a complaint with the U.S. Equal Employment Opportunity Commission. This would especially be necessary if you believe termination may come under any one of the federal protected classes.

Employers can and should use cultural fit as an effective means of bridging diversity with the values and beliefs needed to successfully achieve corporate vision. As an employee, the steps you take to determine cultural fit in an organization is equally your responsibility as it is the company hiring. This all becomes tricky when companies loosely wave this term around without having a documented description of “corporate culture” defined along with its connection to strategic business goals. Hopefully, by properly understanding the term cultural fit, employers and employees can reduce the risk of personal bias and discriminatory masking. Be proactive as a corporation and define your corporate culture! As a potential or existing employee, know your cultural fit!

Discover Your Cultural Fit – Questions

Describe your ideal job. What qualities do you need to flourish?

Describe the ideal company for you.  

  • Industry/field
  • Large, medium, small?
  • Start up company?
  • Company ramping up growth?
  • Well-established and structured company?
  • Specific company names? (Although these companies may not be hiring, you can use the names noted to gauge similar companies.)

Describe your successful working habits?

  • Alone and focused
  • Team player and interactive
  • Structured
  • Entrepreneurial spirit

Describe your ideal working environment?

  • Location (big city, suburban campus, or, work remotely from home)
  • Quiet and subdued
  • Busy, interactive, and not quiet
  • Offices and/or cubicles
  • Open concept with desks
  • Work remotely from home, always or part time

How does the working environment feel to you?

  • Upbeat, energetic, loud
  • Serious and quite
  • Stressful
  • People interacting or primarily working alone?
  • Open or closed office doors?
  • Do you feel like your input would be valued and respected?

Prepare For The Interview

  • Be prepared. Know in advance how you might be interviewed. Internet search and find articles describing current interview trends. Below are two articles about interviews where the term “cultural fit” is used.

Three Ways to Know if An Employee Is A Cultural Fit? By Jeff Pruitt, Chairman and CEO, Tallwave, published INC.com, How To Hire The Best,

Cultural Fit Interview Questions by Workable.com

Interview Questions To Ask The Interviewee

Describe the ideal candidate for this job?

  • Education
  • Skill
  • Experience
  • Personality
  • Works independently or part of a team?

Describe the culture of your organization?

  • Describe an employee(s) who you feel is a great cultural fit and why you feel this way?
  • If a candidate or employee is not a cultural fit, what three traits would bring you to this conclusion?

What traits or working habits do you feel would not be a good cultural fit for this position?

  • If this question cannot be answered directly and adequately in the interview process, and you notice a wide gap differential when comparing yourself and the current employees of the firm, this may not be the company for you.

“The only way that culture in the workplace is effective is if there are sets of values that help the company achieve its strategy,” Barsade notes. “When there is thoughtfulness around what the values are and you tie that to hiring, then you have best hiring practices.” Is Cultural Fit a Qualification for Hiring or a Disguise for Bias? Knowledge@Wharton, Management

Are performance reviews conducted, and if so, how often?

  • Is cultural fit a part of the job interview?

Is it possible for this job to move into other promotable positions? Or, are you looking to fill this position as a steady long-term role?

  • Is this position replacing someone who resigned or one who has been promoted?

Resources

Cultural Fit Interview Questions by Workable.com
Is Cultural Fit a Qualification for Hiring or a Disguise for Bias? Knowledge@Wharton, Management, July 16, 2015
Three Ways to Know if An Employee Is A Cultural Fit? By Jeff Pruitt, Chairman and CEO, Tallwave, published INC.com, How To Hire The Best, August 12, 2016
U.S. Equal Employment Opportunity Commission –  Filing a Complaint
U.S. Equal Employment Opportunity Commission – Protected Classes 

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#2 Cultural Fit, The Rise of Cultural Fit and the Decline of Performance Reviews – How to protect against personal bias? – Published September 26, 2017 

Conducting research to write this post, I feel it is ironic that the rise of “cultural fit” appears to move at a similar rate to the decline of job performance reviews. This trend could make it easier to hire and terminate “at will”  based on personal bias.

At one time performance reviews were the norm, and, perhaps in some companies this method of employee evaluation still exists. An article in HBR, November 2016 issue, Let’s Not Kill Performance Evaluations Yetnotes that by the end of 2015, 30 Fortune 500 companies eliminated performance reviews. Below is a quote from this article, which defines performance and the benefit of evaluations.

“Performance is the value of employees’ contributions to the organization over time. And that value needs to be assessed in some way. Decisions about pay and promotions have to be made. As researchers pointed out in a recent debate in Industrial and Organizational Psychology, “Performance is always rated in some manner.” If you don’t have formal evaluations, the ratings will be hidden in a black box.”

Job evaluations provide employees and corporate leaders the opportunity to gauge achievements based on mutually agreed to expectations. Sometimes performance is easy to measure and other times it can be more difficult when tangible results are not as obvious. Cultural fit is one of those intangible results that could be hard to measure and more subjective rather than objective. Clearly defining “organizational culture” and communicating this verbally and in writing leads to the effective use of the term, cultural fit, and how it supports corporate vision. Only then can employee reviews effectively include discussions about homogenizing with “fit” along with suggested modifications, if any. One would think including cultural fit as part of an employee evaluation is time well spent considering the costly investment of hiring, training, pay and benefits.

“Once the company culture has been defined, ideally every action, strategy, decision and communication should support the cultural beliefs, including all HR mechanisms from recruitment and hiring processes to performance review systems.” How Important Is Culture Fit For Employee Retention

When culture isn’t clearly defined, termination (or not being hired) could be perceived as a decision based on personal bias which may include non-compliance with the Federal protected classes. And, it’s possible one might conclude the decision was based on having different political opinions or lacking common (recreational) interests.

“And I’ve observed this.  Some executives I’ve dealt with over the past few years have used the phrase “not a cultural fit” in exactly this negative, let’s-maintain-the-status-quo way; to mean “that person is too black/female/old/young/non-degreed/linear/non-linear”…in other words, “that person is not enough like me.” Is Cultural Fit Just a new Way To Discriminate

We are experiencing a political polar divide today, which may be impacting working environment morale, affecting people functioning in close proximity sharing different viewpoints. It appears for this reason political views, personal and religious convictions might be on an invisible checklist for determining cultural fit. These reasons are not justifiable to measure a candidate’s potential or current employee(s) ability to succeed. Cultural fit should include performance, team member contribution, thriving as a team player, shares corporate vision, well qualified in skill, experience and communications. And, it is indeed possible to hire based on such qualifcations, without bias, reflecting richness of diversity.  In the article, How Important Is Culture Fit For Employee Retention, the author, a former Navy Seal, writes…

“That’s not to say that all SEALs are cut from the same mold. We have an extremely high level of diversity. Which brings me to an important point. Culture fit doesn’t mean that an organization is recruiting the same kind of people with the same backgrounds and experiences. Or at least they shouldn’t be.”

Here are possible considerations to safeguard against personal bias.

  • Clearly communicate company culture during the interview process as well as in employee handbooks, corporate mission statement and anytime the strategy of the company and its goals are shared. Identifying “culture” should include diversity of thought, perception, and experiences.

“Inclusive leaders understand that personal and organizational biases narrow their field of vision and preclude them from making objective decisions. They exert considerable effort to identify their own biases and learn ways to prevent them from influencing talent decisions. They also seek to implement policies, processes, and structures to prevent organizational biases from stifling diversity and inclusion. Without such measures, inclusive leaders understand that their natural inclination could lead them toward self-cloning, and that operating in today’s business environment requires a different approach.” 6 Characteristics of Inclusive Leaders

  • Schedule outcome focused performance evaluations. Include company culture in the review and note “fit” expectations to the business strategic model the company is pursuing for its success. The focus of the review to be on business skills, performance to goals, and style of communication/engagement with staff and customers (if applicable), which aligns with the description of corporate culture and fit. A signed copy to be kept by both manager and employee.

Keep performance review standards simple and consistent throughout the company. Managers and employees might avoid complicated reviews.

If your company practices informal “coaching” rather than management style reviews, keep record of discussions and suggestions that support performance and cultural fit – employee and manager.

“The future of the workplace depends on how successful these companies become at building out new systems that incorporate frequent feedback, open communication, and coaching.” Why The Annual Performance Review Is Going Extinct 

“High turnover or lengthy open positions? Could there be a “bias” hiring the best when hiring managers perceiving “best” as a threat to their own corporate status?”  3 Unconscious Biases That Affect Whether You Get Hired

Short term employment and sudden termination is costly to corporations. Consider the expense for employee search, interviews and hiring process, training, pay and benefits. Now imagine the cost of resulting lawsuits if sudden termination is not backed by documented performance and “cultural fit” is not defined and/or termination is linked to the protected classes? Can companies then become vulnerable to litigation? “Well, sometimes it’s whatever a hiring manager wants it to mean. And that can be a big issue, leading to poor hiring decisions fraught with bias or even legal liability.” Hiring For Company Culture, Here’s What You Should Know,

Just because litigation resulting from “cultural fit” may not have happened, doesn’t mean it won’t. Imagine the increase to corporate bottom lines if employee turnover and the risk of lawsuits could be avoided? If you are a C-Level Exec reading this post, do you know the $$$ your company spent on employee turnover in the past year, two years, 5 years? How does your HR Department view “cultural fit” and what is their active role to standardize hiring and termination throughout all subcultures in the company?

One would think having a diverse corporate culture best represents the customer/consumer/client audience being served. A diverse workforce can anticipate and strategize how best to meet needs and purchasing habits of ALL people, across the spectrum. So, why limit success through the narrow “cloning” lens that could accompany “cultural fit” misuse?

“Curiosity and openness are hallmarks of inclusive leaders, who hunger for other perspectives to minimize their blind spots and improve their decision-making.” WSJ Article, 6 Characteristics of Inclusive Leaders

Bring performance evaluations back or identify effective “coaching” processes and its documentation. Include cultural fit in the employee review AFTER your firm has defined culture, which is understood throughout the organization; hiring process, employee handbook, communications where corporate vision and strategy is discussed. Hire and maintain a workplace representing a wide audience of views and styles to cover all blind spots. Protect against personal bias. Create a healthy work environment, which role models the effective use of cultural fit in a dynamic way because diversity and success work in tandem.

Resources

Is Cultural Fit Just a new Way To Discriminate, FORBES, by Erika Anderson, March 17, 2015
Let’s Not Kill Performance Evaluations Yet, HBR, by Lori Goler, Janelle Gale, Adam Grant , Nov. 2016
6 Characteristics of Inclusive Leaders WJS, by Bernadette Dillon, director, and Juliet Bourke, partner, Human Capital Consulting, Deloitte Australia, May 4, 2016
How Important Is Culture Fit For Employee Retention By Brent Gleeson, March 29, 2017
Why The Annual Performance Review Is Going Extinct by Kris Duggan is CEO and Cofounder of BetterWorks, October 20, 2015UL 6, 2017
Hiring for Cultural Fit? Here’s What You Should Know, Nick Misener July 6, 2017,
3 Unconscious Biases That Affect Whether You Get Hired , Shana Lebowitz July 17, 2015

“Where, after all, do universal human rights begin? In small places, close to home. So close and so small that they cannot be seen on any maps of the world. Yet they are the world of the individual persons; the neighborhood they live in; the school or college they attend; the factory, farm, or office where they work. Such are the places where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere.”  Eleanor Roosevelt Former First Land and U.S. Delegate to the United Nations

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#1 Cultural Fit – Definition, Origin, Intention, and Misuse – Published September 19, 2017

Since my last posting on August 5th, I have been researching this catchall phrase after knowing several individuals dismissed from their jobs for not being a “cultural fit”. In order to share a summary of pertinent details, this topic will be covered in a three part blog, noted below. This posting covers Cultural Fit – Definition, Origin, Intention and Misuse. The other topics will follow weekly, September 26th and October 3rd, respectively.

  1. Cultural Fit – Definition, Origin, Intention, and Misuse
  2. The Rise of Cultural Fit and Decline of Performance Reviews – How to protect against personal bias?
  3. Discovering Your Cultural Fit

The goal of this trilogy is to inspire QUESTIONS employers could be asking in order to determine how “cultural fit” is being used in their organization today and changes to implement, based on any misuse of this term. Hopefully this writing will also reveal toxic “sub-cultures” within the organization when hiring practices are not aligned with corporate standards. Employees and job candidates, after reading this 3 part series, can be equipped to ask the right questions to determine their own culture match, too.  If a company is hiring based on cultural fit, we can suppose they very well can fire “at will” lacking in cultural fit, without notice or explanation.

Cultural Fit – It’s History, Intention, and Misuse Today

Definition: Cultural Fit – How it should be defined and practiced

Blending within a harmonized working environment for optimum productivity and performance results.

Understanding and expressing corporate identity, mission, vision and strategy with “how we roll“, sharing similar business core values and communication styles at the pace/rhythm set by corporate leaders, directors and managers – consistent at all levels of the organization.

Origin/History

First there had to be an identification of “corporate culture” before there could be the term “cultural fit”. The first recorded study of Organizational Culture was in 1961 by Burns and Stalker, identifying with a dependable constant system of shared beliefs that could bring positive results. Through the years, 1961 through 1992, many leading names in this field joined the discussion, which included behavioral studies of individual personalities, shared beliefs, and performance, along with conducting research to measure effectiveness of grouping in the workplace. All of this led to the corporate culture movement. Resource: On the Origin and Evolution of Corporate Culture by Eric Van den Steen, pages 7-8.

This is an excellent study that digs deep into the origin of corporate culture and probabilities (or not) of cultural fit correlating to increased performance.

“After this partial validation, I draw one important new insight from the model. I show in particular that there will be a correlation between cultural strength and performance, even when the homogeneity of beliefs has no direct impact on performance. This casts some doubt on the culture-based literature that cites such correlations as proofs that culture is valuable and then goes on to explain why it is valuable. While my analysis does not imply that homogeneity is not valuable, it suggests that care must be taken when interpreting such correlations.” Page 19

Intention

The history of organizational culture is complicated and includes psychological and behavioral studies and analysis. The intention of cultural fit, however, is quite simple…bringing skilled employees together with similar working personalities and styles in order to create a thriving working environment that will increase productivity and performance aligned with corporate vision and strategy.

This idea began in the 1980’s and caught on with gusto in early 2000. Simple examples of “culture fit” that align with corporate strategy could be hiring extroverts for fast pace growth or seeking introverts to align with company strategy for study, analysis, then growth. Another example might be to employ those who are risk takers or perhaps, looking to hire deep thinkers whose decision making is the result of study, discussion, and consensus.

Misuse

Cultural fit is a catchall phrase commonly referred to today. I can’t help but wonder how many use this term and do not know anything about its history, intended use, or studies conducted, which reveal its overall effectiveness or ineffectiveness. The following are some of the ways cultural fit is being misused today.

  1. Hiring managers and HR not able to define/articulate their own corporate culture yet hire and fire by the term, cultural fit.
    • Corporate culture description is not noted in the company’s mission statement, corporate vision, websites, and employee handbook or discussed during the interview process.
  2. Cultural fit becomes a filter for personal shared interests, political, and religious persuasion. This term can be used as a mask to avoid compliance to the Federal Equal Employment Opportunity Laws (EEO) which prohibits discriminating in hiring, firing or pay based on a person’s race, color, religion, sex, national origin, age, disability, genetic information, including sexual harassment.
  3. Firing employees for not being a “cultural fit” with no specific reason(s) or comparison to corporate culture. Vague responses are given … “a number of general areas, not one specific area.” Yet, the employee meets all MBO’s, aligns with corporate vision and strategy and thrives with co-workers.
    • This is when suspicion surfaces, based on (2) above.

How do you know if this term is being misused at your workplace? The following are some red flags.

  1. Confusing “Cultural Fit” with expected submission to authoritative “control” leadership.
  2. High employee turnover within some divisions, groups within departments.
  3. Unexpected and sudden employee termination(s).
  4. Referred candidates (outstanding skills and reputation) are quickly eliminated from the interview process, “not a cultural fit.”
  5. Unrealistic lengthy openings of job recs.
  6. No annual or bi-annual employee performance reviews therefore cultural fit becomes the norm for employment and job performance is not considered.
  7. Low workplace morale.
  8. Unwillingness of staff/employees to speak up due to fear of open and honest communication that may not “clone” executive team views.
  9. Interview focuses heavily on personal topics rather than corporate mission, vision and candidate’s business experience.

Corporate culture could be a good thing when it is used in tandem with job performance and it is clearly defined, understood and shared through all levels of the organization. Cultural fit becomes negative when used as a mask; a toxic working environment, compliance to federal discriminatory classes, and blocks hiring those with diverse business skills and experiences who don’t clone with a specific manager or department head.

As a corporate leader, do you know how your hiring Directors and Managers are using the term, “cultural fit”? How is the HR department establishing a standard for the proper use of this catchall phrase? Are red flags being ignored? If “cultural fit” is misused, although most states allow “at-will employment”, could your company still be vulnerable to costly lawsuits?

As an employee are you experiencing red flags? Is workplace morale low? Do you feel your ability to thrive is stunted when your “voice” is forced into silence because of fear? Are you aware of the process for reporting discriminatory practices and do you feel comfortable doing so without the fear of termination?

If you are a job candidate, take the conversation about cultural fit seriously. Ask during the interview, “Specifically, what are looking for to hire one candidate over another? If the answer is “cultural fit”, follow up with this question…”Can you describe your corporate culture and the ideal fit?” If this question is not adequately answered, do you feel it’s the right company for you? What is the risk you assume if offered the job and you accept?

Asking questions is a great place to start for companies to protect themselves and employees and candidates to protect their future. What is your plan, to protect your company as an employer or to protect yourself as an employee? It’s time we all consider cultural fit and its intended use.

Resources

On the Origin and Evolution of Corporate Culture by Eric Van den Steen, April 7, 2003
Guess Who Doesn’t Fit In At Work?  New York Times, Lauren A. Rivera, May 30, 2015
Culture Fit in the Workplace: What It Is and Why It’s Important by Dr. Kerry Schofield , published 2017
Hiring for Cultural Fit? Here’s What to Look For– Business News Daily, By Shannon Gausepohl,  Feb 27, 2017
The End Of Culture Fit Forbes, by 
Recruiting for Cultural Fit by Katie Bouton, July 17, 2015
Is Cultural Fit Just A New Way to Discriminate? By Erika Andersen, March 17, 2015
What is Organizational Culture – the results of a survey totaling 300 responses on the varied perceptions of “culture” – HBR, Michael D. Watkins, May 15, 2013
Is Rejecting A Candidate Because They Are Not a Culture Fit Really Just Thinley Veiled Discrimination? Quora, Gayle Lakkmann McDowell, April 3, 2014

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Cultural Fit (in the workplace) – Published August 5, 2017

In the past 6 months a few individuals within our circle of professional relationships have suddenly been let go from their jobs for this reason…”you are not a cultural fit.” At the time of hire the culture of the organization was not defined. Although the individuals excelled at their jobs and shared the same corporate vision and passion for the mission of the company, specific reasons for not “fitting in” to the company culture were not provided by the direct report or HR.

Concerned about what appears to be a new employment policy direction for corporate America, I recently skimmed the surface, doing some online research. Discovered this “practice” is far more prevalent than I had imagined, leaving me with the following unanswered questions.

  1. When did “cultural fit” first become a corporate hiring/firing practice and is this term being used today as it originally may have been intended?
  2. Could this “catchall” phrase be a mask to avoid compliance to the Federal Equal Employment Opportunity Laws (EEO), which prohibits discriminating in hiring, firing or pay based on a person’s race, color, religion, sex, national origin, age, disability, genetic information, including sexual harassment? (Resource HERE)
  3. Our country is experiencing a political polar divide between liberals and conservatives. Is it possible “cultural fit” includes filtering based on political allegiance?

It will take committed time to peel away the layers surrounding “cultural fit” in order to see the bigger picture and perhaps the vulnerability and risk to BOTH employees and corporations. For this reason, I’m taking time off from blogging to pursue this assignment and will return September 19, 2017.

I am grateful for the incredible response to my blog, Modify, since it began April 22, 2017. Thank you for your support, replying with comments and being an awesome audience to the articles shared. The blog WILL continue September 19, 2017. While I’m working on “Cultural Fit… In The Workplace”, I encourage you to share your feedback with me:

  • Have you (or someone you know) been fired or not hired because of cultural fit? Was cultural fit clearly defined through either the hiring or firing process? Can you share the experience with me?
  • Share your comments, if any, about how I might improve Modify and/or topics to consider for publication when I return mid-September, which fall within the Modify menu categories.

Thank you!! You can share your stories/feedback through email by clicking HERE.

Gratefully,

Debra

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This image cannot be reproduced or shared without written artist consent. Artwork by Jessica Kardish

What Would You Do? – Published August 1, 2017

It’s been a week since I had an uncomfortable experience at our local supermarket. It’s still bothering me.

Last week, picking up a few quick items at our local grocery store, I stepped into the shortest line. There was a young mom with her child, about 3 years old, checking out. Next in line was a mature woman, probably around late 70’s and I was in line behind her.

It didn’t take long to notice the mature woman rolling her eyes, taping her hands on the counter, deep breathing with long sighs. At this point my eyes went past her to the young mom and it was then I noticed she was using coupons for her grocery purchase. It was obvious this mom was aware of the elderly woman’s behavior and appeared uncomfortable.

One would think the elderly woman may have been late for an appointment or feeling rushed for someplace she wished to be? After the young mom left with the child, the woman took plenty of time to engage in conversation with the cashier, no longer in a hurry to get checked. She began questioning why a grocery store would carry clothing and if there were any significant sales of such. She laughed and continued to press the cashier, who simply said, “People do purchase clothes here.” He then ignored any further condescending questions.

This experience is still bothering me because I didn’t say ANYTHING! Should I have said something? People have the right to be who they are BUT when it affects others, which her attitude appeared to affect the young mom and her behavior affected me, then I believe silence only condones, representing approval.

I have allowed this experience to be a source of agitation. Using the Internet as a resource, searched what to do when people are rude? Came across this informative article titled, “5 Polite Ways to Disarm Rude People”, Psychology Today, which explains the difference between rudeness and bullying. Since I was a bystander to the incident and the young mom chose to ignore the woman, it was best not to say anything and let it go. And, the woman’s conversation with the cashier was with him and not with me. Therefore, it was best that I remain silent and follow the response of the cashier…ignore her. If the woman’s actions were towards me, directly, then I could choose how to respond. As indicated in the hyperlinked article, always consider the circumstance.

When is a response necessary? When the behavior becomes bullying, a response is appropriate. The image on this blog, shared with permission, is by an amazing 16-year- old artist, Jessica. The artist rendition powerfully illustrates the results of bullying through facial expression and words, which create the image itself. Depression, sorrow, pain, hurt, alone, hell, rejection, anxiety, broken, represent but a few from the image, the harsh reality of bullying when intervention is necessary. Although we often perceive bullying to only afflict school age children it also occurs among adults, in all age groups. I personally have observed such behavior by grown men and women, especially on sport fields as well as the workplace.

Whether witnessing rudeness and bullying in public, on any sports field, in the workplace, or wherever such behavior takes place, be prepared in how you might respond. This blog post as well as “5 Polite Ways to Disarm Rude People”, provides food for thought in order to make wise decisions; not respond, when to approach a person(s) directly and when to seek and speak to those in authority. So, what would you do?

Love is patient and kind. Love is not jealous or boastful or proud or rude. It does not demand its own way. It is not irritable, and it keeps no record of being wronged. It does not rejoice about injustice but rejoices whenever the truth wins out. Love never gives up, never loses faith, is always hopeful, and endures through every circumstance.

1 Corinthians 13:4-7 The Bible, New Living Translation

 

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A Renter’s Tug-of-War – Published July 15, 2017

Whether you are renting a summer vacation home, looking to rent an apartment/home, or a college student excited about dorm life, this blog provides wise suggestions to protect yourself.

It wasn’t that long ago our son was excited about heading off to college with his two good friends. The three young men were accepted to the same university and shared a large dorm room that first year. Of course, being excited parents, all met to help the boys move in. We noticed the room by far was not perfect. Existing carpet damage, stains, tile issues in the bathroom, damaged desk drawer, some marked walls – were all visible. Overall, it was dorm room standard. Although the boys went through the check- in process with the Resident Assistant (RA), only two broken data ports were noted. Fast forward to the end of the year, and after a good walk-through with the RA, we received a bill totaling $258 for dorm room damages that were pre-existing. Fortunately we had a copy of the signed Room Condition Form (RCF), but it took 17 emails to get the unwarranted charges removed.

Throughout college living and apartment renting, the concern over pre-existing damages and security deposit reimbursement continues to be a struggle regardless of location. The following is a suggested checklist before moving in and out of any rental. It is quite easy today to take precautions when cell phones are camera ready and mobile phone journal apps (I use Day One) easily voice record and date summaries and lists. Being diligent and taking these extra steps to verify pertinent information can save you money, time, and frustration.

  1. CREATE an email folder labeled RENT (or whatever you want to call it).
  2. ALWAYS request a walk-through before moving into any rental, including dorm rooms.
  3. ASK before renting, what is expected at the time of move out (carpet cleaning, professional cleaners, etc), in writing, and ask about the walk- through process at that time. You don’t want to discover before moving out that you are expected to paint the space, clean the carpets and have professional cleaners.
  4. BE DILIGENT to note any existing damage or imperfections throughout, including bathrooms and kitchens.
  5. REVIEW the document to be sure any and all pre-existing issues are noted and take photos of all flaws and damages. Email these photos to yourself and save in your email designated folder. FYI…emails are dated which validates about the time photos were taken. Cell cameras do not date photos, that I am aware of, other than organized and stored by date in iPhoto.
  6. SAVE a paper copy of the signed document, in a place you will remember, that verifies the existing condition of the space.
  7. PHOTO the document with your cell phone, email it to yourself, and save in email RENT folder.
  8. REPORT immediately by email (so you have written record) any other flaws or damage you notice after moving in. Save in RENT folder.
  9. ALWAYS before moving out, request a walk-through. (We, and others we know, have experienced being declined by designated managers saying it wasn’t necessary. Then, surprise, we don’t get the security deposit refunded.)
  10. REQUEST the walk-through document, signed, before handing over the keys.
  11. TAKE PHOTOS of the living space BEFORE you leave. This is important!! Even through you have a clear walk- through report; you could still get hit with charges. Then it’s your word against theirs. Photos are also a great way to cover yourself if, because of timing, you are out of the living space and the walk-through never happens.

A quick Internet search brings up many possible reasons why college students are assessed extra dorm fees and people feel security deposits are not returned, which seems to happen most often in large apartment complexes managed by corporate property management firms. Knowing about the walk-through process before moving in and out, having signed documentation about the living space condition with photos all filed for easy access, can be a proactive way to protect yourself. Enjoy your summer vacation away, apartment/home rental or dorm room experience with peace of mind. A tug of war between renters’ word and theirs might be someone else’s struggle, but it won’t be yours!

 

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Processed with MOLDIV

Hidden Danger – Published July 11, 2017

This past Saturday at 7AM, going through the garage to retrieve the morning paper, the activity of bears in our neighborhood was the only need for caution on my mind. A few minutes later I became aware of a far more serious hidden danger that took me by surprise.

The door leading to the mudroom didn’t even have a chance to close when my garage door DROPPED and the lift system bracket arm was sliding towards the operation box!! Our home just turned 3 years old so I couldn’t imagine that the lift system already had issues. Thankfully, instead of calling the garage door company (contact info label on the door), I called the authorized dealer for LiftMaster, One Clear Choice Garage Doors. They were awesome and had someone to our home by 9AM.

This is the problem and the hidden danger that was explained to me. A number of garage door companies (contracting with new homebuilders) are installing a less expensive bracket arm that cannot adequately accommodate the weight of 2 car garage doors. And, instead of firmly installed lift arms, using a steel bracket securely bolted down the center of the door, the lightweight arms are directly bolted to pressed wood. To make matters worse, our previous bracket arm had 4 bolt slots but only 2 shallow bolts were used. Every time our garage door opened and closed the vibration loosened the bolts until Saturday, when the arm popped off and the door gave way.

Almost always, I drive my car into garage while the door is still going up. And, often times I scoot into the garage while the door is opening or closing. Imagine, how this situation may not have ended well if the door fell while I (on anyone else) was driving into the garage or walking in or out in the direct path of a lift arm fail!!

Whether you have a fairly new home or an older one, check to be sure the bracket arm is adequate for the weight of your garage door and securely fastened. The photo on this blog shows before and after pictures. You can clearly see there are only two shallow and loose bolt holes when the incident took place. We contacted our builder and received an immediate response with assurance they would contact the garage door company who installed our door.

I’m sharing this story because of the hidden danger that could impact your life, forever. A failed bracket arm could be fatal to you, your children, pets and guests visiting your home. If you are not sure about the safety of your door, call your local garage door service company. After reliving what could have been, and although fixed, I’ll schedule garage door maintenance every few years and I’ll wait until the door is completely up or down before walking or driving in/out of the garage. You might consider doing the same. This hidden danger is completely avoidable now that I know, what I know, and you do as well. Be safe!!

Healthy and Confident…Eating with Celiac Disease – Published June 22, 2017

Grateful for all the support received on Tuesday’s posting, Medical Mayhem. The popularity of the article led to this writing, how to eat Gluten-Free (GF). If you are in pain and bloated after eating, I find ice cubes or popsicles help the discomfort along with taking Gas-X. Chamomile tea soothes once the pain begins to subside. Some people experience intense pain leading to an ER visit. Gluten reactions differ so best to have a conversation about symptom management with your physician.

Dining Out & Travel

I’ve received numerous responses about challenges dining at restaurants. Strongly feel that the “gluten-free trend” has hurt more than helped those who suffer from Celiac Disease and gluten sensitivity. We have become confused with a trending population on the receiving end of eye rolling and TV satire humor, too!! How can you rise above this response when dining out?

Gluten-Free restaurant cards are available. Attached is one I have had for many years, PDF document Celiac Disease Medical Alert Cards that prints on business card stock. Mentioning “food allergy” for some reason triggers a higher level of seriousness with restaurants rather than saying “gluten-free”. When ordering you can state to the waiter “Gluten-Free for medical reasons” and hand the waiter this card, or, simply say, “Gluten-Free Food Allergy”. DO CHECK when your meal or that of your GF child is brought to the table. This past Saturday while dining out, after clearly indicating Gluten-Free for medical reasons, my salmon dinner was served with orzo on the plate!! Orzo (often used alone or in rice pilaf) is gluten/wheat pasta not rice.

GF bread is not always available at deli counters or restaurants. Sometimes I’ll bring my own bread in a plastic baggie. FYI…a Deli will put everything on a plate for you to assemble your own sandwich.

Below is a listing of online resources (hyperlinked), which includes another option for GF cards and information available in many languages to use when traveling. I have found Europe to be far more GF accommodating than the USA. The European symbol for gluten-free is known as the cross grain symbol, shown on the blog photo.

Gluten-Free at Home

What about cooking and baking at home? Being GF offers a great opportunity to cut back on carbs. At one time my diet was carb focused, but it isn’t now and I have become accustomed to this lifestyle. Below, however, is a listing of my favorite cereal, crackers and breads. Most listed are available at major grocery chains, Target, and Wal-Mart.

Breads

  • Glutino (usually in grocery store freezer)
  • B-Free Wheat & Gluten-Free (non-GMO)
  • Chebe (awesome pizza crust)
  • Canyon Bakehouse Gluten-Free Breads (awesome rye and cinnamon raisin!!)
  • Barilla Gluten-Free Pasta (BEST!!!)

Baking Breads, Cakes, and Cookies

Flour – Pamela’s All-Purpose Gluten Free Flour or Cup-4-Cup. (Already contains Xanthium gum – binding agent).

Any of your favorite baking recipes can be followed. Consider using ½ to 1 cup less flour and check the consistency of the batter or dough before adding the remaining flour, as needed. Also suggest adding one teaspoon of baking powder to the recipe to lighten the density of gluten-free breads and cakes. Practice recipes until you are happy with the result. Baking at different altitudes makes a difference so I always feel the need to tweak the amount of flour at high altitude.

Pillsbury and Betty Crocker offer great cake mixes. Check my blog Flavor Your Summer, using extracts and flavorings to add a twist of exciting flavor to your cake and cookie mixes.

Bread machine with a GF setting makes amazing bread! The machine I use at home is Zojirushi BB-PAC20.

FYI…anything pickled (including pickles!) contains gluten. Imitation crab also contains gluten and is found almost always in sushi at grocery stores and restaurants. Ditto with soy sauce. Be careful. Sometimes foods we would never consider to have gluten…DO! When purchasing vitamins (including fish oil!) check for the GF certified label. You can be mindful of meeting daily vitamin requirements through the foods you eat.

Eating Gluten-Free for Celiac Disease or gluten sensitivity is far easier now than ever before. It is important, because of GF popularity, to take the lead and distinguish yourself from the trending masses by making meal prep requests clear to your restaurant waiter when dining out or host when eating at someone’s home. Consider using available GF instruction cards if you feel comfortable doing so, and check the meal when it’s served. Look for the certified GF label when grocery shopping or use a phone app to scan bar codes for GF status and GF accommodating restaurants. Gluten – Free Living is an excellent resource for current Celiac Disease news and gluten-free eating. The world isn’t over if you have a Celiac Disease diagnosis! A simple internet search brings up numerous sites about this autoimmune disease. A new world of many opportunities is yours to explore for healthy eating and confident living!

 

 

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Medical Mayhem! – Published June 20, 2017

In 2004 I was diagnosed with Celiac Disease after struggling with digestive system issues that began when I was 13 years old. At 42 years old my weight had plummeted to103 lbs standing at 5’4.75”. Many thought I was hiding an eating disorder, before and after diagnosis. Already feeling physically and emotional horrible, having to carry any label was an unnecessary burden. This disease is very real and the symptoms, varied and inconsistent, making it hard to diagnose. At the time the Gluten Free diet was discussed with me, I was positive for 17 out of 19 symptoms. Slowly through the year that followed, symptoms began to disappear and my weight changed from 103 lbs to 115 lbs.

In 2004 anything gluten-free (GF) was hard to find. GF breads tasted like cardboard. Pasta noodles dissolved as they were cooking. GF options have certainly come a long way since then! In fact, being GF has become trendy. This is both good news and not so good news for those with Celiac Disease or gluten sensitivity. Good news… food companies have an incentive to produce best tasting GF products to compete and meet demand. Not good news… because trendy GF means Celiac Disease patients can easily be grouped with the trending masses. Often I’ve been told, including occasionally at restaurants, it’s just a little gluten, pick out the croutons in a salad, or miniscule amounts of gluten in a vitamin capsule is OK. But, it really is not OK if the gluten triggers a medical condition. The cost of contamination, especially in young children, can have serious medical repercussions. Those who have the autoimmune disease or gluten sensitivity, any gluten (even the smallest amount) can trigger horrific symptoms that can last for days. Symptoms can include stomach pain and swelling, headaches, itchy rashes, inner mouth sores, depression, chronic fatigue and diarrhea, to name a few. So, although I am thrilled amazing breads, pastas and other GF products are available today, it’s important that I take responsibility to be sure that what I am eating is truly free of gluten. A few years ago when I first moved from California, I had a local Chiropractor encourage me to purchase Fish Oil being promoted and sold by the practice. Knowing I had Celiac Disease, this individual assured me that it was gluten free. A month later, feeling poorly with a steady increase of all symptoms, I pulled the bottle and read the finest of print. First ingredient in the Fish Oil…WHEAT! Lesson – always do my own thorough checking.

Suggestions for any medical mayhem…

  1. If your symptoms are chronic, your not feeling heard, and your not getting better, always get a second opinion.
  2. Use web resources to know what questions to ask your physician BUT not to self-diagnose.
  3. Don’t swap dietary restrictions for unhealthy alternatives. Example, gluten free diets loaded with sugar and fat to make up for the gluten free difference, doesn’t end well.
  4. Stay informed! Once diagnosed, whether it’s Celiac Disease or any other medical condition, ask your physician about conferences and resources and stay current.
    • After being diagnosed, I attended a number of conferences by Dr. Peter Green. Outstanding resource! LINK 
  5. Balanced living means giving yourself permission to have solo downtime, especially when struggling with a chronic medical condition that can leave you easily fatigued.

Medical mayhem resulting from any medical diagnosis is almost always a result of not feeling in control of body changes and symptoms, not being heard, and overwhelmed by having to make sudden lifestyle changes. Be confidant and ask those questions that are on your mind, do online research to know additional questions to ask (BUT not for self – diagnosis), and seek qualified resources that offer professional guidance, conferences and support groups to help you through. You can do it!!

My Favorite Celiac Disease Resources

Celiac Disease (Revised and Updated Edition): A Hidden Epidemic Hardcover – January 26, 2010 by Peter H.R., M.D. Green (Author), Rory Jones  (Author)

Celiac Disease Center, Columbia University Website

 

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When Life Feels Like an Inferno – Published June 3, 2017

On Wednesday, May 31st, while driving with friends, we noticed a narrow stream of light grey smoke coming from a vehicle near the center divide of the highway. Within seconds it became an inferno. We were traveling not too far behind, just two lanes over. Cars slowed and some stopped. First thought…whoever is in that truck hopefully made it out. Second thought…how do we get off this road? Third thought…what if the vehicle explodes? We will be impacted. At that moment realized no one had any control of what could happen next. The best we could do is to stay positive and work our SUV towards the furthest right lane to exit the freeway. The truck was carrying diesel fuel and oil. Liquid was pouring on the asphalt, spreading to the other lanes. Cars were cooperating with each other to encourage a steady flow of movement towards the nearest exit, as emergency vehicles were notified and had yet to arrive.

This experience has been consistent with life lessons I’ve had throughout the year about loosening the grip on control because often in life we really don’t have any. This is especially true in circumstances, which is well beyond any personal responsibility however direct impact and repercussions are deeply felt. This blog is about “control” and accepting our lack of and moving forward in spite of it. Any unexpected and shocking news become “infernos” in our life when the initial auto-response is…”I can’t believe this is happening” and there is uncertainty about the end result. Here are my 3 simple take-a-ways, which I hope you find helpful as well.

  • Be calm is something I have had to learn over the years, which will always be a work in progress. Calm opens the mind and heart and leads to options. It enables mental flexibility that leaves room for God’s wisdom to step in, bringing a feeling of AWE as if personally protected by God. Staying calm also challenges the mind to see past the obvious to consider what lies below the surface, which is especially true in relationships. Panic, the opposite of calm, is like a closed and locked door where the rigidness that comes with this emotion is paralyzing, leading to twisted truths and false conclusions.
  • Be focused on what needs to be done and move forward with your conviction. Proverbs 4:25 “Let your eyes look directly ahead and let your gaze be fixed straight in front of you.” To remain focused, be cautious of any temptation to opinion surf or seek consensus. Once your focus is set, protect it and follow it. This is where HOPE is found and solutions are visible…looking forward. Any and all distractions, including emotional ones, keep us running but most likely not getting anywhere.
  • Be kind to yourself, being patient as you work through the predicament, establish boundaries with others to receive the space you need to process and be kind to others who may also be working through the same situation or could be providing needed help or are innocent bystanders. Regardless of circumstances, when we seek the best for others as well as ourselves, we receive good results and generous blessings. But, the antithesis to “be kind” doesn’t end well for anyone.

Is the past forgotten? No. When past difficulties provide positive lessons and inspiration for the future, they should be remembered and shared. Difficult circumstances are encouraging if we can freely move forward with confidence, strength and a solid life lesson in our pocket. But when past reflections prompt bitterness, a need for justice, angst and fear, even best efforts with these chains will lead to discouragement, depression, and failure. It’s not healthy to bury a past laced with negative emotions. If this is the case, it is important to get professional counseling because healing is the only way to prevent repressed buildup that locks in negative emotions stifling joyful living.

It’s a miracle the accident on Wednesday, May 31st, had no fatalities. The driver is hospitalized with leg burns after a brave construction worker pulled him away from the burning truck. Cars slowly and carefully exited the freeway, our SUV included, just as emergency vehicle sirens were heard approaching the scene. And then, multiple explosions took place. Traffic was horrific for the remainder of the day, but horns didn’t blow. Instead, throughout, there was an atmosphere of calm, focus and kindness that will be remembered always. It’s not a matter of “if” and more a matter of “when” unexpected life infernos take place. It’s best to be prepared…Be Calm, Be Focused, and Be Kind. Set realistic expectations because progress is more important than perfection!

“God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” Serenity Prayer, Reinhold Niebuhr

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Must Have “Unexpected” Plan – Published May 30, 2017

Creating a checklist of pertinent information for our adult son, should anything suddenly happen to my husband and/or me, has been on my TO DO list for some time. Yesterday I was motivated to complete this task after reading about a friend’s adult (18 years old+) child who suddenly became gravely ill and could no longer make medical or life decisions. A court release for temporary conservatorship was necessary in order for the parents to make decisions on her behalf. “Because of HIPAA and confidentiality laws, it locks you out of being able to take care of things that you need to for a loved one.” WOW! This triggered two questions; is our 24 year old son prepared to make decisions for us and are we prepared to make decisions for him, if needed?

Well, we have our ducks “somewhat” in order, which is not good enough. Our son is not aware of everything he will need to do in an emergency or where to locate our government documentation and other information. He does nothave an Advance Medical Directive. If my husband and I want to be involved in his best care, since he doesn’t yet have a married significant other, he will need his own directive. Here is a HIPAA Release and Authorization form LINK. Each state may differ in Medical/Healthcare Directives. You can internet search “your state name” Healthcare Directive – AARP for the pdf. Everplans, website suggested below, has a wealth of information about these directives and a form search by state, LINK. Kaiser Permanente has the directive available on their website for the state in which you live. This Kaiser LINK is the one for California, as an example. Where to keep Advance Medical Directives is another great resource, LINK. All of this information is not a substitute for professional legal guidance. Until our son is married, it’s also wise that we have a complete list of his internet, financial and credit accounts including logins/passwords, should the unexpected happen. You might consider the same for single adults in your family.

You may be organized with all this information and have shared with those who are appointed with power of attorney, executorship, and administration. If not, attached Must Have _Unexpected_ Plan is a general list to help you get started. Suggest all information be kept organized in a binder, stored in a secured place. The attached checklist can be the binder Table of Contents. Check off what has been accomplished. Add to the list, where needed. Government offices for your state and county will need to be identified to customize your listing. My husband and I do have important documents along with recorded information, hardcopy and memory stick, in a protected location. After compiling the attached list, however, realize there is much more work to be done!!

If you enjoy online resources, I found Everplans to be a well thought-out and organized website. You might want to check it out (LINK). Click on Resources & Guides (LINK) for a comprehensive category listing without requiring a login account. Whether you use the attached listing Must Have _Unexpected_ Plan, Everplans, or other resource, let your family or trusted and appointed person(s) know.

Taking inventory to plan for the unexpected is difficult and time consuming. These discussions are hard but necessary. Dealing with loss is stressful enough and anything to make the process easier offers peace of mind and benefits everyone!

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Be Prepared! Protect Yourself From Being Hit Twice!! – Published May 23, 2017

No one wants to be in a car accident and we don’t get a “heads up” before one actually happens. The best way to protect yourself is to know what to do and hopefully you are fortunate enough to make it out of the car. Not all insurance companies have best business practices. It is, therefore, especially important that steps are followed and your rights known so you are not misguided, which could cost you thousands of $$$ out of your own pocket.

Friday, Feb 27, 2015 was the day we received a call from our adult son that he was in a car accident. Another vehicle went through a red light. If timing had been slightly different by seconds, he would have had a direct T-bone hit to his vehicle and may not have been able to get out of his car or make a phone call. His first accident, shaken up and needing guidance, he asked, “What do I do??”

Internet search “auto accident checklist” for access to guidelines provided by your car insurance company. We have Amica and you can click this LINK to view their checklist. Keep the checklist along with a working pen and small note pad in the glove compartment at all times. Cell phones are camera ready and you do want to take pictures before any vehicle is moved. Especially for young first time drivers, review guidelines and steps at the time your teenagers get their driver’s license. Being naive can easily be taken advantage.

In higher crime areas police may not come out for car accident calls, especially if there are no apparent injuries. In this case, it is best to still file a police report at the closest police station.

Call your insurance company while at the scene of the accident. They will want to know the other party name, address, drivers license number, car license plate number, insurance carrier and your report of what happened. This is critical. If you don’t have the means to write down information, take a picture with your cell phone of all pertinent info that can easily be sent by email to your insurance company. Ideally, both insurance companies work together to determine accident liability and to confirm coverage for the insured. If a vehicle is “totaled” and cannot be driven, it will be towed to the nearest collision lot or vehicle body shop. This is where the insurance company who confirms liability will send a claims adjuster to review and assess damage to determine if repairable or totaled and should be done within a few days.

Our experience was quite different than what is described above and if it happened to us, it could happen to you. Here is a quick summary:

  • We had to facilitate and manage communications between insurance companies, proactively expediting as neither insurance company was taking a lead for resolution.
  • Although the other party’s insurance company finally assumed liability on March 12th, they didn’t send a claims adjuster to the collision lot until March 23, writing a settlement letter to us the same day.
  • In the meantime, during this waiting period since the accident on February 27th, the insurance company requested our son REMOVE the car from the collision lot. WARNING – NEVER do this. Once you move the car before the responsible insurance company inspects damage, you have just tampered with evidence, taken ownership, and may have assumed all financial responsibility. This pressure we experienced does not reflect BEST BUSINESS PRACTICES. We were grateful that the owner of the collision lot offered wise counsel.
  • When the settlement was finally offered March 23rd, the other party’s insurance company claimed we were responsible for salvage retention and the collision lot fees of $50 per day because we refused to move the vehicle to another location. Exact wording… “Your son abandoned the vehicle at the body shop and made no attempt to move it to a storage free location. For this reason you are liable to pay the salvage retention fee of $1,000 and all fees incurred on the lot since the vehicle was towed there on February 27th.”  WOW!! And, WRONG!! Once the insurance company assumed liability (March 12th) the vehicle became theirs. And, they are the ones who allowed the car to sit on the lot by delaying claims adjuster inspection until March 23rd .
  • The other party’s insurance company refused to budge on their settlement or lack of. On the evening of March 25th, online, we submitted a complaint to the California Department of Insurance, California Insurance Commissioner as well as the State of California Department of Justice, Attorney General’s Office. Thankfully, we keep meticulous notes including date and time of every phone conversation and emails saved. By 9:30 AM on March 26th, we received a phone call that there was a misunderstanding and the other party’s insurance company offered a full settlement,  including responsibility for the $1,000 salvage fees and $50 per day lot fees that they would settle directly with the collision lot.

What is the message of this life lesson to you?

  • Keep in the glove compartment, your insurance company’s auto accident checklist along with a pen and notepad ready for writing down information.
  • The telephone number of your insurance agent should also be in your cell phone directory and consider a pic of an accident checklist in your photo file, just in case you can’t get to your glove compartment.
  • If you don’t feel that your insurance company is working on your behalf, complain. You pay good $$$ for insurance and you deserve their full attention and assistance, even if the other party is at fault. We changed our insurance company after this accident.
  • Keep copious notes. Date and time every phone conversation and keep an “accident” file of all emails.
  • NEVER remove a vehicle from any lot after an accident until liability has been determined, a claims adjuster has written the report, (which you have received and reviewed), a settlement has been agreed to, and car removal clearance given as well as vehicle ownership at this point, concluded.
  • All of the above should be reviewed with first time drivers.
  • If you are feeling stuck, file a complaint with your state Department of Insurance, Insurance Commissioner’s Office as well as the state’s Attorney General. The online complaint feature is simple. The turnaround is quick!!

It’s difficult to plan for circumstances that we hope will never happen. Being prepared, however, is your best protection from being hit twice;  impact of the collision and the financial shock if you’re not reimbursed for damages incurred.

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Patient Beware! – Published May 10, 2017

There will come a time, if this hasn’t happened already, when you or a loved one will be in the hospital either unexpectedly or for a scheduled procedure. The following shares important information you might want to know that could save you thousands of dollars. This blog will use my grandmother as an example of the challenges we faced during a stressful time, specifically dealing with Medicare coverage. Some of the information, however, could also apply to private healthcare insurance. Best to be informed, know the facts and be prepared to ask wise questions of your healthcare provider/insurance company.  What is scary…not knowing what you don’t know.

January 2015 my grandmother who was quite active, physically strong and mentally sharp at 99 years old, was found non-responsive at her home. She was diagnosed with a severe stroke shortly after being admitted to the ER. In a coma, doctors revealed to the family she could pass anytime within 2 weeks. We were quite surprised to receive a call the following morning from the hospital saying her discharge is being prepared for that day, either to the family or to a skilled nursing home if a bed is available. It was quickly determined a bed was not available. We were not equipped or qualified to handle the care my grandmother required if sent home. Three days of phone calls, fact-finding, and speaking with an independent patient advocate gave us the information we needed so my grandmother could remain in the hospital for her final days.

  • Everyone has the right to 24 hours notice before they are discharged from the hospital.[1]
  • Patients must be admitted as an inpatient (not under outpatient observation) and stay 3 hospital days, before qualifying for certain Medicare benefits such as skilled nursing homes for rehab and other needed care. A patient may be responsible for the entire incurred cost of a skilled nursing home if this requirement is not met.
  • A new law in effect August of 2016[2] requires that hospital/care facilities must notify patients of observation status if not inpatient admittance. Prior to this date, those assumed inpatient (receiving same care) after discharge discover their stay was classified as outpatient/observation status, incurring financial responsibility for needed skilled nursing or rehab facilities!![3] Ouch!!!
  • Under what condition is a patient put “under observation”? Observation services are hospital outpatient services that a physician orders to allow for monitoring, testing and/or medical evaluation. This occurs when a person initially arrives at a hospital and a diagnosis cannot be readily determined because of medical uncertainty or after the completion of an outpatient scheduled procedure. Outpatient observation days do not apply towards the 3-day inpatient minimum Medicare requires before being eligible for skilled nursing coverage.[4]

My grandmother was eventually given a room.  But, we later discovered she was admitted under observation and not inpatient. This didn’t make sense because she was already diagnosed and her prognosis determined. What is there to observe? When we shared this “observation concern” and brought up patient rights of 24 hours notice before being released, we were told this law didn’t apply because she wasn’t admitted as inpatient. It appeared there was a rush to discharge her within 24 hours to avoid inpatient status and for the family to assume the coverage for a skilled nursing facility. “Medicare generally pays hospitals flat rates based on the type of medical problem being treated. If the hospital spends less money on your care than Medicare pays, it makes money, and vice versa.” Challenging Hospital Discharge Decisions by CANHR. The full article is noted under footnote (1.)

After unsuccessfully speaking with many levels of hospital patient care; I connected with an independent patient advocacy group suggesting I contact skilled nursing facilities on my own. Often when patients or their families are told beds are not available, there is a vacancy or one coming available the next day. The very first call made to a skilled nursing home (a few miles from the hospital), a bed was indeed available. Ideally, it is best to visit nursing homes to check the quality of care and the cleanliness of the facility you want. Nursing homes cannot be reserved in advance of hospital discharge. So, when the time comes for a skilled nursing facility, immediately make calls to the ones you prefer and speak to their Administrator. Be the coordinator between nursing home and Hospital Patient Care Coordinator.

My grandmother never made it to a skilled nursing home. The hospital eventually did admit her as inpatient. After days of continuous struggle not to move her to another location, she passed away on day 9. Medicare and supplemental insurance covered all costs. We are grateful that she had family by her side throughout and my mom and I were holding her as her last breath with us became her first breath in Heaven.

Know your patient rights. Even if you don’t qualify for Medicare now, be informed of the facts to protect the elderly in your family who depend on wise guidance and care. The Medicare PDF document Are You In A Hospital Inpatient or Outpatient? (footnote 4) is an outstanding summary resource. Identify well-rated rehab facilities and skilled nursing homes before you need them. Although some of the footnote resources cover California, many of these laws could be the same in all states. Be proactive and find out about patient rights in your state. Seek to know what you may not know and make life simple.

[1] Challenging Hospital Discharge Decisions by CANHR 

[2] New Medicare Law To Notify Nursing Home Coverage NY TIMES … 

[3] Are You In The Hospital Or Not? AARP 

[4] Are You In A Hospital Inpatient or Outpatient? Revised May 2014

Recommend Book: Get What’s Yours for Medicare by Philip Moeller (Excellent book!) When You’re In The Hospital But Not Really – pages 67-68 Understanding Your Emergency And Expedited Rights – page 165

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Thriving Relationships – Published May 2, 2017

Relationship struggles can direct us towards healing and transformation when our hearts are open to honest self-assessment.

It has been almost 20 years since my family life became so fragmented that I didn’t think our marriage would survive. At that time, truly, I believed myself to be the best wife and mother: leading, encouraging, and selflessly providing love and support. After a year of prayer, a group marriage program and inner reflection, I began to acknowledge I wasn’t considering the needs of my husband or son (6 years old).

Boundaries keep relationships healthy. I didn’t have any. If there was an opportunity to work or help outside the home, I took it. If there was an opportunity for my son to “experience” something new, I arranged it. My life focused on meeting everyone’s needs and expectations except considering those that mattered most – my husband, son, and often my own. Operating at full speed my goal was to fulfill far too many commitments, perhaps to impress others with all that was being juggled to achieve a feeling of success and importance through busyness. I was actively involved in five church ministries, school fundraiser, women’s bible study outside church, while undergoing a home remodel. Our son participated in all seasonal sports. He also joined golf, karate (3 times a week year round), Boy Scouts, weekly church children’s program and school activities. Simply not enough hours in a day to do it all. I believed we had to be fully engaged to live up to a culturally expected active family life (fallacy!), especially if our “well-rounded” 6-year-old had a chance of getting into a good college. (Really!???) And, it was eating away at our marriage and family life together. When my husband shared his feelings that we do not have the “thriving” marriage or family life he expected, I was shocked, not aware of any issues or problems. The choice came down to divorce or we proactively discuss our family needs, agree on priorities and establish boundaries. It was a long year but eventually the steps we took paved the way for +20 awesome years together and hopefully many, many, more to enjoy.

It was during this struggling time my neighbor shared the following principle, which, is one that continues to direct our priorities today:

Person in Christ; Partner to my Spouse; Parent to my Child; Public Servant (all else)

This principle led to family meetings at predetermined times, so that we could be prepared and well rested. Honestly communicating needs and expectations became the primary goal and the following questions (answer to prayer!) facilitated our time together. And, yes, we most definitely included our 6-year-old son.

  1. What I love about you…
  2. What bother’s me most…
  3. If I can suggest a change, this is what it would be…(best to limit one suggestion per meeting)

Discussing these questions with each other took place three times per year for about two years, graduating to New Year’s Eve annual reviews. Responses were recorded and reviewed at each subsequent meeting to celebrate progress.

The result of proactively taking control saved our marriage with a drastically reduced weekly schedule! Our son chose three activities and admitted that all else on his calendar he never really enjoyed. (He is now a 3rd year medical student and doing just fine!!) I narrowed my commitments and exchanged my focus for quality time with my husband and son. Together, we launched Sunday family golf at the course where we played. Healthy balance was beginning to feel great!

Our wedding vows were renewed Summer of 2000. The picture on this blog reflects that precious day celebrating with family and friends. Proverbs 3:5-6 became my scripture verse – Trust in the Lord with all your heart; lean not on your own understanding, in all ways acknowledge HIM and he will make your paths straight. He did. The Lord made our paths straight and we said, “I DO” again.

There will always be life struggles. Prioritizing needs and consulting with each other while holding steadfast to faith has been our saving grace. I do believe our habits today are our children’s habits tomorrow. Growing up our son was fortunate to experience this process and to understand the importance of boundaries. Someday, he could implement similar meetings with his own family. Any relationship that is struggling can benefit by this life lesson. Begin with an honest assessment of yourself. Then, initiate open communications with positive expectations for the simple life you need and thriving relationships you desire!

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Processed with MOLDIV

Appliance Beware – Published April 29, 2017

At one time most all serial numbers were typically etched in metal. You may have noticed, especially on appliances, this is no longer the case. Serial numbers are inked stamped or printed on labels. PROBLEM!!

We moved into our newly built home May 2014. I didn’t pay attention to “labels” on our major appliances. The one used most frequently is the microwave convection oven with an awesome speed cook feature. This unit is cleaned often because we use it often. Within the first 2 years we had to place a few service calls. On the 3rd service call a 3rd party company was assigned to our home. He looked at our unit and said, “Can’t fix your appliance. The serial number on your label is no longer legible. You will have to purchase a new unit.” WHAT???

It took a week of phone calls to the manufacturer for a resolution. Seriously, we are not the ones responsible for switching from a metal etched serial number to a cheap label! It did not matter that we had extended warranty or operation manuals with the serial number. The number MUST be on the unit, on the label, as delivered when installed. Finally, we were issued a new label with the same serial number, which, apparently they never do.

Solution: At the time of any big-ticket item purchase, locate the serial number. If it is printed on a label, cover it with clear DUCK tape to ensure the serial number is protected and always legible. You might first call the manufacturer to make sure it is OK to cover the serial number with clear tape to protect print clarity and legibility long term. NEVER pull off the tape, because if you do, the serial label will be removed and you’ll be shopping for a replacement, in this case an appliance.

Safeguarding your appliance serial number is for your protection. If you purchase used or refurbished appliances be sure to check that the serial and model number on the product are intact and legitimate before purchasing. This article by Fox News 2014 explains…http://kdvr.com/2014/11/10/used-appliance-alert-missing-model-and-serial-numbers-could-be-big-problem/.

Make your life simple and take product serial numbers seriously!!