home spaces

Modify Your Style

Home-décor and remodeling temptations are everywhere! My husband and I have become obsessed with HGTV!! Aired shows that are repeats discourage us far more than they should! New home building also appears to be popping up everywhere in our area. Walking through model homes has become a favorite pastime, checking-out floor plans and design styles. Recently, on a beautiful Sunday afternoon, my husband and I decided to visit new home developments. Entering the first model, we both gasped! Although we have enjoyed transitional rather than contemporary style, we were wowed at every turn walking through two of the model homes. PROBLEM…we love this contemporary look. Since our home is only 4 years old, a complete remodel is not going to happen. We can, however, incorporate similar features with simple modifications. Whatever your décor style, if you are planning to update, this blog offers sensible and affordable suggestions that can help you modify for the look that you want.

You might consider hiring a professional interior designer if planning large scale changes and/or trying to incorporate two home décor styles. If you have family antiques, a professional can offer advice on how these treasures can best work with the look you are hoping to achieve.

Current Home Trends 2018

Below is a list of some trends for 2018. Since trends change, I prefer using décor pillows, area rugs, blanket throws, bedding, home accessories, and creating an accent wall in order to keep current… simple and affordable.

  • Jewel Tones
  • Matte Finishes – clean and modern look. Black is a big color.
  • Metals – Matte Brass and Gold with fixtures, stools, home accessories, etc. What if I have brushed nickel and chrome?? Paint it.
  • Large scale prints (floral, tropical, contemporary) pillows and drapery, recovering ottomans and upholstered chair seats.
  • Collections that are special to you. Display!


Our home style is transitional and we are looking to add additional contemporary touches. The model home photos above were taken when we visited the Infinity Prato Collection . Shopping this weekend, we found wall tile (below) that could workfullsizeoutput_4c40 to border our existing fireplace and install as kitchen counter backsplash. This would represent a fairly simple modification at a reasonable cost for clean simple lines, similar to the inspiration photos. We recently moved some accessories around and changed-out a table lamp for a contemporary one. Simple changes! Before we start the tile project, however, we will meet with an interior designer. A second opinion is always best before $$$ are spent.

Finding Your Home Style

Even when consulting with an interior designer, it is best to know what feels comfortable to you. fullsizeoutput_4c42There is no right or wrong style. There is, however, a perfect style supporting the feel and functionality of the person/family residing in that space and the scale and balance that brings everything together. The image to your left illustrates most common home décor themes. Perhaps you already know your style. What products are available (wall color, art, furniture, decor accessories, etc) to reflect your style? At Houzz.com, when clicking the left menu bar, you’ll see Shop By Style for every room and product category. Another great resource is The SPRUCE, sharing design update tips. The Spruce shares four primary home styles, Casual, Formal, Contemporary, Traditional. The Spruce – Four Main Styles of a Home. Once you determine a style you want to incorporate in your home, you’re ready for next steps to make it happen without, hopefully, the need of a costly remodel.

Small Changes with Big Impact

Below are suggestions to update your home, considering small changes for big impact. If planning to work with a professional, be ready with a list of products/options that you like as a starting point for discussion. When purchasing online, check shipping costs and return policies.

“Pay attention to these four words, and you’ll end up with a space that looks as good as those rooms featured in the glossy home magazines. The four magic words when it comes to decorating are color, pattern, texture, and shine.” Decorating With Color, Pattern, Texture and Shine, The Spruce

How to choose an accent wall? When you first walk into a room, which wall do you notice first?

  • Fabrics make a difference whether through color, pattern or texture. Reupholster furniture and/or replace furniture and drapery in complimentary style fabrics. Purchase décor pillows, bedding, blanket throws, and bathroom and kitchen décor towels, selecting fabrics (color and texture) to give a room character.

“What are the keys to imprinting your personal style to create instant character? We’ve enlisted three clever interiors experts to provide some design inspiration.” Tricks of the Trade, Elle Decor

If you can’t envision color, furniture, or accessories in your space, a new feature in the Houzz app could help. Houzz’s 3D feature for iPhone and iPad enables you to place items in your room and turn them around to any angle. The Houzz app, updated with this new feature for iOS, is available to download on the Apple App Store℠.

  • Lighting can be replaced such as ceiling fixtures, floor and table lamps, and/or add under-cabinet lighting. I have had great experience ordering through LightingDirect.com, quality and price. Anthropology offers unique lighting products.
  • Accent area rugs updated for a new look. My favorite in quality and investment is by Jaunty, ordered through an interior designer. Pottery Barn has a great collection. And, for a great bargain and selection…overstock.com. I have rugs in my home from all three of these sources.
  • Mirrors create a refreshing change in any room. A good selection at great prices can be found through; Home Goods, Hobby Lobby, Overstock, Hayneedle, and West Elm.
  • Art Work represents those updates that can make a big impact, from wall art to canvas prints. Resources and ideas…

Wall Art: Z Gallery, Tuesday Morning, Amazon.com, Overstock.com, Home Goods, or find unique art through local estate sales – EstateSales.Net App and Next Door.

Enlarge your own memories/photos, framing or ordering canvas art through  Canvas on Demand, Costco Photo Center, Snap Fish, Shutterfly, or your own favorite photo sources you have used in the past. Reframe what you already have displayed by using trending frame options.

Paint Color Tips

  • Warm colors on the color wheel makes a space appear smaller, pulling the eye towards a wall.
  • Cool colors make small rooms appear larger, pulling the eye away from the wall. 1558522-warm_cool_color_wheel
  • Another option…designate the ceiling as an accent wall; cool colors make ceilings appear higher and warm colors make a ceiling feel lower and the room cozy. Wallpapering a ceiling for a dramatic effect was recently shared at a Home Design seminar I attended.
  • Sunny rooms, consider cool colors and rooms that don’t get much do best using warm colors.
  • Search paint colors suggested for specific home décor themes at Houzz.com and The Spruce.
  • Internet search décor pillows in your selected style for popular colors and print trends, inspiring your imagination. Here are a few hyperlinked examples: ContemporaryCountry, Eclectic, Rustic.
  • Try different paint colors, virtually, through Sherwin Color Snap Visualizer or Houzz.com Virtual Paint A Room. You can upload photos of rooms/accent walls you want to paint and see the results with the colors you choose. Lowes Valspar Paint does an awesome job with selected color theme palettes…Trending Paint Colors & Pallettes. Four paint colors are pre-selected for each theme. LOVE THIS! And, click this hyperlink for Valspar Paint Visualizer.
  • Purchase paint samples and color test different areas of the room/wall to consider natural lighting. The color will appear different based on the amount of or lack of natural light. Live with the color for a few days.

Your home should feel comfortable to you and reflect your style. It’s OK to consider input from friends and family, yet, guard from being swayed to preferences that reflect the taste of others and not your own. Changing from one home décor theme to another might be easier then you think. Visit new construction model homes, watch the design shows on TV, visit websites such as Houzz.com and The Spruce, purchase home design magazines, save furniture store catalogs, and get ideas from retail store showrooms, seeking that feel good style. At retail stores snap a few photos of your favorite showroom displays, with permission from store staff. Consult with an interior designer, if needed, to lead your home transformation or for a second opinion. At the end of summer I’ll post my before and after photos. I invite you to share your home updates, too, with Modify readers and me! If you invite someone over who says, “looks nice but not my style”, be assured you did a great job creating a home reflecting “style and comfort” to those who live there!!


All resources referred are hyperlinked in each category noted throughout the blog article.


Keep Walking… positive choices in challenging times



A year ago, an unexpected job loss led to a stressful time. It’s that season in life when you sit back and wonder, “what just happened??” And, proclaim, “Oh my gosh! We simply can’t make this stuff up!” There is a saying…”we can’t control the actions of others but we can control how we respond.” It takes quite a while for this statement to make sense when a sudden string of storms blow through and all you want to do is hide for cover. It was at this time my husband said, “Deb, go write. You have been talking about starting a blog. This is the time. You need a positive distraction and a channel to share experiences.” At that very moment I went to my computer, researched best blogs, signed up with WordPress and began designing Modify…make life simple. I wrote from my heart and included categories representing different experiences, which brought inspiration and balance to my own life and hopefully…to others as well.  It has been one year since I began blogging. I’m grateful to WordPress and to all who have been and continue to be readers of Modify! You helped me heal. Thank you!!

To celebrate Modify’s first anniversary, feel it timely to write about positive choices in difficult times. Life is not meant to be problem free. My Christian faith is based on the belief that we live in a fallen world, which does not exempt some people from life challenges while others suffer inflictions. Everyone, at different seasons of life, will struggle. Trials might look different, but they are still trials; unexpected unemployment, serious health issues, martial uncertainty, relationship(s) strife, financial hardships, and loss of loved ones. This post shares what I found to be most helpful identifying positive choices in difficult times through spiritual faith, acceptance and truth, forgiveness and hope.

Spiritual FAITH

When life suddenly shifts as a result of unforeseen negative events…do not sit idle in stagnant waters. No one will join you there and eventually, feeling isolated in toxic waters will sicken you. When feeling overwhelmed, for me personally, praying and having others pray encouraged a desire to cling to my Christian faith and to move on.

“God is faithful, and he will not let you be tested beyond your strength but with your testing he will also provide the way out so that you may be able to endure it.” 1 Corinthians 10:13

  • Divine intervention empowers future hope and letting go of the past. God only gives us what He knows we can handle is a common response to the above noted scripture verse. Most twists in life, however, cannot be handled alone. My experience, therefore, reflects a different interpretation. The Lord only takes us where He knows He can meet us. It’s at this “meeting” (God dependence) where peace is found, feeling worthy is renewed, and confidence claimed…trusting His Will, care and direction.
  • Spiritual faith inspires moving forward, even when the weight of anxiety makes it difficult to do so. The Land Between…finding God in difficult transitions by Jeff Manion, notes…“We learn that the Land Between is about a journey of trust and that something flourishes there that could not be produced in any other soil.”

One of the messages from the book is about sharing experiences, which led to many of the blog articles written this past year, especially the series on Cultural Fit, referenced under Additional Resources at the conclusion of this article.

  • Embrace your spiritual faith. If you don’t practice a spiritual discipline, consider it. Divine inspiration from the inside out is steadfast and surefooted, a blessed gift and lift to rise above circumstances that might otherwise be impossible to achieve. Christian faith encourages forgiving the past and moving forward in hope of new life.

Acceptance and Truth

Serenity Prayer – Reinhold Niebuhr, “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.”

Being able to move forward leads to the healing steps of acceptance and truth and the courage required to progress here. Accept the truth of what happened and what you cannot change. Then deal with your feelings about it.

  • Articulate your interpretation of what happened. Before you can accurately express your narrative, peel away any emotional layers concealing truth. Work through and let go of self-blame when the situation is beyond your influence. Release the compelling temptation to grip on to guilt. Process those feelings of inadequacy or self-condemnation that can take root in your heart.

“Brown tells Oprah during an interview for “SuperSoul Sunday.” Things that are beyond your control are just that: beyond your control. Don’t let yourself make up a story that suggests otherwise. Pay very close attention to your internal narrative, Brené Brown says.” Huffington Post – The Best Way To Deal With Things That Are Beyond Your Control and Rising Strong by Brené Brown

“Grief, fear, and our deepest feelings of failure can make us blame ourselves for causing what happened or, at least, failing to cope with it.” There Is No Good Card For This: What To Say and Do When Life is Scary, Awful, and Unfair To People You Love.

  • Accept the reality of what happened. Confront your feelings about it. Stuffing eventually bursts under built-up emotional pressure, emotionally and physically harmful. Guard against the interpretation and insights of others that could define your narrative, including comparisons that rob you of properly processing because… your circumstances by far don’t compare to their own. Choose carefully with whom you share your struggles and if needed, seek professional counseling to help process in a healthy manner. The input of others should help refine your narrative and feelings, not replace it.

“All our difficult ties involve some degree of shame, fear and loneliness. At times like that, we don’t need anyone to impress us or skillfully talk us out of our pain. We mostly just need the kindness that compels anyone to try.” There Is No Good Card For This: What To Say and Do When Life is Scary, Awful, and Unfair To People You Love

“It can feel quite isolating or even invalidating when someone is trying that ‘Cheer up’ approach, or comparisons like, ‘It’s not so bad, look at the people who have it so much worse’,” explains Tal Schlosser, Clinical Psychologist at My Life Psychologists. 7 Ways to Support a Friend Through Sad Times Without Trying to Cheer Them  

  • Face truth and let go by writing out your narrative. This is a productive exercise to summarize what happened, releasing the overwhelming stress that accompanies unexpected trials.

“Writing things down on paper can be an amazing way to gain clarity and keep the facts straight. It’s as if the process of moving thought to hand makes it harder for us to lie to ourselves.” How to Cope When Life Does Things You Can’t Control 

Forgiveness and Hope

Remember not the former things, nor consider the things of old. Behold, I am doing a new thing; now it springs forth, do you not perceive it? I will make a way in the wilderness and rivers in the desert. Isaiah 43:18-19

  • Forgiveness releases accumulating anger towards people and circumstances involved in that “twist of fate”.  In some cases legal action may be necessary. Even through this avenue of seeking justice, forgiveness is needed to rise above deeply rooted negative feelings that impact emotional and physical well-being. Forgiveness is a gift for you and not for others and it does not imply denying what has happened. Forgiveness is a powerful means for moving on.

“Although you can’t change what has happened, none of us are powerless. We all have the power to choose our next step in life even if we can’t change the one that came before.” How to Cope When Life Does Things You Can’t Control

“Forgiveness comes when we’re able to recognize that the other person’s actions were more about them-their own motivations and context-than about us.”  There Is No Good Card For This: What To Say and Do When Life is Scary, Awful, and Unfair To People You Love

  • Forgiveness is freedom to hope again. It brings relief from those we mistakenly granted permission to shape our suffering. I find it difficult for bitterness and hope to share the same space. Process-out toxic feelings with forgiveness as your goal and HOPE as your destination.

“During tough times, our emotions run the gamut: denial, anger, fury, despair, numbness, isolation, desperation,” according to Laura Fenamore’s Tiny Buddha post. “In order to heal, we must feel. But we have a say in what we do with our feelings.” When Circumstances Are Beyond Your Control

  • Choose HOPE. When we “keep walking”, the heaviness of despair is lifted. Small steps are perfect steps. We heal and HOPE is realized. Know the power we all have to choose hope and embrace our convictions. This past year I came to understand…

# Rejection/failure tests our convictions.

# Dwelling on rejection and/or negative judgments from others only releases the trajectory of our future in the hands of the wrong people. Resist this temptation!

  • Be in control. Practice attention management. The quote below says it all!

“Attention management is the practice of controlling distractions, being present in the moment, finding flow, and maximizing focus, so that you can unleash your genius. It’s about being intentional instead of reactive. It is the ability to recognize when your attention is being stolen (or has the potential to be stolen) and to instead keep it focused on the activities you choose. Rather than allowing distractions to derail you, you choose where you direct your attention at any given moment, based on an understanding of your priorities and goals.” To Control Your Life Control What You Pay Attention to...HBR Maura Thomas, March 18, 2018

Reclaim your life by recognizing positive choices in difficult times, which begins by processing feelings of denial, anger, bitterness, and despair. Release the unrealistic expectation that life is flawless and free of problems because this is a myth. Unexpected trials are a part of life for everyone…you are not alone. Grip firmly to spiritual faith as the cornerstone to overcoming hopelessness. Accept what you cannot change. Seek truth in those circumstances beyond your influence. Find freedom through forgiveness and relish in newfound hope. Celebrate small steps moving forward. Life has four seasons. Be inspired to keep walking and you will find that spring does come, again. Modify…keep life simple began a year ago, last spring!


Additional Resources

Cultural Fit Series

Life Lesson

Triage for the Caregiver

A Caregiver’s Guide


         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.


Bargain Boutique

Thrifty Treasures


Often times we find ourselves either doing a closet purge, replacing furniture, or looking to change color scheme or décor style. What happens to the items being replaced? The golden rule in our home has always been, if it is in good shape, DONATE. What we are not using, someone else can! Could we sell items on Craig’s list, Next Door, or local town social media swaps? Yes! However, we have always felt inspired donating to a charity that aligns with a cause we are passionate about. This is a true win/win approach that benefits a worthy cause and offers a great opportunity to those looking for bargains.

5 Reasons To Donate To Thrift Stores  “Most thrift stores are created and run to benefit a specific cause. Many of them donate a portion or even all of their proceeds to a specific cause. From churches to, families to the homeless and many others, there are so many causes that you can be helping by donating to a thrift store. With the ability to donate to a good cause, give your clothing a second home and even finding some new pieces for yourself, it’s clear to see that thrift store shopping is a true win-win!”

Donating can be complicated because not all are organizations are non-profit. Some charities are for-profit and may not be clear about which charities they support, if any. This blog post shares information about how to choose items to donate, when to recycle, popular thrift stores and their profit or non-profit status along with charitable organizations supported.

Donating What You Are Not Using

Quality counts when donating to thrift store centers. Clothes, furniture and other household items (small appliances, vases, and home décor items) that are torn, stained or cracked most likely won’t lead to a successful sale. If a thrift store item(s) reflect a condition you wouldn’t purchase, then someone else probably won’t purchase it, either. Many years ago my husband and I donated a sofa to one of our favorite charities, Shepard’s Gate, a non-profit organization “Helping Women and Children Escaping Cycles of Addiction, Homelessness and Abuse”. When the truck came to pick up the sofa, which we had thoroughly cleaned, we were complimented on the new furniture we purchased and asked where to go for the sofa being donated. The men were shocked when we pointed to the sofa and said, “this one is for you.” We were surprised to hear that often donated sofas are stained, torn/holes, which are difficult to sell.

What happens to items received that are in poor condition? They get BULK sold and can end up in 3rd world countries, undermining domestic commerce thereby making it difficult for townspeople to become economically self-sufficient. Landfill is another destination for such donated items, which cannot be sold. Neither of these destinations are good options.

I rely on thrift stores to keep my family clothed and fed. What you donate matters By Melinda Selmys  “Getting rid of trash donations can cost thrift stores money in garbage fees and makes extra work for volunteers. Dumping your drawers out into a box and expecting someone else to deal with it is not generous or environmentally conscious; it’s just inconsiderate.”

Rags or riches? Why thrift stores sell some donations and toss others“Goodwill Industries of Denver, which operates the Fort Collins Goodwill and 28 others in the Denver area and Northern Colorado, discarded 1 in 3 donations in 2014. Call the store to double check that it can accept your donations.”

Often times the large bags we keep in the garage to collect clothing can collect unwanted visitors that squeeze through small spaces. Keep charitable giving bags inside the home, perhaps in a closet, to keep pests out.

9 Secrets of Thrift Store Employees “A former Goodwill employee who did a Reddit AMA once found a rat at the bottom of a bag of clothing. It made the entire back room smell, and we had to get rid of all the clothes.”

To fully support the charitable organization you are passionate about, donate items that are in fair shape, suitable for resale, so your contribution is a benefit and not a burden. Items that are not “donate suitable” can be recycled and eventually used for reproduction of fabrics, goods, and furniture. Check local recycle resources in your community. How to Recycle Clothing and Accessories Recycling Guide will lead you to recycle locations.

Thrift Stores and Charitable Organizations

The following is a list of popular thrift store organizations. Thrift stores can be unique to certain states and towns. The listing below contains national, state and local community organizations that might be available in your area. Check your own local thrift stores, determine if they are non-profit or for-profit and the supported charity/charities. This article offers an insightful summary… This is where your thrift store dollars are really going. The listing below includes some of the stores noted in the article.

Salvation Army Non-Profit  7,546 centers nationwide stocked with clothes, furniture, decorations and, of course, unlimited odds and ends. In addition to addiction rehabilitation and housing, Salvation Army offers Christmas assistance (dinners, gifts and community events for families in need), prison ministries, hunger and homeless relief and work against human trafficking.

Goodwill  Non-Profit  There are currently 3,000 stores nationwide stocked with everything from household goods to clothing. In addition, Goodwill offers community-building and job assistance for those who are underemployed, formerly incarcerated or disabled — though there has been controversy over how disabled employees are paid.

Housing Works  Non-Profit  There are currently 12 stores, all in New York City, offering antique furniture, high-end designer clothing, books and yes, even coffee. Additionally, Housing Works offers housing services, legal advocacy, medical and dental care, job training and rehabilitation.

ARC  Non- Profit ARC Thrift Stores distributes the proceeds to the ARC and ACL Chapters in your community. ARC Thrift Stores’ mission is to ensure that all people with intellectual and developmental disabilities and their families have the opportunity to decide how they live, learn, work, and play. We work, with your support, to create opportunities for people with intellectual and developmental disabilities to be included in their communities.

Catholic Charities  Non-Profit  National Organization Catholic Charities extends the healing ministry of Jesus Christ to the poor and those in need. . Marisol Services, affordable housing, shelter services, early childhood education, family, kinship and senior services/home based counseling, emergency assistance, parish outreach, counseling

Habitat for Humanity  Non-Profit  Habitat for Humanity Stores (New Items), Habitat for Humanity ReStores (Donated Items) Habitat for Humanity is a global nonprofit housing organization working in nearly 1,400 communities across the United States and in approximately 70 countries around the world. Habitat’s vision is of a world where everyone has a decent place to live.

Treasures DE Task Force Non-Profit Non-profit human service organization dedicated to providing assistance to people in Colorado’s Douglas and Elbert counties who are in serious economic need, at risk of homelessness, or in a similar crisis. In 2016, Treasures on Park Street generated $386,993 in revenues which are used to help our neighbors here in Douglas and Elbert counties who are in financial crisis. Through thrift store sales we are able to provide funds to buy food for the Food Bank as well as monies to get heat, electricity and water turned back on, the rent paid, or emergency lodging funded for clients in need.

Beacon’s Closet  For-Profit  Beacon’s Closet donates clothing deemed unsellable to Garage Sales Against Violence as well as other charities.

Savers and Value Village  For-Profit – Small percentage goes to non-profit charities. Savers discloses how much it gives to various charities resulting from sales of donated items.

Buffalo Exchange  For-Profit  Also supports various charities.

Silver candle holders, my thrift treasure find, $10/pair!

Internet search thrift stores in your local community. Call the organization if the website doesn’t clearly indicate whether it is for-profit or non-profit, or to know the charity/charities being supported. Take the time to prepare donated items to be a benefit to charitable organizations/people who depend on your generosity. Your effort today will make the lives of those experiencing difficult challenges, a bit easier tomorrow. If you know someone who wants what you don’t, and is willing to pay for it, consider donating the money received. When you can, visit the thrift stores you support to see what sells and what doesn’t, to help plan your future donations. You might also come upon an awesome find yourself, and someone else’s generosity is now your thrifty treasure!!



home spaces

Spring Into Action!


Spring is a celebration of new life. Your home, inside and out, deserves a fresh start, too! Below is a comprehensive listing of how you and your family can organize and refresh your living space this spring.

Getting Started

  • 1-2 large Plastic Bin for items to give-away.
  • 1-2 large Plastic Bin for items to keep.
  • 1 roll Large Plastic Garbage Bags for items to throw away, if beyond usable.
  • 1 notebook to list household repairs and “To Do’s” or use mobile phone NOTES.
  • Schedule purge and cleaning projects on your calendar. Remember, this is a process and not a one-day job.
  • If you employ a housekeeper, make a copy of this list and highlight the housekeeper’s responsibilities. Remember to do the same to identify your tasks.

Make a list of spring-cleaning you would like your housekeeper to cover. Meet with him/her to review. Discuss housekeeping chore changes, if any, you would like implemented. This may include areas of the kids’ rooms and bathrooms in order for your children to carryout specific tasks.

Home Interior and Exterior

  • Closets – Take stock of clothes, coats, shoes, and handbags. Include your family in this process. What you’re not wearing, someone else most definitely can. As a family, choose your charitable organization and teach your children how to share with joy. Great lifetime habit!
  • Pantry – Reorganize and toss all outdated food products such as canned and jar food items, yeasts, etc. I used extra office supply containers in my pantry, which work great! Love the “extra shelf”, an under-shelf rack, from the Container Store!  All pantry storage items from the Container Store, click HERE.Processed with MOLDIV
  • Take stock of your kitchen cabinets. Too many mugs and stemware? Place extras in your charitable contribution bag. Need to replace your dishes, pots, and pans?
  • Dust all ceiling lighting fixtures, fans, corner cobwebs, door-frames, air vents, and baseboards. Note any replacements and repairs.
  • Remove pillows and cushions from sofas and chairs to vacuum, fluff, and turn over.
  • Dust and clean window treatments and blinds.
  • Dust artwork and photos hanging on the walls or displayed around the home.
  • Clean and/or replace and silk flower arrangements.
  • Clean or replace planter boxes for plants.
  • Vacuum around the fireplace. If you still have a wood-burning fireplace, schedule a chimney sweep.
  • Clean all glass doors, mirrors, doorknobs, and cabinet knobs.
  • Remove all books from shelving, dust shelves and wipe down books.
  • Check electrical cords for frayed wires. Replace, if needed.
  • Schedule carpet and window cleaners on your to-do list or schedule with a service.
  • Check walls for marks and paint chips. Schedule a fresh coat of paint, if needed.
  • Check window and door frames for seal repair.
  • Wood-siding home? Check annually for dry wrought and repair before damage becomes unsafe and costly.
  • Check for termites.
  • Roof holding up? Check for needed repairs or replacement.
  • Using your heater too much this winter? Check home insulation. Sealed and insulated homes keep heating and air conditioning bills down.
  • Send winter comforters and blankets to the dry cleaner. Turn bed mattresses. Replace beddings and linens. Throw sleeping pillows in the dryer to fluff. OR, replace well used and past “comfy” sleeping pillows.
  • Purge outdated pharmaceuticals, including cold and flu bottles, past the expiration date. This includes pet medications that are not longer needed. Old vitamin bottles tend to accumulate in the kitchen cabinets so clear these out as well.
  • Check grout on kitchens and bathrooms. If the grout needs cleaning or touch up, schedule someone to come in and do the job or put it on your DIY list.
  • If using a bathroom shower curtain, replace it annually.
  • Seal marble and granite.
  • Dust china and/or buffet cabinet shelving, china, and crystal. Polish silver.
  • Review CD’s, DVD’s, and movie videos, if you still own these. Purge or give-away what no longer meets your needs. See what you can give to charity.
  • Outside the home, check gutters and outdoor paint. Schedule cleaning and repairs.
  • Landscape and gardening, plan for DIY or discuss seasonal changes with your gardener as well as any improvements for the coming year. Remember to take proper care by fertilizing and pruning trees, too.
  • Replace front door wreaths with a spring and summer theme.

Home Safety, Functionality, Design

Spring cleaning also includes safety of your home and reviewing its functionality to align with the way that you live best. You may want to work with an interior designer. Knowing that it can takes 6-12 weeks to schedule service workers, plan and schedule a remodel and for delivery of ordered or custom furniture, you may want to consider this list ASAP.

  • Check batteries on smoke and carbon monoxide alarms.
  • Rearrange furniture for better floor plan use in how you live. Photo illustrates changing the feel of a family room layout from confined to an open, inviting and inclusive social area, ideal for entertaining. Replaced large oversized sofa with a smaller 86″ sofa, (Ethan Allen – Chadwick), better scaled for the room.Processed with MOLDIV
  • Furniture need replacing or repair? It’s time to set a budget and start your search.
  • Appliances need to be updated?
  • Display Bath towels need to be replaced?
  • Fresh coat of paint to update and give your home a current fresh look?
  • Do you need to add lighting in your home? This is especially important in reading areas, home office and where children are doing their homework.
  • Review all closets and note which could use built-in organizers. Replace wire hangers with felt or wooden hangers. Rearrange clothing, shoes, handbags, color coordinated for easy access. Winter furs, if any, placed back in storage.
  • Take care of maintenance on your piano or other musical instruments.
  • Eliminate paint that you haven’t opened in 2 years. Companies like Lowe’s, Habitat for Humanity, and PaintCare accept leftover paint in order to recycle it. You can also search for a hazardous waste drop-off facility in your area at Earth911.com.
  • Family treasures to be packed and marked in plastic bins if they are not already. Pack notes to share about the items with future generations. Consider garage shelving or HYLOFT systems for storing above your garage doors to eliminate boxes and clutter along your garage walls.
  • Have you inherited historical family treasures you no longer want? Call local museums and share your history with the community.

Home Office Refresh

  • Purge files you no longer need.
  • Bank, credit card, utility bill statements only need to be kept for one year unless they support tax return documents.
  • Tax returns and supporting documents need to be kept for seven years as required by the government.
  • Investment records such as security buy and sell orders, cancelled checks, and statements can be kept for three years.
  • Family documents such as health records, birth, marriage, death, divorce papers, school transcripts and diplomas in a fire proof safe or safe deposit box. See Modify post, “Must Have Unexpected Plan”.
  • Organizing home files by maintaining a system that works best and makes sense to you. A simple multi category approach, numbering system or color-coded are methods of maintaining a file system for hardcopy files.
  • Consider re-organizing your computer files and emails for simple access when needed.
  • How is that office chair on your back? Think ergonomic!

Tips And Tricks That Work.

  • Assign weekly tasks to the family, age appropriate, to maintain order in the home.
  • Baskets and décor bins are ideal for placing mail and other items kept in the family room, playroom, or bedrooms. Use clear plastic food containers in the pantry so you know when you need to replenish your favorites before you run out.
  • If you haven’t already, use a grocery list mobile phone app to keep track of your shopping list. I use LIST EASE.
  • If lacking space purchase under the bed storage containers for seasonal clothing, school supplies for kids, etc.
  • Purchase a file cabinet for each of your children. Let them create files for each school subject along with their hobbies and sport activities. Guide them in organizational habits and you’ll also eliminate accumulating paper and school projections. Let your children choose which papers and projects they wish to save.
  • Replace misc designated drawers with drawers that have a purpose.
  • Keep manuals and warranties in a binder using plastic protective sheets.
  • Keep magazine subscriptions to a minimum. Tear out articles you like and file or  take a quick cell phone picture of favorite articles and store as a computer file under “Recipes”, “Home Projects” or “Craft Ideas”.
  • When preparing a meal, use the backside of your cabinet door to hang a cooking recipe. This helps keep the copy away from food and in one location while cooking and prevents the risk of favorite recipes accidentally getting thrown out.

Spring is a beautiful time of year when the outdoors offer the sweet sounds of nature waking up against an amazing colorful backdrop of new life bursting through budding blossoms on plants, shrubs and trees!! The air is crisp and fresh. Spring rains (or wet snowfalls!) are washing our landscape, hills, and mountains. Walking back indoors, however, can be an unpleasant experience if the air is stale and the home is looking tired, dusty and cluttered. It’s time to bring the beauty and freshness of the outdoors in. But, where do you start?? Work through this comprehensive list and you’ll spring into action refreshing your home!





Time For A Check-up…Target Change

Modify reasses Target Change figure-magnifying-glass

On January 9th I posted a blog titled Target Change offering suggestions to modify how to effectively articulate New Year’s resolutions, written and verbal. Instead of declaring what we want to give up, goals are best identified by the change we want to experience. It’s been three months since many of you may have identified target change in 2018. This is the perfect time of year to acknowledge progress and implement modifications, if needed. Yes! It’s time for a check-up! This article will guide you on ways you can celebrate your achievements and how to identify where you may have struggled, with suggested modifications to get you back on track!

Successful start to 2018!

Way to go! Congratulations!! It’s time to recognize your success, big and small.

  • Acknowledge progress. Often we immediately move on to the next goal and step over the achievement. Eventually, this can lead to burnout. Pat your own self on the back and be proud of the goal you attained or progress made these past few months. Depending solely on others to acknowledge your success (small steps or big change) may not happen and this can be (unnecessarily) discouraging. If you see a another person’s positive change, say something! People like to know, others are taking notice.
  • Journal your successes. This can be done through an iPhone app (Day One Journal is the app I use), a mason jar or a notebook that stores a collection of success notes. On those days when you are not feeling so positive, read the notes and you’ll have a great opportunity to reset how you feel about yourself and the direction you wish to go.
  • Do what you love. Whether spending time alone with a great novel, watching an inspirational movie, enjoying a quiet soothing bath with your favorite music in the background, planning time with your spouse, special friend(s) or a fun outing with family, celebrate positive change. All steps that move us forward are milestones, even the smallest ones! Yes, wherever you are on the achievement map, you deserve to pamper yourself.
  • Play it forward. Share your testimony and don’t wait until the goal is fully realized. People learn from people. People are motivated by the success of others. Hoarding experiences can appear selfish. Encouraging others through personal success stories is an incredible and generous way to inspire others. Be this person, especially as a role model to our youth and elderly who often struggle with dwindling hope.
  • Pride? Be Aware! Feeling invincible after achieving goals can be a slippery slope. Guard yourself and set healthy boundaries that will keep you focused. Goals are a lifetime work in progress and not a one-time sprint.

Get back on path!

Achieving goals, whether physical, emotional, family related, personal, spiritual or career focused (perhaps a few if not all of the above) require some form of suffering because change is needed for change to happen. The desire for change was most likely triggered by a feeling of discomfort. And, therefore, identifying and working through weak habits in order to target change will most likely feel uncomfortable. When discomfort brings a level of “suffering” that we didn’t anticipate, it’s easy to become disillusioned and quit. I have come face to face with discouragement just when I’m about to reach the summit of attaining a goal or finishing a project, sometimes fighting the urge to give-up in order to keep moving forward. Funny how this always happens!! Being at the precipice of significant change/reaching a milestone can sometimes damper our spirits instead of feeling empowered by victory so close to becoming a reality. Hang in there! No pain no gain as the saying goes. Imagine that your level of discomfort or discouragement is really saying…job well done, you are almost there!!

Identifying Challenges For Steps Towards Success.

  • What led to setbacks? What could you do differently? Do you need to better prioritize your commitment? Being honest is a critical step to moving forward.
  • Is this goal or change what you want or what others want? Motivation can only persevere if YOU own and are passionate about the experience you are looking to attain.
  • Are you setting a realistic amount of time to achieve your goal? Or if your goal is to overcome an emotional weakness, are you getting enough sleep? Fatigue weakens the motivation and strength to be emotionally healthy? Fatigue has always been my worse enemy and it could be yours. Identify a good cushion to prevent fatigue from becoming a wedge between you and success.
  • Overcommitment a distraction? If you are finding lack of time because over other commitments then assess your day-to-day activity. If the passion and goals of others have become your focus and work, you might need to reflect on ways you can reprioritize and graciously learn how to decline such requests. You alone are responsible for prioritizing your ambitions as worthy. If you don’t, no one else will.
  • Quit?? If you slipped down the slippery slope and quit, it’s OK. Get back up! Be patient and kind to yourself. Realize that some of the greatest world inventors and leaders changed the trajectory of how we live simply because…they got back up!!! You can, too!
  • Personalize your approach. Methods that have worked for others may not work for you. Do something about it. Great article published April 2014 in Harvard Business Review, The Key to Lasting Behavioral Change, Think Goal Not Tactic by Elizabeth Grace Saunders. The author elaborates on four points to encourage perseverance through challenges; determine where you’re stuck, brainstorm other tactics, test your hypothesis, get accountability.

Yes, habit change takes discipline, patience, and practice. But no, it shouldn’t feel like you’re constantly trying to force yourself to do something you really don’t want to do. That’s unsustainable. To make new habits stick, they must work with the reality of who you are and what’s best for you.

Christians around the world are about to celebrate a significant religious holiday, Easter, symbolic of forgiveness, grace, and new life demonstrated by Christ’s death on the cross. In order to successfully attain target change often forgiveness and grace is a required qualification, to others and ourselves to bring us to “new life”. A very special young woman in Africa, my sponsor daughter, recently shared wise words beyond her years. “Faith makes all things possible. Hope makes all things work. Love makes all things work. I am optimistic about the future.” You, too, can be optimistic about your future as you seek positive life change. Embrace faith, hope and love. Be kind and patient with others and yourself. Pamper yourself to celebrate small steps and big change. Honestly assess setbacks and recalibrate to get back on path. And as my sponsor daughter also shares in her writing…”be like the eagle that is strong, has focused vision, and can fly through storms when other birds hide.”


Target Change, Modify…make life simple

The Key to Lasting Behavioral Change, Think Goal Not Tactic by Elizabeth Grace Saunders, APRIL 07, 2014

Day One Journal 

Life Lesson

Planning Pain…what you should know

Planning Pain ...drug-2081888_960_720

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. This 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 on 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 families.

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 about questions rather than providing answers. Perhaps you feel as I do…the importance of being informed about pain management options to best plan future healthcare. If we are not in a position to make these decisions, then someone else will. Would you prefer having control over what goes into your body and being fully aware of 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?