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,

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,

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.


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?


Life Lesson

Who Knew? You Decide!


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! – 


#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.


Life Lesson

When To Call It?…making decisions during a health crisis


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.


Life Lesson

Chasing Lost Mail…what you can do!

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.


  • 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.


Life Lesson

Your Living Trust…details you need to know

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!


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

Life Lesson

Planning For A Healthy New Year? READ those labels!

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