Collin County Denton County
Fall/Winter2009 Spring 2010
Henderson Complimentary Issue
CSS â€˘ Spring 2008
What Is CHOLESTEROL REDUCING
with Care Providers
THE CENTER FOR WOMEN SPECIALIZING IN CARE FOR
MOMS, DAUGHTERS, SISTERS AND GRANDMOTHERS.
The Center for Women on the campus of Texas Health Presbyterian Hospital Denton is dedicated entirely to women’s health care. For Labor & Delivery, we have the area’s only Level III NICU, for peace of mind just in case. We offer a full range of classes, newsletters and all the information and support you need to make the experience as successful and rewarding as possible, including a full-time lactation specialist. Our Women’s Imaging features digital mammography, ultrasound, stereotactic and bone densitometry suites. We even have a remarkable Women’s Resource Library to offer you information on just about any issue relating to your health. The Center for Women is all about you, and we have you covered for every stage of your life. 1-877-THR-Well
Doctors on the medical staff practice independently and are not employees or agents of the hospital. © 2010
lthough it is almost March, I bring greetings and best wishes of this stillyoung year to you. Snowy weather—practically everywhere—has been the headline-making news so far and certainly that’s better than the financial gloom of a year ago. Here at SENIOR Magazines, 2010 means that we are entering our fifth year. And that makes it doubly appropriate that we add a new fifth magazine to our publishing family. So, with this Spring 2010 issue, Scottsdale SENIOR Magazine joins Collin County SENIOR Magazine, Colorado Springs SENIOR Magazine, Denton County SENIOR Magazine and Texoma SENIOR Magazine. If you have friends or relatives in the greater Scottsdale, Arizona area, be sure to tell them to look for Scottsdale SENIOR Magazine—or better yet, provide us (by e-mail, by phone or USPS) the names and addresses and we’ll send them—entirely complimentary as always—the very first issue of Scottsdale SENIOR Magazine. Personally, I am so very pleased to be able to feature a true American sweetheart (her birthday, in case you didn’t know, is Valentine’s Day!) on our spring cover. Like so many, I was a Brady Bunch watcher and thus am a long-time fan of Florence Henderson. It’s wonderful to learn more about her and I hope that many of you will be able to attend a performance of her one-woman show. Read more on pages 6 and 7. As you read about Florence, you’ll learn too just how appropriate this next item is. Florence has a new service to help folks—especially her demographic (fellow seniors)—find their way through the intricacies of the internet. And if you avail yourself of the services of her FloH Club you’ll be able to visit our fully-redesigned SENIOR Magazine website.Yes, it IS bigger and better for now you can read articles from all of our regional magazines in one place, on-line. And we’re on Facebook and Twitter too. Have a glorious Spring!
Denton County SENIOR • Spring 2010
Associate Publisher GARY JACOBSON, Scottsdale, AZ Features Writer/Copy Editor HELEN V HUTCHINGS Graphic Designers SALLY SUE DUNN MICHAEL REISING Distribution JENN STEINKE, Colorado CARRIE GANDY, Texas & Oklahoma Advertising/Sales JOSH CATES, All Markets Josh@YourSENIORmagazine.com GARY JACOBSON, Scottsdale, AZ Gary@YourSENIORmagazine.com SENIOR Magazine, Inc. President & CEO, Josh Cates Vice President & CFO, Bob Cates Subscriptions/Customer Inquiries SENIOR Magazine P.O. Box 64108 Colorado Springs, Colorado 80962 www.YourSENIORmagazine.com 719-481-9626 (Colorado) 940-231-2220 (Texas) All advertisements in this Magazine are placed by third-parties. [We] do not control or endorse such advertisements or their content. Further [We] do not manufacture, sell, distribute or provide any of the goods or services advertised herein (unless otherwise expressly stated herin). [We] hereby expressly disclaim any liability with respect to the information contained in such advertisements and any goods or services advertised herein. [We] further disclaim any and all warranties or respresentations, express or implied, with respect to such information and such goods and services, including any warranty of merchantability or fitness for a particular purpose (it being understood that [We] do not acknowledge that any such warranty exists). [We] are not liable or responsible for any loss, injury, damage, or harm that you may suffer as a result of the information contained in any advertisement or the goods or services advertised herin. [We] refers to the name of the Magazine, The Senior Resource Guide.
POSTMASTER: Keyword: Your SENIOR Magazine
Publisher & Editor-in-Chief JOSH CATES
Send address changes to: SENIOR Magazine P.O. Box 64108 Colorado Springs, CO 80962-4108
Contents Spring 2010
ADULT HOME CARE Saving A Few Dollars Could Cost You 9 11 24-Hour Live-In-Care In Your Home ASSISTED LIVING ????????? 13 ATTORNEYS Fighting Old Age 15 Alzheimer’s, A Legal Perspective 17 DENTISTS Straighten Your Teeth At Any Age 19 FINANCE & INSURANCE
20 Retirement Planning 21 2010 Checklist 23 Medicare and Long Term Care FUNERAL PLANNING Should We Go or Just Send Flowers 25 HOME HEALTH A Benefit Covered Breathing Better with COPD ?????????? It’s All in a Picture Do You Know What to Choose The Need for Hospice
27 29 31 33 34 35
What is Cholesterol
HOSPITALS Reducing Your Risk Early Heart Attack Care
PHARMACIES & EQUIPMENT The Best Way to Roll PHYSICIANS
40 Reducing Your Risk
Boomeritis Taking Care of Your Feet and Ankles Back Pain Doesn’t Always Mean Surgery The Road to A Satisfying Sex Life Thyroid Control Shingles Test Your Knowledge Anosmia Glaucoma Medicines
43 45 47 49 51 53 55 57 58
RETIREMENT LIVING ????? Discovery of Recovery A Stitch in Time Improving Communication
Denton County SENIOR • Spring 2010
61 62 65 66
ON THE COVER
By: Helen V Hutchings
Florence Henderson on stage in her one-woman show, All the Lives of Me . . . is coming to the greater Dallas/Forth Worth area. However, as we went to press, the dates and locations for Texas performances had not yet been finalized, so watch your local listings.
he sings. She dances. Of course, she’s an accomplished actress and performer, truly an all-around entertainer. But Florence Henderson also skypes, and e-mails messages and photographs to family and friends, and surfs the net. Florence is very much a testament to the wisdom of remaining engaged and active—mentally and physically—for she too is “one of us”. Florence Henderson’s Broadway debut was, similar to anyone starting out, a small part. But her abilities and talent quickly caught the eye of the likes of Rogers and Hammerstein and Joshua Logan. Thus two years later in 1954, at the ripe old age of 20, Florence was cast as the star, originating the role of Fanny on Broadway in the musical Fanny. Nearly 1,000 performances later (and remember in those days you really had to “project” vocally as there were no individual microphones amplifying each cast member), it is understating things just a bit to observe Florence Henderson’s career was “well launched”. On Broadway and as part of touring companies she’s be Maria in The Sound of Music, Anna opposite Ricardo Montalban in The King and I, Nellie Forbush in South Pacific, Annie in Annie Get Your Gun and so many more. In 1969 television came calling in what would turn out to be another “biggie” in Florence ’s professional career. She was cast as Carol Brady, aka “mom”, in The Brady Bunch. The series ran for five seasons but even though it technically ended in 1974, it has never been off the air right up to today as it currently is syndicated and on the air in 122 countries around the world plus the US .
Denton County SENIOR • Spring 2010
There’s more to the lady than just her work on stage and screens (big and little). Although her first marriage in 1956 to Broadway producer Ira Bernstein ended in divorce in 1985, they had had two sons and two daughters. Florence openly says that events of the mid-80s left her shaken and she battled depression. Seeking help to cope with her depression led to Florence meeting Dr John Kappas. They subsequently were wed in 1987. Renowned hypnotherapist Kappas is credited with not only defining the profession but establishing the first training program, the Hypnosis Motivation Institute, the first-ever in its field to be nationally accredited by the US Department of Education. With Kappas Florence shared love, but he also helped her gain a new level of awareness and skills. Today Florence herself is a certified hypnotherapist. Together they coped with and battled the cancer that ultimately claimed Kappas in September 2002. Since then, Florence has been an advocate and motivational speaker for women’s health issues and is, among her other humanitarian activities, a spokeswoman for City of Hope Cancer Research Center. This indomitable lady has no plans to retire—and she walks the talk. She has a new venture and a new show, and with both she bears witness to her belief in the importance of exercise and trying to have and attain a personal harmony between that mind, body and spirit triad. Entertaining on stage, however, came to her more easily than her adeptness with computers. Although Florence Henderson embraced
the new technology, learning to master it in fact took “a little help from a friend”. As Florence told one interviewer, she was having difficulties doing anything more on her cell phone than place a phone call. Within minutes her friend had explained and shown her how to operate its features like an old hand. Same thing with her personal computer. This experience became the inspiration behind the FloH brand which is dedicated to the concept of Better Living for Seniors and is centered around feeling better through exercise and healthy eating, as well as thinking better through new experiences and tools for living. The first service—fitting into that tools for living category—was launched just last October. In association with a technology partner, it is called the FloH Club; and is a membership, telephone-based, technical support service for older adults. Floh Club matches member-callers with technicians who work remotely from their own homes. Several membership levels are available depending upon a member’s needs. Each membership is matched or paired to one individual computer (pc’s only please, not currently available for Mac or Apple users) and includes a monthly newsletter about technology for older adults from Henderson. Services include anything from simple e-mailing and making online purchases safely, to step-by-step guides on video conferencing, instant messaging, or troubleshooting support for slow or poor computer system performance, error messages, virus/spyware removal and data backup. Additionally, FloH club members can learn how to set up and use wireless networks, printers, digital cameras and more. Because entertaining others does come easily to Florence and because she’s reached that time of life when she has experiences and a message to share—she’s embarked on a one-woman show that is a very personal retrospective. This writer has not had the pleasure of attending a performance of Florence Henderson’s one-woman show that she calls All the Lives of Me . . . A Musical Journey, but reactions from those who have are telling. Like a true Hoosier (yes, Florence was born in Indiana, and since the mid-90s has returned each year to warble God Bless America prior to the start of the Indianapolis 500) she opted to preview her new show on homestate audiences in Indianapolis, backed by no less than the Indianapolis Symphony Orchestra. Critic Philip Potempa concluded his review with, “Henderson can still hit all the high notes and her larger-than-life persona and zest for entertaining is easy to embrace as it keeps audiences enthralled with her song and story.” Lest you discount reaction from a home-town audience and
reviewer, January 2010 Florence took her show to the Rrazz Room in San Francisco. More glowing reviews were forthcoming from David Wiegand writing in the San Francisco Chronicle: “In truth, Henderson, svelte and terminally perky, sings only about a dozen numbers over the course of her 90-minute show, and a couple of those songs are novelty numbers cleverly meant to concede the fact that she may not be a spring chicken, she may or may not have had work done, she really, really likes men, regardless of her squeaky-clean TV image, and so what? She deceives the audience as only a superb performer can: Within minutes, you’ll think she’s in your living room, chatting over cocktails. And by the end of the show, the only question you’ll want to ask is, do you really have to go?” And while the curtain will fall, signaling the end of each performance of All The Lives of… (of course, only after Florence has been called back for an encore), America’s museum, The Smithsonian in Washington, DC, has ensured that Florence Henderson’s place in the entertainment cosmos is preserved for all time as part of the National Museum of American History’s entertainment collections. As shown in photo below Florence Henderson has been honored, along with some of her contemporaries, as one of the Legendary Leading Ladies of Stage and Screen. A fitting tribute indeed to a lady who continues to give of her time, her energy and her talents to entertain and delight us all.
The Smithsonian Nationaltory’s Museum of American His of Legendary Leading Ladiese at Stage and Screen on stag . the presentation ceremony Inset, left to right, Olympic swim champ turned actress Esther Williams, comedienne Rose Marie, Hello Dolly! Carol Channing, catwomane in television’s Batman Juli Newmar, star of Alfred Hitchcock’s The Birds andcover Marnie Tippi Hedren, our star Florence Henderson and Space star of Lassie and Lost in rt. kha June Loc
Denton County SENIOR • Spring 2010
Denton - 940.380.0500 Dallas - 972.245.1515 Ft. Worth - 817.282.9666
Denton County SENIOR â€˘ Spring 2010
adult home care
Saving a Few Dollars On Your Caregiver’s Wages Could Cost You Dearly.
Article courtesy of Heaven at Home ll of us are interested in preserving as much of our money as possible. Therefore, it may be very tempting, if you have the need for a caregiver in your home, to hire directly from an ad in the paper, or an organization or church that you belong to. After all, you can almost certainly get someone to sit with mom for less per hour than you would have to pay an accredited agency. However, the hourly wage that you agree upon may be only the tip of the iceberg. The first thing you have to do is determine whether you should classify your new hire as an independent contractor or an employee. The primary reason for this is so that the tax situation with the IRS and the State of Texas can be properly set up. We have all heard about the trouble that some of the politicians in Washington have gotten into because of the socalled “Nanny Tax”. Well, when you hire a caregiver directly, you also may be liable for the Nanny Tax. Another part of the Nanny Tax requires you and your caregiver to pay Medicare and Social Security taxes on a regular basis. And it is your responsibility to see that the deposits and taxes are filed and deposited in a timely fashion. You will need to get an Employer Identification Number from the IRS. Did you know that the American Journal of Industrial Medicine says that 52 out of 1,000 home health care workers are injured on the job each year? That could leave you open to a lawsuit. At the very least, you should check with your insurance agent about adding a rider to your homeowner policy that will cover domestic help since most policies don’t automatically provide that coverage. And, if your caregiver may drive mom to her doctor’s appointment in your car, be
There are many factors that determine whether a caregiver is an employee or an independent contractor. But, the simplest way to look at it is:
• If the caregiver offers the same type of services to other people at the same time and make their own determinations regarding when they work and what they do, that caregiver will probably be classified as an independent contractor and should carry their own liability insurance and pay their own taxes. • If you tell the caregiver when to show up for work and what to do while there, they will most likely be determined to be your employee. And if so, there are some responsibilities you may have well beyond writing a check to the caregiver every week. • The state of Texas says that, if you pay a person over $1,000 per calendar quarter, you must register with the state within ten days and pay unemployment tax on those wages. However, you are fortunate to be in the State of Texas, because, unlike many states, Workers Compensation would only be voluntary on your part. But, you are required to have a poster displayed that contains information about Texas unemployment benefits, Payday Law and a schedule of paydays.
sure those individuals are listed by name and driver’s license number on your auto policy. Now, if your caregiver is injured, you have a couple of other concerns. How are they going to pay for food and mortgage while they can’t work? Who is going to take care of mom while they recover? Scott Vanderhoef, founder of Heaven at Home senior care says, “Most people just don’t realize the potential pitfalls of hiring a caregiver directly. I know the cost per hour is greater to work through a qualified agency. But, we handle all of the tax and insurance requirements and take a position of helping to insulate our client from things like the potential of litigation. We have a staff of people which allows us to quickly replace a caregiver who, for any reason, can’t fulfill their job, whether it is just for a day or indefinitely. The difference in the cost of hourly wage that we charge can be considered sort of like an insurance against tax responsibility, the possibility of monetary loss, and the loss of services through unexpected developments.” Of course, there are non-monetary considerations as well. Do you have the resources to do a thorough reference and background check on your candidates? Even if you hire someone from your church, unfortunately, that is not assurance that they don’t have something undesirable in their background. A good home care agency will do that investigation, as well as provide bonding for the caregiver. Just don’t be too short-sighted when you consider something as important as becoming an employer to a caregiver into your home. S For more information, you can reach Heaven at Home senior care at 940380-0500. Denton County SENIOR • Spring 2010
Stay in the comfort
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Serving Denton & Cooke Counties for over 13 years...and now serving Collin, Dallas, Fannin, Grayson, Tarrant and Wise Counties.
Services Provided Include:
Assistance with all activities of daily living Dressing assistance
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Denton County SENIOR â€˘ Spring 2010
adult home care
24-Hour Live-in Care
in Your Home
Article courtesy of Unlimited Care of North Texas hen is it time to with 24-hour around the clock live-in discuss care with care, we have had the honor to care for your parents or over four hundred families. As we look loved ones? Now, toward the future and the need for adalthough this will ditional home care we have expanded probably be one of the most difficult our specialized services to the followconversations that you will ever have, ing counties; Wise, Tarrant, Dallas, understanding that your loved one’s Parker, Rockwall, Fannin, Grayson perception of any outside assistance is along with Cooke and Denton. often seen as a threat to their independence or an invasion of their privacy What makes us different from other will help when having this discussion. home care agencies? When approaching this for the first Knowing how difficult constant change time, it is our hope and goal that they is on our patients, we strive for placewill see the value in having assistance ment of a primary caregiver who will and will eventually develop a trusting stay a minimum of two weeks, with relationship with their caregiver. a replacement caregiver staying for Statistics show that 75%, or 3 out of a week. This monthly cycle provides 4 seniors 65 plus, will need some form both the patient and caregiver the time of home care during their lifetime. To- and consistency to build a trusting reday’s seniors have more options avail- lationship that in a very short time alable to them than ever before. One lows that caregiver to become like an option more and more seniors are turn- additional family member. ing to when their physical capabilities After losing my own dad nineteen diminish or while they recover from a years ago and my mother-in-law this short-term disability is to be treated in past December, my passion for the elthe comfort of their own home. Home derly remains my priority. Our goal is to care is considered by many to be one of treat each of our patients like family. Althe most desirable options because it al- though assisted living facilities and nurslows seniors to maintain their indepen- ing facilities are good, there are those dence while remaining in the one place individuals with the financial means to where they feel most comfortable. remain in their own home, wherever So, have the conversation with that home might be. All they need is a your loved one about “Staying in the trusted caring companion to stay with Comfort of Your Own Home”, wher- them and care for their daily needs. This ever home might be and let Unlimited is what we take pride in providing. Care of North Texas, Inc provide you with the qualified, trusted caregivAuthor Linda DeGraffenreid is the ers of your choice to help with this CFO/Owner of Unlimited Care of process. As Unlimited Care of North North Texas and invites you to call her Texas, Inc enters its 14th year serving for information and free consultation at the Denton and Cooke County areas 940-390-0493
The services that we provide include: •A ssistance with all activities of daily living • Bathing assistance • Dressing assistance • Caring companionship •T ransportation to doctors’ appointments, church events and personal errands • Home-cooked meals • Laundry and light home maintenance • Light housekeeping • Medication Monitoring • RN Delegation, supervised medication set-up and routine visits •A nd, we are licensed, insured and bonded Denton County SENIOR • Spring 2010
OPEN for Article
Denton County SENIOR â€˘ Spring 2010
Autumn Leaves 2/26 deadline Denton County SENIOR â€˘ Spring 2010
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Trusts Wills Durable Power of Attorney Martial Agreements Special Needs Trusts Spouse Care Protections Trusts Pet Trusts Co-Ownership of Assets Family Limited Partnerships
Special Needs & Quality Care Long Term Care End-of-Life Decision Making Health Care Decisions Medicaid Public Benefits Profiles and Planning
SPECIFIC ELDER LAW ISSUES Mental Health Issues Medicaid Directives Nursing Home Issues Age Discrimination Elder Abuse Neglect & Exploitation Medicare Grandparents Rights
s #/524 !#4)/.3 Guardianship Conservatorship Attorney Ad Litem Guardian Ad Litem Trustee/Fiduciary Representation Probate Will Disputes
THAD R. FINLEY
ROBERT S. MORRIS
Member National Academy of Elder Law Attorney 2220 San Jacinto Blvd, Suite 200 s $ENTON 4EXAS s 1660 S. Stemmons, Suite 300 s ,EWISVILLE 4EXAS s 1216 N.Central Expwy, Suite 202 s -C+INNEY 4EXAS s &IRM %MAIL VNH HAMMERLECOM s WWWHAMMERLECOM
DAN B. CHERN
Fighting Old Age “Nothing in life is so exhilarating as to be shot without result.” The Malakand Field Force by Winston Churchill, published 1898
By: Virginia Hammerle ather your weapons and prepare for war. We are all in the midst of defending against the tribulations that come with old age. Protect your health. We’re not talking vitamins and exercise here. We’re talking about making sure that people respect your decisions. You need a Medical Power of Attorney. If you have a stroke or are sedated in an operating room, you need to have a delegate who will make health decisions for you. Not the doctor, not the minister, and maybe not your child or parent. Your delegate needs to know how you feel about feeding tubes, limb amputation, and cancer treatments. Your delegate needs the ability to put personal feelings aside to follow your wishes. You need a Directive to Physicians. Death is inevitable, so let’s put some controls on human intervention. This form is also statutory, with a place to add as many specifics as you want. Do so. You need a Designation of Guardian. The laws have rigged guardianship in such a way that you have to pay the attorneys who are trying to declare you incompetent. The protections against a bogus guardianship case are few. Spike their efforts and make your own preferential declaration regarding a guardian. If “they” determine that you need a guardian, at least you’ve chosen the person. There are actually two types; guardian of the person and guardian of the estate.
The powers of attorney described in this article are your first defense against a guardian being necessary. The declaration is the way to control your destiny if a power of attorney does not hold up. Protect your belongings. Your age makes you a target. Housekeepers and aides can literally imprison you and cut off access to the outside world. Your name is repeatedly sold to marketing houses and scam artists. Even your family members may decide they want to get their inheritance early. You need a Power of Attorney. Designate someone to act for you on financial matters. You can make it effective immediately, or you can delay so it only takes effect if you are incapable of mak-
ing your own decisions (think stroke or alzheimer’s). Do it now, while you are able to put together a portfolio of your assets. Your designated attorney-in-fact can pay your bills, make investment decisions, sell real estate and deposit checks. You can specify additional powers in the form, including making gifts. You may need a trust, a corporation, a family partnership or some version thereof. And especially if you have enough assets, this becomes very worthwhile. Do it right and you may even garner tax advantages. These entities are not for the faint of heart and do-it-yourselfers. In general: Make sure you use the Texas statutory form for the powers of attorney, designation of guardian and directive to physician. Doctors, lawyers and courts recognize the forms and are more apt to follow them. Draw up your battle plan, and then follow it. S Virginia Hammerle is the owner of Hammerle Finley Law Firm and a member of the National Academy of Elder Law Attorneys. This article is for general reference only and does not constitute legal advice. For more information on this and other topics, visit w w w. h a m merle.com or call 940-3839300. Denton County SENIOR • Spring 2010
DAVIDGE & WRIGHT, L.P . ATTORNEYS AT LAW T
he primary focus of the law firm of DAVIDGE & WRIGHT, L.P. is to assist clients with “life planning”. We provide peace of mind to our clients by organizing their legal needs to avoid future complications through both estate and business planning. Additionally, we practice probate law, helping clients through the often difficult process of handling the estate of deceased loved ones. A more detailed listing of our practice areas is provided below.
PRACTICEAREAS: Estate Planning Living Trusts Planning for Minimizing Estate Taxes Asset Protection Special Needs Trusts Family Limited Partnerships Elder Law/Medicaid Eligibility Wills
Ask about fixed rate packages for small estates Probate Law Probate of Last Wills and Testaments Intestate Administration Dependent and Court Created Independent Administration Affidavits of Heirship Real Estate Residential Real Estate Document Review and/or Preparation Commercial Real Estate Tax Deferred (Like Kind) Property Exchange
Miller Davidge* & Tiffany S. Wright
940.382.9500 512 W. Hickory Street Suite 112 Denton, TX 76201-9074 16
Denton County SENIOR • Spring 2010
Business Organizations Small Business Formation and Organization Partnerships - Limited and General Limited Liability Companies General Business Matters *Board Certified, Residential and Commercial Real Estate
A Legal Perspective
By: Miller Davidge lzheimer’s disease is an irreversible, progressive brain disease that slowly destroys memory and thinking skills. Eventually it destroys the ability to carry out even the simplest tasks. Alzheimer’s is not something everyone will have, but with our aging baby boomer population, it may become what some have called “the disease of the 21st century”. For those over 65, the possibility of contracting Alzheimer’s doubles about every five years. As we age, neurons in the brain begin to shrink, especially those important to learning and memory. This is a natural and normal consequence of aging. Tasks least affected include language and vocabulary, abstract reasoning and problem solving, and mental-spatial abilities as typified by understanding directions, reading maps, appreciating art. What goes first? Abilities most affected by age are timed memory tests, tasks requiring focused attention, and recall and processing of new information. We can still do these things, just a little more slowly. As a 68-year-old attorney I can testify that I take a little longer than before to do these things, and certainly not as quickly as my partner is who still in her 30s. With Alzheimer’s usually the brain cells destroyed first are those responsible for memory, followed by areas responsible for cognition, emotion, judgment, mood and motor skills. Generally, a physician knowledgeable about Alzheimer’s will make an accurate diagnosis about 90% of the time—an astounding figure, considering that the only conclusive Alzheimer’s diagnosis comes from a postdeath examination of the brain. So, how does a person diagnosed with the disease and his or her family handle legal matters for the Alzheimer’s patient? First, consider that a person with mild
Alzheimer’s will likely be legally competent to make a will and execute other legal documents. Texas courts have used the terms “sound mind” and “testamentary capacity” interchangeably to indicate the level of mental capacity required to execute a valid will. Testamentary capacity is generally defined as the ability to know and understand the business in which the person making the will is engaged, the effect of the action of making his will, the objects of his bounty (property), and the claims upon him and the general nature and extent of his property.
“It is imperative that the attorney not only be satisfied that the Alzheimer’s patient has testamentary capacity, but that the patient is not being influenced improperly.”
Following is “short list” of documents that every older person should have; a will, medical and business powers of attorney, a directive to physicians, and a guardianship designation. A person with mild Alzheimer’s may still have the requisite capacity to execute a will and these other important documents that the patient will need as the disease progresses. In fact, even
someone with moderate Alzheimer’s may have the requisite “cyclical lucidity” to understand their actions and make informed decisions during lucid periods. Often an attorney meeting for an Alzheimer’s patient should be scheduled in the morning to avoid the “sundowning” effect, where the patient becomes more agitated and less lucid as the day progresses. In situations involving an Alzheimer’s patient, the lawyer has to ask himself, “Who is the client?” Many times, the family of the patient will pay the legal fee, but from the lawyer’s viewpoint, the one seeking the lawyer’s services is the client. The same rules of confidentiality, conflict of interest, and undue influence apply. It is imperative that the attorney not only be satisfied that the Alzheimer’s patient has testamentary capacity, but that the patient is not being influenced improperly. The attorney must take extra care to see that his client’s wishes are completely conveyed and then carried forward in the documents. Also, the selection of fiduciaries for Alzheimer’s patients is extremely important. A person given authority under a power of attorney, either for business or health care, should know and understand the patient’s wishes, and be trusted to carry out those wishes. Unfortunately, on many occasions, a person will select a spouse or oldest child, without considering whether that person will carry out the wishes of the patient, or is best suited for that position. A good attorney working with an Alzheimer’s patient can successfully work through the obstacles that arise in the early stages of the disease to provide the client with legally binding estate planning documents that protect the client, and accurately reflect the client’s wishes. For more information, you can reach Miller Davidge or Tiffany Wright at 940-382-9500. Denton County SENIOR • Spring 2010
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Jennifer L. Polen, D.C.
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Straighten Your Teeth—At any Age
By: Norman J Pomerance, DDS ou may no longer be a teenager but you can still have straight teeth. There are numerous procedures available utilizing modern dental techniques to achieve this goal. Depending on the severity of the bite and crowding, the choices available may vary from porcelain veneers, crowns and bonding to various types of orthodontic treatment. If the crowding condition is minor with minimal rotation of the teeth, placing some bonding material over the front surface of the teeth may correct the problem. As the crowding becomes more severe, it becomes more difficult to achieve the desired result with this technique. Porcelain veneers and crowns can correct a variety of problems including spacing, crowding, rotations, and discolorations. They can be utilized with more severe problems but there is usually a need to remove more tooth enamel to achieve the desired result. The above treatments described entail covering the teeth with some type of restorative material. The most natural way to straighten teeth is to utilize orthodontics to move the teeth into a more pleasing arrangement. Orthodontics can correct overbites, underbites, crowding, spacing, and arches that are too narrow or too wide. Orthodontics generally require a longer amount of time to correct the problem, but it is accomplished without placing any material over the teeth, is permanent, if you wear your retainers, and requires no “upkeep”. Traditional orthodontics utilize wires to move your teeth. These wires are attached to brackets which are bonded to your teeth. The brackets can be invisible but the wires usually can be seen. Adjustments are necessary to tighten the wires over time to move the teeth into the desired position. A newer type of orthodontics consists of wearing invisible trays that are virtually undetectable over your teeth. These trays are removable for eating and flossing so good oral hygiene is much easier to achieve with this type of treatment. As the trays gently move the teeth, a new tray is used about every two to three weeks. At times some adjustments of teeth are made to allow for proper alignment, and tooth-colored engagers are bonded to selected teeth to secure the trays to the teeth. A simple case can be completed in less than six months, but a more involved case can take up to two years to complete, as with traditional orthodontics. The trays are comfortable, remain clear, do not interfere with speech or eating and move the teeth efficiently as wires. This type of orthodontics is most suitable for adults of any age who want a more pleasing smile but who do not want to wear traditional braces. To learn more, give us a call today at 940-382-3530.
Our philosophy is to provide the highest level of dental treatment in a caring environment which results in exceeding our patient’s expectations.
Stablilize Your Loose Dentures With Affordable Mini Implants! Invisible Braces Laser Dentistry Nitrous Oxide Teeth Whitening Conscious Sedation Implant Crowns & Bridges Dentures/Partials Smile Rejuvenation Denture Repair Root Canals Crowns/Caps TMJ Treatment Bridges Snore Therapy Extractions Cleanings Bonding Gum Treatments Porcelain Veneers Digital X-Rays Tooth Colored Fillings Mouth Guards Identafi 3000 Oral Cancer Examination Available R
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1308 Crescent St., Suite C Denton, TX 76201 www.njpomerancedds.com No Interest Financing Available (O.A.C.)
Retirement Planning Understanding Your Withdrawal Alternatives
“One of the most important things to remember if you decide to leave your current employer is to investigate your options before making any final, irrevocable decisions.”
Article courtesy of: John W. Ferguson, Jr., CLU, CFS, AIF®, Strategic Financial Partners ore than 20 mil- to a new plan. Internal Revenue Ser- tax-deferred until you begin maklion Americans cur- vice rules allow a transfer of the funds ing withdrawals. If you choose this rently participate from a 401(k) plan or other employer- option, you might want to consider in 401(k) plans sponsored plans to retirement plans of having the money rolled over directthrough their em- your new employer. This can be done ly to your new IRA account. Here’s ployers with an average account bal- even though you may not be eligible why: if you receive your lump-sum ance around $30,000. These pension for the new plan for several months. amount check first and then deposit plans can help to provide security for a When making these transfers between it, 20 percent is withheld because the comfortable retirement. It’s important employers, the investments are first IRS is assuming you’re planning to to understand, however, the tax impli- converted to cash and then the rein- cash out your entire savings. cations of these pension plans when you vestment is made. One of the most important things decide to change employers or perhaps • A third option is to withdraw all to remember if you decide to leave are a victim of corporate downsizing. or a portion of your retirement sav- your current employer is to investigate ings as a lump sum. Any remaining your options before making any final, If you’re a plan participant there are balance in your plan will continue to irrevocable decisions. You may save several alternatives available to you: grow tax-deferred. Be advised that more in the long run. you must pay federal, state, and local • You may leave all or some of your re- income taxes on the entire amount If you would like more information tirement savings with your previous em- you receive. Also, if you are under 59 on any of these topics, please contact John ployers’ plan (although some plans may ½ years old, a 10 percent IRS penalty at 719-388-0211 or firstname.lastname@example.org require you to automatically rollover if for early withdrawal may apply. In your plan proceeds are $5,000 or less). addition, the IRS requires a 20 per- This information is a general discussion of the relevant federal tax laws. It is not intended for, nor can it be used by These investments are often profession- cent automatic withholding if you’re any taxpayer for the purpose of avoiding federal tax penalally managed at a lower cost than if you not rolling it over to another retire- ties. This information is provided to support the promoor marketing of ideas that may benefit a taxpayer. roll your account into an IRA. Unlike ment plan or IRA. By making a total tion Taxpayers should seek the advice of their own tax and legal an IRA, distributions are not required lump-sum withdrawal you do control advisors regarding any tax and legal issues applicable to in an employer-sponsored plan if you’re all of your assets. However, you are their specific circumstances. still working at age 70 ½ (subject to now solely responsible for managing Securities offered through Securian Financial Services, plan documents and other limitations). your money efficiently in order to Inc., member FINRA/SIPC. Strategic Financial Partners is independently owned and operated. Copyright Custom In addition, assets in 401(k) plans are meet your income needs. Communications 2009. Material in this article cannot protected in the event of bankruptcy. • Lastly, your retirement savings can be reprinted without permission. Financial Partners • A second option for your retirement be rolled over to an IRA. In this case, Strategic 1755 Telstar Drive, #501 plan savings is to transfer the money your savings continues to accumulate Colorado Springs, CO 80920 20
Denton County SENIOR • Spring 2010
Finance & Insurance
By: Michele Barber, Northstar Bank of Texas arly in each new year, it is al- access to a computer, or 800 numbers ways good to go over a checklist if you don’t. Additionally, it is always to make sure important mat- a good idea to have a copy of all credit ters are reviewed, current and correct. card numbers in a safe, protected area in With our often fast-paced and very case they are lost or stolen. busy daily lives we need to take a fresh Tax Information It is always good to look every now and then to make sure get a head start on gathering your prethings are in order. vious year’s tax records and to file your tax return as early as possible. If you do your own taxes, forms and schedules A few suggestions of things to assess can be requested from the IRS by mail and review follow. or downloaded from the IRS website, Credit Report It is important that each www.IRS.gov. You will also be helping year you obtain a current copy of your your accountant prepare your return if credit report. It is necessary to protect you start early. yourself from possible identity theft Home and Health Maintenance and important to have on hand as you Make a list of any home maintenance tend to your affairs during the year. You items that need to be taken care of, can get one free credit report annually such as checking the attic insulafrom each of the major credit bureaus; tion, fireplace cleaning, checking the Equifax, Experian, and TransUnion. All air conditioning and heating unit, of them have online services if you have cleaning gutters, checking the win-
dow caulking, making sure your car is inspected—to mention a few. Don’t forget to discard expired medications (but do so properly—most hospitals and clinics will accept for proper disposal—do NOT flush or put in trash) and make plans for your annual routine health check ups as well. Finances Review your financial accounts to ensure you are maximizing your dollars and earning the highest amount possible. It is always good to have a strong working relationship with your banker and/or financial advisor as he or she can be one of your best allies when financial needs or concerns arise. Our economic conditions are uncertain these days, but being prepared can eliminate a great deal of stress and worry. Take time now to get organized and enjoy the days ahead.
www.nstarbank.com Denton Banking Center 400 N. Carroll Blvd. | 940.591.1200 *APY=Annual Percentage Yield **Must meet certain requirements in order to receive reward rate. Contact NSB for details.
South Denton Banking Center 3301 Teasley Lane | 940.383.6234
Denton County SENIOR • Spring 2010
Enjoy Your Retirement
PlAnnIng IS bRIngIng thE fUtURE Into thE PRESEnt, So yoU cAn do SomEthIng AboUt It now”. —AlAn lAkEIn, AUthoR
building blocks for your retirement income plan Social Security & Pensions—Before taking your Social Security or a pension, study your choices! Your decision can impact how much lifetime income you & even a spouse will receive over your life times!
Savings, IRAs & Investments—Withdrawal Strategies from your different “buckets” can impact how long your savings last as well as the taxes you owe each year! Have a plan! Plan for the Unexpected—Emergency Funds ~ Interest Rate Changes ~ Inflation ~ Portfolio Values Expenses—Don’t forget “healthcare”, “insurance”, “taxes” & more. Review & adjust yearly. planning a sound financial retirement roadmap is not to be taken ligHtly. Just as you wouldn’t let an electrician or friend do surgery on you, seek help from a trained financial advisor in preparing & reviewing your retirement plan & investments. Because retirement planning decisions can impact your life for years to come, second opinions should also be a planning priority! for Help in reviewing your retirement income plan, call me today!
rebecca thompson, crpc®, aams® financial advisor
CHARTERED RETIREMENT PLANNING COUNSELOR® AND ACCREDITED ASSET MANAGEMENT SPECIALIST® collin county (214) 733-0137 (toll free) 888-247-1829 Branch Office: 2000 N. Central Expressway, Suite 218, Plano, Texas 75074 Ph: (972) 379-2323. Investment Advisor with and Securities and Investment Advisory Services offered through TransAmerica Financial Advisors, Inc., Member FINRA, SIPC & Registered Investment Advisor
Medicare choices in 2010 could mean better coverage for less money!
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Senior Life Division
Medicare Plans Medicare Supplements Health Insurance Long-Term Care Policies Life Insurance
Benchmark Financial Services is a local company with a Senior Life Division dedi-
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local (469) 247-1829 or toll free (888) 247-1829
Denton County SENIOR • Spring 2010
Your Local Agent: Tucker Thompson
Certified Senior Advisor
Finance & Insurance
Medicare and Long Term Care Who Pays for What?
Article courtesy of Benchmark Financial Services ithout a crystal the facility for the first 20 days of your stay. ball, none of us In 2010, you’re responsible for $137.50 per can know when or day facility charges for the 21st-100th day. if we’ll ever need Medicare won’t cover any part of stays over help taking care of 100 days. Some Medicare-approved, short ourselves. Whether from a short or long term, physician-prescribed home healthcare term situation caused from a bad fall, and approved durable equipment for home dementia, stroke, or any other debili- use may also be partially paid by Medicare. tating medical condition, we may one Some people qualify for additional day not be able to feed ourselves, bathe, government help through Medicaid. dress, go to the bathroom without help, Generally in Texas your monthly income or make sound, safe decisions while per- must be less than $2,022 for singles and forming our daily activities. $4,044 for married. You can’t have more National cost of nursing home care than $2,000 in assets/investments includthree years ago averaged $171/day or ing cds, bonds, stocks, mutual funds, $5000/month. Those figures are higher gold, mineral rights, bank accounts, etc. if today. Paying for even six months of you’re single and $3,000 if you’re married. assisted or fulltime care in your home When people apply for Medicaid, states can severely deplete savings. This article are also required to find out if assets were highlights how some of these potential given away or re-titled in an attempt to expenses can be paid for while also mini- meet Medicaid’s qualifications. If found, mizing negative impact and unnecessary penalties are assessed and heirs can also outflow from your savings. be held responsible for paying back what Medicare or Medicaid may offer the government feels is owed. Because the coverage. Other sources of funds, aside laws are specific and also vary from state to from personal savings, can include us- state, it’s best to contact your state or local ing cash value you may have in life Medicaid office for detailed information. insurance policies, taking out a home If you haven’t looked closely at the equity loan, buying an immediate an- newer long term care policies available nuity, or purchasing a long term care today, you should. More flexible features insurance policy. and their affordable premiums make them On the www.Medicare.gov website, un- a vital component for protecting your savder paying for long term care, you’ll find the ings from the potential drain of long term following statement: “Medicare generally care medical expenses. Historically sold as doesn’t pay for long-term care. Medicare also individual plans, if a person died without doesn’t pay for help with activities of daily needing long term care the benefits would living or other care that most people can do stop. Today, many policies permit unused for themselves”. But Medicare will cover benefits to transfer to a surviving spouse. some short term home healthcare, skilled Premiums are calculated by age and health nursing, and hospice care. For example, if at application, as well as by the type and you meet Medicare’s medical requirements dollar amount of coverage chosen, as well and enter a certified skilled nursing facility as the elimination period. The elimination directly from a hospital, Medicare will pay period can range from 0 days to 365 days
“If you haven’t looked closely at the newer long term care policies available today, you should. More flexible features and their affordable premiums make them a vital component for protecting your savings from the potential drain of long term care medical expenses.” and is the time that must lapse before any benefits are paid: the shorter the elimination period, the higher the premium. By deciding, for example, that your savings would be used to cover the first month or two of a potential assisted living cost can help reduce your premium. A year in a nursing home today may cost $65,000. If a healthy 60 year-old paid $3,000 a year for a long term care policy, he or she would reach 80 before spending $60,000. Regardless of your financial status, it’s very important to update yourself on the options available today to make sure you are doing all you can to protect and help ensure that you and your spouse (if applicable) will be able to maximize and use the assets you have worked a lifetime for. For more details about the newest long term care policies, immediate annuities or how to tap into any life insurance policies, please call Tucker Thompson, Benchmark Financial Services, at 972-548-1629 or 888-247-1829. Denton County SENIOR • Spring 2010
ordability is on ff a n e h W We can assist you with all aspects of your funeral service, regardless of where you own cemetery property or with whom you may have pre-arranged your service.
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Should We Go or Just Send Flowers?
By: Rick Allen, Allen Family Funeral Options any of us have and honor the one who has died, the faced the dilemma funeral service is not for that person. of whether or not The funeral service provides an opto attend funeral portunity for anyone who has been services for some- affected by the loss to share his or her one we knew or send a floral arrange- feelings openly with others, accept the ment instead. Sometimes we see the loss and to say goodbye. So, one reason necessity in doing both. But when we have in favor of attending the serthe decision is to do one or the other, vice is the positive effect it could have what factors do we use in arriving at for us. As one who has lost immediour conclusion? Obviously, a conflict ate members of my family, I can assure in schedule has to be considered first, you the people who choose to attend but when the calendar is clear do we have a positive effect on those who are tend to look for reasons to go or rea- closest to the one who has died. sons not to go? Seeing and talking with your friends When the person who has died is a and co-workers at a funeral for your member of the family, little thought is loved one imparts warmth and comnecessary; attendance is all but man- fort to a hurting heart. Many times we datory. Extended family is even con- learn things about the deceased that we sidered a “must” by most people. The did not know. Leaving a funeral feelstruggle for the vast majority comes ing as if you know the deceased even with making this decision when the better than before often gives a greater deceased is an acquaintance from long appreciation for that person’s life. ago, the family of a friend, or someWe too can get a chance to share one we may have known profession- a story with the family about their ally. Thus, the question that normally loved one. They may not have known faces us is, “Why can’t we go?” something they said or did that made Let’s look at the obvious first. Fu- a positive mark on our lives. So, while nerals are not fun. The mood is usually it’s often easy to find an adequate reasad and people may even be gloomy. son to skip a service, the good that Additionally, we are expected to wear can come our way or that we can pass dark suits, ties, dress shoes, and all of on to others can far outweigh the these are usually not terribly comfort- short period of time we could hold able. If the weather is hot or rainy, this back for ourselves. will often have a negative effect on our Look for ways to make something decision as well. The truth is, we don’t you think will be difficult an easier exhave to look too far to find an abun- perience for everyone involved. You may dance of reasons (excuses) to not at- be positively surprised. tend a funeral. On the other hand, consider the Rick and Melanie Allen, owners of good things that might occur if you Allen Family Funeral Options may be go. Although funerals pay tribute to reached at 972-596-8200.
“when the decision is to do one or the other, what factors do we use in arriving at our conclusion?”
Denton County SENIOR • Spring 2010
Bringing Comfort and Healing into Your Home Ann’s Haven VNA Home Health Bridge Hospice When you need extraordinary care for yourself or your loved one.
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Home Health provides skilled nursing and therapy as well as specialized care. Bridge provides quality, transitional care for terminally ill patients not yet ready to embrace hospice. Hospice care is designed so patients with a terminal illness may live as fully and painfree as possible.
Speaks to the heart of the organization Ann’s Haven VNA . . . serving Denton County since 1979. For More Information: 940-349-5900
Denton County SENIOR • Spring 2010
Home Health & Hospice
A Benefit Covered by Medicare and Medicaid
By: Robert Smith, Visiting Nurse Association ften patients and their are identical regardless of the payer families are reluctant source—Medicare, Medicaid or your to discuss the option insurance company: A physician must of hospice care with certify that a patient has a life-limiting the physician when illness; The prognosis for living is less confronted with the diagnosis of a ter- than six months if the disease follows minal illness. Don’t be hesitant to do it’s normal progression; The focus of so. Sometimes physicians and clini- care is on symptom and comfort meacians fail to suggest hospice until the sures rather than curative care. patient is near death and the benefits When talking with your doctor are lost to the patient and loved ones. about the possibility of hospice, you Your discussion with your physician are entitled to choose any Medicareabout hospice should include your certified hospice agency that provides right to choose the agency you prefer. services in your community. It is imRemember, hospice is a service cov- portant for you and your loved ones ered by Medicare, Medicaid, and some to visit with a representative to know private insurance companies. what range of services a hospice agency Hospice is not giving up on life or provides, including assistance with care simply choosing to die. It is a health outside normal business hours. service based on a philosophy that you Regardless of the agency you choose, may wish to prepare for death in a safe under Medicare and Medicaid benefits, and supportive environment, usually patients are eligible to receive all mediyour own home. Hospice provides com- cations related to their hospice diagnofort care and pain management so that sis and including new medications as patients enjoy quality of life during the the disease progresses (medications you final phase of a terminal illness. may already be taking that are not reHospices services are provided by a lated to the hospice diagnosis are not team of healthcare professionals who fol- covered under the Medicare benefit). low a plan of care that is unique to the This can sometimes be confusing; howpatient’s diagnosis and specific needs. ever, a patient’s hospice team will assist The hospice team is typically comprised in assessing and identifying medicaof a physician, registered nurse, social tions that are covered. worker, home health aide, chaplain, and Medicare beneficiaries who receive volunteer. The team works closely with hospice care are also eligible for medthe patient’s primary care physician to ical equipment and supplies needed continuously re-evaluate services that to accommodate their needs such as may be needed. The team assists in all a hospital bed, special mattress for aspects of care for the patient and fam- skin care, wheelchair, bedside comily. Following death, bereavement care is mode, and oxygen therapy. During also available to family and loved ones. the course of care, there may be a Many people never realize they need for additional services that are are eligible for hospice. The criteria also covered by Medicare.
When you and your family are faced with the crisis of a terminal illness, there are so many questions and concerns that need to be addressed. Do take time to talk to your physician about hospice care, an opportunity to spend your final days with the comfort of knowing that you are receiving quality care and are in your own home, with your loved ones. Understanding your right to choose the agency you want and receiving the full benefits provided to you by Medicare, Medicaid, or other private insurances, can help ensure peace of mind Additional information about hospice care can be obtained by contacting Director of Marketing Elaine Harrison, RN at 214-689-2661 or harrisone@ vnatexas.org “Hospice is a health service based on a philosophy that you may wish to prepare for death in a safe and supportive environment, usually your own home.”
Denton County SENIOR • Spring 2010
Legacy of Caring
can be a devastating disease. Let Jordan Health Services play a key role in the Care and Management of your COPD needs. Jordan Provides: Cardio-Respiratory assessments Prevention strategies Medication teaching focus Self care management Safe use of Oxygen Healthy eating Symptom management
If you or a family member suffers from COPD call us today to see how our Home Care staff can help you.
121 W. Lamberth Road, Suite A Sherman, TX 75092 903.892.3163 800.64.NURSE (800.646.8773) www.jhsi.com
Denton County SENIOR â€˘ Spring 2010
Home Health & Hospice
Breathing Better with COPD
By: Brittany Hartman & Kathy Stevens, Jordan Health Services or many of us those New smoking is key. It is the single most efYear’s resolutions have fective way to prevent the development been forgotten, but for of COPD. If you already have COPD, those with chronic ob- quitting can slow down or even stop the structive pulmonary dis- progression. It is never too late to quit. ease (COPD), there is no better time Talk to your physician about smoking to resolve to breathe better. cessation medications and programs to COPD is a serious lung disease that help you quit. over time makes it difficult to breathe. A little exercise goes a long way. Light COPD is also known as emphysema exercise can make you feel more enerand chronic bronchitis. COPD is the getic while conditioning your muscles. fourth leading cause of death in the Exercise at any level holds benefits for United States and causes serious, long- COPD patients, but before jumping term disability. into any exercise program; be sure to The “airways” are the tubes that carry consult with your physician. air in and out of the lungs through the A healthy diet is important, but nose and mouth. Healthy airways and for people with chronic obstructive air sacs in the lungs are elastic, mean- pulmonary disease, eating well is even ing they bounce back to their original more crucial to overall health. Good shape after being stretched or filled with nutrition helps COPD patients fight air; just the way a new rubber band or infections, prevent illness, and may cut balloon does. This elastic quality helps down on hospital visits. retain the normal structure of the lung As with any disease it is very imand ensure the air moves quickly in and portant to follow the treatment advice out. In people with COPD, the air sacs of your health care practitioner. Treatno longer bounce back to their origi- ment of COPD is different for everynal shape. The airways can also become one, so be sure to take your medications swollen or thicker than normal, and and follow your doctor’s advice on how mucus production might increase. The to treat your disease. If you have quesfloppy airways become partially blocked tions—ASK! See your doctor regularly, or obstructed, making it even harder to even if you are feeling fine, and be sure get air in and out of the lungs. and take a list of all your medications Symptoms of COPD include; a chron- with you to the doctor. ic cough, shortness of breath while doing Avoid exposure to pollutants. Try simple activities such as getting dressed, to stay away from things that could irand coughing up mucus. The most com- ritate your lungs, like dust and strong mon cause of COPD is repeated expo- fumes. Stay indoors when the outside sure to tobacco smoke. This includes air quality is poor. Steer clear of cigayour own or someone else’s. Other things rette smoke. Take precautions against that could put you at risk are exposure to the flu. Avoid crowds during flu seachemical fumes, dust, and air pollution son and always remember your flu and over a long period of time. pneumonia vaccine. You can never There are many things you can do to undo the damage done to your lungs make living with COPD easier: Quitting but following these steps can help pre-
vent COPD as well as make living with the disease much easier. S If you or someone you know has COPD, please let Jordan help. Our skilled staff of health professionals can provide cardio-pulmonary assessments, medication teaching, self-care, safe use of oxygen, healthy eating, and management of symptoms. Ask today how you can get more information for you or your family about COPD by contacting 800-64-NURSE (800-646-8773) or go to www.jhsi.com.
“As with any disease it is very important to follow the treatment advice of your health care practitioner.” Denton County SENIOR • Spring 2010
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Denton County SENIOR • Spring 2010
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Home Health & Hospice
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Denton County SENIOR â€˘ Spring 2010
The LORD is good to all. He shows His mercy to everything He made. Psalms 145:9
ercy Hospice is a highly experienced collection of professionals whose primary focus provides an environment of comfort and support for the patients and families, promoting spiritual healing throughout the family.
Providing highly experienced hospice staff Providing physical, spiritual and psychosocial support
MERCY HOSPICE specializing in end-of-life care
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Lewisville, TX 75067
866.566.3729 Toll Free
Home Health & Hospice
“It’s all in a picture.”
By: Lizzy Lilly, Mercy Hospice very year my husband and I take part in a weekend camp called Camp Conquer. It’s a grief camp in Collin County that helps children ages 9-14 learn to cope with the grief of losing a loved one. When we first started it took a little (okay a lot of ) convincing to get him to go. He’s not a real big “share your emotions” kind of guy. The Sunday night after our first camp, on the car ride home, he made a proclamation that “no matter what, we will be participating in Camp Conquer as long as it exists!” To say the least, I was shocked. I thought for sure he was going to protest and tell me how horrible the whole experience had been, but he surprised me. I asked him what changed his mind and he told me the following story. “Everything changed for me on Saturday night, at the bonfire. (Saturday night the campers write letters to their loved ones and then get to throw them in the fire as a way to say goodbye.) “There was a young boy who had lost his dad to cancer not two weeks before camp. He was a good kid who was pretty messed up by the whole situation. We hit it off right away and got along really well. He was into boxing, just like his dad, and so am I. He stuck by my side from the time we met until the time we left on Sunday morning. His story was no more heart breaking than any of the other
children in camp. In fact, some people would consider it mild in comparison, considering we had kids who had seen their mom or aunt shot to death in cold blood. But it wasn’t his story that got to me. It was that night at the camp fire. After this young boy had burned his letter, he walked up to me and started crying and said, “I can’t remember what my Dad looked like”. I couldn’t do anything but hold him and cry. “When our group of guys got back to the cabin I asked if he had any pictures of his dad; he smiled and ran to get a picture of he and his dad playfighting. I told him, “See, it’s all in the picture. Everything you need to remember the good times you had with your dad are right there.” He laughed and gave me a big hug and went off to play without even a second thought to the events of the night. But it was something I will never forget. Seeing a child realize that the memories he has of his father are of the fun times they had, not that his dad has passed on.” So every year since then we go to camp and we listen to their stories. We hear the pain in their voices; feel the sorrow in their hugs. When the weekend is over we hope that we have touched their lives as much as they have touched ours. It’s not about what we do or to glorify our actions, but it’s about what can be done for the kids who have nowhere to go to get help dealing with their grief.
We, along with Mercy Hospice, want to get the word out. If you know any children between the ages of 9-14 who have lost a loved one and would benefit from this experience, please let us know. You can find out more information at: Camp Conquer Foundation 417 Oakbend, Suite 170 Lewisville, Texas 75067 email@example.com or on the web at www.campconquer.org The dates for camp for 2010 are May 14-16. If you would like more information, please contact us at www. camp conquer.com.
Denton County SENIOR • Spring 2010
It’s Your Choice!
Do You Know What You Choose?
By: Sherry Little, Executive Director, Home Hospice of Grayson, Cooke and Fannin Counties ne unmistakable truth ties, assisted living facilities, and hosHow do I communicate my wishes to that few of us want to pice providers will give you valuable my family? hear is that we will, information and allow informed deci- Opening these discussions with those who someday, die. Given sion-making for you and your family. It love us—and never want to contemplate the that fact, are you pre- will allow you to choose who cares for possibility of life without us—is difficult. pared for your own final journey? There you when the time of need arises. There are a myriad of opportunities that are many questions that each of us needs can give us a launching pad; movies, family to ask and answer to ensure that this Depending on the level of illness, what funerals, television, holidays, and even the special journey will be all that it can be, do I want my physician and other care birth of a child or grandchild. Remember, and that it will be neither burdensome providers to do for me? investigation into the possibilities, deternor gut-wrenching for those we love. Making choices about treatments such mining your own choices, recording them as the placement of feeding tubes and and discussing your reasons, is a gift, not What options for care are available and ventilators during certain situations a burden. Actually, it is most often a relief which do I choose for myself? is a very personal matter. Exploring for those we care about for then they know Exploring the resources for care avail- the details and results of any possible what you want and don’t have to guess. able in your community and whether treatment or other option for care alor not they meet your own life goals lows you to make those choices for For more information or guidance with is an important step in preparation for yourself and complete advance direc- these issues of preparation, or to have somea possible critical or chronic illness. tives reflecting those choices. Why one speak to your group about how to be preInvestigating treatment centers, home leave those choices to anyone else if pared, call or email Home Hospice at 940health agencies, long-term care facili- you can make them for yourself? 665-9891 or firstname.lastname@example.org
End-of-life Care Options
Let me decide What services will best benefit me?
What are my spiritual, financial & emotional needs?
What level of pain control is right for me?
How can I ensure that my family receives support?
Call for our free informational DVD.
Serving Cooke County
You have choices! a nonprofit hospiCe GoVerneD By loCal leaDers
Denton County SENIOR • Spring 2010
1001 e. BroaDway • GainesVille
940.665.9891 • www.homehospice.org
Home Health & Hospice
The Need for Hospice in a Changing Economic Environment
By: Brad Harris, Bluebonnet Hospice he United States health care system is in a state of flux. The dynamic economic conditions and recent developments pertaining to the future of Medicare threaten to create a void in care for our seniors. Potential cutbacks in Medicare will likely affect how our hospitals and physicians are allowed to treat disease processes in the elderly. For seniors on Medicare, without the availability of high priced health insurance, aggressive treatments may become the exception rather than the rule. This may be due to Medicare’s reluctance to pay for aggressive measures in the elderly with a corresponding lack of continuity of care. With these potential cutbacks on the horizon, the need for hospice care will become increasingly important to
our seniors and their families. The void in continuity of care can be filled by a hospice agency. For disease processes that have been managed unsuccessfully or health conditions which can be impossible to treat, hospice will become even more viable than it currently is. Hospice care is conducted by specifically trained professionals who are able to perform a service unlike any that can be provided by an ICU in any hospital. Hospice care is performed by a special breed of professionals who can manage not only the physical symptoms of a disease process but also the spiritual aspects. Hospice care manages physical, mental, and emotional changes experiences by both the patient and the family. Hospice care is often an
overlooked benefit provided by Medicare. In our dynamic economic conditions, and as changes to Medicare take place, hospice care will be there to fill an all important void. Author Brad Harris is the Assistant Administrator at Bluebonnet Hospice. Bluebonnet can be reached at 940-323-2122 for more information.
“We treat our patients like family.”
Home Health Care
• Physical, Occupational, and Speech Therapy • Wound Care/Wound Vac. • Comprehensive Diabetic Care • Medication Management • Skilled Nursing • Oncology Care
• Medical Director • Hospice Nurses • Hospice Home Care Aides • Social Workers • Chaplains and Bereavement Counselor • Volunteers • Medications Serving several Central, North, and East Texas areas, including: Denton, Collin County, Mt. Pleasant, Greenville, Quitman, and surrounding areas. Denton Bluebonnet Home Health and Hospice 2701 W. Oak St., Suite # 102 • Denton TX 76201 Phone number 940-323-2122
Denton County SENIOR • Spring 2010
Common cancers in women
Article courtesy of Texas Health Presbyterian Hospital Denton ou can reduce your risk but increases with age. A woman has a of getting cancer by one-in-70 lifetime risk of ovarian canadopting a healthy life- cer. Unfortunately, this disease is often style, paying attention to diagnosed late in its development as how your body feels and the symptoms associated with it are looks, and having regular checkups. often nonspecific and thus it causes Being aware of some of the character- more deaths than any other type of istics to watch for can be helpful. female reproductive system cancer. The risk of ovarian cancer is low, Factors that increase a womanâ€™s risk 36
Denton County SENIOR â€˘ Spring 2010
of ovarian cancer include: infertility, high-fat diet, personal history of breast or colon cancer, endometriosis, advancing age (women older than 60 years have the highest risk), and abnormal genes (BRCA1 and BRCA2). Women who have taken oral contraceptives, have at least one child, or have breastfed are at a lower risk.
Ovarian cancer is hard to detect until it is in an advanced stage. There is no good test to screen for cancer of the ovary. Your doctor may be able to feel a cyst on one or both ovaries but very few of these cysts will prove to be cancer. Still they should be checked by your doctor. Warning signs of this cancer type include: discomfort in the pelvic area and indigestion, gas, or bloating that cannot be explained; abnormal vaginal bleeding; swelling of the abdomen. The best way to monitor for this cancer is to have yearly well exams. Uterine cancer most commonly occurs in the lining of the uterus. The risk of cancer of the endometrium (the lining of the uterus) increases after age 55 and occurs most often in women between the ages of 60 and 75 years. It is rare in women younger than 40 years. Women who have taken oral contraceptives appear to have a lower risk than those who have not. Factors that increase a woman’s risk for this type of cancer include: use of estrogen alone as hormone therapy (prior to a hysterectomy); not giving birth; menopause after age 52 years; obesity and related conditions such as high blood pressure; diabetes or disorders such as thyroid or gall bladder disease; use of tamoxifen; having endometrial hyperplasia; other inherited cancers, such as certain types of colon cancer. Also at risk are women who do not ovulate and often have irregular or missed periods. Warning signs of endometrial cancer include bleeding after menopause, abnormal bleeding or discharge between periods, and prolonged and heavy bleeding during periods. Doctors do not routinely screen for endometrial cancer as it is usually detected early if the warning signs of abnormal bleeding are evaluated. If you have warning signs of this cancer, your doctor may recommend biopsies, ultrasounds or minor surgery
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to determine the source of bleeding and detect if cancer is present. Cervical cancer was once one of the most common causes of cancer death for women in the United States, but that has improved due to the Pap test, which helps find problems early. There may be no warning signs of early cervical cancer. Signs of more advanced cervical cancer may include unusual discharge from the vagina, abnormal bleeding, or bleeding after sex. Doctors screen for cervical cancer with routine pelvic exams and pap smears. The interval recommended for a pap smear varies based on an individual patient’s history. Recently, HPV tests have been used in conjunction with pap smears to evaluate women at risk. Your gynecologist can provide more information as to whether this test would be of benefit to you. Many cancers are linked to lifestyle factors. Making these changes in your lifestyle will improve your health and some may help prevent cancer. To reduce your risk of cancer: do not smoke; limit your intake of fat (especially saturated fat and trans fat); eat foods with high fiber content; get regular health checkups; exercise every day for at least 30 minutes; limit your time in the sun and use sun block when you go outside; pay attention to changes in your body; limit your number of sexual partners; have recommended exams and tests; limit the amount of alcohol you drink. A healthy lifestyle, screening tests, and regular check-ups can help lower your risk of cancer. Many types of cancer can be cured if they are treated early. Being aware of the types of cancer and how to prevent them or detect them early can help protect your health. Author Christina Dooley, MD, FACOG can be reached at 940-5916600. Her office is at 2501 Scripture, Suite 200, Denton, Texas 76201
“Cervical cancer was once one of the most common causes of cancer death for women in the United States, but that has improved due to the Pap test, which helps find problems early.” Denton County SENIOR • Spring 2010
The Emergency Experts It takes some amazing individuals to deliver the region’s most comprehensive emergency care— over 200 critical care experts across 25 specialties, to be more specific. And each and every specialty is on call or available 24 hours a day, 7 days a week at our Emergency Care Center. That’s dedication you can count on. And that’s why we’re critical care you can trust.
Life-saving critical care specialists
Anesthesiology Mohammed Assadi, MD David Billman, MD David Bryant, MD Lei Chi, MD Philip Eichenholz, MD William Garrett, MD Joy Gathe-Ghermay, MD Michael Hicks, MD Williams Hoffman, MD Michael Huss, MD Asad Hussain, MD Mir Hussain, MD Terry Latson, MD Kirk Lodes, MD Mark Lowe, MD Randy Marcel, MD Brannon Marlowe, MD Luis Michelsen, MD Hoang Nguyen, MD Patrick Ogbue, MD Nathan Pailes, MD Randy Robbins, MD Jamie Ronderos, MD Cynthia Speers, MD Kevin Thomas, MD Suresh Valloppillil, MD Michael Walsh, MD Alvin Wong, MD Norman Wu, MD Melvin Young, MD
Cardiology Simon Allo, MD Jeffrey Kaplan, MD Mitchel Kruger, MD Shirley Williams, MD
Cardiology (Interventional) Daniel Caldwell, MD Gary Fazio, MD William Gray, DO Ricky Harris, DO Atif Hussain, MD David May, MD R. Conrad Park, MD Tanveer Qureshi, MD Raul Santos, MD
Colon-Rectal Eric Romanucci, MD
Emergency Medicine Candis Beard, MD Stewart Coffman, MD James Doyle, MD Gayla Garner, MD Manisha Gupta, MD William Haynes, MD Lisa Kohler, MD Marc Labat, MD Travis Lilly, MD Rouhollah Prueitt, MD Regina Rivera, MD John Saad, MD Angela Straface, MD Mahesh Thiagarajah, MD
Gastroenterology Amjad Awan, MD Joseph Fletcher, MD James Haley, MD Roy Joseph, MD Shawn Panzer, MD Gang Quan, MD
General Surgery Franklin Charney, MD Robert Connaughton, MD Carolyn Garner, MD Stephen Lester, MD Daryl Stewart, MD
Hematology Oncology Jolanta Cichon, MD Dennis Costa, MD Ajit Dave, MD Ketaki Dave, MD Gus Gonzalez, MD Sharad Jain, MD Sushama Jasti, MD Shadan Mansoor, MD Mohammad Qasim, MD Michael Ross, MD Michael Spivey, MD
IM-Hospitalist Afeefa Chaudhry, MD Bruce Harman, MD Smart Idemudia, MD Kerry Mahan, MD Carl Russell, MD Vilay Thongkham, DO Khin Thu, MD Elango Vinjirayer, MD
Nephrology Arshad Asghar, MD Bruce Baker, MD George Rojas, DO Mario Ruiz, MD Matthew Smith, MD
Obstetrics/Gynecology Laura Finger, MD Lori Harvey, DO Monica Popov, MD Caren Reaves, MD Indrani Reddy, MD Joseph Valenti, MD
Orthopedics Major Blair, MD Eric Eif ler, MD Craig Glauser, MD Michael House, MD John Kristoferson, MD Lyn Ward, MD Stephen Weinberg, MD
Pathology Kenneth Ford, MD Lesa Ford, MD Melanie Kahn, MD Richard Keene, MD Chan Lertdilok, MD Thomas Mulhollan, MD
Pediatrics Amy Adams, MD Jeremy Baker, MD Jeffrey Day, MD Bruce Eckel, MD David Goff, MD Mohrokh Hedayati, MD Marilyn Janke, MD Carrie Jones, MD Stephen Schulman, MD Milton Squiers, MD Susan Torrie, MD Diane Van Maele, MD
Pulmonology Glenn Genovese, MD Jamal Mubarak, MD Mukesh Saraiya, MD
Radiology Tracy Bakski, MD Eric Benson, MD
John Bondy, MD Richard Borden, MD Edwin Boren Jr., MD Jeffrey Carenza, MD Henry Chen, MD Chris Chicoskie, MD Ethan Colby, MD Eric Davis, MD Jeffrey Diebner, MD Lance Driskill, MD William Elkins, MD Christopher Goscin, MD Todd Guinn, MD Mark Herrera, MD Jesse Hochman, MD Blaise Jones, MD Gregory Jones, MD Vipul Kapoor, MD Vaibhav Khasgiwala, MD David Kim, MD John Kim, MD David Klamer, MD Samuel La, MD Jason Ma, MD Warren Martin, MD Jonathan Metzler, MD Brian Miller, MD Adrian Moger, MD Bruce Morris, MD John Mulloy, MD Nam Thuy Duc Nguyen, MD Edward Pong, MD Bryan Quarles, MD Steven Reiman, MD Jorge Roman III, MD Clayton Sanders, MD Karen Seaberg, MD Elizabeth Seaberg-Jabbour, MD Victor Shin, MD Anupam Singhal, MD Andrew Small, MD Mark Spivey, MD Paul Staveteig, MD John Sullivan, MD Allison Taten, MD Buddy Thompson, MD Ernest Tschoepe, MD Shannon Walker, MD Gary Webb, MD Ted Wen, MD
To learn more, visit dentonregional.com
Melissa Whitworth, MD Edward Wooten, MD Sara Zajicek, MD
Thoracic Surgery Tea Acuff, MD Tung Cai, MD George Johnson Jr., MD
Trauma Thomas Granchi, MD James Jenkins, MD John Josephs, MD Keith Seto, MD Kent Skipper, MD Mark Tucker, MD Jason West, MD Thomas West, MD
Urology Robert Admire, MD David Casey, MD Galen Howard, MD John Jaderlund, MD Dan McBride, MD
Available as needed: Allergy Bediolia Badie, MD Sven Wust, MD
Breast Surgery Kerri Perry, MD
Dentist Omel Cardenas, DDS
ENT Surgery Junior De Freitas, MD
Hand Surgery Stuart Hilliard, MD
Neurology David Cooke Jr., MD Jayaraman Ravindran, MD Lynn Wang, MD
Ophthalmology Nadeem Haq, MD
Vascular Carlos Cruz, MD
Heart Attack Care
By: William T. Gray, DO, Interventional Cardiologist, Denton Heart Group very year more than nosed before age 65. 460,000 Americans die • Illinesses or conditions such as diabefrom heart attack, with ap- tes mellitus, high blood cholesterol or proximately half of these high blood pressure. Cigarette smokers, individuals dying before those overweight or physically inactive they get to a hospital. While a heart are at risk. attack can be a frightening experience, While some heart attacks can be knowing the signs and symptoms of a similar to the sudden and intense “Holheart attack and what steps to take can lywood heart attack”, most start slowly ensure the individual receives timely, with mild pain or discomfort. Often life-saving medical care. people aren’t sure what is wrong and wait too long before getting help. What is a Heart Attack? A heart attack occurs when a clot in the Here are some key warning signs that heart’s artery blocks the flow of blood a heart attack is happening: to the heart, resulting in the death of • Chest discomfort in the middle of the heart tissue. The more time that passes chest that lasts for more than a few minbefore receiving treatment, the greater utes, or that goes away and comes back. the damage to the heart. This damage is This may feel like uncomfortable prespermanent and cannot be reversed. sure, squeezing, fullness or pain. • Discomfort in other areas which can inWho is at Risk? clude pain or discomfort in one or both The following risk factors apply to both arms, the back, neck, jaw, or stomach. men and women: • Shortness of breath which may occur • A previous heart attack or procedure with or without chest discomfort. to open up the coronary arteries. • Other signs such as breaking out in a • Age, for men 45 and older, women 50 cold sweat, nausea, or lightheadedness. on up. If you or someone you know has chest • Family history of early heart disease, discomfort, especially with one or more especially a father or brother diagnosed of the other symptoms listed above, call before age 55 or mother or sister diag- 911 immediately.
William T Gray, DO Author William T Gray, DO is Interventional Cardiologist with Denton Heart Group and Chairman of Cardiovascular Services at Denton Regional Medical Center. He can be reached at 940-382-8080 Denton County SENIOR • Spring 2010
What is Cholesterol?
Dr Donna S Barsky, R.Ph, D.Ph of TexasStar Pharmacy his short guide can help you manage a discussion with your doctor about your vascular health. This is an important issue that can affect your health. What is cholesterol? Cholesterol is a fatty, wax-like substance found in the cells of your body and blood. It comes from your diet and is also produced by the body. Total cholesterol in the blood includes various components including HDL, LDL, and triglycerides. Cholesterol has an important role in the overall healthy functioning of the body. The body needs the right level of cholesterol to function properly, but too high levels of cholesterol increase the risk of cardiovascular disease. Hypercholesterolemia is the medi40
Denton County SENIOR • Spring 2010
cal term for high cholesterol. High cholesterol is a significant risk factor for coronary heart disease, peripheral arterial disease (PAD), and stroke. High-density lipoprotein (HDL) is known as the “good” cholesterol because it is believed to have protective properties against heart attack. Some medical experts believe there are two major roles of HDL. One, it carries cholesterol away from the blood vessels and back to the liver so the liver can eliminate it from the body. Two, HDL removes the excess buildup of cholesterol from arterial plaque. If you have a low HDL on your blood test (<40 mg/dl), you will not have the benefit of HDL’s cardiac-protective properties. Exercise, weight loss and addition of nicotinic acid derivatives can help to increase these levels
Atherosclerotic or artery plaques are mostly made up of cholesterol and calcium. These plaques deposit on the inside wall of the artery. The buildup of plaque can reduce blood flow and eventually a complete blockage can occur, either from the plaque itself or due to rupture of the plaque, with collection of a blood clot on top of the plaque. Depending on the blood vessels involved, this process can cause a stroke, heart attack, or PAD. If PAD occurs during this process, it can result in decreased function or loss of function in other organs of the body, or an arm or leg. Low-density lipoprotein (LDL) is known as the “bad” cholesterol because it plays a role in the development of atherosclerotic plaques. Think of LDL as butter floating in
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the bloodstream. High LDL levels are the main target of cholesterol-lowering therapies and lifestyle changes. If you have a high LDL on your blood test (>100 mg/dl), it will increase your risk for coronary heart disease, vascular disease, and stroke. Current guidelines recommend lowering LDL more aggressively in patients with more risk factors or known atherosclerotic plaque. Triglyceride is a form of fat made in the body. There are various factors that can cause high levels of triglyceride, including obesity, diabetes, decreased physical activity, cigarette smoking, and excess consumption of alcohol and trans fat. The importance of routine cholesterol screening is that it can identify high-risk individuals. Early treatment of these individuals can decrease the incidence of coronary heart disease, stroke, and PAD. The US Preventive Services Task Force (USPSTF) strongly recommends that men aged 35 years and older, and women aged 45 years and older have their cholesterol tested to screen for lipid disorders. According to the USPSTF, there is good evidence that cholesterol testing can find asymptomatic individuals at risk for heart disease, stroke, or vascular disease, and early treatment of these high-risk individuals can prevent and decrease their risk of cardiovascular disease. The USPSTF also recommends that younger adults (men aged 20 to 35 and women aged 20 to 45) have their cholesterol tested to screen for lipid disorders if they have other risk factors for coronary heart disease. These other risk factors include diabetes, a family history of cardiovascular disease before age 50 years in male relatives or age 60 years in female relatives, a family history of familial hyperlipidemia, and multiple
cardiovascular risk factors including obesity, hypertension, and tobacco use. The early treatment of these higher-risk individuals can prevent cardiovascular disease. Currently, the USPSTF has no recommendation for or against routine cholesterol testing in younger adults (men aged 20 to 35 or women aged 20 to 45) in the absence of known risk factors for cardiovascular disease.
“The importance of routine cholesterol screening is that it can identify high-risk individuals. Early treatment of these individuals can decrease the incidence of coronary heart disease, stroke, and PAD.”
The USPSTF found good evidence that cholesterol testing in low-risk young adults can detect some individuals at increased long-term risk of cardiovascular disease, but the absolute reduction in risk as a result of early treatment in most individuals is small before middle age. Treatment options include both lifestyle changes and drug therapy. Lifestyle changes include dietary counseling to understand the benefits of a diet low in saturated fat and high in fruits and vegetables, regular exercise, stopping tobacco use, and maintaining a healthy weight. Drug therapy can be more effective than any other treatment option alone and these include nicotinic acid derivatives (niacin, Niaspan), bile acid sequestrants (Cholestid, Questran), cholesterol absorption inhibitors (Zetia), Omega-3 esters (Lovaza, Omega-3 Oils), fibrates (ie, fenofibrate,
Gemfibrozil), and statins (Lopressor, Zocor, etc). New research data suggests that statin therapy may lead to regression in atherosclerotic plaque, and more studies are being conducted to confirm this finding. All statins should always be taken at bedtime because that is when most cholesterol is produced by our systems. In most people, a combination of many therapies can give great results and decrease risk substantially. If you have any concerns or questions about your risks, be sure to ask your doctor or call the pharmacy for recommendations. TexasStar Pharmacy can be reached at 972-519-8475
“High-density lipoprotein (HDL) is known as the “good” cholesterol because it is believed to have protective properties against heart attack.”
Denton County SENIOR • Spring 2010
The Best Way To Roll
“...is a motorized wheelchair or scooter the best mobility device for you? Not always.”
By: Don Nelson, Choice Medical Equipment ou see them advertised on tele- requires that its beneficiaries require a vision. You can use one at the manual or power wheelchair for use in grocery store. But, is a motor- their home before Medicare will conized wheelchair or scooter the best sider payment. But, it is essential to mobility device for you? Not always. remember that home is not the only “I got that thing three years ago, but place the mobility device may be used. I can’t take it anywhere. It’s too big for A motorized wheelchair or scooter my car.” “It is too big for my house and may be the only way a patient can be not portable enough to take anywhere.” independent with their mobility-relatThese are just a few of the statements ed aids to daily living (MRALDs), so a we hear from people when they call or manual wheelchair may not be an opstop by after having a motorized wheel- tion. The patient should be informed chair “dropped off” at their home by a regarding the requirements to transdisinterested supplier. port the motorized device, and that When evaluating a patient for a Medicare will not pay for a vehicle lift, mobility device it is important for manual wheelchair or transport chair both parties to discuss all the needs for use outside the home. of the patient as well as the intended There are lots of great carriers and lifts use of the equipment. Sure, Medicare for motorized wheelchairs and scoot-
ers, but the vehicles these items would be installed in or behind are not always compatible with the mobility device that is being provided. More often than not, the power wheelchair or scooter is over the recommended safe maximum weight rating to be transported behind the vehicle using a receiver hitch. Here at Choice Medical Equipment we strive to inform our customers of all the options available to them for their mobility needs and to take into account each person’s specific mobility requirement, existing equipment/vehicle, and budgetary constraints. Author Don Nelson, owner of Choice Medical Equipment can be reached at 940-380-0455.
THE RIGHT CHOICE! Stationary & Portable Oxygen Systems Hospital Beds Manual & Motorized Wheel Chairs Motorized Scooters Walkers, Canes & Crutches Nasal CPAP/BIPAP Commode Chairs TENS Units Seat Lift Chairs Bathroom Assist Devices & Safety Aids Nebulizers ....AND MUCH MORE!!
24-Hour Emergency Service (We Bill Medicare and secondary insurance)
Denton County SENIOR • Spring 2010
2436 S. I-35 E., Ste. 346 • Denton, TX 76205 www.ChoiceMedicalEquipment.net
By: Jay S Bender, MD ere in North Texas we are blessed with good weather and abundant recreational opportunities that help us keep active throughout the year. In addition, there is an increasing trend to remain more active later and later in life. While there are many benefits to maintaining an active lifestyle in our sixties and beyond, there are also potential problems. In 1999, Dr Nicholas DiNubile, an orthopedic surgeon in Pennsylvania, was the first to use the term, “Boomeritis.” Boomeritis describes the negative health consequences of stressing our aging bones, joints, and tendons by pushing ourselves with activities such as jogging, playing golf, and working out. It refers to the recurrence of old injuries as well as new strains and sprains, tendonitis, and bursitis. In particular, we are at risk of injury during the occasional bout of intense activity between other periods without activity. If you are over 50 and have experienced stiffness, aching muscles, and joint pain after a round of golf or a particularly intense tennis match then you know first-hand what Boomeritis is all about. It is crucial to learn how to minimize the risk of injury so that we can remain active and avoid the health problems that go with a sedentary lifestyle such as heart disease, obesity, diabetes and the like. Normal aging is associated with muscle loss, osteoporosis, and mechanical degeneration of tendons and ligaments. Routine exercise helps to reverse these changes by increasing muscle mass and bone density. Cardiovascular endurance, pulmonary capacity, weight control, and the state of mind all improve as well. Ironically, the antidote to Boomeritis is more activity, albeit the right kind. The old saying about an ounce of prevention being better than a pound of cure certainly rings true when talking about staying active.
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Physical therapists Marilyn Moffat and Carole Lewis describe domains of fitness that need to be maintained as we age. By maximizing strength, posture, balance, and flexibility with the right types of exercise, we can reduce the risk of injuries from our sports and cardiovascular activities. Often working with a physical therapist or trainer will help to improve core strength and reduce risk of injury. Learning to properly warm up, cross training, and understanding the need for recovery in an exercise program are also important. A customized exercise program enables people to do better in all aspects of daily life. Falls that can result in a hip fracture can be reduced by as much as 40% after a core strengthening and balance program. This is important since hip fractures are responsible for more deaths each year than breast and endometrial cancer combined. Non-exercise factors are also part of minimizing Boomeritis. Maintaining a healthy diet that supports an appropriate weight will keep stress off of tendons and joints. Calcium and Vitamin D supplementation are also crucial to maintaining good bone strength. If tendonitis or bursitis does develop despite the right exercise program, there are other options. Oral non-steroidal anti-inflammatory medications can help control symptoms as well as improve functioning. Electrical stimulation and ultrasound treatments can also promote healing. Even the occasional use of steroid injections can help in the recovery process. In the most extreme cases involving unrelenting pain or tendon rupture surgical repair may be necessary. One of the most exciting new developments in the treatment of tendonitis is the use of Platelet rich plasma (PRP) injections to improve healing and shorten recovery time. The process of using PRP involves taking some of the patient’s own blood and spinning it in a centrifuge to spate out the cells that release growth factors. The heal-
“The process of using PRP involves taking some of the patient’s own blood and spinning it in a centrifuge to spate out the cells that release growth factors. The healing cells and growth factor are then injected into the area of inflammation.” ing cells and growth factor are then injected into the area of inflammation. There has been good evidence that utilizing the body’s own repair mechanisms is a safe and powerful way of treating inflammatory and overuse problems. The procedure is done in the office, takes about 20 minutes, and has very few side effects. In the end, just remember to be proactive about being active. Don’t forget to listen to your body and seek help from your health care team of primary doctors, physical therapists and trainers, and orthopedic surgeons if problems arise. If you would like to schedule an appointment with Jay S Bender, MD, author of this article, at any of his locations—Denton, Gainesville or Keller—call 940-323-3460. Denton County SENIOR • Spring 2010
Damien M. Dauphinee DPM, FACFAS, CWS* +
Jason Hancock DPM, AAPWCA, AACFAS
Nicole Hancock DPM, AAPWCA, AACFAS**
Reconstructive Foot & Ankle Surgery Neurosensory Testing Sports Medicine Biomechanics Childhood Foot Problems Wound Care for Chronic Foot & Ankle Wounds Primary Podiatric Care Peripheral Nerve Injuries
Come see our New Office in Unicorn Lakes 3319 Unicorn Lakes Blvd., Suite 111, Denton TX 76210 Most Insurance Plans & Medicare Accepted *Board Certified by the American Board of Podiatric Surgery + Board Certified Wound Management **Physician Certified in Wound Care
Taking Care of your Feet and Ankles
North Texas foot and ankle surgeon advises athletes: Don’t play with foot pain and that athletes and par ents should monitor seemingly ‘normal’ foot and ankle pain. As the Fall/Winter sports season reached its conclusion, many adult, adolescent, and child athletes were playing with seemingly normal but persistent foot pain that could be a sign of a more serious injury, according to Damien M Dauphinée, podiatric foot and ankle surgeon and a member of the American College of Foot and Ankle Surgeons (ACFAS). “Playing with pain often is viewed as a badge of honor among athletes, but they must be aware that the persistent pain they dismiss as normal exercise-related stress could be something far more serious,” said Dr Dauphinée who advises athletes of all ages to consult with visit their podiatric surgeon regarding any foot pain. The pain may be due to overuse injuries from repetitive loading of the foot and ankle during running and aerobics. “When athletes overdo their workouts, it may be normal to experience some temporary discomfort,” says Dr Dauphinée. “But if pain continues longer than a few days with continued redness, warmth or swelling, the athlete should see a podiatric foot and ankle surgeon for proper diagnosis and advice on treatment options.” Athletes who ignore persistent foot pain and inflammation, and continue to train, risk potential complications that could sideline them for months. Among possible injuries associated with persistent foot and ankle pain are stress fractures, muscle strains, tendinitis and subtle fractures after inversion ankle sprains. “Stress fractures sometimes aren’t debilitating and some athletes might continue their normal training despite the injury,” according
Article courtesy of Complete Foot and Ankle Care of North Texas to Dr Dauphinée. “But continual rigorous ries than those who run on cushioned activity can worsen the problem. An exam- tracks or natural grass fields. ination and diagnosis by a foot and ankle Footwear should be appropriate for the specialist can determine whether the pain sport and match the biomechanics of the is from overuse or subtle trauma, requiring individual’s foot. For example, those who only a few days of rest, or something that engage in one sport more than three times may require surgical intervention.” a week should wear athletic shoes designed Heel pain in children often is caused for the sport, and shoe technology has adby injuries to the growth plate and sec- vanced to allow for variances in foot charondary growth centers in which tendons acteristics that require stability or cushionpull at the top and bottom of the growth ing or even a combination of the two. plate of the heel. Boys and girls, ages 8 Injuries often result when athletes fail to to 14, are susceptible to this problem, train to build up to a desired goal. Accord-
and its major symptom is pain on either side of the heel. Dr Dauphinee explains that “Growth-plate trauma is common in soccer and other sports that involve a lot of running. Parents should make sure that their children stretch before playing and apply ice to the back of the heel after the game or practice. In some cases, anti-inflammatory drugs and shoe inserts (orthotics) or lifts are recommended, but the potential for recurrent injury exists until the growth plate closes.” Foot and ankle surgeons provide many forms of treatment to keep children pain free and participating in athletic activities. When treating athletes of any age, several factors will be evaluated that could be the underlying cause of foot pain. Included is consideration of the running or playing surfaces because athletes who train on asphalt or cement are more prone to stress inju-
ingly, a runner shouldn’t set a goal of 20 miles a week without gradually progressing to that goal. In children, overuse injuries sometimes occur from excessive parental pressure to achieve in sports making behavioral factors a consideration. And nutrition is important for stress fractures can occur in athletes with poor nutritional habits. Sleeping problems and resultant irritability and fatigue are common among some athletes who exercise aggressively, or over-train. And there are physical characteristics such as variations in bone structure and muscle development evidenced in individuals who are bowlegged or have mal-alignment problems. More information on foot conditions affecting athletes and children can be found at www.completefootandanklecare. com or call us to schedule an appointment at 1-866-490-3668. Denton County SENIOR • Spring 2010
Does Not Always Mean Surgery
By: Jennifer H Zahn, MD can’t swing a golf club without experiencing extreme low back pain.” “I can’t walk more than a block without pain in my back radiating to my calves.” “I can’t lean over and tie my shoes!” These are among the most common concerns I hear from my patients. Fortunately, these are not uncommon symptoms, and, in many cases, can be treated if seen by the appropriate specialist. Clinical back pain affects 212 million adults ages 18 and over. About 70-85% of Americans experience back pain at some time in their lives, and about a third of adults experience some back pain each year. Of these individuals, about 40% of people report they have experienced back pain in the past month. Finally, and even more disturbing, 7-14% of adults in the US report some restriction of their daily activities due to back pain in the past 12 months. As we age, it is common for many of us to be affected by back pain. Whether the pain is the result of arthritis, a herniated disc or spinal stenosis (narrowing of the spine that causes compression of the nerves), it can be very debilitating and compromise an individual’s quality of life. Nothing is more devastating than being forced to ask your loved one for assistance tying your shoes or getting out of bed. Although affected individuals often feel they are willing to do anything to decrease their pain, the idea of surgery can sound very intimidating. Surgery may also prove to be an overly aggressive option for some, a decision that can only be made after looking at a patient’s comprehensive workup. While some patient conditions require surgical intervention, the vast majority of patients experiencing back or
neck pain are successfully treated with much more conservative care plans. In fact, many patients experience pain relief after participating in conservative care plans inclusive of physical therapy and anti-inflammatory medications. Physical Medicine and Rehabilitation (PM&R) is a medical specialty that emphasizes the prevention, diagnosis and non-surgical treatment of disorders and injuries of the nerves, muscles and bones that result in impaired movement and severe pain. PM&R physicians are trained to treat common conditions such as back pain, neck pain, non-surgical musculoskeletal pain, arthritis, osteoporosis, brain injuries, spinal cord injuries, sports-related injuries, stroke, spasticity (stiffening or tightening of the muscles that can impair movement and speech), work-related injuries, and nerve pain. These specialists concentrate on preventative care through strengthening and rehabilitation using their expertise to treat conditions that can occur in any stage of life. PM&R physicians employ a variety of treatment options. Resulting treatments may include medications, therapeutic exercise, injections (including spine and joint injections), electrodiagnostics, Botox® and activity modification. Among these, an Electromyography test, or EMG, is used to diagnose patients experiencing pain, weakness or numbness of the back, neck or hands. Injections, including Botox® injections, can be used to treat spasticity in stroke patients and those suffering from neurological disorders. Through the use of these and other evidence-based non-surgical treatment options and customized care plans, PM&R physicians successfully and safely return the injured individual or worker back to his or her prior level of
function, productivity or performance. PM&R physicians work in tandem with other healthcare professionals including orthopedic surgeons, sports medicine specialists, podiatrists, and primary care physicians. I am priviledged to consult with fellowship-trained orthopedic spine surgeon Dr Michael Catino for those patients who require surgical intervention. As partners, we are able to offer evidence-based surgical, as well as nonsurgical options, for treating back pain. Through this approach, we can help reach the ultimate goal of catering treatment options to patients’ specific needs. So, before you skip out on that weekend round of golf with your buddies, or refuse to take that next walk with a loved one, consider contacting a PM&R physician for a consultation. Author Jennifer H Zahn, MD is a Physical Medicine and Rehabilitation physician at Texas Spine, Orthopedics and Rehabilitation in Denton. She can be contacted at 940- 323-3400 or on the web at www.tsordocs.com. Jennifer H Zahn, MD of Texas Spine, Orthopedics and Rehabilitation
Denton County SENIOR • Spring 2010
The Road to a Satisfying Sex Life
By: Heather Sutton Walsh, MD, PhD xperts and popular culture all agree: better sex and better intimacy lead to overall well being. However, many women do not have a fully satisfying sexual life, and a majority of them do not seek help from their doctors. Many factors contribute to our silence related to sexual health, but chief among these is the idea that we are the only one with our particular problem. Many factors affect female sensuality. Masters and Johnson created a model of normal sexual function that described a progression from excitement, to plateau, to orgasm, and then resolution. Today, the sexual model proposed by Rosemary Basson is considered more representative of female sexuality. Basson described women’s desire as a response to intimacy and sexual stimulation. Some women do not necessarily have a strong desire to have sex, but once they are stimulated by a loving partner, desire develops. Medical barriers to sexual well-being most often develop from chronic disease, especially coronary heart disease, diabetes, depression, and cancer, or hormonal issues that may or may not be related to increasing age, and side effects of medications. These conditions can interfere with all aspects of sexual functioning. Female sexual dysfunction is related to the same risk factors as coronary vascular disease: smoking, high blood pressure, and high cholesterol. Women with hypertension may have decreased vaginal lubrication, decreased orgasm, and increased pain. Some antihypertensive medications can induce sexual dysfunction in otherwise normally functioning patients. Experts theorize that women with diabetes may experience decreased sexual function due to neuropathy, hormone changes, and vascular disease. Women with diabetes may also have decreased vaginal lubrication, decreased orgasm, and increased pain with inter-
course. Sexual problems related to cancer can develop after surgery, chemotherapy, radiation, hormonal manipulation, and medications. Married women are at higher risk for depression than non-married women. Depressed women are at risk for sexual disorders. Another mental health issue that affects sexual function is chronic and acute stress. Relationship variables, attitudes towards sex and aging, and cultural background have a greater impact on sexual function than hormones and aging. Indeed, it has been shown that a good relationship protects against sexual decline in menopause. While hormones (estrogen and testosterone) are important in maintaining normal sexual function in women, the extent is still unclear. Aging will naturally lead to a decline in sexual activity, and a decline in hormone levels can lead to a decline in desire, vaginal atrophy, and/or delayed orgasm. There is controversy regarding the sexual effects of hormonal contraception. Some research reports an increase in desire with oral contraceptive use, while others show little to no change, and still others show decreased desire. Some prescription medications improve sexual function, while others impair it. Common medications that may impair sexual function include antidepressants, antihistamines, antihypertensives, antipsychotics, anti-anxiety meds, cardiovascular agents, and chemotherapy. Relationship and communication barriers are also frequent sources of female sexual problems. The ability of partners to have conversations about intimate issues such as lubrication, sexual self image, body image, and clitoral stimulation is the foundation of sexual health in committed relationships. Couples need to understand that long-term sexual relationships are complicated and change over time. As individuals
change, the couple’s relationship changes, and there may be gender differences in feelings and thoughts about sexuality. To be successful in long term relationships, it is critical for couples to have interactive skills to build sexual communication and sexual technique compatibility, and to learn how to successfully manage health, psychological, and life stage issues. Female sexuality experts agree there should be a focus on the more positive aspects of sexuality for women. Your doctor should be willing to have open, frank discussions about any sexual concerns you may have. He or she can offer help for sexual problems and also assist those without sexual problems who simply wish to enhance their sexual lives. Since sexual problems
usually involve both medical and psychological issues, these problems need careful assessment. Treatment for any underlying disorders is important, as is consideration for referral to a sex therapist. Lubricants can be recommended to reduce sexual discomfort and potentially enhance feelings of sensuality and intimacy. These products may help women overcome medical and psychological barriers to sexual well-being. If you have any questions or concerns about your sexual health, ask your doctor or schedule an appointment with me or one of the physicians at Women’s Healthcare of Denton by calling 940-898-1476 or 940-591-6600 Denton County SENIOR • Spring 2010
North Texas Family Medicine NEW SErvicES: Botox Restylane Microderm
Lisa Houk, FNP, BC Family Nurse Practitioner & Owner Robert Helsten, M.D. Medical Director
SErvicES: Immunizations Microderm Abrasion Blood Pressure Managment High Cholesterol Management Family Care for all ages Lab & X-ray Service on Site Diabetes Management Drug screening with immediate results School & Sports Physicals Occupational Health Chiropractic Care Weight Managment Minor Emergency Medicine D.O.T. Physicals NaturalHormone Replacement Therapy Mole & Lesion Removal Cardiopulmonary Stress Testing Mobile Bone Measure Density Exams Mobile Mamogram - on site Bladder Flow Point Bladder Ultrasound
Jay Houk Office Manager Karen Steed, ENF-C Family Nurse Practitioner Andy Anderson, PA-C Physician Assistant
(940) 686-0860 1340 Highway 377 Suite 110 Pilot Point, TX 76258 Monday - Friday 7:30 A.M. - 5:00 P.M. Saturdays 9:00 A.M. - 12:00 P.M. Wednesdays Closed 12:00 P.M. - 1:30 P.M.
By: Lisa Houk, FNP, BC, North Texas Family Medicine hyroid control, if done diet, proper hormonal balance, and thoroughly, can be one Ashwaganda (Indian Ginseng). of the most challenging Let’s focus on nutrition and how it medical decisions that a affects thyroid. Lack of Selenium, Chrodoctor or nurse practi- mium, Zinc, Iron, Iodine, Copper, Vitationer faces. The Association of Clinical min A, D, E, B2, B6, and B12 discourEndocrinology and the Endocrinology ages thyroid function. Did you know Society have not come to an agreement that artificial sweetners cause Chromion the standard of care for optimal thy- um wasting? Did you know that there roid function. Thus, many patients have are approximately six packets of artifibeen told that their thyroid is “fine”; but cial sweetners in one Diet Coke? Also, truthfully what is “fine”? if you take your multivitamin with a fiOne knowledgeable pharmacist, Joe ber supplement or the new Alli product, Paoletti, nicknames a lazy untreated your fat-soluble vitamins A, D, E, and K thyroid as a “functional hypothyroid- will not be absorbed well? ism”. He suggests that this is caused by an imbalance of T3 and T4, excess T4 What about medicines that negatively therapy, or increased thyroid binding influence thyroid function? globulin. Was your TSH (thyroid stimu- Beta Blockers, Birth Control Pills, Iolating hormone) simply checked or was dinated Contrast Agents, SSRIs (Paxil, an extensive thyroid panel drawn? Prozac, Zoloft), Estrogen, GlucocorOptimal thyroid function should be ticoids, Opiates, Chemotherapy, and the goal instead of settling for “normal” Lithium are just a few. Ferrous sulfate, thyroid function. Illnesses, such as high aluminum hydroxide-containing antblood pressure, high cholesterol, fatigue, acids, lactose, and calcium carbonate, low sex drive, and obesity are influenced also, alter thyroid absorption. How by a poorly functioning thyroid. Why many of us are on any one of these at address multiple diseases and ignore the one time or another? underlying potential cause? So what can we do to support our Did you know that modern American thyroid besides reevaluate what way of life contributes to goes in our mouth? hypothyroid function? Some suggestions would be to take SeleStress, environmental toxins, diet, nium 200-800 mcg daily (or eat fish two medicines, and much more all play a to three times per week); do a Gluten role. Other factors that prevent thy- free diet for at least 60 days; remove asroid from optimally functioning in- partame, trans fats, and processed whole clude natural aging, alcohol, cigarette foods from our diet; correct any horsmoking, diabetes, excess soy, surgery, mone imbalances; and restore proper and radiation. Conversely, factors that gut function. Furthermore, kick start positively support thyroid function in- your thyroid with iodine, Vitamin B6, clude Melatonin (sleep), High Protein L-tyrosine, zinc, and magnesium.
If your provider chooses to supplement with commercial thyroid, requests brand name only. Studies have shown absorption varies from 48 to 80% from generic to brand name. Absorption is increased by fasting and decreased by low stomach acid. It is best taken on an empty stomach, separate from food, medicines, herbals, and vitamins. Also, seasons change and no “one size fits all.” Do not wait too long to recheck the function of your thyroid. If you have gained weight, been diagnosed with a new condition, had a change in medicines, had a baby, or had ongoing major stressors for a season of time, then consider rechecking your thyroid. In conclusion, Henry Harrower, MD from “Endocrine Fundamentals” states, “A good laboratory report is cold comfort to a patient whose symptoms remain unchanged, and the doctor can repeat such reports until he is blue in the face, but they will not help his patient much if unaccompanied by controlled symptoms. The successful physician is the one who knows best how to make his patients feel better.” This is our goal at North Texas Family Medicine. Call today for an appointment, 940 686 0860. Denton County SENIOR • Spring 2010
Paul Bhangoo M.D. Board Certified in internal medicine
Risk Factor Modification Cholesterol/Heart Disease Management Prevention Diabetes Management Blood Pressure Management Wellness Exams Nursing Home Care Phones Answered 24 Hours a Day
940.566.2358 Paul Bhangoo M.D.
3304 Colorado Blvd. Suite 101 Denton, TX 76210 Located Next to Denton Regional Medical Center
Denton County SENIOR â€˘ Spring 2010
Shingles 1 Million
Article courtesy of Paul Bhangoo, MD ccording to the Centers for Disease Control at least 1 million people a year in the United States are diagnosed with shingles. Shingles are characterized by a painful skin rash, often with blisters that last from two to four weeks. About one in five experience severe pain. Neurological pain can continue even after the rash clears up. Although shingles is usually not a life-threatening condition, it is very painful. The virus is most common in people over 55 years of age with immune suppressed systems Shingles is caused by varicella zoster virus which is the same virus that causes chicken pox. According to the CDC, after you’ve had chicken pox, the virus lies inactive in nerve tissue near your spinal cord and brain. Years later, the virus may reactivivate as shingles. It is unknown exactly what triggers an outbreak. The shingles vaccine has been out
since 2006, and has been beneficial to seniors. According to the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices, the vaccine is recom-
“According to the Centers for Disease Control at least 1 million people a year in the United States are diagnosed with shingles.” mended for people age 60 and older. Many seniors are not aware that the vaccine is available or that it’s covered by the Medicare Part D drug plan and many private insurances as well. If not covered by insurance the cost is approximately $200.00. In order to assure coverage we recommend call-
“According to the Centers for Disease Control at least 1 million people a year in the United States are diagnosed with shingles.”
ing your health insurance company. Studies on the vaccine show it reduces the risk of getting shingles by 50% and reduces the risk of getting a more serious case by two-thirds. The signs and symptoms of shingles usually affect only a small section of one side of the body. Those signs and symptoms may include: pain, burning, numbness or tingling, a red rash that begins a few days after the pain, fluid-filled blisters that break open and crust over, and itching. Pain is usually the first symptom of shingles. For some it can be intense. Dr Paul Bhangoo, Board Certified in internal medicine, is an internist who treats shingles and is knowledgeable about the shingles vaccine. If you have any signs or symptoms of shingles or want more information about the vaccine, please make an appointment with our office at 3304 Colorado Blvd., Suite 101, 940-566-2358. Denton County SENIOR • Spring 2010
@cjYMcif @Y[g´5[U]b @]ZY]gmciffibkUm" KU`_]h]bghm`Y" Eliminate varicose and spider veins. No surgery. No downtime. No scarring. Walk in and Walk out.
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Ana Cecilia Lorenzo, MD, FACS, RVT Board Certified in General and Vascular Surgery Registered Vascular Technologist
CALL NOW FOR YOUR CONSULTATION
214.387.4202 Centennial Medical Center , Pavilion I 4401 Coit Rd., Suite 401, Frisco, Texas 75035
Restoring Legs to their Healthy Good Looks
Test Your Knowledge of Venous Disease
By: Ana Cecilia Lorenzo, MD, FACS, RVT f you are embarrassed by unTreatment for varicose veins sightly, painful spider or variand vein reflux is solely cos4. metic in nature. Another cose veins, you are not alone. Up to 40% of women and 25% of false. Vascular surgeons apmen suffer from varicose veins or preciate venous disease for some form of vein disease. Here’s a true the medical condition that it is. While or false quiz. See how you do. policies may vary among companies, insurance coverage is provided for many The pain caused by vein different venous conditions. The staff dysfunction can be severe of Vein Care Solutions work with nu1. and interferes with daily merous insurance carriers to provide activity. This one is true. appropriate treatment for symptomatic Symptoms can range from venous disease. aching and throbbing to burning and itching. The range of symptoms can Most venous disease can be lead to misdiagnosis especially in padefinitively treated without 5. tients with coexisting nerve and autosurgical incisions. True. immune disorders. A vascular surgeon Minimally invasive techcan determine the extent of disease niques are preferred since and options for treatment. there is less tissue disturbance and risk for wound healing complications. Turbulence in dilated vari- While the options for vein therapy cose veins can lead to clot are multiple, most procedures are 2. formation that may progress performed in the surgeon’s office. All to involve the deep veins. therapy for venous reflux is performed This one is also true. The on an outpatient basis. more dilated the vein, the more disorderly the flow within it. Turbulent flow Fortunately, assessment of the sympcan lead to clot formation. While most tomatic patient is non-invasive. Dr clots are superficial and benign, some Lorenzo can review the pertinent asclots may propagate, leading to deep vein pects of your medical history and perinvolvement and even clots in the lungs. form a physical exam that is complemented by an ultrasound study of the All patients with significant affected leg. And, with summer just venous disease have vari- around the corner, it’s a good time to 3. cose veins. False. The dys- initiate a treatment program for unfunction of venous disease sightly veins. Have the quality of life can lead to severe swelling you deserve without the embarrasswithout varicose surface veins. Back- ment of varicose or spider veins. Love flow or reflux can cause skin discol- your legs…again. S oration or inflammatory change with skin ulceration. Some patients have chronic, non-healing leg wounds as For more information and to schedule a consequence of longstanding vein an appointment with Dr. Lorenzo please dysfunction. call 214-387-4202.
“If you are embarrassed by unsightly, painful spider or varicose veins, you are not alone. Up to 40% of women and 25% of men suffer from varicose veins or some form of vein disease.”
Denton County SENIOR • Spring 2010
Denton County SENIOR â€˘ Spring 2010
By: Russell J. Otto, MD, FACS he sense of smell is one of the four human special senses. The special senses determine, in many ways, how we interact with our environment in our daily lives. While the sense of smell typically is ranked behind sight, hearing and taste in importance, problems with smell can adversely impact one’s quality of life. Anosmia is the lack of an ability to smell or detect odors. The quality of smell can also be reduced, heightened, or distorted. Anosmia can be caused by a variety of conditions. Depending on the condition, the duration of anosmia may be temporary or permanent. Only a small area on either side in the roof of the nasal cavity, about the size of a folded postage stamp, is involved in the detection of odors. A nerve from the brain, one for each side of the nose, pokes its fibers through the po-
“The lack of an ability to smell or detect odors.”
rous bone of the skull base to place smell sensory receptors in the roof of the nose. Conditions that lead to blockage of airflow to this portion of the nose typically result in temporary anosmia. The most prevalent is the common cold. The nasal congestion diminishes the sense of smell that we have all experienced. Another com-
“Degeneration of the fibers occurs with normal aging, but can signal conditions such as Parkinson’s and Alzheimer’s diseases or a tumor.” mon cause is nasal polyps due to allergy, and sinusitis. When properly treated, the polyps and inflammation can be reduced to help restore smell perception.
Ears, Nose, Throat Conditions Adult & Pediatric Head & Neck Tumors Sinusitis Allergy Testing & Immunotherapy
Conditions associated with degeneration or damage to the nerve fibers in the roof of the nose lead to permanent anosmia. Head trauma, exposure to toxic vapors such as glues and tobacco, and overzealous use of over-the-counter vasoconstrictor nasal sprays are examples of conditions that damage the nerve fibers. Degeneration of the fibers occurs with normal aging, but can signal conditions such as Parkinson’s and Alzheimer’s diseases or a tumor. Anosmia can lead to secondary effects like depression or weight loss. It can also become dangerous if you are unable to detect the presence of smoke, a gas leak, or rotten food. A thorough evaluation by your physician can help you sort through many of these issues. Call us today at 940-891-6100 to set up an appointment.
Snoring Sleep Apnea Skin Cancers Hearing Evaluation Voice Conditions
“Now Offering Oral Drops for Allergy Treatment”
2900 North Interstate 35 Suite 416 Denton, TX 76201
fax 940.891.6110 Russell J. Otto, MD, FACS
www.drrussellotto.yourmd.com Denton County SENIOR • Spring 2010
Only Work If You Take Them
By: Lawrence A. Shafron, MD, FACS, Advanced Eye Care Center f you have glaucoma, you are medications faithfully. There are many probably using eye drop medi- solutions available to help you overcations to lower your eye pres- come whatever problems keep you sure. High eye pressure damages the from taking good care of your sight. optic nerve and once the optic nerve Some of these problems and possible is damaged it takes your sight away. solutions include the following: Nerve damage from glaucoma is permanent. The goal of glaucoma treatForgetting If you frequently forment is to lower the eye pressure and get to use your eye drops (more than save your sight. once a week), try using routine daily There are many reasons that people activities as reminders. A morning don’t take their medications as regu- drop can be remembered if you start larly as they should, and they don’t putting it in whenever you brush always tell their doctor, but it is very your teeth in the morning. An eveimportant that you use your glaucoma ning drop can be remembered if you
put it in right before you turn off the light before bed. Ask a family member to help you remember—they love you and want to help you save your sight. Side effects Some drops have mild side effects (brief stinging, darker eye lashes), but others have life-altering side effects (such as asthma or erectile dysfunction). If you frequently choose not to use your drops due to unwanted side effects, tell your doctor immediately. Your doctor can try another medication that is easier for you to tolerate.
ADVANCED EYE CARE CENTER • • • • • • • • •
ReStor ® & ReZoom ® Multi-Focal Lenses LASIK Corneal Diseases Glaucoma Cataracts Full Service Optical Glasses and Contact Lenses Eye Exams For All Ages Board Certified Doctors www.advancedeye.com 2210 San Jacinto Blvd., Suite 1 Denton, Texas 76205 940-382-8000 • 800-375-4555
Denton County SENIOR • Spring 2010
Paul G. Middleton, O.D. Lawrence A. Shafron, M.D., F.A.C.S.
Cost issues All medications are expensive, and glaucoma drugs are no exception. Most commonly used drops are new medications and many times there are no generic versions available. However, talk to your doctor, give him the opportunity to find other medications that may work or work with the drug companies to see if you qualify for any of their special programs. At Advanced Eye Care Center our doctors can help you enroll in these programs. Difficulty getting the drops in Holding the eye drop bottle over your eye and squeezing a single drop into your eye can be challenging. To make matters worse, some bottles are made of hard plastic and are very hard to squeeze, especially if you have arthritis, weakness, or tremors. There are
dosing aids that help hold the bottle, aim the bottle, and squeeze the bottle. So ask your doctor how to get these products. Treating glaucoma is largely preventive. The medications lower the eye pressure to prevent damage, and since high eye pressure does not cause pain, blurred vision or other symptoms, it is natural for patients to think that they don’t need to hassle with the drops. This is wrong thinking. If your medication lowers your eye pressure; then it is working. Always talk to your doctor before stopping any glaucoma medication. Author Lawrence A Shafron, MD is with Advanced Eye Care Center. To schedule an appointment please call 940-382-8000.
“All medications are expensive, and glaucoma drugs are no exception. Most commonly used drops are new medications and many times there are no generic versions available.”
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Denton County SENIOR • Spring 2010
Exercise is Good for Heart and Soul
By: Carey Coleman, RN and Professional Geriatric Care Manager he physical benefits of exercise have long been touted, but what about the emotional and psychological effects? Experts agree, and research data supports, that people who exercise regularly are less likely to have depression symptoms. Furthermore, those patients who are diagnosed with mild to moderate depression are being “prescribed” exercise is an effective treatment with impressive results. This offers an important treatment alternative to patients who are reluctant to take medications for fear of side effects, or the perceived stigma associated with antidepressant drugs. What’s more, some brand new research questions the overall effectiveness of these medications. In fact, new studies reveal that exercise reduced depression symptoms by 50% in individuals who participated in aerobic activities three to five times a week. “The effect you find when using aerobic exercise alone in treating clinical depression is similar to what you find with antidepressant medications,” said Dr Madhukar Trivedi, a professor of psychiatry and director of UT Southwestern’s mood disorders research program. How is that possible? When the human body exercises, it releases chemicals called endorphins. These chemicals react with the receptors in the brain. This results in positive feelings (euphoria) and diminished perception of pain (analgesia). Addi-
Denton County SENIOR • Spring 2010
“The effect you find when using aerobic exercise alone in treating clinical depression is similar to what you find with antidepressant medications,”
tionally, endorphins have a sedative, calming property. Participation in a regular exercise program has also demonstrated improvements in the following areas: A boost in self esteem, confidence and positive mood; reduced anxiety and stress; improved sleep/wake patterns; increases appetite; strengthens cardiovascular and respiratory systems; and helps improve muscle tone and strength while also reducing body fat Yet with all the benefits of exercise, it is interesting to note that according to The American Heart Association only approximately 32% of Americans report that they participate in regular exercise. Whether you are currently a faithful exerciser (good for you!) or contemplating starting a new workout program, the key is to find something you enjoy. In addition, exercising with a partner or in a group also demonstrates much lower “drop-out” rates. Try to think outside the traditional “treadmill” or “aerobic class” box. Some examples of moderate exercise (at least three times a week) include: walking; dancing; biking; running (at a moderate pace); swimming; playing tennis; golfing (if walking and not using the cart); gardening and yard work; housework (especially sweeping, mopping, vacuuming, etc.); and yoga. So, whether you are fighting depression, want a healthier body or want to improve your quality of life (or all three combined), it’s time to get moving! S
Autumn Leaves 2/26 deadline Denton County SENIOR â€˘ Spring 2010
Discovery of Recovery
By: Michelle Shaffer, Good Samaritan Lake Forest Village hen facing recov- experts. Each knows how to optimize ery of various de- the use of equipment, adaptive skills grees and circum- and devices, dexterity and muscle work stance the lingo to return you to your prior level of abilcan seem indeci- ity or, in some cases, better ability. pherable. There are acronyms for every While some overlap of the various style of therapy. Terminology and jargon therapy disciplines occurs here are some are used for speed and efficiency among of the distinctive features of each. Octherapists, doctors, nurses and caregiv- cupational therapy is focused on daily ers. However, the more you know the living functionality. It is concerned better prepared you are to aide in your with dexterity, flexibility, stamina and recovery process because understanding cognitive ability necessary for a perlends itself to motivation. son to dress, feed, toilet and cloth self. Knowing who you are seeing, an Oc- Physical therapy in a senior living envicupational Therapist (OT), or Physical ronment concentrates on locomotion, Therapist (PT), or Speech Pathologist posture, large or gross motor skills and (SLP) may help you set about the tasks fall prevention. Physical therapists are necessary for a more efficient recovery. able to help a person maximize balance You should think of these specialized and muscle mass through practice, exhealthcare workers as personal training ercises and appliances should the abil-
ity to walk become impaired due to any number of circumstances. Speech pathology is distinctively involved with the swallow function, short term memory, problem solving/reasoning skills, communication and nutrition. These experienced therapists have an arsenal of exercises, training tools, adaptive equipment and cognitive re-enforcement or thinking process tasks to remediate a multitude of impairments. The patient’s safety and well-being are always the most important factor in any therapy program. Each of the therapy programs comes with its own language. A complete glossary of terms can be found by searching the internet searching or in medical textbooks. On the next page are some key terms that may be unfamiliar to you.
t’s about living.
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Denton County SENIOR • Spring 2010
Retirement living Occupational therapy deals primarily with daily living skills and these are some common terms. • Adaptive Response is any action that is appropriate and successful in meeting some environmental demand. • Bilateral Coordination refers to the use of both sides of the body together in a coordinated fashion, indicating smooth communication between both cerebral hemispheres. • Dyspraxia is deficient motor planning that is often related to a decrease in sensory processing. • Proprioception refers to the perceived sensation from muscles and joints telling the brain when and how muscles are contracting, stretching, being pulled or compressed. • Vestibular refers to our sense of movement and the pull of gravity, related to our body. Physical therapists are involved with rehabilitating your gait, ability and ease of standing and walking. Common terms for physical therapists include the following.
• ADLs are activities of daily living. • Iontophoresis utilizes a patch with a cortisone solution that becomes electrically charged to drive negative ions from the solution into the tissues. This creates a localized anti-inflammatory effect. • Myofascial stretching relates to soft tissue mobilization techniques such as utilizing massage types of strokes to promote relaxation and focus stretching on individual muscles or groups of muscles. • Mechanical traction involves the utilization of mechanical apparatus to provide stretching to unload joints; the stretch can be either constant or intermittent. Speech pathology covers not only language skills, but also cognitive processes, nutrition and swallowing. When listening to a speech pathologist it could be beneficial to know these terms. • Aphasia is total or partial loss of the ability to use or understand language. • Apraxia is an inability to execute a voluntary movement despite being able to
demonstrate normal muscle function. • CVA refers to the cerebrovascular accident also known as a stroke. • Diadochokinesis is the rapid repetition of several different sounds in a row. • Dysarthria is a group of speech disorders caused by disturbances in the strength or coordination of the muscles of the speech mechanism. • Dysphagia is difficulty swallowing. • Open-set speech recognition refers to understanding speech without visual clues. Author Michelle Shaffer is Marketing Coordinator at Good Samaritan Society, Lake Forest Village. If you would like to tour a therapy center that specializes in elder care and rehabilitation, we would love to facilitate your opportunity to meet with a set of knowledgeable therapists and help you further decipher the lingo of rehabilitative services. Good Samaritan Lake Forest Village is at 3901 Montecito Road in Denton or call 940-891-0856 to arrange a tour and visit with the staff.
his message is for people who want to get more out of life. Senior Housing Apartments and Twinhomes Morrison Residence Assisted Living Rehabilitation | Skilled Care To learn more about our community in Denton, call us at (940) 383-6347.
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Denton County SENIOR • Spring 2010
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A Stitch in Time
Health and Wellness in Senior Living
By: Nancy Martin, RN, The Vintage ne of my most vivid memories of my grandmother is of her sitting near her den window, sewing basket beside her, darning socks for her large family. She seemed to live by the adage, “a stitch in time saves nine”, at least when it came to running a household. But in her day this adage did not carry over to health and wellness. She rarely saw a doctor, all twelve of her children were born at home and she “doctored” the whole family with home remedies. The delectable baked goods she showered her family with were often baked with lard rendered by her own hand on butchering day. Today our health and wellness is one of the most important and frequent topics of discussion in every medium of communication. So much so that there can be conflicting information, especially because things change so quickly. As life seems to move faster and is often more confusing because there are so many choices, seniors may try to simplify their lives as they reach retirement age and beyond. Here is where the “stitch in time saves nine” comes into play in the modern-day healthcare arena. More time, money and effort are going into preparing seniors to become “advance planners” through regular medical check-ups, routine tests and increased education, helping them take charge of their health and wellness. By being proactive with their healthcare decisions (a stitch in time) they can possibly avoid greater health problems in the future which might require additional medications as well as more treatment such as rehab therapy or hospitalization.
“Today our health and wellness is one of the most important and frequent topics of discussion in every medium of communication.” Another choice facing seniors is where to spend their retirement years. Many variables factor into this decision; where is family located, what is the cost, where can they get the services they now need or may need in the future. For some, a continuing care retirement community (CCRC) is a good choice because such
a community allows for the natural occurrence of aging-in-place. There is no need to move from one environment to another to obtain the level of care their health requires at the moment. Continuing care retirement communities offer several levels of care; independent living, assisted living, rehabilitation, skilled nursing care, long-term care; some offer specialized, assisted memory care as well. Familiarity with location and personnel can be a definite plus. Many retirement communities include wellness programs as part of their services for independent and assisted living residents as a means to include that “stitch in time to save nine” component, encouraging residents to participate in their health care decisions in an informed way. Education, guidance and encouragement of good health practices are a large part of the wellness services provided. Assessment of physical complaints or injuries, minor first-aid, answering medical questions, making appropriate referrals and providing necessary resources as requested by residents are all a part of a wellness nurse’s day, aiding each resident to “stitch up” good health and wellness. Author Nancy Martin is a Wellness Nurse with The Vintage Retirement Community and Healthcare Center which is a CCRC that offers independent living, assisted living, comprehensive rehabilitation services, 24 hour skilled nursing care, long-term residential care and a secured memory care area. Consider coming by for a tour. Contact Cindy Rodgers, Community Relations Director at 940384-1500. Denton County SENIOR • Spring 2010
Improving Communication with Care Providers
By: Susan Rogers, MSG, Denton Rehabilitation & Nursing Center t least once a week some- and services. Most are committed to one will come to my of- providing your loved one the best fice anxious to move their care, however, mistakes do happen. It loved one to our com- is important for you to be observant munity because they are and attentive. If something doesn’t dissatisfied with the care provided at an- make sense or doesn’t “feel right”, ask other facility. I listen to their list of com- for clarification. You may also need to plaints and then ask them how the other verify that everything your loved one facility responded when they shared tells you is accurate, too. Sometimes their concerns with them. Most people medications, poor hearing, fatigue or quickly respond that they didn’t feel other factors can cause someone to comfortable expressing their concerns misunderstand or misremember. to the staff, so they decided to move their parent to another facility instead. There’s No Time Like The Present Whether your loved one is receiving The care provider will be best able to rehome health services, visiting a doctor, solve any questions or concerns if you confined to a hospital or recovering in a express them in a timely and factual skilled nursing facility you can improve manner. Make note of the date, time communication with the care providers and persons involved. to ensure that your family member gets the best care. You Attract More Flies With Honey When voicing a complaint it is always Start Off On The Right Foot wise to use what my son calls a “compliWhether moving your mother to an ment sandwich”. Start and end with a assisted living community, setting up compliment and your complaint will be home health care or admitting her into better received. You may say something a skilled nursing facility for rehabilita- like “How can we work together to find tion, the process can feel overwhelming. a solution?” or “Help me to underIt’s a good idea to have someone else stand…” There will be an adjustment with you when you meet with the staff, period as your loved one and the care especially during your initial visit. Feel providers get to know each other, and free to take notes and to ask for clarifica- open communication make this transition if you don’t understand something. tion go more smoothly. Be up-front about your expectations, hopes and fears, and you may be surHelp Is Just A Click Away prised about what you learn. Lastly, you Most communication with care providwill want to verify that the care provider ers is done face to face or over the phone, knows the best way to reach you. but e-mail can be a valuable tool as well. With e-mail you can ask a question or Trust, But Verify share a concern 24 hours a day. You also Most care providers have chosen their have a record of your correspondence profession because they care about the for future reference. people they serve. Most have the best No care provider is perfect, and peointentions in mind as they provide care ple make mistakes. By using these tips, 66
Denton County SENIOR • Spring 2010
you should find that your communication with care providers has improved and you are able to resolve questions and concerns more quickly. Author Susan Rogers is the Community Liaison for Prestonwood Rehabilitation & Nursing Center. For more information, on this topic and Prestonwood you can call 214-731-5955.
“Most people quickly respond that they didn’t feel comfortable expressing their concerns to the staff, so they decided to move their parent to another facility instead.”
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denton spring magazine 2010