Kicking the smoking habitMy last cigarette was Valentine’s Day.  I was a pack a day smoker for years.  My physicians had been mentioning forever and a day how I should really stop smoking.  I watched my mother die of cancer and took care of many patients that were afflicted with this horrible disease.  One would have thought that I would have come to my senses way before now.  None the less the fact that I have arrived and conquered this addiction is a major feat in my life!

I took Chantix to assist me with the process and joined a smoking cessation class which was scheduled for six weeks.  I have continued to sign up for following up classes because I feel that the support is essential to kicking the habit for good.

I was on a mission and I was going to battle this war, come hell or high water.  My sister would make mention of my smoking and ask me how I was doing with not smoking.  I didn’t like her inquiring about my status in this challenge.  I feel that it is a personal battle and I didn’t want to be asked about my progress.  I guess it is just my silliness but I did not want to advertise how I was doing.  It is a solo journey and I knew it.

I took to drinking a lot of water every time I had a thought about smoking.  Good thing I didn’t float away.  I washed all my ashtrays and had a ceremonial speech to each and every one of them and took them out of sight.  Smoking is an unconditional friend and when you stop it is like a death to a friend.  The cigarettes are always there for you…in good times and in bad and always unconditionally loyal.  Then again, with friends like that, who needs enemies?

I started to power walk about two miles every other day and have progressed to three miles about five times a week.  There is that tendency to want to substitute that oral gratification with food.  I thought, “Great!   I will have stopped smoking but I will be three hundred pounds”.  That thought made me drink more water and walk faster.  I mean, after all, what would I do if I had to buy a bigger wardrobe?  I would have no clothes that would fit me.  It would be a disaster!  I attempted to eliminate all the triggers and changed my impulsive behaviors.  If I was talking on the phone, I would doodle, drink water or chew gum.  My mother would be horrified that I am chewing gum.  We weren’t allowed to chew gum when we were growing up.  Sorry, Mama.

I continue to classify myself as a non-smoker.  I am fully aware of the challenges that are present in accomplishing this goal and vow not to become one of those crusading reformed smokers who go about preaching to those who still smoke.  I kicked the habit and that is all that matters.


The End ~ cigarettesThis Valentine’s Day I gave a gift of love to myself and stopped smoking.  I had been smoking since I was a teenager.  Yes, yes…that is a very long time.  I originally started because it was the “cool” thing to do.  You had to smoke if you wanted to be in the “in-crowd”.   I would sneak cigarettes from my mother’s pack since my income at such an early age was not enough to buy my own pack of cigarettes.  My allowance was only a quarter a week.  I remember that one of the candy stores in the neighborhood would sell “loosies” …loose cigarettes instead of in the pack.  Cigarettes were much more affordable that way for kids who wanted to be “cool”.

My mother smoked until she was diagnosed with breast cancer and it mediatized to her brain and bone.  I took care of her as each follow up MRI showed her brain transforming into swiss cheese on the films with all the tumors advancing to take over her brain.  She died on February 4, 1990.  My father smoked when I was a young child until the statistics surfaced in the medical community that smoking was not a healthy habit to have.  Both my brothers smoked as did my maternal grandparents, aunts and uncles.

I joined a smoking cessation class on the anniversary date of my mother’s death.  I now consider myself a non-smoker.  Hurrah!  It has been a challenge but one that I am happy I overcame.  Yes, there are thoughts in my brain every now and again that say “a cigarette would be a wonderful thing after I finish my supper.”  Sometimes the brain says stupid things and I have learned not to listen when it says things like that.

I have been fifty seven (57) days of being free from the chains of smoking.  The hassle of making sure my supply didn’t run out, figuring out an acceptable place to do “the dirty deed” not to mention the high cost of the addiction and the effects it has on my health and well being are concerns that have all magically disappeared from my life.

The process all started with “intention” and taking my power back in my life.


COPDWhen our elders are in the need of support to manage their medical issues, a credentialed agency should be arranged to provide oversight.  Relying on neighbors with no background in managing care that has medical health issues as a component is dangerous and irresponsible.

Jack is on an inhaler that he takes twice a day for his pulmonary condition of (COPD) Chronic Obstructive Pulmonary Disease.  He obtained samples of Anoro Ellipta from his physician during his last visit.  He called up the local pharmacy to find out what the cost would be when he runs out and needs it refilled.  $900 for a dispenser that would only give him seven treatments.  Because of this cost, Jack has chosen to not take this medication even though I advised him to go back to the doctor and ask for more samples or a substitute.

Jack called me into his house the other day.  His inhaler was running low on doses remaining and he wanted to know how to get the packet of powder that came in the box into the dispenser.  I informed him that the medication is already in the inhaler as he was handing me the packet of powder he wanted me to instill.  The packet was filled with silica that is used in packaging to prevent the accumulation of moisture.  There was a picture of a face on the front of the packet that was encircled in red with a line through it, clearly denoting that it was not to be used for consumption or inhalation.

Jack could use home care services as I had recommended numerous times to his daughter-in-law.  Jack is a veteran so this support would be no cost to him if arranged through Veteran’s Affairs.  It is difficult for his daughter-in-law to manage Jack’s care from several states away yet she continues to manipulate various neighbors with no medical background to oversee his care.  This set up is an accident waiting to happen and Jack will unfortunately be the victim.  He clearly needs oversight done by professionally credentialed individuals!


End of life care ~ hospiceThe ultimate goal of Hospice is to create a balance of quality of care, quality of life and dignity to the dying process.  It provides a support system to the patient and family by overseeing the medical care that is rendered.  Outside resources such as a home health aide, social services and clergy can be incorporated into to the plan of care.

Ted was in end stage liver failure and his cardiac status was weak with the insertion of a cardiac defibrillator implant several years ago.  He was fragile and his reflexes were dulled by the medications he was taking to eliminate the constant pain he was having.

When he ran his truck into the garage door, Becky, his wife was faced with the nagging responsibility of taking away his keys to prevent him from driving.  Ted was administering his own pain medications before this incident.  Becky felt he was overmedicating himself when he started having hallucinations.  She had now become the self appointed “warden” of Ted’s medications.  With much support from friends, Becky called Hospice services to come into the home.  She finally realized that she needed support for Ted and herself to cope with his end of life care.

The Hospice nurse ordered a “Comfort Care Kit” to be stored in the refrigerator of the home.  It contained medications to address pain, nausea, anxiety and respiratory distress to be used in alleviating symptoms exhibited during the dying process.

Becky and Ted now have systems set in place to support them medically, emotionally and psychologically.  They can now concentrate on the time they have left together knowing that there are others who are there to offer comfort and advice.





There is nothing like the support of family when times become rough in life.  The loyalty and support they can give is like no other yet some families become distant when the times become tough.


Jeff was there to settle his parents estate when they died.  His wife, Emily, investigated options for long term care placement when his father was diagnosed with dementia.  Emily was a nurse and knew that her father-in-law was not safe to live at home any longer.  Once Jeff’s parent’s estate was settled, Jeff’s family disappeared.   Even though one of his siblings lived in the next town and the rest of his siblings lived in the same state, he never saw any of them.

Emily came from a family where they were in constant touch with each other so she had a difficult time adjusting and understanding this distance with Jeff’s family.  Being a nurse, Emily was there for all family members when they needed guidance and advice for medical problems.  The lack of support was very disconcerting to her but Jeff didn’t seem to be bothered by it.

Emily and Jeff relocated to Florida to escape the cold winters of the north east.   Jeff ignored his health for years and medical issues cropped up demanding surgeries for a hip replacement, cataract surgeries and several prostatic surgeries to correct his benign prostatic hypertrophy.  Jeff was also diagnosed with dementia. Emily informed Jeff’s siblings of all the surgeries and after several years his Long Term Care placement.

Jeff has been in the nursing home for three months and his siblings have not once written to him.  They ignored the strain that Emily was going through with all of Jeff’s surgeries not to mention their relocation to Florida.  They have not reached out to inquire how Emily is coping with all of these events nor how their brother has acclimated to the placement.  Jeff has since created a new family and has become very involved within the Long Term Care facility.

I have seen what is called “The dumping syndrome” many times in long term care.  The families just dump their relatives off, never to be seen again.  The staff becomes the new family to the patient/resident.  Emily visits twice a week religiously.  People come into our lives and some stay longer then others.  The saying “Families are forever” doesn’t necessarily hold true for blood lines.  Sometimes families are created through embracing friends.


Car keys and shots of alcoholWith dementia there is confusion, disorientation, interrupted reflexes, spatial and visual disturbances among many other symptoms that can be exhibited.  Being able to make sound judgments while driving becomes increasingly difficult as the dementia condition takes over the brain.

Mark is 83 years old and insistent on driving every night to the local bar.  He is not really a social guy but after a few drinks he is able to talk to anyone.  He doesn’t declare himself as an alcoholic although he has been doing this same routine for years.  He refuses to admit that he has more then normal forgetfulness even though he forgot that he just came back from the store.  He doesn’t remember that he had supper half an hour after he completed the meal.  His cognitive deficit is becoming more noticeable as time goes on.

Angie, his wife, is becoming more and more concerned.  She has been unable to get him to relinquish the car keys or stop going to the local bar every night.  Her fears that he will get into an accident are well grounded.  Angie has attempted to talk to Mark about his memory but he is adamant that he has no difficulty.

Angie needs to involve Mark’s primary care physician and if his physician refuses to get involved then she can visit the local police and Motor Vehicles.  This scenario is an accident waiting to happen.  Safety is a concern with this recipe of dementia mixed with drinking alcohol and driving.  Some things in life are just not negotiable!


Tired old eyesIt works for children to be attentive to their parents as they age and start having health issues that require supportive services.  Some parents refuse to ask for assistance and struggle to make it through each day.  They “don’t want to be a bother” to their children.

Mary went to see her neighbor John today to see how he was making out.  He has many health issues and is currently receiving chemo therapy.  His 98 year old mother-in-law who has dementia has temporarily come to live with him.  Mom’s health care worker fell and broke her leg and will not be back to work until after her rehabilitation is completed.

John’s energy is waning.  Mom is confused and when night time comes around, she becomes extremely disoriented.  She gets up several times during the night opening doors and letting the dog out without being leashed.  John is up all night and has to cook meals for the two of them during the day not to mention doing the laundry, maintaining the house and running errands. He is exhausted!  John’s children call every day to check on him but they live several states away.  John said he would ask them to come when he finally can’t take care of things anymore.

Mary suggested that John hire a home health aide to be on duty through the night so at least he could get a full night’s sleep.  If his children are unable to come and assist him  and their 98 year old grandmother on a daily basis, then at least he could hire a substitute who is credentialed.  Mary had suggested this option to John’s son and daughter-in-law several times in the past.

It works for children to pay attention to the needs of their parents even if it is not requested.  I have found that with the elderly, their lips say “no” but their eyes say “yes”.  Receiving chemo therapy drains energy, stamina, immunity, appetite and desire for socialization, among many other things.  It doesn’t work to rely on the person to ask for assistance with them being in such a compromised state.  All you have to do is look in their eyes and their story will be divulged to you.  One way you can anticipate their needs before hand is by arranging for supportive services if you yourself are not available to assist.


Blame Game sign

Neglect towards the elderly is the same thing as abuse.  Staying in touch by phone is not the same as being physically present especially when an elder has major medical issues.  It works to arrange for supportive networks that are credentialed if the family cannot be present.

John lives by himself and looks in on his 98 year old mother-in-law.  John’s neighbor, Mary, frequently makes meals and takes some over to John.  Men are not necessarily considered masters of the kitchen and she knows John enjoys the food she delivers to him.

John recently had a fall which brought his son and daughter-in-law into town for the purpose of “reorganizing his life”.  His daughter-in-law, Judy, proceeded to rummage through his house and make decisions about things without even consulting with John.  She asked Mary what her thoughts were about services that her father-in-law might benefit from.

The daughter-in-law lives several states away.  Mary recommended to contact a Home Care agency through the Veterans Affairs to arrange for a visiting nurse and a home health aide to visit her father-in-law.  She gave her phone numbers to contact  as well as recommending a “Medic Alert Bracelet“.

Judy and her husband went back home after a week and stayed in touch with Mary through phone calls and texting.  The communication from Judy became abusive in tone, demanding and manipulative, insisting that Mary stop in to see John every day and have supper with him several times a week. Mary continued to recommend that Judy contact the VA to arrange for home care with the social worker.  During the last phone call, Judy’s husband became abusive and demanded that Mary no longer go to visit John.

John’s son and daughter-in-law apparently are feeling guilty that they only come and visit John once a year.  They are looking to blame others for their negligence in overseeing their father’s care.    Their actions are controlling, manipulative and disrespectful to both John and Mary.

Passing off responsibility of looking after your father to a neighbor and then criticizing the neighbor is not only rude but irresponsible and ungrateful.  If they truly had John’s best interest in mind, they would have arranged for supplemental medical oversight with a home care agency before they left from their visit.  Instead they choose to manipulate neighbors and friends through intimidation and negative behaviors.


Medication bottlesWhen medications are prescribed with varying administration times, it becomes confusing especially for the elderly.  Organizing systems for proper administration addresses the importance of taking the accurate medications at the appropriate times.


Mary relocated to another state three years ago and instantly made friends with one of her neighbors, John.  John was confused the other day about all the medications he was supposed to be taking.  Twenty containers were lined up on the kitchen window sill in no particular order. He asked Mary to assist him in clearing up the confusion.

John’s son, Mitch, and daughter-in-law, Judy, were making their yearly visit after John has been discharged from the hospital from a fall.  The purpose of their visit was to “reorganize” John’s life.  Judy’s attempt at assisting him was overwhelming to John but he said nothing to her as she rummaged through his home and papers during the week long visit.  He remained silent and after Judy left,  John felt safe enough to tell Mary what a disruption his daughter-in-law was in going through his house without even consulting him on anything.  John to tends to his mother-in-law who is ninety eight years old with no assistance from any of the family all year long so to have his son and wife barrel into his life during this visit was over whelming to him.

His medications were unclear so with his permission Mary called his primary care physician and obtained a list of exactly which medications John was to be taking and arranged for a nurse to visit every week to oversee his medications.  John was resistant to using daily medication boxes where the medications would have been dispensed for a week at a time.  Mary lined all his medications up in correlation with the list from his doctor and numbered each vial to correspond to the list.  A cardiac medication was missing so the doctor’s office called it in to the pharmacy and he was to pick it up the following day.  John is clear now as to what medication to take and when.

It works to organize medication administration in consultation with the patient.  Putting a system in place where the patient is resistant doesn’t work.  Having a credentialed professional to oversee the process benefits the patient both socially and medically so that accurate administration of appropriate medications is accomplished.



Roller CoasterPhysicians need to understand the anxiety levels of their patients as well as their living conditions, financial status and their patient’s understanding of the disease process that is being treated.  This is especially crucial if new medications are being added to the treatment regimen.

Matthew has been an unstable diabetic for years and taking two oral glycemic agents. He was recently prescribed Byetta. It’s origin is from Monster Lizard Spit and is a glucagon-1-agonist belonging to the incretin mimetics.  It was approved by the FDA in 2005 for the treatment of type 2 Diabetes Mellitus and is not a substitute for insulin.

Matthew was hesitant in using the injectable.  He was aware of the instability of his blood sugar and had increasing anxiety using a new medication, not to mention he lives alone and just had his food stamp allotment cut to $16 a month.  Because of this, there is limited available food in the home.  After many calls to his insurance company and the local pharmacy, his new medication was finally available three weeks after originally prescribed.  He attended classes at his physician’s office to be instructed on it’s use.

The next morning Matthew’s blood sugar rose to 251 and he hesitantly injected the smallest amount that could be prescribed.  The directives from his physician was to inject twice a day, once in the morning and once in the evening.  He tested his blood sugar several times during the day and discovered that the blood sugar plummeted down to 58 within two hours.  He found himself on a diabetic roller coaster.  Fortunately a friend stopped by and found him in a stuporous condition and called me.  I advised her to give him orange juice to drink and a small cut up apple to eat.  An hour later his blood sugar was 127.  I strongly advised him not to take the evening dose and called him every two hours to check on him.  For three days the blood sugar maintained this roller coaster course.  It was a weekend and he was unable to consult with his physician.  I advised him to immediately make an appointment with his physician as soon as possible.  His doctor immediately stopped the Byetta and instructed him to keep a log of what he ate and his blood sugar levels and to return in a week.

Matthew’s understanding of Diabetes, medications ordered and the importance of a balanced diet, exercise and a stable emotional state is of great importance in maintaining a balanced blood sugar.  Instructions given to a patient should exercise return demonstration so that it is clear the patient understands how to handle any side effects that might arise.