Wednesday, March 25, 2009

Thank you but no thank you: Managing information and advice during a critical illness


I've discussed my experience, of what it was like to live with the uncertainty caused by a diagnosis, with friends who’ve experienced a critical illness. Our stories were similar. We felt incredibly blessed by friends and even by people we didn’t know so well. We received calls, visits, and letters. Well-being ceremonies and prayers were performed on our behalf. We also found that a desire to do something useful was very prevalent among people we knew. For most anyone, hearing the news of a diagnosis brings up fears and reactions towards the idea of a serious illness. Giving us support by sharing medical information or stories about what happened to their friend’s sister, who had “nearly” the same thing, often made them feel less helpless.

By the time I received my diagnosis, I was feeling ill and digesting a lot of information was difficult for me. I found that I needed to shelter myself from receiving too much unqualified medical information. On the one hand, I did not want my own fears to prevent me from seeking quality information or from finding the best medical care. On the other hand, the information I found about Meningioma on the internet was distressing. Jonathan Alter shared this sentiment in his Newsweek article “My Life with Cancer”. He said that “a little knowledge can be a dangerous and depressing thing. The Internet is a fantastic resource for patients, who increasingly use it to ask pertinent questions of their doctors. [but] It can also baffle and disorient”. Some people handle the ordeal of a disease diagnosis by consulting with lots of people and sifting through lots of information. I might have used that strategy to cope with my diagnosis if it had not been for the help I received from two doctors I know personally, who deal with oncology issues. (Blessings to Gail and John). They told me that the tumor I had was “the good kind”. So, rather than searching far and wide for a specialist, as one might do with a rare form of cancer, they advised me to focus my efforts on finding a surgeon who had done the specific type of surgery I needed hundreds of times.

At this point, I began to limit my own internet research to the gold standard medical websites: the Mayo Clinic, the National Institutes of Health (NIH) and WebMD. Since that time I have been told that patients and family members can call or email the Stanford Health Library  or the health information services at CPMC  where you can ask a librarian to do the research for you. This is especially wonderful if you are feeling too ill or too overwhelmed to do this for yourself.

When I felt that I had enough information to make informed medical decisions for myself, it became easier to deal with unsolicited advice. I discovered that the reason people gave unsolicited advice was either because they were trying to help me or help themselves feel less helpless. I learned that it was not my duty to listen to someone’s advice, regardless of whether the motivation was altruistic or fear based. Once I understood that, I was able to thank people for their caring before they launched into unsolicited advice giving. I often reassured them that I was under the best care possible. Controlling the medical information coming my way helped me keep my level of distress at a minimum. Sometimes, stopping a conversation before advice giving began, made room for other, more valuable, kinds of caring and support to take place. What I needed most wasn’t information; I needed to speak truthfully from the heart.

(Next: A different view of Alzheimer's)

Sunday, March 15, 2009

Meningioma: meningo-what-now?

I realize that I’d talked about Meningioma previously, but had not mentioned what happened and what a Meningioma is. Here’s that story.

In early August, I was sitting at my computer at home when my left ankle went limp. As near as I could tell, my symptoms fit the description of someone having a stroke. I’d studied age related diseases so I was familiar with the simple “Act F.A.S.T.” test to do if you think someone is having a stroke. So I compared movement on both sides; I lifted my right leg and rotated my foot at the ankle and wiggled my toes. Then I tried to do the same with the left foot. I could barely raise my left leg and I could not “think” my foot or toes into moving. That was when I knew I was in trouble. With a stroke, brain cells are dying and the faster you can get help the better the chance you have of a good recovery. So I rolled my office chair to the phone and called 911. The paramedics arrived before I’d gotten off the phone. By the time they arrived I was already getting some movement back. I began to think I’d made a big deal out of nothing. Thank goodness the paramedics convinced me that it was better to go to the ER and see if I could find out what it was.

After questions, blood tests, neurological exams, two CT scans, and an MRI, it was determined that I had a Meningioma brain tumor, which is usually a benign, very slow-growing tumor of the brain or spine. They are quite common; 4% of cadavers have them, and those people never knew it. I have since learned that they usually are detected in people between the ages of 40- 60 and are found more often in women than in men.

Because meningiomas grow slowly, they may not produce symptoms for years, which was true in my case. The neurologist believed it had probably been forming for the last 10-20 years. My meningioma was pressing against my right side motor-control center, which is why I was exhibiting symptoms on my left side. My husband and I recalled a few past, very similar episodes of weakness in the left leg, but we’d always come up with more prosaic explanations for them (leg falling asleep, my being klutzy and my getting older).

Because of the slow growth of meningiomas, one treatment may be to monitor it. Whether or not to monitor the growth depends on the location and size (usually under 2 centimeters). Mine measured 4.3 centimeters. It was large enough to warrant surgical removal- the treatment most often used to treat meningiomas.

As someone who watches TV and loves the cinema, it was difficult to connect the MRI images I was being shown to myself. It was like watching an episode of Grey's Anatomy -- only I was the patient and McDreamy forgot to show up to deliver the news. Although everyone who dealt with me at the CPMC Emergency Rooom was fantastic: concerned about my comfort, safety and privacy, I simply could not take it all in. I don't think the news would have sunk in at all if it had not been for the manner in which the CPMC doctors delivered my diagnosis: straightforward, honest, compassionate, and in a gentle tone of voice. People thought I was pretty calm when I heard the news. I was calm; I suppose I was in shock. I was trying to accept and absorb the news.

(Next: Thank you but no thank you)

Thursday, March 5, 2009

Gerontechnology: Eldercare-at-home startup seeks beta testers

My previous post about gerontechnology was sparked by an email forwarded to me by my husband. A colleague of his had been faced with long-distance care for her mother. Because of that experience she volunteered to participate in a small focus group by two young women just out of the graduate program in public health from Berkeley. She was impressed with their "passion and focus around caretaking strategies for elders". They are developing a business plan around ways to keep seniors in their homes and are now seeking some Bay Area contacts to road-test their services.

Should you have clients, friends or relatives you're caring for in the greater Bay Area who might benefit from this type of service, please contact Maham or Heather directly. Their contact information follows along with some information about their concept:

"We are a start-up (two Master's in Public Health grads from Berkeley) that has begun providing Aging in Place Assessments for Bay Area families. Essentially, we will do an in-home visit at your family member's home where we systematically evaluate opportunities to:
  • make it safer
    • (ex. install grab bars, handrails, better lighting, etc.)
  • do maintenance that will prevent bigger problems down the road
    • (ex. replace smoke detector batteries, fix leaky sinks, etc)
  • set up technology to keep them connected to their family
    • (ex. digital picture frames, phones with amplification, etc)
We are doing the initial consultation for free because we are still in pilot mode. We are experts in the best products for keeping people comfortable and independent in their homes.

Again, this is a totally free service, and your family will get a customized strategy with specific recommendations for your unique home, situation, and health status. It can serve as a useful roadmap for planning to help your loved one stay in their home with a high quality of life.

Drop me an email if you are interested.

Thanks,
Maham

--
Maham Daher
Masters in Public Health & MBA
University of California, Berkeley
Haas School of Business

Cell: 617-319-6290
maham_daher@haas.berkeley.edu

(Next: Meningioma: The brain and other grey matters)

Sunday, March 1, 2009

The emerging uses of gerontechnology

It’s apparent that there will not be enough professional caregivers to deliver services as we’re doing it today. Nor can increasingly strained family members meet the impending demand. Gerontechnology, “the study of aging and technology for the benefit of improved living and working environments for the elderly and their caregivers,” has great potential to improve the care the elderly can get with fewer caregivers.

A New York Times article, “Sensors Help Keep the Elderly Safe, and at Home” suggests that the use of technology can support aging in place (staying in ones home). The article describes a system (eNeighbor) that helps an older person live alone independently and provides protection if they have a health incident. The system consists of twelve different devices, including:
  • a personal emergency call button that a person can push to get assistance,
  • a camera,
  • a telehealth device that can check on symptoms and measure vital signs in the home,
  • sensors which identifies changes like if a refrigerator has been opened or closed, if medication has been taken, or if they have they gotten out of bed.
Other Gerontechnology examples:
  • Link2Care - an internet site offering information on every facet of caregiving for dementia, care planning, decision-making, and consultation - free.
Other Gerontechnology resources:
I’m not suggesting that technology is a substitute for social support. The benefits of having close, personal relationships is well documented. But if technology in someone’s home can improve their health outcomes and provide a safer environment (at a lower cost than assisted living), I'm all for trying it. And giving caregivers a tool that lightens their burden is an added bonus.

(Next: Berkeley grads seeking some Bay Area contacts to road-test their ideas for keeping seniors in their homes.)