If Only Our Pet Could Talk

I think for most pet owners, there are days when we wish we could know what our pet was thinking. This is especially true when it comes to medical decision making. We adopt our pets when they are young and healthy and it doesn’t cross our mind that someday, they might get sick or die. The same thing is true for humans. We want to pretend that we will all live forever.

In my work as a clinical bioethicist, I help families who are struggling to make the right medical and end-of-life decisions for their seriously ill loved ones. I never imagined that I would be having these conversations about my beloved kitty, BooBoo. BooBoo had been living with chronic renal failure for over 9 years. She had outlived every expectation and broken all the records for survival at the vet clinic. This sense of my cat being unstoppable and able to overcome every challenge blinded me to the reality that even a cat, who was a medical miracle, could die.

As her health began to change, certain decisions had to be made. I was lucky because I know how to use one of the tools from my work called the Best Interest Standard. Here is how it works.

Step 1. Ask plenty of questions regarding your pet’s medical condition, treatment options including the option of doing nothing, and the risks and benefits of the different options.

Step 2. Ask quality-of-life questions to understand how your decision will be experienced by your pet.

Step 3. After the decision is made, keep checking in to see how your choice is working. If the decision is not working out, then re-evaluate the situation and make a new decision.

The second step is the step that is often missed. When we ask quality-of-life questions, we are asking what it will feel like for our pet. If your beloved pet has to have surgery, what kind of pain will she be in after the surgery? How long will your pet be in pain? What can be done to make the process easier on your pet?

Here is an example of how I made sure I kept BooBoo’s experience in mind.

The vet said that he could run a special thyroid test to see if she was deficient. It was a simple blood test but before I agreed, I asked, “If she does have a problem with her thyroid, what will you do about it?” The doctor said, “I won’t be able to do anything about it because the medicine that would help her thyroid would harm her kidneys.” So I asked him, “Why put her through the needle stick if it won’t help.” He replied, “Some people just want to know.”

Here is where I had to remind myself that what I might want may not be what is best for my kitty. Sure I would like to know, but I didn’t want to put her through the stress of one more blood test when there was no benefit. When we ask about the risks and benefits we are asking, “What are the good things that could happen from the treatment and what are the bad things that could happen?” This doesn’t mean that we shouldn’t choose the treatment, we just have to be responsible pet owners and to understand there can be bad outcomes.

BooBoo got to a point where she had to have daily sub-cutaneous injections, I had to pill her 5 times a day and her quality of life had deteriorated. The doctor told me that he could put in a feeding tube and I could put all of her fluids and medications down the tube so she her quality of life would improve. No more shoving pills down her mouth or sticking her with a needle. It sounded like a perfect solution. Even though I knew it might not make her live any longer, it would sure improve the quality of her remaining days. So I agreed. Unfortunately, BooBoo had a stroke after the procedure and died a few days later.

Did I make the right decision?

I think I did. I asked lots of questions, thought through my choices and did the best I could. Even though it didn’t turn out right, I have peace of mind knowing I gave her the best quality of life possible. Even when I knew she was dying, instead of leaving her at the vets, I brought her home for the last two days of her life so she could have quality time with me. These were precious moments for both of us. When the end was very near, I returned to the vet so she could have a peaceful end. In life and in death, I did right by her by thinking about her needs first.

For a list of questions you can use when making medical decisions for your pets or your humans, go to the resource page on TheCaregiversPath.com

Have a kind and respectful day.

Viki interviews Anne Bland, author of Breathe on September 18th, 9AM Pacific on blogtalkradio.com/kindethics

Viki interviews Denise Baird Schwartz, MS, RD, FADA, CNSD, Health Care Professional from Los Angeles, California and author of Breathe on September 18, 9AM Pacific on blogtalkradio.com/kindethics

Join me as I interview Denise Baird Schwartz as she discusses her new book Breathe – A True Story of Letting Go of My Parents Gracefully, For I Will See Them Again. Breathe was written and published in the first few months after her mom passed during an unexpected hospitalization. It was written during that raw period, when the most important aspects of your life become clearer. The book is a fast read, but it holds a powerful story that can change your life. It will make you laugh, cry and smile. Breathe is a journey of learning to let go.

Bland is a healthcare professional with over 35 years experience in the hospital setting with a focus on taking care of critically ill patients in the intensive care unit. She wants to help others better understand end of life decisions in the hospital. This understanding comes through open communication prior to an illness between family members and their healthcare providers. Breathe views this period as a part of life that is not a time to deny or dread, but one that can be used to reflect on how you live your life.

The nurturing process is so evident in Breathe. The women in Bland’s life, from her great-grandmother forward, have shaped her life, who she is, how she views life, her faith, and has provided her with an inner peace. Breathe will enhance your journey in life, provide you with clarity for end of life decisions related to advance care planning, and allow you the opportunity to help others. Breathe is about honoring lives well-lived and how these lives have shaped the next generation with a focus on family values, caring for others, and giving back.

Breathe opens the door for a meaningful dialogue between patients, their families, and healthcare providers. The book is about living, loving, and letting go gracefully when the time comes.

The royalty from the sale of the book goes directly for relief and development to eradicate extreme poverty and hunger.

Website: www.breathe-annebland.com
Order online at www.amazon.com, www.barnesandnoble.com, www.xlibris.com
Available in hardback, paperback or eBook
Denise Baird Schwartz, MS, RD, FADA, CNSD, Health Care Professional from Los Angeles, California

YouTube videos enhance the emotion found in Breathe. To access the 2 minute videos Google YouTube.com, put in Breathe Anne Bland.

The 2 videos are “Living, Loving, and Letting Go Gracefully” and “Letting Go”.

Have a kind and respectful day.

Viki interviews Lori La Bey from http://www.seniorlifestyletrends.com and http://www.AlzheimersSpeaks.com on August 30, 9AM Pacific on blogtalkradio.com/kindethics

Viki interviews Lori La Bey from http://www.seniorlifestyletrends.com and http://www.AlzheimersSpeaks.com on August 30, 9AM Pacific on blogtalkradio.com/kindethics

Lori La Bey of Alzheimer’s Speaks and Senior Lifestyle Trends is a driver of Change. She helps families, communities, organizations, and businesses maneuver the turmoil of aging and illness. She has dedicated her life to working with people in transition. Lori has done this by guiding businesses and organizations on how to improve service delivery to enhance relationships with senior consumers and their families. Lori’s mission is to shift society’s negative perception of aging and illness, by getting individuals and businesses to appreciate and embrace the gifts wrapped in every stage of life. She believes by removing the fear, the embarrassment, and the judgment that cripples our relationships; we can enhance our connections with the people we love and care for.

Lori understands Caregiving from the inside out. She lost her Father to brain cancer after a 4 ½ year battle. Her Mother has struggled with Alzheimer’s for 30 years and is now in her end stages of the disease. Today she shares tips and techniques she learned as a Caregiver. Her goal is to help people embrace the person who once was, engage the person before them, and let go; allowing love to flow forward; as the ill and aging surrender to the shell of a body that in prisons them.

Lori owns Alzheimer’s Speaks and Seniors Lifestyle Trends. She was recently featured on FOX News for her cutting edge work with Alzheimer’s disease. Lori is a Speaker, Trainer, Consultant, Spokes Person, Author, and now a self proclaimed Advocate on Steroids for Alzheimer’s disease.

Lori is also writing a book on Alzheimer’s disease which will teach people to:
Remove their fear of Alzheimer’s by helping them identify stress triggers so they can reduce combative behaviors and create remarkable moments. The books working title is called: “Alzheimer’s Speaks -Guiding Caregivers to be Their Very Best! Giving Voice and Enriching Lives – As the Cookie Crumbles.”

You can contact Lori La Bey at any of the following:
Resource Website http://www.AlzheimersSpeaks.com
Blog http://www.AlzheimersSpeaksBlog.com
Business Website Http://www.SeniorLifestyleTrends.com
Email Lori@SeniorLifestyleTrends.com
Lori@AlzheimersSpeaks.com
Phone 651-748-4714 or 800-708-8661

Have a kind and respectful day.

When you are going the wrong way, turn around.

When we are making the decisions for those in our care, it is important to make sure that the decision is still working. You may find that you made the best medical decision you could and then the plan didn’t work. When this happens, it is important to reconsider the treatment plan. Otherwise, you’re driving down the wrong road: You can keep driving and driving, but you will never get to where you are going. You need to stop, ask for new directions and then start down a new path.

You may also need to modify your expectations when things don’t work. Sometimes we are so desperate for the plan to work that we can’t bear to see the truth when the plan fails. You are not helping your loved one by continuing treatments that don’t work. You are only subjecting the patient to needless side effects and increased suffering. One thing that doctors may want to do is to try a time-limited trial of a proposed treatment option. “Let’s try it for a few days or for a little while and see how it goes.” This is a really great option. After the set time expires, you can check to see if the decision is working. If it is not working, go back through the decision making process and make a better decision based on the new information about the patient’s changing condition. Don’t be stubborn and keep driving your loved one in the wrong direction. Take this as an opportunity to turn around and get it right.

Have a kind and respectful day.

Stop! The plan isn’t working as expected.

Sometimes, in spite of our best efforts, the plan we designed for the person in our care, doesn’t work or stops working. When this happens, it is important to reconsider the treatment plan. Otherwise, you’re driving down the wrong road: You can keep driving and driving, but you will never get to where you are going. You need to stop, ask for new directions and then start down a new path.

We may also need to help patients/families modify their expectations when things don’t work. Sometimes people are so desperate for the plan to work that they can’t bear to see the truth when the plan fails. You are not helping your your patient by continuing treatments that don’t work. You are only subjecting the patient to needless side effects and increased suffering.

One thing you may want to try more often is a time-limited trial of a proposed treatment option. Explain to the family, “Let’s try it for a few days or for a little while and see how it goes.” This is a really great option because it helps the patient/family feel like you are trying but it also gives them a reality check when it doesn’t work. You will want to give them specific symptoms to look for, (that they can understand), so they can see with their own eyes that the plan has failed.

After the set time expires, you can check to see if the decision is working. If it is not working, go back through the decision making process and make a better decision based on the new information about the patient’s changing condition. Don’t be stubborn and keep driving your patients in the wrong direction. Take this as an opportunity to turn around and get it right.

Have a kind and respectful day.

When your loved one is incapacitated, who will make his or her decisions?

Who should make the decisions when this person can’t? The answer to this question could be any one of the following:
Person specified on the Advance Directive
Conservator or guardian
Spouse
Significant other/partner
Adult child of patient
Parent
Adult sibling
Relative
Friend
Family
Healthcare team
Administrator of the nursing home (in some states)

While this is a general list, the answer really depends on where you live, what the patient has specified and if the court has gotten involved. Each state calls the decision maker by a different name: surrogate decision maker, agent, proxy or durable power of attorney for healthcare. The laws that determine who should make the decisions also change state by state. For example, the administrator of a nursing home may be allowed to make the decisions in one state, but can’t in a different state.

Another rule that varies is the law that dictates a specific hierarchy of decision makers. A hierarchy means there is a legal order to who will be allowed to make the decisions for someone who has lost capacity. You may need to ask the social worker, the bioethics committee or the legal department at the hospital to help you figure out the appropriate laws in your state.

Here are some tips to consider when choosing your decision maker.
1. Pick someone who will understand what the doctor is saying.
2. Pick someone who knows you well and has listened to what you want.
3. Pick someone who won’t fall apart in a crisis.
4. Pick someone who will do what you have asked, even if it difficult to do.
5. Pick someone who is close by geographically.
6. Write down whom you don’t want to be involved in the decision making.
7. You can pick two or three people to work together as your decision makers.
8. Your spouse, significant other or partner may not be your best choice, and you may want to choose someone else.
9. In the “Other” section of the form, state whom you do and don’t want to be told your medical information.

Have a kind and respectful day.

Patience – Lessons Learned – Viki’s Journey

Patience – Lessons Learned –  KindEthics.com Newsletter

Quote of the Month:

The individual is capable of both great compassion and great indifference. He has it within his means to nourish the former and outgrow the latter.
Norman Cousins

I love when life reminds me of the lessons that I thought I had learned, but then I find out I need a refresher course. This month’s newsletter is about having patience, but not just your average patience, instead good-natured and seeking to understand patience. There are two parts to this story.

The second part first:

Two weeks ago I had to make about 50 phone calls to set up the events for my book tour in July. As I was contacting different groups and reaching out to the community organizations that help those with differing levels of capacity, I was on a roll. Each call was a wonderful opportunity to connect with like-minded people about our common goals. I tend to be a quick person and was enjoying the speed with which I was accomplishing my tasks. Then it happened, I contacted some organizations that focus on helping those who communicate more slowly or differently, and all of a sudden, my world slowed down. The reason being, the people I needed to talk to also suffered from the same issues of communicating differently. What had taken me 10 minutes to accomplish on other calls, now took me 25 minutes.

I had a choice. I could politely excuse myself from the call and just move on to someone else. I could get frustrated or start multi-tasking while I waited for them to say what they needed to say. Or, I could be present, slow myself down, listen differently and be patient. I realized that patience was not about “waiting it out,” but it was about staying connected with an open heart as I remembered I needed to listen differently.

When I did this, I heard amazing things. One gentleman with bipolar disease told me that he hoped others would understand when he said, “I can do it – Until I can’t.” I had never heard this phrase but it was a gift to me because it so clearly explains the needs of someone with a fluctuating mental illness. I had understood the concept as this is exactly what I talk about throughout my book. Keeping people included and empowered, despite their limitations, until those instances when they need us to step in and protect them. But I hadn’t had such an easy way to say it. I am so grateful he shared it with me.

Part 1 of the story:

Back in March, when it was Brain Injury Awareness Month, I was fortunate to connect with a wonderful woman named Tammi Diaz. She suffered a traumatic brain injury when she was hit by a car, but she has overcome her injury, found a new way to be, and is a wonderful advocate for those in her community. I contacted her because I wanted to interview her on my online radio show because I thought it would be great for my listeners to hear first hand from someone who still deals with the effects of a brain injury. When I first spoke with her, I was acutely aware of her slightly slower speech. Not much slower, but just enough to notice. She shared with me her stories about the amazing way she advocates at the state legislature and her passion for improving the public transportation in her community. Coming from a show biz background as a child, I wondered if my listening audience would keep listening once they heard her voice. I realized I might lose some listeners but that was the whole point of the show, to get people to hear from people struggling with brain injuries. (You would have thought that a few weeks later, I would have known that I needed to be patient when I was making all those phone calls. But my own agenda and schedule got in the way. Lesson re-learned.)

I booked her on the show along with the director of the Brain Injury Association in Utah. What a wonderful and inspiring interview. I realized that we don’t hear these types of voices in the media or on television shows. This is a silenced community like so many who struggle with mental illness, dementia, developmental delays etc.

So what is in this message for all of us? I hope that you can remember to slow down and to listen differently when you are talking to someone with a speech or brain disorder. Don’t rush, don’t complete their sentences, don’t get annoyed and don’t think it isn’t worth your time. The gift of understanding that you may receive from someone who experiences the world differently is inspiring. I am so grateful that I got the opportunity to practice what I teach. Each phone call brought a gem of knowledge and a connection with a terrific person. Please role model this kind of behavior for your kids, your colleagues and for others in the public when you can see a store clerk growing impatient with someone with a disability. We can make a difference in the lives of others, by listening with a generous heart and a good-natured attitude.

Have a kind and respectful day.

Caregiver Yoga – Right in your home while you raise money for your school

Interview with Laura Colvin-Brown about Caregiver Yoga and raising money for your school. June 10 at 10AM pacific. www.blogtalkradio.com/kindethics

Take care of your self AND your school! Finally… a way for busy parents and educators to get in a little TLC for themselves, while helping out their favorite school…aaaahhh!

If you are like all the other parents and educators that I know, you don’t have time to visit your local yoga studio: who would watch the kids?! …..but you WISH there were a way. Well, now there is!

How about THIS…. we will send you eight new yoga classes every month… that you can watch and do right from your home computer or laptop ANYTIME… and you can do them as many times as you like! 8 all new gentle flow yoga classes will be sent right to your inbox every month when you subscribe to our service. This is like having a private yoga studio right from your screen… for only $15/ month! ….and the best part? Half of that goes directly to the school or group who sent you here.

Compare this to a yoga studio near you: some charge $15 PER CLASS! This is the easiest, most reasonable way to get your yoga in and help your school out at the same time.

Sign up today to receive 8 full video classes every single month!
www.OnlineYogaFundraiser.com
www.FlagstaffYogaFestival.com

Have a kind and respectful day.

Join Viki at Barnes & Noble, Las Vegas on 6/23 from 4-6pm

Viki Kind, MA is happy to announce she will be giving a free presentation at Barnes & Noble in Las Vegas, NV on Wednesday, June 23rd from 4-6pm.

Viki is the author of The Caregiver’s Path to Compassionate Decision Making: Making Choices for Those Who Can’t.

When:
Wednesday, June 23, 2010, from 4-6 PM
Where:
Barnes & Noble
Best on the Boulevard
3860 Maryland Parkway
Las Vegas, NV 89119
702-734-2900

Viki’s book will be available for purchase and she will be on hand to sign your copy!

Have a kind and respectful day.

Join Viki as she talks about “Empowering Caregivers to Make Better End-of-Life Decisions” at Circle of Care Leeza’s Place, June 16th in Sherman Oaks.

Empowering Caregiver’s to Make Better End-of-Life Decisions at Circle of Care – Leeza’s Place on June 16 from 12-1:30.
Everyone is welcome!

Being empowered and educated about the dying process brings peace of mind knowing that you will be able to handle what may come your way. Attendees will learn about the needs of the dying, how to make good end-of-life decisions and hospice services can benefit your entire family. Viki Kind joins with Circle of Care Leeza’s Place to create a safe haven ot ask yoru questions and to talk about your fears.

Circle of Care Leeza’s Place
5000 Van Nuys Suite 110, Sherman Oaks, CA 91403
818-817-3259 F 818-817-3263

Circle of Care Leeza’s Place is an intimate and safe setting where caregivers and loved ones recently diagnosed with any memory disorder can gather for education and support, and to prepare themselves for the challenging journey ahead. Developed in response to the challenges Leeza Gibbons and her family encountered while seeking specific and needed support, and funded in full by the generosity of our community through the Circle of Care Foundation, Circle of Care Leeza’s Place offers new supportive settings for the purpose of
Educating, Empowering & Energizing.

All programs are FREE OF CHARGE & held on site unless otherwise noted.
Please feel free to contact Stefanie Elkins at 818-817-3259 or selkins@leezasplace.org.

Have a kind and respectful day.

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