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December 26, 2014 / 4 Tevet, 5775
 
At a Glance

Posts Tagged ‘medication’

Should Newlyweds Hold Off Having Children?

Wednesday, October 28th, 2009

I know that just the title of this article is going to cause an uproar in some circles, and I know that some people might be aghast at how I can even ask that question. To some it is obviously halachically unacceptable to postpone starting a family. After all, the Jewish people are exhorted to pru urevu – to be fruitful and multiply. So, let me say at the onset, this is something every engaged couple should discuss with their rav. Getting a heter – even for a few months- just might be a lifesaver.

What do I mean by a lifesaver? A friend of mine who dabbles in making shidduchim told me how she went to pick up a prescription for her ailing father. The pharmacist, knowing that she is involved in setting people up, mentioned, after taking a phone call, how he gets so many inquiries from parents wanting to know whether the person being redd to their child was on any type of medication. “Of course I can’t tell them,” he said, “it’s illegal for me to divulge any information, but you would be surprised at how many young people are taking medication.”

For me, that ironically, was a positive statement. It means that these young men and women (and their families) recognize that they have a problem and are taking anti-depressants, anti-anxiety, or anti psychotic drugs to help stabilize themselves.

But I wondered how many people in the “shidduch parsha” aren’t taking medication, but desperately need to. How many are able to “put on a good act” and fool members of the community and those setting them up? How many have very serious mental health or even physical issues, but are able to hide them? How many teachers, rebbes, neighbors, etc. actually know that the girl or boy has personal issues, but are not honest with the “out of towners” seeking information?

I think we all know of situations where a decision was made NOT to “shter” the shidduch and be honest about certain issues the other party or his/her family may have – in the hope that marriage would straighten them out. How many young lives have been ruined because people deliberately held off giving important information? Parents can do all the “checking” in the world but if everyone who knows the “truth” is tight-lipped, especially those whose opinions would be considered reliable – like teachers or rebbeim, then it is all for naught, and their child will “arein fahllen” [a Yiddish term that means will fall in over her/his head, kind of like tumbling into quicksand.]

Let me clarify that obviously there are halachos of lashon hara to consider when it comes to giving information regarding a potential shidduch. But I wonder how many people take the time to study the halachos or speak to a rav to understand what they can or should say, so the innocent party doesn’t fall into a situation that could have been avoided.

Nobody really knows what the person they are marrying is like until after the fact. Even if both parties are nice, “normal” people they might come to the conclusion after several months together that they made a huge mistake. A 19-year-old girl with very little life experience marrying an equally “clueless” 22-year-old boy may realize too late that they are very wrong for each other.

In either situation, whether the person realizes he/she married a person who is not mentally well, or just someone not suited to them, getting divorced might be an unfortunate but necessary option – one however that can get very complicated if there are babies in the picture.

I have met many divorced men and women, and I am always taken aback when I hear they were married for 20 or 30 + years before they ended their marriage. I usually ask them if the marriage was good but somehow soured after many years. Many tell me they realized early on that they made a huge mistake, but since the wife had gotten pregnant right away they stayed miserably married until their youngest was grown.

I couldn’t help but think how tragic that was for the couple involved – trapped for decades with a spouse they couldn’t stand. Even worse, their children had grown up in a dysfunctional home and now had a skewed view of what marriage was, or had emotional issues from growing up in a home lacking shalom bayis where the parents fought or openly disliked each other. How unfair to these children, innocent casualties of their parents’ inability to get out of a bad marriage when they could have. They are the collateral damage.

The situation is much more horrific for those hapless young men and women who are married to a toxic person – someone physically or verbally abusive, who constantly makes their spouse feel inadequate or mercilessly lays a guilt trip on him/her no matter what they do; someone very controlling, inflexible, socially inept, or with addictions like gambling, drugs etc. Getting free from these monsters is usually very difficult – but if there are children in the picture – then severing ties can be very difficult. The two bad options available can be very costly in every sense of the word- emotionally, financially, and physically: a nasty divorce or remaining trapped in a nightmarish “union.”

I truly feel that the first year of marriage is a time to “test the matrimonial waters,” when a young couple can really get to know each other and assess if they are compatible or not; if they can -with a mutual effort – work out their “differences” (which are inevitable since no two people are identical in the way they think and do things) or if they made an honest mistake and amicably go their separate ways – no strings attached.

If, as the case may be, a newlywed ended up with someone who is “impossible” to live with due to some kind of insurmountable emotional or mental dysfunction – then they can emancipate themselves from this untenable marriage and get on with their lives.

Until both parties are confident that their true zivug was next to them under the chuppah, waiting a year, or even six months, before trying to conceive, might be the best things they can do for themselves and their future family.

When What Looks Like Dementia Is Really Something Else

Wednesday, January 28th, 2009

 


The moment we can’t remember where we put our keys, or the few seconds it takes to try to remember where we parked our car causes fear in everyone that I know who is over 50. Immediate thoughts of Dementia or worse creep into our minds as soon as we experience a momentary memory loss. As much as we fear for ourselves, well spouses may sometimes fear even more, seeing symptoms of memory loss or disorientation in their partners. With chronic illness, these symptoms may be a sign of the disease progressing to a new level, or it may be something else completely.


Chronic illness advances the body in its aging process. And so a person in his early 50s who is chronically ill may react to an infection the same way we’d expect from an 80- or 90-year-old person. Because of the chronic nature of the illness, the symptoms displayed are usually seen by family and even sometimes professionals as a natural progression of the illness and looking for other causes of the symptoms may not be the first course of action.


Moshe was hospitalized, yet again, because of pressure sores that were a result of his constant need to sit in his wheel chair. The hospital stay for this procedure was usually around six weeks. His wife was startled when Moshe called her at 3:00 a.m. one night.  When she answered the phone, she heard her husband’s whispered voice, “I think someone is trying to kill me.” Moshe’s wife panicked.


Despite years of chronic illness her husband had always been mentally competent. She knew that as the illness progressed there was a chance that his cognitive skills might deteriorate. But he had been mentally sound for so long she thought they had escaped this part of the progression of his illness. All night her husband kept calling with whispered stories of strange people trying to poison him, of being forcibly moved to unfamiliar places and even asking her to call the police before they killed him.


When she arrived at the hospital the next day, Moshe’s condition seemed a bit better. He would wax in and out of this paranoid state, alternating between recognizing the nurse and refusing to take medication convinced it was poison.  But as the day progressed, so did the paranoia and the nurses were talking about using restraints and forcing medication on him.


Moshe’s wife was beside herself. Could the illness suddenly progress to this stage so quickly? Two days ago they were talking about filing income tax and paying bills and today Moshe had accused his wife of being part of the group that was trying to kill him.  Things got steadily worse over the next few days. A neurologist was called for a consult. Even a psychiatrist was called in. Tests were ordered.


Moshe’s wife saw her life as a “well spouse” taking a turn for the worse in a way she never thought possible. Finally, several days after the onset of the paranoia, it was discovered that Moshe had a Urinary Track Infection. He was put on a dose of antibiotics immediately and within hours the bizarre symptoms he was displaying began to diminish. Slowly, his mental state returned to normal.


The doctor explained to Moshe and his wife that people with chronic illness react to infection the same way the aged do and they can often display symptoms that look more like mental illness than physical ones. This makes diagnosis difficult.  Especially when the person suffering from the chronic illness is relatively young, medical professionals sometimes forget to look for a simple physical cause and just assume it is the illness progressing.


Well spouses need to be acutely aware of this phenomenon. This is especially true if their spouses are young and have not shown cognitive impairment to date. A sudden change in behavior, memory, even onset of paranoia may be a result of nothing more than a simple infection. Infection needs to be ruled out as the cause before blaming the progression of the illness.


Unfortunately, it may be up to the well spouse to remind the doctors of this and insist on the testing, as too often the chronic illness is diagnosed as the total cause for any medical condition or change that we may see in those we love.


You can reach me at annnovick@hotmail.com.

Mobilizing For The Caregiver

Wednesday, July 18th, 2007

        In my years of writing The Person Behind The Chair my articles focused mainly on the emotional toll of caregiving for the spouse and family of the chronically ill. I have only touched upon the actual financial cost, which is staggering. If a spouse needs to be placed in care, the cost of that care can bankrupt a family. Most health insurance policies do not include care facility costs as part of what they cover. Even Long Term Care Insurance may not cover a facility placement, and if it does, the cost may only be supplemented.

 

         In Canada, where there is socialized medicine, nursing home placement costs are income based. And so, for most people in the middle class, the cost after the government supplement can be as high as $2000 a month for a private room. For most of us, that is more than half of our monthly income. So even if a spouse works, and more than half goes to the partner’s care, what is left for the healthy spouse and his family to live on after that?

 

         There could be house payments, tuition and clothing, without even mentioning how you put food on the table. And that is with the help of socialized medicine, which doesn’t exist in the U.S. This is one reason (among many) that spouses opt to keep their chronically ill mates at home. But the expense of chronic illness, without nursing home placement, is also overwhelming.

 

         Most medication required by chronic illness is very expensive. It is also a progressive problem. As the disease worsens the amount of medication a person needs increases. More meds means more cost. Also, chronic illness can quickly affect other parts of the body. Anti-depressants, anti-spasmodic, painkillers, muscle-relaxants, along with new medications as the disease progresses, may cause the breakdown of other organs. Then there is the inevitable cost of medication, for the spouse, whose stress over time might require medication for his/her own health.

 

         On top of all of this is the cost of accommodating the home to the progressive inability that comes along with long-term illness. Everything from special beds to oxygen tents, canes to walkers, wheelchairs to Hoyer Lifts are, just to mention a few, pieces of equipment that might be needed. Widening doorways and building ramps to accommodate the equipment is also very expensive, as are the assistants needed to help move, bathe and sometimes feed the person with chronic illness.

 

         To date little has been done to ease the financial burden of chronic illness on the individual families it attacks.

 

         One of my readers recently sent me an idea. She too is financially overburdened from the cost of caring for her husband. She suggested that the readers of my column along with every friend and relative they could muster, join politically active organizations like AARP (American Association of Retired Persons) and CARP, its Canadian equivalent.

 

         The cost of membership is small. Then, as a group, we can ask these organizations to make the financial burdens of chronic illness one of their priorities when dealing with the government. If it is a request from a large number of the membership, and a priority to the organization, hopefully, it will be something they will take on when lobbying the respective governments. Certainly it is worth a try.

 

         Another reader complained that as a middle-class Canadian, she was paying the same amount for nursing home care, as was a millionaire whose wife was in the same facility. He felt that the income brackets for the amount paid had to be more fine-tuned and those in the highest income bracket should get the smallest subsidy, if any.

 

         Lastly, one reader suggested that there be a cash benefit paid out to caregivers who nurse their spouses at home. She equated it to Canada’s Child Benefit, which is an income-based cash allowance for preschoolers that can often mean the difference between a mother staying at home to raise her children or working outside the home. She felt it would help spouses keep their chronically ill partners at home while easing the burden that comes from doing this.

 

         Whatever the suggestion, it all involves getting our respective governments to see the tremendous financial burden caregiving imposes on a family. If anyone has other suggestions on how to make care- giving a government priority, please feel free to send me your suggestions for sharing with other caregivers. Meanwhile, increased membership in AARP/CARP may be a good start.

 

         For further information or membership, AARP can be reached online or at 1 888 687 2277. CARP can be reached online at Carp@50plus.com or at 1 416 363 8748.


         You can reach me at annnovick@hotmail.com

The Importance Of A Medical List

Wednesday, January 10th, 2007


(Names changed)


 


         A man passes out in the street. A woman is in an accident. A senior suffers a heart attack. A chronically ill grandmother gets disoriented and lost. Emergency help is called. These people are hospitalized. The doctors need to know whom to contact and what medications they are to receive. They need to know what illnesses they suffer from and any allergies they have before they can be treated properly. Who will talk for them, if they cannot speak for themselves?


 


         Carrying a medication list with you at all times is vital for the chronically ill, the elderly and anyone who is taking medication or has information that needs to be shared if they are unable to speak for themselves. Medic Alert bracelets and necklaces alert physicians to allergies and other medical problems and should be worn by anyone with a serious problem. But, what if you don’t have a serious problem? What if you are just hard of hearing and are on just a few medications? Who will speak for you, and is it important?


 


         David’s story: David was 92. He was sound in mind and body and could live by himself with minor cleaning support. His biggest problem was being hard of hearing and needing hearing aids. He also was taking a few medications since his heart attack over 20 years ago. David had moved to a warmer climate when he was 60. His daughter lived a short plane ride away. It was David’s custom to go for a short walk every morning to buy the newspaper and then go home and read it over his morning coffee.


 


         David rarely put in his hearing aids until after his morning paper walk. However, one morning David passed out on his way to the newsstand. An ambulance was called and he was taken to the nearest hospital. David can still remember the horror of what happened next. He remembers people looking at him at the hospital but not being able to hear what they were saying. He remembers not being able to tell them he couldn’t hear them.


 


         He was disoriented, frightened and confused. The next thing David remembers was waking up in the psychiatric ward of the hospital. People around him were yelling and behaving strangely. He was heavily sedated.


 


         David’s daughter called her father every day at the same time. It was their routine. When Shelly got no answer at the usual time and for hours later, she knew something was wrong. She immediately flew to her father’s house and finding it empty, started calling hospitals and checking police records. She located her father, brought him his hearing aids and started to try and fix the mistakes that had been made. But, as they both found, it was not easy to get him out of the ward into which he had been mistakenly placed.


 


            First, David had to prove his competence. At 92, David thought the doctors were crazy when they started to question him. What do you do with a chair? Where does a shoe go? David was getting more and more agitated and frustrated until he finally told them that, if they didn’t get him out of there, he would put the shoe on his foot, then sit on the chair and give the doctor a swift kick at the first opportunity.


 


         With that, the doctor’s saw he was indeed competent. Meanwhile David had gone through a harrowing experience and not only missed taking his medication for two days but received other medication that could have caused problems for him, because no one knew what he needed.


 


         Everyone, young and old, chronically ill or with a minor problem, should carry a medical list with them at all times. It is what will speak for you when you cannot speak for yourself. It should list the medications you are on, the dosages and how often you take them. It should list your allergies and any aids needed to function normally such as hearing aids, glasses, canes and even a wheelchair.


 


         It should list any conditions you have, a list of your doctors and whom to contact in case of an emergency. The list should be with you whenever you leave the house – perhaps in a clearly marked envelope in your wallet, pocket or purse. A second list should be clearly labeled and be put in a prominent place in your home if you live alone, or easily accessible for someone who lives with you. It should contain all the information you need to tell a doctor in an emergency. It will assist in any treatment you need, and could even save your life.


 


         You can reach me at annnovick@hotmail.com

Coping With Depression – The Holistic Alternative

Wednesday, November 10th, 2004

(Names are changed)

Last week I wrote about well spouses who eventually chose to get a physicians help with the problems they were having coping, with their partners’ chronic illness. While interviewing well spouses on this topic, I discovered that several people had chosen to avoid discussing their problems with a professional and instead sought help in over-the-counter holistic medication and herbs. Many did this without the help, guidance or monitoring of a nutritionist, homeopath, doctor, pharmacist or naturopath.

It is important to remember that all medications, whether herbal or prescribed, need to be handled with care and monitored by a professional. All our prescribed medications have been tested and dosages standardized. This is not necessarily true for all over-the-counter natural medications. The same product produced by different companies may have different strengths and purity. They may contain ingredients that are contra-indicated with other medications that you are taking. Though there is certainly a place for these medications, and many may help where prescribed medication have not, it is important to remember that they are medications. Like all medications, they need to be monitored by someone who is familiar with them and knowledgeable about where and how they are produced.

Zev was a well spouse under tremendous stress. He was also overweight and had a family history of heart disease. Zev was experiencing chest pain periodically. His doctor sent him to cardiologists, who after doing several tests, suggested that Zev have an angiogram. To Zev’s delight, the angiogram only showed negligible blockages of ten percent in his arteries. Zev’s cholesterol had always been within a normal range. Still, his cardiologist felt it needed to be lower and put him on cholesterol medication.

The possible side effects of the medication were disturbing to Zev. He went on the Internet and researched several natural alternatives to the medication his doctor prescribed. Instead of just switching the prescribed medication for the natural one, Zev brought the information to his cardiologist. Together they worked out a safe plan to see if the alternative medication would work for him. Over time, and with the help of his cardiologist, Zev was able to switch to the natural medication that he was more comfortable with.

Shoshana was a well spouse. She was also in the sandwich generation. Shoshana had young children, a husband with MS, and a mother with many problems, which included a heart condition and depression. As Shoshana’s mother’s health worsened as she aged, so did her depression. Shoshana had heard about a herb that was thought to be helpful with depression. She brought some to her mother. Following the suggested dosage on the bottle, her mother began to take the medication.

It never occurred to Shoshana or her mother to discuss this new herb with her doctor or cardiologist. Whenever the herb was on sale, Shoshana picked it up regardless of brand. It never occurred to her that the dosages and purity could be different in different brands. It never occurred to her that it could contain ingredients that could pose a problem with her mother’s other medications.

Pela was a well spouse who had high blood pressure. Her blood pressure had been under control for a long time. Quite suddenly, it rose again. Her doctor tried many new medications, but had great difficulty getting her blood pressure consistently under control again. It would be normal for a while and then spike again. Only later was it discovered that Pela was a licorice addict and that the licorice she consumed was nullifying the effectiveness of the blood pressure medication.

Aaron’s chronic illness was causing a tightening in his muscles during the day. As a result, he began to have pain in those muscles at night. His doctor put him on a muscle relaxant on alternate nights. On the nights that he took the relaxant, he slept well. On the other nights, he barely slept. It was not that the pain was unbearable on the nights without the pill. It turned out that the pill was habit forming and Aaron could no longer get sleep without it.

Stanley and Sharon were on the same medication to help them sleep. Stanley had no problem, while Sharon felt she was becoming addicted. Stanley could take the medication as needed. Sharon could not sleep without the medication once she began taking it. Sharon had to come off the medication. She had to come off the medication very slowly. Stanley is still using it.

Doctors today are more open than they used to be to discussing alternative medicine. It is possible today to find a doctor who will consider alternative ways of dealing with a problem. In the same vein, professionals in alternative medicine realize that people are often taking medication prescribed by their doctor when they approach them about a specific problem. The key is to get a professional you trust to help guide you.

Medication is very individual. What works like a charm for one can be a disaster for another. Going on or off some medications require small changes in dosages. Consistency and monitoring by a professional is vital. Do not become your own physician, buy something over the counter, pop the pill and expect miracles. Not only may your miracle not materialize, but you might find a nightmare in its place.

Coping With Depression

Wednesday, November 3rd, 2004

(Names are changed)

Many people in my generation were brought up with an aversion to any medication that did not deal with a physical problem. We were doctor oriented and went to the doctor for anything from a bad cold to a serious bone break. The doctor knew best … the doctor said … There was no Internet to give us access to information about symptoms, holistic alternatives, other medical healing and side effects, and so we relied heavily on whatever the doctor told us to do for everything.

Anxiety and depression were something you coped with silently. You rarely discussed it, even with your doctor. After all, nothing could be done about it medically (so we thought) and seeing a psychiatrist well… it just wasn’t done. That was for crazy people, we mistakenly believed, not ordinary people with problems. If life was hard, you needed to learn to deal with it.

Today, things have changed somewhat. A bit of the old attitudes remain, but many people will seek help for family problems, even if it means seeking this help in a different community in order to remain anonymous. But the attitude about taking medication in order to help you cope better with your problems or your depression often remains the same.

Many older well spouses are hesitant to talk to their doctors about their chronic sadness. They remain embarrassed by the depression that stalks their waking hours and denies them the relief of sleep at night. The lack of sleep only further adds to their depression.

I asked for clarification recently from a doctor friend on how medication can help with a problem that is caused by a situation and is not due to a physical cause like a chemical imbalance. I was quite surprised at her answer. She told me that according to the old theories, there are two unrelated, distinct types of depression: those caused by a chemical imbalance, and those caused by difficult life situations.

This belief has been replaced by a new theory. Today, many doctors feel that situations that cause us to feel depressed over long periods of time affect the balance of chemicals, such as serotonin, in the brain. The problems caused by a difficult and depressing situation cause barrages of intensely negative thoughts. These thoughts and stresses affect the balance of chemicals in the brain that control our moods. This problem can be helped with medication, in conjunction with psychotherapy.

Both medication and psychotherapy work to address a chemical imbalance in the brain. The medication does so chemically. Cognitive psychotherapy helps achieve the same result by helping change intensely negative thought patterns. This, in turn, affects the chemical imbalance in the brain and relieves the depression.

Medication will not help with your spouse’s illness and all its offshoots, but it may help you get out of bed in the morning and deal with what you need to do to get through the day. It may even give you enough mental energy to do something nice for yourself. It is definitely an avenue that a well spouse, or anyone else having difficulties, should consider exploring with his or her physician.

Heather was a veteran well spouse. Her husband’s chronic illness had been ongoing for over 20 years. Until now, Heather had coped fairly well. Though life had been difficult, she had raised her children, married off one, became a grandmother, all the while working at a stressful job. Now, 20 years later, Heather found herself having difficulty getting through the day. She had difficulty getting out of bed in the morning. The desire to just stay under the covers was almost overpowering.

Simple household tasks became insurmountable chores, and even doing the laundry or making dinner seemed to take more energy then Heather could muster. Heather could not understand this change in herself. Her doctor suggested she go on an anti-depressant medication to see if it would help. At first Heather was reluctant, but as getting through the day became harder, she agreed. Slowly Heather began to feel better. As she felt better, she functioned better. She was shocked one day to hear herself singing as she did the dishes. Singing was something she couldn’t remember doing for years.

Sarah was also a veteran well spouse. Over the years, Sarah looked forward to any “simchas” they had. Happy occasions were just too rare to not milk them for every bit of joy. She loved the preparations for her sons’ bar mitzvas and her children’s weddings. The work never bothered her as she embraced each task with joy. That is why it was a shock to Sarah when she couldn’t summon the energy for her youngest son’s wedding. She even went so far as to suggest that there be no wedding at all. She suggested that the couple just take the money both families had budgeted for the wedding and have the immediate family only witness a ceremony in a rabbi’s study. The couple and the bride’s family rejected that idea, leaving Sarah to deal as best she could with her part in making the simcha. Everything that she had once done with such joy was now a tortuous task. She put off dealing with everything until the last minute, unable to summon the energy for the most simple of tasks.

Sarah summoned the courage to speak with her doctor. Reluctantly, and under her physician’s care, Sarah started on medication. Within six weeks, Sara began feeling like her old self. Her only regret was that she hadn’t talked to her doctor earlier.

Tzvi’s thoughts had lately turned to suicide. He knew he would never take his own life but found himself thinking of driving off the bridge, opening a plane door when flying, and jumping off a balcony. Each time these suicidal thoughts came, he always thought, “Then the pain will just be finished.” Tzvi had taken care of his wife for most of their forty years of marriage. These thoughts that popped into his head scared him. He had become anxious all the time. It was difficult for him to admit these thoughts to anyone, including his doctor. Tzvi could not believe the relief he felt once he began the medication his doctor suggested.

I am neither a doctor, nor a social worker. I am just a well spouse relaying stories of other well spouses for mutual support and to heighten awareness. I am not advocating medication, nor telling you to avoid it. What I am suggesting is that if you are having difficulty coping with life’s major ups and downs, an alternative that may help is to speak to your doctor. Help to get through the day is available. It is an avenue worth exploring for anyone walking around with a cloud on his head or the weight of the world on his shoulders.

Printed from: http://www.jewishpress.com/sections/magazine/coping-with-depression/2004/11/03/

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