THIS MONTH’S PROFESSIONALS

Barry J. Jacobs, Psy.D.

Barry J. Jacobs, Psy.D.

Clinical Psychology

Barry J. Jacobs, Psy.D. Barry J. Jacobs, Psy.D. is a clinical psychologist, family therapist and the author of the book, The Emotional Survival Guide for Caregivers—Looking After Yourself and Your Family While Helping an Aging Parent (Guilford, 2006). As a clinician, he specializes in helping families cope with serious and chronic medical illnesses. As an educator, he works as the Director of Behavioral Sciences for the Crozer-Keystone Family Medicine Residency Program in Springfield, PA and has had adjunct faculty positions with the Temple University School of Medicine, University of Pennsylvania School of Nursing and the Department of Psychology of the Philadelphia College of Osteopathic Medicine.

Dr. Latonya Law

Dr. Latonya Law

Family Nurse Practitioner

Dr. Latonya Law is a Family Nurse Practitioner, board certified by the American Academy of Nurse Credentialing Center (AANCC) and licensed by the state of Georgia. She is devoted to the advancement of medicine and contributes by holding memberships to the American Nurses Association, Black Nurses Rock, and Georgia Nurses Association.

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This Month’s Questions & Answers

  • BissyLewis
    BissyLewis, SUPPORT NETWORK Member Asks
    Q.

    "I am a caregiver for my mother who has Congestive Heart Failure. Her weight continues to creep up and she had a weight gain of 2.9 lbs overnight. I have been well-instructed by home health nurses to call her doctor or take her to the ER if this occurs afterhours or on the weekend. Today is Sunday, and I am worried. She wants me to give her an extra Torosemide, but I feel she needs to go to the ER. She has dementia and is frequently stuboorn and intractable about going to the ER. She also suffers from COPD and Stage 111 Kidney failrure. She can tell she is retaining fluid, and acknowledged she had not been going to the bathroom, despite taking her usual dose of 2 Torosemides a day. How can I impress upon her the importance of managing these symptoms and following the advice we have been given?"

    A.

    Being a caregiver for an elderly parent is hard on so many levels. For your whole life they have been independent and an authority figure. Once the shift happens in that you are now the authority figure, it’s a very tough line to walk. Know that sometimes you have to be the tough guy and trust your instincts to seek the best care for her. She may not want to go to the ED, but remember that her dementia can affect her logic and decision making capabilities.
    As far as her heart health, I would speak with her cardiologist on how to handle this situation in the future. Many times an extra dose of diuretic is all that’s needed to get out of the valley of fluid overload. I would ask for rules on when it would be okay to give an extra dose instead of go to the ED. What you really want to watch for and go to the ED for is any signs of difficulty breathing related to fluid overload. This would be shortness of breath or a wet sounding cough. Weight gain and decreased urination does not always necessitate an ED visit.
    To impress upon her the importance of managing symptoms and following advice, I would explain that an ED visit early prevents a hospital stay later. It is far easier to intervene early with an assessment and dose of diuretic in the ED, than allow the symptoms to progress to the point of difficulty breathing requiring more advanced interventions and an admission to the hospital. It’s also critical to keep her fluid status balanced without overuse of diuretics in light of her kidney failure. So though an extra diuretic may get rid of the fluid, it could do more harm than good to her kidneys, so it’s best that a medical professional make the decision based on her labs and symptoms.
    Be well, Tessa

  • Wifey4ever
    Wifey4ever, SUPPORT NETWORK Member Asks
    Q.

    "How to deal with stress and not feel discourage"

    A.

    Feeling discouraged is certainly stressful. So what’s the best way of dealing with discouragement? There are only two paths forward—changing your situation or changing your attitude about your situation. If it’s possible to change your situation through medical means to improve your heart’s functioning, then I recommend exploring them. However, if that’s not possible and you have to live with the residual effects of heart disease or heart damage, then it is vitally important to adopt a more positive attitude. Cautious and realistic optimism is associated with less depression and better overall outcomes; pessimism tends to have the opposite effect. How can you be more positive? For many people, waking up each morning and listing the things for which they are grateful—not the least of which is the gift of life—re-frames their medical predicaments as an obstacle to get over rather than an insurmountable barrier to happiness. In other words, focus your attention on what you have and still enjoy rather than what you’ve lost. For more on positive thinking, I suggest books such as Flourish and Authentic Happiness by psychologist Martin Seligman, Ph.D.—Barry J. Jacobs, Psy.D., AHA volunteer, co-author of AARP Meditations for Caregivers

  • KimBach1234
    KimBach1234, SUPPORT NETWORK Member Asks
    Q.

    "I am studying pre-nursing now. I plan to apply for a job as a CNA in a couple of months. My current concern is my husband. He knew he had high blood pressure 2 years ago. He is 45 years old and he is a drinker. On average, he has 4 - 6 beers per day. He has gained a lot of weight due to his drinking habit and no physical activity. Now, he is going for Keto diet for the hope of losing weight, and he does not let me to cook for him. He complains that my cooking is to plain to eat. His Keto has full of of fat and meats. I am really concerned about his condition. He is very stubborn. I do not know what to do to help him."

    A.

    Your husband is very fortunate that you cook for him and care so much about him. I understand your concern for his health; he does drink too much and is looking for short-cuts for losing weight. Unfortunately, though, I feel sure that the more you pressure him, the more he is likely to dig in his heels and defy you. The best way for you to wield influence, therefore, may be to praise him for any step he takes toward greater health—including the Keto diet—and not fuss with him too much about other things he should be doing. Recommend—but don’t push him—to see his primary care provider. Let that trained professional (not you) work with him on making better lifestyle choices—Barry J. Jacobs, Psy.D., AHA volunteer, co-author of AARP Meditations for Caregivers

  • Walker2019
    Walker2019, SUPPORT NETWORK Member Asks
    Q.

    "My Mom had a massive stroke today while she was in rehab recovering from what the Dr.'s believed was a mini stroke. The entire left side of her brain was affected and part of her right. The Dr explained in detail her grim diagnosis. The only thing the hospital staff can do is try to keep her as comfortable as possible. My Mom has been living with me for the past 15 years. She's not only my Mom she's my best friend. I informed the Dr. if there is no chance of recovery then I wanted a DNR added to her chart. They also removed the feeding tube they put in her and most of the other tubes as well upon my request. I told the Dr. I wanted Mom to come home with me and to have her placed on hospice care. This has occurred in less than 24 hours. My main question is how do I give her some food when she is completely unresponsive? Should I give her Gerber custard pudding or the like? A little bit added to her tongue for her to taste? I am completely out of my depth here and need any advice you can give. She made it clear to me years ago she would rather be dead than to be put in a nursing home to waste away. Please help me."

    A.

    Feeding someone who does seek food or indicate hunger is difficult. Thankfully, the body converts from sugar to ketones for energy and hunger subsides. If your mother had favorite tastes, introducing a small amount to the tip or side of her tongue may be pleasurable. Wetting a mouth applicator with a favorite taste may also suffice. Hospice care will help you provide your mother with excellent care and fulfill her wishes to die at home. Thank you, Dr. Joseph Hanna

  • dandersen57
    dandersen57, SUPPORT NETWORK Member Asks
    Q.

    "Our son was born with congenital heart disease but wasn't diagnosed till age 20. He had four open heart surgeries within 8 years. The last one was to put in a mechanical valve and repair an aneurysm on his heart. The night of the surgery he suffered a bilateral stroke. He has come along way since then. (14 months ago). He was always apprehensive about getting a mechanical valve because of the ticking sound. Now he is obsessed with this and worries about it stopping. As his mother/caregiver I want to help him to cope with this. How can I help him? If there is any info to help us, I would sooo greatly appreciate it. Thanking all in advance for any help. Donna"

    A.

    Your son’s stroke may have predisposed him to some psychologic difficulties. Even without a stroke people with artificial body parts can become obsessed with their function. Heart valve disease and surgery are common. An author and prosthetic heart valve recipient, Adam Pick, has written extensively on the concerns of individuals in The Patient’s Guide to Heart Valve Surgery. He also created an award-winning website HeartValveSurgery.com that may help your son. Lastly, please consider seeking out local assistance for your son with a psychologist specializing in medical phobias. Thank you for this question. Dr. Hanna

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