Ageless Lifestyles Radio

  

  

  

  

  

  

  

  

Host: Anti-Aging Psychologist Dr. Michael Brickey

Expert Guest: Jacqueline Marcell

Broadcast: 3-25-08 on webtalkradio.net where the latest shows are broadcast and posted as podcasts

Jacqueline Marcell has learned a lot about caring for parents. She has a fascinating story with lots of lessons and tips. Her marvelous book, Elder Rage reads like Stuart Smalley on steroids. It explains how just when her life was falling apart, her parents’ problems exploded. Elder Rag–with its drama, wit, and humor is a great read. What especially interests me, however, is that in between the compelling stories, she shows how to solve a lot of problems. What’s more, the experience led her to become a passionate advocate for eldercare services, and reform of the often dysfunctional systems that are supposed to help our parents. In the first part of the show we’ll learn about Jacqueline’s experiences with the system and how her sheer determination got her through it. In the second part of the show we’ll focus on practical advice and how to get the best services. Her website is www.ElderRage.com

TRANSCRIPT ©Michael Brickey–excerpts permitted with attribution

MB: This is Dr. Michael Brickey with Ageless Lifestyles Radio, cutting-edge thinking for being youthful at every age. On each show I interview experts on what it takes to live longer, healthier, and happier. Our program takes a holistic approach in addressing anti-aging psychology, medicine, alternative medicine, fitness, nutrition, and wellness. Our emphasis is on innovative thinking and practices that have solid data and results. Life keeps asking us to learn new skills. We graduate from school and we learn to need resume-hunting and job hunting skills. Many of us become parents and learn everything from Lamaze to diapering to dealing with tantrums. Currently my wife and I are still trying to learn how to tell our seven-year-old identical twins apart and learning how to help our teenagers figure out which college to attend. Then comes the time to deal with aging parents’ problems. I experienced my share in the last several years with my father needing hospice services and my mother losing her short-term memory and eventually getting into a good assisted living facility. You hear about the sandwich generation. I guess, with caregiving for three generations, I’m a double-decker sandwich.After we get through these life lessons, we often say, “Boy, I wish I knew then what I know now.” The trick is learning from other people’s experiences early in the process. Joining me on this show is Jacqueline Marcell, who has learned a lot about caring for parents. She has a fascinating story with lots of lessons and tips. Her marvelous book, Elder Rage, reads like Stuart Smalley on steroids. It explains how, just when her life was falling apart, her parents’ problems exploded. Elder Rage, with its drama, wit, humor is a great read. What especially interests me, however, is that in between the compelling stories, she shows how to solve a lot of problems. What’s more, the experience led her to become a passionate advocate for eldercare services and help reform the often dysfunctional systems that are supposed to help our parents.

JM: I was a television executive and I’d had a whole string of bad things go wrong - personally, professionally, and then Mom needed care. She’d had a heart attack 11 years before and Dad had done a great job taking care of her, but he couldn’t do it any more and he wouldn’t give up. So I went to San Francisco to try to help the situation. I had been up there many times, of course, in the 11 years, trying to get him to accept help. I got up there, thought I would maybe be there for a month or so, and I was there for almost a year without a day off, getting him to accept help and getting my parents properly cared for and diagnosed and treated and just everything - the whole eldercare system was just not helping me appropriately. So like you say, if I only knew then what I know now, it wouldn’t have taken me all that time. I would know exactly what to do.

MB: So what was the first thing that didn’t go right?

JM: Well, I didn’t understand that my father - you know, he’d always had a bad temper; this was nothing new to me. It had never been at me before. So growing up, you know, he was 90% great, but boy, was that temper a doozy. And now it was at me, and screaming, yelling, throwing me out the house, calling me nasty names. And I’d cry, and you know, I just couldn’t believe he could possibly be so horrible. I didn’t understand that he was addicted and trapped in his own bad behaviors of a lifetime. But now they were getting distorted. He’d get upset over things that were - you know, just seemed illogical or irrational, at times, and then the next day he’d be normal. So I didn’t understand what dementia was. I didn’t understand it’s intermittent; it comes and goes in the beginning. I didn’t know how to get him to the right doctors who could uncover it early enough. And all that cost me a tremendous amount of time, energy, money, and heartache.

MB: What was your experience with doctors?

JM: Horrible! You know, I’m thinking, well, I have no medical background. You know, I’m relying on the doctors that have taken care of my parents for 20 years. And you know, I would describe all these horrific things that my father had done, and they’d look at me like, you know, “Well, we’ve never seen him be mean. We’ve never seen him rage. We’ve known him 20 years.” He was socially adjusted his whole life. My godfather read my book and he said, “You know, in 57 years, I never once saw this in your father.” And I have a cousin, a distant cousin who said, oh, I just made it all up, never seen my father like that. So my brother said, “Well, have them call me.” Because my brother was the one who got the brunt of it. It was the dirty little family secret, you know, that we didn’t share with anybody. My best friends, growing up, I didn’t share. You know, this was very hidden by the four of us in the family. And what a shame, because had we been growing up in this time right now, we would’ve known how to find help, how to get him in anger management, how to get him medicated properly, how to react to him instead of endorsing and ingraining that behavior, and walking on eggshells, hoping not to upset him. So when you do that, you know, your whole life, you’ve created your own monster in a way, and then you add a dash of dementia on top of it, the chances of you being able to turn that around when somebody’s in their 80s are pretty slim, but I did. And that’s when I finally was so infuriated about what I hadn’t known and what I hadn’t been told by these doctors and healthcare professionals that I was coming in contact with, was when I said, “Okay, I’m chucking my career, my whole 20-year career as a television executive. I’m going to go into eldercare because they need me.”

MB: You describe him as kind of an Archie Bunker and your mother as kind of an Edith Bunker. And he knew how to put on a good show when he went to the doctors’ offices or when he was in front of professionals. Is that common?

JM: I didn’t know how common it was until my book. Elder Rage has been out there now long enough and I get emails every single day - several - that will say, “Oh, my gosh! I thought I was the only person with a father like yours,” or “My mother - you know, we must be related, my mother is just like your father,” or “My husband is just like…” or whatever, and describing that how amazingly sharp they can be when they go to the doctor. Well, if you’re going to a doctor that doesn’t understand how to get to the very early signs of this - I mean, anybody can diagnose it in stage two when a person is wandering or starting to - has a car accident or leaves the stove on and almost burns the house down, or has such drastic behaviors that you get it. You know that it’s what we used to call untreatable senility. Or you know, you know, “Dad, I just told you that four times in the last ten minutes,” and you’re starting to think, “Okay, maybe he’s got some type of dementia.” Alzheimer’s is just one type of dementia - I didn’t even know that, and most people don’t until they get into it. But the mission that I’m on is to get people to understand it earlier, way before that happens, because you don’t go from normal to not knowing that you’ve asked the same question four times in ten minutes, that you’ve got a short-term memory problem like that or that you don’t remember where you live, after 37 years of living on that street. That’s way far into the disease. So we need to catch it very early. And unless you get to professionals who are trained in uncovering that - and it’s more than “What day is it? What time is it? Who’s the governor?” and the mini mental state exam. It’s a complex diagnosis and a complex evaluation. And those professionals are few and far between. So that was my mistake - relying on professionals that didn’t have any training in that. And then I didn’t find out until much later that Dad had told all the professionals he came in contact with, whenever I wasn’t there, not to listen to anything I said because all I wanted was his money - like, I wish he had some! So it just was unbelievable. I just could not believe. And I’m not shy. I have taught at the college level. I’m a pretty educated person. I’m in a major metropolitan area, San Francisco Bay area, and I am begging, screaming, you know, looking, searching for answers, and was not directed properly for a whole year. So that’s when I realized, if that happened to me, this has got to be happening on such a scale around this country with people that may not be as aggressive, may just be taking whatever the doctors say, may not have the education to try to figure things out. And it was tough, tough for me! And maybe in locations that have even fewer and farther between resources to turn to. That’s when I said, “Okay, this needs my help.”

MB: Knowing what you know now, how does a lay person find whether a doctor is knowledgeable, and how do you find the good doctors?

JM: That is really a key factor, isn’t it? And that’s why everything I do, I spread the ten early warning signs of Alzheimer’s disease. They’re in my book. They’re on my website at ElderRage.com. I want these on billboards, I want them on sides of buses, I want them on public service announcements, so that the general public and healthcare professionals are so aware of these warning signs and that it’s common knowledge of what they are, that when the daughter takes the mother to the doctor and says, “I have kept a little diary here of all the ten warning signs that I’ve been noticing my mother doing, and I have specific examples of this one, and then it was a month later she did this, and a month later that. And so, Dr. Smith, I’m really going to need a referral to the best neurologist in the county or that we can find, that you know of, that is a specialist in dementia.” So that - you know, that’s a very specialized thing. So isn’t it interesting now, I - with no degree in medicine except my DLE, my doctor of life experience - I’m educating doctors all over the country for their CMEs, for their Continuing Medical units.

MB: Wonderful.

JM: And I’ve educated - I can’t even tell you how many doctors I’ve educated. But oh, hundreds and hundreds of nurses, social workers, case managers, for their CEUs. But when I can get a doctor educated for a CME, I am thrilled because then I know - I’m teaching them in a very kind way that they just don’t know enough, and getting them the resources of how to help that family take notes, keep track of the warning signs, and then not just say, “Well, honey, your Mom’s getting old.” You know, that’s what people tell me all the time; that’s what they hear from many of these doctors.

MB: So it’s a two-pronged approach that you’re both educating the professionals but you’re also getting the lay people to really know what to ask for, what to look for, and taking the data into the doctor.

JM: Exactly. They have to. Otherwise, you know, most people put - you know, the doctor should know! You know, what the doctor says. But if you’re attuned enough to say, “Hmm, this is a GP. May not have been trained in dementia.” But I know these warning signs and I’m seeing them in my mother. And she’s still independent - she can still drive and she can still be at home and take care of herself. But gosh, yesterday she couldn’t find her keys - which we all have that happen - but all the sudden I open the freezer and there’s her keys there in the freezer. And I said, “Mom, why did you put your keys in here?” “Well, I didn’t put them there.” “Well, there’s been nobody here but us. We drove here together in your car. You can’t find your keys. I just found them here.” “Well, I didn’t put them there.” So you know, if you know that that was a warning sign, putting things in odd places, you’d have a light bulb go off in your head, instead of just thinking, “Oh boy, did I put these in here?” You’d start to think, “Well, gee, okay, this could be the beginning of some type of dementia, possibly Alzheimer’s, and I need to make a note of this, write it down, and see what else I notice.” Maybe this was fluke. You know, maybe she was putting something else in there. She had the keys in her hand and she was putting the groceries away and they just happened to fall, and she wasn’t specifically doing that. So you have to keep track of these for awhile. It’s that short-term memory, when they ask you the same question in a short period of time, or tell you a story and then ten minutes later start telling you the same story. It’s not when they tell you something one day and then three days later they tell you again, and you’re going, “Mom, you told me that!” and it was three days ago. Well, we tell people this, we tell people that - “Did I tell you this already?” We all do that; that’s normal aging. But it’s more like if you just told me that. That’s the short-term memory isn’t working right. So that’s a key one to watch for. Some of the other ones are the personality gets shifted a bit, you know, where just all the sudden there can be - they just burst into tears over something. Or like Dad - he’d just fly into a rage. Now, he always flew into a rage, but now it was over because he didn’t have strawberry jam instead of his raspberry jam, you know what I mean? I mean, weird things where you’d go, “Jiminys, all right.” And if you chalk it up to old age, you chalk it up to stress - you know, he’d been taking care of Mom for such a long time, couldn’t do it anymore. She almost died from his inability to care for her. And that’s why I had to persevere. This wasn’t something I wanted to do. It was a necessity, because I couldn’t leave Mom alone with him. There was no way. She would’ve died from his inability to care for her any longer. I mean, when I got there she was - oh, it makes me just shudder right now. She was in the hospital, was there for three months from him not taking her to the hospital. She was 82 pounds when I got there from a urinary tract infection, and he didn’t think maybe that was important enough to take her to the hospital. So I couldn’t leave her. I was in this Catch-22. I call it the Caregiver Catch-22. I was trapped there. Couldn’t leave her alone with him. Couldn’t get the doctors to believe me because it was so intermittent, it was so coming and going. It was the very beginning of it. He was darling when he needed to be. I was not taking him to the right doctors who could uncover it early enough. I couldn’t get a caregiver to stay because he’d throw them out of the house within a day or two or call them nasty names. I couldn’t put them in a nursing home - she required full nursing care, he didn’t. He would just take her out. I couldn’t put him in a home; he didn’t qualify yet. I couldn’t - I was like just completely trapped. And that’s when I said, “Okay, well, I’m not my father’s daughter for nothing. You think he’s stubborn. Okay, I am going to figure this out, come hell or high water.” And I persevered until I did. And once I did, that’s when my whole life took a left turn and I made the decision to do something important.

MB: So we have short-term memory. We have behavior changes. We have just not taking care of things. What are some of the other signs?

JM: Oh, let’s see. Disorientation to time and place - you know, like one day driving with Mom and Dad and we’re at the main drag where they lived for decades and I’m in the left turn lane to go see Aunt Dora. And all the sudden he’s screaming at me to turn right. And I’m like, “Dad, what are you talking about. You know she lives over here.” And he goes, “She lives over here! She lives over here!” And I’m thinking, “What? What is wrong with him?” And then all the sudden he just looks blank. And he goes, “Honey, nothing looks familiar.” And I’m like, “That is so weird!” You know, and I cried, and I’d think, “Oh, he’s getting older now.” If I knew that that was a warning sign, we would’ve gone down to Aunt Dora’s and I would’ve made a phone call to the Alzheimer’s Association. I would’ve known to call the area agency on aging or I would’ve known to call the Alzheimer’s Foundation. I would’ve known where to find the resources and I would’ve known how to locate a neurologist specialized in dementia, to get him in there and evaluated early. People say, “Well why do you want to know? Who wants to know if you’ve got Alzheimer’s?” Well, you do. Because if you do, medical science in the last 15 years - we’re blessed to have four band-aids, I call them. You know, they’re medications. They’re band-aids; they’re not a cure, they’re not going to stop the disease, but in most people they can slow down the progression of the disease. Now that’s huge! You get the diagnosis early and you can slow the progression of the disease down, and then you can make sure that your loved one is being treated with an antidepressant, because most people with any type of dementia are greatly helped with that. And the of course, holistically - eating right and exercising and putting all the effort into getting the person to be as healthy as possible in every way, shape, and form that they can be; and socially - getting them involved in senior centers and adult day centers so that they’re active and busy and so they’re not just spending their days in bed or in front of the TV because they get so depressed. But managing it - the depression is one of the warning signs of dementia, so is it depression alone or dementia or a combination? So you’ve got to get the right doctors, so you’ve got to be attuned to this. Then, okay, let’s say you can delay it for a year from progressing to the point where they need 24/7 care - they’re still independent, they’re still able to do a lot of stuff - that’s huge, huge! Because medical science is working so feverishly trying to come up with a cure or trying to come up with a medication that will stop it in its tracks, or maybe even delay it for two or three or five years. Most people don’t. Most people chalk all these symptoms up to old age - “Well, you know, she’s always had a bad memory,” “Oh, she’s always been difficult,” “Oh, she’s always gotten lost” - whatever. It’s the more-so theory of aging - whatever you were as a young person, you get more so that way as you get older. But now these symptoms start to distort that intermittently, where the - it’s so subtle in the beginning that the family doesn’t catch it. So it progresses. Now it progresses to a crisis, and if you haven’t reached out when it was early, now you’re in the crisis where you’ve got to have 24/7 care. You cannot leave them alone, period.

MB: Big-time safety issues, yeah.

JM: Now, even if you get the diagnosis, even if you get the medication, even if you’re doing everything holistically possible health-wise, you can’t go backwards. You can’t go back to the relative independence that you had in the early stage. And see, the early beginnings of this can last - there’s a stage called MCI, mild cognitive impairment, and that can last five or ten years. So it’s really subtle when this thing starts. It takes a long time to get going. Okay, so you’re in MCI for five to ten years. Well, a large percentage of those people will go to Stage 1. Not everybody - they’re still doing tests to see how many people - but nobody goes to the doctor for MCI. You know, it’s like - uh, you know. But they think it’s between 70 and 90% right now, is what the statistics are showing. So a large percentage of those people are going to go to Stage 1. Stage 1 can last two to four years. Everybody ignores that, too, because, well, they’re not that bad. But then you got to that point where there’s been a car accident or they’ve wandered downtown and ended up in the next county over, completely lost - whatever’s happened. Now the family’s screaming for help and they’re saying, “I can’t take it anymore.” You know, it’s been building, building, building, building, and now we’re at the point where, okay, now we’ve got to do something about Dad. Well, now it’s too late. Now you’ve got to take time off work. Now you’ve got to try to find or hire caregivers. Now you’re doing everything you can to elder-proof the house and keep them safe at home and try to get people to care for them 24/7. And this is why Alzheimer’s Disease is costing this country $61 billion dollars a year. 79% of that is the lost productivity from the absenteeism of adult children and spouses having to take time off work to care for their loved ones, because they didn’t wake up in MCI or Stage 1 and do anything about it. So if we could all wake up, if I can get everybody to wake up early, think what we can save families in terms of heartache, but think what we can save our society in terms of all these elders that are progressing into the Stage 2 where they need full-time care sooner than they should have if they’d gotten evaluated earlier. Now let me tell you, Stage 2 lasts two to ten years. Some people move through very quick, other people - ten years of that. Then they go to Stage 3, which is the end, and that is nursing home time. And that’s one to three years of pure hell. I’m trying to just wipe Stage 3 and most of Stage 2 off the map, so if we can catch it early enough, then we delay, we delay, we delay, they die from something else, because one out of eight persons by the age of 65 will get this - one out of eight by 65, and one out of two by 85. So that’s why it’s so imperative for this early, early understanding of this.

MB: What have you learned about how to coordinate the efforts with your siblings?

JM: Well, you know, like I told you, my Dad was really awful to my brother growing up. My brother was eight, nine years older, and I didn’t get that upbringing. You know, my Dad was orphaned when he was ten. He had a fourth-grade education. He lost his mother, his father, his siblings all got battered around, he’s in an orphanage. So there was a lot of rage in that little boy that wasn’t dealt with. Now he marries my mother and boom, there’s a baby right away. So he had tremendous jealousy. He wasn’t evolved enough himself as a man - he was still a little boy and my mother was his anchor. And I think there was just a lot of jealousy of that child. And my brother got the brunt of it, unfortunately. And then eight, nine years later I come along, and I’m a girl - for some reason I don’t get that. I don’t get that same jealousy thing. But I saw my brother deal with it, and it ruined his life, actually. So when my mother had that heart attack - they had an on and off relationship their whole lives. You know, we’re well into adulthood and middle age now and it’s still on, off, on, off. And they never, ever did get along. Well, they had a blowout, Mom had the heart attack, and they never spoke again for eleven years. And I kept trying to get them back together - wouldn’t work. So my brother wiped his hands of all of us, including me. So when I got up there to have to try to solve this and I’m there for a year, there was no help coming from my brother. And it was really hard. You know, this was his mother also. I was sitting in the hospital for three months, feeding her every bite of those meals and, you know, being there until midnight - I’d send Dad home before it got dark - you know, thinking, “Well, he could be here feeding his mother. This is his mother, too.” But I had to walk a mile in his moccasins, you know. I had to realize what my father had put him through and that he did not get the love that I had gotten growing up, and I had to let it go. And so I made amends with him and as soon as my mother was out of the hospital, I got my mother to see her only son. She hadn’t been able to see him - my father wouldn’t allow it - for eleven years. And I mended that fence without any expectations of help from him whatsoever. If I were to do it again, what I would do - and what I tell families, if you’ve got a sibling that doesn’t want to help with the caregiving or they’ve had a much different experience than you had growing up, like I did, you know, people would say to me, “Honey, so sorry about what you’re going through with your Mom and Dad. Is there anything I can do?” And I’d be like - I didn’t know what to say, you know. What I tell people now is make a list of all the things that you need to do, as a caregiver and otherwise, because some people will be happy to come in and sit with you Mom while you go to the market or you do this or that. Other people don’t want to do that part of it. Some people will be happy to bake some cookies for the freezer, though - something that they could do to help. So make a list of all those things. “Gee, you know, my watch needs a battery. I haven’t had a chance to get a battery for my watch. Could you do that for me?” “Sure, I could do that for you.” Now, if I’d asked my brother, “Gee, the car - I haven’t had a chance to get it serviced. It’s way overdue. The tires need rotating.” You know, something where he didn’t have to be involved with Mom and Dad while they were at adult daycare all day and he didn’t have to see them and he didn’t have to be involved in it - I could’ve made a list of things that he might’ve been able to help me with and just said, you know, “Here’s a list of things. If you feel like it, pick one. You know, if you don’t, it’s okay, too. I’m just making up this list and giving it to anybody.” And you know, I’d have at the bottom of the list, “Take me to lunch.”

MB: I love it. It’s such a simple solution, but most people wouldn’t think of it.

JM: Yeah. You know, “That lamp that Dad threw at the caregiver last week is broke. Can you get that fixed?” You know, “He pulled on the curtain rod and that’s all bent and broke.” When you’re a caregiver - you don’t have time for all those things that consume our lives anyway - and then you add caregiving on top of it. Everything else goes by the wayside - until you get your loved on into adult daycare, which I cannot say enough about. I’m a huge advocate for that. And I was a year into it, you know, because I’d have people say, “Well, why don’t you get your parents into that?” I was like, “What is that? A nursing home? I can’t get my father in the shower. How do you recommend I get him to go THERE?” And so, you know, he was a sundowner. He was up all night, she was up all day, meaning I was up the whole time. I couldn’t turn him around. I mean, I am slamming doors, I’m vacuuming next to him - he is out like a light during the day. It’s called sundowning. It’s very common with elderly people, particularly those with dementia. The only way that I was able to finally turn that around was when I got the right doctors, we got the medication to slow down the progression of the disease, we got the antidepressants in both, I was able to optimize nutrition and fluid intake - and then get them into adult daycare all day so that they were busy. You know, they had their crafts and their cooking class and their movies and their field trips and singing. They had all kinds of activities all day - and nutrition and physical exercise. And it was perfect for them and it gave me a little break. And then they’d come home from that and they’d be exhausted and they’d sleep through the night. So it was perfect! And you know, if I’d only known to do that sooner, that it would’ve turned around the sundowning. And I’m for seven-day-a-week daycare because, boy, he’d hit that bed on Friday afternoon after daycare and I could not get him up. Friday night, Saturday, Saturday night, Sunday, Sunday night - Monday morning, he did not want to get out of that bed because he’s been into everything the entire weekend, getting up and just eating. That’s all I could get him to do. So I’m for seven-day-a-week daycare. I’m really an advocate. I’m such an advocate for NADSA, which the National Adult Day Services Association, NADSA.org. They gave me their media award because everything I do I mention the value of adult daycare because nobody knows about it. And you know, it’s not a money-making venture. I mean, you know, for $50, to have your loved one go - I mean, how do they make money at that rate. We’ll go into that, and they have hearts of gold, that do that work.

MB: What have you learned about how to recruit and manage caregivers?

JM: Well, I tried everything. I did everything wrong. Everything I did wrong - you can read the things I did wrong, and then how to do it right is in my book, in Elder Rage. But you know, I didn’t know how to hire caregivers. I was calling agencies, you know, and they - “Oh, we’ve dealt with very difficult elders. We know how to manage them.” And, well, good caregivers are in such demand that if you’ve got a very difficult elder like Dad who would call them nasty names and scream and yell if they didn’t do something just perfectly right, and throw things at them - you do not need to be abused, there’s too many other jobs where people would love to have you come and take care of them. So I couldn’t get a professional caregiver. Plus, it was like 20 bucks an hour.

MB: Wow.

JM: You know, it was very expensive. And how am I going to do that? So I started to try to hire - the good thing about going through an agency, though, is that they do - if you check this - background checks. And you’ve got to make sure, okay - “Oh, yes, we did background checks.” “Oh, how far back did you check?” Do they check one year back, three years, ten years, lifetime? Do they check the county, the state, nationally? Criminal - you know, felonies as well as misdemeanors? What do they check? So don’t just be fooled by “Oh, we do background checks.” You want to know what background checks they do. But that’s the good thing about hiring an agency is that they’ll usually do that for you. Plus, the other good thing is, if your caregiver has a problem with their family or their loved one or their car breaks down or whatever, you can call and they’ll have a person there who can fill in and they’re supervised, you know, and they’re bonded - most places will be bonded. Well, all that costs money. That’s why you pay quite a bit of money for that. Well, I had two people needing 24/7 care and the cost was just prohibitive. So I tried to hire caregivers, you know, putting ads in the paper or calling other people, saying, “Do you know anybody?” “Oh, we had one for my Uncle Joe and he’s passed now and she’s great,” and then trying to find her in between, and then of course, trying to find one that lives close enough to where you’re loved one lives. And then I was fingerprinting my own caregivers and taking their picture and being my own little FBI agent. And then, you know, you’ve got to lock up all the valuables. I don’t care how reliable people are, just don’t put temptation in anybody’s path. And even with all of that, I had people steal from us, people on drugs. I had everything go wrong that could go wrong. Until I finally met this gal who came to the interview - the amazing Arianna - and I was at the end of my rope. And you’ll have to read about this gal, with no experience and one year of high school, this gal was the angel I had asked for. And she, with my help, was able to help me turn Mom and Dad’s lives around and get everything accomplished. She and her Mom stayed, taking care of Mom and Dad. I was just so lucky to find her.

MB: If you had to find an Arianna now, how would you go about looking?

JM: Well, I’d know the questions to ask. I’d know to call all the references. And I’d know to go to their home unexpected-

MB: Oh, I like that.

JM: Because that’s the level of neatness and cleanliness I would expect to find in my parents’ home. You know, there’s certain questions you can ask and certain questions you can’t ask, I guess, when you’re hiring people. But you can, you know, kind of go through those. You can get a legal form kind of thing. But I think experience - and I just happened to luck out - she had no experience, but I was just at the end of my rope after about a year of this and I was just, “Fine, whatever, come on in.” But now, I - what a risk I took, you know? But it took me a long time to get her trained. It’s the references. It’s really talking to people - they know this person, they’ve worked - and get five or ten. I mean, really get a lot of references before you allow somebody to be in your home. And realize, you know, these people are not college-educated people, by and large. They’re oftentimes people from other countries, oftentimes people with very limited education, and you care asking them to do a tremendous number of things. You’re asking them to feed, to cook, to prepare - you know, I had them administering pills, because if you have a professional, they’re going to come in and preload a Mediset with a nurse, you know. So here I’m trying to teach her how to do everything - she was like an extension of me, of everything that I was trying to - and I’m, you know, a highly educated person and it was hard for me to do. You’ve got to allow for a learning curve for your caregiver and give them ten attagirls or attaboys for every mistake that they make and try to guide them and teach them how. And reward them - you know, every time - it finally started to hit. First money I got, boy, was big bonuses for amazing Arianna and her Mom. I gave them everything. These people deserve everything.

MB: And I love your idea of going unexpectedly to their home. You just learn so much just by seeing what it’s like.

JM: By observing, yeah. “Oh, I was in the neighborhood and I wanted to stop and give you this.” And you’re going to get an eyeful. You know, you might think twice if you’re a person that likes things neat and organized or clean or - because that’s the level you’re going to expect in the home they’re going to be coming and caring for.

MB: And you could even do that with the pretext, “I have another form I needed you to fill out” or something like that.

JM: Yes.

MB: You’re listening to Ageless Lifestyles Radio on www.Webtalkradio.net.  We’re talking with eldercare advocate and reformer, Jacqueline Marcell. She is the author of Elder Rage, which has been endorsed by an awesome who’s who list of celebrities and healthcare experts and political leaders. Her website is http://www.elderrage.com/. There’s information about her books, her seminars, her blog, and lots of practical advice and resources for helping elders. Anything you want to add to that, Jacqueline?

JM: Oh, I just want to add, take care of you. If you’re a caregiver, make sure you put you first, because, you know, I didn’t. I was so trapped and I got breast cancer. And who do you think called me more than anyone? My brother. So don’t alienate that sibling that’s not able or willing to help with your parents. That’s your family. And you never know. You may need that relationship later. My brother and I have a wonderful relationship now.

MB: Do you think possibly the stress of all the family issues and the job changes and everything contributed to getting breast cancer?

JM: Yes. I think that we are hit with carcinogens all the time, in our air, in our water, in our food. And then you either have an immune system that fights it off or you don’t. And I was under the most incredible stress of my life. And you know, I’ve run some companies so I’ve been under some stress, but this was a stress that was like no other - I cried every day for a year. It was so intense that I was catching every cold, every - you know, I was just - my immune system just went. And that’s when, I believe, the cancer was able to start.

MB: And you’re in full remission and doing well?

JM: I’m in remission, yes. I get tested every three months and so far so good, knock on wood. But what I learned the hard way in both cases is the importance of putting ourselves first. People think it’s selfish or egotistical. But you know, you’re all you have. You know, this is - what you have is you. And in order to be effective and loving partner or for any of your friends or family, you want to put yourself first, because it’s too much for them to - having to try to take care of you also. Everybody’s got their own things, so if we all took better care of ourselves. You also use, you know, the positive imagery - I teach affirmations, I teach gratitude at my seminars, I teach the power of positive thinking and just humor, the power of humor. Boy, the first thing I did when I got diagnosed with breast cancer was I got Netflix and I rented every comedy that I had never seen or the ones that I wanted to see again, because I didn’t want horror movies or anything that would - you know, I wanted to flood my system with endorphins. I wanted to flood it with laughter. And I’ll tell you, they made no money on me - I watched three movies a day, sent them back, got three more. I had a lot of complications. I’ve had six surgeries, six months of chemo, six months of radiation, had a lot of complications - blood transfusion, the whole bit. And I’ll tell you. Positive thinking and keeping going - I didn’t miss one speaking engagement. It wasn’t heroic; it gave me a reason to get out of bed, and gave me something to look forward to, to go do, because I’m so passionate about my work. I couldn’t even imagine if I didn’t have my work to do while I’m going through all of that. But I incorporated a lot of humor into my life wherever I could. And then I made myself little flash cards, my gratitude list that I read over every day - I still read over every day - and just focusing my mind on anything positive and all the positives in my life. Because, you know, when you first start to make that list, you can’t think of one darned thing. And then you put down, “Okay, I’m still breathing. All right, let’s see, what else?” And then, you know, you start to think of more and more and more things, and then if you focus your mind on those, you can’t have a positive and a negative thought at the same time, so who doesn’t want to just have the positive? So I made some flash cards. I put little signs all over the place. I practiced my Stuart Smalley in the mirror - “You’re a wonderful person.” I wake up every morning and kiss my arm [kissing sounds] - “You’re still here, you’re fabulous.” And you know, it helps. It really helps.

MB: One of the things that I really admired in the book was the way that, when things went wrong, you really went in very assertively and got people to make them right. For example, the toilet story in the nursing home.

JM: Oh my gosh, yes. Well, you know, as we know, I take after my father. I told amazing Arianna, “When I get to that age, if I’m like my father, please throw my book at me!” Because, see, by then, we’ll know. We’ll have this wired, so I’m not worried. But the good news is I’m very strong. And when I see an injustice, I’m going to make it right. You know, Mom was in a room when she came out of the hospital - this was my first - you know, after the three months of nursing her back to health and she gets transferred across the street to the sub-acute unit of a nursing home. You know, and every day - Dad’s there during the day, I come late afternoon, I’m there until late at night. And we’re both feeding her every bite. And there’s this lady in the room - they put a lady in the same room with her, you know, with the curtain and the whole thing, and she had this terrible skin condition - I mean, just terrible, all over her body, and she was a very large woman. And nobody ever came to visit her. My Dad said nobody was there all day, and then nobody would be there all night. So I felt bad for her so I was always trying to help her. And you know, I had got a TV for Mom’s room so I made sure that this lady could see it too and every, and I was trying to chat with her a little bit. And then I noticed a little tiny sign outside of our room that said, “Contagious.”

MB: Uh-oh.

JM: And I said, “What!?” And so I pressed the night nurse, when I was there, and I said, “What are - Mom’s not contagious. This person is contagious?” “Yes, she is.” I said, “Well, what the __ is she doing next to my mother? And I have been helping her and nobody told me she was contagious.” So I raised holy heck, as you can imagine. I got in there the next morning. I said, “You’d better tell they’d better have a - I’ll be here the first thing in the morning to meet with the administrators.” And oh, my gosh! You know, “Well, you know.” And I said, “Wait a minute. She’s using the same toilet that my mother’s using. I don’t see it scoured with Clorox every time.” “Well, well, you know, her skin disease is just on her back.” I said, “My mother sits there and leans back all the time with her gown open. What are you telling me?” “Oh, blah-blah-blah.” By the time I got back, the lady had been moved to a private room. We kept a private room. A sign was outside ours that said “Private.” You know, I was like, well, what happens to people that don’t have an assertive daughter like me? What would’ve happened to Mom? Dad couldn’t read that sign with his eyes - he wouldn’t have seen that, he wouldn’t have known what to do. So just think of the horrors that must happen where I raised holy heck about it. What you do in that case is you call the area agency on aging and you talk to the ombudsman. And that’s the person who’s your advocate as a family to tell you what’s going on with nursing homes - how many liens, how complaints, have they had any lawsuits, have they had anybody die suspiciously, what’s the statistics about that place that your loved one’s been put in? You know, she was just transferred there across the street. I had no say of where she was going. It was, “Well, she’s going across the street.” I’m like, you know, I didn’t even know I had an opinion on these things. But now, I’d make sure that that place was fined and cited and everything else. What you don’t know can cost you a lot.

MB: The moral is that even when you have professionals taking care of a parent, you still have to inspect what they’re doing and there often are problems, and when there are-

JM: Yeah, and we only hear about the bad nursing homes. You know, there’s a lot of - God bless anybody that does that work. You know, it has got to be very, very difficult to work in a nursing home. I give - anybody that does, my hat is off to them. And we have so few people going into nursing. We have such a shortage of nurses, you know, all the way around, let alone nurses that want to work in that environment. So, you know, you’ve got to be proactive. And you know, I dropped in at 3:00 in the morning one night. I just had a - I don’t know, I didn’t feel right, and I just got up and got dressed and drove there at 3:00 in the morning. And you know, the guy sitting there was asleep and the buzzers were going off and people were calling for help, and there’s nothing worse than hearing elderly people calling for help and nobody going. Oh! It just makes me cry right now thinking about it. And nobody going to see if they’re okay. And I raised you know what. I got in there, and thank goodness my asleep because if she had been awake and begging for help or had fallen or something, I can’t even imagine what I would’ve done. So - oh, you got me choked up here! They’re overworked, they don’t have enough workers, there’s too many patients. You see, my whole bottom line point of what I said earlier, if everybody knew those ten warning signs, if they woke up early, if the professionals were attuned and the families questioned it, they got the right diagnosis early enough, we delay the disease, people wouldn’t be having to go into nursing homes as much, and a lot of these horrors would be eliminated. I was just shocked a couple of years ago, AARP had an article out about nursing homes - they said that 90% are understaffed. Well, that’s heartbreaking. So you’ve got to be an advocate for your loved one if they’re in a nursing home - or anywhere, you know. Adult daycare - you have to be following up on what’s happening there. If they’re in assisted living, making sure that the activities that you were sold on that were going to be done are happening. You know, what are the meals like? You’ve got to make sure you have a meal yourself at these places. And try a place out first. You know, put your loved one there for rested, you know, instead of signing that they’re going to live there.

MB: Oh, that’s a good strategy.

JM: You know, find out a place that - “We’d just like to try it for the weekend while my husband and I go out of town. We’d just like to have Mom be taken care of for the weekend.” And see how it goes before you commit. That’s a very good thing to always do.

MB: And if something goes wrong, then you said the ombudsman, of course the administrator, and the state licensing agency.

JM: Yeah.

MB: And there’s always wonderful data at Medicare.gov.

JM: Yes.

MB: You can go right in and specify a mile radius around where you want, and incredible detail about the nursing homes in the area.

JM: Yes! You know, I have all these links on my website at ElderRage.com. Just scroll down on the left side at the bottom; it’ll say “Eldercare links.” And I have gathered every valuable link that I can find. And you’re just going to find tons and tons of how to find nursing home reports, how to evaluate, how to find - just everything related to eldercare I’ve put on my website. And it’s all free. Just trying to spread good information to people.

MB: Well, I want to be sure to get one more tip from you. How did you handle taking away the driving license?

JM: Oh, my gosh! You got about an hour? Dad was horrible. We couldn’t find the car keys and he had taped them to his leg.

MB: Oh, my goodness.

JM: You know, we’re patting him down, we can’t find the car keys. He had taped them to…! I’m here to tell you, dementia doesn’t mean stupid. Oh! Now, see, with the knowledge I have now, what I would do if I knew that he should not be driving - I mean, Dad, you know, he couldn’t see the big E, number one. His sense of direction, his reflexes were bad, his hearing was bad, he couldn’t wear his - he wouldn’t wear his hearing aid. Just, you know, and the beginning of the dementia had started, which I did not - but he just should not - I knew somebody was going to die if I didn’t take the car away. So he hated me, just hated me - horrible! Well, now, see, what I would do is I would call the Department of Motor Vehicles and I’d ask for the supervisor, I’d make friends with that person, and I’d say, “Somebody’s going to die unless you help me. So what I need you to do is be the bad guy so I don’t have to take the brunt of it. I can just be the good daughter.” And then I would tell Dad, “Oh, the Department of Motor Vehicles called today while you were at daycare or while you were in the shower or wherever, and I’ve got to take you down there tomorrow or this afternoon or whatever,” and he would scream and - I can just hear the swear words, like a sailor, it would be like a blue streak, but it would be at them, not at me. And then I’d have the appointment all set up, I’d take him down there, and they’d do the eye test and they’d do - you know, if he somehow passed that, then they’d give him the written exam, and somehow passed that and cleared the parking lot for a driving test - it wouldn’t even take more than the big E that he couldn’t see - but you know, then THEY would take the license away, and then I could be the devoted daughter that says, “Oh, shoot, I’m so sorry this has happened. You know I don’t want you to feel trapped at home. I want to sign you up for…” - in most areas they have transportation for seniors, you know, shuttles that’ll take people for a very - free if you’re a certain age or a very nominal fee. And I would get one of those big button phones, you know, and I would preprogram it so - maybe even a picture phone, so it would have a picture of a taxi or a picture of the shuttle or the neighbor, a picture of the neighbor, and I’d have it one-touch dialing so that he could always reach somebody if he needed to go somewhere. Now this was of course before we got into where he needed 24/7 care. This was early on when I was there. That’s what I would do now. And get the club and put it on the steering wheel, because I don’t care how many times you tell somebody that they shouldn’t drive. He would agree - the doctors would tell him, and he’d say, “Okay, I won’t drive.” And then he’d forget and he’d think he was just fine, and then he’d go out there and start the car, and boy! So at least get the club on the steering wheel or, you know, I don’t know, you’ve got a kill switch in a locked glove compartment. And “I don’t know. The car won’t start. I guess we’ll have to have it towed.” So you might have it towed somewhere, out of site, out of mind. And, “Oh, they just can’t find that part from Japan.” Do whatever. Put a notch in their keys so the keys don’t work. If you’ve got an older car with a distribution cap, take the distribution cap - you know, there’s a million things you can do. But just make sure they do not drive. And most people don’t, because they don’t want to be the chauffeur, they don’t want to be trapped having to go get every little thing that the person needs. But I can’t tell you the lawsuits that people get themselves into when they don’t take those car keys away soon enough. They wait until there’s a crisis, and the crisis is often somebody getting killed.

MB: Jacqueline, thank you so much for sharing. I simply love your book.

JM: Thank you.

MB: Your website, ElderRage.com, has just fabulous information on it. And I’m so happy that you’re doing the advocacy and the reform work that you’re doing. It’s a real blessing for all of us.

JM: I’m doing my darnedest. And I’m still so passionate about it! You know, I said, isn’t it funny how sometimes when life takes you to your knees, it may be the same experiences that take you to your highest purpose, your highest passion, and your highest work.

MB: Well said.

MB: Each show I like to share a baby step to help people live longer, healthier, and happier. When my son was about ten years old, he became very ill. He became so weak he could barely talk, he could barely stand up, and we took him to Children’s Hospital. They poked and probed for about an hour and a half and shrugged their shoulders and say, “We don’t know what’s wrong,” and sent him home. My wife called her mother, who had been an art history major, and described the problem, and she said, “You know, David visited me in Philadelphia about a month ago, and there’s a lot of Lyme Disease in our area. Sounds a lot like Lyme Disease.” So we got on the internet, checked the symptoms - they matched very well. Took him back to Children’s Hospital. We told the doctors, “David has Lyme Disease. Please start the treatment right away.” They did and it cleared up within about 24 hours. Without that persistence, without getting the information, David would probably have very serious disabilities today and for the rest of his life. The baby step is that the information for just about anything that we need or the answer for about anything that we need is out there, if we keep looking, if we’re persistent, if we’re determined to find it. And this fits very well with what Jacqueline described, of how, when things don’t make sense in taking care of parents or any area of life, we need to keep asking, to keep probing, to keep being persistent until we get the information we need, the answers we need.

This is Dr. Michael Brickey with Ageless Lifestyles Radio on http://www.webtalkradio.net/.  I’d love to get your feedback and comments. Just sent them to radio@drbrickey.com. Information on anti-aging psychology and the Defy Aging Newsletter, which is free, is at DrBrickey.com. Thank you for listening on our quest to live longer, healthier, happier lives.

 

  

  

  

  

  

  

  

Host: Anti-Aging Psychologist Dr. Michael Brickey

Expert Guest:  Sharon Cutler

Broadcast: 3-17-08 on webtalkradio.net where the latest shows are broadcast and posted as podcasts

There is no shortage of information for Boomers and seniors. The problem is wading through the sea of information to find answers and solutions. Often the starting point is figuring out what questions to ask or how to get a good assessment of problems and needs. Wouldn’t it be wonderful to have a go to person? My go to person is Sharon Cutler, who is Editor of MatureResources.com and Founder of The Positive Aging Network. On today’s show Sharon shares how she goes about finding information.Her website is http://www.matureresources.com/  

TRANSCRIPT ©Michael Brickey–excerpts permitted with attribution MB: This is Dr. Michael Brickey with Ageless Lifestyles Radio, cutting-edge thinking for being youthful at every age. On each show I interview experts on what it takes to live longer, healthier, and happier. Our program takes a holistic approach in addressing anti-aging psychology, medicine, alternative medicine, fitness, nutrition, and wellness. Our emphasis is on innovative thinking and practices that have solid data and results.

Well, there’s no shortage of information; the problem is wading through all the information to find the answers and the solutions. Sometimes the internet can give us information in seconds while we’re still in our pajamas, and sometimes it offers us nothing but ads. It often gives us lists and credentials, but little feel for what the services are really like. For example, if you’re trying to find a new family doctor with Marcus Welby qualities, it’s a daunting task. And we know what a family doctor is and we know what we want in a family doctor. When it comes to services for seniors, the tasks is often more daunting. The starting point is often finding out what questions to ask and how to get a good assessment. And it’s even more daunting when the senior is in another city.

Wouldn’t it be wonderful if you had a go-to person? I do. My go-to person is Sharon Cutler. She’s a long-time advocate for Boomers and seniors and she’s editor of MatureResources.org, a cornucopia of information on seniors and on Boomers. She’s also founder of The Positive Aging Network, and I have the pleasure of being a columnist for MatureResources.org. Sharon, I know you’ve been advocating for seniors and Boomers for many years. What inspired you to start MatureResources.org?

MB: Well, you are!

SC: Yes. But I too have to look for resources. Anyway, when I started my career, it was in childcare, and people would need help, and so I started an agency myself. And in addition to needing like housekeepers and companions for the elderly and things like that, inevitably the family member would say, “I would like to find a good lawyer or a good doctor,” and it set my mind to think that people had difficulty accessing the right resources, and even know the starting point. So I decided to make Mature Resources, which is almost a brand now - we’ve had the name Mature Resources now since about 1987, 1988.

MB: Wow.

SC: Mature Resources really means that anyone over 40 or 50, hopefully through one of the venues that we’ve had - now it’s a website - hopefully we will provide many of the answers, or at least a starting point.

MB: I’m going to really put you to the task. Let’s imagine that - well, first of all, I know you recently moved from Florida to Chicago. Let’s imagine that your parents were in California and you were just starting to get hints that they were having health problems and maybe even some senility. And let’s say that you couldn’t leave home to go to California. How would you go about assessing the problem and getting services for them?

SC: That’s a very good question because many millions of people - I think between seven and ten million estimated people - are children of people who need help, that they need any level of care or they need to have options. So if I was going to have a parent in California, one of the first things would be to use the internet - I certainly encourage people to use the internet - and I would go to the California state government and then the local agencies on aging. You can find them just by putting in “aging agencies” or “senior organizations,” and then picking and choosing the appropriate departments, agencies, community services, and start to make a list and pick what you feel is appropriate to go to the next step, which is finding out what they can do to help you.

MB: Once you have your list of agencies, then what? How do you assess what’s really going on with Mom and Dad?

SC: Well, there’s various things. And I think the world of senior care is quite, quite confusing. Most of the - it truly is. Most of the occupational titles that narrows this did not exist 20-25 years ago, for even some people like senior move managers, daily money managers, who are helping this, but most people in fact have not heard of them. Well, there has to be a starting point. You need somebody there to assess the situation. One of the people that I might call is a community outreach for seniors. Sometimes they send somebody out. I’d see if that was available in that particular town or county. And then there’s also geriatric care managers who are fee for service professionals, usually social workers, who send out a nurse or a social worker. They do an assessment and they help you to determine how Mom or Dad is and what Mom or Dad needs in the future, and then they follow up for as long as your contract with them is.

MB: Before you retain these, what kind of questions would you ask to find out if they were the right people for the job?

SC: I would look up their information online, first of all. I would find out if they were licensed, what their backgrounds are, if they have insurance - you know, especially like a homecare agency, because you want to make sure that theirs is the proper licensure. I would ask them how many years in business. I would probably ask for a few references, and be careful when you call up that they’re not their best friend. Often I think longevity helps. And also if you could find somebody out there who perhaps knows an agency that has worked with them. Sometimes you can even call a library and you’ll find out - or call a doctor’s office. It’s often hit and miss. But when people come to me with a background of many, many years, actually meeting with different kinds of professionals and locating things for my own website and for my own - I just created the 50-Plus Expo in New York. I always wanted to bring people and products and services together. So it’s a - it’s not a treasure hunt, but it is a mission that you have to have tenacity, you have to have patience, and you have to be resilient and know that it’s going to take time.

MB: It sounds like Columbo to me. I picture him going into the library, “Excuse me, ma’am, I’ve got one more question to ask you.” Just nagging a lot of agencies and organizations until you get the answers you need.

SC: Right. You would be very, very lucky if, on the first shot, at the end of the first phone call, you got the answers. I was reading this article that was in Kiplinger’s and it told a story about a couple who wanted to have dream retirement, and they were very logical and knew that they had to both plan for themselves and plan for how long they’ve be caring for her mother. Anyway, when they finished writing their list, it had 4,000 items on it. So I couldn’t fathom what 4,000 things to do would be. A lot of those had to do with their financial situation, stocks and bonds and insurance and stuff, consolidating, picking where they would live and what they would do after retirement, which sometimes in retirement, it’s recreated and goes back to a different kind of career. But 4,000 items - think of that. When most of us, if we have a couple of things to do, it’s overwhelming.

MB: Well, you just knew that was probably 4,000 things right there.

SC: Right.

MB: So you get your care manager lined up - you pick somebody that you trust - and they say, “Well, we need to get some medical exams.” Do you just trust who they refer you to, or do you do more homework then?

SC: There’s always homework to be done, whoever you go to, whether it’s a geriatric care manager, whether you feel that a person needs homecare - whoever you call is going to tell you that “I’m the right solution.” You know, “My company is the right solution. We’ve been in business this long and…” But you might find that someone needs adult daycare, which is a relatively new whole category of care, where people go to a center for the day and they have all kinds of activities, and then they return in the evening, you know, by bus or car, and that might be a solution for someone who needs some care for the person in the daytime. So there’s all kinds of ways that you can approach it. One thing that I tell people is Rome didn’t happen in a day, and you really have to look at all the choices. And you probably still won’t know the choices, all the choices.

MB: Using adult daycare as an example, I’ve seen some that are just marvelous programs and very stimulating, and some that are just kind of adult babysitting. Long-distance, how would you tell the difference?

SC: Well, if you have telltale signs that something is amiss with your parents, I certainly would take a flight there and see. As a matter of fact, this often during the holidays that Mom or Dad says, you know, “Everything is okay, I’m terrific,” and you happen to go there for the holiday, you know, just check in and have some fun, and all of the sudden you realize that Mom has had the stove on all day and that she’s not remembering certain things, and you realize that things have changed and they’re not admitting to it because they’re scared, and that’s happened to many people that I know. So I think that seeing it directly and then, of course, if you’re in that community, it makes it that much easier to look things up. But you know, you can do it on the internet. I just think that you need some kind of personal intervention.

MB: So let’s say you do go to their home. You’re Columbo, again, and you’re gathering this information. Are you writing it all down? And do you have some kind of checklist that you know what to look for?

SC: One of the processes that I have, we have a long checklist. I couldn’t find it for you now because I’ve moved and I everything in boxes right now. But yes, you should be taking notes about the person, about what’s going on mentally, what you see physically, what you get the feeling of emotionally - because many times older people get depressed - and write it down and go from there. And I think that being a questioner, being a sleuth, as you said, enables you to a position of power where you ask the questions, and if you don’t get the right answers from somebody who you think might be able to help, then you go to the next step. For instance, in Florida, there’s 211, which is a crisis and information and resource hotline. Here it’s 311 in Chicago. And 911 we know is for emergency and 411 is for information, so they all end in ones. You have to get to know what’s available in that community. And oftentimes it means bringing Mom or Dad back closer to you at home - they’re at home or in a senior living environment.

MB: The checklist you use, is that something that’s proprietary or that other people might access? Or are there other good checklists?

SC: There are checklists all over. There are articles. If you look up “caregiving” on the internet or “caregivers,” I’m sure you’ll get over a million - as a matter of fact, I’m sitting here and I’m going to look it up right while we speak, because I just saw 16,600,000 Google entries for research and information, how to find research and information, just basically. And then I did it for “elder care” and I got over a million entries. It’s a process. And unfortunately, as we get older, most of us haven’t planned for it and sometimes it’s an emergency, and decisions have to be made very, very quickly - all of the sudden Mom or Dad needs hospitalization or needs some kind of care. So either you have to go out there and start doing the investigating, or you hire someone - and it should be a social worker, geriatric care manager, or call the local government agencies and find out who they would recommend. So when it’s immediate, that’s when it’s the worst.

MB: So let’s say Mom has to go to the hospital. Do you just, again, go with what the doctor recommends, or do you research the hospital?

SC: I don’t know how extreme you can get. If Mom or Dad has to go to the hospital, it’s probably pretty serious. It’s enough to keep them under observation and testing and things like that. And then, of course, with the new rules on Medicaid and Medicare and the insurance issues, Mom or Dad can be in the hospital for one day and their insurance only pays for that one day, and they really need to be there and under supervision for several days. So it’s a tough. I had a situation a couple of years ago. I never thought I would be a caregiver, and my husband was checked for something during an ordinary examination and it was only through a very astute urologist that took a CAT scan of him. He didn’t seem to have any problems that were detectable, but the doctor was more cautious, and he found out that my husband had non-Hodgkin’s Lymphoma. Oh, actually he didn’t, and even the surgeon who took out the tumor didn’t know. He said, “You have some kind of lymphoma and I don’t know the first thing about it.” So the surgeon sent us no place. I mean, he just like stopped dead in his tracks. And if we didn’t have a local organization - in Florida, at the time - that worked with the Sylvester Cancer Center, and they do a lot of clinical trials. My husband probably would’ve been one of those people who all the sudden you hear, you know, “My husband has terminal cancer,” and they just detect it at the end. So I think half of it is luck. But I believe in planning ahead if you can.

MB: Plan your luck.

SC: I believe in putting your ducks in order. And in answer to the question about checklists, we have different forms and different adder-on questions, depending on - we give a free consultation through the Positive Aging Network. We give a ten-minute free conversation so you feel comfortable with us. And then if we want to proceed, we tell you how we work. And then what’s different about what we do is that we will research and we just won’t say, you know, “You need a homecare agency” or “You need assisted living.” We’ll do different options based on what you say or if you send us doctor’s notes and stuff, and we’ll give several choices based on not having relationships with those people, but on research that we do, checking up people through the government, the licensing departments, different ways.

MB: So a number of organizations have favorite providers that maybe even get referral fees or something, and you’re very independent and research-oriented.

SC: Right, right. There are companies - and I’m trying to remember the name of the type of thing they are. Some of them are very, very good. They’re professionals who can get you or someone you love into the best assisted living facility, let’s say, or the best nursing home. And they work on contract with many, many, many of those facilities or types of communities. So while it’s free to you, which is great, they have a vested interested in a placement in one of their contractual places. That’s not to say that they don’t do a good job, because many of them are quite successful and have very good reputations. But they’re not neutral, they’re not unbiased. And the thing that I was always told, even when I had a homecare agency, is that the government always gives out three choices. Let’s say they work with homecare agencies, they have a list and they’ll give you three, perhaps based on - there’s a list, whatever. And that’s what we do. But I think we’re the first people to call ourselves senior information professionals, because we do research - and as a matter of fact, somebody wanted some information and - well, out of it was things that you wouldn’t even think about. This woman wanted to help her mother with things to do during the day, and she wanted to know how she could get to bridge and where were bridge lessons or sessions and stuff like that. So it can be anything from pleasure, you know, things that you want to do, and things that you need to do.

MB: Bridge lessons or a bridge group may sound like a minor thing, but to a senior who that’s the most exciting thing in their social life, that’s real important and can really keep somebody cognitively sharp.

SC: Right. Absolutely, absolutely. Because one of the one worse things to make someone depressed is aloneness, loneliness, and not having anyone to share thoughts with. I recently went to one of a chain of adult daycare centers and I was so impressed with it because they had more activities - it was like a country club. You know, sometimes when I go into an assisted living facility - and a lot of them are really gorgeous - I say, “Wouldn’t this be nice?” But I don’t want to be in it yet, but yet I see all the activity and I see they’re designing the menus and I see how they stimulate you mentally, and the swimming pool and this and that, and it gives you a nice feeling. But oftentimes the assisted living and continuing care communities are quite expensive monthly, so finances will always come into play, as well.

MB: Yeah, I recently had to find assisted living for my mother, and so my brother and sister and I visited quite a few facilities, and we wanted to taste the food - because I think that’s one of the most important things, since it’s the highlight of the day three times a day - and really get a feel for the atmosphere there and how friendly the staff were. And there’s no substitute for actually going there and experiencing it.

SC: Absolutely. And looking over things very, very carefully. I saw the same thing - well, rehabilitation centers are quite different because they’re shorter term and, you know, you’re there to get well. And the whole atmosphere and everything about it - it’s amazing, people don’t have a clue. When I first started in 1985 with my companion and nanny service, they were building the first assisted living facility on Long Island. And we all looked around and we actually went to a meeting at this place - it was locally, one of my friends was admission. And I said, “I don’t know.” And the common thought among those of us who were seeing it as professionals, “I don’t know if these things are going to really work out, assisted living.” And it’s every place. It’s every place, you don’t really have a choice. And there’s all these guidebooks you have.

MB: What do you mean by guidebooks?

SC: For instance, I moved to Chicago so I picked up in one of the drugstore chains, a senior resource guide-

MB: Oh, okay.

SC: Yeah, they can be helpful and they can be very confusing, because there’s all these different areas. There’s help at home, health services, health and wellness, professional services, elder law, life insurance, moving consultants. So it’s a start. I think one of the best things is to have a team, like you did with you mom - to have several people in the family all involved, so that the stress level isn’t just on one person. A lot of people are living long, long lives. And I know you’re very aware of it. I think it’s about 78 years old or something that’s the average lifespan. And people 85 and up are the fastest-growing population. I just heard about someone who is 101 and is a painter, paints pictures and lives by themselves. How great that is.

MB: You’re listening to Ageless Lifestyles Radio on Webtalkradio.net, and we’re talking with the information concierge of aging, Sharon Cutler. She’s the editor of MatureResources.org - make sure you type “.org” - a site that’s full of columns and resources for Boomers and seniors. She’s also founder of the Positive Aging Network that she was talking about, a concierge-style services organization for just about everything legal related to seniors. Information on the Positive Aging Network is on the MatureResources.org website. Information on anti-aging psychology and my books Defy Aging and 52 Baby Steps to Grow Young, and my free Defy Aging Newsletters are at NotAging.com. Sharon, you’re gathering so much information, how do you keep it all organized?

SC: Well, they’re in boxes right now.

MB: How did you get them organized?

SC: Well, I have different topics, because I also write, I write what I preach. As a matter of fact, I’m a columnist also for another website called http://www.longisland.com/. Infuriates my better half, my husband, because I do have so many files on care giving, on healthcare, on recommended websites - it’s overwhelming the amount of information. And of course, I can just go - I’m pretty well aware of where to go on the internet when I need further information. But I have plenty of files, plenty of paper.

MB: I’m going to take you back to California-

SC: Okay.

MB: And you realize, oh my goodness, I don’t have any power of attorney or do not resuscitate, or any of these documents. Is that something you would do yourself, or would you get an attorney?

SC: I would use an attorney, call the local law association and get a list, or if the community has an elder law attorney association. And I’m just looking here in Chicago. A lot of things to do is the state planning, asset protection, wills and trust, power of attorney, guardianship issues - it goes on and on.

MB: How would a person do their homework before they go to the attorney so they know what to ask for?

SC: Basically, they have to start the research, or call someone like myself, or call a geriatric care manager - except that they would want to come in and see Mom or Dad - which is a great idea, because they can also tell you what is needed. If you know specifically that you need an advance directive or wills and trust, I would certainly care the local bar association, the elder care division, and then go on the individual websites that they will recommend. And I think that if they lost their license or something happened to them as a lawyer, they would be removed from that list.

MB: Say Mom had to go to the hospital. How you handle Medicare can make a big difference in how big the bill is. Any tips on how to make sure that you’re handling Medicare right?

SC: Well, a lot of times there are social workers in the hospital who actually work with the patients and the family. My husband’s going through that now with Medicare - just turned 65 - and he spent quite a few hours trying to figure out Medicare and Medicare supplements, who should I use, what’s missing, especially since he has a prior existing condition now. And you just hope after all your investigations that you did the right thing, but I certainly would go on to Medicare.gov or SocialSecurity.gov, or just type “Medicare,” type in on your computer “Social Security.” I’m doing the same thing with everything now - you know, it’s not elder care related, but it’s living related - to find out about how I get a new license plate. Everything has to be done. And it’s not easy. I have a lot of books on simplifying your life. And I have to read them, of course. It would be sweet if everything was perfect. I love people when you say, “How are you?” and they say, “Oh, I’m terrific!” And no one knows what really exists. And we all have our good times and we have our times when we need assistance. You know, help is just a phone call, or many phone calls. It’s getting on to the Yellow Pages. It’s calling up professional associations. It really requires a lot of time.

MB: With things like Medicare, there are rules, for example, that if you’re there, I think it’s four days or longer, and you step down to a nursing home, then Medicare covers the nursing home for, I think, 100 days. But if you’re there for three days, too bad - you would have to pay for nursing home completely out of pocket. And if you disagree with the decision the hospital has made, you can appeal it, and that often results in you staying there long enough to qualify for the nursing home step-down.

SC: Right, right. But most people don’t know, you know, initially, especially when you go into the hospital and it’s not planned for. You know a lot - I mean, you’re an expert in this field also and I’m sure you help a lot of people.

MB: Yeah. So let’s say that your mother or your husband was in the hospital and it was one of those situations where the staff just wasn’t doing its job and talking to them didn’t seem to work. How would you go about advocating to get it done right?

SC: I would probably call up the local age *26:29. Yeah, they have *26:32 to check on different places. And if they’re doing the proper thing, then they’re going to want to release them anyway. Yeah, it’s a very sticky situation. I think you have to find professional help or speak to a social worker there, who’s supposed to be nonbiased, and just explain the situation and see what they would suggest. It is a real concern. But hopefully a lot of the people just need minor tune-ups in terms of getting their financial planning done, getting their retirement or their money issues, insurance. I have friends who are consumed with their parents, both on a local and a long-distance basis.

MB: Oh, yes.

SC: One of my best friends, her mother just demands that she come over at least once a week and she writes the - checks her checkbooks and the checks and balances and pays her bills and takes her to the doctor. And fortunately, she has a good employer - that’s not always the case - and she makes up her hours, but certainly she’s away from her office a lot of the time.

MB: Yeah, it can be a difficult balance. For people who need them, there are support groups that can do a lot of good.

SC: Right.

MB: Back in the hospital and nursing home visits, I’m a big believer that you not only want to go there to visit and to hopefully cheer the person up and see what they need, and often since the food is so atrocious, bring them some fresh food-

SC: Back to food.

MB: Some palatable food. But it’s a good time to check everything to check and see if they’re getting the right medications and they’re developing bedsores or pressure points and things like that, because most of the nurses and staff are overworked and often things get by.

SC: Right. And those are the things that you eventually read in the newspaper. I don’t know how you would check for certain things, you know, if the doctor - because there are usually on-call doctors associated with the nursing home. I guess you could call in your own physician to do a second opinion and to just check. But basically, it’s whoever they provide.

MB: Well, a lot of times you have to do that through the nurses, get permission from your parent or whoever it is to ask for a copy of the medication list, and then make sure that you know what each medication is supposed to do and whether it makes to you.

SC: That’s right, because different medications - and even food - you shouldn’t eat certain foods with certain medications and-

MB: Oh, it’s absolutely amazing. I see people in nursing homes who have severe diabetes and I see things on their tray that are just horrible for diabetes. And I ask, “Well, aren’t you on a diabetic diet?” And they say, “Well, I don’t know.” So I ask the nutrition staff and they say, “Our instructions our just to give them smaller portions. We don’t do special diabetic diets anymore.” And then they cited HIPAA privacy regulations, that other patients would know that somebody was diabetic.

SC: Right.

MB: I mean, it’s far more important that people get the right food than whether their roommate figures out they have diabetes, you know?

SC: Oh, gosh. Yeah, again, with your professional expertise, you really see it firsthand all the time. I, on the other hand, have knowledge and resource and research. I try to find out as much information, but that’s when experts like yourself are called in.

MB: The network that you’re developing and I love your website. What other things do you think are going to be happening for services for Boomers and seniors?

SC: I kind of like products that isn’t the ordinary products, and I think that’s where we’re going to go. For instance, on your phone, let’s say you have a cell phone. I couldn’t read one of the phone numbers just now and it really got me frustrated because the numbers are so small. There are phones that have larger numbers. There are doorknobs and stuff that are easier to use. I believe that the wave of the future is going to be making things easier from young to old. Of course, in young children, you have to lock things up. But as we grow, as we age, different things happen at different times. You know, at 40, your eyes suddenly seem to be changing. It happened on my birthday. So I believe in getting as much as *30:54 and making things as simple as possible. And probably a lot of things haven’t been invented yet, and emergency systems that you can have in your home or in the assisted living, you know, which gives you some peace of mind. But again, those are choices. And any age can use it, and I just think that we’re coming up with more and more services that people should be aware of. I just used - when we moved, I must’ve been in la-la land because I thought we were all packed up, and I had someone from - my friend at the senior move management company come over. And she said, “You have about three days’ worth of work, with anywhere from three to five packers, and you’re leaving in four days.” I said, “What?” I had no conception. Your mind is dealing with a lot of different issues, and moving, of course, is extremely stressful, right up there with death, divorce, taxes, those things. But a few years ago, Senior Move Managers, people use their movers. I had things double and triple-wrapped. It’s amazing, the slightest thing had tissue paper and duct tape around it, and it could turn out to be a button. That was a little extreme at times, but nothing was broken. And I couldn’t have done it myself.

MB: It’s kind of analogous to what you do for seniors. It’s a very stressful time in people’s lives. The amount of things to do and information to learn is overwhelming. People can do it themselves, but if they can afford it or if they don’t have the time to learn it all themselves, hiring a professional just makes it so much easier.

SC: Exactly, exactly. You can’t do it all and you don’t now how to do it all. And there are so many choices, and hopefully if one choice doesn’t work out, another one will. But with people who have expertise or good research or value referrals that they have based on working with companies previously - you know, there is a lot of competition in every industry. There’s a lot of homecare agencies to choose from. As a matter of fact, I was speaking a homecare agency owner here in Chicago and found out that they can do things differently than ours did in Florida. In Florida, companion service or a nurse’s registry, they don’t do hands-on care. They’re not allowed to, you know, give you the medication or help you into the bathtub and outside of the bathtub - they’re not supposed to. Here, it’s hands-on. But here, the prices were almost double. I was astounded at some of the prices, but they’re used to it here, I guess. So I think planning, you know, like long-term care and so forth, but I think we have to be responsible for ourselves and then try to avoid having to either have your own issues, something that pops up that just changes your life or changes the lives of those you love. So like the Girl Scouts say, be prepared. I still remember that and that was a long time ago.

MB: That got burned in, along with the cookies, huh?

SC: Right.

MB: Sharon, I want to thank you for sharing your expertise with us. I think in your previous life you were probably a matchmaker and now you’re doing of the seniors and Boomers and the services that they need, and I think you’re just a delight.

SC: Oh, I appreciate that compliment. I will save it.

MB: Okay.

SC: And also, if anyone wants to write to me and to get free tips on caregiving, they can write to SharonCutler@gmail.com and request the free tips on caregiving. And you can write to my email if you have any special issues.

MB: Okay. And the website, again, is MatureResources.org. And information on anti-aging psychology is at NotAging.com. I’d like to share a baby step to help people live longer, healthier, and happier. I adopted a catch phrase a long time ago that you get what you expect and inspect. When it comes to little things like if somebody shortchanged you a dollar or you didn’t get that $5 rebate, it’s not worth my time. But when it comes to healthcare issues, when it comes to safety issues, you do have to not only have expectations of getting good quality services and getting what you need, but you do have to inspect it, because the mistakes are just too costly. And as I was talking about with Sharon, in a nursing home, you need to check the medications and make sure they’re right. You need to check the food and see whether it makes sense. You need to check and see whether Mom is getting turned often enough to prevent bed sores. So if you don’t already have the maxim, recommend adopting the maxim that when it comes to things that are important in life, expect and inspect. And if you’re not feeling well enough to do the inspecting yourself, then you need to find someone to do it for you. That’s what friends are for. And I’d love to get your feedback and comments. Just sent them to radio@drbrickey.com. Information on anti-aging psychology and the Defy Aging Newsletter, which is free, is at DrBrickey.com. This is Dr. Michael Brickey with

Ageless Lifestyles Radio on Webtalkradio.net. We’re talking with Sharon Cutler Editor of MatureResources.org. Information on anti-aging psychology is at DrBrickey.com. This is Dr. Michael Brickey with Ageless Lifestyles Radio on Webtalkradio.net. Thank you for listening on our quest to live longer, healthier, happier lives.

 

  

  

  

  

  

  

  

Host: Anti-Aging Psychologist Dr. Michael Brickey

Expert Guest: Dr. Christiane Northrup

Broadcast: 3-1-08 on webtalkradio.net where the latest shows are broadcast and posted as podcasts

Dr. Christiane Northrup is one of America’s most trusted medical advisors. She sees menopause as a life affirming –if a woman listens to her body and the wisdom it offers. She is an OBGYN physician who takes a holistic, mind-body-spirit approach to menopause, PMS, and women’s health. Dr. Northrup founded the trailblazing Women to Women health care center. She is author of The Wisdom of Menopause and Women’s Bodies, Women’s Wisdom. She has appeared on Oprah, The View, Good Morning America, Rachel Ray, and hosted six PBS specials. Her website is http://www.drnorthrup.com/

TRANSCRIPT ©Michael Brickey–excerpts permitted with attribution

First a caveat: Men, if you think today’s show is only for women, think again. The more you understand about menopause and women’s health, the better your relationships will be with the women in your life. And women, you might want to encourage your husbands or boyfriends to listen to the program, as well, because our guest today, Dr. Christiane Northrup, is one of America’s most trusted medical advisors. She has a very unique take on menopause as life-affirming, that is, if a woman listens to her body and the wisdom it offers. She is an OB/GYN physician who takes a holistic, mind-body-spirit approach to menopause, PMS, and women’s health.

Dr. Northrup founded the trailblazing Women to Women Health Care Center. She is the author of two books, The Wisdom of Menopause and Women’s Bodies, Women’s Wisdom. She’s appeared on Oprah, The View, Good Morning America, Rachael Ray, and hosted six PBS specials. In the first part of the program I want to emphasize Dr. Northrup’s unique holistic approach to menopause, and then in the second we’ll look at more specific things about problems such as PMS symptoms and health problems. Dr. Northrup, when I started reading your book, The Wisdom of Menopause, I was expecting a rather dry tome or manual, and I was delighted and just got sucked into the gripping drama of “What happens to her next?” and “What happens to this patient?” Have you always been so tuned in to listening to your body and intuition, or was this a revelation in your life?

CN: No, I started out that way. My Dad was what we would call today a holistic dentist, and he used to say that the mouth was the center of the personality, and that’s why people didn’t want you messing around in there, and also why dentists had the second highest suicide rate, second to psychiatrists.

MB: Oh my goodness.

CN: So there was a bit of mind-body integration going on in my childhood. And then when I got to medical school, I was completely enthralled with everything that modern medicine could do. And it wasn’t really until I got finished with my residency and met my cousin at a macrobiotic restaurant and she told me she was healing her fibroid tumors with a macrobiotic diet. Now, I had just finished a four-year surgical residency and my approach was surgery, so-

MB: Two different worlds.

CN: I began to meet with Michio Kushi of the macrobiotic community - he brought that to the United States back in the ‘50s - and I sat with him as he went over the diet and also the lifestyle of patients who had been given up on by standard medicine. And sitting there for months, looking at the medical records of people and seeing that they’d already been through everything I was trained to offer was a revelation, as I found many of them get better. And after that, I realized there was also a limitation to diet. And ultimately, when people understood the unity of their mind, their body, their emotions, particularly the influence of the subconscious, what they don’t know that they know, then you’ve got the keys to the ignition, your own ignition, and you can get somewhere. Otherwise, you’re at the whim of the culture which really believes that people are meant to disintegrate at the age of 50, that it’s all downhill from there, that your sex life goes away - all kinds of things that are simply beliefs and not grounded in fact or science at all.

MB: So you see menopause as a wake-up call. Can you tell us what you mean by that?

CN: Yes. It’s as though everything in your life converges to get your attention so that you will do what it takes to get healthy in the second half of your life, or you know, maybe - a friend of mine the other day, Gay Hendricks, said, “Why don’t we call it the second third of your life? Because maybe we can live to 150.” But what happens in a woman’s brain - and I know that this is happening in a man’s brain, as well, to some extent, is that as your ovaries are changing and not producing an egg every single month, you actually get an excess of estrogen relative to progesterone. Now, progesterone is a very calming hormone. It also increases heat and it’s very high during pregnancy, so women feel, usually, very calm during their pregnancies and unflappable. But when you don’t have as much progesterone and you have estrogen, that begins to work on certain areas of your brain, the amygdala and the basal forebrain, which is where old memories from childhood and so on are stored, and unfinished business from the past comes up. It’s as though the hormonal change uncovers things that have always been there. So in my experience, women at perimenopause, which is a six to thirteen year process, remember - menopause just means the final menstrual period - so perimenopause is when all the drama and the action takes place. You haven’t actually stopped your periods; you’ve just started the brain and body changes. So during that time, a woman may remember childhood abuse. She may have no tolerance for the kind of injustice that she’s put up with at her job or perhaps in her family. It may be as simple as saying, “I’m sick of being the one who always starts dinner. I’m surrounded by a houseful of teenagers, all of whom can boil water. I’ve had it!” And what that is, is it’s labor pains of birthing your true self. And the thing that’s so wonderful about midlife is you’ve been out in the workforce usually, you know how to drive a car, you know how to run a bank account, you have enough ego strength, you have enough skills finally to have created a container where your true self can finally thrive. You’re not proving to the world that you can do it. It’s not like being in school - although many women go back to school at this time and enjoy it more than they ever did. So I call it break down to break through. There is no question that the incidence of chronic degenerative diseases increases in the second half of life. This is not inevitable. It has to do with lifestyle choices. And what I believe happens is that, at this turning point, the body will not let you get away with the stuff you’ve been doing for the past 50 years that wasn’t a good idea in the first place.

MB: Before we elaborate on that, it’s only in the last couple of years I’ve heard much about estrogen dominance. How did we end up with this impression that everything was just a lack of estrogen?

CN: No kidding! Yeah, how did we? Well, you know, we could do a brief romp through the history of Premarin. Premarin was the first oral estrogen that was available and made from the urine of pregnant horses, back in 1949, 1950. Before that, estrogen was available only as an injectible. Now, when you have your ovaries removed with a hysterectomy, then you have the rug pulled out from under you in terms of estrogen, progesterone, and testosterone. And so clearly, we have needed a supplement to replace a woman’s missing hormones. And so we thought of the menopause actually, culturally, as a deficiency disease, you see - doctors were thinking about it as you were lacking something. And the truth is that you’re not lacking anything when the body is healthy, when the adrenals are healthy and the ovaries are healthy. But remember, one in three women has a hysterectomy in this country, and so she’s changed the blood supply to her ovaries. And in those women, clearly estrogen, which is considered the most important hormone, but progesterone is left out in the cold and testosterone has gotten short shrift, as well. So it’s all such an interesting thing because science takes place within the context of a culture, and so we look for what we expect to find. If we’re looking at menopause as a deficiency disease and if we have managed to create a pill from the urine of pregnant horses, then if the only tool you have is a hammer, everything looks like a nail.

MB: And we got to pregnant horses so that we could have a patentable medicine that would profitable, as opposed to a generic that wouldn’t earn much money.

CN: Exactly. That’s the whole thing about the term “bioidentical” hormones. Bioidentical simply means hormones that match exactly what your body produces, and those can be made from wild Mexican yams or soybeans, and that gives you the basic hormonal moiety, and then you make changes in the lab, but you end up with a hormone that matches the molecular structure of your own hormones. And if you know the way hormones work in the body, it’s a lock and key, but it’s more than that, because the charges around the molecule of a hormone, the positive and negative charges, cause it to fold in a unique three-dimensional structure that your body recognizes because it has evolved over millions of years to recognize, for instance, 17-beta estradiol. It hasn’t evolved over millions of years to recognize the urine of a pregnant horse. But as you say-

MB: See, as you said, our bodies are smart.

CN: Yeah, and those things are not patentable. The delivery system, however, can be patentable, and that’s why we have some very good choices with the patches, the transdermal patches, Climara, Estraderm. Those are bioidentical hormones that match what is in your body. But it is the delivery system that the pharmaceutical company was able to patent, and therefore they can make money on them.

MB: You see menopause as a gift and a metaphor. What do you mean by that?

CN: The gift of menopause is that you are now your own person and you must source your life from your own spirit, your own higher power, who you really are uniquely. So I often say to women, “Remember what you liked at 11, when you were 11, before your hormones started in.” And the gift is you live from the inside out, instead of the outside in. What happens is women then, because they are operating from who they really are, not from who the world expects them to be, they often find themselves doing the best art they’ve ever done, having the best sex of their lives, being healthier than they’ve ever been, being happier than they’ve ever been. This is the big secret, that life gets better in your 50s and 60s. And this is a secret because our culture believes just the opposite. We are such a youth-focused culture that people who hit 30 suddenly begin to think something is wrong. Can you imagine anything that’s more death-affirming than that, that at 30 it’s all over? This is simply insane. And it creates a great deal of pain and suffering that is needless, because the truth is you’re really at your best starting at about 50. And I think that maybe 65 is when we hit our stride in a big way.

MB: And there’s wonderful research that shows as we get older, a higher and higher proportion of Americans say they’re very happy, and it goes from 28% in your 20s all the way up to 38% in your 70s.

CN: Isn’t that wonderful?

MB: You talk a lot about women being in a subservient role. Do you think there’s something about puberty that brings that on, at a hormonal level?

CN: I do. I absolutely do. I believe that what it is, is that females are the bodies in which new life is formed. And in order to nurture new life successfully, you need support. And therefore you will do whatever it takes to get that support. We are mammals, after all. And so I believe that the women’s movement had to happen, where women said, “Wait a minute. I’m not going to be subservient anymore. I can do this on my own.” So then what we’ve had, what the Baby Boomers have been the pioneers in, is women going out and having sperm donors, or just deciding to have a baby on their own. As you know, in the ‘50s, you would’ve been so ostracized. You couldn’t have done that and stayed healthy, given that we all need community and we need support and social support to stay healthy. So we’ve changed all the rules. The Baby Boom generation has changed all the rules. Now we’re at a point where we can have true partnerships with men, because when you understand your own strengths and you understand yourself as a woman, as the source of life itself, when you see how important that is to the planet and you begin to own your own gifts, you also understand - and this is really new information for me and my daughters in about the past three years, in a way that we live it - you understand that it is this life force that you know how to support, that you actually support men with. Men don’t do well without the support of either their inner feminine or a woman in their life. We know that from psychology studies. The men who are the happiest and healthiest are the ones who have women in their lives. And when you know this as a woman and you don’t see him as more than, you see yourself as equals, but you have specific gifts, and when you can uplift a man and reflect to him his heroic status, when it’s warranted, then you can improve all of life on earth. It has taken me so long to get it that men are much simpler than women. They don’t get complicated like women do. Haven’t you found this? I mean-

MB: Yes.

CN: Yeah.

MB: Very much so.

CN: You have no idea where women go in their minds. I mean, it is like some kind of a maze in there where we make things so complicated. We hold on to old baggage. A man will have forgotten that, whatever you’re bringing up - you know, the fact that he left you standing at the street corner and didn’t know you were going to be there. You’ll be hanging on to that ten years later and you’ll haul it out of your purse and land it on him when something like that happens again, and a guy is kind of defenseless because he doesn’t even remember. Men are in the moment, and when a woman understands that her mind is multi-modal and she can remember forward and backward in time, and she can remember the birthdays and the needs of her whole family, that’s a tremendous gift that we cannot expect men to share that gift with us. They have different gifts and talents. So the anger that comes up at midlife needs to be addressed, but then it needs to be released or you will have a very unhappy second half of your life if you continue with your anger at men in particular.

MB: As my wife says, “Well, it’s all connected!”

CN: Right. And you know, this is why, in medical school, on my boards and all the multiple choice tests, I could figure out a way in which every choice was correct at least once. That’s a woman’s brain. A guys says, “It’s obvious what the answer is.” To a woman, it is not obvious because it’s all connected.

MB: You describe women as wired for intuition. Are they more wired than men are?

CN: I believe that they are wired differently than men are. Men call it a hunch, and the way you see the intuition playing out in men - if I may be stereotypical - would be on the sports field, where they sort of intuitively know where the ball is going to be tossed. Or the great hockey player Wayne Gretzky was able to tell what someone was doing behind his back - and if that isn’t intuition, I don’t know what is, because the definition of intuition is knowing something with insufficient data. I believe that all of us are intuitive, but we are taught to shut that down as children. The energy medicine teacher, Donna Eden, points out that when you say to children - when you acknowledge an energy field around people and places and plants and so on and you acknowledge that it’s there, the child will not lose his or her ability to see energy around things. And in fact, she has many young people that she trained in Ashland, Oregon, who have always been able to see auras, for instance. And that’s part of intuition. Clearly when you walk into a room, your gut knows who’s safe and who isn’t, and we train that out of kids by saying things like, “Don’t talk to strangers.” That’s really a wrong thing to teach anybody, you know; “Just don’t talk to people who seem strange” would be better.

MB: You pointed out that women are more prone to depression until menopause, and then after menopause their rates of depression are equal to rates for men. Does menopause cause women to become more like men?

CN: You know, I think that it does, actually. There’s a role reversal that happens at midlife, sort of kicks in their vocational arousal, as it were. So they want to go out in the world and get it. Many want to start new businesses, and so on. And in fact, the inner part of the ovaries, the stroma, does get bigger, so many women produce more testosterone around the menopausal transition, physically. But metaphorically, there is this huge drive to go out and get something done. Many men have already been out there fighting in the workplace for years, and so many come to the home and want to get more into cooking or gardening. And what works beautifully in a relationship is when they can trade off a bit and start doing what the other has been doing. I believe that women develop their more masculine side and men develop their more feminine side. So for the first half of life, men lead with the low heart and women lead with the high heart - and the low heart, I mean the genitals and so on. But at midlife these things switch around because we really need to come to balance so that it isn’t one or the other. And depression is interesting because it’s often been called anger turned inward. And what happens with many midlife women - it certainly happened with me - is that the anger comes out and gets expressed and you find that it’s simply energy, it’s just jet fuel. Anger means that you have been shortchanged in some way or you feel that you have been, or things haven’t turned out the way you wanted them to. And so it’s your job to address how to change the circumstances of your life. And I’d much rather deal with a woman who is angry than a woman who is depressed, but there isn’t a question - the female brain is more prone to depression, and I think it’s related to the fact that we have the ability to remember every thing bad that ever happened to us.

MB: You talk a lot about accepting responsibility as opposed to being a victim. What do you mean by that?

CN: Yes, this is the most bracing message I have, and that is that you must be responsible for your life, which simply means the ability to respond. It doesn’t mean that you are to blame for what happened. It doesn’t mean that if you were raped as a child or beaten in a marriage or passed over in a job that that is right or just. It simply means you are responsible for your response. So I was recently at the Books For a Better Life Award, and a woman who wrote a book called The 51% Minority - she was a lawyer who was working in a law firm and had been there a long time, was a senior litigator, I believe. And she found that someone who was ten years her junior, who didn’t have half the workload, was earning more money than she was. So she took it to the authorities in the business, and I believe that her boss said, “I will match your salary with his, as long as you don’t tell anyone” - like, don’t let this get