Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Compass and Clock Spring/Summer 2019 Edition


Published on

Compass and Clock is a publication that helps folks 40 and older navigate today to remain independent tomorrow. We focus on Housing Choices, Healthcare, Financial Planning, Legal Guidance, Leisure Pursuits and Family Support. Our goal is to provide you with the tools, resources and knowledge for a better quality of life.

Published in: Lifestyle
  • Login to see the comments

  • Be the first to like this

Compass and Clock Spring/Summer 2019 Edition

  1. 1. 12 3 6 9 Navigating life today to remain independent tomorrow &C MPASS CL CK SPRING/SUMMER 2019 WESTSOUND, GIG HARBOR TO PORT ANGELES Health Care Housing Choices Financial Planning Legal Guidance Family Support Leisure Pursuits The Road AheadThe Road Ahead Age-Friendly Gardening Age-Friendly Gardening Disease to Wellness: Shifting the Focus of Healthcare Disease to Wellness: Shifting the Focus of Healthcare SPRING/SUMMER 2019 WESTSOUND, GIG HARBOR TO PORT ANGELES F REEPUBLICATIO N *FREE*PUBLIC ATION*FREE*P UBLICATION * TAKE ME I'M YOURS! 2626 5050 5656 Cover Story
  2. 2. Do what you want to do! It’s your thing!
  3. 3. • Elder Law • Estate Planning • Medicaid Planning • Wills & Probates • Powers of Attorney • Guardianships • Supplemental Needs Trust • IRA Trusts • ...and More What does the future hold for you? Let us help you plan for the future with practical tools and advice to guide you to a comprehensive Life Care Plan™ that addresses your future housing, healthcare, financial and legal needs. FREE Legal & Estate Life Care Planning Seminars 19717 Front Street NE Poulsbo, WA 98370 Richard C. Tizzano Elder Law & Estate Planning Attorney Text MYNEWSLETTER to 42828 to receive our FREE monthly E-newsletter. LEGAL PEACE OF MIND 360-779-5551 Wow, Richard’s book tells it all. Great guide for maneuvering through our later years in life. Totally recommend this. ORDER  A MUST READ! Tony Hinson Elder Law & Estate Planning Attorney
  4. 4. Mary Coupland Publisher/Editor-in-Chief Owner and Operator, Compass & Clock Past President, Board of Directors, Mavericks Bainbridge Director of Marketing, Homeport Photography Member of Kitsap Provider Group Member of Jefferson County Provider Group Member of Silverdale Chamber of Commerce Member of Aging Smart Gig Harbor Group 206-321-8016 WELCOME TO COMPASS AND CLOCK Richard C. Tizzano, JD Consultant/Advisor Elder Law Attorney and Principal of Sherrard McGonagle Tizzano & Lind PS. Specializes in Elder Law & Estate Planning, Personal Healthcare Crisis Management, Strategic Health Cost Risk Mitigation, Sustainability of Care, Guardianships, and Adoptions. Member of the Washington & California State Bar Assocation Member of the Kitsap County Bar Association / BV-Rated Lawyer by Martindale Hubbell Board Member, Puget Sound Youth For Christ Member of Poulsbo Rotary & Chamber Past President, Kitsap Community Foundation Community educational instructor/ speaker on estate planning & elder care issue Published Best Selling Author: Accidental Safari, a guide for navigating the challenges that come with aging. Available on www. By Carol Fisher for Compass & Clock Welcome to the Spring/Summer 2019 edition of Compass and Clock! This issue is very special to me as it marks the one-year anniversary of this guide to a wide-ranging group of professionals that continues to grow. Compass and Clock is, at the surface, a comprehensive guide to retirement planning. Inside you’ll find information to help you with: • Financial Planning • Legal Advice • Health Care • Housing Options • Family Support • Leisure Pursuits However, Compass and Clock is much more than a publication. It is an educational program designed to help you navigate retirement, aging in place, maintaining physical and financial health, and catastrophic illness. It is a labor of love conceived in tribute to my parents. My mother battled Alzheimer’s disease for a decade and we all suffered inadequate guidance during that long journey. My father wisely hired a consultant for advice on home healthcare, memory loss care, insurance, and legal questions. Yet, despite our effort to obtain information from a knowledgeable source in geriatric care, we were still drowning in ignorance. New problems arose as the Alzheimer’s progressed, and it was challenging to find solutions that fit my parents’ specific needs. In retrospect, the gaping deficit was the lack in coordination of the services the consultant recommended. This experience is the inspiration for Compass and Clock. This past year, the professionals you’ll find in these pages have filled my heart with pride as the truly service-minded community I envisioned. In the Fall/ Winter 2018 issue, I recounted how they assisted a couple in a particularly dire situation with a spectacularly successful outcome. Our community continues to monitor that couple’s progress to ensure their needs are met. Yet, for all the countless instances in which our members quickly responded to coordinate services for clients, there are also acts of kindness that go unsung. Most recently, a senior couple was relocating. The wife was left to handle the myriad details while simultaneously caring for her husband who was suffering from dementia. Moving day was terribly overwhelming, but the crew of United Moving and Storage proved super sensitive to their situation. Only when her husband remarked he was cold; did she realize she had packed his coat. One of the crew came to the rescue with his own coat to keep her husband warm. Later, she became flustered that she’d made no provision to feed him during those long hours, and that same crew member offered his own lunch so her husband could eat. And when it became clear that her potted plants could not be transported in the truck without damage, Andy, the Director of Sales Operations, and his wife, personally transported and delivered the plants to the couple’s new home the next day. At Compass and Clock, we know kindness is a good thing. One random act; one kind word. Kindness feels good to give and to receive. That good feeling is contagious. Kindness. Pay it forward. It’s how we do things at Compass and Clock. I couldn’t be prouder on our first anniversary.
  5. 5. Volume 3 We are Proudly Printed in the USA! Bonnie Dickson Editor Contributing Writer Creative Services - Print WriteEditDesign 253-279-6401 Carol Fisher Contributing Writer Better Days Writing & Creative 402-301-6376 FINANCIAL PLANNING 4 Financial Solutions Assessment 5 Letters to the Publisher 6 IRA Trusts & Supplemental Needs 8 Veterans Aid & Attendance 10 Going“Green”at Death 12 Hybrid Long-Term Care Options 14 What is an Advance Beneficiary Notice? HEALTH CARE 16 Holistic Dentistry-Healing and Happiness for Patients 18 Confronting Depression in Aging Senior 20 Five Tips for Living Well with Dementia 22 Regenerative Therapies: It’s Time to Live Pain Free 24 Physical Therapy for Hands Can Treat Both Trauma & Chronic Conditions 26 Disease to Wellness: Shifting the Focus of Healthcare 28 Opioids and Your Hearing 30 Treatment of Varicose Veins is not Vain 32 The Role of Occupational Therapy for Aging in Place HOUSING CHOICES 34 Protecting Against Bathroom Dangers 35 Live Well: Our Approach to Whole-Person Wellness 36 Growing Old Together: Pets and You 38 Building Homes for the New Family LEGAL GUIDANCE 40 Considerations When Hiring Caregivers LEISURE PURSUITS 42 Veteran to Veteran Hospice Program-Making a Difference for our Veterans 44 Eat Right 46 Sunday Driving 48 Traveling Life’s Roads: Choosing Your Transportation Options 50 Age-Friendly Gardening 52 Check Out New Friends at the Library 54 Organizing, Transitioning & Decluttering 56 The Road Ahead 58 Gig Harbor Senior Center Requests the Community’s Help 59 RESOURCE DIRECTORY Table of Contents We are a group of compassionate, experienced professionals dedicated to your well-being and safety. Our goal is to share knowledge, tools & resources to educate & empower you, and help you strengthen your quality of life as you age. 12 3 6 9 Navigating life today to remain independent tomorrow &C MPASS CL CK In loving memory of Elgin Louise (Bean) Skewes, 105 yrs old. Adventurous to the end, an inspiration to us all. Cover Photo: Justin Saetrum Nurse Manager at Martha & Mary Health and Rehab Center
  6. 6. 4 Spring/Summer 2019 A financial assessment should be an ongoing process, throughout life and does not end with retirement Financial Solutions Assessment If you’ve made 2019 the year to take control of your personal finances here are some great tips for getting on track. Check off the steps you’ve already taken and make note of the items with the most priority. Taking even small steps will get you closer to your goals. FINANCIAL GOALS RETIREMENT ASSETS & INVESTMENTS LIABILITIES & MONTHLY EXPENSES RETIREMENT LONG TERM CARE  setting priorities, making a plan Partner with your financial advisor and other trusted professionals (i.e. Accountant, Lawyer, etc) to develop a plan based on your preferences. Find a Financial Advisor Develop a Goal Review Your Goals Twice a Year Discuss Retirement Plans with Family Take charge of your finances. Don’t wait for a crisis or major life event to get your act together. Live within your means. Many are borrowing against their future. Understand where your money is going.    Take Advantage Of Employer Sponsored 401K Plans Understand The Differences Between Traditional Ira And Roth Ira Plans Start An Emergency Fund Identify How You Are Spending Now Evaluate Your Current Spending Set Realistic Goals Track Your Spending Be realistic about the prospect of living into your 80's or 90's, and the housing and financial implications of ill health and limited mobility. determine your wishes and desires Maintain Complete Records Of Your Financial & Estate Planning Documents Including Healthcare, Powers Of Attorney, Wills, And More Review The Location Of Documents With Loved Ones And Beneficiaries Acknowledge and understand that aging will have many health care implications and that you need to make plans while still healthy. prepare for all scenarios. Know How To Protect Your Assets From Non-Qualified Medical Expenses Research Long Term Care Insurance Hybrid Policies Research Local Housing Communities
  7. 7. Financial Planning Investment Services At First Federal Investment Services, we know that the savings and investment decisions you make today will impact your financial future Mutual Funds • Annuities • Stocks • Bonds • IRAs • Retirement Planning Wealth Management Insurance: Life, Disability and Long Term Care College Savings • Retirement Plans for Businesses Learn More > > 360.417.3204 Investment and insurance products and services are offered through INFINEX INVESTMENTS, INC. Member FINRA/SIPC. First Federal Investment Services is a trade name of First Federal of Port Angeles. Infinex and First Federal of Port Angeles are not affiliated. Products and services made available through Infinex are not insured by the FDIC or any other agency of the United States and are not deposits or obligations of nor guaranteed or insured by any bank or bank affiliate. These products are subject to investment risk, including the possible loss of value. Halina D’Urso Infinex Financial Advisor 360.681.7681 Halina.D’ Daniel Burris Infinex Financial Advisor 360.344.4901 Shawnie Peters Infinex Associate Financial Advisor 360.681.7671 Dear Mary, Your Periodical is outstanding. There are articles by Experts in their Field and articles that relate to Quality of Life for older people. One that I was interested in was on POD. I have a Financial Planner and I will discuss it with her. Another (article was) about CBD Protection for the Heart & Nervous System. Then there was the fun read…Sunday Driving. I intend to follow the itinerary and I will have Pie at the Chimacum Cafe. Thank you  Alice, Bainbridge Island ~ 2018 Dear Mary, My husband attended Richard Tizzano’s talk at the Sequim Library last Wednesday and was so thankful to have learned about him and to receive the info he imparts.  The woman friend that attended your ‘aging’ event with me held at the Sequim Community Church facility has also reaped unexpected benefits from some of the contacts she made while there. She and I continue to be impressed by your business acumen for developing the Compass & Clock Magazine, initiating and managing the recent aging event, and, and...your finishing touch with a gift certificate to dinner at The Lodge.  Now that’s follow up/follow through and has created additional goodwill and word-of-mouth promo on C&C. My husband brought home your recent magazine from Richard’s talk and has encouraged me to read it because he feels there are, again, some very helpful pieces therein.  So....we’ll continue to encourage our contacts to get involved with C&C and those included in your cadre of compassionate professionals. Continued success to you and your associates Pepper, Sequim ~ 2018 Mary is always happy to hear from readers. Please send feedback, suggestions, and more to Mary at Letters to the Publisher
  8. 8. 6 Spring/Summer 2019 Financial Planning IRA Trusts & Supplemental Needs By Tony Hinson W hile the Individual Retirement Account (commonly referred to as an “IRA”) has been around since 1974, it has only become a major part of most people’s retirement plan in the last 10-15 years. These days, with 401k rollovers and increased contribution limits, it is not at all unusual for a couple’s IRAs to account for a large part of their savings and estates. In fact, we are entering a time when the IRA is really going to come into its own as a retirement nest egg, and an asset that will be passed down to spouses, children, and charities. In my estate planning practice, I am increasingly seeing IRAs well into six figures, comprising in some cases up to 75 percent of the total assets in a married couple’s estate. Let’s Review the Basics As most people know, with a traditional IRA, the owner may begin drawing on the account at age 59 1/2, and must begin drawing on the account at age 70 1/2. The amount that must be withdrawn is called a Required Minimum Distribution (RMD) and is based on the person’s life expectancy as determined using IRS tables (called the Uniform Lifetime Table). Generally, all withdrawals from Traditional IRAs are taxable income. The rules for Roth IRAs are a bit different, in that there are no RMDs, and as long as the account has been open for at least 5 years, withdrawals after age 59 1/2 are not taxable. IRA Beneficiaries IRAs are not probate assets, meaning that your will or trust does not direct where your IRA passes after your death. The IRA beneficiary designation form you complete with your bank, financial advisor, or broker is the document that controls who receives your IRA after your passing. For this reason, it is vitally important that you periodically review the beneficiary designations of your IRA(s) to make sure there is a form on file, and that the beneficiaries listed on that form are the ones you want. Failing to designate beneficiaries or simply listing your ‘estate’ can have severe income tax consequences we will discuss later. Leaving an IRA to a Spouse By far the most common primary beneficiary of an IRA is the spouse of the IRA owner. In most cases, the surviving spouse will simply ‘roll over’ the IRA into an IRA of their own. In essence, the surviving spouse becomes the new ‘owner’ of the IRA. The same rules for Traditional and Roth IRAs discussed above now apply to this IRA, and the surviving spouse will designate his or her own beneficiaries of the IRA. Leaving an IRA to a Child or Other Person When an IRA passes to a non-spouse, different rules apply. Both Traditional IRAs and Roth IRAs now become an ‘inherited IRA’, and the new owner must begin to withdraw RMDs from the IRA the year following the original owner’s death. The RMD amount is based on the beneficiary’s life expectancy. If an IRA passes to a child, then the RMD amount will typically be much smaller than the deceased parent’s schedule, and the IRA payments are said to be ‘stretched’, which accounts for why financial advisors often refer to these inherited IRAs as ‘stretch IRAs’. Distributions from a Traditional IRA are taxable income to the beneficiary, while those from a Roth IRA are not. Failing to Name a Beneficiary If no beneficiary is named for an IRA, or if the beneficiary listed is the person’s ‘estate’ or typical living trust, different rules apply. For a Traditional IRA, if the individual passes 401K
  9. 9. Financial Planning before age 70 1/2 and either fails to name a beneficiary or names their estate or trust, then the entire IRA must be distributed within 5 years. If the individual passes after age 70 1/2, then the IRA must be fully distributed using the deceased owner’s RMD schedule. In most cases, this will lead to a greatly accelerated withdrawal, with the accompanying accelerated income tax liability and the potential loss of years of tax-free growth within the IRA. For a Roth IRA, the five-year rule applies regardless of the age of the IRA owner at their passing. It bears repeating: make sure you work with your financial advisor or IRA custodian to make sure you have a beneficiary designation form on file, and that it is reviewed and updated as needed. Charity as Beneficiary If you have a charity or charities you want to include in your estate planning, a Traditional IRA is an excellent candidate for this gift. Generally, the charity will not incur any income tax liability from receiving a Traditional IRA. This means you can maximize amounts passing to charity, while leaving other assets that are not subject to income tax to your children and other heirs. In addition, various types of charitable remainder trusts can receive an IRA, allowing your heirs to receive annual payments for a certain number of years (or their lifetime), with the remaining amount in the trust passing to charities of your choice. IRAs and Trusts Generally, trusts, like estates, are not appropriate beneficiaries for IRAs, as they will suffer the same income tax consequences discussed earlier. However, in certain cases, it may be advisable to use a specially-designed trust as an IRA beneficiary. If carefully drafted by a knowledgeable attorney, such a trust will be accepted by the IRS as a designated beneficiary and avoid the harsh consequences discussed earlier. In particular, a carefully drafted Special Needs Trust can serve as the beneficiary of an IRA for the benefit of a disabled spouse, child, or other individual, while still preserving that person’s eligibility for Social Security, Medicaid, and other benefits. Pulling it All Together IRAs are becoming a major part of many people’s estates. Careful and coordinated planning with an estate-planning attorney and your financial advisor is critical to ensure your IRA passes to whom you want while maintaining the income tax and retirement savings benefits an IRA offers. Now is a great time to review your IRA beneficiary designations and make sure they are correct and match your overall estate plan! Tony Hinson, Elder Law & Estate Planning Attorney, Sherrard McGonagle Tizzano & Lind. 360-779-5551. JOB INFORMATION PROJ. NO.: 9148636/604238326 SPECIFICATIONS TRIM SIZE: 7.5" × 4.7813" NOTES The riskiest financial move is doing nothing. Your wealth plan should keep up with the changing circumstances of your life, as well as with the cycles in the financial markets. A new career, a new grandchild, a new business, a significant shift in your portfolio—any of these events could necessitate a fresh look at your strategy. As Morgan Stanley Financial Advisors, we can work with you to develop a plan and then help you manage your investments and assets through life’s changes. Call today to arrange an appointment. We’ll work together to plan for what may come. © 2018 Morgan Stanley Smith Barney LLC. Member SIPC. MAR014 CRC1988327 01/18 CS 9148636 01/18 L to R: Diane Boileau, Registered Associate; Tiffany Timar, Senior Registered Associate; Doug Berger; Jason Berger; Jan Morris The Casacade Group at Morgan Stanley Doug Berger Senior Vice President Financial Advisor Jason Berger Associate Vice President Financial Advisor Jan Morris Financial Advisor 2011 NW Myhre Road, Ste 301 Silverdale, WA 98383 360-613-0212 thecascadegroup
  10. 10. 8 Spring/Summer 2019 Financial Planning A s a veteran myself, I am fortunate to work with many of my fellow service members in developing their estate plan and exploring any potential benefits available through both the Department of Defense and the Department of Veterans Affairs (VA). One the most often overlooked, but potentially life-changing benefits, is Aid and Attendance (A&A). This program has traditionally used a household income cap to determine eligibility and to determine the amount of the benefit. With a ‘general’ limit of $80,000 but no set asset limit, claims approvers often applied inconsistent and arbitrary standards in reviewing applications. The rules for eligibility for A&A changed significantly in October 2018, and apply to all new applications received after that date. General Test for Eligibility The veteran applying for this benefit must be 65 years of age (or officially disabled). The veteran must have 90 days of active duty service, of which 1 day must fall within the eligible wartime periods listed below and their discharge must not be determined to be ‘dishonorable’ by the VA. The veteran must be disabled so that they require assistance with activities of daily living, but their disability need not be service-connected. Finally, a surviving spouse applying for benefits, if not a veteran themselves, must have been married to the veteran at the time of the veteran’s death and must not be remarried at the time of the claim. Income Eligibility Test Generally, the joint, ‘countable’ income of a veteran and spouse must fall below the maximum pension available under the program they are applying for benefits. For a married couple applying for A&A, that current maximum is $26,766 and the available pension would be the difference between the maximum available and the couple’s countable income. However, there are certain deductions from gross income that are allowed when computing ‘countable’ income, and some income sources are not included. Notably, unreimbursed medical expenses over 5 percent of the maximum available benefit may be deducted from income, and SSI and welfare benefits are not counted in income. Asset Eligibility Test: Under the new rules, the VA uses the maximum Community Spouse Resource Allowance (CRSA) as a bright-line test to determine the net worth limit for A&A eligibility. Currently, this amount is $123,600 in Washington state. It may be different in other states. Much like other such limits under federal law, the amount is adjusted annually for inflation. Additionally, there are several rules used to determine the applicant’s net worth: 1. Countable Income Included in Net Worth The annual countable income of the applicant is included in the net worth computation. 2. Primary Residence Excluded from Net Worth The value of the applicant’s home and accompanying real estate (not to exceed 2 acres) is excluded from this asset limit. If the home is sold, the proceeds must be used to purchase a new home in the same calendar year, which would result in a very tight timeframe if a home is sold at the end of the year. If the residence is offered as a rental, the rental income is included in countable income and included in net worth as explained above. 3. All Other Assets Included in Net Worth All other assets owned by the applicant (and spouse) are included, with any debts or liens deducted from such assets. It is important to note that there are no qualified annuities available to exclude as with Medicaid, and all assets are included regardless of whether they are listed for sale at the time of application. Notably, transfers made to a Single Premium Immediate Annuity (a ‘Medicaid annuity’) will trigger a possible penalty under the lookback period, discussed below for the entire amount transferred to the annuity. New Three-Year Lookback Rule Prior to the rule change in October 2018, the VA never imposed a transfer penalty on veterans who gifted away property to qualify for A&A. Now, however, the VA imposes a 3-year lookback period for disqualifying transfers, with a maximum 5-year penalty period because of such transfers. If a disqualifying transfer is found to have occurred within the lookback period, then a penalty is imposed. The penalty is a period of ineligibility that runs from the date of the disqualifying transfer. If the VA imposes a penalty for such a transfer, the applicant has 60 days to recover the asset, and must within 90 days provide notice to the VA that the assets has been returned. Veterans Aid & Attendance By Tony Hinson
  11. 11. Financial Planning Penalty Period To compute the period of ineligibility due to a disqualifying transfer, take the portion of the value of the asset which, if not gifted, would have caused the applicant to exceed the asset eligibility limit and divide that number by the maximum monthly A&A benefit payable to a veteran with one dependent (regardless of the particular veteran’s dependent status). That number, rounded down, is the number of months the applicant is ineligible from the date of the gift. As an example, assume a couple has a net worth of $143,600 and gifts away an asset worth $25,000. Before the gift, the couple had an excess net worth of $143,600 - $123,600 = $20,000. The maximum monthly A&A benefit for 2019 for a veteran with one dependent is $26,756/12 or $2,230. Dividing $20,000 by $2,230 results in an 8.96-month penalty period, rounded down to 8 months. This period then runs starting the month after the transfer. Seek Assistance While the new rules may seem burdensome or complex, my fellow veterans should explore every benefit available to us, including A&A. I encourage you to seek the help of great programs and services available to you, such as www. and Tony Hinson, Elder Law & Estate Planning Attorney, Sherrard McGonagle Tizzano & Lind. 360-779-5551. Eligible Wartime Periods The VA uses the following wartime periods to determine eligibility for VA Pension benefits: •Mexican Border Period (May 9, 1916 – April 5, 1917) •World War I (April 6, 1917 – Nov. 11, 1918) •World War II (Dec. 7, 1941 – Dec. 31, 1946) •Korean conflict (June 27, 1950 – Jan. 31, 1955) •Vietnam (Feb. 28, 1961 – May 7, 1975 in the Republic of Vietnam; otherwise Aug. 5, 1964 – May 7, 1975) •Gulf War (Aug. 2, 1990 – through a future date) Dr. Robin Fiscus Doctor of Audiology (360) 373-2571 Use your benefits! Simply HEAR at Simply Hear! Are you due for a New Technology Appointment? Need Hearing Aids? The Veterans Choice Program allows eligible Veterans to receive Audiology Care in their own communities. • Don’t pay for HEARING AIDS! • We are a Preferred Veterans Choice Provider • VA covers the absolute best technology - no charge for a lifetime of batteries, and new technology every 5 years! • Hearing Aids through the VA Choice Program offered by Dr. Robin Fiscus, Audiologist. Call for more info. 2635 Wheaton Way Bremerton Listen Up Veterans
  12. 12. 10 Spring/Summer 2019 Financial Planning 163 Wyatt Way NE, Bainbridge Island, WA 98110 206-842-2642 360-779-7872 100% Trusted/Insured Funds Affordable and Portable Payment plans available Plan ahead. For your family’s peace of mind. Complete Pre-Arranged Burial and Cremation Plans Complete Pre-Arranged Burial and Cremation Plans & HILLCREST CEMETERY I n recent years, the term “green” as in living green, driving green, eating green, etc., etc. has become a familiar term. Rightfully so considering the state of our environment. Is it possible to reference “green” concerning death and final disposition? What does “green” burial and “green” cremation mean? Is it available to us, and at what cost? The short answer is yes for burial and currently no for cremation; but we are moving closer to having green cremation, which we will discuss in a separate article. Let’s begin with what green burial means. Green burial is the act of burying someone in a cemetery without the use of any embalming or other preservative means. It also eliminates items such as a traditional metal casket or concrete vault that would directly or indirectly inhibit the natural processes of returning a body back to the earth or cause harmful materials or chemicals to be introduced into the ground. To go further, green burial does not disturb the earth any more than necessary to accomplish the burial. What we are accomplishing is a much simpler and far more environmentally friendly version of burial. It is also an affordable and far more environmentally friendly alternative to conventional cremation. As we are all aware, the choice of cremation has become widely accepted throughout the country. Just like when the automobile was introduced to society, no one would have guessed the extreme popularity that would follow; so has it been true for cremation. The issue is that both require the use of fossil fuels for their energy source. What is involved, what does it cost, and where is it available in our area? Let’s take those questions in order. You must first find a funeral home and cemetery willing to handle this type of service. There is one of each available on Bainbridge Island and Hillcrest Cemetery on Old Mill Road is currently the only location with a designated area for Green Burial. Once this decision is made, the family will need to acquire grave space in the cemetery. The next consideration is to what extent do you wish to go green when it comes to the handling of the deceased. Do you want a simple shroud or do you prefer more of a simple casket style basket or carrier made of wicker and containing no harmful materials or chemicals? Finally, what type of marker are you going to use; something personally made or a natural rock engraved with the loved ones information? The cost for the services and burial items at the funeral home,average around $2,500.00 and slightly less if only a shroud is chosen. Grave space costs about $900 per grave space plus any perpetual care fees; typically 20 percent of the grave price. Therefore, the complete cost will range from between $3,300, if you own your grave, to $4,650 if you need to purchase everything. The result is an affordable option to cremation and a much more affordable option in comparison to traditional burial. Green burial is gaining popularity. Existing cemeteries, such as Hillcrest, will become what is termed “hybrid” cemeteries, which simply means they allow traditional, cremation and green burial in the same cemetery, resulting in better and more complete use of existing properties already established as cemeteries. This change will also inevitably result in a more efficient and complete use of land already designated for burial. When considering funeral services and the final disposition of your loved one or yourself, you can be comfortable in knowing that there is another affordable and environmentally sound way of handling burial available in our area. As for green cremation, check out our next article addressing Alkaline Hydrolysis or “Flameless Cremation.” Going “Green” at Death By Tim Dinan, Owner Cook Family Funeral Homes
  13. 13. Joyce and Walter finally have the money to take their dream vacation... and you can too! Learn how you can enjoy your retirement. You earned it! If you are a qualified homeowner 62 or older, a Home Equity Conversion Mortgage (HECM) can allow you to turn a portion of your home equity into cash that can be used to enhance and extend your retirement. Maybe you will even choose to take that romatic vacation you have always dreamed of! Most, but not all, reverse mortgages today are federally insured through the Federal Housing Administration’s Home Equity Conversion Mortgage (HECM) Program. This advertisement talks about HECM loans only. © 2019 Fairway Independent Mortgage Corporation (“Fairway”) NMLS#2289. 4750 S. Biltmore Lane, Madison, WI 53718, 1-866-912-4800. All rights reserved. Fairway is not affiliated with any government agencies. These materials are not from HUD or FHA and were not approved by HUD or a government agency. Reverse mortgage borrowers are required to obtain an eligibility certificate by receiving counseling sessions with a HUD- approved agency. The youngest borrower must be at least 62 years old. Monthly reverse mortgage advances may affect eligibility for some other programs. This is not an offer to enter into an agreement. Not all customers will qualify. Information, rates and programs are subject to change without notice. All products are subject to credit and property approval. Other restrictions and limitations may apply. WA License Number MLO-38002. Want to learn more? Visit my website and register for an event at or call me at 360-949-1595 What are the Qualifications? One borrower must be 62 years or older Purchased home is required to be your primary residence ( at least 6 months) New property must be: single-family home, 2-4 unit dwelling or FHA- approved  condo For a home purchase, you must have an adequate down payment for your new  home based on your age  (Note: not available in all areas) No credit score requirements, some income and credit qualifications apply to make sure you have the ability to pay taxes and insurance NMLS #38002 Joan Qvigstad Reverse Mortgage Planner Direct: 360-949-1595 Mobile: 360-271-5946 Fax: 866-558-7479 Email: Location: 19410 8th Ave NE, Suite 103 Poulsbo, WA 98370
  14. 14. 12 Spring/Summer 2019 Financial Planning T he possibility (or greater than 50 percent probability) of needing long-term care before dying concerns many people, particularly seniors and their families. While the reasons for this concern are many, they can be narrowed down to the twin fears of losing your independence and outliving your money. Long-term care, which includes care in a nursing home, assisted living facility, adult day care, or your own home, is very expensive. In 2018, the median monthly long-term care costs were $8,669/$9,718 (semi- private/private room) for a nursing home; $5,135 for assisted living; $1,408 for adult day care; and $5,339 for home health care in Washington state. There are only three possible ways to pay these expenses. They are: pay out of pocket from your own (or your family’s) assets and income, qualify for Medicaid (a government poverty program, which covers only certain nursing homes), or use long-term care (LTC) insurance. For many of us, LTC insurance is the best option, and the questions then become when to buy insurance and what type of insurance to buy? The answer to the when question is the sooner the better, because the cost will be lower, and the insurance will be easier to get. The answer to the what type question is that depends…on your budget, as well as your general approach to insurance. Do you want to insure the worst-case scenario, or are you content to have some insurance rather than none, and be a co-insurer? Traditional LTC insurance can cover the worst-case scenario, but it is the most expensive type of LTC insurance, and has the problems of “use it or lose it” and increasing premiums. New “hybrid” policies, which combine life insurance and LTC insurance, have a fixed cost, which cannot increase, and do not have the “use it or lose it” problem. This is because someone, either the insured person or their beneficiary, is guaranteed to collect the full death benefit, in the form of LTC benefits and/or a death benefit. For example, several hybrid policies provide a choice (at application) of a monthly LTC benefit of between 2 percent, 3 percent, and 4 percent of the death benefit. Therefore, a $250,000 (death benefit) policy with a 4 percent LTC rider will provide a monthly LTC benefit of $10,000, which will last for 25 months. If 2 percent is elected at application, the monthly LTC benefit will be Hybrid Long-Term Care Options By Stephen Hecht
  15. 15. Financial Planning My office has over 25 years of work experience with State Farm. We are a trusted resource for both personal and business insurance needs. We also provide flood insurance and FREE notary services. We look forward to working with you! Let us show you how to save money! Paula K Weissinger Agent, CPCU, CLU 206-855-0855 175 Parfitt Way SW, Ste 180 Bainbridge Island, WA AUTO • HOME • LIFE • HEALTH • BANK • BOAT • BUSINESS Bainbridge Island, Kingston and Poulsbo Chamber Member Deborah D’Angelo CPA, CGMA Brian Hedrick MBA Elizabeth Watters CPA, MBA Rachel Brandt EA Where Trust, Integrity and Service Matter SERVICES: • Income tax preparation for individuals, estates, trusts, and businesses • Preparation of estate, inheritance, and gift tax returns • Tax and estate planning • Accounting services and consulting Walter L. Schultz CPA, CGMA Our Experienced Team: 360-779-5606 or 206-842-3408 19679 Front Street NE, Poulsbo $5,000, which will last for 50 months. If the insured person dies before the full amount is paid, the balance will be paid to the beneficiary. An additional benefit of these hybrid policies is that one policy can cover both spouses. Many of my clients purchased traditional LTC insurance 20 or more years ago, when they were in their late 40s to mid-50s. At that time, a monthly benefit of $3,000 was adequate, and most policies included an inflation provision, which automatically increased the benefit by 5 percent compounded annually. Therefore, those policies are currently providing benefits of $8,000 per month or more if the initial benefit was greater than $3,000. Premiums for those policies when purchased, depending on age, marital status, health, and benefits selected were probably in the range of $100-$500 per month. All of those policies are considered “guaranteed renewable,” meaning that the insurance company cannot cancel (except for non-payment of premium), but the premiums can be increased on a policy series basis, subject to approval by the insurance commissioner of the state in which the policy was issued. In addition, the bad, but not unexpected, news is that all of those premiums have increased over the years, in some cases by 50 percent to 100 percent. The good news is that when increased premiums are approved, insurance companies must give policyholders options to reduce or eliminate the increase, but all of those options involve a reduction in benefits. One of those options is to eliminate the inflation provision, thereby freezing the monthly benefit at its current level. Since many of these policies now have adequate, or more than adequate benefits, based on current costs, this is a viable cost saving option for many of my clients. This brings me back to the new hybrid policies, one benefit is that the premiums are fixed and cannot increase. In many cases, a healthy couple in their 50s can qualify for a $150,000 policy covering both spouses for a monthly premium in the $300-$400 range. Finally, one of the newest hybrid policies offers a “cash” LTC benefit, meaning that the full benefit can be paid without having to submit actual bills, as long as the insured person is receiving some qualified care. This can be very helpful in the case of a spouse, who is uninsurable for medical reasons, because as long as the insured person is receiving some care, the benefits can be used for both spouses. This is a complex subject that does not lend itself to a do-it-yourself approach. Help from someone who is knowledgeable and experienced in the field is essential. Stephen L. Hecht, CLU, ChFC Long Term Financial 360-868-4429
  16. 16. 14 Spring/Summer 2019 Financial Planning 14 Dear Marci, I have Original Medicare. My doctor said that she does not believe that Medicare will cover a certain procedure, and that she would like me to sign an Advance Beneficiary Notice. What does this mean, and what should I do? -Jesse (Austin, TX) Dear Jesse, An Advance Beneficiary Notice (ABN), also known as a waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the services. The ABN may look different, depending on the type of provider who gives it to you. An ABN is not an official Medicare coverage decision. The ABN allows you to decide whether to get the care in question and accept financial responsibility for the service (pay for the service out-of-pocket) if Medicare denies payment. The notice must explain why the provider believes Medicare will deny payment. For example, an ABN might say, “Medicare only pays for this test once every three years.” Providers are not required to give you an ABN for services or items that are never covered by Medicare, such as hearing aids. Note that our providers are not permitted to give an ABN all the time, or to have a blanket ABN policy. If you receive an ABN from your provider, there are a few things you should ask before choosing whether to sign the ABN or refuse care: If your provider thinks the service is medically necessary, ask why you need to sign an ABN. Medicare should pay for most medical services you need, unless the service is specifically excluded from coverage, in which case an ABN is not required. Ask your provider if they are willing to help you appeal Medicare’s coverage decision, if the service is denied, by writing a letter justifying your medical need for the service. If your provider refuses to write a letter or help you appeal, you may want to find a different provider. While the ABN serves as a warning that Medicare may not pay for the care your provider recommends, it is possible that Medicare will pay for the service. To get an official decision from Medicare, you must first sign the ABN, agreeing to pay if Medicare does not, and receive the care. Make sure you request that your provider submit a claim to Medicare for the service before billing you. The ABN may have a place from where you can elect this option. Otherwise, your provider is not required to submit the claim, and Medicare will not provide coverage. An ABN is not an official Medicare coverage decision. Medicare has rules about when you should receive an ABN and how it should look. If these rules are not followed, you may not be responsible for the cost of the care. When your Medicare Summary Notice (MSN) shows that Medicare has denied payment for a service or item, you can choose to file an appeal. Remember, receiving an ABN does not prevent you from filing an appeal, as long as the provider submits a claim to Medicare. You can contact your Statewide Health Insurance Benefits Advisor (SHIBA) for more information about the process at statewide-health-insurance-benefits-advisors-shiba You may not be responsible for the denied charges if the ABN: • Is difficult to read or hard to understand • Is given by the provider (except a lab) to every patient with no specific reason as to why a claim may be denied • Does not list the actual service provided, or is signed after the date the service was provided • Is given to you during an emergency or is given to you just prior to receiving a service (for instance, immediately before an MRI). You can contact your Senior Medicare Patrol (SMP) for assistance if you are suspicious of a provider’s handling of the ABN or if you believe you were falsely billed for service. If you don’t know how to contact your SMP, call 877-808- 2468 or visit -Marci What if my provider refuses to bill Medicare? Dear Marci, My provider is refusing to submit a claim to Medicare. What can I do? -Donnie (Ogden, UT) Dear Donnie, The way to handle this situation may vary based on what kind of Medicare coverage you have and why your provider is refusing to submit a claim. If you have Original Medicare: Below are some reasons why a provider may refuse to file a Medicare claim, along with information about what to do in each situation: Your provider believes Medicare will deny coverage Your provider must ask you to sign an Advance Beneficiary Notice (ABN). Before signing an ABN, ask additional questions to find out whether your provider considers the service to be medically necessary, and whether they will help you What is an Advance Beneficiary Notice?
  17. 17. STEPHANIE KIRK 360.779.1082* Guiding you to benefits that fit INSURANCE | ANNUITIES | EMPLOYEE BENEFITS J C M A D I S O N I N C . C O M Concerned about the rising cost of health care in retirement? Let’s face it together! Medicare Planning Long Term Care Insurance Annuities Call to arrange a consultation or RSVP for an upcoming Medicare 101 Education Event *Calling this number will put you in touch with a licensed agent. appeal Ask your provider to still file a claim with Medicare, even if they believe coverage will be denied. You can appeal if Medicare denies coverage. Your provider may ask that you pay in full for services. If you are seeing a participating provider, your provider can collect your Part B deductible and coinsurance at the time of service, but they should not ask you to pay in full. Ask your provider to submit a claim to Medicare. Medicare should let you know what you owe after it has processed the claim. You may also find it useful to contact your state’s medical licensing board to report the issue. Non-participating providers are allowed to request payment up front at the time of service. Your provider should file a claim with Medicare on your behalf so you can receive Medicare reimbursement (80 percent of the Medicare-approved amount). Your provider has opted out of Medicare. Opt-out providers have signed an agreement to be excluded from the Medicare program. They do not bill Medicare for services you receive. You should not submit a reimbursement request to Medicare for costs associated with services you received from an opt-out provider. Your provider refuses to bill Medicare and does not specify why. All Medicare-enrolled providers are required to submit claims. A refusal to bill Medicare at your expense may be Medicare fraud or abuse and should be reported. To report fraud, contact 1-800-MEDICARE, the Senior Medicare Patrol (SMP) Resource Center at 877-808-2468, or the Inspector General’s fraud hotline at 800-HHS-TIPS. If you have a Medicare Advantage Plan or Part D prescription drug plan: If you are experiencing billing issues with providers or pharmacies in your Medicare Advantage Plan or Part D plan’s network, you can ask your pharmacy or provider to contact your plan directly. If you continue to experience issues or if your pharmacy or provider is unresponsive, you can file a grievance with your Medicare Advantage or Part D plan. Contact your plan to find out how to file a grievance. -Marci Dear Marci is a free e-newsletter from the Medicare Rights Center (, the nation’s largest independent source of information and assistance for people with Medicare. This information is republished with permission from the Medicare Rights Center. For more info visit” For more free answers to your Medicare questions, visit Medicare Interactive (MI) at Subscribe to Dear Marci by registering for your free account on MI.
  18. 18. 16 Spring/Summer 2019 Health Care Holistic Dentistry - Healing and Happiness for Patients F or many people, a visit to the dentist is something to be dreaded - put off for as long as possible. Many patients fear they will experience pain. Patients also dread the intimacy of having a stranger working so closely to their face and mouth. Other patients wish to avoid the guilt their dentist will make them feel over the state of their teeth. Finally there is fear of the expense for treatment. Studies show that these anxieties affect up to 60 percent of dental patients and often lead patients to delay care that they need, until pain or stress finally forces them to go. It doesn’t have to be that way. There is a new approach to dentistry that emphasizes the personal connection between the dentist and the patient. An approach that is holistic - healing the mind and heart as well as the body. Where being treated with kindness is as important as clinical technique. This is holistic dentistry. The moment a patient steps in the door of a holistic dental office, the experience is different. Beautiful art fills the walls. Natural light spills in through the windows. Flowers and plants line shelves. Pleasant music and beautiful scents fill the air. This ambience is the first step in helping fearful, wary patients break old associations and form new ones. Once in the office, the dentist greets the patient personally. This establishes a direct bond between patient and dentist. The dentist listens to the patient, learning about the patient’s dental issues as well as forming a complete, rounded picture of the patient’s overall health and the patient’s hopes for their treatment outcome. During this important, initial conversation, the holistic dentist employs active, non-judgmental listening. This freedom from judgement is crucial to establishing a positive bond with the patient, a bond that is the foundation for complete healing. By speaking directly with the patient, the holistic dentist has the opportunity to fully understand their patient and their needs, helping ensure that treatment will address all of the patient’s needs. The next step is a gentle examination of the patient’s teeth. During this time, the holistic dentist will be explaining what they are looking at and what they are By Helena Soomer Lincoln, DDS, Ph.D., P.S.
  19. 19. Health Care 115 Hall Brothers Loop, Suite 105 Bainbridge Island, WA 98110 • Crowns, veneers, and bridges: designed and finished in-house • Full arch restorations on 4 implants • Complex extractions, grafting, and implants • Full and partial dentures Holistic Dentistry that transforms smiles and lives! “Dr. Lincoln is amazing!!! She brings the perfect blend of art and science to her patients and the results are nothing less than spectacular!!! After nearly three decades of hiding my teeth when smiling, I am finally able to relax and feel at ease.”~Tres Cozine (206) 488-8006     A gentle personal touch combined with the latest dental technology Affordable senior dentistry Helena Soomer Lincoln DDS, Ph.D. PS All with a smile, a story, and a song seeing. Again, this happens without judgment. The focus is on clearly communicating with the patient and ensuring that patient knows what the dentist is seeing and feels fully informed at all times. Once this exam is complete, the next step in holistic dentistry is to go over all the options for treatment with an open assessment of benefits, risks, and costs. The goal is to ensure that the patient feels empowered to make a decision about their treatment path with full knowledge and understanding. This may include no treatment at all! In holistic dentistry, the aim is not revenue, but relationships. An often overlooked aspect of determining the treatment plan is cost. In holistic dentistry, there are options to finance the treatment if necessary. A holistic dentist works with the patient directly to work out a flexible payment plan. This opens up more treatment options for patients, once again empowering patients to receive the best possible outcome. Once a treatment plan has been agreed to, the dentist and patient will work out the timing for treatment, taking into account the patient’s schedule and post-treatment needs as well as ensuring that there will be plenty of time for the dentist to perform the treatment in the best possible way. During treatment, the holistic dentist will use songs and stories during treatment. When patients are told a story, their mind is taken away from the treatment to another place. The proper story does more than distract the patient - it sets a positive emotional tone that fundamentally alters a patient’s perception and emotional reaction. Treatment is delivered gently, with genuine kindness and care. Water can be used in place of metal instruments in many instances. All contact with the patient’s mouth and teeth is made with care to ensure there are no sudden or harsh sensations. Extractions are done with an intimate knowledge of each tooth’s anatomy and a patient technique that ensures the tooth’s roots are fully loosened and ready for extraction. The tooth to be extracted is carefully handled to ensure the surrounding bone is not traumatized, making recovery short and relatively comfortable. At the same time, holistic dental treatment is done efficiently so that the patient does not spend more time in the chair than required. Holistic techniques like this ensure that the patient experiences the minimum discomfort while under the dentist’s care and afterwards. Restorations such as crowns and veneers are created using the latest technology, including 3D scanning and design. New, advanced materials will ensure that the restorations are comfortable, look great, and will be durable. The holistic dentist employs stains and glazes to ensure that restorations match the patient’s smile, painting with subtle shades of color. The dentist works chairside with the patient to get everything just right, from the fit, to the bite to the final look. And again during all of this work, the holistic dentist is telling stories that help the patient relax and relieve much of the discomfort that they might otherwise feel. In fact, the dentist will vary the pace of the story to help bring it to an end just as the treatment is done. A beautiful ending for the patient. After treatment, the holistic dentist will follow up personally to ensure the recovery is going well and any restorations are working as intended. This personal connection is essential in helping patients feel that they are cared for before, during, and after treatment. With holistic dentistry, patients feel truly cared for because they are. The holistic dentist has genuine affection for each of their patients and is personally invested in their patients’ care and healing. This deep personal commitment is the hallmark of holistic dentistry.
  20. 20. 18 Spring/Summer 2019 Health Care D epression in older adults is a serious concern. The National Institute of Mental Health considers depression in older adults to be a major public health problem. An estimated 6 million persons, aged 65 and older, suffer from depression in our country. Perhaps most troubling, it is highly suspected that only 10 percent of seniors with depression are being treated for it. Terry Gaines became all too aware of this problem last year when she became concerned about her mother, Vera Sakai, who began exhibiting signs of what she later discovered to be depression. “In the months after my father passed, my mom just seemed to be tired all the time and I discovered she was napping for 3 – 5 hours every day. This was highly unusual for my mom. As long as I can remember, she was always an early riser who was on the go from 7a.m. until bedtime!” Initially, Terry attributed this behavior to her mother “just getting older,” but she became more worried when her mom began showing signs of confusion in addition to losing weight and complaining about stomach problems despite a poor appetite. “When she began repeating the same story to me three times in the same phone call, without remembering she did so, that’s when I insisted we see her doctor,” Terry said. Terry was anxious on the day of the doctor appointment, as she suspected her mother was in declining health. In particular, she fretted that her mom was displaying early signs of dementia. However, Vera’s doctor indicated she was really in very good shape for a 76 year old. The doctor’s primary concern was Vera’s isolated lifestyle since her husband’s passing and her general lack of interest in doing even activities she used to love to do, like going to the movies and painting in her studio. “My mom’s doctor said he suspected she was suffering from depression and explained that this was likely the root cause of her troubling symptoms.” Vera began a treatment plan for depression shortly after the doctor visit and her symptoms began to fade. “It was actually pretty amazing how quickly the problems began to resolve themselves,” said Terry. “I’m just so thankful we figured this out!” Vera was lucky to get the care she needed to combat her depression, as it is not always recognized and properly treated in older persons. Many healthcare providers view seniors experiencing depression as simply a natural response to illness or a normal reaction to the changes in life that come with aging. Many older persons hold these beliefs to be true, too, further deterring their own treatment. This is very concerning, as an older person who has depression is not only feeling sadness and despair, but is at an increased risk of cardiac disease. A reduced ability Confronting Depression in Aging Seniors By Jennifer Bailey
  21. 21. Health Care to rehabilitate from illnesses and surgery is also linked to depression. Bottom line? Addressing depression in aging people is critically important! Here are some tips to do so: Know the signs of depression. Aside from feeling blue and anxious for weeks on end, depressed people often feel hopeless, helpless, irritable and restless. They may also exhibit a loss of interest in activities they once found pleasure in and experience increased fatigue or sleep problems. Other signs include difficulty concentrating and making decisions, a multitude of aches and pains, headaches, cramps and even digestive problems that seem unresolvable. Understand the causes. It is true that depression in older adults is commonly related to other health problems, both directly and as a psychological response to illness or disability. Other causes include loneliness and isolation, a reduced sense of purposefulness, anxiety about the future and enduring grief over the loss of a loved one. Remember, too, that prescribed medications, particularly when multiple medicines are in play, can produce depression. This is true for all people, but seniors are extra susceptible because they metabolize medications at a slower rate. Seek diagnosis and treatment. Address signs of depression with your health care provider. Be direct and forthright about your lifestyle, your mental state and your suspicions about experiencing depression. Know that multiple treatments are available to you. All of them should be seriously considered to relieve your symptoms. Get support. Family members and friends can support an older person who has depression in many ways. Helping to manage their treatment plan may be the key to success. This may include checking to see that prescriptions are filled and taken as directed, and ensuring a healthy diet with some light exercise is happening. Regular social interactions, whether it be family gatherings or attending community events, is hugely beneficial and cannot be overstated. Everyone should be mindful that kind words and frequent hugs are meaningful gestures that demonstrate our care for a person fighting depression. Being depressed is not a normal state for anyone at any age, but for seniors it is especially dangerous and cannot be ignored. By quickly identifying signs of depression and addressing them promptly, overall wellbeing can be restored and the light of life reignited. Jennifer Bailey is the Marketing and Communications Manager at Martha & Mary, a non-profit care organization that has been serving children, seniors, and families since 1891. 2019BestofHomeCare ProviderofChoice Nationallyrecognizedforexceptionalin-homecare. OfferedtoseniorsandadultsthroughtoutGreaterKitsap. 360-626-7840 | | 10thCONSECUTIVEYEAR!
  22. 22. 20 Spring/Summer 2019 Health Care L ife may seem a little scary after receiving an Alzheimer’s or dementia diagnosis. People experience a range of emotions from fearful to embarrassed and everything in between. Some may want to hide their diagnosis or symptoms entirely. This is completely natural. It’s important to remember that everyone deals with challenges differently. Remember that your life does not end with a diagnosis. You have a choice in how you live with Alzheimer’s or dementia. It is possible to live well by taking control of your health and wellness and focusing your energy on the most meaningful aspects of your life. Get educated Learning as much as you can about your diagnosis is the first step toward empowering yourself to take control of your life and make decisions that will help you live well with dementia for as long as possible. There is an abundance of information available online. To help ensure you get the most credible, reliable and objective information, use well-respected websites. For instance, the Alzheimer’s Association website is full of information, educational resources and more at Adjusting your lifestyle After being diagnosed, start thinking about how you can adjust your lifestyle to work better for you. An example of this could be setting reminders on your phone for weekly and daily tasks, such as getting the mail or taking your medication. Making a consistent daily routine and letting go of or simplifying complex tasks are coping strategies that can aid daily life. For example, if you are having difficulties cooking dinner, try simplifying the process by using a crockpot to make a full meal without spending a lot of time figuring out the cooking process. Engage your brain and body While engaging your brain and body are important things for everyone to do, they are especially helpful for people living with Alzheimer’s or dementia. Taking care of your body can help you live well for as long as possible. Aerobic exercises to increase your heart rate for 20 to 30 minutes provide the most benefit for physical and cognitive health. Try vigorous walking, bicycling, or tennis. Along with physical activity, mental activity also offers benefits. There is no conclusive evidence that brain exercises slow or reverse cognitive decline; however, learning new information, taking a class, or challenging yourself to try a new hobby or activity may increase your brain activity. Maintain social connections Maintaining social connections with your friends and family can make your journey with dementia easier to face and impact your health. Connecting with others who also are living in the early stages of dementia can be a comforting and satisfying experience. These individuals truly understand what you’re going through. Building a support network can validate what you’re experiencing, reduce the impact of stigma and improve your quality of life. Seek support A common concern among individuals living in the early stages of Alzheimer’s or dementia is loss of independence. You may feel that by asking others for help, you will lose your sense of self or become dependent. While it may seem like a sign of weakness at first, asking for help when you need it may help you maintain your independence and allow you to remain in control. Start building your team by identifying a decision-maker you trust. Often this person is a family member or friend. Have a conversation about the type of help you may need and your long-term priorities. Build up your team with other helpers. Family, friends, neighbors, professionals and your community should all play a part as members of your care team. Alzheimer’s isn’t the end of your story, but a new chapter in the book of life. How you approach living with Alzheimer’s disease can determine how your story goes: be patient with yourself, create a routine, develop strategies to cope, engage your brain and body, and maintain a community of social support to live well through challenge Five Tips for Living Well with Dementia
  23. 23. Health Care and change. The Alzheimer’s Association Washington State Chapter provides a variety of support and social engagement programs for people living with memory loss and their care partners: Kitsap County Look Again - Early Stage Memory Loss Museum Walk First Friday of the month, 10:00 - 11:30 a.m. Bainbridge Island Museum of Art Alzheimer’s Cafes First Wednesday of the month, 1:30 – 3:30 p.m. Cosmo’s Ristorante & Delicatessen, Port Orchard Contact: Kenna Little at (206) 529-3868 Third Thursday of the month, 1:00 – 3:00 p.m. Roundtable Pizza, Silverdale Contact: Lora Lehner at (360) 649.6793 Early Stage Memory Loss Support Group Second Thursday of the month, 10:30 a.m. – 12:00 p.m. Contact: Kenna Little at (206) 529-3868 Caregiver Support Groups First Tuesday of the month, 10:30 a.m. – 12:00 p.m. Silverdale Lutheran Church Gathering Place, Silverdale Contact: Patti Denman at (206) 402-9857 Second Wednesday of the month, 1:30-3:00 p.m. Kaiser Permanente Medical Center, Port Orchard Contact: Lora Lehner at (360) 649-6793 Jefferson County Alzheimer’s Cafe Fourth Tuesday of the month, 2:00 – 3:30 p.m. Ferino’s Pizzeria, Port Hadlock Contact: Patricia Smith at (360) 379-4186 Caregiver Support Group Second Monday of the month, 10:30 a.m. – 12:00 p.m. Port Hadlock Community United Methodist Church Contact: Patricia Smith at (360) 379-4186 Clallum County Caregiver Support Groups Second Monday of the month, 9:30 - 11:30 a.m. Port Angeles Senior Center Contact: Mardell Xavier at (360) 477-5511 Second Thursday of the month, 1:00 – 2:30 p.m. Sequim Bible Church Contact: Carolyn Lindley at (360) 683-5294 Article provided by: Alzheimer's Association Washington State Chapter | 1.800.272.3900 Information & support for people affected by Alzheimer’s and dementia. 24/7 Helpline 1.800.272.3900 Visit us online at 1534 Whited Place Northwest, Bainbridge Island 206.780.1970 BAINBRIDGE ISLAND • Long Term Care • Hospice Support • Respite Services & Caregiver Relief • 1 Caregiver to 6 Residents Contact us: We’d love to give you a tour. BAILEY MANOR ADULT FAMILY HOME A Place Called Home Providing attentive personal care in a peaceful home setting A Place Called Home Providing attentive personal care in a peaceful home setting
  24. 24. 22 Spring/Summer 2019 Health Care Written by Dr. Cy Fisher, N.D. M any of us experience back, knee, or shoulder pain. Pain shows no mercy and can affect us at any age, ranging from being a small annoyance, to keeping us from work or from performing daily tasks. In fact, if you experience back pain you are certainly not alone: Estimates vary, but approximately 60percent to 80percent of the population will experience at least mild back pain at some time in their lives. According to a 2007 Agency for Healthcare Research and Quality study, about 27 million US adults, aged 18 or older (11 percent of the total adult population) reported experiencing back pain,. About 70percent of back pain sufferers – roughly 19.1 million – sought medical treatment, the agency says. Pain usually limits our ability to do what we want, whether from physical inability to perform tasks, or from a deep fear that if we do what we want we will exacerbate the pain. Overall, pain in the body is usually due to ligaments and/ or tendons being stretched past their ability, much like a rubber band that has been pulled beyond capacity. This stretching causes laxity, which then causes pain at the site as well as in the surrounding or supportive tissues around the site. If the body does not heal itself, or tighten the affected tissues after the initial cause of laxity, the pain becomes chronic. Available Treatment Options Surgery and medications should be a last resort to relieving pain but traditional medicine often uses them as the first line of defense. Non-invasive treatments are numerous and, depending on the situation, are more effective than traditional therapies. A few great examples include chiropractic care or physical therapy as either help restore function to joints by strengthening the muscles surrounding them and restoring alignment and proper structure to the body. Other options include prolotherapy, platelet rich plasma prolotherapy (also known as PRP), and stem cell therapy. These three therapies are natural regenerative modalities and wonderful alternatives to surgery and steroid injections. Each therapy consists of a simple injection. The solutions used create a dramatic increase in the body’s healing response to the area of pain. Prolotherapy and PRP The standard prolotherapy solution contains dextrose, lidocain (a numbing agent), and a mild pro-inflammatory agent. The PRP solution consists of the healing parts of the patient’s own blood – called platelets mixed with the standard prolotherapy solution. Both solutions promote inflammation for quick repair. This repair is a direct result of injecting the solutions at the beginning and ending of the tendons and ligaments that have become stretched too far thereby promoting the growth of newer and stronger tissues by initiating heightened blood flow. The increase in blood to the area pulls nutrition and reparative cells to the site of pain to rebuild and tighten the tissues that have lost full function. As the tissues tighten and become more stable, the pain is alleviated and stability is restored to the area. Both prolotherapy and PRP are great compliments to, and are often used in conjunction with, other pain relief Regenerative Therapies: It’s Time to Live Pain Free Find the Best Natural Solutions to Your Symptoms Relieve Pain. Restore Function. Are You Ready for a More Natural Approach? • Natural Pain Relief • Anxiety Management • Digestive Health • Sleep Better • Depression • Stress Management • Fatigue • Hormone Balance • Regenerative Therapies • Spine/Muscle Therapies • Hormone Balance • Type 2 Diabetes • Food Allergies / Sensitivities • 6 Week Weight Loss • And More Bayside Professional Building 9481 Bayshore Drive NW Suite 103A Silverdale 360-698-4141 Naturopathic Doctor, Dr. Cy Fisher
  25. 25. Health Care methods such as, chiropractic care, physical therapy, or even after a necessary surgery. Stem Cell Therapy Stem cell therapy injections allow the body to restore and grow tissue at an accelerated rate using growth factors and other substances. Stem cells rapidly help repair and restore normal joint function after the joint has been injured or degenerated. Stem cells, or amniotic mesenchymal stromal cells (hAMSCs), come from tissues that have recently aided the growth of a fetus in utero. The cells can be isolated from the amnion sac (the sac in which the fetus was growing in) and cultured in a solution. Post-natal cells are easily cultured and expanded without ethical concerns and with high differentiation potential. They are also cultured without risk of cancer. Orthopedic therapies often use these phenomenal cells to regenerate cartilage and cartilage connective tissue, as well as bone and tendon tissue, but can be used for a variety of issues. New research regarding the utilization of stem cells shows amazing results. There are many additional resources available should you choose to understand the science in more detail and learn what other uses stem cell therapies support. You can also contact our office for further information. After Treatment: What to Expect The first 3 to 4 days following injection therapy, patients may experience soreness and/or aching as the treatment initially induces a mild inflammation. The best way to manage this is to keep moving. Patients will be able to maintain normal daily function following treatments although we suggest not participating in sports or exercise for at least a week, at which time the patient can slowly return to the more rigorous activities of his/her choice, paying special attention to pain levels. Treatment Duration: What to Expect Typically, injection therapies take approximately six weeks with monthly treatments. With any treatment, patients will see the best results if they maintain the basics of good health, particularly a healthy diet, staying hydrated, and getting adequate sleep each night. Clinically we often see patients living pain free well before six weeks due to a combination of injection therapies and individualized/ customized diet and lifestyle plans, although treatment schedules can vary person to person. Top row left to right: Dr Pankaj Sharma, MD, Dr Naren Siddaiah, MD, Dr Yuen San Yee, MD Bottom row left to right: Dr Abimbola Adike, Dr Carol Murakami, Jacci Hagg, ARNP Digestive Health Consultants, PLLC Founded in 1982 Complete Digestive Care » Hepatitis » Liver Failure » Pancreatitis » Celiac Disease » Gall Gladder » Autoimmune Disorders » Crohn's Disease Chronic Gastrointestinal Issues we Treat: » Ulcerative Colitis » Irritable Bowel Syndrome » Irritable Bowel Disease » Barrett's Esophagus » Eosinophilic Esophagitis » Helicobacter pylori (H.pylori) » And More We provide both preventative & wellness care, acute care, and chronic care for several gastrointestinal disease processes. 3261 NW Mount Vintage Way Silverdale (360) 479-1952 “You can trust Caliber Home Loans, Inc. to provide best in class service for your mort- gage financing needs.” Andrea Epstein Andrea Epstein Loan Consultant “You can trust Caliber Home Loans, Inc. to provide best in class service for your mortgage financing needs." “You can trust Caliber Home Loans, Inc. to provide best in class service for your mortgage financing needs." Call me today and put my 18 years of experience to work for YOU!” Serving Sequim, Port Angeles, Port Townsend and the Surrounding Area Superior Service & Personal Expert Guidance throughout the home financing process 206.818.4110 Caliber Home Loans, Inc., 1525 S. Beltline Rd Coppell, TX 75019 NMLS ID #15622 ( 1-800-401-6587. Copyright © 2019. All Rights Reserved. This is not an offer to enter into an agreement. Not all customers will qualify. Information, rates, and programs are subject to change without prior notice. All products are subject to credit and property approval. Not all products are available in all states or for all dollar amounts. Other restrictions and limitations apply.Washington Consumer Loan Company License No. CL-15622. NMLS#: 316823 175 West Washington Sequim, WA 98382
  26. 26. 24 Spring/Summer 2019 Health Care A s a hair stylist, Mecca Schindler relies on her hands for her job. But when a car accident severely injured her right hand, she didn’t expect to be unable to work for six months — or require dozens of physical therapy sessions. Schindler was driving her son to school in November 2017 when another driver hit their car head-on as they waited at a stop sign. The deployed airbag shattered her wrist and split her hand in half nearly to the middle of her palm. Her skin remained intact so Schindler didn’t realize just how severely she was injured. “When the paramedics arrived, I was holding my hand,” she recalls. “But I didn’t know how bad my wrist was and I told them I needed them to fix my hand so I could get to work.” A week later, she had surgery to insert a plate and screws, along with a donor bone, into her hand. Then, the hand had to be sewn to close the deep split. “Only after the surgery did I realize how bad it was because I saw the photos,” she says. Fortunately, Schindler didn’t have nerve damage or a tear in the tendon. However, she still faced a long recovery. Work was not an option. When she began physical therapy in December, she only had 16 percent function in her hand. “She had almost no movement left in her dominant hand,” says Scott Richards, SCS, MSPT, a physical therapist with Kitsap Physical Therapy who treated her at the Bremerton location. “In addition to fractures, she had pretty significant soft-tissue damage and major swelling. Her hand was so tight and taut that it looked like it was made out of plastic.” Schindler ended up in physical therapy for about six months, initially visiting the office three days a week. In addition to the sessions with Richards, she followed a home program that included exercises and other techniques. “It took a very long time to get the swelling under control and get the mechanics of the fingers back,” Richards says. “She powered through the pain, and never lost sight of what she was trying to achieve. As a result, she had great outcomes.” Schindler estimates she had about 60 sessions at Kitsap Physical Therapy. By the end of physical therapy last June, Schindler had regained 88 percent function. Today, she feels she’s closer to 95 percent. She’s resumed her regular work schedule and doesn’t have any restrictions in daily activities. “My hand is great,” she says. “My right wrist doesn’t move like my left hand but as far as recovery goes, I feel great.” Schindler recalls breaking into tears when Richards cleared her to end office treatments. It was a bittersweet moment because Kitsap Physical Therapy had meant more than just physical recovery. “It was a hard, dark time for me. Coming to physical therapy helped me mentally,” she says. “The entire staff was welcoming and kind, and they helped me through that time. I think Scott and his staff helping me recover and seeing me two to three times a week was a safety net. You could just tell they enjoy being there and they love their job. They care about their patients.” Richards says due to the extent of the damage he didn’t expect the result to be so successful. He credits Schindler for being willing to do whatever it took. He says that the home program plays a big role in outcomes not only in trauma cases like Schindler’s, but also in treating chronic conditions. “Being consistent with the home program is an important component of every hand therapy regimen because there’s a limited amount of time the patient is working with us one-on-one in the office,” he says. He notes that hand therapists can treat a variety of cases, including arthritis and carpal tunnel syndrome. “Many people have arthritis in their fingers, thumbs, and wrists and think there’s not much they can do about it,” Richards says. Arthritis and other non-traumatic joint disorders, in fact, are the five most costly conditions among American adults, according to the Arthritis Foundation. The foundation conservatively estimates that 45 million adults in the United States have been diagnosed with arthritis. Richards says he would like to see more physicians tell patients with arthritis that physical therapy could be a good option for them. “We can’t change the fact they have arthritis in their joints but through certain techniques and education, we can help reduce the pain and improve the range of motion and function for everyday activities,” he says. “We can help them gain a higher-function lifestyle.” KPT has certified hand therapists at 5 clinics: Bremerton, Port Orchard, Silverdale and both Poulsbo locations. Physical Therapy for Hands Can Treat Both Trauma and Chronic Conditions
  27. 27. Health Care HAND THERAPY ARTHRITIS How Therapy Can Help  1. Learn Arthritis Management Strategies.  Arthritis management strategies provide those with arthritis the skills and confidence to effectively manage their condition.  These techniques have proven to be valuable for helping people change their behavior and better manage their arthritis symptoms.  Learn more about self-management education program.  2. Be Active.  Research shows physical activity decreases pain, improves function and delays disability.  It is recommended that people with arthritis undertake 30 minutes of moderate physical activity at least 5 times a week, or a total of 150 minutes per week. The 30 minutes can be broken down into three ten-minute sessions throughout the day.  Learn more about physical activity for arthritis from your therapist, in a protected environment.  3. Watch Your Weight.  Research confirms that maintaining a healthy weight can limit disease progression and activity limitation.  A modest weight loss (5% or 12 pounds for a 250 pound person) can help reduce pain and disability.  4. See Your Doctor and Therapist.  Early diagnosis and professionally guided management is critical to maintaining a good quality of life, particularly for people with inflammatory arthritis.  Learn about splints and orthoses that can improve and protect joint function.  5. Protect Your Joints.  Sports or occupational based injuries to joints can increase the likelihood of developing osteoarthritis. Jobs that have repetitive motions, (for example: repeated hand use), place individuals at higher risk.  Avoiding injuries to joints can reduce the likelihood of developing osteoarthritis.  Basic joint protection principles limit hand joint deformation when implemented early in the arthritis process. (CDC) Prevalence and Treatment of Arthritis: 40 million people in the US suffer from arthritis Estimated to reach 59 million Americans by 2020 (Arthritis Foundation) 1 in 25 working age adults attribute work limitations to arthritic conditions, 1 in 4 with diagnosed arthritis have work limitations. (Arthritis Foundation) Patients can be evaluated and treated by a licensed PT/OT without a physician’s referral, called Direct Access. Some insurance plans may still require you to consult with a physician first, in order to be reimbursed for services, so please check with your insurance provider as plans differ. Prevalence and Treatment of Arthritis: 40 million people in the US suffer from arthritis. Estimated to reach 59 million Americans by 2020. (Arthritis Foundation) 1 in 25 working age adults attribute work limitations to arthritic conditions and 1 in 4 with diagnosed arthritis have work limitations. (Arthritis Foundation) Patients can be evaluated and treated by a licensed PT/OT without a physician’s referral, this is called Direct Access. Some insurance plans may still require you to consult with a physician first, this is in order to be reimbursed for services, so please check with your insurance provider as plans differ. HOW THERAPY CAN HELP 1. Learn Arthritis Management Strategies. 2. Be Active. 3. Watch Your Weight. 4. See Your Doctor and Therapist. 5. Protect Your Joints. ARTHRITIS Bainbridge Island (206) 842-6288 Bremerton (360) 792-1015 Kingston (360) 297-7050 Port Orchard (360) 895-9090 Poulsbo-NKMC (360) 779-3764 Poulsbo-Village (360) 779-3777 Silverdale (360) 613-1834 locations to serve you7 Unique Features 3500 9th Street, Bremerton * Assisted living community in Bremerton * Please inquire about additional housing options for adults under 55 * Relaxing & welcoming atmosphere * Clean & comfortable * Tenured staff * Daily Activities 360-479-4130 3500 9th Street, Bremerton Hands define our humanness. Humans constantly use their hands to interact with the environment and they engage spontaneously in a wide variety of manual activities during everyday life. Protecting hands is the best opton for keeping them functioning at their best. Aristotle called the hand the "tool of tools". Without your hands, your ability to work is greatly reduced. The hand is the second most common body part to be injured at work Every year, roughly 30 percent of all workplace injuries are from cuts and lacerations and 12 percent of those were strictly to the hands. Seventy percent of hand injuries in the United States occur when people are not wearing gloves. As of the 2012-2013 fiscal year, the average total incurred cost per claim in the United States for hand, finger and wrist injuries was $22,384 according to the National Safety Council.
  28. 28. 26 Spring/Summer 2019 Health Care Healthcare systems like Jefferson Healthcare--a public, Critical Access Hospital (CAH) in Port Townsend--are increasingly focused on preventative care to improve the health of individuals and the community. In many ways, Jefferson Healthcare’s hospital and clinics are industry leaders in the shift from treating disease to promoting a healthier lifestyle and emphasizing prevention and wellness. “Many of us are already practicing this approach with our patients,” said Dr. Joe Mattern, chief medical officer at Jefferson Healthcare, referring to his primary care practice partners. Behaviors such as diet, exercise and tobacco use contribute about 30 percent to a person’s overall health, according to research by the Wisconsin Population Health Institute, while clinical care accounts for a mere 20 percent. Another 10 percent is a result of our physical environment, but social and economic factors contribute a staggering 40 percent to long-term health. Addressing these social and economic factors is essential for healthcare systems and physicians trying to maintain or restore a patient’s health. Of the social factors influencing overall health, poverty is the most significant. Other considerations play a dominant role, too, including housing; employment; availability of clean water and healthy food; social interaction and its flip side, isolation; and community safety. Social and economic factors can be crucial influencers of health. “When you don’t invest in these things upfront, then you’re cleaning up the resulting mess,” said Dr. Joe Mattern, chief medical officer at Jefferson Healthcare. In an understandable metaphor, Mattern likened healthcare to a pizza. “It’s a finite pie. There will be some who gorge on more than one or two pieces, and others who will never get a slice.” He said that while many practitioners in the primary care clinics are already aiming at a more holistic approach, they are trying to pay greater attention to those patients who fall through the cracks and are not getting their share of the pie. “I need time to think about who’s not in front of me in the clinic, too,” Mattern said. To illustrate the goals, Mattern said that a diabetic might have a greater chance of an overall improvement in health if the patient could manage his or her anxiety and depression. Likewise, well-child checks in young children are designed to thwart future health issues when they become adults. Cancer screenings and behavioral health screenings might mean avoiding costly interventions later in life. Even investing in swimming lessons is an example of prevention. Dunia Faulx heads the population health department at Jefferson Healthcare, a unique department dedicated to investigating how social interventions could lower costs and improve health – not only for individuals but also for the whole community. Faulx explained, “The field of population health assesses health outcomes of a group of individuals with the goal of creating a healthier community.”  Jefferson Healthcare’s Population Health Department bridges the gap between traditional individual medical care and healing the social needs of the community, according to Faulx. As a public, rural hospital, however, it cannot invest in all of the social determinants of health at once. Initially, issues targeted for improvement were aid in housing, provision of healthy food, and decreasing social isolation. In 2019, the department will also look at addressing transportation barriers; working to promote financial health including supported employment; and ensuring support and health in early life. Additionally, in the clinical setting, primary care has integrated behavioral health and reproductive health. Jefferson Healthcare’s new dental clinic, which will accept Medicaid patients opens in June of this year. Also in the works is medically assisted treatment for opioid-addicted patients. Historically, insurance companies, Medicare and Medicaid have not reimbursed healthcare systems for providing those types of services, making it difficult to integrate them into a holistic approach to health and to address the social factors that contribute so much to a person’s health. However, there is movement now in the reimbursement world to offer incentives for keeping patients healthier. Reimbursement models from insurance providers are slowly catching up to the shift in care from sickness toward wellness. The old approach isn’t gone completely, but at Jefferson Healthcare, changes are evident. There is an intentional shift toward prevention, education, and support for patients, their families, and the community as a whole. Jefferson County Public Hospital District No. 2, doing business as Jefferson Healthcare, is a DNV-accredited, fully integrated healthcare system providing services to over 29,000 residents of east Jefferson County on the Olympic Peninsula of Washington State. The hospital is a fully accredited 25-bed Critical Access Hospital under CMS guidelines, with complete 24-hour coverage by a physician staff of hospitalists. In addition, Jefferson Healthcare has clinics located in and around the hospital and local communities. Disease to Wellness: Shifting the Focus of Healthcare
  29. 29. Health Care LIVE LIFE PAIN FREE.By proactively controlling your health, you can be pain-free, independent and live the life you’ve always dreamed of. SOME OF THE CONDITIONS WE TREAT: • Chronic Pain • High Blood Pressure • Neuropathy • Depression • Diabetes • Memory Loss • Fatigue • Joint Pain • Fibromyalgia Call (360) 394.4357 to take the first step. 18870 8th Ave NE • Suite 108 • Poulsbo, WA 98370 O ne of the largest C hinese M edical C linics in the U SA , right in your backyard.
  30. 30. 28 Spring/Summer 2019 Health Care O pioids possess a strong affinity for dependency and addiction when used medicinally to treat moderate to severe pain, or recreationally for pain relief or psychedelic effects. Hearing loss is rarely recognized as a side effect of opioid use and abuse. Yet, with more than two million Americans dependent on prescription pain pills, as the opioid crisis continues its devastating grip on the nation, this hearing loss aspect of the epidemic is an important consideration for healthcare providers and individuals taking pain medications. Studies indicate opioid use can lead to permanent profound sensorineural (damage to the hair cells in your inner ear or to the nerve pathways that lead from the inner ear to the brain) hearing loss in either one ear or both ears and it may occur gradually over time or suddenly. Other common side effects of prescription opioids include tinnitus and vertigo. While the exact mechanism is unknown, audiometric tests and proposed theories suggest opioid-induced blood vessel constriction in the inner ear, can lead to cochlear (the sense organ that translates sound into nerve impulses sent to the brain) blood starvation. The narrowing of blood vessels may also impede blood flow to the auditory nerve and brain. Numerous factors like genetic predisposition to hearing loss, exposure to noise or other ototoxic chemicals (chemicals that affect the ear or its nerve supply), the combination of opioids with NSAIDS (medications known for their ototoxic effects as well) and concurrent medical conditions like renal failure, all contribute to ototoxicity in patients. In one study, a small group of men under the age of 50 with a history of noise exposure and opiate abuse showed 100 percent had hearing loss, suggesting opiates may worsen noise induced hearing loss. Opioid use has other side effects as well, including cognitive dysfunction and reduced neural plasticity (the brain’s ability to form new neural connections. A small study on opiate users showed reduced and delayed responses to auditory stimuli along with altered sensory information processing. The growth and development of nervous tissue occurs throughout life but is diminished by opiate addiction, especially in a region of the hippocampus responsible for spatial and pattern discrimination. This minimizes the benefits of using hearing aids or auditory/ cognitive training. Opioids can have a direct impact on hearing that can be temporary or permanent. If you are taking any opioid/ opiate/NSAID you should obtain a diagnostic hearing and communication evaluation from an audiologist and monitor your hearing over time for changes in your hearing. 3 out of 4 wearers said hearing aids make them more confident in social situations Camron Meikle, Au.D. 345 Knechtel Way NE #105 • Bainbridge Island, WA 98110 115 Village Way • Port Ludlow, WA 98365 206-842-6374 • Are You Ready to Treat Your Hearing Loss & Improve Your Quality of Life? 8 out of10 wearers said hearing aids improve their quality of life 7 out of10wearers said hearing aids improve their relationships Opioids and Your Hearing By Camron Meikle, Au.D.
  31. 31. Health Care You. Us. Better together. Hello Neighbor! People travel from around the world to receive treatment from Seattle Cancer Care Alliance. You, on the other hand, don’t have to leave the neighborhood! Thank you for welcoming us to the community. Berit L. Madsen, MD, FACR Medical Director, SCCA Peninsula
  32. 32. 30 Spring/Summer 2019 Health Care W hile unsightly, varicose veins are far more than cosmetically concerning. The condition is a genuine medical disorder that is often quite painful and disruptive to lifestyle. The discomfort may cause sufferers to curtail activities they enjoy, and even affect simple activities of daily living such as walking or standing. What are Varicose Veins? Veins carry blood to the heart. One-way valves in the veins control the flow of blood in the proper direction. Varicosities occur as a result of faulty valves allowing reflux (back up) causing blood to collect in the veins, resulting in bloated, swollen vessels. Left untreated, varicose veins may lead to complications such as superficial thrombophlebitis (a blood clot in a vein close to the surface of the skin), and painful skin ulcers that are very slow and difficult to heal. Causes Varicose veins can be genetic (inherited). Aside from genetics, however, the most common cause is extreme prolonged pressure on the abdomen or legs. This includes conditions such as obesity, pregnancy, and standing or sitting for extended periods of time. Symptoms Varicose veins most commonly occur in the legs. Some people experience them in one leg, while others find both legs affected. Symptoms include: • Bulging, ropy, dark blue or purple veins visible under the surface of the skin • Leg achiness, frequently described as “heaviness” • Painful, throbbing leg pain or cramping • Itching, especially of the lower leg and ankle • Skin discoloration over the enlarged vein(s) • Leg swelling Diagnosis Symptoms should be investigated by a healthcare provider. During evaluation, visual examination involves two primary positions. The first, while the patient stands upright to observe how pressure of full body weight affects the veins. And the second, while the patient sits or lies prone (flat on back) and lifts each leg, one at a time. By doing so, the provider will note if the swelling is reduced while the leg is elevated, essentially “draining” the varicosity. An important component in diagnosing varicose veins is an ultrasound examination. Also known as a Doppler study, or duplex ultrasound, this non-invasive (requiring no incision or injection) imaging test employs sound waves, not radiation, to assess blood flow and causes no discomfort. Choosing a Provider Telangiectasias (“spider” veins) are often associated with varicose veins. These fine, threadlike veins are quite common and may be easily treated in an office setting. As a result of our cultural emphasis on cosmesis (restoration of beauty) there are a great deal of vein centers competing for the care of leg vein health. However, not every vein center is staffed by medical providers thoroughly knowledgeable in vein disease. To reduce the risk of overlooking a serious underlying disease process, consult a board-certified vascular surgeon for the diagnosis, treatment, and management of varicosities. While genetics and lifestyle can indeed contribute to varicose veins of the legs, there are other rare conditions, such as vascular anomalies, that may cause varicosities of the legs or other parts of the body. In these cases, misdiagnosis could result in further exacerbating the problem with inappropriate treatments that lead to undesirable or irreversible outcomes. A vascular surgeon will know when to order additional testing, such as magnetic resonance imaging (MRI), for a picture of the vessels and adjacent anatomy, and refer the patient to a specialty center for treatment, if necessary. Common Treatments Conservative, Non-Surgical Providers will recommend a three-month trial of conservative measures prior to any intervention. These are intended to reduce discomfort without injections or surgery and include some, or all, of the following: • Compression (tight-fitting knee-high, thigh-high, or pantyhose worn daily to support weakened vessel walls and improve blood flow) • NSAIDs (non-steroidal anti-inflammatory drugs such as Tylenol) • Limb elevation (resting with one’s feet above the level of the heart) • Weight loss, if necessary • Increased activity, to promote blood flow Patients should return for re-evaluation after this course to determine if there is significant improvement of symptoms. If successful, these simple steps may be continued for as long as the patient feels well. Treatment of Varicose Veins is not Vain By Carol Fisher