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
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REEPUBLICATIO
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Cover Story

2. cristaseniorliving.org
Do what you
want to do!
It’s your
thing!

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
www.westsoundlegal.com
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 TODAY~www.Amazon.com

A MUST READ!
Tony Hinson
Elder Law & Estate
Planning Attorney

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
compassandclockmc@gmail.com
www.compassandclock.com
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.
Amazon.com
www.westsoundlegal.com
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. Volume 3
We are Proudly Printed in the USA!
Bonnie Dickson
Editor
Contributing Writer
Creative Services - Print
WriteEditDesign
253-279-6401
writeeditdesign15@gmail.com
Carol Fisher
Contributing Writer
Better Days Writing & Creative
402-301-6376
thecarolfisher@gmail.com
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. 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. 5www.compassandclock.com/
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
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Infinex Financial Advisor
360.344.4901
Daniel.Burris@ourfirstfed.com
Shawnie Peters
Infinex Associate Financial Advisor
360.681.7671
Shawnie.Peters@ourfirstfed.com
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
compassandclockmc@gmail.com.
Letters to the Publisher

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. 7www.compassandclock.com/
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
https://fa.morganstanley.com/
thecascadegroup
thecascadegroup@morganstanley.com

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. 9www.compassandclock.com/
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.
veteransaidbenefit.org and www.veteranaid.org.
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
www.simplyhearaudiology.com
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. 10 Spring/Summer 2019
Financial Planning
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206-842-2642 360-779-7872
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& 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. 11www.compassandclock.com/
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© 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
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www.reversemortgagewithjoan.com

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. 13www.compassandclock.com/
Financial Planning
My office has over 25 years
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Our Experienced Team:
360-779-5606 or 206-842-3408
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$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
steve@longtermfinancial.com

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 https://www.insurance.wa.gov/
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 www.smpresource.org.
-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. STEPHANIE KIRK
360.779.1082*
stephanie@jcmadisoninc.com
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 (www.medicarerights.org), 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 www.medicarerights.org.” For more free answers to
your Medicare questions, visit Medicare Interactive (MI) at
www.medicareinteractive.org. Subscribe to Dear Marci by
registering for your free account on MI.

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. 17www.compassandclock.com/
Health Care
115 Hall Brothers Loop, Suite 105
Bainbridge Island, WA 98110
www.fairytaledental.com
• Crowns, veneers, and bridges:
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• 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
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(206) 488-8006
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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. 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. 19www.compassandclock.com/
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 | athome@marthaandmary.org | www.MarthaandMary.org
10thCONSECUTIVEYEAR!

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 www.alz.org.
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. 21www.compassandclock.com/
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
alzwa.org | 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 alzwa.org
1534 Whited Place Northwest, Bainbridge Island
baileymanor.com 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. 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
www.kitsapnaturopathic.com
360-698-4141
Naturopathic Doctor, Dr. Cy Fisher

25. 23www.compassandclock.com/
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
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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. 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. 25www.compassandclock.com/
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
www.KitsapPT.com
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. 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. www.jeffersonhealthcare.org
Disease to Wellness: Shifting the Focus of Healthcare

29. 27www.compassandclock.com/
Health Care
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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 • www.hearforlifeaudiology.com
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. 29www.compassandclock.com/
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. 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