Living a Healthy Life with Chronic Pain (48 page)

Because research on medications changes rapidly, consult your health care provider, a pharmacist, or a recent drug reference book for the latest information.

When using medications alone is not sufficient to manage coronary artery disease and angina, several types of heart procedures and surgery may be helpful.

• Coronary or “balloon” angioplasty.
  Coronary angioplasty relieves the symptoms of coronary artery disease by opening the blockages and improving blood flow to the heart. In this procedure, a catheter with a balloon at the tip is inserted into the artery to widen a narrow passage in the vessel. Your physician may choose to insert a tiny mesh tube called a stent to help keep the narrowed vessel open. Many stents contain medications that may help prevent the artery from clogging up again.
  

• Coronary artery bypass surgery.
  Bypass surgery creates a new route for blood flow to your heart. During a bypass, a surgeon uses a blood vessel from your leg or chest wall to create a detour around the blockage in the coronary artery. One or more blocked arteries may be bypassed. The surgery usually requires several days in the hospital, and the recovery time can be weeks to months.
  

The medical community can do a lot to prevent coronary artery disease and manage angina. People with these conditions can live long, full lives. The combination of healthy lifestyle and selective use of medications and cardiac procedures has dramatically lowered the risk of heart attack and early death. You also have an important job to do. It is up to you to eat well and exercise, manage stress, and take your medications as prescribed. If you do not do your part, your health care team will be much less effective.

However, even with good care, people with coronary artery disease and angina need to plan for the future. Specifically, they need to make their wishes known regarding end-of-life issues and medical care. The next chapter has more on this vital self-management task.

Table 19.2
Medications for Managing Coronary Artery Disease and High Blood Pressure*

^*
Because research on medications is changing rapidly, we suggest you consult your physician, pharmacist or a recent drug reference book for the latest information.

To learn more about the topics discussed in this chapter, we suggest that you explore the following resources:

American Heart Association.
To Your Health: A Guide to Heart-Smart Living
. New York: Clarkson Potter, 2010.

American Medical Association.
Guide to Preventing and Treating Coronary Artery Disease: Essential Information You and Your Family Need to Know about Having a Healthy Heart
. Hoboken, N.J.: Wiley, 2008.

Casey, Aggie, Herbert Benson, and Ann MacDonald.
Mind Your Heart: A Mind/Body Approach to Stress Management, Exercise, and Nutrition for Heart Health
. New York: Free Press, 2004.

Casey, Aggie, Herbert Benson, and Brian O’Neill.
Harvard Medical School Guide to Lowering Your Blood Pressure
. New York: McGraw-Hill, 2005.

Granato, Jerome.
Living with Coronary Artery Disease: A Guide for Patients and Families
. Baltimore: Johns Hopkins University Press, 2008.

Heart and Stroke Foundation.
Recovery Road: An Information Guide for Heart Patients and their Families
.
www.heartandstroke.com/site/c.ikIQLcMWJtE/b.3751099/k.C320/Heart_disease__Recovery_Road.htm

Heller, Marla.
The DASH Diet Action Plan: Proven to Lower Blood Pressure and Cholesterol Without Medication
. New York: Grand Central Life & Style, 2011.

Ornish, Dean.
Eat More, Weigh Less: Dr. Dean Ornish’s Life Choice Program for Losing Weight Safely While Eating Abundantly
. New York: Quill, 2001.

Ornish, Dean.
The Spectrum: A Scientifically Proven Program to Feel Better, Live Longer, Lose Weight, and Gain Health
. New York: Ballantine, 2008.

Rippe, James M.
Heart Disease for Dummies
. Hoboken, N.J.: Wiley, 2004.

Taylor, Jill Bolte.
My Stroke of Insight: A Brain Scientist’s Personal Journey
. New York: Viking, 2009.

C
CHRONIC PAIN IS RARELY A LIFE-LIMITING CONDITION,
but it can accompany diseases that become progressively worse. Also, people with chronic pain can develop additional conditions as they age. They often worry about what will happen to them if their condition becomes truly disabling. They fear that at some time in the future they may have problems managing their condition and their lives.

One way people can deal with fears of the future is to take control and plan for it. You may never need to put your plans into effect, but you will be reassured knowing that you will be in control if the events you fear come to pass. In this chapter, we examine the most common concerns and offer some suggestions that may be useful.

Regardless of our state of health, most of us fear becoming helpless and dependent. But this fear is even greater among people with potentially disabling health problems. And it usually has financial, social, and emotional components as well as physical concerns.

As your health condition changes, you may need to consider changing your living situation. This may involve hiring someone to help you in your home or moving to a place where more help is provided. How you make this decision depends on your needs and how they can best be met. Your physical, financial, social, and emotional needs all must be considered.

Start by evaluating what you can do for yourself and what activities of daily living require some kind of help. Activities of daily living are the everyday things such as getting out of bed, bathing, dressing, preparing and eating meals, cleaning house, shopping, and paying bills. Most people can do all of these things, even though they may have to do them slowly, with some modification, or with help from gadgets.

Some people, though, may eventually find one or more of these tasks no longer possible without help from somebody else. For example, you may still be able to fix meals but no longer can do the shopping. Or if you have problems with fainting or sudden bouts of unconsciousness, you might need to have somebody around at all times. You may also find that some things that you enjoyed in the past, such as gardening, are no longer pleasurable. Using the problem-solving steps discussed in
Chapters 2
, analyze the situation and make a list of the potential problems. Once you have this list, solve the problems one at a time.

First, write down every possible solution you can think of for each problem. For example:

Can’t go shopping

• Get daughter to shop for me
  

• Find a volunteer shopping service
  

• Shop at a store that delivers
  

• Ask a neighbor to shop for me
  

• Shop for groceries on line and have them delivered
  

• Get home-delivered meals
  

Can’t be by myself

• Hire an around-the-clock attendant
  

• Move in with a relative
  

• Get a Lifeline Emergency Response system
  

• Move to a board-and-care home
  

• Move to a retirement community
  

Select the solution that seems the most workable (step 3 of problem solving). It will depend on such things as your finances and the availability of family or other resources. Sometimes one solution will be the answer for several problems. For instance, if you can’t shop and can’t be alone, and household chores are becoming difficult, you might consider a retirement community that offers meals, regular house cleaning, and transportation for errands and medical appointments.

A good self-manager often makes use of other resources (step 6 in the problem-solving steps in
Chapters 2
). Your local hospital, senior center, or center for people with disabilities can provide information about resources in your community. They can also give you ideas about how to deal with your care needs. For our retirement community example, look up the independent living center or agency that assists people with disabilities in your area. It should be able to direct you to an out-of-home care facility appropriate for you.

It may help to discuss your wishes, abilities, and limitations with a trusted friend, relative, or a professional such as a social worker or occupational therapist. Sometimes another person can spot things you may overlook or would like to ignore. Several kinds of professionals can be of great help. Social workers are good for helping you decide how to solve financial and living arrangement problems and for locating appropriate community resources. Some social workers are trained in counseling and can assist you with emotional and relationship problems that may be associated with your health condition or advancing age.

An occupational therapist can assess your daily living needs and suggest assistive devices or rearrangements in and around your home to make life easier. They can be especially helpful for people with chronic pain who have limited movement. Occupational therapists can also help you figure out how to keep engaging in pleasurable activities.

If for any reason you are admitted to the hospital, you will see a discharge planner before you go home. This person (usually a nurse) will check to make sure you know how to care for yourself and you have the help you need. It is very important that you be honest with this person. If you have concerns about your ability to care for yourself, say so. Solutions are almost always available, and the discharge planner is a real expert. However, the planner can help only if you share your concerns.

To get your financial affairs in order, consult a lawyer. He or she can help you preserve your assets, prepare a proper will, and perhaps execute a durable power of attorney for both health care and financial management (see
page 335
). If finances are a concern, contact a local agency such as a senior center for the names of attorneys who offer free or low-cost services. Your local bar association chapter can also refer you to a list of attorneys who are competent in this area. These attorneys are often specialists in elder law, but they generally are familiar with the laws applying to younger persons with disabilities as well.

Make changes in your life slowly, one step at a time. You don’t need to change your whole life to solve one problem. Remember that you can always change your mind, so leave your options open. If you think that moving out of your own place to another living arrangement (relatives, care home, or elsewhere) is the right thing to do, don’t give up your present home until you are settled in your new home and are sure you want to stay there.

If you think you need help at home, hiring someone is less drastic than moving. If you can’t be alone and you live with a family member who is away from home during the day, going to an adult or senior day care center may be enough
to keep you safe and comfortable while your family is away. In fact, adult day care centers are ideal places to find new friends and activities geared to your abilities.

If you find that you cannot manage alone, the first option usually is to hire somebody to help. Most people just need a person called a home aide or something similar. These are people who provide no medically related services that require special licensing but do help with bathing, dressing, meal preparation, and household chores.

There are a number of ways to find somebody. The easiest, but most expensive, is to hire someone through a home care agency. You can find these companies online or listed under “home care” or “home nursing” in the Yellow Pages. These are usually (but not always) private, for-profit businesses that supply caregiver staff to individuals at home. The fees are usually about double what you would expect to pay for someone you hire directly. The advantage is that the agency assumes all personnel and payroll responsibilities. It guarantees the skill and integrity of the attendant and can replace an ill or no-show attendant right away. It also pays the staff directly, so you do not have to pay the attendant.

Most of these agencies also can provide licensed staff who are certified to handle more medically involved tasks. Unless you are bedridden or require some procedure that must be done by someone with a certain category of license (such as a registered nurse), a home aide will most likely be the most appropriate and least expensive choice for your needs.

Other types of agencies act as referral services. They maintain lists of prescreened attendants or caregivers, and you select the one you wish to hire. The agency may charge a placement fee, usually equal to one month’s pay of the person hired. It will assume no liability for the skill or honesty of these people, so you’ll need to check references and interview carefully. Look online or in the Yellow Pages under the listing for “home nursing agencies” or “home nursing registries.” Some agencies provide both their own staff and registries of staff for you to select from.

Senior centers and centers serving the disabled are also resources for finding a home aide. They often have listings of people who have contacted them about their home attendant services or who have posted a notice on a bulletin board there. These job seekers are not screened. You must interview carefully and check references before they start working for you.

Many experienced home care attendants advertise in the classified “employment wanted” section of the newspaper or on websites such as Craigslist. You can find a competent helper this way, but the advice again is to interview and check references carefully.

Probably the best source of help is word of mouth—a recommendation from someone who has employed a person or knows of a person who has worked for a friend or relative. Putting the word out through your family and social network may lead you to a jewel.

Home sharing may be a solution for the person who can offer living space to someone in exchange for help. This works best if you primarily need help with household and garden chores. Some people may also be willing to
provide personal care, such as help with dressing, bathing, and meal preparation. Look for community agencies or government bureaus that match home sharers and home seekers. Voluntary organizations, church or religious organizations, and even universities may offer this service.

In the United States, every county has an Area Agency on Aging. You can find your local agency in the phone book or online. These are excellent places to call when you are looking for resources. In Canada, most provinces have government senior services organizations and community services councils that are valuable resources.

If you are considering a move out of your home, you have several options to find the lifestyle and level of care you need. When you are looking, consider the levels of care that are offered. These usually include independent living, where you have your own apartment or small house; assisted living, where you get some help with dressing, taking medications, and other tasks; and skilled nursing, which includes help with all common daily activities and some medical care.

If you require very little personal care but recognize the need to live in a more protected setting (security, emergency response services, and so on), consider a retirement community. These can consist of owned units, rental units, or so-called life care facilities in the United States. Government-subsidized facilities are also available for low-income applicants. Even if you are not of retirement age, many facilities accept younger people. For example, some take residents at age 50 or younger if one member of the household is the minimum age.

There are almost always waiting lists for retirement communities, even before they are built and ready for occupancy. If you think such a place would be right for you, get on the waiting list right away, even if it will be a couple years before you think you want to move. You can always change your mind or decline if you are not ready when a space is available. If you have friends living in local retirement communities, ask to be invited for a visit and a meal. In this way you can get an inside view. Some communities have guest accommodations where you can arrange to stay for a night or two before you commit to a lease or contract.

Residential care homes are also known as board-and-care homes in the United States or assisted living in Canada. These homes are licensed to provide nonmedical care and supervision for individuals who cannot live alone. The living arrangements can be family-like or more of a boardinghouse, hotel-type setting.

In either type of facility, the services to the residents are the same: all meals, assistance with bathing and dressing as needed, laundry, housekeeping, transportation to medical appointments, assistance with taking medications, and general supervision. The larger facilities usually have professional activities directors. When considering a residential care home, it is important to evaluate the setting and the residents already living there to make sure you will fit in. For example, some of these facilities may cater
to individuals who are mentally confused. If you are mentally clear, you would not find much companionship there.

Although all homes are required by law to provide wholesome meals, make sure the cuisine is to your liking and can meet your dietary needs. If you need a salt-free or diabetic diet, for instance, be sure the operator is willing to prepare your special diet.

The monthly fees for residential care homes vary, depending on whether the facilities and services are basic or luxurious. Compare costs, review your budget and needs, and take your time making a decision.

Also called a nursing home, extended care facility, or convalescent hospital, the skilled nursing facility provides the most comprehensive care for severely ill or disabled people. Sometimes, a person who has had a stroke or a hip replacement is transferred from the hospital to a skilled nursing facility for a period of rehabilitation before going home. Recent studies have shown that almost half of all people over 65 will spend some time in a nursing home, many of them only for a short time.

Skilled nursing facilities provide medically related care for people who can no longer function without such care. This means that professional nursing staff may administer medications by injection or intravenously and manage feeding tubes, respirators, and other high-tech equipment. Nursing home patients are usually physically limited, so staff also help them get in and out of bed, eat, bathe, and use the bathroom. For people who are partially or temporarily disabled, the facility might provide physical, occupational, and speech therapy, wound care, and other services.

Not all nursing homes provide all types of care. Some specialize in rehabilitation and therapies, and others specialize in long-term custodial care. Some provide high-tech nursing services, and others do not.