“The best and most beautiful things in the world cannot be seen or even touched – they must be felt with the heart.”

Helen Keller

“Seniors often know that their memory and cognitive and physical abilities are declining, and reminders are only hurtful,” says Francine Lederer, a psychotherapist in Los Angeles who works with “sandwich generation” patients and their parents. But even when we manage to hold our tongue, frustration lingers. That’s when we have to be doubly mindful, because by repressing those emotions, we’re more likely to have an emotional outburst.   “You might be justifiably annoyed,” Lederer says, “but take a step back and consider how your parent must feel as she faces her diminished capacities.” When people first start “slipping,” they are aware of the loss, and they are often terrified, scared and saddened.   Since forewarned is forearmed, here are eight common things we often catch ourselves saying plus suggestions for less hurtful ways to say them.

1. “How can you not remember that!?” That lengthy discussion you had last week with your dad about getting the car inspected might as well never have happened. Seniors often lose short-term memory before long-term and forget all kinds of things we think are monumentally important, like where they put their glasses or the keys — or when to take the car in to the shop.   Say instead: “See this sticker? If the car isn’t inspected before the end of the month, a cop will give you a very expensive reminder.” Place a few Post-its notes around — on the dashboard, fridge and bathroom mirror. Add a smiley face to keep the tone light. And if you still think your parent might forget, make the appointment then call your mom that morning to remind her.

2. “You could do that if you really tried.” How hard is it to change the light bulb in the table lamp? Well, if your hands shake a lot or you can’t reach the shelf where you keep spare bulbs — or you’ve grown wary of electrical outlets — very hard. Simple tasks, like tying shoes, can become next-to-impossible if you have arthritis in your fingers or your back doesn’t bend easily. And being shamed into trying something doesn’t help.   Say instead: “Let me watch and see where you’re having trouble so we can figure out how this can get done.” Or if you live out of town: “Ask (So-and-so) for help.” Seniors, like everyone else, want to maintain their independence. But if a project is truly beyond their capabilities and they either don’t know anyone who could help (or won’t ask), you might want to try to find someone who can lend a hand.   (MORE: Is How to Be a Loving Advocate for Your Parents)

3. “I just showed you how to use the DVR yesterday.” Learning new technology is tough for any adult, but gadgets with lots of buttons and options pose a special challenge for someone whose cognition or eyesight is failing. Even those of us with nimble fingers and well-functioning frontal lobes can be stymied by a new device that labels the controls differently from the one we are used to.   Say instead: “The blue button on top turns the TV on, and there’s one set of arrows for changing the channel and another for the volume. I’ll show you again.” Better yet — ask your parents’ cable or satellite provider to recommend a senior-friendly remote control with a simple design. Some companies give these to seniors for a nominal charge. If not, purchase one at a local electronics store. Or if they’re okay following instructions, you could write or print out step-by-step directions in large, legible type and leave it near the remote or listings guide.   (MORE: Technology Buying Guide for First-Time Users)

4. “What does that have to do with what we’re talking about?” One minute you and your dad are discussing summer vegetables and the next he’s talking about a problem with the sprinkler system. What happened? Conversations with elderly parents often “go rogue” — either because they can’t keep their mind on the thread or they are simply bored and want to change the subject.    Say instead: “I was telling you about my garden. You love my fresh lettuce!” If the subject is important to you, try to bring the conversation back on track without pointing a finger at the senior’s slipping powers of conversation. And to avoid suppressing genuine anger or sadness, gently explain why the conversation was important to you. Another option: Say nothing and just listen.

5. “You already told me that.” And you don’t ever repeat yourself? We all say things more than once — but because elderly parents seem to do it all the time, we lose our patience with them.   Say instead: “No kidding?! And don’t tell me that the next thing you did was . . . .” Yes, you can make a joke out of it — but only if your parent won’t feel hurt. Best-case scenario: Your mom or dad will feel amused and relaxed enough to join in.

6. “I want your silver tea service when you die.” This is wrong on so many levels. Even worse than casually referencing their death is the fact that you come off like a circling vulture.   Say instead: “I have been reading how it’s helpful for everyone if parents leave a list specifying what will be left to whom.” Stress that unless they make their wishes known, there may be conflict among siblings and other relatives. I know one woman who gave her children and grandchildren stickers which they could use to mark items they desired (by placing them in the back or on the bottom).

7. “Wake up! (Or shhhh!) I thought you wanted to see this.” The darkened halls of concerts, movies, plays and religious services (or even the TV room at home) cue our elderly parents that it’s time for a quick snooze — which might be OK if there aren’t people around you trying to hear the show. There’s no need to remind older people that they’re committing a faux pas. And if their hearing is diminished, they may not realize that everyone can hear them “whisper.”   Say instead: “Mom, I know you don’t want to miss this.” Most likely she’ll fall asleep again. Then it’s up to you how many times you want to bother with the nudges — and not take it personally that your parent fell asleep on you.

8. “Hel-lo?! Your grandson’s name is Ryan.” How many times have you called your husband by the dog’s name? Mixing up appellations can be a sign of cognitive impairment — or just a normal problem with word recall. The more it happens, though, the more likely it is that your parent is moving into a stage where he needs medical intervention.   Say instead: “It’s Ryan, Dad. Your first grandson’s name is Ryan.” There aren’t a lot of different ways to say this: The difference here is how you say it. Don’t sound critical or angry; say it gently and with a friendly smile. If your father is truly confused, he’ll probably be relieved that you’re not offended. If it’s just a slip of the tongue, he’ll be glad you’re not annoyed. If he really truly can’t remember your children’s names, you have larger issues to deal with.   The most important thing, Lederer stresses, is that as our parents age, we go out of our way to maintain good relationships. “When dealing with elderly people, let your motto be, ‘Reframe, don’t blame,’” she says. A slip of the tongue can unleash a world of hurt and ill will. As exasperating as elderly parents can be, spouting off without thinking will only make them — and you — feel bad.

Lillian Carter (August 15, 1898 – October 30, 1983) was the mother of former President of the United States, Jimmy Carter.

One of the most emotionally complex and difficult things a person can experience is taking care of an elderly parent. I unfortunately had to spend time tending to my aging, dying father, and thought I’d pass along these several points, each of which I found to be significantly helpful during then and now with caring for my mom in the phase of my own life.

1. Accept that things have changed. When a parent starts in any way depending upon their child, a world has turned upside down. Be prepared for that radically new paradigm. Old roles may not apply; old methodologies may not apply; old emotions may not apply. Be prepared to work from — and write — a whole new script.  With my father things happened to quick and I had to think medical as a RN (my profession).  I knew what to ask when he was in the hospital and when to stop chemo and ask for hospice and how to go about with my mom when she was telling me all these different people said this and that.  I just had to say mom the MD is the bible (with my mom being severely catholic) and with all the money you pay him he is the best candidate to listen to in what should be done for the best optimal care not a priest or catholic friend or a child not in the medical profession.  She was cooperative in doing this where I made the call being in one room of my mother’s and father’s home and my mom in another room.  I called the MD introducing myself and what my profession was with several years being a RN.  I stated to the MD “If this was your father what would you recommend at this time?” (with knowing the answer already).  The MD stated I would stop the chemo.  I knew the next option was hospice and told the md please get my father under hospice with than allowing my mother to take over the conversation from there and hung up.  This gave my mother independence now in finalizing the hospice care.
2. Take it slowly. Taking care of an elderly parent is generally a marathon, not a sprint. Don’t rush it. You and they both are in uncharted territory. Let the process reveal itself to you; to the degree that you can, let whatever happens unfold organically. As much as you lead what’s happening, follow it.
3. Expect nothing emotionally. At the end phase of their life, your parent might open up to you emotionally and spiritually; they might express for you the love that, for whatever reason, they haven’t before. But they also might not do that; your parent might even more tenaciously cling to their crazy. If as you care for your aging parent you bond with them in a new and deeper way, of course that’s fantastic. But going into caring for them expecting or even hoping for that to happen is to wade into dangerous waters. Better to have no expectations and be surprised, than to have your hopes dashed.
4. Expect their anger. When you start taking care of your parent, they lose the one thing they’ve always had in relationship to you: authority. That’s not going to be easy for them to give up. Expect them, in one way or another, to lash out about that loss.
5. Give them their autonomy. Insofar as you can, offer your parent options instead of orders. It’s important for them to continue to feel as if they, and not you, are running their lives. Let them decide everything they can about their own care and situation.
6. Ask their advice. A great way to show your parent love and respect — and, especially, to affirm for them that they are still of true value to you — is to sincerely ask them for advice about something going on in your life.
7. Separate their emotional dysfunction from their cognitive dysfunction. Insofar as you can, through your conversations and interactions with your parent, learn to distinguish between their emotional and cognitive dysfunction. The patterns of your parent’s emotional dysfunctions will probably be familiar to you; those, you’ll know how to deal with. But their cognitive dysfunctioning will probably be new to you. Track it; react to it gingerly; discuss it with your parent’s health care providers. Mostly, just be aware that it’s new, and so demands a new kind of response. This is a part of the process where it’s good to remember point No. 2.
8. Love your health care providers. During this phase of your life, you don’t have better friends than those helping you care for your parent. Cleaning person, social worker, physical therapist, nurse, doctor, caring neighbor — treat well each and every person who plays any role whatsoever in caring for your parent. When they think of your parent, you want everyone involved in their care to have good, positive thoughts; you want them to want to care well for your mom or dad. Steady kindness, and little gifts here and there, can go a long way toward ensuring that’s how they feel.
9. Depend upon your spouse. You may find that your parent is more comfortable relating to your spouse than to you. Though that can certainly hurt your feelings, don’t let it. It’s simply because your parent doesn’t share with your spouse all the baggage they do with you; mainly, they’ve never been the dominate force in your spouse’s life. Your spouse and your parent are peers to a degree that you and your parent can never be. Let that work for you. Depend upon your spouse to be as instrumental in the care of your parent as he or she wants to be.
10. Protect your buttons. No one in this world knows your emotional buttons like your mom or dad does. Surround those buttons with titanium cases and lock them away where your parent couldn’t find them with a Rorschach test. Unless he or she is an extraordinarily loving and mature person, your parent is bound to at least once try to push your buttons, if only to establish their erstwhile dominance over you. Don’t let them do it. You might owe them your care, but you don’t owe them your emotional well-being. With your parent, let “No buttons for you!” be your motto.
11. Prepare for sibling insanity. Expect the worst from your sibling(s). For perfectly understandable reasons, many people go positively bonkers when their parents start to die. Money, childhood mementos, furniture and possessions from the family house, money, diversified assets, money, the will… you get the idea. Prepare for the coming crazy. Do not participate in it yourself. Insofar as you must, of course protect yourself. But no amount of money on earth is worth your dignity.
12. Take care of yourself . It’s so easy to surrender to the care of your aging parent more of your life than you should. But you serve well neither yourself nor them if you fail to take walks; to stretch out; to eat right; to make sure you spend quality time away from them. Make taking time to rejuvenate yourself as critical a part of your care routine for your parent as you do cooking their meals or making sure they take their meds. Your life still needs to be about you.
13. Talk to a friend. If you have a friend with whom you can regularly meet and talk, or even chat with on the phone, do it. During this time the input and love of a friend is invaluable to you. Sharing what you’re going through with someone not immediately involved with it can be like a life preserver when you’re bobbing in the ocean. As soon as you get involved with tending to your parent, call your best friend, and tell them that you’re going to be depending upon them to do what friends do best: care, and listen.
14. Have fun. One of the things we most need in life is the one thing we most readily jettison once we begin caring for an elderly parent: fun. Fun! Have some! Have lots! Rent a Marx Brothers movie. Wear a goofy hat. Make your parent wear a goofy hat — when they’re sleeping, Whatever it takes. But remember: A day without fun is like a day where you almost go to jail for pushing your old mom or dad down a stairwell. Whenever, wherever and however you can, truly enjoy.
15. Pray or meditate. Life doesn’t offer a lot more emotionally salient or complex than caring for an aging parent. Accordingly, then, open yourself up to God, whatever that might mean to you. Be sure to with some regularly get down on your knees, or sit comfortably in a quiet place; close your eyes; breathe deeply and slowly; and wait to come over you the peace that surpasses understanding. What you’re undergoing with your parent right now is bigger than you, your parent, or anyone else involved. Do not fail to avail yourself of the great and mighty source from whose perspective it has all, already, been resolved..

“If you suspect that someone has had a brain injury, the first step is to talk with the person, share your observations, and encourage the person to get help. The next step is for the person to share a medical, family and military history with the physician.”

Harvey E. Jacobs, Ph.D. and Flora Hammond, M.D

A Brain Injury is damage to the brain that results in a loss of function such as mobility or feeling.

Traumatic Brain Injuries can result from a closed head injury or a penetrating head injury.

Closed Injury:  A closed injury occurs when the head suddenly and violently hits an object but the object does not break through the skull.

Penetrating Injury: A penetrating injury occurs when an object pierces the skull and enters brain tissue. As the first line of defense, the skull is particularly vulnerable to injury. Skull fractures occur when the bone of the skull cracks or breaks. A depressed skull fracture occurs when pieces of the broken skull press into the tissue of the brain. A penetrating skull fracture occurs when something pierces the skull, such as a bullet, leaving a distinct and localized injury to brain tissue. Skull fractures can cause cerebral contusion. Brain trauma occurs when a person has an injury to the brain, and can be mild or severe. When a person sustains trauma to the brain, he or she may lose motor functions along with cognitive and physical abilities. Physicians use the Glasgow Coma Scale to determine the extent of brain trauma. This is a neurological scale that measures the level of a person’s consciousness. The Rancho Los Amigos Scale is used to monitor the recovery of the brain.

There are several different types of brain injuries. A mild injury may cause temporary symptoms while a severe injury could require years of rehabilitation. The two most common types of brain trauma are 1. traumatic brain injuries and 2. acquired brain injuries.

1-Traumatic brain injury occurs from external force on the head or neck. These injuries can occur from blows to the head or aggressive twisting of the neck. Some ways this could happen include falls, motor vehicle accidents, sports, and vigorous shaking. In infants, Shaken Baby Syndrome is a type of traumatic brain injury.

2-An acquired brain injury means simply you got this injury after you were born and it was caused by a condition or illness after birth. This type of injury can result from several different causes like strokes, toxic poisoning or brain tumors. Degenerative diseases and lack of oxygen may also cause this type of brain trauma. Here are some examples of acquired brain injuries:

-Bleeding in the brain which can lead to brain injury.   Blood Vessels in the brain can rupture resulting in an intra-cerebral hemmorage (one of the causes of a stroke). Symptoms may include headaches, loss of vision, weakness to one side of the body and eye pain to even garbled speech.

-Anoxia Another insult to the brain that can cause injury is anoxia. Anoxia is a condition in which there is an absence of oxygen supply to an organ’s tissues, even if there is adequate blood flow to the tissue.  Common causes of anoxia are near drowning, choking, suffocation, strangulation, heart attacks, lung damage, or very low blood pressure.

-Hypoxia:  Hypoxia refers to a decrease in oxygen supply rather than a complete absence of oxygen, and ischemia is inadequate blood supply, as is seen in cases in which the brain swells. In any of these cases, without adequate oxygen, a biochemical cascade called the ischemic cascade is unleashed, and the cells of the brain can die within several minutes. This type of injury is often seen in near-drowning victims, in heart attack patients, or in people who suffer significant blood loss from other injuries that decrease blood flow to the brain.

-Toxemia, which is poisoning from chemical or biological factors that can damage the brain. Toxemia can be caused by drugs, chemicals, gases or even toxic foods.

-Viruses and bacteria. An infection of the brain can be very damaging like:

*Meningitis is a inflammation of the lining around the brain or spinal cord, usually due to infection; Neck stiffness, headache, fever, and confusion are common symptoms.   *Encephalitis (en-sef-uh-LIE-tis) is inflammation of the brain. Viral infections are the most common cause of the condition. Encephalitis can cause flu-like symptoms, such as a fever or severe headache. It can also cause confused thinking, seizures, or problems with senses or movement..

*HIV can lead to brain injury. HIV, can affect the brain in different ways. HIV-meningoencephalitis is infection of the brain and the lining of the brain by the HIV virus. It occurs shortly after the person is first infected with HIV and may cause headache, neck stiffness, drowsiness, confusion and/or seizures. HIV-encephalopathy (HIV-associated dementia) is the result of damage to the brain by longstanding HIV infection.  It is a form of dementia and occurs in advanced HIV infection. Mild Neurocognitive Disorder is problems with thinking and memory in HIV, however is not as severe as HIV-encephalopathy. Unlike HIV-encephalopathy it can occur early in HIV infection and is not a feature of Aquired Immune Deficiency Syndrome – AIDS.

*Lastly Herpes. There are two types of herpes simplex virus (HSV). Either type can cause encephalitis. HSV type 1 (HSV-1) is usually responsible for cold sores or fever blisters around your mouth, and HSV type 2 (HSV-2) commonly causes genital herpes. Encephalitis caused by HSV-1 is rare, but it has the potential to cause significant brain damage or death.                                                                                                    *Other herpes viruses. Other herpes viruses that may cause encephalitis include the Epstein-Barr virus, which commonly causes infectious mononucleosis, and the varicella-zoster virus, which commonly causes chickenpox and shingles.*Viral infections due to blood sucking insects like mosquitoes and ticks to animals with rabies a rapid progression to encephalitis once symptoms begin. Rabies is a rare cause of encephalitis in the U.S.

When a person is diagnosed with a brain trauma, doctors will decide if rehabilitation is needed. Rehabilitation programs may vary depending on the type of brain injury and estimated recovery time. Treatment usually consists of physical therapy and daily activities. In extreme cases, patients may need to learn how to read and write again.

Therapy for brain trauma typically takes place on an outpatient basis or through an assisted living facility. Therapy may last several weeks, months or even years, and sometimes the patient is not able to make a full recovery.

It may not always be obvious when a person has sustained a brain injury. The patient may have hit his or her head and not have symptoms until a few hours later. Some signs of a possible brain injury are headaches, confusion and loss of memory. If brain trauma is not treated, it could cause permanent damage or death.

Brain injuries can affect the patient and the patient’s family, with emotional and financial hardship. When problems arise with treatment or financial issues, a brain injury lawyer or specialist may need to intervene.

“The fear of death follows from the fear of life. A man who lives fully is prepared to die at any time.”

Mark Twain

Scoliosis is a problem with the spine where the spine is curved instead of straight, with the upper back being rounded and the lower back having a “swayback,” or inner curved problem, reports WebMD.

According to the Scoliosis Research Society, 85 percent of all scoliosis causes are idiopathic, meaning the cause is unknown. The remaining causes of scoliosis include birth defects, such as vertebrae that form abnormally before birth, and certain disorders such as cerebral palsy, Marfan’s syndrome, muscular dystrophy and Down syndrome. Infections and spinal fractures can also cause scoliosis.curvature of the spine during surgical correction of this condition. Screws and rods are placed in order to stabilize and straighten the spine.

What You Should Know About Adult Scoliosis

Scoliosis is defined as a curve of the spine of 10 degrees. Adult scoliosis is broadly defined as a curve in your spine of 10 degrees or greater in a person 18 years of age or older. Adult scoliosis is separated into 2 common categories:

• Adult Idiopathic Scoliosis patients have had scoliosis since childhood or as a teenager and have grown into adulthood.  We do not yet know the cause of idiopathic scoliosis, but there is a lot of genetic work going on in an attempt to answer this question.

• Adult “De Novo” or Degenerative Scoliosis develops in adulthood. Degenerative scoliosis develops as a result of disc degeneration. As the disc degenerates, it loses height. If one side of the disc degenerates more rapidly than the other, the disc begins to tilt. As it tilts, more pressure is placed on one side of your spine and gravity tends to cause the spine to bend and curve. The more discs that degenerate, the more the spine begins to curve.Types of idiopathic scoliosis are categorized by both age at which the curve is detected and by the type and location of the curve.
• When grouped by age, scoliosis usually is categorized into three age groups:
• Scoliosis is more common in girls than in boys, and the diagnosis is usually made after a child reaches 10 years of age. A doctor performs a physical examination and may take X-rays to definitively diagnose the disease. An X-ray tells if there is any growth left in the growth plates of the femur or humerus, and scoliosis can become worse if the patient has more growing to do, states MedicineNet. Serial X-rays are performed to track the changes of the spinal curve, which helps determine the best course of treatment.

• Infantile scoliosis: from birth to 3 years old
• Juvenile scoliosis: from 3 to 9 years old
• Adolescent scoliosis: from 10 to 18 years oldTerms Used to Describe Spinal CurvatureTerms that describe the direction of the curve:
• Scoliosis curves are often described based on the direction and location of the curve. Physicians have several detailed systems to classify specific curves, but here are some common terms used to describe scoliosis:
• This last category of scoliosis, adolescent scoliosis, occurs in children age 10 to 18 years old, and comprises approximately 80% of all cases of idiopathic scoliosis. This age range is when rapid growth typically occurs, which is why the detection of a curve at this stage should be monitored closely for progression as the child’s skeleton develops.

• Dextroscoliosis describes a spinal curve to the right (“dextro” = right). Usually occurring in the thoracic spine, this is the most common type of curve. It can occur on its own (forming a “C” shape) or with another curve bending the opposite way in the lower spine (forming an “S”).Symptoms of scoliosis include an uneven waist, uneven shoulders, disjointed hip and a protruding shoulder blade, according to Mayo Clinic. The spine also curves or twists in acute cases, and the disease can cause one side of the ribs to protrude more than the other. Severe cases also induce labored breathing and back pain.Scoliosis can be recognized and diagnosed with a clinical exam, but xrays are necessary to fully evaluate the magnitude and type of scoliosis present. For a proper scoliosis evaluation, full length, whole spine xrays need to be performed. An MRI may also be recommended if there are symptoms of leg pain that may be associated with stenosis or if there is concern about possible spinal cord compression or abnormalities.The treatment of adult scoliosis is very individualized and based on the specific symptoms and age of the patient. Many patients have scoliosis and have very minor symptoms and live with it without treatment. Patients with predominant symptoms of back pain would typically be treated with physical therapy. Patients with back pain and leg pain may receive some benefit from injection treatment to help relieve the leg pain.  If lumbar stenosis (narrowing of the spinal canal) is present and is unresponsive to non-surgical treatment, then a decompression( removal of bone and ligaments pressing on the nerves) may be recommended. If the scoliosis is greater than 30 degrees, a fusion procedure will most likely be recommended along with the decompression. The fusion is recommended to prevent the curve from progressing when the spine is destabilized by the bone removal that is necessary to  decompress the nerves. Fusions are usually accompanied with metal rod and screw placement into the spine to help correct and stabilize the scoliosis and help the bone heal or fuse together. The length of the fusion, or the number of spine levels included, depends on the type of scoliosis and the area of the spine involved. The goal of adult scoliosis surgery is to first remove pressure on the nerves, and second to keep the scoliosis from progressing further.
• Treatment
• Diagnosis
• Severe scoliosis can lead to heart and lung problems if not treated, as the ribs press against the chest, making breathing more difficult, states Mayo Clinic. Adults who had scoliosis as a child may experience more back pain throughout their lives as compared to people without scoliosis.

“An estimate that 50 percent of men in their 50s have an enlarged prostate. The prostate is the gland that produces the fluid that carries sperm. It grows larger with age.”

The Urology Care Foundation