What are Advance Directives?

Advance directives center around the principles of your right to die and death with dignity. With an advance directive, you can express how much or how little you want done for you when you are no longer able to make these decisions.

• Advance directives are a way of making your voice heard when you can no longer communicate. They allow you to appoint someone to make your health care decisions for you when you no longer can and to administer or withhold treatment and procedures based on your previously stated wishes. Advance directives are not just for the elderly. All people who desire to direct their medical care in the future should complete an advance directive.
• All 50 states and the District of Columbia have laws regarding advance directives. Authorities also agree that no difference exists between withholding lifesaving treatment and withdrawing life-support treatment. This is especially important in a situation where someone is resuscitated despite his or her wishes because the advance directive could not be found and the person is put on life support. Once the advance directive is shown to health care professionals, life-support measures can be withdrawn according to the advance medical directive.
• An advance directive does not mean "do not treat." This is a common misperception and not correct. Of course, if you want it to mean do not treat, then that is something that your surrogate needs to know.
• Proper execution of an advance directive is a delicate task. A person should discuss this with loved ones and consider personal values and beliefs.

• It is also impossible to think about all the possible medical and social scenarios that may happen in the future during the course of a disease and person's lifetime. Thus, people often change their minds contrary to their living wills while still capable of making their own decisions. Living wills can be modified to reflect any such changes.

Definitions Involved in Advance Directives

Advance directives: An advance directive is a written document or series of forms that must be signed to be binding. The documents indicate an individual's choices about medical treatment.
Two types of advance directives are generally completed: a living will and a medical power of attorney (also referred to as designation of a health care surrogate or health care proxy).

• Living will: This written statement tells health care professionals what type of life-prolonging treatments or procedures to perform if someone has a terminal condition or is in a persistent vegetative state. Living wills should not be confused with a regular will. A living will addresses issues regarding your medical care while you are still living.
• Medical power of attorney (or designation of a health care surrogate): This legal document allows you to select any person to make medical decisions for you if you should become temporarily or even permanently unable to make those decisions for yourself. This person is also referred to as your attorney-in-fact or durable power of attorney for health care. Most people choose a family member, a relative, or a close friend as their surrogate decision maker. It is important that the designated person knows and understands your wishes and preferences and has a written copy of either your living will or medical power of attorney.

Life-prolonging treatments: These are procedures that are not expected to cure your terminal condition. They generally are used to sustain life. Examples of life prolonging treatments include mechanical ventilator (breathing machine), kidney dialysis, and cardiopulmonary resuscitation (CPR).
Terminal condition: A terminal condition is an incurable (without cure) condition that is in its terminal stages.
Persistent vegetative state: This permanent coma or state of being unconscious is caused by injury, disease, or illness. No reasonable expectation of recovery exists.
Do not resuscitate (DNR): This document tells health care professionals and emergency personnel that if your heart stops beating (cardiac arrest) or if you stop breathing (respiratory arrest) that they are not to attempt to revive you by utilizing CPR, chest compressions, intubation, or shocking the heart.
Artificial nutrition and hydration: This procedure is the administration of nutrition and fluids through IV lines and feeding tubes. IV (intravenous) hydration is a common proactice in the hospital by which fluids are delivered into veins. Tube feeding introduces liquid food through a nasal or oral tube into the stomach. Sometimes intravenous (IV) antibiotics are also included in this category. The POLST form (Physician Orders for Life-Sustaining Treatment) addresses the patient's preferences regarding artificial hydration and nutrition. This form can be signed by the patient or their decision maker and the treating physician.

Anticipatory Grief

What is Anticipatory Grief?

Patients and families facing terminal illness usually begin the grieving process prior to the actual loss. This is called “anticipatory grief.” Although it may be uncomfortable, anticipatory grief is sometimes helpful and may result in fewer grief complications later. Each person will experience grief in his or her own unique way. The same is true with anticipatory grief. It is a natural process that helps individuals prepare for emotional and physical closure. It is also a time when both patient and family prepare for change.

Things to Consider

Emotional and physical symptoms associated with grief may also be associated with anticipatory grieving. You may experience some of the following:

• Loss of appetite
• Tension and irritability
• Fatigue and insomnia
• Tearfulness
• Restlessness
• Indecision about what to do
• Guilt or anger
• Mood changes over small things, crying unexpectedly

Frequently, there may be a desire on the part of the patient to put his or her “affairs in order,” so that their wishes will be honored. This is sometimes referred to as completing “unfinished business.”
Often, there is a concern on the part of the patient about how loved ones will cope after the loss. The patient may wish to ensure that loved ones obtain practical life skills during this time, such as learning to balance the checkbook or learning how to cook.
The patient may also express the need to emotionally withdraw from others. Caregivers may observe “distancing” behavior, such as the patient becoming less conversational, losing interest in activities that once held meaning, and refusing to allow close friends and family to visit.

What to Do

• Reach out to persons and groups that can offer you support and help.
• Seek help through counseling with a therapist, minister, priest or rabbi.
• Remind yourself that everyone needs adequate time to grieve.
• Utilize any spiritual beliefs that bring you comfort or relief.
• Express yourself through art, poetry, music, journaling, or gardening.
• Engage in life review through photographs, music, conversation and writing.
• Identify issues and concerns, which are important to address prior to the loss.
• Talk about your feelings.
• Address legal/financial/funeral issues as appropriate.
• Discuss future plans as appropriate.
• Identify whether or not your expectations are realistic. 

Even though the loved one you've been caring for is still alive, you may have already started feeling the weight and pain of their loss.
While some people might think of this as a type of depression, it's really a distinct form of grieving. And it's also a natural, expected response to caring for someone with a long-term or incurable illness.
This kind of grief can hurt as much as what you feel when a loved one dies. Sometimes, it may make the loss after death easier, but not always.
It's real. You can't ignore it and hope to just power through. So allow yourself to process the grief and appreciate the time you have left.
What Is Anticipatory Grief?
Unlike the grief and mourning that happen after someone has passed away, this "anticipatory grief" begins before the person has died. But the emotions can be similar.
When someone has a disease, injury, or condition that permanently changes their personality, like Alzheimer's, the grief may come as it sinks in that your loved one, as you knew them, will be "gone" even before they're gone.
You might have anxiety, dread, or sadness as you wait for their passing.
You could also feel a sense of loss and longing for your independence and freedom as your own life changes because much of your time and energy is now going to someone who needs you. And that can also lead to guilt.
Anger, bitterness, even resentment are common feelings, too, as you're forced to come to terms with the fact that you can't change the outcome.It's important to remember that all of these feelings are normal in such a difficult situation. And often, primary caregivers -- those whose take on the daily responsibility for someone's well-being  -- feel a piece of this loss each day, more deeply and in a way that others in their lives probably don't.
Be Honest About Your Feelings Whether it's a support group, a counselor, a good friend, or within the privacy of a journal, sharing what you're going through can ease those moments when you're sad, powerless, and tired. Your loved one may be dealing with their own grief, and you might find comfort together.
It's OK to cry or admit that you're angry or frustrated. These are helpful ways to keep pent up emotions from turning into resentment toward the person you care for or from taking a toll on your health.

When a friend is grieving the loss of a loved one, it’s easy to feel helpless. Sometimes we think we’re doing the right thing by trying to cheer them up, pointing out the positives or letting them know that they should try to move on. Well-intentioned as we may be, those efforts tend to put pressure on them and leave them feeling invalidated.

So here are eight ways to help you support your friend in times of need.

Let go of time expectations. The person grieving may struggle for longer than expected. If this happens, regardless of how frustrating or frightening it may be for you, let them grieve for however long they need, knowing you won’t judge them for it.

Recognize the stages of grief. Most people suffering a loss will go through these stages, often in no particular order and sometimes repeating stages: denial, bargaining, anger, depression and acceptance. Each one is healthy and necessary. The more familiar you are with these stages, the better equipped you’ll be to support your friend.

Variables to grief. One person’s grief is never the same as another’s. Variables include the cause and length of death, the personal resiliency of the grieving person, what their previous experiences have been, how large their support network is and their relationship to the person lost. Be understanding of how this can change their experience of grief from your own or someone else you have known.

Resist telling them how strong they are. We are often inclined to praise the person who appears to be coping stoically with a loss. The problem is that we need to allow them to be human and vulnerable sometimes too. After all, there’s strength in letting out your emotions from time to time.

Offer the bereaved ways to memorialize. Funerals and memorial services work to give support and closure to the bereaved. We can also memorialize in other ways, like planting trees, writing letters or having remembrance gatherings.

Ask them what they need. It’s normal to feel you can guess what your friend needs based on what you might need in their position. Because we’re all different, it is best to ask them what it is that you can do for them. If they say “I don’t know” or “nothing,” resist the desire to walk away in your frustration or worry. Just offer your support in whatever way you can and let them know that you will be there when they think of something.

Continue to check in on them. At the time of a funeral, many people offer help and support to the grieving person. As the weeks and months pass everyone’s lives move forward and they generally forget to follow up on their offerings of help and support. Be the person who follows up. You don’t have to give all of your energy, but your caring will be appreciated and will provide untold comfort.

Reel In a Veteran From the Cold

Grief and Loss just steam from death of a family member. We can also experience they way we are treated from employment, living conditions, and how we are perceived from society.

I have provided assistance such a person from rude and crude ways from employer that pushed a much hidden agenda they had other employee providing observations to the senior staff regarding work and other non work related experience. From the very start the patient continuously suffered more from being thrown into a VASH project based housing in another city from where my patient resided.  VA did not provide safe, secure, and warm living conditions after the present administration took everything away from my patient.  While, VA continues” Not” think of the Veteran “Feelings and Thoughts” at all.

Since, the debacle occurred health has taken a toll on the patient with a few long term stays in the Medical Center.  I was the only one that made a visit to ensure proper treatments, care, and provided uplifting improved Self –Esteem.

We are requesting legal assistance  to enroll into the 501 3 (C) program to garner improved Financial Assistance for the Veteran "Hand Up." back into Society the Shadow Administration  imposed upon a Veteran.

We Implore you kind and generous care to provide items and services, which will slingshot my patient back into employment, Improved Living Conditions, along with a vehicle, which will provide transportation for employment with a quick evacuation,when employment is securely secured.    

We have set up an Bereavement Appeal at https://igg.me/at/aEJufQ5xizc  

Items which are currently requested for the Patient Birthday and Re-Entry Appeal

·         Dental and Vision Exams

·         Cardiologist Specialist

·         Retired Flag Officer act as  a Mentor

·         Employment

·         Improved Living Conditions in a Small Patriotic Town

·         Advanced Education

·         2008 Chevrolet Yukon  with trailer hitch

·         Long bed trailer

·         Heart Healthy Foods

·         10 W boots and shoots

·         Business Attire

·         Chevron Fuel Card

·          Laundry and dry cleaning services

·          Full Coverage  Auto Insurance for 1 year

On behalf of the Patient / Veteran, We Are Very Grateful For Your Support and Care. 

How to Managed Anxiety After a Loss

Worry and anxiety can develop after a major loss. Anxiety is a general feeling of tenseness or uneasiness. You may feel generally anxious (called free-floating anxiety). Anxiety can cause physical symptoms, such as an upset stomach or a headache. Anxiety can also cause you to act in ways that are unusual for you, such as being more demanding, less patient, or more irritable.
Worries and anxiety can sometimes seem to take over your life, making you feel like everything is falling apart at the same time. You may need to slow down and take things one at a time. If you are feeling overwhelmed, ask for help from someone you trust.
You can manage your worry and anxiety by:

• Talking or writing about the things that are bothering you. Even if you are not sure what is bothering you, finding words for your feelings often helps you figure out what is causing your anxiety.
• Taking charge of whatever you can. Making plans to deal with your day-to-day activities and concerns helps relieve the worry and anxiety that springs from a sense of insecurity. However, resist the urge to make major life decisions when you are anxious or worried.
• Allowing other people to do some things for you that you would normally do yourself. This may be difficult. If worries and concerns are interfering with your ability to take care of personal needs and other responsibilities, ask for help from others. Allowing other people to help you also helps them, because it gives them an opportunity to show their care and concern for you.
• Asking for comfort. You may need companionship and help until you feel less anxious and worried. Ask someone you trust to stay with you. This is not a sign of weakness-it is a sign that you are aware of your need and you are taking good care of yourself.

If intense worries and high anxiety last longer than a few days, talk with your health professional or Dr. Nicholas Losito, Ph.D. for  Counseling, medicine, referrals  or a combination of the two may help you manage anxiety that makes it difficult for you to function.

Childhood Emotional Neglect

In my experience, having helped many clients through many losses, one of the greatest prolongers of each of the 5 Stages is having grown up without enough emotional attention, validation and response from one’s parents: Childhood Emotional Neglect, or CEN.When your parents do not respond enough to your emotions as a child, you learn very early and well that your emotions and emotional needs are irrelevant (or even bad) and should be avoided. To adapt, you wall off your feelings and needs so that they will not burden your parents. Not surprisingly, when you are living with your feelings blocked off, it throws major obstacles into your path through the 5 Stages.How Childhood Emotional Neglect Blocks the 5 Stages of Grief
Makes it Hard to Move Past Denial: It’s only a short jump from denying one’s feelings to using denial as a general coping mechanism. It’s easy for a CEN person who has lost a loved one to end up prolonging his grief by refusing to feel the painful feelings that need to be accepted and processed. Alex, who stays busy to avoid his sadness and loss is a perfect example of that. Over time, avoiding your feelings of loss does nothing to process them. The result: you are stuck.
You Can’t Accept or Work With Your Anger: In phase 2, your anger is there to protect you. But if anger wasn’t allowed from you in your childhood home, you may have great difficulty allowing yourself to be angry as a grieving adult. You may be at risk of instead turn your anger inward at yourself, compounding your feeling of loss with even more pain.
Difficulty Accepting Help and Support: CEN makes you feel guilty or weak for having normal emotional needs. It’s hard for you to ask for help or accept comfort from others even in the best of times. When you’re grieving, there are few things that can help more than the love and support of someone who cares about you.
Depression Phase is Prolonged: With your emotions walled off, your anger directed at yourself, and the people most able to support you kept at bay, you are at great risk for getting stuck in a depression that won’t let go. How can Joanne move forward to the next phase, accept the painful reality of her loss and heal from it when her brain chemicals are thrown out of balance by depression?
Open up and talk to someone who can give you comfort. Ask for support and accept it. It will help.
Make a point to feel your feelings of grief, even if only for a brief period every day. Think about the one you’ve lost, and cry if you need to.
Pay attention to whether you are stuck in anger or depression. Might an anti-depressant give you a kick-start to deal with the genuine sad feelings that are waiting to be processed? Consult a professional, if needed.
Start addressing your Childhood Emotional Neglect. It’s important to begin to feel all of your feelings, not just your grief. Just as your grief is blocked in some way, so also is your joy. You need to feel all of your emotions in order to heal and move forward.

The whole point of the 5 Stages is to move through them. Experiencing one phase, allowing yourself to be in it and face it prepares you to move to the next phase. Moving through the phases allows your brain to process the reality, preparing you for acceptance. Acceptance must happen before you can turn your attention forward to rebuilding yourself and your life.If this is you, it’s important to re-direct and focus yourself.4 Ways to Manage Your CEN Through GriefWhen you are grieving something, it’s crucial to acknowledge that you only feel grief when you had something great to begin with. So a part of your grief must be appreciation and gratefulness for what you had.