ADVICE
Sick mom doesn’t need protecting
wife. Although your inDEAR ABBY: My
stinct is to protect her, I
wife has stage 4 breast
don't think you can. Sadcancer. She is only 51,
ness in her situation is
and our most optimistic
prognosis is three to four normal. I'm sure if you
were to ask her if she'd
more years. Our chilprefer the kids censor
dren, 15 and 16, undertheir remarks
stand her disease,
in front of her,
but don't really
she would tell
have a sense of
you she wants
how much longer
to hear everywe all have tothing she can
gether.
about what
Recently we
they are thinkwent out to dining.
ner, and the kids
©2013 Newspaper Enterprise Association
When peostarted talking
ple have a terabout my retireminal illness,
ment plans and
their college plans. Later they have a right to be
sad when contemplating
that night, my wife told
the things they will be
me how sad it was hearmissing -- in your wife's
ing the kids talk about
case it will be seeing her
things she knows she
children get married, her
will never see.
grandchildren and more.
I have been debating
Let your children exwhether I should have a
press themselves fully
talk with the kids and
with their mother, and if
perhaps suggest they
avoid subjects that make she's having a bad/sad
day, listen and let her
their mother sad. What
unburden herself. A joy
do you think? -- NOT
shared is twice a joy, and
TALKING ABOUT THE
a burden shared is half a
FUTURE
burden.
DEAR NOT TALKDEAR ABBY: As a
ING: Before talking to
gift, my boyfriend,
your children, I think
"Seth," gave me a Chiyou should talk to your
huahua puppy. I like
dogs, but have never expressed a desire to have
one. In fact, I have repeatedly mentioned my
dislike for small dogs
and that I wouldn't have
a dog due to my travel
schedule for work. I'd
have to pay for food, veterinary care, toys, boarding, etc., and the dog
would be alone in my
apartment all day while
I'm at the office.
Seth still chose to give
me one. When I refused
his gift, he yelled and
left. My friends think I
was rude, and that Seth
was sweet for buying me
a puppy. I tried explaining to them, but they
were sarcastic and mean
about my decision not to
accept the dog.
This isn't the first time
something like this has
happened with Seth. For
my birthday he bought
me a smartphone, signed
me up for a two-year
contract and expected
me to pay the monthly
bill. I refused that, too.
Am I wrong? -- SIMPLE
GIRL IN SOUTHERN
CALIFORNIA
DEAR SIMPLE
GIRL: You and Seth appear to have a serious
disconnect when it
comes to communication. Is this the only area
of your relationship in
which he is tone-deaf?
Your boyfriend seems to
be the master of the
"grand gesture," with no
thought about the responsibilities his generous gifts will impose on
the recipient.
Because you told him
clearly that you dislike
small dogs, he should
not have forced one on
you. In fact, he shouldn't
have given you any living, breathing dependent
creature without first
having made sure it
would be welcomed. You
did the right thing -- the
humane thing -- in not
accepting the animal.
Dear Abby is written
by Abigail Van Buren,
also known as Jeanne
Phillips, and was
founded by her mother,
Pauline Phillips. Contact
Dear Abby at
www.DearAbby.com or
P.O. Box 69440, Los Angeles, CA 90069.
‘Good’ bacteria delivered to gut in new form
DEAR DOCTOR K: I overinfections also kill bacteria in the
heard a colleague talking about
gut that compete with C. diff.
"poop pills" used to treat diarrhea. However, they often don't kill C.
That can't be right. Can
diff. This leaves a void that
it?
allows C. diff to multiply.
DEAR READER:
Once it takes hold in the
Yes, "poop" means what
gut, C. diff creates toxins
you think it means.
that cause diarrhea, fever,
Same thing as "dooabdominal pain and indoo." It's gross, but it's
flammation that can be
true. So-called "poop
life-threatening.
pills" are being used to
Treatment of C. diff beASK DR. K
ANTHONY L.
treat diarrhea caused by
gins by stopping the antibiKOMAROFF, M.D.
bacteria called Clostridotic that triggered it in the
©2013 The President and
Fellows of Harvard College
ium difficile, or "C. diff."
first place. If that doesn't
Let me explain.
work, the doctor prescribes
Our intestines are
one of a handful of antibifilled with many different kinds of otics that specifically kill C. diff.
bacteria. Most live happily there;
But C. diff is becoming increasthey don't invade or attack the iningly resistant to antibiotics.
testine that is their home. C. diff
Ever since the discovery of
bacteria live in our guts, but in
penicillin, the obvious treatment
low numbers -- low because other
for bacterial infections has been
bacteria in the intestine out-comantibiotics. But as the problem of
pete them for nutrients.
antibiotic resistance has grown,
So far, so good. The problem
doctors have been experimenting
starts with antibiotic treatment.
with another approach. They are
Every antibiotic is good at killing
filling the gut with the bacteria
some types of bacteria, while havthat are C. diff's normal competiing no effect on other types. A
tors. They're treating bad bacteria
doctor chooses a particular antibi- with large numbers of good bacteotic based on the type of bacterial
ria.
infection that is being treated.
The good bacteria are abundant
Many people are hospitalized
in feces. Transplants of fecal mafor infections, such as pneumonia
terial (poop) from a healthy donor
or urinary tract infections. Most of are placed into the intestine of the
the antibiotics used to kill these
person who is ill. As originally
used, fecal transplants have been,
frankly, rather unpleasant. Fresh
stool from a healthy donor has
been thinned, and then either
pumped into a tube threaded
through a patient's nose and into
their intestine, or given in the
form of an enema (a liquid injected into the rectum).
Now there's an easier way to
deliver the dose: poop pills. Researchers at Harvard-affiliated
Massachusetts General Hospital
have used capsules containing
frozen fecal extracts from healthy
people to successfully treat diarrhea caused by C. diff.
Disgusting as it sounds, the
donor feces are processed so only
bacteria remains in the pill. The
pill that is swallowed is clean and
odorless. It is, essentially, a probiotic pill. And its protective gel
cover does not dissolve until it is
deep in the digestive tract.
Hopefully, the clean and odorless poop pill will prove as effective as the original ways of
delivering good bacteria into the
gut. They weren't pretty, but they
worked.
(Dr. Komaroff is a physician
and professor at Harvard Medical School. To send questions, go
to AskDoctorK.com, or write: Ask
Doctor K, 10 Shattuck St., Second
Floor, Boston, MA 02115.)
As patients face death, doctors push straight talk on care
LAURAN NEERGAARD
AP MEDICAL WRITER
WASHINGTON (AP)
— Dr. Angelo Volandes
remembers performing
rib-cracking CPR on a
frail elderly man dying of
lung cancer, a vivid example of an end-of-life
dilemma: Because his
patient never said if he
wanted aggressive care
as his body shut down,
the hospital had to try.
He died days later.
Years later, the Harvard Medical School researcher now tries to
spur conversations about
what care patients want
during life's final chapter
through videos that illustrate different options.
"This is about patient
empowerment," said
Volandes, who describes
his program in a new
book aptly titled "The
Conversation."
Most Americans say
they'd prefer to die at
home, with treatment to
free them from pain, but
the prestigious Institute
of Medicine says the reality too often is unwanted care and not
enough comfort. One
main reason: Doctors
have a hard time discussing dying and pa-
tients don't know what
to ask. Now the institute
is recommending
changes in the health
system to help patients
— not doctors or circumstances — dictate their
care, and it all starts with
some straight talk.
"These conversations
should be part of a life
cycle, not just at the end
of life," said Dr. Philip
Pizzo of Stanford University, who co-chaired
the institute's panel that
is holding meetings on
how to implement the
recommendations. "Regardless of whether an
individual is choosing
more or less, both ends
of that spectrum are important and we should
honor preferences."
Already some programs are under way to
jumpstart the discussions. VitalTalk trains
doctors for emotional
conversations such as
whether it's time to stop
cancer chemotherapy,
and how to ask what patients value most for
their remaining time.
"Doctors know what
they should do, they just
don't know how to do it
effectively," said VitalTalk co-developer Dr.
Anthony Back, a Univer-
sity of Washington oncologist.
And health facilities
can license Volandes'
videos to show families
what options ranging
from CPR to feeding
tubes to hospice involve,
before they talk with the
doctor.
For example, one
video explains that if
CPR is attempted, you
also may be put on a
ventilator — a tube down
your throat that pushes
air into your lungs, preventing eating or talking.
In a matter-of-fact manner, it shows health
workers inserting that
tube in a mannequin
and, briefly, a real patient lying sedated and
intubated.
In carefully controlled
studies, Volandes found
patients were less likely
to opt for aggressive
end-of-life care after seeing the videos than if
someone just described
their choices.
About 200 hospitals
and other health facilities around the country
use the videos. The
biggest real-world test is
going on now in Hawaii:
The state's largest insurer has licensed the
videos for use in every
hospital, and in other
health facilities including
primary care offices. Researchers are tracking
the impact.
"If one of our members makes a conscious
decision that, 'I want to
fight until my last dying
breath,' we're supportive
of that," said Hilton
Raethel, chief health officer of HMSA, the notfor-profit Hawaii
Medical Service Association. "But we want that
to be a choice you make
as opposed to, it's something that's imposed on
you."
These decisions are
much more complicated
than a checklist, said Dr.
Diane Meier, an Institute
of Medicine panelist and
director of the Center to
Advance Palliative Care
at New York's Mount
Sinai Medical Center.
Conversations are
critical because of the "it
depends" factor. Maybe
you're sure you won't
want to be on a ventilator once your cancer becomes advanced. But say
you catch a treatable
pneumonia in the meantime. Would a few days
on a ventilator be worth
it then? These are things
we need to think about.
Tuesday Mar. 24, 2015 - 3
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THAT SCRAMBLED WORD GAME
by David L. Hoyt and Jeff Knurek
Unscramble these four Jumbles,
one letter to each square,
to form four ordinary words.
DEAHA
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SHAMFI
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MARYEM
Now arrange the circled letters
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Yesterday’s
(Answers tomorrow)
Jumbles: DINKY
AGILE
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