>> NO ONE WANTS TO BE A BURDEN, BUT SOMETIMES ALL OF US NEED HELP.
JUST WHO DO WE TURN TO THEN?
"CAREGIVERS, CARING FOR US AT HOME" TONIGHT "ON CALL WITH THE PRAIRIE DOC."
>> MAJOR FUNDING FOR "ON CALL WITH THE PRAIRIE DOC" HAS BEEN PROVIDED BY:
>> AVERA IS A PROUD SPONSOR OF "ON CALL" ON SOUTH DAKOTA PUBLIC BROADCASTING.
>> LARSON MANUFACTURING IS PROUD TO SUPPORT "ON CALL TELEVISION" AS IT CONTINUES TO
OPEN DOORS FOR IMPORTANT MEDICAL INFORMATION.
>> AND BY THE SOUTH DAKOTA FOUNDATION FOR MEDICAL CARE,
THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION FOR SOUTH DAKOTA.
>> AND WITH THE ONGOING SUPPORT OF THESE INDIVIDUALS AND INSTITUTIONS...
>> GOOD EVENING AND WELCOME TO "ON CALL WITH THE PRAIRIE DOC."
THERE IS A TENDENCY TO THINK OF ASSISTED LIVING FACILITIES
AND NURSING HOMES FOR LOVED ONES WHEN THEY GET OLDER BUT,
IN TRUTH, IT IS COMMON FOR A FAMILY MEMBER TO BE THE PRIMARY CAREGIVER TO MANY
ELDERLY AND DISABLED RELATIVES.
AT HOME AND IN THE ASSISTED LIVING AND IN THE NURSING HOME.
FIRST, LET'S TAKE A LOOK AT THIS WEEK'S PRAIRIE DOC QUIZ QUESTION.
BEFORE WE GET INTO THIS.
TONIGHT, GIVE TWO SYMPTOMS OF CAREGIVER BURNOUT.
THERE ARE MANY BUT WE'RE LOOKING FOR JUST TWO OF THEM, ANY TWO.
VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED
INTO A DRAWING TO WIN A SIGNED COPY OF OUR BOOK, "THE PICTURE OF HEALTH."
EACH OF MY ESSAYS, ORIGINALLY WRITTEN FOR THIS SHOW, COMES
WITH A WONDERFUL ACCOMPANYING PHOTOGRAPH BY DR. JUDITH PETERSON.
WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW.
REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN!
>>> WE ANSWER YOUR QUESTIONS ABOUT CAREGIVERS OR ABOUT ANY
SITUATION ASSOCIATED WITH CAREGIVING AS THEY ARE CALLED
IN OR SENT TO US VIA FACEBOOK OR EMAIL.
CALL IN QUESTIONS TO 1-888-376-6225 OR SEND US AN
EMAIL TO THE ADDRESS ON THE SCREEN.
JOINING US TONIGHT IS DR. FRANNIE ARNESON OF THE
AVERA MEDICAL GROUP PALLIATIVE MEDICARE GROUP, SIOUX FALLS, SOUTH DAKOTA.
FRANNIE, THANK YOU SO MUCH FOR JOINING US.
>> THANK YOU FOR HAVING ME.
>> SO LET'S START WITH AN EXPLANATION OF PALLIATIVE CARE.
I MEAN, A LOT OF PEOPLE KIND OF KNOW WHAT HOSPICE IS.
MANY PEOPLE DON'T KNOW WHAT PALLIATIVE CARE IS.
MAYBE YOU COULD COMPARE AND CONTRAST.
>> SURE. SO, PALLIATIVE CARE IS A MEDICAL SUBSPECIALTY.
IT'S RELATIVELY NEW. IT'S ONLY BEEN RECOGNIZED FOR OVER A DECADE.
I THINK TALKING ABOUT THE SIMILARITIES BETWEEN THAT AND
HOSPICE FIRST MAKES THE MOST SENSE. >> OKAY.
>> SO, BOTH FIELDS TEND TO CARE A LOT ABOUT THE PATIENT
AND THEIR FAMILY AND NOT JUST THE MEDICAL PROBLEMS BUT WHOLE-PERSON CARE.
SO THEY'RE REALLY CONCERNED ABOUT PHYSICAL WELL-BEING AND SYMPTOM MANAGEMENT,
HOW PATIENTS ARE DOING PSYCHOLOGICALLY, SOCIALLY, SPIRITUALLY, EMOTIONALLY.
THEY BOTH CONSIST OF MULTIPLE DIFFERENT SPECIALTIES WITHIN THE FIELD.
SO, SOCIAL WORKERS, NURSES, PHYSICIANS, CHAPLAINS,
VOLUNTEERS, PHARMACISTS, TO REALLY BE ABLE TO HELP THE WHOLE PATIENT.
NOW, WITH HOSPICE CARE, IT IS LIMITED BY PROGNOSIS.
SO, TO BE ELIGIBLE FOR HOSPICE BENEFIT, GENERALLY SPEAKING,
YOU HAVE TO BE LOOKING AT A LIMITED PROGNOSIS, GENERALLY SIX MONTHS OR LESS.
HOWEVER, PHYSICIANS ARE ALLOWED TO BE WRONG, SO A LOT
OF PATIENTS END UP KICKED OFF OF HOSPICE BECAUSE THEY'RE DOING TOO WELL. >> YEAH.
>> WHEREAS, WITH PALLIATIVE CARE, THERE IS NO PROGNOSIS OR DIAGNOSIS LIMITATIONS.
IT'S REALLY ANY PATIENT THAT HAS A SERIOUS OR COMPLICATED
MEDICAL DIAGNOSIS AND COULD USE AN EXTRA LAYER OF SUPPORT.
SO WE SEE PATIENTS ALL THE TIME THAT ARE CONTINUING TO GET TREATMENTS FOR THEIR ILLNESSES.
>> CANCER. >> YEAH, LIKE CHEMOTHERAPY, RADIATION. THEY MIGHT STILL BE ON DIALYSIS.
>> AND ON HOSPICE, THEY STOP ALL THAT.
>> ABSOLUTELY. HOSPICE TENDS TO BE MORE FOCUSED ON COMFORT-DIRECTED
CARE AND KIND OF AVOIDING BACK AND FORTH TO THE HOSPITAL.
WHEREAS, WITH PALLIATIVE, IT'S REALLY CONCURRENT CARE, SIDE
BY SIDE WITH THE OTHER MEDICAL TEAMS TRYING TO PROVIDE
COMFORT AND MAKING SURE THAT THEIR VALUES ARE BEING
RESPECTED AND THE MEDICAL CARE ALIGNS WITH THEIR MEDICAL PRIORITIES ALONG THE WAY.
>> SO IN 1996, THERE WAS A STUDY, THE SUPPORT STUDY,
SUPPORT, STANDING FOR SOMETHING, BUT IT WAS IN
ACADEMIC CENTERS THROUGHOUT THE COUNTRY, MOSTLY MED
STUDENTS AND RESIDENTS WERE BEING TAUGHT THERE.
AND THEY LOOKED AT WHETHER PEOPLE HAD ADVANCED DIRECTIVES, WHEN THEY HAD
ADVANCED DIRECTIVES WERE THEY APPROPRIATELY RESPECTED, THE
ADVANCED DIRECTIVES RESPECTED, OR THE LIVING WILL RESPECTED.
THEY LOOKED AT HOW MANY WENT TO THE INTENSIVE CARE UNIT,
HOW MANY HAD A FOR SURE CHANCE OF DYING, HOW MUCH PAIN THEY WERE IN. AND IT WAS PRETTY BAD.
>> REALLY BAD. >> YEAH. I MEAN, IT SHOWED A LOT OF PAIN,
50% OF THE TIME, 50% OF THEM WERE IN PAIN.
THEY ALSO SHOWED THAT WHEN THEY HAD AN ADVANCED DIRECTIVE,
OFTENTIMES IT WAS NOT RESPECTED.
THEY ALSO SHOWED THAT WHEN THEY WERE -- THEY HAD NO CHANCE OF RECOVERY, THEY WERE
STILL PUT INTO THE INTENSIVE CARE UNIT, STILL INTUBATED, STILL GIVEN EVERYTHING THAT
THEY COULD DO, DRAGGED THROUGH ALL OF THESE THINGS.
SO THEN THEY REPEATED THE STUDY WITH AN EFFORT TO TEACH
THE DOCTORS AND TO TEACH THE NURSING STAFF AND THE PATIENTS ABOUT ADVANCED DIRECTIVES,
EVERYTHING, AND AFTER THREE YEARS REPEATING, THEY FOUND NO DIFFERENCE.
IT'S TERRIBLE. >> HEARTBREAKING. >> AND I THINK THAT MUST HAVE
BEEN PART OF THE IMPETUS TO DO PALLIATIVE CARE. ARE WE DOING BETTER NOW?
AND IS PALLIATIVE CARE THE REASON WE'RE DOING BETTER IF WE ARE?
>> I THINK THAT WE ARE SLOWLY MOVING THAT NEEDLE AND DOING SOME BETTER.
I THINK THAT PART OF IT -- AND I CANNOT TAKE CREDIT TO THE
PALLIATIVE CARE FIELD BECAUSE THERE'S SO MANY EXCELLENT
PHYSICIANS AND OTHER DISCIPLINES, LIKE SOCIAL
WORKERS, NURSES, THAT ARE REALLY ADVOCATING FOR PATIENT PREFERENCES AND PRIORITIES.
I MEAN, FAMILY PRACTICE DOCTORS, I THINK, WOULD BE AN
EXCELLENT EXAMPLE OF FOLKS THAT ARE REALLY ADVOCATING FOR
WHAT'S IMPORTANT TO THEIR PATIENT.
SO I THINK THAT THE NEEDLE IS MOVING A LITTLE BIT.
I THINK THAT WE HAVE STRESSED ADVANCED CARE PLANNING A LOT
MORE OVER THE LAST DECADE, AND NOT ONLY ARE WE STRESSING
PATIENTS COMPLETING THOSE DOCUMENTS BUT THE MOST
IMPORTANT PART IS MAKING SURE THAT WHOEVER YOU APPOINT TO
MAKE YOUR MEDICAL DECISIONS TO KIND OF SPEAK ON YOUR BEHALF IF YOU CAN'T --
>> IF YOU CANNOT. >> RIGHT. TO MAKE SURE THAT THAT PERSON
KNOWS WHAT YOU WANT SO IT'S REALLY ALL ABOUT THE CONVERSATION AND MAKING SURE
THAT YOUR FAMILY AND LOVED ONES, ESPECIALLY THE ONES THAT YOU DON'T PUT ON THAT FORM,
AND THAT MIGHT NOT AGREE WITH YOU, THAT THEY'RE INVOLVED IN
THAT CONVERSATION AND UNDERSTAND WHY YOUR
PREFERENCES AND VALUES ARE WHAT THEY ARE.
>> YEAH. I LOVE HOW YOU PUT THAT BECAUSE IN MY MIND, IF YOU
COME TO THE EMERGENCY ROOM AND YOUR FAMILY -- AND YOU'VE GOT
A LIVING WILL, BUT YOUR FAMILY HASN'T BOUGHT IN, THE FAMILY
CAN SAY, DO EVERYTHING AND WHAT DO YOU THINK THE DOCTOR'S GOING TO DO?
THEY'RE GOING TO DO EVERYTHING. THEY'RE GOING TO FOLLOW THE FAMILY WISHES.
SO THE MOST IMPORTANT PART OF A ADVANCED DIRECTIVE OR A
LIVING WILL IS TO HAVE THE CONVERSATION WITH YOUR FAMILY,
AS YOU SAID THERE.
>> AND CHOOSE THE PERSON THAT CAN PUT THEIR OWN EMOTIONS
ASIDE AND TRULY MAKE THE DECISION THAT YOU WOULD MAKE
FOR YOURSELF AS OPPOSED TO THE DECISION THEY FEEL IS RIGHT FOR YOU.
>> YEAH. >> WHICH IS HARDER THAN IT SOUNDS. >> YES.
>> AND I THINK ALSO PROBABLY THE HARDEST PART IS THE FEEDING TUBE.
>> IT IS DIFFICULT.
>> THAT'S THE BIGGEST ONE. AND, UNFORTUNATELY, I THINK WE
PUT THAT FEEDING TUBE IN AND THEN WE ASK QUESTIONS LATER.
I THINK THE REAL THING, PARTICULARLY YOU HAVE THE
MAJOR SCENARIO IS A STROKE PATIENT, RIGHT? THEY HAVE THIS BIG STROKE.
THEY COME IN TO THE EMERGENCY ROOM, AND IMMEDIATELY EVERYBODY WANTS TO
PUT A FEEDING TUBE IN BECAUSE YOU CAN'T SWALLOW FOR YOURSELF, RIGHT?
WELL, REALLY, THERE'S EDEMA IN THE BRAIN, YOU NEED TO LET THE
EDEMA REDUCE, LET'S NOT FEED THEM, LET'S NOT DO I.V.
FLUIDS, LET THEM DEHYDRATE FOR A BIT FOR A COUPLE DAYS, LET'S
LIVE WITH THE PATIENT TO SEE WHAT HAPPENS OVER THE NEXT FEW DAYS.
AND THEN YOU CAN DECIDE IN THREE DAYS, REALLY, OKAY, AND
THEN FAMILIES COME TO THEIR SENSES AND GO,
THIS IS NOT WHAT MY DAD WOULD HAVE WANTED.
>> RIGHT, RIGHT. >> SO, FEEDING TUBE IS A TOUGH ONE.
>> I AGREE WITH YOU. AND NOT JUST FEEDING TUBES.
I THINK THAT MAKING SURE THAT WE'RE HAVING THAT CONVERSATION ABOUT
WHAT'S IMPORTANT TO THE PATIENT BEFORE WE DO ANY INVASIVE INTERVENTION.
>> ANTIBIOTICS. >> RIGHT. BEFORE WE DO IT, LET'S HAVE A
CONVERSATION AND MAKE SURE THAT THE CARE WE'RE DELIVERING
ACTUALLY ALIGNS WITH THE PATIENT'S VALUES.
>> NOW, -- BOY, I LOVE WHAT WE'RE TALKING ABOUT.
RIGHT UP MY ALLEY, THIS IS IT, THIS IS SO IMPORTANT.
DID YOU HEAR THAT? DID YOU HEAR THAT?
BUT LET'S TALK ABOUT CAREGIVERS BECAUSE CAREGIVERS
ARE A POINT OF ATTENTION TONIGHT.
CAREGIVERS, THERE'S SUCH A THING AS A CARE PROVIDER,
WHICH IS A DOCTOR OR A NURSE OR A P.A., NURSE PRACTITIONER,
WHATEVER IT MIGHT BE, THAT'S A CARE PROVIDER. BY DEFINITION.
CAREGIVER IS THE PERSON CARING FOR THE PATIENT AT HOME, OFTENTIMES.
LET'S TALK ABOUT CAREGIVERS. IN BROAD BRUSH, THERE'S MANY KINDS OF CAREGIVERS.
>> IT'S SO DIVERSE, RIGHT?
BECAUSE SOMETIMES IT'S, YOU KNOW, A CHILD CARING FOR AN ELDERLY PATIENT.
A LOT OF TIMES IT'S A SPOUSE CARING FOR THEIR HUSBAND OR WIFE.
IT MIGHT BE A GRANDPARENT CARING FOR A GRANDCHILD.
IT MIGHT BE AN EX-WIFE CARING FOR HER EX-HUSBAND.
>> I HAVE SEEN THAT. >> YES. I HAVE, TOO, MANY TIMES.
AND, SO, I DON'T THINK THAT YOU CAN PUT A LABEL ON WHAT
DEFINES A CAREGIVER IN TERMS OF THEIR DEMOGRAPHIC, BUT I
THINK THAT THE QUALITIES THAT THEY SHARE IS THAT THEY ARE
INVESTING THEMSELVES INTO THE CARE OF THAT PERSON AND REALLY
IT TENDS TO BE A VERY PERSONAL AND FOR MOST OF THEM, I THINK,
A VERY FULFILLING AND GRATIFYING ROLE.
>> YOU KNOW, I SENSE THAT, TOO. AND WHEN IT ISN'T GRATIFYING,
IT COULD BE, BUT FOR SOME IT IS NOT, AND YOU WORRY ABOUT
THE ONES WHO ARE SORT OF STUCK, QUOTE, UNQUOTE, OR THEY HAVE TO DO IT,
OTHERWISE WE HAVE TO GO TO THE NURSING HOME AND THEN WE'D LOSE THE FARM.
OR I HAVE TO BECAUSE MY SPOUSE IS THE CHILD OF THIS PERSON
AND I AM THE ONE THAT CAN STAY AT HOME AND TAKE CARE OF MY IN-LAWS AND I HAVE TO.
I MEAN, THERE'S SOME PEOPLE WHO ARE STUCK.
WHAT'S YOUR COMMENT ABOUT THE STUCK PEOPLE?
>> WELL, I THINK THAT IN THOSE SITUATIONS, PROVIDING THEM
WITH THE MOST SUPPORT FROM OTHER ARENAS AS POSSIBLE IS REALLY IMPORTANT.
SO IF IT'S A PATIENT THAT QUALIFIES FOR HOME HEALTH SERVICES, ADD THAT.
IF IT'S A FAMILY THAT HAS SOME FINANCIAL MEANS AND CAN AFFORD
TO PAY FOR SOME EXTRA CAREGIVING TO GIVE THAT PERSON A BREAK, PROVIDE THAT.
IF THE PRIMARY CARE DOCTOR IS ASKING QUESTIONS ABOUT HOW THEY'RE DOING
AND CONTINUING TO GIVE THEM FEEDBACK ABOUT WHAT A GOOD JOB THEY'RE DOING,
POSITIVE FEEDBACK, I THINK, CAN GO A LONG WAY FOR US HUMANS. RIGHT?
WE LIKE TO FEEL LIKE WE'RE DOING A GOOD JOB.
AND, SO, TRYING TO IDENTIFY THE PARTS OF THE CAREGIVING
THAT ARE MOST DIFFICULT FOR THEM AND THAT THEY FIND THE
LEAST REWARDING AND FIGURING OUT IF THERE'S A WAY TO
OFFLOAD SOME OF THOSE TASKS SO THAT THE CAREGIVING CAN BE MORE REWARDING.
AND THEN YOU'RE RIGHT, AT THE END OF THE DAY, SOME PEOPLE
JUST AREN'T CUT OUT TO BE A CAREGIVER.
AND IN THOSE SITUATIONS, WE NEED TO THINK ABOUT PLAN B, C, D,
AND MAYBE EVEN E AND HELP SUPPORT THEM IN THAT.
>> SO, I OFTEN THINK ABOUT GOOD CAREGIVING HAS TO ALLOW
THAT PERSON ENOUGH TIME FOR HER OR HIMSELF TO BE ABLE TO
CONTINUE TO DO IT OR ELSE YOU WON'T BE ABLE TO DO IT. >> RIGHT.
>> YOU HAVE GOT TO BE ABLE TO HAVE BREATHING ROOM, YOU'VE
GOT TO BE ABLE TO -- I MEAN, WE'RE TALKING BURNOUT.
WHAT WOULD BE THE THINGS THAT WOULD INDICATE THAT YOU CAN --
YOU SENSE THAT THERE'S BURNOUT HAPPENING AND/OR RECOMMENDATIONS?
>> YOU KNOW, I THINK THAT IT'S THE SAME SIGNS THAT WE SEE IN
HEALTH CARE PROFESSIONALS OR OTHER PROFESSIONS, THAT YOU'VE
BECOME CALLOUS, YOU MAYBE ARE FEELING ANGER TOWARDS THAT PERSON,
YOU'RE FINDING VERY LITTLE INTEREST IN OTHER
THINGS THAT WERE BRINGING YOU PLEASURE PREVIOUSLY, AND I
THINK THAT A LOT OF TIMES, ESPECIALLY IN A DOCTOR'S
OFFICE, IF WE DON'T ASK, WE MIGHT NOT KNOW THAT IT'S GOING ON.
SO I THINK IT IS REALLY IMPORTANT THAT WE KIND OF
BUILD INTO OUR ASSESSMENTS SOME QUESTIONS FOR THE CAREGIVER HOW THEY'RE DOING.
>> HOW THEY'RE DOING.
>> I ALWAYS TELL MY PATIENTS AND FAMILIES, IT'S A MARATHON, NOT A SPRINT.
AND YOU HAVE TO LEAN ON YOUR VILLAGE, RIGHT?
THE PEOPLE THAT ARE OFFERING HELP, SAY YES AND GIVE THEM
VERY CONCRETE THINGS THAT THEY CAN HELP YOU WITH.
IF IT'S THAT, IT'S DIFFICULT TO GET TO THE STORE,
ASK ONE OF YOUR GOOD FRIENDS TO PICK UP TOILET PAPER AND BRING IT
TO YOU OR BRING A MEAL OR CAN YOU JUST SIT WITH MY HUSBAND
FOR THREE HOURS WHILE I TAKE A NAP.
>> YEAH. YOU KNOW, A LOT OF PEOPLE WILL COME UP AND SAY, FOR VARIOUS
REASONS TO VARIOUS PEOPLE, CAN I HELP? WHAT CAN I DO TO HELP?
YOU KNOW, THERE IS -- A LOT OF PEOPLE RESIST HAVING -- TAKING THAT HELP. >> RIGHT.
>> BUT I'VE BEEN THINKING A LOT ABOUT THAT LATELY. WE ALL NEED HELP SOMETIMES.
>> ABSOLUTELY. >> YOU KNOW WHAT? WHEN YOU GRACIOUSLY ASK FOR HELP,
SOME PEOPLE GAIN FROM BEING ABLE TO GIVE. PEOPLE LOVE TO GIVE.
>> OF COURSE THEY DO. >> I MEAN, THAT MAKES EVERYBODY BETTER.
SO, I THINK, YOU KNOW, ONE ENCOURAGING WORD WOULD BE TO SAY YES, I COULD USE YOUR HELP.
I ONLY NEED IT, YOU KNOW, HALF AN HOUR TO GET TO THE GROCERY STORE, OR THAT NAP.
>> RIGHT, RIGHT. >> WE'VE GOT SOME QUESTIONS.
DO PALLIATIVE DOCTORS WORK ON PEDIATRIC CASES?
>> THEY SURE DO. ANY AGE, ANY STAGE. >> ANY AGE, ANY STAGE.
>> OF ANY SERIOUS MEDICAL ILLNESS. SO, THERE ARE SOME PALLIATIVE
MEDICINE PHYSICIANS THAT ACTUALLY SUBSPECIALIZE IN PEDIATRIC PALLIATIVE CARE.
MOST OF US TEND TO SEE MAINLY ADULTS, JUST BECAUSE THERE'S
MORE ADULTS THAT TEND TO HAVE SERIOUS ILLNESS, BUT CERTAINLY
I SEE MY SHARE -- MY FAIR SHARE OF CHILDREN AS WELL.
>> SO, AS A PALLIATIVE CARE SPECIALIST, DID YOU START AS
AN INTERNIST OR DID YOU START AS A FAMILY PHYSICIAN AND THEN
DO THIS FELLOWSHIP TYPE OF A THING? HOW DID THAT GO?
>> I'M ACTUALLY A NEUROLOGIST BY TRAINING.
>> THAT'S RIGHT, I KNEW THAT, ACTUALLY. YOU TOLD ME THAT.
THE LAST TIME YOU WERE ON THE SHOW, WHAT WAS THAT?
>> A COUPLE YEARS AGO, I THINK. >> TWO YEARS AGO. >> A WHILE AGO.
I WAS FASCINATED BY THE BRAIN APPARENTLY IN MY EARLIER DAYS.
AND THEN ALMOST EVERY SPECIALTY CAN SUBSPECIALIZE IN PALLIATIVE MEDICINE.
SO THAT'S WHAT I CHOSE TO DO.
IT'S AN EXTRA YEAR OF TRAINING AND SPECIALIZATION. AND I PRACTICE THAT 100% NOW.
>> THAT'S GREAT. DOES A PALLIATIVE TEAM HELP CAREGIVERS?
I MEAN, OBVIOUSLY YOU DO, YOU'VE ALREADY ADDRESSED THAT.
HOW CAN THE CAREGIVER TAKE A BREAK IF THEY ARE OVERWHELMED? I MEAN --
>> I WANT TO GO BACK TO THAT OTHER QUESTION FOR JUST A SECOND. >> YEAH.
>> BECAUSE I WANT TO POINT OUT, IN THE ACTUAL DEFINITION OF PALLIATIVE CARE,
IT'S THE ONLY MEDICAL SUBSPECIALTY THAT
INCLUDES THE PATIENT AND FAMILY AS THE UNIT WE GIVE CARE TO. >> AH.
>> SO YES, WE ABSOLUTELY CARE. AND THE FAMILY IS WHOEVER THE PATIENT DEFINES AS FAMILY.
IT HAS NOTHING TO DO WITH BLOOD RELATION. >> RIGHT.
IT MAY BE A SPOUSE, IT MIGHT BE A PARTNER. >> FRIEND. OR IT MIGHT BE A FRIEND.
>> OR FRIEND. >> YUP. >> HOW ABOUT THAT CAREGIVER BREAK,
HOW IMPORTANT IS THAT AND HOW -- LET'S SAY THERE'S NOBODY THERE TO GIVE YOU THAT HELP.
I MEAN, HOW CAN -- I MEAN, TO ME, IF YOU'RE NOT GETTING
BREAKS, YOU CAN SAY, I CAN'T DO THIS ANYMORE AND WALK AWAY,
AND THAT PATIENT THEN GOES TO WHERE SOMEONE ELSE CARES FOR THEM.
>> RIGHT, RIGHT. AND THIS IS CLEARLY A VERY COMPLICATED QUESTION,
AND IT CERTAINLY DEPENDS A LOT ON THE FINANCIAL RESOURCES OF THE PATIENT AND FAMILY.
CERTAINLY IF YOU HAVE THE MEANS, USE IT TO HIRE YOURSELF A BREAK, TO HIRE SOME HELP.
IF NOT, THERE ARE A LOT OF PROGRAMS THAT BY SPEAKING TO
YOUR PHYSICIAN, REALLY, ANY OF THEM, THEY CAN PUT YOU IN
CONTACT WITH A SOCIAL WORKER THAT CAN HELP ALIGN YOU WITH
RESOURCES IN THE COMMUNITY THAT CAN ASSIST WITH THE BURDEN THAT YOU'RE FEELING.
>> SO USE THOSE RESOURCES. >> ABSOLUTELY. THAT'S WHAT THEY'RE THERE FOR.
>> CAREGIVING COMES IN MANY FORMS AND COVERS ALL AGES. ALL STAGES.
>> SO, WHEN WE TALK ABOUT CAREGIVING, IT COMES IN A LOT
OF DIFFERENT FORMS, WHETHER IT'S CHILDREN CARING FOR THEIR
PARENTS WITH A MENTAL ILLNESS OR PARENTS CARING FOR THEIR
CHILDREN OR A CHILD WITH SPECIAL NEEDS OR A SPOUSE
CARING FOR ANOTHER SPOUSE OR A ADULT CHILD CARING FOR THEIR ADULT PARENT.
AND, SO, WE LOOK AT, YOU KNOW, EVEN WITH ALL THOSE DIFFERENT
SCENARIOS THAT WE'RE TALKING ABOUT CAREGIVING,
WHEN WE'RE CAREGIVING FOR ANOTHER PERSON, HOW ARE WE TAKING CARE OF
OURSELVES TO ENSURE THAT WE STAY HEALTHY THROUGHOUT THAT PROCESS.
WHAT WE SEE, WE TEND TO SACRIFICE DIFFERENT PRIORITIES FOR OURSELVES.
SO, WHETHER THAT'S OUR OWN MEDICAL CARE, OUR OWN DENTAL CARE, OUR OWN SELF-CARE,
HOBBIES, EVEN THINGS LIKE OUR OWN HYGIENE WE MIGHT SKIP
BECAUSE WE ARE TRYING TO DO THE BEST TO TAKE CARE OF THAT
PERSON THAT WE'RE CAREGIVING FOR.
I WOULD DEFINITELY ENCOURAGE PEOPLE TO REMEMBER ALL OF THE
THINGS THAT THEY'RE DOING WELL AT. ACKNOWLEDGING THAT THEY'RE DOING THEIR BEST.
ACKNOWLEDGING THAT SOMETIMES WE DON'T HAVE ALL THE ANSWERS
OR ALL THE INFORMATION WHEN IT COMES TO CARING FOR A CHILD
WITH SPECIAL NEEDS OR CARING FOR OUR OWN CHILDREN JUST AS
PARENTS OR CARING FOR A SPOUSE WITH A MEDICAL DIAGNOSIS OR
ALZHEIMER'S, DEMENTIA, ALL THOSE COMPONENTS, WE DON'T HAVE ALL OF THE INFORMATION.
SO THEY'RE DOING THE BEST THEY CAN. WE'RE ALL DOING THE BEST THAT WE CAN.
AND THEN IT'S OKAY TO ASK FOR HELP AND IT'S OKAY TO GIVE
OURSELVES A LITTLE GRACE WHEN IT COMES TO NOT HAVING ALL THE
ANSWERS BECAUSE WE'RE HUMAN AND WE'RE NOT PERFECT.
IN BROOKINGS, WE ACTUALLY HAVE A BROOKINGS COUNTY MENTAL HEALTH RESOURCE GUIDE,
WHICH ALSO TOUCHES ON SOME OF THOSE DIFFERENT SUPPORT GROUPS, LIKE
THE BROOKINGS EMPOWERMENT PROJECT WHERE CAREGIVERS ARE
MAYBE HELPING CARE FOR THEIR OLDER CHILDREN WHO HAVE A
MENTAL ILLNESS OR GRIEF SUPPORT GROUPS, DIFFERENT
SUPPORT GROUPS ARE LISTED IN THERE.
SO I ALWAYS ENCOURAGE EVERYONE TO TAKE A LOOK AT WHAT THAT'S LISTED, BUT DEFINITELY
REACHING OUT TO YOUR LOCAL CONGREGATIONS AND ASKING IF
THEY OFFER ANY OF THAT IS A GREAT OPTION AS WELL.
THERE'S ALSO A LOT OF WONDERFUL SUPPORT GROUPS THAT
ARE AVAILABLE FOR DIFFERENT GRIEF GROUPS, ALZHEIMER'S
SUPPORT GROUPS, AUTISM SUPPORT GROUPS WHEN IT COMES TO PARENTS.
SO, REALLY LOOKING AT ACCESSING YOUR LOCAL SUPPORTS,
HELP LINE CENTER AND 211 IS A GREAT RESOURCE WHEN IT COMES
TO LEARNING ABOUT WHAT'S AVAILABLE LOCALLY.
LOOKING AT ALL THOSE NATURAL SUPPORTS LIKE CHURCHES AND
YOUR FAMILY, JUST KIND OF BEING WILLING TO ASK FOR HELP IS OKAY.
>> ISN'T THAT NICE MUSIC? THAT'S OUR OLDEST SON, ERIC,
PLAYING THE GUITAR AS OUR MUSIC BACKGROUND. I JUST LOVE IT. I'M SORRY.
THIS IS YOUR PROGRAM AND YOUR QUESTIONS ARE KEY TO THE DIRECTION OF OUR DISCUSSION.
CALL IN YOUR QUESTIONS TO 1-888-376-6225 OR SEND US AN EMAIL TO ASK@PRAIRIEDOC.ORG.
PLEASE DO THIS. THIS IS YOUR SHOW, YOUR QUESTIONS ARE VERY IMPORTANT TO US.
I THOUGHT HER POINT ABOUT THESE RESOURCES OUT THERE THAT
PEOPLE HAVE THAT WE DON'T REALLY -- AREN'T ALWAYS AWARE
OF THE COUNSELORS OR THE SOCIAL WORKERS. LET'S TALK ABOUT THAT A LITTLE BIT MORE.
>> I THINK THAT PRIMARY CARE DOCTORS ARE SO, SO IMPORTANT.
IF YOU DON'T HAVE ONE, YOU NEED ONE.
BECAUSE I ALWAYS THINK OF THEM AS THE QUARTERBACK.
THEY'RE THE ONES THAT HAVE TO KNOW TONS ABOUT EVERYTHING AND
RECOGNIZE WHEN THEY NEED HELP.
SO, THEY'RE SO GOOD AT TRIAGING, FIGURING OUT WHAT OTHER RESOURCES ARE AVAILABLE
AND HOW YOU CAN BEST BE HELPED. SO YOUR PRIMARY CARE DOCTOR,
IF YOU'RE VOICING CONCERNS LIKE THAT, THEY CAN GET YOU IN TOUCH WITH A SOCIAL WORKER,
WHO THEN MIGHT BE ABLE TO BRANCH OUT AND FIND ALL SORTS OF DIFFERENT RESOURCES.
SO, I ALWAYS THINK THE BEST PLACE TO START IS YOUR PRIMARY CARE DOCTOR BECAUSE,
GENERALLY, IF THEY DON'T KNOW THE ANSWER, THEY KNOW HOW TO FIND IT.
>> AND THAT COULD BE A FAMILY PHYSICIAN, AN INTERNIST. >> YES.
>> IT MIGHT BE A P.A. OR A NURSE PRACTITIONER. >> YUP, ABSOLUTELY.
>> I THINK WE SHOULD ALL HAVE ONE OF THOSE.
I MEAN, IF YOU DO AND YOU TRUST THAT PERSON, THAT'S -- YOU'RE A WINNER THERE.
>> IT'S ESSENTIAL. >> SO IMPORTANT.
SO, MY WIFE BROUGHT THIS, I WANT TO SHOW YOU A PICTURE HERE.
HERE IS THE PICTURE OF, HUM, OF ME ON A SAILBOAT.
AND, SO, I'M GOING TO GO TO THE MAYO THIS COMING WEEK AND
SHE'S GOING TO PUT IT ABOVE MY BED. AND HERE'S THE QUESTION.
WHY WOULD ANYBODY WANT TO DO THAT, FRANNIE?
>> YOU ABSOLUTELY WANT TO DO THAT.
AND IT'S BECAUSE IT MAKES YOU A PERSON TO YOUR MEDICAL TEAM INSTEAD OF JUST A PATIENT.
IN THE HOSPITAL, WHEN WE'RE SURROUNDED BY CHAOS AS MEDICAL
TEAMS AND WE'RE REALLY BUSY AND WE'RE TRYING TO DO THE
VERY BEST CARE WE POSSIBLY CAN, WE SOMETIMES CAN FOCUS
MORE ON THE ROOM NUMBER AND THE DIAGNOSES INSTEAD OF THE PERSON.
SO WE SOMETIMES WILL SAY, YEAH, THE GENTLEMAN IN ROOM 3120 WITH A HISTORY OF
X, Y AND Z, INSTEAD OF, YEAH, IT'S BILL. >> THE SAILOR. >> RIGHT.
WHO HAS KIDS AND A WIFE AND HE WAS A PHYSICIAN AND THIS IS WHAT HE CARES ABOUT.
SO, IT REMINDS US AS MEDICAL TEAMS THAT THIS IS A PERSON IN
THE BED AND YOU WANT YOUR --
YOU WANT YOUR DOCTORS AND YOUR MEDICAL TEAMS TO IDENTIFY WITH
YOU AS THAT BECAUSE AS A PHYSICIAN, I ALWAYS TRY TO
THINK OF, WHAT IF THIS WERE MY MOM, HOW WOULD I WANT HER
TREATED, WHAT IF THIS WERE MY HUSBAND, WHAT IF THIS WERE MY CHILD,
AND YOU WANT YOUR DOCTORS AND YOUR TEAMS TO THINK OF YOU THAT WAY AND THEM
SEEING YOU IN YOUR BEST HEALTHY NORMAL LIFE HELPS THEM TO DO THAT.
>> AND, NOTICE, IT WAS COLD. I'M NOT SURE THERE'S A LITTLE
ICE ON THE WATER, I'M NOT SURE.
BUT, LOOK, I'VE GOT THE LONG, AND I'VE GOT A SMILE ON MY FACE.
>> I WAS GOING TO SAY, YOU MIGHT END UP WITH A PSYCHIATRY CONSULT ON THAT ONE.
[ Laughter ] >> GOSH, THAT WAS FUN. SHE CAUGHT ME WITH A PURE JOY FEELING.
>> FANTASTIC. >> IT'S A WONDERFUL STORY.
THANK YOU, DEAR, FOR DOING THAT AND THINKING OF THIS AND
SURPRISING ME YESTERDAY WITH THIS PICTURE AND SHE SAYS,
YUP, BECAUSE YOU'RE GOING TO SHOW IT ON THAT SHOW TONIGHT.
>> YEAH. >> AND THAT WAS IT.
DOES THE PALLIATIVE CARE TEAM OFFER SOCIAL SERVICES SUPPORT?
>> SO, WE DO HAVE SOCIAL WORKERS EMBEDDED IN OUR TEAM
THAT ARE AVAILABLE TO HELP WITH THE CARE OF PATIENTS.
AND, SO, THE THINGS THAT THEY TEND TO DO FOR US IS THEY HELP
ASSESS WHAT THE PSYCHOSOCIAL NEEDS ARE,
THEY HELP TO ALIGN THEM WITH COMMUNITY RESOURCES,
IF APPROPRIATE, AND THEN MOST OF THEM HAVE COUNSELING BACKGROUNDS, TOO. >> YES.
>> SO THEY'RE JUST FANTASTIC AT LISTENING AND HELPING
PEOPLE WORK THROUGH EMOTIONAL PROBLEMS.
>> I LOVE SOCIAL SERVICES. >> THEY'RE FANTASTIC.
>> A VIEWER FROM FLANDREAU ASKS, PLEASE GIVE US AN IDEA
OF SOME OF THE DIFFERENT ILLNESSES THAT PALLIATIVE
TEAMS WORK WITH, PALLIATIVE CARE WORKS WITH.
AND I WOULD SAY, SOME OF IT IS TERMINAL CANCER.
>> SOME OF IT IS.
>> SOME OF IT IS JUST TERMINAL HEART DISEASE, TERMINAL LUNG DISEASE.
>> IT ISN'T ALWAYS EVEN TERMINAL. >> IT'S PEOPLE WHO ARE VERY SICK. >> RIGHT.
SO WE SOMETIMES WILL SEE PATIENTS WITH, LIKE, A HEAD,
NECK CANCER, FOR INSTANCE, WHERE THE TREATMENT IS AIMED
AT CURE, BUT THE TREATMENT GOING THROUGH IT IS VERY DIFFICULT SYMPTOMWISE.
>> IT'S PEOPLE WHO HAVE HAD NECK CANCER, THEIR TONGUE IS SO SORE,
THEIR MOUTH IS SO SORE, THEY CAN'T SWALLOW, NOTHING TAKES GOOD ANYMORE. >> RIGHT.
THE CHEMO AND RADIATION ARE REALLY REALLY DIFFICULT AND SO IS THE SURGERY.
SO SOMETIMES IN THOSE PATIENTS, WE'LL WALK ALONGSIDE
THEM AND HELP WITH THE PHYSICAL SYMPTOMS, AS WELL AS
THE EMOTIONAL BURDEN IT TAKES WHEN YOU'RE SEEING CHANGES IN
YOUR APPEARANCE, WHEN YOUR APPETITE IS DIFFERENT, WHEN
YOUR INTERACTIONS WITH YOUR SPOUSE MIGHT BE DIFFERENT.
SO WE WALK ALONGSIDE AND THEN AT THE END OF THE DAY, A LOT
OF THEM ARE CURED AND DON'T NEED US ANYMORE AND WE CELEBRATE THAT.
WE ALSO SEE A LOT OF PATIENTS WITH LUNG DISEASE, HEART
DISEASE, LIVER DISEASE, KIDNEY DISEASE, CANCERS, DEMENTIAS,
STROKES, ANY OTHER NEUROLOGICAL DISEASES.
I HAVE A WHOLE CLINIC WHERE I SEE OUR ALS PATIENTS. AS A NEUROLOGIST --
>> LOU GEHRIG'S DISEASE, WHERE THEIR BRAIN WORKS, THEY'RE
JUST LOSING ANY CONTROL OF THEIR MUSCLES. >> YES.
>> THAT'S A REAL TRAGIC DISEASE. >> YEAH.
AND IN THAT CLINIC, I FUNCTION AS A NEUROLOGIST, BUT I USE SO
MANY OF MY PALLIATIVE CARE SKILLS.
>> WOW. SO, IT MAKES ME THINK ABOUT SEVERAL THINGS. I DON'T WANT TO GO THERE.
BUT WHAT I WOULD SAY, THERE ARE --
THERE'S NO LIMIT TO THE REASON TO CALL FOR PALLIATIVE CARE.
AND IT DOESN'T MEAN THAT WE'RE GIVING UP ON OUR TREATMENT.
>> OH, ABSOLUTELY NOT. ACTUALLY THE REVERSE.
A LOT OF TIMES BY US HELPING WITH SYMPTOM MANAGEMENT,
PATIENTS CAN ACTUALLY TOLERATE THEIR TREATMENTS BETTER AND LONGER.
>> IT IS OFTEN THE ELDEST CHILD WHO IS THE PRIMARY
CAREGIVER FOR PARENTS AS THEY AGE. THAT'S RIGHT.
THE ELDEST CHILD IS THE CAREGIVER FOR THEIR PARENTS AS THEY AGE.
MORE OFTEN THAN NOT, THAT PERSON IS A DAUGHTER.
>> IT BECAME APPARENT THAT SHE NEEDED HELP WITH EVERYDAY TASKS AND DRIVING.
WE ASKED HER IF SHE'D LIKE TO LIVE WITH US, AND IT HAS BEEN 12 YEARS.
BEFORE WE EVEN TALKED TO MY MOTHER, I TALKED IT OVER WITH
MY HUSBAND, WHO IS -- WAS, I SHOULD SAY, HE HAS PASSED AWAY,
BUT HE WAS A VERY KIND AND PATIENT PERSON,
AND HE JUST DIDN'T SEE ANY PROBLEM WITH IT AT ALL. AND HE LIKED MY MOTHER.
I HAD WORKED IN A NURSING HOME AT ONE TIME AND IT PREPARED ME FOR CAREGIVING.
I LEARNED ABOUT MEDICATION MANAGEMENT, BATHING, RESPECT FOR OUR AGING POPULATION.
YOU NEED TO TAKE YOUR MEDICATIONS CONSISTENTLY ACCORDING TO YOUR DOCTOR.
I USE A CHARTING SYSTEM.
I JUST MADE UP A CHART ON THE COMPUTER, THE DATE, TIME, AND THE MEDICATION.
THAT WAY IF YOU ADD AN OVER-THE-COUNTER, YOU WRITE IT
DOWN, THAT WAY YOU KNOW THAT YOU CAN TAKE SOME MORE TYLENOL
AFTER EIGHT HOURS OR WHATEVER IT SAYS ON THE BOTTLE.
AND MAKING SURE THAT THE MEDICATIONS ARE COMPATIBLE WITH OVER-THE-COUNTER.
AND THIS HOUSE IS NEWER, SO IT COMPLIES TO WHEELCHAIR ENTRANCE.
AND MY MOTHER IS IN A WHEELCHAIR. SO THAT HAS HELPED IMMENSELY. A TOILET GRAB BARS.
MY HUSBAND PUT THOSE IN. AND ALSO WE HAVE A SHOWER CHAIR.
MAKING SURE YOU HAVE TIME OF YOUR OWN. MY PASSION IS READING. I LOVE TO READ.
AND I HAVE CERTAIN TIMES OF THE DAY THAT I TAKE TIME TO READ.
WORK IS NOT A DIRTY WORD TO ME.
AND I LOVE TO BE OUTSIDE AND WORKING ON THE LAWN OR FLOWER BEDS OR WHATEVER THE CASE.
IT'S VERY REWARDING.
I DON'T WANT TO THINK BACK SOMEDAY AND SAY, OH, I WISH I WOULD HAVE DONE THAT.
BUT IT'S NOT FOR EVERYBODY.
SO, YOU KNOW, DON'T FEEL GUILTY IF YOU'RE NOT ABLE TO HANDLE IT.
LIKE I SAY, EVERYBODY'S DIFFERENT.
MY MOTHER HAPPENS TO HAVE A GREAT SENSE OF HUMOR AND COGNITIVE FUNCTION.
UNFORTUNATELY, SHE HAS SEVERE MACULAR DEGENERATION, LOSS OF HEARING AND IS ON OXYGEN.
I FEEL IT'S MORE OF A CHALLENGE FOR HER THAN IT IS FOR ME.
SHE'S MY BEST FRIEND, ALWAYS HAS BEEN. AND SHE'S MY MOTHER. [ MUSIC ]
>> THAT'S A WONDERFUL PICTURE AND A WONDERFUL STORY OF CAREGIVER DAUGHTER.
I LOVE THE FACT THAT SHE TAKES SOME TIME, SHE MADE THAT POINT, SHE'S IN THE GARDEN,
SHE DOES SOME READING, THAT SHE ALSO MADE THE POINT, YOU
KNOW, SOME PEOPLE AREN'T BUILT TO DO THAT.
I LOVE -- I ALSO LOVED THE POINT SHE MADE ABOUT GRAB BARS IN THE BATHROOM.
I THINK ALL OF US SHOULD SPEND SOME TIME LOOKING AT OUR OWN
HOME AND MAKE THEM AMENABLE FOR PEOPLE WHO ARE DISABLED
BECAUSE WE COULD HAVE A PERSON VISITING THAT IS DISABLED.
WHAT ELSE WOULD YOU TAKE FROM THAT, FRANNIE?
>> I ABSOLUTELY AGREE THAT HER TAKING TIME FOR HERSELF AND
YOU CAN TELL BY THE WAY SHE TALKED ABOUT IT, SHE'S INTENTIONAL ABOUT IT.
SO SHE'S NOT JUST LETTING IT HAPPEN BY ACCIDENT.
SHE'S ACTUALLY SCHEDULING TIME FOR HERSELF BECAUSE IF WE
DON'T, THE DAY SLIPS AWAY AND AT THE END, WE'VE HAD NOTHING,
YEAH, TO REFILL OUR BUCKET SO WE HAVE MORE TO GIVE THE NEXT DAY.
>> RIGHT. AND IT'S INTERESTING, THIS 91-YEAR-OLD WOMAN'S DAUGHTER,
THE OLDEST DAUGHTER, ALSO IS THE MOTHER TO ONE OF OUR PRODUCERS.
SO, WE THANK YOU FOR DOING THAT FOR US, GINGER.
THANK YOU SO MUCH FOR BRINGING VALORIE'S STORY FOR US,
VALORIE'S AND YOUR MOM'S STORY. I LOVE THAT.
A SIOUX FALLS WOMAN SAYS, I'VE BEEN A CAREGIVER FOR MY MOM FOR MANY YEARS.
HOW DO I ENCOURAGE ANOTHER PERSON WHO IS ALSO CAREGIVING TO SEEK ADDITIONAL HELP?
MY FRIEND HAS BEEN TRYING TO TAKE CARE OF HIS WIFE BY HIMSELF.
SHE NEEDS ADDITIONAL CARE, BUT THE HUSBAND IS RELUCTANT TO.
>> IT'S A HARD ONE. HARD ONE.
>> PEOPLE NEED TO BE ABLE TO ASK FOR MORE HELP, DON'T THEY? >> THEY DO.
BUT, ON THE OTHER HAND, WE HAVE TO RESPECT ADULT'S DECISIONS, RIGHT?
>> YES, WE DO. >> SO, IF HE FEELS THAT HE'S
MANAGING AND IS VERY RELUCTANT TO HELP, JUST BECAUSE WE THINK
HE NEEDS HELP DOESN'T MEAN HE DOES.
AND SOMETIMES WE HAVE TO ALLOW HIM TO LIVE THROUGH IT. >> YES.
>> AND FIND THAT FOR HIMSELF BECAUSE OFTENTIMES WHEN ADULTS
THAT CAN MAKE THEIR OWN DECISIONS ARE FORCED TO DO SOMETHING, IT DOESN'T GO WELL.
>> RIGHT. I THINK WE HAVE TO RESPECT PEOPLE'S FREEDOM TO CHOOSE.
>> RIGHT. >> THAT'S A PRINCIPLE CALLED
AUTONOMY THAT WE SHOULD RESPECT EVERY PERSON'S FREEDOM TO CHOOSE.
BUT MAYBE THAT PERSON, LIKE A GUY, MOST GUYS, ARE VERY RELUCTANT TO ASK FOR HELP.
GUYS SHOULD LEARN. IT'S OKAY TO ASK FOR HELP. >> RIGHT.
>> IT DOESN'T MEAN YOU'RE NOT THE MOST MASCULINE GUY IN THE WORLD.
YOU COULD BE EVEN MORE MASCULINE BY ASKING FOR HELP.
BY THE WAY, WHEN YOU ASK FOR HELP, SOMEBODY GETS BACK. YOU KNOW?
WHEN THEY GIVE, THEY'RE REWARDED, TOO. >> ABSOLUTELY.
I THINK CONTINUING TO SHOW THAT FRIEND THAT THERE IS
SUPPORT IF HE WANTS TO REACH OUT FOR IT, BEING PRESENT AND
ATTENTIVE IS GREAT, BUT FORCING IT, PROBABLY NOT A GOOD IDEA.
>> GOOD POINT. WE HAVE A CALLER FROM ABERDEEN
WHO SAYS, WHO PAYS FOR PALLIATIVE CARE?
NOW, I KNOW THAT HOSPICE, WHEN THE PHYSICIAN CALLS AND IT'S
MEDICARE-AGE PERSON, THAT MEDICARE COVERS HOSPICE WHEN IT'S ACCEPTED.
SO, THAT'S AN ADDED MEDICARE BENEFIT.
IF YOU QUALIFY OR CLOSE TO QUALIFYING, ISN'T THAT A GREAT THING?
MEDICARE -- AND MOST INSURANCE PEOPLE DO COVER HOSPICE.
>> ABSOLUTELY. >> WHAT ABOUT PALLIATIVE CARE?
>> MOST INSURANCE PLANS COVER PALLIATIVE CARE.
THE EXACT SAME WAY THAT THEY WOULD COVER A CARDIOLOGY
CONSULT OR A PULMONARY CONSULT BECAUSE WE'RE JUST ANOTHER
MEDICAL SUBSPECIALTY AND WE'RE RECOGNIZED AS THAT BY INSURANCE COMPANIES.
SO, MOST INSURANCE COMPANIES ARE GOING TO COVER IT THE SAME
WAY THEY WOULD COVER ANY SPECIALIST VISIT.
>> MEDICARE? >> YES. >> MEDICARE. >> ABSOLUTELY. >> COVERS IT.
>> I MEAN, THE SAME WAY IT WOULD COVER ANY OTHER SPECIALTY VISIT. >> VERY GOOD.
A VIEWER FROM WALL ASKS ABOUT MANAGING MEDICINES WHILE DEALING WITH A SERIOUS ILLNESS.
WHO'S RESPONSIBLE FOR THIS JOB? MANAGING MEDICINES.
>> SO, OUR PALLIATIVE CARE TEAM OFTENTIMES MAKES A LOT OF
MEDICATION RECOMMENDATIONS AND WE MIGHT PRESCRIBE MEDICATIONS.
HOWEVER, IT'S ALWAYS IN VERY CLOSE COMMUNICATION WITH THE OTHER TEAMS INVOLVED.
SO OFTENTIMES IT'S NOT JUST THE PRIMARY CARE DOCTOR BUT
IT'S ALSO THE ONCOLOGIST OR THE CARDIOLOGIST OR THE LUNG SPECIALIST.
SO WE'RE CONSTANTLY TALKING AND COMMUNICATING AND MAKING
SURE THAT ALL OF THE MEDICATIONS THAT WE'RE
PRESCRIBING ALIGN WELL WITH THEIR UNDERLYING TREATMENT.
>> YEAH. SO, I'M GOING TO THROW A CURVE
BALL AT YOU, AND THIS IS IN ALIGNMENT WITH THE SHOW THAT
WE RECORDED LAST WEEK, IT WILL BE SHOWN IN MAY, AND THAT IS,
THE QUESTION, DO YOU THINK THAT MANY PATIENTS ARE OVERMEDICATED?
>> I THINK THAT IS A DIFFICULT QUESTION.
I THINK THAT IN SOME SITUATIONS, THAT IS TRUE.
WHEN I SEE A PATIENT THAT IS SERIOUSLY ILL, AND PROBABLY
NEARING THE END OF LIFE, I THINK THAT OFTENTIMES THERE
ARE A LOT OF MEDICATIONS THAT THEY'VE ALREADY GOTTEN THE
MAXIMUM AMOUNT OF BENEFIT THAT THEY'RE EVER GOING TO GET FROM
THAT MEDICINE AND AT THIS TIME IS JUST ADDING THE PILL
BURDEN, MAYBE THEY'RE SWALLOWING 20 PILLS IN THE
MORNING, 13 IN THE AFTERNOON AND 15 AT BEDTIME, SO,
OFTENTIMES I THINK IT IS REALLY HELPFUL TO REALLY GO
THROUGH THOSE MEDICATION LISTS WITH A FINE-TOOTH COMB AND
MAKE SURE THAT EVERYTHING THAT THEY'RE TAKING STILL MAKES
SENSE AND THAT WE'RE STILL GETTING MORE BENEFIT THAN POTENTIAL BURDEN.
NOW, I THINK THAT THE OPPOSITE IS ALSO TRUE FOR SOME CLASSES OF MEDICATION.
BECAUSE I KNOW THAT STUDIES SHOW A LOT OF PATIENTS AT THE
END OF LIFE STILL HAVE REALLY DISTRESSING PHYSICAL SYMPTOMS,
SO IN THOSE CASES, THEY'RE ON THE WRONG MEDICINES.
THERE MIGHT BE SOME MEDICATIONS THAT WE'RE NOT
USING ENOUGH OF TO PROVIDE COMFORT, DEPENDING ON WHAT THEIR PERSONAL VALUES ARE.
>> YOU GAVE A CASE EARLIER TONIGHT WHEN WE WERE
DISCUSSING WITH THE PREPROFESSIONAL STUDENTS, OUR
PDAs, ABOUT A CASE OF A MAN WHO CAME IN WITH SEVERE PAIN AND SUFFERING.
AND YOU SAW HIM A WEEK LATER AND HE WAS BETTER. TELL ME ABOUT THAT.
>> SO, THIS IS A GENTLEMAN THAT I SAW A COUPLE WEEKS AGO
THAT WHEN HE CAME TO MY OFFICE, HE WAS HAVING SEVERE
PAIN, SEVERE NAUSEA, LIKE, WRITHING IN OUR EXAM ROOM,
MOANING, CLEARLY VERY DISTRESSED.
AND I COULDN'T EVEN DO MY ENTIRE ASSESSMENT, HE WAS SO UNCOMFORTABLE.
AND, SO, WE METICULOUSLY LOOKED AT HIS MEDICATIONS,
LISTENED TO HIM ABOUT WHAT SYMPTOMS WERE IMPACTING HIM
THE MOST, AND CHANGED SOME OF HIS MEDICATION REGIMEN.
A COUPLE WEEKS LATER, I SAW HIM TODAY, ACTUALLY, AND HE
RATED HIS PAIN AT A ZERO OUT OF 10. HIS NAUSEA AT A ZERO OUT OF TEN.
AND, SO, ALTHOUGH I CAN'T FIX HIS UNDERLYING CANCER, WE
CERTAINLY CAN MAKE AN IMPACT ON HOW HIS DAILY LIFE CAN LOOK
AND IT CAN BE RELATIVELY PAIN-FREE AND RELATIVELY NAUSEA-FREE.
>> CURVE BALL QUESTION AGAIN. AMERICA'S TRYING TO STRUGGLE WITH THIS QUESTION.
AND YOU CAN SAY, I DON'T WANT TO ANSWER IT. BUT THE QUESTION OF CANNABIS.
MARIJUANA IS A MEDICINAL PLANT THAT'S OLDER THAN THE HILLS
AND HAS BEEN USED THERAPEUTICALLY FOR THOUSANDS OF YEARS.
AND NOW IN A TIME WHEN NARCOTICS AND OPIOIDS -- OR
OPIOIDS, SAME THING, ARE CAUSING A FAIR AMOUNT OF
DEATHS, 70,000 DEATHS A YEAR, AND WE'RE PROBABLY NOT AT THE
PINNACLE OF THAT NUMBER, WHAT DO YOU THINK ABOUT CANNABIS AS A THERAPEUTIC AGENT?
WHERE SHOULD WE GO IN THIS DIRECTION, IF YOU WERE THE EMPEROR OF THE WORLD?
>> SO, FIRST I WANT TO COMMENT ON THE OPIOID CRISIS, JUST FOR A SECOND.
I THINK THAT EVERY SINGLE TIME WE TALK ABOUT THAT IN OUR
COUNTRY, IT WOULD BE MY HOPE THAT WE WOULD SAY A CAVEAT
THAT THIS EXCLUDES PATIENTS WITH CANCER-RELATED PAIN OR TERMINAL ILLNESS.
BECAUSE THERE REALLY TRULY IS A GOOD INDICATION FOR CERTAIN
SUBSET OF PATIENTS THAT THESE MEDICATIONS ARE LIFE ALTERING
IN A GOOD WAY AND WHEN THEY'RE USED --
>> YOUR PATIENT WAS AN EXAMPLE OF THAT.
>> WHEN THEY'RE USED CAREFULLY AND RESPONSIBLY AND WE'RE SCREENING PATIENTS
APPROPRIATELY AND EDUCATING THEM, THEY ARE MEDICATIONS THAT WE ABSOLUTELY NEED.
AND, SO, I FEEL VERY SIMILARLY ABOUT MEDICAL MARIJUANA.
IN MY PROFESSION, I'M ALWAYS GRATEFUL FOR ANY ADDITIONAL
TOOLS THAT I HAVE TO HELP PATIENTS ACHIEVE COMFORT AND SYMPTOM RELIEF.
SO, IT WOULD BE MY HOPE THAT SOMEDAY THAT WOULD BE AN
ADDITIONAL TOOL THAT IS MADE AVAILABLE TO US.
>> IN SOUTH DAKOTA. >> YEAH. >> ME, TOO. A WOMAN FROM ARLINGTON SAYS,
DURING THE LAST COUPLE OF YEARS, I'VE NEEDED HELP WITH MY HUSBAND.
IT'S REALLY HARD TO FIND PEOPLE TO HELP WITH CARE IN RURAL SOUTH DAKOTA.
I CAN SOMETIMES GET HELP TO GET SOMEONE TO HELP ON
SUNDAYS, SO I CAN GO TO CHURCH, BUT THAT'S EVEN A STRUGGLE.
DOES THE PALLIATIVE PHYSICIAN MANAGE THIS OR THE PRIMARY PHYSICIAN?
>> I MEAN, I'D SAY THE BEST ANSWER IS THAT WE WOULD WORK
TOGETHER TO TRY TO BRAINSTORM IDEAS AND SEE IF THERE ARE
ADDITIONAL COMMUNITY RESOURCES. I ABSOLUTELY AGREE WITH YOU, THOUGH.
SOUTH DAKOTA AND OTHER PLACES THAT HAVE VERY RURAL AREAS, IT'S DIFFICULT.
IT REALLY IS. YOU KNOW, THERE'S AREAS IN OUR
STATE THAT DON'T HAVE HOME HEALTH CARE, THAT DON'T HAVE HOSPICE CARE EVEN.
SO, I WOULD AGREE, THAT IS A VERY CHALLENGING SITUATION.
SINCE YOU MENTIONED THAT SOMEBODY WILL SOMETIMES COME
AND WATCH WHILE YOU'RE ABLE TO GO TO CHURCH, I'D LEAN ON THAT
CHURCH COMMUNITY BECAUSE SOMETIMES -- >> I WOULD, TOO.
>> -- THAT CHURCH COMMUNITY WILL HELP YOU OUT ON A
WEDNESDAY SO YOU CAN GO GET YOUR NAILS DONE OUR YOUR HAIR DONE. >> RIGHT.
MAYBE STANDING UP AT CHURCH OR TALKING TO THE MINISTER AND
SAY, COULD YOU BRING IT UP AND SAY, I NEED HELP, I NEED HELP,
I JUST NEED AN HOUR HERE, AN HOUR THERE AND AN HOUR THERE.
>> AND WHAT I FOUND IS IN THESE SMALLER COMMUNITIES,
WHEN YOU ASK FOR HELP, THERE'S USUALLY A LOT OF ME, ME, ME, THEY PULL TOGETHER,
THEY'RE SO COMMUNITY DRIVEN AND THEY CARE SO MUCH ABOUT ONE ANOTHER.
YOU CAN'T BE SCARED TO ASK FOR HELP, THOUGH, WHEN YOU NEED IT.
>> OKAY. AND WE'VE GOT A FEW MINUTES
LEFT, WE'VE GOT A BUNCH OF QUESTIONS COMING IN RIGHT NOW. THANK YOU VERY MUCH.
A CALL FROM MILBANK ASKS, CAN PALLIATIVE CARE TAKE PLACE IN
PLACES OTHER THAN THE PATIENT'S HOME?
>> SO, MOST OF THE TIME, ACROSS OUR COUNTRY, MOST
PALLIATIVE CARE HAPPENS IN THE HOSPITAL, ACTUALLY, WHICH IS
KIND OF A TRAGEDY BECAUSE THAT'S WAY FURTHER DOWNSTREAM THAN WE'D LIKE, RIGHT?
WE WANT TO BE INVOLVED WHEN PATIENTS ARE FIRST DIAGNOSED
WITH SERIOUS THINGS, NOT ONLY WHEN THEY'RE IN A CRISIS AND END UP IN THE HOSPITAL.
THAT IS WHERE THE MOST ROBUST SERVICES ARE. AND THEN NEXT WOULD BE IN CLINIC.
SO, IT'S RARE TO FIND A COMMUNITY, SOUTH DAKOTA'S
REALLY INCLUDED IN THAT, WHERE PALLIATIVE MEDICINE PHYSICIANS
ARE AVAILABLE TO COME TO YOUR HOME.
>> OKAY. A MAN FROM STURGIS ASKS, HOW
DO YOU GET THROUGH TO A SIBLING THAT THEY'RE DOING
THINGS WRONG WITH THE CARE OF A PARENT?
IS THERE SOMEONE THAT CAN HELP FACILITATE CIVIL CONVERSATION?
THAT'S A TOUGH QUESTION.
THERE'S NOTHING MORE IMPORTANT THAN THE LOVE BETWEEN SIBLINGS.
AND THE CARE THAT PEOPLE PROVIDE, IT CAN TEAR APART.
I WOULD JUST ASK A LOT OF FORGIVENESS NEEDS TO BE
EVERYWHERE THROUGH THIS, YOU KNOW, FORGIVENESS,
FORGIVENESS, TALK AND PROMISE, YOU KNOW, MAKE A CONVERSATION,
SAY, I DON'T WANT TO HAVE HARD FEELINGS,
I'M JUST GIVING YOU MY FEELINGS, HOW CAN I HELP.
>> I WOULD SAY THAT THAT IS PROBABLY THE NUMBER ONE OR
NUMBER TWO INDICATION THAT WE ARE INVOLVED IN A PATIENT'S
CARE, IS WHEN THERE'S DISCHORD BETWEEN FAMILY MEMBERS OR
THERE'S A LOT OF CONFLICT BECAUSE ONE OF OUR EXPERTISE
OR SKILL SETS IS ACTUALLY COMMUNICATION AND HELPING TO
SUPPORT FAMILIES THROUGH VERY DIFFICULT TIMES AND DECISIONS.
>> YEAH. >> SO THAT WOULD BE AN
INDICATION TO ASK FOR A PALLIATIVE CARE CONSULTATION.
>> DOES THE PALLIATIVE CARE TEAM HELP THE PATIENT WITH A
SPIRITUAL QUESTIONS THAT A SERIOUSLY ILL PERSON MAY HAVE?
SPIRITUAL QUESTIONS, WE'VE GOT LESS THAN A MINUTE.
>> ABSOLUTELY. BECAUSE OUR SPIRITUALITY IS
CORNERSTONE TO MOST OF US IN OUR LIVES, AND IF WE'RE NOT
WELL SPIRITUALLY OR JUST LIKE EMOTIONALLY, WE'RE NOT TRULY WELL.
AND WE NEED THAT TO FIND PEACE.
>> I WANTED TO SPEND A HALF AN HOUR ON THE SPIRITUAL SIDE OF THINGS.
>> I KNOW. >> I DIDN'T GET THERE. FAITH COMMUNITY, NURSE, THAT'S
AN IMPORTANT RESOURCE, THINK THAT, TOO.
>>> AND, NOW, FOR THE WINNER OF TONIGHT'S PRAIRIE DOC QUIZ QUESTION.
GIVE TWO SYMPTOMS OF CAREGIVER BURNOUT.
ANSWER COULD INCLUDE TWO OF THE FOLLOWING.
WITHDRAWAL FROM FAMILY AND FRIENDS. FATIGUE. ANGER. DEPRESSION.
ISOLATION. LOSS OF INTEREST. CRYING. SLEEPLESSNESS. OVERSLEEPING.
AND THE ANSWERS THAT TONIGHT'S WINNER GAVE WERE ANXIETY AND FATIGUE.
IT WAS ANGIE FROM YANKTON WHO ANSWERED THE QUESTION CORRECTLY.
THANK YOU, ANGIE, FOR PARTICIPATING.
AND A BOOK WILL BE IN THE MAIL TO YOU SOON.
WE'LL BE RIGHT BACK AFTER THIS.
>> HAVE YOU HEARD? THE PRAIRIE DOC HAS A RADIO SHOW.
LISTEN TO YOUR LOCAL SOUTH DAKOTA RADIO STATION
FOR "PRAIRIE DOC CONVERSATIONS."
THIS PROGRAM FEATURES PHYSICIANS AND OTHER HEALTH
PROFESSIONALS DISCUSSING VARIOUS MEDICAL TOPICS
IMPORTANT TO YOU AND YOUR FAMILY.
ASK YOUR LOCAL RADIO STATION IF THEY BROADCAST PRAIRIE DOC CONVERSATIONS.
>> THANK YOU FOR LISTENING. UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE.
>> IT WAS A NUMBER OF YEARS AGO AND I WAS WORKING IN THE
EMERGENCY ROOM WHEN A SEVERELY COMPROMISED 20-YEAR-OLD WOMAN
WITH CEREBRAL PALSY CAME IN BATTLING A LUNG INFECTION.
SHE WAS MODERATELY MENTALLY HANDICAPPED AND HAD MUSCLE SPASTICITY OF ALL
HER MUSCLES WHICH HAMPERED HER ABILITY TO COUGH AND CLEAN OUT HER LUNGS.
THIS WAS NOT HER FIRST TIME WITH PNEUMONIA, AND IT WOULDN'T BE HER LAST.
WHAT WAS MOST REMARKABLE ABOUT THIS YOUNG WOMAN, HOWEVER, WAS
THE LOVE AND SUPPORT SHE HAD FROM HER ENTIRE FAMILY, NOT JUST MOM AND DAD.
HER THREE SIBLINGS WERE ALSO PART OF THIS WONDERFUL CAREGIVER TEAM.
THEY JOKED WITH HER, ENCOURAGED HER, REASSURED HER,
LOVED HER - ALL OF THEM. IT WAS BEAUTIFUL TO SEE.
THE STORY TURNS SAD AS EVENTUALLY, MONTHS LATER, THE PATIENT SUCCUMBED TO AN
INFECTION DESPITE AGGRESSIVE TREATMENT.
HOWEVER, THE COMPASSION AND JOY I SAW THAT DAY, LIKE RAYS
OF LIGHT EMANATING OUT OF HER CAREGIVERS, LEFT ME HAPPY INSIDE.
CAREGIVERS COME IN ALL SHAPES AND SIZES AND FROM ALL WALKS OF LIFE.
MALE AND FEMALE, SPOUSE, ADULT CHILD, PARENT, GRANDPARENT, FRIEND OR HIRED ASSISTANT.
THEY CAN PROVIDE CARE AT HOME, IN ASSISTED LIVING CENTERS, IN
NURSING HOMES OR IN SOME OTHER INSTITUTION.
THEY WILL BE DOING THIS JOB POSSIBLY OUT OF OBLIGATION,
DUTY, FINANCIAL RESPONSIBILITY, LOVE,
COMPASSION OR SOMETIMES AS A JOB FOR PAY.
MANY PEOPLE DEVELOP THE NEED FOR A CAREGIVER AFTER TRAUMA,
ILLNESS, STROKE, OR SIMPLY AGING, WHILE OTHERS REQUIRE HELP FROM BIRTH.
THE NEEDS OF THE COMPROMISED INDIVIDUAL CAN ALSO VARY.
SOMETIMES THEY REQUIRE LOTS OF HELP WITH ACTIVITIES OF DAILY
LIVING, INCLUDING BOWEL AND BLADDER CARE OR EVEN HELP WITH FEEDING AND HYDRATING.
SOMETIMES THE PERSON ONLY NEEDS SOMEONE TO CHECK IN ON
THEM EVERY DAY OR GIVE THEM A KIND WORD EVERY ONCE IN A WHILE.
AFTER MY DAD DIED, I FOUND MYSELF CALLING MY MOM EVERY
MORNING WHILE I WAS ON THE WAY TO WORK FOR A SHORT CALL.
AFTER SEVERAL YEARS OF THIS, WHEN A STROKE TOOK THIS
PLEASURE AWAY, I CAME TO REALIZE HOW MUCH I GREW FROM
AND ENJOYED THOSE DAILY CONVERSATIONS.
IT HAD BEEN A MUTUAL GIFT WE WERE GIVING EACH OTHER.
THE FOLLOWING LESSONS FOR CAREGIVERS MIGHT BE HELPFUL. PRACTICE LISTENING.
BE KIND, HONEST, AND RESPECT YOUR PATIENT'S CHOICES AS MUCH AS POSSIBLE.
SEEK ALTERNATIVES IF YOU'RE FEELING BURNED OUT.
AND REALIZE THE VALUE YOU RECEIVE BY THE GIVING OF YOURSELF.
>> A BIG THANK YOU TO FRANNIE ARNESON FOR VOLUNTEERING TO
COME TO OUR STUDIO IN YEAGER HALL ON THE CAMPUS OF SOUTH DAKOTA STATE UNIVERSITY.
THE EXPERIENCE IN THE FIELD OF CAREGIVING WAS KEY TO TONIGHT'S PROGRAM.
>>> MY NEW BOOK, "LIFE'S FINAL SEASON," ADDRESSES THE NEEDS
OF CAREGIVERS AND IS AVAILABLE AT THE LOCATIONS YOU SEE ON YOUR SCREEN RIGHT NOW.
AND IT IS ALSO ON LOAN AT PUBLIC LIBRARIES IN BROOKINGS AND VERMILLION.
ASK YOUR LOCAL LIBRARY ABOUT IT.
>>> OUR MEDIA WORLD HERE AT THE PRAIRIE DOC IS MORE THAN OUR PROGRAM EACH WEEK.
YOU CAN HEAR US ON MANY RADIO STATIONS AROUND SOUTH DAKOTA
WITH OUR "PRAIRIE DOC CONVERSATIONS."
PRAIRIE DOC RADIO IS ON KBRK HERE IN BROOKINGS EACH WEDNESDAY.
0VER 59 NEWSPAPERS PRINT THE "PRAIRIE DOC PERSPECTIVES" EACH WEEK.
AND, FOR THOSE OF YOU TRAVELING OUTSIDE OF SOUTH
DAKOTA, YOU CAN WATCH THE PROGRAM LIVE ON FACEBOOK, 7:00 CENTRAL TIME ON THURSDAYS
WHILE YOU CALL OR TEXT YOUR QUESTIONS JUST THE SAME AS WHEN YOU ARE WATCHING US ON SDPB.
LIKE OUR FACEBOOK PAGE AND GO THERE EACH WEEK AND JOIN THE CONVERSATIONS.
>>> THE SOUTH DAKOTA DEPARTMENT OF HEALTH HAS ALREADY GOTTEN SEVERAL
CONFIRMED CASES OF THE FLU AND THE SEASON IS JUST BEGINNING.
IT REALLY ISN'T TOO EARLY TO GET YOUR FLU SHOT.
IT IS IMPORTANT NOT JUST FOR YOU BUT TO HELP PROTECT THOSE AROUND YOU.
THAT DOES IT FOR TONIGHT.
FROM ALL OF US HERE AT "ON CALL WITH THE PRAIRIE DOC,"
UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE.
>> A CAN OF POP, A SINGLE CHOCOLATE CANDY AND EVEN A
SLICE OF BREAD CAN CAUSE PROBLEMS.
"DIABETES, NOT A SWEET CONDITION" NEXT TIME "ON CALL WITH THE PRAIRIE DOC."
>> ALL OF US WANT OUR FAMILY, NEIGHBORS, AND FRIENDS TO HAVE THE ABILITY TO MAKE
APPROPRIATE DECISIONS ABOUT THEIR HEALTH CARE.
TO DO SO, THEY NEED ACCESS TO INFORMATION FROM RELIABLE
SOURCES, LIKE Dr. HOLM AND HIS GUEST PHYSICIANS.
HELLO, I'M STEPHANIE HERSETH SANDLIN AND I SERVE ON THE
VOLUNTEER BOARD OF DIRECTORS OF THE HEALING WORDS
FOUNDATION, A 501c3 ORGANIZATION ESTABLISHED TO
SUPPORT THE WORK OF THE PRAIRIE DOCS.
WITH YOUR CHARITABLE DONATION, YOU CAN HELP THE FOUNDATION
CONTINUE TO OFFER FREE AND EASY ACCESS TO THE ENTIRE
LIBRARY OF PRAIRIE DOC HEALTH EDUCATION PROGRAMS.
THIS MISSION IS SO VERY IMPORTANT TO RURAL COMMUNITIES
AND RESIDENTS, IN PARTICULAR, ACROSS SOUTH DAKOTA AND NEIGHBORING STATES.
PLEASE CONSIDER A PERSONAL OR CORPORATE GIFT.
JUST GO TO PRAIRIEDOC.ORG TO FIND MORE INFORMATION ON HOW YOU CAN HELP. THANK YOU.
>> MAJOR FUNDING FOR "ON CALL WITH THE PRAIRIE DOC" HAS BEEN PROVIDED BY:
>> AVERA IS A PROUD SPONSOR OF "ON CALL" ON SOUTH DAKOTA PUBLIC BROADCASTING.
>> LARSON MANUFACTURING IS PROUD TO SUPPORT "ON CALL TELEVISION"
AS IT CONTINUES TO OPEN DOORS FOR IMPORTANT MEDICAL INFORMATION.
>> AND BY THE SOUTH DAKOTA FOUNDATION FOR MEDICAL CARE,
THE MEDICARE QUALITY IMPROVEMENT ORGANIZATION FOR SOUTH DAKOTA.
>> AND WITH THE ONGOING SUPPORT OF THESE INDIVIDUALS AND INSTITUTIONS...
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