Thursday, July 31, 2014

What to Write to a Friend With Terminal Illness

On a flight last month, I introduced myself to seatmates and eventually handed the mother-daughter travelers my condolence tips bookmarks.

"This is great," the daughter said. Her elderly mother remarked, "I live in a retirement community and we lose residents from time to time. The manager sets up a nice tribute display, and I like to send a card to the family." But their next question took an interesting turn.

"We have a couple friends who are terminally ill. I'd like to send a card, but what should I say?"

Let's explore this:
  • Terminal illness is "the advanced stage of a disease with an unfavorable prognosis and no known cure."
  • A prognosis of a number of months (or years) is not a scheduled departure date. 
  • The outward condition (appearance) and functioning of a person with terminal illness will vary and may defy others' expectations. 
  • Until you are dead, you are alive. 

Blogger Michelle Devon writes with firsthand knowledge in Dying to Live. She shares some riveting thoughts on the tug-of-war between living to stay alive and being the person you want to be.
"Learning to live with disease that is expected to result in your death absolutely does change your perspective. But as my blog title says, I'm not alive and dying. I'm dying to live!"

I asked Arbor Hospice's Lead Grief Support Services Coordinator, Melissa Schultz, LMSW to comment on the interpersonal challenges of living the "last chapter."

"The diagnosis of a terminal illness can be extremely isolating. Many people back off because they aren't sure what to say and are afraid to say the wrong thing. The most important thing is to offer a comforting presence. Whatever you choose to write, speak from the heart. It's okay to acknowledge the illness in a supportive manner, such as 'I'd like to come visit you, if you're up for it.' It would be a disservice to you and your friend to pretend that nothing has changed, but that doesn't mean they need to be pitied or avoided. As Maya Angelou stated, 'I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel."

Every day, in countless scenarios, we have the opportunity to say "thank you, I appreciate you." Keep that in mind during your daily activities and when you write a note to anyone. Here are some suggestions about writing to be a friend with terminal illness:

Don’t Write
Do Write
  • I’m gonna miss you so much! 
  • Get well soon! 
  • Hey, Steve Jobs lived a long time with his pancreatic cancer, so … 
  • Have you thought of: medical advice/legal or tax advice 
  • What are you going to do about your (special needs family member) 
  • Good riddance to that boring job! 
  • Are the kids finally doing some housework?
  • CARE: How are you today? 
  • FEEL: I’m so sorry this has happened. 
  • ENCOURAGE: Take care of yourself. 
  • REMEMBER: I am thinking about you. In fact, I was just_____ and I remembered when __. 
  • ROUTINE: Did that last storm send (pet) under the bed? 
  • LISTEN: I would love to share a cup of tea sometime soon; I’m a good listener. By the way, my email is _____ 
  • ADMIRE: I admire your courage and always have you in my prayers 
  • AFFECTION: Give my love & hugs to __.

This blog post was written by Deborah R. Chappa, the Condolence Note Coach. She works in a Livonia funeral home and is an author, blogger and instructor on writing condolence notes. She is conducting a workshop on Wednesday, September 10 at 1 p.m. at the Livonia Civic Center Library. To register, call the Adult Services Desk at (734) 466-2590.

Thursday, July 24, 2014

Lessons from Loss - One Year Later

The one-year anniversary of a parent’s death is a milestone for any adult child.  Bearing witness to a year of "firsts" without your parent: of birthdays – yours and theirs; of holidays, big and small; of national and political events; and of family happenings; all of which would have had an impact on them and of which they would have influenced your response to, can be an emotional roller coaster. 

As I conclude the one year anniversary of the death of my mother this week on July 23, I am struck by the dichotomy of how hard and how easy it has been to let go of her memory. As the ten-day period approached of the time she was admitted to the hospital to the time she died, I found myself reliving moment-by-moment what happened last year and dreading what was coming each day. 

There was the call that she needed to go to an emergency room; then having her admitted to the hospital; the subsequent cancer diagnosis; then a call that she was in organ failure post-surgery; and finally the decision to bring her to The Residence of ArborHospice for the last 36 hours of an incredible life.  

Physically feeling nauseated each step of the way, I had to remind myself that I knew what the outcome was this time, and I had some control.  I also am astounded at how much I have learned from my mother since her death, and wish I could tell her in person how much I appreciate those lessons.  

I have to acknowledge, however, that we did not have the type of relationship where I could have told her in person.  I am so thankful that a week before she was admitted into the hospital, we had a half-serious phone conversation in which I acknowledged that she might have been right about something for the past thirty years – we both laughed, and moved on to another topic.   

One year later, having grown in knowledge about that topic, I am grateful she had me learn about it the way she did.  She was not perfect, as none of us are, but was wiser than I gave her credit for.   

Now this year of mourning is over, and while we never truly are done on our grief journeys, I know that the intensity of the journey will change.  Some days will be worse than others, but I know with support from family and friends who have been on this journey before me  that I too will be able to remember more of the moments that bring smiles and laughter than tears.

This blog entry was written by Gloria D. Brooks, Arbor Hospice President & CEO. You may contact Gloria by commenting below or emailing her at

Monday, July 21, 2014

Common Reasons Aging Adults Do Not Receive Enough Nutrition

As we age, receiving the nutrition our bodies need is hindered by new obstacles. The statements below are some of the most common comments I hear from seniors regarding their eating. Addressing these concerns is an important step in reducing the incidence of malnutrition and dehydration in seniors, as well as the potential for depression due to inability to consume favorite foods and fluids.

"Nothing tastes the same." Aging adults often tell me that food tastes too salty, too sweet, too spicy or that it has no flavor at all. Our sense of taste and smell change over time, and some of our favorite foods no longer taste right. Medications can also change how food tastes. If food tastes too strong, try limiting processed foods which often have a lot of added salt and sugar. While adding seasoning to favorite recipes may have been common practice in the past, try cooking without seasoning and add it later, if desired. Experimenting with different spices or herbs make recipes more appealing.

"I just can't eat that much food" or "I am just not hungry." Decreased hunger and a lack of appetite is common in aging adults. A full plate of food may seem overwhelming for seniors and they may actually eat less when faced with too much. Try decreasing meal portions and increase frequency of snacks. Limit concentrated sweets as they can diminish appetite and eat foods high in nutritional value. While fluids are important, drinking large quantities before or with meals can cause less consumption of more nutritious foods.

"I have trouble getting the food to my mouth." The simple act of eating can be difficult for some people, causing a decrease in nutritional intake. Arthritis, loss of strength or an illness often make holding utensils more difficult. Try using utensils with thick, soft foam-like handles, such as OXO Good Grips Utensils. The head of a fork and spoon can also be bent to the right or left if desired. Plates with sides may be helpful for people who have trouble getting food on their forks. Buying dishes with suction cup bottoms can keep plates from sliding away. There is also a large variety of drinkware that can make drinking easier.

"I have trouble chewing or swallowing." Chewing and swallowing problems can have a dramatic impact on nutritional status. Ill fitting dentures, missing teeth and mouth sores can make eating and drinking very difficult, and may cause people to limit the types of food that they choose. Often, a dentist can help alleviate or minimize these issues. A level two or mechanical soft diet, which contains chopped meats and soft foods, can be appropriate for people with these concerns. Those who suffer from dysphasia, defined as difficulty chewing and swallowing, often limit their eating choices and are afraid to eat due to coughing and aspiration. Refusing to eat, pocketing food, frequent throat clearing, taking a long time to eat and unexplained weight loss are some of the warning signs of dysphagia. A level one or pureed diet may be helpful for people with dysphagia. Refer to the Arbor Hospice website for more information on types of diets.

This blog post was written by Jill Gettle, Arbor Hospice Registered Dietician.

Wednesday, July 16, 2014

Breathing Changes During the Dying Process

There are a few different ways that breathing changes during the dying process. This is usually a later sign and indicates changes in the body's ability to regulate its most basic functions. These changes usually happen after the person who is dying has become less responsive and aware of what is happening.

One breathing pattern experienced by dying patients is often called the "death rattle." The death rattle is often caused by accumulation of lung secretions. This breathing pattern can be identified by:
  • Shallow, irregular breathing with periods of no breathing (apnea) for five to 30 seconds or longer
  • Noisy, rattling or gurgling breathing
  • Panting type breaths
Most individuals experiencing this breathing pattern are comfortable and unaware of their surroundings or their noisy breathing. This type of breathing does not cause added suffering. The pattern of breathing will shift and change. You may notice irregular breaths with periods of no breathing. These pauses may last for longer periods of time. Breathing may become heavy and deeper or very shallow and quick. Silent, gasping movements of the mouth without taking in any air may happen in the last minutes of life. Often the last breaths are deep and sighing.

What You Can Do

If noisy breathing is upsetting to you or other family members, you can:
  • Elevate the head of the bed
  • Turn the person from side to side
  • Avoid suctioning, which has little effect and will often cause more congestion
  • Using a soft damp cloth wrapped around your finger, gently wipe the mouth of any secretions that accumulate
  • Talk to your Arbor Hospice care team. There are medications available to help dry up some of the secretions and decrease the noise.

Thursday, July 10, 2014

The Four Things That Matter Most

Please forgive me. I forgive you. Thank you. I love you.

Dr. Ira Byock, an expert on palliative care and end-of-life issues, offers these "four things that matter most" to patients and families in his clinical practice.

In an "On Being" interview with Krista Tippett, Byock noted that patients or family members often tell him that they don't know what to say to each other at the end of life or in the face of life-threatening challenges.

"If you're really stuck at any time, those four things are a nice way to start, whether you use them verbatim," he explains.

"No relationship is perfect and many relationships are troubled..." Tippett observed. "In a lot of families, there's going to be real work involved in being able to say those words and mean them..."

"I've wondered if there's something about being in that extreme moment of life, as you say, normal but ultimate, that creates an opening for some people to do that work, to say those words where it hasn't been possible in other points of the life span," she wondered.

"It shakes us free of the veneers, the layers of personality, of who we think we are, of protecting ourselves," Byock responded.

"You know when the times are that you can say those things most easily, when you've just slammed on the brakes and just narrowly missed getting killed and you're shaking like a leaf and you're in a cold sweat, and everything just almost ended. Pick up your cell phone. I'll tell you, it becomes really easy to call your spouse or your mother or father or your child and just say those things. You know, it just shakes us free."

To whom would you like to say one or more of the things "that matter most?" Resolve to do so sooner rather than later.

This blog post was written by Dennis Sparks, Arbor Hospice Volunteer. You may contact Dennis by commenting below or emailing him at

Monday, July 7, 2014

Using Music to Facilitate Relaxation

We all know that the benefits of relaxation are numerous: reduced heart rate, reduced muscle tension, decreases in anxiety and stress, lower levels of cortisol in the body, among other benefits. However, the skill of relaxation is one that eludes many. I would like to suggest the implementation of music as a tool to help facilitate relaxation.

Meditation and relaxation are all about being "in the moment." Being in the moment means focusing
on events that are occurring presently, rather than thinking about past or future events. For example, one might choose to focus their attention on their breath. Paying attention to each inhalation and exhalation forces a person to be present and focusing on the current moment. Similarly, music can provide an external stimulus to take a person's mind off of their thoughts and worries. These two ideas can be combined if a person focuses on breathing in rhythm with a piece of music.

Music can be a very useful tool for helping a person relax but how do you choose the right music for relaxation?

  1. Choose preferred music. Whether you are picking out music for your own relaxation or for a loved one, keep musical preferences in mind. Music with positive emotional associations and memories can provide an overwhelming sense of well-being for a person. This may e an old song from someone's childhood, slow classical music or new age music, among other options.
  2. Pay attention to tempo. Be mindful of the tempo of the music that you choose. It should have a slow tempo. If a person is feeling particularly anxious or stressed when beginning to relax, they could choose music with a slightly faster tempo to match their emotional state, but the tempo should slow down throughout the piece. The principal of entrainment tells us that a person's natural biological rhythms will change to match the dominant stimulus present in their environment. This means that if a person is focusing on music, their heart rate and respiratory rate may change to match, or come close to, the tempo of the music.
  3. Watch out for abrupt changes. Prior to using the music for relaxation, listen to the music to notice if there are any abrupt or unexpected changes. When a person's body and mind become more relaxed, an unexpected change in the tempo, timbre or quality of the music may reverse any positive effects that have occurred thus far.
  4. Avoid music with words. While songs with words may offer that warm feeling of a positive memory, it is best to avoid words during relaxation as they engage our brain in cognition during an intended relaxation session. If you or your patient find the human voice soothing, choose music that uses words from an unfamiliar language. Look into classical vocal (choral or a soloist with instrumental accompaniment) music or Gregorian chant.
Remember these tips when choosing music for relaxation. Also remember that relaxation is a skill that must be practiced - it may not come easily the first time you try it.

Wednesday, July 2, 2014

What is Reiki?

Reiki is a Japanese massage technique for stress reduction and relaxation that also promotes healing. It is administered by "the laying on hands" and is based on the idea that an unseen "life force energy" flows through us and is what causes us to be alive. If one's "life force energy" is low, then we are more likely to get sick or feel stress; if it's high, we are more capable of being happy and healthy.

A Reiki treatment feels like a wonderful glowing radiance that flows through and around you. Reiki treats the whole person including body, emotions, mind and spirit creating many beneficial effects that include relaxation and feelings of peace, security and well-being.

Reiki is a simple, natural and safe method of spiritual healing and self-improvement that everyone can use. It has been effective in helping virtually every known illness and always creates a beneficial effect. It also works in conjunction with all other medical or therapeutic techniques to relieve side effects and promote recovery.

Its use is not dependent on one's intellectual capacity or spiritual development and therefore is available to everyone. It has been successfully taught to thousands of people of all ages and backgrounds.

While Reiki is spiritual in nature, it is not a religion. It has no dogma, and there is nothing you must believe in order to learn and use Reiki. In fact, Reiki is not dependent on belief at all and will work whether you believe in it or not. Because Reiki comes from God, many people find that using Reiki puts them more in touch with the experience of their religion rather than only an intellectual concept of it.

Reiki can be used for hospice patients as an intervention to further promote comfort for patients and can provide reassurance in much the same manner as hand, back and foot massages. Reiki is a wonderful tool that can be used to assist patients into a state of relaxation and help alleviate pain.

This blog post was written by Michelle Chaves-Torres, Arbor Hospice Massage Therapist. You may contact Michelle by commenting below or emailing her at