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People who are exposed to cold and flu germs every day -- doctors, flight attendants, teachers -- know a thing or two about how to stay healthy when everyone around them is sick. Their suggestions can help you, too.
Wash your hands -- a lot. No matter what line of work you’re in, if you come in contact with people who are contagious, you have to wash your hands over and over, says Alan Pocinki, MD. Pocinki practices internal medicine at the George Washington University Hospital in Washington, DC.
“Wash your hands as much as you can stand, and then some more -- especially after wrapping up a visit with someone who’s sick,” Pocinki says.
It sounds so simple, but soap and water are the constant companions of doctors and nurses. To completely get rid of viruses from your skin, you need to scrub hard for 20 seconds or more. A good way to time yourself is to sing "Happy Birthday" twice while scrubbing the backs of your hands, between your fingers, and under your nails. It doesn't matter if the water's hot or cold -- the very act of scrubbing will physically remove the germs.
Use alcohol-based hand sanitizer.If you can’t get to soap and water, sanitizer can killcold and flugerms.
Avoid getting close to people who are sick. For example, don't shake hands.
“Doctors tend to be very cautious about hand shaking,” says Terri Remy, MD, medical director of Medical Associates at Beauregard in Alexandria, VA. “Just explain, ‘To keep transmission ofcoldsandfludown, I’m not shaking hands. But hello! Nice to meet you!’ They understand.”
Keep your surroundings clean. Arlington, VA, massage therapist Amanda Long asks clients to stay home if they feel bad. But to be safe, she sanitizes doorknobs and light switches between sessions. It's a practice she swears by.
“My hyper-vigilance has paid off,” Long says. “I was sick more often when I worked in an office, where people pawed into shared candy dishes and generally just mingled in a crowded space without much attention to germs. Now that I don't have sick days, I don't get paid if I don't work. And I know my job is to heal, not pass on a cold or the flu.”
Denver – Connect for Health Colorado® Chief Executive Officer Kevin Patterson released the following statement in response to today’s Supreme Court decision on the Public Charge Rule:“I am disappointed about the overall impact this ruling will have on all of us, but especially on our friends, neighbors and co-workers seeking a permanent residency status. This rule will force people to get health care in more expensive ways and will cause worse health outcomes for Coloradans; exactly the opposite of our mission and the work our state has led to increase access, affordability and choice in health. I’d like to remind our customers that the financial help they may receive through the Marketplace does not count negatively against them if going through the public charge review process. Our Assisters, Brokers and Customer Service Center can answer questions about financial help. We also developed a resource that includes immigration lawyers who can answer questions more directly about the public charge process.”
A drawing of Kent Hamm at his fraternity at age 21 helps wife Linda remember the man as he was. Photo by UCHealth.
On a sunny morning in mid-November, Linda Hamm rises from a couch in the comfortable apartment she shares with husband Kent in a Highlands Ranch retirement community. She steps into another room and returns with a framed drawing of a young man with neatly combed hair who looks into a mirror while adjusting his tie. Penciled in at the bottom of the picture are the words “Kent 12/11/60.”
“This is a fraternity picture of the man I married,” Linda says.
Kent Hamm, now 80, sits quietly in an armchair and gazes at the sketch of his 21-year-old self. Linda sets the picture down and retrieves a scrapbook stuffed with chronologically arranged photos and news clippings that document Kent’s life with family and friends in small-town Louisiana, as well as her own.
The thick binder is a work in progress: Linda continues to document the tangible memories of their separate lives and the partnership that spans nearly six decades. She and Kent met in 1960 as students at Louisiana Tech University in Ruston, married two years later, raised two boys and spent 45 years in the same home in a Houston suburb before retiring and moving to the Denver area five years ago to spend time with their four grandchildren.
“The scrapbook shows his life, my life, and our life together,” Linda says, spreading her hands across the pages.
Deteriorating stages of dementia
Linda is not merely reminiscing. She’s preserving memories for Kent, who for several years has been changing before her eyes, his memory eroding and his personality altering unpredictably. He has dementia, a progressive brain disease that causes cognitive decline beyond what is expected with normal aging. Dementia includes, but is not limited to, Alzheimer’s disease. An estimated 5.7 million people in the United States have the disease, and the number is expected to increase as the population ages.
Dementia is a challenge for Kent, who built a successful, half-century career in medical and technical equipment sales but is now mostly dependent on Linda and others to make decisions for him. But dementia has also caused great emotional turmoil for Linda in her role as caregiver – one she didn’t anticipate filling. That’s not unusual, said Dr. Bennett Parnes, medical director of the UCHealth Seniors Clinic on the Anschutz Medical Campus and an associate professor in the University of Colorado School of Medicine’s Division of Geriatric Medicine.
Dr. Bennett Parnes, medical director of the Seniors Clinic, Kent’s primary care physician, helped to launch the Living Well with Dementia program. Photo by UCHealth.
“It’s hard for caregivers who have known this person who is in many ways a different person,” Parnes said. “Psychologically it is really challenging.”
Living with dementia
Today, though, Linda and Kent have a helping hand from the Seniors Clinic through a program called Living Well with Dementia. The idea, based on a model called Care Ecosystem developed at University of California San Francisco, connects caregivers to a team of providers trained to address the medical, pharmacological, psychological and social problems caused by dementia.
The Living Well with Dementia program receives funds from Comprehensive Primary Care Plus (CPC+), a Centers for Medicare and Medicaid Services effort that encourages primary care practices to develop innovative ways to improve patient care. Parnes said the support has allowed the Seniors Clinic to deliver integrated care to patients, and their caregivers, living with dementia.
The Hamms receive regular help from Adreanne Brungardt, care team navigator for the Living Well with Dementia program at the UCHealth Seniors Clinic. Photo courtesy of Adreanne Brungardt.
The linchpin of the Care Ecosystem approach is the care team navigator, who receives training in the fundamentals of dementia and maintains regular contact with caregivers and fellow team members. At UCH, that’s Adreanne Brungardt, by trade a neurologic music therapist, who currently works with 43 families referred by their primary providers (the program has served 65 over the past year).
Battling burnout as a dementia patient caretaker
Caregivers referred to the program initially complete assessments, Brungardt said. She then makes a call that begins with a straightforward but lighthearted question aimed at understanding each caregiver’s specific story: “What made you say yes to me bothering you?”
Brungardt then makes a home visit – the Seniors Clinic is the only Care Ecosystem implementation site to include this feature – which helps her establish a trusting relationship with caregivers and patients. Monthly phone calls follow, with Brungardt listening to specific concerns, suggesting possible solutions and routing questions to other team members for additional help and advice. The program team also meets weekly to discuss patient and caregiver issues from different perspectives.
The overall goal is to help caregivers avoid emotional exhaustion and burnout, Brungardt said. In turn, healthy and better equipped caregivers can help their loved ones more effectively.
Unpredictable challenges with dementia
That’s no easy task, Brungardt added. People with dementia exhibit new behaviors over time, such as irritability, paranoia, and difficulty in ordinary tasks. The limited number of medications available treat only symptoms or occasionally slightly slow progression and have a host of side effects.
“There is no miracle drug for dementia,” Brungardt said. “It is a disease in the brain that doesn’t just change memory.”
For example, a seemingly unremarkable event, like having a visitor, may trigger severe agitation in a person with dementia and spike stress and frustration in a caregiver. Loved ones looking for a solution often must find ways to communicate differently with their loved ones, Brungardt said.
“The question for caregivers is, ‘how do I change the environment and my own responses?’” she said.
Early signs of dementia
It’s a challenge that resonates with Linda Hamm. Parnes diagnosed Kent with dementia two years ago, though he and Linda both say that in retrospect there were earlier signs of deterioration. For example, near the end of his last job with a Pennsylvania-based company for whom he worked 25 years, he began having trouble tracking his sales orders – something previously unheard of in that job or during stints with industry heavyweights like Fisher Scientific and GE.
“It bothered me. I knew something was going on,” Kent said.
Still, after the move to Highlands Ranch, Kent didn’t want to stop working altogether. He says it was in his blood; his dad sold clothing in Alexandria, Louisiana “for years and years and enjoyed it. I knew I wanted to go to work at six years old.”
He got a job at outfitter giant Cabela’s Lone Tree outlet, working in several departments and finally as a greeter, but he says he had trouble remembering his schedule. Linda noticed that he began driving very slowly, a worrisome sign but one she chalked up to unfamiliarity with a new city. But she was more hard-pressed to explain his decision to cede responsibility for their finances to her.
“I was never involved in the finances,” Linda said. “He had taken care of everything and was as sharp as a tack.”
With assistance from Brungardt and the Living Well with Dementia team, Kent and Linda hope to stay in their Highlands Ranch retirement community as long as possible. Photo by UCHealth.
New abnormal after dementia diagnosis
The diagnosis of dementia provided an explanation for the changes but also ushered in a new time of uncertainty. Linda began to see that the troubling changes weren’t going to subside.
“It’s been a journey,” she said. “At first, it seemed like every day was a new problem. It was very frustrating for both of us.”
“One of the hardest things in dealing with dementia is that it is a progressive disease,” that exacts an inexorable toll on patients and can wear down caregivers, Parnes said. “You don’t first go through a rigorous training course on how to do it, you are just thrown into it. It’s easy to get burned out,” he added.
Kent’s dementia also intertwined with other problems. Parnes initially prescribed an anti-anxiety medication that Linda said settled Kent’s emotions. However, he has back problems caused by spinal stenosis, and when he worked on his physical therapy, he began falling. Linda checked with a pharmacist with the Seniors Clinic who told her a side effect of the medication was weakness in the legs.
At Parnes’ direction, she weaned him off the medication, but that led to a personality change. He began resisting doing his exercises, brushing his teeth and shaving. Linda’s frustration rose with each refusal.
“I was dealing with [the question of] was it more important to be his wife or his mother,” Linda said. “Things like that were getting in the way of our relationship.”
Caring for a loved one with dementia
Parnes helped her through that as well, suggesting that Linda put his toothpaste on his brush and bring him his shaving razor instead of fruitlessly telling him to start the tasks himself. It wasn’t easy advice to follow, she conceded.
“At first I was angry that he wasn’t doing it on his own,” she said. “I don’t say anything now. It’s part of getting ready in the morning.”
The demands of caregiving, however, took a personal toll. “I’ve given up my life and that was very difficult at first,” Linda said. She had to abandon Bible study classes and committee work she participated in at their retirement community. Kent is uncomfortable in large groups, so they avoid parties, another painful change.
“He used to be a wonderful host,” Linda said, as Kent listened. “We would have large parties in Houston, then would wash the china and silver together before we went to bed.”
The parties were in their 45-year residence in tiny El Lago, Texas, a short drive from NASA. Neil Armstrong, Buzz Aldrin and dozens of other astronauts called El Lago home while the Hamms lived there.
“It was an exciting place for our boys to grow up,” Linda said. “We loved that home. We loved the memories of that home.”
A scrapbook of photos and clippings Linda has put together is another spur to memory for Kent, who has dementia.
Creative problem solving
While Linda worked hard to care for Kent, she said that for some months she felt that they were on a merry-go-round, with one challenge following another. For example, his personal trainer at the retirement home moved. That led to another fall and sent him back to a community physical therapist.
“I was so frustrated,” Linda said. “I like everything to be smooth. We’d get over one thing and something else would crop up.” She struggled to see Kent’s path forward.
The referral to the Living Well with Dementia program helped to change that. Brungardt called her to explain what would be involved, then made her home visit, which put Linda at ease.
“She made me feel very comfortable,” Linda said. “I have confidence in what she says because she listens and asks questions.”
Brungardt’s monthly calls are far more than chats. To illustrate, Linda pulled out a legal pad with a page full of questions she had readied for their most recent conversation. They ranged from financial queries to dietary issues to voter fraud – Kent had been contacted because his signature on his last ballot didn’t appear to match with earlier ones. Linda covered the page with notes gleaned from Brungardt.
“So many things that you just don’t think about keep popping up,” Linda said. “Before we hang up, I have a date on my calendar for the next call.”
Finding the confidence to handle dementia
With Brungardt’s help, Linda said she continues to be more accepting of the reality of Kent’s dementia. For instance, she used to try to jump in and correct him when he told stories that got events out of order. Brungardt helped her to let that go.
“She said what difference does it make if the facts aren’t right?” Linda recalled. “I can stay in his conversation. I don’t want him talking to a wall.”
A center that provides assisted living, skilled nursing and memory care is down the street from the retirement community, but Linda said she and Kent intend to stay at home as long as possible. She is much more confident that they can meet that goal because of the Living Well with Dementia program.
“I am hopeful because we have a support system that will help us with the problems,” Linda said. “I have told Adreanne, ‘You have given us hope that we can make it through this.’”
Thanks to clever marketing tactics, e-cigarettes (also called e-vaporizers) have become a popular alternative for cigarette smokers and are attracting new users who’ve never picked up a cigarette before.
E-cigarettes contain nicotine just like traditional cigarettes, but it’s often available at higher concentrations.
“Vaping is as addictive to smoking cigarettes — if not more so — because of the nicotine concentration e-cigarette manufacturers are putting into their products,” Dr. Sippel says. “Vaping the equivalent of a pack of cigarettes could give you double the amount of nicotine.
“Another reason vaping is highly addictive is — unlike when you start smoking and contend with irritated lungs and the bad smell — e-cigarettes are available in a variety of flavors that smell really good and vaping doesn’t cause any lung discomfort.”
Learn more about talking to your kids about vaping, vaping and pregnancy, and an e-cigarette study.
Vaping probably won’t help you quit smoking cigarettes
Many cigarette smokers turn to vaping when they’re looking to quit, but there are better options.
“Some studies show that vaping isn’t helping people quit smoking cigarettes and many of those people are now using more nicotine,” Dr. Sippel says. “There are several products people can try to help them quit smoking, in addition to other non-medical tools, instead of turning to vaping.”
He recommends the following smoking cessation aids instead:
Nicotine replacement products
Over the counter: nicotine gums, lozenges, patches
Bupropion SR (Zyban®) Varenicline tartrate (Chantix®)
Other tools
Participating in cognitive behavior therapy
Creating a support system
“If you’re trying to quit smoking, speak with your provider and they can work with you to come up with a plan that to help you succeed that doesn’t involve vaping,” Dr. Sippel says.
Learn more about UCHealth’s smoking cessation programs.
E-cigarettes contain harmful chemicals
While it is widely known that traditional cigarettes contain harmful ingredients, there’s still much unknown about the potential long-term effects of vaping.
“What we do know is that many e-cigarette manufacturers added vitamin E acetate in vaping cartridges, which is a molecule that is hard for lungs to clean out and can cause inflammation and lung injury,” Dr. Sippel says. “This is where we have seen some reports of serious lung injury.
Dr. Jeff Sippel explains why you should shop vaping.
“It’s one thing to avoid cartridges with vitamin E acetate in them, but when you vape, you’re also breathing in oil. Oil does not need to go into your lungs and there is a potential for injury when you are smoking oil. So, we don’t yet know what other problems could come from vaping down the road.”
The Centers for Disease and Control continues to investigate reports of lung disease related to vaping.
Young people who vape face greater risks later on
If you’re a parent, you may not even know your child or student is vaping because it’s not as disruptive or obvious as cigarette smoking. The truth is, many are. In fact, vaping devices are the No. 1 way U.S. teens are using nicotine.
“It’s easy for kids to get drawn in to vaping because it’s marketed in a way to hide and disguise the activity and it comes in a ton of yummy flavors,” Dr. Sippel says. “There are even websites that sell hoodies with built-in usb chargers and inhalation devices disguised as the strings.”
There’s a misconception that vaping is less harmful than smoking cigarettes, but it’s simply not true. Dr. Sippel warns parents to not be tempted rationalized it as the “lesser or two evils.”
“Kids who vape are going to end up smoking cigarettes or become lifelong vapers which is going to give them high risk of lung injury and emerging illness we don’t even know about yet. No matter how you look at it, vaping is going to cause problems.”
The CDC offers additional tips on how to talk to your teens about the dangers of vaping.
UCHealth’s Comprehensive Lung and Breathing Program is recognized by the U.S. News and World Report “top hospitals” rankings as the best in the nation. Search for the UCHealth respiratory care program closest to you here.
The news is full of stories about a fast-spreading virus from China called the novel (new) corona-virus. Scientists around the globe are racing to learn more about the virus. Concerned about what this means for your health and your family’s safety?
The Centers for Disease Control (CDC) believes the immediate risk to the American public is low right now, but they’re asking everyone to help reduce the risk of infections spreading.
How to protect yourself and your family
Check the CDC website for up-to-date information, especially if traveling. Get a flu shot to prevent the flu. While the corona-virus is different from the flu virus, the flu is still a serious illness.
Practice good health habits. Wash hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer when washing isn’t an option.
Avoid touching your eyes, nose and mouth.
Avoid close contact with people who are sick.
Stay home when you’re sick. That includes staying home from work, school, errands and travel.
Cover a cough or sneeze with a tissue, then throw the tissue in the trash.
Clean and disinfect frequently touched objects and surfaces, such as phones, keyboards and doorknobs.
Get plenty of sleep, be physically active, drink lots of fluids and eat nutritious food.
Sources Centers for Disease Control and Prevention: About 2019 Novel Coronavirus (2019-nCoV) (January 28, 2020): cdc.gov/coronavirus/2019-ncov/about/index.html.
