We are raised to think of death not as a necessity but as an enemy. When people who are still healthy are confronted with someone who is dying, they are intensely uncomfortable. They are frightened of losing the dying person, of their own deaths, and of death’s finality. “Death isn’t like breaking up with someone and time heals it,” said Helen. “Death is death, period, and no one wants to deal.” Sometimes their discomfort, their not wanting to “deal,” makes people appear insensitive. Alan was in a mall, shopping, and someone he knew came up and asked, “Why have you got all those shopping bags? Aren’t you dying soon?” Alan snapped back, “How soon are you dying?” but he was surprised and confused and hurt by his friend’s question. Dean had a friend who habitually made a joke of looking around at Dean’s furnishings and saying, “Oh, that’s new. Leave it to me in your will.” Dean finally replied, “Okay, that’s fine. Do you want the kitchen chairs too?” After that, the friend dropped the joke. Such remarks sound insensitive, as though as though the person is taunting you with life and health. But they are not; no one is this callous. Insensitivity is the method some people use to deal with their own pain and fear. The method is certainly inappropriate. Both Alan and Dean let their friends understand how inappropriate their remarks were and that they should be more careful in the future. Sometimes people’s discomfort with the reality of death isolates those who are dying. People facing death often find that other people are friendly and sympathetic but want to talk only about easy, comfortable subjects. When the subject of death comes up, they talk instead about what they’ve done recently, or about the future: “I can’t wait until we get you to a ballgame.” They also sugar-coat the subject: “Remember how sick you thought you were before, and a month later you were off on a trip.” This is hard on the person facing death. He or she may be happy enough to talk about the weather, the news, or sports, or to gossip about mutual friends. But being prohibited from talking about the things that are of most concern makes a person isolated and sad. On the other hand, everyone facing death knows some people who will “deal.” Perhaps it is someone who also faces death or someone who has lost a person they loved, or a professional who has had training in helping people handle the emotions and problems of dying. Often it is someone who loves the dying person and is less afraid than other people of the reality of death. These people tell the person who is dying that they will not leave, they will stay as long as they can. With Alan’s young nephew, that message is reversed. Alan’s nephew worries about Alan’s death, and Alan tries to help by telling him he won’t be abandoned: “My nephew cries when he thinks about it,” Alan said. “I tell him, ‘I’m not going to give up easily and I’m going to try to be there for your graduation. Don’t be disappointed if I can’t, but I’ll try.’”*224\191\2*
Archive for July, 2011
The first issue to settle is whether you can still drive your vehicle after spinal cord injury, with some type of adaptation. You may need to go through a driving evaluation and assessment for adaptive equipment. Driver education for persons with disabilities is usually available through rehabilitation centers. You can get more information from your state Department of Rehabilitation. Of course, private driver training programs are also available.Most states require drivers to report a physical disability that might significantly affect their driving status and require that these drivers be reexamined. If you do not report your disability, your automobile insurance carrier may not be obliged to cover you in the event of an accident. Check with your insurance company and state motor vehicles department before driving your adapted vehicle.After the proper driving training, you’ll need to make decisions about types of vehicles and special accommodations. There are various ways for a driver to get a wheelchair in and out of the car. Vans can be fitted with a wheelchair lift or a ramp that folds down so that you can wheel inside. Some people with power wheelchairs prefer to remove the driver’s seat and adapt the vehicle so they can drive while seated in the wheelchair. Others use full-size vans and stow the power chair between the front seats, transferring into the car seat to drive. Some people drive two-door cars with wide doors and more access to the back seat, which allows them to fold the chair and put it in the back. If you have some walking ability, you can put a chair or scooter on a lift on the back of the car and walk to the driver’s seat. Also available are lifts that put a wheelchair into the back seat of the car.Containers called chair toppers can be purchased to install on top of your vehicle. These ingenious contraptions automatically lower a hook from an overhead compartment, which resembles a car-top luggage carrier. The hook slips under the seat of the wheelchair (which is easily collapsed by pulling up on the seat) and carries it vertically upward until it flips on its side and slips into the open container. The container then closes, to store and protect the chair. An advantage of this device is that you can transfer from the chair to the car seat, hook the chair, and push the button in the car to raise it. This is helpful for those unable to walk or without sufficient strength to lift the wheelchair, and it protects the driver from the elements.When you are buying a new vehicle, check with the manufacturer about cash allowances for modifications. Ford, General Motors, and Chrysler all give some rebate toward hand controls, pedal adaptations, van conversions, or lifts. Dealers usually have brochures available on the dollar amounts their manufacturers grant. This allowance can be a major economic boost in these expensive purchases.If you do not drive, perhaps a personal care attendant or family member can drive your vehicle. Your personal safety is important, so make sure you have proper tie-downs for the wheelchair. A valid driver’s license and good driving record may need to be on your list of questions when you hire an attendant. Insurance covering the driver and passengers in the car is another essential.A note on technological aids in driving: Before investing in the latest technology to aid in your driving, talk with others who have used the device about pros and cons. Some items require sensitive care and frequent fine-tuning. If you know in advance that a technological device needs tender loving care, you may be less stressed about the time you spend taking your car or van to the shop.When considering hand controls, think about what type of driving you are likely to do. Some hand controls are permanently mounted in the vehicle. If you travel and rent cars often, or own more than one vehicle, you may want to buy portable hand controls. These can be switched from one car to another and are easily installed and removed, without permanently altering the car. They are also useful if another family member will sometimes be driving the same car, using the foot pedals.
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Middle aged adults are the focus of most cholesterol research and recommendations. After all, they are the ones just entering the high-risk phase of life for coronary artery disease. But should lipids be a concern for children and older adults? Yes.Children. The process of developing atherosclerosis begins early in life, butusually it becomes severe enough to cause problems only later in life. Evidence suggests that high cholesterol levels in childhood promote an earlier development of atherosclerosis and, by extension, increase the chances for development of coronary artery disease in adulthood.However, the evidence is not clear enough to justify recommending cholesterol tests for all children. Certainly children older than 2 who come from “high-risk” families—one parent has a cholesterol level of 240 mg/dl or higher or a parent or grandparent had evidence of coronary artery disease before age 55—should have their blood cholesterol measured. (See Cholesterol levels in children and adolescents from high-risk families, this page, for an interpretation of test results.)If a child’s cholesterol value is elevated, dietary changes are the first course of action. Actually, all children older than 2, regardless of whether a cholesterol level is known, should follow the same eating strategies that are recommended for adults. These strategies focus on reducing fat and cholesterol in the diet, maintaining a healthful weight, and encouraging physical activity. If by 10 years of age a child’s cholesterol level remains elevated above 190 mg/dl (or above 1 70 mg/dl in children from high-risk families) despite the best dietary attempts, then one of the lipid-lowering medications may be required. Not every medication is suitable for children, however, so the pediatrician will prescribe the appropriate one.*247\252\8*