Author: sarambarton

Categories
cancer caregiver cancer management caregiver education

Caregiver Strategies for Continuous Cancer Management



“Cancer police! Freeze, sucker!”….Imagine finding out that your late-stage cancer has been chased down throughout your body by your cancer team and stopped. With its hands in the air and no place to go, the disease that has ravished your body and soul just stands there like a surly, unrepentant career criminal, contained for the moment and hopefully going away for a long stretch in a maximum security prison. What happens now?
 
In real life, a criminal investigation is followed by a trial, with prosecutors and defense attorneys arguing back and forth, presenting motion after motion, deposition after deposition, and witness after witness. There are forensics, surveillance videos, and phone records introduced as evidence. Some cases can drag on for years before they get to trial and the judge hands down some semblance of justice. Victims can feel victimized over and over again by these brutal and unfair circumstances and often face the prospect of living with that terror on an ongoing basis, never knowing what dangers lurk in the shadows.

Most cancer patients get treatment that either works or doesn’t. Doctors make their decisions based on what’s going on in the body at that moment in time. Standard protocols are carefully monitored. Everything is based on what has been learned through clinical studies. There are patient scans and tests to determine the extent of the damage caused by cancer. Doctors will argue for or against this treatment or that one, often with contradictory opinions.

But new research that arrests cancer in its tracks is churning out a new kind of cancer patient who needs ongoing treatment to maintain the status quo. You’re no closer to a cure, but you’re also no closer to death — you’re in limbo as the ongoing treatment process continues to hold cancer at bay. It’s like serving some kind of twisted “life sentence without parole” for the person most affected by the disease.


How does this work? What if the doctors told you that you could continue living, but only if you stay on a harsh chemotherapy regimen for the rest of your life? Instead of a set number of chemo rounds, followed by months of recovery time, you’re told you will now going to have ongoing treatment every month. Expect to deal with significant side effects with every dose of chemo. How do you cope as a cancer patient and find peace in the face of such a cruel reality, especially when you know there will be no reprieve any time soon? And how does your caregiver give you the kind of care and support you need to get through that rigorous routine? 

I first came across this dilemma more than five years ago, when I met a Stage IV stomach cancer patient, who talked about the rigors of his cancer survival plan. Every day, for the rest of his life, he would have to face the side effects of a very powerful drug that left him with balance issues, muscle weakness, nausea, and other unpleasant hurdles to leap over on an ongoing basis. Every night, right after dinner, he would take his medication and hit the sack, totally wiped out. This once-vital man still took vacations with his wife, still tried to work part-time, but it was a genuine struggle just to maintain that status quo and get through the day with continuous cancer treatment. His wife was his dedicated caregiver. It was easy to see just how committed they were to each other. He had once saved her life after a horrific car accident; now she was returning the favor. What was their secret for success? They consciously accepted the harsh realities of the treatment he faced and together they conscientiously worked their way through the problems, one issue at a time, making adaptations as needed.
Since then, I’ve had conversations with other cancer patients in similar straits because I want to know how we cancer caregivers can improve the care we provide. We need to understand the pitfalls and benefits of ongoing cancer treatment, what it does to the quality of life for those we love, and how it affects daily life for those directly impacted by it.
Now, thanks to cutting edge research, some cancer patients are finding out that having an incurable cancer is no longer a certain death sentence. In some instances, the disease can be contained, but that option comes at a great personal cost. There will be ups and downs during continuous cancer treatment. Just as one round ends, another will begin; when that one ends, another will follow. That means no break from the grueling side effects, no time off for “good behavior”. It takes a tremendous amount of courage to decide to proceed forward with that kind of treatment plan.
We caregivers need to mitigate as many of the debilitating aspects of this as possible, so that our loved ones can continue to achieve their goals, follow their dreams, and be involved in the activities that make them feel whole. We want them to have enough quality of life so that they feel satisfaction in their lives and they are able to cope. We must work to tamp down the negative outcomes and boost the positive outcomes.
I’m convinced this calls upon us to become a new breed of proactive caregivers — wiser helpers who provide more effective support for patients whose treatments are continuously evolving. Good cancer caregivers understand that there are some necessities we must provide to our loved ones if we are to be successful. These include:
Comfort for the physical and psychological pain — 
When we know what is causing the greatest distress to our loved ones, we can better reach out to the cancer team to identify the solutions and apply them quicker, whether it’s palliative care for pain, better nutrition options that make food more palatable and digestible, or adaptive tools to overcome physical and mental limitations that interfere with the normal activities our loved ones want to take on

Companionship that continually nurtures the soul —
When our loved ones constantly need help from us in order to function physically, we caregivers give it; it’s important to recognize that this creates a serious imbalance in our non-cancer relationship and we need to periodically return to that on good days, to embrace the essence of our “old” selves again, to laugh and have fun together like in “the old days”, throughout the caregiving process
Compassion for all the frustrations, worries, anger, and sadness that get in the way of living a normal life with continuous cancer management — 
When we know what hinders our loved ones the most, we can seek ways to overcome these challenges in meaningful ways that empower our loved ones again and again, by tapping into the hidden strengths and minimizing the weaknesses that get in the way of success; in this way, we empower our loved ones to experience moments of satisfaction that are born of their hard-fought determination to succeed despite the obstacles that stand in their way
Commitment to making this partnership work for patient and caregiver —
As we focus on the role we play as facilitators, we recognize our responsibility to do what our loved ones need done and we don’t take charge of the disease; we consciously put control back in the hands of the people who most need it — the cancer patients who have been thwarted in their efforts to live their lives as they so choose; at the same time, we must also recognize our own need to stay healthy and active, so that we can function as effective help mates
I’ve talked about the four stages of care on my website, The Practical Caregiver Guides. They are:

Temporary
Serial
Progressive
Permanent


Learn more here: Four Types of Care

Many cancer patients need temporary caregiving, especially when the cancer or the treatment side effects hamper normal activities, but once that’s over, so is the need for a cancer caregiver.
Some patients need serial caregiving over time, especially when the cancer recurs or metastasizes. The caregiver steps in to help when a loved one is struggling, but when things are good, the caregiver steps back, with the understanding that there may be a need again in the future.
Some, especially people with late-stage cancers, need progressive caregiving. They know they are likely to continue to lose function because the disease is gaining on them. Eventually, they will enter a hospice program, for end-of-life care.
But what comes between serial and progressive care, when a loved one’s cancer is still present, but managed with continuous treatment? Your loved one will be repeatedly going through the same cycles of treatment and side effects over and over again, without being able to go off the medications. As harsh as this will be on the body, it will be even tougher on the psyche. Life has to be “good enough” to endure the hardships. It becomes more important than ever for the cancer patient to feel invested in his or her life, to able to achieve personal goals, make dreams come true, and experience a sense of satisfaction and fulfillment.
The biggest challenge for a cancer patient and caregiver over time is likely to be the cumulative effect of the rigorous, never-ending treatment on daily life. It will be important to stay focused on the positive and find ways to remain aware of what is working, in order to help your loved one face a future of living in limbo. The better you understand the physical, psychological, and personal aspects of this situation, the more likely you will be to attend to issues as soon as they creep into the picture. Being proactive means understanding as much about your loved one’s cancer as possible.
What are the side effects of the particular treatment your loved one must undergo to keep the cancer in check?
If you knew that once a month, you would have to indure a horrible week in order to have two or three good weeks, would you be confident that you could get through it over the next month, the next year, or the next decade? When you’re facing a cancer diagnosis that includes rounds of chemo, radiation, and even some surgery, you are likely to talk yourself into getting through the treatment because you expect a positive outcome when it’s all over. But for cancer patients who have a “life sentence without parole”, there is no real light at the end of the tunnel, no pot of gold on the other end of the rainbow. It’s important that we, as caregivers, we recognize the real hardship of this kind of life, and it’s vital that we find ways to help our loved ones achieve as much quality of life as they can under the circumstances.
What are the actual cycles of these side effects and how can you help to alleviate the brunt of the rigorous treatment?
As overwhelming as it is for our loved ones to contemplate a seemingly endless life of ongoing cancer treatment, our efforts to recognize their worries and find meaningful solutions not only provide comfort, both physical and emotional, but also keep us focused on seeking answers. Sometimes a little medical information can make a difference. What if your loved one is not hydrating as much as the body needs? That’s likely to make chemotherapy more difficult to endure. What if your loved one isn’t able to eat? Working with a palliative physician to control physical symptoms and a cancer nutritionist to tweak food choices can make a huge difference.
But what if your loved one is terrified about the future and is convinced that continuous treatment is a losing proposition? By recognizing the emotional chaos and sorrow that this kind of diagnosis brings to a cancer patient, you are more likely to find ways to help your loved one remain engaged in the effort. Patients who feel satisfaction with what what they are doing will feel life is worth living. Patients who don’t have that are more likely to quit.
How big a factor does guilt play in your loved one’s cancer experience?

Believe it or not, cancer patients often feel guilty that they need the help of caregivers. They can often convince themselves that we are wasting our time, our energy, and our talents on caring for them. When guilt interferes with our efforts to assist, our loved ones will sometimes withdraw, believing that they must do things for themselves, even when they don’t have the strength or stamina to do that. How can we help them to let go of their anxieties? We can share our honest thoughts and feelings.
There are times that caregiving becomes difficult for us — that’s a given. But for those of us committed to the process, we want to be there for our loved ones. That’s why we need to find our own support system, one that will continually help to recharge our batteries and to empower us in our responsibilities. If your loved one feels guilty that you are spending too much time providing care, those feelings are likely to resolve if he or she sees that you are still achieving your own goals and finding satisfaction in your own activities.
What can you do to live as healthy and active a life while your loved one undergoes this treatment?
Tired and frazzled caregivers can actually pile stress onto overwhelmed cancer patients. By taking responsibility for our own limitations, be they time constraints or too many responsibilities, and for our attitudes, which can negatively affect the people who need our help, we are forced to look for better resources. Sometimes it means we have to reorder our priorities and let go of things on our “to do” lists that just aren’t that important. And sometimes it means we must really go deep and analyze the way we are providing care to our loved ones, so that we can better meet his or her REAL needs.
How can you help yourself to understand how your loved one’s cancer impacts the quality of life for him or her?
With an eye towards making things work better, you can ask yourself what your observations are about your loved one under the circumstances. Believe it or not, a lot of cancer patients are proud of their own efforts to get through difficult experiences without breaking. Just as an experienced marathon runner takes the race in stride, sweating out the hill climbing and breathing a sigh of relief on the downhill descents, cancer patients can and should recognize just how amazing they really are in times of trouble. Don’t be afraid to praise real efforts your loved one makes. Don’t be afraid to admit that you are in awe of your loved one’s determination to live life out loud!
You can find more help for cancer caregiving at The Practical Caregiver Guides

 

Categories
cancer cancer caregiver community support

Dogs, Cancer, and Caregiving

 

It was just happenstance. I set out to put together a bibliography for readers of cozy mysteries (think Agatha Christie) that feature dogs. I did my research over two days’ time, searching various sources to come up with a respectable list of canine characters in fiction. Once I had all my information in order, I posted it to my cozy mystery library site. And that’s when it happened. Someone threw me a curve ball.

It came in the form of a request from an author of dog mysteries. She wanted me to include Susan J. Kroupa’s Doodlebugged Mysteries on my bibliography. It sounded great until I checked out the books and saw they were listed as kiddie lit. I was doing an adult bibliography. How could I diplomatically navigate this conundrum without offending anyone? I decided my best bet was to do some research. Maybe I could start a “junior cozy mystery” list. Or I could come up with a respectful reason why I couldn’t include it. I had to try to find a reasonable solution.

The funny thing was that I found a lot of adults loved the series and thought the books were well-written and amusing, with enough adult elements to make them work as cozies. They also thought the books were fun to share with kids and grandkids. But what does this have to do with cancer?

My research wasn’t done yet. In addition to providing a list of books, I also like to help readers connect to authors whose books they may enjoy reading. That meant I had to find Susan’s website. I flipped through a couple of her pages, looking at her books and bio. We had some things in common. We were both librarians at one point in our lives. We’re writers, nature lovers, and dog fanatics. Then I clicked on her blog. And that’s when I found it:

What Love Looks Like — Susan J. Kroupa

I saw that photograph of her daughter, Sarah, holding a baby. Sweet-faced. Mother of five. Colon cancer stole her away just before Christmas.

My heart sank because it’s a story I know too well. I still remember Michelle and her extraordinary battle to defeat the monster that is colon cancer. I still remember my amazing cancer friend’s effort to pour as much living into her last year of life as was humanly possible. There were so many trips, so many photographs, so many things Michelle did with her family to remind them of her unending love before she left them. Here was another young mother with another amazing family.

But when Susan wrote about her daughter’s battle with cancer and eventual death, she didn’t write about the sorrow. She wrote about the love that their community shared with the whole family. She wrote about how people came together to support them in ways that I wish every cancer family could have. It’s a wonderful testament to what we can and should do for those in our circles who are in need.

So I am sharing Susan’s link with you now, not because she wrote extensively about what to do and how to do it, but because she managed, in a very short piece, to capture the spirit of generosity that really is the face of love. This is real giving at the heart level. People got it right at the right time. They stepped up to the plate. If we could bottle this and sell it, it would be a tonic that could soothe the most discomforted soul. It will never take away the pain of losing a daughter so young, but it obviously made a difficult and challenging time less so. This is inspiration for every cancer family. Don’t give up, reach out. Ask for the right kind of help for your family, for yourself. Know what you can and can’t do realistically and don’t be afraid to say you need more help. Susan can tell you what happens when you recognize that need and people respond.

You never really know what lies beneath the cover of a book until you open it and read. Everyone has a story. I’m glad I was curious enough to learn more about an author and I’m glad to share this with you. Maybe someone else’s life will be made better by the story of Susan’s daughter because readers like you will see the possibilities and act. Don’t be afraid to be the love.

Categories
cancer World Cancer Day

How I Spent World Cancer Day

I admit it. I was doing other things than posting about World Cancer Day on February 4, 2016. I know I probably should have gotten out there and generated a lot of publicity for the event, but the truth is I was busy doing other things.

It’s not that I didn’t think about cancer. Cancer is never far from my mind, not with all the people I adore who are in various stages of treatment and disease management. To them, it’s an everyday thing. Cancer is never far from their thoughts.

No, I spent World Cancer Day out of the loop. For me, it was much more important to find out how a friend’s sibling was doing after a stem cell transplant. What had changed for him in the months since he underwent the grueling process? Was he finally getting back to doing what he wanted to do, live his life? Had there been drawbacks to the treatment? Had there been benefits? I listened to my friend talk about what was still difficult and what was now easier. The one thing that really stood out was the growing closeness between siblings as they bonded during the caregiving process.

But I also spent time thinking about another friend, a long-time cancer survivor who has spent years reaching out to everyone, using yoga to do it. In the years since we first met, she seems to have grown a heart as big as Cleveland, embracing people in arms that seem to stretch across the miles, welcoming the shy, the reluctant, the hesitant into her circle. That’s a beautiful thing to see.

And I was glad to see another cancer friend, who has spent the last year in a fierce struggle to find the right treatment that would not only prolong her time on this earth, but also give her the quality of life she so rightly craves, engage in normal pursuits. No longer do all her FB posts now involve her disease. She is getting back to her passions, making beautiful music again and teaching students who will go out into the world and make it better.

But it’s not necessarily the same for another friend, one whose breast cancer has spread. Instead of having the time and energy to reach out to all those other breast cancer survivors who count on her sage advice, she is spending her days at the cancer center and her nights recovering.

I also thought about the friend of a friend, a woman I know only from her very sweet, compassionate posts in a cancer circle. She’s been so quiet lately. It’s hard not to worry about her. Only last year, she was enthusiastically planning a flower garden.

And I thought about a recent loss, about someone I loved who was hit smack dab in the face with a diagnosis of pancreatic cancer. We thought we might have a few months with her. I had already begun to think of ways I might help her, what I could do to support her. Before I even had the chance to start, she was gone. We call that “dying from complications”, but any way you look at it, it’s cruel. We don’t really get to say goodbye the way we wanted to, planned to, expected to, all because life was snatched away in the blink of an eye.

And that is always followed by the aftermath, the grieving period. On the one hand, you tell yourself, she could have spent months suffering. On the other hand, it was quick, merciful. We wish we had more time. We wish we could just rewind our lives for some extra moments to remember.

So, my apologies to all the entities who reached out to me to promote World Cancer Day. The truth is cancer was never out of my thoughts. I am grateful for the progress in cancer treatment that has helped some of my friends and relatives get back to the business of living. They are still here, still amazing me. But I wish that there was greater progress for all cancer patients. The current expectation that one out of three people will get cancer at some point in their lives is a frightening one. It means we all know someone with the disease. But there are also more than a hundred different types of cancer. We should always remember that not all cancer is the same. Some types are curable, some are well managed over time, and some come like thieves in the night and steal the lights that illuminate our lives, leaving us in darkness and sorrow.

But above all, when we think of cancer, we should never forget that people are not their disease. The next time you look at someone with cancer, remember to see beyond the ravages of the illness. Look into those eyes and see the soul. Get lost in that wonderful smile. Let the music of laughter set your heart on fire. Some people will survive their cancer, some will not. But as long as they are with us, there is life. Live it in spite of the cancer. Don’t hold back. Don’t be shy. Don’t hesitate. Tomorrow is promised to no one. There are no guarantees. Be here now and recognize the good in every moment, but do it with a circle of like-minded people who know how precious life really is. Never take it for granted. Never assume there will be other opportunities to get around to saying the things that are in your heart, in your head. You never know when things might turn bad.

Then again, sometimes things turn good and because you lived in the moment and spoke the truth about what matters most to you, you are that much closer to being the person you want to be — not defeated by cancer, not destroyed by cancer, but made whole by the wonderful people you have had the chance to meet on the road. And they are so much more than their disease. Cancer will never take that away from them, even if it takes them away from us.

Categories
Christmas grief hospice pancreatic cancer

What Pancreatic Cancer Took From Us

Dying from complications….one day busy with holiday shopping and ordinary errands, the next irreversibly transformed into a shell of herself, all because of unexpected developments that seem to accompany some of the more difficult cancers to treat.

It’s a shock for all who knew and loved her. Less than a month ago, she finally discovered why she hadn’t really felt well in a while. Not only was she diagnosed with one of the most difficult cancers to treat — pancreatic cancer — she was Stage 4. At best, she might buy a few extra months to get her affairs in order and say her goodbyes with chemotherapy. There was a slight possibility that she might enter clinical trials and discover some small miracle that knocked back the cancer enough to allow her to enjoy a little more time, a few more moments of joy. But there was also the very real possibility that palliative care would be the only real Band-Aid for what ailed her.

The shock of such a brutal diagnosis coming just before Thanksgiving was hard for those of us who loved her to accept, but it was especially difficult for her. It came as the great holiday season commenced. This was her time of year. She adored decorating her house. There were tiny little Christmas scenes everywhere — miniature cottages set upon white batting on tabletops and snowmen tucked into nooks and crannies. There were always decorative candles scenting the air, pine cones and boughs draped on fireplace mantels, and angels on high. She even scattered little treasures throughout her winter garden. The walk up to her gingerbread-like house on a snowy night was magical, especially enhanced with the tiny twinkling lights she draped here and there.

She loved shopping at this time of year, whether it was for people or pets. She was the only person who always remembered, after my mom died, that my dad likes real handkerchiefs. Every year, she would make sure he had new ones. She made sure that cats and dogs had toys that would offer hours of playtime that would amuse their pet owners. She took great pains to shop for the people she loved. I thought about that the other day when I donned a fleece top she had given me more than ten Christmases ago. I am reminded of her every time I pull it on over my head.

The last time I saw her was at her son’s wedding a few months ago. We spoke on the phone a few times as the countdown to the ceremony began. She was ruminating on the fact that the planning and execution of the wedding was an exhausting process. Did she really want to wear silver shoes and a lace dress? I told her she would look lovely. I advised her to smile and focus on having a good time, because that’s what her boys would remember years from now. I had no idea it would be the last time we would all be together for a happy occasion. There was so much fuss, she lamented. She remarked that she would be glad when it was all over and she could relax again. I think that was indicative of what was happening to her body as the secretive cancer began to spread. She wasn’t feeling quite right, but it was the kind of feeling that was too vague to be remedied. The symptoms could have been anything. That’s the trouble with pancreatic cancer. By the time the doctors figure out what the trouble is, it’s often too late.

That wedding, in the end, will be our salvation in many ways. I am so grateful we had that chance to gather. It was poignant when the mother of the groom took to the dance floor with her son. It was even sweeter to see her out on the dance floor, wiggling and wriggling as the sound system pounded out a steady beat. She was smiling and laughing, laughing and smiling. That is how I will remember her.

But I will also remember the tremendous tribute to her motherhood that came in the form of her two sons at her bedside during her sudden and unexpected final hospitalization. There, in her hospice room, these fine young men took turns watching over her, making sure that she was as comfortable as possible after the heart attack and stroke robbed her of her faculties. Their compassionate efforts were testimony to the love she raised them with and the time she dedicated to their upbringing. As her new daughter-in-law gently leaned in to check on her breathing and cover her up when the blanket was kicked away, I realized her son had chosen a bride who would stand with him in difficult times. But I also watched another young woman, newly engaged and soon to join the family, gently place her hands on the bedridden patient whose life was about to end. This dying woman would not be there to share the joy of seeing her second son marry the woman he loves. She would not have the chance to dance at another wedding because cancer caused these terrible, irreversible complications. My father keeps saying she would have been a wonderful grandmother. It’s too true. She would have thrilled at the prospect of that. She would have loved to spend hours outdoors with little children, working in her garden as they napped in their playpen in the shade on a fine summer’s day.

That is perhaps the hardest thing to accept about her untimely death — all of the experiences she never got to have, all of the joy and the laughter she dreamed she would someday know. It’s so easy to imagine what would have come next in her life if cancer hadn’t come knocking at her door. It’s so easy to picture all of the activities that would have brought family and friends together to celebrate the good things in life.

It will take time for all of us who knew her to find our equilibrium once more. There is no denying that there is a hole in our circle now that she is gone, never to return. But I hope that with time, those of us who love her will find ways to keep her with us as we gather. We will recall her passion for cooking that set amazing meals on her table, her endless hours of nurturing her charming cottage garden, and her love for Christmas. With every passing year, we will incorporate a little more of her goodness into our own lives, finding ways to share the warmth she brought into our lives by offering it, in turn, to others. It won’t happen instantly. It will take time for us to realize how much we miss the little sparkles of joy she shared, the small touches she added in our lives. But I am confident that we will do it. We will be here with her sons, their wives, and her grandchildren, remembering the magical moments she gave us over her lifetime, and we will honor her by embracing her essence, by letting her live through our own inspired actions. In that way, she will never really die. She will always be a part of us, eternally residing in our hearts.
Categories
cancer immune system infection

Avoiding Crowds with a Weakened Immune System

It’s funny how many times normal life as I know it gets interrupted by cancer. Whether it’s a friend whose epic battle rages on, through brutal chemotherapy regimens, or someone I love getting a devastating diagnosis on an undetected and very lethal type of cancer, it seems like every time I turn around, that beast is going after the people I care about in this world.

This is the season of celebrations, of holiday parties, joyful gatherings, and family times. For most of us, it’s something to look forward to with delighted anticipation. But for someone who has an immune system weakened by cancer treatment, it can be a royal bummer.

Why? The minute you’re told you can’t go out to the movies or eat in your favorite crowded restaurant, what little fun you have in your life evaporates. When you hear that you need to avoid the general public, it’s heartbreaking. It’s the equivalent of being sentenced to solitary confinement in a dreary jail cell.

Or is it? That subject came up recently in a cancer circle. How can you have any fun if you’re stuck at home? You might be surprised.

Having spent some time working with hospitalized kids in the pediatric wards of a couple of hospitals, I saw firsthand the value of keeping bedridden patients engaged in having fun. Why shouldn’t adults benefit from the same strategy? Laughter makes us feel better. Playing keeps our spirits light. When we’re having a good time, we aren’t thinking about what cancer is taking from us. We’re thinking about what we enjoy. That’s great medicine for our psyches.

When my mom had to lay low, we brought the fun to her. We had movie afternoons and evenings that were great fun. She loved movies, so we got her premium movie channels for the TV and got her a subscription to Netflix. Sure, she could watch the movies by herself, but the truth is my mother was a social butterfly. There was nothing she enjoyed more than watching them with other people, so we made it an occasion.

When she couldn’t go out to dinner in a crowded restaurant, we brought dinner to her and made it a festive occasion. When she couldn’t mingle with other customers at local stores, we made sure she got to choose what groceries she wanted us to bring home. And sometimes, just because she was going bonkers staring at the same four walls, we went for long exploratory drives that took us on the roads less traveled.

People who are facing the serious challenge of wonky blood counts and suppression of the immune system during treatments still need to have social lives. They still need to feel like they belong to the living world. That’s why, as cancer caregivers, it’s important that we make fun happen for our loved ones.

Whether you read a favorite book to a loved one whose hands are challenged by neuropathy or you get together in the kitchen to prepare a favorite meal, think outside the box. When the outside world seems to pose a great risk, open up the house and let the sun shine in. What’s wrong with inviting a few friends over for a game of cards or dominos? What’s wrong with picking up a tasty meal to share with family?

The important thing to remember is that life is always supposed to be fun, and never is this more important than when cancer snatches away our loved ones’ quality of life. As cancer caregivers, it’s our responsibility to address the psychological aspects of such a blow. We want our loved ones to remain invested in life. The last thing we want is for them to feel all the good times are gone and despair is all that lingers on. Without fun activities, the hours drag on and on, pulling down the fragile spirit of someone challenged by cancer and its treatment.

Make an effort to lift your loved one’s spirits by making home, sweet home even sweeter. Know what your loved one enjoys and make it happen at home. No one wants to be alone, like some sad, little bubble boy encapsulated in a plastic sphere, forced to play alone while everyone else has playmates. Keep plenty of hand sanitizer at the ready, wash your hands frequently, and make sure all visitors know that no one should come who might have a cold, the flu, or any other virus. You want your loved one to be safe, so take simple and smart precautions. And then open the door. Invite the laughter, the love, the joy into the house. Make your loved one part of all the action, at a pace he or she can handle.  Build on the moments that make us feel connected as human beings. Respect your loved one’s endurance level. It’s amazing what that will do for the human spirit. It sends the message that life goes on, even with the challenges of being vulnerable to infection. That means cancer doesn’t win this one. Cancer is not in charge of our inner children. We are.

Whether you host a party to trim your tree or invite folks over to spin a dreidel, give your loved one the chance to be involved. Bring the joy of the season home. Don’t be afraid to go hog wild. Don’t worry about overdoing the lights, the festive music, the food. Better to have too much fun (is that even possible?) than not enough. Celebrate!

Categories
American Cancer Society free wig program cancer Pantene Beautiful Lengths hair donation

A Bad Hair Day Is Always Better Than a Bad Cancer Day

I’m not known as an impulsive person. I’ve been known to analyze and over-analyze things to infinity and beyond before making a decision. I rarely ever just “go with the flow”. I like to know the lay of the land and what my options are before I commit to anything. I need to know that I can stay the course once I choose it. It makes me more than a little persnickety.

 

Some time ago, I was stunned when one of my cancer advocate friends found out that, not only had her cancer spread, it had gone big time into several organs. This beautiful, kind, sweet, talented, funny, and very smart lady was facing a battle that seemed overwhelming in its brutality. She was willing to go through procedures that would give the rest of us nightmares, just to have the chance to live longer.

It’s been a hard road for her over the last couple of months. As painful as it is for me to witness, it’s that much harder for her to endure. But she keeps looking for the beautiful in life, and because she does, she’s been a great inspiration for me. I just wish that I could take away the pain and suffering she’s experienced, the terror that chases her through the long, sleepless nights, the sorrow that fills her heart with tears.

When I found out that chemotherapy was robbing her of her beautiful long hair, I wanted to do something that would show her how much I support her through this grueling process. How could I show her that I care in a way that would be positive in a world filled with too many negatives?

I set my sights on donating my hair to a wig program. I checked out my options and finally decided on the Pantene Beautiful Lengths program. There were rules — no dyed hair was allowed. And there couldn’t be too many gray hairs because they don’t absorb dye well when the wig is crafted. I had to have at least eight inches of hair to send in. I learned that it takes eight ponytails to make one wig. That means that seven other people have to donate their hair before a woman in need gets a human hair wig. Pantene Beautiful Lengths wig donation program

Why the Pantene Beautiful Lengths program? They have partnered with the American Cancer Society to provide free wigs to women over 18 who are in cancer treatment and can’t afford to purchase one. Anyone who’s been around cancer survivors knows how quickly the bills add up when treatment starts. Cancer often not only robs you of your chance to continue working during treatment, it takes what’s left of your savings. The American Cancer Society has good information on local and national resource and support services available on its website, and that’s where you’ll find more on the free wig program.

I decided I could handle giving up my hair in a dear friend’s honor. But what would I do when it was gone? I tried to picture myself with short hair. Would I wind up looking like Ringo Starr or Jamie Lee Curtis? I spent a couple of hours trying to imagine how it all would end. I found photos of celebrities with hair styles I liked, in hopes I would somehow develop a glamorous persona during this process. But time and time again, I kept coming back to the fact that my friend was losing her hair because of cancer. She was going bald because of her (hopefully) lifesaving treatment. That trumps everything. A bad hair day for me is always better than a bad cancer day for my friend.

I took the plunge. I found a Super Cuts in a busy location, thinking that I was more likely to get a hair stylist with experience. Sure enough, Jennifer had cut hair for other hair donors. Instead of one long ponytail, she created two pigtails, which kept more of my hair on my head than I expected.

It’s been a few weeks since I went from long hair to short. If I had known how easy it would be to donate hair, I would have done this long ago. In fact, I probably would have made it an annual event. That’s why I encourage you, if you are able, to donate in honor of someone you know who is going through cancer treatment.

As much as I worried about what would happen to me after my hair was cut, it was nothing compared to what’s happened to my friend. Some days are good, some days are horrible. What she’s been through has been far more challenging than I expected.

Sometimes my friend goes “bald”, letting her hairless state speak for itself when she hangs out with people who make her feel comfortable about herself. She doesn’t have to pretend with those of us who adore her. And sometimes, when she wants to forget about cancer, she dons a wig to go out in public. If you saw her at her favorite coffee bar, you would see a glamorous lady with a dazzling smile. For those few moments, she is back to being her old self, doing what she loves to do as a dedicated “foodie” with a camera, documenting her culinary adventures. I get to travel with her vicariously as she samples mouthwatering dishes that make me salivate every time. I treasure those times on her behalf, knowing how important it is to her that she embraces the life she still lives. But in every photo she shares, there is one thing I seek — the light in her eyes. Is she finding some little smidgen of joy as she goes through her day? As much as the horrors of cancer and cancer treatment have piled up, is she still seeing the beauty in the sunset, still feeling the warmth of the sand on her bare feet, still touching the salt water as the waves roll into shore?

When it comes to cancer, it’s important to be greedy about joy. We should clutch it tightly and refuse to give it up. Joy is that one thing we can share in abundance with those we love, but only as long as we make room for it in our souls. It’s what puts a song in our hearts, a bounce in our step, and makes us still want to dance to a beautiful tune, even when our bodies are too weary to rise.

When push comes to shove, when cancer dominates a life, the only things that really matter are love and comfort. We love, so we offer comfort in any form we can — whether it’s practical advice, humor, strong shoulders that can handle the tears, or even just the chance to celebrate those too-few moments of joy that still creep into the room like a ray of sunshine on a gloomy day. When all the high tech tools of oncology and carefully concocted medicines no longer seem to push back the cancer to the corner, love and comfort are all we have left to share. We stand by those we love and we never surrender to this insidious disease. We don’t care about the lack of hair on a head. We care about the beautiful person who is still here with us and we celebrate her beauty.

Categories
#LiveLikeMichelle cancer caregiver CTCA grief hospice

Michelle DID Win

Michelle DID win. As I join so many others in grieving the loss of this vivacious, determined, spirited young woman, that is uppermost in my mind. #LiveLikeMichelle….

She started out her life with cancer by blogging about what it was like to face such as horrible diagnosis. Wife, mother of young children, daughter, sister, and friend to so many, Michelle had no intention of allowing cancer to suck the joy out of life. She was going to beat this thing, come hell or high water. You know what? She did.

Too often we hear that people battled cancer and the cancer finally got the upper hand, resulting in death. Too often it sounds like they failed because they were weaker than the disease. The words “brave” and “courageous” can be found in obituaries in every newspaper around the globe. But battling cancer isn’t what makes someone brave or courageous. Battling the demons that stop us from living with cancer is the real test of the soul. We wage war with an enemy that steals our humanity as it marches through the human body. Cancer is a weapon of mass destruction. It terrifies us all with its mighty power, especially when it’s an aggressive, untreatable kind of cancer cell that invades. But that’s not the foe we need to fight, first and foremost.

Cancer cells destroy — that’s true. In lucky times, the right mix of treatments and drugs sometimes halt cancer in its tracks. Then again, cancer can be sneaky. Those cells can hide in the body, only to resurface at the most inopportune times. We never know which way the cells will mutate, or where they might show up next, or whether there’s a treatment that will be effective. That black cloud of uncertainty hangs heavy over the lives of cancer survivors and the people who love them. All that darkness can take its toll on the soul, drowning us in a sea of sorrow for what could have been, what might have been, what never was.

It’s easy to hate cancer, to give in and give up when we first hear that horrible diagnosis, to surrender before we’ve even begun to understand the real enemy. When we allow our fear of cancer to decide how we live our lives, we give up our personal power, self-determination, and above all, our right to choose to live our lives out loud.

Michelle taught me much about personal courage and bravery. Right up to her last few days, she fought hard to remain the wonderful young woman we adored. That mattered to her, even in hospice care. Imagine feeling like you’ve let down the people who love you because you just don’t have the strength, the energy, the power to rise above the cancer any more. You want to go on giving, but you’re just too exhausted to do it.

Michelle DID win because she allowed us to join her on her journey through a war zone where cancer is a weapon of mass destruction. Every time she was knocked down, she stood up. Every time she lost her footing, she got to her knees and then to her feet, dusted herself off, and continued on. Cancer never took that brave, courageous spirit from her. As the power of those destructive cells wreaked their havoc on her body, her spirit grew. Love became more important. Sweet moments mattered more than sorrow, more than hate. There was no such thing as an ordinary day. She chose to make her time on this earth count for something.

Michelle could have hated her life, could have raged against the unfairness of it all. She chose to encourage all of us to grab the light. She picked her path up the mountain, and in doing so, became a wise teacher. Michelle DID win.

None of us who ever had the chance to meet this dynamic, determined, dedicated young woman will ever be the same because we choose to remember and honor her. She lives on through us, through the things we learned vicariously as she battled to save her psyche and her soul against all odds. No virtual reality, no video game ever produced a fighter quite like Michelle. She was the real deal. She was a valiant warrior in a too-real war that doesn’t have a reset button.

And she did save her psyche, staying focused on what mattered even as doubt pushed at the door. She did rescue her soul from that dark, endless night by growing in power as a human being. She did become extraordinary, this woman with the soul of a warrior — not because she fought a battle with cancer, but because she lived in spite of cancer. Who would she be when the dust settled? That mattered.

Too often we see death as failure. We forget that each of us is mortal, that with every passing day we move closer to the end of our own lives. Sometimes we’re so focused on that, we forget to live. We squander our hours in meaningless activities. We hold back our unspoken thoughts, hold in our deeply felt emotions, hold ourselves off from really engaging in life. Michelle made those moments count. She was “working the room” everywhere she went, networking with hearts and minds on her crusade to make life matter. Michelle DID win.

Cancer never took the love out of her. She worked hard to make sure her children would be safe after her beautiful spirit departed from her body. She wanted her family to go on believing in sunshine, blue skies, and good times. She wanted everyone to thrive in her absence, not fall apart. You could see it in the things she chose to do. She was building memories to keep the hearts above the high water mark, to keep the souls she loved swimming when the tears came. And they have come.

Yes, Michelle’s spirit departed, but she is everywhere around us. She’s there, in the random act of a kindness shown by a stranger, in a hearty laugh that reminds us we have this glorious moment in time, in an outstretched hand when the heart is heavy. We need to recognize that same wonderful spirit in others and appreciate it, because that’s what Michelle taught us to do.

Michelle DID win. Our lives are richer for those beautiful smiles, the touching words, the moments that she chose goodness over evil, kindness over cruelty, generosity over stinginess. The world was a better place because she lived. The light she brought to this earth grew brighter as her spirit faced an enemy that wielded cancer as a weapon of mass destruction. The real enemy in the cancer fight is apathy. There was nothing dispassionate about Michelle. She cared about everything and everyone.

As we now go on facing life without Michelle, we should not think we have lost that beautiful spirit. She sowed the seeds in each of us who yielded to her joie de vivre. Her own light faded when she left us, but she lit our souls with her fiery passion for love, for life. It is up to us to feed that flame, to carry on that legacy in the way we choose to live. We honor her by remembering that apathy, disinterest, and dispassion are the real enemy. Live in the moment. Embrace love and let it fill your soul with its warmth. Seek joy and don’t stop until you find it. Demand all this from yourself and don’t take no for an answer. Burn brightly, as Michelle did, even in the face of that horrible weapon of mass destruction, cancer. Don’t let your light go out. Long after you are gone, your spirit will live, as Michelle’s does, in all the people whose lives you touch.

Rest in peace, dear Michelle. And thank you for being you.

Categories
#LiveLikeMichelle colon cancer CTCA CTCA Blogger Summit hospice Michelle Whitehead Hastings

Why You Should #LiveLikeMichelle

In the real world, people come and go with blinders on. We all too often ignore the good and the bad that we see every day. We go about our daily lives automatically and we let ourselves get bogged down by petty problems, disagreements, and obstacles. We’re really only half alive to what is in front of us and we never really reach out for that brass ring. And then cancer shows up and life as we know it is turned upside down. Nothing will ever be the same.

The first time I set eyes on Michelle Whitehead Hastings, I was sitting in a conference room at the Cancer Treatment Centers of America in Goodyear, Arizona, at a Blogger Summit. It was hard not to notice her. She was electric, from the wild streak of color in her hair to her bright clothing to her effervescent personality. When she walked into the room, she was hard to ignore because she exuded life. Everywhere she went, there was a crackle of electricity. That’s because she’s a real live wire.

In conversations we shared here and there during the weekend, one thing leapt out at me. Michelle was passionate about living life. Forget the cancer for a moment. Forget the grueling treatments and the side effects. Forget the debilitating effect it has on the survivor and the family. If there was one thing Michelle was determined to do it was to live despite cancer. That #&*+= cancer wasn’t going to spoil the party!

I went home with the memory of this vibrant, funny, warm woman etched on my mind and I never stopped caring. That’s because Michelle’s greatest strength is her ability to get everyone on the bus for a memorable ride through life.

Over the last few years, I’ve continued to follow her Facebook postings through the ups and downs she’s faced, through the trips to Las Vegas, the country music concerts, the renewal of her marriage vows with her adored husband, and the adventures with her kids. And through it all, I’ve known one thing. Michelle really does know how to live.

Even in hospice care, she knows how to live. She asked folks not to start mourning her yet, because she’s still busy working on her Bucket list. (Actually, studies have shown that people who enter hospice care tend to live longer than those who don’t, and they experience a higher quality of life — Michelle seems determined to prove that premise right.) And what a Bucket list it is!

What spurred me to write about Michelle and tell you that you should follow her lead? It was a photo she posted the other day. She and her brothers were off to the tattoo parlor to get matching tattoos that would remind them of their love of apple season. It was to be “a little” tattoo, but when I saw the apple blossoms sprouting along each of those arms…well, how can anyone forget to remember their good times with Michelle? I imagined that session with the tattoo artist as the Whitehead brothers gamely held out their arms — oh, to be a fly on the wall for that conversation. And from what I understand from a subsequent posting, there’s also going to be a mother-daughter tattoo session. I can’t wait to find out what design they choose. I’m already looking forward to the photos.

It’s hard to say no to Michelle when she has a plan; all she has to do is flash that vibrant smile. But a tattoo is hardly a requirement for remembering her. That’s because she’s put her indelible mark on a lot of us in so many ways, whether you’ve known her for decades or, like me, you met her briefly. She’s made a point of staying connected to everyone. Michelle is constantly reaching out and giving back. I’ve admired the way she let people help her get things done. So many people shy away from this, despite their needs, but not Michelle. She welcomes the support, and in doing so, she gives the best support of all to the people who love her. Suddenly, helping Michelle becomes an opportunity to join the circle of life.

The photos have been wonderful. We’ve lived vicariously as Michelle has taken this tumultuous journey filled highs and lows. I’ve seen the formal portraits, the action shots, the candid pictures that capture the moments that matter to her as she updates her status. She might be reclining in a chair as she cheers on Syracuse (“Bleed Orange!”), or in the middle of a pumpkin patch on a farm visit with her kids, or arm in arm with the man she so loves as they say “I do” one more time. With each new image, my heart grows a little bigger and my eyes see more of what makes life worth living.

One of my favorite photos Michelle is at Goofy’s Kitchen, cuddling up to the Disney icon. Most adults might feel silly posing with a cartoon character. Not Michelle. You can tell she’s loving every minute of it as she leans in close to that canine snout and smiles broadly for the camera. When I saw that, I almost believed for just a second or two, that Goofy was real.

But it wasn’t just Michelle who experienced that unbridled Disney delight. A second photo showed the group of girlfriends huddled together as happiness enveloped them like a big, fat hug on their special visit.Years from now, that mother with the baby in her arms will pull that photo out of a drawer and remember her adventures with Michelle. She will look at her nearly grown child and feel that warm, happy glow again. That’s because she was touched by someone special, someone who taught her to never stop grabbing for the good side of life. She will #LiveLikeMichelle and she’ll pass that enthusiasm onto her lucky child.

That’s the magic of Michelle. She doesn’t leap tall buildings in a single bound or fly faster than a speeding bullet. In her world, people matter, the good moments have real power, and love makes it all bearable.

Wherever darkness finds you, turn on the light inside yourself by believing the good matters more than the bad. Those are the threads that weave the blanket of the soul that keep us warm when the challenges of life seem insurmountable. Point your spirit towards the sun, away from the storm, and seek shelter in those little nooks and crannies where humans are kind to each other and love is the tender of the realm. That’s how you #LiveLikeMichelle.

Categories
cancer cancer recurrence

Being Extraordinary Is a Choice

I’ve heard so many cancer patients labeled “extraordinary”. What does that mean? That doing battle with cancer somehow instills super powers in those who survive?

Frankly, I think cancer is the catalyst, but “extraordinary” is a choice that some people make. I say that on the heels of learning that a wonderful young woman is yet again fighting the demon we identify as cancer and at the moment, it doesn’t look good.

She’s not the only one. Another very wise, very compassionate woman has spent years helping others to stay in the game, but now she awaits word of her fate. It looks like it could go either way. The uncertainty is unnerving.

Two very different women with one thing in common — they are extraordinary. But it’s not their cancer that made them that way. It was the choices they made when push came to shove. Cancer forced them to the edge of the abyss. Most people would have looked down, but these two women chose to look up, to believe they could climb their way past the despair. They were motivated to seek answers, to reach out for the right kind of support to keep them going, to go kicking and screaming into the sunlight, leaving the dark nights of the soul behind.

These two wonderful beings wrap their arms around their loved ones every day. They know what they have — they recognize the wind beneath their wings. But that’s not what makes them extraordinary. It’s that they still want life to be good for their social circle. They still believe in good people, good things, in a good life. That’s what they’ve chosen to see. Even as life tests them again and again, even as the sun goes behind the clouds and the rains come, they seek those sunny days and want to share them with us.

And because they do, our lives are richer for it. We feel for them. We long for a cure. We want them to be around forever. They are wise teachers. They have given us the opportunity to understand that time is finite and we should not squander it. In living their lives extraordinarily, they teach us that we are rich when we are loved and poor when we turn away from joy and laughter. Their pain is real. They cope with so many side effects and complications that knock them off their feet, but they somehow manage to get up again and fight on. They are grace under fire. They are ordinary human beings doing extraordinary things with their difficult circumstances, without magical powers or a miracle cure at hand.

Every day, some cancer patients choose to be extraordinary; it’s definitely a power they embrace by conscious effort. They turn their faces to the warmth of the sun’s light, away from the cold, bitter winds of cancer and the desolate landscape of despair. They may not make it as far as they want to go. Their families and friends may graduate without them, marry without them, even have children without them, but all that love they have invested in people over the years will live on. All of the hearts and minds of relatives, friends, and strangers they have touched will remember how they showed us that extraordinary is a state of mind that we must choose to embrace. The shadow of death cannot defeat the light that comes from living life out loud. We have only this time on earth, these few moments. Don’t waste it fretting about the unseen future. Grab the here and now and make it extraordinary.

For more help with cancer caregiving, visit The Practical Caregiver Guides

Categories
cancer patients flu season immune system

Think “Sink!” and Save a Life

Flu season….These two words can strike terror into the hearts of the sturdiest of cancer caregivers. For most people, it’s more of a nuisance than anything else. But for a loved one with a compromised immune system, it can be a matter of life or death. What can you do? Think “Sink!”

Decades ago, when my aunt was dying of cancer, we went for a visit at a time my allergies were in high gear. I spent the whole time worrying about her. What if I was wrong and I had a cold, not allergies? Did I have a temperature? Were my glands swollen? I constantly checked my symptoms in an effort to protect her delicate immune system. No one wants to be Typhoid Mary for someone so very vulnerable, so I made sure I didn’t put her at risk. I kept a physical distance, washed my hands often, and forced myself to be cognizant of the potential risks. Thankfully, we were able to have a wonderful visit, without complications or catastrophe. It was the last time I saw her and a memory that has stayed with me through the years.

As a caregiver, I went through a similar time when my mother was dying of cancer, carefully taking precautions to fend off contagions that could wreak havoc with her. I bought a lot of hand sanitizer, making sure there was always a bottle of it on the dining room table for visitors and one in the car, for those trips to the hospital or physician’s office.

I also bought a lot of hand soap and frequently reminded myself to think “Sink!” as soon as I came home. For those who don’t know, common medical wisdom actually suggests that antibacterial products are less healthy than just plain old soap and water when it comes to cleanliness. Washing your hands properly can be a Broadway moment — most people just do a cursory job of scrubbing up. It’s recommended you sing a complete version of “Happy Birthday” in order to be properly disinfected your hands. Me? I like to get creative. At this time of the year, I might hum “Jingle Bells” all the way through. My other favorite is “These Are a Few of My Favorite Things”, from The Sound of Music: “Raindrops on roses and warm woolen mittens….”

Many cancer caregivers take great precautions to keep visitors from spreading viruses, bacterium, and germs during visits to the home, but what happens when they themselves wander out into the wilderness? Every time we head out to the store, we’re intermingling with the public. Every time we grab a shopping cart, we’re touching surfaces that other people have touched. Every time we work out on the equipment at the gym, we’re exposed (I carried my own packets of wipes and cleaned the machines before AND after I used them). For normal people, this usually isn’t that big a deal. We can fend off the occasional cold virus. But as caregivers, we’re supposed to remain healthy. How else can we care for our loved ones?

Right now, the current flu vaccine apparently isn’t working as well as hoped. The Center for Disease Control recently announced that this year’s outbreak has reached the epidemic stage and it’s rapidly spreading across the United States. What does that mean for you? Every time you go out in public, you’re at risk for catching the virus. If you bring it home with you, your loved one may catch it.

Should you stay locked up at home? Not necessarily. What you should do is exercise some caution. Make sure you are careful to use sanitizing wipes or hand sanitizers whenever you are touching surfaces used by the public. Avoid people with obvious sniffles, coughing and flu/cold symptoms. Make sure that when you come home, you wash your hands properly. Think “Sink!”

Feel a cough or a sneeze coming on? Don’t put your hand to your mouth or nose! Go “hands free” and use the crook of your elbow to shield folks from that spray of secretions. And if you keep a box of tissues for those unexpected winter sneezes caused by allergies, dust, dry air, or holiday decorations that have been sitting all year in the attic, think “Sink!” after that nose gets wiped. It’s just one more layer of protection for your loved one.

But there’s more that you can do. Regularly disinfect kitchen and bathroom surfaces. Pay attention to those items most likely touched by human hands — the refrigerator door handle, the microwave handle, the toilet handle, door knobs. It’s not a matter of hosing down the place every day. Get a good general purpose cleaner and keep it handy, for a quick wipe down, with roll of paper towels (don’t reuse a cloth or sponge — these are incubation factories unless they are sterilized after each use). Don’t forget the TV remote, especially if your loved one shares it with other people!

Believe it or not, even computer, tablet, and cell phone surfaces are prone to harboring harmful germs. Stanford University students examined cell phones and determined they were 18 times dirtier than toilet handles. Never use regular cleaning products on electronics! There are special wipes and microfiber cloths you can buy that are made specifically for electronics — they won’t damage your equipment while they safely remove contaminants. (Follow manufacturer recommendations for safe cleaning of electronics!)

Just one last thought — so many people like to share photos and videos on their phones, passing them around from person to person. You might want to cheerfully intercept it as it heads toward your loved one and be the holder of that germ factory. Your loved one still gets to enjoy the show, but without being directly exposed.

Get yourself a rubber ducky and put it on the sink as a friendly reminder. Train yourself to think “Sink!” and you’ll have a better shot at keeping you AND your loved one healthier this winter!

For free caregiver education, visit The Practical Caregiver Guides — help someone you love!