Almost every country and culture in the world celebrates the New Year, although it is not celebrated at the same time of year in every culture.  They also seem to have certain foods that they partake of on New Year’s Eve or New Year’s Day in order to bring them good luck in the new year.  Let’s take a look at a few of them.

In the southern parts of the United States, black-eyed-peas are eaten in order to bring prosperity throughout the new year, and are often combined with collard greens (and often ham hocks or hog  jowls). The black-eyed-peas represent “eating coins” and thus gaining wealth.  The collard greens are representative of money (as are kale and cabbage).  At many southern New Year’s celebrations, you will find a dish caled Hoppin’ John which is made from black-eyed-peas, ham hock, rice and other ingredients.  Sometimes a shiny dime is placed in the dish and whoever receives it on their plate gets an extra helping of good luck. 

In many parts of the United States, ham is served.  The hog symbolizes prosperity throughout other parts of the world, as well.   Part of this is because as pigs root for food, they are always “rooting forward” symbolizing progress.  In Italy, the fatty parts of the hog are served too, symbolizing fattening of the wallets.  The pig is also used as a good luck food in Austria but comes in the form of little pink pig cookies. 

In Asia, long noodles play a part in the New Year’s celebration as a food that symbolizes long life, but the noodle must not be broken before it is entirely in the consumer’s mouth.  For the Chinese, oranges and tangerines are also consumed as foods to ring in their new year.   A recent explanation has it that the words “luck” and “wealth” in Chinese sound much like the English words “orange” and “tangerine” respectively.   Dumplings are also eaten because they are said to resemble nuggets of gold.

Another green leafy vegetable, cabbage, is said to bring luck and good fortune to the Germans (in the form of sauerkraut) and the Irish because it is green and resembles paper money.

In Italy, lentils are thought to be of good fortune for the new year because of there resemblence to coins or gold nuggets.

Pomegrates are consumed at the new year as a symbol of abundance and fertility in Turkey and other Mediterranean countries.

In north America, Asia AND Europe, fish is often a “good luck” food representing “moving ahead” into the new year because fish swim forward.  Eating fish is also associated with abundance because fish swim in schools.  Perhaps this is why our family always had poached salmon with dill sauce on New Year’s Day.

Several countries serve round or ring-shaped cakes as part of their New Year’s celebration as they represent having come full circle.  In Greece, there is the Vassilopita (often containing a hidden coin); in Italy, they have panetonne; in Mexico, the Rosca de Reyes and in Holland, the donut-like Ollie Bollen. 

Long ago, I had a small catering company and was called to deliver a special tray to an Iranian family who was celebrating their New Year (in March, the first day of spring).  The tray consisted of gold foil wrapped coins, apple, garlic, a nut candy and colored eggs making up a grouping that consisted of seven edible things that began with the letter “S” (in Persian language). This tray was to be placed on the dinner table or next to an additional non-edible display as a symbol of sweetness, love, prosperity, health, beauty, purity, opulence, patience and actually a few other hopes.

Some traditions arise out of natural circumstances.  In Spain, 12 grapes are eaten at midnight,  1 for each strike of the clock or 1 for each month passed symbolizing the coming of a “sweet” year.  This tradition is said to have begun around 1909 when there was a surplus of grapes in the Alicante region of Spain.

In some cultures, rice is also a part of the New Year tradition.  In the Scandanavian countries, a sweet rice dish is served containing a hidden almond.  Whoever received the almond was said to have good luck throughout the coming year.  (It’s surprising to me that with all these hidden coins and nuts that no one choked!  My mother actually used to wrap coins in waxed paper and hide them in my birthday cakes! )

When I had New Year’s Day parties at my house, we had a fortune cake…..I wrapped little paper fortunes around a fancy toothpick, covered the edge with foil and then stuck them into the cake.  Each person chose a fortune with their slice of cake. 

If you have the opportunity, ask your aging loved one(s) if there were any “good luck” foods served to them in their childhood during New Year’s celebrations.  You might be surprised.

Registration for the ceremony was offered several weeks ago, but no one was turned away for not having registered previously.  Upon arriving, we were given the chance to choose an ornament to place on the Christmas tree in honor of the loved one being remembered and a marker to write on it.  There were 2 different shapes of ornaments: round and heart shaped.  There was also an assortment of colors from which to choose.  I hadn’t thought of it before, but the colors would be very important to some people, for instance, my nephew passed at the tender age of 6 (hit by a car) and his very favorite color was green. His siblings wrote messages on green balloons at his funeral and “sent them up to him”.

I chose a red heart for my father ( I think because my heart is still bleeding for him) and a white heart with sparkly green swirls for my nephew.

After enjoying a wonderful brunch in the foyer of the church, we went into the worship area for prayers, hymns and a presentation by author and grief support facilitator, Joanne Petrie.  She was a wonderful speaker and stressed that grief may come not only from the loss of a person, but the loss of a situation – divorce, the loss of a job, the loss of a home, (and I’ll add, in the case of many caregivers, the loss of freedom or the life once lived).  She also stated that recovering from grief does not put you back to “normal” but leads you to accept a “new normal”.  How profound.

After the presentation, there was another song and then the names of all loved ones represented on this day were read one by one.  As the name was read, the family members came up to the tree and placed the ornament there.  Many stood for a moment of silence or placed a kiss on the ornament.  Many cried.

The ceremony ended in prayer for those we had lost and for those who will carry on.  Hugs abounded. 

I am now a fan of Ceremonies of Remembrance.  It was a wonderful experience and something that a family member or friend could do each year without traveling to a graveside which might be a long distance away.  I hope that many churches, temples and synagogues will adopt this kind of ceremony if they have not already done so.

I must add that the ornaments were given back to the family members at the end of the ceremony and now my father’s ornament rests on our tree at home in a place of honor.  (I will send my nephew’s ornament to my sister.)

I also wanted to introduce you to the QAS website because they have some great teaching articles about vitamin K (a vitamin that should be limited when receiving Coumadin therapy) and also about some other medications that should be avoided during therapy.  He will discuss those more in later posts.

So without further adieu……

There is good news for patients taking Coumadin^® (warfarin)!

The good news for patients, family members and those who care for a loved-one taking Coumadin® (warfarin) came March 19, 2008 when Medicare announced coverage for patients to test their blood in the privacy of their home. The policy extends benefits to Medicare beneficiaries who have been taking warfarin for at least 90 days for any of the following reasons: atrial fibrillation, mechanical heart valve replacement, or venous thromboembolism (DVT/ PE).  

What is patient self-testing?

Patient self-testing allows patients taking warfarin to test their blood at home with a small finger-stick sample of blood – not too different for diabetic patients who check their blood for insulin levels.

Coumadin^® is a medication that requires a small sample of blood to measure the effect of prolonging the bleeding time designed to prevent dangerous blood clot development. Medicare and many private insurance company’s provide reimbursement for up to, but not more frequent, than weekly home testing to reduce bleeding risks.

Home INR testing however, requires a physician’s prescription for one of the FDA-approved, small, hand-held monitors and for testing supplies. The monitor and testing supplies are not available in retail pharmacies but can be obtained through specialty distributors such as Quality Assured Services, Inc. (QAS).  QAS is a Medicare and private insurance company that distributes, trains, and communicates patient’s home test results to the patient’s physicians.   

Who is a candidate for home INR testing?

Patients who are motivated, with a desire to improve their control of warfarin and reducing the risk of side effects are good candidates for home INR testing. The test is simple to perform by the patient or a caregiver.

How home INR testing works

Home INR testing enables patients to test more frequently than monthly, in the comfort of their home, resulting in better warfarin control and therefore improved safety. Home testing results may be phoned in through a secure 800# provided through the distributor of the monitor. Testing strips are shipped directly to the patient’s home at no additional charge.

Weekly testing is a testing frequency that has been proven superior in clinical studies. Testing weekly evaluates the effect of patients: diet, overall health, metabolism of Coumadin^® and interaction of other medications. Patients or care providers simply phone each home test result into their physician’s office or online service.

How to get started

Patients or caregivers can have many of their questions answered by visiting home INR testing. Specialty pharmacy providers such as QAS, Inc. provide full-service assistance including insurance, clinical and technical support at no charge to the patient.

I am copying verbatum a flyer that is distributed by the Alzheimer’s Association entitled “Principles For a Dignified Diagnosis” because although it was published earlier in 2009, I had never seen it and thought maybe many of you had not seen it either.  It’s important.

“Principles fro a Dignified Diagnosis is the first statement of its kind written by people with dementia on the subject of the Alzheimer diagnosis experience.

In the 2008 report Voices of Alzheimer’s Disease: A Summary Report onthe Nationwide Town Hall Meetings for People With Early Stage Dementia, the Alzheimer’s Association identified diagnostic challenges and dissatisfying interactions with the medical community as two major challenges articulated by people living with the diseases.  These principles are their insights on how to make that experience better.

* Talk to me directly, the person with dementia.

    I am the person with the disease, and though my loved ones will also be affected, I am the person who needs to know first.

* Tell the truth.

Even if you don’t have all the answers, be honest about what you do know and why you believe it to be so.

* Test early.

Helping me get an accurate diagnosis as soon as possible gives me more time to cope and live to my fullest potential and to get information about appropriate clinical trials.

* Take my concerns seriously, regardless of my age.

Age may be the biggest risk factor for Alzheimer’s, but Alzheimer’s is not a normal part of aging.  Don’t discount my concerns because I am old.  At the same time, don’t forget that Alzheimer’s can also affect people in their 40s. 50s and 60s.

* Deliver the news in plain but sensitive language.

This may be one of the most important things I ever hear.  Please use language that I can understand and is sensitive to how this may make me feel.

* Coordinate with other care providers.

I may be seeing more than one specialist – it is important that you talk to my other providers to ensure you all have the information so that changes can be identified early on and that I don’t have to repeat any tests unnecessarily.

* Explain the purpose of different tests and what you hope to learn.

Testing can be very physically and emotionally challenging.  It would help me to know what the purpose of the test is, how long it will take and what you expect to learn from the process.  I would also appreciate the option of breaks during longer tests and an opportunity to ask questions.

* Give me tools for living with this disease.

Please don’t give me my diagnosis and then leave me alone to confront it.  I need to know what will happen to me, and I need to know not only about medical treatment options but also what support is available throught the Alzheimer’s Association and other resources in my community.

* Work with me on a plan for healthy living.

Medications may modify some of my neurological symptoms, but I am also interested in other recommendations for keeping myself as healthy as possible through diet, exercise and social engagement.

* Recognize that I am an individual and the way I experience this disease is unique.

This disease affects each person in different ways and at a different pace.  Please be sure to couch your explanation of how this disease may change my life with this in mind.

* Alzheimer’s is a journey, not a destination.

Treatment doesn’t end with the writing of a prescription.  Please continue to be an advocate – not just for my medicial care for my quality of life as I continue to live with Alzheimer’s.

For more infomation and support, contact the Alzheimer’s Association: http://www.alz.org or call 1-800-272-3900.

Many of these principles would apply to other diagnoses as well.

I wanted to add

There are two main types of blood thinners:  anti-coagulants and anti-platelet drugs.  Oral anti-coagulants are drugs that interfere with the biochemical effects of Vitamin K that are essential for blood clotting.  Anti-platelet drugs prevent small blood cells called platelets from aggregating, which is one of the first steps in forming a blood clot.

The most commonly used anti-coagulant in the US is warfarin (also known as Coumadin), which can be taken orally.  However, it takes 2 or 3 days for warfarin to become fully effective, so if immediate anticoagulation is required, intravenous heparin is usually administered in addition.  Warfarin also requires that blood levels be drawn in order to determine the effectiveness of the medication.  These are drawn more frequently at the beginning of therapy and less often thereafter. 

The best-known anti-platelet drug is aspirin.  In addition to its common use as a pain-killer, aspirin is often prescribed for long-term use at low doses to prevent formation of blood clots which can cause strokes or heart attacks.

Obviously, blood thinners must be used carefully since blood clotting is an important physiological safety system that protects us after injuries.  Doctors, patients and caregivers must work together to achieve the right balance between preventing harmful blood clots and permitting beneficial clotting after cuts or other injuries.

All patients receiving blood thinners should take certain precautions.  Elderly patients should observe the same precautions even more scrupulously, which often requires assistance and input from family members and caregivers at home.  Fortunately, most of these precautions are basic common sense.

1.  Take drugs exactly as directed.  Elderly patients may need help remembering to take their medications on schedule.  Make sure the doctor and pharmacist know what other drugs are being taken – some medications may cause an adverse reaction when taken with blood-thinners.  Antibiotics can lessen the effectiveness of Warfarin (Coumadin) and so blood must be tested to determine if adjustments in medication need to be made during antibiotic therapy.

2.  Do not take any other drugs, vitamins, cold medicines, herbal remedies, etc – even common over-the-counter products – without consulting the doctor first.  Aspirin in particular MUST NOT be used without a doctor’s advice, because it is also an anti-platelet drug and may inhibit blood clotting beyond what’s actually good for the patient.  You might be surprised by some of the things that can interfere with blood thinners:  according to the Los Angeles Times (“Booster Shots”, Sept 24, 2008),  Pepto-Bismol may also cause an adverse reaction.  The bottom line is to talk to the doctor before taking anything.

3.  Tell all health care providers about the blood thinners because they may need to modify their usual procedures to prevent or reduce bleeding.

4.  The American Heart Association recommends carrying an emergency medical ID card that lists the drugs being taken; the patient’s name, address and phone number, and their doctor’s name, address and phone number.

5.  Minimize activities that might cause cuts or abrasions.  Most elderly patients probably won’t be playing contact sports, but there are less dramatic ways to start bleeding:  shaving and brushing teeth.  To avoid razor nicks use an electric shaver, and switch to a soft toothbrush to go easy on the gums.  Also, be sure to talk to the dentist before any dental work, even routine cleanings.

6.  Geriatric massage, which is sometimes used to improve circulation and increase joint mobility in the elderly, is not recommended for patients taking blood thinners, because of the risk of damaging delicate blood vessels  resulting in subcutaneous bleeding.

7.  Vitamin K, which is found in leafy green vegetables (lettuces, spinach, brusel sprouts)  and other foods, can interfere with warfarin therapy.  Caregivers who provide food should talk to the doctor about how much of these foods you should prepare for your elderly loved one.

8. Of course, every precaution should be taken to reduce the risk of falls and their subsequent injuries.

He went on to buy another car and managed not to crash it.  He gave that one to my sister when he moved to Idaho to live with me and I gave a sigh of relief.  With his dementia and his lower extremity neuropathy, he should not be driving.  But…..lo and behold……when I was work one day, he ORDERED a truck and had it delivered ! It was a used truck and an eager salesman brought it out to the house for a test drive.  My father purchased it there and then, for WAY too much money.  As you might guess, it was just after that that I filed for guardianship.  But receiving guardianship does NOT wash away all problems.  Saying “No” to things just brings out a lot of turmoil so creative thinking is required at these times.

There are many reasons that our elders may need to curtail their driving; dementia is just one.  Other reasons are slowed reaction times, decreased vision and hearing, diabetes, certain medications that have been prescribed, transient ischemic attacks (mini-strokes) and quite a few others.

When a person can no longer drive, they feel a huge loss of independence.  But sometimes that loss is necessary in order to protect the loved one and other possible innocent victims.  If you feel that your parent or loved one should no longer be driving, here are a few things that you might try if simple reasoning with them has not worked. 

Speak with their physician and relate your concerns.  Doctors are not uncomfortable taking “the bad guy/gal ” role and elders will often give more credence to what their physician says than to what a care giver says.

Consult your local “Area on Aging”.  They often have access to an occupational therapist who will obtain a prescription for a driver’s evaluation.  If an elder does not pass, these results will be forwarded to the Department of Motor Vehicles who will then void their driver’s license.

If your parent or loved one has dementia, consult their Alzheimer’s specialist who will counsel them or order a driving evaluation.

If these things fail, desperate action may be required.  Distraction is helpful- “could you just help me plant these tulip bulbs first?”; keys can be hidden (although that doesn’t work for long); certain parts of engines can be dismantled; cars can be taken “to the shop” for inspection and “the problem may be bigger than we thought”.  

These things don’t ALWAYS work, but helps to bide time and as an elder gets used to “not driving”, they are a little easier to accept the role as a non-driver as time goes on. 

These bath tubs are advertised as being great for elderly, disabled or mobility-impaired individuals.  They are made of fiberglass or acrylic, are found in sizes ranging from 48″ X 28″ to 60″X32″  and are said to fit any bathroom.  If the bathtub area is too big, there is an “extension kit” which essentially adds a shelf area to the tub.  They each have a seat installed and there is also the option of choosing one that is complete with a hydrotherapy unit (we chose this option because my father has both arthritis and leg muscle cramps).  The cost for these units can be in the thousands, so it is a fairly expensive purchase but can be one that enables a person to continue to live at home rather than in an assisted living facility.

Having experienced the walk-in tub for over 6 months, I am going to say that it was not the right choice for my father, but it may be a good choice for other senior citizens.

The positive aspects of it were the built-in anti-slip seat, the anti-slip tub floor, the low-level entry, the temperature control (it does not allow the temperature of the “hot” water to be hot enough to burn), the height on the sides of the tub which helps to keep my father from falling, the ease of cleaning the “unit” and the hydrotherapy.

The negative aspects of it are that it is an almost claustrophobic bathing experience when using the shower curtain, as the bathing area is very small.  Additionally, if your bathroom is such that an extension (or shelf)  is required, the shower curtain must sit on the inside of the tub making an even smaller bathing area. 

This is definitely not a product that will enable a person with dementia to have more independence.  It’s much too technical.  Once entering the tub, there is a special lever that must be pulled in order to make the tub water-tight.  My father is confused by the hand-held shower sprayer (doesn’t realize that it can be left hanging in its casing) and several times, I have heard him turn on the hydrotherapy jets without having any water in the tub (is a burnt-out motor in our near future?).  He also forgets (with short-term memory, that means 2 minutes later) that the shower curtain must be on the inside of the tub itself, so very often, we are sopping up water from the floor after his shower (water on the bathroom floor contributes to slipping, as well.)

It is also NOT conducive to caregivers helping with the showering of  the patients or loved-one.  The sides are too high, thus contributing to back strain and the water does not stay in its designated area.  If a caregiver was helping  their loved-one to bathe (rather than shower), it would be fine.

I think this is probably a great product for those in their late 60s and 70s who may be “a little wobbly” and could use the extra support and also benefit from the hydrotherapy.  I don’t think it’s a good product choice at all for those with dementia who are trying to continue to bathe on their own.

Your thoughts?

Please see our YouTube video on this subject for more information.

I have handled having to take away the driving priviledges, restricting use of power tools, eliminating coffee maker and coffee-pouring activities but taking away the items he has carried with him since becoming “an adult” is something I can’t seem to get past.  It’s like taking away that LAST bit of independence . In our society, we are almost synonymous with the “bartering power” or money that we have.
Can you offer any advise?