Christina's Considerations

The Burning Question: Who Will Foot the Bill for America’s Increasing Burn-Care Costs?

I think about burn patients when I see the ergonomic tube squeezer I added to my shop as soon as it came onto the market.  Yes, it helps those of us with hand weakness and coordination, but it is also excellent for getting just about every drop of any product out of a tube.  This may not be important for toothpaste, but it is for expensive medications.  This is where burn patients come in and their reliance on expensive ointments, salves and other topicals.

I'm pleased to share a guest post that highlights the cost of burn treatment and the impact of burns on patients.

Guest Post:  Celia Belt, a burn survivor, is the founder of the award-winning Moonlight Fund Inc., a non-profit organization that provides financial and emotional assistance to burn survivors and their families.  She is the author of Remarkably Intact: Angels Are No Strangers to Chains (Broer Books, paper, $18.95).  For more information, visit: www.remarkablyintact.com.

Each year in the United States, half a million Americans will be treated for burns so severe as to require hospitalization.  The “survivors”—including more than three-hundred children each day and a drastic increase in U.S. military members since the turn of the millennium—can be expected to undergo arduous, agonizing surgeries and  painful rehabilitation lasting for years. 

The emotional and physical trauma of these fellow citizens is not a pretty picture. Nor is it an inexpensive one.  According to estimates, patients with severe burns with no complications can expect a whopping $1.6 million bill for treatment over the cost of their lifetime.  For patients who do go on to develop complications as the result of severe burns, hospital bills can run more than $10 million.

Where is that money coming from?  Partly from you and me in the cost of increased healthcare premiums.  But often times from people like me, directly.  As the cofounder of the Moonlight Fund (www.moonlightfund.org), a Texas-based non-profit organization for burn survivors and their families, we’re often tasked with raising funds to help with the costs of expensive procedures in addition to the emotional support and caregiver assistance our organization was founded for. Many times I’ve reached into my own pocket—not because I’m a saint, but because I’ve been there.  As a childhood burn survivor myself, scalded over 32% of my body, I’m well aware that infections resulting from burns—which occur in one out of three cases—add between $58,000 and $120,000 to treatment costs.  Skin breakdown—which happens one out of two times—adds up to $107,000 more.  Disfigurement and scarring?  Up to $35,000 on top of that.  Then, of course, there are the psychological issues associated with severe trauma.  57% of burn victims need help for it, help that costs as much as $75,000 per patient.

It’s no wonder I spend a good deal of my time trying to find scholarship beds for survivors soon leaving the burn unit or negotiating with compression garment companies to give us a break on high-cost wound garments for our patients.  The time we spend writing grant proposals, hosting fundraisers, and digging into our own pockets to help people could far better be spent helping them emotionally recover and fit back in to a society horrified at burned skin.

Burn victims—who are often socially isolated due to their wounds—appreciate you not staring at them on the street.  But that doesn’t mean we want to be invisible.  Today, more than ever, we can’t afford to be.

Fall Risk? Get a personal alarm!

So, last year I was a fall risk, due to my Guillain Barre Syndrome, and did fall on a regular basis.  I didn't go outside unless someone in my family was around.  Early one evening I ventured off the patio to do something I don't remember.  I do remember thinking I could fall and no one would know, because my husband and daughter were inside.

Well, I did fall in the pathway and couldn't get up.  I even crawled over to a stack of potting soil to use it to climb, but it wasn't really high enough.  I called out for my family and laid there exhausted for a while.  Finally, my daughter came looking for me and helped me climb up the potting soil and stand.  At the time, I thought I should find some alarm.

Not long ago, I was introduced to SABRE’s line of safety gear for outdoorsmen/women and they sent a sample of their alarm ( and gel pepper spray) for me to test.  I explained my interest with their  Personal Alarm Clip and LED Light not just from a general safety perspective, but especially for those who are a fall risk or have other functional limitations.

The alarm is perfect for any age and is easy-to-use.  A press of the button is attention grabbing; with a 120 dB alarm audible 600 feet (185 m) away. It is easily accessible, simple and effective; when clipped to avoid fumbling for the alarm. To activate the weather-proof alarm, simply press the button to turn the alarm on and off, alerting others to your situation. The multi-modal LED flashlight also ensures that you are visible in all light conditions.

While I have recovered to the point where I'm not falling, Im still at risk due to my sensory ataxia.  I can see this little device giving me a bit more freedom and allowing me to be more independent.  If I need help, my family will know in advance to listen for the alarm.

If you feel stuck inside or fear being in a situation (at work or home) where you need help and no one will hear your calls, consider an alarm like this as part of your personal safety and security plan. My recommendation is to always alert those you will need to help (family, coworkers, neighbors, bystanders, etc) when you might use it ... before you head out on your own.

Get out there and enjoy life, in spite of the challenges you might face!  And, stay safe!

 

 

 

 

Weighted Utensils

Last year, I wrote about my difficulties holding a fork or even a toothbrush.  I needed a larger handle to grip, so I found the Good Grips stainless steel forks, knives and spoons with their  chunky handle.  This item was also added to my little collection of tools for those with functional limitations in the online shop.

Fast forward to today and my disease and symptoms have evolved and changed; as sometimes happens.  It isn't a gripping challenge, as much as tremors that now afflict my hands.  This means that an eighth or more of my half teaspoon of sugar for my morning coffee usually gets sprinkled across the counter.  Fortunately I've found a solution - a weighted spoon. 

During my first occupational therapy session this week and I mentioned my little tremor and sugar spilling challenge.  She handed me a weighted fork to test with some beans and it worked.  I'm ordering one today and will also add these utensils to my little shop - now that I know why one would need them.  

If you do have the functional limitation of being able to grip and grasp a dining utensil, then check out the link below. 

Bathrooms and Functional Limitations

Who knew navigating a bathroom could be so frustrating and potentially unsafe.  Well, I did, at least I thought so until I had my own experiences in 2017 and into 2018.  Below, I outline the challenges and solutions I found, even if it was a little later than I needed.  Keep in mind I was a fall risk due to balance, coordination and strength issues.  I also struggled, significantly, to rise.  

Brushing Teeth - the safety here was my fear of tooth decay, in addition simply to wanting to feel better after brushing.  However, I had a hard time holding and controlling my toothbrush.  I needed a bigger handle and something to help me do a better job of the brushing process.  I found this in Dr. Plotka's travel toothbrush to be my new best friend because its silver flossing bristles helped me keep my teeth clean and the bigger handle helped me actually be able to attempt to brush my own teeth.  As my health improved and my hand strength and coordination improved, I switched over to the regular toothbrush and its chunky handle.

Bathing - Even though I wanted to soak my aching muscles in a bath and feared falling while standing in a shower, I simply could not safely get to a standing position after a bath.  The paralysis of my lower legs and feet combined with my lack of strength made me fear falling in the tub, as well.  Although I tried holding onto everything, nothing helped.  Perhaps a grab bar would have helped, but I simply switched to showering, especially since lifting my feet to get into a bath was also a challenge and I have a walk in shower.

Showering -

The first think I did was purchase an anti-slip bath/shower mat at Ross. 

Just like brushing my teeth, washing my hair was also a challenge.  In addition, I had to hold onto the shower wall, especially when closing my eyes.  I didn't realize there were suction cup safety bars until after my condition began to improved.  Had I know, I would have gotten one.

I also found Palmer's Co-Wash Cleansing Conditioner which allowed me to pump the product into my hand (I couldn't lift bottles) and wash it out of my thick hair without worrying about getting all of the suds out. 

A wet washcloth was too heavy and I was likely to drop it, creating the risk of a fall if I tried to bend down to pick it up. So, I used exfoliating bath gloves to wash, instead.

Opening Tops - Any top... to moisturizer, toothpaste, supplements/medication was impossible for me to open without help from my family.  I finally found a foam jar opener and left it in the bathroom so I could open the tops myself.

Getting Up - Whether it is up and over the side of a bathtub or up from a toilet, I needed something to hold on and pull or push myself up.  The only help I had came from my husband and the toilet paper holder - which surprisingly held up.  But, there are grab bars and poles available to help those with long term needs; or for when you are alone.

The reason why I share all of this personal information is because when I needed solutions to my functional limitations and challenges, I was laser focused on the task at hand and then getting to a safe place to rest from the fatigue of the effort.  The solutions I did use, were things I had already seen or knew about.  It wasn't until I began to improve and I had plenty of time sitting on my sofa with my feet up and my laptop that I really started looking for tools that could help those facing similar situations.  

Why is no one using our patient portal?

A while back I wrote an article on why patient portals aren't being used.  It was written while I was in a fatigued frenzy as a patient trying to find a diagnosis.  Since then, I continue to experience the healthcare system and identify opportunities to improve communications with patients.  My most recent recommendation to home health organizations is to actually get a portal so patients can confirm treatment dates.  To practices who have a portal with forms to be completed prior to a procedure being scheduled, make sure they are the most current version and the save function actually works; to avoid wasted time and rework.

Here is the original article written for Multibriefs...

Patient portals and the functionality they offer have the potential to increase access to service, improve convenience and more effectively engage patients and consumers. They can also increase efficiencies for both patients and their providers.

It is for these reasons that most providers, payers and technology vendors have at least considered offering patients and consumers access to these online tools. Unfortunately, some of those who have adopted patient portals complain that they have made the investment, only to realize low adoption and utilization rates.

So, why might patients not be using your patient portal?

Many patients — especially those with low health or tech literacy rates — may have heard of your portal, but don't understand the benefits to them individually. Or perhaps, there are barriers to them acting to gain access; such as believing they aren't tech savvy enough or simply not having the motivation to change old habits.

Aside from providing access to a platform, the provider/payor/vendor also needs to invest in strategies that facilitate user education, training and adoption. In some cases, this requires turning to family caregivers who need access themselves in support of the patient, or who can help them learn and navigate the most relevant areas to them personally.

In other cases, the provider/payor/vendor needs to reflect upon the targeted population and the usability of the portal, its functions and offerings. A few examples of user complaints include:

It is difficult to register and gain access to the portal

Not enough relevant info — such as a list of imaging studies completed, but no access to the report or results

Staff and/or providers don't respond to messages in a timely manner — if at all

Appeals and grievances can be submitted through the portal, but the decision is mailed through the U.S. Postal Service, resulting in delays

A recent Black Book Research poll found that 96 percent of patients report leaving their doctor's office with limited knowledge of how to use the patient portal. Of the 40 percent who attempted to use the software in 2016, 83 percent said it was too complicated. For benchmarking purposes, this means only 7 percent of patients found the portal simple enough to use.

An excellent way to identify opportunities to improve your patient portal is to assess the portal design, functionality and alignment with your patient needs and interests. Some questions to reflect upon include:

Is there statement that reassures patients of the portal's security measures and privacy safeguards?

If there is a delay in when test results or reports are released to patients, is that clearly communicated?

Can patients complete routine questionnaires online and make periodic updates to their information?

Would an online appointment summary of key findings and/or follow-up add value for patients who don't remember everything the physician tells them during the encounter?

Is it easy for patients to see summaries, reports and results and forward them to other providers on their care team?

Are engaging tools and resources available to guide patients on self-management activities, such as suggested apps, medical device options/recommendations or multimedia educational content?

Can patients message both administrative and clinical staff to avoid frustrating call trees and phone tag?

Can users securely upload documents to attach to their messages or add to their medical record?

Another technique is to gain insight to the patient perspective by obtaining feedback from your population by asking a pool of patients to assist you with user testing. This would include feedback on the ease of gaining access, navigating the site, their assessment of resources and information, and completing transactions, such as requesting an appointment, messaging, bill pay, etc. User testing by patients and their family caregivers can also help you determine whether:

the site easy to navigate at home for all segments of the population

the portal accommodates the patient's, or family caregiver's, learning needs

the resources, information, functionality are relevant to the patient population(s) served and provide value to users

patients want to see other online tasks accommodated by the portal, such as requesting medication refills, bill payment

your patient want to upload data, such as glucose levels, daily weights or information from wearable sensors for trending and alerts to both the provider and patient when some intervention is needed.

Patients have become accustomed to this technology in other areas of their lives, such as retail, banking, travel and general communications. They expect it from their entire healthcare network, starting with their providers and payors of care.

Mental Health Informatics

The current issue of the Annals of Family Medicine includes two articles that deal with mental health and information technology.  There are many assumptions about mental health in the age of digital health, so perhaps the findings of this research will give patients and providers some additional insight  This will help improve decisions to support self-management activities.

Mental Health Apps - This study examined how mobile health apps frame mental health; including who is affected and how to manage symptoms.  Of the 61 apps identified, 34 (56%) addressed panic/anxiety/stress, 16 (26%) focused on mood disorders and 11 (18%) addressed well-being or other issues.  The two dominate findings are that poor or fragile mental health is ubiquitous and users can easily manage their health with apps.  However, the sufficient scientific data for the claimed benefits was not offered.  In addition, the representation of users does not match with the actual diversity found in the population of those with mental illness. 

Access to Clinic Notes - This study assessed patients who had access to primary care clinic notes through secure online portals.  Patients with at least one mental health diagnosis were compared to those without; and both had similar perceptions to online access to notes. Most patients had positive perceptions about OpenNotes and were similarly enthusiastic about the utility of reading their doctors notes online.

The results of both studies highlight  the importance of providers/physicians recognizing the risk and benefits of information technologies that are available to their patients.  In the case of apps, physicians will want to address use of mental health apps by their patients and educate them on normal mental states and the importance of supports when needed.  This is to challenge the possibility of over self- diagnosis and implication of individual responsibility for mental well being.  Conversations should include a limitations of app use and the importance of seeking clinical attention for important or enduring psychological distress.

Physicians may also want to consider that access to clinic notes may help patients engage more actively in their treatment and improve communication and build more trusting relationships.  It might also stimulate more non-judgmentally written notes to further strengthen the patient-physician relationship.  I would also add that clinical notes reflecting the conversation may also help patients improve their compliance with physician recommendations and the treatment plan. Yes, it may be appropriate to block some parts  available online for certain patients due to safety reasons, but in a family practice this should be a small population.

The findings from both of these studies do point to the increasing reality, which is that patients are going online and using tools for information and tools to better manage their mental health.  It is the responsibility, and in the best interest interest, of physicians to have informed conversations with their patients, as appropriate.

Another ZDoggMD... Through the Haze of Medical Marijuana

ZDoggMD, AKA Dr. Damania, is one of the coolest of the cool docs around.  It does make me happy to see him weighing in on the topic of medical marijuana.  Let him guide you through the haze and watch!  I do love the background smoke!

 

 

Advocacy and Activation

A couple of things happened in the last two days that made me think it is time for me to again mention patient advocacy; including self-advocacy.  First, the monthly meeting of Chronic Disease Coalition Ambassadors occurred and the importance of patient advocacy and even self advocacy came up.  The second thing to occur, beginning yesterday, was the potential delay in another treatment due to an "insurance authorization" issue.  I had already been digging down to identify the actual issue when the CDCA call occurred.

Across my career I've ensured that people had a shared mental model and understanding.  When it came to patients, I welcomed and encouraged them to identify advocates, or advocate for themselves.  But, what is advocacy?  It really is about speaking up, questioning, addressing concerns, asking for clarification, and ensuring that one's needs and desires are heard and understood. Healthcare professionals are human and make mistakes and sometimes these cause harm to patients.  Advocacy is a way to keep patients safe and minimize the risk of harm; or at least lessen its impact.

One place that I've turned for educational content that uses engaging video to help consumers and patients better advocate for themselves is the Joint Commission's Speak Up Initiative.  Below is just one of the videos, on the topic of identifying a family/friend advocate.  Videos also address scenarios and issues, such as, doctor visits, at home, preventing medication errors, reducing your risk of falling and more.

 

Back to my advocacy issue... I was told by the speciality pharmacy my treatments scheduled for next week would have to be delayed because insurance authorization for payment was still pending.   The disappointment and frustration I felt "activated" me and my first call was to the insurance company to check on the status of the authorization.  I was told that one had not been submitted by the pharmacy.  After a few more questions and some digging by the customer service rep, I was told that there was an authorization from January that covered my treatments through mid July.

So, I called the speciality pharmacy back to explain this and ask why they needed a new authorization.  They did some digging and found out that yes, next week's treatment is actually already covered.  In the process, I identified some opportunities for my insurance plan to improve their communication process and for the speciality pharmacy to improve their tracking processes.  In addition, I learned a bit more about how the authorization process works for these recurring treatments, so if this happens again, I'll be prepared to ask even better questions.

The result is that my treatment remains as scheduled and it won't disrupt my plans for the next few weeks.  Had I just accepted that initial phone call and the needed delay as fact, I would have been frustrated, stressed and a bit angry that I would have to cancel my plans for a little road trip to get away and rejuvenate.  

So, ask questions until something makes sense.  If the healthcare providers don't have answers, encourage or ask them to look into the matter and get back to you.  Follow up on leads that take you back to the person who has the information you need.  Also, don't be afraid to make a little noise and reach out to a supervisor, manager or even the chief executive officer, if something is especially important.

Senior Safety: Death from Falls

The CDC just released data on unintentional injuries for persons age 65+ in the US between 2007 and 2016.  While unintentional injuries are the seventh leading cause of death, falls account for the largest percentage.

• 1/4 of US residents aged 65+ report falling each year
• fall-related ER visits are estimated at 3 million per year
• In 2016, 29,66 US residents age 65+ died as a result of a fall, compared to 18,334 deaths in 2007

My first thought is that we have more seniors today than we had in 2007,  as a result of Baby Boomers attaining a senior status.  We aren't referred to the silver tsunami for nothing.

However, the CDC evaluated this data a bit more and found that the rate of deaths from falls have increased by 31%, or 3.0% per year, since 2007.

 

Falls are preventable and healthcare providers should be addressing fall risk with their patients during annual visits.  But, older adults shouldn't wait for an annual visit if they have any concerns about the impact of medications, reduced activity, chronic conditions and age related changes in gait and balance.  The National Institute on Aging's Go4Life site provides information, exercise demonstrations and tools to help seniors get started on a journey to improve their endurance, balance, flexibility and strength.

But also consider it may be time to look into mobility aids, bed rails or other assistive devices to stay safe.

 

 

 

 

 

Healthy caregiving to promote abilities; not enable disabilities!

I came across an excellent infographic that will help guide individuals and their family caregivers build abilities and reduce functional limitations.  I can also see how this might benefit those re-entering the workforce and working with their human resources department and supervisor on accommodations.

The concept of "reablement" is new for me and does fit along the continuum between disabilities and abilities. The word even conveys that this is a process, a journey or an evolution.  Anyone valuing aging in place, as opposed to living in a care facility or with family, will be especially interested in this approach of building strengths.

Life after an illness or injury can feel like climbing a mountain.  This infographic breaks down the steps into manageable pieces and supports those embarking on their recovery journey.

 

Functional Medicine and Essential Oils

Over the years, especially recently in light of my own, I post on functional limitations.  My interest stems from disaster planning a few years ago and the awareness that an evacuation plan needs to account for the physical and other functional limitations of a population.  More recently my interest has turned to reducing, eliminating, accommodating or treating the conditions that produce the limitations. 

Functional Medicine is a medical practice or treatment that focuses on optimal functioning of the body and its organs, usually involving systems of holistic or alternative medicine. It seems to me that it is really directed at eliminating or lessening limitations and this reminded me of a website that  included essential oils in a listing of holistic approaches and alternatives medicines.  This then reminded me of a graphic and article that spoke to me a while back about essential oils for the pain of  peripheral neuropathy. 

So, I thought I'd list the five essential oils for peripheral neuropathy here and see if anyone has tried these and noticed improvement. I will be embarking on my own testing and look forward to comparing notes.

     Peppermint Essential Oil: Helps relax muscles, relieves pain, increases circulation, respiration, and provides nervous system support.

     Eucalyptus Essential Oil: Antiseptic, antibacterial, anti-inflammatory, improves respiration, and helps relieve muscular spasms.

     Frankincense Essential Oil: Stimulates the immune systems, relaxes muscles, and has anti-inflammatory qualities.

     Rosemary Essential Oil: Known for improving circulation, relaxes muscles fibers and suppresses muscles spasms.

     Lavender Essential Oil: Pain relieving, anti-inflammatory, antidepressant and helps reduce damaging effects of stress on the body.

 

Now, in addition to potentially helping to reduce the symptoms of peripheral neuropathy, any of these scents will also help improve the smell of any hospital or other care facility.

If you don't know where to turn to obtain these essential oils, I'd love to recommend my little shop for patients just like me.

 

IS CBD the Holy Grail?

During my long healthcare career, I've worked with chemical dependency programs in acute, residential and outpatient settings.  It was during this career that I saw the rise and fall of various addictions and heard The Joint Commission proclaim pain as the fifth vital sign. The pressures to hand out "pain medication" to patients who would provide feedback on whether or not this was done, contributed to where we are with opioids.  But, are their alternatives to opioids and other pharmaceutical medications?  This is a question I keep asking and today's guest post seems to align with my own research on the subject of CBD.    But, I want my readers to hear from experts and am pleased to bring you today's guest post.

 

Guest Post:  Laura Lagano, MS, RDN, Integrative Clinical Nutritionist

Every so often a new supplement or nutraceutical arrives on the scene being hailed as the next best thing. Right now, the buzz about CBD is at a deafening roar. But do people really know what they are buying and, more importantly, why they are buying?

As an integrative clinical nutritionist and co-founder of the Holistic Cannabis Academy,  I’m still astounded at how very little professionals and consumers really understand. So, can we set the record straight on a few key facts?

 

The Name Matters

Nomenclature can get tricky here. CBD, or cannabidiol, can come from a marijuana plant (that which also contains enough THC for a psychotropic effect) or from hemp. Both marijuana and hemp come from the mother plant known as cannabis sativa. By US definition, hemp must contain less than 0.3% THC so that’s why using CBD does not produce a “high” feeling.

CBD, one of many different cannabinoids in cannabis, has multiple health benefits. Strains, (the more technically correct name is cultivars) of marijuana can be cultivated to have particularly high ratios of CBD relative to the THC content. If you’re familiar with the story of Charlotte Figi (profiled on the series “Weed” by Sanja Gupta), her seizures were significantly reduced because of the high levels of CBD in that cultivar. But when buying CBD products today online and at retail stores, it’s the hemp derived CBD that you are using.

 

Why It Works

Think of hemp-derived CBD as a gateway to wellness. Why? Because it is a potent anti-inflammatory and the vast majority of chronic disease involves inflammation. Even the US government is convinced about the potency of CBD as an anti-inflammatory agent; they hold patents for cannabinoids medicine.

In addition to its anti-inflammatory effects, CBD works as an anti-oxidant and neuroprotective. It’s shown therapeutic promise for ADHD, autism, migraine, Crohn’s disease, Parkinson's disease, Alzheimer's disease, cerebral ischemia, diabetes, rheumatoid arthritis, and certain cancers. Progressive healthcare practitioners are often recommending CBD and THC-containing cannabis to their patients as adjuncts to other more conventional therapies.

 

What to Buy

A key consideration about cannabinoid medicine – the use of cannabis and its plant constituents for health and wellness – is something called the “entourage effect.” As the name implies, cannabinoids work better together as a team, rather than alone in isolation. So, when purchasing a hemp-derived CBD product, look for the terms such as “whole plant spectrum” to insure you’re getting all that the plant has to offer.

As with many new modalities or products, consumer demand often drives the growth of a new industry.  This is exactly what’s happened with CBD; there are literally hundreds of infused topicals, tinctures and food products available for purchase. Without guidance from a health professional, consumers take matters into their own hands. But smart consumers should be asking these three questions:

Where is the hemp grown?

What’s the extraction method used?

Has the product been lab tested?

Having these answers at least gets you in the right ballpark when deciding what to buy.

CBD comes in various formats – gel caps, oils, balms, patches, and sprays. These can be taken by mouth, applied on the body, or vaped. The delivery method and dosage that’s best for you is a matter of trial and error. Seeking the advice of a health professional trained in cannabinoid medicine is a great way to get started on your CBD education journey. CBD may not be the holy grail, but when combined with other holistic lifestyle changes, it sure can make a big difference.

Laura Lagano, MS, RDN, CDN is an integrative clinical nutritionist and co-founder of the Holistic Cannabis Academy, an online medical cannabis education platform for health practitioners.   Pictured Laura (left) and Donna Shields, co-founders of HCA.

 

Visit Christina's Online Shop to see the available full spectrum CBD products !

Aloe Vera: A Healthy Option

When I was a child, my mom had aloe vera growing out in the garden.  If we scraped a knee or had an itchy rash she would break a leaf and rub it where it hurt.  Mom's touch and the natural aloe gel both made me feel better.  As a teen, young adult and mom I knew to have a bottle on hand to also cool any burned areas of my skin; usually from the sun's rays.

Aloe vera is still around today and many people probably still associate it with these more common uses.  However, I've learned recently there is more to the story of aloe.  Below is a list of other, perhaps surprising, ways aloe vera can be used.

• Aloe Vera has anti-inflammatory properties that can also help treat blemishes and acne.
• It softens dead skin cells , which helps reduce the fine lines and wrinkles of aging.
• Almost 8 million women suffer from interstitial cystitis (IC), a chronic bladder condition that can be extremely painful and debilitating. It is typically treated with one prescription medication that not only provides little relief to many, but also causes hair loss.  But, one study show that 92% of  patients experience significant relief of one or more symptoms with whole-leaf, freeze-dried oral aloe vera. In addition,  63-68% report substantial improvement in pelvic pain, urethral burning, and urgency and frequency of urination.
• A number of studies are also pointing to the value of aloe vera in helping control blood sugar, relieve diabetic nerve pain, and treat diabetic-related foot ulcers. A recent meta-analysis of eight randomized controlled trials involving 470 patients, for example, found that adults with prediabetes who took aloe vera supplements saw improvement in fasting plasma glucose, while those with Type 2 diabetes saw improvement in HbA1c levels, indicating blood glucose control over the previous two to three months.

One company, Desert Harvest,  has created concentrated aloe vera gel and other products to complement conventional treatment and care strategies for patients suffering from diabetes, interstitial cystitis, psoriasis and other conditions. Products include:

•  Aloe Vera Capsules, a whole-leaf, cold-processed, freeze-dried, highly concentrated, ‘super-strength’ aloe vera that can be used to help control blood sugar
• Releveum® Skin Repair Cream, classified as an over-the-counter drug by the FDA, which contains 4% lidocaine that offers instant pain relief for diabetic neuropathy and 96% aloe vera and other natural ingredients that help reduce inflammation and heal associated skin ulcers when used daily.
• Concentrated Aloe Vera Gele', providing skin relief for those allergic to lidocaine.

 

What other conditions does it treat?  Add a comment any include a link to any research findings.

It's the little things... zippered baggies!

I thought I'd share one of my early Facebook Page posts from  August 2017.  Zippered baggies are still creating challenges, especially those sealed baggies for prepared foods, such as, sliced cheese and sandwich meats.  

Back then, I only had so much energy and making a sandwich for myself seemed easy, until I got out the plastic baggies holding the cheese and meat.  I couldn't cook much, but also tried contributing some help by putting things away and once again those darn baggies were a huge challenge to close due to limited hand strength, coordination and dexterity.

 

Yes, it is the little things that can sometimes create the great frustrations! Who knew?

Emergency Request to Reverse Court Ruling to Invalidate Medical Aid-in-Dying Law in CA

In March of this year, I featured a three part guest post series on end of life care and it included choices and preparing for end of life.  One of those choices in California is being threatened this week.  The California attorney general for filed an emergency request late Monday with the state court of appeals to reverse a lower court ruling to invalidate the End of Life Option Act. The End of Life Option Act remains in effect until further notice.

Similar to laws in Washington, D.C. and six other states, the California law gives mentally capable, terminally ill adults with six months or less to live to the option to request prescription medication they can decide to take to end unbearable suffering and die peacefully in their sleep.

Last Tuesday, Riverside County Superior Court Judge Daniel Ottolia invalidated the law because he claimed the legislature violated the state constitution by passing it during a special session limited to health care issues. He gave Attorney General Xavier Becerra five days to file the emergency request to reverse his ruling in the case, Ahn vs. Hestrin — Case RIC1607135.

"The enactment fell within the scope of the special session called, in part, to consider efforts to 'improve the efficiency and efficacy of the health care system ... and improve the health of Californians,'” says the attorney general’s appeal filed in the 4th District Court of Appeal. "As the Governor indicated, the Act deals with pain, suffering, and the comfort of having the health care options afforded by the Act."

This is an important intervention, because polling shows 76 percent of Californians across the political and demographic spectrum support medical aid in dying. This majority support includes 82 percent of Democrats, 79 percent of independents, 67 percent of Republicans, 75 percent of whites, Latinos and Asian Americans, and 52 percent of African Americans.

Words cannot express the gratitude and relief that I feel thanks to this action by Attorney General Becerra,” said Matt Fairchild, a 48-year-old, retired Army staff sergeant in Burbank who advocated for the law and takes 26 medication to manage his symptoms from terminal melanoma that has spread to his bones, lungs and brain. “Knowing I still have the option of medical aid in dying if my suffering becomes intolerable brings me comfort because I will not have to endure a needlessly agonizing death.”

Last June, Compassion & Choices released a report estimating that 504 Californians have received prescriptions for medical aid in dying since it took effect on June 9, 2016. Last July, the California Department of Public Health released a report showing 191 terminally ill Californians received prescriptions from 173 doctors for aid-in-dying medication during the nearly seven month period from June 9, 2016 until Dec. 31, 2016; 111 of those individuals (58%) decided to self-ingest the medication.

California is one of seven states — including Colorado, Montana, Oregon, Vermont, Washington, and Hawai‘i — as well as the District of Columbia, that have authorized medical aid in dying. Collectively, these eight jurisdictions represent nearly one out of five Americans (19%).

Educational Video on CBD

I've been struggling with where to find trusted information on cannabis and CBD; all while knowing video is more engaging.  I've now found Green Flower and their free videos on a variety of related topics.  My first one to watch was Autoimmune Disorders and Cannabis.

We all want to know we are doing the right thing for our health and that often starts with increasing our knowledge.  Once we understand more about our condition, alternatives, and options, the natural shift is to self-advocacy.  But first, we must learn and improve our knowledge.

I have attempted to post what I know or could learn about CBD, but maybe it is time for others to share their knowledge and expertise.  Watch this video to begin your CBD learning journey.  Lean more starting with this link!

 

The Big Squeeze: Ergonomic Tube Squeezer

There was a time when I could hardly squeeze toothpaste out of the plastic tube, but that was nothing compared to the metal tube of my favorite hand cream.  So, I started thinking and researching.  In the process I learned about the Big Squeeze... before it was even on the market.   When it finally made it to market late last year, I got one (green) and tried it... and really like it.  Here are my reasons why:

1. It has a big handle for an easy grip and grasp and the long handle provides some needed leverage for squeezing down on the end of the tube.
2. The turning mechanism is also big and broad for easier grasping with weak or uncoordinated fingers.
3. Then, turning and moving the product (medication, hand cream, paint, glue, toothpaste, etc.) toward the tube is EXTREMELY efficient ... meaning there is little to no waste -- which can mean saving money.
4. Unlike some squeezers, you can easily remove it from the product and use it on something else. I went around the house the day I got it and squeezed every tube I could find.
5. If you get the bright pink or orange Big Squeeze, scanning the environment and finding it will be a little easier.

The video below shows the Big Squeeze in action.  The hospital administrator in me sees its value to nurses in the burn, wound care or other units.  The patient in me  sees being able to do more for myself, lessening the burden on my family, and saving money over time. 

If you get one, share your thoughts in a comment!

 

 

PERSEVERANCE “To carry on in your course of action, even in the face of difficulty, with little or no evidence of success”

Guest Blogger: Tim Hague

The following is an excerpt from my book  PERSEVERANCE - The Seven Skills You Need To Survive, Thrive And Accomplish More Than You Ever Imagined. I was just forty-six years of age when diagnosed with young onset Parkinson’s disease, which soon ended my career as a registered nurse and healthcare professional. Three years later my son and I went on to win the inaugural season of The Amazing Race Canada. 

 “Perseverance. It’s not always sexy. It’s not often exciting. And it can be lonely. What does it take to keep walking forward despite all the evidence that you’re likely done? What does it take to keep moving when there’s little chance you can improve your position and a likely chance that you’ll be sent home? That day we proved that just showing up and continuing to work hard, regardless of what it looked like, was enough. Tomorrow would be another day.

 We also did what we said we were going to do: we had a great time. When people ask what my favorite race destination was, I always put Carcross at the top of the list. We learned to enjoy and have fun with the race. We tackled the day to the best of our ability, and we were exceptionally content with the results.

 Talk to me about Parkinson’s. Tell me what I’m not supposed to be able to do. Tell me about all the limitations that will be placed on me and I’ll tell you about a guy who beat Parkinson’s on a snow-covered sand dune in Carcross, Yukon. I’ll fight to prevent this disease from defining me, and I encourage you to live the same way. I can’t get rid of my burden outright, but in Carcross I reminded it that it wasn’t in charge.

 As Tim Jr. and I drifted off to sleep that night, we felt relieved that the day had gone as well as it had and excited about starting the next leg. None of the teams knew the misery that awaited.”

 Perseverance - it’s more than just ‘don’t give up’, rather, it is a set of skills that can be learned. Published by Penguin Random House Canada PERSEVERANCE goes on sale everywhere May 8, 2018.

 Tim Hague is the author of PERSEVERANCE - The Seven Skills You Need To Survive, Thrive And Accomplish More Than You Ever Imagined (Viking: May 15, 2018).  A professional speaker, educator and advocate for people suffering from Parkinson’s disease, you can learn more about Tim and his work at  www.TimSr.ca. 

GBS and Mobility Awareness

May is National Mobility Awareness, as well as, Guillain Barre Syndrome Awareness month.  These two go hand in hand since GBS is causes paralysis and fully immobilizes some for months.   My hope is that everyone reading this post will recognize and appreciate they mobility they have and work to maintain, accommodate and improve their abilities.  

Mobility issues affect more people than most realize. In fact, the Centers for Disease Control and Prevention reports that over 18 million adults find it difficult to walk a quarter mile, and that roughly 40 million adults have some physical functioning difficulty. For those who may know others who have mobility challenges, there are things they can do to help with the challenges, as well as reduce the risks that they may become worse.  Here are 5 ways to help someone in your life who may have limited mobility:

1. Focus on accessibility. It’s easy to overlook those devices that may make life simpler for those with mobility challenges, but they can be a tremendous help. Take stock in the devices and items that the person has and determine if there are better ones that can be offered up to help them with mobility. 
2. Offer your help. Many people with limited mobility, whether temporary or long term, are too proud to ask someone for help. By offering it they will be more likely to take the assistance that they need.
3. Keep them social. Mobility challenges and fear of a fall can weight on one’s mind and mood, making it important that they stay social. Find them social groups that would interest them or support groups, where they can share, talk, and have a few laughs.
4. Help them exercise. Limited mobility doesn’t mean there are no ways they can exercise. Today, there are people who do chair yoga, chair exercises, swimming workouts, and more. Find something they can do to keep as active as possible and keep them doing it, as it will help their mental and physical health.
5. Offer healthy foods. Having mobility challenges may make it more difficult for them to exercise, which could help lead to weight gain. Providing them with healthy meals and snacks can go a long way toward keeping the weight down and their health in good condition.

I've spent my professional life finding solutions to challenges,  and I especially love to see innovation and continual improvement.  So, listed below are some accessibility devices I've found that can help keep people moving.

• The iWALK2.0. is hands-free, pain-free alternative to using crutches and leg scooters.  It’s easy to learn to use, intuitive, and safe. From the knee up, the leg is doing the same walking motion that comes naturally to it. The device is essentially a temporary lower leg, which gives people their independence and mobility back as they recover from an injury. The device helps to make it possible for people to engage in many of their normal routine activities, such as walking the dog, grocery shopping, and walking up or down stairs.

 

• For those who can, and should, walk on two feet but need a little support there is the EZ Fold & Go Walker that is light-weight (less than 8 lbs) and folds smaller than traditional walkers, but it is sturdy; supporting up to 400 lbs.  Aside from not looking so "clinical" it is also ideal for traveling and easy storage in tight spaces; such as an office.
• The Security Pole and Curve Grab Bar is for a different type of mobility.  Sometimes mobility means standing up from a sofa/chair/toilet, or getting into or out of a shower/bathtub.  Or perhaps, it is taking that step up/down into a sunken/elevated room or workspace.
• Mobility can also mean "getting going", such as when getting out of bed or a car and taking those first couple of steps.  The Mobility Bed Rail with it pivoting arm provides stability and support as those first couple of steps are taken.  The Metro Car Handle Plus fits in door striker of a vehicle to provide support for a person getting out of the vehicle... so they can get to walking.

What innovative devices have you found to improve mobility?

Sober Grid: Addiction Recovery with the Aid of an App

As a child, I attended AA and Alanon meetings with my grandparents whenever I was visiting over the summer.  It was what we did, especially since my "born again" recovering alcoholic grandfather took pride in helping those new on the journey to sobriety or stumbling along the way.  Later in life, I learned more about addiction at a 158 bed psychiatric and chemical dependency hospital while leading operations.

In some respects, addiction recovery has been present across my entire life and career.  There were the emergency room patients... and additional family members.  So, when I learn of innovative tools to help those embarking on their journey or trying to avoid the potholes, detours and exit ramps, I do get excited.  SoberGrid, an app is my latest, and maybe, best  find because it incorporates the ubiquitous social media and mobile technologies.

A recent article covers the details of how it works, but here I want to share the highlights via images and links to the app for those who need it, or their caregivers.  

       

 

SoberGrid also offers a Provider Portal that allows EAPs and providers to connect with their alumni and stay in touch after treatment.  Watch this video!

 

Listening to patients is good business

I'll always be a hospital administrator and that means I think about sustaining the organization.  This is the top goal for me, because it is the starting point for ensuring that patients get the best care possible.  My experience last year taught me exactly how not listening to patients, part of the communication process, leads to a leakage of business for physicians, hospitals and other community providers.

In previous blog posts I've provided examples of how I, as a patient, wasn't heard by my local physicians.  This ultimately lead to me seeking treatment in Los Angeles - two to four hours away, depending upon traffic.  My post today will highlight the outcomes and their impact on the local healthcare community.  Never mind the added cost to my family.

As a reminder, here are a couple of relevant experiences:

I began strongly advocating for myself when my condition worsened and my neurologist didn't seem to be looking beyond his diagnosis of Idiopathic Peripheral Neuropathy.  The word idiopathic means "unknown cause" and is a catchall for everything that may have caused the condition.  While it is a good temporary diagnosis, patients should continue to work with their physician to identify the underlying cause(s).  He later admitted,  he was most concerned about ruling out Multiple Sclerosis, a tumor and other more "common" diseases.

My condition progressively got worse and my primary care physician wasn't interested in seeing me - probably assuming I was in good hands with the neurologist... a specialist.  

I started looking for a new primary care physician, but couldn't seem to find one accepting new patients.  Around the same time, I learned of a second opinion service offered by my husband's employer.  Mayo Clinic and Tufts University neurologists both agreed on my suspected condition upon reviewing my case and they recommended I seek treatment with a neuromuscular specialist... and one associated with an academic medical center.

A few weeks prior to receiving the report from the physicians reviewing my case as a second opinion, I personally settled on the diagnosis of Guillain Barre Syndrome after researching and consulting with Dr. Google. 

Given that I couldn't find a local physician to help me, I took the Mayo and Tufts doctors up on their suggestion and contacted UCLA.  So here is the leakage of revenue out of the local healthcare market. 

• Revenue for professional services associated with my treating physician and the other physicians who are consulted including anesthesiology, radiology and pathology
• Ancillary service and testing revenue including, labs, EMGs, hand physical therapy and pharmacy
• Outpatient charges for a lumbar puncture and monthly infusion therapy, and now every three weeks, for at least one year.

All of this care is currently provided by UCLA Health, a speciality pharmacy and home infusion company all based in Los Angeles.  They are the ones being reimbursed hundreds of thousands of dollars.  I suspect my local community would probably say they have capacity to accommodate my treatment needs, if asked.  But, why at this point, would a patient ask when no one listened and it took 7 1/2 months to get a diagnosis.

I did see a local infectious disease physician to rule out Lyme Disease and have recently returned to regular physical therapy in the local community with a provider I had used previously. But, these are very tiny fish in the big expensive ocean of what is my treatment plan and its cost.

So, listen to patients when they say they are getting worse.  Bring them back in if weeks and/or months have gone by to reassess and talk specifically about the changes in their symptoms and/or functional limitations.  If you have ruled out more common conditions, think about the less common possibilities and do some more testing.

Don't assume the specialist is taking care of the patient's needs.  If you are the primary care physician, and the health literate, normally healthy patient is calling to say they are getting worse and that they are constantly falling, don't assume the "specialist" is giving the patient all of the care necessary.  You are the quarterback of the patient's healthcare team and may have to do some intervening on the patient's behalf.

And finally, don't ever have an office person tell the patient who is at their physical and emotional lowest, "let me see if the doctor wants to see you" and then never call that patient back... even to say no, the doctor doesn't want to see you.  Communication is the top reason, by far, for medical malpractice lawsuits.  It is also a top contributor to medical errors and delays in diagnosis.

What is truly ironic about this situation is that I've never had an opportunity to really work locally; no matter how much I tried.  And, when I need my local healthcare delivery system the most, it doesn't avail itself to me even when I'm begging for health professionals to listen to me - a healthcare professional.

 

 

420 Gift Guide - Christina's CBD Considerations

My background is in the business of healthcare and that includes promotion of products and services.  But, never in my 35+ year career would I expect to produce a 420 Gift Guide for 2018.  As a matter of fact, I only learned that the term 420  is code term for the cannabis culture and according to my favorite wiki, it dates back to 1971 and five high school kids.  

But, here we are... my suggestions for those celebrating April 20th with products containing hemp and/or CBD.  I'll leave the THC products to those focused on that market!

My first recommendation isn't for my human friends, instead it is for our four legged friends who also suffer from chronic disease and functional limitations.  Have you ever seen an older dog with arthritis or hip pain?  

Phyto Animal Health Bacon Apple Donuts are CBD-infused soft chews help provide support to your dog’s cardiovascular function, fights anxiety, supports joints and hips, and provides other desirable side effects such as glowing skin and hair. Did someone say bacon?

These will soon be available and I'm wondering if I should expand my CBD line-up to our pets who also make us feel better and distract us from our illness.  If your interested, leave a comment or send me a message.

The second item on my gift guide is a product I don't currently carry, because I'm just not sure how beauty fits in with functional limitations.  However, when you are feeling fatigued and drained of energy, maybe more vibrant skin aids in improving your emotional health. 

My husband and I each tried Cannabis Beauty Defined Cleanser  and it did seem to tighten our skin; a great benefit when you are aging.  It is formulated to maximize the effects of CBD to protect skin from the damage caused by free radicals. This cleanser is non-drying, sulfate free and packed with vitamins, minerals, and enriching moisture to leave your skin looking vibrant and healthy. It’s an extremely effective anti-inflammatory and is known to help slow down the anti-aging process, as well.

In third place we get back to my interest in CBD and Real Scientific Hemp Oil (RSHO) Salve works wonders for tired muscles, aching joints, or sore bodies. Simply rub the salve on the area that hurts and soon you’ll be on your way to relief. Beyond that, RSHO salve can be used to relieve rough elbows, cracked cuticles or even an itchy scalp and dry hair.

Since this has been proven to be beneficial to me and a few customers, this is in stock and ready for delivery.

Pain can interfere with sleep; which can then lead to productivity, safety and relationship issues.  When I need to sleep, my go to CBD product and fourth recommendation is the Real Scientific Oral Concentrate - Green Label .  At first glance it may seem expensive, but the 15G tube contains 1500 mg of CBD in its raw form, as well as, vitamins, minerals, essential fatty acids, terpenes, and other cannabinoids. 

Start with a .5 ml dose and work your way up to find the amount right for you.

 

It might seem I should stop at four recommendations for a 4/20 gift guide, but I'll stop at five.... because four times five equals 20! So, my fifth and final recommendation is for those days when you are sluggish, fatigued and even have some distracting aches.  

Mango Citrus Dixie Botanicals Kicks  are a great way of getting the benefits of caffeine without drinking more coffee or energy drinks.  It is a healthy, low calorie energy chew blended with 60 mcg of Vitamin D3 for a more natural boost. These Kicks also contain B vitamins and pure CBD-isolate to help give you the energy you need on-the-go. 

In addition to the mango-citrus flavor, chocolate is also available.

I'm currently offering a 10% discount off your first purchase and also offer bulk discounts. So visit my carefully selected and tested, list of CBD products and find something for yourself or someone you love to celebrate 4/20/18; at 4:20pm.

 

Chronic Disease Coalition: Protecting Patient Rights

In February, I became an Ambassador of the Chronic Disease Coalition representing the Guillain Barre/CIDP community.  I will be leveraging my experience as a healthcare executive and learnings as a patient to continue my passion for ensuring patients receive the best care possible.  Although my role in healthcare has evolved, this passion has remained strong since the day a 17 year old hospital admit clerk/PBX operator decided she would pursue a hospital administration career path.

My GBS journey was spotlighted in February and the stories of others will continue to be added.  Our stories reflect shared experiences and individual struggles.  They are important because they add faces to data and "policy"; reflecting imperfections and opportunities for improvement in the healthcare delivery system and beyond.

One shared experience is reflected in California's new Senate Bill 1156.  This legislation, if passed, would force those who receive charitable assistance with premiums and their share of cost, on to public programs already that are already struggling with access issues. Chronic disease is disruptive enough, don't add to this burden buy prohibiting the support of patient healthcare costs from non-profit charitable organizations.  Patients who are paying their share of cost and premiums should be allowed to remain on their existing insurance plans, so they continue to have access to the care team that knows them best.   It doesn't, and shouldn't, matter if charitable organizations, churches, or their mother helps them with these costs.  Vote no on these bills in California and in every other state.

Having said this, there is a difference between charitable organizations being allowed to help patients remain on their existing private plans, and public plans who may also be non-profits, cost shifting and paying for private insurance premiums to avoid the actual cost of care.  The latter presents a conflict of interest and should be prohibited. The reason is this wrongly shifts the burden of costs to other private insurance plan members and away from the MediCal and other public plans who are responsible.

CBD Primer: Comparing Options

The taboos surrounding medical marijuana; including CBD means there is a huge need for educating patients and their family caregivers.  Go to any online support group for chronic illness and diseases and you will likely find questions from patients who are ready to try something different; but, don’t know where to start.

The price, although decreasing considerably in the past 18 months, is often a bit of sticker shock. Is CBD oil really out of one’s price range?  Perhaps, given that it isn’t yet covered by insurance plans.  But, when looked at in the context of options, such as replaced prescription medications, work/school absences and personal productivity; it may be more affordable than one initially believes.

The first step is to recognize the need, and how, to compare options and prices PER MG. Often, this will reveal that prices are comparable, when comparing multiple products.  For example, a 1000mg liquid would last long and the price/mg could actually be much less compared to a 100mg tincture.

I asked someone in the business for advice for CBD shoppers and present three important things to consider for those new to CBD who are beginning to understand and evaluate options.

1. Look for the amount of CBD in the product. Many people get confused about how much to take, and can experience some sticker shock when they first start researching. CBD oil isn't inexpensive! But, when you are shopping around, make sure to check how much CBD oil is in the product. If it's inexpensive, it can be a situation of buyer beware.

2. Everyone’s needs are different, just as their health and response to injury or illness can vary. Looks for a product that has enough CBD oil for you.  Some products contain blends of different oils, so research and look for CBD products (oral or topical) that have what you need. That can mean, a 1000mg bottle of oil for one person, or a 15mg tube of concentrate for another. Many individuals start with .5 mg doses of pure CMD oil and work their way up from there. 

3. Choose a full spectrum oil, if you can. Full spectrum means that the oil has the full complex of the cannabinoids in the product, not just the isolated CBD.  (See graphic below)  This is important, since the natural extractions of hemp contain over 400 compounds, and they work together, synergistically. Technically, that term is call The Entourage Effect. If the CBD oil is made from all the good stuff that mother nature made, you're getting a much richer, more nutritious oil product. This is opposed to liquids or compounds made from just the CBD molecule.

When it comes to price, two things can account for the differences: potency and quality.  The best CBD oil from hemp is subjected to rigorous testing.  Quality CBD is manufactured in a Good Manufacturing Procedures (GMP) certified facility, one that is also approved to handle THC. Why? Because, CBD oil from hemp may still contain trace amounts of THC, so you want to make sure that your supplier and manufacturer are compliant with all the manufacturing guidelines and laws of the Federal Drug Administration.

Testing helps ensure quality, safety and consistency in products being sold.  It also cost money and the cleanest extraction method, using CO2, is also is the most expensive.  Many feel this method is worth it, because oil extracted using chemicals may result in a CBD product tainted by things you don't want to consume!   Carefully read labels for the extraction method and testing.  If it isn’t clear, advocate for yourself and ask about this where you purchase products.

In evaluating different suppliers, also consider that the 2014 US Federal Farm Bill is clear that in order to cross state lines, the CBD oil must be derived from mature hemp stalks from plants grown overseas.  Until the law changes, consider whether suppliers seem comply with this law. 

Dressing with Functional Limitations

Getting dressed or undressed can be a challenge for those with functional limitations.  Shoe horns can help with getting shoes on and there are special devices to help those who even have trouble pulling on socks. My must have was a buttoner and zipper device with a thick  non-slip handle that would be easy for me to grasp given my lack of finger/hand coordination, strength and dexterity. 

The hook end slips through the hold of zippers when pinching it isn't a realistic possibility and handle provides a little leverage for pulling it up or down.  Yes, elastic waist bands are the best, but sometimes a girl (or boy) just wants to wear her favorite shorts or jeans. 

As for the buttoner end, slide it through a shirt or pant button hole and loop it over the button.  Then pull it through the hole with a little guidance from your other hand.  Again, the handle provides some extra leverage for those who need it.

For those who only need the buttoner, another option is comes from Good Grips.  And, as I've addressed in a prior post, there is also the Magnetic Button that works well for dress shirts and other small buttons.

If you have used anything to overcome one of your dressing functional limitations, please share it with others in the comments.