Care Recipient Health

I recently refilled my mother’s prescription and found that she had previously been given pills that were half the dosage of what had been prescribed—even though the pharmacist’s label indicated the vial’s contents were what had been prescribed. How do I prevent such a potentially tragic mistake in the future?

“This problem requires diligence on the part of the pharmacist and being proactive on the part of [the caregiver],” says Mary Kremzner, PharmD, deputy director of the division of drug information at the Food and Drug Administration. “There’s always an imprint on the pill,” she explains, “and you can always verify this imprint with an outside source.” The Internet and up-to-date copies of The PDR Pocket Guide to Prescription Drugs or The Essential Guide to Prescription Drugs are good starting-point references. “Or,” says Dr. Kremzner, “you can call the FDA.”

Being proactive has never been more important because, she adds, “there are so many generics now. A pill may appear different, but it’s only a different manufacturer with the same medicine. People are just not alerted. Don’t ever feel funny about calling a manufacturer or asking your pharmacist.”

Such mistakes, says Dr. Kremzner, “are unintentional—pharmacists feel sick when they’ve made a mistake. This is about establishing a relationship with your pharmacist and checking through sources to make sure [the medication] is what it is.”

Medicare Part D was covering a drug I was taking. Then my doctor switched me to one not covered. What do I do?

“See what drugs are allowed by your plan, then ask the doctor if an allowed drug would be effective,” says Dina Wizmur, deputy general counsel for the Medicare Rights Center in Washington, DC. “If your doctor says other medicines won’t do, you can appeal [to Medicare] and request an exception to your plan. There’s a standard form available at your plan’s website or your doctor’s office.” About 67 percent of exception requests are approved, say Wizmur. If not approved, you can appeal.

A friend told me he has osteoporosis. Isn't that a woman's disease?

"While it's not as common as it is in women, osteoporosis is pretty common in men: about one in four will have an osteoporosis-related fracture in his lifetime," says Felicia Cosman, MD, clinical director of the National Osteoporosis Foundation. "[It] presents the same dangers in men as in women. Suddenly you might break a bone by banging into the furniture or from coughing or a minor fall."

An important diagnostic step is to "get a bone density test, which helps find osteoporosis in the early stages," she says. "Ten years ago, Medicare approved reimbursement for bone density tests in women 65 years and over. For men, it's only been in the last few years that Medicare has reimbursed a screening for ages 70 and above."

My dad has Alzheimer's and I've recently noticed he has trouble swallowing when he eats. Is this common?

Dysphagia—the umbrella name for swallowing disorders—occurs in later-stage Alzheimer's when "the deterioration of tongue, throat, and voice-box muscles and sensation interferes with swallowing coordination," says Robert W. Bastian, MD, founder of the Bastian Voice Institute for Voice, Swallowing, and Airway Disorders in Chicago.

There are, according to Dr. Bastian, noticeable warning signs: "Frequent coughing during and after drinking or eating, or a ‘gargly' voice" are chief among them.

Dr. Bastian does offer some remedies. "Be sure he eats with attention and vigor. Also, choose food carefully. In many cases, thin liquids [should be] avoided; thicker liquids flow through the throat more slowly and give more time to respond and re-swallow. And," he adds, "consider patient positioning; many swallow better with their chin tucked down toward the chest, as though gazing at one's belt buckle." Also, coaching can help. Dr. Bastian suggests you encourage your dad to "optimize the eating experience: ‘Swallow again, Dad. Let's sip a little juice next.'" The right kind of attention is a potent ally.

My husband has COPD, and I am looking for a diet plan for him. Can anyone help me?

Many individuals with COPD become malnourished because they lose
interest in food or lack the energy to eat, says Karen Novak, a
registered dietitian and nutrition educator at St. Vincent's Medical
Center, Bridgeport, CT. But helping your loved one with COPD maintain
proper body weight with a diet rich in vitamins and minerals is
important, she says. Someone too thin will lack energy and resistance
to disease, while excess weight further strains the heart and lungs,
which compromises breathing.

To ease breathing difficulties and avoid infection in those with COPD, Novak suggests these mealtime tips:

• Offer a varied diet with plenty of fruits and vegetables. Such foods are rich in antioxidants, which enhance lung function.
• Keep the calorie content up with nutrient-dense foods. Avoid snacks that lack nutritional value.
• Serve six small meals rather than three large ones. Feeling too full makes one feel short of breath.
• Provide fluids to thin mucus. Eight cups daily, served between meals, should help allow the mucus to be coughed up more easily.
• Serve the main meal early for all-day energy.
• Formulate a healthy eating plan with a dietitian or physician.
• Keep meals relaxing. A calm, attractive setting helps one, quite literally, breathe easier.
• Reduce salt intake. It causes water retention, which makes breathing more difficult.
• Avoid foods that cause gas or bloating, such as apples, avocado, beans, broccoli, cabbage, melon and soda.
• Continue oxygen use during and after meals to ease digestion.
• Have your loved one rest between bites. Chewing can be exhausting
  if it interferes with breathing, so cut portions into small bites or
  serve soft foods.
• Avoid meals that are too hot or cold. Excessive temperatures can trigger coughing.