Understanding Frontotemporal Dementia-Interview with Sarah Lopata

I would love to hear from you. Send me questions or comments.

Dementia doesn’t always start with forgetting. Sometimes it starts with a personality shift that feels like a stranger moved into your house, a sudden loss of empathy, a scary change in judgment, or speech that just won’t come out right. We’re joined by Sarah Lapata from the Association for Frontotemporal Degeneration (AFTD) to unpack frontotemporal degeneration (FTD) in plain language, with the details families actually need when they’re trying to make sense of what’s happening.

We talk about why FTD is a leading cause of young onset dementia, why it can be misdiagnosed as Alzheimer’s or a psychiatric disorder, and why the path to an accurate diagnosis can take years. Sarah explains what makes FTD different, what “anosognosia” means when a loved one truly can’t see their own symptoms, and how that lack of insight can turn everyday life into conflict, especially around safety issues like driving. We also walk through the FTD umbrella, including behavioral variant FTD, primary progressive aphasia, movement-related syndromes that can resemble Parkinson’s, and the overlap some people face with ALS.

We get into genetics, what “sporadic” vs “familial” can mean, and why meeting with a genetic counselor can help you think through testing without pressure. We also highlight palliative care as a holistic support that can start earlier than most people assume, plus the value of support groups and the AFTD helpline for real-world strategies and relief.

If this conversation helps, subscribe, share it with someone who’s caregiving, and leave a review so more families can find it when they need it most.

AFTD – The Association for Frontotemporal Degeneration

Support the show

Welcome To Patty’s Place

SPEAKER_00
0:17

Welcome
to
Patty's
Place,
a
place
where
we're
gonna
talk
about
grief,
dementia,
and
caregiving.
I
started
this
podcast
in
honor
of
my
mom,
Pat,
who
passed
away
from
dementia
almost
three
years
ago
now.
I
am
your
host,
Lisa.
I
want
this
to
be
a
place
where
you
know
you're
not
alone
and
we
can
have
these
difficult
conversations
and
hope
we
can
just
guide
ourselves
through
this
challenging
times
for
it.
So
grab
yourself
a
cup
of
tea,
a
cup
of
coffee,
or
if
you're
having
a
really
bad
day,
a
glass
of
wine,
and
we
will

Meet The FTD Expert Guest

SPEAKER_00
0:44

get
started.
I'm
very
excited
about
our
guests
today.
So,
because
you
know,
as
I
talked
about
before,
there's
different
types
of
dementia.
So
we're
gonna
talk
about
a
particular
type
of
dementia
today.
So
my
guest
is
Sarah
Lapata.
She
is
with
the
Association
for
Front
to
Frontotemporal
Degeneration.
Hopefully
I
said
that
correctly.
Okay,
welcome,
Sarah,
to
Patty's
place.
Thank
you.
So
thank
you
so
much.
So
what
is
FTD,
as
you
call
it?

What Frontotemporal Degeneration Means

SPEAKER_01
1:17

Sure.
Um,
thanks
again
for
having
me
here
today.
Um,
frontotemporal
degeneration
refers
to
a
group
of
brain
disorders
caused
by
degeneration
in
the
and
damage
and
death
of
the
frontal
and
temporal
lobes.
So
you
may
have
heard
of
frontotemporal
dementia,
frontotemporal
lobar
degeneration,
and
PICS
disease.
Um,
it
presents
with
behavior
or
communication
or
movement
symptoms
and
is
frequently
diagnosed
between
the
ages
of
45
and
60,
which
makes
it
a
leading
cause
of
young
onset
dementia.

SPEAKER_00
1:59

Wow.
So
how
is
it
different
from
other
dementias?

How FTD Differs From Alzheimer’s

SPEAKER_01
2:05

That's
a
great
question.
So
um
when
people
think
about
dementia,
I
think
a
lot
of
people
automatically
go
to
memory,
right?
They
think
about
Alzheimer's.
That's
kind
of
what
people
are
familiar
with.
Um,
but
unlike
Alzheimer's,
memory
often
remains
intact
in
early
stages
of
FTD.
Yeah.
So
you
might
see
um
uncharacteristic
behavior
or
communication
or
movement
symptoms.
That's
the
those
are
the
symptoms
that
um
people
see
with
FTD.

SPEAKER_00
2:40

So
just
like
it's
they're
like
not
their
self,
like
in
the
way
they
react
to
different
things
or
their
feelings
and
stuff
like
that.

SPEAKER_01
2:47

Uh
yeah,
exactly.
Okay.
Yeah.
And
sometimes
one
of
the
things
that
really
stands
out
for
a
lot
of
people
is
they
notice
that
their
loved
one
um
seems
like
they
don't
have
empathy
or
they
seem
apathetic.
Uh,
they
don't
want
to
do
anything
that
they
used
to
want
to
do.
Um,
so
it
can
feel
like
very
confusing.
Um
and
and
that's
and
that's
really
common
in
FTD.

SPEAKER_00
3:12

Okay.

Why Diagnosis Takes So Long

SPEAKER_00
3:14

Why
does
it
take
so
long
to
get
a
diagnosis?
So
I
was
doing
research
on
the
website,
and
I
noticed
that
was
one
of
the
first
things
that
struck
me.
Why
does
it
take
so
long?
Yeah,
that's,
I
mean,
it
really
does
take
a
while.

SPEAKER_01
3:26

Um,
the
average
is
3.6
years
to
get
an
accurate
diagnosis.
Um,
for
some
people,
they
can
get
it
pretty
quickly,
but
for
most
people,
it
is
a
very
long
journey.
Um,
because
I
think
there's
a
lot
of
things
that
goes
into
making
the
diagnosis
challenging.
Um,
one
thing
is
that
FTD
is
what
we
say
um
is
heterogeneous.
So
that
means
like
there's
a
significant
diversity
in
how
symptoms
present.
If
you
have,
say,
like
um,
if
you
have
a
beh
the
behavioral
variant
of
FTD,
it
doesn't
necessarily
mean
that
all
of
your
behaviors
are
going
to
be
the
same
as
someone
else
who
has
the
same
variant,
right?
Okay.
So
it's
not
always
really
easy
to
like
check
the
boxes.
Um
and
then,
you
know,
also
because
symptoms
can
begin,
you
know,
so
much
earlier,
you
know,
in
their
40s
or
even
as
young
as
in
their
20s,
you
don't
automatically
think
it's
dementia
and
you
try
to
rule
other
things
out
first.
So
you
can
go
a
long
time
without
a
proper
diagnosis,
and
that
can
impact
your
relationships,
your
career,
everything.
Um,
and
then
even
when
you
do
finally
try
to
get
a
diagnosis,
um,
there
can
be
a
lot
of
misdiagnosis.
People
um,
it's
frequently
misdiagnosed
as
Alzheimer's
or
psychiatric
disorder,
like
depression
or
bipolar
disorder.
Um,
with
the
movement,
um,
the
movement
variants,
it
looks,
it
can
look
like
Parkinson's.
So
um,
they
can
miss
the
true
underlying
diagnosis.

Which Doctors And Tools Help

SPEAKER_00
5:06

So,
what
type
of
doctor
should
somebody
go
to?
Should
they
start
with
the
neurologist
or
neuropsychiatrist?
Where
where
should
they
even
start
if
they're
suspecting
that
their
loved
one
just
isn't
quite
themselves?
Yeah,
that's
a
that's
great.

SPEAKER_01
5:20

Um
yeah,
so
if
sometimes
if
you
go
to
your
primary
care
physician,
you
might
get
referred
to
a
mental
health
clinician
or
someone
to
kind
of
be
dealing
with
some
of
the
symptoms
that
look
like
something
else.
Um,
but
we
do
know
that
neurologists,
that's
the
way
to
go.
Okay.
Um,
and
actually
on
AFTD's
website.
So
if
anybody
is
thinking,
is
this
happening
to
my
loved
one
or
is
this
happening
to
me,
right?
If
you're
noticing
weird
like
symptoms
in
yourself,
um,
AFTD
offers
uh
diagnostic
checklists
on
our
website,
and
you
can
go
through
and
see
how
much
of
it
applies
to
you,
and
you
can
take
that
with
you
to
your
doctor.
So
you
might
have
a
neurologist
that
you
can
say,
that's
wonderful.
Um,
if
not,
you
could
go
to
your
primary
care
doctor
and
take
that
with
you.
Um,
we
also
have
a
locator
tool
on
our
website
that
has
FTD
specialized
medical
centers
that
are,
that
are
listed
there
too.
So
you
might
be
able
to
find
one
close
enough
to
you.
Um,
but
we
do
know
people
travel
pretty
far
sometimes
to
find
a
specialist
uh
that
would
help
them.

SPEAKER_00
6:33

And
I
did
notice
those
checklists
on
the
website.
I
thought
they
were
pretty
awesome
because
there's
they're
so
simple
to
you
know
to
print
out
and
check
with
it.

SPEAKER_01
6:41

Yeah,
yeah.
And
it
really
gives
you
the
language
to
use
because
sometimes
um
I
think
you
know,
like
as
a
lay
person,
as
someone
without
medical
training,
you
don't
always
know
what
to
say
to
describe
what
you're
seeing
in
your
loved
one,
um,
to
really
have
it
hit
home
with
your
doctor.
So
this
is
really
helpful.
That
kind
of
like
translates
the
behaviors
or
the
issues
and
the
symptoms
to
make
it
um
work
with
your
doctor
so
they
can
understand

Genetics, Testing, And Counseling

SPEAKER_01
7:08

it.

SPEAKER_00
7:08

And
now,
how
uh
how
do
genetics
play
a
role
in
the
form
of
dementia?
Because
I
know
anybody
that's
had
a
family
member
with
any
type
of
dementia,
you
you
start
to
worry
like,
am
I
gonna
get
it?
You
know,
do
you
think
it
plays
a
role
in
this
particular
one
or
or
are
we
not
sure
yet?

SPEAKER_01
7:26

So
we
know
that
in
in
over
half,
about
60%
of
people
who
are
diagnosed
with
FTD,
there's
no
one
else
in
the
family
with
FTD
or
related
conditions.
So
we
refer
to
this
as
sporadic
or
apparently
sporadic
because
we
don't
know
the
true
underlying,
we
don't
know
all
of
the
genetic
causes.
So
we're
still
learning,
research
is
still
moving
forward.
Um,
but
we
do
know
that
about
more
than
half,
60%
are
are
not
um
associated
with
uh
a
genetic
underlying
cause.
Um
but
in
40%
of
the
cases,
we
know
that
there's
a
family
history
of
dementia
or
a
related
neurological
condition.
Um
we've
we
call
that
familial
FTD.
Okay.
And
within
that,
there
is
a
greater
likelihood
of
being
able
to
find
um
a
genetic
variant
that's
associated.
So
of
you
know,
of
all
of
the
cases
of
FTD,
they
will
find
15
to
20%
of
people
do
have
an
underlying
genetic
cause.
Um,
so
it's
not
a
whole
lot,
but
it's
definitely
um
prevalent.

SPEAKER_00
8:38

Okay.
But
I
mean,
yeah,
I
mean,
you're
always
worried,
like,
and
I
know
that
there,
I
know
for
the
other,
excuse
me,
I
know
there's
the
other
types
of
dementia,
there's
like
a
blood
test
or
something
you
could
take.
And
I
always
think,
do
I
want
to
know?
I
don't
know.
You
know,
it's
kind
of
scary
either
way
with
it.

SPEAKER_01
8:54

But
yeah,
and
you
know,
what
we
know
is
that
because
diagnosis
can
be
challenging,
um,
and
they
are
working,
like
the
res
biomarker
research
is
happening.
So
we
are
really
hopeful
that,
you
know,
we
know
like
with
the
Alzheimer's
biomarker
test,
like
you
know
that
that
can
rule
it
out
for
people,
which
is
it's
helpful
to
know
because
if
you
get
the
proper
diagnosis,
it
can
lead
you
to
the
proper
support,
the
proper,
you
know,
the
right
treatments,
the
right
if
there,
you
know,
as
research
is
is
moving
forward
and
advancing,
it
can
connect
you
to
be
able
to
participate
in
the
right
research.
So
if
that's
what
you
want
to
do.
So
that's
um,
yeah,
it's
such
a
hard
decision
though.
And
um,
you
make
a
really
good
point.
Like,
um
you
don't
know
if
you
want
to
know,
or
there
are
pros
and
there
are
cons.
Um,
so
AFTD
does
recommend
that
everybody
meets
with
a
genetic
counselor
um
who's
diagnosed
with
FTD
because
they
can
help
walk
you
through
that
decision
making.
Um,
just
because
you
meet
with
a
genetic
counselor
doesn't
mean
you're
gonna
get
a
test,
but
it
helps
you
figure
out
if
that's
the
right
choice
for
you.

SPEAKER_00
10:06

And
when
you
you
said
like
movement,
so
like
what
are
out
of
the
ordinary
like
movements?

Movement And Language Warning Signs

SPEAKER_00
10:12

Because
you
know,
we
all
like
kind
of
trip
or
fall
or
you
know,
have
those
types
of
things,
but
when
should
you
like
kind
of
get
concerned
on
the
movement
part?

SPEAKER_01
10:21

So
because
FTD
and
and
because
it's
a
progressive
neurological
disease,
you're
going
to
see
things
progress.
You
will
see,
you
know,
it
might
start
out
like
um
with
some
stiffness,
um,
neck
stiffness,
or
tripping,
not
being
able
to
orient
in
space,
falls,
things
like
that.
But
when
it
when
you're
seeing
it
happen
more
and
more,
is
when
you
really
should
pay
attention.
Um
and
that's
something
when
you
would
want
to
talk
to
a
doctor
or
explore,
you
know,
the
diagnostic
checklists.

SPEAKER_00
10:58

Okay.
And
I
also
noticed
when
I
was
on
the
website,
there's
it,
there's
other
uh
conditions
that
kind
of
go
along
with
this,
with
it.
Like
was
it
aphasia
and
a
few
other
ones?
Is
are
is
that
pretty
common
for
someone
then
to
have
like
two
different
ones?

FTD Subtypes Under One Umbrella

SPEAKER_01
11:14

Yeah,
so
I
think
what
you're
talking
about
is
the
subtypes
of
FTD,
so
different
kinds
of
ways
it
can
present,
right?
Um
so
for
there's
a
behavioral
variant
where
you
see
the
personality
changes
and
apathy
or
judgment.
Um
and
then
with
aphasia,
primary
progressive
aphasia
is
more
um
language
and
communication
symptoms.
Um
so
you
could
be
losing
the
meaning
of
words,
or
um,
you
could
know
the
meaning
of
words
and
know
exactly
what
you
want
to
say,
but
you
just
can't
say
it.
You
can't
find
the
word,
um,
or
it
just
doesn't,
your
sentences
don't
look
the
way
they
used
to.
Um
and
there's
also
primary
progressive
apraxia
of
speech,
which
is
kind
of
similar
to
um
that
has
a
little
bit
of
movement
because
it's
the
part
of
the
brain
that
controls
the
muscle
that
makes
your
mouth
make
the
words.
So
you
can't
make
the
words
anymore,
okay.
Um,
but
you
still
know
what
you
want
to
say.
Um,
and
then
there
are
a
couple
other
the
movement
disorders.
Uh,
we're
looking
at
corticobasal
syndrome,
CBS,
um,
that
affects
movement.
Um,
you
see
um
symptoms
that
resemble
Parkinson's.
So
some
that
again,
that
that's
sometimes
part
of
the
diagnostic
challenge
is
that
people
think
that
it's
Parkinson's,
um,
but
then
um,
but
it's
actually
under
the
FTD
umbrella.
Um,
progressive
supernuclear
palsy
is
another
one
of
the
movement,
um
the
movement
variants.
Um,
you'll
see
stiffness,
um
poor
balance,
and
then
also
you
also
see
like
um
a
progressive
kind
of
like
inability
to
move
your
eyes
or
opening
or
closing
your
eyes.
So
all
of
like
it's
there's
so
many
things
that
could
that
fall
under
it.
So
it
is
a
lot
to
take
in.
Um,
but
if
you're
if
you're
experiencing
that
or
your
loved
one
is
experiencing
that,
it
might
be
uh
progressive
uh
supernuclear
palsy
or
PSP.
Um
and
then
also
FTD
ALS.
So
um
they
FTD
and
ALS
can
occur
in
the
same
person.
Um
sometimes
we'll
most
of
the
time
when
that
happens,
you
do
see
symptoms
of
FTD
first,
um,
and
then
they're
followed
by
the
motor
symptoms
with
ALS
afterwards.
Wow.
That's
a
lot.

SPEAKER_00
13:53

Yeah,
it's
a
lot,
it's
a
it's
a
lot.
It's
a
lot,
it
is
a
lot.
Uh
yeah.
How
common
is
this
particular
this
this
how
common
is
FTD?

SPEAKER_01
14:05

Um,
you
know,
it's
considered
a
rare
form
of
dementia.
Um,
we
know
there
was
a
study
that
is
from
2011,
so
it's
pretty
long
ago.
But
it
suggested
between
50
and
60,000
people
in
the
US
have
it.
Um
that
was
a
long
time
ago.
And
we
also
know
that
with
misdiagnosis
and
underdiagnosis,
that's
probably
not
a
completely
accurate
reflection.
Um,
but
it's
um
we
know
that
with
more
understanding,
more
awareness,
um,
more
education
for
healthcare
professionals,
we're
getting
a
better
understanding
of
how
many
people
do
have
FTD.
But
yeah,
it
is
still
considered
a
rare,
um,
disease.

SPEAKER_00
14:53

Can
because
I
know
somebody
can
have
mixed
dementia
as
well.
Like
maybe
they
start
with,
say,
vascular
dementia
or
Alzheimer's.
Can
they
then
get
symptoms
of
FTD
too
as
it
progresses?

SPEAKER_01
15:07

Yeah,
you
know,
with
um
we
what
we
do
know
with
FTD
and
the
progression
of
FTD
itself
is
that
you
could
start
with
symptoms
that
present
like
the
behavioral
variant
and
it
would
eventually
move
into
other
parts
of
the
brain.
Um,
so
then
you
will
see
other
like
language
or
communication
symptoms
or
movement
symptoms
and
the
same
thing,
like
vice
versa.
Um,
and
you
do
you
can
see
that
very
similarly
in
mixed
dementia.

SPEAKER_00
15:35

Okay.

When A Loved One Lacks Insight

SPEAKER_00
15:36

So
this
is
a
question
probably
not
just
for
FTD,
but
anybody
who
has
a
loved
one
with
dementia.
But
I
love
this
question
on
your
website.
Why
does
my
loved
one
uh
can't
why
can't
they
acknowledge
their
FTD
and
the
impact
on
the
family?
Yeah.

SPEAKER_01
15:55

You
know,
that
one
is
such
that's
so
difficult
for
caregivers.
Um,
and
we're
also
really
learning
that
it's
difficult
for
persons
who
are
diagnosed.
Um
so
the
term
that
we
use
for
this
is
called
anasygnosia.
That
means
a
lack
of
insight
into
their
own
condition.
So,
you
know,
it's
it
can
be
on
a
spectrum,
um,
but
it's
not
denial.
And
it
feels
like
denial
and
it
feels
like
manipulation.
So
it
is
just
so
hard
for
care
partners
and
family
members
to
witness
that
in
their
loved
one
if
it
just
seems
like
you're
saying,
here's
here's
the
medical,
here's
your
record,
and
it
says
you
have
FTD.
Um,
but
their
loved
one
says
that
nothing
is
wrong
with
me.
I
don't
know
what
you're
talking
about.
I
I
don't
do
that.
Um
so
it's
something
that's
really,
really
difficult,
and
it
is
a
it
is
a
common
symptom.
Um,
but
again,
it's
it's
truly
part
of
the
disease.
Someone
with
who's
who's
experiencing
this
really
truly
can't
help
it.
Um
but
we
work,
you
know,
with
care
partners
to
support
them
as
they
face
it
and
adapt
to
it.
Um,
they
deserve
that
support
and
validation.
And
um
it's
also
part
of
the
diagnostic
challenge,
too,
because
if
somebody
doesn't
believe
that
something
is
wrong
with
them,
they
truly
can't
see
that
something's
wrong
with
them.
It
really
makes
it
difficult
for
them
to
agree
to
go
to
a
doctor
and
get
evaluated.
And
so
that's
something
that
AFTD's
helpline
staff
is
really
good
at
working
with
family
members,
care
partners,
um,
to
talk
about
like
what
are
different
strategies
you
can
use
to
approach
this
symptom
because
it
is
it's
really,
really
difficult.
Um
and
one
another
thing
is
really
joining
a
support
group
because
you
can
connect
with
other
people
who
are
going
through
this
too,
and
you
feel
like
so
much
less
alone
in
this
in
this
part
of
it.

SPEAKER_00
18:07

My
mom
had
that
symptom,
even
though
she
wasn't
diagnosed
with
FTD.
She
she
ended
up
uh
they
they
said
she
was
diagnosed
with
mild
to
severe
dementia,
and
actually
on
her
death
certificate,
they
listed
vascular
dementia.
But
it
was
when
I
finally
went
on
the
Alzheimer's
Association
website,
and
I
saw
I
can
never
say
that
word,
but
I
saw
what
it
was,
and
I
was
like,
that's
her.
Like
she's
she's
not
in
denial,
she
just
thinks
everything's
fine.
And
then
my
dad
had
a
hard
time
with
it,
you
know,
to
admit
it.
And
you
could
not
say
the
word
demonstra
around
her,
she
would
get
so
upset,
you
know.
So
we
just
never
did,
you
know,
and
it
it
took
it
does
take
a
while
to
accept
that
that
they're
not
fighting
you.
They
just
really
don't
understand
that
this
is
what's
happening
to
them.

SPEAKER_01
18:58

Yeah,
absolutely.
And
it
is
one
of
those
things
um
that
we
do
really
try
to
support
caregivers
and
um
family
and
friends
and
um
and
persons
who
people
who
are
diagnosed
too,
because
they
they
can
sometimes
see
it.
The
lack
of
insight
doesn't
mean
like
a
complete
lack
of
insight
all
the
time.
Um,
it's
a
spectrum.
So
sometimes
people
can
see,
like
they
do
know
they
have
FTD,
but
they
don't,
they
may
not
be
able
to
see
everything
that
is
happening
from
the
care
partner's
perspective.
So
it
can,
it's
just
devastating
for
them
too.
Um,
I
think
the
more
we
get
to
understand
what
it's
like
to
live
with
a
diagnosis,
we
are
developing
much
more
compassionate
responses
to
each
other
um
and
just
being
able
to
be
there
for
each
other
because
it
is
it's
really,
really
hard
for
families
to
to
address
this
symptom.

SPEAKER_00
19:55

It
is.
It's
it's
very,
it's
very,
very
difficult.
So

The Hard Conversation About Driving

SPEAKER_00
20:00

the
question
of
driving
always
comes
up.
So
when
do
you
step
in
as
a
caregiver
and
say,
I
don't
think
you
should
be
driving
anymore?

SPEAKER_01
20:11

Yeah,
that's
a
really
difficult,
it's
a
difficult
situation.
I
mean,
like
we
talked
about
with
anasygnosia
too,
that
how
can
you
tell
somebody
that
they
shouldn't
be
driving
if
they
don't
even
realize
that
what's
happening
is
actually
happening.
Um
but,
you
know,
because
the
simp
some
of
the
symptoms
of
um
FTD
include
impaired
judgment
and
disinhibition
and
anasygnosia,
um,
that
really
does
raise
red
flags
around
safe
driving.
Um
but
it
is
such
an
individual
decision.
So
I
do
think
we
recommend
um
that
families
consult
with
their
physician
for
support,
navigating
navigating
the
situation
because
um
it
can
be
really
hard.
Um,
and
then
we
do
also
recommend
that
people
call
the
helpline
to
talk
about
different
strategies
to
prevent
harm
or
prevent,
you
know,
accidents
or
or
danger
and
stuff.
And
how
can
you
kind
of
navigate
this
very
sensitive
and
and
tricky
part
of
the
disease?

SPEAKER_00
21:13

I
was
grateful
my
mom,
well,
my
mom
was
never
she
never
liked
to
drive
anyway,
you
know,
she
only
liked
to
drive
local.
And
she
I
think
it's
when
she
she
kind
of
knew
maybe
something
wasn't
right,
but
she
couldn't
admit
it.
My
dad
had
bought
a
car
and
she
was
with
him
when
she
bought
the
car,
but
then
she
just
decided
that,
you
know,
he
bought
this
car,
she
hated
this
car,
this
car
was
too
big,
she
was
never
gonna
drive
this
car,
and
that
was
it.
She
just
wouldn't
drive
anymore.
And
I
looking
back,
I
think
that
was
probably
her
way
of
realizing,
you
know,
maybe
she
shouldn't
drive
anymore.
Cause
it
was
just
like
out
of
the
blue.
She
was
like,
I
hate
this
car,
I'm
not
gonna
do
I'm
not
doing
this.
And
we're
like,
Okay,
okay,
uh,
with
it.
Now,
my
dad,
on
the
other
hand,
who's
gonna
be
80,
uh,
I
don't
know.
That
could
be
a
little
bit
of
a
fight
with
him
with
the
driving.
I
don't
know.
Yeah.

SPEAKER_01
22:01

Yeah,
it
is
hard.
I
do
think
that
a
a
physician
can
really
help
kind
of
navigate
it
and
figure
out
like,
do
you
take
the
do
you
go
to
the
DMV?
Do
you,
you
know,
like
different,
different,
just
different
ways
to
approach
it.
And
each
person
is
so
different,
right?
So
she
was
like,
I'm
not
going
to
do
this
anymore.
Right.
Other
people
still
really
truly
want
to
drive.
And
that's
your
freedom.
That's
your
autonomy.
Oh,
right.
Um,
so
when
so
many
other
things
are
being
taken
from
you,
that
it's
you
can
really
understand
why
it's
so
hard
to
do
to
get
that.

SPEAKER_00
22:32

For
sure.
So
do
you
does
traumatic
brain
injury
have
any
effect
with
FTD?

TBI Risk And Disease Progression

SPEAKER_00
22:41

Do
you
think
do
they
think
that
might
be
a
cause
of
it?

SPEAKER_01
22:45

So
um
FTD
is
a
brain
disease.
Um
it's
not
thought
that
it's
associated
with
a
single
injury
or
a
trauma.
Um
most
people
with
a
traumatic
brain
injury
don't
develop
FTD.
Um,
and
most
people,
a
lot
of
people
with
FTD
don't
have
a
TBI
history.
So
um,
you
know,
it
sometimes
if
it's,
you
know,
um
repeated
severe
head
injuries
could
be
associated
with
FTD,
but
it
doesn't
imply
that
that's
what
caused
it.
Um
just
kind
of
raises
your
risk
factors,
um,
but
that's
not
necessarily
um
associated
directly.

SPEAKER_00
23:32

And
what
should
somebody
expect
as
the
degree
as
the
disease
progresses?
You
know,
like
especially
if
you
catch
it
a
little
early,
you
know.

SPEAKER_01
23:42

Yeah,
um,
so
with
progression,
with
FTD,
like
you
know,
I
said
earlier
that
for
one
person
it's
different
from
other
people,
you
know.
And
one
of
the
things
we
say
is
if
you've
met
one
person
with
FTD,
you've
met
one
person
with
FTD.
Right.
So
we
can't
always
predict
what
it
will
look
like
for
everybody.
Um
sometimes
it
can
be
very
quick.
Um,
and
sometimes
people
can
live
with
a
diagnosis
for
longer
than
a
decade.
Okay.
Um,
sometimes
20
years.

SPEAKER_00
24:15

Oh
wow.

SPEAKER_01
24:16

Um,
so
you
don't
always
know
when
you
get
a
diagnosis
what
that
will
look
like.
Um,
but
you
can
expect
that
as
the
disease
progresses,
um,
it
can
go,
it
will
broaden
from
just
one
area
of
your
brain
um
to
other
parts
of
the
brain
and
areas
of
functioning.
So
if
you
started
um
out
noticing
movement
symptoms,
it
might
progress
to
behavior
symptoms
um
as
time
over
time.
Um,
but
yeah,
the
journey
is
so
different
for
everyone
in
that,
in
that
way.
Um
and
it
can
be,
of
course,
devastating
to
get
a
diagnosis.
Um,
I
think
one
of
the
things
that
can
help
with
the
progression
of
FTD
or
really
any
um
any
cause
for
dementia
is
is
palliative
care.
Um,
you
know,
like
a
real
holistic
approach
to
care
that
includes
the
needs
and
and
desires
of
the
person
diagnosed.
Um,
it
prior
it
preserves
dignity
and
autonomy
for
as
long
as
possible.
Um
and
you
know,
we
do
hear
from
people
who've
been
diagnosed
themselves
that
they
feel
really
overlooked
and
discarded
and
alone
after
receiving
a
diagnosis.
And
palliative
care
is
just
such
a
wonderful
approach
to
holistic
care
that
they
really
do
take
see
the
person
for
who
they
are,
you
know.
Um,
so
not
that
that
will
change
the
progression
of
the
disease,
but
it
does
help
somebody
feel
more
heard
um
and
respected
and
honored
through
the
process.

SPEAKER_00
25:59

And
I
agree
with
you.
Uh,
you
know,
I
think
the
palliative
care
people
push
off,
they
think
that's
only
for
like
at
the
very,
very
end,
but
it
isn't.
You
can
bring
them
in
earlier.
And
most
of
the
time,
too,
they
help
the
caregivers
too.
Yes.

SPEAKER_01
26:14

With
yeah,
and
if
you
are
helping,
if
you're,
you
know,
preserving
dignity
and
autonomy
of
somebody
feels
actually
seen,
um,
it
really
does
help
with
like
escalated
behaviors
or
feeling
really
stressed,
and
it
helps
with
stress
in
the
home
too.
And
you're
right,
like
if
the
caregiver
feels
like
they're
also
part
of
it
and
that
they,
you
know,
and
they
see
their
loved
one
feeling
respected,
then
they
also
feel
um
a
little
bit
of
comfort.
It
helps
um
and
just
it
helps
something
that
is
so
difficult
to
face
and
difficult
to
go
through,
um,
be
a
little
less

Palliative Care And Symptom Treatment

SPEAKER_01
26:48

so.

SPEAKER_00
26:48

Now,
are
there
any
approved
treatments
or
medications
right
now
on
the
market
for
FTD?

SPEAKER_01
26:54

Yeah,
currently
no.
Um
there
is
research
being
done,
of
course.
Um,
but
for
symptom
management,
there
are
some
medications.
So
if
you
have,
um
if
you're
working
with
your
doctor,
um,
your
neurologist,
you
can
like
if
there
are
symptoms
that
are
challenging,
because
a
lot
of
the
symptoms
with
um
FTD
are
very
difficult.
Um,
so
that
you
know,
you
can
you
can
talk
to
your
doctor
about
um
what
kind
of
medication
can
help
with
those
symptoms.

SPEAKER_00
27:22

And
you
mentioned
uh
support
groups,
and
I
noticed
you
have
those
listed
on
your
website
as
well,
correct?

Support Groups, Helpline, And Next Steps

SPEAKER_01
27:30

Yes,
we
do.
And
you
know,
support
is
such
a
lifesaver.
Um,
we
encourage
everyone
to
build
support
early,
however
that
looks
like
for
you.
Um,
we
know
many
caregivers,
um,
a
lot
of
caregivers
don't
even
reach
out
to
our
helpline
until
they're
already
drowning.
So
um
we
definitely
encourage
early
looking
into
what
options
you
have.
Um,
grief
is
just
underlining
throughout
the
FTD
journey.
And
um,
it
really
does
help
that
uh
having
a
support
group.
Some
people
are
resistant
or
they
feel
like,
oh,
I'm
not
into
going
sitting
around
in
a
support
group
and
talking
about
my
feelings.
But
um
we
really
encourage
people
to
try
it.
There
are
real
practical
tips
um
and
and
resources
that
are
shared
in
these
meetings.
And
also
with
FTDs,
especially,
it
is
so
misunderstood
in
like
the
among
the
general
public
that
when
you
find
other
people
who
are
who
are
going
through
this
and
facing
this
together,
that
you
feel
so
much
less
alone.
Um
and
can
really,
and
it's
it's
part
of
respite
too,
you
know,
you're
taking
that
hour
to
talk
to
other
people
who
are
going
through
it.
And
it
really
can
kind
of
help
bring
you
down
um
from
all
the
way
up
here
in
the
stresses
of
caregiving.
Um
and
we
do
also,
so
we
do
have
groups
for
um
for
caregivers
throughout
the
country.
We
do
have
some
that
meet
in
person.
We
have
a
lot
that
meet
virtually
because
that's
really
easy
to
access
for
caregivers.
You
don't
always
have
to
find
somebody
to
take
care
of
your
loved
one.
Um
and
then
we
also
do
have
groups
for
per
for
people
who
are
diagnosed
that
they
can
join.
Because
we
have
seen
in
the
last
few
years
a
huge
increase
in
people
getting
diagnosed
a
little
bit
earlier,
and
they
really
want
that
support
too.
So
um
we've
we've
had
we
do
have
groups
for
people
who
are
diagnosed,
and
and
we
want
to
be
there
and
support
them
too,
because
it's
so
hard
to
receive
that
diagnosis
and
then
what
you
know,
what
do
I
do
with
this?
So
um
coming
together
is
a
really
good
thing.

SPEAKER_00
29:44

And
I
think
one
thing,
and
and
I've
joined
different
support
groups,
and
I
think
what
a
lot
of
people
don't
realize
is
that
when
you
go
to
the
support
group,
whether
it's
virtual
or
it's
in
person,
you
don't
have
to
say
anything
if
you
don't
want
to.
You
know,
you
can
just
listen.
Yeah,
and
I
have
found
I
agree
with
you
a
hundred
percent
that
when
I
started
talking
to
other
family
members
that
their
family
you
know,
their
loved
ones
had
dementia,
there's
this
instant
bond,
and
you
like
just
understand
what
they're
saying.
And
you
even
can
laugh
at
times
about
things
that
they
said
or
did,
but
you
just
they
just
understand.
You
don't
have
to
explain
everything,
you
know.
They
and
it
it
does
make
you
feel
better.

SPEAKER_01
30:25

Yeah,
and
I
think
um
one
of
the
that's
somebody
just
recently
said
this
to
me
that
that
it's
her
tribe,
right?
That
she's
she
went
to
this
group
and
it's
those
are
her
people.
So
they
meet,
you
know,
outside
of
group,
yeah
um,
yeah,
and
and
get
together.
And
it's
just
having
people
you
don't
have
to
explain
yourself
to,
um,
and
that
there's
no
judgment,
right?
And
and
unfortunately,
some
of
the
symptoms
of
FTD
can
really
be
stigmatizing.
Um,
and
people
hesitate
to
talk
about
it.
But
if
you're
in
a
group
of
other
people
who
are
going
through
the
same
thing,
um,
even
if
it's
a
different,
if
it
looks
different
for
everyone,
you
know
you're
not
gonna
get
judged.
Um,
and
that
you're
there
truly
because
you
love
your
person
and
you
want
to
help
them
and
you
want
to
be
there
for
them,
but
you
just
need
to
figure
out
how
do
I
cope
with
this
in
a
way
that
is
healthy
and
safe.
Um
and
you
know,
with
the
FTD
support
groups,
because
it's
uh
a
leading
cause
of
younger
onset
dementia,
a
lot
of
care
partners
are
younger
and
they
sometimes,
you
know,
they
might
try
another
dementia
group,
a
support
group,
and
feel
like
they're
not
around
people
that
get
them
or
that
are
understanding
what
they're
going
through.
So
finding
an
FTD
support
group
can
be
really
helpful
for
you
if
you
don't
kind
of
fit
like
what
you
think
of
when
you
think
of
a
dementia
support
group.
Um,
so
we
do
have
like
groups
for
parents
who
have
young
kids
in
the
home
and
their
spouse
has
it.
Um
and
they,
you
know,
just
and
young
adults
who
are
caring
for
their
parent.
Um,
we
have
a
group
for
17
to
26-year-olds
who
can
come
and
and
talk
to
each
other
and
get
support.
So
um,
yeah,
we
have
a
whole
lot
of
groups
on
our
website.
Um,
it's
all
there.
But
also,
if
you're
feeling
overwhelmed
and
I
just
can't
even
look
at
this
list
of
groups,
you
can
call
the
helpline.
And
and
we
know
that
what
sometimes
caregivers
are
just
like,
I
can't
even
do
that.
I
can't
take
that
step.
But
the
helpline
is
there.
Um,
and
I
just,
you
know,
just
to
share
their
number,
I
want
to
shout
them
out.
But
their
phone
number
is
866-507-7222,
or
you
can
email
them
at
info
at
theaftd.org.
Um,
and
you
just
put
it
out
there,
I
need
a
support
group,
and
they'll
help
you
find
the
right
one
for
you.
Yeah,
it's
it's
they
try
to
make
it
as
easy
as
possible.

SPEAKER_00
33:02

And
I'll
make
sure
I
put
that
on
there.
Yeah,
because
sometimes
as
a
caregiver,
you
have
so
many
lists
going
on
that
you're
like,
I
just
can't
right
now.
But
if
you
I
know
something
simple
that
you're
like,
okay,
I
can
call
this
number
or
I
can
send
this
email,
and
it
just
helps
so
much
with
all
of
that
for
it.
Um,
and
I
know
we
could
talk
forever
and
on
about
this
because
it's
such
an
interesting
um,
it's
it's
different
than
a
lot
of
the
other
dementias,
but
yet
it
kind
of
falls
into
play
with
it.
And
I
know
this
one
too,
it's
been
in
the
news
a
little
bit
more
with
some
other
celebrities,
famous
people
that
have
we've
heard
they've
been
diagnosed
with
this.
So
like
people
start
talking
about
it.
And
it
should
have
been
talked
about
anyway.
All
the
dementia
should,
yeah.

SPEAKER_01
33:42

Yeah,
that's
but
it
is
really
the
getting
that
awareness
and
and
more
public
awareness
that
people
do
under
they're
like,
that
sounds
familiar.
So
it
is,
it
is
helpful
though.
And
and
we
and
with
that,
we
are
seeing
an
earlier
diagnosis
in
the
in
the
disease.
So
that
is
that
is
just
helpful
for
families
um
when
they
get
that
earlier
accurate
diagnosis.

SPEAKER_00
34:04

Yeah,
because
sometimes
you're
like,
what
is
wrong
with
this
person?
They're
you
know,
and
you
just
you
don't
always
think
right
away,
it
could
be
something
really
you
know,
neurological
or
uh
neurodegenerate
uh
Yeah,
you
think
it
could
be
a
midlife
crisis,
right?

SPEAKER_01
34:21

Or
like,
you
know,
I
guess
I'm
just
gonna
get
divorced.

SPEAKER_00
34:25

But
it's
actually
a
brain
disease.
Yeah.
Yeah.
Yeah,
with
it.
Because,
you
know,
uh
with
all
the
dementia,
some
you
know,
sometimes
they
lose
their
inhibition
and
they
say
things
and
they
do
things,
and
you're
like,
oh
my
god,
what
is
going
on?
You
know,
and
to
help
figure
that
out.

SPEAKER_01
34:40

It's
so
hard
not
to
take
that
personally
too
when
it's
yeah,
when
it's
someone
that
you've
loved
for
like
20
years,
and
then
all
of
a
sudden
this
change
is
happening
and
you
don't
understand
it.

SPEAKER_00
34:51

Exactly.

AFTD Website, Conference, Closing

SPEAKER_00
34:52

So
the
website
is
theftd.org.
Um,
it's
the
AFTD.

SPEAKER_01
34:59

Okay.
Yes.
The
A-A
G-A-F-T-D
dot
O-R-G.
Okay.
And
there's
so
much
information
on
the
website.
Um,
and
there's
also
like
on
the
homepage
and
on
every
page,
there's
a
a
button
for
the
helpline
up
in
the
upper
right-hand
corner.
Okay.
You
can
click
on
that.
You
can
even
schedule
a
call.
So
whatever
works
for
your
time,
you
don't
have
to
wait
for
a
call
back.
You
know
when
you're
gonna
get
your
call.
So
um
that's
definitely
a
great
option,
too.
Um,
and
then
there's
just
so
much
information.
We
have
um
a
ton
of
webinars.
Uh,
we
are
also
on
social
media,
so
um
that
is
something
that's
really
helpful
for
people
too.
We're
on
Instagram
and
on
Facebook,
um,
on
TikTok,
LinkedIn.
Um,
and
I'm
sure
that
I'm
forgetting
one
of
them
too,
but
um
there's
uh
the
the
information
is
there.
We
share
a
lot
of
updates
about
events,
um,
and
and
we
have
an
annual
education
conference
that
is
for
the
community.
Um,
and
also
we
see
a
lot
of
healthcare
professionals
come
too,
and
that's
where
you
really
get
to
know
um
what
the
lived
experience
is
like.
Um,
it
is
in
person
and
it's
also
virtual.
So
um
that's
in
May
every
year,
and
um
it's
free
to
attend.
So
um
it's
something
to
really
put
um
in
the
back
of
your
mind
if
you're
if
you're
thinking
about
it.
Um,
it's
very
informative,
but
it's
also
a
place
to
come
together
with
the
community
and
um
to
learn
more
about
you
know
different
resources
and
um
you
know
evidence-based
treatments
and
things
like
that.

SPEAKER_00
36:43

So
well,
that
that
is
awesome,
all
this
information.
So
I'll
make
sure
I
put
all
this
on
there
so
people
can
get
the
information
that
they
need.
So
thank
you
so
much
for
joining
us
here
today.
I
I've
learned
so
much.
Thanks
for
having
me.
Yes,
I
have
learned
so,
so
much.
So,
like
I
said,
I'll
put
it
all
on
there.
So
hopefully
everybody
has
enjoyed
this
conversation
and
you
got
a
lot
of
information
as
well
for
this
particular
form
of
uh
dementia
and
neurodegenerative
diseases.
So
I
hope
you've
enjoyed
your
cup
of
tea,
your
cup
of
coffee,
or
if
you're
having
that
really
bad
day,
a
glass
of
wine,
and
please
join
us
for
another
edition
of
Patty's
Place.

Getting Sober: “The First 90 Days” – FROM THE VAULT

Getting Sober: “The First 90 Days”: FROM THE VAULT

A Quick Note from the Coffee Shop:

If you notice something familiar in your feed over the next several weeks, Glenn and Mikey are on a brief medical sabbatical while Mikey rests and heals up following surgery to repair an abdominal aneurysm. To keep the coffee brewing and ensure our community doesn’t miss a beat, we’ve raided the vault to bring you an encore run of our “Best Of” catalog—handpicked straight from our all-time top download stats. Enjoy revisiting these essential conversations, thank you for keeping Mikey and the show in your prayers, and stay tuned—we will be back live in the coffee shop very soon!

Sober.Coffee Podcast Summary (Bonus #28)

Hosts: Mike & Glenn

Mike and Glenn open up the coffee shop to break down the reality of the first three months in recovery. Ninety days is the crucial habit driver—the proving ground where new living mechanisms, coping strategies, and daily reflexes are formed. Reflecting on their own early days and the recurring pain, confusion, and high relapse rates that affect newcomers, the hosts lay out a straightforward, honest roadmap of what to actually expect and how to survive the initial quarter.

The Brutal Honesty of Early Sobriety

  • The Golden Rules (1 & 1A): Rule one is simply don’t drink. Rule two is to become an absolute sponge—listen, observe, and learn.
  • Head vs. Heart: Mike admits he was the rare newcomer who walked into meetings taking furious notes out of sheer desperation. Glenn points out the trap many fall into: trying to make recovery an intellectual exercise in the head, when lasting change only takes root in the heart.
  • It’s Going to Be Uncomfortable: Significant transformation does not happen in 28 days. Expect emotional turmoil, physical aches, weird sleep, and feeling completely out of your own skin. Just like the first 90 days at the gym, you have to surrender to the awkwardness and embrace the soreness knowing what you are building toward. As their friend Dr. John famously noted: AA is not a feel-good program; it is a get-well program.

Essential Survival Tools for the First 90 Days

  • 90 Meetings in 90 Days: Immerse yourself fully in the environment. But avoid “sidewinder” attendance—don’t just show up to check a box, sit with your camera off, or judge people. Show up early, participate, help with readings, stay after to chat, and actually engage.
  • Find a Guide / Temporary Sponsor: If the formal word “sponsor” spooks you, just find a friend who has walked the path before you and can help you navigate the steps and room culture.
  • Sanitize Your Environment: Get alcohol completely out of your living space. Ditch the drug dealer’s number, stay out of bars, and steer clear of the people, places, and things tied to active addiction. If you hang around the barbershop long enough, you eventually get a haircut.
  • Prioritize Rest & Mindfulness: Early sleep cycles are completely disrupted. Prioritize sleep and give your nervous system a chance to reset. Glenn highlights using guided meditations (such as Michelle’s Sanctuary on YouTube) to silence late-night head noise.
  • Fill the Time Void: Going from drinking 12 hours a day to nothing leaves massive empty hours. Fill that space intentionally: attend back-to-back meetings, grab pizza between sessions, or join sober sports leagues like AA bowling, pickleball, or golf.
  • Halt Major Life Changes: Do not attempt to fix or rebuild your entire world in the first few weeks. Making major life upheavals early on is building a castle on a foundation of sand.

Closing Perspective Celebrate every single milestone—one day, one week, thirty days, and ninety days are massive victories that provide 100% proof that you can get through today. Most importantly, a 90-day reset isn’t reserved just for newcomers. Anyone slipping into old complacency or poor routines can commit to a fresh 90-day journey right now to realign their habits, health, and spiritual footing.

Congrats, You’re The Parent Now-Interview with Kim & Alex

I would love to hear from you. Send me questions or comments.

Caregiving can sneak up on you. One day you’re doing a favor, the next you’re managing medications, appointments, mobility issues, safety at home, and the emotional whiplash of watching a parent change. We sit down with Kim Branch Lucid and Alexander Nuri, co-authors of Survival Guide to Caring for Aging Parents, to talk about what the earliest warning signs really look like, especially with Alzheimer’s disease and dementia, and how to respond before a “small problem” becomes a crisis.

We also dig into why eldercare feels like a maze in the United States. Medicare basics, Medicare Advantage versus supplements, Medicaid eligibility that varies by state, patient privacy, and the constant question of “what’s covered” can wear families down fast. Kim and Alex share practical guidance for getting help, including when a Medicare or Medicaid consultant can save time, money, and stress, and why moving a parent to assisted living or memory care still requires strong family advocacy.

Then we get real about the risks nobody warns you about enough: financial scams targeting older adults, caregiver guilt, burnout, and the quiet loss of your own life if you don’t set boundaries. We cover self-care that actually works, support groups, and the legal documents that keep families from scrambling later, like power of attorney, POLST, and trust planning.

If you’re caring for aging parents or you see it coming, listen now and share this with someone who needs it. Subscribe, leave a review, and tell us: what part of caregiving feels most confusing right now?

https://www.caring4agingparents.net/

Support the show

Welcome To Patty’s Place

SPEAKER_02
0:10

Welcome
to
Patty's
Place,
a
place
where
we're
gonna
talk
about
grief,
dementia,
and
caregiving.
I
started
this
podcast
in
honor
of
my
mom,
Pat,
who
passed
away
almost
three
years
ago
from
dementia.
I'm
your
host,
Lisa,
as
we
try
to
navigate
these
difficult
waters
and
have
these
conversations.
And
just
so
you
know
that
you're
not
alone
in
all
of
this.
So
grab
your
cup
of
tea,
your
cup
of
coffee,
or
if
you're
having
that
really
bad
day,
a
glass
of
wine,
and
come
join
us
today.
So
today
I'm
excited.
We
have
two
guests
here
today.
We
have
Kim
Branch
Lucid
and
Alexander
Nuri.
They
are
co-authors
of
Survival
Guide
to
Caring
for
Parents,
Aging
Parents.
Between
them,
they
bring
over
50
years
of
combined
health
care
experience,
plus
also
personal
experience
of
navigating
for
their
parents
and
in-laws.
So
thank
you
for
joining
us
today
on
Patty's
Place.
Thank
you
so
much.
So
so
much
to
talk
about
here.
So

When It’s Time To Step In

SPEAKER_02
1:03

let's
start
with
the
first
big
question.
How
do
you
know
when
it's
time
to
step
in
and
start
taking
care
of
your
parents?

SPEAKER_03
1:11

I'll
I'll
jump
in.
Um
I
think
it's
there
are
little
signs
along
the
way
that
add
up.
In
in
the
case
of
my
mother,
I
mean,
very
specifically,
it
was
her
more
and
more
asking
for
me
to
help
with
things.
I
I
can't
reach
this,
I
can't
reach
anything
on
the
top
shelf.
Or
um,
could
could
you
help
me
do
this?
I
can't
open
the
jar.
I
mean,
it
started
with
me
buying
little
gadgets,
the
robo
jar
opener
and
things.
Um
but
it's
it's
the
little
signs,
or
in
the
case
of
dementia,
which
I
I'm
fortunate
my
mother
did
not
have
dementia,
but
there's
still
that
repeating,
repeating,
repeating
the
same
story
over
and
over
again,
asking
the
same
question
over
and
over
again,
which
is
a
sign
that
something's
not
right.
So,
those
to
me,
it's
the
the
the
increased
asks
for
assistance,
which
I'm
grateful
my
mother
did
ask,
uh,
and
then
just
the
cognitive
awareness.
Alex.

SPEAKER_00
2:20

Yeah,
I
think
Kim
said
it
well.
Um
my
mom
uh
has
Alzheimer's,
and
uh
some
of
the
signs,
aside
from
just
the
forgetfulness,
the
little
signs
that
Kim
alludes
to
were
just
things
like,
I'm
tired
of
cooking.
I
don't
think
I
can
cook
for
myself,
I
need
some
help.
And
so
we
had
to
hire
a
caregiver
to
come
in
and
cook
for
a
while.
Um,
she
was
driving
and
she
had
two
car
accidents.
Thank
God
nobody
got
killed,
but
you
know,
ended
up
having
to
take
away
our
car
because
her
reaction
time
started
to
slow
down.
And
um,
when
we
had
a
conversation
that
I
would
say
something,
she
would
forget
what
I
said
five
minutes
later.
So
I
started
to
see
little
signs
like
that
and
realized
that
something's
going
on
and
started
to
get
her
into
more
um
in-depth
care.

SPEAKER_02
3:01

You're
saying
that
your
mom
didn't
want
to
cook
anymore.
It
made
me
think
of
my
mom
because
she'd
be
like,
I'm
tired,
I've
cooked
for
50
years,
I'm
done
already.
She'd
be
like,
and
and
my
case
of
my
mom
too,
she
was
a
wonderful
cook,
excellent
cook.
And
she
couldn't
do
it
anymore.
Like
it
things
were
not
turning
out
and
stuff
was
so
not
like

The Care Load Grows Fast

SPEAKER_02
3:19

her.
Uh
so
what
do
you
think
is
the
biggest
surprise
people
run
into
when
they
suddenly
become
a
caregiver?

SPEAKER_03
3:29

Alex?
Okay,
okay,
yeah.

SPEAKER_00
3:32

I
think
the
biggest
surprise,
and
I
think
I
I
say
this
to
a
lot
of
my
friends
who
are
caring
for
parents,
is
um
as
uh
as
they
get
older,
uh
the
amount
of
time
and
energy
and
commitment
to
caring
for
them
grows
exponentially.
Um
so
when
you
first
um
you
know
start,
it's
like,
okay,
yeah,
sure,
I'll
take
you
to
a
doctor
appointment,
or
sure,
um,
you
know,
you
need
some
help,
you
know,
you
know,
go
into
the
laundry,
or
or
you
you
need
some
help,
uh,
maybe
you
don't
feel
like
eating
out
or
eating,
and
I'll
order
some
food
for
you,
or
I'll
pick
up
your
medications.
And
then
it
just
kind
of
goes
on
and
on
and
on
and
becomes
more
and
more
of
a
responsibility
and
and
um
you
know
takes
more
and
more
uh
time
away
from
your
life.

SPEAKER_03
4:10

That's
a
good
answer.
I
I
think
uh
similarly,
you
know,
at
the
beginning
you
think
of
you
doing
little
errands,
because
I
was
already
going
grocery
shopping
for
my
mother
or
taking
her
shopping,
taking
her
to
doctor's
appointments.
I
was
already
doing
that.
It's
um
when
you
start
really
stepping
in,
you
realize
there's
so
much
more
than
you
thought
it
was.
You
thought
it
was,
you
know,
take
her
to
the
doctor,
and
then
you
realize
it
was
well
look
at
the
whole
house,
make
sure
that
the
she
can't
chip
on
the
carpet,
make
sure
that
she
can
reach
her
dishes,
make
sure
her
mobility
is
good
enough
to
stand
so
she
can
cook.
Because
I
went
through
the
same
thing
with
my
mother
of
just
I
can't
cook
anymore.
And
it
wasn't
that
she
didn't
want
to
cook,
it's
that
she
could
not
stand
without
holding
on
to
something
to
support
her.
She
couldn't
be
someplace
with
two
hands
free
to
cook
for
herself.
So
you
just
realize
it
just
it
it
balloons
into
a
lot.
I
think
the
biggest
surprise
um,
and
we
we
discussed
this
briefly
in
our
book,
I
think,
is
that
you
think
you
can
work
your
full-time
job
and
do
this
on
the
side.
And
then
when
you
realize
it
is
a
full-time
job
by
itself,
then
as
I
always
say,
and
I
know
this
wasn't
your
question,
but
then
it's
time
to
get
extra
help
because
it
it
can't
be
a
full-time
job
for
it
to
keep
your
sanity,
it
can't
be
a
full-time
job.
So
um,
I
think
that's
the
biggest
surprise
is
you
realize,
oh
my
gosh,
it
is
so
much
more
than
I
thought
it
was
gonna
be.
I
thought
put
her
in
assisted
living
and
I'm
done.
You
know,
but
it's
not
a
good
thing.

SPEAKER_02
5:56

Yeah,
and
you're
not,
not
at
all.
That's
what
a
lot
of
people
think.
Oh,
you
you
drop
them
off
and
you
and
you're
not
taking
no,
you're
you're
doing
just
as
much
work
because
you're
still
scheduling
doctor's
appointments
or
making
sure
medication,
you're
going
in
to
check
on
them,
making
sure
the
room
is
clean,
how
are
they
doing?
Yeah,
it's
still
just
as
much
work
for
that.

SPEAKER_01
6:17

Exactly.

The Maze Of Care And Coverage

SPEAKER_02
6:18

Um,
you
call
it
a
maze
in
your
book.
What
do
you
mean
by
that?

SPEAKER_03
6:24

Um
it
started
off
very
much
as
the
maze
of
navigating
the
US
healthcare
system.
Oh,
and
that
is
a
I
realize
you
know
things
are
different
in
countries
that
have
more
friendly
healthcare
systems.
I
don't
want
to
put
any
labels
on
it.
Right.
But
it's
figuring
out
well,
what
does
Medicare
cover
and
and
what's
the
difference
between
part
A
and
Part
B
and
Medicare
Advantage
and
all
the,
you
know,
all
of
that.
And
then
there's
this
whole
legal
side.
Well,
okay,
if
I
have
a
power
of
attorney,
what
is
that
control?
What's
the
difference
between
that
and
a
healthcare
power
of
attorney?
And
and
then,
oh,
if
I
want
to
just
get
my
parent
transported
and
I
want
to
go
with
them
to
an
appointment,
but
they're
in
a
wheelchair
and
I
need
help,
where
do
I
go
for
that?
And
what's
covered?
What
are
available
services
in
my
community
that
I
can
take
advantage
of?
And
oh,
does
my
mother
qualify
for
Medicaid,
or
does
she
make
too
much
money,
or
or
is
are
the
rules
not
what
I
thought
they
were?
So,
in
the
process
of
writing
the
book,
and
we
interviewed
a
lot
of
people,
and
in
the
course
of
my
experience
with
my
mother,
I
learned
a
lot
about
Medicaid,
and
it's
completely
different
in
whatever
state
person
is
living.
So
in
California,
where
my
mother
was,
Medicaid
has
uh
expansion
that
allows
people
with
greater
than
the
minimum
income
level
to
still
be
qualified
if
they
have
no
assets
and
just
navigating
all
of
that.
So
we
really
felt
it's
it's
all
a
maze.
It's
navigating
healthcare
and
the
payment
and
the
legal
documents,
and
then
just
the
maze
of
how
do
I
deal
with
my
parents'
mental
state,
and
you
know,
if
it's
dementia
or
Alzheimer's,
then
it's
then
it's
that
on
top
of
it.
So
kind
of
a
maze.

SPEAKER_00
8:26

Yeah,
and
Kim
is
right.
We
started
with
you
know
navigating
the
US
healthcare
system
and
it
quickly
expanded
to
all
the
other
dimensions
of
navigation,
like
finding
an
assisted
living,
putting
them
in
a
skilled
nursing
facility,
finding
the
right
doctor,
getting
geriatric
care.
I
mean,
it
was
A
to
Z.
How
do
you
go
about
navigating
and
finding
the
right
choices
and
and
and
make
the
right
uh
decisions
and
have
the
uh,
if
you
will,
the
authority
to
make
some
of
those
decisions
because
of
patient
privacy
issues.
So
there's
a
lot
to
it,
this
uh
more
than
just
the
US
healthcare
system.

SPEAKER_02
8:57

It
is,
and
it's
it
it
is
so
overwhelming,
you
know,
it
no
matter
what
the
illness
is,
it
it
really
is.
And
like
with
my
dad,
he's
in
the
VA
system.
So
that's
a
whole
nother,
you
know,
beast
to
try
to
navigate
uh
with
that.
And
then
and
then
what
you
have
with
my
mom,
it
was
okay,
well,
do
you
go
Medicaid
or
do
you
do
private,
you
know,
because
then
you
gotta
look
at
all
the
different
um
avenues
for
that,
and
then
you're
like,
oh
my
god,
the
cost,
and
you
just
are
like,
What
do
you
do?
Because
it's
just
you're
trying
to
do
the
best
for
your
loved
one,
but
it's
really
hard
to
try
to
figure
it
all
out,
and
it's
so
confusing
uh
with
it.

SPEAKER_03
9:44

And
the
same
thing
like
Yeah,
and
I
think
um
uh
on
that
topic,
private
versus
Medicaid,
it's
we
don't
go
anywhere
into
this
kind
of
depth
in
the
book
in
the
book,
but
um
people
should
find
uh
a
consultant,
like
a
Medicare
consultant
or
a
Medicaid
consultant.
There
are
plenty
of
people
who
consult
for
nothing
because
if
they
place
you
in
any
kind
of
a
facility,
they're
they're
compensated
by
the
facilities.
And
it's
licensed
and
regulated,
so
they're
not
incentivized
to
send
you
to
one
place
over
another.
So
there
are
those
people
out
there,
but
again,
you
have
to
ask
your
friends
and
figure
out
where
they
are.
But
what
you
sometimes
find
is
that
there,
if
you
do
decide
to
go
the
Medicaid
route
as
an
example,
there
are
a
lot
of
trade-offs.
Then
you're
limited
to
you're
limited
to
facilities
that
will
take
Medicaid.
And
then
once
the
your
parents
on
Medicaid,
then
they
have
to
get
all
their
medical
through
the
Medicaid
program
and
not
regular
Medicare.
And
so
you're
doing
that
trade-off.
So
obviously,
if
your
parents
have
means
and
there
are
finances
to
support
private
payment,
that's
always
gonna
give
you
the
best
care.
I
mean,
sadly.
Yeah.

SPEAKER_02
11:10

But
yeah,
it's
true.

SPEAKER_03
11:11

You
know,
it's
a
lot
to
navigate
there.

SPEAKER_02
11:14

It
really
is,
with
all
of
it.
Uh

Spotting Scams Before They Hit

SPEAKER_02
11:17

and
I
I
also
noticed,
too,
you
mentioned
that
uh
financial
scamps
target
elderly.
Huge,
huge
issue.
What
do
you
think
families
should
watch
for?
And
it's
probably
one
of
the
clues
too,
to
when
you
should
step
in.
What
should
people
look
for?

SPEAKER_00
11:35

Well,
I
mean,
I
think
both
of
us,
Kim,
I
think
you
have
your
mom
experienced
that.
I
can
tell
you
my
mom
and
my
uncle
both
experienced
and
were
caught
up
in
a
a
scam
where
they
were
um
told
that
their
grandchildren
were
in
Mexico
in
jail
and
they
had
to
wire
you
know
$5,000
or
they
would
be,
you
know,
thrown
thrown
in
jail
and
never
heard
from
again
and
scared
the
the
the
crap
out
of
them.
Um
and
unfortunately
they
they
were
so
fearful
and
they
were
told
if
they
reached
out
for
help
that
you
know
the
their
grandsons
would
be
killed.
And
they
did
a
very
good
job
of
imitating
you
know
the
grandkids'
voice.
And
it
came
to
the
point
where,
like,
mom,
why
didn't
you
call
me?
Why,
why
didn't
you
just
ask
for
my
opinion?
I
could
have
told
you
this
was
a
scam.
And
she
goes,
I
was
scared.
I
was
too
scared.
And
that
happened
to
both
my
uncle
and
my
my
mom.
And
um,
you
know,
we
talked
about
it
afterwards,
and
I
said,
Look,
don't
ever
feel
like
if
you're
if
something
like
that
happens
again,
you
can
always
reach
out
to
me.
So
that's
kind
of
what
happened.

SPEAKER_03
12:30

Yeah,
we
had
one
with
my
mother-in-law
um
where
she
was
contacted
by
publishers
clearinghouse
to
let
her
know
that
she
had
won.
And
I
and
to
qualify
it,
this
was
a
woman
who
sent
in
these
publishers'
clearinghouse
forms
nonstop
whenever
they
came
in
the
mail.
So
she'd
sent
in
the
form.
So
for
someone
to
call
and
say
you
won,
is
wow,
something
I
sent,
I
finally,
I
finally
won
this
time.
And
they
did
the
old,
you
know,
we're
gonna
come
by
on
Tuesday
and
bring
you
your
$500,000
check.
Are
you
gonna
be
there?
And
then
they
said,
you'll
have
to
pay
tax
on
this.
But
if
you
can
just
wire
us
$4,200
up
front,
yeah,
then
you
don't
have
to
pay
the
taxes
later.
But
don't
tell
your
children
we
want
this
to
be
a
big
surprise.
So
she
trudged
to
her
local
Fred
Myers
grocer
in
Washington,
and
they
have
a
in
like
a
Western
Union
desk,
and
she
wired
the
money
and
then
called
my
husband
to
let
him
know.
And
um,
you
know,
he's
got
a
background
in
cybersecurity,
so
this
is
like,
well,
let's
call
the
FBI
immediately.
And
the
FBI
said,
once
that
money's
wired
and
gone,
it's
gone.
There's
not
a
way
to
trace
it.
There's
it's
gone.

SPEAKER_02
13:46

Yeah.

SPEAKER_03
13:46

So
that
was
a
difficult
lesson.
With
my
mother,
it
was
a
little
bit
easier.
She
was
very
tech-savvy,
no
dementia.
And
she
would
call
me
up
and
say,
I
got
an
email
from
my
bank
that
says
that
I
owe
them.
I
said,
Mom,
forward
it
to
me.
Don't
click
on
anything.
So
that
became
what
we
did
is
the
forward
it
to
me,
do
not
click
on
anything,
because
I
know
how
to
hover
over
the
sender's
address
and
see
that
it's
being
sent
by
not
Bank
of
America.
Right.
And
you
find
those
little
misspellings,
wrong
word.
So
those
I
think
you
just
have
to
instruct
your
parent.
If
anything
looks
suspect,
don't
touch
it,
don't
click
on
anything,
you
know,
send
it
to
me
or
wait
till
I
can
come
look
at
it.

SPEAKER_02
14:32

And
they
and
I
have
to
say
the
scammers
have
become
way
more
um
sophisticated.
So
it's
it's
harder
and
harder
uh
with
it.
And
I
know
for
my
well,
my
mom
was
never
a
tech
savvy,
like
she
just
had
a
really
basic
cell
phone
and
and
even
that,
it
was
a
flip
phone,
and
even
that
she
hardly
ever
used.
Um,
my
dad
has
an
iPhone,
but
he
gets
so
frustrated
so
easily
uh
trying
to
use
it.
So
I
think
that
kind
of
goes
into
that
too.
I
think
they
just
feel
so
upset
that
they
can't
do
it,
too,
that
they
want
to
try
to
be,
you
know,
because
it
kind
of
it's
so
weird
because
it
flips,
right?
It's
like
how
you
treat
your
little
kids
is
almost
how
you
end
up
treating
your
parents.
And
you
hate
saying
it
that
way,
but
exactly.

SPEAKER_00
15:16

You
become
the
parent,
they
become
the
children.

SPEAKER_03
15:18

Yeah.
What
didn't
they,
Alex?

SPEAKER_00
15:20

I
said
you
become
the
parent
and
they
become
your
children.

SPEAKER_03
15:23

Exactly.
One
little
trick
that
I
started
doing
that
is
good
to
instruct
a
parent.
Um,
I
was
getting
reach
outs
from
a
cousin
of
mine
on
Facebook
who
I
knew
was
not
reaching
out
to
me.
It's
a
cousin
who
has
dementia
and
he
would
not
out
of
the
blue
say,
Hey,
hi,
how
are
you?
So
I
will
respond
back
with
um,
doing
great.
How's
Patty
and
Michael?
Or,
you
know,
just
throw
out
some
made-up
names
that
have
no
relationship
to
the
person
they're
pretending
to
be,
to
see
what
would
happen.
And
usually
what's
the
few
times
I've
done
that,
then
I
don't
hear
anything
back.
But
that's
my
way
of
sort
of,
you
know,
stump
them,
pretend
like,
oh
wow,
it's
so
nice
to
hear
from
you.
Susie's
worried
about
you,
and
then
they'll
go,
oh,
I
know,
tell
her
I'm
okay.
And
then
you're
like,
yeah,
there's
no
Susie.

SPEAKER_02
16:14

So
yeah.
No,
that's
a
good
tip.
That
really
is.
That
is
a
good
tip.

Caregiver Self-Care And Boundaries

SPEAKER_02
16:19

Uh
in
one
you
said
you
dedicated
an
entire
chapter
to
caregivers'
own
self-care.
Why
do
you
think
that
was
necessary?

SPEAKER_03
16:30

Um,
I
I
guess
I'll
start.
Alex
is
nodding
his
head.
Alex
was
Alex
was
pushing
for
this
chapter
more
than
I
was,
even
though
I
think
it's
important.
Um
I
think
you
know,
there's
so
many
studies
that
say
if
you're
not
bringing
your
whole
self
to
this
to
the
table
for
caregiving,
you're
doing
your
parent
a
disservice.
But
you
cannot
bring
yourself
if
uh
your
mental
and
physical
health
is
compromised.
So
whether
it's
and
and
I've
been
doing
yoga
for
40
years
and
Pilates
for
20
years,
and
so
to
me,
it's
having
some
mind-body
practice
is
really
important.
You
don't
have
to,
it
doesn't
have
to
be
athletic,
you
don't
have
to
go
do
these,
you
know,
power
yoga,
vinyasa
flow
classes.
You
go
take
a
meditation
class,
go
sit,
you
know,
sit
on
the
floor
with
your
eyes
closed,
lay
over
a
bunch
of
pillows
doing
yoga
ninja,
just
but
take
that
time
to
breathe
deeply
and
relax
and
reset
and
recharge
the
battery.
I
mean,
I
also
think
it's
really
important
to
get
an
adequate
sleep.
Everyone
says,
you
know,
the
three
things
sleep,
diet,
exercise.
Those
are
the
things.
You
know,
eat
a
healthy
diet.
You
don't
have
to
go
on
a
crazy
diet,
just
get
enough
protein,
you
know,
get
some
carbs,
get
some
fats,
move
around
a
little
bit,
go
for
a
walk,
whatever
it
is,
and
take
that
mental
health
break.
And
then
you're
bringing
a
whole
person
to
the
table.
It's
better
for
you,
it's
better
for
your
parent.
And
then
at
some
point
in
time,
your
parent
will
be
gone,
and
you
don't
want
to
have
done
everything
100%
for
your
parent,
nothing
for
yourself,
and
then
you're
left
just
grieving.
So
I
don't
know,
Alex.

SPEAKER_00
18:24

And
also
losing
your
social
contacts
and
all
the
other
aspects
of
your
life.
Uh,
so
the
impetus
for
me
pushing
for
this
uh
was
um
my
wife
and
I
were
at
one
point
uh
caring
for
four
adults.
Um
her
uh
her
dad
and
her
mom,
uh,
who
just
passed
last
year,
late
last
year,
one
within
four
months
of
the
other,
and
then
uh
I
take
care
of
my
brother
who
has
uh
schizophrenia
and
my
mom,
who's
95
years
old.
Um,
so
it
became
very
evident
watching
my
wife
go
through
the
process
of
watching
her
parents,
you
know,
first
of
all,
being
responsible
for
parents
with
caregivers
around
the
clock
and
the
toll
it
was
taking,
then
eventually
when
they
passed
the
grieving
process
and
and
how
that
affected
her
emotionally
and
physically,
and
you
know,
started
to
have
health
issues
and
that
sort
of
thing,
uh,
it
was
very
evident
that
this
is
a
topic
that
we
got
to
talk
about.
I
mean,
as
Kim
said,
if
you
aren't
able
to
take
care
of
yourself,
you're
not
gonna
be
good
to
any
of
the
people
you're
caring
for
because
you're
gonna
have
a
breakdown,
you're
gonna
have
major
health
issues,
uh,
it's
just
gonna
be
all
downhill.
So
you
have
to
set
boundaries,
you
have
to
balance
your
your
care
with
the
family
members,
with
your
your
life
and
all
the
things
you
want
to
do
with
your
life,
whether
that
be
social,
physical,
take
a
trip,
uh,
get
therapy,
and
and
that
also
is
very
important
too
for
some
people.
Uh
that
that
was
very
helpful
for
my
wife
to
talk
to
somebody
about
it.
Um
and
so
I
think
any
way
which
way
you
can
get
the
support
you
need
so
you
can
get
through
this
process
is
critically
important.
Otherwise,
uh
you
know,
you're
just
not
gonna
make
it
through
the
process.

SPEAKER_03
19:52

So
the
one
thing
I
would
add
to
that
um
that
is
part
of
self-care,
and
Alex
alluded
to
it,
is
support
groups,
whatever
they
are.
Um
whether
it's
a
Facebook
group
online
or
something
at
your
church
or
synagogue
or
other
place
of
worship
or
in
your
neighborhood,
community
center,
senior
center,
wherever
there's
a
place
where
you
can
talk
to
other
people
going
through
the
same
thing.

SPEAKER_02
20:17

I
would
agree
with
that.
Because
it
also
helps
you
too,
because
you
feel
that
guilt.
And
so
when
you're
talking
to
other
people
about
it,
it
helps
you
set
those
boundaries
and
not
feel
so
guilty
to
say,
like,
okay,
today
I
need
to
take
care
of
XYZ
for
me,
and
then
I
can
do
this
later,
you
know.
But
but
it's
hard.
It's
really
hard
to
do
that
because
you
do
feel
guilty.
You
you
just
do.

SPEAKER_00
20:42

And
as
a
caregiver,
you're
always
asking
yourself,
am
I
doing
enough?

SPEAKER_02
20:45

Right?

SPEAKER_00
20:46

Yeah.
And
and
is
it
the
right
thing?
And
am
I
spending
as
much
time
as
I
should?
And
you've
got
to
be
able
to,
you
know,
push,
pull
back
a
little
bit
and
say,
How
am
I
feeling?
How
am
I
doing?
Am
I
okay
in
a
good
place?
Am
I
keeping
and
maintaining
my
support
group,
my
relationships,
my
friendships,
doing
what
I
love
and
what
gives
me
purpose
and
joy
in
addition
to
caring
for
my
family
member.

SPEAKER_02
21:06

And
I
also
think
too,
you
know,
people
always
ask
the
caregiver,
caregiver,
well,
how
are
you?
What
do
you
what
do
you
need?
And
um,
and
it's
to
me
anyway,
I'm
always
like,
I
don't
know,
you
know,
and
sometimes
I
just
wish
somebody
would
just
be
like,
here,
I'm
gonna
do
this
for
you.
Okay,
because
sometimes
you
just
don't
know
how
to
ask.
I
mean
I
find
for
me
some
people
are
easier
to
ask
than
others,
you
know,
something
simple.
And
then
other
times
you're
just
like,
I
don't
know.

SPEAKER_00
21:31

You
know,
and
it's
it's
an
uncomfortable
sometimes.
I
mean,
I
can
say
this
from
my
experience,
it's
an
uncomfortable
topic
to
talk
about
and
say,
when
they
ask
you
how's
everything
going,
well,
it's
not
going
well.
You
know,
my
mom
is
having
tits
and
rants
and
going
through
a
really
difficult
time
with
Alzheimer's,
and
I'm
trying
very
hard
to
stabilize
it.
I
don't
want
to
share
the
proverbial
dirty
laundry
because
I
I
just
don't
think
that's
you
know,
first
of
all,
there's
a
privacy
ish
issue,
but
the
other
part
of
it
is
that
uh
I
just
feel
guilty
doing
that.
I
just
feel
embarrassed.

SPEAKER_02
22:01

Yeah,
I
mean
it
is,
it's
really
hard
you
know,
to
find
that
balance
with
all
of
it
uh
with
it.

Why They Wrote The Guide

SPEAKER_02
22:08

So
why
did
you
two
decide
to
write
the
book
together?

SPEAKER_03
22:14

Okay.
We
were
uh
we
were
both
laid
off
from
our
jobs
at
the
same
time.
We
worked
together.
We
had
a
similar
job.
We
20-year
history
of
working
together,
so
we
decided
to
start
a
business
focused
on
people
in
career
transition,
and
nothing
whatsoever
to
do
with
caring
for
our
parents.

SPEAKER_02
22:32

Okay.

SPEAKER_03
22:32

And
we
had
regular
scheduled
meetings
and
we're
working
through
the
business
and
what
to
do.
And
every
other
time
we'd
get
together,
we'd
get
derailed
by
I
had
to
take
my
mother
to
a
doctor's
appointment.
Or
does
your
mother
get
urinary
tract
infections?
What's
up
with
that?
And
it
was
nonstop.
Alex
would
say,
Oh,
I'm
sending
you
something.
And
I'd
pick
up
my
phone
and
there'd
be
a
picture
of
a
transport
wheelchair.
And
Alex
would
say,
This
is
invaluable.
And
I
mean,
it
went
on
like
this
for
a
while.
And
finally
I
just
went,
man,
we
should
just
we
should
write
a
book
on
this.
Because
then
it
started
with,
oh,
yeah,
I
have
this
friend
who's
got
Medicaid
to
pay
for
her
to
care
for
her
mother.
I
didn't
know
you
could
do
that.
You
know,
having
all
these
conversations,
and
we
kind
of
taught
each
other
so
much,
and
then
we
decided,
you
know,
we
should
write
a
book
on
this.
And
in
the
interim,
I
know
lots
and
lots
of
books
have
been
written
on
this
subject.
And
I'm
sure
they're
all
wonderful.

SPEAKER_00
23:30

Yeah,
and
this
is
also
before
AI
as
well.
We
should
add
uh
so
we
we
we
wrote
this
from
scratch.
We
did
it
multiple
times,
and
of
course,
you
know,
we're
doing
this
part-time
while
we
have
other
things
that
we're
doing
in
our
lives.
Um,
Kim
teaches
Pilates,
I
do
uh
executive
coaching
on
the
side
part-time.
So
doing
it
part-time,
you
know,
extended
the
the
time
to
publish
the
book.
But
we
also
heard
not
just
from
our
experiences,
but
the
other
thing
that
kind
of
pushes
over
to
do
this
is
that
we
have
a
lot
of
friends
and
family
dealing
with
very
similar
things
that
we're
dealing
with.
I
have
uh
my
my
wife
has
friends
who
are
literally
uh
like
a
daughter
who's
drives
from
the
west
side
here
to
the
valley,
which
is
basically
a
round
trip
of
50
miles,
and
sees
her
mother
from
eight
to
ten
every
night,
seven
days
a
week.
And
we're
like,
wow,
uh,
you
know,
how
how
can
she
even
do
that?
And
so
we
actually
went
and
spent
some
time
with
her
and
trying
to
get
her
some
help
and
that
kind
of
stuff.
Uh
so
um,
you
know,
everybody
has
a
story,
and
as
you
mentioned
earlier,
Elisa,
is
that
the
population
is
aging
and
you're
seeing
more
people
in
the
90s?
Uh,
my
my
father-in-law
died
at
101.
Oh,
wow.
Uh,
we
have
an
uncle
who
just
died
a
couple
of
weeks
months
ago.
He
lived
to
be
100.
My
dad's
96.
I
mean,
people
are
living
longer
with
all
these
medications,
and
you
know,
that
means
there's
an
increased
burden
on
the
healthcare
system
and
on
the
caregivers.

Advocating In Facilities And At Home

SPEAKER_02
24:44

Is
there
a
particular
case
study
from
the
book
that
really
sticks
with
you?

SPEAKER_03
24:52

There
are
there
are
a
few.
I
mean,
we
have
case
studies
about
taking
the
car
keys
away
from
my
mother-in-law
and
what
that
was
like,
and
um,
some
of
the
case
studies
that
um
in
some
instances
we've
used
the
actual
names,
in
other
instances
we
we've
changed
the
names,
kept
the
story
just
for
the
sake
of
protecting
people's
privacy.
Um
but
I
think,
you
know,
one
of
my
favorite
stories,
it
had
to
do
with
my
mother.
She
was
in
a
rehab
facility.
I
I
didn't
think
much
of
the
rehab
facility,
and
she
didn't
either.
And
they
were
just
absolutely,
in
my
opinion,
treating
her
abusively.
Ultimately,
what
we
did
was
we
we
got
her
moved
to
another
facility.
And
I
actually
talk
a
little
bit
about
that
in
the
book
and
the
implications
of
Medicare
Advantage
versus
Medicare
supplement.
But
the
story
was
um
that
the
import
is
tied
to
the
importance
of
keeping
your
sense
of
humor.
So
my
mother
had
a
full
set
of
teeth.
Um,
she
just
couldn't
get
out
of
bed
to
brush
them.
So
one
day
a
caregiver
came
in
the
room
and
they
were
terrible
about
she'd
say,
I
need
to
use
the
restroom,
and
they
they'd
kind
of
say,
Well,
you
already
went,
you
know,
and
leave
her
in
the
bed
wet
and
things
like
that.
But
this
one
day
a
caregiver
said,
Is
there
anything
else
I
can
help
with?
She
said,
Would
you
please
help
me
brush
my
teeth?
And
the
caregiver
said,
Where
are
they?
Of
course,
there
my
mother
said,
In
my
mouth.
So
she
and
I
had,
you
know,
laughed
till
we
cried
about
that
one.
So
that
was
that
was
sort
of
my
favorite
entertaining
case
study.
We
have
some
many
more
serious
case
studies.
I
don't
know,
Alex,
if
you
have
a
different
favorite.

SPEAKER_00
26:37

I
I
don't
have
a
different
favorite.
I'm
again,
we
have
so
many
different
ones.
I
wish
I
I
thought
of
one
as
you
were
talking
that
reminded
me
of
something
that
we
probably
should
have
put
in
the
book.
And
this
is
one
where
my
mom
lived
uh
at
an
assisted
living
center.
And
there
uh
turned
out
unbeknownst
to
me
at
some
point
that
there
was
a
ladies'
man
who
would
be
going
around
and
trying
to
kiss
older
women
and
you
know,
you
know,
befriending
my
mom
and
befriending
other
women.
And
he
was
a
charlatan,
quite
frankly.
Very
good-looking
guy.
And
I'm
like,
what
the
heck?
You
know,
who
is
this
guy
you're
talking
with
and
texting?
And
I'm
like,
mom,
this
is
not
okay,
you
know.
So
that
was
put
a
stop
to
that.

SPEAKER_03
27:13

You
should
have
put
that
in
the
book,
Alex.

SPEAKER_00
27:14

I
should
have.
I
should
have.
I
should
have
maybe
part
two.

SPEAKER_02
27:18

There
you
go.
Go
ahead.
Well,
and
I
think
too
what
people
uh,
as
we
kind
of
talked
about
a
little
bit
earlier,
but
it's
so
important
when
like
my
mom
had
to
go
to
memory
care.
Uh,
they
had
told
us
that,
you
know,
yeah
by
the
time
she
got
diagnosed,
she
was
already
like
moderate
to
severe
with
her
dementia.
And
she
was
also
still
very
mobile,
so
she
was
kind
of
highly
unusual
that
she
could
be
that
far
advanced
and
she
was
still
mobile.
So
they
were
like,
you're
not
gonna
be
able
to
take
care
of
her
at
home.
So,
you
know,
she
had
to
go
to
memory
care.
But
I
think
it's
so
important
too.
Like
my
dad
and
I
went
like
every
day
for
the
most
part,
and
you
know,
he
would
go,
you
know,
say
in
the
morning,
I'd
go
later
and
things
like
that,
and
how
important
it
is
for
the
family
members
to
be
there
so
that
you
can
be
on
top
of
all
those
things
and
notice
what's
different
with
them
right
away,
and
the
caregivers
and
and
be
able
to
advocate
for
them
at
those
facilities,
you
know,
and
it
would
break
my
heart
sometimes
because
there
would
be
some
residents
there
that
you
never
saw
anybody
come
visit
them.
You
know,
and
I
always
felt
so
bad,
you
know,
because
I'm
like,
they're
still
there,
you
know,
and
it
I
felt
like
it,
especially
with
dementia,
it
was
even
more
important
to
advocate
for
her
and
be
there,
you
know,
because
if
my
dad
and
I
did
mention
something,
it
got
taken
care
of
right
away
because
they
knew
us
so
well,
you
know,
uh,
for
it.
So
it
it
just
it
doesn't
stop
just
because
if
you
have
to,
you
know,
go
to
a
a
different
facility
for
it
than
at
home.

SPEAKER_00
28:50

Yeah,
and
the
other
thing
that
you
have
to
uh
consider,
you
know,
going
to
these
facilities
is
the
ratio
of
caregivers
to
patients.
Because,
you
know,
if
it's
16
to
1
versus
8
to
1,
you
know,
they're
divided
six
ways
come
Sunday,
and
some
patients
need
more
care
than
others,
and
that
means
your
parent
may
get
left
out
and
be
alone
in
a
room
or
maybe
with
a
roommate
that
they
don't
like,
right?
Isolated
for
hours
and
hours
at
end,
and
it's
very
it
can
be
very
depressing.
So
uh,
you
know,
if
you
have
family
members,
in
my
case,
we
we
do
my
uncle
and
her
brother,
and
uh
we
have
a
cousin,
we
rotate
visitations
on
on
a
weekly
basis,
we
bring
her
you
know
food.
Um,
she
has
other
friends
who
visit
her
in
their
activities.
Sometimes
she
wants
to
participate,
other
times
she
doesn't,
but
keeping
track
of
things
and
building
a
relationship
with
uh
the
um
caregivers
on
staff
are
is
really
important
and
uh
they
know
me
really
well
and
they've
been
very
accommodating
and
um
so
uh
just
monitoring
and
being
active
is
is
critical.

SPEAKER_02
29:44

It
really
is.
Yeah,
because
like
I
said,
the
caregivers
knew
who
you
know
I
was,
who
my
dad
was,
and
that
and
so
they
would
be
able
to
tell
us
right
away,
you
know,
whether
it
was
good
or
bad
or
or
things
like
that.
And
then
when
there
were
new
caregivers,
we
were
able
to
say,
like,
and
when
my
mom
first
got
there,
she
liked
to
be
involved
with
things,
and
then
after
a
while
she
didn't
always,
and
I
would
always
we'd
always
say,
Don't
ask
her,
does
she
want
to
go
to
bingo?
Because
she'll
say
no.
But
if
you
ask
her,
oh,
can
you
help
me
set
this
up?
Then
she'd
be
like,
Okay,
and
she'd
go
and
do
it,
you
know.
Exactly.

SPEAKER_00
30:17

And
one
more
thing
I'll
add
is
that
you
know,
my
mom
has
Alzheimer's,
but
it
nowhere
as
uh
is
nowhere
as
severe
as
as
your
mom
had.
Um
she
has
uh
um
Alzheimer's,
which
really
is
affecting
her
short-term
memory,
not
long-term
memory.
She
has
a
memory
like
an
elephant,
but
um,
because
of
some
of
the
health
issues
she
has,
uh,
we
had
to,
you
know,
basically
have
somebody
with
her
seven
days
a
week.
So
we
have
a
caregiver
who
s
goes
there,
you
know,
in
the
morning
till
night,
and
not
obviously
24
hours,
and
makes
sure
that
she's
attended
to
with
her
needs
and
doesn't
have
any
episodes
or
wanders
away
or
or
freaks
out
or
anything
like
that.
So
that
that
has
helped.
It's
costly.
Uh
and
you
know,
and
you
know,
that's
something.
And
I
know
Kim
also
went
through
a
similar
situation
where
she
was
supporting
her
mom
financially.
And
that's
another
thing
that
um,
you
know,
is
a
big
factor
here.
It's
like,
you
know,
when
your
parents
potentially
like
run
out
of
money,
you
know,
then
what?
You
know,
it's
a
big
deal,
you
know.
So
that's
that's
a
that's
a
a
factor
you
really
have
to
take
into
consideration.

SPEAKER_02
31:14

Well,
too,
and
I
know
I
I've
had
you
know
as
I
said,
as
the
population
is
getting
older,
I've
had
other
friends
that
they're
going
through
this
with
their
family.
And
it
isn't
any
cheaper
to
have
caregivers
at
home.
It's
just
as
expensive.
You
know,
people
think,
oh,
I'll
just
do
that.
It's
not
cheap
either
way.
You
know,
and
it
and
it's
sad
that
it
is
that
way,
you
know,
and
you
have
to
think
about
all
those
things.

SPEAKER_02
31:38

Um
so
what
what
kind
of
legal
documents
do
you
recommend
that
every
family
have
in
place
before
a
crisis
hits?

SPEAKER_00
31:46

Okay,
I'll
take
this
one.
In
in
uh
again,
this
is
coming
from
California,
but
I
think
two
things
that
really
help
smooth
the
waters
for
for
me
with
my
mom.
One
was
getting
her
to
sign
a
power
of
attorney,
and
there
are
two
elements
of
that.
One
is
the
the
uh
health
care
decisions
that
we
make.
So,
for
example,
uh
if
um
you
know
um
she
needs
medication
or
I
have
to
talk
to
the
doctor,
I'm
free
to
do
that.
And
the
other
is
uh
my
managing
her
finances
and
having
the
right
to
you
know
control
her
bank
accounts
and
savings
and
pay
our
caregivers
and
all
that.
So
signing
a
power
of
attorney
with
both
financial
accountability
and
health
care
decision-making
uh
ability
really
has
smooth
the
waters
in
terms
of
my
caring
for
my
mom.
And
then
the
other
document
that's
equally
important
is
the
Pulse,
which
is
basically
end-of-life
decisions
whether
if
something,
an
event
were
to
happen,
does
she
want
to
be
you
know
resuscitated
or
not,
depending
on
this
the
situation,
having
that
document,
you
know,
signed
on
file
so
doctors
and
caregivers
know
what
to
do
in
the
event
that
she
has
a
severe
issue.
Um,
we
went
through
a
situation
like
this
many
years
ago
with
my
grandmother,
and
I
remember
my
my
she
had
um
you
know
a
heart
attack,
and
the
the
doctor
asked,
um,
do
you
want
us
to
resuscitate?
And
we
asked
her,
What
does
that
entail?
Uh
it
entails
chest
compressors,
and
at
95
years
old,
her
ribs
will
crack
and
penetrate
her
lungs.
And
when
we
heard
that,
we're
like,
uh
no,
we
don't
want
to
go
there.
So
we
we
decided
to
you
know
to
let
her
pass,
and
she
passed
peaceful,
peacefully,
fortunately.
Um,
but
learning
from
that
experience,
we
made
sure
that
you
know
all
of
our
family
members
have
post
agreements.
Um
so
and
the
last
one
I'll
say
is
trust
agreements.
Trust
agreement
is
important
so
that
if
you
have
uh
parents
with
inheritance
uh
uh
funds,
then
it
doesn't
get
taken
by
the
state,
get
that
done.
So
and
we
just
went
through
this
with
my
my
wife
with
her
her
parents
passing
between
um
her
brother
and
and
my
wife.
Uh,
that
process
was
very
smooth
because
of
the
trust
of
the
funds
and
selling
the
house
and
all
those
things
you
have
to
do
and
divesting
uh
the
assets
went
very,
very
smoothly,
and
we
were
able
to
get
that
done,
you
know,
in
in
short
order.
But
imagine
not
having
that
or
having
siblings
who
are
fighting
over
money
or
fighting
over
assets.
That
it
that
can
be
just
a
nightmare.

SPEAKER_02
33:50

So
and
I
am
very
grateful
that
my
parents
had
did
the
powers
of
attorney
years
before
my
mom
they
got
sick
because
we
had
a
family
member
that
did
get
sick,
and
that
made
them,
you
know,
realize
that.
And
so
I've
I've
always
been
very
grateful.
And
then
even
when
my
mom
got
sick,
my
dad
went
and
updated
it.
So
this
way
I
was
the
first
one
on
there
and
stuff
like
that.
Uh
for
I
mean,
I
know
people
don't
like
to
talk
about
it,
but
it's
really
important
because
when
it
hits,
you
need
those
things.

SPEAKER_01
34:20

Right.

SPEAKER_02
34:20

You
really
do.
So

Where To Find The Book Online

SPEAKER_02
34:22

you
have
uh
a
website
as
well.
It's
caring
for
the
number
four,
agingparents.com.
So
what
entails
what's
on
the
website
as
well?

SPEAKER_03
34:32

It
it's
mostly
um
it's
mostly
about
the
book,
you
know,
uh
links
to
where
you
can
buy
the
book.
A
couple
of
our
blogs
are
on
the
site.
Um,
we
are
in
the
process,
hopefully,
it's
a
big
learning
curve
for
me,
but
of
migrating
to
a
different
platform.
Okay.
And
when
we
one
that
I
know
how
to
use
better
than
the
the
site
that
we
had
built
for
us.
And
when
we
do
that,
then
all
of
our
blogs
will
be
there
as
well.
Because
we
um
we
blog
every
week,
and
so
we're
producing
much
more
new
information
than
what's
in
the
book.
We're
talking
about
more
deep
things
about
sibling
rivalry
when
you
know
siblings
can't
agree,
things
like
protection
from
scams,
how
to
fall
proof
a
house.
I
mean,
whatever
it
is,
we've
we've
taken
the
book
and
put
it
on
steroids
with
the
blog.
And
right
now
you
have
to
go
to
Substack
and
it's
carrying
the
number
for
agingparents.substack.com
to
read
the
blogs.
We
do
from
the
book
site,
the
caringforagingparents.com,
you
can
link
to
our
Substack,
our
Instagram,
our
Facebook.
We
have
all
those
links
on
the
site.
But
that
site
itself
is
mostly
about
the
book
and
about
us.

SPEAKER_02
35:54

Okay.
And
where
else
can
people
buy
the
book?
And
the
and
the
name
of
the
book
is
Survival
Guide
to
Caring
for
Aging
Parents.

SPEAKER_03
36:01

Correct.
So
it's
everywhere.
Okay.
Um
we
made
sure
that
it
was
everywhere
because
we
have
you
know
friends
and
family
who
boycott
certain
vendors.
So
we
made
sure
that
it's
uh
it's
on
Amazon,
it's
on
Barnes
and
Noble.
It's
we
went
through
Ingram
Spark,
so
it
got
pushed
out
to
uh
Kobo
and
Apple
Books,
and
you
can
find
it
online
and
it'll
show
up
in
things
that
we
never
heard
of,
like
thrifty
books
and
that
tend
to
overcharge
there.
So
um
I
urge
that
you
like
use
the
links
from
my
website
to
not
pay
extra.
But
we
are
also
an
audiobook.
Okay.
So
um
Audible,
Apple,
Google
Play,
we're
in
all
those
places
on
audiobook.
And
also
my
new
favorite
that
I
promote
whenever
I
can,
which
is
Libre.fn,
because
this
is
intended
to
support
local
small
booksellers.
So
you
can
sign
up
for
it
the
same
way
you
would
for
other
larger
audiobook
platforms.
And
you
you
get
a
book
a
month,
it's
the
same
price
as
other
platforms,
but
you
get
to
designate
the
local
bookstore
you
want
to
support.
So
I
have
a
neighborhood
woman-owned
bookstore
where
I
live,
and
I
support
that.
So
when
I
download
a
book,
whatever
those
royalties
are
that
go
to
the
bookstore,
instead
of
them
going
to
the
big,
big
billionaire
guys,
it
goes
to
my
local
bookstore.
So
that's
I
love
Libro.fm.
I
love
that.

SPEAKER_02
37:35

Okay.
Yeah.

unknown
37:36

Yeah.

SPEAKER_02
37:36

We
have
to
talk
about
it.

SPEAKER_00
37:37

I'll
just
add
we're
also
on
Kindle,
uh,
an
ebook.
That's
the
other
one.
Oh
yeah.

SPEAKER_02
37:40

Oh
yeah,
yeah.
So
there's
all
different
platforms.
So
that
that's
really
cool.
Uh,
and
you
have
lots
of
lots
of
good
information
for
everybody
here
because
it
is
like
you
said,
it
is
a
maze
that
we
have
to
try
to
figure
out
for
it.

Final Takeaways And Goodbye

SPEAKER_02
37:54

So
it
is.
So
thank
you
so
much
for
joining
us
here.
I
I
really
thank
you
so
much.
Yes,
yes.
You've
given
us
so
much
information.
So
hopefully
you
will
check
out
the
book
as
well.
And
you've
learned
a
lot
for
us
as
we
get
figure
our
way
through
the
maze.
So
please
join
us
again.
I
hope
you
enjoyed
your
cup
of
coffee,
your
cup
of
tea,
or
if
you're
really
having
that
bad
day,
that
glass
of
wine,
and
you
join
us
for
another
episode
of
Patty's
Place.

Sober.Coffee Special Announcement

 In this can’t-miss episode, Mike and Glenn sit down for an open, personal conversation about stepping away for a sabbatical. They share the reasons behind the pause, what lies ahead, and why they’re planning to make this brief break count. Tune in for an honest look at hitting reset and what listeners can expect next. 

How to Stop Panicking & Trust the Season You’re In

What season are you in right now?

Maybe business is booming and creativity feels effortless. Maybe everything feels quiet, uncertain, uninspired, or painfully slow. Or maybe you’re somewhere in between, trying to figure out what the heck is changing.

In this episode of Magic Made, Megan and Chrissy are talking about the seasons of creative business, entrepreneurship, and life, and why a slower season doesn’t automatically mean something has gone wrong.

We live in a culture that loves the hustle. More clients. More content. More growth. More productivity. KEEP GOING. But just like nature moves through winter, spring, summer, and fall, our businesses, creativity, energy, and lives move through seasons too.

And every season asks something different of us.

We’re diving into how to recognize when it’s time to push forward and when it’s time to rest, why change can feel so uncomfortable even when it’s completely natural, and how to stop attaching a negative story to every lull, pivot, or uncertain chapter.

We also talk about burnout, navigating hard life seasons while running a creative business, surrendering control, affirmations and mindset, finding magic in the mundane, and the simple reminder Chrissy returns to during difficult chapters:

Nothing lasts forever.

Megan also shares the “10 seconds at a time” mentality that has stuck with her for years and how tiny moments of courage, movement, or simply noticing a little glimmer of magic can help us move through seasons that feel especially heavy.

Because your winter doesn’t erase everything you created during your summer.

Your pause doesn’t mean you failed.

And you don’t need anyone else’s permission to be exactly where you are.

00:00 The Seasons of Creative Business
02:31 Why Hustle Culture Makes Slow Seasons Feel Wrong
05:08 Are You Ignoring the Signs to Slow Down?
07:51 Why Change Feels So Uncomfortable
10:46 Every Season Serves a Purpose
12:58 What Can a Hard Season Teach You?
15:55 Why Is Rest So Hard?
18:08 Nothing Lasts Forever
20:09 Getting Through Hard Seasons 10 Seconds at a Time
21:57 Using Mindset & Affirmations to Keep Going
24:13 Finding Magic in the Mundane
26:22 Stop Asking “Why Is This Happening to Me?”
28:09 Is It Happening TO You… or Just Around You?
30:05 Remember What You’ve Already Survived
31:28 Give Yourself Permission to Own Your Season
33:49 A Reminder for Whatever Season You’re In

🎧 IN THIS EPISODE:

• Navigating slow seasons in business
• Hustle culture and the pressure to always be productive
• Recognizing when your body is asking you to slow down
• Creativity, burnout, rest, and entrepreneurship
• Why change feels uncomfortable
• Learning to trust different seasons of life
• Finding meaning without forcing a story onto everything
• Using affirmations and mindset during difficult seasons
• Finding magic in ordinary moments
• Giving yourself permission to rest
• Moving through uncertainty 10 seconds at a time
• Separating your worth from your productivity
• Trusting that a slow season isn’t forever

💫 A QUESTION FOR YOU:

What season are YOU in right now?

Winter? Spring? Summer? Fall? Or some weird fifth season that doesn’t have a name yet?

Tell us in the comments. What feels good about this season, and what is challenging you?

There is no “best” season to be in. Sometimes simply naming where we are helps us stop fighting it.

✨ ABOUT MAGIC MADE

Magic Made is a podcast about creativity, confidence, business, movement, personal growth, and finding a little more magic in the everyday. Join Megan and Chrissy for honest conversations about building creative lives and businesses while still being very real humans figuring it out along the way.

If this episode gave you the reminder you needed today, subscribe to Magic Made, leave us a comment, and share it with someone who might need permission to stop pushing and trust the season they’re in.

#CreativeBusiness #Entrepreneurship #SlowSeason #Burnout #CreativeEntrepreneur #Mindset #PersonalGrowth #HustleCulture #MagicMadePodcast

Lobster Pants and Plane Trout

The guys discuss how having “relations” while vacuuming will almost always result in divorce, when the scent of Wasabi can save your life, and why “porcupining” has an extremely low success rate. 

How To Advocate For A Loved One When Healthcare Gets Complicated-Interview with Tiffany Auvil

I would love to hear from you. Send me questions or comments.

One phone call can change everything: “Your insurance didn’t approve it, so we’re canceling treatment tomorrow.” That moment kicks off a powerful conversation with Tiffany Ovell, a registered nurse, functional medical health coach, and caregiver coach who learns what it really takes to protect a family when the healthcare system gets messy.

Tiffany shares how her husband’s renal cell cancer returned years later, metastasized, and turned their lives into a rotating schedule of specialists, scans, and decisions. Even with two decades inside clinics and leadership roles, she’s shocked by how often caregivers are expected to accept confusing answers without context. We talk through the prior authorization mix-up that nearly delayed immunotherapy, why medical codes and documentation matter, and how “push back politely” can be the difference between waiting and getting care.

Then the story gets even more complicated: vision symptoms, an inconclusive eye biopsy, brain lesions, gamma knife radiation, an emergency craniotomy, and the discovery of a second primary cancer, central nervous system lymphoma. Tiffany explains why rare diagnoses get missed, how treatment changes overnight, and what it looks like to weigh quality of life versus quantity of life when the road ahead is terminal.

We also get real about hospice, end-of-life conversations, and the grief that comes after a loved one dies at home, including the small decisions nobody prepares you for and the financial and legal tasks that show up when you’re already exhausted. Tiffany’s book, The No BS Guide to Caregiving, is built for people who “don’t have a Tiffy,” and her website offers tools to help you get organized fast.

If you’ve ever felt overwhelmed by caregiving, dementia, cancer care, insurance denials, or medical paperwork, hit play, then subscribe, share with someone who needs it, and leave a review so more caregivers can find this support.

ffanyauvil.com

Living a Life in Balance – PODCAST

Honest conversations about mental health, relationships, purpose, and being human.

Listen on: Apple Podcasts Spotify

Support the show

Welcome And Why This Podcast Exists

SPEAKER_00
0:10

Welcome
to
Patty's
Place,
a
place
where
we'll
talk
about
grief,
dementia,
and
caregiving.
I'm
your
host,
Lisa.
I
started
this
podcast
in
honor
of
my
mom
who
passed
away
from
dementia
almost
three
years
ago.
So
I
want
this
to
be
a
place
where
you
know
you're
not
alone
and
we
can
have
those
difficult
conversations.
So
please
grab
yourself
a
cup
of
coffee,
a
cup
of
tea,
or
if
you're
having
a
really
bad
day,
get
a
glass
of
wine
and
come
join
us
today.
So
today
I'm
really
excited.
Our
guest
is
Tiffany
Avil.
Hopefully
I
said
that
right.
She
is
a
registered
nurse,
a
functional
medical
health
coach
and
caregiver
coach.
And
she's
got
more
than
20
years
experience
in
healthcare,
which
also
includes
senior
leadership.
And
she
is
currently
completing
her
doctorate
of
science
in
integrative
healthcare,
and
she's
the
author
of
the
No
BS
Guide
to
Caregiving.
So
welcome,
Tiffany.

SPEAKER_04
0:58

Thank
you.
I
am
happy
to
be
here.

SPEAKER_00
1:00

Yes,
I'm
excited
because
you
have
a
very
interesting
story
to
talk

From Nurse To Cancer Caregiver

SPEAKER_00
1:05

about
with
it.
So
let's
see.
So
you
spent
20
years
inside
the
healthcare
system,
right?
And
then
you
became
a
caregiver
for
your
husband.
So
how
did
that
come
about?

SPEAKER_04
1:17

So
my
husband
was
originally
diagnosed
with
um
renal
cell
cancer
when
he
was
39
back
in
2016.

SPEAKER_02
1:24

Oh
wow.

SPEAKER_04
1:25

And
um
we
were
very
fortunate
at
the
time.
Uh
he
had
a
large
tumor
on
his
left
kidney,
and
it
hadn't
spread
past
his
kidney.
So
all
they
did
was
remove
his
kidney,
which
they
even
did
with
a
robotic
surgery.
So
he
was
discharged
the
next
day
and
was
off
work
for
three
months
and
considered
cured,
had
follow-up
scans,
everything
was
good.
And
then
um
seven
years
later,
he
had
some
uh
vision
issues,
and
that
led
to
us
eventually
scanning
his
um
chest
and
abdomen,
and
we
found
that
the
renal
cell
cancer
was
back
in
his
pancreas
and
his
liver.
Okay,
and
that
was
in
January
of
23.

SPEAKER_00
2:09

Okay.
My
uh
my
grandma
and
a
very
close
family
friend
both
had
pancreatic
cancer.
That
that's
a
whole
beast
right
there.

SPEAKER_04
2:17

It's
a
whole
his
aunt
actually
passed
away
in
2013
with
pancreatic
cancer.
Um,
so
when
it
first
showed
up
in
the
pancreas,
we
were
thinking
it
could
be
pancreatic
cancer.
Um,
but
he
had
some
procedures
and
they
found
that
it
wasn't.
It
was
the
renal
cell
cancer
had
reoccurred
and
had
metastasized
to
the
liver
and
the
pancreas.

SPEAKER_00
2:37

Wow.
So
so
what
did
being
on
the
other
side
of
the
bed
teach
you?
That
two
decades
of
nursing
didn't.

SPEAKER_04
2:46

Um,
and
so
I've
always
felt
like
I've
been
a
compassionate
nurse.
Um,
and
I've
spent
the
majority
of
my
career
in
ambulatory
clinics.
So
I
was
in
like
the
bedside
when
you
say
like
in
a
hospital
setting.
I
was
there
for
the
first
three
years
as
an
LPN.
So
that
would
have
been
like
from
25
to
28.
And
then
I
went
to
um
a
clinic
and
I
spent
different
specialties,
um,
but
mainly
in
family
practice.
And
I
had
over
the
years
done
all
the
things.
I've
done
prior
authorizations,
I've
done,
I
learned
how
to
do
coding,
I
learned
about
the
billing
side,
um,
especially
as
I
moved
up
between
um
manager
and
system
director.
I
really
like
to
get
into
the
weeds
of
things
because
I
don't,
I've
never
been
one
to
just
say
that's
that
department's
job.
You
know,
I
need
to
understand
it
because
I
feel
like
understanding
it
helps
me
be
a
better
leader.
And
we
were
really
fortunate
that
I
had
that
experience
because
there
were
a
lot
of
times
that
my
husband,
I
feel
like
he
was
saved
or
he
had
um
essentially,
I
probably
would
have
lost
him
a
lot
sooner
had
I
not
known
what
I
knew.
Um,
and
one
of
the
things
that
I
always
kind
of
tell

The Prior Authorization That Almost Canceled Treatment

SPEAKER_04
4:05

people
to
kind
of
help
them
wrap
their
minds
around
what
I'm
saying
is
um
I
used
to
do
prior
authorizations
way
back
in
the
day.
And
the
night
before
my
husband's
first
immunotherapy
appointment,
the
nurse
from
the
oncology
office
called
me
and
told
me
that
um
they
were
gonna
cancel
his
appointment
for
the
next
day
because
our
insurance
was
not
approving
it.
And
our
insurance
was
great
insurance.
Um,
he
he
was
the
uh
primary
person
on
it.
I
had
it,
but
we
never
required
prior
authorization,
even
for
an
MRI.
So
there
was
no
way
in
my
mind
they
were
gonna
deny
us
immunotherapy.
So
instead
of
just
accepting
it,
I
was
like,
look,
don't
cancel
his
appointment.
Let
me
call
my
insurance
company
and
see
what's
going
on.
Um,
so
I
knew
how
to
talk
to
the
insurance
company.
I
knew
that
they
used
codes
and
not
plain
language.
So
I
had
everything
that
I
needed
up
front.
And
when
I
talked
to
my
insurance
company,
there
was
no
denial.
They
wouldn't
deny
immunotherapy.
The
specific
code
was
like
everything,
there
was
no
reason
for
me
being
told
they
were
canceling
the
appointment
the
next
day
because
of
my
insurance.
So
I
called
the
nurse
back
and
I
explained
to
her
what
I
learned
from
my
insurance
company.
And
she
was
very
apologetic.
And
she's
like,
Okay,
I'm
so
glad
you
did
that.
We'll
see
you
tomorrow.
Ten
minutes
later,
she
calls
me
back
and
she
said,
I
just
spoke
with
our
prior
authorization
specialist.
Now,
back
in
the
day,
when
I
was
still
doing
this
job,
I
well,
the
nursing,
like
bed
clinic,
um
actual
hands-on
nursing
instead
of
management
or
leadership,
I
was
the
one
that
did
the
prior
authorizations.
So
I
was
the
nurse
that
took
you
back,
I
got
your
vitals,
I
gave
you
your
treatment,
I
followed
up
with
you,
you
know,
and
now
it's
siloed
out.
Um,
it's
not
always
that
person
who
does
it
for
you.
And
so
in
this
particular
case,
they
had
prior
authorization
specialists.
Um,
and
I
knew
from
where
I
work,
we
had
nurses
that
filled
that
role,
but
not
everyone
did.
Um,
a
lot
of
people
hire
people
and
then
they
train
them
to
do
the
job.
Uh,
and
so
when
the
nurse
called
me
back,
she
said,
our
prior
authorization
specialist
said
that
you
use
the
wrong
code
essentially,
when
I
spoke
to
the
insurance
company.
And
I
was
like,
I
used
the
wrong
what?
And
she's
like,
Yeah,
you
used
the
wrong
code.
And
I
said,
No,
I
didn't.
Like,
what
code
is
she
saying
I
was
supposed
to
use?
And
when
she
read
it
back
to
me,
I
knew
immediately
what
happened
was
the
prior
authorization
specialist
flipped
her
codes.
So
where
she
should
be
putting
the
procedure
code,
she
was
putting
his
diagnosis
code,
and
the
systems
were
not
recognizing
it
as
a
code
at
all
because
they're
different
values,
different
numeric
order,
you
know,
decimals
included
and
not.
And
right.
I
was
I
was
very
agitated,
but
also
very
kind.
And
I
told
the
nurse,
I
was
like,
Look,
I'm
this
is
what
happened.
This
is
why
your
prior
authorization
specialist
is
not
getting
an
approval.
Um,
what
she
needs
to
do
is
this.
And
if
she
needs
me
to
walk
her
through
how
to
do
her
job,
she
can
call
my
cell
phone
and
I'll
be
happy
to
do
it
for
her.
But
otherwise,
we'll
see
you
tomorrow
at
9:30
in
the
morning.
And
the
nurse
was
like,
I'm
so
sorry.
We
will
see
you
tomorrow.
We'll
see
you
tomorrow.
And
um
my
husband,
of
course,
you
know,
like
a
lot
of
people,
I'm
I'm
a
little
mouthy
at
times.
Um,
and
so
my
husband,
he
was
like,
I
can't
believe
you
did
that.
Like
they're
gonna
be
so
mad
at
us
for
pushing
back.
I'm
like,
no,
they're
not.
Like,
they're
not
gonna
be
mad.
And
when
we
got
there
the
next
day,
the
nurse
and
the
doctor
both
came
to
us
and
were
so
grateful
that
I
figured
it
out.
Here
they
had
had
patients
who
had
been
denied
treatments
and
they
could
never
figure
out
why,
because
it
didn't
make
any
sense.
And
now
they're
thinking
for
however
long
and
however
many
patients,
this
was
the
issue
the
whole
time.
And
it
took
somebody's
another
patient's
wife
to
figure
it
out.
And
I
realized
then,
you
know,
we're
all
human
on
the
back
end,
you
know,
like
in
the
clinics
and
doctors
are
humans
and
we
make
mistakes.
But
we
often
think
that
if
it's
a
word
coming
from
a
doctor's
office,
it's
gospel.
True.
You
know,
if
your
insurance
is
denied,
you
hear
my
insurance
denied
it,
you
never
question
it
because
you
think
they
know
what
they're
doing.
And
most
of
the
time
they
do,
you
know,
but
there's
mistakes
that
happen.
Um,
and
so
I
had
three
nurses
um
that
worked
for
me
at
the
time
who
did
prior
authorizations.
And
the
very
first
thing
I
did
after
we
figured
this
out
was
I
called
them
up.
I
was
like,
if
you
ever
get
somebody
denied
cancer,
you
best
be
following
up
with
someone
else.
Like,
don't
just,
you
know,
because
it
can
happen.
You
know,
you
can
we
people
are
dyslexic,
or
even
those
who
aren't
dyslexic
can,
you
know,
change
numbers
and
letters,
double
check
your
work,
you
know,
that's
one
of
the
big
things
and
making
sure
you're
doing
it
right,
especially,
you
know,
with
this
case.
I
always
wondered
like
how
if
it
was
the
same
person
who
was
getting
denied,
denied,
denied,
denied,
why
weren't
they
checking
that
person
to
see
why?

SPEAKER_00
9:10

Yeah,
exactly.
And
um,
yeah,
you
really
do
have
to
become
that
advocate

How Healthcare Players Pull You Apart

SPEAKER_00
9:15

and
ask
those
questions
because
insurance
is
crazy.

SPEAKER_04
9:19

It's
a
whole
and
I
often
tell
people,
like,
you
know,
I
I
separate
the
healthcare
system
into
three
major
players.
You
have
like
your
providers
and
your
doctors,
you
have
your
facilities,
so
whoever
they
work
for,
you
know,
if
it's
a
hospital
or
a
private
practice
or
whoever,
and
then
you
have
your
insurance
companies.
And
they
all
three
have
different
objectives.
They
all
say
the
patient's
the
first,
but
really
the
patient's
part
of
it,
but
they're
not
usually
the
primary
objective.
Yeah.
You
know,
the
insurance
companies
want
to
save
money,
the
facilities
want
to
make
money
by
getting
more
money
from
the
insurance
companies.
The
providers
are
kind
of
stuck
in
the
middle,
wanting
to
give
you
the
best
care
they
can,
limited
to
what
the
other
two
say.
So,
you
know,
it's
a
it's
a
strange
game
that
we
have
to
walk.
And
um
unfortunately,
that
wasn't
the
only
issue
or
concern
that
came
up
during
my
husband's
two
little
over
two
years
of
treatments
that
I
had
to
step
in
and
um
question
and
investigate
and
fix.

SPEAKER_00
10:25

And
and
I
completely
understand
that
because
a
long
time
ago
my
dad
was
in
the
hospital
and
we
thought
he
was
having
a
heart
attack,
brought
him
into
the
emergency
room,
and
you
know,
they
they
took
care
of
him
and
all
that.
And
then
my
mom
and
dad
got
these
bills,
and
they
were
saying
they
weren't
gonna
pay
for
the
uh
ER
doctors.
The
insurance
was
saying
that,
and
they
were
like,
because
they're
not
covered.
And
I
was
like,
Am
I
supposed
to
stop
and
ask
while
he's
in
the
middle
of,
you
know,
the
hospital
was
in
the
network,
but
the
ER
doctors
weren't.
I
was
like,
Am
I
supposed
to
ask
that
while
he's
having
a
heart
attack?
You
know,
it's
crazy.

SPEAKER_04
11:00

Uh
the
things
and
that
happens
too.
I
when
we
had
uh
providers
come
through
that
um
where
I
worked,
we
had
to
have
locums
for
a
time.
And
the
locums,
depending
on
what's
going
on,
can
bill
under
the
absent
provider,
but
we
ran
into
a
situation
where
there
was
no
real
absent
provider.
We
just
didn't
have
a
provider
hired
in
that
area
anymore.
So
then
you
can't
bill
them
the
same
way.
So
we
ended
up
having
issues
where
patients
were
coming
in
and
being
seen
by
providers
who
were
not
under
our
network.
I
mean,
they
were
technically
employed
by
us,
but
they
weren't
credentialed
through
the
insurance
company,
so
it
the
insurances
wouldn't
pay
for
them.

SPEAKER_00
11:38

Yeah.
You're
already
dealing
with
that
whole
like
web
craziness
of
the
diagnosis,
and
then
you
have
all
of
that
other
stuff
with
the
insurance
for
it.
So
for
someone
who
whose
loved
one
was
just
diagnosed
and
you
know
you
feel
completely
overwhelmed,
what
are
the
first
few
things
you
tell
them
to
do?

SPEAKER_04
11:59

So
the

Get Organized Before The Next Crisis

SPEAKER_04
12:00

first
thing
that
I
really
preach
is
organization.
Um,
if
you're
gonna
fight
for
anything
later,
or
if
you're
gonna
have
to
find
things,
you
want
it
all
in
one
centralized
area.
Um,
a
lot
of
people,
that's
a
three-ring
binder.
Uh,
some
people
it
might
be
a
Google
Drive,
it
might
be
your
notes
app,
but
making
sure
everything
is
together.
And
when
I
say
everything,
I'm
talking
copies
of
your
insurance
card.
I'm
talking
an
up-to-date
current
medication
list,
a
list
of
your
entire
care
team.
Like
a
lot
of
us,
um,
you
know,
for
my
husband,
for
example,
he
didn't
have
just
one
doctor.
He
had
a
primary
care
doctor,
he
had
an
ophthalmologist
that
was
checking
out
his
eyes,
he
had
an
oncologist
that
was
doing
his
cancer.
When
he
developed
central
nervous
system
lymphoma
on
top
of
the
renal
cell
cancer,
he
ended
up
with
a
different
oncologist
that
specialized
in
lymphomas
of
the
brain.
And
so
it's
hard
to
try
to
find
the
information
you
need
in
an
emergency
if
it's
not
altogether.
And
then,
God
forbid,
as
the
caregiver,
if
something
were
to
happen
to
you,
you
know,
you
want
to
be
able
to
have
someone
pick
it
up
and
and
roll
with
it.
And
having
it
all
together
will
make
sure
that
happens.

SPEAKER_00
13:10

No,
that
that
is
that's
very
true
because
they'll
ask
you
what
medications
are
they
on,
and
sometimes
you
can't
remember
all
of
them.
So
to
have
that
list,
especially
if
somebody's
on
a
lot
of
medications
with
it.
So
you
said
that
your
husband
was
treated
for
the
wrong
cancer
for
over
a
year.
How
does
a
mix
misdiagnosis
like
that
happen?

SPEAKER_04
13:30

So
it's
kind
of
complicated.
My
husband
was
treated
for
renal
cell
cancer,
um,
which
he
had,
but
what
led
us
to
finding
the
renal
cell
cancer
was
he
was
having
some
vision
issues
and
um
with
his
right
eye.
And
um
he
ended
up
seeing
an
ophthalmologist
the
entire
time
as
well.
They
did
procedures
on
his
right
eye,
they
biopsied
his
right
eye,

When The Diagnosis Changes Everything

SPEAKER_04
13:55

uh,
and
we
could
never
find
a
definitive
diagnosis
for
what
um
was
wrong
with
his
eye,
other
than
it
has
to
be
renal
cell
cancer.
Um,
he's
already
got
it
in
his
abdomen,
you
know,
he
had
it
in
his
liver
and
his
pancreas.
It's
rare,
but
it
has
to
be
what's
in
his
eyes,
too.
Um
a
year
later,
January
23
is
when
he
first
got
diagnosed
with
the
recurrence.
Um
January
24,
his
PET
scan
came
back
and
he
had
lesions
in
his
brain.
So
we
thought
metastasis
from
the
renal
cell
cancer
to
his
brain.
He
had
a
procedure
done
um
on
Valentine's
Day
called
gamma
knife
radiation.
Um,
so
if
anyone's
not
familiar
with
it,
it's
a
very,
very
safe,
very
precise
uh
radiation
uh
procedure
that
goes
into
the
brain.
Um
it's
so
safe
that
patients
actually
can
go
back
to
work
the
next
day.

SPEAKER_00
14:48

Oh,
wow.

SPEAKER_04
14:49

Um,
and
my
husband
woke
up
the
next
day
and
couldn't
put
his
pants
on
or
write
his
name.
Oh.
And
so
I
took
him
to
our
local
ER
where
I
worked
at.
He
had
a
CT
done
and
he
had
swelling
on
the
brain
that
was
crossing
the
midline.
So
we
had
to
transfer
him
to
the
hospital
where
he
was
receiving
his
um
treatment.
Because
mind
you,
um,
I
live
in
rural
West
Virginia.
Okay.
So,
you
know,
uh
the
oncology
center
that
we
went
to
is
an
hour
and
a
half
away
from
our
house
because
that's
the
closest,
most
appropriate
place
for
his
type
of
cancer.
Um,
and
so
they
transferred
him
there
and
he
ended
up
having
the
next
day
an
emergency
craniotomy.
And
they
went
in,
removed
the
swelling
um
in
the
piece
of
his
brain
that
was
causing
the
swelling.
Um,
and
again,
he
was
discharged
the
next
day
because
you
know,
we've
advanced
medicine
a
lot
in
some
areas.
Right.
Um,
but
a
week
later
they
called
us
and
was
like,
pack
your
bags,
get
up
here,
you
need
to
be
admitted.
Oh,
and
what
happened
was
the
cancer
that
was
in
his
brain
was
not
renal
cell.
Oh
it
was
central
nervous
system
lymphoma.
And
so
after
discussing
it
with
the
providers
and
researching
it,
because
I've,
you
know,
of
course,
being
on
both
sides
of
the
bed,
I'm
like
looking
things
up,
trying
to
figure
out
what
it
was.
I
found
that
his
eye
was
textbook,
intraocular
lymphoma.
But
nobody
would
have
thought
you
would
have
had
two
primary
cancers
at
the
same
time.

SPEAKER_02
16:22

Wow.

SPEAKER_04
16:23

And
even
his
ophthalmological,
and
we
biopsied
his
eye
and
it
was
inconclusive.
So
there
wasn't
anything
that
anyone
did
to
miss
it.
It
was
just
one
of
those
things
that
occurred.
Um,
and
you
know,
I
even
talked
to
the
ophthalmologist.
I'm
like,
could
it
have
been
intraocular
lymphoma
the
whole
time?
And
because
intraocular
lymphoma,
when
left
untreated,
will
spread
to
the
brain
and
become
central
nervous
system
lymphoma.
And
um,
he
was
like,
you
know,
that's
a
possibility.
Uh,
because
this
looking
back,
that's
what
it
appears.
Um,
looking
forward,
you
would
have
never
had
assumed
that.
Um,
but
they
have
two
completely
different
treatments.
Um,
his
renal
cell
cancer
was
treated
with
immunotherapy
and
targeted
cell
therapy
um
oral
medication.
So
he
had
infusions
and
oral
meds
where
the
um
central
nervous
system
lymphoma
is
actually
treated
with
a
high
dose
chemo.
And
so
he
had
to
be
admitted
to
the
facility
every
other
week
for
five
days
to
receive
high
dose
methotrexate
um
to
cure
the
uh
central
nervous
system
lymphoma.
Um
and
he
was
cured
of
it
from
July
until
April
1st
of
2025.
So
um
what's
that,
like
seven
months,
eight,
nine
months?
And
um
he
started
having
symptoms
that
I
thought
were
stroke-like.
And
then
I
took
him
to
the
hospital,
found
out
that
the
cancer
had
come
back
in
his
brain.
And
that
was
when
he
decided
that
he
didn't
want
to
do
treatment
anymore.

SPEAKER_00
18:02

And
that,
you
know,
that's
a
hard
decision
to
get
to
with
it,
which
goes
it
I
think
it's
harder
sometimes
for
the
caregiver
than
the
person
who
is
sick.

SPEAKER_04
18:12

Yes.
I
having
been
in
nursing
so
long,
I
had
seen
patients
who
hold
on
and
suffer

Choosing Hospice And Defining Quality Of Life

SPEAKER_04
18:20

um
for
loved
ones.
Right.
You
know,
they
they
wouldn't
let
go
because
their
daughter
wouldn't
let
them
go.
And
uh
so
I
knew
how
I've
seen
both
sides
of
that.
And
um,
and
so
when
his
cancer
first
came
back,
we
knew
it
was
terminal
um
and
that
we
were
just
managing
symptoms
and
slowing
progression.
And
so
I
told
him
then,
I
was
like,
you've
got,
you
know,
well,
first
when
he
had
the
cancer
the
first
time
in
2016,
he
told
me
that
if
it
ever
came
back,
he
wasn't
gonna
do
treatment.
But
there
was
something
major
that
happened
between
2016
and
it
coming
back
in
2023,
and
that
was
we
had
our
son
in
August
of
2020.

SPEAKER_00
19:04

Okay.

SPEAKER_04
19:04

And
so
um
we
had
a
discussion
early
on,
and
I
asked
him,
I
was
like,
Are
you
gonna
fight?
And
he's
like,
Yeah,
I'm
I
got
Finnegan.
We
we're
gonna
fight.
I
was
like,
All
right,
we're
gonna
fight.
I
said,
We're
not
gonna
half,
you
know,
we're
not
gonna
half
fight
it.
Right,
we're
gonna
go
full
on.
And
I
told
him
then,
I
was
like,
but
when
you're
tired,
you
need
to
tell
me
because
I
will
do
what
you
need
me
to
do.
And
so
um
over
the
two
years,
there
were
a
lot
of
times
where
things
just
kind
of
got
sketchy.
And
the
last
November,
um,
the
cancer
in
his
abdomen
from
his
renal
cell
really
began
to
spread.
And
so
we
actually
started
hospice
um
then.
Uh
and
it
wasn't
the
I'm
gonna
die
tomorrow
kind
of
hospice.
I
called
it
like
DCAF
hospice.
It
was
the
palliative
prep
kind
of
thing.
They
came
out
like
once
a
month,
but
they
had
his
information,
they
had
him
in
the
system.
You
know,
the
paperwork
was
all
done
and
they
knew
us.
Um,
so
when
he
decided
in
April
of
25
that
he
he
was
done,
I
didn't
have
to
fight
to
get
paperwork
done
real
quick.
All
I
had
to
do
was
pick
up
the
phone
and
call
the
hospice
organization
and
be
like,
hey,
this
is
what
happened,
this
is
where
we're
at.
And
so
then
they
started
picking
up
visits
and
was
there
with
us
until
the
end.

[Ad] Living a Life in Balance – PODCAST

SPEAKER_00
21:10

My
mom
used
to
always
say,
it
used
to
make
her
angry
when
people
would
say
that
uh
anybody
who
had
the
terminal
illness,
and
they
would
people
would
say
that,
oh,
they
gave
up.
And
my

(Cont.) Choosing Hospice And Defining Quality Of Life

SPEAKER_00
21:19

mom
would
always
say,
they
didn't
give
up,
their
body
gave
out.
There
is
a
difference.
It
used
to
make
her
so
angry.
She's
like,
no,
you
know,
uh,
with
it.
And
also,
people
don't
realize
everything
that
hospice
can
do.
You
can
get
hospice
a
lot
earlier.
It's
not
like,
oh,
it's
the
end.
They
they
they
do
so
much
for
you.

SPEAKER_04
21:38

Uh
not
only
the
and
your
family.

SPEAKER_00
21:40

Yes,
your
family
that
helps
so
much
with
it.
Um,
you
know,
in
your
book,
you
say
caregiving,
there's
so
much
caregiving
advice
about
self-care
and
staying
positive.
Why
do
you
think
that
approach
doesn't
work?

SPEAKER_04
21:55

I
don't
want
to
say
it
doesn't
work,
but
it's
also
it's
often
used
as
the
only
approach.
And
I
really
feel
by
teaching
a
caregiver
to
advocate,
by
asking
questions
and
being
more
involved
in
the
decision-making
process
of
the
care
and
not
just
taking
it
like,
for
example,
that
ex
with
uh
his
insurance
saying
his
immunotherapy
was
denied.
Um
it
gives
you
more,
I
don't
want
to
say
power
over
the
situation,
but
um
it's
kind
of
like
more
power,
you
know.
You
you
you've
had
a
more
participating
um
I'm
losing
my
words
today.
I'm
sorry.
That's
okay.
But
you
you
were
you're
able
To
participate
in
it
at
a
higher
level.
Right.
And
so
when
your
loved
one
passes
away,
you're
not
back
air
questioning
yourself.
Um,
could
I
have
done
this?
What
if
I
done
this?
You
know,
I
had
people
early
on
try
telling
Dave,
like,
you
need
to
go
to
a
clinical
trial,
you
need
to
go
to
a
clinical
trial.
And
Dave
was
very
adamant,
I
don't
want
to
go
in
a
clinical
trial.

SPEAKER_00
22:59

Right.

SPEAKER_04
23:00

Uh,
you
know,
I
I
had
for
years
stressed
about
quantity
quality
of
life
versus
quantity
of
life.
You
know,
his
grandmother
had
passed
away
before
he
and
I
ever
got
together,
but
she
had
developed
dementia
and
their
family
had
put
her
a
feeding
tube
in
her.
And
this
was
in
the
90s,
like
early
90s.
And
um,
she
lived
for
10
years
with
that
feeding
tube
and
not
knowing
who
her
family
was.
And
so
he
always
remembered
that.
And
he's
like,
I
don't
want
to
be
a
burden,
I
don't
want
to
be
the
person
who's
laying
there
and
not
knowing
who
I
am.
I
want
to
have
quality
of
life
versus
quantity.
And
um,
I
think
that's
a
big
distinction
that
we
need
to
talk
about
a
lot
of
the
times.

SPEAKER_00
23:50

Oh,
I
agree.
I
agree,
because
it
becomes,
yeah,
the
quality
of
the
person's
life.
Like
when
we
when
my
dad
and
I
brought
hospice
in
for
my
mom,
you
know,
when
they,
you
know,
they
go
through
the
all
the
paperwork
and
asking
you
about
DNRs
and
all
that.
We
automatically
knew,
you
know,
my
mom
didn't
want
that.
She
wouldn't
want
the
feeding
tube,
all
of
that.
Um,
and
actually
the
hospice
had
told
us
with
dementia
patients
it's
actually
better
not
to
have
the
feeding
tube
because
they
don't
know
what
it
is,
they
get
scared,
they
pull
it
out,
and
then
you're
back
in
the
hospital,
and
it's
this
vicious
circle.
Um
and
it
doesn't
really
do
uh
the
work
that
you
do.

SPEAKER_04
24:25

They
just
hold
on
there
to
be
in
a
vegetative
state
a
lot
of
the
times.

SPEAKER_00
24:31

Yeah,
yeah.
Um,
and
and
the
thing
with
positive,
um
my
dad

Hard Talks About Death And True Wishes

SPEAKER_00
24:36

is
going
through
a
lot
of
health
issues
right
now,
so
I'm
now
being
his
caregiver
now,
too.
And
he's
having
some
issues,
he's
not
eating
a
lot.
And
you
know,
one
of
my
friends
was
the
other
day
was
like,
Oh,
just
be
positive.
And
I'm
like,
Well,
I
can
be
all
the
positive
I
want,
but
if
he's
not
eating,
that's
a
problem.
You
know,
it's
like
yeah,
and
I
agree
with
you,
you
you
have
to
advocate
because
sometimes
when
the
person
is
sick,
it
it's
not
that
they
don't
want
to
advocate
for
themselves,
but
they
just
don't
have
it
in
them
at
that
moment.
They
don't
have
the
strength,
yeah,
and
and
you
you
need
to
be
able
to
ask
those
questions
to
the
doctor
and
ask
those
difficult
questions
that
you
really
don't
want
to
know
the
answers,
but
you
you
need
to.

SPEAKER_04
25:15

So
you
Yeah,
and
I'd
add
to
that
too,
um,
and
I
can
tell
from
our
conversation
that
you've
had
those
conversations
with
your
dad.
And
so
you
know
what
his
true
wishes
are.
Yes.
And
a
lot
of
people
are
afraid
to
have
these
conversations
because
they
feel
like
it's
inviting
it.
Right.
Like
if
I
don't
talk
about
it
and
I
ignore
it,
then
you
know,
this
is
never
gonna
happen.
And
that's
the
farthest
thing
from
the
truth.
You
know,
it's
we
all
are
going
to
die
at
some
point.

SPEAKER_00
25:42

Right.

SPEAKER_04
25:42

Um,
and
so
knowing
what
your
loved
one
wants
and
following
that
um
is
another
thing
that
will
empower
you
to
be
a
better
caregiver,
I
think.

SPEAKER_00
25:52

Well,
as
a
matter
of
fact,
a
couple
weeks
ago,
because
my
dad's
had
this
lung
issue,
but
anyway,
he
was
he
just
went
from
the
ICU
down
to
the
stepdown
unit,
and
he
was,
you
know,
still
kind
of
still
in
in
somewhat
of
a
critical
state.
And
I
said
to
him,
like,
well,
do
you
think
you're
dying?
And
he
was
like,
Well,
and
then
I
psycho,
do
you
think
you're
gonna
see
my
mom
soon?
Do
you
think
you're
seeing
her
soon?
And
he's
like,
hesitated.
And
then
he
was
like,
No,
I
don't
think
I'm
gonna
see
her
soon.
I'm
like,
Okay,
well
then
there
we
go.
You
know,
like,
and
I
know
some
people
might
have
been
like,
Oh
my
god,
how
could
you
ask
him
that?
But
I
needed
to
know
where
his
mental
state
was.
Like,
did
he
feel
that
that's
where
he
was
at?

SPEAKER_04
26:30

You
know,
and
a
lot
of
times
studies
show
that
people
who
are
dying
know
it
even
if
they
don't,
you
know,
like
if
he
would
have
said
yes,
then
that
would
have
been
a
a
sign
and
a
sense,
okay,
let's
let's
take
a
step
back
and
figure
out
where
we
want
to
move
things
because
I
do
believe,
and
I'd
seen
it
too
with
dementia
patients
when
I
used
to
work
in
a
nursing
home
as
a
CNA
years
ago.
You
know,
they
know.
You
know,
my
husband,
he
knew.
Um,
you
know,
and
there's
even
stories,
if
you
listen
out
there,
people
who
die
traumatically
who
are,
you
know,
months
or
weeks
leading
up
to
their
death
are
trying
to
make
arrangements
that
they
never
done
before.

SPEAKER_00
27:12

Yeah.

SPEAKER_04
27:13

You
know,
it's
sort
of
like
your
body
knows,
okay,
my
time's
done.
I
better
settle
things.
Um,
if
you
look
back,
a
lot
of
times
you
can
see
those.

SPEAKER_00
27:21

Yeah,
that
that
is
that
is
very
true.
And
and
it
I
I
agree
with
you.
People
think
that
if
they
bring
it
up,
then
you're
inviting
it,
but
it
isn't.
You
need
to
know
those
things

What No One Tells You About After

SPEAKER_00
27:32

uh
with
it.
Now
you
said
your
husband
he
died
at
home.
What
do
you
wish
someone
had
told
you
about
that
and
everything
that
followed?

SPEAKER_04
27:41

I
knew
I
wanted
him
early
on
to
be
home
with
us.
Um,
he
he
in
the
beginning,
we
had
discussions
and
we
talked
a
lot
about
the
end
um
because
we
knew
it
was
coming.
And
um,
so
like
I
remember
one
of
the
discussions
we
had
early
on
was
he
told
me,
he's
like,
if
I
get
bad,
I
want
you
to
put
me
in
the
hospital
so
I
can
die
at
the
hospital.
I
was
like,
why
would
you
want
to
die
at
the
hospital?
Like,
I
want
you
home.
And
he's
like,
No,
I
don't
want
to
do
it
in
front
of
Finn.
You
know,
I
don't
want
Finn,
that's
our
son,
Finnegan.
He's
like,
I
don't
want
Finnegan
to
to
deal
with
that.
And
I
was
like,
So
you'd
rather
him
see
his
dad
leave
the
house
one
day
and
never
come
back?
Right.
And
when
I
asked
him
that,
he's
like,
Okay,
we'll
stay
at
home.
You
know,
but
it
was
I
think
the
being
at
home
was
a
great
thing.
Um
it
was
the
after
that
was
hard.
The
the
figuring
out
like
when
to
clean
the
closet
out,
you
know,
um
when
to
move
the
boots.
I'll
be
honest
with
you.
I'm
looking
over,
I
have
a
refrigerator
in
here
that
still
has
all
of
his
hats
on
it
because
I
haven't
taken
them
down
and
it's
been
since
April
of
25.
You
know,
we
all
move
at
our
own
pace.
Um,
and
so
that
that
that's
been
I
think
the
biggest
surprise
is
just
how
hard
it
is
um
sometimes
to
let
go
of
those
things.

SPEAKER_00
29:09

I
would
agree
with
that.
And
well,
I
wish
my
mom
could
have
been
at
home.
So
I
felt
like
because
she
wasn't
she
was
in
a
memory
care
facility,
but
it
was
a
really
nice
facility,
and
she
had
her
own
apartment
and
everything
was
all
her.
So
it
was
her
bed
and
everything.

SPEAKER_04
29:25

Her
home
at
that
time.

SPEAKER_00
29:26

Yeah,
so
I
at
least
felt
good
with
that,
and
I
was
able
to
be
with
her
and
everything.
But
I
remember,
you
know,
everybody
deals
with
it
differently.
But
my
dad
that
morning,
like
he
started
cleaning
out
the
apartment,
and
thank
God
I
had
some
family
friends
there
because
after
a
little
while
they
were
like,
I
think
we've
done
enough
for
today.
I
was
like,
seriously,
what
are
you
doing?
Like,
I
mean,
I
knew
it
needed
to
happen,
but
I
was
like,
could
we
wait
a
little
bit
here?
You
know,
um,
and
I
still
have
a
lot
of
her
um
her
clothes
and
things,
and
I
keep
going
I
I
through
hospice,
you
know,
they
do
the
uh
the
memory
bears
and
and
and
I
know
somebody
they
put
the
quilts
together
and
stuff,
and
I
just
haven't
quite
gotten
there
yet.
But
that's
what
I
want
to
do.
I
just
haven't
gotten
there.
But
yeah,
we
all
move
at
our
own
pace.
Like
I
have
things
that
were
hers,
and
I'm
like,
nope,
I
I
just
need
to
keep
it.
It
makes
me
happy
when
I
see
it,
you
know,
with
it.

SPEAKER_04
30:15

Um
so
obviously
you're
just
closer
still
in
my
garage
and
trash
bags
waiting
to
go
to
Goodwill.
Yeah.
Or
have
a
yard
sale.
You
know,
there's
certain
things
that
I
gave
to
friends
and
family
that
I
knew
would
want
things,
or
maybe
have
a
little
piece
of
something,
but
you
know,
I
pulled
it
all
out
of
the
house,
but
it's
still
in
the
garage
waiting
for
something
to
be
done
with
it.

SPEAKER_00
30:36

Exactly.
I
still,
like
I
said,
I
still
have
uh
her
a
lot
of
her.
I
mean,
I
I
got
rid
of
some
of
her
clothes,
but
other
ones
are
still
there.
And
then
some
of
them
I
wear
because
I'm
like
just
some
days
I'm
like,
I
just
need
to
feel
her,
you
know,
with
that.
And
I
agree,
it
just
goes
at
your
own
pace
with
it.
It
it's
hard
no
matter
when
you
do
it,
but
you
don't
let
anyone
rush
you.

SPEAKER_04
30:56

You
do
it
as
you
need
to.

SPEAKER_00
30:57

Exactly.
You
know,
and
go
through
it
as
slowly
or
as
fast
as
you
you
need
to,
because
it
hits
you
at
different
points
with
it.
So
obviously
you're
a
nurse
and

Writing The No BS Guide To Caregiving

SPEAKER_00
31:06

and
now
you're
a
widow
and
you're
an
author.
So
who
did
you
write
this
book
for
and
what
do
you
want
them
to
walk
away
with
knowing?

SPEAKER_04
31:15

Uh,
my
husband,
like
I
said,
he
often
said,
What
do
people
who
don't
have
a
Tiffy
do?
Um,
and
that
was
like
his
thing,
especially
whenever
we
would
run
into
bumps
in
the
road
or
I'd
have
to
be
calling
the
insurance
companies.
He's
like,
What
do
people
who
don't
have
a
Tiffy
do?
And
so
um
the
last
month
I
took
off
work
um
because
he
was
full
care
at
that
time.
And
um
sitting
at
home,
not
going
to
work
50
hours
a
week,
uh,
and
I
still
took
my
son
to
daycare
during
that
time
because
I
wanted
him
to
still
have
some
normalcy
in
his
life.
Um,
I
had
time
to
think
and
it
I
had
done
some
fiction
a
long
time
ago,
and
I
was
like,
I
need
to
write
a
book.
I
need
to
tell
people,
you
know,
how
they
can
do
these
things.
And
so
it
evolved
from
there.
Um,
and
then
last
year,
also
on
top
of
all
that,
my
grandmother
she
had
suffered
from
dementia
and
she
passed
away
on
September
12th.

SPEAKER_03
32:12

Okay.

SPEAKER_04
32:13

And
so
my
mom
had
been
her
full-time
caregiver
live
in
actually
since
November
the
year
before,
because
her
longtime
boyfriend
of
36
years
had
passed
away
suddenly
in
the
middle
of
the
night.
And
so
um
after
my
grandmother
passed
away,
I
I
don't
know
what
happened
to
me.
Um,
my
birthday
was
shortly
after
that,
and
I
kind
of
like
I
feel
like
I
had
a
mental
breakdown,
but
I
didn't.
Um,
and
like
I
remember
going
to
work
that
Monday
after
my
birthday,
and
I
was
like,
I'm
just
gonna
quit.
I'm
gonna
quit
my
job.
I
don't
need
to
work
anymore.
I
can
work
at
McDonald's,
and
because
of
my
husband's
life
insurance,
I
was
able
to
pay
off
my
house,
pay
off
my
vehicles,
you
know,
I
don't
have
any
debt.
And
so
I
was
like,
I'll
I
don't
need
to
do
any
of
that.
I
just
need
to
be
home
with
Finn
and
I
have
to,
you
know,
and
then
um
I
ended
up
taking
some
time
off
work
uh
uh
FMLA
wise
and
decided
then
not
to
return
to
work
and
work
on
uh
figuring
out
a
way
to
make
a
living
helping
others
who
needed
a
Tiffy.

SPEAKER_00
33:18

Well,
and
I
think
everybody
needs
uh
needs
to
learn
how
to
advocate
because
it's
so
overwhelming.
It
is.
You
know,
you
have
the
the
healthcare
part
of
it,
but
then
you
have
the
financial
part
of
it,
and
then
also
trying
to
uh
balance
your
own
life
at
the
same
time,
and
it
it
just
gets
or
if
you
have
kids,
you're
balancing
them
on
it,
and
then
there's
things
that
pop
up
that
nobody
tells
you
about.

SPEAKER_04
33:42

Like
when
my
husband
passed
away,
he
had
a
will
because
we'd
learned
from
others,
like
you
know,
just
because
I'm
the
wife,
make
it
easy
and
put
it
all
in
a
will,
you
know.
Right,
right,
do
things
and
so
um,
like
he
had
a
will,
but
I
didn't
anticipate
when
I
went
to
the
courthouse
that
I
was
gonna
have
to
pay
$86
to
to
process
the
paperwork
that
we'd
already
done.
Right,
you
know,
like
you
have
to
pay
$86
to
like
do
the
estate
beneficiary
things.
I'm
like,
are
you
serious?
Yeah,
like
we
were
in
a
place
where
that
was
fine,
you
know,
like
$86
was
I
don't
want
to
say
nothing,
it's
$86,
but
I
was
able
to
afford
it.

SPEAKER_00
34:22

Right.

SPEAKER_04
34:22

There's
people
out
there
who
don't
have
the
$86
and
they
just
lost
their
loved
one,
and
now
you're
trying
to
get
$86
out
of
them
to
say
they
lost
their
loved
one.
So
people
don't
realize
like
all
the
things
that
come
after
the
caregiving,
too.

SPEAKER_00
34:35

Yes,
yes.
You
get
through
the
caregiving,
but
then
it's
a
whole
nother
uh
experience
afterwards
with
everything
for
it.
So
your
book
is
called
The
No
BS
Guide
to
Caregiving.
Where
can

Where To Find The Book And Resources

SPEAKER_00
34:51

people
purchase
the
book?

SPEAKER_04
34:53

So
it
is
on
Amazon
and
Apple
Books.
Um,
and
uh
it's
done
really
well.
People
who've
read
it
um
really
seem
to
enjoy
it,
and
um,
it's
not
just
a
book
about
caregiving.
You
know,
I
often
say
you
if
you
have
um
medical
problems
or
if
you
are
part
of
the
healthcare
system,
you
can
benefit
from
reading
it
too
because
you
might
be
the
one
who
has
to
ad
advocate
for
yourself.
Um,
and
so
it's
really
meant
to
help
navigate
the
healthcare
system.

SPEAKER_00
35:27

Which
people
need
a
lot
of
that
help
because
it's
very
confusing.

SPEAKER_04
35:31

It
is.
Even
for
people
who
work
on
it,
it's
confusing
because
it's
very
siloed.

SPEAKER_00
35:35

Yes.
And
you
also
have
a
website,
correct?

SPEAKER_04
35:38

I
do.
Um,
my
website
is
tiffanyovell.com.
Um,
I
currently
have
some
free
resources
up
on
there.
Um
I
actually
just
put
out
a
companion
workbook
to
go
with
the
NoBS
Guide.
Um,
and
so
there
are
some
pieces
of
it
that
are
on
the
website
that
you
can
download
and
start
your
organization
process.
Because
again,
I
always
really
stress
being
organized.
Um,
and
I'll
be
adding
more
resources
to
it
over
time.

SPEAKER_00
36:08

Well,
thank
you
so
much
for
joining
us.
This
has
been
so

Final Takeaway And Goodbye

SPEAKER_00
36:11

insightful,
very
helpful.

SPEAKER_04
36:13

Thank
you
for
having
me.
I
really
appreciate
it.

SPEAKER_00
36:15

Yes.
So
hopefully
you've
enjoyed
this
and
make
sure
you
get
yourself
organized
because
that
is
very,
very,
very
uh
important
tip
there.
So
hopefully
you've
enjoyed
our
discussion
today.
So
hope
you
got
your
cup
of
tea,
your
cup
of
coffee,
or
if
you're
having
that
really
bad
day,
a
glass
of
wine,
and
please
join
us
for
another
edition
of
Patty's
Place.

Here Are the Steps We Took – Featuring Big Bill

Here Are the Steps We Took

Sober.Coffee Podcast Summary

Big Bill returns to the Sober.Coffee shop for Part 2 with Mike and Glenn, serving as living proof that the program of Alcoholics Anonymous works. Early on, when fear of dying collided with the misery of living, Mike and Glenn needed to see that proof in someone else before they could believe it was possible for themselves. After swapping stories about past day-drinking chaos and creative rationalizations, Bill breaks down his exact blueprint for guiding another person through the Twelve Steps.

The Blueprint for Working with Others

Bill shares the sequential method he uses when taking a sponsee through the program:

  • Share the Story: Bill begins by sharing his own story to build trust and identification.
  • Read the Big Book: Sponsees are asked to read the first 164 pages of the Alcoholics Anonymous Big Book. Bill notes it can feel overwhelming at first, but urges newcomers to read it anyway.
  • Step-by-Step Study: Together, they read through the Big Book and the Twelve Steps and Twelve Traditions (12 & 12), going through the steps in order.
  • Weekly Cadence at the Sponsee’s Pace: They meet once a week, intentionally working at the speed of the sponsee.
  • The 3-Step Pause: Bill will guide anyone through the first three steps. At Step 3, he pauses and asks: “Do you want to keep going with me?” It is up to the sponsee to decide if Bill is the right person to take them the rest of the way, honoring the principle of attraction rather than promotion.
  • The Sponsoring Paradox: The miracle of sponsorship is that the sponsor often grows more than the sponsee.

Amends: The Cadence of Steps 8 & 9

Bill emphasizes the importance of following the cadence of the steps without skipping ahead:

  • Step 8 (The Willingness): Step 8 simply asks us to compile the list—specifically of people harmed, not merely those who were irritated or angered. Bill breaks the list into three categories: Now, Maybe, and Never.
  • Step 9 (The Action): Amends take time and should be executed when the timing is right, with care never to cause additional harm. Bill tackles the hardest amends first. If direct amends are impossible, Bill suggests writing a letter, reviewing it with a sponsor, and letting it go.
  • The Motive: Amends are selfless and humbling, not selfish. The goal is to make the amend regardless of how the other person responds, because unsettled amends leave us blocked from God.

Finding What Works

When asked what to tell someone who insists AA doesn’t work, Bill’s answer is simple: AA is not the only path—if it doesn’t work for you, find what does, because your life is worth it. If you ever need to return, the doors of AA remain open.

Bill leaves listeners with a guiding truth: “I was a hopeless alcoholic. I took a few simple actions. I had a vital spiritual experience. I have not had a drink since. If you want what I have, I will show you what I did.”