Sandeep Jauhar is a cardiologist and the director of the Heart Failure Program at Long Island Jewish Medical Center. He writes regularly for The New York Times and The New England Journal of Medicine. Intern: A Doctor's Initiation is his first book. Information about the book is available at www.sandeepjauhar.com.

Guest Blogger Sandeep Jauhar--

Harvard Medical School Professors of Radiology Peter Doubilet and Carol Benson are a married couple with five grown children between them. They teach and see patients at the Brigham and Women’s Hospital in Boston where Peter is Senior Vice Chair of Radiology and Carol is Director of Ultrasound and Co-Director of High Risk Obstetrical Ultrasound. While Peter and Carol are passionate about their research and teaching, they consider it their greatest privilege to be able to work with pregnant women and expectant couples, checking on their babies’ health and helping them get to know their babies before they are born.

Guest Bloggers Peter Doubilet and Carol Benson--

We are two radiologists, married to each other, whose careers have been devoted to obstetrical ultrasound for more than twenty years. This remarkable technology has revolutionized the way that doctors and midwives care for pregnant women, and has also given today’s parents an opportunity never before available in human history: the chance to see their baby and even begin to get to know him or her before the big arrival day. In our ultrasound practices, we are struck by parents’ hunger for even the smallest detail about their baby, which prompted us to give expectant parents a glimpse into the mysteries of the womb by writing Your Developing Baby.

Ultrasound technology relies heavily on computer power. Since the early to mid 1980’s, we have witnessed dramatic improvements in ultrasound that have paralleled the rapid increase in computer memory and speed over that time period. These improvements have included: (i) increased detail and clarity of conventional two-dimensional (2D) ultrasound images, which permit us to see the organs inside the developing baby; (ii) the development and refinement of three-dimensional (3D) ultrasound, which provides pictures of the outside of the baby that are often striking and that have provided doctors with new ways to check on the baby’s development; (iii) the introduction of color Doppler ultrasound, which shows blood flowing inside the body, such as the blood flow in the baby’s umbilical cord.

These technological advances have translated directly into more and better ways that health care providers can use ultrasound in obstetrical practice. There are many reasons that doctors or midwives get ultrasounds on their pregnant patients. The reasons fall into two categories: scans done on women who are experiencing no problems, to check that the baby is developing normally; and scans done to assess a problem the mother is having. Regardless of the reason it is done, if an ultrasound detects an abnormality it can often direct the doctor or other caregiver to initiate appropriate treatment that improves the health, or even saves the life, of the baby or mother. Here’s an example:

Caitlin (fictionalized name) had a blood test during her pregnancy that showed that she had Rh antibodies in her blood which could potentially attack the red blood cells of her baby in utero, leading to life-threatening anemia. Her doctor began doing biweekly ultrasounds at 20 weeks of pregnancy to monitor the baby. At 26 weeks, Doppler ultrasound found that the blood flow pattern in the baby’s brain showed signs of anemia. Because of this finding, the doctor, guided by ultrasound, maneuvered a long, thin needle into the mother’s abdomen, through the wall of her uterus, and into the baby’s umbilical cord. He removed a sample of the baby’s blood, and a test of this blood confirmed that the baby was anemic. The doctor then did a blood transfusion, injecting red blood cells through the needle directly into the baby’s bloodstream. After two more transfusions during the pregnancy, Caitlin gave birth to her new son at 33 weeks. He had another blood transfusion right after birth, and, after spending three weeks in the neonatal intensive care unit, went home as a healthy baby. Caitlin’s doctor explained to her that if her pregnancy had occurred in the pre-ultrasound era, when the baby’s anemia could not have been diagnosed and treated, her baby might either have died in utero or been born with serious problems.

While ultrasound helps to improve the care of pregnant women when there is a problem, the large majority of ultrasounds, fortunately, are completely normal. When the ultrasound is normal, the parents-to-be are comforted by the scan and find it to be a thrilling event. They are excited to see the baby’s heartbeat – the pulse of a new life inside the mother’s body – and are fascinated by seeing images of the baby they may not meet for several more months.

About: Your Developing Baby, Conception to Birth is the first non-medical book to use such an extensive collection of state-of-the-art 2D and 3D ultrasound images paired with original labeled drawings that identify exactly what the reader is seeing. Reader-friendly explanations allow these remarkable images and diagrams to be understood with unprecedented clarity.

Every expectant parent wants to know: “How is our baby growing? What does our baby look like now?” In this book, the authors chart the extraordinary growth of the fetus throughout pregnancy, and 3D ultrasound images reveal stunning views of the outer contours of the face and limbs. Conventional 2D images (most useful to doctors) show the development of the internal organs, including the heart, brain and kidneys.

The book explains the dramatic developments that occur in the first trimester, as well as changes in form and function during the second and third trimesters. Readers will learn how the brain becomes organized for thought, and will see the lungs as they prepare for the first breath of air and the digestive system as it readies for the first swallow of milk. The authors describe the fascinating phenomena of multiple pregnancies and demystify some of the common diagnostic procedures anxious mothers often undergo, including amniocentesis and chorionic villus sampling (CVS). A chapter called “Knowledge is Power” offers compelling stories about expectant parents for whom ultrasound images have provided reassurance, others for whom this diagnostic procedure ensured their babies’ safe arrivals.

Related: Being Pregnant Does Not Mean You Need To Be Depressed

              How To Baby Proof Your Marriage

Ken Terry is a former senior editor at Medical Economics Magazine, the leading business publication for physicians. Terry has received journalism awards from the American Society of Business Publication Editors (2000), the American Society of Healthcare Publication Editors (2001-2002), and the American Business Media. He was a finalist for the latter organization's prestigious Neal Award in 2003 and 2006, and he won a Neal Award in 2007. Ken Terry is the author of Rx for Health Care Reform; Recent-- San Francisco Chronicle

Terry has contributed to: The New York Times, The Village Voice, Rolling Stone, Health, Inc., Men's Health, Parenting, Downbeat, The Progressive, and The Nation. Recently he was a presenter regarding health care reform at the National Congress on the Un- and Underinsured (Dec '07) and at the East Coast annual conference of the New York State Osteopathic Medical Society (Apr '07).

Guest Blogger Ken Terry--

At last count, 47 million Americans were uninsured. Those people paid for part of their own care, and the rest of us paid for the “free” services they received in emergency rooms and hospitals in the form of higher insurance rates and taxes. If you deduct those outlays from the cost of covering the uninsured in good private plans, a 2003 study estimated, it would cost about $69 billion to insure them. Uwe Reinhardt, a health economist at Princeton University, said that estimate was too low for several technical reasons I won’t go into here. He figured it would cost around $100 billion to cover everyone. Since U.S. health spending has increased by about 30 percent since then, we can assume that universal coverage would now cost around $130 billion.

(It would be more accurate to update the calculation using the cost per capita. But with the number of unemployed growing twice as fast as the population, the cost of covering them would be at least this high.)

The Presidential candidates’ estimates are in the same ballpark. Former candidate John Edwards says his universal coverage proposal would cost up to $120 billion per year, and Hillary Clinton estimates hers would come in at $110 billion. Barack Obama’s plan would cost half as much, but he doesn’t claim it would achieve universal coverage in the short term. John McCain isn’t seeking to insure everyone.

One problem with all of these estimates is that they’re based on current, not future health care costs. So they’d be obsolete as soon as we covered everybody. The very next year, health spending would grow seven or eight percent, and we’d either have to raise insurance premiums and taxes or cut benefits to maintain universal coverage.

Also, estimates like these don’t consider how many people are underinsured: that is, they have some insurance, but still have trouble paying their medical bills. Using rigorous standards, experts have calculated that 16 to 19 million people are underinsured. But, given how much deductibles and copayments have risen in recent years, the real number might be much higher. According to a new AFL-CIO survey, more than half of people in insured families say their insurance doesn’t cover all the care they need at a price they can afford.

Finally, let’s not forget about the 43 million people on Medicaid. Most states pay providers so little for these patients that many physicians won’t see them. So while Medicaid recipients—most of them poor women and children—have insurance, they don’t have good access to care.

To provide comprehensive coverage to everyone—which is what’s required to guarantee access—will cost a lot more than $130 billion. How large that price tag might be isn’t clear, and won’t be until we start facing facts.

Related: Universal Coverage is a Three-Legged Stool

              Should The Big Mac Be Taxed?

Rocky Lang is a film director, screenwriter, producer and author of four books. He produced Ridley Scott's White Squall and the Emmy Award winning mini-series Titanic. He has directed three feature films and series television. He recently produced Racing For Time for Lifetime.  Rocky Lang is also a co-author of Confessions of Emergency Room Doctors and Lara Takes Charge. This May, Mr. Lang will be honored as Father of The Year by the American Diabetes Association for his books for children and his diabetes advocacy.

Guest Blogger Rocky Lang--

It was several years ago and my then wife Jeannie, a physician and professor at U.S.C. School of Medicine had a few doctor friends over and after a couple of bottles of wine, the stories started to flow.

“I had a patient come in with not only a doorknob up his butt, but the entire mechanism. It was right there on the x-ray,” said a young resident.

Oh yeah, said another…” I did a cell phone extraction and the thing was still ringing." Another asked, “was it on vibrating mode too?"

I thought these stories were priceless and I wrote them down thinking I would use them in one of my movies, for I am a film writer, director and producer. I reasoned, fact is definitely stranger than fiction.

Over the years I continued to collect stories and the result is my new book, Confessions of Emergency Room Doctors, which incidentally I wrote with my then wife Jeannie’s new husband, Dr. Erick Montero, who happens to be a first rate chest cutter. While transplanting hearts, he found the time to dig up some of the craziest and hilarious emergency room stories from the doctors and nurses he works with.

Aside from the personal stories, we also have anecdotes from patients like the lady who complained about the jelly on her English muffin. Upon closer examination the nurse realized the woman had spread KY jelly on her succulent morning meal.

Of course there is a section on Dr.’s names such as a couple of dentists that shared an office, Dr.’s Tooth and Gums….and the surgeon Dr. Slaughter and the urologist, Dr. Cockburn.

We have a great story about a man who was convinced there was a rat inside his wife’s vagina ready to bite him each time they had sex. Turned out she had a surgical needle left in her vagina after a previous surgery.

There are a number of great practical jokers in and around the emergency room. One senior resident got smashed at a hospital party and passed out. He awoke a few hours later in a full body cast in a dark hallway, courtesy of the junior residents and interns he screamed at for the previous year. Nice send off for a nice guy.

I particularly liked the area where we found a number of strange entries in medical charts. One chart read, “She had been constipated most of her life until she got divorced.”

All in all, this was a hoot to write and research. Having come from a family that has a number of doctors in it, I always appreciate how much the doctors I know really care about their patients and the state of our health care system…. but my gosh, do they have some great stories.

Related: How To Find Help in a Hospital

              How a Local Hospital Reduces the Spread of Bacteria

Jim Miller is the creator of Savvy Senior, a syndicated information column for older Americans and their families that is published in more than 400 newspapers and magazines nationwide. Jim is also a regular contributor on NBC’s Today Show, and is the author of The Savvy Senior, The Ultimate Guide to Health, Family and Finances for Senior Citizens, (Hyperion, 2004). 

Jim is frequently quoted in articles about issues affecting senior citizens and has been featured in numerous high profile publications, including Time magazine, USA Today and The New York Times. In addition, he has made multiple appearances on CNBC, CNN, Retirement Living Television and national public television.

Guest Blogger Jim Miller--

For the millions who are uninsured or underinsured, there are lots of ways you can reduce your medication costs without cutting quality. The following tips can also help seniors with a Medicare prescription drug plan avoid their “doughnut hole” coverage gap, or reduce their costs once they reach it.

Cost Cutters

Most people don’t comparison shop for their prescription drugs. They get a prescription from a doctor, go to their favorite pharmacy to fill it, and usually don’t even ask the price. But, you can save money – sometimes lots – if you shop around. Drug prices can vary significantly from pharmacy to pharmacy, and shopping online (It’s your best tool!) can be especially convenient and effective. Here are some costs cutting tips that may help:

· Buy generic: Generic drugs are as safe as brand-name medications and typically cost 30 to 80 percent less. Ask your doctor if the medication you’re taking is available in generic form or check online at www.rxaminer.com . Discount retailers like Wal-Mart and Target are currently offering great deals, charging only $4 for a 30-day supply, while Kmart offers a 90-day supply for $15. Costco also offers low cost generics to its members.

· Ask about cheaper alternatives: Even if your drug doesn’t have a generic equivalent, there may be an older, less expensive brand-name drug your doctor can prescribe. Brand-name drugs on the market for seven or more years are up to 40 percent cheaper than newer ones, and studies show that older drugs are just as effective.

· Ask about free samples: Many doctors have extra supplies of medications in their offices and are willing to help out patients in need.

· Buy in bulk: Many pharmacies give discounts if you buy a three month supply of drugs at once versus a 30-day supply.

· Split your pills: Ask your doctor about cutting your pills in half. Pill splitting allows you to get two months’ worth of medicine for the price of one, but not all pills can be split. Splitting devices are available in most pharmacies, or for those hard to split pills see www.precisionpillsplitters.com .

· Shop online: Using online or mail-order pharmacies is another way to cut costs – often 25 percent or more. A top resource for finding U.S.-based pharmacies offering the lowest prices is www.destinationrx.com – click on “Price Compare.” (Tip: Make sure the online pharmacy you’re buying from has the “VIPPS” seal of approval – see www.vipps.info). Seniors enrolled in a Medicare prescription drug plan also need to make sure the online pharmacy they’re buying from is included in their network. Otherwise, the purchase may not count toward their deductible.

· Buy from Canada: This option offers huge savings – between 30 and 80 percent – on brand-name drugs and you’ll be happy to know that the U.S. Customs office has eased import restrictions, so you don’t need to worry that your pills will get seized at the border. If you’re interested, see www.pharmacychecker.com , an independent resource that finds the lowest prices from licensed and reputable Canadian pharmacies. (Note: This is not a good option for Medicare Part D enrollees because it will not count toward their deductible.)

· Seek extra help: If your income is limited, you can probably get help with your drug cost through pharmaceutical patient assistance programs (see www.rxassist.org and www.pparx.org ), state pharmacy assistance programs, Medicare’s extra help, national and local charitable programs and more. To find out if you’re eligible for these programs visit www.benefitscheckuprx.org . Other good resources to see are www.needymeds.com and www.medicarerights.org – click on “Discount Rx Resources.”

· Get a discount card: Many pharmacies offer drug discount cards to people with and without coverage, regardless of income. The cards may be free or carry a small upfront fee. (If the fee is large, don’t buy it.) These are essentially store “loyalty” cards that can cut your costs by 10 to 25 percent, but not all drugs are eligible for discount. Other resources offering discount cards that are worth a look are www.familywize.com , www.togetherrxaccess.com and www.aarppharmacy.com .

· Check out Bid for Rx: This is a new Web resource ( www.bidforrx.com ) where licensed pharmacies compete to fill your prescriptions.

Related: A Doctor Shortage in the US?

              Should You Purchase Longevity Insurance?

              When Do I Begin My Social Security Benefits?

Sandeep Jauhar is a cardiologist and the director of the Heart Failure Program at Long Island Jewish Medical Center. He writes regularly for The New York Times and The New England Journal of Medicine. Intern: A Doctor's Initiation is his first book. Information about the book is available at www.sandeepjauhar.com.

Guest Blogger Sandeep Jauhar--

Most knowledgeable observers agree that healthcare in this country is in crisis. Aside from the well documented problems of access, cost, and inefficiency, there is now a looming doctor shortage. According to a recent report, the country can expect a shortage of nearly one million nurses and 24,000 doctors by 2020. This deficit is most acutely felt in primary care.

Unfortunately, fewer and fewer medical school graduates want to go into primary care. Let me try to explain why with an example. Some time ago, I saw a new patient in my cardiology clinic. He was an elderly man from Haiti who spoke only French, so I had to start off the visit by calling for an interpreter. When I finally got someone on the phone, my patient told me that he had been having palpitations. Since his E.K.G. was abnormal, I decided to order some tests.

Midway through the visit, the man asked me if I would serve as his primary-care doctor. Though I am a cardiologist, I still practice some general internal medicine, so I said yes. But frankly, I was ambivalent.

He was 66, which meant arranging a colonoscopy to screen for colon cancer and checking a prostate-specific antigen level. The P.S.A. is an imperfect test, but I did not have time to discuss the pros and cons of it, so I made a mental note to do so later.

The man also was going to need counseling about smoking cessation and coronary risk reduction; pneumonia and tetanus vaccinations; forms filled out for his social worker; and (based on his history) screening tests for alcoholism and major depression. There was more to do, of course, but this was more than enough to keep me busy.

However, I wasn’t about to bring any of this up. Even if my patient had spoken English, each topic would have taken too much time out of my busy clinic day.

Primary care has become untenable in the era of 15-minute office visits. A study published a few years ago in The American Journal of Public Health estimated that it would take over 4 hours a day for a general internist to provide just the preventative care that is currently recommended for an average-size panel of adult patients. “The amount of time required is overwhelming,” the authors wrote.

This year, family-practice residencies took only 1096 U.S. seniors, the fewest number in the past two decades. Those students who do match into internal medicine increasingly are forgoing primary care for sub-specialty practice.

One of the reasons, of course, is money. The average medical school debt is now $140,000+ and internal-medicine subspecialties, especially procedure-based ones like cardiology, are more lucrative than primary care. But a more important reason, I think, is that medical students increasingly view primary-care physicians as harried and overworked. With decreasing reimbursement and increasing medical liability costs, who needs the hassle?

Aging baby boomers are starting to become patients just as aging baby-boomer physicians are getting ready to retire. By 2017, the number of Medicare beneficiaries has been projected to grow from about 40 million to 56 million. Americans over 85 already are the fastest growing demographic group in the country. The nation is going to need new doctors, especially geriatricians and other primary-care physicians, to care for these patients. How exactly this is achieved will determine in no small measure the future of healthcare in this country.

More on HealthCare

Jim Miller is the creator of Savvy Senior, a syndicated information column for older Americans and their families that is published in more than 400 newspapers and magazines nationwide. Jim is also a regular contributor on NBC’s “Today” show, and is the author of The Savvy Senior, The Ultimate Guide to Health, Family and Finances for Senior Citizens, (Hyperion, 2004).

Jim is frequently quoted in articles about issues affecting senior citizens and has been featured in numerous high profile publications, including Time magazine, USA Today and The New York Times. In addition, he has made multiple appearances on CNBC, CNN, Retirement Living Television and national public television.

Guest Blogger Jim Miller--

Imagine the perfect senior home: no steps, wide doorways to accommodate wheelchairs, ramps, easy-to-turn door levers, large cabinet knobs, non-slip floors, lowered cabinets, higher wall outlets and grab bars everywhere. Add in low maintenance inside and out and you’d be all set! Well, that might be a little too much to ask. However, there are some simple modifications that can be done and you don’t have to spend a fortune doing it.

Household Tips

A home that’s perfectly convenient for people in their 50's and 60's can actually become an obstacle in their 70's and 80's. The first tip in making your home more senior-friendly is to simply eliminate clutter – this is one of the best solutions in preventing accidental falls. Also be sure to move lamp, extension, and telephone cords out of your pathways and remove any throw rugs that slide or tape them down. Another good tip is to add lighting everywhere. Seniors need twice as much light to see clearly as someone in their 40's. Full-spectrum bulbs are a good option because they can reduce glare. Also consider replacing round doorknobs with levers, and light switches with rocker switches. They’re easier to use for those with arthritis. And to better accommodate wheelchairs or walkers you can easily widen your doorways (two inches) with inexpensive offset door hinges. It’s also wise to have handrails installed in hallways and wherever steps are present.

Bathroom

More home accidents happen in the bathroom than any other room. Some solutions include:

· Bath/shower: Add non-skid mats both inside and outside the bath/shower to reduce chances of slipping and falling. Install grab bars for additional support (they come in all styles and colors). And consider getting a hand-held, flexible shower head and a bath/shower chair for bathing comfort and safety.

· Sink: If you have arthritis or limited hand strength, replacing twist knobs with lever handle faucets can make a big difference.

· Toilet: If you have problems with leg strength or balance, adding a raised toilet seat extender (it adds two to four inches) and grab bars next to the toilet will make getting up and down a lot easier.

· Other tips: Install a water-resistant, wall-mounted phone in or near the bath/shower in case of a fall. To avoid burning yourself, add anti-scald devices or turn down the water heater to warm or 120 degrees, and don’t forget a nightlight for those middle-of-the-night trips to the bathroom.

Kitchen

This is another room that can cause a lot of physical stresses on the body. Some correctable areas include:

· Lighting: Brighten up your countertops with easy-to-install under-cabinet task lighting.

· Cabinets: Replace cabinet and drawer knobs with D-shaped handles. They’re more comfortable to grasp for those with arthritis. And replace cabinet shelves with sliding, pull-out shelves – this let’s you access items much easier.

· Appliances: If you’re in the market for new appliances, choose a refrigerator-freezer with side-by-side doors, so everything you use regularly can be placed at mid-shelf range. Dishwashers with a drawer design are easier to load and unload and have it installed on a raised platform to eliminate bending over. Stoves that open from the side are easier to get into because you don’t have to lean over a hot door. And a countertop microwave is also easier to reach and safer verses one above the stove.

· Extras: Install a peg board with hooks for pots, pans and utensils that’s easy to get to – as opposed to bending over to retrieve them from lower cabinets. And get a “reacher” (18 to 36 inches) to reach items on high shelves.

Outside

Install motion sensor lights outside the front and back doors and driveway so you’re never in the dark. Put a small table or shelf outside the entrance to hold packages while you unlock the door (remote control door locks are also available at moderate prices). And for walker or wheelchair users, there are easy-to-install add-on ramps for the front steps and mini ramps to go over high entrance thresholds.

Tips: For more information on senior home modification tips and universal design – including where to find the modification products and contractors to install them, visit www.homemods.org . Also see www.aarp.org/families and click on “Home Design.”

Related:  When Do I Begin My Social Security Benefits?

                Do-It-Yourself Wills

                Nursing Home Care On The Decline

The author of 13 books including most recently The Human Odyssey: Navigating the Twelve Stages of Life, Thomas Armstrong, Ph.D., has spent his life writing and speaking about human development, with a particular focus on children. He has appeared on The Today Show, CBS This Morning, CNN, and has presented more than 800 keynotes, workshops, and seminars in 42 states and 16 countries.

Guest Blogger Thomas Armstrong--

The New York Times examined more than 1200 nursing homes purchased by private investment groups in the past eight years, and discovered that, compared to national averages, these homes declined in care given, and scored lower in 12 of 14 indicators used to track ailments of long-term residents.  Homes owned by such investment firms as Warburg Pincus and the Carlyle Group (owners of Dunkin' Donuts), had greater than average incidences in residents of bedsores, easily preventable infections, and unnecessary restraints in freedom and mobility.  Investment firms move in and take over unprofitable nursing homes, fire nursing staff and cut back on other resources, begin making money, and then may sell the homes at a big profit.  While this particular strategy benefits investors, it leaves many aged nursing home residents more vulnerable to a range of age-related risks including depression, loss of mobility, and loss of the ability to dress and feed themselves.  A big problem with investor-owned nursing homes is that they often legally structure their ownership in such a way that it becomes difficult to sue them when residents become ill or die due to neglect.  Because they are privately owned, they are also immune to many of the local, state, and national regulations that apply to publicly owned nursing homes.  They are, therefore, able to function below the radar screens, and above the law.  According to the New York Times, nursing homes received $75 billion in 2006 from Medicare and Medicaid, making them a veritable cash cow for those investment groups that prey on them, cutting expenses, making huge profits, and leaving residents with sub-par living conditions.  To read the entire New York Times article, click here. 

More From Thomas Armstrong   More About HealthCare Issues

Dr. Mark Goulston is a former UCLA professor who helps high performing leaders, senior management and sales people reach their full potential using skills he learned training FBI and police hostage negotiators. He is a member of the National Association of Corporate Directors and the Worldwide Association of Business Coaches and writes the weekly Tribune syndicated career advice column, "Solve Anything with Dr. Mark" and columns on leadership for FAST COMPANY and Directors Monthly . He is frequently called upon to share his expertise with regard to contemporary business, national and world news by television, radio and print media including: Wall Street Journal, Harvard Business Review, Fortune, Newsweek, Time, Los Angeles Times, ABC/NBC/CBS/Fox/CNN/BBC News, Oprah, and Today. Mark Goulston is the author of The 6 Secrets of a Lasting Relationship. For more information visit: www.markgoulston.com.

Guest Blogger Mark Goulston--

Need a little tenderness in your relationship with your aging parents? If so, it might be helpful to keep in mind the words of a teacher of mine, Dr. Milton Greenblatt, used as a favorite quote in my book, Get Out of Your Own Way: Overcoming Self-Defeating Behavior.

First we are children to our parents,

Then parents to our children,

Then parents to our parents,

Then children to our children.

Your aging dad is fighting having his independence taken away from him, but he is a danger to himself and others if he continues to drive. How can you take the keys away without hurting his pride and triggering the fear and anger that he feels underneath?

You try explaining all the facts of the situation, but it just makes it worse. Instead of cooperating he just becomes belligerent. So you back off and believe him when he says: "I can drive just fine," even when you know in your heart he's not able to drive safely. You could just wait until he gets that moving violation ticket or fails his next driving test (and be like the majority of adults who handle the situation passively and hope something bad doesn't happen).

On the other hand you can take charge and say calmly and factually: "We are not going to allow you to drive, because the risk of you hurting yourself or someone else is just too great. In its place we will do what we can to provide you with transportation so you can get where you need to go."

And then duck.

Just because your dad makes you feel like you are hurting him or ruining his life doesn't mean that you are. Just because he gets angry and replaces it with being depressed, doesn't mean you have caused it.

The key is to maintain regular contact even if he becomes angry or says nothing. Don't let his mood or behavior control the consistency of those visits (even if they make the visits briefer).

I remember one adult son who did just this with his dad whose impaired memory continued to deteriorate and who didn't want to do much of anything. His mother frequently asked her son if he could come and encourage his dad to go out for walks and do more instead of just spending time in his den in a funk. During one visit, he was strongly encouraging his dad to get up and go for a walk when his father looked at him and his mother and said: "Do me a favor. Don't visit again so soon. Both of you just leave me the f*** alone."

The son told me he was completely taken aback, but he didn't leave. Instead he went into an other room to visit with his mom who shared how difficult the father had become, but then reassured her son not to take it personally. The son was determined to not leave the situation as it was.

An hour later he went to sit on the porch not to convince, but to just visit with his dad, who by this time had quieted down. His father was staring out at the golf course that he once loved but no longer played on. Instead of trying to convince, cajole or manipulate his dad into doing something, the son said to his dad in the most inviting and caring voice: "So dad, how's it going?"

The dad looked at his son, looked away, then looked at the ground when his eyes began to tear up and whereupon he said: "I never thought it (i.e. my life) would turn out this way."

"I understand," the son replied tenderly especially since this was the first time he had ever seen his dad cry.

Connecting can be a powerful catalyst to deeper communication. A few minutes later, the dad, who was not someone to want to deal with his situation honestly and who was never told he had cancer twenty-five years earlier at the insistence of his wife who knew it would freak him out said: "Son, what is Alzheimer's Disease?"

Not wanting to dismiss such an honest reaching out, the son replied: "It's when your memory starts to fail and you sometimes have trouble remembering where you are or what you are doing."

The son then related watching his dad's face squinch up like one of the rotten apple dolls they sell in New England. His dad's face was a mixture of fear and an intense effort to concentrate when he said to his boy: "So