WEBVTT 00:00:00.300 --> 00:00:03.720 Welcome to the Light Keepers podcast. I'm Clayton 00:00:03.720 --> 00:00:06.299 Vandiver, your Light Keeper, with a show dedicated 00:00:06.299 --> 00:00:09.179 to everyone who wants to get the most quality 00:00:09.179 --> 00:00:12.800 out of life that they can. My co -host, as always, 00:00:13.000 --> 00:00:15.519 is Charlene, our very own licensed clinical social 00:00:15.519 --> 00:00:18.820 worker certified in the state of Florida, who 00:00:18.820 --> 00:00:21.339 is going to be talking with us this week about 00:00:21.339 --> 00:00:26.399 chronic, critical, and terminal. What they mean... 00:00:26.809 --> 00:00:30.010 and so much more on this edition of the Light 00:00:30.010 --> 00:01:01.280 Keepers Podcast. And before we start, as always, 00:01:01.380 --> 00:01:03.359 please leave your questions or comments below. 00:01:03.460 --> 00:01:06.879 We will answer them next week on our next edition, 00:01:07.219 --> 00:01:10.500 which airs every Wednesday evening at 7 p .m. 00:01:10.500 --> 00:01:13.200 Eastern. The Light Keepers podcast is an exclusive 00:01:13.200 --> 00:01:15.560 production of A Guiding Light, and we'll tell 00:01:15.560 --> 00:01:17.420 you more about A Guiding Light at the end of 00:01:17.420 --> 00:01:19.920 the podcast. But right now, we don't have much 00:01:19.920 --> 00:01:22.459 time, so let's get right into this week's discussion 00:01:22.459 --> 00:01:27.540 about chronic, critical, and terminal. What in 00:01:27.540 --> 00:01:31.920 the world do those mean? So those are terms that 00:01:31.920 --> 00:01:35.159 are frequently used in medical conversations, 00:01:35.459 --> 00:01:38.599 and a lot of times people don't have a full understanding 00:01:38.599 --> 00:01:41.500 of the difference between them, and it can be 00:01:41.500 --> 00:01:45.120 a little confusing. I'll say I have absolutely 00:01:45.120 --> 00:01:47.519 no idea how to define those terms. Let's start 00:01:47.519 --> 00:01:49.959 with chronic. What does chronic mean? So chronic 00:01:49.959 --> 00:01:54.219 is a condition that doesn't go away. It lingers 00:01:54.219 --> 00:01:58.840 and it comes back up and it continues on with 00:01:58.840 --> 00:02:01.620 or without treatment. So, for example, arthritis 00:02:01.620 --> 00:02:04.920 is a chronic condition. Oh, I can relate to that 00:02:04.920 --> 00:02:09.599 one. Okay. A lot of people can. Yes. Okay, so 00:02:09.599 --> 00:02:13.180 critical. Critical is when the house cat comes 00:02:13.180 --> 00:02:15.400 up during a taping and decides she wants to be 00:02:15.400 --> 00:02:18.810 part of the show. Yes, thank you. Thank you, 00:02:18.810 --> 00:02:23.110 Izzy. But what is critical? So, therapy cat aside, 00:02:23.430 --> 00:02:27.370 critical is when you have someone who's very, 00:02:27.509 --> 00:02:32.949 very sick. This is someone who is, another term 00:02:32.949 --> 00:02:35.270 that you may hear, acute. Someone who has an 00:02:35.270 --> 00:02:38.349 acute condition, which means critical, which 00:02:38.349 --> 00:02:43.370 means it's a very bad situation that might be 00:02:43.370 --> 00:02:48.039 recoverable. Might not. Okay, I see. Well, then 00:02:48.039 --> 00:02:53.120 what about terminal? So terminal is probably 00:02:53.120 --> 00:02:56.479 the worst one that you want to hear when in a 00:02:56.479 --> 00:02:58.939 conversation with a medical professional because 00:02:58.939 --> 00:03:01.919 terminal means that the illness has progressed 00:03:01.919 --> 00:03:05.000 to the point that there is no recovery and you 00:03:05.000 --> 00:03:08.719 are now looking at a life -limiting situation. 00:03:09.719 --> 00:03:15.259 This is usually when hospice is called in. Okay. 00:03:15.259 --> 00:03:19.099 Well, why is it, I guess it's sort of obvious 00:03:19.099 --> 00:03:21.060 why it's important that these be distinguished 00:03:21.060 --> 00:03:25.840 from one another. A chronic situation, much lighter, 00:03:26.039 --> 00:03:28.680 much something that you can live with, I guess. 00:03:29.080 --> 00:03:33.819 Absolutely. Absolutely. Chronic illnesses, they 00:03:33.819 --> 00:03:37.139 can be bad. I mean, lupus is considered to be 00:03:37.139 --> 00:03:40.400 a chronic illness because it doesn't go away. 00:03:42.990 --> 00:03:46.409 it's not life -ending you know it may be a nuisance 00:03:46.409 --> 00:03:51.150 and it may be affecting quality of life but it 00:03:51.150 --> 00:03:54.270 it's not going to end your life in the near future 00:03:54.270 --> 00:03:57.750 i see so things like well where where do things 00:03:57.750 --> 00:04:02.490 like you know parkinson's or that where where 00:04:02.490 --> 00:04:05.639 does that sort of uh of an issue fall in the 00:04:05.639 --> 00:04:08.800 chronic critical and terminal range so these 00:04:08.800 --> 00:04:12.699 are things that actually progress so parkinson's 00:04:12.699 --> 00:04:16.579 dementia alzheimer's these are chronic illnesses 00:04:16.579 --> 00:04:22.439 that can reach a terminal stage so in the beginning 00:04:22.439 --> 00:04:26.199 when they progress slowly you're looking at a 00:04:26.199 --> 00:04:28.220 chronic illness it's not something that can be 00:04:28.220 --> 00:04:30.420 cured it's not something that's going to go away 00:04:30.420 --> 00:04:34.519 it's just going to progress over time As these 00:04:34.519 --> 00:04:37.800 progress and they get worse and they get to the 00:04:37.800 --> 00:04:40.160 point where they're now interfering with one's 00:04:40.160 --> 00:04:43.600 ability to live. For example, with dementia, 00:04:43.680 --> 00:04:46.220 when you have someone who's maybe no longer able 00:04:46.220 --> 00:04:49.699 to swallow. Now you're looking at situations 00:04:49.699 --> 00:04:53.079 that are becoming more critical. They're in the 00:04:53.079 --> 00:04:55.920 critical range. Because they're creating scenarios 00:04:55.920 --> 00:05:00.360 where life could be threatened. I see. And when 00:05:00.360 --> 00:05:02.980 they become unmanageable, I suppose that's when 00:05:02.980 --> 00:05:06.360 they reach the terminal stage? When someone is 00:05:06.360 --> 00:05:11.740 terminal, they've reached a stage where their 00:05:11.740 --> 00:05:16.899 life expectancy is usually not much beyond six 00:05:16.899 --> 00:05:18.959 months to a year. Like I mentioned in a previous 00:05:18.959 --> 00:05:24.329 episode. Someone who is admitted to hospice has 00:05:24.329 --> 00:05:27.290 a life expectancy of six months or less, along 00:05:27.290 --> 00:05:30.889 with a terminal diagnosis. I see. This means 00:05:30.889 --> 00:05:33.529 that they have an illness that's going to take 00:05:33.529 --> 00:05:36.810 their life within the next six months, most likely. 00:05:36.870 --> 00:05:40.069 Like we also talked about during that podcast, 00:05:40.509 --> 00:05:43.709 that's not guaranteed. None of us are born with 00:05:43.709 --> 00:05:47.029 an expiration date. Nobody knows for sure, but 00:05:47.029 --> 00:05:50.670 if the disease progresses as it normally would 00:05:50.670 --> 00:05:54.600 that is the expected time frame. Right. But everyone 00:05:54.600 --> 00:05:56.779 is different. Everyone is unique. And, of course, 00:05:56.839 --> 00:06:00.300 consult your own health care professional that 00:06:00.300 --> 00:06:04.600 has a much better idea of what your individual 00:06:04.600 --> 00:06:09.000 needs might be, always. But we do welcome you 00:06:09.000 --> 00:06:11.160 to join the conversation and leave your comments, 00:06:11.339 --> 00:06:13.939 leave your thoughts and questions down below, 00:06:14.079 --> 00:06:16.600 and we will see them. We will address them in 00:06:16.600 --> 00:06:21.579 upcoming episodes. What is the important takeaway 00:06:21.579 --> 00:06:24.579 whenever you hear the words chronic or critical 00:06:24.579 --> 00:06:27.540 or terminal from your health care professional? 00:06:28.240 --> 00:06:31.319 So the key takeaway there is to keep in mind 00:06:31.319 --> 00:06:36.920 that these are determining factors in terms of 00:06:36.920 --> 00:06:40.040 the plan of care. And by plan of care, I mean 00:06:40.040 --> 00:06:43.100 the course of medical treatment is going to be 00:06:43.100 --> 00:06:45.720 determined by whether the doctor feels you have 00:06:45.720 --> 00:06:49.910 a chronic illness. a critical illness or a terminal 00:06:49.910 --> 00:06:53.290 illness. Or a cath that's attached to you and 00:06:53.290 --> 00:06:58.110 is becoming difficult to get to the ground. Okay, 00:06:58.250 --> 00:07:00.569 so it determines your medical care and how the 00:07:00.569 --> 00:07:02.689 doctor and you, how that conversation is going 00:07:02.689 --> 00:07:07.290 to progress. What can you do in each of these 00:07:07.290 --> 00:07:10.350 states to give you, you know, our focus is always 00:07:10.350 --> 00:07:14.339 on the very best. quality of life possible. And 00:07:14.339 --> 00:07:17.100 we don't focus on end of life. We don't focus 00:07:17.100 --> 00:07:22.939 on those issues. We focus on how you live every 00:07:22.939 --> 00:07:26.420 moment leading to those eventualities, which 00:07:26.420 --> 00:07:30.199 we all face. So the key thing that you want to 00:07:30.199 --> 00:07:33.920 do in all of those is you want to stop and assess 00:07:33.920 --> 00:07:38.740 how you define a good quality of life. Okay, 00:07:38.839 --> 00:07:42.019 how do you do that? Well, you look at the things 00:07:42.019 --> 00:07:43.980 that are important to you and you think of the 00:07:43.980 --> 00:07:47.300 things that you can't do without. And don't think 00:07:47.300 --> 00:07:49.000 of the obvious things. Of course, we all need 00:07:49.000 --> 00:07:52.220 oxygen. We all need to be able to breathe. But 00:07:52.220 --> 00:07:55.779 would you consider yourself to have a good quality 00:07:55.779 --> 00:07:59.279 of life if you couldn't get out of bed? Would 00:07:59.279 --> 00:08:01.279 you consider yourself to have a good quality 00:08:01.279 --> 00:08:04.600 of life if you weren't able to recognize anyone 00:08:04.600 --> 00:08:09.079 around you? So if you did not have the ability 00:08:09.079 --> 00:08:11.480 to be independent, if you could not take care 00:08:11.480 --> 00:08:14.540 of yourself, if you could not have that mental 00:08:14.540 --> 00:08:17.879 awareness, is that a quality of life that you 00:08:17.879 --> 00:08:21.259 would want your life prolonged in? Because if 00:08:21.259 --> 00:08:25.259 the answer is no, it's a good time to start thinking 00:08:25.259 --> 00:08:27.600 about having that conversation with your family 00:08:27.600 --> 00:08:29.620 about what kind of medical treatment you would 00:08:29.620 --> 00:08:32.879 want if you reach a situation where you can no 00:08:32.879 --> 00:08:36.620 longer make your own decisions. Ah, because that, 00:08:36.679 --> 00:08:40.259 again, is one of those factors that may enter 00:08:40.259 --> 00:08:43.320 in once things become critical. Absolutely. And 00:08:43.320 --> 00:08:46.679 what some people don't realize, and this is something 00:08:46.679 --> 00:08:50.799 that I've heard a lot, well, when I get to that 00:08:50.799 --> 00:08:54.259 point, I'll decide what I'm going to do. No, 00:08:54.259 --> 00:08:57.139 you won't. You won't be able to decide. Exactly. 00:08:57.639 --> 00:09:00.639 Exactly. And a lot of people don't realize that 00:09:00.639 --> 00:09:03.919 a situation can go from chronic to critical. 00:09:04.460 --> 00:09:08.539 to terminal very quickly oh that's a good thing 00:09:08.539 --> 00:09:13.139 to keep in mind and especially that i think most 00:09:13.139 --> 00:09:16.799 everyone puts themselves in their mind into the 00:09:16.799 --> 00:09:20.419 situation that they're in right now not really 00:09:20.419 --> 00:09:23.620 able to imagine that situation any different 00:09:23.620 --> 00:09:28.539 correct and it's really hard to put yourself 00:09:28.539 --> 00:09:30.759 into the position into the frame of mind that 00:09:30.759 --> 00:09:35.110 okay When I'm not able to think as I am able 00:09:35.110 --> 00:09:38.289 to think right now, then I'm going to decide 00:09:38.289 --> 00:09:41.269 to do something different. No, you won't. You 00:09:41.269 --> 00:09:43.730 won't be able to. You won't know you need to. 00:09:43.950 --> 00:09:46.809 And probably one of the biggest things that I 00:09:46.809 --> 00:09:50.429 have heard that makes me cringe every time is, 00:09:50.490 --> 00:09:54.210 my family will know what I want. Or my favorite 00:09:54.210 --> 00:09:57.830 one, the doctors know what to do. Oh, ho, ho, 00:09:57.950 --> 00:10:01.750 ho, ho. So if you leave your care in the hands 00:10:01.750 --> 00:10:06.070 of doctors, they are required, they are required 00:10:06.070 --> 00:10:09.629 by their Hippocratic Oath and by law to do everything 00:10:09.629 --> 00:10:12.690 possible to keep you alive for as long as possible, 00:10:12.730 --> 00:10:16.269 regardless of whether or not you are in a quality 00:10:16.269 --> 00:10:19.690 of life that you find acceptable. And that's 00:10:19.690 --> 00:10:21.570 where that quality of life becomes important. 00:10:21.789 --> 00:10:24.070 And if you're not able to tell them what quality 00:10:24.070 --> 00:10:27.250 of life you feel is acceptable, then they make 00:10:27.250 --> 00:10:29.610 that decision for you, which is simply to maintain 00:10:29.610 --> 00:10:35.149 you. That could be awful. That could mean living 00:10:35.149 --> 00:10:41.090 on a ventilator for years. Years. And if you're 00:10:41.090 --> 00:10:47.190 on a ventilator, guess what? Now you are hooked 00:10:47.190 --> 00:10:51.759 up to a machine. 24 -7. You no longer have the 00:10:51.759 --> 00:10:54.159 tube going in your mouth and down your throat. 00:10:54.220 --> 00:10:56.440 Now you have a hole in your throat with a tube 00:10:56.440 --> 00:10:58.419 connected to it that's still connected to the 00:10:58.419 --> 00:11:02.399 machine that can't, most of the time, be maintained 00:11:02.399 --> 00:11:06.379 at home. So now you're in a facility 24 -7. Now 00:11:06.379 --> 00:11:08.620 if you're someone who wanted to live out your 00:11:08.620 --> 00:11:11.519 remaining days at home, not hooked up to machines, 00:11:11.539 --> 00:11:16.700 gone. potentially you didn't have any choice 00:11:16.700 --> 00:11:18.960 in that matter. Correct. And one of the things 00:11:18.960 --> 00:11:22.179 that we most strongly advocate for on this show 00:11:22.179 --> 00:11:26.080 is being able to live life on your own terms. 00:11:26.080 --> 00:11:28.799 And part of that is informed decision -making. 00:11:29.139 --> 00:11:31.740 Okay, what is informed decision -making in the 00:11:31.740 --> 00:11:33.860 little bit of time we have left? Informed decision 00:11:33.860 --> 00:11:36.620 -making is basically where you have the information 00:11:36.620 --> 00:11:40.460 that you need to make the decision. to get the 00:11:40.460 --> 00:11:43.960 care that you want to receive and not get the 00:11:43.960 --> 00:11:47.940 care that you don't. And that makes sense. So 00:11:47.940 --> 00:11:50.139 informed decision -making is having the right 00:11:50.139 --> 00:11:53.919 answers to the right questions. Correct. Knowing 00:11:53.919 --> 00:11:57.279 the questions. And being able to make good decisions 00:11:57.279 --> 00:12:02.460 for yourself when you're still able to, and being 00:12:02.460 --> 00:12:05.240 able to express those so that your doctors, your 00:12:05.240 --> 00:12:08.879 family, all of your caregivers... will know what 00:12:08.879 --> 00:12:11.500 your wishes are once you're no longer able to 00:12:11.500 --> 00:12:13.820 tell them. And it's not just about being able 00:12:13.820 --> 00:12:15.820 to guide your own care. It's taking that burden 00:12:15.820 --> 00:12:18.200 off of your family. I cannot tell you how many 00:12:18.200 --> 00:12:21.080 times I've been standing in the ICU with a family 00:12:21.080 --> 00:12:24.080 devastated over having to make the decision to 00:12:24.080 --> 00:12:26.379 take a loved one off life support, and they're 00:12:26.379 --> 00:12:28.220 wondering if they did the right thing because 00:12:28.220 --> 00:12:31.000 they didn't know what their loved one wanted. 00:12:31.240 --> 00:12:34.500 And you know what I can imagine? You say that 00:12:34.500 --> 00:12:36.759 your loved ones will know what your wishes are. 00:12:37.580 --> 00:12:39.799 and this one will know that your wishes are this 00:12:39.799 --> 00:12:42.659 this one will know that your wishes are different 00:12:42.659 --> 00:12:45.220 from that and this one will know that there's 00:12:45.220 --> 00:12:48.509 an entirely different scenario that they think 00:12:48.509 --> 00:12:51.289 is what you would want. Because everyone has 00:12:51.289 --> 00:12:54.090 a slightly different perception of every member 00:12:54.090 --> 00:12:56.870 of their family and what their wishes might be. 00:12:57.070 --> 00:12:59.629 Correct. And you and I both have seen situations 00:12:59.629 --> 00:13:02.309 where it's in writing, it's in black and white, 00:13:02.350 --> 00:13:04.669 and you've still had siblings fight over the 00:13:04.669 --> 00:13:07.389 plan of care because they interpreted it differently. 00:13:07.710 --> 00:13:10.230 And that's one of the most heartbreaking parts 00:13:10.230 --> 00:13:13.350 of the entire equation because that divides families. 00:13:13.470 --> 00:13:17.279 That hurts feelings that sometimes are never 00:13:17.279 --> 00:13:21.019 able to heal correct so if anything that we say 00:13:21.019 --> 00:13:25.799 on this show is able to help any family prevent 00:13:25.799 --> 00:13:29.580 that and and step away from all of that divisiveness 00:13:29.580 --> 00:13:33.980 then we've done something good absolutely well 00:13:34.919 --> 00:13:37.820 Of course, this is all a highly personal choice 00:13:37.820 --> 00:13:40.000 and no conversation that we have on the Light 00:13:40.000 --> 00:13:42.480 Keepers podcast should ever take the place of 00:13:42.480 --> 00:13:44.700 your own medical care team or other professional 00:13:44.700 --> 00:13:48.440 advisor who should always be consulted by you 00:13:48.440 --> 00:13:52.000 on your specific situational needs. And it's 00:13:52.000 --> 00:13:53.919 always good to be willing to talk about quality 00:13:53.919 --> 00:13:56.700 of life because every single one of us faces 00:13:56.700 --> 00:14:00.159 some of these issues some of the time. Either 00:14:00.159 --> 00:14:03.500 not prepared at all or very well prepared indeed. 00:14:04.190 --> 00:14:07.070 for joining us here every Wednesday at 7 p .m. 00:14:07.070 --> 00:14:10.570 Eastern for the Light Keepers podcast. This is 00:14:10.570 --> 00:14:13.029 an exclusive production of Vanimation Studios 00:14:13.029 --> 00:14:16.230 brought to you by A Guiding Light, 501c3 nonprofit 00:14:16.230 --> 00:14:20.529 organization dedicated to education and information 00:14:20.529 --> 00:14:24.070 that allows informed preparation for living the 00:14:24.070 --> 00:14:27.610 very best life possible. 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And we're so grateful for your 00:15:21.139 --> 00:15:23.200 support and sincerely hope you will join the 00:15:23.200 --> 00:15:26.110 conversation in coming weeks. Add your questions 00:15:26.110 --> 00:15:28.309 and comments below. Speaking of that, hit the 00:15:28.309 --> 00:15:31.669 like and subscribe buttons. It's free. And turn 00:15:31.669 --> 00:15:34.470 on that notify bell so you'll catch every single 00:15:34.470 --> 00:15:37.370 episode. I'm Clayton Vandiver, your Light Keeper. 00:15:37.809 --> 00:15:39.409 We'll see you next time.