February 18, 2025 • 33 mins
Welcome Vangie Jones, a hospice nurse for 20 years as she shares with us all we need to know about hospice including the myth that it is only for the final days or weeks. This will be a three part recording since we had so many questions for Vangie that we all want to know
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Hello and welcome to our podcast about living on the
Lewy Body Roller Coaster apodcast for Lewy Body Dementia
patients and their families.
Presented by Lewy Body patientsand their families.
Speaker 2 (00:13):
You will hear firsthand the ups and downs and
twists and turns of Lewy BodyDementia from families directly
affected.
We'll share our support andexperiences on all things Lewy
Body.
Speaker 1 (00:25):
We're your hosts, Linda and Curry.
I have a loved one with Lewybody dementia.
Speaker 2 (00:31):
And I am living with Lewy body dementia.
Speaker 1 (00:33):
Let's get started.
Speaker 3 (00:39):
All right, welcome back again for part three with
Vanjie.
She's been a trooper, and,curry, you've been a trooper too
with recording, because I knowit's hard for you to record, but
we just knew this was such areally important topic that we
all really need to know about.
(01:00):
Do you want to ask her the nextquestion, curry?
Speaker 2 (01:02):
You betcha about.
Do you want to ask her the nextquestion?
Curry you betcha Vanjie?
I read that the biggestchallenges for hospice are
combating misconceptions, latereferrals and managing
expectations.
Do you agree and can youelaborate on these?
Speaker 4 (01:18):
I think that that is a big problem for hospice
companies to get their messageout in the fact that our
misconceptions can be.
It's so true, because one majormisconception I hear all the
time, I've heard it for 20 yearswell, if you're going to bring
(01:39):
that hospice in, they're goingto be dead because they're going
to give them that morphineNumber one misconception, then
they're going to be dead becausethey're going to give them that
morphine Number onemisconception.
Studies have proven thatgetting a patient's pain
controlled increases time livedby 27 days.
Now that might not seem a lot,but if that pain's been out of
(02:02):
control and it improves theirability to communicate.
So what happens when we givemorphine is if a patient dies
after starting morphine, thatpatient was actively dying, very
actively dying, and everyonewas in denial.
That's just an honestconception, my opinion, because
morphine, what it does does, itactually causes that client,
(02:27):
that patient, to have moreconscious moments because our
body will make us unconsciouswith chronic pain so they can
have conscious times of spendingwith their families.
So that's misconception numberone, that we're going to kill
them.
Another one is oh, they're notgoing to feed them, they're not
(02:49):
going to give them.
You know they're going to stopthe very feeding.
No, no, no.
Now are we going to encourageyou, as caregivers, to not force
feed.
Yes, because if you're havingto force feed, they're not
swallowing, right, you know, andso you're going to choke them.
But in the dying process, whena patient is starting to get to
(03:20):
the point they don't eat ordrink, it is because they're in
a new phase and they're dying.
They're in a spiritual and anemotional state, so they're
interprocessing.
They don't need the nutritionthey needed before.
And so we encourage you okay,if you offer your Lewy body
(03:44):
patient something to eat andthey don't want it, let it go,
come back to it later, maybethey'll have it later.
But don't also say, oh, youhave to eat.
If you don't eat, you know, youjust gotta eat.
And I always tell my families welive in a society in the United
States, in Western civilization, where food is our comfort area
(04:09):
.
We do food for birthdays, forbar mitzvahs, for anniversaries,
for family dinners, forChristmas, everything.
That's when we feel we aregiving.
We're giving through our food,and so it gives that caregiver
something to fulfill that.
(04:30):
What I tell my caregivers is orwhat I did, is you know what,
when they say they don't wantthat it's okay.
You know how you can give tothem.
Get some lotion and massagethose legs.
Get some lotion and put it onthat back.
Talk to them, start doingmemories, start talking about
(04:51):
that life journey that you allhave had together, because they
need to take those memories withthem.
They're not going to pass onuntil they know, a their life
has had purpose, a their lifehas had purpose and B that their
traditions, their things aregoing to be carried on and that
their loved ones are going to betaken care of.
(05:11):
And so that's a bigmisconception is that we're
going to do that.
The other misconception is thatwhen we talked about earlier
that you're going to get thrownout if you lose weight or if
something changes, nope, notfrom six months.
You're going to be in therecarrying on, you know.
(05:31):
And so I think there are somevery, very important
misconceptions.
Hospice does not believe ineuthanasia.
Guys, we are not coming in todo that.
Our goal is about in the lifeand how to make it quality
someone asked if hospice speedsup dying and hospice.
Speaker 3 (05:52):
What speeds up dying?
Speaker 4 (05:54):
no no, yeah, and in fact we won't.
We won't.
I've had plenty of clients in20 years say um, I want you to
end this and I'm sorry, I'm notgod I can't do that I can't do
that between you and you, andand you'll get there when you're
(06:15):
ready to yeah, yeah, but that'sa.
Speaker 3 (06:19):
That's definitely a misconception that people think
right like yeah we're aboutphysical, emotional and
spiritual support for everybody.
Speaker 4 (06:28):
Yeah, and, and, and.
Speaker 3 (06:30):
There's no place for euthanasia in that right and I I
just until I got involved onthis journey.
And more now on to what hospiceis.
Honestly, I thought hospice iscalled when you only have like
two weeks to two months, youknow, less than two months or
even two weeks left to live, andclearly that's not the case, as
(06:55):
you so eloquently shared withus, that it's to help you have a
better what's left of the timethat you have.
Speaker 4 (07:03):
Exactly.
And you know, if somebody doesdie within that first three or
four days, like I said before,they were actively dying.
They were waiting.
They were waiting for theirfamily to get support and for
them to be given permission.
Speaker 3 (07:20):
And once they knew everyone was going to be
supported, they, they, theypassed themselves on, they, they
move on and um, and that's okaythat's what uh bonnie had
shared with us is, uh, herhusband, randy, was really
holding on and she, I think shesaid she grabbed his hand and
said it's okay, it's time foryou to go, like both of our
(07:42):
children.
It took a few days for both ofour children to actually fly
down to see him, but then she'slike, it's like she gave him
permission and then, and then heand he passed.
So the next two questions kindof um, I gave curry a break,
just just so you know he I madehim go walk, take a walk.
(08:03):
He's not being punished people,he can't sit still that long.
So the questions are and thismight be hard to ask or even for
our listeners to hear theanswer to, but people have asked
us to ask how are Haas's peoplesure someone is going to die?
(08:23):
Hospice people sure someone isgoing to die, and can you share
with us things to look out forthat might indicate our loved
ones have taken that turn?
Because you talking to me andme talking to my girlfriend, I
he clearly was already in theprocess when she called hospice,
you know, looking, looking back.
So what could you share withour listeners to look out for?
Speaker 4 (08:46):
Okay, well, there are symptoms and first I want to
give them a name of a book thatanyone can get.
Okay, and this book iswonderful and it's called Gone
From my Sight.
You can get it off Amazon.
What's it called?
Gone From my Sight?
And you can get it off Amazon.
(09:07):
I think it's $7.99.
Last time I looked, it's byKaren Cantran, I think.
Yeah, I'll look it up.
I'll look it up.
Yes, and this book goes throughthe phase and it starts at
about six to four months.
Here's the symptoms you're goingto see and all diseases I don't
care what they are all diseasesare going to start having some
(09:29):
of the same symptoms.
And so when you're looking,there's a three-week prior to
any acute phase and that's wherethey just started really
slowing down.
They maybe became very quiet,pensive, they're doing a lot of
inner thing.
They seem like they're sleepingall the time, but they may
actually not be sleeping, theymay just be processing internal
(09:52):
thought in there and they starteating less.
They become much weaker.
Symptoms you're going to seethe last week to death are
symptoms like blood pressuredrop.
Hands and feet are cold.
They will also be very mottled.
(10:15):
The skin, the feet, the knees,the feet, hands.
They become purplish, pale gray, they are blotchy or mottled
that's what we call.
It is mottling and then thearms are cold, but the trunk
will feel very warm or hot, likethere is a temperature.
They may become unresponsiveNot everybody does.
(10:39):
There'll be periods of rapidbreathing where there's also a
period following where there'sapnea or no breathing and that
will start leading to a girdlingcongestion.
Now what is that?
That is because they're notswallowing and the fluid that
drains from our saliva and ournose isn't getting swallowed,
(11:03):
it's getting stuck, and so westart seeing that.
Then you start seeing increasedshallow breathing and those are
the signs and symptoms that youcan really start looking for
right away.
In that three-week period beforethat, you're going to see, like
I said, less food and drink,increased sleeping, increased
(11:26):
restlessness, increased anxiety,and almost every single patient
is going to have that increasedrestlessness and anxiety.
It is the body's lack of oxygen, the brain's lack of oxygen.
As we're getting closer todeath, it increases that
(11:46):
restlessness and anxiety.
It is also the soul trying toleave the body and that's a
difficult process, and sodefinitely everyone should get
that book.
This is a book that we gave toall our hospice clients because
(12:06):
it brings you right down to thefinal stages, so you can look at
that and say, oh whoa, maybe Ishould be calling hospice.
We got some of this stuff goingon.
So her name is Barbara Karen.
Yep, she's a registered nurse.
Speaker 3 (12:22):
Yep, just found it.
Okay, I ordered it while wewere talking.
Speaker 4 (12:26):
It's a great book.
Speaker 3 (12:32):
It's just a great book.
I keep going back to Bonnie,because she literally came on
the day after her husband passedaway because she just wanted to
share her experience to helpother people.
Sure, and everything you'resaying is I hear her telling me,
you know, as it was leading upto hospice actually coming, and
(12:57):
then, when they did come, sosomeone asked, asked, asked if
you could talk about and thiswas someone with Lewy body as
this can she talk about how wecan stop our medications, choose
to stop eating and drinkingwhen we get to the end stage, we
don't have to suffer anymore?
And there's a thing wementioned Five wishes.
Yeah, Long time ago we we talkedabout the five wishes.
Speaker 4 (13:20):
Every patient in hospice.
That's why you sit down, that'swhy you get it soon enough so
that their their wishes arebeing followed.
Um has the right to reach tostop medications, food and water
at any time they choose.
Okay, um, that's their choice.
They can choose how theirprocess is going to happen.
(13:43):
Okay.
So then the next question isgoing to be well, how long can
they live without food or water?
So that depends on theindividual.
First of all depends upon howmuch adipose tissue you got.
If you've got enough fat on you, you can live a little while.
But general rule is you canlive without food, food for up
(14:09):
to 21 days, wow, okay.
Now water is a different thing,you know, um, but I will also
tell you the body wants to getdehydrated before death, because
dehydration brings a naturalbody's pain relief.
And if you think about whenthose patients can't move
(14:31):
themselves, that skeletal systemis now the heaviest thing on
that dying patient and it'sheavy and it hurts when it gets
stiff.
And so dehydration helps kickin your own endorphins to help
relieve that pain.
And so the body's naturalresponse is to stop eating, stop
(14:52):
drinking.
But a client can choose thatwhenever they want.
That's their choice, because weacknowledge that there's a
death coming.
What happens is how do you wantit, and that's your choice.
Speaker 3 (15:08):
Yeah, Did you just sorry.
I was looking at, I'm taking itall in, Sorry.
Did you say how long they cansurvive without having?
Speaker 4 (15:17):
any water.
Yeah, that's a little bitdifferent.
And once they start gettingdehydrated then your kidneys
shut down, you know, and um,those types of things.
So that's when I always saythat that usually is that you're
going to have like five toseven days now.
And everyone's different.
Yeah, but generally um ifthey're taking a sip.
(15:41):
They might take a sip every twohours.
That may be all their bodyneeds to be to keep going.
So it it just depends on howmuch.
But if they completely stopdrinking and stuff, then you're
looking that we're getting veryclose, yeah, so especially when
the urine gets very dark, veryconcentrated, or it's stopped,
(16:03):
no urine output, and it's notbecause we have a distended
bladder.
Speaker 3 (16:07):
Right, so this question goes with that, kyra,
we always talk about pee andpoop in our support groups
because it's a thing.
Does hospice more times thannot put a catheter in to avoid
agitating the person who'sactively dying?
Speaker 4 (16:29):
Here's why we put if a catheter goes in, it's because
that patient's become bed boundand incontinent but maybe not
be at that phase yet, that acutedying phase.
To prevent bed sores and stuff.
We try not to put them in anysooner than we try not to put
(16:49):
them in at all.
But if we need to, then it'snot something we're going to do
per se at the last, unless,unless, guys, it is a comfort
measure also to the caregiver,because they can't do the
turning and the care that wellthen, that might be a reason we
(17:09):
would.
Speaker 3 (17:10):
Yeah, oh, I just had another question.
It went right in and right out.
Hopefully, hopefully, it comesback to me.
Speaker 4 (17:20):
And if we're going to talk about poop, which I don't
have any problem talking aboutbut, um, I always tell everybody
that, even up until the endstage, that last week they
didn't need to have a bowelmovement.
You have 27 feet not inchesfeet of intestine, so it takes a
(17:41):
long time for someone that'snot active.
If you're up and moving, okay,you're moving your peristalsis.
When you're no longer active,that peristalsis isn't moving.
It takes a long time to getfrom here to there, and so a
suppository needs to be given.
If you're no longer swallowingon a regular basis, okay, so
(18:03):
that those bowels are moving,because that also is a very
discomforting thing.
When you have a distendedabdomen because you've been
constipated or you haveabdominal cramping, and so your
nurse will stay on top of that,they'll either give enemas or
they'll give a suppository,those type of things.
Speaker 3 (18:19):
Yeah, I know Constipation is a big thing.
It's either one way or theother.
Right, curry One way or theother.
And here I wrote it down, how,which I was surprised.
How long do bed sores take toactually manifest?
Speaker 4 (18:38):
Let me tell you, in the dying process there was a
specific type of bed sore calleda Kennedy's ulcer.
Okay, and one can look it up.
It felt just like the kennedy'sand it is a bed sore that shows
up within 72 to 48 hours ofdeath.
It is a sign of imminent deathin some people.
(18:59):
So a caregiver changed them inthe morning, bottom looked good,
turns them over at threeo'clock in the afternoon and
this is giant purple spot ontheir coccyx area.
That's generally probably akennedy's ulcer and it's saying
life is intimate because deathis in an imminent, because
(19:21):
that's an ischemic area, thatbonyony prominence.
Blood has slowed so much it'snot getting there at all.
In a patient that's just bedbound, okay, but they're still
cognitive, they're still eatingand drinking.
As long as someone is turningthem, it doesn't generally
(19:41):
happen until you start seeingnutritional deficits.
They stop eating as much andthen they can come very quickly.
I had a sister-in-law who justrecently died herself with
hospice and she could not turnand could not stand to have her
left leg touched because shedevelops blood clot in it and
(20:04):
and so it took very and she wasa very bad brittle diabetic so
it took no time for her to startgetting some bad um the cubes
yeah, I know, um, I keep goingback to you, bonnie, if you're
listening.
Speaker 3 (20:16):
She had, didn't she tell us curry like within days,
I guess it.
I can't remember exact time,but she had said how he got bed
sores, and I was shocked that ithappened so fast, and what
you're saying.
Speaker 4 (20:32):
I'm glad I remember what I was going to ask you with
that, because that's justanother sign to look out for, I
guess when they get to that, Iguess when, when they get to
that Another sign that the bloodflow has slowed so much in that
body because that body hasslowed down and is getting very
prepared for death, that thoseareas are popping up everywhere,
(20:54):
yeah, and that's when they needto be turned.
Very often, you know, every twohours repositioned and pillowed
and stuff like that.
So that's when you want to knowyou have a really good mattress
on that hospital bed.
Speaker 3 (21:12):
Yeah, I heard one caregiver speak of terminal
agitation.
I know that kind of goes withwhat we were talking about above
, but someone wanted to knowdetails.
I guess not everyone doeseveryone in the dying process go
through that terminal agitationphase or no?
Speaker 4 (21:30):
Well, to say everyone dies is too general, because
that's not necessarily true.
You could have somebody thathas been unresponsive for a long
time.
You know that.
Let's take an Alzheimer'spatient who has not beenive for
a long time.
Okay, you know that.
Let's take an Alzheimer'spatient who has not been
cognitive for a long time in anursing home, but they still get
(21:50):
them up and they're still kindof feeding them themselves, kind
of force feeding and stuff likethat.
That patient has been slowingdown for so long they may not
have any terminal arrest.
Terminal arrest, islessness.
You see more when a patient hasbeen cognitive right till that
last couple weeks or so, thatlast three weeks, and then they
(22:11):
start having less let, then theyhave less, um, oxygen to the
brain.
Things are, you know, they'restarting to have some breathing
problems, that type of thing,and that's where that
restlessness comes in and thatagitation.
We call it terminalrestlessness, um, and they're
kind of just all over the placeand and um, they may even be I
(22:36):
gotta get out, I gotta get out,I gotta get up, I gotta get up,
those type of things that'sexactly what one of our one of
the members in our supportgroup's sister had explained to
us, which goes with your nextquestion, Curry.
Speaker 2 (22:50):
Yeah, how would hospice help someone who starts
having breathing issues?
Speaker 4 (23:06):
Well, it depends on increasing nebulization
treatment.
Maybe the person has had someaspiration and so they're having
some lung congestion, but he'sso close to death the family
does not want him treated.
Okay, so then we might bring inoxygen um for them to make, and
(23:27):
also we give some medicationstwo most common are um atropine
and scopolamine um, and thoseare really antimucolitics and um
antichologenic, and what theydo is they help dry up that
secretion that's developing,that's causing them to have some
(23:48):
breathing problems.
If it's due to that problem,we're going to teach them.
We may need to teach them raiseyour bed more often, those type
of things.
So we're going to do what wecan.
Speaker 3 (24:02):
I know, hopefully, we've asked you all the right
questions that our listenerswanted to know um, so I need to
ask you this next question doyou think we missed asking any
specific question that lovedones need to know about hospice?
Speaker 4 (24:17):
I think that you need to know about one thing for
sure Every hospice shouldprovide to a client on a mission
or within 24 to 48 hours,what's called a comfort pack.
We used to call them emergencydrug kit, so that there are
emergency things in your homethat you can, and so what
(24:37):
they're going to cover is pain.
So there's going to be someeither morphine or oxycodone one
of those things because they'reutilized not just for pain,
they're utilized for shortnessof breath.
They help bring that breathingdown so that patient is not
getting hypothyroid fromhyperventilating.
There's going to be medicationin there for secretion.
(24:58):
There should be some Tylenolsuppositories in there for
temperature.
If they're not swallowing atthat point, you're going to have
medicine in there forrestlessness.
Now you have to be careful,guys.
Remember.
You know the meds that yourLewy bodies can take alopecia
and all those type of things.
However, in the very end phase,like that last three days, that
(25:23):
is a good drug.
Maybe too if they're havingsevere agitation.
But you need to tell them upfront.
You do understand, because allhospices just kind of put that
in there unless they know, andnot all hospices are going to
know.
You like you know you.
Speaker 3 (25:40):
Yeah, and know Louie body like we know Louie body.
Speaker 4 (25:43):
That's right.
So you're going to have Tylenolin there, you're going to have
something for breathing,something for agitation,
something for pain and shortnessof breath, and that should be
there.
So they need to make sure thatthey're getting that comfort kit
.
Okay, you don't want to be twoo'clock in the morning and need
something.
They say, well, it'll be 48hours, that's the other thing.
(26:04):
A lot of companies may use adrop agency to bring your meds
to you.
It takes a while.
Ask that question.
When you sign up, do yournurses bring it out?
Can my family pick it up?
How is that going to work whenit comes to any kind of meds?
Because they should also checkall your meds every time they're
(26:27):
in the home and anythingthey're financially paying for.
They should make sure youalways have a week to two weeks
worth in a home because ofweather, you know.
So that's one thing that Ithink we need to remember.
I think the other thing is justremembering that, follow that
(26:48):
FASTA report, get someone tocome out and just assess you,
especially if you've had anyurinary tract, any bed sores,
any forms of pneumonia, whetherit's aspiration or bacterial,
because that loved one couldbenefit from this service and so
(27:08):
could you, because it's notjust for them, and remember that
assessment does not, should nothave a charge for it, for sure.
Speaker 3 (27:18):
Yeah, that's great to know.
Did you see me raising myfingers, Carrie?
Speaker 2 (27:22):
I did.
Speaker 3 (27:23):
And before Carrie starts with thanking you, I know
our girlfriend was verystressed out when they mentioned
Haldol, because those of us inthe Louis world we're like no
cross, there's no way.
But they said only given whenhe's near death, and he was.
Speaker 4 (27:47):
That's right, and it would only be given.
And I think Ativan is probablyon y'all's list too, isn't it?
Yes, yeah, yeah, and those aregenerally the first two.
But before I threw away Ativan,I would try to throw away
Thorzy.
I would say, ooh, stay awayfrom Thorzy, you know, and
(28:08):
that's one that some agenciesuse because it's an old word,
that's cheap.
And I'd say, you know, I'drather try a little liquid Xanax
, because you can do Xanax.
Right, can y'all do Xanax?
Yes, yeah, well, xanax comes ina liquid.
With lots of agencies I've hada lot of Lewy body patients that
were still ambulatory andmoving, but they were having
(28:31):
episodes of severe restlessness,agitation and stuff.
Get them a little Xanax liquidbecause they could take it.
We'd put it in a little juiceand get it down.
So you've got to let them know.
We know we can't take thesedrugs, we don't want these
things.
Only at the last thing.
Speaker 3 (28:50):
Yeah, I think all of our listeners have the NIH Lewy
Body book that lists the thingsyou can't take, because we've
got it right by our, you know,right with us.
Speaker 4 (29:01):
And that's good because you might get a hospice
that's never had a Lewy Body.
You know they're not educated.
I always speak and everybody'sdifferent, but I always believed
that before I went into apatient's home I better know
where I where I'm going andwhat's it about.
And so, even if I did not know,that disease there's a lot of a
(29:21):
lot of dementia diseases.
You know, I researched it beforeI went to that home.
I wanted to know what I shouldexpect, so I could also paint
that picture.
Yeah, okay, when are you at?
So, yeah, you want a good teamfor sure.
Speaker 2 (29:38):
It sounds like that you formed a very good team.
I've got to tell you that Iwish all hospice people were as
informed as what you are.
Yeah, Well thank you.
Speaker 4 (29:50):
I had an excellent.
I worked with an excellent team.
They weren't my team, but Iworked with excellent people and
actually I will tell you thatevery single nurse I worked with
in 20 years had never thoughtof hospice.
That God called each one ofthem.
He took some of them from laborand delivery and they became
(30:10):
the best hospice nurses you eversaw.
And I didn't go to hospice.
They came to me.
I was doing care with chronicAIDS clients and chronic
children that were born withdeficits, that were going to be
terminal, and I prayed about itand God said, yeah, that's where
you're going to be terminal.
And I didn't.
And I prayed about it and godsaid, yeah, that's where you're
going.
Wow, it was.
Speaker 3 (30:31):
It was the most rewarding, happiest 20 years of
my life wow, well, we can'tthank you enough for coming on
and sharing, and I can see why.
Thank you shout out to uh, ivaneddie, who are your brother and
sister-in-law brother-in-lawand sister-in-law.
Now I know why they put me incontact with you, vanjie,
because the information youprovide is going to help so many
(30:54):
people.
So any last final words beforewe start our ending.
Just seriously, I can't even Idon't know about you, curry, but
I feel like I'm a hospiceexpert now.
Speaker 2 (31:06):
I'm so glad that I heard all this.
Speaker 3 (31:08):
Yeah, he really needed to hear from, and this
just goes back to something yousaid, like having somebody in
hospice telling the person youneed to do this because you know
sometimes they don't listen tothe family.
It's just, it's good thatpeople are hearing this from
someone other than their lovedone.
Speaker 2 (31:27):
Definitely.
Speaker 4 (31:28):
Well, I want to thank you all for asking me.
It's been quite an honor.
It's a love that I'm nevergoing to get over.
I'm going to always be ahospice nurse, even though right
now, what I'm teaching ispeople how to have quality in a
different form, and so I truly,truly thank you.
Thank you for allowing me.
It's been an honor.
Speaker 2 (31:50):
Well, I want to personally thank you too, and I
tell you, sitting here listeningto you and all the information
that you've given out, it's justtremendous.
Speaker 3 (32:03):
I'm in awe of all your knowledge.
We have people that can't readanymore and listening is a thing
, but yeah, yeah, thank you inawe.
Yeah, because all yourknowledge.
We have people that can't readanymore, like and and listening
as a thing, but yeah, yeah,thank you well, folks, that's
all we have time for this week.
Speaker 2 (32:17):
Uh, once again, thank you, vangie, for coming on.
We really appreciate it andfolks remember you can email us
with suggestions on what you'dlike us to discuss on a future
episode, or you can ask anyquestions you have, and we'll
sure do our best to help get youthe best answers possible.
Speaker 3 (32:34):
And if you want to learn how you can become a
supporter of the podcast, pleasesee the episode notes below,
which I will remember to do.
Curry, he told me I forgot toadd that link because we post
the information under theepisode notes for you to become
a supporter, because the morepeople that support us, the more
(32:56):
people we can help.
Speaker 2 (32:58):
Okay, folks, thanks again for joining us.
Speaker 3 (33:00):
Until next week.
This is Linda.
Speaker 2 (33:03):
And Curry signing off .
Hello and welcome to our podcast about living on the
Lewy Body Roller Coaster apodcast for Lewy Body Dementia
patients and their families.
Presented by Lewy Body patientsand their families.
Speaker 2 (00:13):
You will hear firsthand the ups and downs and
twists and turns of Lewy BodyDementia from families directly
affected.
We'll share our support andexperiences on all things Lewy
Body.
Speaker 1 (00:25):
We're your hosts, Linda and Curry.
I have a loved one with Lewybody dementia.
Speaker 2 (00:31):
And I am living with Lewy body dementia.
Speaker 1 (00:33):
Let's get started.
Speaker 3 (00:39):
All right, welcome back again for part three with
Vanjie.
She's been a trooper, and,curry, you've been a trooper too
with recording, because I knowit's hard for you to record, but
we just knew this was such areally important topic that we
all really need to know about.
(01:00):
Do you want to ask her the nextquestion, curry?
Speaker 2 (01:02):
You betcha about.
Do you want to ask her the nextquestion?
Curry you betcha Vanjie?
I read that the biggestchallenges for hospice are
combating misconceptions, latereferrals and managing
expectations.
Do you agree and can youelaborate on these?
Speaker 4 (01:18):
I think that that is a big problem for hospice
companies to get their messageout in the fact that our
misconceptions can be.
It's so true, because one majormisconception I hear all the
time, I've heard it for 20 yearswell, if you're going to bring
(01:39):
that hospice in, they're goingto be dead because they're going
to give them that morphineNumber one misconception, then
they're going to be dead becausethey're going to give them that
morphine Number onemisconception.
Studies have proven thatgetting a patient's pain
controlled increases time livedby 27 days.
Now that might not seem a lot,but if that pain's been out of
(02:02):
control and it improves theirability to communicate.
So what happens when we givemorphine is if a patient dies
after starting morphine, thatpatient was actively dying, very
actively dying, and everyonewas in denial.
That's just an honestconception, my opinion, because
morphine, what it does does, itactually causes that client,
(02:27):
that patient, to have moreconscious moments because our
body will make us unconsciouswith chronic pain so they can
have conscious times of spendingwith their families.
So that's misconception numberone, that we're going to kill
them.
Another one is oh, they're notgoing to feed them, they're not
(02:49):
going to give them.
You know they're going to stopthe very feeding.
No, no, no.
Now are we going to encourageyou, as caregivers, to not force
feed.
Yes, because if you're havingto force feed, they're not
swallowing, right, you know, andso you're going to choke them.
But in the dying process, whena patient is starting to get to
(03:20):
the point they don't eat ordrink, it is because they're in
a new phase and they're dying.
They're in a spiritual and anemotional state, so they're
interprocessing.
They don't need the nutritionthey needed before.
And so we encourage you okay,if you offer your Lewy body
(03:44):
patient something to eat andthey don't want it, let it go,
come back to it later, maybethey'll have it later.
But don't also say, oh, youhave to eat.
If you don't eat, you know, youjust gotta eat.
And I always tell my families welive in a society in the United
States, in Western civilization, where food is our comfort area
(04:09):
.
We do food for birthdays, forbar mitzvahs, for anniversaries,
for family dinners, forChristmas, everything.
That's when we feel we aregiving.
We're giving through our food,and so it gives that caregiver
something to fulfill that.
(04:30):
What I tell my caregivers is orwhat I did, is you know what,
when they say they don't wantthat it's okay.
You know how you can give tothem.
Get some lotion and massagethose legs.
Get some lotion and put it onthat back.
Talk to them, start doingmemories, start talking about
(04:51):
that life journey that you allhave had together, because they
need to take those memories withthem.
They're not going to pass onuntil they know, a their life
has had purpose, a their lifehas had purpose and B that their
traditions, their things aregoing to be carried on and that
their loved ones are going to betaken care of.
(05:11):
And so that's a bigmisconception is that we're
going to do that.
The other misconception is thatwhen we talked about earlier
that you're going to get thrownout if you lose weight or if
something changes, nope, notfrom six months.
You're going to be in therecarrying on, you know.
(05:31):
And so I think there are somevery, very important
misconceptions.
Hospice does not believe ineuthanasia.
Guys, we are not coming in todo that.
Our goal is about in the lifeand how to make it quality
someone asked if hospice speedsup dying and hospice.
Speaker 3 (05:52):
What speeds up dying?
Speaker 4 (05:54):
no no, yeah, and in fact we won't.
We won't.
I've had plenty of clients in20 years say um, I want you to
end this and I'm sorry, I'm notgod I can't do that I can't do
that between you and you, andand you'll get there when you're
(06:15):
ready to yeah, yeah, but that'sa.
Speaker 3 (06:19):
That's definitely a misconception that people think
right like yeah we're aboutphysical, emotional and
spiritual support for everybody.
Speaker 4 (06:28):
Yeah, and, and, and.
Speaker 3 (06:30):
There's no place for euthanasia in that right and I I
just until I got involved onthis journey.
And more now on to what hospiceis.
Honestly, I thought hospice iscalled when you only have like
two weeks to two months, youknow, less than two months or
even two weeks left to live, andclearly that's not the case, as
(06:55):
you so eloquently shared withus, that it's to help you have a
better what's left of the timethat you have.
Speaker 4 (07:03):
Exactly.
And you know, if somebody doesdie within that first three or
four days, like I said before,they were actively dying.
They were waiting.
They were waiting for theirfamily to get support and for
them to be given permission.
Speaker 3 (07:20):
And once they knew everyone was going to be
supported, they, they, theypassed themselves on, they, they
move on and um, and that's okaythat's what uh bonnie had
shared with us is, uh, herhusband, randy, was really
holding on and she, I think shesaid she grabbed his hand and
said it's okay, it's time foryou to go, like both of our
(07:42):
children.
It took a few days for both ofour children to actually fly
down to see him, but then she'slike, it's like she gave him
permission and then, and then heand he passed.
So the next two questions kindof um, I gave curry a break,
just just so you know he I madehim go walk, take a walk.
(08:03):
He's not being punished people,he can't sit still that long.
So the questions are and thismight be hard to ask or even for
our listeners to hear theanswer to, but people have asked
us to ask how are Haas's peoplesure someone is going to die?
(08:23):
Hospice people sure someone isgoing to die, and can you share
with us things to look out forthat might indicate our loved
ones have taken that turn?
Because you talking to me andme talking to my girlfriend, I
he clearly was already in theprocess when she called hospice,
you know, looking, looking back.
So what could you share withour listeners to look out for?
Speaker 4 (08:46):
Okay, well, there are symptoms and first I want to
give them a name of a book thatanyone can get.
Okay, and this book iswonderful and it's called Gone
From my Sight.
You can get it off Amazon.
What's it called?
Gone From my Sight?
And you can get it off Amazon.
(09:07):
I think it's $7.99.
Last time I looked, it's byKaren Cantran, I think.
Yeah, I'll look it up.
I'll look it up.
Yes, and this book goes throughthe phase and it starts at
about six to four months.
Here's the symptoms you're goingto see and all diseases I don't
care what they are all diseasesare going to start having some
(09:29):
of the same symptoms.
And so when you're looking,there's a three-week prior to
any acute phase and that's wherethey just started really
slowing down.
They maybe became very quiet,pensive, they're doing a lot of
inner thing.
They seem like they're sleepingall the time, but they may
actually not be sleeping, theymay just be processing internal
(09:52):
thought in there and they starteating less.
They become much weaker.
Symptoms you're going to seethe last week to death are
symptoms like blood pressuredrop.
Hands and feet are cold.
They will also be very mottled.
(10:15):
The skin, the feet, the knees,the feet, hands.
They become purplish, pale gray, they are blotchy or mottled
that's what we call.
It is mottling and then thearms are cold, but the trunk
will feel very warm or hot, likethere is a temperature.
They may become unresponsiveNot everybody does.
(10:39):
There'll be periods of rapidbreathing where there's also a
period following where there'sapnea or no breathing and that
will start leading to a girdlingcongestion.
Now what is that?
That is because they're notswallowing and the fluid that
drains from our saliva and ournose isn't getting swallowed,
(11:03):
it's getting stuck, and so westart seeing that.
Then you start seeing increasedshallow breathing and those are
the signs and symptoms that youcan really start looking for
right away.
In that three-week period beforethat, you're going to see, like
I said, less food and drink,increased sleeping, increased
(11:26):
restlessness, increased anxiety,and almost every single patient
is going to have that increasedrestlessness and anxiety.
It is the body's lack of oxygen, the brain's lack of oxygen.
As we're getting closer todeath, it increases that
(11:46):
restlessness and anxiety.
It is also the soul trying toleave the body and that's a
difficult process, and sodefinitely everyone should get
that book.
This is a book that we gave toall our hospice clients because
(12:06):
it brings you right down to thefinal stages, so you can look at
that and say, oh whoa, maybe Ishould be calling hospice.
We got some of this stuff goingon.
So her name is Barbara Karen.
Yep, she's a registered nurse.
Speaker 3 (12:22):
Yep, just found it.
Okay, I ordered it while wewere talking.
Speaker 4 (12:26):
It's a great book.
Speaker 3 (12:32):
It's just a great book.
I keep going back to Bonnie,because she literally came on
the day after her husband passedaway because she just wanted to
share her experience to helpother people.
Sure, and everything you'resaying is I hear her telling me,
you know, as it was leading upto hospice actually coming, and
(12:57):
then, when they did come, sosomeone asked, asked, asked if
you could talk about and thiswas someone with Lewy body as
this can she talk about how wecan stop our medications, choose
to stop eating and drinkingwhen we get to the end stage, we
don't have to suffer anymore?
And there's a thing wementioned Five wishes.
Yeah, Long time ago we we talkedabout the five wishes.
Speaker 4 (13:20):
Every patient in hospice.
That's why you sit down, that'swhy you get it soon enough so
that their their wishes arebeing followed.
Um has the right to reach tostop medications, food and water
at any time they choose.
Okay, um, that's their choice.
They can choose how theirprocess is going to happen.
(13:43):
Okay.
So then the next question isgoing to be well, how long can
they live without food or water?
So that depends on theindividual.
First of all depends upon howmuch adipose tissue you got.
If you've got enough fat on you, you can live a little while.
But general rule is you canlive without food, food for up
(14:09):
to 21 days, wow, okay.
Now water is a different thing,you know, um, but I will also
tell you the body wants to getdehydrated before death, because
dehydration brings a naturalbody's pain relief.
And if you think about whenthose patients can't move
(14:31):
themselves, that skeletal systemis now the heaviest thing on
that dying patient and it'sheavy and it hurts when it gets
stiff.
And so dehydration helps kickin your own endorphins to help
relieve that pain.
And so the body's naturalresponse is to stop eating, stop
(14:52):
drinking.
But a client can choose thatwhenever they want.
That's their choice, because weacknowledge that there's a
death coming.
What happens is how do you wantit, and that's your choice.
Speaker 3 (15:08):
Yeah, Did you just sorry.
I was looking at, I'm taking itall in, Sorry.
Did you say how long they cansurvive without having?
Speaker 4 (15:17):
any water.
Yeah, that's a little bitdifferent.
And once they start gettingdehydrated then your kidneys
shut down, you know, and um,those types of things.
So that's when I always saythat that usually is that you're
going to have like five toseven days now.
And everyone's different.
Yeah, but generally um ifthey're taking a sip.
(15:41):
They might take a sip every twohours.
That may be all their bodyneeds to be to keep going.
So it it just depends on howmuch.
But if they completely stopdrinking and stuff, then you're
looking that we're getting veryclose, yeah, so especially when
the urine gets very dark, veryconcentrated, or it's stopped,
(16:03):
no urine output, and it's notbecause we have a distended
bladder.
Speaker 3 (16:07):
Right, so this question goes with that, kyra,
we always talk about pee andpoop in our support groups
because it's a thing.
Does hospice more times thannot put a catheter in to avoid
agitating the person who'sactively dying?
Speaker 4 (16:29):
Here's why we put if a catheter goes in, it's because
that patient's become bed boundand incontinent but maybe not
be at that phase yet, that acutedying phase.
To prevent bed sores and stuff.
We try not to put them in anysooner than we try not to put
(16:49):
them in at all.
But if we need to, then it'snot something we're going to do
per se at the last, unless,unless, guys, it is a comfort
measure also to the caregiver,because they can't do the
turning and the care that wellthen, that might be a reason we
(17:09):
would.
Speaker 3 (17:10):
Yeah, oh, I just had another question.
It went right in and right out.
Hopefully, hopefully, it comesback to me.
Speaker 4 (17:20):
And if we're going to talk about poop, which I don't
have any problem talking aboutbut, um, I always tell everybody
that, even up until the endstage, that last week they
didn't need to have a bowelmovement.
You have 27 feet not inchesfeet of intestine, so it takes a
(17:41):
long time for someone that'snot active.
If you're up and moving, okay,you're moving your peristalsis.
When you're no longer active,that peristalsis isn't moving.
It takes a long time to getfrom here to there, and so a
suppository needs to be given.
If you're no longer swallowingon a regular basis, okay, so
(18:03):
that those bowels are moving,because that also is a very
discomforting thing.
When you have a distendedabdomen because you've been
constipated or you haveabdominal cramping, and so your
nurse will stay on top of that,they'll either give enemas or
they'll give a suppository,those type of things.
Speaker 3 (18:19):
Yeah, I know Constipation is a big thing.
It's either one way or theother.
Right, curry One way or theother.
And here I wrote it down, how,which I was surprised.
How long do bed sores take toactually manifest?
Speaker 4 (18:38):
Let me tell you, in the dying process there was a
specific type of bed sore calleda Kennedy's ulcer.
Okay, and one can look it up.
It felt just like the kennedy'sand it is a bed sore that shows
up within 72 to 48 hours ofdeath.
It is a sign of imminent deathin some people.
(18:59):
So a caregiver changed them inthe morning, bottom looked good,
turns them over at threeo'clock in the afternoon and
this is giant purple spot ontheir coccyx area.
That's generally probably akennedy's ulcer and it's saying
life is intimate because deathis in an imminent, because
(19:21):
that's an ischemic area, thatbonyony prominence.
Blood has slowed so much it'snot getting there at all.
In a patient that's just bedbound, okay, but they're still
cognitive, they're still eatingand drinking.
As long as someone is turningthem, it doesn't generally
(19:41):
happen until you start seeingnutritional deficits.
They stop eating as much andthen they can come very quickly.
I had a sister-in-law who justrecently died herself with
hospice and she could not turnand could not stand to have her
left leg touched because shedevelops blood clot in it and
(20:04):
and so it took very and she wasa very bad brittle diabetic so
it took no time for her to startgetting some bad um the cubes
yeah, I know, um, I keep goingback to you, bonnie, if you're
listening.
Speaker 3 (20:16):
She had, didn't she tell us curry like within days,
I guess it.
I can't remember exact time,but she had said how he got bed
sores, and I was shocked that ithappened so fast, and what
you're saying.
Speaker 4 (20:32):
I'm glad I remember what I was going to ask you with
that, because that's justanother sign to look out for, I
guess when they get to that, Iguess when, when they get to
that Another sign that the bloodflow has slowed so much in that
body because that body hasslowed down and is getting very
prepared for death, that thoseareas are popping up everywhere,
(20:54):
yeah, and that's when they needto be turned.
Very often, you know, every twohours repositioned and pillowed
and stuff like that.
So that's when you want to knowyou have a really good mattress
on that hospital bed.
Speaker 3 (21:12):
Yeah, I heard one caregiver speak of terminal
agitation.
I know that kind of goes withwhat we were talking about above
, but someone wanted to knowdetails.
I guess not everyone doeseveryone in the dying process go
through that terminal agitationphase or no?
Speaker 4 (21:30):
Well, to say everyone dies is too general, because
that's not necessarily true.
You could have somebody thathas been unresponsive for a long
time.
You know that.
Let's take an Alzheimer'spatient who has not beenive for
a long time.
Okay, you know that.
Let's take an Alzheimer'spatient who has not been
cognitive for a long time in anursing home, but they still get
(21:50):
them up and they're still kindof feeding them themselves, kind
of force feeding and stuff likethat.
That patient has been slowingdown for so long they may not
have any terminal arrest.
Terminal arrest, islessness.
You see more when a patient hasbeen cognitive right till that
last couple weeks or so, thatlast three weeks, and then they
(22:11):
start having less let, then theyhave less, um, oxygen to the
brain.
Things are, you know, they'restarting to have some breathing
problems, that type of thing,and that's where that
restlessness comes in and thatagitation.
We call it terminalrestlessness, um, and they're
kind of just all over the placeand and um, they may even be I
(22:36):
gotta get out, I gotta get out,I gotta get up, I gotta get up,
those type of things that'sexactly what one of our one of
the members in our supportgroup's sister had explained to
us, which goes with your nextquestion, Curry.
Speaker 2 (22:50):
Yeah, how would hospice help someone who starts
having breathing issues?
Speaker 4 (23:06):
Well, it depends on increasing nebulization
treatment.
Maybe the person has had someaspiration and so they're having
some lung congestion, but he'sso close to death the family
does not want him treated.
Okay, so then we might bring inoxygen um for them to make, and
(23:27):
also we give some medicationstwo most common are um atropine
and scopolamine um, and thoseare really antimucolitics and um
antichologenic, and what theydo is they help dry up that
secretion that's developing,that's causing them to have some
(23:48):
breathing problems.
If it's due to that problem,we're going to teach them.
We may need to teach them raiseyour bed more often, those type
of things.
So we're going to do what wecan.
Speaker 3 (24:02):
I know, hopefully, we've asked you all the right
questions that our listenerswanted to know um, so I need to
ask you this next question doyou think we missed asking any
specific question that lovedones need to know about hospice?
Speaker 4 (24:17):
I think that you need to know about one thing for
sure Every hospice shouldprovide to a client on a mission
or within 24 to 48 hours,what's called a comfort pack.
We used to call them emergencydrug kit, so that there are
emergency things in your homethat you can, and so what
(24:37):
they're going to cover is pain.
So there's going to be someeither morphine or oxycodone one
of those things because they'reutilized not just for pain,
they're utilized for shortnessof breath.
They help bring that breathingdown so that patient is not
getting hypothyroid fromhyperventilating.
There's going to be medicationin there for secretion.
(24:58):
There should be some Tylenolsuppositories in there for
temperature.
If they're not swallowing atthat point, you're going to have
medicine in there forrestlessness.
Now you have to be careful,guys.
Remember.
You know the meds that yourLewy bodies can take alopecia
and all those type of things.
However, in the very end phase,like that last three days, that
(25:23):
is a good drug.
Maybe too if they're havingsevere agitation.
But you need to tell them upfront.
You do understand, because allhospices just kind of put that
in there unless they know, andnot all hospices are going to
know.
You like you know you.
Speaker 3 (25:40):
Yeah, and know Louie body like we know Louie body.
Speaker 4 (25:43):
That's right.
So you're going to have Tylenolin there, you're going to have
something for breathing,something for agitation,
something for pain and shortnessof breath, and that should be
there.
So they need to make sure thatthey're getting that comfort kit
.
Okay, you don't want to be twoo'clock in the morning and need
something.
They say, well, it'll be 48hours, that's the other thing.
(26:04):
A lot of companies may use adrop agency to bring your meds
to you.
It takes a while.
Ask that question.
When you sign up, do yournurses bring it out?
Can my family pick it up?
How is that going to work whenit comes to any kind of meds?
Because they should also checkall your meds every time they're
(26:27):
in the home and anythingthey're financially paying for.
They should make sure youalways have a week to two weeks
worth in a home because ofweather, you know.
So that's one thing that Ithink we need to remember.
I think the other thing is justremembering that, follow that
(26:48):
FASTA report, get someone tocome out and just assess you,
especially if you've had anyurinary tract, any bed sores,
any forms of pneumonia, whetherit's aspiration or bacterial,
because that loved one couldbenefit from this service and so
(27:08):
could you, because it's notjust for them, and remember that
assessment does not, should nothave a charge for it, for sure.
Speaker 3 (27:18):
Yeah, that's great to know.
Did you see me raising myfingers, Carrie?
Speaker 2 (27:22):
I did.
Speaker 3 (27:23):
And before Carrie starts with thanking you, I know
our girlfriend was verystressed out when they mentioned
Haldol, because those of us inthe Louis world we're like no
cross, there's no way.
But they said only given whenhe's near death, and he was.
Speaker 4 (27:47):
That's right, and it would only be given.
And I think Ativan is probablyon y'all's list too, isn't it?
Yes, yeah, yeah, and those aregenerally the first two.
But before I threw away Ativan,I would try to throw away
Thorzy.
I would say, ooh, stay awayfrom Thorzy, you know, and
(28:08):
that's one that some agenciesuse because it's an old word,
that's cheap.
And I'd say, you know, I'drather try a little liquid Xanax
, because you can do Xanax.
Right, can y'all do Xanax?
Yes, yeah, well, xanax comes ina liquid.
With lots of agencies I've hada lot of Lewy body patients that
were still ambulatory andmoving, but they were having
(28:31):
episodes of severe restlessness,agitation and stuff.
Get them a little Xanax liquidbecause they could take it.
We'd put it in a little juiceand get it down.
So you've got to let them know.
We know we can't take thesedrugs, we don't want these
things.
Only at the last thing.
Speaker 3 (28:50):
Yeah, I think all of our listeners have the NIH Lewy
Body book that lists the thingsyou can't take, because we've
got it right by our, you know,right with us.
Speaker 4 (29:01):
And that's good because you might get a hospice
that's never had a Lewy Body.
You know they're not educated.
I always speak and everybody'sdifferent, but I always believed
that before I went into apatient's home I better know
where I where I'm going andwhat's it about.
And so, even if I did not know,that disease there's a lot of a
(29:21):
lot of dementia diseases.
You know, I researched it beforeI went to that home.
I wanted to know what I shouldexpect, so I could also paint
that picture.
Yeah, okay, when are you at?
So, yeah, you want a good teamfor sure.
Speaker 2 (29:38):
It sounds like that you formed a very good team.
I've got to tell you that Iwish all hospice people were as
informed as what you are.
Yeah, Well thank you.
Speaker 4 (29:50):
I had an excellent.
I worked with an excellent team.
They weren't my team, but Iworked with excellent people and
actually I will tell you thatevery single nurse I worked with
in 20 years had never thoughtof hospice.
That God called each one ofthem.
He took some of them from laborand delivery and they became
(30:10):
the best hospice nurses you eversaw.
And I didn't go to hospice.
They came to me.
I was doing care with chronicAIDS clients and chronic
children that were born withdeficits, that were going to be
terminal, and I prayed about itand God said, yeah, that's where
you're going to be terminal.
And I didn't.
And I prayed about it and godsaid, yeah, that's where you're
going.
Wow, it was.
Speaker 3 (30:31):
It was the most rewarding, happiest 20 years of
my life wow, well, we can'tthank you enough for coming on
and sharing, and I can see why.
Thank you shout out to uh, ivaneddie, who are your brother and
sister-in-law brother-in-lawand sister-in-law.
Now I know why they put me incontact with you, vanjie,
because the information youprovide is going to help so many
(30:54):
people.
So any last final words beforewe start our ending.
Just seriously, I can't even Idon't know about you, curry, but
I feel like I'm a hospiceexpert now.
Speaker 2 (31:06):
I'm so glad that I heard all this.
Speaker 3 (31:08):
Yeah, he really needed to hear from, and this
just goes back to something yousaid, like having somebody in
hospice telling the person youneed to do this because you know
sometimes they don't listen tothe family.
It's just, it's good thatpeople are hearing this from
someone other than their lovedone.
Speaker 2 (31:27):
Definitely.
Speaker 4 (31:28):
Well, I want to thank you all for asking me.
It's been quite an honor.
It's a love that I'm nevergoing to get over.
I'm going to always be ahospice nurse, even though right
now, what I'm teaching ispeople how to have quality in a
different form, and so I truly,truly thank you.
Thank you for allowing me.
It's been an honor.
Speaker 2 (31:50):
Well, I want to personally thank you too, and I
tell you, sitting here listeningto you and all the information
that you've given out, it's justtremendous.
Speaker 3 (32:03):
I'm in awe of all your knowledge.
We have people that can't readanymore and listening is a thing
, but yeah, yeah, thank you inawe.
Yeah, because all yourknowledge.
We have people that can't readanymore, like and and listening
as a thing, but yeah, yeah,thank you well, folks, that's
all we have time for this week.
Speaker 2 (32:17):
Uh, once again, thank you, vangie, for coming on.
We really appreciate it andfolks remember you can email us
with suggestions on what you'dlike us to discuss on a future
episode, or you can ask anyquestions you have, and we'll
sure do our best to help get youthe best answers possible.
Speaker 3 (32:34):
And if you want to learn how you can become a
supporter of the podcast, pleasesee the episode notes below,
which I will remember to do.
Curry, he told me I forgot toadd that link because we post
the information under theepisode notes for you to become
a supporter, because the morepeople that support us, the more
(32:56):
people we can help.
Speaker 2 (32:58):
Okay, folks, thanks again for joining us.
Speaker 3 (33:00):
Until next week.
This is Linda.
Speaker 2 (33:03):
And Curry signing off .
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