March 24, 2025 • 47 mins
When a loved one ages beyond typical medical concerns into what Dr. Warren Wong calls "the decade of frailty," everything changes—including how we should approach their care. In this episode, geriatrician Dr. Wong reveals why elder care requires specialized knowledge that many family doctors don't possess.
Have you ever wondered why traditional medical appointments focus almost exclusively on disease management rather than your aging loved one's changing abilities? Dr. Wong explains how geriatric medicine mirrors pediatric care—but in reverse. While pediatricians track developmental milestones as children gain abilities, geriatricians monitor functional states as elderly individuals gradually lose certain capacities.
The conversation takes a surprising turn when Dr. Wong reveals common caregiving practices that can actually harm elderly skin.
For caregivers feeling overwhelmed, Dr. Wong offers a powerful concept: establishing "a line in the sand" as a necessary boundary for well-being. This acknowledgment that caregivers must recognize their limits—even as those limits may shift over time—provides both permission and wisdom for the caregiving journey. As host Jay Smiles reflects, this conversation reminds us that our efforts aren't in vain—professionals like Dr. Wong see our struggles and are working to improve support systems for caregivers everywhere.
Visit drwarrenwong.com or look for his forthcoming book "The GOLD Book: Getting Older with Love and Dignity" to access more of his practical wisdom for the caregiving journey.
Host: J Smiles Comedy
Producer: Mia Hall
Editor: Annelise Udoye
#EndAlz, #dementiacare, #dementia, #alzheimers, #alzheimerscare, #comedy #podcast, #warrenwong, #paceprogram, #eldercare #gerontology #geriatrician
"Alzheimer's is heavy but we ain't gotta be!"
IG: https://www.instagram.com/parentingup
FB: https://www.facebook.com/parentingup
YT: https://www.youtube.com/channel/UCDGFb1t2RC_m1yMnFJ2T4jw
Patreon: https://patreon.com/jsmilesstudios
TEXT 'PODCAST" to +1 404 737 1449 - to give J topic ideas, feedback, say hi!
Be sure to leave us a review!
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
I'll just give you a very simple tidbit.
When a child gets an owie, youput a band-aid on it.
Well, that's probably the worstthing to do for a frail, older
person whose skin is no longerlike the skin of a healthy
little baby.
There's actually a term for it.
It is adhesive associatedinjury.
When you buy band-aids and theysay that they stick really well
(00:24):
, those are bad band-aids.
And they say that they stickreally well, those are bad
band-aids for older people.
Because chances are, when youtake that band-aid off,
especially if it's the forearmor the hand, there's a good
chance you're going to tear theskin off too whoa, whoa, doc,
wait a minute, look where I'mfrom.
Speaker 2 (00:46):
We would say you're coming in hot Doc Attempting to
use a typical wound care bandage.
I could actually take the skinoff.
Speaker 1 (01:01):
Yes, especially if your arms or forearms have been
exposed to sun damage for years.
Your skin is a lot thinner whenyou get very old.
Even these non-stick pads canbe a little bit, sometimes stick
and still cause problems.
(01:22):
So a lot of times what Irecommend is it's just a very
simple thing People would comein and there'd be bandages all
over these horrific skin tearsthat frequently are dog-eared
skin tears and we would justshow caregivers how to actually
correctly manage a wound.
(01:42):
And you can guess, jay, how olddoes a child have to be before
they know how to use a fork anda knife?
Speaker 2 (01:50):
Okay, I'm going to guess.
Okay, I don't have kids, I'mgoing to guess three.
Speaker 1 (02:00):
No, so you don't have kids Usually using a fork and a
knife is about seven or eightyears old.
Speaker 2 (02:04):
Yeah, listen so I told you, Doc, I don't know kids
Usually using a fork and aknife is about seven or eight
years old, yeah, Listen.
So I told you, Doc, I don'tknow what the hell I'm doing.
Listen, I got my mom.
My mom is my first baby and Igot her at 63.
Speaker 1 (02:14):
You know.
So think of it this way that ifI asked you, can your mom use a
knife and a fork?
You would know the answer rightaway, or you would know no, and
so she cannot anymore.
And so that tells you something.
When I say, look at that, aha,she's not at the level where she
can use a knife and a fork.
What is she at the level of?
(02:36):
Can she use a fork?
Can she use a spoon?
Those are the kinds ofquestions that a geriatrician is
very likely to ask.
Speaker 2 (02:46):
Parenting Up caregiving adventures with
comedian Jay Smiles is theintense journey of unexpectedly
being fully responsible for mymama.
For over a decade, I've beenchipping away at the unknown,
advocating for her and pushingAlzheimer's awareness on anyone
and anything with a heartbeat.
Spoiler alert this shit isheavy.
(03:07):
That's why I started doingcomedy.
So be ready for the jokes.
Caregiver newbies, ogs andvillage members just willing to
prop up a caregiver.
You are in the right place.
Hi, this is Zeddy.
I hope you enjoy my daughter'spodcast.
(03:30):
You got, okay.
Today's supporter shout outcomes from Instagram.
Okay, it's only me Quote I lovethat you refer to your mom as
your favorite girl.
I called my mom the same aswell Emoji heart eyes.
(03:53):
Emoji blush cheeks.
You are so welcome.
She is my favorite girl.
Now, if you want to receive thespecial supporter shout out
like, review us on ApplePodcasts, instagram or YouTube.
(04:14):
Thank you.
Today's episode old peopledeserve different.
You can't just rip the band-aidoff.
Old people deserve different.
You can't just rip the band-aidoff.
Parenting up family.
I know y'all are probably sickof me telling you we did it
again, but it's not even me.
(04:35):
I didn't even do it.
The caregiving gods just decideto give me really cool people
who know really, really coolstuff about the space that we're
in.
And here it is again Dr WarrenWong.
Speaker 1 (04:54):
How you doing Doc.
Hey, jay, I'm so happy to behere.
Speaker 2 (04:57):
Thank you.
Now y'all are probablywondering, like Jay, so why is
Dr Warren Wong cool?
Well, first of all, he lives inHawaii.
In Hawaii how damn cool is that?
How many of you have ever livedin Hawaii?
I know I haven't.
I have been there, but it's.
It's cool just to say you'veever visited there.
But he actually lives there.
And then he's a geriatrician.
(05:20):
Now, all right, that's a fancyword for saying he actually, on
purpose, specializes in eldercare and then he cares about
caregivers.
How many people out thereactually care about us, right?
Usually physicians, anybody inthe medical field.
(05:43):
They're trying to take care ofour LOs and, yeah, I like that.
But hell, we're the ones doingthe heavy lifting.
Come on now.
Y'all know I'm a comedian.
We're the ones doing the heavylifting.
My mama with Alzheimer's.
She ain't done nothing hard in12 years Since she got diagnosed
.
I've been doing all the hardwork.
(06:05):
Now, okay, she is living, sheis fighting through an awful
disease, but I'm just saying,listen, I'm over here busting my
ass every day just trying tofigure out how to make her
swallow a pill.
All right, dr, talk to us abouthow.
Did you even decide thatgeriatric care was a specialty,
(06:29):
that you wanted to be involvedin, versus any other kind of
medicine.
Speaker 1 (06:32):
Well, you know, when I first started being a doctor,
I was in internal medicine inSan Francisco.
That's actually where I grew up.
I was born in San Francisco,chinatown, and I was a local boy
in San Francisco.
I was born in San Francisco,chinatown, and I was a local boy
in San Francisco, and I decidedto.
After I finished my internalmedicine training, I decided to
go back and serve my community,chinatown, and I worked at a
(06:55):
place called Onlock, which inChinese means peace and
happiness, and it takes care offrail older people and the name
says it all it's to providepeace and happiness for these
people and the medical care wasjust part of a much bigger team
(07:15):
and the day-to-day activitieswere what was really important.
Now, the Unlock was the originalsite of what maybe some of your
listeners would know about isthe PACE program your listeners
would know about is the PACEprogram, which means that it is
a Medicare approved benefit forMedicare beneficiaries who meet
the criteria for the program.
But PACE is available in manyplaces across the country.
(07:37):
It's not available everywhere,but it is a Medicare benefit.
But that's how it started andactually I wanted to segue a
little bit into like, well, howis a geriatrician different?
Speaker 2 (07:50):
And so Go right ahead , you go right ahead.
Listen, you got there before Idid.
Speaker 1 (07:58):
Okay, I'll tell you a story that I hope, but how come
you're, yes, right?
Speaker 2 (08:02):
How are you different from a family practitioner that
just happens to stick with youfrom the time that you're 30 to
40 to 60 to 70?
Speaker 1 (08:12):
So I would kind of actually say that the parallel
that I like to use the most iswe're kind of the opposite end
of the spectrum of apediatrician.
So a regular adult doctor mighttalk about your diabetes, your
(08:34):
blood pressure, your heartfailure, whereas a pediatrician
talks about developmental states, how you know, what are you
able to do, Are you able to putyour clothes on, and things like
that.
And actually as geriatricianswe see it kind of in a mirror
image of.
That is, we look not at thedevelopmental stages but we look
(08:55):
at the functional states how'syour diabetes, how's your
hypertension?
But we would go into thingslike well, what can you do now?
Are you able to manage your ownbills?
That's a certain high-levelskill.
That might be one of the firstthings to go in a person who's
(09:17):
starting to develop some degreeof Alzheimer's disease.
And then we would ask somequestions that usually most
caregivers know the answers tobut most physicians never would
ask.
For instance, I frequently askthe question is this person able
to use both a knife and a fork,or does this person just use a
(09:39):
fork, or does this person use aspoon?
And when you think about it,that's exactly the opposite of
what you see, when children,they first learn how to use
their hands, then they learn howto use a spoon, then they learn
how to use a fork.
And you can guess, Jay, how olddoes a child have to be before
they know how to use a fork anda knife?
Speaker 2 (10:04):
Okay, I'm going to guess.
Okay, I don't have kids, butI'm going to guess three.
Speaker 1 (10:13):
No, so you don't have kids.
Usually using a fork and aknife is about seven or eight
years old.
Speaker 2 (10:19):
Yeah, listen.
So I told you, doc, I don'tknow what the hell I'm doing,
listen, I got my mom.
My mom is my first baby and Igot her at 63.
Speaker 1 (10:29):
You know.
So think of it this way that ifI asked you, can your mom use a
knife and a fork?
You would know the answer rightaway, or you would know no, and
so she cannot anymore.
And so that tells you something.
When I say, look at that, aha,she's not at the level where she
can use a knife and a fork.
What is she at level of?
(10:50):
Can she use a fork?
Can she use a spoon?
Those are the kinds ofquestions that are geriatricians
very likely to ask.
Speaker 2 (10:58):
Let me tell you this, dr Warren no doctor has ever
asked me that and I've actuallybeen to some geriatricians not
not to say I'm not about todecide who is or is not doing it
right, but those are somereally great questions to think
about and think of.
You know, in terms of thedevelopmental stages, like I
(11:21):
absolutely have heard of parentsand family members say, oh, my
child is not developingaccording to statistics Because
the pediatrician said that he orshe is not speaking, or they're
not crawling, or they're notrolling the ball right, they're
(11:42):
not rolling, they're notthrowing the ball back and forth
.
Rolling the ball right, they'renot rolling, they're not
throwing the ball back and forth, but then to say that in
reverse, that's pretty powerfulfor someone.
As they age, at what age does ageriatrician get involved with
an adult?
Speaker 1 (12:00):
Well, so most of our patients are in their 80s, but
I've actually had some patientswho are as young as 40 to 50
years old that actually therewere.
Even some neurologists havesent patients to me to do a
little bit of neurocognitivestatus testing and get a second
(12:22):
opinion about how a person isdeveloping.
But most frequently ourpatients are in their 80s and
that's because I like to put itthis way is there are certain
insights that people can get, isyou know, the diseases that
people are very likely to get intheir 50s and 60s and 70s are
(12:45):
the diseases like heart failure,complications of diabetes,
kidney failure and people whoage beyond that start to get to
the age where those are not theissues.
I think of the 80s as the age,the decade of frailty.
I think of the 80s as the age,the decade of frailty.
Speaker 2 (13:07):
So I'll give you a very simple example of that, jay
how many people do you know,who are 80 years old, who are
still driving Okay, driving andthose of us who know them are
happy about it Zero.
Well, actually I know one Iactually know only of one, and
(13:29):
that person they don't drivevery far, they don't drive very
often, but it's, you know, maybelike to the post office and to
church, because church is liketwo miles away.
Speaker 1 (13:41):
So I'm gonna go with none well, the truth is actually
quite a few people at the ageof 80 are still driving and have
driver's licenses.
I think that among people whohave some dementia that's going
to be significantly less, butquite a few people at the age of
80 are driving.
Then the follow-up question ishow many of them are driving at
90?
(14:01):
Then the follow-up question ishow many of them are driving at
90?
And then the number goes quitea bit lower.
And the point is between 80 and90, it's a functional status
decline that's very commonbetween 80 and 90, is that 80 is
the decade where your abilities, regardless of whether a person
(14:24):
has Alzheimer's disease or anykind of dementia tend to go
downwards.
In the 80s, people are lesslikely to travel and, gradually,
less and less likely to be ableto do things such as driving.
So getting back to yourquestion, jay, about what age
group do most geriatricians takecare of?
We take care of people in theirusually in their 80s and beyond
(14:46):
, because their functionalstatus is starting to decline.
And when the functional statusstarts to decline, we kind of
start to look at thingsdifferently in terms of not just
worrying about the diabetes,the heart failure, we start
looking at very basic things howwell are they eating, how well
are they sleeping, what aretheir bowel movements, how much
are they able to liveindependently?
(15:07):
And then we look also at thecaregivers and say how well is
the patient able to do with thiscaregiver?
Speaker 2 (15:17):
Dr Warren, in terms of caregiving the caregivers
doing caregiving for individualswho are 70 and 80 years old
what have you noticed that thattype of caregiving requires that
may be different thanindividuals who are caring for
(15:39):
significantly younger people?
Speaker 1 (15:41):
yeah, so uh, when they're caring for younger
people, it's usually aboutchronic illness, it's about
medication management and thingslike that.
Sometimes it's about emotionalstatus, but I think it's
important to know I'm caring forthis person.
What is it that I actually needto do?
To do and it could be anythingfrom just managing bills and
(16:13):
grocery shopping, or much moredifficult is when a person
starts to really become unableto do some very basic things,
such as needing assistance toput their clothes on or going to
the bathroom or showering andbathing.
That actually is a differentset of tasks that require a
different thing from caregivers.
And then there are people whohave emotional problems,
(16:36):
feelings of loneliness, andthat's a different set of quote
tasks, but things that areimportant to do with an older
person.
Frequently, when people areyounger, it's more just about
the medication management.
Speaker 2 (16:54):
How do you figure that out, especially the
emotional loneliness?
Let's say, you, someone likemyself, you're a family member
or a friend and you see thatthis elder person that you care
for, maybe their spouse isdeceased or they're living alone
(17:15):
, or even if they're living in aassisted living community, but
they might not really havefriends Every time you go to
visit, really have friends everytime you go to visit.
This has happened to me, whereI go to visit extended relatives
and I'm like, geez, yeah, I seethat there's an activity room,
(17:35):
but my loved one is never in it.
They're always in their unit intheir apartment, but it's hard
to get involved.
Or when should you get involved?
How can you tell if they'regetting an adequate amount, I
guess, of companionship?
Hey, what's up?
Parented Up family.
Guess what.
(17:55):
Have you ever wanted to connectwith other caregivers?
You want to see more behind thescenes footage?
Want to know what me and Zeddyare doing?
I know you do All things.
Jsmiles are finally ready foryou, even when I go live.
Uh-huh, do it now with us onPatreon.
(18:18):
Join us in the Patreoncommunity.
Catch everything we're doing.
Visit Patreoncom forward.
Slash JSmilesStudios with an S.
Speaker 1 (18:33):
Yeah, so I think that's.
The first question is to findout what the actual needs are,
and there's a whole list andcategories of what kinds of
assistance people need.
List and categories of whatkinds of assistance people need
everything from just organizingtheir lives to companionship,
and I think people have ageneral understanding of what is
important to people and whatbrings light to those people.
(18:57):
And then the flip side of it iswhat are you able to deliver?
And I think that's a reallyimportant question and, as a
geriatrician.
Speaker 2 (19:05):
Dr Wong, I got it.
I just got to pause you rightthere.
What are you able to deliver?
I want everyone listening andwatching the Parenting Up
community to take that deep toyour heart and soul.
What are you able to deliver?
And I want to add, in asustained fashion don't't
promise to the person who'selderly or suffering or anybody
(19:30):
else in the family, somethingthat you can't deliver and or
consistently bring about,because that could cause a lot
of chaos in the system that istrying to create some bit of
stability for this person who isnow elderly and trying to just
(19:50):
figure out how to live in thisnew normal.
Thanks for saying that.
Speaker 1 (19:55):
Doc, and you know, it's about getting enough oxygen
for yourself, and I actuallythink that a significant amount
of time this causes familydiscord because some family
member basically saying I can'tdo this, and that's so common.
And of course it createsresentment because the other,
(20:15):
the person who's doing more, iskind of thinking, well, I can't
do this either, but they aredoing it.
Speaker 2 (20:22):
You must know my family.
Speaker 1 (20:27):
But I think part of the role of the dietician partly
is to go into these issues andsay you know, I see something
that's not quite right here.
And you know some families asibling might say I'm out of
here, I don't even want to beinvolved, and that requires some
degree of family reconciliation.
(20:48):
Well, let's break it down intowhat you actually can and cannot
do, and then you have to kindof take it for what it is.
And getting back to yourquestion about the perfect
answer to that question of howdo you make sure all your loved
one's needs are met, well, youknow I don't have an answer for
that.
Do you know why?
Because I've been at thisbusiness long enough, jay, to
(21:10):
when I make suggestions, peoplefrequently say well, say I don't
think that will work.
And the reason is because theyknow their own stories.
So what I tell them is okay.
I'm just telling you what theproblem is.
This is not working.
You need to figure it out.
And a lot of times when theyacknowledge that there's a
(21:34):
problem, they can figure it out,but when they don't acknowledge
there's a problem, it juststays a problem.
Speaker 2 (21:44):
Right, what are, what are the some of the more um,
unique stories that, uh, of yourclients or your patients that
led them to come to you?
Right, because many people juststick with their family
practitioner from the time thatthey're an adult to the time
that they find a casket, butobviously something makes them
(22:08):
shift and come to you.
So has it been like you know,hey, that family practitioner
just got to the point where heor she really was just dropping
the ball, so they ended upcoming to you.
Or do you feel that people arejust becoming we are becoming a
more intelligent, I guesscommunity and saying, oh OK, as
(22:34):
I get older, I need to find ageriatrician.
How are people getting to youroffice?
Speaker 1 (22:40):
Yeah, so I.
So this is a prior life for me.
Mostly now I'm I'm writingbooks and things like that and
doing podcasts.
But you know, in my career alot of it was word of mouth from
families.
I was getting a fair number ofreferrals from the Alzheimer's
Association.
(23:00):
But the other thing is I reallyrespect primary care doctors
and a lot of the primary caredoctors would say this is a
little bit beyond me Because youdo this all the time.
I want you involved and youknow it's one thing to go to a
(23:25):
primary care doctor says well,you need the help of a social
worker.
It's another thing to go tosomeone who actually knows the
social workers and says I thinkthis social worker would be
really good for you, for yourneeds.
Or here I know somebody at theAlzheimer's Association and it's
kind of like you.
The thing is a familypractitioner has a million
(23:48):
different things to be concernedabout Older people, frail,
older people.
That's my main course of everysingle day and I get to know the
nuts and bolts of what's goingon.
And so many physicians actuallyreferred patients to me and
says I don't know this area theway you know this area and it's
(24:09):
really interesting.
Sometimes I would get referralsand I would look at the chart
and I said I don't know why I'mgetting the referral.
And then it was always acorrect referral.
Do you know why?
Why, because the physician knewit was a correct referral, but
they never wrote down the reason.
All they would write about wasdiabetes, hypertension, heart
(24:32):
failure.
They wouldn't say things likeperson can't walk or the
person's having family problems.
They knew those things, but doyou know how many dollars people
get for documenting those kindsof things?
Zero.
So they document the thingsthat the insurers look for to
document and it's a verytraditional way of looking at
(24:54):
things.
I really admired physiciansbecause when I would talk to
them about their patients, theywould know a lot more than they
ever wrote in the chart.
They said, oh yeah, thisfamily's a real problem.
They would say things like thatand the patient needs help.
Speaker 2 (25:23):
That is very comforting, Doc.
That is very comforting.
I know you are a major, majoradvocate and supporter of
caregivers.
How did you come to know andfeel such passion for the
community of caregivers?
Speaker 1 (25:38):
Well, everybody says the physician is important,
right, important, right.
But in the daily life of aperson who has become frail and
older, you know, the care reallyis the difference between a
(26:00):
good day and not a good day,right, and this could even be
true for home health aides, whoare not paid a lot of money but
they can make all the differencein a person's well-being on any
average day.
And then, on top of that, youknow the amount of sacrifice
that's involved in that.
I've talked with familycaregivers that I would say, you
know, I really think this is alittle bit beyond the call of
(26:23):
duty.
When every day at lunchtimeyou're driving an hour home to
make sure your mom's doing okayand then driving an hour back to
work after you've checked onher in the middle, that's kind
of that's a little bit.
I don't know that that'ssustainable.
And I would say that, and youknow, let's try and figure
(26:44):
something else out.
And I would say that, and youknow, let's try and figure
something else out.
So I think, you know,caregivers are the angels, and
they're angels because there's alot of work to be done.
So I'm not an angel, I'm just.
Speaker 2 (27:15):
You know, I'm not actually going through the.
I'm not going home to take careof somebody at night, so I just
felt like this is a person whohas a life At a minimum.
(27:49):
You're an angel wing.
I'm going to say you're anangel wing stylist, so you
shampoo the wings and keep thembrushed breadth and the layers
that family caregivers and orhome health aides are having to
overcome and having to embraceevery single moment of every
single day.
What are some of the storiesthat you can share that may be a
(28:13):
little more riveting, maybeeven humorous, of things with
caregivers, with their lovedones, where, when you heard it,
you were like, is that right?
But?
But the more you heard themyou're like is that right?
But the more you heard them,you're like I guess this really
is real life for some people.
Speaker 1 (28:31):
Yeah.
So I did want to go a littlebit backwards and say that you
know.
Getting back to how is it yourinterest?
You know, we don't justinterview and examine the
patient, we also spend a lot oftime with the caregivers and in
that way it is a little bitsimilar to pediatrics you talk
(28:53):
with the parent as well as youtalk with the child and you find
out what the issues are.
You know, memory is strange,right?
So a lot of things that a personremembers are the more
difficult moments and, by theway, jay, it's so fantastic that
you do the show because you'rethe one supporting the
(29:14):
characters.
But you know, when you asked meabout some of the stories, I
always remember some of the moredifficult stories.
So One difficult story thatreally stuck in my brain was
this man who brought his wife in, who swore up and down that she
(29:40):
must have dementia, and she wasan extremely anxious woman who
had a great deal of difficultyeven listening to questions, had
a great deal of difficulty evenlistening to questions, and
more so in the presence of herhusband, who was basically
(30:01):
verbally abusive towards her,and she was extremely nervous
around him and couldn't evenhear my questions when he was in
the room and he'd saidsomething that actually really
upset me.
He said I should have divorcedher 30 years ago, and that made
(30:25):
me think, oh my goodness, whatkind of a hell does she live in?
And so that's not a, that's nota funny story, but you know, I
have to say that.
Speaker 2 (30:38):
You're right about that Well it's not funny, but
even though it isn't funny, itis very significant and I am
(31:25):
happy you shared it because itis another example of how a
person can present as thoughthey have a disease when
actually maybe it's moreenvironmental circumstances and
stress and elements that otherfamily members or their medical
team may not have picked up onthat's causing this appearance
of, you know, dementia oranxiety or what have, or what
have you and you're like OK, nowI can link all of these things
together.
Link all of these thingstogether, and here at the
Parenting Up community, ofcourse we're available, we like
to add a little levity, but themost important thing is that we
want family caregivers to beable to hear and see themselves
(31:49):
in the stories of others and Iam certain that there is someone
who needed to hear what youjust said so that they can grow
and learn and either be preparedor fortified from their story.
So thank you very much forsharing.
Speaker 1 (32:06):
Now I do remember a very funny story actually now
Okay, probably okay, that's yourdramatic f story actually now
Okay, probably okay, that's yourdramatic flair, Dr Warren.
But it was not related toAlzheimer's, but it was related
to end-of-life care.
We had the program that westarted in which we were doing
(32:27):
home visits on people who werenot on hospice but who were
terminally ill and had decidednot to go on hospice, and I was
on call and taking calls fromthese people nights and weekends
, and one night I got a callabout a person who had a cancer
(32:52):
and I was told that she wasschizophrenic as well, and so
she called me and said that shewas bleeding from her rectum and
so that's, of course, a seriousproblem.
And so I went to her home andshe was schizophrenic and it was
(33:14):
funny because she never wantedher lights on.
It was totally dark in her unit.
So I knock on the door and shesays come in.
And it's totally dark insideand I said where are you?
She says come this way and Ihave my rectal ready to do my
rectal exam and I said where areyou?
(33:36):
And then I have to guide myselfalong her body, which is
hilarious.
So I remember funny things andI remember things that upset me,
but that was extremely funny.
Speaker 2 (33:49):
Doc, how do you never mind, you don't have to recall
how you do that, but I meanshe's that feels like the worst
game of uh, halloween, thehalloween version of hide and
seek that I've ever heard.
Actually I thought here I amand I have to examine your
(34:10):
rectum in the dark for astranger like you, like I don't
even know you for real.
Speaker 1 (34:16):
But that was actually kind of a of.
I remember it mostly because inmy mind it was kind of funny.
Speaker 2 (34:23):
So yeah, well, no, that's funny to me, I mean, but
I'm a comedian, have beenprobably correctly labeled as
having odd senses of humor, andoften we go too far with where
our brains allow us to live.
(34:45):
I understand.
Tell us.
This is, first and foremost, drWong.
This has been such a wonderfulconversation.
I have appreciated everythingyou've shared.
Before we end, I want you tolet the community know about
(35:08):
your books, about yourconsulting and advisory
offerings, and where they canfind you, where they can get in
touch with you and get yourservices.
Speaker 1 (35:22):
Yeah, so I've actually been putting in years
in the writing a book.
It's still not done.
So I work on it every day.
It's going to be called theGOLD book, g-o-l-d and that's an
acronym for getting older withlove and dignity, and you know
we all pass away, but let's makesure there's love and dignity
(35:43):
in that.
And the caregiver is such acritical part of that.
And when you think about it,how many books are there written
to guide a mother about how totake care of their child?
There's tons of books.
How many books are therewritten about how to guide a
(36:04):
person to take care of theirelderly, frail mother?
Very few.
So I've been working very, veryhard, hard on that.
I work on it every day.
In the meantime I had a coupleof websites that are kind of had
little tidbits from it.
There's geriatrics withalohacom, which I'm not no
(36:26):
longer writing actively inbecause we switched over to dr
warren wongcom, but there's alot of very useful information
there about skin care and how tomanage minor skin problems, for
instance.
I'll just give you a verysimple tidbit when a child gets
(36:46):
an owie, you put a Band-Aid onit.
Well, that's probably the worstthing to do for a frail, older
person whose skin is no longerlike the skin of a healthy
little baby, because there'sactually a term for it is
adhesive associated injury.
And so when you buy Band-Aidsand they say that they stick
(37:12):
really well, buy band-aids andthey say that they stick really
well, those are bad band-aidsfor older people because chances
are, when you take thatband-aid off, especially if it's
the forearm or the hand,there's a good chance you're
going to tear the skin off too.
Speaker 2 (37:26):
Whoa, whoa Doc, wait a minute, look, and where I'm
from, it would say you're comingin hot doc, just attempting to
use a typical wound care bandage.
(37:47):
I could actually take the skinoff, yes.
Speaker 1 (37:53):
Especially if your arms or forearms have been
exposed to sun damage for years.
Yeah, your skin is a lotthinner when you get very old
and even these nonstick pads canbe a little bit sometimes stick
and still cause problems.
(38:13):
So a lot of times what Irecommend is it's just a very
simple thing People would comein and there'd be bandages all
over these horrific skin tearsthat frequently are dog-eared
skin tears, and we would justshow caregivers how to actually
correctly manage a wound and itstarted off by doing the
(38:35):
difficult job of removing theadhesive without tearing at the
skin.
And then we would show we neveruse adhesive.
We always use elastic bandsthat just wrap around.
Speaker 2 (38:50):
Really.
Yeah, it's like a netting.
So what elastic bands, bands?
Speaker 1 (38:54):
well you, I mean, if you just go to amazon, just look
for uh, dressing, netting,netting, dress dressing okay, oh
okay, you know what?
Speaker 2 (39:03):
I've seen those, yeah , and those are.
I've seen those.
Speaker 1 (39:05):
They're definitely a little bit more expensive, but
it's worth the money.
Those things are so betterYou've already sold me on it.
Speaker 2 (39:12):
Yeah, my mother will never have another band-aid
sticky nothing on her startingthis moment.
Yeah, that's easy, that's tooeasy.
Speaker 1 (39:22):
Yeah, and also avoid using dry gauze.
You know, okay, yeah, youalways need to put something on
that will keep it from stickingon the skin.
Because even the dry gauze, ifyou pull it away and there's
blood there, the blood willstick to the gauze and it starts
to pull on the skin.
Speaker 2 (39:42):
Wow, you hear that Parenting Up family Just when I
thought we were winding down theconversation.
Two major golden egg nuggetsthat's what we get here.
We always get the good stuff.
Speaker 1 (40:01):
Yeah, so that geriatrics is all how.
There's about four or fiveposts about how to take care of
the skin.
Speaker 2 (40:05):
Thank you, thank you so much, dr Warren.
We end every episode with asegment I call the snuggle up,
where it's a.
It's my perspective that if, ascaregivers, we could just
snuggle up to these moredifficult ideas, then it would
(40:30):
make the journey easier.
What is a snuggle up that youthink would benefit family
caregivers?
Speaker 1 (40:40):
Yeah.
So first of all, you, jay, are amajor snuggle up because you
know I know about your careerand how much you've turned
around and said this is reallyimportant and you know the
amount of support for caregiversis it's pretty dismal and the
(41:04):
social care services that weoffer are actually very limited,
actually very limited.
So I want to first of all give abig hurrah for you and for
caregivers as well, and you knowI did.
We talked a little bit beforeand I remember one thing that a
(41:28):
caregiver once said was I have aline in the sand, and that line
in the sand is when my husbandgets to be this way, I'm going
to have to do somethingdifferently, I'm going to have
to no longer care for him andyou know, just having that line
in the sand is good for yoursanity.
(41:50):
It's kind of say I am doing somuch, but there's a line in the
sand for my sanity and myabilities that I really need to
put out there and, interestingly, that line in the sand can move
as your abilities change.
But at least a concept ofhaving a line in the sand, that
this is not endless, thatthere's a certain amount that
(42:14):
I'm committing to, I thinkthat's really important.
Speaker 2 (42:19):
I love that.
Have a line in the sand andrecognize that it may move as
your ability and circumstanceschange.
Aloha.
Speaker 1 (42:35):
Aloha, lots of love.
Speaker 2 (42:38):
You're welcome back anytime.
Speaker 1 (42:48):
And when that book, when you're ready to release it
in part or in total, let us know.
Speaker 2 (42:50):
Okay, thanks so much, jay Dr Wong.
Thank you so much for amagnificent conversation, so
many great tidbits.
Please let the Parenting Upcommunity know where they can
find you, where they can getyour information, where they can
connect with you.
Speaker 1 (43:06):
Jay, it was just such a fantastic time I had with you
and great to see your wonderfulsmile and laugh and talk about
and then have those little ahasabout.
Oh, maybe I'm doing something Ishould change about the way I
take care of when my mom has anowie.
So I'm glad to offer thoselittle tidbits.
Speaker 2 (43:27):
What are your websites and or books that
people can look forward to, andor books that people can look
forward to.
Speaker 1 (43:36):
So the websites right now are drwarrenwongcom and
geriatricswithalohacom.
The book I'm working on stillnot out there will be about gold
getting older with love anddignity.
Speaker 2 (43:49):
Thank you so much.
Snuggle up.
Number one Folks are watchingus, y'all.
(44:11):
Dr Warren Wong has never been acaregiver, but for decades he
has watched and helped andsupported family caregivers in
multiple states, in multiplecities.
So don't lose heart.
Our efforts are not in vain.
The Calvary is coming.
(44:33):
People are doing what they canto sound the alarm.
Make sure we get betterresources, we get more attention
, we get more help.
All right, so hang in there.
Number two if you or your LOhappens to be over the age of 79
(44:58):
, consider consulting ageriatric physician.
You may not have heard of it,you may not think it's necessary
.
Perhaps you really enjoy yourfamily practitioner.
Your LO may think, oh no, Idon't want to change, there's
(45:18):
nothing wrong.
I've been with them for 20, 30years.
They helped me through thisdisease.
They know all my kids.
They helped me through divorce.
There are things that geriatricphysicians are trained to notice
, to see, to point out thatfamily practitioners it just
(45:39):
ain't they did.
You know what I mean Like acivil engineer and an architect
are not trained for the samethings, even though they both
build stuff.
All right, feel me on that.
Just consider it.
Just consider it, especially ifyou over 79.
(46:02):
All right.
Number three what are you doingright now to live long enough
to need a Dr Wong?
That's right, I'm coming in hotand I'm coming right for you.
Are you going to make it to 79plus years?
Are you going to be 80, 89, 92,101 and need a geriatrician?
(46:28):
Need somebody to actually askyou hey, are you using your fork
or are you just trying to cut asteak with a spoon?
I hope to hell somebody doeshave to ask me that.
Check your life, caregiver.
Check your life If you're notliving in a way to need a
geriatrician.
Boo, boo, boo Boo.
I'll just give you a very simple tidbit.
When a child gets an owie, youput a band-aid on it.
Well, that's probably the worstthing to do for a frail, older
person whose skin is no longerlike the skin of a healthy
little baby.
There's actually a term for it.
It is adhesive associatedinjury.
When you buy band-aids and theysay that they stick really well
(00:24):
, those are bad band-aids.
And they say that they stickreally well, those are bad
band-aids for older people.
Because chances are, when youtake that band-aid off,
especially if it's the forearmor the hand, there's a good
chance you're going to tear theskin off too whoa, whoa, doc,
wait a minute, look where I'mfrom.
Speaker 2 (00:46):
We would say you're coming in hot Doc Attempting to
use a typical wound care bandage.
I could actually take the skinoff.
Speaker 1 (01:01):
Yes, especially if your arms or forearms have been
exposed to sun damage for years.
Your skin is a lot thinner whenyou get very old.
Even these non-stick pads canbe a little bit, sometimes stick
and still cause problems.
(01:22):
So a lot of times what Irecommend is it's just a very
simple thing People would comein and there'd be bandages all
over these horrific skin tearsthat frequently are dog-eared
skin tears and we would justshow caregivers how to actually
correctly manage a wound.
(01:42):
And you can guess, jay, how olddoes a child have to be before
they know how to use a fork anda knife?
Speaker 2 (01:50):
Okay, I'm going to guess.
Okay, I don't have kids, I'mgoing to guess three.
Speaker 1 (02:00):
No, so you don't have kids Usually using a fork and a
knife is about seven or eightyears old.
Speaker 2 (02:04):
Yeah, listen so I told you, Doc, I don't know kids
Usually using a fork and aknife is about seven or eight
years old, yeah, Listen.
So I told you, Doc, I don'tknow what the hell I'm doing.
Listen, I got my mom.
My mom is my first baby and Igot her at 63.
Speaker 1 (02:14):
You know.
So think of it this way that ifI asked you, can your mom use a
knife and a fork?
You would know the answer rightaway, or you would know no, and
so she cannot anymore.
And so that tells you something.
When I say, look at that, aha,she's not at the level where she
can use a knife and a fork.
What is she at the level of?
(02:36):
Can she use a fork?
Can she use a spoon?
Those are the kinds ofquestions that a geriatrician is
very likely to ask.
Speaker 2 (02:46):
Parenting Up caregiving adventures with
comedian Jay Smiles is theintense journey of unexpectedly
being fully responsible for mymama.
For over a decade, I've beenchipping away at the unknown,
advocating for her and pushingAlzheimer's awareness on anyone
and anything with a heartbeat.
Spoiler alert this shit isheavy.
(03:07):
That's why I started doingcomedy.
So be ready for the jokes.
Caregiver newbies, ogs andvillage members just willing to
prop up a caregiver.
You are in the right place.
Hi, this is Zeddy.
I hope you enjoy my daughter'spodcast.
(03:30):
You got, okay.
Today's supporter shout outcomes from Instagram.
Okay, it's only me Quote I lovethat you refer to your mom as
your favorite girl.
I called my mom the same aswell Emoji heart eyes.
(03:53):
Emoji blush cheeks.
You are so welcome.
She is my favorite girl.
Now, if you want to receive thespecial supporter shout out
like, review us on ApplePodcasts, instagram or YouTube.
(04:14):
Thank you.
Today's episode old peopledeserve different.
You can't just rip the band-aidoff.
Old people deserve different.
You can't just rip the band-aidoff.
Parenting up family.
I know y'all are probably sickof me telling you we did it
again, but it's not even me.
(04:35):
I didn't even do it.
The caregiving gods just decideto give me really cool people
who know really, really coolstuff about the space that we're
in.
And here it is again Dr WarrenWong.
Speaker 1 (04:54):
How you doing Doc.
Hey, jay, I'm so happy to behere.
Speaker 2 (04:57):
Thank you.
Now y'all are probablywondering, like Jay, so why is
Dr Warren Wong cool?
Well, first of all, he lives inHawaii.
In Hawaii how damn cool is that?
How many of you have ever livedin Hawaii?
I know I haven't.
I have been there, but it's.
It's cool just to say you'veever visited there.
But he actually lives there.
And then he's a geriatrician.
(05:20):
Now, all right, that's a fancyword for saying he actually, on
purpose, specializes in eldercare and then he cares about
caregivers.
How many people out thereactually care about us, right?
Usually physicians, anybody inthe medical field.
(05:43):
They're trying to take care ofour LOs and, yeah, I like that.
But hell, we're the ones doingthe heavy lifting.
Come on now.
Y'all know I'm a comedian.
We're the ones doing the heavylifting.
My mama with Alzheimer's.
She ain't done nothing hard in12 years Since she got diagnosed
.
I've been doing all the hardwork.
(06:05):
Now, okay, she is living, sheis fighting through an awful
disease, but I'm just saying,listen, I'm over here busting my
ass every day just trying tofigure out how to make her
swallow a pill.
All right, dr, talk to us abouthow.
Did you even decide thatgeriatric care was a specialty,
(06:29):
that you wanted to be involvedin, versus any other kind of
medicine.
Speaker 1 (06:32):
Well, you know, when I first started being a doctor,
I was in internal medicine inSan Francisco.
That's actually where I grew up.
I was born in San Francisco,chinatown, and I was a local boy
in San Francisco.
I was born in San Francisco,chinatown, and I was a local boy
in San Francisco, and I decidedto.
After I finished my internalmedicine training, I decided to
go back and serve my community,chinatown, and I worked at a
(06:55):
place called Onlock, which inChinese means peace and
happiness, and it takes care offrail older people and the name
says it all it's to providepeace and happiness for these
people and the medical care wasjust part of a much bigger team
(07:15):
and the day-to-day activitieswere what was really important.
Now, the Unlock was the originalsite of what maybe some of your
listeners would know about isthe PACE program your listeners
would know about is the PACEprogram, which means that it is
a Medicare approved benefit forMedicare beneficiaries who meet
the criteria for the program.
But PACE is available in manyplaces across the country.
(07:37):
It's not available everywhere,but it is a Medicare benefit.
But that's how it started andactually I wanted to segue a
little bit into like, well, howis a geriatrician different?
Speaker 2 (07:50):
And so Go right ahead , you go right ahead.
Listen, you got there before Idid.
Speaker 1 (07:58):
Okay, I'll tell you a story that I hope, but how come
you're, yes, right?
Speaker 2 (08:02):
How are you different from a family practitioner that
just happens to stick with youfrom the time that you're 30 to
40 to 60 to 70?
Speaker 1 (08:12):
So I would kind of actually say that the parallel
that I like to use the most iswe're kind of the opposite end
of the spectrum of apediatrician.
So a regular adult doctor mighttalk about your diabetes, your
(08:34):
blood pressure, your heartfailure, whereas a pediatrician
talks about developmental states, how you know, what are you
able to do, Are you able to putyour clothes on, and things like
that.
And actually as geriatricianswe see it kind of in a mirror
image of.
That is, we look not at thedevelopmental stages but we look
(08:55):
at the functional states how'syour diabetes, how's your
hypertension?
But we would go into thingslike well, what can you do now?
Are you able to manage your ownbills?
That's a certain high-levelskill.
That might be one of the firstthings to go in a person who's
(09:17):
starting to develop some degreeof Alzheimer's disease.
And then we would ask somequestions that usually most
caregivers know the answers tobut most physicians never would
ask.
For instance, I frequently askthe question is this person able
to use both a knife and a fork,or does this person just use a
(09:39):
fork, or does this person use aspoon?
And when you think about it,that's exactly the opposite of
what you see, when children,they first learn how to use
their hands, then they learn howto use a spoon, then they learn
how to use a fork.
And you can guess, Jay, how olddoes a child have to be before
they know how to use a fork anda knife?
Speaker 2 (10:04):
Okay, I'm going to guess.
Okay, I don't have kids, butI'm going to guess three.
Speaker 1 (10:13):
No, so you don't have kids.
Usually using a fork and aknife is about seven or eight
years old.
Speaker 2 (10:19):
Yeah, listen.
So I told you, doc, I don'tknow what the hell I'm doing,
listen, I got my mom.
My mom is my first baby and Igot her at 63.
Speaker 1 (10:29):
You know.
So think of it this way that ifI asked you, can your mom use a
knife and a fork?
You would know the answer rightaway, or you would know no, and
so she cannot anymore.
And so that tells you something.
When I say, look at that, aha,she's not at the level where she
can use a knife and a fork.
What is she at level of?
(10:50):
Can she use a fork?
Can she use a spoon?
Those are the kinds ofquestions that are geriatricians
very likely to ask.
Speaker 2 (10:58):
Let me tell you this, dr Warren no doctor has ever
asked me that and I've actuallybeen to some geriatricians not
not to say I'm not about todecide who is or is not doing it
right, but those are somereally great questions to think
about and think of.
You know, in terms of thedevelopmental stages, like I
(11:21):
absolutely have heard of parentsand family members say, oh, my
child is not developingaccording to statistics Because
the pediatrician said that he orshe is not speaking, or they're
not crawling, or they're notrolling the ball right, they're
(11:42):
not rolling, they're notthrowing the ball back and forth
.
Rolling the ball right, they'renot rolling, they're not
throwing the ball back and forth, but then to say that in
reverse, that's pretty powerfulfor someone.
As they age, at what age does ageriatrician get involved with
an adult?
Speaker 1 (12:00):
Well, so most of our patients are in their 80s, but
I've actually had some patientswho are as young as 40 to 50
years old that actually therewere.
Even some neurologists havesent patients to me to do a
little bit of neurocognitivestatus testing and get a second
(12:22):
opinion about how a person isdeveloping.
But most frequently ourpatients are in their 80s and
that's because I like to put itthis way is there are certain
insights that people can get, isyou know, the diseases that
people are very likely to get intheir 50s and 60s and 70s are
(12:45):
the diseases like heart failure,complications of diabetes,
kidney failure and people whoage beyond that start to get to
the age where those are not theissues.
I think of the 80s as the age,the decade of frailty.
I think of the 80s as the age,the decade of frailty.
Speaker 2 (13:07):
So I'll give you a very simple example of that, jay
how many people do you know,who are 80 years old, who are
still driving Okay, driving andthose of us who know them are
happy about it Zero.
Well, actually I know one Iactually know only of one, and
(13:29):
that person they don't drivevery far, they don't drive very
often, but it's, you know, maybelike to the post office and to
church, because church is liketwo miles away.
Speaker 1 (13:41):
So I'm gonna go with none well, the truth is actually
quite a few people at the ageof 80 are still driving and have
driver's licenses.
I think that among people whohave some dementia that's going
to be significantly less, butquite a few people at the age of
80 are driving.
Then the follow-up question ishow many of them are driving at
90?
(14:01):
Then the follow-up question ishow many of them are driving at
90?
And then the number goes quitea bit lower.
And the point is between 80 and90, it's a functional status
decline that's very commonbetween 80 and 90, is that 80 is
the decade where your abilities, regardless of whether a person
(14:24):
has Alzheimer's disease or anykind of dementia tend to go
downwards.
In the 80s, people are lesslikely to travel and, gradually,
less and less likely to be ableto do things such as driving.
So getting back to yourquestion, jay, about what age
group do most geriatricians takecare of?
We take care of people in theirusually in their 80s and beyond
(14:46):
, because their functionalstatus is starting to decline.
And when the functional statusstarts to decline, we kind of
start to look at thingsdifferently in terms of not just
worrying about the diabetes,the heart failure, we start
looking at very basic things howwell are they eating, how well
are they sleeping, what aretheir bowel movements, how much
are they able to liveindependently?
(15:07):
And then we look also at thecaregivers and say how well is
the patient able to do with thiscaregiver?
Speaker 2 (15:17):
Dr Warren, in terms of caregiving the caregivers
doing caregiving for individualswho are 70 and 80 years old
what have you noticed that thattype of caregiving requires that
may be different thanindividuals who are caring for
(15:39):
significantly younger people?
Speaker 1 (15:41):
yeah, so uh, when they're caring for younger
people, it's usually aboutchronic illness, it's about
medication management and thingslike that.
Sometimes it's about emotionalstatus, but I think it's
important to know I'm caring forthis person.
What is it that I actually needto do?
To do and it could be anythingfrom just managing bills and
(16:13):
grocery shopping, or much moredifficult is when a person
starts to really become unableto do some very basic things,
such as needing assistance toput their clothes on or going to
the bathroom or showering andbathing.
That actually is a differentset of tasks that require a
different thing from caregivers.
And then there are people whohave emotional problems,
(16:36):
feelings of loneliness, andthat's a different set of quote
tasks, but things that areimportant to do with an older
person.
Frequently, when people areyounger, it's more just about
the medication management.
Speaker 2 (16:54):
How do you figure that out, especially the
emotional loneliness?
Let's say, you, someone likemyself, you're a family member
or a friend and you see thatthis elder person that you care
for, maybe their spouse isdeceased or they're living alone
(17:15):
, or even if they're living in aassisted living community, but
they might not really havefriends Every time you go to
visit, really have friends everytime you go to visit.
This has happened to me, whereI go to visit extended relatives
and I'm like, geez, yeah, I seethat there's an activity room,
(17:35):
but my loved one is never in it.
They're always in their unit intheir apartment, but it's hard
to get involved.
Or when should you get involved?
How can you tell if they'regetting an adequate amount, I
guess, of companionship?
Hey, what's up?
Parented Up family.
Guess what.
(17:55):
Have you ever wanted to connectwith other caregivers?
You want to see more behind thescenes footage?
Want to know what me and Zeddyare doing?
I know you do All things.
Jsmiles are finally ready foryou, even when I go live.
Uh-huh, do it now with us onPatreon.
(18:18):
Join us in the Patreoncommunity.
Catch everything we're doing.
Visit Patreoncom forward.
Slash JSmilesStudios with an S.
Speaker 1 (18:33):
Yeah, so I think that's.
The first question is to findout what the actual needs are,
and there's a whole list andcategories of what kinds of
assistance people need.
List and categories of whatkinds of assistance people need
everything from just organizingtheir lives to companionship,
and I think people have ageneral understanding of what is
important to people and whatbrings light to those people.
(18:57):
And then the flip side of it iswhat are you able to deliver?
And I think that's a reallyimportant question and, as a
geriatrician.
Speaker 2 (19:05):
Dr Wong, I got it.
I just got to pause you rightthere.
What are you able to deliver?
I want everyone listening andwatching the Parenting Up
community to take that deep toyour heart and soul.
What are you able to deliver?
And I want to add, in asustained fashion don't't
promise to the person who'selderly or suffering or anybody
(19:30):
else in the family, somethingthat you can't deliver and or
consistently bring about,because that could cause a lot
of chaos in the system that istrying to create some bit of
stability for this person who isnow elderly and trying to just
(19:50):
figure out how to live in thisnew normal.
Thanks for saying that.
Speaker 1 (19:55):
Doc, and you know, it's about getting enough oxygen
for yourself, and I actuallythink that a significant amount
of time this causes familydiscord because some family
member basically saying I can'tdo this, and that's so common.
And of course it createsresentment because the other,
(20:15):
the person who's doing more, iskind of thinking, well, I can't
do this either, but they aredoing it.
Speaker 2 (20:22):
You must know my family.
Speaker 1 (20:27):
But I think part of the role of the dietician partly
is to go into these issues andsay you know, I see something
that's not quite right here.
And you know some families asibling might say I'm out of
here, I don't even want to beinvolved, and that requires some
degree of family reconciliation.
(20:48):
Well, let's break it down intowhat you actually can and cannot
do, and then you have to kindof take it for what it is.
And getting back to yourquestion about the perfect
answer to that question of howdo you make sure all your loved
one's needs are met, well, youknow I don't have an answer for
that.
Do you know why?
Because I've been at thisbusiness long enough, jay, to
(21:10):
when I make suggestions, peoplefrequently say well, say I don't
think that will work.
And the reason is because theyknow their own stories.
So what I tell them is okay.
I'm just telling you what theproblem is.
This is not working.
You need to figure it out.
And a lot of times when theyacknowledge that there's a
(21:34):
problem, they can figure it out,but when they don't acknowledge
there's a problem, it juststays a problem.
Speaker 2 (21:44):
Right, what are, what are the some of the more um,
unique stories that, uh, of yourclients or your patients that
led them to come to you?
Right, because many people juststick with their family
practitioner from the time thatthey're an adult to the time
that they find a casket, butobviously something makes them
(22:08):
shift and come to you.
So has it been like you know,hey, that family practitioner
just got to the point where heor she really was just dropping
the ball, so they ended upcoming to you.
Or do you feel that people arejust becoming we are becoming a
more intelligent, I guesscommunity and saying, oh OK, as
(22:34):
I get older, I need to find ageriatrician.
How are people getting to youroffice?
Speaker 1 (22:40):
Yeah, so I.
So this is a prior life for me.
Mostly now I'm I'm writingbooks and things like that and
doing podcasts.
But you know, in my career alot of it was word of mouth from
families.
I was getting a fair number ofreferrals from the Alzheimer's
Association.
(23:00):
But the other thing is I reallyrespect primary care doctors
and a lot of the primary caredoctors would say this is a
little bit beyond me Because youdo this all the time.
I want you involved and youknow it's one thing to go to a
(23:25):
primary care doctor says well,you need the help of a social
worker.
It's another thing to go tosomeone who actually knows the
social workers and says I thinkthis social worker would be
really good for you, for yourneeds.
Or here I know somebody at theAlzheimer's Association and it's
kind of like you.
The thing is a familypractitioner has a million
(23:48):
different things to be concernedabout Older people, frail,
older people.
That's my main course of everysingle day and I get to know the
nuts and bolts of what's goingon.
And so many physicians actuallyreferred patients to me and
says I don't know this area theway you know this area and it's
(24:09):
really interesting.
Sometimes I would get referralsand I would look at the chart
and I said I don't know why I'mgetting the referral.
And then it was always acorrect referral.
Do you know why?
Why, because the physician knewit was a correct referral, but
they never wrote down the reason.
All they would write about wasdiabetes, hypertension, heart
(24:32):
failure.
They wouldn't say things likeperson can't walk or the
person's having family problems.
They knew those things, but doyou know how many dollars people
get for documenting those kindsof things?
Zero.
So they document the thingsthat the insurers look for to
document and it's a verytraditional way of looking at
(24:54):
things.
I really admired physiciansbecause when I would talk to
them about their patients, theywould know a lot more than they
ever wrote in the chart.
They said, oh yeah, thisfamily's a real problem.
They would say things like thatand the patient needs help.
Speaker 2 (25:23):
That is very comforting, Doc.
That is very comforting.
I know you are a major, majoradvocate and supporter of
caregivers.
How did you come to know andfeel such passion for the
community of caregivers?
Speaker 1 (25:38):
Well, everybody says the physician is important,
right, important, right.
But in the daily life of aperson who has become frail and
older, you know, the care reallyis the difference between a
(26:00):
good day and not a good day,right, and this could even be
true for home health aides, whoare not paid a lot of money but
they can make all the differencein a person's well-being on any
average day.
And then, on top of that, youknow the amount of sacrifice
that's involved in that.
I've talked with familycaregivers that I would say, you
know, I really think this is alittle bit beyond the call of
(26:23):
duty.
When every day at lunchtimeyou're driving an hour home to
make sure your mom's doing okayand then driving an hour back to
work after you've checked onher in the middle, that's kind
of that's a little bit.
I don't know that that'ssustainable.
And I would say that, and youknow, let's try and figure
(26:44):
something else out.
And I would say that, and youknow, let's try and figure
something else out.
So I think, you know,caregivers are the angels, and
they're angels because there's alot of work to be done.
So I'm not an angel, I'm just.
Speaker 2 (27:15):
You know, I'm not actually going through the.
I'm not going home to take careof somebody at night, so I just
felt like this is a person whohas a life At a minimum.
(27:49):
You're an angel wing.
I'm going to say you're anangel wing stylist, so you
shampoo the wings and keep thembrushed breadth and the layers
that family caregivers and orhome health aides are having to
overcome and having to embraceevery single moment of every
single day.
What are some of the storiesthat you can share that may be a
(28:13):
little more riveting, maybeeven humorous, of things with
caregivers, with their lovedones, where, when you heard it,
you were like, is that right?
But?
But the more you heard themyou're like is that right?
But the more you heard them,you're like I guess this really
is real life for some people.
Speaker 1 (28:31):
Yeah.
So I did want to go a littlebit backwards and say that you
know.
Getting back to how is it yourinterest?
You know, we don't justinterview and examine the
patient, we also spend a lot oftime with the caregivers and in
that way it is a little bitsimilar to pediatrics you talk
(28:53):
with the parent as well as youtalk with the child and you find
out what the issues are.
You know, memory is strange,right?
So a lot of things that a personremembers are the more
difficult moments and, by theway, jay, it's so fantastic that
you do the show because you'rethe one supporting the
(29:14):
characters.
But you know, when you asked meabout some of the stories, I
always remember some of the moredifficult stories.
So One difficult story thatreally stuck in my brain was
this man who brought his wife in, who swore up and down that she
(29:40):
must have dementia, and she wasan extremely anxious woman who
had a great deal of difficultyeven listening to questions, had
a great deal of difficulty evenlistening to questions, and
more so in the presence of herhusband, who was basically
(30:01):
verbally abusive towards her,and she was extremely nervous
around him and couldn't evenhear my questions when he was in
the room and he'd saidsomething that actually really
upset me.
He said I should have divorcedher 30 years ago, and that made
(30:25):
me think, oh my goodness, whatkind of a hell does she live in?
And so that's not a, that's nota funny story, but you know, I
have to say that.
Speaker 2 (30:38):
You're right about that Well it's not funny, but
even though it isn't funny, itis very significant and I am
(31:25):
happy you shared it because itis another example of how a
person can present as thoughthey have a disease when
actually maybe it's moreenvironmental circumstances and
stress and elements that otherfamily members or their medical
team may not have picked up onthat's causing this appearance
of, you know, dementia oranxiety or what have, or what
have you and you're like OK, nowI can link all of these things
together.
Link all of these thingstogether, and here at the
Parenting Up community, ofcourse we're available, we like
to add a little levity, but themost important thing is that we
want family caregivers to beable to hear and see themselves
(31:49):
in the stories of others and Iam certain that there is someone
who needed to hear what youjust said so that they can grow
and learn and either be preparedor fortified from their story.
So thank you very much forsharing.
Speaker 1 (32:06):
Now I do remember a very funny story actually now
Okay, probably okay, that's yourdramatic f story actually now
Okay, probably okay, that's yourdramatic flair, Dr Warren.
But it was not related toAlzheimer's, but it was related
to end-of-life care.
We had the program that westarted in which we were doing
(32:27):
home visits on people who werenot on hospice but who were
terminally ill and had decidednot to go on hospice, and I was
on call and taking calls fromthese people nights and weekends
, and one night I got a callabout a person who had a cancer
(32:52):
and I was told that she wasschizophrenic as well, and so
she called me and said that shewas bleeding from her rectum and
so that's, of course, a seriousproblem.
And so I went to her home andshe was schizophrenic and it was
(33:14):
funny because she never wantedher lights on.
It was totally dark in her unit.
So I knock on the door and shesays come in.
And it's totally dark insideand I said where are you?
She says come this way and Ihave my rectal ready to do my
rectal exam and I said where areyou?
(33:36):
And then I have to guide myselfalong her body, which is
hilarious.
So I remember funny things andI remember things that upset me,
but that was extremely funny.
Speaker 2 (33:49):
Doc, how do you never mind, you don't have to recall
how you do that, but I meanshe's that feels like the worst
game of uh, halloween, thehalloween version of hide and
seek that I've ever heard.
Actually I thought here I amand I have to examine your
(34:10):
rectum in the dark for astranger like you, like I don't
even know you for real.
Speaker 1 (34:16):
But that was actually kind of a of.
I remember it mostly because inmy mind it was kind of funny.
Speaker 2 (34:23):
So yeah, well, no, that's funny to me, I mean, but
I'm a comedian, have beenprobably correctly labeled as
having odd senses of humor, andoften we go too far with where
our brains allow us to live.
(34:45):
I understand.
Tell us.
This is, first and foremost, drWong.
This has been such a wonderfulconversation.
I have appreciated everythingyou've shared.
Before we end, I want you tolet the community know about
(35:08):
your books, about yourconsulting and advisory
offerings, and where they canfind you, where they can get in
touch with you and get yourservices.
Speaker 1 (35:22):
Yeah, so I've actually been putting in years
in the writing a book.
It's still not done.
So I work on it every day.
It's going to be called theGOLD book, g-o-l-d and that's an
acronym for getting older withlove and dignity, and you know
we all pass away, but let's makesure there's love and dignity
(35:43):
in that.
And the caregiver is such acritical part of that.
And when you think about it,how many books are there written
to guide a mother about how totake care of their child?
There's tons of books.
How many books are therewritten about how to guide a
(36:04):
person to take care of theirelderly, frail mother?
Very few.
So I've been working very, veryhard, hard on that.
I work on it every day.
In the meantime I had a coupleof websites that are kind of had
little tidbits from it.
There's geriatrics withalohacom, which I'm not no
(36:26):
longer writing actively inbecause we switched over to dr
warren wongcom, but there's alot of very useful information
there about skin care and how tomanage minor skin problems, for
instance.
I'll just give you a verysimple tidbit when a child gets
(36:46):
an owie, you put a Band-Aid onit.
Well, that's probably the worstthing to do for a frail, older
person whose skin is no longerlike the skin of a healthy
little baby, because there'sactually a term for it is
adhesive associated injury.
And so when you buy Band-Aidsand they say that they stick
(37:12):
really well, buy band-aids andthey say that they stick really
well, those are bad band-aidsfor older people because chances
are, when you take thatband-aid off, especially if it's
the forearm or the hand,there's a good chance you're
going to tear the skin off too.
Speaker 2 (37:26):
Whoa, whoa Doc, wait a minute, look, and where I'm
from, it would say you're comingin hot doc, just attempting to
use a typical wound care bandage.
(37:47):
I could actually take the skinoff, yes.
Speaker 1 (37:53):
Especially if your arms or forearms have been
exposed to sun damage for years.
Yeah, your skin is a lotthinner when you get very old
and even these nonstick pads canbe a little bit sometimes stick
and still cause problems.
(38:13):
So a lot of times what Irecommend is it's just a very
simple thing People would comein and there'd be bandages all
over these horrific skin tearsthat frequently are dog-eared
skin tears, and we would justshow caregivers how to actually
correctly manage a wound and itstarted off by doing the
(38:35):
difficult job of removing theadhesive without tearing at the
skin.
And then we would show we neveruse adhesive.
We always use elastic bandsthat just wrap around.
Speaker 2 (38:50):
Really.
Yeah, it's like a netting.
So what elastic bands, bands?
Speaker 1 (38:54):
well you, I mean, if you just go to amazon, just look
for uh, dressing, netting,netting, dress dressing okay, oh
okay, you know what?
Speaker 2 (39:03):
I've seen those, yeah , and those are.
I've seen those.
Speaker 1 (39:05):
They're definitely a little bit more expensive, but
it's worth the money.
Those things are so betterYou've already sold me on it.
Speaker 2 (39:12):
Yeah, my mother will never have another band-aid
sticky nothing on her startingthis moment.
Yeah, that's easy, that's tooeasy.
Speaker 1 (39:22):
Yeah, and also avoid using dry gauze.
You know, okay, yeah, youalways need to put something on
that will keep it from stickingon the skin.
Because even the dry gauze, ifyou pull it away and there's
blood there, the blood willstick to the gauze and it starts
to pull on the skin.
Speaker 2 (39:42):
Wow, you hear that Parenting Up family Just when I
thought we were winding down theconversation.
Two major golden egg nuggetsthat's what we get here.
We always get the good stuff.
Speaker 1 (40:01):
Yeah, so that geriatrics is all how.
There's about four or fiveposts about how to take care of
the skin.
Speaker 2 (40:05):
Thank you, thank you so much, dr Warren.
We end every episode with asegment I call the snuggle up,
where it's a.
It's my perspective that if, ascaregivers, we could just
snuggle up to these moredifficult ideas, then it would
(40:30):
make the journey easier.
What is a snuggle up that youthink would benefit family
caregivers?
Speaker 1 (40:40):
Yeah.
So first of all, you, jay, are amajor snuggle up because you
know I know about your careerand how much you've turned
around and said this is reallyimportant and you know the
amount of support for caregiversis it's pretty dismal and the
(41:04):
social care services that weoffer are actually very limited,
actually very limited.
So I want to first of all give abig hurrah for you and for
caregivers as well, and you knowI did.
We talked a little bit beforeand I remember one thing that a
(41:28):
caregiver once said was I have aline in the sand, and that line
in the sand is when my husbandgets to be this way, I'm going
to have to do somethingdifferently, I'm going to have
to no longer care for him andyou know, just having that line
in the sand is good for yoursanity.
(41:50):
It's kind of say I am doing somuch, but there's a line in the
sand for my sanity and myabilities that I really need to
put out there and, interestingly, that line in the sand can move
as your abilities change.
But at least a concept ofhaving a line in the sand, that
this is not endless, thatthere's a certain amount that
(42:14):
I'm committing to, I thinkthat's really important.
Speaker 2 (42:19):
I love that.
Have a line in the sand andrecognize that it may move as
your ability and circumstanceschange.
Aloha.
Speaker 1 (42:35):
Aloha, lots of love.
Speaker 2 (42:38):
You're welcome back anytime.
Speaker 1 (42:48):
And when that book, when you're ready to release it
in part or in total, let us know.
Speaker 2 (42:50):
Okay, thanks so much, jay Dr Wong.
Thank you so much for amagnificent conversation, so
many great tidbits.
Please let the Parenting Upcommunity know where they can
find you, where they can getyour information, where they can
connect with you.
Speaker 1 (43:06):
Jay, it was just such a fantastic time I had with you
and great to see your wonderfulsmile and laugh and talk about
and then have those little ahasabout.
Oh, maybe I'm doing something Ishould change about the way I
take care of when my mom has anowie.
So I'm glad to offer thoselittle tidbits.
Speaker 2 (43:27):
What are your websites and or books that
people can look forward to, andor books that people can look
forward to.
Speaker 1 (43:36):
So the websites right now are drwarrenwongcom and
geriatricswithalohacom.
The book I'm working on stillnot out there will be about gold
getting older with love anddignity.
Speaker 2 (43:49):
Thank you so much.
Snuggle up.
Number one Folks are watchingus, y'all.
(44:11):
Dr Warren Wong has never been acaregiver, but for decades he
has watched and helped andsupported family caregivers in
multiple states, in multiplecities.
So don't lose heart.
Our efforts are not in vain.
The Calvary is coming.
(44:33):
People are doing what they canto sound the alarm.
Make sure we get betterresources, we get more attention
, we get more help.
All right, so hang in there.
Number two if you or your LOhappens to be over the age of 79
(44:58):
, consider consulting ageriatric physician.
You may not have heard of it,you may not think it's necessary
.
Perhaps you really enjoy yourfamily practitioner.
Your LO may think, oh no, Idon't want to change, there's
(45:18):
nothing wrong.
I've been with them for 20, 30years.
They helped me through thisdisease.
They know all my kids.
They helped me through divorce.
There are things that geriatricphysicians are trained to notice
, to see, to point out thatfamily practitioners it just
(45:39):
ain't they did.
You know what I mean Like acivil engineer and an architect
are not trained for the samethings, even though they both
build stuff.
All right, feel me on that.
Just consider it.
Just consider it, especially ifyou over 79.
(46:02):
All right.
Number three what are you doingright now to live long enough
to need a Dr Wong?
That's right, I'm coming in hotand I'm coming right for you.
Are you going to make it to 79plus years?
Are you going to be 80, 89, 92,101 and need a geriatrician?
(46:28):
Need somebody to actually askyou hey, are you using your fork
or are you just trying to cut asteak with a spoon?
I hope to hell somebody doeshave to ask me that.
Check your life, caregiver.
Check your life If you're notliving in a way to need a
geriatrician.
Boo, boo, boo Boo.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Intentionally Disturbing
Join me on this podcast as I navigate the murky waters of human behavior, current events, and personal anecdotes through in-depth interviews with incredible people—all served with a generous helping of sarcasm and satire. After years as a forensic and clinical psychologist, I offer a unique interview style and a low tolerance for bullshit, quickly steering conversations toward depth and darkness. I honor the seriousness while also appreciating wit. I’m your guide through the twisted labyrinth of the human psyche, armed with dark humor and biting wit.