Jarrod Shapiro, DPM
We're All Caregivers

A few weeks ago, I was really tested as a caregiver. My wife contracted influenza and was in terrible shape for most of the week. To make matters worse, I had a very busy workweek and was on call – a relatively busy one at that. My wife was so sick that she wasn't able to get out of bed and couldn't take care of our two kids (Lazarus 9 years old and Lyra 3 years old). In case this wasn't bad enough, my wife and I don't have any family nearby to help in situations like this.

This presented a very difficult situation for my family, and it started me thinking about caregivers. During the week my wife was sick, and I was the caregiver for everyone. My son was able to take care of my daughter while I was at work (with a lot of preparation). One of my partners covered my office hours one day when my wife's illness was too severe for me to leave, and I had to take care of all the cooking, cleaning and home incidentals. Between taking care of my wife, kids and work, I probably slept a few hours each night.

At the end of this, I was left with one major impression: caregivers have it hard.

Luckily my situation was temporary. As a caregiver, I am young, healthy and able to handle whatever comes along, and have the extra advantage of being able to function on very little sleep.

But what about those caregivers in permanent situations?

As a foil for my situation, one of my patients has been dealing with a chronic ulcerative condition for more than a year. This patient is older and not healthy. My patient is cared for by a daughter and her husband. Under normal conditions, my patient is not greatly difficult to care for, but a few weeks ago, the daughter underwent surgery herself, making it impossible for her to be the primary caregiver. Luckily, she had her husband to help. However, this situation – like mine – presented significant difficulties.

What happens when the caregiver needs care? This can be a terrible situation. I recently met an uninsured man with acute Charcot neuroarthropathy who was the breadwinner for his family. He had a very physical job that would not allow him to remain nonweightbearing and in a cast for the several months necessary to resolve his acute problem. He just had to work. It was either work or starve. What a terrible situation for him and his family. He was stuck. His personal situation made appropriate care impossible, and he is highly likely to experience future complications if his Charcot collapse progresses any further. It's really a catch 22.

Tonight's Premier Lecture is
New Approaches to Tinea Pedis
and Onychomycisis
Warren S Joseph, DPM, FIDSA

This is unfortunately a common situation that many of us do not fully appreciate. Quittner and associates reported a nine country epidemiological study looking at the prevalence of depression in patients with cystic fibrosis and their caregivers. It is obvious that depression was very high in the patients, but elevated anxiety was also found in 32% of the adult caregivers (2-3 times community levels). Levels of depression were similarly elevated.¹

You might argue that this seems intuitive, and I would agree with you. Caregivers have unrelenting strain and anxiety dealing day in and day out with not only the illness of the patient, but also their own personal issues. It's surprising that more caregivers are not depressed.

As a physician, I try to remain cognizant of just how difficult it is for my patients dealing with either chronic disease or acute situations. Consider, for example, a patient undergoing right foot surgery. They may not only be nonweightbearing on crutches but have other significant limitations. Climbing stairs may be dangerous or impossible. Driving a car is prohibited. Some previously simple activities of daily living such as doing the laundry and washing dishes are extremely difficult while standing on one foot. The list of new limitations may be daunting.

As a result, one of the first pieces of information I obtain when evaluating a preoperative patient or one about to experience significant limitations (for example a wound care patient) is their social situation. This generally includes the following:

Pre-Operative Patient Social Situation Review

	•	Employment situation – Including level of activity, need for restrictions, and openmindedness (as experienced by the patient).
	•	Driving environment – Type of car (left foot surgery allows driving unless the car is a stick-shift) and ability to carpool or have someone chauffer the patient (especially to the postop appointments).
	•	Home physical environment – Type of house, number of stairs into the house, inside the house, number of levels, carpets, location of the bathroom, and shower set-up.
	•	How malleable the home situation is – Will it be possible to set the patient up on the first floor of a two floor home?.
	•	Level of caregiver support – Is there an able adult who can provide the patient significant help?.
	•	Family situation – For example, is the patient a major caregiver for others?.
	•	Upcoming travel plans – Never good to find out your patient plans to travel to Europe two weeks after their triple arthrodesis.
	•	Other concerns of the patient

As a final thought, when speaking to my patients in situations where someone is providing caregiving for them, I will check in with their caregiver to make sure they are taking care of him or herself. If the caregiver becomes ill from lack of self-care, it can become a significant problem with few solutions. Keeping in mind that each of us is a caregiver to someone will help us stay in the humanistic frame of mind necessary to make the best decisions with our patients.

Best wishes,

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]