Dr. Nabili received his undergraduate degree from the University of California, San Diego (UCSD), majoring in chemistry and biochemistry. He then completed his graduate degree at the University of California, Los Angeles (UCLA). His graduate training included a specialized fellowship in public health where his research focused on environmental health and health-care delivery and management.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In the United States, four out of every five adults has no advance
directive, a situation that some have likened to taking your car to
the mechanic and saying, "I think it needs a tune-up, but if you find
something really wrong with it, just go ahead and fix it, even if it
won't run afterward? And by the way, please charge me for the work
and if I can't pay for it, I'm sure my estate will!"
When asked what would provide a good death, the majority of
Americans answer, in essence; "Quick, painless, at home, and
surrounded by family."
In 1950, about half of Americans who died did so at home. Now,
about 85% of Americans die in a health-care setting: a hospital, a
nursing home, or a rehabilitation center. At least 12% die in an
intensive-care unit.
Over the past three decades, the United States -- all 50 states
and the District of Columbia -- have passed laws to legalize the use
of living wills, health-care proxies, and/or the durable power of
attorney. The U.S. federal government has validated state laws on
advance directives through the 1991 Patient Self- Determination Act.
And the U.S. Supreme Court has handed down an opinion acknowledging
the congruence of the Constitution of the United States with state
laws on the right to designate future medical treatment.
When do advance directives become helpful?
Advance directives become active when a patient is no longer able to make
his/her own health-care decisions or becomes mentally incapacitated. Until such point is reached, the patient is the ultimate decision maker regarding their health.
Some common scenarios where these directives can help with the decision making
process are
critical medical illness affecting mental capacity.
Advance directives not only help with decision-making in times of incapacity, but they can also clarify one's preferences during times of uncertainties while still cognitively intact. At times, deciding whether to accept or decline a treatment may overwhelm a person and cast uncertain on their judgment. By referring to previously delineated preferences based on overall goals of care, such decisions may become simpler to make as smaller components of
a bigger picture.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Dementia is a significant loss of intellectual abilities such as memory capacity, severe enough to interfere with social or occupational functioning. There are different criteria classification schemes for dementias such as cortical, subcortical, progressive, primary, and secondary dementias. Other conditions and medication reactions can also cause dementia. Dementia is diagnosed based on a certain set of criteria. Treatment for dementia is generally focused on the symptoms of the disease.
Suicide is the process of intentionally ending one's own life. Approximately 1 million people worldwide commit suicide each year, and 10 million to 20 million attempt suicide annually.
Alzheimer's disease is a common cause of dementia. Symptoms and warning signs of Alzheimer's disease include memory loss, difficulty performing familiar tasks, disorientation to time and place, misplacing things, and more. The biggest risk factor for Alzheimer's disease is increased age. Treatment for Alzheimer's is often targeted toward decreasing the symptoms and progression of the disease.
Coma is the inability to waken or react to the surrounding environment. The Glasgow Coma Scale is frequently used to measure the depth of coma. Causes of coma include trauma, bleeding, edema, lack of oxygen, poisoning, or hypoglycemia. Prognosis for a patient in a coma depends on the cause of the coma.
Most often, caregivers take care of other adults who are ill or disabled. Less often, caregivers are grandparents raising their grandchildren. The majority of caregivers are middle-aged women. Caregiving can be very stressful, so it's important to recognize when it's putting to much strain on you and to take steps to prevent/relieve stress.
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