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CHIROPRACTIC AND HEALTHY JOINTS

Human joints come in many shapes and sizes and allow us to move and carry out normal activities of daily living. Joint health is imperative. Without joints, we would be rigid and immobile. But they are also often injured, causing pain and discomfort. Almost 80% of injury-related healthcare visits (that’s about 65.8 million visits per year) are the result of musculoskeletal injuries involving bones, joints and muscles. Commonly injured joints include the knees, shoulders, ankles and spine.

How do joints work?

Joints are designed to withstand the loads placed on them and provide a full range of motion. Each joint is made up of at least two surfaces that touch each other and allow for movement. These include ball-and-socket joints like the hip, hinge joints like the knee and elbow, and gliding joints like those in the spine.

The bones that make up the joint allow for movement, and the muscles that pull the bones produce the movement. Muscles are attached to bones by structures called tendons. Tendons must be both strong to facilitate movement and compliant to prevent damage to the muscle tissues. Ligaments, which are stiff structures that connect bones, help to prevent excessive movement.

Muscles, tendons and ligaments are attached around each joint at very specific positions, with joint surfaces shaped in exact dimensions. Fluid within most of the joints lubricates the joint surfaces to reduce friction and allow for lifelong use.

How do I keep joints in good shape?

The movements that you perform on a daily basis are critical to long-term joint health, as are proper nutrition, a healthy exercise regimen and a healthy lifestyle. Proper lifting is also important.

Moving a joint through its full range of motion serves several important purposes. Joints are not supplied directly with blood as are other organs within the body, so the saying “Use it or lose it” applies to joint function.

Most joints in the body are lined with cartilage—a firm but pliable tissue that covers the surfaces of the bones that make up the joint. Cartilage within a joint is nourished by synovial fluid, which is “forced” into the joint cartilage through a process called imbibition.

The pressure within the joint providing nourishment to the cartilage occurs only when joint movement happens. This is why movement is critical to joint health. Grinding of bone on bone without a cartilage covering leads to degenerative joint disease, tearing up the bones and creating cysts, bone spurs and excess bone production.

A spinal disc is made up of two parts: a larger, outer-most, more ligament-like portion, and an inner jelly-like portion. These two structures are primarily fluid- or water-based, and they also rely on movement for their nourishment. Therefore, movement in the spine is also critical to the health of the spinal joints.

Proper diet and nutrition also contribute to joint health by providing the joints with enough healthy nutrients for long-term stability and resistance to wear and tear. A healthy lifestyle – one that is free from tobacco products and other toxins – helps to ensure proper blood supply to tissues surrounding joints and speeds up the healing of joint injuries when they occur.

How are joints injured?

Most of the injuries to joints occur because abnormal stresses are placed on a normal joint. A joint can be injured acutely from a single traumatic event, like an ankle sprain. The ankle joint is protected by ligaments on the inside and outside. When the ankle moves excessively inward, the ligaments on the outside of the joint are torn. The ankle swells, leading to bruising and pain. In some cases, small pieces of bone and cartilage may be torn away. Fracture of the tibia and/or fibula (ankle bones) can also occur.

Other joint injuries are called repetitive-stress injuries or cumulative-trauma disorders. These injuries occur when relatively small abnormal stresses are repeatedly placed on normal joints. The stresses placed on joints by poor posture, poor joint position during the performance of a task, and/or poor workstation ergonomics make these joints more likely to be injured.

How can I prevent joint injuries?

There are three basic principles that are especially important when considering the impact of proper joint movement:

• When lifting an object, be sure that the largest muscles in the area perform the task. The larger the muscle or muscle group utilized for lifting, the less stress placed on smaller, more vulnerable muscles and the joint itself.

• During any activities, you should be able to comfortably assume several different postures, to avoid staying in one posture for extended periods. Muscles will fatigue and joints are more likely to be injured when you hold a particular posture, especially a poor one, such as staying partially bent forward at the waist.

• When performing tasks, keep the joints that are being used either in their neutral posture or approximately halfway into their range of motion. Working with your joints at the extremes of their ranges of motion for prolonged periods places abnormal stress on those joints and can result in repetitive-stress injuries.

When lifting heavy objects, follow these simple suggestions:

• When lifting anything from the floor, keep the spine straight and lift with the legs.

• Do not bend over at the waist and lift primarily with the muscles of the low back. Your body is more easily injured in this position.

• Keep the object being lifted close to your body.

• Keep your elbows flexed.

• Keep your head up and your neck straight as you lift.

If you experience pain, consult your doctor of chiropractic. Chiropractors are uniquely trained to treat common musculoskeletal conditions, including low back pain, neck pain and joint pain. They can also help you choose proper rehabilitation exercises and prevention techniques to get you back on your feet and reduce the likelihood of future injuries.

Feeding Everyone On Busy Spring Evenings

I know that spring is just about here when I hear the ding of baseball bats in the evenings as I’m driving past the recs and parks — it’s a sound I love! Softball was one of the great loves of my life when I was growing up, and I love watching my boys play baseball. As is often the case with me, the food associated with baseball and softball is also part of my love of the sports — I’m sure I caught the unmistakable smell of French fries and Swedish fish recently! Even though we rarely buy food from the concession stands, I still get a thrill out of the spring-sports-food smells, and I like to have something delicious for us to eat while at the games.

I only have two little guys playing baseball this year, but between their games and practices and my older boys’ track meets, many of our evenings this spring will be spent at the field or the track. I’ve written a couple of articles in the past about foods that are easy to bring on the road for dinner, which I’m going to update below, but I also wanted to share for the younger parents that what started as a necessity for us has become not so necessary: when my kids were all little, they couldn’t wait until we got home at 7:00 or later from games to eat, so I either had to feed them before we left the house, which would mean eating before 5:00 (ridiculously early for our daily schedule), or bring food with us. But now, the kids are all old enough that if I wanted to wait until we got home to feed them dinner, that would be fine! It’s amazing how things change as kids get older!

I still find bringing food to the field to be easier than putting dinner together after getting home, and more fun too — we all love it, seriously! As long as I stick to my simple system, our sports dinners are streamlined and satisfying.

My basic formula is: entrée (protein + carb/grain) + fruit + dessert. I like the entrée to be a cooked item (even though it’s no longer hot when it’s time to eat); the fruit is either fresh fruit or applesauce pouches; dessert is usually a prepackaged baked good. I find this to be an easy formula to work with and it provides a meal that’s easy enough to transport. Favorite entrees include:

Hot dogs, meatballs (frozen), chicken nuggets (frozen), taquitos (frozen), dumplings (frozen), salt potatoes with beef jerky or sausage

All of these things are easily cooked on a baking sheet in a 400 degree oven for twenty minutes while I’m getting everyone ready to go. Hot dogs get put in buns; meatballs are either eaten as they are, or I’ll bring a bag of slider rolls with us; chicken nuggets are well paired with chips/pretzels/popcorn; taquitos don’t need anything else, nor do dumplings. As for salt potatoes, this Syracuse favorite is easy to prepare, and a big hit with my boys! Boil the small potatoes in heavily salted water for twenty minutes or so, and that’s it. My boys eat them like apples! For protein, I will usually either bring a box of beef jerky, or, if I’m feeling energetic, I’ll cook breakfast sausage links in the oven while the potatoes are boiling (can you tell I’m a big fan of cooking things in the oven? Even things that don’t include that information in its preparation instructions! Twenty minutes at 400 degrees is perfect for lots of things). 

Go-to fruit options are grapes, strawberries, clementines, applesauce pouches

For fruit, I find bringing a big bowl of washed grapes makes all my boys happy. Less easy and more expensive but still part of our rotation are strawberries. A bag of clementines is easy to bring and particularly perfect on hot days. I also always have applesauce pouches on hand, so they do nicely as well. 

Desserts include cookies, donuts, brownies, rice crispy treats.

We are big fans of prepackaged Hannaford cookies, Stewart’s donuts, Cosmic brownies, and rice crispy treats! They’re good incentives for the boys (especially the littlest boys) to eat the rest of the food I bring.

As for drinks, sometimes I’ll bring juice pouches or boxes, but I prefer for them each to bring their own water bottle. I also bring a bag of lollipops to encourage my youngest to keep it together until the sporting event is over. And I only bring napkins, no plates, bowls, or utensils. I try to keep it as easy as possible! Whatever isn’t eaten at the field is brought home and everyone can have more there if they want; if all the food is gone and they’re still hungry, they’re also welcome to have cereal when we get home. (I also leave some of what I make at home for anyone who doesn’t go to the game or meet.)

This is the way we eat two or three times a week from the second half of April through the middle of June. I hope it’s helpful for some of you as you navigate your evening spring activities (and really, all of your evening activities all year long!).

Kate and her husband have seven sons ages 18, 16, 14, 13, 11, 8, and 4. Email her at kmtowne23@gmail.com.

Saratoga Senior Center Calendar

April Events at the Center! 

Live Music with Rod Driscoll 

Friday, April 14 • 2 p.m. 

$10. Pizza from 9 Miles East served! A lively & engaging concert featuring golden oldies and classic popular music from the 1930’s all the way to the 1960’s. Swing, sway and sing a long with Rod’s singing and guitar playing. Laugh along with his jokes, stories and off beat humor! Join us for a great afternoon of music and fun! 

Trivia Night!

Monday, April 17 • 5:15 p.m.

“Where all those useless facts you’ve been collecting can finally come in handy!” Pizza bites served. Bring your own beverage. Join us for fun, friendly competition! Prizes! Please sign up, seating is limited. $5. Sponsored by Humana.

PaL’s Meals To Go 

Prepared meals you just have to heat up. Pick up any time Monday or Tuesday between 9:30 & 3:30 p.m. Order by noon the Friday before.

Monday, April 17 and Tuesday, April 18: 

Baked chicken, roasted potatoes, carrots

Monday, April 24 and Tuesday April 25: 

Meatloaf, mashed potatoes, gravy

Tarot Card Reading

facilitated by Mary Shimp

Thursday, April 20 • 10-2 p.m.

$5 donation. Do you have some unanswered questions about your life? A tarot card reading provides insight into what the future holds. Call for a 15 minute appointment.

AARP Driver Safety Course

facilitated by Warren Lavery

Friday, April 21 • 9:30-4 p.m.

In-person at the Senior Center. $25 for AARP members and $30 for non-members. Payment by Check only, made out to AARP. Bring your drivers license and AARP card to the training. Bring your own lunch and beverage. Advance registration required, seating is limited. Call the front desk at 518-584-1621.

The Wild Irish Acres Step Dancers under the direction of Terri Hughes 

Sunday, April 23 • 4 p.m. 

A return visit from these lively dancers. Irish step

dance is a wonderful celebration of the arts and Ireland’s unique culture. Please sign up. 

Beading Workshop 

facilitated by Jerry Matthews

Monday, April 24  • 1:30 p.m.

$10 materials fee. Whether you are just beginning or an experienced beader, join Jerry to create beautiful and one of a kind jewelry. Please sign up, seating is limited.

Dine in Dinner – Old Bryan Inn

Tuesday, April 25 • 5:30 p.m.

Dinners are held at the Senior Center. $12 per dinner. Roast pork with Honey Sage Gravy. Please sign up. Sponsored by Humana.

ADVANCED DIRECTIVES WORKSHOP AND PANEL DISCUSSION

Wednesday, April 26 • 1:30 p.m. 

Light Lunch. 2 p.m. Film and Panel Discussion.

St. Peter’s Health Partners Medical Associates -Palliative Care Partners in conjuction with the Saratoga Senior Center will be presenting the documentary film Extremis. Extremis is a short documentary that follows Dr. Jessica Zitter, an ICU and palliative care specialist who leads a hospital ICU team. The film addresses the challenges patients and families face when making decisions in the midst of a medical crisis. During the panel discussion following the film, we will be discussing the importance of advance care planning and serious illness discussions. RSVP is requested as seating is limited. Call the Senior Center at 518-584-1621

Controlled Chaos Improv Performance Troupe

Friday, April 28 • 3 p.m.

$5. Refreshments served. Do you love watching “Whose Line Is It Ayway?” Then this is the show for you. Controlled Chaos loves to “mix things up” by making each show unique in its selection of short-form games, in- cluding some they invented themselves. They are not afraid to try anything! 

Poetry Workshop

facilitated by Marissa, Senior Skidmore Student

Fridays • 2 p.m.

Love poetry? Marissa is bringing poetry to you in all different manners. Poetry bingo, make a song sonnet, share your favorite poems, learn some basic poetic tecniques and write a poem! Please sign up, seating is limited.

NEW! Massages facilitated by Zuzia

Wednesdays • 11 a.m. – 1 p.m.

$5 donation. Zuzia’s work is deeply relaxing and supports profound release, gently and effectively, of long.

How To Avoid Mosquitos Using a Natural DIY Repellent

How to Avoid Mosquitos Using a Natural DIY Repellent 

With the change of seasons comes pesky ticks, mosquitoes and biting flies. Mosquitos can be quite the nuisance, producing itchy little bumps. However, on the rare occasion they have been known to be carriers of West Nile Virus (WNV). According to the New York State Department of Health, “Mosquitoes become infected (with WNV) when they feed on infected birds. The infected mosquitoes can then spread the virus to humans and other animals.” NYSDH also states that “In humans, WNV may cause a mild illness, but may also cause encephalitis (inflammation of the brain) or meningitis (inflammation of the lining of the brain and spinal cord).” While these instances are rare, it is important to reduce the threat of disease and find ways to protect yourself as well as avoid the unpleasant side effects associated with mosquito bites.

Why Are Mosquitoes and Biting Insects Attracted to Us?

It has been said that mosquitoes will travel upwards of one to two miles in search of a meal (your blood) and they are mostly attracted to carbon dioxide emitted by humans and animals. The more carbon dioxide you emit, the greater the attraction.

Genetics are also said to play a role in how humans attract mosquitos. Individuals with higher concentrations of natural steroids and cholesterol on their skin, those who produce higher amounts of acids (uric) may be more likely to attract mosquitoes.

On the upside there are some tactics to reduce the likelihood of getting bitten. There’s also a simple and effective recipe to ward off these pesky critters. 

Tips to Avoid Mosquito Bites
• Avoid wearing sweet smells, perfumes and colognes (especially those with nonanaldehyde-this will increase your chances of getting a bite by 50%)
• Avoid wearing black, cyan, red and orange. A recent study conducted by the University of Washington, found that black attracts mosquitoes the most, while colors like green, purple, blue and white may actually deter different species of mosquitoes.
• Avoid drinking alcohol, eating bananas and sweets, as these items sweeten up your blood and make you very attractive to these little vamps.
• Wear long sleeve tops and full coverage on legs, when outside during mosquito season.  Be careful not to wear loose clothing, when going outside, as loose clothes can trap insects, especially an issue for ticks.
• In addition to covering oneself, there are other options like bug repellants to help prevent bites, however avoid DEET where possible due to the potential toxicity and hazards linked to effects on the central nervous system.

Why to Avoid DEET Where Possible

DEET (also named N,N-diethyl-meta-toluamide) is one of the key ingredients found in common on-the-shelf bug repellant products. DEET is an organic solvent used in plastic and rubber cements and paint removers. The Medical Sciences Bulletin, published by Pharmaceutical Information Associates Ltd. reported, “Up to 56% of DEET applied topically penetrates intact human skin and 17% is absorbed into the bloodstream.” DEET is absorbed by the skin and gut and the most serious concerns about DEET are its effects on the central nervous system. 

A Duke University study revealed that combined exposure to DEET and an ingredient called permethrin, a mosquito spray ingredient, can lead to motor deficits, as well as learning and memory dysfunction. Another 2009 study indicated that DEET is not only a behavior modifying chemical, but that it also inhibits cholinesterase activity, one of many important enzymes needed for the proper functioning of the nervous systems in humans, animals and insects, putting it in a class with other hazardous pesticides that have been shown to do the same.

Natural Repellents As An Alternative

Natural bug repellent has a long use throughout history. Some people swear by folk methods such as ingesting large amounts of garlic, however there is little evidence as to whether or not garlic is effective for everyone. Other proactive treatments include taking Vitamin B at least a month before mosquito season, but the jury is still out on this too. While it doesn’t hurt to try these, it is suggested to wear a bug repellant, and below is an easy recipe to get you started.

Essential Oils Used  to Repel Biting Insects

First off let’s explore some plant based ingredients and essential oils that are used in natural bug repellents to ward off mosquitoes and biting insects. All of these essential oils can be purchased at www.saratogabotanicals.com: lemon eucalyptus, citronella, peppermint, lemongrass, geranium (also effective for ticks), pine, cedar, thyme, clove, patchouli, wintergreen, and tea tree (also effective for ticks).

The most effective essential oils for repelling mosquitoes include citronella, thyme oil, geranium, peppermint oil, cedar oil, patchouli and clove, which have been found to repel malaria, filarial and yellow fever vectors (in countries with these known risks) for periods of 60-180 minutes. The most effective for ticks are tea tree and geranium.

DIY Natural Bug Repellent Spray

When following this recipe it’s important not to make any essential oil substitutions without fully researching the individual oil and possible contraindications. Also safety first: Gloves, goggles, and protect your surfaces. Essential oils are strong and must always be diluted for use on the skin. The following essential oils were chosen because they are considered generally safe and non-toxic for use on people, with some exceptions. Recipes that will be used on children over the age of three should contain no more than 1% essential oils. Avoid use on children under the age of three years old. This  recipe contains approximately 2%. If you intend to use this on children, only use half of the amounts indicated for each essential oil. Avoid use if pregnant or breastfeeding and always consult your doctor should you have a chronic medical condition or concerns regarding essential oil use.

Ingredients:

• 4 oz of carrier oil (jojoba, sunflower, olive oil, neem etc)

• 15 drops of citronella oil

• 15 drops lemongrass essential oil

• 10 drops lemon eucalyptus essential oil

• 5 drops thyme essential oil

• 3 drops peppermint essential oil

Instructions:

Pour carrier oils into desired container. Add essential oil drops. Shake well to incorporate ingredients and also before each and every use. Label your product and keep it out of reach of children. 

And voila! You’ve got a natural solution to ward off those pesky biters just in time for the spring and summer months!

Staying Fit as You Get Older

Exercise is often prescribed for patients of all ages to reduce complaints about pain in muscles and bones, but some feel it gets harder to exercise as they get older. The social aspect of exercise is huge. Exercise is becoming more and more popular among older adults. Seniors can interact with each other while they are at their local gyms. Nowadays, many gyms have hours of operation that are friendly to seniors.

Health and social benefits aside, many seniors still have questions about exercise:

I’ve been inactive for so long. Won’t it hurt to exercise?

You can always become as physically fit as possible, given your current health status and limitations. When you commit to a physical fitness program, you will move toward enjoying life more fully.

First, pick an activity that you enjoy doing and perform it regularly. Make your exercise program as pleasant as possible. If you feel exercising is a chore, you will be uncomfortable with the program and will quit. If you can, ask a friend to exercise with you so you can support each other.

Second, begin your exercise program gradually, starting with five minutes of exercise each day. As you become more comfortable with the routine and notice the positive effects of fitness, you may increase the exercise time.

If you have been inactive for some time, you may feel some small aches and pains. They will fade with time. Be sure to tell your doctor if you experience any unusual pain or other symptoms during or after your exercises. Check with your doctor of chiropractic before starting any exercise or physical fitness program. While exercise is beneficial to your health, the type of exercises you perform can be affected by your health status.

How do I start?

Develop a plan for an exercise program and stick with it. Make your exercise program an integral part of your normal daily activities – or use normal daily activities to help your muscles and bones become as healthy as possible.

• Research shows that “functional exercises”— those that mimic actual daily activities, such as walking up and down stairs and getting in and out of a chair — can be quite effective.

• Research suggests that people who live in two-story houses are less prone to certain types of heart disease. Repeatedly climbing a flight of stairs or rising from and returning to a seated position helps build leg strength and aerobic fitness. If you hold a weight during these exercises, you can increase your level of physical activity even further.

• Household chores, such as vacuuming, loading and emptying the dishwasher and moving wet laundry from the washer to the dryer can increase strength and flexibility. Lift with your legs, when necessary.

I don’t feel as strong as I used to. Can I still exercise?

• As we age, we lose muscle mass. Some healthcare providers suggest that weight training will help prevent strength loss and keep patients feeling younger. Unfortunately, many seniors find they can’t lift the heavy weights necessary to actually build muscle mass, but don’t be discouraged. Recent studies show that while muscle strength diminishes with age, muscle endurance does not. It means that, as we get older, we may benefit from switching strength exercises to endurance exercises, working muscles with lighter weights for a longer period of time.

Exercises that emphasize endurance, such as dancing, walking or bicycling, may be not only more beneficial but also more enjoyable. Many senior citizens have neighborhood areas where they can get together to walk. Walking with a family member or friend helps your physical fitness — and helps build relationships. These exercises are also aerobic and will benefit your heart health. For people who cannot walk or ride a bike, there are endurance- and flexibility-enhancing exercises that can be performed in a chair. Set goals for yourself that can be tracked and make exercise a part of your overall health plan.

I have arthritis. How can I exercise safely?

Physical activity actually decreases arthritic pain. Many people with rheumatic conditions are physically inactive. There is oftentimes a fear factor for seniors when it comes to activity and arthritic pain – a social fear, a fear of pain, a fear of falling, etc.

However, for those with arthritis, the worst thing they can do is stop moving. In most cases, you can — and should — exercise.

In fact, recent research has shown that older people with arthritis gain modest improvements in physical function, pain, general mobility and flexibility, when participating in long-term exercise programs. Water-based exercises, such as swimming or “water walking” can work on joints without putting them through the stress of weight bearing. If necessary, your doctor can show you how to use a cane, a walker or other assistive devices to help prevent falls and injuries while you are physically active.

Which fitness program will help me most?

The best exercise program should be tailored to your individual health status. Your doctor of chiropractic can help you plan the fitness program that is right for you. Typically, low-impact activities that keep joints moving and minimize pain, such as walking, swimming and water-based exercise, are effective. Research has shown that exercise can reduce joint stiffness, pain and inflammation associated with arthritic conditions, which affect most of us as we age.

Doctors of chiropractic can not only help restore muscle and joint function that have been affected by injury, illness and age-related conditions, but they can also maintain the health and flexibility of your muscles and bones. They often prescribe exercise to prevent and treat many of these conditions, helping older patients to remain active and independent.

Dr. Matt Smith has been a Chiropractor in Saratoga Springs for 36 years. He and his daughter Dr. Kevy Smith Minogue can be reached at 518-587-2064 or at MySaratogaChiropractor.com.

Medical Decision Making In Your Estate Plan – The Documents You Need And How They Work

Medical decision making, especially in times of crisis, can be fraught with challenges. If you are not able to make your wishes known at the time, your family may be put in the difficult position of making decisions for you without knowing what you would want. The situation will potentially get worse if family members disagree about what action to take.

To spare yourself and your family from these problems, it is wise to plan ahead for your medical decision making. The documents that should be part of that plan are a Health Care Proxy and a Living Will. In addition, based on your particular circumstances, it may be advisable to complete a Medical Orders for Life-Sustaining Treatment (MOLST) form.

What is a Health Care Proxy?

A Health Care Proxy is a legal document that allows you to appoint an individual, your “agent,” to make medical decisions for you. It only becomes effective in the event that you are no longer able to make those decisions for yourself. If that time comes, your Health Care Proxy agent will ensure that your individual wishes are conveyed to your health care providers.

Do I need a Health Care Proxy?

It is recommended that you have a Health Care Proxy. It allows you to have a trusted person be your voice in the event you are unable to make your own health care decisions. Everyone over the age of eighteen (18) should appoint a health care agent.

How do I choose a Health Care Proxy Agent?

Your agent should be someone you trust, for example a spouse, other family member, or trusted friend. You should choose someone that you believe will adhere to your wishes and instructions. A successor agent should be chosen in the event your primary agent is unable to act for any reason. It is imperative that you discuss your wishes regarding your care, clearly and in detail, with your agent.

What as a Living Will?

A Living Will is a legal document in which a person directs the types and duration of treatment, such as artificial nutrition, he or she would want to receive if ill and unable to communicate their wishes at the time of treatment. 

Do I need a Living Will?

It is advisable, because if you do not have a Living Will, the decisions regarding your medical treatment may become a dispute between family members and doctors. Such a dispute may result in a judicial proceeding to determine your wishes. Having a Living Will increases the chances that the decisions made regarding your care will be consistent with what you want.

Do I need a living will if I already have a health care proxy?

A Living Will is different from a Health Care Proxy. It does not appoint an agent to make your decisions. It serves as a way to express in greater detail the types of decisions you would want your Health Care Proxy agent to make. 

What kind of wishes should I address in my Living Will?

You should address whatever is important to you regarding your health care decision making. For example, people often describe their wishes regarding the administration of artificial hydration and nutrition, their religious beliefs regarding illness and death, and their thoughts regarding physician assisted termination of life.  

How does a Living Will become valid?

There are no formal requirements for executing a Living Will. It is suggested that to be sure your Living Will constitutes “clear and convincing evidence” of your wishes, you should put your desires in writing, and sign and date the document in the presence of two witnesses. 

What as a Molst?

A Medical Orders for Life-Sustaining Treatment (MOLST) form (NYS DOH-5003) is a medical order form printed on bright pink paper signed by a patient or their representative and a physician, nurse practitioner, or physician’s assistant. The MOLST form details the patient’s medical orders for life sustaining treatment.

How is a Molst different from a Health Care Proxy or Living Will?

The MOLST form is not intended to replace a Health Care Proxy or Living Will, and it is not generally completed as part of a person’s normal estate planning. Instead, it is often used in cases where a patient has serious health conditions, which potentially could result in their death within the next year.

What type of issues does a Molst address?

A MOLST form addresses whether the patient wants particular medical interventions or assistance, such as cardio-pulmonary resuscitation (CPR), intubation, transfer to a hospital, and artificially administered fluid and nutrition. If these interventions or types of assistance are not authorized, then medical providers would be directed to not provide them.

As part of proper estate planning, it would be advisable that you have a Health Care Proxy and Living Will. A MOLST form would likely not be necessary, unless you are facing serious health challenges that may result in your passing within the next year. These documents, along with a Power of Attorney, a Will, and/or a Trust are the basic components of a proper estate plan.

Matthew J. Dorsey, Esq. is a Senior Partner with O’Connell and Aronowitz, 1 Court St, Saratoga Springs. Over his twenty-five years of practice, he has focused on the areas of elder law, estate planning, and estate administration. Mr. Dorsey can be reached at 518-584-5205, mdorsey@oalaw.com and www.oalaw.com

Things Will Get Better

If there is one word to describe the current public sentiment, it’s “tired.”

For the better part of the last three years, it seems, we’ve been moving from crisis to crisis to crisis, and people are simply exhausted. 

It began with the life-bending changes that came with the pandemic, and the government’s well-intended but socially and financially damaging, and often contradictory response. We’ve been subjected to forced isolation which has exacerbated already prevalent mental health and substance abuse issues. Despite the daily sacrifices, more than a million of our friends still succumbed to the disease.

And now, even the most trivial political issues are being leveraged to pit family against family and neighbor against neighbor on a daily basis. Many of us walk on eggshells in order not to inadvertently wade into a political fight, while others troll for sport to instigate them. 

For the last year, we watched as the wanton printing of money spawned the highest inflation in over four decades, absolutely eviscerating the purchasing power of the middle and lower-middle classes, and decimating their ability to provide for their families. All the while, the Fed’s ham-handed strategy of rapid monumental interest rate increases to rein in inflation, which it insisted against every economic principle was “transitory”, has already resulted in a handful of notable bank failures, and greater economic uncertainty. 

There’s an old Chinese curse that says, “May you live in interesting times.” I think it’s fair to say that we are, and have been, and the hits just keep coming. 

For the last year, market conditions have been the worst we’ve seen in nearly fifteen years. As a Certified Financial Planner® professional, people ask me all the time if my phone is ringing off the hook. People assume there is a lot of panic among those planning for their major financial goals. The truth is, I rarely get any panicked calls. 

People have been living with heightened stress for so long that most seem to be taking the market in-stride. While past performance is no guarantee of future results, every US market downturn, no matter how deep, has eventually resolved itself, with markets going on to find new highs. The US economy is so massive and diverse that it has successfully grown itself out of every problem it has ever faced. This time should be no different.  

I know you’re tired. We’ve all been coping with the experiences of the last few years in our own ways. The tide is out right now, but it will come back. We’ll all appreciate it a bit more when it does. Continue to keep your chin up, and your head on straight. 

Remember to work with your trusted advisors to help you navigate these uncertain times. Things will get better.

Stephen Kyne, CFP® is a Partner at Sterling Manor Financial in Saratoga Springs and Rhinebeck. Securities offered through Cadaret, Grant & Co., Inc. Member FINRA/SIPC. Advisory services offered through Sterling Manor Financial, LLC, an SEC registered investment advisor or Cadaret Grant & Co., Inc. Sterling Manor Financial and Cadaret, Grant are separate entities.

How Your Will Controls Your Assets After You Pass Away – The Difference Between Probate and Non-Probate Assets

People sometimes come to me unsure about the distinction between probate and non-probate assets.  The primary distinction is that probate assets are considered to be within your probate estate and therefore are controlled by the terms of your Will.  Non-probate assets are not considered to be within your probate estate and therefore are not controlled by the terms of your Will.

In order to better understand the distinction, I often describe assets as falling into one of three different baskets.

ASSET BASKET NUMBER ONE:  Asset basket number one includes all the assets you have which are titled in your name only.  They are not jointly held with anyone else and they are not payable to a named beneficiary in the event that you pass away.

ASSET BASKET NUMBER TWO:  Asset basket number two includes all the assets that you have which are jointly held with someone else.  These assets generally will automatically pass on to the other joint owner upon your death.

ASSET BASKET NUMBER THREE:  Asset basket number three includes all the assets you have which are payable to a named beneficiary outside of your Will.  These assets will pass to the named beneficiary upon your death, regardless of what your Will says.

These distinctions are important because your Will only controls the assets in basket number one.  Examples of basket number one assets includes things such as:  a car titled just in your name, stock which is only held by you, and any bank account that you have not titled in any way with someone else.  Basket one assets are probate assets.

Examples of basket two assets include things such as:  a home you own jointly with your spouse, a bank account you have jointly with a parent, and jointly held securities.  None of these assets will be controlled by the terms of your Will if you die and are survived by your joint asset owner.  Basket two assets are non-probate assets.

Examples of basket three assets include things such as:  life insurance payable to a specific person or persons, retirement accounts (like an IRA or 401k) payable to a specific person or persons, and anything you have in a Trust – when the trust provisions do not make the assets payable to your estate upon your passing (which they generally do not).  Basket three assets are non-probate assets.

Understanding these distinctions are critical to proper estate planning.  If you meet with an attorney to discuss drafting estate planning documents like Wills and/or Trusts, you must make clear to that attorney exactly what assets you have and which basket they fall into.

People sometimes make the mistake of thinking that their Will can override the non-probate asset character of a basket two or basket three asset.  For example, they may think that regardless of who they list as a beneficiary on their IRA, if their Will leaves all their assets to their spouse, then their spouse will receive all their assets of any type.  This is not true.  If an asset falls in basket number two and is joint with someone other than their spouse, then that joint owner will receive that asset upon their death.  As an additional example, if an IRA is payable to someone other than their spouse, then that other person will receive that IRA upon their death.

It is critical as part of your estate planning to review the status of all your assets.  To the extent you own anything jointly with someone else, you need to confirm who that joint owner is.  To the extent you own anything payable to a named beneficiary, you need to confirm that the beneficiary listed is the one you wish to receive that asset upon your passing.

As you can imagine, sometimes people lose track of the status of their basket two or basket three assets.  For example, they may have forgotten that the designated their four children as the beneficiaries of their IRA, even after they had a falling out with one of the children and intended to remove them as a beneficiary.  These types of mistakes can lead to significant assets going to beneficiaries who should not ideally receive them.

If you are getting ready to consider estate planning, you should get together a list of your assets and determine which of the three baskets each asset falls into.  That information will be invaluable in working with a professional to develop a plan that is right for you.

Matthew J. Dorsey, Esq. is a Senior Partner with O’Connell and Aronowitz, 1 Court Street, Saratoga Springs. Over his twenty-five years of practice, he has focused on the areas of elder law, estate planning, and estate administration. Mr. Dorsey can be reached at 518-584-5205, mdorsey@oalaw.com and www.oalaw.com

Lent with Little (and Big) Boys

We observe Lent in our house, which refers to the six weeks before Easter, starting with Ash Wednesday. It’s meant to be a time of fasting and prayer in preparation for celebrating the most holy time of our faith calendar, thus mirroring the forty days Jesus spent in the desert praying and fighting off temptations as told in the books of Matthew, Mark, and Luke in the Bible. We are currently finishing up the second full week of Lent.

Catholics traditionally give up certain things that we enjoy during Lent, as you might give up unhealthy foods if you’re training to run a marathon, or give up watching late-night TV the week before a big test. These self-imposed restrictions help us turn our minds and hearts toward Easter; they help us “get healthy” spiritually.

For children, the idea of “giving something up for Lent” has predictable and often hilarious results. Are there any Catholic children who haven’t joked (in all seriousness!) that they’ve decided to give up school this Lent? Or homework? Or doing their chores? Each child thinks they’re the first one to think of this, and each child just about dies laughing over it. My four-year-old understands more this year than he ever has, and thinks his brothers’ crazy ideas about giving up eating vegetables and giving up going to bed early on school nights are the funniest things he’s ever heard.

Then there are the children who take the idea of Lenten sacrifice very seriously and try to make it as hard as possible for themselves and tell me that they’ve decided to give up their very favorite things. Except, when your very favorite thing is milk, I’m not going to let you give it up! Nor when you want to give up reading, or going outside to play. Even things like “giving up movie night with the family” aren’t okay with me — things that are good and healthy for the mind, body, soul, and relationships are, in general, not included in the list of the things that children should be giving up, as far as I’m concerned.

As long as they don’t want to give up good and healthy things, though, I don’t generally mind if my big boys decide to make Lent extra Lent-y. I’ve had boys decide to give up all TV, for example, and video games, and non-school computer-related stuff, and it’s definitely hard for them! I admire their struggle and find it inspiring for my own efforts. It’s always interesting, though, that with these hard decisions comes extra considerations: if you give up TV, does that mean *all* the things that are on the TV screen? Or just shows on cable? What about movies? Does Netflix count? What about YouTube? Can you sit in the room with the TV on as long as you don’t look at it? (My four-year-old, after he’d finished guffawing at his brothers’ jokey ideas, told me he’s giving up TV. I told him *absolutely not*.)

Even when the kids give up the “normal” things for Lent, I still find them tweaking their chosen sacrifices throughout the first week or two. Does giving up dessert mean all dessert? Or maybe just candy? (They always seem to figure this out just at dessert time — especially when cookies are on the menu.) But then, does giving up candy mean all candy? Or maybe the boy really meant non-peanut butter candy? (This is always figured out just when Reese’s are being passed out, amazing.) But after the first week or two, things settle, and the boys are resigned to the fact that there will be times over the next few weeks until Easter that their chosen sacrifice is extra hard — which is the whole point.

Then there are Sundays, which are a little bit controversial. Some people believe that Sundays are not technically a part of Lent; as a result, many Catholics will have what they gave up for Lent on Sundays. Others, however, find this to be terrible! Weak! In this, there is no teaching (other than the Sundays of Lent are, indeed, part of Lent), so to each his or her own. But I will tell you that in my house we’ve always done “the Sunday thing” — had the thing we gave up on Sundays — so on Sundays there is a lot of “I can have dessert today, whee!!” and trying to finagle extra dessert because of it: “But I haven’t been able to have any dessert all week and everyone else could!” Or, “I can play video games today, so I should have the first turn, since everyone else was able to play yesterday and Friday!”

I don’t really mind the search for loopholes and the tweaks — it’s so human! And I so appreciate the willingness to grapple with this hard thing and find a way to do it, rather than refuse to do it at all. It’s like that saying attributed to G.K. Chesterton: “If a thing is worth doing, it is worth doing poorly.” And in doing it, over and over, one will get better at it! Or so I remind myself as I break up yet another squabble over whether or not it’s unfair to have the TV on at all when one member of our household has given it up for Lent. Sigh.

Kate and her husband have seven sons ages 18, 16, 14, 13, 11, 8, and 4. Email her at kmtowne23@gmail.com.

The Three O’s of Eye Care

Quite often, when I am introduced to someone they ask, “What do you do for a living?” and I reply, “I am an Optician and practice owner.”

“Oh, so you’re an eye doctor?” they will say.

“No, I own a practice and I employ eye doctors, specifically Optometrists.”

Next they will ask, “I have never understood what the differences are between Optometrists and Ophthalmologists?”

It is then that I proceed to explain the importance of all three professions when it comes to preserving sight and looking great!

Medical Device and  Fashion Advice

In NYS Opticians are licensed to interpret and fit a prescription pair of glasses and many Opticians also become contact lens certified which allows them to interpret a prescription, fit and prescribe contact lenses. The Optician will look at your Rx and at your face, discuss your uses and lifestyle and then make recommendations about which frames will best accommodate your prescription on your face and work with your use of them, (i.e. If you are typically very rough with your belongings, they may suggest a frame made of surgical steel or titanium). The Optician is typically the most knowledgeable in the office about lens materials and treatments that will benefit each Rx. Opticianry it is one of the only professions that combines “medical device with fashion advice.” They will ensure that you end up with glasses that help you to see better and look great!

Primary Care Physician

Optometrists are the Primary Care Physician for your eyes. A comprehensive medical eye exam by a thorough optometrist will give the doctor a lot of information about your overall health. The eye is the only organ of the human body that a doctor can actually witness blood flow in real time just by looking into the back of your eyes. The doctor can detect hypertension, diabetes, macular degeneration, cataracts and several other more serious conditions and diseases.

Optometrists are the professional experts at determining glasses and contact lens prescriptions. After four years of college they go on to four more years of Optometry school where they spend the bulk of their education on the eyes as an organ, teaming and tracking, convergence, eye health including disease diagnosis, treatment and refraction.

If your Optometrist diagnoses a condition or disease that requires further treatment, they will refer you to the Ophthalmologist who specializes in that condition or disease. For example, if your eye doctor diagnoses you with a cataract, they will send you to an Ophthalmologist who specializes in cataract surgery. If you have a retinal diagnosis, your will be sent to the Ophthalmologist who specializes in treating retinal diseases.

Medical Surgeon

Ophthalmologists are medical doctors who go on to specialize in the diagnosis and treatment of eye diseases and perform eye surgery. Many Ophthalmolgists specialize further by treating only specific diseases and are experts in retinal issues or glaucoma or cataract surgery. Some MDs specialize further practice as neuro-ophthalmologists or pediatric surgeons.

In order to obtain care from the best MD for your eyes and your specific treatment needs, your Optometrist is the expert at referring you. Based on their knowledge and experience with the MDs in your local area, they will know where to send you. They will also know when it may be best to seek treatment outside of the area in extreme cases where treatment by a local expert for your condition is not available.

Nothing replaces a comprehensive annual eye exam by your trusted Optometrist when it comes to preserving your eye-health. The perfect combination is a knowledgeable Optician to interpret and fit you to prescription eyewear that both helps you to “see” optimally with the latest in digital lens design technology paired with a frame that is tailored to you so you leave “looking” great!

Finally, an exceptional pair of glasses does not have to break the bank! Look for sales and deals at your local optical businesses. Many offer seasonal and on-going sales and promotions as well as budget packages. The services and high- end products offered by your local businesses typically far exceed those found at “supposed” discount chain stores and on-line vendors. 

Susan Halstead is a NYS and Nationally Licensed Optician who has been at Family Vision Care Center for 30 years. Susan is both the Optician and Owner and can be reached for questions or comments at 518-584-6111 or Susan@familyvisioncarecenter.com