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Now hiring caregivers for rewarding careers Hiring bonuses up to $1,000 www.LifespanCare.com – (831) 469-4900 HCO# 444700020 Care Management Well-Being Program Home Care "Is there anything else that can be done for callus pain?" As a podiatrist, I get this question a lot. Many patients develop foot calluses for a variety of reasons, and the most common is age related loss of fat padding on the bottom of the foot. With every step, the bones of the metatarsal head hits the ground and our natural fat padding assists in absorbing those shocks. As we age, the fat pad quality decreases or shifts away from this high pressure point, causing what feels like literal skin and bones with each step. With less fat padding (fat atrophy), there is less shock absorption and so the body protects itself by growing a thick callus and you may experience pain with every step. Overtime, these calluses can damage healthy skin underneath. Worse case scenario, this becomes an open ulcer and can lead to infection and amputation in the most vulnerable including those with circulation disorders or diabetes. Professional maintenance is key in treating and preventing foot calluses. Other conditions may look like a callus but could be a plantar wart, amelanotic melanoma, or another type of growth. Check with your doctor to ensure you have the right diagnosis before self treating. Early treatments of a callus include proper shoe wear and safe pedicures to keep the skin thickness under control. However, even with medical pedicures, calluses do come back as quickly as every few weeks. So patients often ask, is there anything else that can provide longer pain relief from callus pain? Absolutely! I am a fan of medical pedicures because this is the most easy to access. Gentle exfoliation of dead skin can decrease the thickness of developing calluses. This can be done with a sugar scrub or emery board designed specifically for the foot. Be aware that sharp blades and mechanical tools should only be used by a medical professional to avoid accidental cuts that can lead to an infection. Next, I recommend sticky pads that have a cut out window to off-load the pressure point. I love using U-pads made of felt between ⅛" to ¼" thickness to alleviate pressure points particularly at the ball of the foot. Make sure you use nonmedicated pads that don't cover the callus directly. Medicated pads can lead to accidental tissue damage. Eventually the pads need to be replaced, so having custom fitted orthotics would be the next consideration. Custom orthotics is very different from generic inserts purchased from the store. Custom orthotics are medical devices prescribed by a podiatrist, which can be custom fitted to fit inside of your preferred shoes. They only work if you're wearing them so some people prefer to have another pair of orthotics for their indoor shoes. This will also help prevent contamination of bringing outdoor shoes indoors. The podiatrist evaluates your feet and your walking pattern to determine the right kind of prescription for your foot pain. What is also important to know are nontraditional treatments options such as foot fillers that are injected under the callus to decrease pain with walking. There are fat allografts and dermal fillers like hyaluronic acid to increase cushion in the foot. This treatment can last longer than shaving the callus. Touch ups may be necessary depending on the person's activity level. A podiatrist who specializes in minimally invasive options, like myself, is who you should consider learning more about these nontraditional treatment options. Steroid injections should be avoided in these areas since that only covers up the pain rather than addressing the biomechanical issue causing the pain. Steroids can also lead to thinning of the fat pad as well with long term use. Dermal fillers or fat allograft injections for the foot are not covered by insurance but are an affordable option for longer pain relief short of surgery. Lastly, long term benefits are seen with minimally invasive surgery. This is different from traditional surgery in that the incision is only 3mm long and no hardware or hospitalization is required. Patients are able to walk sooner with minimal down time. Minimally invasive surgery decreases the risks typically associated with traditional surgery such as infection, hardware rejection and painful scars. As with any surgery, risks and benefits must be weighed before going under the knife so consult with a minimally invasive foot specialist for options. Dr. Tea Nguyen, DPM Minimally Invasive Foot Specialist Pacific Point Podiatry 831-288-3400 In-Home Care is Skyrocketing Plant a seed and watch it grow. It's Springtime and the mountains and meadows in Santa Cruz are ready to show their colors again. All things have their season and for Seniors this time of year can be a trigger remind- ing us that the cycle is happening again and not to miss the opportunity for better planning for our future. We still want to stay in our homes and "Ageing in Place" is still the number one desire for the great majority of seniors but that does have a cost. Planning for this season of life seems to be one of the easiest things to postpone but doing so comes with a "Lost opportunity cost" that is stressful all by itself so take advantage of Springtime new energy and dig in to a plan to lower the cost of in-home care that eventually will be required. How? By thinking of the general stages of ageing in place like the seasons, meeting the changes and chal- lenges as they progress, from mild to medium to full care requirements with your plan. Simple steps like installing grab bars and hand rails in bathrooms and at stairs is a small start while we're still independent and on our own. We do know that as we age, we will need to rely on some in-home help. Now the expense starts to be an issue and this is where the financial planning will pay off. Reverse Mortgage Credit Line to the rescue. There is a great benefit to starting a Reverse Mort- gage with a credit line early because it's the only credit line in banking that actually grows over time. There is no interest charged for funds that are left in the line; zero inter- est expense! The earlier your start one, the longer it has to grow, up to 5% per year. A $300,000 line growing at 5% per year for 15 years turns into over $623,500. If you start one at age 62, and do not require any in-home care until age 82 the line will be $795,989 and if your good health lasts until age 87, you line will grow to $1,015,906 and this growth is not tied to the value of the home. It is written into the note and independent of the ups and downs of the home market. So, you can see that if you are one of those procrastinators mentioned above that postponed your planning for an enjoyable "End game of life", it may not be too late to consider a way to add a million dollars to your plan! Another opportunity becomes available with a Reverse Mortgage to combat the high cost and competitive market for high quality care provid- ers is to use funds from a Reverse Mortgage to create a space in your home for the caregivers to be. Here again, the funds from a reverse mortgage may make the difference in the remodeling needed be- cause there is no monthly payment required for the funds used to make the improvements; no stress on limited savings, no change in monthly bud- get. By adding the option for a "Live in helper" you may be lowering the overall cost of the service a great deal and attract the best of the provid- ers available, a win win situation! Donald Dimitruk is a Registered Financial Consultant ® and a Reg- istered Mortgage Advisor and is available for a FREE consultation about how a Reverse Mort- gage may benefit you at Countryside Financial Services. Please call 831- 464-6464 By Donald Dimitruk, RFC ® RMA Bigstock photo Saving Money with Medicare Services By Corey Azevedo, Executive Director Senior Network Services A common question we hear from clients at Senior Network Ser- vices' Health Insurance Counseling and Advoca- cy Program (HICAP) is about reducing Medicare expenses. HICAP is a no- cost, unbiased program of Senior Network Services, a community nonprofit operating in Santa Cruz for almost 50 years. When people are on a fixed income it makes sense that reducing Medi- care costs is an important topic. There are programs within Medicare to help reduce costs for some Medicare benefits, and there are benefits within Medicare to help reduce medical expenses for Medicare beneficiaries. Medicare Part B covers the cost of many pre- ventive services. The complete list of preven- tive services can be found at https://www.medicare. gov/coverage/preven- tive-screening-services, or by calling our HICAP office at (831) 462-5510. Medicare hopes to save money and help seniors save money by prevent- ing or identifying diseas- es or ailments before they occur. It is important for Medicare beneficiaries to use doctors who accept Medicare assignment when scheduling these preventive services. Some samples of dif- ferent tests or screenings include cardiovascular disease screening, lung cancer screening test, mammogram screening, prostate cancer screen- ings, diabetes screening, and glaucoma tests. There are also prevention measures such as dia- betes self-management training, flu shots, Medi- care Diabetes Prevention Program and Hepatitis B shots. There are many more preventive services provided in addition to the few listed here. Again, it is important to be sure that the health- care provider accepts Medicare assignment. For some preventive services, the beneficiary may have to pay a deductible or copayment depending on the kind of Medicare plan a person has. Along with the other tests and preventive services there is a yearly wellness visit. The goal of this visit is to develop a personal- ized prevention plan to prevent disease based on current health and risk fac- tors. The beneficiary pays nothing for this visit if the healthcare provider accepts Medicare assignment. However, if the healthcare provider performs any oth- er tests or services at the wellness visit there may be costs involved for those services. Another benefit of the yearly wellness visit is it keeps a patient on a doctor's patient list. A challenge in a smaller community like Santa Cruz County can be finding doc- tors who accept Medicare assignment. Staying on a doctors list can be a health benefit of its own. The yearly wellness visit should not be confused with the one-time "Wel- come to Medicare" preven- tive visit. The "Welcome to Medicare" visit similarly must be with a medical provider who accepts Medicare assignment. This benefit is only available to someone within 12 months of Medicare Part B enroll- ment. The visit includes a review of someone's health, education about preventive services, includ- ing certain screenings, shots and referrals for care if needed. This visit does not apply to the Part B deductible so there should be no out of pocket cost for the beneficiary. But there could be coinsurance or a Part B deductible payment if the healthcare provider performs any additional tests or services during the visit that are not includ- ed under the Welcome to Medicare benefit. It is important as a patient to communicate clearly with the medical care provider concerning any costs of additional tests or services. Lastly, one preventive immunization not covered by Medicare Part B is the shingles shot. The shingles shot is covered by Part D prescription plans but remember that most Part D plans have a deductible. In Santa Cruz County there are twenty-five standalone Part D plans. Twenty of these plans have a de- ductible and prices may range from $150 to $235 for a single shingles shot (check with your provider for exact costs). Proper protection calls for two shots. So, unless someone has already paid for their Part D de- ductible, they may have out of pocket costs for the shingles shot. Hopefully, the result of this article is a clearer picture of how Medicare preventive services are helping us save money and remain healthier into our retirement years. You can always find more Medicare information and related topics on our Facebook page located at www.facebook.com/ seniornetworkservices.

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