Monday, April 14, 2014

Tips for Caregivers

Parkinson's is a family disease; one that takes a team of involved and supportive loved ones to help a person with Parkinson's thrive. In most cases however, the bulk of responsibility lies with one main care partner -a spouse, a child, or a friend. For this individual, life is changed forever and they must take on many new roles when their loved one is diagnosed with Parkinson's. Theirs is a demanding job involving compromise, encouragement and strength. Their focus is on providing emotional and physical support, advocating on behalf of their loved one, and learning all that they can about Parkinson's disease. 



Lessons Learned
Over and over care partners report similar experienced about the challenges they face. Because of the progressive nature of Parkinson's, a care partner is challenged to know what degree of support their loved one needs at any given time. It is important that a person with Parkinson's is encouraged to speak for themselves and manage their own life for as long as possible; however, the care partner is a key member of the team. The relationship is sometimes described as one that begins as "partner" and evolves into "care provider". 

Here are a few practical steps for care partners to follow: 
  1. Be an active member of the team: Attend medical appointments and be involved in every decision about your loved one's care. Research shows that people with actively involved care partners tend to do better. 
  2. Ask questions until you understand the answer: Parkinson's is a complex, neurodegenerative disorder and as such, there is a lot to understand. Don't hesitate to ask questions until you feel comfortable that both you and your loved one understand the answer fully -this includes information about medication (what it's for, side effects, when to take, things to avoid). 
  3. Keep your loved one honest: People tend to leave out important pieces of information when speaking with their doctor/neurologist either due to embarrassment or they simply think it doesn't matter. It is very important that care partners encourage their loved ones to tell their doctor everything including symptoms, changes in behaviour, other medications or supplements. 
  4. Speak up for your loved one: Sometimes people with Parkinson's simply cannot communicate for themselves so care partners must speak up for them. 
  5. Know what hospitals and/or care facilities have expertise with Parkinson's disease: Lack of Parkinson's education is the primary complaint that Canadians with Parkinson's and their care partners have about health care professionals coast-to-coast. If you have the opportunity, choose a facility that understands how to best care for someone with Parkinson's disease. 
  6. Get to know the nurses: Whether in hospital, a care facility or at the movement disorder clinic, get to know the nurses that will be caring for your loved one. If necessary, explain the importance of administering medications on-time and act as a Parkinson's resource for them -your efforts will not only benefit your loved one, but every person with Parkinson's who needs care in the future. 
  7. Take the opportunity to educate: Whether in a hospital, walking down the street or sitting in a restaurant, chances are that some aspect of Parkinson's will draw the attention of others to your loved one. Make the most of the situation by explaining what is happening and letting others know how they can help. 
  8. Become an expert about supports & services: Find out what kind of support is available in your community and what the criteria for qualification are (home care, disability, CPP, tax credits). 
  9. Befriend another care partner: Having someone who understands your situation can be invaluable. Over 240 Parkinson support groups operate coast-to-coast -simply contact your Parkinson Society Canada regional office to find the group best suited to you. 
You may find additional resources for caregivers online by visiting www.parkinson.ca and clicking on the Living with Parkinson's tab. 


Photo Credit: Rosie O'Beirne

Monday, March 31, 2014

Diet and Nutrition in Parkinson’s Disease

Parkinson's is a chronic degenerative neurological disease caused by loss of dopamine in the brain. When the dopamine producing cells die, Parkinson's symptoms appear.

Good nutrition can help you maintain a better level of well-being when you have Parkinson's. The quality of your diet will have an impact on reaching a healthy weight, maintaining optimal energy and providing adequate muscle strength.



There are three main areas of concern for people with Parkinson's: weight loss or gain and constipation.

Weight Loss
Weight loss may occur in up to 70% of people living with Parkinson's. A number of factors may contribute to the problem: difficulty preparing food, including fatigue; problems chewing or swallowing; constipation, reduced appetite perhaps due to loss of sense of smell, depression or changes in cognitive ability.

Weight Gain/Overweight
Some people with Parkinson's may be overweight and this may lead to other health problems. Stringent diets may decrease your energy. Compulsive (binge eating) may be a side effect of Parkinson medications. If you are experiencing this behaviour, tell your neurologist and/or doctor.

Constipation
Your diet can have a significant impact on constipation. Two key dietary recommendations for managing constipation are: eat high fiber foods and drink more fluid. Being constipated can slow the absorption of your Parkinson medication, thereby minimizing its effectiveness. Constipation can be treated. More information is available in the brochure on Constipation (PDF).

Other Helpful Resources
Visit Parkinson Society Canada's website for more information and resources on diet and nutrition related to Parkinson's disease. Contact Parkinson Society Canada to request a free Manual for People Living with Parkinson's Disease and find out about the Progression of Parkinson's Disease (PDF) and other resources for individuals and health professionals.

By: Grace Ferrari, Parkinson Expert at Agecomfort.org Health Care Resource Centre

Photo Credit: Michael Fludkov

Monday, March 24, 2014

When the Parenting Roles Reverse: Parenting your Parents with Respect and Dignity

It's inevitable, we age, and there comes a time for all of us lucky enough to have our parents with us into their later years, when the parenting roles reverse.

The parents who have taken care of you and watched over your shoulder as you grew and matured are now relying on you to help them meet their needs.


For your parents, depending on you is a lesson in humility and can bring a range of emotions they may not have expected such as guilt, frustration or even depression or embarrassment.

Transitioning into the role of primary caregiver for your parents in need of parenting is no less difficult for you. Having to make decisions that affect their life, independence and care makes many a son and daughter feel uncomfortable and doubtful as to whether or not they've made the right choices.

Help yourself help your elderly loved ones:

Base Decisions on Respect and Dignity

Respect who your parents are and their wishes of how they would like to live out their life as best you can. They may have a living will or have spoken with you before. Use this to guide you when and if they are unable to express their preferences themselves, as seen in those with Alzheimer's disease.

Don't Leave Difficult Decisions Too Late 

Communication is they key to understanding your parent's situation, feelings, needs and wants. Don't leave difficult but necessary conversations too late, such as 'what would you want to happen when you can no longer bathe by yourself?'
Learn about the preferences your parents have and take note.

Clarify Expectations

Being the primary caregiver in a family can often be a willing burden. You want to help, you feel expected to help, but it takes more than one. If your siblings or involved relatives expect you to care for Mom or Dad, clarify how they expect to contribute. They can help with finances, do the shopping, organize the home care schedules or give you respite breaks when needed.

Don't Neglect Yourself 

How many times have they told you the story about what happened to them at the grocery store? Often people with dementia will repeat stories, sometimes word for word, without remembering they've already told you. They may ask you the same questions over and over again, too.

Share in Their Life 

Spend quality time with your parents and don't dwell on their mortality. Make memories together that will last and fuel you during the more difficult times.

Educate Yourself 

Medical treatment, surgery and rehabilitation options are changing and you need to be the moderator of you and your parent's healthcare. Be informed about any health concerns, join support groups and meet with professionals.  

Plan Ahead for Homecare 

Speak to a professional Care Coordinator at Premier Homecare Services to learn how your parent's independence can be supported with respect and dignity through the compassionate care of our caregivers.

By: Cindy Stead, Private Home Care Expert at AgeComfort.org Health Care Resource Centre

Photo Credit: Raul Lieberwirth

Monday, March 17, 2014

Why a Good Night’s Sleep Should be A Priority

In today's hectic and competitive world, many people have relegated little priority to getting a good night's sleep -believing that using every waking moment to work or learn is far more productive and important. The problem with that philosophy is that you are not giving your body enough time to rest, reset and heal because, shorter hours of sleep mean, a lesser quality of sleep.


It is important not only to fall asleep easily, but to maintain sleep long enough (7-8 hours) so that you can reach that all important part of sleep known as REM. So make sure that you set aside this amount of time for sleeping every night. During the night, we cycle through 5 stages of sleep -with each cycle lasting about 90 minutes. We need to sleep long enough to go through these cycles 4-6 times a night because, with each cycle the REM portion gets longer and, it is during that portion of sleep, that we have our deepest and most restful sleep and when our body is able to repair and heal itself, which is so important to maintaining a strong immune system.

REM sleep is also associated with dreaming because it is marked by intense brain activity. That's how you can tell if you achieve REM sleep and have therefore slept sufficient hours. During REM (Rapid Eye Movement) sleep breathing is more rapid, irregular and shallow, eyes move in different directions and muscles become temporarily paralyzed.

It is believed that during this final stage, the regions of the brain used for thinking, learning, memory consolidation and organizing information are stimulated (like when a computer is re-booted). If you cannot sleep without constantly waking, then you are not getting good sleep and you feel it in the morning and all during your day. It's more important to sleep than to stay up late studying or preparing for a business meeting. Everything should be given its proper time so that you can function at your peak but also maintain a balance in your life.  

By: Tova Greenberg, Sleep Expert at AgeComfort.org Health Care Resource Centre

Monday, March 10, 2014

Putting Lipstick on Grandma at 97

My grandma recently turned 97...in the hospital. She fell and broke her hip, the good one. She will not be going home again.

When I was preparing to visit grandma, I thought to myself what can I do for her that will make her feel wonderful? What does she love in her personal care? Food? Leisure? What are her favourite things in the world?!

Instantly I thought about how important her hair and nails have always been to her so I went to the store and bought a nail file, buffer, nail polish remover and grandma's favourite shade of pink. I also bought hand cream to give her a gentle hand massage. I knew that the family had organized someone to do her hair regularly so I would simply fluff it! I also bought some prewashed mixed berries. Another favourite of grandma's.

As I walked into her hospital room yesterday, she was sitting in a chair wrapped in a blanket. Grandma looked so small and fragile, it was everything I could do to hold back my tears, to smile and pour energy into her room. To make her look and feel beautiful like the grandma I had always known.

Grandma woke as I was setting the bags down, she smiled and said, "Is that you, Kim?", and I hugged her and said, "Yes."

I pulled out the hand cream and pink nail polish and gave her a manicure. She was so excited. Her skin was so thin and cold. I fluffed her hair and then I said, "Grandma, would you like lipstick?".
She says, "Do you think I need it?"
I said, "Absolutely! Shouldn't we always look as good as we can?"
Grandma smiled and said, "Yes, we should."

See, grandma always wore lipstick, so why not now? The only reason  she is not wearing it is because it is hard for her to do it herself. So I searched her drawers...I found several boxes of "Pot of Gold" -the typical hospital present. And then I see her lipstick. I put it on her and then I mix hand cream and lipstick on my hand to make like a cream blush and dab her cheeks Grandma looks like grandma again. She is so beautiful and now she's glowing. My sadness has lifted.       


Just before I leave, grandma says, "I'll have to put my hands on top of the blanket so everyone can see my beautiful nails."

In my 44 years of knowing my grandmother, I have never felt so close to her. I have never touched her like I touched her, cared for her like I cared for her. This gift to my grandmother was a much greater gift to me. I will learn from this experience, share it and cherish this memory forever.

By: Kimbery Irwin, Beauty and Hair Expert at AgeComfort.org Health Care Resource Centre

Photo Credit: Haircuts on Wheels

Monday, March 3, 2014

Music Care For Well Being

Music enhances everything. It has a capacity to reach into every domain and improve our quality of life through stimulation, social integration, communication, expression and daily routine.

Music can be used to evoke wide ranges of either calming or stimulating physical responses. Research has shown that music can affect blood pressure, heart rate, respiration, pupil dilation, discomfort and tolerance to pain. Music can affect our mood, our stress levels, match our emotional responses.


Music may identify and help manage our feelings. Music can unlock and help bring feelings to the surface. Music may be able to wash up to shore deeply buried, hidden, repressed or painful feelings and with support, these feelings may be processed.

Music is commonly used as a mood enhancer. In their research, Levitin and Menon found that listening to music caused a cascade of brain regions to become activated. The limbic system involved in arousal, pleasure and the transmission of opioids (natural pain killing substance, i.e. endorphins) and the production of dopamine, a neurotransmitter needed for healthy function of the central nervous system, was one of the areas activated [1] .
Researchers believe that positive mood and affect are increased with dopamine.

Music can appease stress and anxiety. When the brain attends music and the auditory input is "safe", dopamine and other sedating chemicals that calm and minimize systemic excitability are discharged. Sound vibrations that permeate in the music environment blanket a person and provide a soothing message that the whole brain accepts as calming. The brain attends the music and momentarily forgets its fear and anxiety.

Music has a tremendous capacity to connect people, through shared events, feelings or ideas. It may be a key in motivating participation and developing camaraderie. Music enhances appropriate social interactions and catalyzes recreation and enjoyment where there may otherwise be isolation and loneliness. Music may facilitate intimacy. Music can be a lifelong form of recreation and leisure and enhance fitness training.

 Furthermore, music can bring balance into charged situations. It may serve to neutralize differences and celebrate commonalities. Music may catalyze and develop tolerance between diverse cultures. Listening with open ears and open hearts may expand the borders of respect and working together.

Here are some ways you can stay musically active and enhance your well-being:

  1. Join a choir
  2. Take a dance class
  3. Make a playlist of 10 songs that stimulate you. Play these when you need to be active. 
  4. Make a playlist of 10 songs that calm you. Play these in stressful situations i.e. driving in rush hour traffic.
  5. Go to a live concert.
  6. Find gentle soothing music and take a music bath before bedtime. 
  7. Listen to a new piece of music. 
  8. Learn to appreciate a new style of music. 
  9. Pick up an instrument. This may include taking lessons or rejuvenating old skills.
  10. Join a drumming circle.
  11. Choose a life song, a song that expresses who you are, the values you believe in, that would in fact be a musical epitaph. 
  12. Join a songwriting circle. 
-------------------------

[1] Levitin, D., (2006). This is Your Brain on Music. New York: Dutton p.187

By: Bev Foster, Music Care Expert at AgeComfort.org Health Care Resource Centre

Photo Credit: Alejandro Matos

Monday, February 3, 2014

Why a Family Trust?

It could be your best approach to long-term wealth-management planning.

Why a Family Trust

Too many, a trust is still very much an enigma. While most people have an idea of what is trust is, they have trouble explaining its benefits beyond asset protection and tax minimization. Trusts deserve further illumination because they can be a valuable wealth management mechanism for high net worth families and particularly useful for tax and estate planning. The key to their effectiveness is understanding how they work. Unlike most other financial planning tools, trusts provide the benefit of long-term flexibility and control.

What is a Trust?

A trust is a relationship that arises whenever a person, called the settler, transfers ownership of assets to another person, the trustee, who controls and manages those assets on behalf of, and for the benefit of, specified beneficiaries. A trust effectively separates legal ownership and beneficial ownership. The trust indenture details this relationship and lays out the trust’s mandate and the trustee’s responsibilities and obligations.

Inter-vivos versus testamentary trust

Trusts are classified as either inter-vivos or testamentary.
An inter-vivo trust is created during the life of the settler, while a testamentary trust arises as a consequence of the settlor’s death, as per the terms of his or her will. Either trust can be created as discretionary or non-discretionary. The difference between the two is whether the settler has granted the trustee “discretion” when allocating income and/or capital gains to the beneficiaries or requires the trustee to follow a preordained determination. Discretionary trusts can go as far as providing trustees the authority to decide which beneficiaries will receive benefits, and when, and how much the beneficiaries will receive.
The key point to understand between these two types of trusts is how differently they are treated for tax purposes:
  • Under an inter-vivos trust, all income and capital gains retained in the trust are taxed at the top marginal tax rate, which was almost 48 percent in 2012.
  • Testamentary trusts are taxed at progressive marginal tax rates, the same as individuals.
Consequently, participants of an inter-vivos trust are motivated to distribute all income and capital gains to the beneficiaries to avoid paying the highest marginal tax rate

Tax Planning

To demonstrate how dynamic and flexible trusts can be in tax and estate planning, I have highlighted their more strategic uses. For this purpose we will be looking at discretionary family trusts.
Income splitting is one of the more popular uses of family trusts. This is mainly due to Canada’s graduated tax system. Income-producing assets are transferred to the family trust, whereby income and capital gain are distributed to lower-income beneficiaries. By shifting income to lower-income family members, the family’s overall tax burden is reduced.

When you consider a situation in which a beneficiary has no income, the tax savings can be significant. This is in part due to the personal tax exemption, which allows each person in Canada to earn almost $10,000 a year tax-free. This means that a person can earn – tax free – up to $19,000 of capital gains or as much as $48,000 in dividends, depending on the nature of the dividends.

A family trust also affords business owners the opportunity to multiply the small business capital gains exemption upon sale of shares held within it. This exemption is available to shares that are considered qualified small business corporation shares, which applies to most operating and privately held incorporated companies. Each Canadian resident has a lifetime capital gains exemption of $750,000. Consequently, the trust has available to it as many capital gain exemptions as there are beneficiaries. However, you may want to ask the beneficiaries’ permission first, because once a person’s capital gains exemption is fully used, it is gone.

When income splitting, be aware of Canada Revenue Agency’s attribution rules, which are designed to prevent income splitting in situations where assets are gifted to non-arm’s length individuals such as a spouse or minor children or, in this case, a family trust, resulting in less overall tax being paid. The result is that the income or capital gains in question gets “attributed” back and taxed in the hands of the original transferor. This can be remedied, however, by constructing the asset transfer as a bona fide sale or loan at prescribed rates. Incidentally , at current prescribed loan rates of one percent, it is almost like gifting it anyway.

Estate Planning
  • Preserving assets for children.
When minors, or children who are not mature enough to handle the responsibility, inherit large sums of money, the results can be dreadful. A testamentary family trust can remedy the situation by placing the responsibility of managing those assets in the hands of trustees. The trust indenture can then be designed to distribute the capital to the beneficiaries at a certain age or particular life event. Equally, the trust can help prevent a child’s future spouse from benefiting from the family’s wealth in case of divorce. A family trust can also serve to protect your estate from being included in the “new matrimonial property” should you or your surviving spouse decide to remarry.
  • Creditor proofing. In most circumstances, a family trust can protect your assets from creditors or claims arising from lawsuits, taxes, accidents and other similar financial risks. Because trusts separate legal and beneficial ownership, and because trustees control distributions of capital and income from the trust, beneficiaries are protected against possible creditor appropriations.
  • Charitable giving. Trusts can make charitable giving a less definite and a more tax-efficient experience. With a charitable remainder trust you would continue to enjoy any and all income distributions from the trust while you are alive; upon your death the capital in the trust would then be transferred to the designated charity. Upon setting up and transferring assets to the trust, you will be issued a tax receipt based on actuarial estimates of the charity’s residual interest, which is effectively the discounted present value of the charitable donation’s fair market value. This can still result in a significant ax receipt. Take for example an individual donating his or her investment portfolio worth $500,000 at age 65 and that actuarial tables determine life expectancy to be 15 years and the discount rate to be five percent. The tax receipt would be more than $240,000 {$500,000/(1.05)^15] and at top marginal tax rates that would translate into more than $115,000 ($240,508 x 47.97%) of tax saving today. The only stipulation is that the original capital cannot be encroached upon before it is received by the charity. The advantage of a charitable remainder trust is being able realize the tax relief from charitable giving at a time you deem to be most beneficial, instead of your estate at the end of your life.
  • Probate and confidentiality. Unlike a will, assets in a trust do not pass through probate upon death. The assets within the trust are either distributed or continue to be maintained within the family trust as per the trust indenture. In this way your estate avoids the additional costs and delay of probate. In addition, a will is a public document open to scrutiny, while a trust is a private “relationship” and privy only to its participants. Since the trust exists separately from your estate, the assets within the trust are immune to any challenges to the will.
The benefits of using family trusts in tax and estate planning cannot be denied. When looking to transfer family assets to the next generation, trusts can provide not only a tax-effective means, but flexibility in managing and distributing those assets. Done properly, a family trust is possibly the best vehicle to effect long-term wealth management planning for high net worth families.

By: Luigi Porretta, Senior Tax & Accounting Expert at AgeComfort.org Health Care Resource Centre

Photo Credit: Tax Credits http://www.flickr.com/photos/76657755@N04/

Monday, January 27, 2014

Physical Activity and Parkinson’s Disease

Get Active and Stay Active!
  • People with Parkinson's who exercise fare better over time than those who are not active. 
  • Physical activity should be initiated early in the diagnosis and be a life-long commitment.
  • Engaging in aerobic activity, along with other activities for strength, flexibility and balance, improves Parkinson's symptoms and sense of well being.
jogging

Why Aerobic Activities? 
  • Aerobic activities make the body's large muscles move in a rhythmic manner for a sustained period of time. 
  • Aerobic activities improve physical fitness, including strength and endurance.
  • Aerobic activities have a positive effect on slowness and stiffness, as well as mood, and quality of life. 
Examples include: brisk walking, swimming, cycling, dancing, water aerobics, skating, hiking, treadmill or elliptical, Wii

Why Flexibility Activities? 
  • Flexibility or stretching exercises improves mobility, increase range of motion, and reduce stiffness.
  • Improving range of motion affects posture and walking ability making everyday activities easier.
Examples include: Tai Chi, stretching

Why Strengthening Activities? 
  • Strengthening activities improve muscle strength, walking speed, posture and overall physical fitnes. 
  • Improving strength will help everyday activities, such as getting up from a chair, easier to manage. 
Examples include: yard work or gardening, weights/resistance (free weights, elastic bands, body weight)

Why Balance Activities? 
  • Balance activities improve posture and stability.
  • Better balance reduces the fear of falling and help in perfoming daily tasks.
Examples include: Yoga, hiking, Wii

Get Started!
  • Consult your doctor before starting an exercise program, especially if you have other health issues or are over 60.
  • Work with a physical therapist/physiotherapist to develop a speicifc program that meets your needs. A physiotherapist can ensure you are performing activities safely and that they are right for you. 
  • Choose a variety of activities to reduce boredom.
  • Have fun! Choosing activities you like will help you stay with a program.
Use the following chart to track your progress

Tips: 
  • Take your Parkinson medications on time for maximum mobility.
  • Take 3-5 minutes to warm up at the beginning and cool down as you finish. 
  • Exercise in a way that is safe for you (e.g. when doing balance exercises you may need a stable support nearby). 
  • Concentrate on doing the exercises correctly.
  • Start with shorter periods of exercise and gradually increase. Greater intensity equals greater benefits. 
  • Monitor fatigue both during and after activities. At the end, you should feel tired, but not exhausted. 
  • Drink water to stay hydrated. 
  • Join a group or find an "exercise buddy"
Photo Credit: cuegalos


Monday, January 20, 2014

Inner and Outer Vision

The human body is a sensory process. Each of our sense organs takes in information that we imbue with meaning. For the month of May, get ready for a unique experience as we explore the function of each organ (think grade 9 biology refresher) and a kriya to create awareness and healing for that organ.

Lights, Camera, Action

When light hits the eye, the cornea helps the eye focus as light makes its way through. Behind the cornea are the iris, pupil, and anterior chamber. The iris is the colourful part of the eye. The iris has muscles attached to it that change its shape. This allows the iris to control how much light goes through the pupil. 

Inner and Outer Vision

The pupil is the black circle in the center of the iris, which is really an opening in the iris, and it lets light enter the eye. After light enters the pupil, it hits the lens. The lens sits behind the iris and is clear and colourless. The lens' job is to focus light rays on the back of the eyeball - a part called the retina. 

Your retina is in the very back of the eye. It holds millions of cells that are sensitive to light. The retina takes the light the eye receives and changes it into nerve signals so the brain can understand what the eye is seeing. 

Think of the optic nerve as the great messenger in the back of your eye. The rods and cones of the retina change the colours and shapes you see into millions of nerve messages. Then, the optic nerve carries those messages from the eye to the brain. 

Tears also keep your eye from drying out, keep the eye moist and provide expression through laughter and crying. 

Movement

Your eye muscles also need to be stretched. We tend to use our eyes in limited ways, staring at a computer screen, reading, driving and watching TV. For the most part we don't use our eye muscles fully. In this Kundalini Yoga Kriya for the eyes, you use all the muscles of your eyes, bringing circulation and a full range of motion available to your eyes. For optimal health, the eyes need exercise and rest.


Rest for the Weary

But what about eyestrain? The word is a bit of a misnomer, says Eli Peli, a professor of ophthalmology at Harvard Medical School. Peli says that vision happens in the brain, not the eyes; therefore, sitting at a computer isn't a strain for the eyes in the sense that it causes trouble for their muscles. Instead, the fatigue you feel is your brain asking for mercy. "The brain, in its smart way, projects fatigue onto the eyes, so you'll take a break."

Photo Credit: Conner Downey

Monday, January 13, 2014

Our Winter 2014 Flyer is Out!

Our Winter 2014 flyer is out!

Brrrr.... Winter is here, and we got you covered! This flyer is packed with great aids to help you get through the winter season. Go ahead, and take a look at our winter flyer for amazing items at hot prices.

View the flyer online or request a copy by mail here

cover-page-winter-2014.jpg

Some of the great features of this new flyer include, Nordic Walking Poles, Arthritis Socks, Heart Rate Watch, Portable TENS Relief Pad, Flu Prevention MedicationsPhysical Therapy and Daily Living items, and many other products designed for a variety of people.