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Large Aggregates of ALS Causing Protein Might Help Brain Cells

Large Aggregates of ALS Causing Protein Might Help Brain Cells

Summary: Researchers report the formation of larger, more visible SOD1 aggregates may help to protect brain cells.

Source: UNC Health Care.

Scientists at the UNC School of Medicine have made a significant advance in the understanding of the complex and fatal neurodegenerative disease amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease.

Autopsy studies of ALS patients often reveal the accumulation of large, fibrous aggregates of a protein called SOD1 in disease-affected motor neurons. Researchers have hypothesized that these fibrils are what kill neurons and cause ALS in some people. But in a study published in the Proceedings of the National Academy of Sciences, scientists at the University of North Carolina at Chapel Hill found evidence that these large SOD1 fibrils protect rather than harm neurons.

“This is potentially an important finding not only for ALS research but for neurodegenerative disease research in general, because the formation of fibril aggregates is so common in these diseases,” said senior author Nikolay Dokholyan, PhD, the Michael Hooker Distinguished Professor of Biochemistry and Biophysics at UNC-Chapel Hill.

Large, often fibril-type protein aggregates are in fact the most obvious pathological features of Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, ALS, and other major neurodegenerative diseases. Many of the candidate drugs developed in recent years were designed to clear these protein aggregates. But none of these fibril-targeting strategies have proven effective in large clinical trials. Laboratory studies also have largely failed to prove that large SOD1 fibrils are harmful to neurons.

At the same time, researchers have found that much smaller protein clusters called oligomers – made of only a few copies of these proteins – can be highly toxic to motor neuron-like cells grown in the lab and thus are more likely to be the chief causes of brain-cell death in these diseases.

In a 2016 study, for example, Dokholyan’s lab found evidence that “trimer” structures made of just three copies of the SOD1 protein are toxic to the type of neuron affected in ALS.

For the new study, Dokholyan’s team, including lead author Cheng Zhu, PhD, a postdoctoral researcher in his lab, conducted complicated experiments to compare how trimers affect neurons to how larger fibrils affect neurons.

“One challenge is that the smaller structures such as trimers tend to exist only transiently on the way to forming larger structures,” Zhu said. “But we were able to find an SOD1 mutation that stabilizes the trimer structure and another mutation that promotes the creation of the larger fibrils at the expense of smaller structures. So, we were able to separate the effects of these two species of the protein.”

The researchers expressed the mutant SOD1 proteins in test cells that closely resemble the muscle-controlling neurons killed in ALS. They found – as they did in the 2016 study – that when these cells expressed SOD1 mutants that predominantly form trimers, the cells died much more quickly than control cells containing normal SOD1. The trimer-expressing cells even died more quickly than cells expressing mutant forms of SOD1 that are found in severe hereditary ALS cases.

“Looking at various SOD1 mutants, we observed that the degree of toxicity correlated with the extent of trimer formation,” Zhu said.

On the other hand, the viability of cells containing mutant SOD1 that strongly forms fibrils but suppresses trimers tended to be similar as wild-type SOD1, suggesting that the fibrils are protective, not merely less toxic.

This suggests SOD1 fibrils aren’t the problem in SOD1-linked ALS; they might be a solution. “Taking a drug to promote fibril formation could be one way to reduce toxicity in SOD1-ALS,” Dokholyan said.

sod1

An alternative strategy, he noted, would be to limit the formation of trimers or other small, toxic SOD1 oligomers. SOD1 normally works in cells as a two-copy structure, a dimer. Trimers and other abnormal structures appear to originate when the dimers fall apart. So Dokholyan and colleagues are looking for potential drug molecules that can stabilize the dimers.

SOD1 is linked to a significant proportion of ALS cases. Mutations in the SOD1 gene account for about 12 percent of ALS cases that run in families. All of these mutations destabilize the protein’s normal structure and promote abnormal SOD1 structures. SOD1 mutations also appear to account for about 1.5 percent of cases that do not obviously run in families.

“Although SOD1-associated ALS represents a small fraction of all ALS cases, uncovering the origins of neurotoxicity in SOD1 aggregation may shed light on the underlying causes of an entire class of neurodegenerative diseases,” Dokholyan said. The next steps for Dokholyan’s lab is to pinpoint downstream cellular mechanisms of toxicity of pathological trimeric SOD1 and find drugs that mitigate the formation of trimers.

ABOUT THIS NEUROSCIENCE RESEARCH ARTICLE

Other authors include Mohanish Deshmuhk, PhD, professor of cell biology and physiology and member of the UNC Neuroscience Center; research technician Matthew Beck of the Deshmukh lab; and Jack Griffith, PhD, Kenan Distinguished Professor of Microbiology & Immunology and Biochemistry. Dokholyan, Deshmuhk, and Griffith are members of the UNC Lineberger Comprehensive Cancer Center.

Funding: The National Institutes of Health funded this work.

Source: Mark Derewicz – UNC Health Care
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is credited to Dokholyan Lab (UNC School of Medicine).
Original Research: Abstract for “Large SOD1 aggregates, unlike trimeric SOD1, do not impact cell viability in a model of amyotrophic lateral sclerosis” by Cheng Zhu, Matthew V. Beck, Jack D. Griffith, Mohanish Deshmukh and Nikolay V. Dokholyan in PNAS. Published April 16 2018.
doi:10.1073/pnas.1800187115

CITE THIS NEUROSCIENCENEWS.COM ARTICLE
UNC Health Care “Large Aggregates of ALS Causing Protein Might Help Brain Cells.” NeuroscienceNews. NeuroscienceNews, 16 April 2018.
<http://neurosciencenews.com/sod1-brain-health-8815/&gt;.

Abstract

Large SOD1 aggregates, unlike trimeric SOD1, do not impact cell viability in a model of amyotrophic lateral sclerosis

Aberrant accumulation of misfolded Cu, Zn superoxide dismutase (SOD1) is a hallmark of SOD1-associated amyotrophic lateral sclerosis (ALS), an invariably fatal neurodegenerative disease. While recent discovery of nonnative trimeric SOD1-associated neurotoxicity has suggested a potential pathway for motor neuron impairment, it is yet unknown whether large, insoluble aggregates are cytotoxic. Here we designed SOD1 mutations that specifically stabilize either the fibrillar form or the trimeric state of SOD1. The designed mutants display elevated populations of fibrils or trimers correspondingly, as demonstrated by gel filtration chromatography and electron microscopy. The trimer-stabilizing mutant, G147P, promoted cell death, even more potently in comparison with the aggressive ALS-associated mutants A4V and G93A. In contrast, the fibril-stabilizing mutants, N53I and D101I, positively impacted the survival of motor neuron-like cells. Hence, we conclude the SOD1 oligomer and not the mature form of aggregated fibril is critical for the neurotoxic effects in the model of ALS. The formation of large aggregates is in competition with trimer formation, suggesting that aggregation may be a protective mechanism against formation of toxic oligomeric intermediates.

ew Clues May Help Improve Speech For Some With ALS

New Clues May Help Improve Speech For Some With ALS

Summary: Tongue range motion is reduced while lower lip and jaw motion is increased in people who suffer dysarthria associated with ALS. The findings may help develop new therapies to help those with ALS improve their speech, researchers say.

Source: Penn State.

New clues may help improve speech for people with dysarthria, a type of speech disorder commonly found in patients with amyotrophic lateral sclerosis (ALS).

Findings in a study led by Jimin Lee, assistant professor of communication sciences and disorders at Penn State, could aid patients with dysarthria. Dysarthria can cause slurred speech, slowed speech, abnormal pitch and rhythm, changes in voice quality and limited tongue, lip or jaw movement, according to the American Speech-Language-Hearing Association. Dysarthria has the highest prevalence rate among all types of acquired neurogenic communication disorders.

By analyzing the size of the space used by each articulator (tongue, lip and jaw) while study participants read a paragraph that includes all sounds in American English, Lee found that in people with more severe dysarthria due to ALS, tongue range of motion is reduced, while range of motion for the lower lip and jaw both increase.

This measurement could be useful for estimating speech dysfunction and determining treatment to improve speech in patients with ALS or other neurological conditions, such as Parkinson’s disease, cerebral palsy and multiple sclerosis.

“This highlights the importance of range of motion for speech production, and indicates that if we change range of motion in people with the disorder, if we ask them to expand their overall work space for speech production, then we may see more understandable speech,” Lee said.

“The difference in range of motion in people with dysarthria has been largely assumed, but had not been directly tested. It is exciting to provide empirical evidence based on the movement of articulators. Additionally, the study provides important evidence regarding the different amount of impairment across articulators as well as its high sensitivity to the severity of dysarthria. This has values for both intervention and diagnosis of dysarthria.”

The study, which included 22 ALS patients, is an extension of a previous study that involved 14 people with ALS. The American Journal of Speech-Language Pathology published the latest findings online this week.

Researchers conducted both studies using an instrument to analyze patients’ speech disorders, which measures the movement of tongue, lips and jaw using an electromagnetic field while simultaneously recording acoustic signals. The instrument is a 3-D, portable electromagnetic articulograph — also called the Wave system.

talking heads with questionmarks

Sensors are attached to a patient’s tongue to trace its movement during speech production. Patients are asked to read a specific set of words and sentences. The tool also is connected to a microphone and computer, which stores the data.

“The ultimate goal is to develop effective intervention for people with dysarthria. In order to help people with ALS use their speech as long as possible, we will continue to identify what types of movement will generate speech signals that are easier to understand,” Lee said.

“The majority of people with ALS lose their speech during the progression of the disease. Their tongue function deteriorates fast but the jaw function is relatively preserved, and these two articulators work together for speech production. Thus, we are trying to find a way to enhance their speech intelligibility by looking at tongue and jaw movement characteristics simultaneously.”

ABOUT THIS NEUROSCIENCE RESEARCH ARTICLE

Source: Jennifer Cruden – Penn State 
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Abstract for “Articulatory Range of Movement in Individuals With Dysarthria Secondary to Amyotrophic Lateral Sclerosis” by Jimin Lee; and Michael Bell in American Journal of Speech-Language Pathology. Published May 24 2018.
doi:10.1044/2018_AJSLP-17-0064

CITE THIS NEUROSCIENCENEWS.COM ARTICLE
Penn State “New Clues May Help Improve Speech For Some With ALS.” NeuroscienceNews. NeuroscienceNews, 28 May 2018.
<http://neurosciencenews.com/als-speech-9154/&gt;.

Abstract

Articulatory Range of Movement in Individuals With Dysarthria Secondary to Amyotrophic Lateral Sclerosis

Purpose The current study examined overall articulatory range of movement (ROM) in individuals with amyotrophic lateral sclerosis (ALS). Differential involvement of articulators was also tested using articulatory working space in individuals with varying degrees of dysarthria severity and in typically aging individuals. A strong association between overall articulatory ROM and severity measures among individuals with ALS was hypothesized. In addition, it was hypothesized that differential involvement of articulators would be detected using overall articulatory ROM measures.

Method Twenty-two speakers with dysarthria secondary to ALS and 22 typically aging speakers participated. Speech intelligibility and speaking rate were used as indices of severity. Movement range and overall articulatory working space area (convex hull) of the tongue, lower lip, and jaw were each measured by electromagnetic articulography while the speakers produced the Rainbow Passage.

Results Tongue convex hull size was significantly correlated with both indices of severity. A significant interaction between articulators and groups was observed. Individuals with severe dysarthria had reduced tongue convex hull size and exaggerated lower lip convex hull size. ROM in the anterior–posterior dimension showed a more notable differential involvement pattern than ROM in the superior–inferior dimension. Results in the area under a receiver operating characteristic curve analysis revealed group-specific ROM sensitivity.

Conclusions The findings indicate that tongue ROM is reduced in individuals with more severe dysarthria when estimated using a standardized paragraph containing all American English phonemes. The articulatory working space measure could be useful for estimating speech dysfunction in ALS. ROM of the tongue decreases, but ROM of the lower lip and jaw each increase in individuals with severe dysarthria. Differential involvement of the articulators in the anterior–posterior dimension needs to be further investigated.

ALS

ALS

Stroke Awareness with Dr. Ali Krisht

Stroke Awareness with Dr. Ali Krisht

“‘Time is Brain’ when it comes to treatment and brain health after a stroke,” Dr. Ali Krisht, director of the Arkansas Neuroscience Institute at CHI St. Vincent, said when asked about stroke treatment and care.

Think of a stroke as a brain attack. Someone who has a stroke either has a clot or a bleeding blood vessel in the brain. And the brain doesn’t get enough oxygen. Without oxygen, brain cells start to die within minutes. And once they’re dead, they can’t be replaced.

Treatment Options for a Stroke
For a stroke caused by a blood clot, a drug called tPA is used. That stands for tissue plasminogen activator. It dissolves the blood clots that cause stroke. This drug dramatically reduces the amount of damage caused by stroke when not treated or when treatment is delayed. The sooner these drugs are given, the less damage to the brain and the body and less disability to the patient.

For bleeding blood vessels that cause stroke, treatment is surgery. Tiny clamps are used to stop blood flow and to keep the aneurysm from bursting. In a few cases, a bypass surgery on a blood vessel in the brain can be performed to direct blood to a region of the brain. It’s the same type of surgery that is used in heart bypass surgery – just on the brain.

Time Matters
The window of time for the best results is within three hours of the first signs of stroke. After three hours, treatment is less effective because brain cells die by the minute.

Signs of a Stroke
Stroke symptoms often occur suddenly including numbness or weakness of face, arm or leg, especially on one side of the body, confusion, trouble speaking or understanding. A person might have trouble seeing in one or both eyes. They might have trouble walking, become dizzy or lose their balance. And some patients say they have a severe headache that hits like a clap of thunder – the worst headache they’ve had in their life.

If you suspect you or someone you love is experiencing stroke-like symptoms, call 9-1-1 or visit the nearest emergency room immediately.

Act FAST if you Suspect a Stroke
When someone has a stroke, minutes matter. That’s why spotting stroke symptoms are critical! Symptoms include:

  • Face. Does one side of the face droop?
  • Arms. Does one arm drift downward when being raised?
  • Speech. Does the speech sound slurred or strange?
  • Time. If you observe any of these, call 911!

Keeping your Brain Healthy
“The brain is a muscle, just like all the other muscles in your body,” says Dr. Krisht. “That’s why it is important to practice it every day to make sure it continues to grow.” Good health for your brain includes good blood flow and proper oxygen levels, which can be provided by regular exercise. Another way to ensure the health of the brain is by eating healthy. By eating healthy, you are less likely to have clogged arteries which causes strokes – keeping a good environment for the brain.

Keeping your brain active also helps it to continue to grow. This is especially important as you age. Activities such as learning something new, staying social, and keeping busy with tasks that cause cognitive thinking to occur help keep the brain alert and healthy.

The last very important thing to remember for maintaining a healthy brain is not participating in recreational or illegal drug usage. Every time drugs are taken, they have a direct effect of damaging areas of the brain and brain cells. Plus, the brain pressure is raised to malignant levels where the arteries going to the brain can become injured and cause a mini-stroke and bleeding in the brain.

Learn more about brain health and the Arkansas Neuroscience Institute at chistvincent.com/ANI.

How we help slow down aging with seniors with ALS, Parkinson and AD

CNS atrophy leads to muscle atrophy and lack of exercise can facilitate virus and inflammation attacks. With exercise, simple range of motion that seniors can carry will help slow down ALS, Parkinson and Azheimers disease.

We start with whole foods rich in Vitamin C and zinc to fight the virus and inflammation. We do simple stretch , do not over stretch before moving or transferring the patient.

Our seniors are thriving with our care that is compassionate and hands on allowing the seniors to do simple exercises while sitting or on their bed.

Bath soaks: hydrogen peroxide and EPSOM salts

Veggie smoothie: greens, onions, garlic, ginger, turmeric, coconut oil, soaked nuts, lime

Breakfast smoothie: soaked nuts (cashew, almonds, walnut), probiotic, ginger, turmeric, blueberries, banana, avocado, strawberries, amino acid powder and Orgain protein shake

Parasites, virus and cancer are factors that make them wake up in the middle of the night and not get adequate sleep. So we incorporate turmeric, lemon, garlic, ginger, onions, veggies and Vitamin C rich foods in their meals which we made into a smoothie.

Call 408-854-1883 for holistic bay area caregivers.

https://www.youtube.com/results?search_query=ALS+exercises

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25% holiday discount for senior home care with Motherhealth caregivers

Bay area families are served by Motherhealth caregivers who treat their clients like family. Some of our patients have lung cancer, vascular disease, ALS, heart issues, kidney issues and we incorporate holistic care such as massage and gourmet meals.

Fees start at $28 per hour depending on level of care. 4 hours is minimum and we accept long term care insurance and private pay. We also refer you to other hospice agencies and care home facilities.

Text 408-854-1883 for prompt response and free assessment of your home care needs. Use discount count code HOLIDAY.

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Cognitive Dysfunction Syndrome and Sundowning

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Natural Medicine and Kidney Disease

Natural Medicine and Kidney Disease

Naturopathic Newsletters
from Dr. Jared Hanson N.D., L.Ac.
Natural Medicine and Kidney Disease: An Interview with Dr. Jenna Henderson

Dr. Henderson is interviewed by New York City naturopathic doctor, Jared Hanson. 

Q: This is the first of what I hope will be many in a series of interviews with experts in natural or alternative medicine. Dr. Jenna Henderson N.D. is a naturopathic physician and an expert in the holistic approach to kidney health. Information on natural approaches to kidney disease is incredibly valuable and unfortunately it can be hard to find.
What role do you think natural medicine should play in the treatment of kidney disease?

Dr. Jenna C. Henderson: Having seen natural medicine and mainstream medicine close up in dealing with kidney disease, I think there is a lot the natural medicine can offer patients that they can’t find anywhere else. For those in an early stage of kidney disease, we can bring their bodies back into balance. And for those in a later stage with severely compromised kidneys, we can keep their kidney function going with a maintenance regimen. Natural medicine has the tools to control blood pressure, inflammation and cholesterol and improve kidney function– and all of it without the dangerous side effects of prescription drugs.

Q: So let’s look at someone in an early stage, if they’ve just been diagnosed with kidney disease. Are there specific steps that you would recommend?

Dr. Jenna C. Henderson: In the early stage of kidney disease there is some damage to the nephrons or filtering units, but the kidneys are still able to clean the blood thoroughly. As long as the creatinine is under 1.3 your function is still pretty good.

First get to the bottom of what’s causing the kidney damage. If it’s diabetes, get it under control. If it’s hypertension, control that. If it is one of the inflammatory kidney diseases such as IgA nephropathy, Focal Sclerosis or Minimal Changec– bring down the inflammation.

For the Type 2 diabetic change their lifestyle and lose weight. The addition of some supplements for glycemic control can help too.

With high blood pressure it is important to take medications on a regular basis. Even one skipped dose can be damaging. Of course, I prefer a natural approach with stress management and botanicals. The prescription drugs can cause erectile dysfunction in males and a loss of desire in females. Many of them will weaken the heart over time.

When the kidneys are inflamed there is a loss of protein in the urine. The urine looks foamy when this happens. It is easy to know if what you’re doing to reduce inflammation is working because the urine will be less visibly foamy. Adopt a diet that has many fresh fruits and vegetables and avoid saturated fat and fried foods. Natural anti-inflammatories will make a world of difference – quercetin, bromelain and fish oil will make the urine visibly less foamy.

And from the Eastern perspective do the things that preserve kidney chi and bring you into balance. Get plenty of sleep – at night. This is especially important but hard as many kidney patients deal with insomnia and they are awake all night and sleep during the day. Acupuncture can help and sunlight during the morning hours can reset the body’s internal time clock.

Q: How do the recommendations change for those with more advanced disease, such as patients who are already on dialysis?

Dr. Jenna C. Henderson: Well it’s my hope to prevent their going on dialysis. With advanced disease I would add on to their protocol with high dose coenzyme Q10 and l-carnitine. When the kidneys have sustained damage there is a loss of functioning nephrons to filter the blood. That means that the remaining nephrons have to work harder to keep up with the body’s demands. That is called a state of hyper-filtration, when the kidneys are overworked. That is when they are most vulnerable to fail. The purpose of the coenzyme Q10 and l-carnitine is to supply energy on the cellular level to the nephrons. This will support the remaining nephrons in keeping up with the body’s demands. This approach can keep dialysis at bay for a long time, sometimes indefinitely.

If you have had diabetes, high blood pressure or nephritis for any length of time, you can bet there has been damage and your kidneys are in a state of hyper-filtration. Even if your creatinine is normal. Your kidneys are working harder and harder to keep the blood clean. When the creatinine jumps up it happens suddenly. It’s like your gas tank going from full to zero all at once, but that is how chronic kidney failure happens. It is a chronic situation that all of a sudden becomes a crisis.

When you’re on dialysis it seems like the end of the world but there are many things you can do to keep your body in optimum shape. Keep up the coenzyme Q10 and add solid hawthorne extract to protect the heart. People don’t die from uremic poisoning in this day and age, but they do die from heart failure as a complication of the kidney disease process. Also, green tea to lower the BUN and bioflavonoids to strengthen the blood vessels. If you do hemodialysis it is very hard on the blood vessels. The bioflavonoids are very important. Also eat lots of berries – safe for the dialysis diet and rich in bioflavonoids.

The dialysis diet is very restrictive, but it is important to stick with it. That means that there are a lot of nutrients in fresh fruits and vegetables that are off limits to a dialysis patient because they are high in potassium. When the kidneys fail they no longer filter out potassium and elevated levels could stop the heart. Don’t cheat on this diet, but try to make up the nutrients you are missing with supplements.

Q: When you say dialysis can be kept at bay, do you feel that there are people who are put on dialysis too early when a natural approach would be more appropriate? In your opinion, is there a possibility to come off dialysis in certain patients?

Dr. Jenna C. Henderson: No. When it’s time to go on dialysis, don’t fight it. There are some people who will use extreme protein deprivation and can delay it to some extent, but when it’s time to get on the machine, do it. There are no natural approaches that I’m aware of, and I’ve been looking at this for 15 years, that can help at that point. When the kidney function is gone or you’re left with residual function which is not enough to sustain life, it is time to get on the machine. At that point we look at natural remedies for maintaining optimum wellness.

Q: Do you have any preventative advice for the general public for protecting their kidney function? Are there any hidden threats to kidney function that you think people need to be more aware of?

Dr. Jenna C. Henderson: The most common reason people experience kidney failure is diabetes and second is high blood pressure. Early screening and consistent care can be helpful in most situations.

As far as kidney diseases that involve the immune system I believe that sunlight and Vitamin D are very important. Vitamin D plays a critical role in the function of the immune system. And these diseases are more prevalent in places with less sunlight exposure.

African Americans have these kidney problems frequently but Africans generally do not. In Northern Europe, these conditions are relatively common but in Australia it is much less so. It is a similar worldwide distribution to Multiple sclerosis – another autoimmune disease, being common where there is less sunlight. Since people in the last century have moved indoors and no longer work outside we have seen an explosion of autoimmune diseases.

So one of the best things you can do is get your kids away from the computer and doing something physical outside.

In care home and at home, you may need hospice nursing care

Do you need hospice care when you are in a skilled nursing facility? You may not need one.

But in a care home , at your home or in other facility or assisted living places, you may need a hospice nursing care who provide home health, medical way.

Motherhealth provides home health aids, non medical and holistic way.

We can also refer you to visiting hospice nurses , care homes and other facilities as their opening changes on a daily basis.

Assisted living facilities in the bay area have a waiting time of 6m to 3 years. I am calling all investors who can partner with me to build the latest senior assisted living facility with all in one services.

Email motherhealth@gmail.com for more info. Mailing address is at 1708 Hallmark Lane San Jose, CA 95124 for Motherhealth LLC and Motherhealth 501c6 (non-profit).

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Bay area on-call CNA or caregiver 408-854-1883

Calling all facilities, senior care homes, hospitals, SNF and rehabs who needs sitter, caregiver or CNA, you may text your need to get a caregiver within 12 hours at 408-854-1883.

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Thank you for your response. ✨

Seniors who are homeless prefer to live in a skilled nursing facilities

In the bay area where housing is expensive, some seniors live in their cars or a skilled nursing facilities. Often, some of them are taking drugs or have some kind of addiction.

What to do when we have forgotten to care for our seniors who are now living in senior facilities with no family visiting them.

I was taking care of a senior in the past whose diapers were never change and it took me many hours of oil and hydrogen peroxide, hot water and baking soda to clean her.

As a society, where is our priority with regards to the care of our seniors.

Our caregiving team are like families to the seniors we serve. We fall in love with them. Many seniors cannot afford the personalize companionship with caregivers but is worth it especially during the last months of their lives as we massage them and are their companion during the times that they feel hopeless and depressed.

Holistic senior caregiving is what we offer at Motherhealth caregivers, 408-854-1883

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$30 is the maximum gift amount that the doctor can receive for referring

Stark Law and Gifts Sent to Your Medical Practice | Physicians Practice


Oct 14, 2012 – The Stark Law is clear on your medical practice and gifts from referring physicians,patients, and others. … and vendors wondering if it is permissible to give or accept gifts. … Particularly suspect are gifts which are given after each referral, or after a … The dangers of trusting your employees too much.

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May 7, 2018 – The best gifts for doctors, according to specialists in the medical field, include … Doctorsdon’t so much need a flashy new pair of shoes as they could … We do a lot of writing, even though mostpatients have electronic medical …

To Receive Or Not To Receive, That Is The Question With Patient Gifts


Dec 16, 2016 – … is very clear; if the person giving you the gift is in a position to refer or generate business for … When it comes to deciding whether to accept a gift from a patient, there is no federal law to guide you and the waters are much murkier. … Such gifting not only undermines the physician’sreputation for providing …

Should Physicians Accept Gifts from Patients? – Curbside Consultation …


Aug 1, 2007 – I have been taking care of a wealthy patient for many years. She has always given me small gifts, mostly food gift baskets that I give to my staff.

Should I accept gifts from patients? | The BMJ


by M Davies – ‎2015

Feb 10, 2015 – Doctors often receive gifts from patients who wish to express their gratitude … treat,refer, or commission services for patients and b) you have not … doctors should also take into account factors such as the cost of the gift … the patient enjoying a moment of life that my medical care allowedhim to experience.

1000 bay area caregivers needed with CNA tuition reimbursement and bonus

Many hospitals, senior facilities, assisted living, home care, care home and skilled nursing facilities are in need of CNAs, certified nursing assistants who continue their nursing degree and end up not working with any facilities after their CNA program. Motherhealth is partnering up with the above hospitals and facilities to provide them with caregivers who are currently enrolled in CNA with tuition reimbursement and sign in bonus.

Apply here. Or email motherhealth@gmail.com. Must work at least for 1 year after hiring by the facility with tuition reimbursement. Sign in bonus of $600 after 6m and another $600 after 12m.

Motherhealth also is hiring its own caregivers with profit sharing. Must treat clients like family.

 

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