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Life & Times Transcript

10/14/05

Val Zavala>> Tonight on Life and Times --

Hospice care is meant to comfort dying patients, so why do people wait until their final days to use it?

Marguerite Hirsch>> Here we all hug each other and we show our love. In a hospital, it's just a business to them. It's a job.

Val Zavala>> And then, it's the biggest thing in Leona Valley since horseshoes.

Cris Franco>> Hey, why am I dressed like Woody from "A Toy Story"?

Val Zavala>> Cris Franco takes us to an equestrian competition where girls rule.

These stories and more next on tonight's Life and Times.

Announcer>> Life and Times is made possible through the generous support of the L.K. Whittier Foundation dedicated to improving the quality of life by supporting innovative endeavors in the fields of medicine, health, science and education.

And by a generous grant from Jim and Anne Rothenberg.

Val Zavala>> It can make the end of life more dignified, more comfortable and more compassionate, so why do so few American families take advantage of hospice care? And why do they wait until the last minute to put a loved one in hospice? Well, it has to do with our doctors, our Medicare policies and families themselves. Stephanie O'Neill Noe met one family in the Valley that's making some big decisions.

Stephanie O'Neill Noe>> For ninety-four year old Marguerite Hirsch, this San Fernando Valley Assisted Living facility is home. Hirsch, who is in poor health, moved here in November and plans never to leave for a hospital stay no matter how ill she becomes.

Carol Rees>> "You've been doing really good. You've really improved since the last time I saw you."

Marguerite Hirsch>> "Yes."

Carol Rees>> "Yes, especially in your spirits."

Stephanie O'Neill Noe>> Hirsch, who has a serious heart condition, is among the nearly one million terminally ill Americans who annually opt out of traditional medical care and are instead embracing the lesser-known option of hospice.

Carol Rees>> The goals of care are not for a cure in the physical sense. You don't have the hope of getting better, but you have the hope of having a good life.

Stephanie O'Neill Noe>> Carol Rees is a hospice nurse for VITAS, one of the nation's oldest and largest hospice providers.

Carol Rees>> We try to diminish or minimize as much as we can the suffering that people endure and make the experience as positive as possible. But if you have decided that you would rather live a normal life without having to be poked and prodded and going into the doctor every day or on a machine for three hours a day or permanently, then we're here for you.

Stephanie O'Neill Noe>> Those who choose hospice receive care from teams comprised of nurses who visit as needed, a doctor who oversees care, home health aides who assist in daily tasks like bathing, social workers who provide counseling and clergy who offer spiritual guidance. Patients like Hirsch are provided basic care at their home such as medication to ease suffering and pain, but they are not given life-prolonging procedures. However, Rees says, the patient can decide at any time to go back to traditional medical care.

Carol Rees>> I tell people you turn over every rock. You have a right to rescind your hospice. There's nothing marrying you to this program. You can change your mind in an instant and we will refer you back to your doctor and make sure everything is in place. If you come into hospice and, oh, you here about something, you can change your mind and come back when you're ready, when you find out that either it worked, it's wonderful, or it didn't work and welcome back.

Stephanie O'Neill Noe>> Still, Rees says, many people fear the idea of hospice. Is there a stigma associated with hospice?

Carol Rees>> A lot of times, the first thing that people feel uncomfortable with us coming is because here they come, that means I'm dying. Whereas, you're living. You're still alive. We're here to help you live. That is the hardest thing for the families to come to grips with is to allow themselves to keep on living while they're still alive, and the patient, but it works out really well with the team that we have.

Nancy Griffin>> Let's face it. Our culture doesn't have a very open and honest attitude towards dying. It's been a taboo subject. Families don't talk about it.

Stephanie O'Neill Noe>> Nancy Griffin is the West Coast editor of the American Association of Retired Persons Magazine which is working to improve the availability of hospice care in the United States.

Nancy Griffin>> With high technology and the orientation of doctors to always try to extend the lives of their patients, it's very hard for both patients and doctors and their families to find that point where, you know, enough pain has been endured, enough attempts have been made to save the life and to just say, okay, what we want to do now is to allow the patient to go home and enjoy comfortably the last days or weeks or months of the patient's life.

Stephanie O'Neill Noe>> What's more, in order for a patient to qualify for hospice coverage, two doctors must declare they have six months or less to live, something many physicians are hesitant to do. That's in part why fewer than half the number of people who qualify for hospice care actually receive it. Instead, a majority of the terminally ill die in hospitals.

Nancy Griffin>> There are a number of factors for why it's not larger, which include physician training. Physicians are trained to cure patients rather than to administer palliative care and help them die in a comfortable way. It includes attitudes of families who think that hospice means giving up and they don't want to let go and admit that the patient is going to die.

Stephanie O'Neill Noe>> Moreover, many Americans remain unaware that both Medicare and most private insurance policies provide full coverage for the service. That was welcome news for Hirsch's daughter, Louise Kares. She says that, without the service, these last months of her mother's life would be far more difficult for everyone.

Louise Kares>> I would worry a lot more. I was always worried about her before. Now I know there's someone around that will take care of her. I can go on vacation for a couple of days and not worry about her all the time.

Carol Rees>> So we're like her advocate. We come in and do her blood pressure every week, we check her medications, we make sure that she's getting her needs met. Not just her physical needs, but her emotional needs.

Carol Rees>> "Now the last time I was here, you were wanting to be able to have more independence. Has that happened? Do they pretty much let you get up and walk around as you choose?"

Marguerite Hirsch>> "Yes."

Carol Rees>> "Okay. So are you happier now?"

Marguerite Hirsch>> "Yes."

Carol Rees>> "Good, excellent."

Stephanie O'Neill Noe>> Dr. Paul Diehl of West Hills says he learned nothing about end of life care in medical school. Trained as an internist, he spent the first half of his career working solely to cure patients of their ills. Today he devotes a large portion of his practice to hospice care.

[Film Clip]

Dr. Paul E. Diehl>> The ability to have someone when they're in their last days to be able to go home, to be what I call in their castle with their things, with people that hold them the dearest and to be able to do that and support them, I think, is an absolute. You know, the idea of going to a hospital to spend your last days, I mean, I'm sorry, I myself when I'm at that door, you know, I want to be taken care of just the way that these people are being taken care of through hospice.

Stephanie O'Neill Noe>> Unlike Hirsch, many who qualify for hospice don't get it until they're on the verge of dying and, while hospice can still make them comfortable, patients benefit far more when they enter the program much earlier.

Marguerite Hirsch>> Well, I know I wouldn't get the care or the loving. That's what's important, the loving. Here we all hug each other and we show our love. In a hospital, it's just a business to them. It's a job, you know, the care helpers. Once in a while, they show a little compassion, but mostly I feel it's their job, which is good too, but we all need that extra little hug. "I love all you girls."

Carol Rees>> "I know. We're lucky."

Stephanie O'Neill Noe>> For Life and Times, I'm Stephanie O'Neill Noe.

Carol Rees>> "(Laughter) Am I going to have to give you a tissue?"

Marguerite Hirsch>> "(Laughter) No."

Kcet.org is the place to look for the very latest on Life and Times. You'll find previews of upcoming stories, transcripts and audio of past episodes and links to some of our most interesting features. Just go to kcet.org and click on "Life and Times".

Val Zavala>> It's been dubbed the female Viagra and its makers claim it boosts women's sex drive, but the Food and Drug Administration says not so fast. They want to see more studies. So is it safe and effective? I came to Westwood to speak with Dr. Judith Reichman, a prominent physician, author and expert on women's health. Now tell us about this testosterone patch for women because there are many, many women out there who would love to get their hands on this.

Dr. Judith Reichman>> Well, I'm sorry to say that they can't get their hands on it because it has not been FDA-approved. It was going to come out with the name of Intrinsa, which I thought was a nice name, and it basically gave a certain amount of testosterone that was going to be physiologic for women. That means it wasn't going to give huge amounts of testosterone such as that which is given to men. When they take it, it's ten times more than what we need.

It was basically researched to use in women who were menopausal either with surgical menopause or spontaneous natural menopause and only if they also took estrogen, the idea being that this patch, this testosterone source, was going to help with libido, arousal and orgasmic response.

Val Zavala>> And the question is, did it work? Does it work?

Dr. Judith Reichman>> It did work. It wasn't something that would make women feel like they had become eighteen again (laughter), but there was an increase based on the studies with arousal and a satisfaction with sex and perhaps an increase in the frequency of sex. Not huge. It was moderate, but considered to be significant.

But it didn't work just on anyone. It was really for those women who had lost their source of testosterone because their ovaries were removed and, in some cases, once they were menopausal. Although I have to add that menopausal women, if their ovaries are still intact, are still making testosterone. They're making it from their adrenals. They're making it from their ovaries and they don't have this sudden loss that a woman gets if her ovaries are removed.

Val Zavala>> So why did the FDA say no approval at this time?

Dr. Judith Reichman>> They wanted longer term studies. Mostly the studies were anywhere from three months to six months. They wanted to know what are the long-term effects on coronary vascular disease, heart attacks and strokes. Were there any long-term effects on breast cancer, and they really didn't have that data. However, we know that if physiologic amounts of testosterone are given, in general we don't see tremendous bad changes in cholesterol or lipids.

There are high doses of testosterone that were used from the 1950's in a treatment for breast cancer, so one would think that this wouldn't have any effect on breast cancer incidents. It doesn't seem to increase clot formation. And you have to remember that, when something is given through the skin with a patch, it doesn't have first bypass in the liver. So it doesn't have all the effects that an oral medication might have.

Val Zavala>> Now a lot of people compare this to Viagra, which was approved in fairly short order, in about six months or less than a year. A lot of people are saying, oh, I see. Well, this is for women, so now they're dragging their feet. Is that the case?

Dr. Judith Reichman>> No, it's not really the case. Viagra is not a hormone. What Viagra does is, it allows the increased blood flow so that the penis can basically expand and become erect. This doesn't seem to work in women. Although we need blood flow into the vaginal area for arousal, it really is not going to do anything for libido or for orgasmic response. It's actually the company that's tried very hard to see if it works with women --

Val Zavala>> -- the company that has the Viagra.

Dr. Judith Reichman>> That's correct. And they have stopped the studies because they felt there was really no appreciable effect. Having said that, it's a lot easier to find out if something works in a man when it has to do with sexual response than if it works in a woman. Moreover, we now know that there are an awful lot of aspects to our sexuality that are not purely hormonal and that many women find that their libido is diminished and their orgasmic response is diminished because of psycho-social reasons. They're depressed, they don't like their partner, they have no partner, they're on medication. All that has to be ruled out before we even attempt to do something hormonal.

Val Zavala>> So whether it be the testosterone patch or something else, do you think they'll ever find the key to unlock and boost women's sexual drive?

Dr. Judith Reichman>> I think we're making progress. As far as medication, I haven't given up on the testosterone patch. I think they want more studies. I expect that eventually we will see it on the market. Meanwhile, we have other testosterone formulations. They're just not FDA-approved. We have creams and ointments that are also transdermal. In other words, they go through the skin. We're using compounding pharmacies to make them.

Val Zavala>> A lot of women are using them.

Dr. Judith Reichman>> Women are using them. You need a prescription. The doctor really has to know what she or he is doing and the woman has to be followed. There are going to be variances in the amounts because it's compounded. It is not FDA-approved. You have to be a little careful. NAMS, which is the North American Menopause Society, just came out with their recommendations vis-�-vis testosterone supplementation.

They feel it should be given carefully and only for women who are definitely having sexual problems after the other aspects have been ruled out, such as psycho-social or medical and only in women who are menopausal. They feel it's only been tested together with estrogen, so when it's given, it should be given with estrogen and the smallest amounts should be given in order to reach the treatment goal. But they have come out and said that this stuff works and, in some women, might be appropriate.

Val Zavala>> So it's promising, but in the meantime, we will move carefully.

Dr. Judith Reichman>> Absolutely.

Val Zavala>> Dr. Reichman, thank you so much. Great advice.

Dr. Judith Reichman>> My pleasure.

Announcer>> To send a comment or a question to our program, you can reach us by mail at this address:

Life and Times
4401 Sunset Blvd.
Los Angeles, California 90027

You can also call our viewer comment line (323) 953-5555) or contact us the fast way by e-mail at kcet.org.

Val Zavala>> You may never have heard of the next place we're taking you to. It's Leona Valley, about an hour north of Los Angeles. It's a small town with a huge love of horses and, when the annual girl's equestrian competition comes along, it takes over the hearts, the horses and the hair of every cowgirl in town. Cris Franco went there to see it for himself.

Cris Franco>> Howdy, partners. Giddy up and, whoa, are these jeans tight. Hey, why am I dressed like Woody from "A Toy Story"? Because I'm seventy miles north of the citified concrete jungle of Los Angeles, here at the Miss Leona Valley Gymkhana Queen Pageant, Second Annual. Hey, what's a Gymkhana? Well, I'll show you.

[Film Clip]

Cris Franco>> A Gymkhana is timed horse-riding events such as barrel racing where the fastest rider wins. Unlike a rodeo, it deals strictly with equestrian art. Yep, that's right. It's way back in 2003. The residents of Leona Valley who only number about 2003 get together right here at their community center to put on an all-girls riding, speech and equestrian knowledge competition that they call their Gymkhana Pageant. The whole town gets involved, offering their support to this year's eight formidable contestants who all have big dreams and big hair.

Ten year old Christina Foust and eleven year old Carleen Hayden are vying for the title of Little Miss. Competing in the Junior Miss category are thirteen year old Lauren Aguilar, fourteen year old Justine Nichols and eleven year old twins Alicia and Olivia Eaves. In the Miss category are fifteen year old Robin Barrager and sixteen year old Julianne Fettinger, and they've got some big cowgirl boots to fill, literally.

Because Leona Valley is rapidly earning a reputation as one of California's premier producers of award-winning horsewomen like hometown champions, Jenny McDermott, Miss Rodeo 2001; Tanya Williams, Miss Rodeo Lancaster 1996, and Brandi DeYoung, Miss Rodeo America 2000. Event founders, Tom and Judy Brundage, and Nancy and Mike Pohlig, theorize as to why this small town is producing such big talent.

Tom Brundage>> I think one of the things is just the way of life we have here. The rural atmosphere and the horses are a big part of our life. It kind of encourages them to ride and be better at it.

Cris Franco>> Do you all agree that it's just something about the beauty of the valley that might inspire the girls?

Mike Pohlig>> That's a lot to do with it and you can tell by looking around that we're lucky enough to have the room for horses. A lot of communities don't have that opportunity, so we take advantage of it.

Cris Franco>> Yeah, a horse wouldn't fit in my carport (laughter). Following the early-morning personal interviews with judges, the girls gave rousing speeches. Lauren Aguilar acknowledged the townsfolk who helped save the life of her best friend, her horse, who had nearly died of colic just one week prior.

Lauren Aguilar>> "I also have to give a huge thanks to my dad. He slept in the dirt with my horse and also paid those outrageous vet bills."

Cris Franco>> And Julianne Fettinger's speech was uplifting.

[Film Clip]

Cris Franco>> And one thing was clear. This is a proud community who loves its girls and is crazy about horses. Now the whole family gets behind a horse, right? It's not like a cat or a dog. What are some of the things you all have to do to keep the horses happy in your lives?

Nancy Pohlig>> The horses pretty much run our life (laughter), much more than a regular pet.

Cris Franco>> Big puppy, very big puppy.

Nancy Pohlig>> They're really part of the family.

Cris Franco>> These folks love their country lifestyle and had a variety of reasons as to why they feel that this Gymkhana is very positive for the contestants. The outgoing Queen, Kate Pohlig.

Kate Pohlig>> It's been a great confidence builder and a trust builder between my horse and I as well as other people and sportsmanship altogether.

>> "It gives them a good respect for nature and animals which, in turn, will make people have respect for animals and more respect for people around them."

Cris Franco>> It's better than them being, you know, stuck in front of a computer or a Gameboy, don't you think?

John Eaves>> Exactly, and chasing boys too. I like this substitute much better (laughter).

Tom Brundage>> As you saw today, with the opportunity for these young girls to give speeches in front of, you know, a fairly large crowd at this young age helps their public speaking.

Cris Franco>> And about public speaking, it's very good to learn about speaking in public, okay? (laughter). How good are the young ladies in this year's Gymkhana Pageant?

>> "Excellent."

Cris Franco>> After the Star Spangled Banner --

[Film Clip]

Cris Franco>> The riding began and the girls were excellent.

[Film Clip]

Cris Franco>> Tonight the Leona Valley Community Center is packed with anxious friends and family and what is known as visiting royalties. Those are girls who have won local Gymkhanas and rodeos and are here to support their sisters of the saddle. It's coronation time. The outgoing royalty shed a tear and another almost dropped a trophy, but in the end, Christina Foust was crowned Little Miss, Lauren Aguilar won the title of Junior Miss, and Robin Barrager is the new Miss Leona Valley Gymkhana Queen. Although only three girls were crowned tonight, I think you would agree that they're all winners.

>> "Today is not about winning. It's about having fun and meeting new girls and really getting to know everyone around the community and this is one of the best communities I've been through."

Cris Franco>> And they're carrying on the great tradition of this pastoral valley whose town spirit and sheer beauty seem to inspire young girls to think perhaps I could be a Gymkhana Queen.

[Film Clip]

Cris Franco>> Is that the wave? Teach me the wave. So if the horse is like this, you're waving? No? So, like this? So all I need is the horse and I can be a Gymkhana Queen.

Val Zavala>> We don't really know what it is and it's hard to describe. All we know is that it's unusual and beautiful. It's at Materials and Application, a center for exploratory architecture in Silver Lake, and we sent our photographer there to capture it on video.

[Film Clip]

Benjamin Ball>> My name is Benjamin Ball. I'm with Ball-Nogues Architecture and Design and we started this project about a year ago. It's Mylar and it has a metallic gold coating on it and kind of an amber tint. It's reinforced with bundles of nylon to give it extra strength and also to prevent it from tearing.

[Film Clip]

Benjamin Ball>> It's really about a process and it's about a way of putting materials together and a way of assembling materials and a way of making a shape. I think the inspiration stems from the space that we're in. It really serves a purpose for this particular space, which is to shield you from the sun and to change the environment and the qualities of the light.

[Film Clip]

Benjamin Ball>> I think we've actually achieved something here where you don't need to have the framework of a gallery around it to know that you can appreciate it or know that you can experience it. The more people that come through from the community, the happier we'll be. I love to hear about people just discovering it as they're walking their dog down Silver Lake Boulevard. That's like one of the most rewarding things that could possibly happen for me.

[Film Clip]

Val Zavala>> And that's our program. I'm Val Zavala. For everyone at Life and Times, thanks for watching. We'll see you next time.

Announcer>> Life and Times was made possible through the generous support of the L.K. Whittier Foundation dedicated to improving the quality of life by supporting innovative endeavors in the fields of medicine, health, science and education.

And by a generous grant from Jim and Anne Rothenberg.

Sponsored in part by:


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