STORY BY
Arlene Nisson Lassin

Just a few weeks from my son’s law school graduation, I was thinking how close I was to the parenting finish line. He was soon to be degreed, employed and miles away. This was where I could officially retire my worrying. It was an exhilarating feeling.

Then came the late-night long distance call from an emergency room. The diagnosis: a possible torn ACL (one of the major ligaments of the knee.)

Not even a week later, I received another late-night call from my son, this time from his home. He was experiencing unusual swelling and after a call to his doctor, was told there might be a blood clot..

Feeling helpless, I implored him to go immediately to the ER and not wait until a morning doctor’s appointment. Fortunately, he listened. It turned out not to be a clot but a complication of his initial injury, which ended up to be far more severe than a torn ACL. Another round of emergency surgery for him and another surge of panic for me.

Such is the lot for parents of adult children. Our kids are bound to get sick or injured, but they don’t yet have enough experience making judgment calls on their own health. And, we parents don’t have the right—or power—to make the calls for them. 

So how do we know when it’s time to play the parent card? And, from a healthcare perspective, how do we teach our grown children to be parents to themselves?

‘Mom, you’re not authorized to…’

With the legal age at 18, around the time kids leave home, they are in charge of their own medical destiny from that point on. One mother was shocked to learn upon rushing her 18-year-old high school senior to the ER that she could not authorize treatment because her son was now of legal age.

Another set of parents, Neil and Liz listened, advised (and worried) by phone 1500 miles away, but tried not to interfere with the way their newly New Yorker son was managing a severely swollen face that was only getting worse. When news got to the alarming stage of “possible tumor,” Neil flew up just as his son was admitted to the hospital. The eventual diagnosis ruled out tumor but required a vascular surgeon specializing in head and neck conditions.

Another parent resorted to “well-crafted guilt and begging” across two continents to get her adult son to seek medical attention for a run-in with a poisonous sea urchin. Another parent interviewed had no problem scooping her 28-year-old daughter into the car when she was too feverish to stay awake long enough to finish a sentence. The diagnosis: first-time strep throat—run amuck.

Pamela Berens, MD, professor of obstetrics and gynecology at The University of Texas Medical School, part of The University of Texas Health Science Center at Houston (UTHealth) is also a busy mother of four. She acknowledges that it is harder for parents of adult children who are ill. She recommends negotiation, and if that fails, engage an intermediary or close friend. Sometimes the opinion of a girlfriend or favorite aunt can carry more weight than a parent.

“Kids can be stubborn, and parents want to make sure their kids are safe,” Berens says. “Try to find a middle ground with them, because they don’t view themselves as ‘breakable.’ You might convince them to get it checked out for you rather than for them. Start off with saying, ‘Do me a favor…’”

Sometimes the concern is financial: health care is costly and emergency care can be bank breaking. In these challenging economic times, however, adult children may not have insurance of their own. Or, they may be too new at full adulthood to understand how their insurance works.

“If there is a financial issue, tell the adult child that this is something that is worrying you so it is important enough for you to pay [or contribute monetarily as best you can],” Berens says. Sometimes that can be the incentive to spur them to action.

Another tool she recommends is old-fashioned parental common sense: ask them if they want to forego medical help and be sick for a month, or get medical attention that may result in their feeling better right away.

Hand-wringing from a distance

There’s a medical encyclopedia worth of maladies to worry about with young adults: injuries, STDs, lapsed vaccinations, medication accidents (too much, too little, interactions, reactions) or simply complications that can develop from a cold, flu or common skin eruption.

Mental health issues especially can concern parents—from eating disorders or addictions—to anxiety or depression. Sometimes mental illness is hard enough to recognize when children are living under the same roof with you. Deciphering mood and behavior from a distance can be daunting.

“Withdrawal or isolation is a big signal that something is amiss,” Berens says. “Others are excessive sleepiness, changes in appetite or eating habits, lack of desire to go out, suicidal thoughts.” Some disorders are sneakier than others and harder to spot from long distance, such as anorexia or bulimia, she says, so “communication is vital.”

Laura Rooney, DNP, a professor at the UTHealth School of Nursing and a nurse practitioner works in primary care with patients of all ages. She says when dealing with adult children and illness, it is important to ask key questions that will help the parent to determine if this is a mild, self-limiting illness versus something more severe.

“Communicate with your children and ask about their symptoms,” Rooney advises. Parents may need to check their parental tone at the door, but don’t be afraid to ask questions if you truly are concerned.

Ask yourself as a parent: Would I seek medical attention if I had these symptoms? If so, chances are your adult child should do the same.

For example, high fevers (101degrees F or greater) or those lasting longer than a few days or accompanied by rash are generally not as common in adults, so a visit to a healthcare provider would be prudent. Other serious signs include vomiting and diarrhea, particularly when the adult child is unable to hold down fluids, headaches that cause visual disturbances, upper respiratory infections with shortness of breath, or injuries with swelling and restriction of normal movements.

When it comes to the more intimate details of your grown children’s lives, remind them that certain responsibilities come with certain adult behaviors.  You can ask your adult daughter if she’s found a good gynecologist in her new city without asking her where she was last night.  You can remind your drinking-age children that alcohol and alleged pre-emptive hangover drugs like acetaminophen (Tylenol-like drugs) can be a lethal combination. (They may not believe you, but they will Google it.)

The bottom line: listen and watch. Keep the lines of communication open.  By virtue of their physical distance from you, they may open up more about their health and lifestyle. Respect their newly laid boundaries and assure them that you, too, would like to empty the parental worry bag.  Then, don’t be afraid to step in if a medical issue causes concern—or if you just don’t feel right about it all. (Parental intuition is not an urban myth.)

“Our healthcare team offers comprehensive primary and specialty geriatric medicine services at a single site outside of the medical center,” said Dr. Carmel Dyer, the Roy M. and Phyllis Gough Huffington Chair in Gerontology and director of the UT Center for Healthy Aging.

At the UT Center for Healthy Aging, patients have access to a team of specialists including nurses, nutritionists, geriatricians, and other clinicians who specialize in geriatric cardiology, orthopedics, psychiatry, urogynecology, neurology, wound care, gastroenterology, palliative medicine, and other fields of medicine. Patients with memory problems or dementia can receive care in the Brain Health Clinic at this center.

Clinic services include preventive care, immunization screenings, annual physical exams, care for chronic and acute health problems, memory and depression screening, functional assessments, medication reviews, and advanced care planning. The UT Center for Healthy Aging also offers consults and second opinions. Its lab is on-site, and imaging services can be conveniently scheduled at the UT Imaging facility in the same building.

“We offer patients continuity of care, with a house call program for those with increasing disability and inpatient services for those requiring hospitalization,” said Dyer, executive director of the UTHealth Consortium on Aging. “A key component of our services is that we work with our patients to understand their goals. We inform patients and family members about available community resources to meet their needs. Our ultimate goal is to provide superior medical care and assist patients in maintaining their quality of life.”

UT Physicians is the medical group practice of The University of Texas Medical School at Houston, a part of UTHealth. Incorporating the latest medical treatments and most advanced technologies, UT Physicians offers high-quality, personalized care from a flagship location in the Texas Medical Center and at a growing number of health centers throughout the Houston area. UT Physicians has more than 1,000 doctors who are certified in 80 medical specialties and recognized for cutting-edge medical research and treatment.

The UT Center for Healthy Aging is open Monday through Friday. UT Physicians is a preferred provider for nearly all managed care insurance plans.

For information or to schedule an appointment, please call 713.486.5150 or visit UTPhysicians.com. Also, visit UT Physicians on Facebook.

— Meredith Raine, Office of Institutional Advancement, Media Relations

Change the oil every 3,000 miles. Rotate the tires every 6,000. The owner’s manual for our vehicles is filled with lists and schedules that inform us when to do the routine tune-ups to maximize the life of our cars.

So, where’s our owner’s manual? Below is a maintenance schedule to keep you motoring along at peak performance, maximizing the life of… you.

Read on as Carman Hall Whiting, MD, assistant professor of family and community medicine at The University of Texas Medical School at Houston and UT Physicians family practice physician takes us through our personal maintenance schedule.

Babies and Kids

When does a child need regular/scheduled doctor’s appointments (well-child exams)?
With an emphasis on health maintenance and prevention, a well-child exam is a visit designed to evaluate the overall well-being of the child, Whiting says. Visits include physical examinations, measurements of height, weight and head circumference (in infants), needed immunizations and state recommended screening exams (lead exposure, hemoglobin and hematocrit, as well as cholesterol screening in high-risk children).

As a parent, think of these scheduled appointments as opportunities to ask the doctor questions about your child’s growth, development and milestones. Come prepared with a list of questions.

A child will have more well-child exams in his first year of life than at any other time. The American Academy of Pediatrics (AAP) recommends the following schedule for routine well-child visits:

• 3 to 5 days
• 1 month
• 2 months
• 4 months
• 6 months
• 9 months
• 1 year
• 15 months
• 18 months
• 2 years
• 30 months
• 3 years
• 4 years
• Each year after that until age 21

What are the signs a parent should look for in a sick child that warrant a trip to the doctor’s office?
Taking a sick child to the doctor may seem like a no-brainer, but Whiting says it depends highly on the symptoms of the child, past medical history (i.e. chronic medical conditions) and age. However, she offers a few guidelines to help parents determine whether to make a phone call to the doctor for guidance or an actual visit.

• Infants younger than 3 months should be seen by a doctor if their temperature is greater than 100.4. There are no exceptions to this because babies can have life threatening illnesses.
• For children ages 3 months to 4 years, consider the child’s symptoms and behavior along with the fever.
  • A fever greater than 102.5 warrants a call to the doctor’s office to determine whether a visit is necessary.
  • If the child has a fever but is active when given medication to bring down the fever, eating and drinking normally with cough and symptoms of a cold, then it is likely a viral illness that will run its course in a week to 10 days.
  • If the child is less active, sleepy, not eating or drinking well with even a low-grade fever, a trip to the doctor is warranted.
• In older children, the same general guidelines apply as for children from 3 months to 4 years.
• When in doubt, it is always a good idea to call the doctor’s office for guidance.

When should a child have a hearing test?
It’s likely a child’s first hearing test was as a newborn in the hospital. However, if a newborn did not have this initial screening because of a home birth or other reason, the Nemours Foundation recommends a hearing screening within the first three weeks of life. Beyond that, the Nemours Foundation recommends hearing evaluations for children at routine well-child checkups with hearing tests at ages 4, 5, 6, 8, 10, 12, 15, 18, and any other time if there’s a concern.

Is it safe for children to receive vaccines?
Myths abound about the safety of vaccines for children, often leading to unnecessary anxiety for parents who may question whether to have their child immunized.

According to the AAP, the American Academy of Family Physicians (AAFP) and the Centers for Disease Control and Prevention (CDC), vaccinations have significantly reduced the occurrence of transmittable diseases and reduced the morbidity and mortality associated with these diseases, Whiting says.

“Vaccinations are rigorously tested by the Food and Drug Administration to ensure their safety and efficacy,” she adds. “The data from required testing is again reviewed by the CDC, AAP and AAFP to ensure their safety before they are given to children. There is also a database that collects information regarding serious reactions and side effects associated with their use.”

Whiting says vaccines are indeed safe and one of the best ways to protect children against a number of transmittable diseases that may cause serious illnesses in children.

Most well-child appointments coincide with needed immunizations. The CDC posts an up-to-date schedule of immunizations for children and adolescents.

Teens and Young Adults

When does a girl need her first gynecologic visit and what can she expect?
Once a girl turns 13, it’s time for her to see an adult physician, namely an obstetrician-gynecologist or OB/GYN. In fact, the American College of Obstetricians and Gynecologists recommends girls have their first gynecologic visit with an OB/GYN between ages 13 and 15.

Just like her changing body, a girl may wonder what will happen at this initial visit. Whiting says a girl can expect to have questions answered relevant to her growth and development, including puberty and hormonal changes.

“This is a very good time to have questions answered regarding sexual health, menstrual cycles, the prevention of sexually transmitted infections and pregnancy prevention,” she says. “If a girl has painful periods, unusual vaginal secretions or lower abdominal pain, this visit will be a good time to discuss these issues as well. If a girl is not sexually active and does not have any of these problems, it is very likely a vaginal examination will not be necessary.”

When do teens need a sports physical and why is it important?
Up until high school, a standard physical is probably the norm at an adolescent’s yearly health check. However, once a teen becomes interested in playing sports competitively, the rules of the game change. Before becoming an athlete, a teen needs a sports physical to be free and clear to participate in team sports or sports-related activities.

The American College of Sports Medicine notes that generally high school, college and professional sports teams have a formal requirement for annual sports physicals for athletes.

Whiting says a sports physical protects the health and safety of the player. “The sports physical focuses on family history of heart disease that resulted in early death or other risk factors that may require additional examinations before one is cleared for participation,” she explains. “These may include dizziness, shortness of breath or fainting after sports related activities. The physical exam portion of a sports physical focuses primarily on the vital signs, cardiac, musculoskeletal and neurological exams to detect abnormalities that require further testing.”

Should young adults have their cholesterol screened and when?
Because high cholesterol increases a person’s risk for heart disease, the National Heart, Lung and Blood Institute recommends cholesterol screenings at age 20 and older for everyone. Adults should continue to monitor their cholesterol levels with screenings at least once every five years.

Adults

How often does a woman need a Pap smear?
By looking for changes in the cells lining the cervix, a Pap smear can identify if a woman has an infection, abnormal cervical cells or cervical cancer. Just like a pelvic exam, a Pap smear (or Pap test) often is part of a woman’s routine well-woman exam with her OB/GYN.

Most women can follow these guidelines from the National Women’s Health Information Center about the frequency of a Pap smear:

• Starting at age 21, have a Pap test every two years.
• If you are age 30 and older and have had three normal Pap tests for three years in a row, talk to your doctor about spacing out Pap tests to every three years.
• If you are over age 65, ask your doctor if you can stop having Pap tests.

When does a woman need her first mammogram?
The American Cancer Society recommends women have a mammogram (x-ray pictures of breast tissue at different angles and magnifications) to screen for breast cancer at age 40 and once a year thereafter, as long as they are healthy and well. Screening mammograms help detect breast cancer early in women with no signs or symptoms of the disease and at a time when it is most treatable. While screening mammograms start at age 40 for most women, women with risk factors for breast cancer should start earlier.

Whiting notes the difference between a screening mammogram and a diagnostic mammogram. “A screening mammogram consists of four views of the breast and is done as a method to screen for abnormalities that are undetected on clinical and self breast exams,” she explains. “A diagnostic mammogram consists of six views of the breast and is usually ordered if there is an abnormal finding in the breast such as a lump, pain or as a result of an abnormal screening mammogram.”

When does a man need his first PSA test?
Just as a screening mammogram helps find breast cancer early in women, a PSA test serves that same purpose for a man but by detecting prostate cancer in an early and treatable stage.

Prostate-specific antigen, or PSA, is a protein produced by cells of the prostate gland. A problem such as a cancerous growth in the prostate causes more PSA to be released into the bloodstream, so that it reaches a level where it can be easily detected in a sample, according to the Prostate Cancer Foundation. By measuring the level of PSA in a blood sample, a PSA test helps to identify if prostate cancer is present.

The medical community differs widely as to when a man should have his first PSA test. The National Cancer Institute says some practitioners advocate yearly screening for men over age 50, and some advise men who are at a higher risk for prostate cancer to begin screening at age 40 or 45. However, most medical experts would agree that the best decision to begin PSA screening is the one that’s made between a doctor and his patient.

When do adults need their first colonoscopy?
For some adults, the mere mention of the word “colonoscopy” makes them cringe. Be it the fear of the procedure itself or the dreaded prep work, it’s hard to feel comfortable with a procedure that brings the large intestine up close and personal.

Despite the stresses that may go along with having a colonoscopy, it still serves as a person’s best defense in finding colon cancer. Whiting agrees.

“The most valuable information regarding a colonoscopy is its ability to detect precancerous polyps or cancerous polyps early to aid in the diagnosis and treatment of colon cancer,” she says.

Whiting suggests having a consultation with the physician performing the test to help alleviate some anxiety. “It also may be a good idea to talk to others who have had a colonoscopy to help answer some questions regarding your experience,” she adds. “It may help to have a friend schedule his or her test around the same time. Going through the experience together may make it less anxiety provoking.”

The National Institute of Diabetes and Digestive and Kidney Diseases recommends adults have a routine colonoscopy at age 50. Screening for colon cancer should begin earlier in those with a family history of the disease, a personal history of inflammatory bowel disease or other risk factors.

When do adults need a bone density test?
By measuring calcium and minerals present in bone mass, a bone mineral density (BMD) test is the preferred diagnostic for osteoporosis – a condition marked by weak, fragile and porous bones often leading to a person’s increased risk of fractures.

Women have a greater risk of developing osteoporosis due to the rapid bone loss that occurs following menopause, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. A person’s risk for osteoporosis is linked to other factors, too, including old age, being small and thin, being a white or Asian woman, a family history of the disease, diets low in calcium and vitamin D and sex hormone deficiencies.

The National Osteoporosis Foundation recommends a bone density test for those thought to be at increased risk for osteoporosis:

• Postmenopausal women under age 65 with one or more risk factors
• Men ages 50-70 with one or more risk factors
• Women age 65 or older and men age 70 or older
• Women or men over age 50 with a broken bone
• Women going through menopause with certain risk factors
• Postmenopausal women who have stopped taking estrogen or hormone therapy

The physicals will be available on a first-come, first-served basis, so call 713.486.1200 to make an appointment.

Conveniently located adjacent to H-E-B in the Sienna Village Shopping Center, the comprehensive health center serves Sienna Plantation and neighboring communities and offers primary and specialty care for children, adolescents, and adults.

UT Physicians is the medical group practice of the Medical School at The University of Texas Health Science Center at Houston. Incorporating the latest medical treatments and most advanced technologies, UT Physicians offers high-quality, personalized care from its flagship location in the Texas Medical Center and at a growing number of clinics in Houston-area communities. UT Physicians has more than 1,000 doctors who are certified in 80 medical specialties and recognized for leading-edge medical research and treatment.

UT Physicians at Sienna Village provides health care for the entire family—from routine wellness exams and care for common illnesses to highly specialized treatments for complex medical conditions. Services for adults include a focus on women’s health with well-woman exams, preventative care, and family planning, as well as obstetrics and gynecology. The clinic offers comprehensive pediatric care ranging from school physicals and vaccinations to specialized care for injuries and illnesses.

UT Physicians at Sienna Village has a non-invasive diagnostic cardiology clinic where echocardiograms and stress tests are performed. Additional specialty services for children and adults include rheumatology, endocrinology, orthopedics, neurology, gastroenterology, otorhinolaryngology, and more.

For information, call 713.486.1200.   Also, visit UT Physicians at Sienna Village on Facebook.

Just 152 hospitals of more than 5,100 U.S. hospitals meet the rigorous criteria required to be recognized as a “Top 50 hospital” in key medical/surgical specialties.
Memorial Hermann-Texas Medical Center was newly recognized in the areas of Heart and Heart Surgery and Gynecology. The hospital continues to place in the areas of Urology and Kidney Disease, moving up in both specialties. Memorial Hermann-Texas Medical Center ranked 46 in Heart and Heart Surgery, 38 in Gynecology, 30 in Kidney Disorders, and 48 in Urology.

For the 21st consecutive year, TIRR Memorial Hermann ranks within the top five rehabilitation hospitals across the country. The rankings are published in U.S. News & World Report’s July 21 issue.

“Through its affiliation with The University of Texas Medical School at Houston, Memorial Hermann-TMC gives patients access to more than 800 academic physicians representing more than 80 specialties. Leaders in their field, our physicians offer patients the latest treatments available for a wide range of disorders and contribute to Memorial Hermann’s success in many disciplines including rehabilitation, urology, kidney disorders, gynecology, heart and heart surgery,” said Dean Giuseppe Colasurdo, physician-in-chief for Children’s Memorial Hermann Hospital.

The magazine scores the quality of inpatient care based on each hospital’s teaching status, advanced technological capabilities, patient volumes, reputation with physicians, mortality statistics, nursing proficiency, and other measures relevant to each specialty.

“We are so pleased to be recognized by U.S. News & World Report in its prestigious annual listing of the nation’s top hospitals,” said Juanita Romans, CEO, Memorial Hermann-Texas Medical Center. “I am proud of everyone’s efforts to help us achieve our rankings. Our recognition across such a broad range of specialties speaks to the talent and innovation of our entire team of employees and affiliated physicians and our academic partners at The University of Texas Medical School at Houston and The University of Texas Health Science Center at Houston.”

Memorial Hermann-Texas Medical Center is home to the Memorial Hermann Heart and Vascular Institute. The Institute has a dynamic team of affiliated cardiologist, cardiovascular surgeons, and clinicians to coordinate the best treatment plans for patients.

The Institute offers innovative solutions in cardiovascular care, for improved outcomes and increased patient satisfaction.

STORY BY
Melissa McDonald
Visit HealthLeader

Maureen Duffy’s memories of her grandmother are cloudy. Not because of time, but by a condition that cast a shadow over the woman Duffy had visited as a child.

“She was blue. Even as a child I could see it. She was very negative and just could never really find any joy in life…not even from her children or grandchildren,” Duffy recalls. “A physician diagnosed her with depression, but she was only given tranquilizers. She was not a happy person. By the time she went to a nursing home, no one wanted to visit her. It hurt my heart.”

Duffy’s story is not uncommon. According to the National Institutes of Health, of the 35 million Americans age 65 and over, about 2 million suffer from full-blown (major depressive disorder) depression and another 5 million suffer from less severe forms. In 2004, adults 65 and older accounted for 16 percent of suicides in the United States; non-Hispanic white men 85 and older have the highest suicide rate in the country.

“It is very much a serious condition that can be life-threatening. There are several risk factors that can make you more susceptible to it,” says Jair Soares, MD, chairman of the Department of Psychiatry and Behavioral Sciences at The University of Texas Medical School, part of The University of Texas Health Science Center at Houston (UTHealth) and co-director of the UT Center of Excellence on Mood Disorders. “Today, imaging also shows us that changes in the brain as we age can make a person predisposed for a type of depression called vascular depression.”

Anatomy of depression in the elderly

Vascular depression occurs when blood vessels leading to the brain become clogged, even to the point of stroke. The reduced blood flow impacts the cerebral nerve pathways that are involved in mood.

Risk factors for vascular depression include diabetes, high blood pressure, high cholesterol and high lipid levels. “It is just one of many physical and life changes that can increase an elderly person’s risk of depression,” Soares says.

Other risk factors include

• bereavement—mourning the loss of a spouse, family member or close friend or multiple losses of contemporaries
• loneliness and isolation that may be caused by living alone
• less social interaction or becoming a caregiver
• fear of death and anxiety about aging
• job loss including retirement
• financial distress
• loss of purpose after retirement or reduced mobility
• a family history of depression
• necessary medications for other chronic conditions that can trigger depression
• Major illnesses including stroke and heart attack that can lead to depression. In fact, Soares says, 50 percent of stroke patients will develop depression

The encouraging news is that all forms of depression are highly treatable using medication and psychotherapy, Soares reassures.

Individualized treatment

“Depression in the elderly has to be treated very carefully. The depressed elderly need to be closely monitored for side effects and compliance with medication,” says Vineeth John, MD, associate professor of psychiatry also at UTHealth Medical School. “As we age, our bodies do not metabolize medications the same way they did when we were younger. A treatment plan must be highly individualized and approached with the utmost care.”

John is a geriatric psychiatrist, the specialized field of psychiatry that addresses the needs of elderly patients. “The need for mental health intervention in the elderly will be great as a high number of the US population enters their senior years,” explains John, who practices at UTHealth’s Behavioral and Biomedical Sciences outpatient clinic and at the UT Physicians Bellaire clinic.

“Depression that isn’t treated in the elderly could lead to worsening health complications including dementia,” John says. “Family members, friends and neighbors should be watchful of any symptoms of depression in their older loved ones. It is important to ask them questions if you suspect depression.”

• Are you basically satisfied with your life?
• Have you dropped many of your activities and interests?
• Do you feel like your life is empty?
• Do you often get bored?
• Do you feel happy most of the time?

John says to pay close attention to the answers provided. If you suspect aging members of your life might be depressed, speak with them or encourage them to make an appointment with their family physician. “An elderly person may not even realize he or she is depressed,” John says. “By intervening early, you can actually save someone’s life. Untreated depression is the leading cause for suicide. The suicide rate for the elderly is very high.”

Warning signs of depression include irritability, difficulty sleeping or sleeping too much, change in weight, lack of interest in personal care, frequent crying, memory problems, expressions of hopelessness, helplessness or loss of happiness.

Duffy says her experience with her grandmother helped her recognize the warning signs in her mother-in-law. Despite her best efforts, however, she wasn’t able to persuade her mother-in-law to get help. “My advice is to just keep pushing and asking questions. I kept at it,” Duffy remembers. “I even spoke to her physician about her symptoms, but she didn’t want to seek help. She was in denial. She could have enjoyed life so much more had she gotten the help she needed. Instead, she spent many of her days locked in her bedroom. She eventually died alone in her room.”

The strongest possible prevention for depression is to live a healthy lifestyle, experts say.

“Take care of yourself. Eat well, exercise and if you have an illness be proactive,” Soares says. “We still don’t have a full understanding of depression. We aren’t there yet, but we hope to be soon.”