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Wednesday, February 23, 2011 – Daily News – 3B FEATURES The sad consequences of surgery DEAR DR. GOTT: My 78- year-old mother recently passed away owing to gallbladder surgery. The surgeon that took it out accidentally cut a duct of Luschka, and she had a bile leak into her body. She never recov- ered from the second surgery to repair the leak. Can you explain what the duct of Luschka is and does everybody have one? DEAR READER: Yes, every- one does. The “duct of Luschka” was named after a German anatomist, refer- ring to an accessory duct that transports bile from the working tissue of the liver (as opposed to supporting or connective tissue) into the gallbladder. Unfortunate- ly, with injury to the duct, a devastating outcome can occur about a week after resection as bile drains into the abdomi- nal cavity. My sympathies are with you. DEAR DR. GOTT: My 60-year-old friend seems to suffer from frequent her- pes-simplex-virus outbreaks on her but- tock. She uses hydrogen peroxide and covers the sore with a bandage. Is she supposed to cover the area? Is there a medication she can apply to shorten the duration and repetition of bouts? Is there any food she should avoid to prevent attacks? Please illuminate me on this problem. DEAR READER: Genital herpes is a sexually transmitted disease that includes sores, pain and itching of the buttocks, inner thighs and around the genital area. It results from a type of her- pes simplex virus that enters the body through small breaks in the skin or mucous membranes. The virus is spread primarily through unprotected sexual contact. Illness, stress, fatigue, friction and more can induce outbreaks. Contrary to common belief, the virus dies quickly outside the body, so it is almost impossible to acquire through direct contact with toi- let seats or other objects used by an infected person. Dr. Peter Gott Genital herpes can increase the risk of contracting (and transmitting) other sexually transmitted diseases, bladder retention, proctitis in men and more. Your friend should make an appointment with her gynecolo- gist to have her blood tested for HSV antibodies, a viral culture and possibly a polymerase chain reaction to determine the specific type of HSV she has. While there is no cure for genital herpes, she should receive treatment with antiviral medications that will reduce the fre- quency and severity of her outbreaks. She should immediately advise her partner without making any accusations as to who infected whom. They both should become better educated and take appropriate precautions by learning dif- ferent methods to minimize future infection. They should learn different treatment options and avoid intercourse during the most contagious periods, which occur when either partner has an outbreak of genital herpes. There should be no embarrassment. Her gyne- cologist is appropriately trained and should treat the issue in a professional manner. To provide related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order made payable to Newsletter and mailed to Newsletter, P.O. Box l67, Wickliffe, OH 44092-0167. Be sure to mention the title or print an order form off my website at www.AskDrGottMD.com. Ne’er-do-well niece never notes niceness Dear Annie: Our niece, ‘‘Jane,’’ is 51 years old, an alco- holic and a divorcee. She lives in a home owned by her moth- er, who also pays all her bills. Jane’s only job has been part- time summer work, and she was laid off last year. decided to be mis- erable. It feels like we Annie’s Jane refuses to pay rent or get help of any kind. Her par- ents (my sister and her hus- band) have loaned her a car, and they have done all the repairs to her house. Now Jane refuses to let them come over and visit. Mailbox by Kathy Mitchell and Marcy Sugar have lost the per- son we knew. Is there anything my siblings and I can do to help my sis- ter? — Missing Our Sister Dear Missing: Your sister figures it’s too late for Jane to learn how to support herself Jane meets a lot of guys at the local bar, and some of them move in with her for short periods of time. She and her three grown chil- dren go to our sister’s home for meals on a regular basis, as well as all holiday cele- brations. Yet Jane treats her mother terribly, sometimes refusing to speak to her. My sister is 76. She’s tired of cooking for other people, but it keeps happening. I know my sister and her husband have spoiled this girl, and they disregarded our advice that they are enablers who make matters worse. My sister used to complain about the way Jane lived, but she’s totally given up. She has been fighting depression for years, but now has given up on that, as well, and has I have often written about the importance of having long-term care insurance -- policies that pay for home care or assist- ed living or nursing home care -- in case you are unable to indepen- dently manage the basic activities of daily living. That kind of care is expensive -- as much as $8,000 per month in a private nursing facility or from home health-care aides. Without insurance, you could quickly go through most of your sav- ings and wind up dependent on state-funded care, which is typically given only in Medicaid nursing homes. And at the rate states are running out of money, their facilities certainly won't be able to offer the care you want. Buying long-term care insurance gives you the choice of where you will receive care and how to schedule that care. It is a concept that makes perfect sense -- except for two very reasonable objections: What if I don't use it? When asked, I always respond that I hope you never have to use your LTC insurance, that you live a long and healthy life, and die in your sleep at 95. But what are the odds? Once you're over 65, the odds are 10 times as great that you'll need some form of long-term assistance than that your home will burn down. But you still buy homeowners insurance. And also you should have long-term care insurance. What if my annual pre- miums rise and I can't afford my policy in later years? That's a reasonable worry. Many companies that sold policies a decade or two ago found that they had underpriced the premi- ums. Some insurers have stopped issuing LTC insur- ance policies (although by law they must support exist- ing policies), or they have raised premiums for all existing policyholders. One way to avoid that problem is to buy a "10- pay" long-term care insur- ance policy. If you do that in your high-earning years, you'll be fully paid up with no chance of rising premi- ums. But that involves pay- ing a lot of money upfront for a policy you may never use. Several large insurers recognized this dilemma -- and have created policies that combine the benefits of life insurance and long-term care insurance. Although each policy has its own fea- tures, basically the idea is that if you don't use the money in the policy for long-term care costs, your heirs will receive a death benefit so your money isn't wasted. These policies are funded by a large, single- premium deposit into a life insurance policy. Typically the money comes from sav- ings that you don't plan to use in your lifetime, but would other- wise leave to your heirs (unless you needed to spend it on long- term care). If some of the death benefit is used for care, the balance goes to your heirs. Buying one of these combo poli- cies gives you leverage to get more long-term care coverage than simply self- insuring by keep- ing the money in savings. one of these combo LTC annuity policies. Then, under recent tax law, if you need to access the money for custodial care, it will all come out tax-free (unlike most annuity withdrawals). First of all, you have to have the assets to reposition into one of these policies. But once you make the pur- chase, you never have to worry about rising monthly premiums. You're locked in. There are costs with every policy -- "mortality costs" to cover the death benefit promise and costs to offer the care. Terry Savage The Savage Truth on Money Here's what I mean by leverage: • A 55-year-old woman, investing $100,000, could get $240,000 in death LTC benefits, or $9,600 a month for long-term care. • At 65, that $100,000 deposit would create $180,000 in death benefits, and a $7,200 a month LTC benefit. The withdrawal for care costs is limited to 4 percent of the death benefit each month -- with an optional 3 percent or 5 percent infla- tion increase. That gives you a lot more leverage (money available to pay for care) than you could have received if you simply saved the $100,000 in case you needed care. Some policies, such as the OneAmerica Asset-Care plan, offer a lifetime LTC option for an additional pre- mium. Remember, any money from the death benefit that you don't spend on care goes to your heirs. OneAmerica also offers a combination annuity and LTC policy, called Annuity Care. You don't get the life insurance -- but you might want to do an exchange of an existing annuity (includ- ing accumulated gains) into But you know those costs upfront, because they are baked into the promise of the death bene- fit and the care benefit, which won't change except for the inflation increas- es on the benefits. For sure, you (or your heirs) get something back from the policy -- either the care benefits or the death benefits -- or whatever is left over after you used some of the care benefits. Like traditional life or LTC insurance policies, there are underwriting stan- dards you must meet to pur- chase these policies. So the time to consider it is when you're healthy. Also, the insurance company has to certify your need for care before it will release the benefits for care. There are so many vari- ables in these policies that you should use an expert agent who can compare them and help you find the product that is best for you. The three major insurers listed below all offer varia- tions on these combination policies, which are sold through independent agents. • OneAmerica, www.OneAmerica.com, offers its Asset-Care prod- uct, using either whole life insurance or through an annuity. • Lincoln National, www .Lincoln National.com, offers its Moneyguard product using a variable universal life pol- icy. • Genworth, www.Gen- worth.com, offers its Total Living Coverage product, which has some variation in benefits and premiums based on interest rates. Nationally known LTC insurance expert Phyllis Shelton, www.LTCconsul- tants.com, says: "These combination policies may be an excellent solution for people who have saved for a long-term care need, but would prefer a larger amount of coverage, while still leaving assets to their heirs if the coverage is not and fears that if she stops enabling, she will lose all contact with her daughter and grandchildren. She could be right. But your sis- ter is only postponing the inevitable, making herself unhappy in the interim. All you can do is be supportive: Take your sister out to lunch a couple of times a week. Go to the movies. Invite her over often. Also encourage her to seek counseling for herself, and perhaps she will find the strength to deal with Jane. Dear Annie: Five years ago, my son passed away unexpectedly. His wife did not have the cash on hand to pay for the funeral service, so I loaned her the funds. She promised to repay me after she received the insur- ance money. As you might expect, she reneged on the deal and has not spoken to me since. She has also cut off all contact with our two grandchildren. Now she has ‘‘accepted’’ an needed." You can find more infor- mation about long-term care insurance at Shelton's website -- along with her excellent book on the sub- ject. Growing older is better than the alternative. But growing older and having the care you need is worth the investment. And that's The Savage Truth. offer from my brother to buy the kids new computers. My brother will buy one, and they want me to pur- chase the other one. I don’t feel obligated to cooperate because I already bought her a computer just before my son died, and she still owes me for the funeral. What is your take on this? — Father-in-Law in Chino Valley, Ariz. Dear Arizona: This is the bribe you have to pay to see your grandchildren again. If you can afford it, we think it’s worth it. But make sure she understands that resuming regular con- tact with the grandchildren is the exchange for forgiving her debt (which she will never repay anyway), and for the new computer. And try your best to say it gently. Dear Annie: I have a better response to ‘‘Jim in Omaha,’’ who asked if there are rules about the arm rests in movie theaters. When I was in elemen- tary school back in the 1940s, I was taught that the armrest to your right is yours, leaving the one on your left to the person sitting on your left. If you happen to be sitting on the right side of an aisle, you would have both armrests. This also applies to airplane seats. — Antique School Teacher in Oregon Dear Oregon: We like it. We can only hope patrons will follow your teachings. Long-term care combined with life insurance solves problems _________ Terry Savage is a registered investment adviser and is on the board of the Chicago Mercantile Exchange. She can be reached at www.terrysavage.com.She is the author of the new book, "The New Savage Number:How Much Money Do You Really Need to Retire?" HAVING TROUBLE VOTING ONLINE? Here are some tips so your votes can support your favorite local businesses, and so YOU can get in the running for the FIVE $100 shopping sprees that will be given to FIVE lucky online voters! • Each individual voter needs to enter their own individual email address on the ballot. This is especially important when multiple people are voting on the same computer. For example, a couple using the same computer at home, a public computer at the Library or other public facility. • Any number of voters may use the same computer to vote, and may have the same telephone number and home address! Only the voter name and email address must be unique to each voter! • After one person votes online on a shared computer, it’s best to return to the home page. Then the next voter can go back to www.redbluffdailynews.com and click open the ballot again to vote. • If you do not have an email address, here are some options: • Sign up for an email address of your own! They’re free. Suggestion: Go to www.hotmail.com • Use the email address of a friend or family member, with their permission. Perhaps someone from outside Tehama County, and thus ineligible to vote. • To submit your questionnaire, at the bottom you must complete: • Name of Business at which you would spend your $100 prize if you are a winner • Check the box to accept the “terms of service” (contest rules and such) • Correctly enter the code verification. Have fun voting – and Good Luck! www.redbluffdailynews.com