Tuesday, October 28, 2014

Longevity and Nutrition

"She keeps to herself, a lot." She sleeps all day long.She won't bathe and her memory is getting worse." And the medical doctor said, this is all that can be done for her! How are we supposed to sit back and watch our loved one suffer, dwindling away as a shell of the human she used to be?" These are all questions I have heard from friends, family members, co-workers etc., over the years regarding the elderly.  It is almost as if an unwritten, invisible expiration date has been placed on a body part, or hidden in some undisclosed location, and there doesn't appear to be anything that can be done about it. People get old, they break down, they isolate, they forget, they lose bowel and bladder control and they die.

"NOT TRUE!!!!!  DON'T BELIEVE IT!!!"  That is what I say. As baby boomers advance into the elder years, they are going to bring education, intelligence and dignity into the once known invisible aging population,  and it is going to start with the wellness revolution of nutrition, bodywork, positive thinking, mental focus and fitness.  It will not include limitations of having someone in a white coat writing a prescription of  "drugs and surgery only."  It will be with the pro-active due diligence of exploring holistic and natural ways of embracing healthy lifestyle choices to preserve the benefits of longevity.

So, let's start with the above observations above in paragraph one. Let's say all of the above observations are true, leaving  the question of: "What can be done about giving our loved one's opportunities to embrace a better quality of life?" Having a good doctor is a good idea. But having a doctor educated on nutrition and wellness in the aging populations can sometimes be hard to find.( And I am not professing to flush the prescribed medications down the toilet, either. But to find a doctor who not only understands drug interactions, but who understands nutrition, the implications of environmental toxins, food sensitivities and drug induced malnutrition.)

 In the above example, the symptoms were analyzed, and then more drugs were prescribed by her physician, along with a corn syrup/sugar laden drink touted by a dietition on TV as being the best drink for aging populations!  So,(according to her lab studies on record), the doctor treating the family member never looked further into why the sugar levels had been elevated for 5 years, and prescribed more of this drink which was laden with more sugar to help with her malnutrition.  And when the D3 levels had fallen to dangerously low levels while under the care of her traditional M.D., ( which shocked this family member's new holistic internist when he reviewed her medical records), her behavior was blamed on dementia.( Here is a quote from a study on D3 from the United Kingdom: “We expected to find an association between low Vitamin D levels and the risk of dementia and Alzheimer’s disease, but the results were surprising—we actually found that the association was twice as strong as we anticipated,” said study author David J. Llewellyn, PhD, of the University of Exeter Medical School in the United Kingdom.)

 When Folic Acid was low and was not being metabolized efficiently by her system, (possibly for years), her new holistically oriented internist caught it, and she is now receiving proper supplementation which has helped her greatly, and the levels are now being monitored to normal levels by lab studies.  There was a cascading effect of malnutrition giving horrific results and a traditional medical doctor who never thoroughly checked her blood, stool, urine and hair for drug induced nutritional deficits, and environmental toxins that could have been contributing to her memory loss, but kept treating her symptoms over and over with drugs. Drugs with side effects leading to more symptoms leading to more tests, more diagnoses and more prescriptions!   Her traditional doctor did nothing wrong according to medical practice standards because many MD's, (excluding the holistically oriented ones), appear to have a limited education in nutrition.  From what I have seen as a caregiver of a family member with dementia, other than maybe testing for D3 deficiencies, the traditional medical doctors do not appear to run the same level of tests for  nutrient deficiencies on a general scale as the holistic medical doctors do.

 This woman was given a diagnosis of Alzheimers by her original internist , but when her new holistically oriented internist ordered new labs,  he diagnosed her with Type III Diabetes also known as Vascular Dementia, and said that the only doctor to diagnose Alzheimer's needed to be a  neurological specialist. It wasn't until this woman's blood was checked, her hair was checked and her urine and stool were checked for nutritional status that she was able to get help, which turned around her behavior and lifestyle habits giving her a better quality of life. Her cardiologist cut her heart medication in half. The change with a thorough medical/ nutritional evaluation and specific monitoring has been amazing!

Today, this woman with dementia still has moments of forgetting.  But with very careful monitoring by her holistically oriented family physician, regular lab work every few months, daily supplementation, ingestion of a nutritional longevity products that recently beat out the "Heart Healthy Diet," by 50% (See longevity products at: www.caregiversgetfit.isagenix.com), exercise, meditation, chiropractic, massage, social interaction, and positive validation therapy by her caregivers, she is living a comfortable life.

Has she been cured? No. But her activities of daily living have greatly improved. She no longer craves sugar, sleeps through the night 95% of the time and is energetic. She makes her own bed, gets dressed everyday rather than staying in her pajamas, likes to take baths, puts make-up on without prompting, does her own nails, folds laundry, is doing word scrambles again, writes daily in her diary, exercises on an exercise bike, goes for walks daily, goes to a drumming circle, sings in a choir and remembers things from a day before. Will she ever be completely cured of dementia? Who knows? But her quality of life has improved.  She is not a shell. She is a human, and deserves the best quality of life available.

As caregivers, we need to do our homework by checking drug side effects, staying diligent with doctors, writing down questions before office visits, and having our elderly checked for malnutrition. Recent Pubmed studies from the National Institutes of Health indicate that drug induced malnutrition among those suffering from dementia can oftentimes be left unchecked in nursing homes.

  Because malnutrition can lead to serious diseases including dementia, and even death, it is a very serious issue. Researching the benefits of probiotics, cellular cleansing, CoQ10, fish oil supplementation, and glutathione rich, un-denatured whey protein is a good start in understanding ways to help your loved one to embrace a higher quality of life!. Virgin coconut oil, with medium chained triglycerides, also has lasting benefits for overall health and longevity.  (See: www.caregiversgetfit.isagenix.com for more info. on nutritional longevity products for active seniors and the elderly.)

Researching ways to provide good nutrition as a caregiver is important, along with finding the right doctor. Traditional medical doctors are not nutritionists, and are not accustomed to checking the blood, urine, stool, nutritional habits and hair on every patient in one routine medical work-up. Finding a holistically oriented doctor with a background in nutrition who goes the extra mile to get specific lab work done for healthy aging can prevent malnutrition and can possibly save someone's life. 

Copyright 2014 Caregivers Get Fit! Mama  Nicey

The information in this blog is information. It is not meant to be a replacement for getting medical advice from your own health professional regarding your own individual health challenge or condition. Dr. Denise will not diagnose, treat, or give direct personal consultations/advice to you on this blog for any medical condition, but will give general examples, and scientific research on many different health topics.  How you decide to use the information is between you and your own medical/ health professional.


Monday, October 20, 2014

And Then There Was Nancy

In the late 1980's, my first year as a psychology major brought me to a  long term, state run mental health facility for older women.  Some of the women had been living on the ward for over 30 years. My assignment was to spend a few months visiting one of the residents, and to observe behaviors. Rita, (not her real name) was in her late 60's and was very skittish when I met her. Our first few 2 hour meetings were spent in silence.  I would talk, and she would briefly look at me, and would then look away,  never establishing eye contact. Having a life-time of experience living with a mentally ill parent, and working as an animal rights advocate, dog trainer, and animal handler helped me to follow Rita's lead. Dog's and horses who are skittish, need time to feel safe, and many times need to make the first move towards establishing a contact. This takes a great deal of patience and understanding, and cannot be forced. (I remember watching 3 wranglers on the ranch once, forcing a horse to do something without establishing a trusting, nurturing contact and the horse almost trampled them. They then started whipping the horse  into submission, as if the horse was the problem,  and that they needed to "teach the horse a lesson."  The horse was scared to death by their lack of willingness to build a bridge of comfort and respect before physically handling the horse.) After a few visits of developing trust,  Rita started establishing more eye contact, and started sharing things with me. She would tell me about her childhood, about her life on the ward, and would gossip about other residents, etc. I would visit Rita twice a week, and according to the staff, this  2-3 month college project was the only way that many of these women ever received visitors.

One day, the sky was so blue and the air was aromatically thick with Autumn. You could literally smell the leaves, and the pine trees in the breeze. I thought of Rita being in the sterile four walls of the facility, and thought that maybe she would like to take a stroll with me on the grounds. After getting permission from the staff, I sat with Rita and then suggested that maybe a stroll on the grounds would be something we could do together. There was hesitation from Rita, but I didn't see it. I thought that I knew for sure that she would enjoy getting out, and wasn't thinking of her initial reaction to my suggestion.  Again, I mentioned the walk in the courtyard, and with some convincing, Rita started walking down the hall with me.  About midway to our doorway leading to the outside world, Rita started hyperventilating. We stopped walking and she started mumbling and then rocking her torso.  I brought her back to her favorite chair. She slowed down her breathing and eventually stopped rocking. As tears fell down her face, she kept on repeating, "I'm not ready to leave, I'm not ready. This is my home. This is my home."  I assured her that she was okay, and would not have to leave the facility, even for a walk if she didn't want to. She then calmed down. After sitting with each other and doing deep breathing together, I asked her what she liked most about her home. Without hesitation Rita said one word, "Nancy."

Nancy was one of the nurses on the ward, and was clearly the most loved nurse by the residents. Nancy rarely raised her voice like the other nurses did, and when she was out for the day, her absence was felt by everyone. The ward  itself, even the walls,  felt different when Nancy was gone. Much more chaos existed, much more confusion and episodes of acting out, etc. When Rita had her episode in the hall, I looked back at Nancy, and she mouthed silently to me , "She'll be okay. It's alright," giving me the confidence to bring her back to her chair, etc. Nancy seemed to have a silent desire to see everyone succeed, and to be happy. Her demeanor was one of calm.

Watching Nancy communicate with the residents on the ward was my first experience of seeing anyone using validation therapy. Nancy appeared to enter into the world of whomever she was with, bringing comfort and understanding to every conversation. The residents felt very secure when Nancy was working with them, and rather than using force to get them to comply with her demands, Nancy would connect with them, and would then redirect them to follow through with her requests, having them think that whatever actions they were taking, were actions of their own choosing.  It was highly skillful and incredibly effective. It reminded me of techniques I had been taught as a dog trainer which utilized operant conditioning and positive reinforcement. And behind it all was respect, love and a deeply held conviction to maintain dignity.

Caregivers who find themselves constantly correcting people, may be trying to bring people into a reality that is not their reality. When most of us look up at the sky, we see that it is blue and filled with clouds. If the person that we are caring for has dementia and insists that the sky is red and full of flying elephants, who are we to disagree with them?  In their own minds the sky is red, and that is how they are seeing their reality. Our job is not to correct or to try to bring them back into our reality, it is to connect in much the same way as Nancy did in the above example. People need to feel safe, and that they are being heard. It is not always what we say, but how we say it that will be remembered.  The woman on the ward truly appreciated Nancy's vocal tone.  She never raised her voice, and although she had clear boundaries, she also had every woman on the ward knowing that she cared for them and would be a soft place to land if they needed her.

I was recently visiting a friend who told me of two sisters who lived together for years, until one of them had been diagnosed with Alzheimer's Disease and eventually died. My friend said, while the sisters were still living together, she would hear one of the sisters screaming at the sister with A.D. into the wee hours of morning on a regular basis.  She wasn't allowed to sleep, because her sister with A.D. would wander at night vacuuming the house, taking pictures off of the walls, and cleaning out the closets. My friend's neighbor screamed so loudly once, that the sister  with A.D. ended up leaving her house at 3AM, causing the sister without dementia to wake up the entire neighborhood by screaming in my friend's driveway dressed in her pajamas and curlers, when her sister disappeared. My friend found the sister with A.D. in her car,  which the woman with A.D. had escaped to because she couldn't understand why her sister was always yelling at her. "Why is she constantly yelling at me?"  In her own mind, 3AM meant nothing. All she knew was that she wanted to clean the house at that time, and couldn't understand why her sister was constantly opposed to her cleaning habits.

The woman in the story with A.D. eventually became so agitated from the yelling, that she became violent and had to live in a nursing home away from her sister before passing away. The woman's violent episode  against her sister was blamed on the A.D., and no one ever thought that maybe the constant screaming in her ear, and anger driven exchanges from her caregiver caused her to become extremely agitated,  which possibly led to her violent actions. No one knows for sure, but the point is that many people living with dementia are misunderstood and need to live in peaceful, nurturing, and supportive environments.

Wednesday, October 15, 2014

Waiting For The Bus

   The shopping van had arrived, and when Maggie was quizzed by the driver on her friend Heidi's whereabouts, she shyly said, "I think she went to the restroom!"  The van driver waited 10 minutes before pulling away from the assisted living facility, leaving Heidi behind.  Twenty minutes later, Mabel wanted to use the  lobby's rest room,  but noticed the door had been locked from the inside. So,   Mabel thinking the rest room was occupied, went back to her room and watched an episode of, "As The World Turns."  The day went by, still no Heidi,  and the driver of the van just assumed that Heidi had gone back to her room, and Heidi was never reported as missing.

  Four hours had passed,  and 3 people had complained about not having access to the lobby's rest room. The custodian, wearing a tool belt and kaki pants was summoned to fix the broken lock.  Knocking on the door by several people had yielded no results and a sudden panic set in. ( FYI: This happened in the early 80's. I think by now, most facilities have keys to their restrooms to avoid this scenario.) Before calling the fire department, Mrs. Anderson, the building supervisor decided to enlist  the assistance  of 2 janitors who used drills, screwdrivers, wrenches and rubber hammers to take down the door. An hour later, the metal door had been completely removed from it's hinges by two janitors.  And there in front of residents reading magazines, the receptionist and building supervisor solved the mystery of Heidi's whereabouts.  Heidi was peacefully and pleasantly sitting on the toilet fully dressed in her winter coat, gloves, hat, and color coordinated purse,  totally oblivious to the activity around her. When she wouldn't budge from her perch, Mrs. Anderson, the supervisor said, "Heidi, what were you doing locking yourself in the restroom,  and sitting on the toilet in your winter coat for 5 hours? "Why didn't you open the door when we wanted to know if anyone was in the bathroom?" "Do you have any idea of the trouble and expense people went through to open this door?" Heidi,  appearing to, " come to, " took in a deep reflective breath and then paused, creating a defensive and slightly annoyed posture as if someone had asked her the most absurd question in the world.  And then, with delightful confidence, she lengthened her spine as if she had just remembered the winning letters to a "Spelling Bee" competition answering, "I was waiting for the bus!" " I was waiting for the bus, okay?"

It wasn't long after this incident that Heidi was asked to leave this facility and admitted into a long term nursing home for people with Alzheimer's Disease. Heidi was still ambulatory when she took up her permanent residency in the home. Soon, with much medication and  with very little creative stimulation, Heidi's health deteriorated, and Heidi died.

 How would the above scenario have played out, if Heidi was a 5 year old? What would have happened if Heidi's caregivers would have been people trained in proper communication techniques that honor the gift of presence without judgement?  How might the dialogue have gone? Let's just say that Heidi was a 5 year old who had been observed, on many occasions as being a child who liked to play "hide and go seek?" The caregivers putting the people on the bus would have been able to see that  5 year old Heidi was not present, could have followed through on the lead from her friend by knocking on the bathroom door. Seeing that the door was locked , a caregiver could have said, "Come out. come out wherever you are!"  Or for an elderly woman, "Heidi, the bus is leaving now. Come on,  Heidi,  time to have a fun shopping day. We saved you the best seat, Heidi!"

Greeting Heidi with accusatory questions such as Mrs. Anderson's response can cause even more confusion. Most people suffering from dementia understand that something is wrong with them.  They can easily become depressed and withdrawn from accusatory words and actions by caregivers. When a small little baby "spits up" on us it is expected. We understand that babies are spontaneous, and nothing can be predicted. We just prepare ourselves for everything and lovingly interact with our baby in playful and helpful ways. When a person has dementia, they are also spontaneous and unpredictable. And "yes" sometimes they may "spit up" on us by doing things that are inconvenient like locking themselves in the bathroom while waiting for a bus. These types of behaviors are to be expected, and through positive affirming communication, we can prepare for them.

A friend recently gave me the analogy of losing one's keys when she said, "A person who is forgetful, is like a person who loses their keys. The individual may not remember where they originally placed their keys, but eventually finds them. Whereas, a  person with dementia sees a set of keys in the palm of their hand, can't remember why the keys are in their hand, and can't seem to recall what the keys in their hand are used for."

 However, from what I have seen, is that the person with dementia knows they don't know and are confused and scared,  all at the same time.  One thing that I have communicated to someone with dementia (when there appears to be frustration from forgetting) is, "Would you like an update?"  I never would say, "Are you confused about the keys?" I would never specifically point anything out by asking direct questions, but proactively leave a space of acceptance without judgement followed by silence. If the person with dementia chooses to respond, they may say, "Can you give me an update?" Or at other times a person will say, "I'm fine." There are other times that amazing wisdom is expressed which comes out of nowhere, and can be liberating, leaving an opening for deep intimacy and spiritual connectedness.  But these moments can only happen when there is a feeling of trust, acceptance, and non-judgement.

   In Heidi's mind she was just waiting for the bus, and since it was cold outside, the warm and quiet bathroom was a very logical solution to her needs. She wasn't aware of the passage of time. Only the warmth,  peace and quiet comfort of a secure environment.

Monday, October 13, 2014

South Dakota's Jingling Keys

It started with a loud, "crash," then a "bang," followed by mumbling and the jingling of keys. Lori woke up with a"jolt," thinking to herself, "What on earth is happening?"  Slowly lifting the eye mask off of her face and wiping the sleep from her eyes, she could see the digital clock in the corner of her room reading it was, 4:30A.M. Then it dawned on her, "Mama!" Oh dear, it was clear to see that Mama was packing up her entire bedroom.

Lori walked down the steps to the Master suite which Lori and her husband gave to her mother when she moved in with them. It was a large bedroom filled with pictures of her mother's treasures along with a color TV. There was a bathroom off of the bedroom which made everything convenient for her mother who suffered from dementia and other health challenges. When Lori arrived to her mother's room she was shocked, and almost let out a,"GASP," but decided to not react. "Mother, how are things going?" Her mother looked focussed and annoyed. "I'm on a schedule, Lori. I don't know how in the world we are going to fit everything in the car." Everything in the room was packed in garbage sacks and suitcases.  Somehow, in the wee hours of the night, Lori's mother had managed to pack everything in the room. Pictures on the wall had been taken down and wrapped before being put into boxes, Lori's linens from the closet were packed, toiletries were packed, the bed was stripped, the TV and cable unit was dismantled, and it even looked like she had started to take down the curtains!

"Mother, forgive me if I am having a lapse with my memory, but it's early and I may have forgotten. Are you going somewhere?"  Her mother stopped, and looked surprised. "Lori, don't you remember?" Lori didn't say a word. Her mother picked up another hanger, and continued to pack. "I'm going to visit my mother. We have some catching up to do," she said.  "Oh, that's right," said Lori. (Lori's grandmother had been dead for over 30 years.) Then Lori saw her car keys in her mother's hands. "So, are you going to drive all the way to South Dakota, or are you going to fly?" Lori quizzed her mother. Her mother started laughing as if Lori was the most ignorant person in the world. "No, silly girl, I am going to drive."  (Lori's mother had not driven a car for years due to her dementia.)  "That's a lot of driving, mother. Are you sure you are up to it?" Lori was fishing for words to say. She knew she couldn't hand over her car to a woman with dementia. Lori's mother started getting agitated. She pursed her lips, straightened her spine and took a deep breath. Lori then decided to honor her mother's reality and said, "Mom, you have my support always. If driving 3,000 miles alone to S. Dakota is important to you, then I am behind you 100%.  In fact, I too would like to see grandma."  Lori's mother then changed her defensive body language, stopped pacing and sat closely to Lori. She yawned, and Lori said, "Mom, why don't you join me for a big breakfast. Then, after breakfast, after you drive the kids to school you can have the car." Lori paused again after saying that. Lori's mother said, "After I drive the kids to school?  Lori, I don't know my way around here and the highways are confusing! I'm going to go back to bed.  I'll join you for breakfast later!"  Lori's mother went back to bed, and after she fell asleep, Lori quietly unpacked the room, reassembled it putting pictures back on the wall,etc.  When Lori's mother woke up from her nap, she walked into the kitchen and said, "Good morning, Lori." "Good morning mother," said Lori. "How did you sleep?" Lori's mother looked puzzled, "Well, I slept fine, as always.  What's for breakfast, I'm starving?" Lori made breakfast for her mother, and her mother never mentioned going to South Dakota again.

Lori's note to herself: Dementia proofing the house.  "Time to hide the car keys!" People with dementia can get lost in their own homes, and the problems are exemplified when they leave a familiar environment and get lost far away from home.   Driving without a license is not only illegal, but unsafe for the community. Having someone driving up a one way the wrong way, or pressing the gas instead of the brake can also lead to horrific consequences. The main lesson Lori learned from being awakened at 4:30AM and seeing her mother packing up the house,  was to prepare for the worse, and to expect the best. Hiding the car keys would be a good start followed by a visit to the Alzheimers Association's website and getting a home safety packet. www.alz.org/stl/documents/Safety_Packet.pdf 

With patience, planning and loving communication it is always possible to continue creating happy memories with aging loved ones challenged with dementia, even if they fantasize about driving 3,000 miles away from home without a driver's license to visit a family member who has been deceased for 30 years!  Lori honored her mother's reality and then, by becoming present with her mother's needs, she was able to shift her mother's focus to constructive and safe action.

Friday, October 10, 2014

A Return To Dignity

It was a beautiful day in September.  The trees were losing their leaves, and acorns, stones, broken twigs and pinecones were scattering in every direction underneath my feet.  And each step was bringing me closer and closer to a sacred, and yet familiar curiosity.  Many years had passed, all reflected in deeply hidden memories, some of which I would choose to forget. But nonetheless, there it was again,  all at once appearing  as flashing images and brightly colored passages bringing me back again to another gated, window barred, long term psychiatric facility. 

Unlike other psychology majors enrolled at the university, I was very comfortable spending time with mentally ill people.  I had a lifetime of experience, and was given the secret spark of wisdom and understanding, at the tender age of four. I was told that people who were mentally ill were no different than people with the stomach flu. In my young mind, I clearly understood that mentally ill people did not always” throw up” the same way people did from tummy aches, because they did not have sick tummies. Mentally ill people, would at times, act or say things that sounded scary, or confusing to us not because they were bad people, but because they were “sick in the head.”  (That is the way it was explained to me as a 4 year old by my mother who helped me to understand my dad’s behavior, and it made sense to me.) However, what I haven’t been able to understand my entire life is, “Why do  people in social situations treat people with mental challenges differently than people who appear to be without mental challenges?”  Some of the greatest artists, scientists and geniuses in the world have been known to suffer from mental illness. Without the contribution of these beautiful and unique souls, our society would not be the same.

  I was in my second year of college. I was studying pre-med and psychology, and although my first experience visiting a mental institution was as a four year old, my first project in college was to spend 3 months detailing the behavioral habits of mentally ill women living in long term psychiatric facilities.  Little did my professors know, was that my childhood experiences alone, observing behaviors of patients at psychiatric institutions in the 1960’s, far outweighed the limited knowledge gained from a 3 month psychology behavioral assessment assignment.

My father was institutionalized in the 1960’s.  I was four, and remember visiting him during one of his  stays at a state run psychiatric hospital. People strolled freely on the grounds shadowed by nurses in cat-eyed glasses, ratted up hair and white, starch- ridden, bobby pinned cardboard caps.   The halls were filled with psychotropic sleepers wearing soiled t-shirts, striped robes and polka dotted pants. The women wore lipstick lines up to their noses, with too much rouge holding half lit cigarettes with pampered Hollywood gestures of imagined elegance.  People sat in smoke-filled rooms, grouped together by the staff in self-created isolation. There was pacing in repeated patterns of lines and circles, screaming at the walls, talking to the air, and dancing with invisible strangers. Like a gallery on display exploding with colors of raw emotions, unique and uncontrolled artistry was at play right before my eyes.  I breathed in these colorful expressions slowly and reflectively with child-like excitement. I had never seen adults behaving this way.  And in my innocence, having an unfiltered world view, I only saw a beautiful playground full of unique and creative souls, held together as one in a special place far removed from the limitations of the world.  It was fascinating to see as a four year old. I thought everyone had bloodshot eyes because they were happy. I thought people danced and talked to the air because they were free.  The bars on the windows left questions. ” Why were so many grown -ups wearing their pajamas?" and “Why couldn’t my daddy come home with me?”

 The happiest day of my life as a four year old, was when my mother told me to sit on the front porch one day to wait for a surprise. In less than 5 minutes a car arrived and dropped off my dad. He picked me up in the front yard underneath the maple tree and swung me around in his arms. He wasn’t mentally ill to me, he was just my dad. And I loved him enough to look beyond his suffering, and the suffering his mental illness had brought to our family. It was just the raw and pure emotion of unconditional love between a father and his daughter. 

 Signing in with the receptionist to start my college project on that particular day, left a chill running up my spine. I knew, there was no doubt that my father needed to be institutionalized back in the 1960’s, but hearing the loud reverberating echo of thick metal doors, and jingling keys closing behind me left me wondering, “What would it be like to have someone sign away my freedom, shutting me off to the world outside, bringing me into a sanitized, highly medicated society with tall fences and metal bars on the windows?”   The loud metal doors closed with a “crash,” followed by an echo reverberating through a long corridor.  

  I spent three months visiting the women’s ward of the sanitarium and after watching hundreds of episodes of “Wheel of Fortune” and getting to know some of the women who had been institutionalized there for 30 years was left questioning why so little had been done other than medication and isolation to help people suffering from mental illness over the years? With budget cuts, the sanitarium was soon closed down and I never heard what happened to the women who lived on the ward. Perhaps they were relocated to nursing homes. (Unlike the thousands of mentally ill across the country who are now hungry, homeless and sleeping in cardboard boxes. Or others who may need hospitals or specialized outpatient counseling and treatment which are no longer available to fill their needs because of government cutbacks.)

What I would like to see, regarding the treatment today of people suffering from mental illness?  Many things. But mainly love, compassion, patience, understanding and a return to dignity.

Monday, October 6, 2014

The Subway Stranger

   The air was brisk, the leaves were falling and I was beginning a new career in Manhattan, electrified to embrace changes that were happening in my life. I was a new doctor with a beautiful office two blocks away from Central Park caring for professional film makers, actors, musicians and corporate executives,   who valued natural healing.  Leaving my office on that evening in October, I never knew that in just a few short minutes, a total stranger was going to quietly share his own un-invited opportunity for change with me, simply by sitting next to me and not uttering a word to me on the train.

  Rush hour in NYC always meant a race against time, and my deadline was to board a diesel powered, diesel fuming transit bus awaiting my arrival at Port Authority. This meant catching the subway, jogging through traffic, climbing up escalators, buying tickets and securing a seat on the bus, all in less than 30 minutes. This daily ritual of commuting back and forth to New York from New Jersey had to be timed with the precision of a militaristic, left-brained, mathematically inclined athlete, which I wasn’t even close to being, but somehow,( in order to beat the crunch of the rush ),  ended up enacting with the skill of a highly trained marine.  

  There I stood, standing shoulder to shoulder with commuters wearing trench coats, sipping energy drinks and reading magazines waiting for the “A” train to take me back to the Port Authority.  After hearing the sound of squeaky brakes followed by mumbled gibberish, the subway stopped, and to my delight, rather than standing, I found the last available seat on the crowded train.  Listening to the slow starting momentum of metal and steel, I took a deep breath, a grateful sigh of relief.  And then, without warning, I saw something that hit me like a” ton of bricks, “and nearly broke my heart. 

Sitting next to me on the subway train was a handsome twenty-something man with thick dark hair who was beautiful, and model perfect.  His appearance alone ought to have taken my breath away, but the sadness that he carried in his spirit that day was so obvious, that sitting next to him gave me a lump in my throat, and filled my heart with a deep, unexplained sadness. I felt the weight of his sadness between my shoulders, at the nape my neck, and at the center of my heart,   all at the same time. It was so strong that I had to work hard to hold back my tears, but “Why?” I thought.  “Why do I feel so sad?” 

 Then, with little effort, I found the answer to the subway stranger’s sadness. He was holding printed pamphlets on “Understanding Leukemia,” in both of his hands. He had a blank stare, looking down at the floor, a blank stare gazing out at the moving graffiti dancing in colors on the subway walls. A blank stare of clouds surrounding crowds of people talking, laughing and sleeping. A blank stare, casting his vision EVERYWHERE and anywhere else, choosing to ignore the lab values, office logos, written reports and  information on crumpled paper he held so tightly between his fists and trembling hands. 

The sadness that the subway stranger displayed with his blank stare and slumped appearance, seemed  to reflect an inner realization that important changes, unwelcomed ones,  were about to be made in his life. Changes on the horizon that he had no say about. Changes that could lead to regeneration, personal growth or triumph. Along with changes that he may have feared the most. Changes leading to the reality of not having his dreams fulfilled, or changes ending any opportunity of having any future at all.

 I sat in silence, praying and calling on the angels, and before I could utter a word to him, the subway stranger vanished into thin air.  Somewhere into the crowded city quietly dashing under the blinking yellow sign that read,” Welcome to 42nd Street, “and I never saw him again. 

 As Helen Keller once said, "When one door closes, another opens. But often we look so long, so regretfully, upon the closed door, that we fail to see the one that is opened for us. "  I will never know what happened to the Subway Stranger, but after sitting next to him, (on that busy, "rush to the finish line" evening in October), my commutes on the subway, were never quite the same. The change for me was in having a renewed appreciation for LIFE, and a reminder to not stress out whenever the train is late. To STOP, RELAX and BREATHE without reacting, when things don't go my way.  And to find joy, GREAT joy, in just living another day!  

Copyright 2014 Caregivers Get Fit! Mama  Nicey    All Rights Reserved
The information in this blog is information. It is not meant to be a replacement for getting medical advice from your own health professional regarding your own individual health challenge or condition. Dr. Denise will not diagnose, treat, or give direct personal consultations/advice to you on this blog for any medical condition, but will give general examples, and scientific research on many different health topics.  How you decide to use the information is between you and your own medical/ health professional.

Saturday, October 4, 2014

The Lady With The Purple Hat

It must have been 2AM. Lori was up late, working on her computer in a dimly lit kitchen accompanied by the “humming” steel and glass percussion of a water logged dishwasher.  Peripheral sounds of glasses and plates bounced off the walls. Creaky doors, a mumbling voice, and rhythmic shuffling of slippers  danced among the shadows, and there,  silhouetted against the flashing digital green  timer, stood an elderly woman in a nightgown with disheveled hair, and a toothless grin.  “Mom, is that you?  How are things going for you?” Lori said.  Lori’s mother was rolling her eyes, pursing her lips and shaking her head, getting ready to tell her a huge secret at 2AM. With one hand cupped to Lori’s right ear, whispering and leaning into her, Lori’s mother carefully looked over both shoulders as if being watched by the CIA, not wanting anyone else to hear. “She wants me to stay in my room because she is afraid I will wander around late at night.” Whew, “ (An animated toothless sigh)” Can you believe it?” Lori’s mother was rolling her eyes as if someone had insulted her.  Lori said, “Who is she?” Her mother said, “The lady over there (motioning with her hand, pointing and gyrating her torso in a choreographed, exaggerated fashion)”She’s in my room, Lori”, her mother said. “ The lady with the purple hat.” 

 “Oh,” Lori said with assurance and concern. “Is the lady with the purple hat mean or nice?” Lori’s mother said, “She isn’t mean, but she is very ugly and quite annoying.” Lori said, “Well, I guess I better talk to her then.  Would that be okay with you, Mom if I talked to her?” “Oh yeah, I wish you would.  Then I could maybe get some sleep around here.” Lori’s mother was tired, and obviously had a bad dream. “Okay Mom, (after giving her mother a tall, cool glass of water), “Would you like me to tuck you in?” “That would be fine, “said Lori’s   mom. So, Lori brought her mother back to her room and tucked her in. “Hey, (with a very surprised look on her face as she climbed back into bed), “ I don’t see Miss Annoyance here in the room now,” Lori’s mother  said. “Well, “ Lori said, “Maybe she decided to go home to her family, after all it is a little too late to be working now.”  “I don’t think she will bother you again,” And then, pulling up the comforter,  Lori’s mother rested her head on her favorite pillow, taking in a deep sigh of relief and relaxed her wrinkled face with a peaceful smile.  Lori hugged her mother, kissing the top of her head as she slumbered off to sleep.  In the morning, Lori’s mother didn’t say a word about the lady with the purple hat, and never brought it up to Lori again. 

  Interesting interaction above, and one that comes from a place of receiving rather than leading. To receive cues from people needing support means to listen and respond in ways that honor their place of “being” in that particular moment, at that particular time, giving presence to their reality, not yours. The intention is to create a warm, and loving space of acceptance, void of judgment or expectation.  People suffering from cognitive impairment are usually scared, and much more aware of their cognitive deficits, and of other people’s reaction to their challenges,   than anyone would ever expect. This awareness that they silently carry with them needs to be recognized. If it is not honored, recognized or appreciated, it can cause their self-esteem to plunge into the gutter, causing a decline in their overall quality of life. The last thing, (in my opinion), that people suffering from dementia need are caregivers   who are controlling and unwilling to be led.

If we look at the interaction above and replace Lori’s loving and honoring interaction with her mother with a controlling character in Lori’s place, the interaction could be cold and accusatory. Questions such as: “What are you doing up at 2AM?  Go back to bed! Don’t you know that you are not supposed to be getting up at 2AM? What do you mean there is a lady with a purple hat in your room?  You have dementia, and are seeing things. No one is in your room! Go back to bed now and forget this non-sense!” Now, this may be a huge exaggeration of how some people would interact.  But the truth is, in Lori’s mother’s mind, there really was a lady in her room wearing a purple hat.

 Following a person suffering with dementia into their own reality, affirming their observations  and offering re-direction, can be healing and comforting to them.( By the way, Lori’s story really happened, and happens every day. Statistics prove that one-third of all baby boomers today are now caring for family members with dementia.)

  In my opinion, the greatest tragedies elderly people can experience today are caused by three things: 1) Isolation and depression contributed by drugs that attempt to dull their senses, 2) Agitation caused by care workers (doctors included), unwilling to show elderly people the respect and dignity they deserve, by simply LISTENING to their needs, going into their reality, affirming their insights and re-directing them.(If they are confused and suffering from dementia.) 3) The inability of caregivers who have not been properly screened for their positions who lack education, and the appropriate communication skills needed to respond to the emotional and spiritual needs of people suffering from dementia. People who exercise controlling behaviors rather than supportive behaviors, even if they may be a convenient choice for the family to choose because of location, availability and scheduling should not be put in caregiving positions. (Ie: Some personalities do not lend themselves to being successful caregivers, and can actually cause more emotional suffering than good.)

 People with the challenge of cognitive impairment, are not invisible, but in many ways acutely aware of how they are being received and treated.  What they need is someone close to them lifting them up, creating win-win situations no matter how small the win-win situations may be. People with dementia need to feel needed. I originally did everything for Mom when she moved in, and then realized that she would rather make her own bed. She was thrilled when I had her vacuum the living room and when I gave her the job of making sure the plants were watered, etc. I always make it a point to create a win-win situation for her every day. Little things like folding towels and socks. “Mom, can you show me how YOU like to fold the towels.” She is so happy.  There are other things that are not easy for her to do, like initiating activities. “Mom, our social calendar today includes three items,” then I give her a choice.  Mom chooses one thing. We pick out an outfit for the day. Mom is usually thrilled to be doing something, and always enjoys interacting with others.

The caregiver and the person being cared for can design the blueprint, and then the person being cared for can have a chance to feel empowered.  This gives the person being cared for the opportunity to feel as if they are in the driver's seat, and not ignored.   For example, if mom and I end up planning a field trip to the zoo, and end up not going to the zoo, that is okay.We can be flexible.  Mom may wake up from a nap and look too tired to go anywhere, and will totally forget about the zoo in which case, maybe she needed to take a nap instead of having an activity. At other times, she will wake up and remember wanting to go to the zoo, and we will go to the zoo.  Or, if it is too late to drive to the zoo, (if mom has slept 4 hours) and if she still wants to look at animals, we will go to a pet store instead of the zoo, and will look at puppies.  She is delighted by both choices, and is still feeling as if she is having her needs met, is being heard, and is not being ignored.

  Creating win-win situations as caregivers creates the possibility of showing  the person being cared for that someone is willing  to love them and listen to them without judgment. This creates a safe place oftentimes needed to express  fears, concerns and even (from the example above), hallucinations.  Like,  seeing an ugly and annoying lady with a purple hat in their bedroom at 2AM!!

Copyright 2014 Caregivers Get Fit! Mama  Nicey    All Rights Reserved
The information in this blog is information. It is not meant to be a replacement for getting medical advice from your own health professional regarding your own individual health challenge or condition. Dr. Denise will not diagnose, treat, or give direct personal consultations/advice to you on this blog for any medical condition, but will give general examples, and scientific research on many different health topics.  How you decide to use the information is between you and your own medical/ health professional.

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