Friday, January 23, 2015

Dementia Communication TMI Bleep, Bleep!!




 Lori was seventeen, and her mother was working four jobs just to put food on the table. So, when Lori had a chance to take a summer job at a rural bean canning plant for $3.00 over  the minimum wage, she was elated. However, little did she know was that she was going to have to spend 12 hours a day shadowing a trainer with personal hygiene issues, and a history of TMI.

 A loud whistle blew promptly at 6 A.M., and Lori, wearing a hairnet, plastic goggles, and close toed shoes awkwardly made her entrance. "You're all mine today, and I hope I don't scare the SH. . .( bleep) out of you honey, but if you don't listen to me,  you could lose a (bleep, bleep)  F. . . g (bleep) finger!" A voice with an "edge," came out of nowhere. It was Ida (not her real name.) Ida looked like a beauty queen. Very feminine, petite, and under the hairnet, "made up." She was wearing clothes that looked greasy and dirty. Her over utilized, dollar discount spray bottle perfume was unable to hide the factory smell of metal, grease and body odor. "I like to wear my SH. .. (bleep). . - ridden clothes when I run the machines here, because when I walk in the side door  through the kitchen of my house, I am butt naked! Yep, butt naked like Lady Godiva from the cannery!! I park the car in the garage, leave my clothes in the trunk, take a shower, and then. . . . . . . . Well,  (bragging now with a BLEEP eating grin), let's just say, "Vah, Vah Vah Voooom!" "My new husband doesn't kick me out of bed for eating crackers if you know what I mean!!"  Then huge, (almost evil sounding) explosive laughter came spewing out of Ida, with her shoulders shaking while she entertained herself sharing (rather loudly I might add), her own story for everyone in the break room (especially the men) to hear. Lori, still an innocent, unworldly teen, was nervously looking around the room for an exit sign!! "I'm your trainer, honey, so you better listen up to everything I say!" Ida continued with more and more TMI.  And in the first five minutes of meeting Lori, Ida gave her more (unrequested) sex education, swear words, and gruesome, bloody visuals of how people had lost their fingers, arms, feet, hands and toes in the canning plant,  than she ever wanted to hear. Lori was exhausted. Her brain, and her physical comfort zone had been violated by TMI and TMS!!  (Too Much Information and Too Much Stimulation!) Lori lasted only one day on the job working with Ida, and her bean canning factory future summer ambitions, abruptly came to an end!!  Which is exactly the point of today's post.

How do we as caregivers communicate with our care partners in easy, respectful and understandable ways??? The above example was one of extreme and inappropriate behavior, (maybe too extreme of an example). But the question of how we are connecting and communicating with elderly people suffering from dementia is an important subject worth pondering. Are we overloading those that we love with TMI, and TMS??  Are they looking for an exit sign, ready to bolt out the door like Lori was in the story above? Or do they just hang up whenever you call them? Asking too many of the WRONG questions is a common mistake people make when communicating with people who have been diagnosed with dementia. I think that we all have made these mistakes (I know I have.)  So let's explore some common TMI mistakes that people make every day, unknowingly with people challenged by dementia.

Telephone communication with people experiencing dementia is extremely important. Hearing news from friends and family gives the language centers an opportunity to be exercised. However, people with dementia can only speak of , "now." So, when asking questions, it is not appropriate to ask, "What did you do earlier today?" "Did you have a nice visit last week with your doctor?" These questions are TMI, and impossible to answer. Why? Because they require memory retrieval, mainly short-term memory retrieval. If you call a loved one with dementia, do not ask difficult questions. Ask questions about, "now," or questions about the very distant past. "What are you doing NOW?"  "How are you feeling, NOW?" "Where are you sitting, NOW?"

Or, when your elder care-partner with dementia goes into a  conversational tangent about the past, ask very specific questions about the repeated story. Find out why it is so significant to them. Let them lead the conversation. If they go to the same story such as Lori's mother who always talks about going to church on Sunday's in the 1930's and 40's, her mother's cherry pies, and visits to her grandparent's house. Lori would ask, "What is your favorite memory about visiting grandma and grandpa?" "What did your grandparent's house smell like on Sunday's after church when you would first walk in through the front door?" "What activities did you and your cousins participate in after dinner at your grandmother's house?"  "How long did it take to drive to your grandparent's house in the 1940's?

If you are finding that it feels futile to contact your loved one on the phone, because there are the same stories, and a lull in the conversation, it could be that you are "TMI ing" them without knowing it which in and of itself can lead to over stimulation. If you are a parent, go back to what it was like with your 2 year old, when they would short circuit and have a melt down from being overstimulated. With elderly people challenged by dementia, it isn't much different. They too can become over stimulated with TMI.  A part of them wants to retrieve the information from their short-term memory reserves in their brains, but they can't do it anymore. So, when they become silent on the phone or in person, it may just be that you are asking the wrong questions causing a, "deer in the headlight" moment of an empty mental canvas. Unintentionally, when we find ourselves in these situations, it is almost as if we have hit the invisible "delete" button and now have an empty page!! If it is frustrating for us, it must be a thousand times more frustrating for our loved ones stricken with dementia, because one of the greatest needs that we have as human beings, is to connect to other human beings!!

 So, please remember, that although your loved one on the other end of the phone, may not remember that you called them, please call them ANYWAY!!!!  You are doing yourself and your loved one a HUGE disservice by not staying connected. They need to talk, and talking stimulates brain function.  And you need to know that on a heart level, you are still VERY MUCH CONNECTED!!!!! Don't become a "TMI /TMSer," become a listener, a follower, and a heart to heart connector! Pick up the phone and CALL! You will be glad that you did!!


 Copyright 2015 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, January 19, 2015

Pennsylvania Six Five Thousand!!!





 Connections in life can happen in many ways. They happen between people by crossing cultural, and philosophical boundaries. They normalize tension between nations by nurturing an expanded world view, and usually happen by standing together with equal footing on common ground. People experiencing cognitive changes have layered connections that can be accessed deeply and directly through the healing medium of sound and touch.

  Irma (not her real name), was 87 when Lori first met her.  She was living alone in a modest apartment in Queens, NY.  It was the same apartment that she had lived in for 77 years. She had experienced success in her life as a professional dancer on Broadway, had never married and was her mother's sole caregiver. She nurtured her mother through Alzheimer's disease, and stayed with her until she died. The only thing that Irma had ever known was her strong bond and devotion to her mother.

 Irma came into see Lora for gentle chiropractic care, and what happened next, was astounding. Irma's spine was ridden with arthritis, but her ambulation was normal.  Her face was very clear and for 87, she had hardly any wrinkles. Irma's secret was daily exercise, and yoga. Irma would rise at 5 A.M. every morning, would meditate and pray, then would exercise. She was seeing Lori, not because she was in pain, but because she wanted to release stress and embrace a higher level of "ease." Lori did a gentle form of chiropractic, NSA (Network Spinal Analysis), on Irma, and then did something that is rarely done. Lori, who is also a musician, connected on a musical level with Irma. Lori and Irma would sing together, would share poetry and when Irma was getting body work done, Lori would play her favorite music with pleasant smelling aromatherapy diffusing in the room in the background. Lori, creating a "spa- like," environment connected to as many of Irma's senses as possible. The outcome for Irma, was that she had more energy than she could ever remember, and made some very important decisions in life. For years and years she had wanted to go to a spiritual retreat at Unity Village in Missouri, but never seemed to have the energy to follow through with her dream.  After seeing Lori for only a month, Irma was on a plane to Unity Village. After two weeks, Irma returned and continued getting healing work done which connected her to her own healer within. Irma lived out her final years having the ease and energy to check off things that she wanted to do in her remaining years on her bucket list, and made a very peaceful transition from this world to the next, in her 90's.

  What can we as caregiver's give to people that we care for?  Is our job merely to deliver pills, potions and medical doctor's directives? Or is our job, to connect?  And how do we connect to someone who has limited cognition? Sometimes it by just listening, and being present with someone in the silence without judgement or expectation. Lori connects with her mother and other's through sound, through touch, and through validating communication techniques. This is something that everyone can learn to do. Sometimes even a gentle hug can be healing!!

  Lori's mother was having a very silent, quiet day. She rose just in time to have breakfast at 6 A.M., then immediately went back to bed sleeping all day long. Lori was able to give her some meds and supplements around noon, and then more and more sleeping. Then, as was her normal request, Lori had Pandora playing Swing music. (Her mother just loved Glenn Miller, and Lori was raised listening to Glenn Miller.) It was 3PM, and singing and yelling was coming from her mother's room. "Pennsylvania Six Five Thousand! (Quiet at first.) "Pennsylvania Six Five Thousand," (A little louder.) "Pennsylvania Six Five Thousand," (Now screaming!!!) Lori's mom was fully awake and singing with The Glenn Miller Band!  Studies show that people with dementia can remember songs and lyrics and they do!!!!! Is this healing?? (Anything that contributes to a better quality of life can be healing, so you choose the answer!!)  Lori's mother rose from her slumber smiling and singing!!  She then grabbed Lori for a few rounds of the jitter-bug and the two women danced throughout the house!!! See the links below and please watch these videos. 

Sound healing and hands on healing practices (NSA), can contribute to a higher quality of life for people suffering from dementia and for everyone who wants to lessen stress and experience "ease." And what is the opposite of "ease"? "Dis-ease."

 Side by Side Singers:   https://sidebysidesinging.wordpress.com/video/
 Naomi Feil, MSW  Validation  https://www.youtube.com/watch?v=CrZXz10FcVM

 
 Copyright 2015 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, January 5, 2015

Squeaky White Cows Mooing




  Lori's mother was sleeping well through out the night.  And then it was time for church, and her mother awakened with expectant enthusiasm at 5:30AM. But shortly after her healthy Vitamin C and B Adaptogen health drink to start the day, she fell back to sleep, and didn't wake up until 3:30PM.  It was a rainy, cloudy and cold day. A fresh cherry pie and chicken dinner were both baking and roasting in the oven. The house was cozy. Lori's mother was sleeping in her  pink slippers under a soft, freshly laundered cotton comforter to the sounds of NFL game day cheers,  and did not want to be disturbed.

  So, at 3:30AM, the squeaky, mooing sounds began.  But this time it wasn't Lori's mother who was awakened, but Lori's husband and child.  The bathroom door "squeaked,"  the refrigerator "hummed," the dishwasher, "gurgled," and the dog, needing a pedicure would prance with her nails like a tail wagging tap dancer, on the wooden floors.  The train went by, and on occasion, a family of opossum would play tag on the roof.  As the full moon shined, lighting up the front and back yard which was filled with trees, a silhouette of shadows danced on the walls. Lori, could not sleep, and was now the guilty one, of wandering from the hallway into the kitchen for a cool glass of water, like a zombie with sandpaper shoes on her feet!

 And so Lori walked ever so gingerly, and just when she started up the stairs, the landing made a loud, "Squeak, squeak!"  "Is that you Lori?" It was Lori's mother.  Lori herself was guilty of waking up her mom! "I knew, it, I knew it," said Lori's mother with the enthusiasm of a child. "You saw it, too didn't you, Lori?"  Lori turned around just in time to see her mother in the living room looking out the window. "Oh it was loud, that is for sure, and it came right up to the window in the moonlight, so scared and lost." "Well, I just felt so bad, but I didn't dare to go outside, Lori, so I just watched it and heard it crying!"

Her mother was now shaking her head, but appeared to be delighted to share her adventure with her daughter. "What did you see, mother?"  Lori was curious.  "The cow, Lori." "What did the cow look like?" Lori was asking questions before redirecting her mother back to bed. "She was all white Lori, all white and she was lost and sad because she couldn't find her mother."  "Oh mother, that sounds so sad. She couldn't find her mother, and she was lost in the woods?" "Yes, Lori," her mother said, with even more enthusiasm."Let's try to find her, because she can't be far." So, Lori and her mother looked out of all of the windows on the main floor, but no cow was found. "Shhhhh. . . . . ," Lori's mother wanted them to be quiet. "I don't hear her now, but oh, she was crying and crying." "She was crying and crying mother?" Lori was asking specific questions and her mother was becoming more and more animated. "What did her crying sound like, mother?"

Then her mother started imitating the cry with "mooing," sounds. Lori quickly closed her bedroom door so that her husband wouldn't wake up from the loud, "mooing," sounds coming from the living room. "That is quite a cry mother, no wonder you woke up from that."  "Where do you suppose the white little cow is now?"  "I think she must have found her mother, Lori." Lori's mother was now yawning.  "Lori, we don't need to worry about that cow, especially since it has found it's mother. Let's go to bed, okay?"  So, Lori tucked her mother into bed.  And her mother slept through the night.

An important realization that Lori had was that dreams and even hallucinations have value to a person suffering from dementia.  With a holistic awareness, (rather than finding annoyance and inconvenience with late night interactions), Lori found the lost cow yearning for it's mother,  to be a direct parallel with her own mother's journey to be reunited with her mother and deceased loved ones. Lori's mother had been talking more and more about her deep love and longing for her mother, Lori's grandmother, for over 3 weeks. She told Lori that she misses her mother and her mother's family the most.

 Lori, sitting with her mother on the back porch during the day, looking up at the clouds asked her mother, "What are you going to say, one day when you see your mother again?" "Oh Lori, I do hope I will see her again," said Lori's mother. "When I see my mother I will tell her that I love her, that I have missed her so much, and that I am so happy to be with her again!" Lori, looking up at the clouds, said a silent prayer of "thanks," to God for giving her these precious moments with her mother of sharing, of listening and of being able to walk this sacred journey with her. "You know mother, I think grandmother's sisters and brothers will be with her too,  when you see her, and do you know what I think they will say to you?" Her mother looked puzzled, but serene. And with a relaxed grin, she looked at Lori and said, "What will they say Lori?" "Mother, I think they will say, "Welcome home,"  and "Thank you for a life, well lived, we missed you too." Then they would say, " Now that we are together again, it's time to eat. So, let's  eat!!"  Lori's mother let out a huge laugh and said, "And my mother will offer me some cherry pie, I suppose?"  "Yes mother, cherry pie, and Grandpa's German apple strudel and lebkuchen cookies!"  Lori's mother was still laughing and shaking her shoulders when she looked up at the clouds. Then, tilting her head back with her neck resting on the  lawn chair,  she closed her eyes and with a smile on her face, she fell asleep.


 Copyright 2015 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.

Thursday, January 1, 2015

No More Wandering






Recovering from the flu left Lori exhausted.  Finding a way to get some much needed sleep was an important first step back to health.  But with a week of Lori coughing throughout the night, Lori's mother, who would wake up with her, now had to get back into her own healthy sleeping routine.  Her entire sleep cycle had been disrupted for 8 days!! Lori was very aware of this, and also aware of how intuitive her mother was and how connected her mother was to her own healing cycle.

Sundowning is a term used by researchers to describe various behaviors that people with Alzheimer's and other forms of dementia experience when the sun goes down, and Lori's mother was no exception.  There would be moments of increased anxiety and confusion when the sun would go down.This not only happened when the sun went down, but also, when her mother would wake up in a dark room after a long nap.

 There would be moments, in her awakened state where she would have trouble separating facts from fantasies just after waking up in a dark room. At 2 A.M. one morning, Lori heard the back door alarm sounding and immediately ran into the living room to find her mother looking out the window.  "What are you doing up, mom?" "Oh, I was just listening to the rain."  "You know, Lori it reminds me of what it was like when we used to camp out in the trailer when you were little." Lori, not wanting to re-direct her mother too soon, decided to engage her in conversation, 'Tell me about that in the kitchen, mom." So, Lori made her mother some herbal tea, and the two of them talked until 2:45A.M. Lori was happy to finally get her mother settled and tucked into bed, when an hour later, her bedroom door flew open. Her toothless mother looked upset and confused. "Where is Cathy?" Lori was awakened from a deep sleep. "Cathy, mother?" "Yes," her mother said. (Cathy is her mother's best friend who now lives in Chicago.) "She left without saying good-bye, Lori!" Lori, then remembering Validation techniques started asking her mother questions, and matched her emotional tone. "She left without saying good-bye?" "That doesn't sound like something Cathy would do. When did you last see Cathy?" With her mother settled down, after asking her several questions, her mother on her own decided to go back to bed.

 Lori decided that she needed to get her mother back on a healthy sleeping schedule.  Lori also noticed her mother's desire to spend hours outside in the sun, and since the weather was getting colder, that she didn't appear to be getting adequate sunlight during the day.  Her mother almost craved sunlight, which made Lori question if she might need to have her D3 levels checked again,  along with her melatonin levels which can be very low in people who have dementia.

  Sundowning is common in people with dementia and there are aggravating factors that can make it worse.  Longs hours of sleeping throughout the day, caffeine and sugar, too much T.V., sleeping in dark rooms without a nightlight, etc.  Lori decided to engage her mother more in daily activities that were lost the week before when Lori was sick with the flu. Lori would take her mother for walks outside mid-day in the fresh air to get moderate exercise, she would bring her shopping and would schedule long Skype conversations with family members and friends.  (Having a Skype face to face conversation rather than a phone conversation stimulated her mother and appeared to energize her.)

 Lori also would give her mother low dosages of melatonin at night to help her to sleep.  She noticed that 3 mg/night of melatonin prevented her mother from wandering and she would wake up after a good night's sleep refreshed and alert!!  ( She did this after checking with her mother's doctors regarding prescription drug interactions. ) There is research now, backing the fact that low doses of melatonin, can be helpful to induce sleep in people suffering from dementia.

Lori's mother is now sleeping well throughout the night. There is no more wandering. Having her mother's sleeping schedule intact is not only healing for Lori's mother, but also for Lori. 

  1. Khachiyants N, et al. Sundown syndrome in persons with dementia: An update. Psychiatry Investigation. 2011;8:275.
  2. Sleeplessness and sundowning. Alzheimer's Association. http://www.alz.org/care/alzheimers-dementia-sleep-issues-sundowning.asp. Accessed Jan. 22, 2014.
  3. Caring for a person with Alzheimer's disease. National Institute on Aging. http://www.nia.nih.gov/alzheimers/publication/caring-person-ad/understanding-how-ad-changes-people-challenges-and-coping. Accessed Jan. 29, 2014.
  4. Francis J. Prevention and treatment of delirium and confusional states. http://www.uptodate.com/home. Accessed Jan. 22, 2014.

 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.





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