Wednesday, November 11, 2015

I Miss Me, Too!





  It was a combination of the changing of seasons and the settling of an estate. Lori's mother in law had passed on, and all of the contents in her house were arriving on a truck outside of Lori's mother's window. This left many questions for Lori's mother, and moments that Lori hadn't anticipated.

  "Did she know?" Lori's mother would pass from room to room inspecting the new, very old furniture additions, and was trying out every chair, couch and bed that the movers had delivered, on every floor. "Did she know what, mother?" Lori was listening to her mother while she was putting folded clothes into her newly acquired chest of drawers. "Did she know that she was going to die?" Lori's mother asked the question while focusing her gaze out the window. "That's a great question Mom, worth pondering. I think she knew.  It's something we all think about, but becomes more of a common question we ask of ourselves when we age or when we are facing a serious illness, don't you agree?" "Oh, yes that is true. Ohhh yes." Lori's mother then stood up, walked into her grand daughters room and laid on her new/old bed. "This is a nice room. I'm going to like this very much and look at my new bed!" Lori's mother then laid down on her side with her head on the pillow and struck a glamour pose. Lori, without wanting to ruin her excitement didn't say a word, and continued down the hall into the other room. "Mom, " said Lori's daughter with a frantic tone. "How are you going to tell grandma that is not her room? She's napping in my bed with a smile on her face. I think she thinks MY room is HER room!" Give her some time, she will shift her attention to other things in a few minutes. Let her enjoy herself, honey. "I just don't want an old lady sleeping in my bed, Mom." "Show some respect, young lady, " said Lori. "An old lady who is now in heaven, (your other grandmother),  slept in that bed  for more than a few years, okay???" (Lori's daughter rolled her eyes, and tried not to show Lori her teen-aged disgust!!)

  "Hey where did grandma go, now?" Lori's daughter couldn't believe how perked up her grandmother had become. They both found Lori's mother in the basement admiring the couch and lamps. "What do you think of my living room?" Lori's mother was so happy to see the furniture in place.  "I think that couch has "nap," written all over it!"  Lori's mother laid on the couch and was hugging the pillows. "This bed is smaller than the other bed," Lori's mother was comparing rooms. Lori noticed that a midst the chaos, her mother was putting things together more fluently than she would normally put things together on a daily basis. It was then that she thought that maybe very old people ( as Naomi Feil, MSW who is 86 herself, calls people over 80 with dementia), can become energized synaptically (directly influencing new thought patterns by new connections formed in their brains), by a break in routine. Too much rapid change appeared to cause confusion for Lori's mother.  But a slight change in routine could be stimulating,  forming new thought patterns, creating physical endurance. Her mother's reaction to the new furniture and observations of the movers, etc., almost made her appear to be without disability.

  And then it happened. While Lori was cleaning boxes in her room, transferring journals, mementos, and special cards she had received from people in the past - she found a card with a puppy on the cover from her mother. It was filled with deep love and overflowing compassion, sent to Lori at very difficult time in her life.Probably the most painful emotional ordeal that Lori had ever gone through. The words were so comforting and inspired. Lori's mother spoke from her heart about how hard it is to watch someone who you love so much, experience so much suffering and pain in their lives. Especially when that someone is your child. Reading the letter brought Lori's mother back to her in an instant. The mother who loved her children more deeply than she loved life, and who was always there for Lori, her sisters, her friends, family and spouse though the thick and thin. ALWAYS there with a phonecall, a card, a hand, a hug, a hospital visit, ALWAYS there, loving and accepting everyone with overflowing empathy, acceptance, forgiveness and compassion. Truly a person who always listened on a deep, deep level to the needs and feelings of the person sitting in front of her.  And Lori couldn't help but think to herself after reading the letter "I miss you, I miss you so much mother! I miss you so much it hurts! It hurts so much I can hardly breathe sometimes!!"

This may sound strange to the reader, knowing that Lori is living with her mother, and seeing her every day. However,  the disease of dementia can can rob intimacy, and create levels of detachment. Lori's mother is no longer able to relate in the same way as she did in the past, regarding the initiation of supportive behaviors for others because she has lost so much of her short term memory. And so, Lori decided to cope with the detachment by using some of the things her mother as her role model taught her, throughout her life.

  Lori's mother's greatest life lessons to share with her loved ones have been two things. After being married to a man with mental illness, she had to learn, 1) forgiveness and, 2) acceptance. Lori's mother always told her that the man, (Lori's father) that Lori knew growing up, was not the same man that she  had fallen in love with and married in the early 50's.  His illness took him from her. But she always told Lori, that there are blessings in everything, even when we can't see them. She would say, "If we have faith and can look up, God will show us miracles in everything, and love itself can heal anything, anyone and any situation." Lori has worked hard to forgive others, and to accept God's will which, (as hard as it can be),  includes watching her mother suffer from dementia.

So,  on days like the day Lori had recently, of  finding an old card from the past and thinking, "I miss you Mom." Lori's mother might also have moments of lucidity, when she realizes she can no longer be there in the same way she was in the past for herself, and for others- and may also think to herself, "I miss me , too." 
 
Positive Communication methods for people living with dementia:  We recommend seminars by Teepa Snow,M.S., OTR/L.FAOTA www.teepasnow.com, Naomi Feil, MSW, www.vfvalidation.org, and her books, all of them. And the life changing, ground breaking books, "Contented Dementia," by Dr. Oliver James, "The Mindful Caregiver," by Nancy L. Kriseman, and "Deeper Into The Soul," by Nader Robert Shabahangi, Ph.D, and Bogna Szymkiewicz, Ph.D

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.
   

Friday, November 6, 2015

Invisible People





Lori was sitting in the corner of a pediatric dental office waiting for a consult for her 7 year old daughter. It was a cold winter day and the breeze was blowing into the office through the window cracks causing a shiver up Lori's spine. Lori's daughter had been to 4 dentists, and was not a cooperative patient. When the dentist, a burly man with an edge of impatience in his voice started to explain his findings, he completely ignored Lori's daughter. He didn't even give her any eye contact. From the time of his entry into the office, he sat next to Lori's daughter in a chair and spoke directly to Lori as if her daughter was an invisible, inanimate object. He appeared to have forgotten the common courtesy of connecting to another human being, regardless of her age. Somehow, since Lori's daughter was 7 rather than 27, she had lost her right, in his eyes (whether it was a conscious act on his part, or not) to be acknowledged as a human being and to be heard.

Lori noticed these actions by the dentist because her daughter had a very hurt and surprised look on her face as if to say, "Mother , why is he acting this way?"  So, Lori in a very direct tone said, "Doctor, I would appreciate it if you would speak directly to my daughter, rather than to me,  since she is your patient." The doctor's face turned bright red, and without apologizing, clearing his throat, he very awkwardly addressed her daughter.

Years later, when Lori's mother was diagnosed with dementia, she noticed the same thing with doctors, pharmacists, grocers, people at church, etc!  As soon as people were told of her mother's dementia, they would ignore her mother, almost as if she was invisible. And ignoring her mother was not enough for some people,  who would talk in front of her, about her, as if she no longer had feelings.  It was almost as if people thought that memory loss also meant loss of emotions thus giving some people permission to forget common courtesies extended to others.  "She's gone, and no one is at home," one would say. "She just sits there and stares, looking off into space like a deer in the headlights!" People would make these comments right in front of her!!! And when Lori was a child, she witnessed her own family treating her grandmother in the same way. When her grandmother would be released for an afternoon from the nursing home, no one in her family would talk to her.  She would sit on the family couch alone, becoming an outsider in her own family, from no fault of her own!!!

And then, in Lori's case there would be moments of pure clarity where Lori's mother would say, "I can't remember things," and Lori would offer her assurance of, "You're right, Mom. You can sometimes be pretty forgetful, but I'm here to help you to remember, okay?"  And just by acknowledging the truth when asked about it, would offer Lori's mother a level of comfort and confidence. "We are going to get through this together, Mom. You aren't alone, we've got this and God's got this."  Lori would say these things because according to Naomi Feil, MSW in her book,  "Validation Breakthrough,"  people with dementia do not want to be patronized. When they ask a direct question, they want and deserve to hear the truth.  But what Lori had observed, was that they also don't deserve to be ignored.  There are many ways to connect with people, and through connections, we can create avenues that give people in our lives opportunities to be heard. ALL people, regardless of age, disability, or social standing deserve to be heard, and to be given the common courtesy of respect, dignity and understanding.

And sometimes, if a person is old, young or has a disability - people make assumptions that are totally false and biased.  Lori's mother-in-law, an outspoken Italian woman once had to go to the doctor for a physical. The staff nurse was new, and when she saw an 87 year old woman with labored ambulation walk into the office, she assumed she must be hard of hearing, too. "Mrs. Rigatoni (not her real name), MRS. R-I-G-A-T-O-N-I!!!!!!!" The nurse yelled so loudly, you could practically hear her in another state.  Lori's mother-in-law was so mad at this staff member that she immediately yelled back at her, "I'm old, not deaf!!  Stop yelling at me!!!"


Positive Communication methods for people living with dementia:  We recommend seminars by Teepa Snow,M.S., OTR/L.FAOTA www.teepasnow.com, Naomi Feil, MSW, www.vfvalidation.org, and her books, all of them. And the life changing, ground breaking books, "Contented Dementia," by Dr. Oliver James, "The Mindful Caregiver," by Nancy L. Kriseman, and "Deeper Into The Soul," by Nader Robert Shabahangi, Ph.D, and Bogna Szymkiewicz, Ph.D

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, November 5, 2015

Change Anyone?




Change can happen in an instant. It happens in attitudes, the changing seasons,  how we relate to our inner and outer environment, and to ourselves.  And for most of us, we can adapt to change rather quickly. We give ourselves cues of where we are, what we are doing, how we arrived at our destination, who we are traveling with, and what prompted our journey in the first place.

 The processes that relate to change in human beings, are all mediated by areas in the brain. Our cerebral cortex covers 2 cerebral hemispheres which transfer signals for immediate outcomes into bio chemical-electrical impulses eventually leading to active patterns of sensory motor control and behavior. The rate at which these signals are transferred, interpreted and engaged is directly proportional to the health of our neurons, or nerve cells themselves. As we age, the functional capacity of our neurons can diminish, due to many factors. Nutrition, lack of exercise, dehydration, lack of mental stimulation, physical, chemical and emotional traumas affecting nerve centers, etc.

According to cognitive psychologists Fergus Craik, PhD, and Timothy Salthouse, PhD, the neurons (nerve cells) themselves in human beings can shrink or atrophy, and there's a large reduction in the extensiveness of connections among neurons (dendritic loss). This can happen after 40 years of age, and can continue throughout the aging process. These researchers have concluded in their study, "Memory changes In Older Adults, " published by the American Psychological Association Monitor, that the aging brain has lower blood flow and gets less efficient at recruiting different areas into operations.

 All of the above has to due with normal aging. However, it is common knowledge that the elderly population throughout history has been less flexible to change, than the younger population,   which could possibly be caused by the physiological limitations of aging itself (blood vessels, musculoskeletal systems, and neurons) which literally become , "less flexible, " as we age. And also, there can be many life altering changes happening all at once around the same period of time. Changes caused by the death of a spouse, a serious illness, a change in residence, changes in hearing, vision, losing the ability to drive, physical strength and mobility, etc. So much change can not only be overwhelming, but can be heartbreaking to the person experiencing these sudden changes.

However, when a person has dementia, change is interpreted physiologically, neurologically and behaviorally much differently than from a person experiencing a normal aging brain. Short term memory retrieval is greatly diminished. And a slight change for a person with dementia, can have far reaching implications. Pathways of neurons suffer from a lack of connections, and lead to an incredible degree of confusion. The implications of one little change in routine, is illustrated by the example below.

Lori's mother had been napping for most of the morning. She had eaten well, had her medications and supplements, and wanted to go back to sleep. She woke up around 1 PM. Lori was in the living room on the computer. And then the pacing started. Lori's mother was shuffling her feet, pacing from one end of the room to another looking out both of the windows at either end of the room. Her walking was sped up, almost as if she was ready to walk out of the house. Then she started shaking her head. "I don't know where to begin, it's just terrible, just awful news, terrible. Oh Lori, this is bad, really bad!"  Lori looked up at her mother. "What's happening Mom?" "Your grandma died, and I have to plan the funeral. What am I going to tell everyone? And I wasn't even with her, she died alone, she died alone."  Lori observed her mother pacing and pacing, and then intuitively decided to offer her mother a new understanding of her mother's transition. "Mom, sometimes your heart doesn't bring enough oxygen to your brain and when that happens, you can become forgetful. Would you like me to help you remember what happened? Would that be okay with you?" Lori waited for a response. "I don't remember what happened, Lori." Lori's mother almost looked relieved to admit that she didn't remember. "Well Mom, your mother wasn't exactly alone. She made her transition while she was sleeping and I do believe that she knew you were with her helping her the entire time. You were a great daughter to her, the best ever!! " Lori's mother stopped pacing and looked at Lori. "I was?""Yes Mom, you really were!"

Lori's mother was calming down now, like a child after they cry from being overstimulated by too much input. "You gave grandma a beautiful eulogy. You stood up there at the podium where the preacher stands and told everyone how much you loved her, and I believe she was listening from heaven and that she heard every word of it, she really did!!! At least that's what I believe, mother!" Lori was not holding back. Then Lori's mother had a smile on her face and slowly walked back to her room.

 "What are you thinking right now, mother?" Lori's mother looked out the window. "It's a beautiful day, Lori."  Lori's mother went back to her room and started writing in her journal.  But what surprised Lori, was that her mother wasn't writing about her mother, but about her immediate circumstance, even referencing the month and where she was in the present time and place.


  What was the change that caused the pacing, and anxiety illustrated in the example in the above paragraph???  Lori and her husband were expecting some furniture to arrive by a moving truck and moved some things out of Lori's mother's room, and cleaned some linens. Again, a slight alteration in routine can cause an incredible amount of confusion for a person with dementia,  and can bring up memories from the past.

 Knowing that confusion, anxiety, agitation and pacing behaviors by people with dementia are all probable during times of change, proper planning can create comfort and security for both the carer and caregiver. 1) When leaving the house, allow plenty of time for confusion.If it takes 10 minutes to get to an appointment, allow 60 minutes or more to get ready. Never rush a person with dementia.  Give them time to get dressed,to put on their shoes, and to walk out the door. 2) When traveling long distances stop the car several times to allow for visits to the rest room. A person with dementia can get distracted riding in a car and can forget that they have to visit the bathroom. 3) Always carry Depends, bottles of drinking water, a change of clothes that you keep in the trunk, and healthy snacks when traveling even to church or the grocery store. Again ANY change can cause confusion, and blood sugar can be a physiological change people with dementia can experience, too. So, healthy snacks are good. Lori's mother loves trail mix with walnuts, sunflower seeds, etc.  4) Bring toys. YES TOYS. (Mini etch a sketchers, Word Searches, Sudoko.)

Having an awareness as a caregiver/care-partner of how change affects a person with dementia either in the home, or while traveling away from the home, and expecting the change that change can bring, can  avoid difficult, or confused behaviors altogether,  and lead to a happy, peaceful home. 


Positive Communication methods for people living with dementia:  We recommend seminars by Teepa Snow,M.S., OTR/L.FAOTA www.teepasnow.com, Naomi Feil, MSW, www.vfvalidation.org, and her books, all of them. And the life changing, ground breaking books, "Contented Dementia," by Dr. Oliver James, "The Mindful Caregiver," by Nancy L. Kriseman, and "Deeper Into The Soul," by Nader Robert Shabahangi, Ph.D, and Bogna Szymkiewicz, Ph.D

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.
   

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