living your best to the end

Screen Shot 2015-03-19 at 11.13.02 AMChronic Illness

Many live lengthy lives with Arthritis, Diabetes and ‘silent’ conditions like High Blood Pressure.

Many live with and manage more than one health condition:

  • Heart Failure
  • Kidney Failure
  • Respiratory (Lung) Disease COPD
  • Dementia – Alzheimer’s, Vascular and Lewy Body Dementia

Living with one or more of these diseases also means taking several medications, and having several different health care professionals to manage. Managing can be exhausting – mentally as well as physically.

Since the  body’s ‘systems’ are all interconnected, often these chronic life-long illness and their treatment can cause other problems:

  • stomach (gastro-intestinal or GI) ,
  • skin (psoriasis, exzema, bed sores)
  • mental (brain function: cognitive) and depression.

Getting ever older, many of these contribute to health crises that can weaken to the point of frailty. Often ‘taking a turn for the worse’ prompts thinking about the approaching end.  It can help to understand what may be ahead, to avoid making decisions when in a crises.

Dementia – more than memory loss: it’s a broken brain

Dementia: Communication, hard-to-manage behaviours and safety A much needed re-framing of Dementia from Alberta Health Services clinical nurse specialists, Jennette Coats and Loralee Fox, who embrace care and caring for those with ‘broken brains’. I sat in on their extremely practical and sensitive strategy session for supervisors of Home-Care Workers organized by Revera Health Care.Whose patient population increasingly has one or more Dementia: Alzheimer’s, Lewy Body, Fronto-Temporal Lobe, Vascular Attendees included nurses, occupational therapists, social workers, personal support workers and physiotherapists who shared some of their own coping stories, dealing with their own parents with Dementia: “I could tell my mom all the awful stuff about my divorce. She’d forget as soon as I told her – so I got to ‘dump’ without guilt.” As the broken brain description implies, it’s more than just memory loss that caregivers cope with. It’s the responsive b behaviors – aggression, anxiety, agitation, wandering – that drains emotionally and physically. One of the strongest messages acknowledged the issue of time: Caring for someone with violent behaviours of dementia can take 50% more time Staying safe takes time: trying to be efficient can be self-defeating “Rushing through can cause emotional distress and increase anxiety, agitation, and aggression.” From the Gerio Psychiatric Education program in Victoria British Columbia, the acronym, ABCDE Apologies: One of the most powerful the calming strategies I’m sorry – I didn’t mean to upset you. I’m sorry – you’re right. I’m sorry I made you feel (angry, hurt, dismissed..) I’m sorry – I know you’re trying so hard. I’m sorry – this must be so hard for you. One of the... read more

Alzheimer’s Caregiver, Daughter-in-law

Tina’s story of Alzheimer’s: love and understanding I was fortunate enough to walk through a journey of Alzheimer’s by my father-in-law’s side. Together we mastered the mysteries, the fears and the utter atrocity that the disease brings and we also discovered a deep rooted love and admiration for each other. He was 65 when he forgot his own birthday party My father-in-law, Poppa as he was known by family, was 65 when he forgot to attend the birthday party we were hosting for him. That is how the disease first introduced itself. As a family we all took on different roles. Some did his finances, others his legal counsel and I did the visiting. Being the extended member of the family, Poppa’s finances and legalities were not my business nor my strength. People and patience were and so began my adventure with Poppa and my role as a caregiver and battler of Alzheimer’s. I had never met the disease before, yet in today’s world technology gives us a library of information right in our own laptop. So I read, researched and spoke to anyone who would take a call. I learned quite quickly that Alzheimer’s would bring with it demons for Poppa that I would never be able to see or reason with. In order for Poppa to deal with those black thoughts I had to ensure that with every visit I arrived in a positive and open to anything kinda mood. Good days and bad days There were good days and there were bad days. The good days are when he recognized me or knew me as someone... read more

Alzheimer’s and Restraints: Benefits and Risks

To restrain or not to restrain Until I met Sylvia Davidson, the word restraints scared the bejesus out of me, conjuring up straight jackets, handcuffs, ropes tape over mouth and struggling terrified restrainees. (clearly, I’m watching too many crime shows). That was B-S: Before Sylvia – Advanced Practice Leader, Geriatrics at Toronto Rehab and past President Ontario PsychoGeriatric Association. In Sylvia, I found a woman whose first concern is what’s best for the patient. Considering her patient population has dementia, gaining an understanding of the patient, to determine what’s best for them, is not all that dissimilar to a crime investigation – where the goal is to gain trust towards getting the truth. More than technical skills, this requires an emotional connection. “Nurses here are schooled in the 3 D’s: Delirium, Depression, Dementia. It’s our job to figure out who and how he/she was before dementia.” The Restraints Minimization Act describes when they are to be used: “for the prevention of serious bodily harm to a patient or to others”. There are three categories of restraints: Chemical Environmental Physical Before restraints of any kind are considered, there has to be consent – usually from the surrogate/substitute decision-maker, who is made aware of risks and benefits, a couple of examples of which are: Benefits: facilitating activities, calming and preventing harm. Risks: becoming more agitated, not being able to get to the bathroom (incontinence), being more unsteady afterwards. With consent, a comprehensive assessment process – with the family and the patient at its center. “Family members are so important because they knew this person before dementia set in. If we learn... read more

When an illness knocks you on your ass, you should stay down and relax for a while before trying to get back up.

George Bernard Shaw