Dementia, Alzheimer’s disease = Brain failure

Many people know the terms dementia and Alzheimer’s disease, but what do those words actually relate to so that we can understand what is happening?  I believe that the most appropriate phrase is brain failure.

Areas of the brain are failing.  The brain cannot function properly.  Some of the nerve cells stop functioning, lose connections with other cells and eventually die. Part of the brain is affected.  It is because of the brain changes that your loved one loses abilities. 

There will be “moments” that they are in the present and aware of

what is going on around them. They may even be aware that “something is just not right” with them.  And the family gets all excited and tries to keep them oriented to person (themselves, friends and family), place (where they are), and time (knows day/date).  The clarity may last for a few minutes, to an hour or more. But, then it always reverts back.  And the family is sad, frustrated, angry and all of the other emotions that arise.  Grieving rears its ugly head too.

Let folks with Alzheimer’s live in their moment, whenever that may be

I know that everyone is looking and waiting for the next “moment of clarity.” What if it never comes again?  Your loved one is living in their moment, whatever that may be for them.  They cannot live in your world, the “real” world.  It’s not that they don’t want to, they can’t, their brain is failing and you have to go to their moment.  Stop trying to orient them to time, place, & people.  Just meet them where they are.  Look for the good (anything positive or good) where they are, at the moment.  Stop correcting, stop questioning, and stop getting frustrated in their presence.  They WILL pick up on your feelings of frustration, anger, sadness and anything else you are feeling. They cannot stop the changes in the brain. 

Some have asked about why they are seeing different things in their loved one versus another person’s loved one.  Because the part of your loved ones brain failure may be in a different place than another’s. The things you will see are because of the changes in the brain. 

Look at the diagram below for names and areas of the brain.

Dementias Affect the Brain

Parts of Human Brain

The following information is from Very Well Mind, Kendra Cherry 4/4/2019

The cerebral cortex can be divided into four sections, which are known as lobes (see image). The frontal lobe, parietal lobe, occipital lobe, and temporal lobe have been associated with different functions ranging from reasoning to auditory perception.

• • The frontal lobe is located at the front of the brain and is associated with reasoning, motor skills, higher level cognition, and expressive language. At the back of the frontal lobe, near the central sulcus, lies the motor cortex. This area of the brain receives information from various lobes of the brain and utilizes this information to carry out body movements. Damage to the frontal lobe can lead to changes in sexual habits, socialization, and attention as well as increased risk-taking.

• • The parietal lobe is located in the middle section of the brain and is associated with processing tactile sensory information such as pressure, touch, and pain. A portion of the brain known as the somatosensory cortex is located in this lobe and is essential to the processing of the body’s senses.

• • The temporal lobe is located on the bottom section of the brain. This lobe is also the location of the primary auditory cortex, which is important for interpreting sounds and the language we hear. The hippocampus is also located in the temporal lobe, which is why this portion of the brain is also heavily associated with the formation of memories. Damage to the temporal lobe can lead to problems with memory, speech perception, and language skills.

• • The occipital lobe is located at the back portion of the brain and is associated with interpreting visual stimuli and information. The primary visual cortex, which receives and interprets information from the retinas of the eyes, is located in the occipital lobe. Damage to this lobe can cause visual problems such as difficulty recognizing objects, an inability to identify colors, and trouble recognizing words.

The cerebellum – Sometimes referred to as the “Little Brain,” the cerebellum lies on top of the pons behind the brain stem. The cerebellum is comprised of small lobes and receives information from the balance system of the inner ear, sensory nerves, and the auditory and visual systems. It is involved in the coordination of movements as well as motor learning.

The cerebellum makes up approximately 10 percent of the brain’s total size, but it accounts for more than 50 percent of the total number of neurons located in the entire brain. This structure is associated with motor movement and control, but this is not because the motor commands originate here. Instead, the cerebellum serves to modify these signals and make motor movements accurate and useful.

For example, the cerebellum helps control posture, balance, and the coordination of voluntary movements. This allows different muscle groups in the body to act together and produce coordinated fluid movement.

In addition to playing an essential role in motor control, the cerebellum is also important in certain cognitive functions including speech.

Behaviors have a reason

“DICE” model, Dr. Helen Kales

• • “D” reminds us to “describe” a disruptive behavior. What is it? When does it occur and with whom? What is the patient perspective on the behavior? How much distress does it cause patient and caregiver?

• • “I” reminds us to “investigate” the causes of the behavior. Is it an indicator of unrecognized pain, frustration, fear, or boredom? Does it represent medication side effects or an undiscovered medical or psychiatric condition? Is it the result of sensory changes and functional limitations? Does it represent an inappropriate caregiver expectation or a cultural issue?

• • “C” reminds us to “create” an intervention that addresses the behavior directly. This may include diagnosing and treating pain-inducing physical conditions such as constipation, using a behavioral analysis to craft a behavioral treatment plan, supporting the caregivers, simplifying tasks, finding meaningful activities, or increasing/decreasing stimulation in the environment. Individualized music therapy, for example, can take into account a person’s musical preference and provides soothing music through headphones and an MP3 player. When appropriate, the created intervention may include use of an appropriately chosen and monitored medication.

• • Finally, the very important “E” reminds us to “evaluate” the effect of the intervention, noting whether it has helped and also whether there have also been unintended consequences or side effects of the intervention.

Medications

Medications used for depression, anxiety, aggression & restlessness:

• • Decreased or increased movement

• • mood or mental changes, including abnormal thinking, agitation, anxiety, confusion, and feelings of not caring

• • shortness of breath

• • skin rash

• • swelling

Medications used for severe aggression & restlessness:

• • Abnormal dreams

• • anxiety

• • bloody nose

• • blurred vision

• • bruising burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings

• • change in personality

• • change in walking and balance

• • dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly

• • lip smacking or puckering

• • loss of bladder control

• • loss of strength or energy

• • muscle pain or stiffness

• • muscle tension or tightness

• • rapid or worm-like movements of the tongue

• • rapid weight gain

• • restlessness

• • seeing, hearing, or feeling things that are not there

• • shakiness and unsteady walk

• • slurred speech

• • unsteadiness, trembling, or other problems with muscle control or coordination

• • yellow eyes or skin

Medications use to treat agitation:

• • Changes in patterns and rhythms of speech

• • increased sweating

• • loss of strength or energy

• • low blood pressure

• • nightmares

• • shakiness and unsteady walk

• • slurred speech

• • trouble in speaking

• • unsteadiness, trembling, or other problems with muscle control or coordination

• • unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

• • unusual excitement, nervousness, restlessness, or irritability

• • unusual paleness unusual weak feeling

Medications used to treat paranoia, hallucinations, severe aggression, and severe agitation:

• • changes in patterns and rhythms of speech

• • drooling

• • fever, muscle aches, or sore throat

• • inability to move the eyes

• • inability to sit still

• • increased blinking or spasms of the eyelid

• • lip smacking or puckering

• • loss of balance control

• • rapid or worm-like movements of the tongue

• • restlessness

• • shakiness in the legs, arms, hands, or feet

• • shuffling walk

• • slowed movements

• • slurred speech

• • sores, ulcers, or white spots on the lips or in the mouth

• • uncontrolled twisting movements of the neck, trunk, arms, or legs

Medications used for sleep:

• • Anxiety

• • bladder pain

• • bloody or cloudy urine

• • burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings

• • chills

• • crying

• • decreased awareness or responsiveness

• • dizziness, faintness, or lightheadedness when getting up from lying or sitting position

• • dry mouth

• • euphoria

• • fainting

• • irregular heartbeats

• • irritability

• • lower back or side pain

• • paranoia

• • quick to react or overreact emotionally

• • rapidly changing moods

• • restlessness

• • seeing, hearing, or feeling things that are not there

• • shakiness in the legs, arms, hands, or feet

• • shortness of breath

Medications that people with AD should not take:

• • Hot as a hare: increased body temperature

• • Blind as a bat: mydriasis (dilated pupils)

• • Dry as a bone: dry mouth, dry eyes, decreased sweat

• • Red as a beet: flushed face

• Mad as a hatter: delirium

5 Reasons you are not getting relief from your chronic pain & then what you can do to get relief!

1. 1. You are still mad about it and are fighting it.

1. 1. You are only trying one approach to finding relief.

1. 1. You have given up control of your treatment options because you feel so bad.

1. 1. You may have been misdiagnosed.

1. 1. You have accepted that nothing else can be done and you just need to learn to live with it.

Chronic Pain and our Brain

Think about it.  What happens to your body when you are mad or angry about something?  You tense up your muscles, you shallow breathe, and you are on edge and ready to pounce on anyone and anything that dares to cross your path.  You are in the midst of fighting a battle; unfortunately it is with your own body.  Let that sink in.  Ponder that thought for a few minutes and while you are pondering, breathe, just breathe, deeply. Breathe in through your nose for a count of 6 and breathe out through pursed lips for a count of 6.  Concentrate on your breathing for three minutes. Notice how your body feels and what is happening.  This is a no judgement zone.  You are just to observe and be curious about how your body is feeling.  Do your deep breathing exercises five times a day.

Treat Chronic Pain with more than 1 approach

When you use more than one approach to treat chronic pain you increase your chances of success.  What would your life look like if you were more successful in decreasing your pain level?  Enjoying family and friends?  Enjoying going out and doing more of the things that you want to enjoy?  Can you even remember a time when you felt good enough to enjoy your life?  Look, you may not be able to become completely pain free, but you certainly can lessen the pain and have a better quality of life. Everyone deserves effective treatment. 

Could it be that you are not taking the appropriate medication(s) for your particular needs?  Could it be that you haven’t thought of or been given the option of using multiple integrative treatment approaches?  Maybe your medications were working at one time but now they are no longer working.  What has been shown to improve pain relief?  Acupressure, Acupuncture, Mindfulness Based Stress Reduction, Stretching routines, Yoga, Breathing exercises, Massage, Far infrared heat, Migun bed treatments, talk therapy and guess what?  None of the things mentioned included more medications!  In fact, you may be able to decrease the medications that you are currently on and have better pain relief.  You are more than welcome to throw the bullshit flag, I certainly have, but I must admit I have had more success with the breathing exercises, far infrared heat and Migun bed treatments than I had with medications and I am a pharmacist by trade. Pain medications do not always work for chronic pain. 

How you are affected by Chronic Pain

When you hurt for so long your nerves are just shot and you really can only do what you absolutely must do. That is all the energy that you have.  I get it.  You relationships begin to suffer, your work begins to suffer and you just feel stuck.  Pain wears your body out and you do feel tired and exhausted much of the time.  If you could think rationally, you might be able to look into other treatment options.  Everyone deserves options because the same things do not work for everyone. Maybe you have tried a few things but they did not work or you weren’t willing or able to give them enough time to work. People that are in chronic pain cannot think rationally and logically they just want the pain to stop.  Unfortunately, there are people out in the marketing world that know this and they use that knowledge to manipulate people in chronic pain to buy “X” or try “Y.” None of it works.  Then what happens?  When the chronic pain patient is approached by other options and ideas they don’t want to try them. Why? Because they tried things before and spent a lot of money and nothing worked.  They don’t want to waste any more money and they sure don’t want to get their hopes up only to be dashed again when it might not work.  Integrative health approaches are science based and they won’t put you in the poor house.  If anyone tries to tell you that something will take away all of your pain, they are lying.  You goal is to lessen the pain and get your life back. Physical therapy for chronic pain control may be an option for you. 

What if your pain management treatment plan is wrong for you?

What if your doctor was wrong in the diagnosis?  It happens.  Doctors are human and it is called the practice of medicine not the certainty of medicine.  You may not know or even have an exact cause of your chronic pain, there are things you can do to lessen the pain.  Notice that I said, “You can do.”  That is correct; it is up to you to help yourself.  You cannot be passive in your treatment.  It takes engagement and work to get better.

Have you been told “You just have to learn to live with it.”?  If you have, I am sorry.  I do not agree with that and what it means is that they don’t know what else to do for you.  That is just unacceptable and a disservice to you.  It is one thing to know and to accept that you will be living with a chronic pain issue, but it is quite another thing to not lessen the severity of the pain and to improve quality of life.  Everyone deserves a better quality of life no matter what the circumstan

Pat

1. 1. Eat two fruits every day and drink at least 32 oz. of water during the day.  Decide how much liquid you can drink in one sitting, 2 oz., 4 oz., etc. Do you like it cold, room temperature, iced, hot, add lemon, lime, or an orange if you need a flavor.  Alternate your favorite beverage with a glass of water.  Other liquids count (except for alcohol and fruit juices/sugary drinks), but they are not the best. Keeping hydrated will hep your body and your brain.

1. 1. Walk.  If you do not currently walk, start low and go slow.  5 minutes daily then increase by 2 minutes every week until you can get to 30 minutes per day.  You can do 10 minutes three times a day. Some days may be better than others, be kind to yourself and get back on track as soon as possible. Our bodies are made to move.

1. 1. Strengthen your legs.  One exercise is to do chair stands, place a pillow on the back of the seat and sit down and then stand up (you may need to use a chair or table to steady yourself).  Do 5 repetitions twice a day two times per week.  Three times per week, when you get stronger.  Goal is 8 to 12 repetitions without having to use a chair or table to steady yourself.  Ankle circles (10 rotations each way while seated),  Knee flexion (stand behind a chair and lift your leg up towards your bottom- 6-10 each leg), Knee extension (Seated in a chair extend knee as straight as possible, hold for 3 to 5 seconds and slowly relax back down to floor), Calf raises (use a chair for balance and raise up onto your toes, hold for 2 seconds and go back down & do 6 to 12 reps)

Many people are family caregivers and they don’t even know it…

Do you take on responsibilities for your aging parent that they can no longer handle?

If you do any of the following, you are a family caregiver!

• • Grocery shop

• • Make doctor’s appointments

• • See that they get to the grocery store or doctor’s office(s) by having someone else take them

• • Pick up prescriptions, run errands, mow the lawn

• • Laundry

• • Clean the house

• • Make sure that they get to the hairdresser or barber

• • Take over their finances (paying bills, making sure insurance policies are in place and paid, etc.)

• • Find and pay for in-home care (whether it is their money or your money)

• • If you help with any of the daily living activities (bathing, dressing, brushing or hair and teeth, toileting, feeding or preparing meals

• • Taking time off of work to help

So you see, it is both the hands-on tasks and the tasks that you handle with phone calls, paying for services, making sure services are in place when needed, etc., that make you a caregiver.  Guess what?  Most people that do not do the hands-on caregiving do not identify as family  caregivers…but, you are and that comes with a cost to you and your own health.

Think about it, you are at work and you get a call from your mom and she needs something NOW.  You either leave work now or you figure out who to call to go and help her.  What is happening to you and your body right at that moment?  Your chest or stomach gets tight, you clench your teeth, your breathing becomes shallow and your shoulders tense up, all the while your mind is racing, thinking and figuring out what to do and who to call.  This time it was a “minor” crisis but next time it may not be minor.

You get the problem handled and now you get back to work. Simple, right?  No, not even close to what really happens to a person when they have handled or taken care of a crisis.  It will take you about an hour to calm down enough to refocus and work somewhat effectively again.  It will take much longer for the cortisol dump (some adrenaline too) to completely “get out” of your body.

Health Risks of Family Caregivers

Now imagine two, three or even four crises a day.  What will happen to you and your body over time?  You are at increased risk of the following:

• • Stomach or digestive issues

• • Headaches

• • Low back pain

• • Sleep disturbances or Insomnia

• • Depression

• • Anxiety

• • Weight gain

• • You can’t concentrate very well

• • Heart disease

How will you manage your own stress?

Stress happens!  How will you handle it in your life?  You get to choose.  You can either handle it in a healthy way or an unhealthy way.

Unhealthy Ways:

• • Drinking excessively

• • Smoking

• • Overworking

• • Increasing caffeine consumption

• • Buying stuff/Overspending

• • Taking medications inappropriately (even over-the-counter medications)

• • Not sleeping

• • Over-eating or Under-eating

• • Eating too many sweets

• • Sleeping too much

They sneak up on you too.  A little more each time you indulge.  About two or three months in, someone who loves you may say something, unless you are hiding it.  Doesn’t matter, eventually it will come out. You are human and maybe, just maybe you didn’t realize what you were doing or why you were doing it.  Now you have been made aware of it.  What will you choose?  Continue on this path or work on decreasing your stress in a more healthy way?

Healthy Ways:

• • Choose more healthy food options

• • Walk or run for 20-30 minutes a day

• • Decrease or stop your alcohol intake

• • Drink more water throughout the day

• • Take a few hours for yourself to do things that you enjoy every week

• • Get good sleep

• • Learn deep breathing techniques and practice daily for 5 minutes

• • Having a sense of humor even inappropriate humor is a stress reliever

Kick the perfectionist in you to the curb.  It is not all or none = success.  Be like the willow tree and bend but don’t break.  Yes, it is easier said than done. As with most things, the more that you practice the better you become and you always get to choose.

My shameless plug for my services:

I get it; you are smart and very good at your job.  You feel that you should be able to figure all of this out and handle it.  Maybe you can, for a while, and then at about three years in you are truly at your breaking point.  Are you smart enough to know when you just don’t know?  There is nothing wrong with you not knowing.  It is not your field of expertise so stop beating yourself up.  Maybe it is time that we had a conversation to see if I can help you and your loved one.  It is not an either, or it is a both, and. I can help you to provide better care AND get your life back.

Let’s talk and see.

Pat Collins

865-684-8771 (leave a message if I am unable to answer right away)

Email:  pat@empoweringhealthoptions.com

Do you have your list ready?

You are in the midst of caring for your loved one and you haven’t slept much, you can’t remember the last time that you had a “real” meal and maybe you haven’t even been to your own home in two or three days.  You are overwhelmed, exhausted, mentally whipped and want to just run away But, you don’t run away and you just “suck-it-up buttercup.”

People come to visit and maybe even bring a meal or stay for a while.  It is good to have a few visitors and to take a little break.  After a while, it is time for them to leave and as they are leaving, they may say something like… “Let me know if I can help you in any way.”  Or, “Call me, if you need anything.”

Caregivers: Be prepared for those that ask what you need

Most really do mean it.  They will help you, they just do not know what you need help with or what you want help with.  People get territorial.  Of course you need help and would like help with …” Oh crap, I can’t think of anything now that I have been put on the spot. “So, you just smile and say, “We are fine, right now.”

Five minutes after they leave, you think of everything that you do need help with.  But, do you call them and let them know?  You mean to let them know but then life happens and you are back in caregiver mode.

What might your life look like if you actually had a list of things that you could use some help with already made?  Now let’s think outside the box for a few minutes… what are the three things that would help YOU the most?

Sitting with your loved one for three hours on Thursday

Doing Your laundry on ______________

Cleaning Your house on ______________

Mowing Your lawn on ________________

Making a meal and bringing to where you are on ______________

Having the oil changed in your vehicle on ____________________

Coming and visiting with you on ____________________________

Mowing your loved ones lawn on ___________________________

Doing laundry for your loved one on ________________________

Cleaning the gutters on __________________________________

Caregivers: It is okay to make your life easier

Whatever it is that will make your life a little easier is what you need to write down and put a day, date or time on it!  Why put a time frame on it?  So, if they can’t do it the day or time you ask for they will think of a day and time that they can do it for you.  You could always have a chores list posted on the refrigerator and have people sign up for things that they are willing to do and can do.  For example, I don’t mind doing laundry, running errands or putting a meal together. I do mind cleaning the house, dusting and sitting with someone.  So, I will do the things that I don’t mind doing and I will be glad to help you.  Someone else may be perfectly fine with sitting with your loved one and another may be perfectly fine with cleaning your house or your loved ones house.  Give people the jobs that they like to do or do not mind doing.  Don’t give them things they hate doing.  You will have to see what works best for you.  If having a chores list and people signing up does not work, then have a list of three things and tell them what they are and let them pick.

Be open to the possibility that people care for you and truly want to help you.  Don’t rob them of a blessing.

Do you know the one thing that gets you in to the most trouble? When you ASSUME!

It can cause us to go to war with our spouses or significant others and not even know why. It causes hurt, confusion, anger, and even the silent treatment.  That one thing is an assumption.

We have the best of intentions, but …

We all make assumptions. Look at things from our own point of view and our own life experiences. We believe that when someone we love is telling us something that concerns them or upsets them, that we need to “fix it” or “find a solution.” For me, that is in my nature and I automatically go into assessing the problem or issue and finding a solution.  It works great for my clients, but not so great for my loved ones as they just wanted to vent.  Of course, had they told me that they just wanted to vent, then I would be more than happy to listen and empathize with them.  But that is a whole other conversation about communicating for understanding.

Situations may be similar, but they are not the same

Assume makes an “ass” out of “u” and “me.”  Why?  Because we really don’t know what is going on in another person’s mind. Even with our closest relationships, we don’t really know what they are thinking.  We know what is going on in our mind, accessing our memories of our version of a similar situation.  Guess what?  The situations may very well be similar but they are not the same. People are different, parameters are different, circumstances are different, and consequences may be different. We just don’t know.

To those that have felt bulldozed by us, most of us are really sorry and we did not mean to make you feel as though you could not handle your own issues, usurp your authority or your own decision making rights.  We really do know that you can make your own choices and handle your own issues.

Be still and listen, that is all

Sometimes, people just need to vent, rant and rave, to get it all out. Please don’t automatically assume they want you to problem solve for them.  This is what I am trying to always remember to do myself…I will listen, try my best to understand and before I offer any advice or recommendations, ask if they would like some help.  I am a work in progress and it is okay that you are a work in progress too.  At least you do care.

Have a great day.

Pat

Are your meds hurting you, helping you or doing nothing at all?

Right Meds, Right Dose, Right Person, Right Now

List of most common medications are listed below.

Are you tired of the trial and error method on your prescription medications?  Are you ready to know what will work and what won’t work?  Are you ready to invest in yourself and your health?  If they answer is, Yes, to any of those questions, then the genetics test for drug-gene medication response is for you.  Do it once and use the information for the rest of your life.

It is an in-home, cheek swab with a form for your doctor to sign. Yes, a part of my services are to help you with the ordering process, filling out the forms, submitting the sample, emailing your test results to you and going over them with you via telephone.

FAQs – Is it covered by insurance?  I do not bill insurance.  You may pay for it and turn in bill for reimbursement to see if your insurance will pay for the test.  It is usually covered by Health Savings Accounts and Flexible Spending Accounts. If none of these apply, then you may be able to count it off on your income taxes as a medical expense.  How much does the test cost?  $799.00 (price subject to change if manufacturer changes their pricing)

Check the following medications listed below to see if you would benefit from knowing what will work, what won’t work and what might work.  It is correct that you only have to do this test once as your genes do not change.  The report will be updated as more information is acquired.

Medication List for Comprehensive Testing for Medication Response (the most common ones are listed here)

Ready to Order the RightMed® Test

Contact:  Pat Collins

Empowering Health Options

Ttelephone:  865-684-8771 (if I am unable to answer, please leave me a message and I will return your call)

Email – pat@empoweringhealthoptions.com

If you are a caregiver or seeing that your loved one is being taken care of…you may be in my tribe.  I learned a new phrase today, Compassion Fatigue.  We always hear about “caregiver burnout,” but I had never heard the phrase “compassion fatigue,” until today.

Here are some symptoms of Compassion Fatigue:

Feeling physically and emotionally exhausted all of the time

Feeling disconnected or detached from your own body or thoughts

Feelings of unfairness toward the caregiver relationship

Irritability

Feelings of dislike or hatred (of yourself or others)

Trouble sleeping

Insomnia

Weight loss or Weight gain

Headaches

Low backaches

Poor job satisfaction

Self-medicating with alcohol or medications

Are you at risk for Caregiver Burnout?

If you are a caregiver dealing with stressful situations…YES!

What can you do to alleviate Compassion Fatigue as a Caregiver?

1. 1. Be open to the possibility that you can provide better care AND get your life back

1. 1. At about the 3 year mark, you are probably at the end of your rope and need someone to help.  When you get to this point and are ready for help, that is when I can be of service to your loved one and to you too.

1. 1. Talk therapy, venting to a trusted friend.

1. 1. Regular exercise

1. 1. Recognize that self-care is necessary and not selfish.

1. 1. Eating healthier foods.

1. 1. Drinking more water every day

1. 1. Find something you enjoy and do it weekly

1. 1. Attend support group meetings

Accepting help is not a weakness.  Give yourself a break, this may not be your area of expertise and that is okay. You have your own areas of expertise and you are great at those.  One thing we were taught very early in pharmacy school was, “Are you smart enough to know, when you don’t know?”  Then, you find those that do. Collaborating and working together makes it easier for everyone to do their best and get the best results.

Pat Collins

Empowering Health Options

Email pat@empoweringhealthoptions.com

Telephone 865-684-8771

You may not be able to metabolize the medication, at all, for it to become effective. Pro-drugs must be converted into their active metabolite in order to work inside the body. Maybe, your body burns through the medication too quickly for it to be of help to you. How can you find out? A gene test for medications.

Most of us have experienced it ourselves or know of someone who has made the statement that a certain medication just did not work for them. What do you do then?

Call your doctor and tell them that it isn’t working? Continue taking the medication anyway? Just stop taking the medication and do not tell the doctor?

Those are the most common things that people do. So, let’s look at them and see what usually happens and how our health may be damaged. Hang on; it’s going to be a bumpy ride. Some of you will nod your head in agreement, some will begin to wonder how to be in better control of their situation and some will shrug their shoulders and just go, “Oh well, it is what it is.” Those of you that are the “shruggers” can stop reading now. This is not for you.

I know that ibuprofen works for me and I know that naproxen is like taking water, for me. Others may have the opposite reaction in their own bodies. That is a minor inconvenience on the scale of taking a medication for a need. What about when you have a surgery?

Pharmacogenomics for opioid metabolism would have made a difference for me

Yes, indeed. I had a surgery and was given a prescription for Percocet® (oxycodone & acetaminophen) for the post-op pain. Remember, we are on IV morphine (usually) before we are released. I was sore and in some pain, but that is just surgery. You will never be completely free of pain that is just not realistic. I am a pharmacist and I know this and am okay with it. I also know that the pain won’t last forever and I will do what I need to do to get better as fast as possible. That is just my nature. Now it is time for a pain pill. I take it and go on about my business. It gets to be about an hour later and I know that it takes 30 – 45 minutes to be absorbed, metabolized to the active drug and move on throughout the body. Something is wrong! I am hurting, really hurting. I take 800mg of Ibuprofen and another pain pill. An hour later, I am behind in pain management.

I call my surgeon and tell them that I cannot tolerate the Percocet®, to call in something else. Of course they think that I want another medication that is a Schedule II narcotic and would have to be written, picked up and then taken to the pharmacy to be filled. I told them no, just call in generic Vicodin®. They did. I could take 2 of them and the Ibuprofen and deal with the post-op pain.

Why didn’t I tell my doctor that the Percocet® was not working? I knew that it wasn’t working but at the time I had no proof as to why. This was the mid-1990’s. You know as well as I do, that when you tell your doctor a pain medication is not working and that you need “Your drug of choice, one that you know works for you.” You are viewed with skepticism and more likely than not a “drug seeker” or worse a “drug abuser.”

“What do you mean it is not working, it is one of the most powerful drugs that we have?” What you want to say versus what you do say is two different things. You want to say, “Dammit, I know that, but it is not working for me. I don’t care that you think it should work. It isn’t and I should not have to suffer because you are being stupid and not able to consider that not every drug works for every patient the exact same way!” Sometimes you have to help the doctors along in understanding drug metabolism and pro-drug vs active drug. The average person doesn’t know that and they should not be expected to know that. It is not their area of expertise.

Until you have had a treatment failure with pain management, you do not understand

Until a physician has experienced the lack of pain relief in their own life, they do not understand it and will not get it. Why? Because they have had one semester of pharmacology in medical school and most do not know how the medications work or do not work in certain populations. Don’t even get me started on drug reps and what they spout out about their products. Crap, we may be here all day on this one topic. That is okay, I will do other blogs on other topics. This is important to a lot of folks.

How is narcotic pain medication dosed? Guess what? It is based on morphine equivalents. Morphine is the standard. You aren’t even getting the morphine unless you are a cancer patient and then you will be given that reluctantly. Look, I get it we need to be more aware and mindful of pain medications. I agree with that. It has been proven that the more effective the pain relief at the beginning the less pain medication is used overall and the quicker the patient is off the narcotic and back to being normal. That is what we all want. I know some of you are worrying about drug addiction. There is a difference between drug addiction and drug dependence. Your body may be dependent upon a medication but that does not mean you are addicted.

There are some folks that are addicted and for them it is way beyond pain control. They have a mental and physical dependence with an uncontrollable desire/behavior in getting and using the substance. I have talked to folks that are addicted to substances. What I found out was that it wasn’t about getting high; it was about not getting sick while coming off the substance. All of the ones that I talked with all stated that you will never get back to the first high that you experienced your first time, but would still keep trying to achieve it. It is the pattern that we see over and over again. That and undiagnosed depression. Quite a few folks are self-medicating and that includes alcohol and nicotine too. Another topic for another time too, moving on to the rest of our story.

I always chase a few rabbits. Keep count. In one of my talks with a group we chased eight rabbits. Everyone had a good time and got the answers that they needed.

What type of metabolizer are you?

Back to the pain medication issues and the whys… We have known for some time that there were differences in pain relief for people, but why? What can we look at or find out to better help these folks without them being looked at as drug seekers or drug abusers. Everyone deserves a better quality of life. Is it in metabolism, absorption and excretion? Yes, yes it is. Now we have the genetic predictors of how you metabolize or do not metabolize certain drugs. This explains why some people get great relief from certain medications and others get no relief at all.

For myself, I am one of the 10% of the population that cannot metabolize Percocet® into the active metabolite (the one that causes the pain relief) nor can I convert enough Vicodin® (which is why I needed a much higher dosage) to get some pain relief. Now I have the proof that the medication that I do need is actually morphine.

I am not a chronic pain patient, but in my brief experience with surgery and other acute painful situations, I get why people will do almost anything to get some relief. I have had two migraines to where I would have taken anything that I could have gotten my hands on to get some relief from that pain.

What if by having the genetic tests done for yourself, you could find out what medications would work the best for you and your needs? What would your life look like? What could your family life actually be like?

I have had mine done and now have the reports to use the rest of my life. Whether I need antidepressants, blood pressure medications, heart drugs, chemotherapy drugs, Alzheimer’s disease medications or Parkinson’s medications, I have the list of medications that will work for me and those that definitely will not work for me and those that may work for me. Another thing to consider, the test will also help you figure out what medication(s) may be causing your terrible side effects and/or adverse reactions.

I researched this type of testing two years ago, but it was cost prohibitive. Over $2,000.00! Now, it is way more affordable. I am not posting the price here, but will be glad to share it with you via email or telephone. The one I am affiliated with was developed in connection with the Mayo Clinic.

Have your test done now and use it for years. Yes, I get a fee for providing this service. Even if I didn’t I would recommend it anyway. Invest in yourself and your health today. As a bonus, you get to talk with me when your test results are ready and we go over them and get you back in control of your healthcare needs.

Have a great day and pass this information along to those who may benefit from this information.

Pat Collins
Empowering Health Options

865-684-8771 (If I am unable to answer, please leave a message.)

Email pat@empoweringhealthoptions.com

We have heard it, possibly said it and probably thought it … “My mom is killing me!”  You know what I mean and if you don’t then this article is not for you.  She is not literally killing you, but frustrating the hell out of you.

Family Caregiving Conflicting Feelings

You have all of these things running through your mind…I have to be at work, I have to help my kids, I have to show up for my other commitments; there is just not enough time in the day!  What did you overlook?  Your spouse/significant other and yourself, we have all done it.  The things that you are secure about, you kind of push to the side. We always put ourselves and our needs last so, what are one or ten more things?

Signs we may be having conflicting feelings

Ponder a few minutes on neglect.  That is what we are doing. We are neglecting our partners, we are neglecting ourselves.  How long will it be before problems in our relationships pop-up?  How long will it be before we start feeling run down, exhausted, and ailments start popping up?  We may even get sick with a cold or infection of some sort.  Our low back begins to hurt all of the time, our migraines become more frequent, our stomach is just in knots.  Yes, you know what is coming next…the pouncing on anything and anyone that pisses you off.  Even things that normally would not phase you seem like big deals now.  What do you leave in your wake?  Then hurt feelings of your partner, your kids, fellow workers, your friends, and your mom?

Yeah, I know, we were going to talk about conflicting feelings. I see it as you love this person and want the best for them and their care BUT, you are so mad, angry and frustrated at them that you want to either choke them or run away. You truly love this person but you just do not like them right now and you are just plain mad. Oops, how can I feel that way?  I can’t. But, I do?  Then I feel shitty for feeling the way that I feel. Well, hell, now what do I do. You are human Take a breath, and realize it’s your reptilian part of your brain that is reacting and not your logical brain.  The logical brain takes about 3 more seconds to kick in and be available to you for use.  You really aren’t mad at your mom, you are really mad at the situation, the struggles, the problems and all of the confusing and probably contradicting information that you are receiving all at the same time.

Be kinder to yourself.  Realize that your own self- care is not a luxury; it is a necessity for you to be able to provide better care to your loved one.  It still counts, even if you are not the “hands-on” caregiver but more of the “overseer to needed care.”

For those that recognize that they may need some help, as this is not their area of expertise, I offer services and support plans that are specific to you and your loved ones needs.  Let’s have a conversation to see if I may be of service to you.

Pat Collins

865=684-8771 (leave a message, if I am unable to answer and I will return your call)

1. 1. Get Organized

1. 1. Prioritize

1. 1. List Your Resources

1. 1. Assess Needs

1. 1. Prepare a Proactive Plan

Most of us want to stay at home until we die.  We want our independence and our familiar surroundings for as long as possible.  Some of us will have to transition to other levels of care due to our future health needs.  But until that time, we want to stay in our own home for as long as it is safely possible.

5 Tips for Older Adults

How can we live our life on our own terms?  Stay as healthy and physically active as possible.  Yes, we will have to modify some of our activities, but we will still be active and social.  Maybe I should have placed Proactive Plan as number one, but some folks freak at having to figure out a plan when they do not know where to begin.

1. 1.  Get Organized

Find your ducks and get them in the same pond.  What insurance plans do you currently have?  List them with the name, policy number and a telephone number.  Medical, Dental, Long-term care insurance policy and any other insurance benefit policy.  Next, your personal medical history, all of your physicians and healthcare team members, with telephone numbers, list of current medications, dosages and why you are taking them (you may be taking them for some other reason than their intended use).

Do you have a Will, medical and financial power of attorney?  Do you have a living Will that states your wishes and desires for your medical care should you become incapacitated?  If not, have a party and invite your family and friends so that everyone can do it together.  Get it written down.  Now, you need to make it legal.  You can use Legal Shield (or something like that), that is affordable and have your documents legalized.  Now that this is done, continue your party and enjoy. A part of being independent and making your own decision is to take responsibility and the necessary steps to make it happen.

Find your retirement investment(s) information, your pension plan, any other investments that you may have and list the name, policy or account number and telephone number. List all of your banking information and investment advisor’s name and telephone number. Deeds, mortgage loan information, debts owed (credit cards too), vehicle titles,

Get a file box or a fire proof safe and place this information in there.  Do not just throw it in there; you have worked hard to gather this information so let’s keep it organized.  Use file folders for each item or label envelopes for each item.

2. Prioritize

Assess where you are right now.  What might you need to address in the next 6 months?  Chronic health concerns and issues, evaluating the safety of your home, adaptive needs, home repair or even some remodeling to allow for safer aging in place (decreasing fall risks), vision, hearing and balance checks,

Wills and powers of attorney, preventing complications of chronic health conditions, increasing lighting in the home, social engagements, increasing physical activity, transportation needs should you become unable to drive, grab bars in shower/tub, eating for your body’s needs (nutritional balance), money coming in and bill payments going out, etc.

Write them down and then rank them in order of importance.  Why write them down?   What gets written down gets done.

3.   List Your Resources

Write down your income resources and how much you can take in each month.  What investments, pension plans, retirement plans do you have access to and what can you get to easily and what would take time to access?  What are the benefits of your medical insurance?  If you have long-term care insurance what will it pay per day and will it cover in-home care?  For how long?  Would you be willing to sell your current home to move to another home that would be better suited for you and your needs?  Everything that you own is a resource that you can use for your needs.

Consider your non-monetary resources such as family, friends, church, civic organizations, government programs and local offices on aging in your area.  Find out what is available to you for low to no cost.  Resources are things that can benefit you socially, spiritually, emotionally, and even physically.

4.  Assess Needs

Realistically look at and write down what you will need to age in place.  Once that is done, is it realistic or feasible to stay where you are or might you need to find another place?  Can you be objective?  Sometimes we can and sometimes we can’t.  An occupational therapist can come to your home and assess the situation for safety.  Will you need help with cleaning and chores?  Can you afford to pay someone to handle that for you?  Please do not assume your family will do this for you or that they can stay with you whenever you need them to.  They may want to help, but because of their responsibilities they are unable to meet your work needs.  Your needs will change over time and you need to expect that and readjust as needed.  Be flexible and open to the possibility of change.  Change doesn’t have to be bad.

5.  Prepare a Proactive Plan

For those of you that fly by the seat of your pants….. You drive the rest of us crazy.  Stress will make you do things that you would not normally do.  You cannot be rational in a stressful situation.  What will a proactive plan provide you?  A roadmap or guide so that you have what you need whenever a situation arises and you can make better decisions and choices.  You do have to play the “What if” game so that you can look at your choices or options.

Benefits of a proactive plan include:  Less stress, More options, Better communication, You know what resources you have and how to access them, You have the information you need in most of your “what if” situations, You get to be with your loved one at a time when they need you emotionally and physically without feeling like a piece of taffy being pulled in 5 different directions all at the same time.  Remember, whether you have a plan or don’t have a plan, there will be a plan made. It’s all about having that plan to access when you need it and are too stressed out to do your research.

If you need help, contact me Pat Collins @865-684-8771 or email me at pat@empoweringhealthoptions.com  I work with folks throughout the U.S.

Some subtle signs that may indicate your parent needs help at home:

• • Spoiled food that doesn’t get thrown away

• • Check the refrigerator for expired food, grime and mold

• • Multiple jars of the same food in varying states

• • Weight Loss

• • Pots that are burned on the bottoms

• • Food that has been left out

• • Missing important appointments

• • Unexplained bruising

• • Trouble getting up from a seated position

• • Difficulty with walking, balance and mobility

• • Uncertainty and confusion when performing once-familiar tasks

• • Forgetfulness

• • Odd Conversations

• • Acting a little paranoid

• • Unusual fears

• • Nervousness

• • Mom and Dad cover for each other, fill in the gaps

• • Unpleasant body odor

• • Infrequent showering and bathing

• • Clothes have an odor

• • Strong smell of urine in the house

• • Noticeable decline in grooming habits and personal care

• • Dirty house, extreme clutter and dirty laundry piling up

• • Carpet Stains in a normally clean house

• • The yard is not being maintained

• • Holding on to walls or furniture as they walk

• • Stacks of unopened mail or an overflowing mailbox

• • Late payment notices, bounced checks and calls from bill collectors

• • Poor diet or weight loss

• • Loss of interest in hobbies and activities

• • Changes in mood or extreme mood swings

• • Forgetting to take medications – or taking more than the prescribed dosage

• • Frequently misplaces things

• • Diagnosis of dementia or early onset Alzheimer’s

• • Depression

• • Unexplained dents, scratches or dings on the car

It may be normal aging health conditions or it may be more, check with their doctor.

Your aging parents will be able to hold it together for short periods of time.  A few hours or even a day is usual.  They will be able to carry on general conversations and even act appropriately.  Don’t pepper them with questions, right now just observe and make notes.  

Can I really do self-care for myself? Yes!

You hear a lot about self-care and how we should all be making that a priority in our lives.  If you are a caregiver, you hear it even more.  When you are in the middle of being a caregiver, “take care of yourself first,” “make time for yourself,” “take a break,” and many other phrases by well-meaning folks just make us crazy.

Presently, I am not a caregiver, but I have been one and so when I say “we” it is because I have been there too.  Yes, self-care is important, but when do you find the time?  You will never “find the time.”  You have to make it a priority and schedule it into your day or week just like an appointment.  Write it down.  What gets written down gets done.

Good self-care includes:

Draft some of those well-meaning folks to help with the caregiving chores so that you can do your self-care.  Notice that I said draft them.  That is akin to delegating some of your tasks to others.  Yes, it can be done.  Think about the things that really do not have to be done by you.  Make a list and divvy it up amongst others.

Let’s get back to the actual self-care issue and the benefits of self-care.

Self-care does not have to cost you any money.  You can walk or run every day.  Work up to 30 minutes.  It is a great stress reliever and you get to have some alone time to just let your thoughts wonder.  You don’t even have to figure anything out during this time.  When a thought arises, just say to yourself…”Isn’t that interesting?”

Make plans ahead of time to get away.  Even if it is for one day, heck even if you could only get away for four hours, wouldn’t that be pretty awesome?  Yes, it would.  If you can’t get a volunteer, then draft someone or hire someone.

Self-care for your own health and well-being

Let’s look at self-care from a benefits standpoint.  You will be calmer and more in control of your emotions.  You can think more clearly and make better decisions.  You will actually be more productive and have more energy for caregiving.  It will improve

Your relationships.  Relationships become strained and die because of neglect.  No matter what the reason.

Do something that you enjoy either by yourself of with someone that you love.  Recharge your batteries so that you can be the best caregiver possible.

I know, I know, it is New Year’s Eve and it everyone is asking you what your resolutions are for the coming year.  I don’t have any and come to think of it, I never have been one to make them.  I have seen it year after year at the gym.  It is packed from the first of the year until about February and then it really slacks off.

I am sure that it is that way for most resolutions.  Why?  They are usually made with the best of intentions.  What happens between the declaration and the actual resolution?  Maybe the goal was not specific enough.  This one is usually for losing weight and working out/going to the gym.  Did you remember to state the amount of weight you are going to lose and by when?  You have to be specific and it has to have a time table.  Just like at work you need to set SMART goals.

S – Specific (simple, specific, significant)

M – Measurable (meaningful, motivating to you)

A – Achievable (doable, attainable)

R – Realistic (relevant, reasonable, results-based)

T – Time based (time limited, by when)

If you would like to set a goal for yourself, then by all means go for it.  Get specific and write it down.  Have an accountability partner to support you, not to nag you. Small steps, this is a marathon and not a sprint.  You will mess up, it is okay. Have a plan in place for when you mess up.  I say just start where you are and go forward. Celebrate your successes. Focus on the present and what one thing you are doing today to help you achieve your goal.  Change your thought processes.  If you ever hear yourself saying, “I can’t,” or “I failed at…,” stop right there.  It is okay that you failed, that means that you really did try and maybe you can’t right now but soon you will be able to because you kept working on your goals. You’ve got this!