Category: Uncategorized

November 24, 2021

It is that time of year. We go to visit our parents and/or other family members for more than three hours. Maybe you haven’t seen them for a few months or since last year. Sure, everyone is on their best behavior, for a while. “For a while,” is the key. Covering up and hiding things can be done for a few hours. The conversations are general. The house is clean (in the living room, dining room and probably kitchen). What about the rest of the house? What do the cars look like?

When you haven’t seen someone every week, you notice things that are amiss much better. Nothing major, but a lot of little things. I get it. Holidays, family dynamics, travel, cleaning, cooking, pressures at work, etc. It is stressful. Even if it is a good and loving family time, it is still stressful.

This is also a good time to stealthily check things out and observe. This is not the time to be rapid fire questioning or even questioning at all. Just look, listen and observe. It is troubling when our loved ones begin to lose their independence due to a health condition or aging. It is a big stressor for us when we realize what is happening. No matter how hard it is to look for possible issues, it will be even harder to ignore them and get blindsided at the most inopportune time.

Physical heath changes – Have they lost weight?

                                         Have there been any changes to their medications?

                                         Are the taking their medications correctly?

                                         Are they walking differently?

                                         Are they hesitant to get up and walk?

                                         Does it seem they are unsteady or have a fear of falling?

                                        Do you notice any cuts or bruises on forearms or legs especially?

Behavior changes – Have they lost interest in things they used to enjoy?

                                 Have sleep patterns changed? Napping more, less or sleeping more or less

                                 Do they seem to be sad or angry? They may deny it, but how do they look?

                                 Are they repeating the same stories?

                                 Are they giving money to things or people that they have not done before?

                                 Are they not bathing regularly?

                                 Are they wearing the same clothes day after day?

                                 Are they losing track of time?

                                 Are they showing an increase in agitation?

                                 Are you noticing verbally or physically abusive behaviors?

Environment – Is there a lot of unopened mail laying around?

                        Is there more clutter than you remember before?

                        Do you see spoiled food or past expiration date food in the refrigerator?

Are there any small things undone? Ex. Burnt out light bulbs, laundry overflowing, crumbs or grime on counter tops?

Are there any dings in the car? Scratches?

Is the yardwork being kept up?

Does the cookware have burn marks in it or on the outside?

The exterior of the house is not being maintained. Gutters, spigots, painting, etc.

Cognition, Memory or Judgement – Missing appointments?

                                                           Getting lost while walking or driving?

                                                           Trouble finding the right words?

                                                           Unable to complete sentences?

                                                           Unable to recall names of familiar people or objects?           

Unless they are in immediate danger, do not make a fuss. Plan for a time to meet later and talk. When you meet, express your concerns and your observations, they will probably become defensive. Do not get personal. Re-state your observations and how all of you can work together for solutions.  Maybe they need a check-up with their doctor? Maybe they are having issues or problems with their medications?

Your aging parents are not going to share things with you. They may not lie, but they are keeping secrets. Spouses will cover for each other. What one may no longer be able to do or handle the other one will step in and handle it.

High on the priority list will be an eyesight check-up and a hearing test. They may not be able to clean as well, because they cannot see as well. They may have fights or spats because they cannot hear each other and neither of them understands what is wrong with the other. Hearing also affects their balance.

Some secrets that they keep – They are falling sometimes

                                                They are in pain

                                                They are short on money

                                                They may go on spending sprees

                                                They may be drinking more

                                                Someone is financially abusing them

                                                Someone is physically or emotionally abusing them

 These conversations can be very awkward and they may deny that anything is happening to them. Tread lightly. You want them to trust you to help and not to blame them or hurt them further by how you act towards them. Ask them if you can talk about XYZ. Share an article with them about it happening to someone else and ask their opinion and insight. If they refuse to talk or share with you then you may want to find someone else that they will talk to. Their doctor, pastor, a friend of theirs, someone they will be comfortable talking with.

You may not get anywhere with them. They may stub up and say no to your help. You can’t make them; you can only try to help them. If they are of sound mind, they get to make the decisions, even if they are the wrong decisions.                                 

What two legal documents do you need?

July 28, 2021

How can you make sure that your business, your financial accounts, your bills are taken care of should you become incapacited for a period of time or for the rest of your life?

The two legal documents that you need are:

1. Durable Power of Attorney for Finances

  2.  Durable Power of Attorney for Health care

Now, all states are not the same so make sure that the forms are legal in your state.

Stop the fighting before it starts. And, you know that there will be fighting about who is taking care of what and how they are going to handle it. Choose someone who wants to be the durable power of attorney for health care and finances. It may not be the same person.

The reasons may be many for not choosing your spouse or another family member. They may not want to or even be able to be the power of attorney. Finances are just not their expertise. You can’t trust them to do what you want. They piss you off, or whatever the reason. It does not matter; it is your choice.

If you do not make a choice or you do not have these powers of attorney, then the courts will decide conservatorship for you. You do not get to have any input or a say and it will take a lot of time, money and stress. Your money. A conservatorship takes a lot of time and a lot more money than getting these taken care of by a lawyer. You can even use one of the prepaid legal plans for your will and durable powers of attorney, if you are concerned about the cost. I would like for you to consider this an investment in you, your wishes and needs to be handled and done as you want them to be handled and done.

Make your wishes known, fill out your living will and then get on with your life.

Check with your bank about what they need to have in place so someone else can-do banking on your behalf using your accounts. If a durable power of attorney is over three years old, some banks will not honor the power of attorney for fear that it may have been revoked or someone else is the current power of attorney. Also, if you have a safety deposit box, make sure you have two or more people on the signature card to access the box. If not, good luck with getting into that box. It will be locked down tighter than Fort Knox.

Pick one to three people that you trust and set them up as your powers of attorney. Ask them first, then make your wishes known. What gets written down gets done. Who is the best person or persons to make medical decisions for you? Who is the best person or persons to handle your finances and bills?

If you have had these in place for over 5 years, do you need to change them or update some information?

Pat

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.

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.

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.

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.

Look at the diagram below for names and areas of 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

Can Behaviors be managed Without Medication?  What are the Pro’s & Con’s?

Medications are not without risks.  There are no approved medications for behavior management in a dementia.  The medications that are being used are being used “off-label.”  That means that they are probably being used for a side effect that they cause and not the intended or approved use.  Does that make it right or wrong?  Each of us has to decide that for ourselves.  As long as you understand the risks versus benefits, make the best decision for yourself and know what to look out for as far as other side-effects and adverse reactions.  Adverse reactions are things that happen that we do not expect.

In my opinion, it is always better to use non-drug approaches whenever possible.  Yes, it will take time and effort, but with consistency behaviors will get better or at least not worsen.  Will some eventually need medication?  Possibly to Probably.  That’s the thing with a chronic illness, there are no absolutes and situations and needs change so be open to the possibility of making other decisions when needed.  What is the best decision that you can make, right now, with the information that you have, right now?

Behaviors have a reason

Drug side effects

Infections

Pain

Discomfort

Uncorrected problems with vision and hearing

How you act and react matters – your attitude and feelings are what they pick up on

You become the detective:  Do they have a fever?  If yes, call doctor.  Do they need to go to the bathroom?  Have regular toileting schedule.  Are they too hot or too cold in their clothing?  Are they bored?  Have they had enough exercise during the day? Are they drinking enough?

“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.

If nothing physiological is the problem, distract and redirect.

How do you handle issues with other family members wanting to “try” supplement “X, Y or Z?”

As we age, we cannot metabolize and clear medications and supplements as well as we once could and they can and do built up in our bodies.  So, the dosage we took in our 50’s may be way too much for us in our 60’s, 70’s and beyond.  Supplements can & do cause real harm to people.  Don’t be misled by the claims of “Natural,” “Proven,” or even “Improves cognition.”  There have been NO large scale, repeatable studies that can prove to the scientific community any supplement or herbal product will help once a person has a dementia.  I understand the want, the desire the need for something to help, but that is just not possible at this time.  The time to consider using supplements is way before a diagnosis has been made.  U.S. National Library of Medicine https://www.nlm.nih.gov/

You can find and research for legitimate studies there with the results of the studies.  Let the doctor be the “bad guy” if you need help.  Family dynamics, they are usually interesting and quite trying at times.  Keep the main thing the main thing, appropriate care and compassion for your loved one.  Their bodies cannot metabolize and clear as well as they once did and we are not going to tax the body any more than we have to.  Acknowledge their well- meaning ideas and concerns, but state that at this point they need – visits, love, just being with you and sitting or talking.  If that doesn’t work then you can just pull out the “Hell to the no!”

Medications

Medications used for depression, anxiety, aggression & restlessness:

Citalopram (Celexa®), Mirtazapine (Remeron®), Sertraline (Zoloft®)

Side Effects

Less common:

• 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:

Anticonvulsants or Mood Stabilizers – Divalproex sodium (Depakote®), Carbamazepine (Tegretol®), Oxcarbazepine (Trileptal®)

Side Effects

Less common:

• 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:

Lorazepam (Ativan®),  Clonazepam (Klonopin®), Alprazolam (Xanax ®), Oxazepam (Serax®)

These medications cause sleepiness and possible confusion and an increase risk of falls & dizziness

You want to use the shorter acting ones which are all but the Clonazepam.

Side Effects

Symptoms of overdose:

• 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:

Antipsychotics – Risperidone (Risperdal®), Quetiapine (Seroquel®), Olanzapine (Zyprexa®)

Less common:

• 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

These medications should only be given when the doctor thinks the issues are severe.  These have been known to increase mortality in folks with dementia.

Medications used for sleep:

Zolpidem (Ambien®), Ezopiclone (Lunesta®), Zaleplon (Sonata®)

Note – these should only be used if absolutely needed and for only a short amount of time.  The person may become more confused and they are at a higher risk of falling.

Side Effects

Less common or rare:

• 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:

Medications with strong anticholinergic (AC) side effects, such as sedating antihistamines, are well known for causing acute cognitive impairment in people with dementia.

Analgesics – Meperidine (Demerol®)

Antiarrythmics – Disopyramide (Norpace®),

Antidepressants – Amitriptyline (Elavil®), Doxepin (Sinequan®), Imipramine (Tofranil®),

Antiemetics – Promethazine (Phenergan®), Dimenhydrinate (Drammamine®), Meclizine (Antivert®), Cyclizine (Marezine®),

Antipsychotics – Chlorpromazine (Thorazine®), Pimozide (Orap®), Thioridazine (Mellaril®)

Antihistamines – Chlorpheniramine (Chlor-tri-me-ton®), Cyproheptadine (Periactin®), Diphenhydramine (Benadryl®), Hydroxyzine Hcl (Atarax®)

Gastrointestinal & Urinary Antispasmodics – Hyoscyamine (Levsin®), Dicyclomine (Bentyl®), Flavoxate (Urispas®), Oxybutinin (Ditropan®), Tolterodine (Detrol®)

Muscle Relaxants – Carisoprodol (Soma®), Chlorzoxazone (Parafon Forte DSC®), Cyclobenzaprine (Flexeril®), Metaxolone (Skelaxin®), Methocarbamol (Robaxin®), Orphenidrine (Norflex®)

Older adults may be more sensitive to anticholinergic effects in the central nervous system because of age-related changes in pharmacokinetics and pharmacodynamics, reduced acetylcholine mediated transmission in the brain, and increased permeability of the blood-brain barrier. Anticholinergics are known to cause confusion, memory loss, and worsening mental function in people who are older than 65 years.

Acetylcholine is essential for memory and anticholinergics block the release of the neurotransmitter acetylcholine in the central nervous system and the peripheral nervous system.

The way to remember the effects of anticholinergic medications is using the mnemonic Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter.

• 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. You are still mad about it and are fighting it.
2. You are only trying one approach to finding relief.
3. You have given up control of your treatment options because you feel so bad.
4. You may have been misdiagnosed.
5. You have accepted that nothing else can be done and you just need to learn to live with it.

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.

When you use more than one approach to an issue 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.

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.

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.

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 circumstances.

Pat

5 Things you can do, right now, to improve your quality of life:

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..
2. 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.
3. 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)

When strengthening – slow, deliberate and controlled movements are needed

4.   Breathe.  Practice lying down until you are comfortable with this exercise.  Should you become dizzy or light headed,                 stop.  Place your hand or a magazine on your belly, take in slow deep breaths (4 count), you want your belly to rise                   and not your chest.  Breathe out through pursed lips (4 to 6 count).  Do for 5 minutes two or three times per day.

5.  Take charge of your healthcare needs.  Get educated and learn what your best options are (use reliable health                            information). Get organized, have your powers of attorney completed, make your wishes known, have the talk with  loved ones and get on with living.  When you say or think to yourself, “I can’t,” get rid of that phrase!  At least make it in to “I can’t, right  now, but I will get there.” Listen to your body. Remember, you are a part of your healthcare team and all team members need ti  be working towards optimal health.

Many people are 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 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 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.

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

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.”

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 __________________________________

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?

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 Assume.

We all do it. We 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.

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.  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.

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

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

Are you experiencing Compassion Fatigue?

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:

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 Compassion Fatigue?

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

What can you do to alleviate Compassion Fatigue?

1. Be open to the possibility that you can provide better care AND get your life back
2. 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.
3. Talk therapy, venting to a trusted friend.
4. Regular exercise
5. Recognize that self-care is necessary and not selfish.
6. Eating healthier foods.
7. Drinking more water every day
8. Find something you enjoy and do it weekly
9. 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

Are your medications helping you, hurting you, or just plain not working for you at all?

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?

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 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.

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.

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?

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)