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Cortisol made my pants too tight OR The influence of Cortisol on waistline weight

We all know Cortisol is a stress hormone. You may have heard that prolonged stress can lead to central weight gain AKA waistline weight. What you may not have heard is how to respond to waistline weight. Even I developed waistline weight due to stress and I write about these issues.

My story: My daughter was pregnant with her second child. She planned a C-section delivery.   I was surprised when she announced she was already in labor as she collected me at LAX.  It was two days before her scheduled C-section! Instead of getting settled-in we were off the UCLA Medical Center for an assessment. The next two days were a circus of progress and setbacks. These culminated in an emergency C-section delivery.

I was with her behind the surgical drape: the anesthetist didn’t see a bag of IV fluids leaking; I did and reported. My daughter lost 2 liters of blood which required a draw to order blood. I was steadying her arm and wrist so they could take the sample. I looked at the monitor; her blood pressure was dropping FAST! The leaking bag of IV had never been replaced.   Another one was hung (#4) and the anesthesiologist went to get a 5th. Another bottle of a different compound was added to her IV. A second surgeon scrubbed-in.   I watched my daughter float in and out of consciousness. When she was conscious, she complained of pain. That required two boluses of medication delivered to the port for her epidural site. Finally, the main surgeon lowered the barrier drape so I could see her. She said they might not need the transfusion. Her brow was sweaty but relief was written in her eyes.

How long did it take you to read that paragraph? That’s how fast all these events took place!

My daughter’s post-operative course was initially very bumpy; so was the baby’s. I stayed with her in the hospital. Her stay was extended due to those complications.

The night before she was due home, I came back. What a mess! We all left in a hurry and it showed. I did four bags of laundry, changed sheets, washed long-dirty dishes and tossed rotten food as well as some general cleaning. All of these tasks must be completed by 11:30-12:00 the next morning for their homecoming!   The circus just moved home and included another ring; the 2-year old grandchild. No matter how we had tried to prepare her; the 2 year old was still leery about this baby who was not visiting, she was staying. Every night, I fell into bed about 10:30 and got up at 5:00am to do more laundry, more cleaning or more cooking prep before my first grandchild awoke. Then the circus began anew.

My revelation; One would think that all this activity might reduce my weight; not so. When I dressed to fly back, I put on the same pair of slacks I had worn on arrival: they wouldn’t close! I had to borrow a diaper-sized safety pin to hold them together. At first I puzzled about my diet. Then I realized I had succumbed to central weight gain from Cortisol.

My response; Now I knew the pathway to reducing my weight. Contrary to most weight-loss advice, running, lifting weights and other vigorous exercise does not work to reduce the Cortisol dump. Instead, one must create pathways for calming. Instead of reading on the plane, I chose a seat by the window and “studied” clouds. I reduced my caffeine intake. I took short walks, not race walks. I practiced guided imagery and deep breathing process. I also had to practice “kitchenus interruptus”.   That’s the tendency to head for food when one is really not hungry. Things are better now so I can resume my regular exercise program.

This plan does not mean one can eat cake and mediate it away. It does not mean one can only do deep breathing exercises and not get physical exercise. It illustrates methods for lowering Cortisol first to clear a path for other weight loss methods. We are not immune to stress but we need not succumb to it either. Are you finding waistline weight since caregiving?

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“I Don’t Need To Check My Sugars.”

A surprised adult child told me that her Mother was recently hospitalized because her blood sugars were too high to even test. When the senior was asked, she replied that she didn’t see the need. She added that she was drinking extra orange juice. (The logic of that escapes me) The doctor hospitalized her and would not release her back to her independent-living home. Let’s unpack this situation.

First, seemingly-sudden changes like these are common in seniors. The issues range from blood sugar levels to refusal to use an appliance, or a refusal to follow dietary guidelines. These refusals usually involve the management of chronic conditions. Chronic conditions cannot be cured and continue the rest of their lives. The management of a new condition adds to the management of previous condition(s). These tasks become a full-time job! A former client lamented that she had not had time to clean her refrigerator. I pointed out that she was now doing in-home dialysis. I asked her to view this as a new full-time job (and give herself a break). Ask yourself if your senior has a full-time management job. Is this incident your senior’s way of saying they are feeling overwhelmed?

Second, the situation may seem sudden to you; it isn’t. Think about the last 2-4 weeks. There were probably some early warning signs you didn’t realize were signals of change. Did the senior make a comment such as I don’t need my walker any more, or did they complain about all the bathroom trips due to the water pills?   These may have been their way of showing you that their tolerance for these life-style effects was sinking fast. Some indicators take the form of behavioral changes. The senior referenced earlier had forgotten an appointment three weeks prior; she never did that before. Ask yourself is this change a sign of deeper issues?

What could you do with the change? The immediate response may involve a move to a more supportive facility or bringing help into the home. Beyond those plans, there are deeper issues such involving the senior’s will to go on. Have they just lost their driving privileges? Did their best friend pass away? Are they having more problems getting out of the house?

One of my former clients was down cast because her recent health issues required her to give away her beloved dog. She could not keep up with its care. My conversations with her did not center on what had happened but around what it meant to her life. At the same time, the grocery store had a sign, “Take a bird to lunch”. I asked her if she would like to investigate the idea together. She purchased a bird feeder and some seed and had it put up outside her window. From that moment on she was involved with her birds. Ask yourself, what do all these management changes mean for my senior’s quality of life? Is there any way to give something back?

Sometimes there is no way to compensate for all the changes. It’s time to shift to a different paradigm. Our society has no cultural tradition for leaving life by decision. Elderly Eskimos decide when it is time for them to go. They leave the igloo in the spring and get on the melting ice to float away. Our society allows similar decisions such as electing to remove life support under a DPOA. Those measures only apply in extraordinary situations. We allow cancer patients to decide if they want to discontinue treatment. There are other reasons why an elder may decide to leave that are not cancer-related. Ask yourself, is there a deeper agenda operating here? If so, how can I come to terms with that agenda within myself?

I have seen more than one elder decide it is their time to go. Their decision contrasts with medicine’s orientation to preserving life. Preservation of life is a laudable goal but should not remove an elder’s personal decision.   Preserving the senior’s decision may be the more important form of preservation at their point in life. Some seniors find it hard to discuss their decisions with their adult children.

The roommate of one of my former clients related the events leading up to the Mother’s death. She told the daughter and me that they had discussed her Mother’s decision to go and prayed together. The Mother told her roommate that she did not think she could have this talk with her daughter. The roommate said she was instructed by the Mother to explain this to us after the Mother’s passing. It came as a surprise to the daughter. She and I discussed its impact. I offered that it may have been her Mother’s last form of parenting; to spare her such a difficult discussion. Actually, I thought the daughter, who had health issues of her own, would have been overwhelmed by a direct discussion. (Perhaps Mother knew best) Ask yourself, how would I handle such a time-to-go discussion?

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The Eyes Have It Or…

Why Seniors May Not Comply With Medical Orders

I was recently diagnosed with a slightly elevated pressure in one eye and blocked oil glands in my eye lids. This experience has given me new insights into the process of compliance with medical orders. First, a context; I have been disgusting healthy. My doctor could not believe that I took no prescription medications! This diagnosis came as a shock.

Blinking exercises were ordered. I had to adjust my daily routine to fit these exercises in four times each hour. It took me a week to find spaces in my day to do these as I exercised, cooked, wrote these blogs, and worked with clients. It took more than effort, it took my energy. I was so tired! I was also determined to make it work. Fortunately, I was only incorporating routines related to one diagnosis; what if I faced that on multiple diagnoses?

Many seniors face simultaneous, lifestyle adjustments related to various conditions. Pile these adjustments on top of each other and you have a recipe for exhaustion in mind and spirit. At first I was frustrated with myself at being tired. Then I realized that I needed to be patient with myself; incorporating takes time. I imagined myself folding the exercises into my life as one would fold ingredients into stiffly-beaten egg whites; carefully and methodically. When caregivers observe a senior in frustration or despair; we should recognize it as a normal expression of adjustment-related low energy. Caregivers can work with them to find ways to make adjustments “fold” more smoothly into their lives.

Two eye-soaks a day were ordered for me to unclog the oil glands in my lids. I collided with mechanics! Heating the washcloth in the microwave required many attempts to get it just the right temperature. Handling and folding the hot washcloth presented other issues. Arranging my early morning and bedtime routines for “soak space” was another process. Sometimes, the time would get away from me and I couldn’t do it. Sometimes I got involved in something and forgot. Creating a new routine also takes time, planning, energy, and patience.   Seniors need those too.

Consider your senior facing a new medical routine. Do they forget sometimes? It’s not dementia it’s a new part of their lives. Does your senior express despair? I’m not surprised; after many attempts with hot washcloths, I wondered if I would ever get it right. Caregivers can help by pointing to all they accomplished earlier in their lives. Caregivers can affirm that forgetting in the beginning is not unusual. Caregivers can support their senior by discussing ways to make the process workable.

Lubricating eye drops were ordered for me. That’s a skill I never needed before. What a comedy of errors!       I didn’t know drops could run in so many directions, everywhere except my eyes. It took many attempts to get it right. Practice was my key to success. My determination supported my practice. My incentive fueled it all.

How many seniors need to learn a new skill to comply with a medical order? Many do. Have they given themselves an injection before? Do they know how to apply a supportive bandage or appliance? Do they know how to care for new dentures? Skills take practice and time. Seniors may say “I don’t want to bother (or) it doesn’t matter” to caregivers. What they are really saying is; “I’m struggling to learn a new skill (or) I need guidance and encouragement to become successful”. Speak to the emotions underlying the struggle. Offer confirmation, affirmation and support.

Caregivers become frustrated when they see the new dentures sitting on the counter, or mishandling of injection equipment. We often attribute these failures to stubbornness. Caregivers see these failures in terms of their consequences; receding gums or infections are serious. The learning curve on a new skill is also serious. It really takes several sessions to help a senior learn a new skill. I was only given 5 minutes by my doctor! Our job as caregivers is to help the senior get around their learning curve. Part of that process is to call on their determination and review their incentives. What are your seniors’ incentives? When have they employed determination in their earlier lives? Review their success history with them. My determination came wrapped in an incentive; I will have a second grand child in two weeks. I want to see these children grow up. I want to participate in their lives; for that I need eyes. The eyes have it.

 

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We All Walk For Alzheimer’s.

 

seniorsidekickswalk

Last Saturday, Springfield held its Walk to End Alzheimer’s at Erin’s Pavilion in South Wind Park. The Alzheimer’s Association has come a long way; I know because I volunteered when they began these walks at Washington Park in 2008.

This year, the crowd was much larger. The opening ceremonies included singers as well as speeches. Most of all I was impressed with the family teams. Three daughters who had lost their Mother to Alzheimer’s came to the walk. Some family teams wore the photo of their loved one lost to Alzheimer’s. Other families had Tee shirts imprinted with their team’s name, referencing their lost member. One family designated their toddler as “#1 Coach” for their family team. He was named for their lost loved one.

This tragic disease impacts all ages. These teams illustrate, honor the impact and recognize those departed.  As the crowd embarked on the walk, they formed a sea of purple. I wish everyone every one could have seen that “wave of purple”; it’s always the right time to give to the Alzheimer’s Association.

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The Super Bug Scourge & Senior Care

The following article appeared on msn 9- 2-16:

Special Report: ‘Superbug’ scourge spreads as U.S. fails to track rising human toll

 

WHO just issued another report on 9-22-16 on the same subject:

United Nations high-level meeting on antimicrobial resistance

Antimicrobial resistance summit to shape the international agenda

 

The WHO reports are large, and multi-faceted. They refer to seniors but don’t dwell on them. Their reports are worth reviewing to better understand the extent of the problem.

Unfortunately, both of these articles related general information about all age groups, not seniors. Yes, all of us should be aware. However, seniors use the healthcare system more frequently than younger people (exclusive of infants). Thus, seniors stand a greater chance of requiring a hospitalization; where the super bugs live.   Senior tend to have weakened immune systems which can open them to infections. I recommend that caregivers be especially alert to what’s bugging their seniors.

An internet search for (super bugs seniors) revealed 10 references and 12 more pages!  6 of those articles on the first page referred to 1 in 4 seniors bringing superbugs to aftercare facilities or home with them.   Of those references, the one by Interim Healthcare, 3-16-16; How to control infection rates in the elderly after a hospital stay, had the clearest discussion on the topic.

Many articles encouraged senior patients as well as their caregivers to wash their hands thoroughly, with soap and water. We might be sure to wash our hands before and after our visit with the senior; how many of us help the senior to wash their hands? We should. Washing hands before preparing food is common practice. How many of us wash our hands after cleaning up? We should. Lately, washing hands has been replaced with the use of anti-bacterial soaps. Studies show these many contribute to breeding superbugs: back to soap and water. Some articles pointed out that certain superbugs live in the nose. Therefore, washing hands after blowing the nose or catching a sneeze sends these bugs down the drain. That goes for the senior as well as the caregiver. After all, what anyone touches, once contaminated, becomes a superbug haven. Some superbugs, such as MRSA, transmit through skin-to-skin contact. If the caregiver is treating a post-surgical site or a wound, clean hands and cleaned patient skin are a must.

Here are some other, practical ideas for caregivers moving a senior to post-hospital care or home recuperation:

  1. Bag it. Put personal effects in bags; then carry them. All kinds of surfaces can become contaminated. Bagging reduces that.
  2. Do not put personal items in the patient’s room until they have been sanitized. Even if those slippers look clean it doesn’t mean they are clean.
  3. There are many ways to get things de-bugged: sprays, alcohol, thorough laundering, (sometimes) exposure to strong sunlight and freezing. The CDC or your local Public Health Department has guidelines on their websites for proper sanitation procedures.
  4. Have the patient take a shower or wash and change clothes once they arrive (IN A SEPARATE SPACE). Bring them to the bathroom to wash, then to the bed. Bag those clothes and take them to the laundry and right into the washing machine. Handle as little as possible.
  5. Clean yourself as well. Once they’re in bed, shower and put your clothes in the wash. You’ve been to the hospital, lugged the bags to their destination, handled the senior and their belongings; you’ve got superbugs on yourself.
  6. Visits require three sets of hand washing, yours, the senior’s and the visitor’s. You do not need to give your visitors any superbug gifts. They should not expose the newly-released senior to contaminants.
  7. MONITOR the senior. Bowel issues, diarrhea or a temperature spike require an immediate call to the doctor.
  8. No small children as visitors for a couple days. Children are two-legged Petri dishes; heaven knows what they carry. They can say hello to their grandparents via Skype; it’s still resistant to superbugs. Children could also succumb to superbug infections, or carry contamination home to smaller siblings. Both are bad outcomes.

After a couple days to a week, if no symptoms appear, you, the senior and the grandchildren will all be in the clear. These precautions are not the way we used to do things. However, today’s superbugs require extra care.

 

 

 

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Keep Dancing

My daughter sent me this photo and caption..

seniorsidekicksdancing

 

I don’t know where she got it.  The photo reminded me of a recent senior’s situation which I would like to share:

A recent patient shed tears because she no longer had friends.  Then she listed FOUR symptoms that would prevent her from attending a neighborhood gathering!    I pointed out that her perspective was the problem, not her medical issues.  Decades working with seniors have shown me that one’s medical diagnosis does not determine social engagement.  Some seniors push on taking their aches and pains along for the ride.  Others cite their aches and pains as reasons to withdraw.

Aches and pains are real, so are medical conditions. However, there’s more to life than medical conditions.    I’ve observed that those who engage in life usually have a “youthful perspective”. It begins with a youthful personal decision.  A youthful decision is forward-looking, if not for yourself; then for your children, grandchildren or future generations.  A youthful decision may not embrace all the new technology but agrees to contend with it and find a way to master it.  A youthful perspective becomes the driver helping us (seniors) to get up and dance alongside our aches and pains.  You’ll notice I said “us”.  I have joined the ranks of seniors myself.  I am determined to dance into my future!   Other seniors have shown me that such a decision becomes even more important as years pass.  So keep dancing, even if you must sit down between dances.

 

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Commentary:”More American Are Dying in Poverty”; Bloomberg News, August 2016.

 

While the topic, More American Are Dying in Poverty”; Bloomberg News, August 2016, is important, it raises some interesting questions. Early in the article, it states; “Though no empirical measure can truly illustrate the day-to-day reality of being poor. … When including out-of-pocket healthcare costs, more elderly Americans are classified as living in poverty”. Yes, it’s true.   However, the costs listed do not tell the whole story.

In my decades of experience working with seniors, I noticed that other kinds of out-of-pocket costs are not directly considered healthcare and impact seniors financially. These costs include landscaping, house cleaning and home repairs. In previous years, the senior mowed, painted and cleaned house themselves. Seniors may also need someone to run their errands because they no longer drive.  None of these kinds of costs are considered “staying overnight in hospital” yet they are costs to seniors. Sometimes family takes on these tasks; sometimes they can’t; then it becomes a senior’s out-of-pocket expense.  I therefore request the total senior living expense be re-determined to more accurately reflect expenses by including a senior supportive living cost factor.

The article goes on to describe the 1963 formula which defines the poverty line as the dollar equivalent of three times the cost of feeding a family of four based on the 1955 Household Consumption Survey that is adjusted for inflation each year. REALLY?!   That’s 61 years of successive inflation! No wonder “supplemental measure’s poverty line is consistently 0.5 to 1% point above the official measure”.   That consistently inaccurate percentage is an excellent indicator that those measurements need to change. Why are we still using it? Additionally, the percentage of seniors in our population in 1950 was 5.6%. In 2010 it was 13%. No wonder measurements are off; we are using a yardstick from Donna Reed’s era to measure a country in the digital age!

The article continues by pointing to measures that have helped reduce poverty such as child care tax rebates and SNAP food benefits for children. We have 34.2 million caregivers today; where are their senior care tax rebates? Where’s the senior care SNAP? Studies have shown it’s cheaper to keep seniors with their families or in their own homes? If families take on these responsibilities, is that not as important to maintaining this society as child rearing? Where’s the senior caregiver’s help?

The article compares various factors and offers an interactive. “Acs concludes that if the same poverty rate that existed between 2000 and 2010 were in place today, 11 million fewer (italics mine) people would be considered poor”. That description separates the “historical rate for different age groups” from their percentage of total population. In 1955, the Baby Boom, was just reaching school age. Now, all the Boomers are reaching senior age. Thus, our population is completely reversed in percentages to that of 1955! I believe that the aggregate of an unsupported and growing senior percentage diminishes society’s capacity to absorb these senior supportive living/caregiving costs. Therefore, I suggest that what we need today is a new yardstick which includes current realities, as a basis for true determination of where we are now. Only with an accurate basis can we make solidly supportive public policy that will help our society survive the Age Boom and its consequences leading to senior end-of-life poverty.

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