More about Strokes…

March 3rd, 2011

Ten years ago my mother- in-law was eighty years old and living many states away from us in Ohio.  She was a very active, retired school teacher who still volunteered at the library, socialized with her friends, took care of her own home and had many hobbies.  Many of her friends were retired teachers as well.  One day one of them picked her up to take her to a luncheon that they regularly attended.  My mother-in-law said that the entire group noticed that this particular friend was acting strangely during lunch but they could not pinpoint what the problem was.  As she was driving them home; she seemed confused, missed familiar turns, and ran over the curb several times.  Not wanting to be impolite or critical, the passengers said nothing and they each were delivered home eventually.  My mother-in-law called to ask me about her friend’s symptoms.  Could it be a stroke?  I urged her to call her friend and have her call EMS to take her to the hospital.  It was not until later, however, as her friend’s symptoms worsened, that she finally called for help and was taken to the hospital with a stroke. 

Often people know something is wrong when they or someone they are close to is having a stroke but they do not know exactly what it is so they do not do anything.  Sometimes symptoms are subtle at first.

 “My head is foggy today”, a typically alert eighty-five year old might say.

 “I can’t seem to find the right words”, an eloquently speaking seventy-nine  year old might complain. 

“My left leg just isn’t working right today.  I don’t know what’s wrong with it.  I keep bumping into things”, a normally steady, active eighty-three year old might voice.

 “I’m having trouble reading the paper today.  My eyes won’t focus”, a seventy-seven year old who is an avid reader might report.

 An attractive, young, female, TV sportscaster may begin to slur her words then speak gibberish in front of millions of viewers.  All of these sudden changes may be signs of a stroke or precursor of a stroke.  They are warnings of a potential medical problem that requires attention. 

A stroke involves damage to a portion of the brain.  The area of the brain affected will determine what the symptoms are.  The symptoms may vary considerably as the site of the damage varies.  Two people with a stroke may have very different symptoms.  One person’s stroke may affect only speech while another’s may affect their right arm or left leg.

I have always told my clients and their families to pay attention to their intuitions or instincts.  If you have a feeling something is wrong, then it probably is!  You don’t have to know what the problem is, just identify that there is a problem and then take action to get help.  You know yourself, family or friends and what is normal for each.  There are often warnings and you are the one that can spot the earliest indicators of a problem.  Do not worry about being wrong, exaggerating, or embarrassing someone.  It takes medical professionals and often diagnostic tests to determine what might be going on.  No one should expect you to know, only to make and share observations.  This is a time when you need to act as an advocate for yourself or your family or friend.  They will receive the best care if you do.  It could mean life or death or make the difference between maintaining quality of life and losing it.

What You Need to Know about Strokes

February 28th, 2011

During the recent Super Bowl, there was a young female sportscaster on television who began to slur her words and talk in jibberish.  Audiences were alarmed and concerned that she might have been  having a stroke.  It was a very real concern.  She was exhibiting some signs and symptoms of a stroke.  Though the risk of stroke is much greater in older people, young people can experience strokes as well.  In 2004 more than 100,000 people under sixty-five experienced strokes.   Strokes are not just a disease of the elderly. 

 Young women, especially, can be at higher risk for strokes.  Risk factors for those under fifty-five include:

  1. Migraine headaches that also produce visual disturbances (aura)
  2. Birth control pills-even low dose estrogen may greatly increase risk
  3. Hormone replacement therapy
  4. Lupus or other anti immune diseases
  5. Clotting disorders

In my experience as a nurse I have found that the biggest fear of many seniors  is not of dying, but of having a stroke and being disabled, unable to control their body or unable to speak.  Strokes can be very frightening so it is extremely important to know the warning signs and what to do if they occur.  It is extremely important to act quickly when a stroke occurs.  It is a medical emergency requiring immediate action!  If addressed soon enough, the stroke may be stopped and/or the effects minimized.

In order to effectively treat most strokes, you must get to a hospital, be diagnosed and treated within 3 hours from the beginning of the first symptoms***   Don’t waste time!  If there are symptoms, call EMS and get to the hospital. 

 If it has been longer than 3 hours since the beginning of symptoms, you should still go to the hospital for other types of therapies to minimize damage, and prevent additional strokes or complications.

Thank goodness the sportscaster did not have a stroke.  She was reportedly diagnosed with a migraine but there was no way of knowing that until she was taken to the hospital. 

What is a stroke? 

Another medical term for a stroke is a CVA.  That is a cerebral vascular accident.  It occurs when a blood vessel, that carries oxygen and nutrients to the brain, is either blocked by a clot or bursts and bleeds.   Part of the brain does not get the blood it needs so it begins to die.

So, a stroke is caused by the lack of blood supply to an area of the brain and without oxygen rich blood that part of the brain dies or is damaged.

There are 2 types of strokes:

  1. The most common is an ischemic stroke.  Ischemic means without oxygen.  It occurs when there is a blockage in a blood vessel in the brain.
  2. The other type is a hemorrhagic stroke in which a blood vessel in the brain ruptures or bleeds and the area it supplies with blood is damaged.

In both cases, an area of the brain is damaged by the lack of blood supply.  Strokes are the number 3 killer in the US only heart disease and Cancer are responsible for more deaths. 

Symptoms of a stroke:

Symptoms of a stroke vary somewhat according to the area of the brain affected.  Whatever function that part of the brain fulfills is what is affected but the following symptoms are some indicators of a possible stroke and should be paid attention to..

  1.    Sudden numbness or weakness-may involve the face, arms or legs-especially if on just   one side of the body
  2.   Sudden trouble seeing-in either or both eyes
  3.   Sudden confusion- unsure of surroundings, memory loss
  4.   Sudden difficulty walking-dizziness, loss of balance, drifting to one side
  5.   Trouble speaking or understanding
  6.   Severe headache

As soon as you become aware of any of these symptoms, you need to call EMS and get to an ER immediately! 

When I first began my nursing career, most people were unfamiliar with the symptoms of heart attacks.  Many people waited to seek medical attention because either they did not know what was happening or those around them did not know the signs to observe for.  Most people today know the symptoms of a heart attack but many are still not sure of the signs of stroke.  Lives can be saved if we are all familiar with these symptoms and know what to do if they occur.

Educate yourselves and save lives!  For more information, visit The American Heart Association websites.

www.heart.org          or www.strokeassociation.org

Alternative Realities II

February 4th, 2011

In December I wrote about alternative realities and how an experience that I had gave me a new perspective on how a dementia patient may feel.  I continue to ponder how to meaningfully connect with those who have Alzheimer’s, other dementias or simply altered realities for any number of reasons, be it mental or physical.   It is such a difficult issue.

My husband is basically healthy at the age of 67.  After we met, 16 years ago, it took me quite some time to realize that his hearing was impaired.  I often worked with hard of hearing clients but there were usually clues that prompted me to speak up.  Sometimes people would; speak loudly themselves, or lean forward to hear me, or watch my lips, or ask me to repeat myself.  My husband was soft-spoken and seldom indicated that he had not heard me but finally I realized he often had not understood what I said.  I made adjustments as to how I talked with him.  I spoke more loudly and avoided talking to him in the car or in noisy places to help our communication.  Several years ago I discovered that, not only was it difficult for him to hear conversations, but there were some things that he did not hear at all, (not just my nagging).  High pitched sounds like birds shrilly singing or the jingle of the cat’s collar were completely absent to him.  What a shock it was to realize that he couldn’t hear them at all!  That was his reality while mine was full of sweet songbirds and the jingling warning that the cat was underfoot.  They are very different realities.

The truth is that, even though we may have been in an identical situation to someone else, our realities may be very different.  We have all heard stories of police interviews with witnesses to the same crime who have very different descriptions of suspects and accounts of what actually occurred.  Are they all lying?  I don’t think so.  They are sharing their interpretation of the episode.  Each account is very real to each of them.  Comparing my husband’s experience to mine may have similar results.  His account may not include the cat entering the room, if he did not hear it, or the birds singing, while mine might.  Many things affect our experience or reality.  Stress, sensory deficits, hormones, pain, drugs, denial, prejudices, education, culture and many other things can shape our perceptions resulting in varied realities.  When I first entered the nursing profession many years ago, “reality orientation” was the therapy that we were taught to use with confused patients.  Well, if a healthy, normal adult is waking from anesthesia after surgery, it may be useful to use such techniques to remind the patient where they are and what is happening.  That technique is not likely to work, however, on a person with advanced Alzheimer’s, I discovered early in my career.   There is a much wider gap between realities and “reality orientation” is not the bridge that is likely to help span it.  Respect, laughter, music, love, and touch may be more effective in such cases.

Reality is an anchor that we hold tightly, whether we have dementia or not.  Reality’s truths keep us from drifting away.  They support our beliefs, values, religions, and political views.  What do we have left if we cannot trust our realities?  How can one function in life if they cannot trust what they remember, or what they see, or what they have been taught?  Without these realities, we have no solid ground to stand on but sand shifting below us.  When we insist to a family member with Alzheimer’s that their reality is not actually true, they may feel fear, anxiety, concern or anger.  It might be so threatening to them that their denial would kick in.  They may be incredulous, as we often are, that we do not see things the same way.  The Alzheimer’s patient’s reality may be quite different from ours and we, of course, know that theirs is wrong.  In truth, they are no more wrong than we are.  Their reality is very real to them, as my husband’s reality and mine are.  It must be even more difficult that they know and trust us.  How can they reconcile that, especially with dwindling cognitive and coping resources?   I don’t believe they can, but as caregivers and family, we must.   Every day, family and caregivers struggle to bridge these reality gaps.  The best we can do many days is simply to respect those different realities.  Ultimately, I think the goal is to share realities.  As family members know, it can be extremely powerful to experience those moments!  Sometimes we must wait for our realities to intersect.  It may only be for a moment so we must be prepared and vigilant in observing for them and then cherishing them when they happen.  It is even a sweet moment for me when my husband hears the cardinal singing outside our bay window!

Maddie’s Recovery

January 15th, 2011

 

 I phoned the assisted living facility where my client Maddie* resided to discuss the level of care she was receiving.   Three weeks prior she had had a stroke which dramatically changed her life.  Though she was left with few residual physical limitations, her memory and cognitive abilities had changed.   After a week in the hospital and another week in inpatient rehabilitation, she was discharged to the assisted living rather than returning to her independent lifestyle in her apartment in a retirement community.  Though she continued to show some improvement for the first weeks there, she still had not resumed many of the activities that she had been doing six months before.  She was not able to write letters or play the piano again.  She had some difficulty placing people when they called even when she had known them for a long time.   She settled into the routine at the assisted living, but her new deficits remained obvious as she did not recognize items such as books, jewelry, etc. that had been part of her life for many years.  There were lots of gaps in her memories.  She functioned fairly well in the setting and seemed at least “comfortable” both physically and psychologically but I had really hoped for more for her.  I wanted her to have a higher quality of life.

Her hospitalization had been quite grim but I had seen her go through other similar hospitalizations and come out remarkably well.  Throughout the week at inpatient rehab she had regained most of her physical status and speech.  According to the rehab standards, she was doing well.  Coming home from the hospital was the first time I really felt doubtful that she would make her usual remarkable recovery.  She recognized so little on the ride home and was even unsure what city we were in.  Her new apartment was carefully filled with familiar things but she did not realize it.  She fell into the new routine with guidance from the nursing assistants but was still a fish out of water swimming through someone else’s life.

Unexpectedly, several weeks later, there was a remarkable change in her status.  She suddenly began to write letters again.  She started knitting which she had not done in months.  Conversation began to flow more smoothly with fewer stumbles over unavailable words.  Memories began to slowly emerge.  She was able to find her way to the dining room on her own with simple reminders.  Clearly to me, she no longer needed the level of care she had been assigned when she was first admitted to the facility so I phoned to discuss the change with staff.  I was finally able to reach the designated staff person to discuss Maddie’s improvement.  Though ultimately it is a nurse who is responsible for a care plan for assisted living residents, it is not always a nurse who is involved with the day to day management of care.  Such was the case at this facility.  A non-clinical staff person was the one who supervised the nursing assistants.  When I reached her, I began to explain the changes that I had noted and why I thought Maddie needed to be re-evaluated for a change in her level of care.  While the nursing assistants had been doing an adequate job, there was inconsistency of care and some were overly attentive while others were much less so.  The supervisor mentioned concern because one of the nursing assistants had made an observation that she believed indicated Maddie was not doing well.   “She wears the same clothes every day”, the aide reported to her supervisor.  The nursing assistant had done a good job observing and passing on the information but that is where the information became skewed.  From that information assumptions were made by the aide and then her supervisor.   If the resident is not changing clothes, she must not have improved, the supervisor assumed.  She questioned her appropriateness for a change in level of care.

Do not assume!  That is my mantra and here was yet another example.    There were assumptions made and they were not validated.  The nursing assistant had done her job of observing her patient (though if she had observed without assumptions of her own, she would have noticed a drying rack in the bathroom with clothes hanging from it.)  She would have also observed that though the patient was wearing the same clothes each day, her hygiene was always good and her clothes clean and neat.  If the supervisor  had looked further or stopped to consult the resident, she would have found that Maddie was washing her clothes each evening and putting them on in the morning as had been her routine  for many years.  She was actually performing at a much higher level than the staff was aware. 

Eventually, the assistive living staff re-evaluated Maddie’s status and agreed that she qualified for a lower level of care.  This proved to be better for her from the standpoint of her independence as well as financially a considerable savings.  Where did the assistive living staff go wrong?  I believe it was with assuming.    We must view situations without a predetermined idea but open to the evidence and verifying and validating as we go.  There are so many lessons here for all of us.  Maddie continued to improve and with support is now living a life filled with activity, independence and purpose.  It was a remarkable recovery!  I am still preaching “DO NOT ASSUME!”

*Maddie is a fictitious name but the story is based on a real incident.

Advocating & Combating Ageism

January 6th, 2011

 Combating ageism and advocating for the  elderly are issues that I am passionate about!  Health is what what my long nursing career has been focused on.   In order to address  physical health  and wellness of seniors, I realize that it is necessary to destroy or at least scale, the walls of ageism.  In order for the elderly to attain wellness , (the highest state of general health possible for them), we must be prepared to advocate for or “actively support”  them in doing so.  It will not just happen.  It’s a new year and many people have  already made resolutions.   Though I certainly need to exercise, eat better and relax more, I resolve instead to be a better advocate for the frail elderly and advocate for them at every opportunity I encounter or can create. 

Ageism is a phenomenon that is prevalent in our culture.  It is a general term defined as discrimination based on age.  Commonly applied to discrimination against the elderly,  it may apply to any age group.  Ageism towards the elderly manifests itself in many forms, some of which are blatant but others more subtle and disguised.  Jobs may be denied to senior applicants  because of their age, gray hair or older appearance.   The elderly are often not included in conversations or ignored when in public.  The perception of younger people may be that seniors are not computer savvy, or intelligent.  They are often treated with disrespect, even annoyance by all ages of society.   Ageism may appear as quite innocent behavior like  referring to older people as “sweetie” or “honey” rather than by their names but doing so can be patronizing to an older person.  They should first be asked how they would like to be referred to.  At times, ageism presents itself in very unlikely places.  Shockingly, I have even heard doctors and  nurses complaining that it was ridiculous to order physical therapy for an eighty-seven year old,  because he was ” too old”.  Interestingly, that eighty-seven year old had been very active prior to having had gall bladder surgery.  He would again be very active after recovering and physical therapy would certainly prove to be beneficial, (even cost effective), not ridiculous!  Lack of respect- Assumption- Ignorance- Generalization- Intolerance-Fear  All of these either contribute to or are results of ageism towards the elderly. 

My youngest daughter was part of a multi-age modern dance company from the time she was seven years old until the time she was an adult.  Even as a child, she was  treated as a  contributing member of the troupe and her  input was valued as much as the older dancers’ opinions and contributions were.  I think that her experience in that company contributed to the fact that she has always treated everyone respectfully whether they were five years old or eighty-five years old.  I wish that more people in our society could have similar  experiences.  Perhaps, if we were all valued, we would be more likely to value others for who they really are,  rather than seeing their thinning gray hair, wrinkles  or slow gait and assuming that they have nothing worthwhile to offer society.  Seniors are a treasure chest filled with unexpected wisdom and insight.

Combating ageism against the elderly is a battle that should begin (or continue) with each of us throughout this new year.  There is no place in our society and especially in the senior care industry for ageism!  All of us who work in healthcare, or any other industry that serves seniors, should resolve to be more aware of and less tolerant of ageism.  Seniors should have the same rights as people of all ages.  They should be treated with the same respect that all people deserve! If vulnerable, they should be protected.  They should be viewed as individuals and their problems approached as such.  I have no doubt that quality of life for the elderly would improve tremendously if ageism declined.  Health would improve as well and it would be more cost effective.  I challenge you to join me in my resolution to look for and create every opportunity possible to advocate for the elderly and defeat ageism.  It may seem like a huge feat but I believe even the smallest efforts can make a difference!  In the past, other walls have been toppled…

Wellness Wishes for the New Year!

The Gift from the Caregiver

December 23rd, 2010

Over the past month, I have heard the Christmas classic , “The Little Drummer Boy”, played hundreds of times on the radio.  I  enjoyed it every time.  I think it defines the “gold standard” for gift giving.  It is the story of a small, poor boy,  simply and honestly giving of himself to a very important recipient.  The magnitude and value of that small gift is evident in the song.  Many of us hustle around looking for the ultimate gift for those we care about, but there are  others who are quietly giving that gift year round.  They are the caregivers providing physical care, support, and love to family members, friends, church members and even clients.  Many of them feel inadequate and overwhelmed by the needs of their family or cares but strive to provide more care for them as their needs change.  These caregivers not only address the physical needs of their loved ones but also needs in all areas of life and wellness…spiritual, emotional, intellectual, social, environmental and the person’s need for  purpose.  Often, caregivers  do not consciously realize the scope of their role.  They do it out of love and intuitively.  It can be extremely difficult.  I hope these caregivers realize what an incredible gift they are giving their loved ones.  It is a gift of  self, love, respect, time and support.  It is the gift that allows the person to be; as healthy as they can possibly be, as autonomous as they can possibly be, as creative as they can possibly be and as happy as they can possibly be.  It is not a gift that can be purchased. 

 Many adult children of seniors are faced with difficult decisions.  Considering options and all the needs of their senior is so very important.   Sometimes there is a seemingly easy solution but it is often not in the senior’s best interest.  Giving the situation loving attention and energy to find the best solution for the senior and the entire family is the greatest gift an adult child or other family member can give! 

For the people who may not be able to express their thanks and for those who do not even realize they have the ultimate gift, I personally thank all of you caregivers for your gifts to your family and cares.  Daily, you bring gifts and you honor those to whom you give.  You are truly giving the greatest gift of all!  Knowing that you have done so is your gift to yourself as well.   Cherish it and hold it gently, close to your heart so you can bring it forward whenever you need it.  Bless you.

Alternative Realities

December 18th, 2010

As a health care practitioner with many years of experience, I think I have a good understanding of most aspects of health and aging.  Though there is always more to learn about the latest drugs, trends and research, often my true education comes from a more obscure source.  This happened recently when I caught a glimpse into the reality someone with a cognitive impairment might experience.  I have worked with many patients with strokes , Alzheimer’s, etc. but this gave me a new perspective. 

My mother has always had an incredible memory for details.  Though a bit slower since an acute illness several years ago, at nearly ninety, she still remembers details from seventy years ago with crystal clarity.  Recently, specific wording has become more difficult for her to find, but she still recalls; the waiter from a restaurant we went to last week, what each of us ate, and  whether we finished eating it or took it home in a “doggy bag”.  My point is that I understand what it is like to be forgetful because I have been forgetful my entire life while my mother had a nearly photographic memory.  What I did not understand until recently though, was what it actually felt like not to remember.

It had been a difficult week for me and I had been sleeping poorly.    I went to bed exhausted and finally fell into a deep, deep sleep.  When I awoke in the morning, I was a bit confused when I opened the blinds to see wet pavement and leaves and debris strewn over the yard.  There was no rain predicted for the night before and I had heard nothing during the night.    “Wasn’t that an awful storm last night?” my husband commented as I poured my coffee.  “What storm?” I questioned.  There couldn’t have been a storm.  I had not heard anything and I was a light sleeper even when wearing earplugs to muffle the sounds of the night.  “It was a terrible storm!  Didn’t you hear the thunder?  It stormed for hours,” he announced.  My husband tends to be dramatic and sometimes exaggerate but there was evidence in the yard and street that there hadbeen a terrible storm.  I felt a bit confused.  This account of the storm was coming from a man who slept through hurricanes and tornadoes while I NEVER missed waking to a storm.  “Where was the dog?” I asked since the dog, who is usually exiled from the bedroom, is allowed in during storms when she becomes quite frightened.  I could not believe I had not even heard the dog!  As the day progressed, I heard other accounts of the stormy night.  I became even more incredulous that I had been totally unaware of the event.  I began to relate my experience to that of my patients with cognitive impairment. 

The impact of not experiencing the same reality as those around me hit me like a bucket of ice water.  This is how my patients felt!  Their reality truly is different than mine or their family’s.  The difficulty of reconciling that in one’s own mind is tremendous.  How difficult and frightening it must be for them to meld their reality with the world around them that presents an alternative reality.  Dealing with Alzheimer’s patients or stroke patients or even simply confused patients has shifted for me.  The insight I gained from that experience will always remind me to try to see, hear and experience the reality that my patient or family member is experiencing no matter how different from my reality it may be.

Aspects of Advocating for the Aged

August 17th, 2010

Advocate-v. to support actively, argue for, n. someone who actively supports, one that pleads another’s cause, argues for or openly supports.

How does advocating apply to the elderly?  There are many opportunities to advocate for seniors in one’s life.  One does not have to wait for emergencies or urgent situations.  Advocating can and should be proactive.  Having an advocate can greatly impact a senior’s wellness and quality of life.  Anyone can be an advocate.  Following are some reminders that may help in being an effective advocate for the aged.

Adults-Remember seniors are adults with life experiences though perhaps now fragile and vulnerable.

Appreciate-Respect seniors and appreciate their wisdom and life experiences.

Admit-Admit that family roles may be changing.

Anticipate & Adjust-Anticipate the changes that may occur and adjust for new needs.

Alert-Be alert for safety issues and signs of abuse from caregivers or others.

Ask-Ask questions & listen carefully to answers.  DO NOT ASSUME ANYTHING!!!

Answer-Answer questions & validate understanding.

Assist-Assist seniors versus caring for.  Be available to help.  Allow as much autonomy as possible.

Ageism-Be aggressive in fighting ageism.  Do not let health care practitioners assume things when dealing with seniors…Do not let waiters ignore them…Do not tolerate people talking down to seniors…Observe for innocuous ways ageism may present itself and address appropriately.

Practice being a senior advocate.  What a difference you can make in their lives!

The Power of Wellness

December 7th, 2009

Hello, my name is Carol Long.  I am a gerontological nurse who is beginning a new practice in senior wellness and geriatric care management.  In my years of nursing practice, I have had the opportunity to work with many seniors.  Each has enriched my life in a unique way and taught me valuable lessons.  I hope to be able to share these experiences through my business, community activities and this blog…I invite and welcome your input.  You are the ones who hold the wisdom and inspire me and others in healthcare.

Through SOZO Senior Wellness, my new business, I hope to empower seniors in their journey through aging and the families walking with them.  I want to shift the concept from “taking care of” to “supporting and partnering with”.  The connotation of care-giving can be nurturing and positive but it can also  diminish a senior’s power if they are not given choices or their wishes are not honored.  Through wellness concepts we are able to build on a client’s  strengths.  We address the challenges of aging from a different perspective.  We can provide tools, resources, education and support for the journey.

Wellness can be woven gently into the senior years.  It should be personal and individual, not a cookie-cutter program forced on someone.   Dimensions of Wellnessphysical, mental, spiritual, social, emotional, vocational and environmental describe all aspects of our lives. By appreciating the connection between body, mind and spirit we begin to see that wellness is more than the absence of illness as once thought.  It is striving for the highest level of health possible and living life to its fullest.

I invite you to share your thoughts on incorporating wellness into a senior’s life.