Saturday, May 28, 2016

When Caregiving Ends What’s Next? Redefining Your Purpose

In the midst of active caregiving it’s can be hard to imagine a time when you wont have this level of responsibility. However, change is one of the few constants in life and at some point, you will no longer need to fill this role. What’s next?

How the caregiving ends can impact “next steps.” Did the person die or become self-sufficient? Did something change requiring you to give up that responsibility? Your age, other family responsibilities, what you did before becoming a caregiver and how connected you stayed to other people and activities during that time also plays a role

While some are relieved and seem to be able to pick up where they left off before becoming a caregiver, others are lost as their identity and sense of purpose-their reason for getting up in the morning- is gone. In the latter situation, when the person dies, this can become a complication to grieving.

Note about grieving: It is important to recognize that grief does not last forever, it doesn’t come in stages, and there is considerable misinformation out there on this topic. One of the leading researchers is George A. Bonanno at Columbia University whose 20 years plus studies of grief and loss finds that By far the most common response we see in our research is a pattern we call "resilience." We see this pattern in between one third and two thirds of bereaved people. It looks like the term suggests. People who show a resilient outcome struggle initially with the pain of loss, as almost everyone does, but they manage to deal with the sadness and distress with equanimity. Their pain is acute, usually lasting most pointedly for a few days to a few weeks but then begins to subside. It is not that they don't grieve, or that they didn't care; far from it. Rather, they are able to put the pain aside when they need to and they continue to meet the demands of their life. They work, they take are of loved ones. They even laugh and experience moments of joy. They accept the loss, readjust their sense of what is, and move on.

If you are having difficulty refocusing and moving on to “what’s next” consider the following:

Stabilize your life by:
• Taking care of the basics that were often over looked such as getting sufficient sleep, eating healthy whole foods, exercising etc.

• Reconnect with your living space. Whether the person lived with you or you had to go to them, create a living space that brings you comfort, contentment and joy. This is good time to de clutter. Check out The KonMari Method for Tidying When Affected by a Chronic Condition  

• Take a vacation, even if it’s a weekend in a hotel across town. Use the  Take a Break Pinterest Board to engage in any number of activities to help ease daily stress.

• If you belong to a church, synagogue, or other religious group and were unable to participate because of your caregiving responsibilities, reconnect.

• You’ve poured out a lot of energy so if people are offering to do things for you, let them. Massages, spa day and even getting a haircut helps you recharge.

• Assess your financial and living situation along with other aspects of your life that you might have put on hold. Don’t try to tackle this all at once and definitely get some assistance if you need help with financial planning etc. Put off what you can until tomorrow.

• Look at family dynamics. Sometimes caregiving can put you at odds with family members for one reason or other. Is there anything outstanding that you really need to address? If it’s minor, let it go.

• Reconnect with friends and people you enjoy, as well as other activities, that may have fallen by the wayside. Consider the three important findings of the Harvard longevity study (now over 75 years old) Social connections are really good for us, loneliness kills; It's not just the number of friends you have, and it's not whether or not you're in a committed relationship, but it's the quality of your close relationships that matters; Good relationships don't just protect our bodies, they protect our brains.

• Practise mindfulness (living in the present moment) as much as possible so that you don’t get swallowed up in regret (it’s common for caregivers to feel guilt for not doing enough, missing symptoms etc.) or traumatized by what could happen in the future. Check out Mindful: Taking time for what matters 

• Recognize that nothing is permanent and that change is an important part of life. We’re designed to be resilient and we can build on that by maintaining a broad repertoire of possible responses to challenges such as talking, distracting oneself, writing, finding ways to laugh about it, doing something to change the situation, deep breathing, and so on.  Read more on this topic at Suffering: How optional is it? 

• If you are continually obsessing about what’s happened and fears for the future, check out How to Stop Obsessive Thinking. 

• Be gentle with yourself

 Reconnect to your purpose by:
• Asking yourself what you believe in and how that may have been shaped by your recent experiences.

• Assess what your caregiver experience has given you. Maybe it’s taught you how to advocate for someone, mediate between people with differing viewpoints, coordinate care, make food for those with special dietary needs etc. etc. What aspects of it did you enjoy?

• Identify what brought you joy and contentment before and after being a caregiver. Anything from the “before” phase that you’d like to try again?

Once a caregiver always a caregiver isn’t true for everyone. It’s okay to recognize and refocus your energy into a hobby, job, politics, church or another activity that you find interesting and fulfilling. We give the world and ourselves what it needs when we do what we love and what inspires us. If you like caregiving, there are both jobs and volunteer opportunities that would welcome someone with your experience.

• Consider a career/job change that is more in line with your current understanding of yourself.

Wednesday, May 25, 2016

Take a Break: Make a Poppy for Memorial Day

I needed a quick and easy way for a group of students to make a lot of poppies for our town’s Memorial Day activities last year. So this is the design I came up with.

• Stack 5 or 6 layers of red tissue paper
• Draw a circle-I used about a 2-½ inch circle (the inside of a roll of Duct Tape)-and cut.
• Since I had a flower punch of approximately an inch, I made the middle from black construction paper. Cutting out a smaller black circle, which is frayed a bit, will have the same effect.
• Lay the black circle/flower in the center of the red stack of tissue paper circles and punch a hole in the center.
• Stick a brad through.
• Pull the tissue paper up layer by layer to form the flower.

Don’t have brads handy? Not a problem. Top the black flower/circle with a smaller yellow piece of construction, crepe or tissue paper and staple in the center. Best to do a + shape with the staples. Once the layers of paper are each pulled up to form the flower, the staples wont be noticeable.

Use a straight pin to adhere to a shirt.

Not interested in today’s activities, try the Take a Break Pinterest Board.

Saturday, May 21, 2016

Journal Watch May 2016

• Chronic Pain May Trigger Many Cases of Addiction: Chronic pain may be a major driver behind the recent surge in addiction to opioids. More than eight in 10 people abusing prescription drugs said they were doing so to treat pain. Journal of General Internal Medicine 

• Experimental Light Therapy for Migraines: Researchers in Boston exposed 69 migraine patients to different colors of light. They found that while blue light exacerbated headache pain, a narrow spectrum of low-intensity green light significantly reduced light sensitivity. In some cases, this green light also reduced migraine pain by about 20 percent, the researchers found. Brain

Cells Carry Memory of Injury, Which Could Reveal Why Chronic Pain Persists: A new study offers clues as to why chronic pain can persist, even when the injury that caused it has gone. Although still in its infancy, this research could explain how small and seemingly innocuous injuries leave molecular ‘footprints’, which add up to more lasting damage, and ultimately chronic pain. Cell Reports 

• Emotional Expression Shows Benefits vs. Cognitive Behavioral Therapy for Chronic Pain: A therapeutic intervention involving confronting and expressing emotional and traumatic experiences shows greater improvement in fibromyalgia pain compared with conventional cognitive-behavioral therapy (CBT), randomized trial results show. It was also linked to significant pain reductions when offered as a one-time intervention in the primary care setting. 

Yoga, Aquatic Exercise can Help Combat MS Symptoms: Exercise can have a positive influence on certain symptoms of multiple sclerosis, say researchers. Patients who do yoga and aquatic exercise suffer less from fatigue, depression and paresthesia, as reported by researchers. Medicine & Science in Sports & Exercise 

Tai Chi Deemed Beneficial for Knee Osteoarthritis: For knee osteoarthritis, similar benefits are seen for Tai Chi and standard physical therapy, according to a study published online in the Annals of Internal Medicine

 CAM Use in Those with More than One Chronic Condition: Researchers found that chronic conditions were common, with 22.3 and 33.8 percent of U.S. adults reporting one and two or more conditions, respectively. Many reported use of at least one form of CAM, with the most common being multivitamins, multiminerals, or both (52.7 percent), vitamins (34.8 percent), and minerals (28.4 percent). Adults with two or more conditions were more likely than those with no conditions to use multivitamins or multiminerals or both, vitamins, minerals, nonvitamins or herbs, mind-body therapies, chiropractic or osteopathic manipulation, massage, movement therapies, special diets, acupuncture, naturopathy, or some combination of these therapies. Preventing Chronic Disease 

• Yoga May Improve Memory Better than Brain Training: A small study of adults with mild cognitive impairment found that those who practiced yoga versus brain training had bigger improvement in visual spatial memory and reductions in depression and anxiety. Live Science 

• Yoga Could Help Asthma Suffers Breathe more easily: A meta analysis by the Cochrane Review found evidence yoga can improve the quality of life and symptoms of sufferers to some extent. 

• Launches Ad Campaign Against Chewing Tobacco
• Warns that antifungal drug fluconazole during pregnancy may raise the risk of miscarriage
• Will examine what makes a food “healthy”
• Approves Tecentriq (atezolizumab) to treat the most common type of bladder cancer, urothelial carcinoma.
• Issued Stronger Warning on Side Effects of Fluoroquinolones-Should not prescribe these drugs to people with sinusitis, bronchitis or uncomplicated urinary tract infections.
• Approved Brintellix, antidepressant, Changing Name to Trintellix, to Avoid Confusion with Brilinta
• Approves Nuplazid for Parkinson’s Hallucinations
• Approved generic Crestor, statin

Lonely, Isolated People May be Prone to Heart Disease, Stroke: Social isolation raised risk by about 30 percent, exerting the same level of influence on heart health as risk factors such as anxiety and job stress, the British review found. Heart 

• Regular Exercise May Boost Prostate Cancer Survival: A study of more than 10,000 men with localized prostate cancer found that men with the highest levels of exercise before their diagnosis were 30 percent less likely to die of their prostate cancer than those who exercised the least. More exercise seemed to confer an even bigger benefit. American Association for Cancer Research 

• Physical Activity Associated with Lower Risk for Many Cancers: A study of 1.4 million participants during a median of 11 years of follow-up found that higher levels of physical activity compared to lower levels were associated with lower risks of 13 of 26 cancers: esophageal adenocarcinoma (42% lower risk); liver (27%); lung (26 %); kidney (23%); gastric cardia (22%); endometrial (21%); myeloid leukemia (20%); myeloma (17 %); colon (16 %); head and neck (15% ), rectal (13%); bladder (13%); and breast (10%)Most of the associations remained regardless of body size or smoking history. Overall, a higher level of physical activity was associated with a 7 percent lower risk of total cancer. JAMA Internal Medicine 

• About Half of Women May Benefit from Mammograms at 40: New research suggests that all women turning 40 should get a breast cancer risk assessment, since half of them may have risks that are high enough to warrant annual mammograms right away. The finding is important because the latest guidelines on mammograms advise that most women can wait until the age of 45 or 50 to start having annual screenings. American Cancer Society and the American Society of Breast Surgeons 

Night Shift May be Tough on aWoman’s Heart: Women who work rotating night shifts may face a slightly increased risk of heart disease, a new study suggests. "We saw a modest increased risk of heart disease associated with longer duration of rotating night shift work, which appears to wane after stopping shift work." JAMA 

• Pesticides Linked to Raised Risk of ALS: Exposure to pesticides and other chemicals may increase the risk for ALS (amyotrophic lateral sclerosis), a fatal neurological disease, researchers say. Persistent exposure to the pesticide cis-chlordane increased ALS risk nearly sixfold. Exposure to pentachlorobenzene -- which was used in the manufacture of fungicides -- doubled the odds for ALS. Polybrominated diphenyl ethers, used as a flame retardant in furnishings and textiles, raised the risk by about 2.7 times, the researchers said. Military service was also linked to greater risk for developing ALS, but the investigators can't explain why. JAMA Neurology 

A Healthy Lifestyle Can Prevent Cancer: A large proportion of cancer cases and deaths among U.S. individuals who are white might be prevented if people quit smoking, avoided heavy drinking, maintained a BMI between 18.5 and 27.5, and got moderate weekly exercise for at least 150 minutes or vigorous exercise for at least 75 minutes, according to a new study. JAMA 

Alcohol Processed Meats May Increase Stomach Cancer Risk: Alcohol, processed meats -- such as hot dogs, ham and bacon -- and excess weight all may raise a person's risk of stomach cancer, a new review finds. Further, the risk seems to increase as a person drinks more alcohol, or eats more processed meats or gains more weight. The report suggests that: Three or more alcoholic drinks per day every day increases risk; For every 1.8 ounces of processed meat eaten every day -- the equivalent of one hot dog or two slices of bologna -- the risk of cancer in the lower stomach rises by 18 percent. Diet, Nutrition, Physical Activity and Stomach Cancer 2016 

Omega -3 Fish Oil Supplements Might Boost Antidepressants’ Effects:Researchers reviewed the findings of eight clinical trials worldwide, as well as other evidence, and concluded that the Omega 3 fish oil supplements appear to help battle depression in people already on medication. American Journal of Psychiatry 

Teens Who Eat Lots of Fruit May Lower Their Breast Cancer While Women Who Drink Alcohol Increase Risk: Consumption of apples, bananas and grapes during adolescence was strongly associated with a drop in breast cancer risk. Roughly three daily servings of such fruits was linked to a 25 percent drop in risk by middle age. drinking fruit juice did not appear to confer any benefit. A second in the same journal found that women who increased their overall alcohol intake by two drinks per day ended up boosting their breast cancer risk by up to 30 percent. BMJ 

Food that Can Help Fight the Risk of Chronic Inflammation: A new study by the University of Liverpool's Institute of Ageing and Chronic Disease has identified food stuffs that can help prevent chronic inflammation that contributes to many leading causes of death. Diets rich in fruits and vegetables, which contain polyphenols, protect against age-related inflammation and chronic diseases. The results of our study suggest that (poly)phenols derived from onions, turmeric, red grapes, green tea and acai berries may help reduce the release of pro-inflammatory mediators in people at risk of chronic inflammation. British Journal of Nutrition 

Too Many Potatoes can Increase Blood Pressure: Consuming four or more servings of potatoes a week was linked with an increased risk for high blood pressure -- 11 percent for baked, boiled or mashed and 17 percent for fried -- compared with eating less than one serving a month. Surprisingly, potato chips didn't appear to increase the risk, the Harvard researchers reported. BMJ 

Genetically Modified Crops are Safe Review: Crops created through genetic engineering are as safe to eat as crops developed through traditional plant-breeding methods, according to the National Academies of Sciences, Engineering and Medicine panel. The panel could find no link between consumption of genetically modified crops and rates of cancer, kidney disease, obesity, type 2 diabetes, gastrointestinal diseases, celiac disease, food allergies or autism, the report stated. Genetically Engineered Crops: Experiences and Prospects 

• Probiotic Supplements Beneficial for those with Rheumatoid Arthritis: Probiotic supplementation seems beneficial for patients with rheumatoid arthritis (RA). The probiotic capsule contained three viable, freeze-dried strains: Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum. The International Journal of Rheumatic Diseases 

• Calorie Restriction Improves Mood, Health in Non-Obese: Calorie restriction may improve health, mood, sexual function, and stress levels even in non-obese individuals, according to research published online May 2 in JAMA Internal Medicine

Low Dose Aspirin Tied to Better Cancer Survival in Study: People with cancers of the colon, breast or prostate may have better survival odds if they use low-dose aspirin, a new research review suggests. PLOS ONE 

Cognitive Behavioral Therapy May Help Depressed Teens: A study of 200 teens who were unwilling to take medication to treat their depression found that those who tried a type of short-term "talk therapy" -- known as cognitive behavioral therapy (CBT) -- were more likely to recover than those who didn't. Pediatrics 

• Botox Can be Used for Chronic Migraine: Botox is a safe and effective treatment for chronic migraine, spasticity in adults, cervical dystonia and blepharospasm, an updated guideline from the American Academy of Neurology says. American Academy of Neurology's Annual Meeting 

Metformin Safer for Heart than Other Common Type 2 Diabetes Drugs: Metformin reduced the risk of dying from heart attack and stroke by about 30 percent to 40 percent compared with other commonly used drugs called sulfonylureas, such as glibenclamide, glimepiride, glipizide and tolbutamide, researchers report. Annals of Internal Medicine 

• Metformin May Reduce Cancer Death Risk: The study found that for women with type 2 diabetes and cancer, the odds of dying from cancer appeared to be 45 percent higher compared to women with cancer who didn't have diabetes. But, in women with cancer who took metformin to treat their type 2 diabetes, the risk of dying from cancer seemed about the same as it was for women without diabetes. International Journal of Cancer 

Diagnosis, Treatment and Prevention of Lyme Disease: Evidence is evolving regarding the diagnosis, treatment, and prevention of Lyme disease, HGA, and babesiosis. Recent evidence supports treating patients with erythema migrans for no longer than 10 days when doxycycline is used and prescription of a 14-day course of oral doxycycline for early neurologic Lyme disease in ambulatory patients. The duration of antimicrobial therapy for babesiosis in severely immunocompromised patients should be extended to 6 weeks or longer. JAMA 

 Statins Might Not Lower Colon Cancer Risk: Long-term use of cholesterol-lowering statins does not appear to reduce the risk of colon cancer, but a person's cholesterol levels might affect risk, a new study suggests. University of Pennsylvania 

With Flu Shot, Timing May be Everything: British researchers assessed 276 people 65 and older who received vaccinations against three different flu strains between 2011 and 2013. Flu shots may be more effective when people get them in the morning than in the afternoon. Vaccine 

Lithium Beats Newer Meds for Bipolar Disorder: Lithium outperforms newer mood stabilizers in the treatment of bipolar disorder, a new study has found. Patients taking lithium had lower rates of self-harm and unintentional injury compared to those taking other bipolar drugs, such as valproate (Depacon, Depakote), olanzapine (Zyprexa) or quetiapine (Seroquel). JAMA Psychiatry 

Warfin Tied to Dementia: Patients on the clot-preventing drug warfarin showed a higher dementia risk if their blood levels of the medication were frequently too high or too low. And that was true not only for people with atrial fibrillation, but also for those using warfarin for other reasons. 

• Too Many People Still Take Unneeded Antibiotics: Nearly one-third of the antibiotics prescribed in the United States aren't appropriate for the conditions being treated, a new federal government study shows. JAMA 

 Cognitive Behavioral Therapy Advised for Chronic Insomnia: Cognitive behavioral therapy is recommended as the initial treatment for all adults with chronic insomnia disorder, according to a clinical practice guideline published online May 3 in the Annals of Internal Medicine

• Depression Strikes Many Caregivers of Critically Ill: Caregivers to patients who have spent at least seven days in the intensive care unit] commonly experience symptoms of depression for the full first year after ICU discharge, according to a Canadian study. A large portion of them improve over the year, but a sub group does not. Younger caregivers and those making under $39,000 were more apt to be more depressed. NEJM 

• Early Palliative Care Helps Caregivers: Introducing palliative care shortly after cancer diagnosis led to better quality of life for caregivers. It also led to fewer symptoms of depression among the caregivers. This study is the first to show that offering palliative care early may offer significant benefits for people caring for dying cancer patients, the researchers said. ASCO 

Obamacare Expanding Coverage for the Poor: State Medicaid expansions under Obamacare have improved low-income Americans' insurance coverage, increased their doctor visits and enhanced detection of chronic health conditions, which could lead to improvements in health, a new study suggests. The findings are important as policymakers continue to debate the value of expanding Medicaid, the publicly funded health insurance program for the poor, researchers said. Annals of Internal Medicine 

 Americans Getting Adequate Water Daily: Americans' worries about not being properly hydrated may be unfounded: A new government report finds most are getting enough water each day. The data, from the U.S. National Health Nutrition Examination Survey for 2009 to 2012, found that adult men take in 117 ounces of water daily, on average -- more than 14 cups. For women, the number is 93 ounces, or almost 12 cups daily. In 2004, the Institute of Medicine set "adequate" daily intake of water at 125 ounces for men and 91 ounces for women. The new data suggest that the average man approaches the needed level, and the average woman more than meets it. Data Brief