Nurse v. Daughter (3)

     Today has been a full day of visual and auditory hallucinations, delusion and somnolence (sleeping deeply). In response to that the "nurse" in me would say, "The bats are flying free tonight" because we all know that medical personnel have a very warped sense of humor. It is how we deal with the stresses of our work. The "daughter" is feeling disappointed in the step backwards. 
     The "nurse" is trying to find a pattern or a reason for this intermittent problem that Mom seems to be experiencing. The "daughter" is hoping that a staff member would be able to provide some information and reassurance about this. Yeah- not so much.
     As the "nurse" I am able to reassure my clients and their families how this is normal when the body is healing from something as devastating as a stroke. It is very different when you are the passenger on this emotional roller coaster. I go home at night thankful for the progress made that day, only to come back the next day to see most of the progress  from the day before lost.
     The brain is an organ that does what it wants, when it wants. It is not like a muscle that gets a little stronger every day when you work at it regularly. It laughs at us when we try to make sense of it. Knowing and understanding this does not make this process easier.
     As I sat with my Mom and sister last night we laughed and teased each other and just had a good time in general. We  all take comfort in the fact that she has not lost her sense of humor. In the same sentence Mom began talking about the woman who was standing behind her. There was no woman behind her. She also has memories that occurred 15-20 years ago that are coming back and she believes that they are present day events. Not all of the memories are pleasant and this is causing her some stress. We all take a deep breath as we try to convince her that my brother is not in the next room shooting his "potato gun" (which is something he did one holiday about 15 years ago). We will need to thank him for that memory.
     From the nurse in me: these are not unusual occurrences. The brain is healing, trying to rewire things around the injury. There will be more things that a family can expect to be surprised with.
From the "daughter": I am anxious to see more consistent progress and be done with the confusion.

Nurse V. Daughter (2)

     Well, another day at the rehab facility. Mom looked good this morning. Her speech is getting better everyday. Her occasional "off key" sense of humor is keeping us on our toes. She is still having some long periods of extremely deep sleep. We are not quite sure what to make of that just yet. It can be very difficult to wake her when she gets too deep. I mean, we are talking deep sternal rub at times with little response. Then she pops her eyes open and is mad that someone has disturbed her. Visual hallucinations are improved- no snowmen recently.
     Therapy is getting in to full swing and she seems to be doing well with it. I know that the therapists are not working her hard yet because she is not mad at them. I have always felt that unless you are cussing your therapist, they are not pushing you hard enough. They look at her and are afraid to push too hard. I know she has more in her than what they are trying to get out.
     Got to meet the physician today who will be following her. He tried to tell me that clamping a Foley catheter or cathing for a post residual urine was a skill performed in an "acute care facility", not a rehab facility. For anyone who knows what I am like- yeah, my brain pretty much exploded about that time. I stopped talking to him at that point. (There is a lot more to that part of the story that needs to be shared at a later date.)
     The staff at the facility have been good overall. I have been a little disappointed at a few things, but nothing earth shattering. Let's face it- nothing is perfect. I have worked in a number of facilities throughout my career and have not made every patient that I have cared for happy. Most seem to care very much about the care that they provide and I am satisfied with that.
     Keep following for the on going saga and the difficulty of being the professional and the daughter at the same time. Later in the week we request a full shower- woo hoo!

Who Am I? (Nurse v. daughter)

     I became a nurse because I like to be on the "knowing" side of medicine. Being able to speak to other health professionals on their level gives a feeling of control when you are experiencing an "out of control" event in your life. I find satisfaction in being able to help people take those kinds of events and make them manageable. It is a challenge that I have always enjoyed. Even as an EMT I enter into peoples lives at a time when they are in crisis and try to put them at ease while chaos rains down around them.
     Just over a week ago my step Dad called to say that he was having trouble waking my Mom.  Mom had a stroke. It was rather extensive with total paralysis of one side of her body (hemiparesis). Talk about having an "out of control" event. I was very torn between being part of the professional care giving team or the daughter. It is never a good idea to try to play both roles because you end up doing both badly.
     The last week has been a roller coaster ride. Paramedics, emergency room, intensive care unit and finally rehab. Considering the extensiveness of the stroke she has done quite well. Still no movement of the left arm or leg, but her speech has improved and there is very little facial droop at this point. Her sense of humor never left although short term memory has been a problem. When I have stepped in to the professional role a few times over the past week to make her work at doing things for herself she has politely invited me, "to leave any time you are ready." Visual hallucinations in the afternoons when she is tired can be funny. The snowman in the room (here in SC) was probably one of the best. As a professional I understand that these are not abnormal occurrences and can appreciate the funny side of it. As a family member it can be difficult to watch because there is nothing that anyone can do to convince her that the snowman did not exist.
     We have many weeks of recovery ahead of us. Let us see if I can stay out of the professional role. I will keep everyone updated as to how my own brain is fairing during this process. I'll do my best to keep it from exploding- knowing how things should be done versus how I see them being done. I am truly the person who goes in to the hospital that no one wants to care for. I am not demanding, but if something is to be done a certain way, then that is the way it should be done. Let's see if my case managementt background helps or hinders.

Women really are from Venus

     Women do not do things the same way that men do.  That is what makes us special. We are more cerebral. We like to talk before we act. That was one of the most difficult things for me to learn about emergency care- sometimes you have to act first, talk later.
     But when it comes to cardiovascular issues we truly do things differently. For example, our symptoms of heart attacks are not the same. We are less likely to have the generally recognized "crushing chest pain" and shortness of breath. Our symptoms are much more subtle. They include things like pain in the center of the back, nausea or abdominal cramping and sudden, unexplained weakness from the waist up. It is also possible to experience symptoms of an impending cardiac event for many days before the acute event.
     Some simple things to remember to help take care of yourself or the woman in your life:

• Know your cholesterol and work with your physician to control it.
• Do not ignore any unusual symptoms that you may be experiencing. Tell medical personnel when the symptoms began and describe them in detail. 
• Know the family history. A cardiac history in the family may put you at greater risk of a potential cardiac event.
• If a physician does not address the symptoms to your satisfaction, go to another physician. Run if necessary. Advocate for yourself or your loved one.

     Women have a tendency to down play their symptoms. They also tend to delay treatment until dinner is made, the kids homework is done, the house is cleaned for week, etc. Love all the women in your life. Help them to take care of themselves. And to the women- listen to YOUR heart and take care of yourself.
     The professionals at Brook Health Care, LLC can help you with any specific information that you may need. Let us know how we can help. (info@brookhc.com)

Dark Chocolate is good for you....really!!

     February is Heart Health Month.  Our blog focus will provide you with some fun heart healthy tips. 
The first for this month-
     If you are going to indulge in chocolate make it dark chocolate.  It has been shown that dark chocolate has some cardiovascular (CV) benefits.  This is one of the most popular topics that I am asked to speak about.  Numerous studies have shown that flavonols and other chemicals in dark chocolate offer some protective benefit to the CV system.  They decrease vascular inflammation, may lower LDL cholesterol and may lower blood pressure. 
dark chocolate also contains less sugar.  Try to find chocolate with at least 70% cocoa.
This protective effect seems to be more beneficial for women, but men should take note as well.  As with everything- all things in moderation.  Too much and you lose the health benefit.
     If you are going to buy chcolate for your favorite person this Valentine's Day- make is dark chocolate to really reach their heart.Web Page

Turning the Page

     Identifying the need for some assistance in the home can be difficult.  The problem is twofold.  The individual who needs the care usually does not want to admit it.  Or, because of the assistance that they are receiving from others, they do not see that they need help.  Then there are the children, or other family members, who do not want to admit that the individual needs help.  It becomes a matter of not wanting to admit that they are older and have more limitations on their physical or mental abilities.  Admitting that the person you looked up to for advice or direction in life now needs that direction from you or someone else can be very difficult.
     That realization does not come over night.  It usually takes an acute event of some sort to bring it to the fore front.  An acute event would include something like you going into the hospital unexpectedly.  All of a sudden it is realized that there is now no one to go shopping or help with the laundry for Mom and Dad.  There are some simple questions to ask yourself that will help you determine if you need some help for yourself or a family member:
1. What is the condition of their home environment?  Are they keeping up?  Is the house being cleaned every week? 
2. Do they appear to be losing weight?  Is there food in the refrigerator?  Is there food in the cupboard?  Does it change periodically?  (This would indicate that they are using it.)  What are some of the expiration dates on the food?  Is food being stored properly?
3. When was the last time their medications were refilled?  This may indicate that they are not taking their medications as prescribed.  Or, do they seem to be running out of medication before they should?  They may be forgetting and taking it too often.
4. Does it look like the mail is being opened regularly?  Is it piled up in the corner?  Have bank statements been reconciled every month?
5. Are they bathing and changing their clothes daily?  Are the clothes they are wearing stained?
     Make a list of all the things you do for your older relative.  Be as detailed as possible.  Keep the list for one week.  As you do things on different days, add to the list.  Share this list with others in the family.  Should something happen to you, someone else will know what needs to be done.

Telephone...tag you're it

     Do you remember the game"Telephone" most of us played as children?  We would line up side by side, whisper something totally silly in one person's ear, they would whisper what they thought that they heard in the next person's ear and so on down the line.  You were not allowed to repeat it and by the time it got to the end it was nothing like the original message.
     I have used this method of illustrating the importance of accurate communication in classes that I have taught.  It is easy to feel, "If I say it, they should be responsible for understanding it."  Or "They should know what I meant."  My children learned early on that if I did not turn and have eye contact with them that I probably was not listening to what they were saying.  They learned to make sure that they got my full attention.  I did the same with them as I was competing with TV, phone or radio.
     Communication is 50-50.  Everyone needs to take responsibility for what they say as well as what they hear.  There are some simple techniques that can aid in this process.
1. Make eye contact when speaking or listening.  Facial expressions and body language help us to understand and remember the message.
2. Avoid doing multiple tasks when you are supposed to be listening.  Multi tasking is not conducive to listening and learning.
3. Repeat or summarize the communication for the sender so that you both know what was said is what was heard.
4. Do not be afraid to ask questions to clarify the information.
5. Do not be afraid to repeat anything that has been misunderstood.
6. Make your communication thorough, but not overly detailed.  The message can get lost in too many details.
7. Be sensitive to the age of the person you are communicating with.  Use verbiage that is consistent with their age. 
8. Speak slower with an older person.  Their brain does not process information s fast as it used to.  Give them time to hear what you have said and formulate an answer or question.
     If something is misunderstood, look back to figure out where the breakdown took place.  This can help you to identify how this individual hears information,  This can help you to provide information in a more effecient way the next time.  Stop playing telephone tag.