Am I losing my mind? - A new breakthrough for many...

Am I losing my mind?  Sadly this often is a question that may be fearfully muttered under the breath of many people.  Maybe its' following a stroke, a traumatic brain injury, a debilitating neurological causing havoc, or the effects that occur after brain surgery.

For years I have had the experience of both personally and professionally dealing with the effects caused by changes that occur when the brain experiences changes in it's function.  It's a difficult thing for any of us to see that person we love slip away, and feel helpless to intervene.  Currently the incidence of both Alzheimer's and Dementia continue to grow each day with our ever-increasing aging population.  In my work with hospice I see and help people that have come to the end of this journey after trying numerous ineffective treatments.  Many of us that have a had a personal experience may ask why or how this happens?  Understanding a challenge is the first step in trying to create a plan to achieve success over the struggle you face.

Brain 101 - A layman's approach to understanding how our brain works

Therefore, how does the brain function and what happens to create the pathway for the onset of both Dementia and Alzheimer's?  First, let's look at what are the parts of our brain and their importance to our cognition and function.

• The cerebrum is the major portion of your brain.  It provides the resource to help with memory, problem solving, thinking, feeling, and controls the body's movement.

• The cerebellum is at the back of your brain under the cerebrum and helps you stand steady while you perform physical actions.

• The brain stem is below you cerebrum and in front of your cerebellum, and connects the brain to the spinal cord.  It is the source of life because it controls our automatic functions that allow us to breath, have a beating heart,  and aids in digestion.

• The brain functions as a result of being nourished with a network of blood vessels that include capillaries, veins, and arteries.  Without the oxygen rich blood the brain cannot exist.

• Next is the squiggly grey matter we see called the cortex.  It is the outermost portion of the cerebrum and is responsible for:

• Sensations - sight, sound, and smell

• Is the problem solving resource 

• Creates and stores memories

• Controls voluntary movement

• Our brains are also divided into two parts called hemispheres - The right and left - the control the opposing side of the body - the left brain is where the conversation truly begins.

• The next portion of the brain is the pathway to action and thought.  Our brains contain billions of little nerve cells called neurons.  These are responsible for transferring information that results in action.  It is this selected pathway that is attacked when a person has Alzheimer's. These cells are joined together, and go into action when an electrical charge is received that releases a chemical.  These chemicals are called neurotransmitters and are the brains messages to create responses in the body. These responses are recorded at the cellular level, and store our memories and thoughts.

  

A Thief in the Night

Alzheimer's is that robber that steals our mind by causing the destruction of those small nerve cells.  As the disease progresses the brain actually reduces in size, and inhibits most every function of the brain.  In the Alzheimer's brain:

• The cortex will shrivel up causing damage to the areas that involve thinking, planning, and memory.
• The shrinkage occurs mainly in the hippo-campus which is the most significant center for memory in the brain.
• Finally, the ventricles in the brain grow larger.

As a result:

• The tissue of a brain with Alzheimer's has fewer nerve cells than a healthy brain.
• Plaque and clusters of protein fragments build up more rapidly between cells blocking the pathways
• The dead and dying cells create structures called tangles that inhibit brain function.

Scientists don't have a specific cause yet for why this occurs in the brains of people with Alzheimer's, but the tangles and plaques are the possible suspects.  Once a person is diagnosed with Alzheimer's the course of the disease is thought to last from 8 to 20 years.  Much like other diseases there is a progression in the severity and symptoms:

• Early stage disease causes effects to occur generally 20 years before it may even be officially diagnosed.  In this phase people experience changes in their memory and problem solving abilities.

• In mild to moderate stages, which lasts 2 to 10 years, the impacts continue creating social challenges because of their increasing confusion.

• The final stage of Alzheimer's may last from 1 to 5 years and causes the brain to shrink which creates the inability to communicate, and most often these people can no longer recognize their own family.

Alzheimer's truly acts as that thief in the night that sneaks into your life, and robs you of your life without much warning.  With such a tragic and stealthy disease it's imperative to do whatever we can as people to protect against losing our mind.  Thankfully, there is some hope on the horizon. 

 

The Key to Unlocking a Better Tomorrow

Currently there are many drugs out there that are being used to help manage the diseaseprocess, but they often are the culprit of causing side effects without much of a result. Thankfully there is something on the horizon that is fast approaching.  

Take a peek at how it works...

The regeneration of our mind

Now think about a world where people wouldn't have to be fearful of aging, and quietly questioning if there losing their mind.  It's time to tackle these degenerative diseases that are causing havoc on so many lives.  Let's take control today.  Join me in preventing that next family from suffering the affects of their loved one's loss in cognition.  

Contact me today to get involved.  Take care, Dave.

Holding the Hourglass – 3 Steps Nurses Can Take to Support End of Life Discussions

Not very many people have an hourglass in their home any more, but for some people as children it represented a fascinating object they watched as the granules drained out into the other side.  Life is similar to that hourglass because the moments of our lives continually drain like the sand, and eventually result in our passing.  Death has become more of a challenging subject to discuss in our culture throughout the decades, and now is often treated like the elephant in the room.  For those of us who call ourselves nurses, it can be something we encounter often in our careers.  Some nurses struggle with the topic of death, and experience angst at having to care for a patient at the end of life.  In order to provide empathetic patient-centered care, nurses need to be comfortable participating in conversations with patients who have end of life needs.  Therefore, it’s imperative that nurses take these 3 steps that will help to initiate end of life discussions with the patients in their care.

1. Seeing the picture – Developing Awareness and Advocacy

What do you see?  In this picture there is an old lady and a young lady.  Just like looking at this picture we can see different things in the patients that are entrusted to our care.  The first step in being successful at approaching end of life discussions is being aware the need exists. 

She was an 89 year old little lady who came in through the Emergency department complaining of back pain, and feeling like she couldn’t catch her breath.  As the team started the work her up for chest pain, she received all the customary evidence-based interventions.  Baby aspirin, IV, EKG, oxygen, and lab work.  When the results came back it was conclusive that she had experienced a cardiac arrest precipitated by a blocked artery.  After speaking with her and her family the decision was made by the surgeon to do bypass surgery.  She was stabilized with medications through the night, and was the first case in the morning.  After she and her family said their tearful goodbyes she was whisked off to surgery.  An hour later the surgeon came out to the waiting room hesitantly, and began to share the news that their mother (“the patient”) had a massive stroke during surgery.  She was now on life support, and sent to the ICU.  Her family was now confronted with the challenging decision about removing her life support or watching and waiting.  Not long after she returned to the ICU her family made the choice to stop the lifesaving interventions, and allowed her to pass away naturally.

This picture is one that many of us have seen all too often.  Chronically ill patients like this come through the hospital doors without truly being offered the care they need or what is appropriate for their condition.  As the nurse caring for these patients, you need to be able to identify these patients in your care.  That means being aware of the trajectory of their disease progression, and the realities of what can actually be done for the patient.  You may not be the one to initiate that conversation or provide the news concerning the prognosis, but as a nurse you must understand the process to be prepared to have end of life discussions with your patients.  Was there another alternative in this case?  Is this what the patient and family wanted?

2. Understanding their Story – Listening to their heart

At the bedside or in any discussion with a patient, nurses must listen to what patients are saying.  It is no different dealing with patients that have a terminal prognosis.  It is important at these times to be acutely aware and tuned in to hear what their heart is saying.  All people have the issue of death in common, and it is often a theme that is natural for people to ponder.  Thoughts that make people think about how it will happen, who will be there when it occurs, or how will it feel?  These are a normal progression of thoughts for people facing mortality.  As nurses we have to be ready for these conversations, and approach them with an empathetic ear.  We have to be willing to put aside our own personal judgments and feelings, so we can be with them in the moment as they start processing their emotions about their death.

A process where they are learning to cope with the challenge they face.  This process was first famously outlined by Swiss Psychiatrist Elisabeth Kübler-Ross in her 1969 book, On Death and Dying, and was inspired by her work with terminally ill patients.  Motivated by the lack of curriculum in medical schools on the subject of death and dying, Kübler-Ross examined death and those faced with it at the University of Chicago's medical school. Kübler-Ross' project evolved into a series of seminars which, along with patient interviews and previous research, became the foundation for her book… The stages, popularly known by the acronym DABDA, include:

1. Denial — One of the first reactions is Denial, wherein the survivor imagines a false, preferable reality.
2. Anger — When the individual recognizes that denial cannot continue, it becomes frustrated, especially at proximate individuals. Certain psychological responses of a person undergoing this phase would be: "Why me? It's not fair!"; "How can this happen to me?"; '"Who is to blame?"; "Why would God let this happen?".
3. Bargaining — The third stage involves the hope that the individual can avoid a cause of grief. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle. Other times, they will use anything valuable against another human agency to extend or prolong the life. People facing less serious trauma can bargain or seek compromise.
4. Depression — "I'm so sad, why bother with anything?"; "I'm going to die soon so what's the point?"; "I miss my loved one, why go on?"
   During the fourth stage, the individual becomes saddened by the certainty of death. In this state, the individual may become silent, refuse visitors and spend much of the time mournful and sullen.
5. Acceptance — "It's going to be okay."; "I can't fight it, I may as well prepare for it."
   In this last stage, individuals embrace mortality or inevitable future, or that of a loved one, or other tragic event. People dying may precede the survivors in this state, which typically comes with a calm, retrospective view for the individual, and a stable condition of emotions. http://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model

Working effectively with people at the end of life requires an understanding of this process, and being able to listen for the cues to where the person is in their journey.  By knowing the stages you can recognize the emotions the person is displaying, and use that information to initiate a conversation that matches their readiness.  After establishing a trusting dialogue you can be the supportive caregiver that encourages them to make their wishes known to those involved in their care.  Having access to this information is necessary for introducing resources to the patient and family that will support achieving their goals of care by utilizing a patient-centered approach.

Delivering Hope - How an explanation creates a comfortable journey

Patient-centered care according to the IOM (Institute of Medicine) is “Care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions."  Not only must nurses understand their patient’s end of life needs, but they must be knowledgeable concerning the resources available to support their care.  Nurses can explain how resources are available that can address their physical, emotional, and psychological needs. 

Whether you’re in the hospital at the bedside or in the community a nurse’s main role is to provide information to support the understanding of the people they serve.  The end of life journey is difficult for any family because of the realization they experience when they consider the loss of the person they love.  As nurses we can support them in this struggle by painting the picture of the journey.  What will the progression of the disease look like, how will they feel, and what can be done to keep them comfortable?  Explaining that when they hold their loved one’s hand in may be cold or the color may change, they may sound differently when they breathe, or they may say things that don’t make sense.  It’s important for the nurse to normalize the process, and to encourage those involved in their care to express their feelings to the patient. 

Dealing with patients at the end of life can test our personal strength as individuals, but being there to support patients and families at such a fragile time in life is an honor.  Therefore, don’t shy away from having discussions with patients at the end of life.  As their nurse see their need, listen to their story, and deliver the hope they need by being that caring presence that ensures they have a comfortable journey. 

 This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at

This Nurse Wonders. Find out how to participate.

Click here to visit Living Sublime Wellness.

The "Marc" of a True Physician - A Decade of Compassionate Care

Just recently we again experienced the great care of this physician, and the amazing team of individuals who support his efforts.  It was scary knowing she had to have surgery, but comforting to have such a caring and compassionate physician who was able to calm our nerves.  I just wanted to repost this to say thank you for giving my wife such great care, and providing me with peace of mind.  

What is it that sets apart a great physician when you look at those who've been involved in your care?  Is it the board certification, the experience and credibility, or their rate of successful patients treated?  I would imagine for each and every one of us that those are obviously important, and guide our decisions when choosing a physician for our care.

The other amazing gifts a physician can offer is their humanity, compassion, and empathy.  I know this first hand because we as a family have needed that care for the past ten years.  Thankfully we've been the recipient of all these wonderful traits that I've described above in our surgeon.  He has been skillfully taking care of my wife for ten years, and providing the expertise and guidance we've needed to make it through these challenges in our lives.  What makes this amazing man the "Marc" of a True Physician boils down to 4 things as I look back on a decade of care:

• He speaks to us with respect - We don't have medical degrees or wouldn't ever claim to be as brilliant as this man, but he doesn't treat us any differently.  He takes the time at appointments to carefully speak to us in terms that we can grasp without being demeaning, and with total dignity and respect.

• He's Transparent with the Truth - When we've had those difficult appointments, and know that things in my wife's condition haven't been progressing well he's been honest.  He doesn't claim to be the answer to every cure, but instead promises that he will always keep our best interest at heart during her treatment.  It has increased our confidence in him because we know that he will always deliver the truth because he's a man of integrity.

• He's a Patient Teacher - Not only does he speak to us with respect, but he takes the time to ensure we have an understanding and grasp of the challenges we're facing.  He takes the time to go through the labs and the scans to share what each number and term means.  He knows that by increasing our understanding he's helping to reduce our anxiety and fear.

• He Cares for Us as His Own - Throughout the years when we've been faced with difficult decisions concerning my wife's care, he has said on a number of occasions "This is what I would do for my own family".  Hearing those words creates so much gratefulness and thankfulness in my heart because I know that he is caring for my family that day if they were his own.

This has been a challenging journey, but it has made all the difference to have such an amazing physician at our side.  He has been a blessing in our life even through the struggles.  Being exposed to a physician who speaks to us with respect, is always truthful in every situation, ensures we understand the gravity of our decisions, and promises to care for us like we were his family has made all the difference.  I want to publicly thank Dr. Marc Mayberg for providing a decade of compassionate care for my wife.  I can never repay you for your kindness, the skillful use of your talents, or the empathy you've showed after each surgery when you shared the successful outcomes of my wife's procedures.  You are truly an amazing man and physician.  Thank you.

Dave

Thoughts for the Day - Empathy is the Key to Human Connection

“You think your pain and your heartbreak are unprecedented in the history of the world, but then you read. It was books that taught me that the things that tormented me most were the very things that connected me with all the people who were alive, or who had ever been alive.”
― James Baldwin

“We must learn to regard people less in the light of what they do or omit to do, and more in the light of what they suffer.”
― Dietrich Bonhoeffer, Letters and Papers from Prison  

“Self-absorption in all its forms kills empathy, let alone compassion. When we focus on ourselves, our world contracts as our problems and preoccupations loom large. But when we focus on others, our world expands. Our own problems drift to the periphery of the mind and so seem smaller, and we increase our capacity for connection - or compassionate action.”
― Daniel Goleman, Social Intelligence: The New Science of Human Relationships  

 “I do not ask the wounded person how he feels, I myself become the wounded person.”
― Walt Whitman, Song of Myself 

“No one cares how much you know, until they know how much you care”
― Theodore Roosevelt