“The ICU is Not a Pause Button”

Yesterday’s article in “The End” — a New York Times series about end-of-life issues — raises some worthwhile topics.  But I didn’t care for the tone, which I found somewhat inhumane — especially since (or because?) the author is an ICU nurse.  I’ll try to look past that to summarize her key points, in case any of the points resonate with you:

  • if your family member is elderly and frail, avoid the ICU
  • “When a family member is in the I.C.U., it’s not enough to [make a phone] call. You need to drop what you’re doing and be at that person’s side, figuring out what is best for them.”
  • while families think of the ICU as a “pause button,” patients are miserable in the ICU.  The author would probably say that families shouldn’t wait for out-of-town relatives to arrive to decide how to proceed.
  • the ICU is not a nice place to die because of all the unpleasant things happening to the patient:  “mask on, mask off, a feeding tube in his nose, IVs in his arms, having his dry mouth sponged, his throat suctioned, defecating and being cleaned up”

These are probably good things to consider now, not when sitting in the ICU…  If you do end up in the ICU, it seems that we can’t rely on the medical staff to have a conversation with us as to where things are headed, or that efforts are futile or hurtful.  The staff is focused on keeping the patient alive.

Here’s a link to the article:

opinionator.blogs.nytimes.com/2015/08/26/the-i-c-u-is-not-a-pause-button

The End
The I.C.U. Is Not a Pause Button
The New York Times
By Kristen McConnell
August 26, 2015 4:15 am

Robin

 

 

Falls and Dysphagia (new publication co-authored by BSN)

This post will be of interest to those dealing with falls and/or dysphagia (swallowing difficulty).

Local support group member Phil Myers and I co-authored a case study on falls and dysphagia in the latest issue of the Association of Frontotemporal Degeneration (AFTD) newsletter.  The case study is about “Jackie Riddle” — a composite of my father’s PSP symptoms (confirmed through brain donation) and Phil’s wife Jackie’s PSP symptoms (also autopsy-confirmed).  Though “Jackie Riddle” had PSP, since the focus of the case study is on falls and dysphagia, all of our BSN group members, regardless of diagnosis, will find something of value here.

The newsletter is written for healthcare professionals but I’m fairly certain the language is understandable.  We assumed that healthcare professionals are completely un-knowledgeable about PSP, fall prevention, and treatment of dysphagia.

There are also sections in the newsletter specifically for healthcare professionals working at care facilities.  So if any of you has a loved one in a care facility, those sections may be particularly helpful for staff.

The last two pages of the newsletter are my ideas for practical things that can be done about falls and dysphagia.  Again, though it’s titled “in PSP,” these ideas apply to all four disorders in our BSN group.

Check it out; it’s hot off the presses:

www.theaftd.org/wp-content/uploads/2015/07/PinFTDcare_Newsletter_summer_2015.pdf

Robin

“Could a vitamin or mineral deficiency be behind your fatigue?” (short article, Harvard)

Fatigue can be a symptom in all of the disorders in our local support group.  Today’s Healthbeat email from the Harvard Medical School points to one mineral and two vitamin deficiencies that may cause fatigue.  It might be worth having an MD check one’s vitamin levels to rule these out as problems if fatigue is present.

Robin

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Excerpts from

Could a vitamin or mineral deficiency be behind your fatigue?

Healthbeat
Harvard Medical School
August 1, 2015

The world moves at a hectic pace these days. If you feel like you’re constantly running on empty, you’re not alone. Many people say that they just don’t have the energy they need to accomplish all they need to. Sometimes the cause of fatigue is obvious — for example, getting over the flu or falling short on sleep. Sometimes a vitamin deficiency is part of the problem. It might be worth asking your doctor to check a few vitamin levels, such as the three we’ve listed below.

* Iron. Anemia occurs when there aren’t enough red blood cells to meet the body’s need for oxygen, or when these cells don’t carry enough of an important protein called hemoglobin. Fatigue is usually the first sign of anemia. A blood test to measure the number of red blood cells and amount of hemoglobin can tell if you have anemia. The first step in shoring up your body’s iron supply is with iron-rich foods (such as red meat, eggs, rice, and beans) or, with your doctor’s okay, over-the-counter supplements.

* Vitamin B12. Your body needs sufficient vitamin B12 in order to produce healthy red blood cells.  So a deficiency in this vitamin can also cause anemia. The main sources of B12 are meat and dairy products, so many people get enough through diet alone. However, it becomes harder for the body to absorb B12 as you get older, and some illnesses (for example, inflammatory bowel disease) can also impair absorption. Many vegetarians and vegans become deficient in B12 because they don’t eat meat or dairy. When B12 deficiency is diet-related, oral supplements and dietary changes to increase B12 intake usually do the trick. Other causes of B12 deficiency are usually treated with regular injections of vitamin B12.

* Vitamin D. A deficit of this vitamin can sap bone and muscle strength. This vitamin is unique in that your body can produce it when your skin is exposed to sunlight, but there also aren’t many natural food sources of it. You can find it in some types of fish (such as tuna and salmon) and in fortified products such as milk, orange juice, and breakfast cereals. Supplements are another way to ensure you’re getting enough vitamin D (note that the D3 form is easier to absorb than other forms of vitamin D).

“The 2 Most Important Caregiver Tips”

In this short article in US News & World Report, the author limits her discussion to the two most important caregiver tips.

The two tips are:

#1 – Learn as much you can about your loved one’s disease or illness to know what to expect. Otherwise, you’ll be driving blind.

#2 – Care for your loved one the same way you would want to be cared for if you were living with the disease. After learning as much as you can about [your loved one’s illness], put yourself in your loved one’s shoes by asking yourself, “What fears and uncertainties would I feel in the face of this…diagnosis?”

I think this is good advice. But #1 is hard to achieve when the specialists aren’t even able to say with better than 50/50 odds what the neurological diagnosis is! So you learn all you can about one disorder only to learn a new diagnosis a year or so later.

The author notes that someone at the Lewy Body Dementia Association described LBD as a disorder that: “walks like Parkinson’s and talks like Alzheimer’s.” That sounds like a good description for some with LBD.

Here’s a link to the article:

health.usnews.com/health-news/patient-advice/articles/2015/05/01/the-2-most-important-caregiver-tips

The 2 Most Important Caregiver Tips
How to survive, thrive and even find joy in caring for a loved one with dementia.
US News & World Report | Health
By Brenda Avadian
May 1, 2015 | 9:00 a.m. EDT

Robin

“Coping with Caregiver Guilt: how humor and respite can help” (US News, 5-22-15)

Thanks to a BSN local support group member who forwarded a tweet about this article on to me.

The article on caregiver guilt is in US News & World Report.  The author encourages caregivers to “schedule periods of respite to relax and gain strength for guilt-free caregiving.”  She says that even five minutes of respite can be worthwhile.

Here’s a link to the article:

health.usnews.com/health-news/patient-advice/articles/2015/05/22/coping-with-caregiver-guilt

Coping With Caregiver Guilt
How humor and respite can help caregivers manage guilt.
US News & World Report | Health
By Brenda Avadian
May 22, 2015 | 11:21 a.m. EDT

Part of the article is a 3-minute youtube video of the author discussing the alternatives, in a tongue and cheek fashion, to taking a five-minute respite.  (I didn’t think it was so funny, but your mileage may vary.  The article is worth a quick-read, however.)

Robin