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Archive for category: Original Posts

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Alzheimer’s Disease

I learned early in life about the perils of impaired cognition.  I worked for Scotiabank for many years as a customer service agent.  In this role, I would assist many clients who I now assume had dementia with their finances.  I remember having to call family when one elderly woman replaced her visa card six times in one month.  The family found them all in the lettuce compartment.  Or, the other lady that paid the same roofer three times.  She was being taken advantage of.  In school, I read the book “The Man That Mistook His Wife for a Hat”.  What a great way to understand dementia and Alzheimer’s disease.

It is national Alzheimer’s week so I thought I would take some time to talk about this very sad and difficult illness.  Alzheimer’s disease, or related dementias, impact 1 in 11 Canadian’s over the age of 65, with three-quarters of these being females.  It is expected that within a generation, this will double, to around 1.3 million people (http://www.alzheimertoronto.org/ad_Statistics.htm).

Signs of Alzheimer’s disease or dementia include:

  • Judgment: such as forgetting how to use household appliances.
  • Sense of time and place: getting lost on one’s own street; being unable to recognize or find familiar areas in the home.
  • Behavior: becoming easily confused, suspicious or fearful.
  • Physical ability: having trouble with balance; depending upon a walker or wheelchair to get around.
  • Senses: experiencing changes in vision, hearing, sensitivity to temperatures or depth perception.

Assessment of this is often done medically by eliminating other factors that could explain these problems (such as poor sleep, medication use, other conditions, stress, etc).  Also, an Occupational Therapy Assessment in the home is very helpful at determining how the noted problems are impacting function, how these can be addressed or treated, if the person is safe to be at home (with or without supports), and what care is required.  Following the assessment, the Occupational Therapist can make recommendations regarding devices, strategies, and supports that can help to reduce the impacts of the disability, improve safely, promote independence, and ensure the caregiver is trained to provide the necessary support.  Such suggestions could include ways to:  

  • Remove hazards at home.
  • Prevent unwanted wandering.
  • Safeguard medications.
  • Reduce physical barriers that impact mobility.
  • Improve visual perception through aids, devices and care techniques.
  • Reduce against risks of unsafe food and beverage preparation or consumption.

As with most things, early diagnosis and intervention is key.  Seek medical attention and ask for an OT in-home assessment to gather information about how to improve function, and to safely prevent premature losses that can result from lack of information about the condition and its management.

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Julie’s Picks

I will be honest.  Most of my “leisure” reading is in the form of MBA textbooks, online research, and class notes.  However, every once in a while I get the chance to pick up a book that I would consider “interesting” even if still relating to my job as a health professional, my interest in wellness, or my role as a business owner.  Instead of trying to summarize these books in a book report, I thought I would provide “Julie’s Picks” for great reading about business, health, and keeping things in perspective.

 

How Will You Measure Your Life – Clayton Christensen.  My entrepreneurship prof recommended this book to our class.  And what a treasure.  This is a quick read, and relates business strategy to relationships.  My favorite part is when the author talks about how as parents we need to make “deposits” into the bank account that is our children.  Without regular “deposits” we will have nothing to withdrawal when we need it.  We cannot expect our bank account to be plentiful if we have not added to this over many years.  This is a lesson I have carried forward into my own life – even if it is just pennies a day, I need to build my fortune with my children and spouse now, so my relationships are rich later.

 

Lean In – Sheryl Sandberg.  This is a wonderful book about women in business. And not a girly book.  Sheryl has experienced immense business success in the male-dominated corporate world and talks about how women need to “sit at the table” and “lean in” to their careers while encouraging husbands, dads and partners to “lean in” at home.

 

The Fire Starter Sessions – Danielle Laporte.  A friend, and fellow entrepreneur, suggested this book.  Not only is it funny, informative, and forthcoming, it has worksheets after each chapter that encourage reflection, goal setting, and some deep thought.  The quotes in this book are inspirational, while also being somewhat unconventional and often “hit you in the head” obvious.  Danielle asks you to explore how you want to feel in life and then encourages you to do those things that make you feel that way.

 

A New Earth – Eckhart Tolle.  This book was the topic of an earlier blog.  As the book used for a post-program study for Hamilton’s Chronic Pain Program, I witnessed the impact this book had on people who were experiencing significant disability.  I read this in awe.  While having some very heavy content, this is mixed with practical and real stories that explain the importance of “presence” and highlight how people need to transform negative into positive thinking in order end conflict and suffering.

 

I will continue to share my picks as I find them.  Please feel free to also share yours.

 

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Terry Fox – The Legacy Continues

“It took cancer to realize that being self-centered is not the way to live. The answer is to try and help others.” Terry Fox

 

I was 5 when Terry Fox began his epic journey across Canada. I remember watching this on a television with bunny ears and no remote. He would run in the rain, fog, and cold, with his prosthetic limb and very distinguishable gait. Even in a world without the internet, Facebook, email and Twitter, news of his journey spread and touched millions of Canadians. Unfortunately, Terry died before he could complete his journey, at the way-too-young age of 22.

 

What I find so incredible about Terry’s story, however, is that it didn’t die with him. Even 33 years later Canada remains committed to continuing his legacy through education about Terry, his disease and his mission, and by continuing to promote and encourage others to run as Terry did, and to donate. My children will again participate in the Terry Fox Run this September, as I did in school before them.

 

According to the Terry Fox Foundation, to date they have raised over $600M for cancer research. But above the massive amounts of money raised, and the heroic action of being one man, all alone, dedicated to

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raising funds and awareness for an important cause, Terry set an example. He became a poster-boy for overcoming challenges and to have hope. He paved the way for others (Rick Hansen included) to do epic things to raise awareness, and money, to fight for important causes. He demonstrated, as his quote indicates, that being self-centered does not progress a Nation, nor does it raise a generation of loving youth committed to the greater good. The answer is to help others. In some way, or some form, to give back and make your existence matter. This can be as simple as a kind word or friendly gesture, or as significant as donating time, money or careers to worthy causes. We have a lot to learn from Terry Fox – still – even if he is only here in spirit to teach us.

 

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Do You Value Your Health?

Cinderella (the band, not the princess) is right…”you don’t know what you got til’ it’s gone”.  Perhaps you have to work in health care, or experience ill health, or watch a friend or family member go through a medical problem to appreciate how important wellness is.

 

Several months ago I attended a seminar.  Towards the end we were asked to rate our five most important values from a list of 35 words.  Most people rated things like “success, honesty, trust, happiness, family, integrity”.  These are all things I also value, but what amazed me was that I was the only one in the seminar to put “health” on my list.  What?  These people don’t value their health?  Not really, it is just that when you are well, the concept of “health” is off your radar.

 

Now there is a difference between valuing your health on paper and actually living that way.  I know, despite having a health problem that can at times level me for days, I still take my health for granted.  Just like I take it for granted that my car will start each morning, hydro will stay on, water will be clean, and that my community is a safe place for my family.  Perhaps knowing what you take for granted is the first step to not.

 

But the question remains, if you value health, then do you live that way?  Or, if wellness is not on your radar, should it be?  The secrets of wellness are well known.  Exercise your mind and body by engaging in daily physical and cognitive challenges.  Consider meditation.  Analyse your diet and pick out the weaknesses so you can slowly improve your eating to reduce your risks.  Look at your stress.  What causes this?  Can you safely sustain the demands you are facing? What are your coping mechanisms?  There is now so much information available online and in the media about health, and while this can be good (depending on how much time you have to sort through it), it is also overwhelming.  But I truly believe that we all know when we are making bad health decisions.  We don’t need the internet, magazines or television to tell us what we intuitively know we are doing wrong.

 

I am going to assume that everyone values “health” but I know not everyone lives that way.  Maybe it is time that we all visualize a life without our health to appreciate this and to make positive behavioral changes.  After all, integrity, honesty, success, family and happiness are difficult to value, if one is too ill to enjoy them.

 

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Stress-tember

Apparently September is second only to December on the list of the most stressful months.  Why?  Because it is a month of reorganization, a new schedule, and change.  For me personally, September is a period of “adjustment” as the routines of the summer (or lack thereof) dissolve, and new patterns emerge.

 

I always start with the best intentions.  I make and post signs to cue my kids to my expectations of them in the morning and after school.  Alarms are set to make sure that people are getting up, dressed, and to the bus without skipping breakfast.  A lunch chart is made (by them, with parameters of course) so that I can shop for the food they will eat, and know that most of the stuff I send won’t return uneaten.  Closets are cleaned and organized, and their clothes have been inventoried, shuffled, and replenished as needed.  The fall and winter gear have been surveyed to see what is needed before the first cold-front strikes.  My husband and I have had “the talk” about who is doing what, who is working when, and who will get the girls here, there and everywhere.  Everyone has been registered for all their fall activities, after checking our calendar and determining that we, as two parents with four kids, can manage the organized chaos that is extracurricular activity.  Okay, I see why September is stressful.

 

There are many ways to try and manage the stress that is created during this period of transition.  Personally, my planning for September starts in July.  Yes, it’s true…our kids are barely out of school and I am planning for their return.  Similar to planning for Christmas I suppose, being ahead of the crowd can go a long way.  For example, stress can be reduced when a list of “to dos” is created, and time is set aside, week by week, to accomplish each task.  Involving the kids in the planning is not only a valuable way to delegate some of the responsibility, but also a way for them to learn the skills of organization, and to be part of the return to school process.  For example, our kids clean their own closets and inventory their own clothes, they sort through the school supplies from last year, and they always come shopping with us for back to school items as this reduces the returns.

 

But like joining a gym, these new routines will be difficult to maintain and it will take perseverance, dedication and effort to try and develop and sustain the new schedule and any accompanying mental, emotional, and physical anguish that comes from change.  It will take at least four weeks for the stress of the new schedule to subside, and for everyone to find their groove.  This is the part I call “adjusting” and is defined as the time when I get quiet, more focused, and need some extra sleep.

 

But even more important than planning and organizing early, is knowing what you are capable of handling, and making sure you do not bite off more than you can chew.  Everyone varies in their ability to plan, organize, look ahead, and tackle change.  If these are struggles for you, then take it slow, reduce the demands, start early, and ask for help.  After all, soon after we survive stress-tember we be engulfed in the most stressful month of all – dread-cember: my personal nemesis.

 

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I Already Passed Kindergarten

Every September I take some time to write letters to the teachers my children will have for the upcoming year.  I have found this to be an effective way to help the teacher get to know my child more quickly, and to understand who they are beyond their informal and scripted report card from the year before.

In this letter I describe my child – what they are like as a student and a person, and what they do and don’t do well.  But beyond this, I also explain the culture of our family when it comes to homework.  I remember when my daughter was in kindergarten she didn’t finish a homework assignment.  I got a note home from the teacher highlighting this.  It was written to me.  I responded with: “I already passed kindergarten, please hold my child responsible for not meeting her classroom expectations”.   I have enough to do.  I have to parent them, keep them safe, plan for the present and future, make sure they get along with their siblings, ensure they become responsible and respectful adults, have clean clothes, food to eat.  I really don’t need to do their homework.

My children know my philosophy on schoolwork.  This is for them, not me.  It is up to them to know what is due and when, and to ask for help if they need it.  They are not to cram and ask for things the night before.  Bedtime is bedtime, not to be extended because of homework procrastination.  When I help them this is in the form of assisting them to organize the work, break it into manageable chunks, showing them simple ways to understand the content, and asking them if they feel this will meet the expectations of the classroom.

I expect teachers to hold my children accountable for completing their assignments.  If this means no recess, extra homework, a failing grade, trip to the principal’s office, so be it.  I trust the school system and the measures they have in place to educate my children – if I didn’t, I would pursue other options.  Learning, like working, involves responsibility, commitment, accountability, organization, planning and time-management.  Kindergarten and beyond is the perfect place to accumulate these skills, as I feel the true value of school is not in the content, but in learning how to learn, be around others, and manage the expectations of someone in charge.

In Kindergarten my girls had to participate in a car rally.  The task was simple – make a car, and parade around the school in a foot race, holding the car around your waist.  One kid arrived with a car made of wood.  It had working lights, mirrors, and tires that rotated on a functional axle.  He couldn’t even lift it.  I wonder if his dad failed the assignment.   

 

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Mean Lady at the Bus Stop

Yup, that is me.  That mom at the bus stop that, while waiting for my kids to board the bus, ends up supervising and “parenting” the other kids that are not behaving.  I remember a few years back I was waiting for the bus with my daughter.  There were several kids waiting with us, and a few parents.  Three boys were first in line, standing on the curb.  They were pushing, shoving and playing around as boys do, each time falling or running onto the road.  I told them to stop what they were doing, stand in line properly and patiently wait for the bus.  My neighbor called me a meanie.

 

I am happy to be a meanie when it comes to safety, especially with children.  Part of this is the curse of working in auto insurance.  I know if one of these boys gets hit by a passing car, this could be life threatening or at the least, life altering.  I also know the driver of that car will likely suffer life-long mental anguish knowing they inadvertently harmed a child – even if this was not their fault.  Also, my child, and the other children at the bus stop that would witness such an accident would never be the same.  They could have nightmares, flashbacks, and suffer from traffic anxiety, an aversion to riding the bus, or attending school.  Lastly, from a personal liability perspective, I can’t help thinking that if children are being unsafe, and get injured, and this is witnessed by a responsible adult who did not try to prevent it, that adult could be held partially responsible.  Either way, the outcome is bad for all involved.

 

Transportation by bus is one of the safest ways to get children to and from school.  According to transport Canada, only .3 percent of personal injury or death from collisions involved school buses.  Of the 142 deaths involving a school bus over the last 10 years, only 5 have involved passengers of the bus with the rest being drivers, pedestrians, cyclists or other motorists (http://www.tc.gc.ca/eng/roadsafety/tp-tp2436-rs200702-menu-133.htm).  Therefore, children are more unsafe around buses than they are in buses.  In fact, riding the bus is safer than walking or getting a ride in a regular vehicle.  What becomes key then is helping children to understand pedestrian safety, the rules for getting on an off a bus, and waiting at the bus stop.

 

It is back to school time.  We all need to remember that children are both careless and carefree.  Children are not expected to understand and process the dangers of traffic until age 10 and beyond, and as such, as responsible adults and parents we need to help them understand all aspects of bus safety and, if needed, be “meanies” when monitoring their behavior – even if they don’t belong to us.

 

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Hot Day. Distracted Mind. Child Dies.

In keeping with my earlier post about safe driving and bad habits, I thought I would touch on another very tragic, but preventable, circumstance surrounding cars and children.  It was the first very hot and humid day this summer when I heard of the death of a two year old after his grandmother left him in the car.  She just forgot he was there and went about her day.  While it might seem inconceivable that this could happen to any caring and well-intentioned adult, I read an article recently that helped me to understand how possible this is.

 

Several years ago a mother in Calgary was returning to her job as a University Professor after a one year maternity leave following the birth of her second child.  She was a well-educated and diligent mother that did everything she could to protect the safety of her children during pregnancy, at home, and in the community. With her return to work the family had to adopt a new routine.  She dropped her older child at day care and proceeded to take her daughter (11 months) to her new child care provider.  The mother and daughter were singing and laughing in the car when the child fell asleep.  The mother then spent the next several minutes putting together a very detailed mental plan of how she was going to get her child out of the car seat and into the day care without waking her.  Once she visualized that process, and understood how it would all work, her mind rapidly switched to thoughts about her first week back at work and all the things she needed to accomplish.  She arrived at work, went about her day, and realized when she came to her car to go home that her daughter was still in the car seat.

 

Her purpose of engaging in the interview and having the article published was to help people understand how this could happen and how it can be prevented.  For her, she believes that the process of “visualizing” the drop off of her daughter made her mind believe that it actually happened.  When her mind switched to thinking about work, it was convinced that her other responsibilities had been completed.  This is the power of visualization, and of a distracted mind.

 

But I feel the most important aspect of the article were the strategies for prevention.  The mother went on to have other children and talked openly about the steps she now takes to ensure she does not relive this tragedy.  She explained that she always makes sure she puts something in the back seat with her children.  Her purse, work bag, lunch. This requires her to enter the back seat of her car when getting out.  Or, the opposite could also work – put a diaper bag, toy or child backpack in the front seat to cue you to their presence.  This mother also said she has asked her child care providers to call her directly if her children are not dropped off on time, as expected.  Lastly, when putting her children in their car seat she puts on a bracelet that is kept in the seat.  She takes it off when getting them out. This serves as a visual cue, but has also become part of her new car seat routine that will reinforce a new behavior (put the bracelet back in the car seat when leaving the vehicle, making her access the seat).

 

According to WebMD “there is no safe amount of time to leave a child (or pet) in a car”.  The temperature inside a car can rise or fall exponentially faster than the temperature outside, as your car functions as a greenhouse.  Just get in your car on a hot day and try to breathe.  Preventing child death from being left in a car is possible, and parents need to be wary of new routines, changes in schedules, and the cognitive process of remembering multiple things.  And most of all, don’t be naïve enough to believe the self-fulfilling “this could never happen to me” phenomenon.  Any oversight, regardless of how significant, can happen to us all.

 

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Attendant Care for “Normal”?

Like “happiness”, the word “normal” is one of those subjective words defined differently by all.  Yet, in the world of disability, “normal” becomes a question.  Can someone “live a normal life”, or are they “back to normal”?  How do you answer these questions when normal is so hard to define? 

 

On a recent holiday, I witnessed a woman with a disability engage in compelling acts of what I call “normal”.  I was so taken by this that I had to take the below picture.  What do you notice?  The location of the wheelchair makes the owner of this unidentifiable.  This was not an isolated event.  Everyday I would see this wheelchair stashed somewhere – off to the side, in a deserted hallway, or almost out of sight.  The wheelchair was so far removed from the person that it could never “define her” and really was just a means of transportation.  I would watch her husband wheel her to the poolside, into the restaurant, or out in the theatre then she would transfer to a “normal” chair and he would move her wheelchair out of sight.  True, maybe they just wanted this out of the way, but if the goal was practicality, she would not have taken the time and effort to transfer when sitting in the wheelchair for most things would be easier.

 

I believe that this woman just wanted to feel “normal”.  She didn’t want to be recognized by her chair, and wanted to experience the world the way non-disabled people do – sitting on a pool lounger, in a dining chair, on a couch, or even in the water on a floaty.  And who allowed this to happen?  Her husband.  He pushed her around the resort, secured her chair for transfers, moved this out of the way, and re-secured it when changing locations. I also saw him carry her in and out of the pool so she could float in the water, and he was her personal waiter for drinks, food and other items she needed that she could not obtain herself.  In my world this is a perfect example of attendant care.  Transfers, mobility, equipment maintenance, and ensuring comfort and security are all parts of the current form used by Occupational Therapists in auto (and WSIB) to calculate attendant care.  So, let’s not underestimate the time someone might take to help someone feel “normal”, whatever that means to that person, in that environment and at that time.  I believe “facilitating normal” is a valuable and important part of being an attendant and should be fairly represented in our calculations of care.  

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A Place Called Vertigo

I am not sure what the word “vertigo” refers to in U2’s hit song, but as someone living with vertigo, I can tell you it is not a place you want to be.  Vertigo is highly unpleasant and can be caused by multiple factors including visual or auditory problems, or more commonly, head injury.  I best describe my vertigo as my eyes and ears sending different messages to my brain regarding the position of my body in space.  So, while my eyes tell me I am sitting still in a chair, my ears tell me I am on a boat in the middle of a hurricane.  The result of these mixed messages is spinning, nausea, dizziness, problems walking, and ultimately dysfunction.

 

For me, my benign positional vertigo (BPV) lives in my right ear.  As a result, I cannot lie on my right side, laterally flex my head to the right, lie flat with my neck extended, or look down into extreme flexion.    While I can tolerate these movements momentarily, I cannot hold these positions for more than a few seconds otherwise I am sent into a spin that can last for days.  I am fortunate to know my triggers and do my best to avoid them (no yoga for me).  I have also learned, after living with this problem for two decades, how to catch my symptoms early to prevent a slight episode of dizziness from turning into days of bed rest. 

 

When my clients experience vertigo, and describe this to me, I can fully appreciate where they are coming from.  The story is a book I too could write.   But, like other “hidden” ailments, I get concerned when the medical community does not take this complaint seriously.  This is especially true in my industry where insurers and their assessors often want “proof” of a health problem to support someone’s recovery. While I recognize that people can be dishonest, my experience is that people don’t make this stuff up.  Health professionals need to give people the benefit of the doubt, including insurance situations. To understand, or better yet, support someone with any “invisible” problem like vertigo, health professionals need to be compassionate, and should care enough to listen, to research and learn, and ultimately believe.  Empathy, TRUST, and understanding will go a long way to support those that need it. I can only imagine how frustrating, devastating and angering it would be for someone to assume or opine that my “place called vertigo” is not a place at all: because, believe me, I live here.