Monday, June 30, 2008

take the oxygen first: advice to stubborn caregivers

Caregivers seem to be naturally stubborn. Maybe it takes a hardhead to be able to focus on the day to day grind of meeting the needs of our loved ones. But while stubbornness can be a positive personality trait when it keeps us going month after month, year after year; it can also be a negative trait when it suppresses an open mind. Being hardheaded can prevent us from accepting new ideas, or opening up to new concepts. It narrows our field of vision, like blinders on a horse. It creates a closed-mind.
I have seen it over and over again, maybe you have too. Too often I meet a caregiver that is wound up and ready to explode. It is obvious to everyone around them, but they cannot see it. They will tell you that everything is under control. “I’m fine”, they say. And, tragically, to the extent that they are “fine”, they are heading for a very big crash. Besides the toxic effects of stress on one’s health. They are closed off to the concept of surrender and the acknowledgement that they need help. But that is exactly what every caregiver needs…help. Remember, more than 50% of caregivers die before the person they are caring for.
Dr. Jamie Huysman, the co-founder of Leeza’s Place, gives a great talk. In his speeches you can often here him suggest that caregivers “take the oxygen first”. What a marvelous concept! This is a perfect analogy to the average caregiver’s dilemma. And, it is the very concept that I have been advocating all along. Flight attendants, when giving preflight instructions, direct people traveling with children, that if cabin pressure is lost and the oxygen masks are deployed, that they should put their own oxygen mask on before helping their children with their mask. The reason is that there are only a few second before you lose consciousness, and in order to be effective and save others, the parent (caregiver) needs to see to their own needs first.
So I plead with my stubborn caregivers. Acknowledge that you need help, and be willing to hand the job over to others whenever you can, and see to your own needs. Remember that alarming statistic from earlier posts that over 50% of caregivers die before the person they are caring for. Well add to that another 10 – 20% that become incapacitated and no longer able to continue caregiving for their parent or spouse. The causes are many, it might be a major stroke, or a serious cancer, or a fractured pelvis. Unfortunately, I have seen too many a cases of older adults with profound Alzheimer’s whose caregiver is out of the picture.
Over the years I have spoken, one on one, with hundreds of caregivers. My overwhelming impression is their unwavering commitment to their loved one. They believe, that no one can care for their parent or spouse as good as they can. That no one can possibly know their loved one as well as them. I happen to agree with them. This is why I continue to recommend that they take action to preserve their health. Because if something happens to them, who will care for their loved one? So I encourage them to use adult day care, to find respite care options, to attend support groups. In support groups they can share their experience with other, newer caregivers, and they can also learn from other, more experienced caregivers.
I also recommend board and care and assisted living. Usually, this is the option that caregivers are very specific about NOT doing. And there you have it, before you can finish your sentence; they are railing how they will never allow it. These stubborn caregivers have made up their mind, sometimes decades earlier, and they are not about to listen to anything that challenges their preconceived notions.
part 2 next week

Thursday, June 19, 2008

Guided Imagery for Stress Management cont.

Guided Imagery is a proven and amazingly effective tool used clinically in hospitals, clinics and wellness centers all over the United States. Probably the most effect application and use of Guided Imagery is for Stress and emotional exhaustion and burnout. It is beneficial for all age groups. Caregivers like yourself can find tremendous benefits in your ability to cope with the frustration and hopelessness that often accompanies long-term caregiving
For those coping with health problems, guided imagery can ease anxiety, reduce pain and accelerate healing in tandem with your medical doctor’s treatment.
For the caregiver, imagery is an excellent addition to your self-care regimen. It will help you to manage stress, stay positive and motivate you to maintain your own health. It can also assist in releasing the anger, frustration and guilt that so often accompanies playing this role in your family. Caregivers report that guided imagery has helped them to accept and move through change with greater ease.
Guided imagery is a gentle but powerful technique that focuses and directs the imagination. Although it has been called "visualization" and "mental imagery", these terms are misleading. Guided imagery is more than just mental pictures, imagery involves all of the senses, and almost anyone can do this. Neither is it strictly a "mental" activity – it also involves emotions and the other four senses, and it is precisely this whole body focus that makes for its powerful impact.
Over the past 25 years, the effectiveness of guided imagery has been increasingly established by research findings that demonstrate its positive impact on health, creativity and performance. We now know that in many instances even 10 minutes of imagery can reduce blood pressure, lower cholesterol and glucose levels in the blood, and heighten short- term immune cell activity. It lessens headaches and pain. Because it is a right-brained activity, engaging in it will often be accompanied by other functions that reside in that vicinity: emotion, laughter, sensitivity to music, openness to spirituality, intuition, abstract thinking and empathy.
And because it mobilizes unconscious and pre-conscious processes to assist with conscious goals, it can bring to bear much more of a person's strength and motivation to accomplish a desired end. So, subtle and gentle as this technique is, it can be very powerful, and more and more so over time.
In the fold-out insert of my CD is says that Guided Imagery is an excellent mini-vacation that you can do in your favorite chair.
And the best part is:
Ø It cost nothing
Ø It does not take much time
Ø And you don’t need special equipment
Do you want to know how to guided imagery?
There are three basic steps:
I. Focused breathing
II. Progressive relaxation
III. And the mini-vacation
How do I do guided imagery?
1) Pick a location in your home that is comfortable and private.
2) Set aside 15 to 30 minutes that will be free of interruptions
3) Find a comfortable chair or lie on bed.
4) Take a couple of deep tension releasing breaths
Then, as your breath returns to normal put all of your attention on your breath. Keep your focus only on your breath. (Tip: when other thoughts or worries come up, gently release them and return attention to your breath).
5) After about 3 to 5 minutes, start your progressive relaxation:
ü Starting at the crown of your head, and very slowly moving down, begin thinking of each part of your body and visualize them releasing tension (muscle, tendons and ligaments) and relax.
ü As you slowly move down your entire body, imagine that with each breath you are drawing in soothing, calming energy and exhaling out tension and stress. Progressively move down your whole body.
6) Then, transport yourself mentally to your mini-vacation by picturing a special place that is safe and serene. Use your active imagination, and using your five senses make it as vivid as possible.
ü Sight
ü Sound
ü Touch
ü Smell
ü Taste
7) Allow yourself to spend as much time as you like in this special place. If you like, this is a good time repeat affirmations to yourself. They will be readily absorbed into your subconscious to manifest in the days to come.

Monday, June 16, 2008

Stress Management for Caregivers of Alzheimer's using Guided Imagery

I start most of my talks with a question to the audience. What, I ask, is the number one killer of adults in this country? The answers I get back are: Cancer! Heart Attack! Stroke! Do you agree?
I propose that Stress is the #1 killer of adults by far, and I think there is overwhelming evidence to support this idea. Tons of research has shown that people suffering from long-term stress are twice as likely to suffer a stroke. They are at a much higher risk for heart attack. Additionally they are much more likely to develop cancer. Add those statistics up and we have a convincing argument. But it’s not just the top three killers, people under long-term stress are at greater risk of most all auto-immune diseases, diabetes, hypertension, depression, headaches, gastrointestinal problems, and the list goes on and on.
The first thing we need see is that stress is not an emotion, even though we often think of it as one. We say we are sad or angry or frustrated. But stress is much more. It is a physiological process that we go through involving our hypothalamus, pituitary and adrenal gland working in concert. Signals get sent, hormones get released, and things start happening. Blood vessels constrict, platelets get released, as do cortisol and adrenalin. The stress response of the body is meant to protect and support us when a physical or mental event threatens us. This process is often referred to as the “fight or flight response.” We prepare for physical action in order to confront or flee a threat. Imagine our ancestors out hunting and gathering. They turn a corner and come face to face with a saber-tooth tiger or a bear. Immediately they are faced with two options, they are going have dinner or be dinner. This is the “fight or flight” response, and this is what is happening to our body under stress.
Even though today’s threats are not life and death…at least not immediately, but the same physiological conditions are taking place. The problem is the fight or flight response is intended to be short acting. The same hormones and neurotransmitters that in short term can save our life, begin to tear us apart if it does not turn off.
How do we turn it off? Well on the face of it, it’s easy. We need outlets that take our minds off the stress provoking source. If work stresses you out, go to the movies, take a weekend off, join a gym, take a walk, read a book. If you are spiritually inclined you can utilize church, prayer, and meditation. But for the caregiver most of these outlets do not apply because caregiving is often a 24 hour a day, seven day a week commitment. Perhaps that explains the Alzheimer’s Association statistics that say 50% of caregivers die before the person they caring for. Stress? What else could it be?
Caregivers often use the excuse that they have no time. But there are indeed a few outlets available to them. Adult Day Care offers respite for caregivers. Dropping your loved one off at an ADHC (Adult Day Health Care) will give you precious hours to do with as you will: see to your own needs, visit friends, go to your own doctor or dentist, clean house, or just take a nap. Another tool for caregivers is support groups. Albeit they generally only meet once a month, it can be a relief to meet some other people going through similar issues as yourself. Perhaps there may be some useful information to be had from others that overcame problems that you are just now facing. The best stress management tool, however, is “guided imagery”. Guided Imagery is basically a mini vacation that you take in your mind. When done correctly it eliminates stress completely. It cost next to nothing to do, and once you learn it, it can be a utilized every day.
Not too long ago, the Los Angeles Caregiver Resources Center (LACRC) located on the campus of the University of Southern California at the Andrus Gerontology Center and the Los Angeles County Area on Aging commissioned me to produce a Stress Management CD utilizing Guided Imagery, specifically for caregivers. The result was a comprehensive state of art CD utilizing not only guided imagery, but neurolinguistic programming, Kapsian hypnosis, Eriksonian hypnosis and special entrainment music designed to promote a hypnotic and more relaxed state of mind. It had a six-page foldout insert explaining guided imagery, research documenting the effects of stress, and step by step formula for designing you own personalized guided imagery script. The CD itself has five 15-minute tracks. Four have progressively deeper and complex relaxation techniques. Each building on the other to not only creates deep relaxation in the moment, but to also program the subconscious to cope more effectively in the future. When the CD was released it was very popular and the EduCare committee, an affiliation of several non-profit organizations then distributed 2 thousand copies of the CD to caregivers for free. Alas, as far as I know, all 2000 copies have be given away. Fortunately I made some retail copies and have been selling them when I give talks and when people contact me online. If you are interested, drop me an email, send me a check and I will ship one off to you.
While my CDs are unique in that they were written and recorded specifically for caregivers, there are other stress management CDs on the market. I recommend that you get one. I think it is the single best stress management tool you can have in your arsenal. Unlike other things you can do. Guided Imagery cost nothing, you can do it without leaving the house, and it only takes a few minutes. If you are reading this you are already online…Google guided imagery. Find a CD, mine or someone else’s, and buy it. It’s a excellent investment in your health and your peace of mind.