Isolation

"To affect the quality of the day, that is the highest of arts," Thoreau.

Choosing isolation, as Thoreau is reported to have done, is different from the isolation that seems inherent with dementia. There is a collapsing inward that happens to the person with dementia; a narrowing of their interests, their awareness, that restricts everything down to their own needs, their own world. Then there is the isolation from the world. I have been surprised both by those people who make the effort to include and support us, and by those who don't. People one would think would be kind and supportive to either the care receiver or care giver aren't; and conversely there are those one might least expect to be kind and inclusive who are. One of those persons is someone in the extended family who is planning a hunting trip that not only includes Dwane but seems to be a gesture of helping Dwane complete his bucket list. How extraordinary! He is looking forward to it, and I get a few days reprieve. I am so grateful for the kindness of this person.

Apples? The new cure all?

"Apples, and especially apple juice, turn out to be brain food," Hara Estroff Marano.

In Psychology Today, June 2010, there is interesting information on research of the effectiveness of apples with dementia. According to the article in a study of people with moderate to severe Alzheimer's disease who consumed 8 ounces of apple juice a day, the behavioral and psychotic symptoms of the disease fell by 27%. That means less anxiety, agitation and delusional symptoms. Apples juice fed to mice also reduces generation of the neurotoxin betamyloid thought to cause Alzheimer's disease. It also increased levels of neurotransmitters which help movement, sensory perception and attention; decreased some negative components that can be activated during aging; and reduced free radicals of oxygen in the central nervous system.

It sounds worthwhile to add one to two cups of apple juice to our daily diet.

Weight

"Yikes! Belly fat equals smaller brains, and a higher risk of Alzheimer's." Remedy magazine Fall 2010.

The quest for overall health, even in the face of a terminal illness, needs to include weight management, physical activity, good nutrition, and peace of mind. Because my mother exposed me to a good knowledge of nutrition, our weight is fine. Exercise is a dilemma. He cannot walk much because of pain in legs. Bike riding is iffy with balance issues, so perhaps we can join a place with a pool for him to swim. There is significant research stating the benefits of exercise to one's physical, mental and cognitive states. In fact, research for some time has stated that to stay at the weight we are we need at least 30 minutes of exercise. To lose weight we need 60-90 minutes. So, what can we implement today to support exercise, weight and well being?

Awake

"Only that day dawns to which we are awake," Henry David Thoreau.

I am re-reading a book a friend gave me in 1995, Wherever you Go There You Are, by Jon Kabat-Zinn. It concerns daily mindfulness, and the author contends (and I have observed) that many people spend their entire lives in a dream-like state. Mindfulness is something we can practice as we provide care for our loved one with a terminal illness.

"Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally," Jon Kabat-Zinn. What a good intention for us and for those around us.

Creativity and dementia

"Even though our brains age, it doesn't diminish our ability to create," Dr. Bruce Miller.

The following is copied from The Mayo Clinic Alzheimer's Newsletter: "Dr. Bruce Miller of the University of California at San Francisco has been a key person in drawing attention to the creative abilities in some individuals with frontotemporal dementia. He has pioneered research recognizing that degeneration in the left side of the brain may limit language but may actually enhance and release musical or artistic abilities. His work moved him to realize just how much creativity exists in dementia patients.

Over the past decade, more and more research has demonstrated the benefits of the arts for older persons especially those with cognitive decline such as memory loss due to Alzheimer's, as well as other causes of dementia. At a forum held at the University of Wisconsin, Milwaukee, in November 2006, leading researchers acknowledged that although more research was needed in the area of creativity, the benefits of creativity for those impacted by dementia were undeniable."

Suggestions for creativity in the article include yoga and doing art forms such as painting, drawing, dancing. The benefits can be significant.

Living out of gratitude

"Wake at dawn with a winged heart and give thanks for another day of loving," Kahlil Gibran.

What great advice. There is considerable evidence that our lives are better when we have an attitude of gratitude. That expression is one the Twelve Step Programs use to achieve serenity - "have an attitude of gratitude". It is a good practice for us who are providing care. Some days we may have to look carefully to find things about which to be grateful, but they are there. Today I am grateful for the cool morning, the more spacious (less committed) day I have before me. An opportunity to fertilize my garden and do a longer run than usual. Perhaps a Netflix movie tonight after a great meal. Perhaps start a new oil painting. Many, many reasons for thankfulness.

Governing one's surroundings

"You govern your surroundings by the nature of what is taking place in your consciousness," Joel S. Goldsmith.

Very true. I learned this in my first few weeks of teaching many years ago. A large part of the atmosphere in a classroom is created by the conscious intention of the instructor. Order, respectful interactions all occur based upon the conscious intention of the instructor. Conversely, so do disorder, ridicule occur because nothing better was intended.

That is also true in the home and/or in relationships. It is important to be conscious of what we are thinking, intending, feeling - because that is what sets the tone of the area. That is why I consciously choose to think, feel and intend the best for all. It makes a difference. And it is easy to know what we are thinking and intending by catching ourselves off and on during the day. Check in with what we are thinking and feeling: that is our intention. It may not be what you thought it was. And that is one way to develop self honesty. Am I showing up as I intend to show up? My thoughts and feelings reveal the trueness of this for me. Let's be conscious of what environment we want to create in our surroundings while we are providing care.

Compassionate thoughts

"We have met the enemy and he is us," Pogo by Walt Kelly cartoonist.

I remember my whole family delighting in this quote when I was a child. It is delightful that some of the greatest wisdom can come in the form of cartoon strips. Of course, I guess that is the function the jesters and clowns used to serve -- passing along wisdom in the guise of humor. At a recent gathering someone was saying they were so grateful to not have the health concerns of someone else, but if the above quote is true (and I think it is); what one of us has, we all have. How does this apply to caregiving and the care receiver? Certainly, conditions could be reversed and it could be we that need the care provided. Perhaps that can help us be compassionate. For this journey, we drew the card for the caregiver. What can that mean to us?

Sundowner tips

"As many as 20% of people with Alzheimer's (and other types of dementia) may experience increased anxiety, confusion, agitation, restlessness and disorientation that starts in the early evening and continues into the night," Mayo Clinic Health Source.

To help reduce late-day confusion, Mayo Clinic has these tips:
1. Plan activities and exposure to light during the day
2. Discourage daytime naps
3. Limit caffeine to early morning
4. Encourage walking at least twice a day
5. Suggest repetitive tasks late in the day (i.e. folding towels)
6. Turn on several bright light during evening
7. Avoid interruptions and noise at night
8. Keep a night light on
9. Encourage visitors

How we look

"Take care, there is much power in a glance. If accompanied by a malicious thought, it can cause harm." Rebbe Nachman of Breslov

There is power in our thought, opinions, ways we perceive others. A spiritual director once told me of the power of "shining love": looking with love onto another human. I was with a dear, dear friend recently and the love we have for each other shines through our eyes. Let us give thought to how we think and look at others. It is important for me to protect Dwane from contempt; which I have seen people with dementia receive. We can help our loved one avoid that by modeling the behavior we want others to show to our loved one. It really works. People tend to treat others the way that is expected of them. I cannot prevent people from avoiding us, which of course some do with their discomfort with dementia; but I can help people to treat Dwane graciously when we are included.

Wonders we can control

"Work on having only positive thoughts. It will do wonders for your mind," Rebbe Nachman of Breslov.

Something we can actually control to greatly enhance our lives! I have heard people say, but how do we do that? A good start is to have the intention of avoiding any negative thought: this means worry, anger, fear, anxiety, judgement, negativity about oneself/others/situations. Then catch yourself when you are entertaining a negative thought. Isn't the word "entertaining" an interesting one? We do choose and entertain our thoughts. Which thoughts do you want as guests in your mind? The ones you choose affect your entire health, relationships and circumstances. Listen to positive-thinking tapes. Retrain your brain to think positively. It is amazing what a difference this can make in any circumstance; including living with dementia.

Fear

"Know! A person walks in life on a very narrow bridge. The most important thing is not to be afraid." Rebbe Nachman of Breslov

A friend reminded me of the wonderful writings of this Hasidic Master. Some people think that there are just two emotions, fear and love, from which all other emotions are distilled. Might be true. When people are angry, it seems it is really that they are afraid. So, how not to be afraid of what lies ahead of us in caregiving and in all things? Perhaps this is another good application of "Act as if." If we practice anything long enough (some psychologists say about 30 days), it becomes a habit for us. So, let's act as if we are unafraid.

Folic acid

"Low folate levels are associated with poor cognitive performance in the general population." Mayo Clinic Alzheimer's Newsletter

The article goes on to say that among the population of people who have normal folate levels, taking folic acid supplements did not help; but it might be worth a conversation with one's doctor. It is yet another benign way that may be helpful to the cognitive functioning of the person to whom we are providing care.

Practice

"An ounce of practice is worth more than a ton of preaching," Mahatma Gandhi.

So true. People's behavior is often much more revealing than their words, and can contradict what they say they believe. Only when one truly integrates their values so that their words and behaviors match are they maturing individuals. Sometimes we get some unusual help in developing this congruence from people who push our buttons. There is much for us to learn about ourselves from what pushes our buttons. Some deep healing that can occur. What in the act of caregiving pushes your buttons? For me it is to have something that I have carefully put somewhere relocated. Frustrating. It is sometimes hard to remember that it is probably not willful that he does this, but part of the disease process.

Fun with family

"I know but one freedom and that is the freedom of the mind," Antoine de Saint-Exupery.

It is such a wonderful thing that we can choose our thoughts and our topics of conversation. Absolutely free will in both. Yesterday we hosted a family gathering. Great fun. The food was delicious; Dwane handled freezing the homemade ice cream. Good conversation, a lot of laughter. A long walk alongside the creek. A time of blessing for us and those we love. I had asked, somewhat tongue in cheek, that people bring a lawn chair and their good will. There is such a difference when we extend our good will to one another. A good time was had by all.

Worry

"Worry is fear -- but fear on the offensive. Worry is the guest we put up for a night who turns out to be a serial killer," Harry Cronin, CSC.

It is hard not to worry sometimes. We see the decline in functioning and worry what it means for the care receiver and ourselves. We read the stages of dementia and worry about how we will get through what is ahead, address each stage and get the help we need. But Fr. Cronin is right. Worry is worse than useless; it is destructive. Somehow we must not succumb to the temptation to worry. The only way I know how to do that is to stay in the present moment; because, after all, this moment I am handling, this moment things are okay. So, all is well. When I stay in the here and now, all is well.

Forgiveness

"The ability to forgive those who have ignored us, wounded us or even killed us, comes only after long practice, and leads to the deepest personal freedom," Dr. Joan Borysenko.

Forgiveness. It might be the key to mature and healthy life. We all have those family members, friends, colleagues, acquaintances or strangers to forgive for some transgression. But, the person most important to forgive is ourselves. For the times we are impatient with the person with dementia, for not recognizing the signs sooner to get medical help, for assuming the person wouldn't do something when it was he/she couldn't do it. For all those times, let us forgive ourselves. Let us free ourselves entirely. Perhaps, too, we need to forgive our loved one for having dementia.

Contentment

"He who is contented is rich," Lao Tzu

Contentment. It seems that is an elusive thing for people in some stages of dementia. What are some ways to foster contentment? Music is a great one. I play nostalgic music often to create contentment. Yesterday we had a delicious dinner. Then we watched a movie from some decades ago. And then we sat outside to enjoy a meteor shower. Activities that bring contentment to us both. Sometimes contentment is achieved by my simply avoiding an argument or upset. We are rich indeed.

Freedom of choice

"Societies have done the best when people have sought the freedom to make the most of their own abilities," Milton Friedman.

Watched a documentary on the noted economist, Milton Friedman. He attributes the success of societies to people having the freedom of choice so that they can make the most of their own potentiality. Since families are a microsystem I think this applies to families too. Isn't it a discerning process to foster freedom while creating safety for persons with dementia?

Be yourself

"Be yourself; everyone else is already taken," Oscar Wilde.

What a funny way to remind us to be our authentic selves. I remember once hearing Oprah tell her audience they could be all they wanted to be, but to not try to be Oprah, as she had that one covered. In my life I have sometimes been told/asked, "Who do you think you are?" Sometimes that is said or inferred to us about how we are handling this dementia journey. Perhaps it is said whenever one does something in an individual way, without following the social norm. Who do I think I am? I know I am what I think, so I think peace, well being, fun. Who do you think you are?

Change yourself

"Change yourself and your work will seem different," Norman Vincent Peale.

Sometimes caregiving can be a strain and tiring. Sometimes it may seem that it is endless and without joy. When these feelings come, it is time to change yourself; change your attitude. Take a break. Arrange respite for yourself. Look for the joys in your life. Sometimes we cannot see the joys because we are too tired. We need to make sure we are refreshed enough to do this task, and to do it with equanimity, if not with joy.

Bliss

"Follow your bliss," Joseph Campbell.

I am well familiar with the above quote, have seen it on bumper stickers and it has always kind of annoyed me. Seemed irresponsible. Joseph Campbell tells of overhearing a family in a restaurant where the father is trying to get his son to eat something he does not want to eat, the mother says to not make him do something he does not want to do, and the father replies with astonishment, "what will he turn out like if he does only what he wants to do?" Indeed, how would we turn out if we did only what we wanted to? That is implied in the book, Outliers, too; that people who could follow their passions can achieve great success. But, how many of us have responded to economic necessity and done what we had to do? Might that be true in our providing caregiving too? That we are doing it only because we feel we have to? Campbell says, "The waters of eternal life are here all the time in joy." It seems that finding joy is imperative in whatever we do.

myths

"Life can be easy; however, we must choose to see it that way." Eugene D. Holden.

I am watching a series of videos loaned by a friend, The Power of Myth, Joseph Campbell interviewed by Bill Moyers. Fascinating. Seems to me that the journey with dementia, both for the care receiver and the care giver, are hero journeys. Dealing with suffering and coming out the other side. Perhaps it is helpful for us to consider that this is a universal and mythical journey, more than just personal to us. According to Campbell developing one's potential can be accomplished only by suffering or insight, and that it is important to avoid succumbing to what society dictates we do. That is why this is an opportunity for us to carve our way uniquely with the task of caregiving, making a new way to deal with this suffering, and using it for the greater good of ourselves and others.

Giving thanks

"Gratitude is the creative energy that creates more opportunities for you to be grateful," Eugene D. Holden.

What a lovely reason for which to be grateful; it creates more opportunities for which to be grateful. What can we be grateful for in living with dementia? It seems we can get bogged down in the countless responsibilities that accompany this caregiving. I am grateful for the cool air this morning, for the peace. I am grateful that things are going quite well (considering we are living with a progressive and terminal illness). I am grateful to have found a handyman to fix things around the house that Dwane used to do. I am grateful for the bounty of the local farmers' markets and my own garden. For what are you grateful today?

Quality of thought

"I select ideas as carefully as I would select a precious gem." Ernest Holmes.

Do you ever consider the content of your own thoughts? Our thoughts have power. We are learning more and more that this is true. I think the world might be a very different place if we each were disciplined about having thoughts and ideas that were positive and supportive of ourselves and others. Of course, we cannot control what others think (although there is some research that suggests others do respond to our positive thoughts), but we most certainly can control the quality of our own thoughts. Are our thoughts gems or garbage? It is our choice.

Thinking

"Neuroscience does offer new, exciting validation that our thoughts and feelings change the structure and functioning of our brain," Mark Waldman and Andrew Newberg, MD.

There is considerable information out there nowadays that our thinking is what creates our lives. If we expect planes to always be running late, that is more likely our experience. If we expect people to treat us well, that is more likely our experience. Life will treat us better if we treat it better. But the above quote goes beyond that. New research indicates that the thoughts and feelings we choose to have actually change the structure of our brains. Meditating on positive and loving thoughts and feelings changes our brains to generate more empathy, compassion and inner peacefulness. (How God Changes Your Brain by Andrew Newberg, MD and Mark Waldman)

Memories

"The responsibility of older age is to continue to make memories," Val Farmer.

That seems a paradox if you are dealing with the type of dementia, the most common type, which includes significant memory loss. But I think what Dr. Farmer is referring to is continuing to have stimulating and enriching experiences, and perhaps we can still enable the person with dementia to have these experiences. He also suggests that in making memories we include photos, video recordings and audio recordings. That may or may not help someone with dementia to relive memories, but it worth considering. Video or audio taping is a good idea to capture memories of heirlooms and items that are important for you and for the person for whom you provide care. What are the stories you can pass on to others about heirlooms or events? Val Farmer suggests that older people continue to make new memories, make lasting memories and to preserve one's memories.

Good for all

"What is good for each one of us is good for everyone," Eugene D. Holden.

What if that is true? What if there is no need for competition because if someone else got something we wanted that just made it more likely for us to get it? Quantum physics suggests this is true. Perhaps we would all be better off if we truly wished the highest and the best good for everyone, to include ourselves. That attitude could even impact the way we provide care, and might even change the world.

Benefits of nature

"Just getting outside helps improve your mental health," Kelly Marker.

Dr. William Bird, health adviser to Natural England, has conducted various studies showing the benefit of our spending time in natural environments, especially those with grass or a small garden. According to his studies, spending time outdoors can decrease anxiety and depression, lessen pain, and increase optimism. Even having plants and flowers in the home has benefits. Although, this research does not specifically address dementia, it would seem to me that exposing our loved one to greenery is beneficial.

Act as if

"Act the part and you will become the part," William James.

In the 12 Step Programs, the saying is, "Act as if". Powerful. It is incorrect when people say they are grumpy because they are working nights or trying to quit doing something. We behave the way we decide and choose to behave. So, if we want to "show up" in a different way in our situations, it is as simple as deciding how we want to be, and then acting that way. It really is that simple.