Keeping Peace During Holiday Gatherings

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The holiday season should be a time devoted exclusively to peace and joyful celebrations. When you think about this time of year, what comes to mind? For me, it’s time with family and friends. In the hustle of everyday life, it is nice to take a step back to spend time with the people you love.

But, the holidays are often the only time that most of the family can get together at once. So, many times families must have difficult conversations during this time. For example, a common conversation is how to continue caring for an aging parent, uncle, aunt or grandparent.

In truth, tensions like this among family members are often exacerbated by ongoing disputes,  rivalry  and conflicting expectations for the holiday. Of course, we feel it is our responsibility to keep the peace, which is not always easy when you bring together several different personalities,  all with different opinions.

Here are a few strategies to help keep the peace during your holiday gatherings:

  • Set a time and place for difficult conversations that you have to have. And, only have the decision makers in the room. Too many opinions can make a hard conversation, even harder.
  • Fun is the always a great buffer.  Singing Christmas carols, playing musical instruments, putting on a talent show and playing games are all great ways to get everyone to relax and enjoy each other’s company.  One year we did our own photo booth, which was a huge hit.
  • Learn something new.  During your holiday gathering, have each family member tell something new they learned or did for the first time this year.   Your family will learn that they have a lot more in common than they think.  We did this a few years ago, two family members who wanted to learn to quilt are now doing so with other family members.

Hopefully your holiday gatherings are peaceful, and the only disappointment you experience is when all of your loved ones leave.  Remind everyone to reach out to each other throughout the year, and you could even set a goal for the family to come together again in the summer!

*Updated article from December 19, 2014

Stroke and Nutrition

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A stroke occurs when there is a change in the flow of blood to the brain that leads to a change in and/or loss of function. Some risk factors for stroke include:

  • High blood pressure
  • Stress
  • Family history
  • Health conditions including diabetes, heart disease, and obesity
  • Lifestyle factors, such as a diet high in fat and cholesterol, lack of exercise, and smoking

The effects of a stroke can vary, and depend on the location of the damage in the brain and the amount of damage. There may be changes in behavior or the ability to perform daily activities. Some individuals may find it more difficult to feed themselves or swallow. If these problems are present, an Occupational Therapist can help with self feeding, while a Speech Therapist can help with swallowing problems. A doctor can help determine appropriate treatment options.

Healthy eating may help with weight and blood pressure management, which can help to prevent another stroke. In general, healthy eating involves:

  • Low sodium: to help control blood pressure.
  • Plenty of vegetables, fruits, whole grains, and fat-free or low-fat dairy products: to help keep blood pressure under control.
  • Choosing heart-healthy fats: such as soybean, canola, olive, or flaxseed oil over saturated fats and trans fats to reduce the buildup of plaque in your blood vessels.

There are many ways to incorporate healthy eating into your diet. Some ways to start include:

  • Choose foods with less than 300 milligrams (mg) of sodium per serving.
  • Use herbs and spices, or herb mixes (e.g., Mrs. Dash) to flavor food.
  • Choose carefully when eating out. Restaurant foods can be high in sodium.
  • Choose fiber-rich foods. These include fruits, vegetables, and whole grains. Choose fruits like bananas, oranges, cantaloupe, and apples, and vegetables like sweet potatoes, spinach, zucchini, and tomatoes. Whole grains include whole wheat bread products, oatmeal, brown rice, and quinoa.
  • Eat fatty, cold-water fish (e.g., salmon, mackerel, and sardines) twice a week. These provide heart healthy fats. Try to choose fresh or frozen varieties, as canned may be too high in sodium.
  • Limit saturated fat and trans fat. Saturated fats are found mostly in animal foods, foods made with animal products, or fried foods. Trans fats are found in meat and foods that contain hydrogenated oils (e.g., peanut butter and margarine).
  • Limit cholesterol from food to 200 mg per day. Foods high in cholesterol include egg yolks, shrimp, and full fat dairy foods.

Check with a dietitian or doctor for your specific dietary needs.

Diverticulosis and Nutrition

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Diverticulosis is a chronic condition where there are sac-like pouches protruding from the large intestine. When these pouches become inflamed or infected, the condition is then known as diverticulitis.

The most commonly suspected cause of diverticulosis is a low fiber diet. Consuming low fiber can lead to constipation, which can make it difficult to pass stool and lead to straining. This straining can put pressure on the colon, which may lead to the development of the sac-like pouches. Individuals with diverticulosis should consume a high fiber diet to prevent constipation. A high fiber diet should include an additional 6 to 10 grams of fiber beyond what is typically recommended (25 to 35 grams a day). Foods high in fiber include:

  • Brown rice, quinoa, buckwheat, oatmeal, and other grains
  • Fruits such as prunes, apples, bananas, and pears
  • Popcorn
  • Fruit and vegetables with skin/peel on
  • Beans, peas, and legumes
  • Nuts and seeds
  • Whole grain breads, pastas, crackers, and cereal Previous recommendations include avoidance of nuts, seeds, and hulls. There is no evidence to show this contributes to the development of diverticulitis, therefore the current nutrition recommendations focus on increased fiber.

When the sac-like pouches become inflamed or infected, your doctor may recommend no foods by mouth to allow your large intestine to rest. As you begin eating foods again you should slowly begin with low fiber foods that are easy to digest. Foods low in fiber include:

  • Tender well-cooked meats
  • Eggs
  • Smooth peanut butter
  • Tofu
  • Cream of wheat and grits
  • Refined grains such as white bread and cereals made with white flour
  • Canned and/or well-cooked vegetables or vegetable juice
  • Mashed potatoes
  • Canned, soft, and/or well-cooked fruit, or fruit juice without pulp
  • Broth

As the infection and inflammation heals, fiber can slowly be added back into the diet.

Check with a dietitian or doctor for your specific dietary needs.

Stroke and Nutrition

By | Health and Wellness | No Comments

A stroke occurs when there is a change in the flow of blood to the brain that leads to a change in and/or loss of function. Some risk factors for stroke include:

  • High blood pressure
  • Stress
  • Family history
  • Health conditions including diabetes, heart disease, and obesity
  • Lifestyle factors, such as a diet high in fat and cholesterol, lack of exercise, and smoking

The effects of a stroke can vary, and depend on the location of the damage in the brain and the amount of damage. There may be changes in behavior or the ability to perform daily activities. Some individuals may find it more difficult to feed themselves or swallow. If these problems are present, an Occupational Therapist can help with self feeding, while a Speech Therapist can help with swallowing problems. A doctor can help determine appropriate treatment options.

Healthy eating may help with weight and blood pressure management, which can help to prevent another stroke. In general, healthy eating involves:

  • Low sodium: to help control blood pressure.
  • Plenty of vegetables, fruits, whole grains, and fat-free or low-fat dairy products: to help keep blood pressure under control.
  • Choosing heart-healthy fats: such as soybean, canola, olive, or flaxseed oil over saturated fats and trans fats to reduce the buildup of plaque in your blood vessels.

There are many ways to incorporate healthy eating into your diet. Some ways to start include:

  • Choose foods with less than 300 milligrams (mg) of sodium per serving.
  • Use herbs and spices, or herb mixes (e.g., Mrs. Dash) to flavor food.
  • Choose carefully when eating out. Restaurant foods can be high in sodium.
  • Choose fiber-rich foods. These include fruits, vegetables, and whole grains. Choose fruits like bananas, oranges, cantaloupe, and apples, and vegetables like sweet potatoes, spinach, zucchini, and tomatoes. Whole grains include whole wheat bread products, oatmeal, brown rice, and quinoa.
  • Eat fatty, cold-water fish (e.g., salmon, mackerel, and sardines) twice a week. These provide heart healthy fats. Try to choose fresh or frozen varieties, as canned may be too high in sodium.
  • Limit saturated fat and trans fat. Saturated fats are found mostly in animal foods, foods made with animal products, or fried foods. Trans fats are found in meat and foods that contain hydrogenated oils (e.g., peanut butter and margarine).
  • Limit cholesterol from food to 200 mg per day. Foods high in cholesterol include egg yolks, shrimp, and full fat dairy foods.

Check with a dietitian or doctor for your specific dietary needs.

Parkinson’s Disease and Nutrition

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Parkinson’s disease (PD) is a chronic movement disorder. PD involves the failure and death of vital nerve cells in the brain, called neurons. Some of these neurons produce dopamine, a chemical involved in bodily movements and coordination. As PD progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.

Primary motor signs of Parkinson’s disease include the following:

  • Tremor of the hands, arms, legs, jaw, and face
  • Bradykinesia or slowness of movement
  • Rigidity or stiffness of the limbs and trunk
  • Postural instability or impaired balance and coordination

Common nutritional concerns for people with Parkinson’s disease are:

  • Unplanned weight loss
  • Difficulty eating due to uncontrollable movements
  • Swallowing dysfunction
  • Constipation
  • Medication side effects (e.g., dry mouth)

Nutritional concerns vary by individual based on signs and symptoms and stages of disease. It is important to work closely with a doctor or dietitian to determine specific recommendations.

When it comes to nutrition, what matters most?

  • Increase calories. If a tremor is present, calorie needs are much higher. Adding sources of fat to foods (e.g., oil and cheese) is one way to do this.
  • Maintain a balanced diet. Eating properly involves eating regularly. If uncontrollable movements or swallowing difficulties are making it hard to eat, seek the advice of an occupational or speech therapist.
  • Maintain bowel regularity. Do so with foods high in fiber (whole grain bread, bran cereals or muffins, fruits and vegetables, beans and legumes) and drinking plenty of fluids.
  • Balance medications and food. Individuals taking carvidopa-levadopa may need to adjust the amount of protein eaten and the time of day it is eaten, or take their medication with orange juice. If side effects such as dry mouth are making it difficult to eat, work with a health care professional to help manage these.
  • Adjust nutritional priorities for your situation and stage of disease.

Check with a dietitian or doctor for your specific dietary needs.

Cancer and Nutrition

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Cancer begins when cells in the body become abnormal. As these cells duplicate, a mass of tissue made of abnormal cells forms and is called a tumor. Normal cells grow and divide and know to stop growing. Over time, they also die. Unlike these normal cells, cancer cells continue to multiply and do not die when they are supposed to. If the tumor gets bigger, it can damage nearby tissues and organs. Cancer cells can also break away and spread to other parts of the body.
Nutrition is important for both cancer prevention and treatment. If diagnosed with cancer, there are numerous treatments that can be utilized, all of which can cause side effects capable of affecting nutrition. Some effects of cancer treatments include:

  • Fatigue: Get plenty of rest, and if unable to eat large amounts, choose calorie-dense foods (e.g., butter, cheese, ice cream, and milkshakes)
  • Nausea and vomiting: Avoid excessive exposure to the smell of food, and take medications with food if able
  • Taste changes: Stay well hydrated (this can be linked to dry mouth) and eat citrus foods to stimulate saliva production
  • Dry mouth or thick saliva: Stay well hydrated and try sucking on ice chips
  • Sore mouth or sore throat: Pick soft, easy-to-chew foods; add gravy and sauce to food
  • Diarrhea: Drink plenty of fluids, choose low-fiber foods, and avoid irritating foods (e.g., dairy, sugar, and spicy foods)
  • Constipation: Eat fiber-rich foods and stay well hydrated
  • Loss of appetite and weight loss: Choose calorie-dense foods (e.g., butter, cheese, ice cream, and milkshakes)

There are also unique side effects that can vary depending on the location of the
cancer. For example:

  • Head and neck cancer may lead to chewing difficulties
  • Colon cancer may be associated with more gastrointestinal-related side effects (e.g., diarrhea)
  • Lung cancer may lead to an increase in shortness of breath, which can make eating more difficult

Nutrition is also important for cancer survivors, as well as those looking to prevent cancer. The following guidelines can help minimize the risk for cancer:

  • Eat plant-based foods (e.g., fruits, vegetables, and whole grains).
  • Be physically active for at least 30 minutes a day.
  • Avoid sugary drinks and excessive energy-dense foods (e.g., chips, cookies, and candy).
  • Limit consumption of red meats (e.g., beef, pork, and lamb)
  • Limit consumption of processed meats (e.g., bacon, sausage, and salami)
  • If consuming alcohol, keep it to 2 drinks/day for men and 1 for woman
  • Avoid excessive salt consumption

Check with a dietitian or doctor for your specific dietary needs.

Nutrition for Bone Health

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Many factors contribute to the health of our bones, including gender, race, age, and nutrition. Osteoporosis is a condition characterized by weakened and fragile bones, increasing the risk for fractures. Good nutrition can help prevent osteoporosis, including plenty of calcium and vitamin D. Most people need about 1,000 mg of calcium a day, or about 3-4 servings of dairy, including:

  • Milk (whole, skim, soy, and almond)
  • Cottage Cheese
  • Yogurt

Foods with lower levels of calcium include:

  • Dark greens (e.g., kale and collards)
  • Salmon
  • Almonds
  • Fortified cereals

The body produces vitamin D when exposed to the sun; however reliance on this is not recommended as many people do not get enough sun exposure to produce 100% of their vitamin D needs. Foods rich in vitamin D include:

  • Fortified cereals
  • Milk
  • Fortified juice
  • Egg yolks
  • Cod liver oil
  • Fatty fish (salmon and mackerel)

It is very important to consume a variety of foods such as fruits, vegetables, whole grains, and lean meats, as these different foods have additional nutrients to improve bone health:

  • Vitamin K: Green leafy vegetables (e.g., spinach, kale, Swiss chard, turnip greens, collards, mustard greens, romaine, and parsley).
  • Vitamin C: Oranges and orange juice, grapefruit, red peppers, broccoli, kiwis, strawberries, and other fruits and vegetables.
  • Magnesium: Nuts (e.g., almonds and cashews), cooked spinach, raisin bran cereal, brown rice, peanut butter, and baked potatoes (with skin).
  • Protein: Both animal sources (e.g., meat, fish, eggs, and milk) and nonanimal sources (e.g., beans, lentils, nuts, and seeds).
  • Zinc: Lean beef, breakfast cereal, cashews, Swiss cheese, and milk.

Regular exercise can also help to further strengthen bones, especially weight bearing exercise. Weight bearing exercise is activity that forces your bones and muscles to work against gravity. Different types of weight bearing exercises include brisk walking, jogging, hiking, soccer, basketball, dancing, tennis, skiing, bowling, and weight training (using free weights or machines).

 

See a doctor or dietitian for your specific nutrition needs.

Nutrition for Dementia and Alzheimer’s

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Dementia is the loss of memory, cognitive reasoning, awareness of environment, judgment, abstract thinking, or the ability to perform activities of daily living. The most common form of dementia is Alzheimer’s disease, a type of dementia that involves slowly developing symptoms that get worse over time. Dementia resulting from vitamin deficiencies, or caused by underlying disease (such as brain tumors and infections) may be reversible. Other forms of dementia, such as Alzheimer’s and vascular dementia, are not reversible, and are often treated with medications.

As dementia progresses, changes can occur that may affect someone’s ability to obtain adequate food and nutrients to maintain their health status. Such changes will vary depending on the type of dementia, as well as the stage of the disease. Some of these changes include:

  • Altered sense of smell and/or taste
  • Inability to recognize food or distinguish between food and non-food items
  • Poor appetite
  • Chewing difficulties (pocketing food, repetitive chewing, etc.)
  • Swallowing difficulties
  • Forgetting to eat
  • Shortened attention span leading to a loss of interest in eating
  • Difficulty using eating utensils
  • Increase in pacing or walking
  • Drug side effects

The symptoms of dementia vary, and the treatment and nutrition care should be determined by these symptoms. Some techniques to consider for continued delivery of food and nutrition include:

  • Provide kind reminders to eat.
  • Provide meals in a low stress environment, minimizing noise and visual
  • distractions.
  • Develop a meal routine that can be repeated over time, to provide meals at
  • similar times, or even similar meals every day.
  • Have someone eat with the individual to provide assistance and reminders
  • on how to eat.
  • Have family join the individual at meal times to encourage eating.
  • Pay attention to other health issues, such as infections, fevers, injuries, or
  • other illnesses, as these may increase food and fluid needs.
  • Provide well-liked food and drinks to encourage eating.
  • Limit the amount of food served at one time so as not to overwhelm.

Provide finger-type foods for individuals struggling to use utensils:

  • Hamburgers
  • French fries
  • Carrot sticks

Check with a dietitian or doctor for any specific dietary needs.

How to Cope with Grief During the Holidays

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Thanksgiving, Christmas, Hanukah, Ramadan, Kwanza and New Year’s Day are annual holidays that can be a very difficult time for people who have experienced the death of someone they loved.

Memories during the holiday season serve as reminders of our loss. Watching others who are feeling thankful and are celebrating when you feel overwhelmed, lonely or sad can be very painful.

The first step in coping with grief during the holidays is to acknowledge that the first holiday season is difficult, and then to prepare for it, in advance, by making specific plans and obtaining the support that you need.

Remember too that sometimes anticipation of a holiday can be more difficult than the arrival of the day itself.
Set realistic expectations for yourself. Remind yourself that this year is different. Decide if you can still handle the responsibilities you have had in the past. Examine the tasks and events of celebrating and ask yourself if you want to continue them.

Surround yourself with people who love and support you. Share your plans with family and friends and let them know of any intended changes in holiday routine. Memories can sometimes be a source of comfort to the bereaved. Share your memories with others of holidays spent with your loved one by telling stories and looking at photo albums.

Try to avoid “canceling” the holiday, despite the temptation. It is fine to avoid some circumstances that you do not feel ready to handle, but avoid completely isolating yourself. Allow yourself some time for solitude, remembering and grieving, but balance it with planned activities with others.

Allow yourself to feel joy, sadness, and anger – allow yourself to grieve. It is important to recognize that every family member has their own unique grief experience and may have different needs related to celebrating the holidays. Not one way is right or wrong. Experiencing joy and laughter does not mean you have forgotten your loved one.

Draw comfort from helping others. Consider giving a donation or gift in memory of your loved one. Invite a guest who might otherwise be alone for the holidays. Adopt a needy family during the holiday season.

Take care of yourself. Avoid using alcohol to self-medicate your mood. Try to avoid the hustle and bustle of the holiday season. Physical exercise is often an anecdote for depression. Writing in a journal can be a good outlet for your grief expression.

Create a new tradition or ritual that accommodates your current situation. Some people find comfort in old traditions. Others find them unbearably painful. Discuss with your family the activities you want to include or exclude this year.

Some examples of new rituals and traditions include:

Light a candle in honor of your absent loved one.
Put a bouquet of flowers on your holiday table in memory of your loved one.
Visit the cemetery and decorate the memorial site with holiday decorations.
Have a moment of silence during a holiday toast to honor your loved one.
Place a commemorative ornament on the Christmas tree.
Dedicate one of the Hanukah candles in memory of your loved one.
Play your loved one’s favorite music or play their favorite game.
Plan a meal with your loved one’s favorite foods.

The most important thing to remember is there is no right or wrong way to celebrate the holiday season after the death of a loved one.

Who’s Involved in Hospice Care?

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Typically, hospice teams work alongside your caregivers to develop an individualized comprehensive care program.  The hospice team usually consists of:

RN Case Manager

This is the person who will coordinate the various elements of your care. Their goal is to coordinate care in the most effective way possible for each individual, and their family.

Hospice Aide

This person can provide care in the home, community or hospital. This can include overnight stays, bathing, and other care to ensure that the individual, and their family, is comfortable.

Social Worker

Social workers often start by assessing the situation. They determine the wants and needs of the families we serve. They also educate individuals and give advice on the dying process. But, they also advocate for the patient’s final wishes.

Spiritual Counselor

Spiritual care can be an important aspect to emotional support. The spiritual counselor is there to develop a plan for each person’s beliefs. Then, they act as resource to carry out this plan.

Medical Director

Any medical needs will be handled by the medical director, in collaboration with the individuals’ physician. This person will ensure that the medical wishes are fulfilled for each person. But, this person’s duties may also extend to the families, and/or caregivers.

Volunteer Coordinator

This person coordinates the volunteer schedule. They match volunteers where with the people they believe they will work best with.

Bereavement Coordinator

This person provides counseling services to those who have been affected by a death.

Volunteers

Hospice volunteers are an important part of the hospice team. They are there to provide a helping hand, support and compassion to the people served. The volunteers may provide transportation, preform household chores, and prepare meals.

Administrative and Support Staff

The administrative and support staff is there as a resource if families need any assistance, or if they have any concerns. These are typically the people to call if you have general questions about insurance coverage, or services.

Hospice care requires a full team working toward a common goal. All of these people are equally important to providing quality hospice care.