My confession. Is it Defeat or just good Judgment?

If you have noticed, I keep posting my blogging to do list as reminders of  what I want to blog about:

  • Post on delusions and hallucinations
  • Do book review on “Could it be Dementia
  • Do book review on “Behind the Mask
  • Do book review on “Living with Lewys
  • Reply to Elderly Lady in Training’s comment posted on 1-31-2009
  • Reply to Imogene’s comment posted on 2-5-2009

However, I need to make a public confession. I’ve noticed over the past several months that I no longer am able to organize and synthesize many of my thoughts into a brief, concise and comprehensive summation. I used to have a powerful photographic memory. Now I don’t. I no longer can do any math problems in my head. I didn’t come up with the right answer to the logic problem which I posted the other week. I even made a big faux paux this morning. I thought it was 6:20 AM and got out of bed thinking that I would watch the TODAY show. I even drank my morning cup of coffee. I somehow looked at the clock incorrectly—-it was only 4:20 AM!

All of this hit home whenever I’ve tried to do the book reviews of the above 3 books. The authors graciously sent me the books which I promised to review and post the review in the blog. I’ve read all 3 of the books which profoundly affected me in positive ways. But I can’t remember enough in order to summarize each book. That just isn’t like me. I used to be able to do long forensic reports to judges in California. In fact, I was allegedly considered to be the best writer of reports of all the Docs on staff. Where did that ability go? I can’t do it anymore. It cames very naturally to me. I was so looking forward to sharing my thoughts on the above books. I give my apology to the authors for not following through with a review of their publications. Nonetheless, I strongly recommend them and feel they should be read by all.

So, my question to me is this. Am I giving into defeat or am I making a good sound judgment not to do them? I think I have the answer. Each time I try to synthesize a review, I get frustrated and stressed to the point of getting overwhelmed for not being able to do it. Just like we have to do in many aspects of life, we consider the risks versus the benefits. I think the risk of continuing to put myself under more stress is not using good judgment. I guess that isn’t really defeat. Ah, I am suddenly having a brainstorm as to what will help. Well the, having said all of this, I think I’ll go have 10 more cups of coffee, eat a dozen of doughnuts and have a couple puffs of pot. Of course, I’ll skip the gingko and the fish oil today. No socialization. No relaxing music. Only loud heavy metal screaching. Afterward, I’ll put myself into a deep hypnotic trance………wow, then I really be smart for the day!  icon_lol1

I found this article online this morning…

Ten Pointers for Elderly Caregiving

The world is getting old and unfortunately, people have lesser time now for our elderly than they had ten years ago. We cannot blame our elderly for these things, because, after all, growing old is inevitable. For us who dedicate our time and effort to taking care of the elderly, we have to make sure that we at least do the job properly. After all, when it is our turn to grow old, we won’t want other people taking care of us simply because it is their job; we want to be taken care of the way our children, our grandchildren, or our family would take care of us. Here are ten things to remember when taking care of the elderly. These will surely make the twilight years of your patient seem much more comfortable.

1. Communicate – a common problem among elderly patients is the communication handicap which is a result of certain physiological changes that come with age. Poor hearing and eyesight are two of the most common problems among the elderly that become a barrier to communication. When communicating with the elderly, caregivers must use a low-pitched voice because elderly patients can easily perceive low intensity sounds compared to high frequency sounds. Caregivers should also speak to the patient up-front and enunciate the words slowly and clearly. In some cases, the patient will not be able to hear at all, so they would be hard-pressed to read your lips instead.

2. Validate reality – Dementia is common among geriatric patients. This is a result of the deteriorating brain tissue. Elderly lose their short term memory and most often, live in the past. To help our elderly patients maintain a certain level of mental alertness we have to constantly remind them of reality. We can do this by reminding them of the date, the place where they currently are, and talking to them about certain details in their life like their children or their spouses. We also have to remind them of their own personal details such as their names. The more relevant the information we feed to them, the more effective reality validation becomes. This also prevents elderly patients from developing other more serious complications like psychosis and depression.

3. Moisturize and rehydrate – the skin is the most outward barrier of protection for humans and this loses its integrity in elderly patients. The skin becomes less elastic because of the diminished collagen production and dehydration. Nerve endings become less sensitive to stimuli. While we cannot reverse the aging process, what we can do is preserve the skin’s current condition as much as possible. Moisturizing agents may be used to preserve the surface condition of the skin, while rehydration can attempt to replace what water is lost to aging. We also have to be extra careful when giving our patients a bath because their decreased sensitivity to temperatures can cause inaccurate perception of high and low temperatures.

4. Mind nutrition – most elderly patients have a prescribed diet plan because of certain medical conditions. In these cases we have to see to the strict implementation of the diet plan to prevent serious health risks to our patient. A general rule when it comes to nutrition, however, is to make sure that our patients receive their daily share of nutrients and fiber. An appropriate diet can help keep physiological functions in check as well as prevent certain metabolic disorders like constipation and incontinence. Elderly should also be given foods that are easily digested and easily consumed. Always be conscious of your patient’s dietary restrictions.

5. Move – our joints are made for movement. In elderly patients, the cartilage cushion in joints as well as the liquid filled capsules in between joints has either become inelastic or dry. While there is very little that we can do to physiologically remedy this problem, we can help with the palliative treatment by encouraging them to perform range of motion exercises with our assistance. Regular movement of the joints does not only keep our elderly patients flexible for their age, but it also preserves the strength of their bones. Resistance training may also be used for more active and stronger geriatric patients.

6. Keep the environment safe – in the elderly home, there are things that we should consider to keep our patients safe. Sharp furniture edges have to be cushioned, ample, soft, but bright lighting should be available (yellow light is preferred over white light), floors should be insulated and installed with slip-guards, hand rails attached to the walls of areas where our patient would frequent, and common items like toothbrushes and grooming supplies should be kept within reach and in the same location every time. Extra effort should also be taken to rid the environment of allergens because elderly patients can be very sensitive to these things. Dust should be cleared, pillows should be of the hypoallergenic type, and fabrics used should not contain any loose fibers that may cause respiratory problems for our patient.

7. Check vitals – this is very important for patients with heart conditions. For those patients who are known to be hypertensive, blood pressure has to be monitored several times during the day, especially after physical or strenuous activity. We also have to note their normal blood pressure baseline, and any changes in this should be immediately reported to their attending physician. Respiratory rate and pulse rate also have to be monitored constantly. Temperature has to be recorded at least once a day, in case our patient might be developing a fever because of some underlying infection.

8. Expose – geriatric patients who are isolated from society usually deteriorate more rapidly. It is always advisable to take our patients on walks, or go shopping at the mall. Just make sure that your patient is safe at all times to prevent any accidents from happening.

9. Maintain dexterity – elderly patients tend to lose efficient fine motor movements with age. We can help with this by keeping our patients occupationally busy. Giving them activities that they can do with their hands will help a lot, like scrapbooking, macramé, or playing chess or any other board game. Be sure to keep away from activities that require sharp objects, though, such as knitting, crocheting, or embroidery. Keep their fingers busy.

10. Ensure medication – most of our patients usually have prescriptions that they have to take at certain times of the day. We have to make sure that they take their medications on schedule and religiously, otherwise, we may be posing serious health risks for them. With these ten tips, we should still remember that the most important component of our team is our patient. Always keep in mind that no matter what we do, our patient should be at the center of everything that we do, therefore, we have to do everything in their best interest and welfare, otherwise, we would not be working to prepare for the day when we too are in our patients’ situations.

by Bryan Mari Argos

Many of my forensic psychiatry experiences in California involved going to quite a few Counties in the Northern part of the State. I testified as an expert witness regarding whether patients were competent, ready to leave the hospital or to remain for continued treatment. The following humor has a little more truth to it than one can imagine. Enjoy and have a laugh—-it would just be my luck that an attorney would read this! Oh, this was just an email joke which I received. They didn’t happen with me.

These were recorded verbatim and published by Court Reporters that had the torment of staying calm and remaining professional while these
exchanges were actually taking place.

ATTORNEY: This myasthenia gravis, does it affect your memory at all?
ATTORNEY: And in what ways does it affect your memory?
WITNESS: I forget.
ATTORNEY: You forget? Can you give us an example of something you forgot?

ATTORNEY: Now doctor, isn’t it true that when a person dies in his sleep, he doesn’t know about it until the next morning?
WITNESS: Did you actually pass the bar exam?
_________________________ ___________

ATTORNEY: The youngest son, the twenty-year-old, how old is he?
WITNESS: He’s twenty, much like your IQ.

ATTORNEY: Were you present when your picture was taken?
WITNESS: Are you shitting me?

ATTORNEY: So the date of conception (of the baby) was August 8th?
ATTORNEY: And what were you doing at that time?
WITNESS: getting laid

ATTORNEY: She had three children, right?
ATTORNEY: How many were boys?
ATTORNEY: Were there any girls?
W ITNESS : Your Honor, I think I need a different attorney. Can I get a new attorney?

ATTORNEY: How was your first marriage terminated?
WITNESS: By death.
ATTORNEY: And by whose death was it terminated?
WITNESS: Take a guess.

ATTORNEY: Can you describe the individual?
WITNESS: He was about medium height and had a beard.
ATTORNEY: Was this a male or a female?
WITNESS: Unless the Circus was in town I’m going with male.

ATTORNEY: Is your appearance here this morning pursuant to a deposition notice which I sent to your attorney?
WITNESS: No, this is how I dress when I go to work.

ATTORNEY: Doctor, how many of your autopsies have you performed on dead people?
WITNESS: All of them. The live ones put up too much of a fight.

ATTORNEY: ALL your responses MUST be oral, OK? What school did you go to?
ATTORNEY: Do you recall the time that you examined the body?
WITNESS: The autopsy started around 8:30 p.m.
ATTORNEY: And Mr. Denton was dead at the time?
WITNESS: If not, he was by the time I finished.

ATTORNEY: Are you qualified to give a urine sample?
WITNESS: Are you qualified to ask that question?

And the best for last:

ATTORNEY: Doctor, before you performed the autopsy, did you check for a pulse?
ATTORNEY: Did you check for blood pressure?
ATTORNEY: Did you check for breathing?
ATTORNEY: So, then it is possible that the patient was alive when you began the autopsy?
ATTORNEY: How can you be so sure, Doctor?
WITNESS: Because his brain was sitting on my desk in a jar.
ATTORNEY: I see, but could the patient have still been alive,
WITNESS: Yes, it is possible that he could have been alive and
practicing law.



9 Responses

  1. About– 2. Validate reality: “we have to constantly remind them of reality.”…..I had training in dealing with Dementia but it was conflicting info that I received. One teacher would tell us to “go with the flow” with whatever the elder was thinking or doing–that to jolt them back to reality would only confuse them further or scare them.
    The other teacher taught us the above method–validate the reality. So, which is correct???

  2. I sincerely hope that one single solitary court reporter was not subjected to all these!

    This selection of lawyer stories was the funniest thing I have seen or heard. I read them twice and laughed out loud both times.

    Glad you are back!

  3. I can’t imagine what it must feel like to find something difficult which you once found easy.

    Reading your posts gives me the impression that even now you find writing in a cogent, readable and interesting way and a lot easier than most people do, including me!

    I’ll tell you a little story that just might help a little. As I have mentioned before, logic puzzles present no problems for me – I’m used to finding them easy, and don’t really understand how anyone can find them difficult. However I have found something that I am way below average at – map reading in open countryside. My husband and I go walking together. If we’re in really remote areas I believe it’s important that I know where we are even though he’s far better, and faster, at navigating than I am. So I force myself to do the map reading – and he tells me where I’m going wrong even though he only glanced at the map for perhaps 5 minutes over breakfast! In some ways I find this hard – I don’t like being bad at things. Then I began to think: imagine how dyslexics must feel, if they find reading and writing as hard as I find map reading. And I began to see my “disabilty” in a more positive light – because it helps me to be more sympathetic to others’ difficulties.

    I’m not suggesting there’s any parallel with what you are experiencing. But if you do want to review something and you’re finding it hard going, then some of the tricks that us less able writers have to resort to might just help eg making notes as you read the book in some sort of structured way.

    By the way – there’s absolutely no need to respond to my 1-31-2009 comment. I do have another question though – why do psychiatrists need to study other aspects of medicine – anatomy, the digestive system, the urinary system etc? Does a knowledge of how the body works – and malfunctions – physically, have much bearing on the work of a psychiatrist? I’m just curious – please don’t bother to reply unless you feel like it. Other readers of your blog might enlighten me.

  4. […] Another decent blogger placed an observative post today on My confession. Is it Defeat or just good Judgment? A …Here’s a quick excerptThe authors graciously sent me the books which I promised to review and post the review in the blog. I’ve read all 3 of the books which profoundly affected me in positive ways. But I can’t remember enough in order to summarize each book. … The world is getting old and unfortunately, people have lesser time now for our elderly than they had ten years ago. We cannot blame our elderly for these things, because, after all, growing old is inevitable. … […]

  5. LOL! Loved your lawyer jokes!

    On a more serious note, regarding the comment from Barbara, your “go w/the flow” teacher is correct. As caregivers, we need to validate the reality *of the person w/ dementia*, an approach which is called “habilitation.” To try and orient them to our reality leads to agitation, frustration and possibly a catastrophic reaction. A really good book to read is “Learning to Speak Alzheimer’s” by Joanne Koenig Coste in which she talks about the “habilitation.”

  6. In answer to your title question, I think it’s not defeat but good judgment to avoid stress & frustration. Stress can actually cause more confusion. I made the same faux pas under stress as you did– got up 4 hours early for work– and I don’t have dementia! 😉

  7. I also would not have known by your writing that you are having trouble organizing your thoughts.

    As far as the 10 points go:
    #2 validate reality – I have trouble doing this with my grandmother. Most of the time she wants to know the time or what day of the week it is. But there are times when she talks about her husband who died several years ago. She will ask me if I have seen him or talked to him. I just don’t have the heart to remind her that he is dead. I am too afraid she will l become upset. I have never seen my grandmother cry and I don’t know if I could handle it if she did. I try to avoid the question or just tell her that I have not talked with him. Is this wrong of me? Should I be telling her he is dead?

    I agree with Elderly lady about the notes. I have to do that all the time. It really helps. Maybe your wife or children could help you write the reviews based on your notes. By going back and reading them, your memory will possibly be refreshed and you could just dictate.

    I am glad to see you posting again. I really enjoy reading your blog and I have learned a great deal from you.

  8. Reminds me of afew lines in one of the Carlos Casteneda books, when a bewildered Carlos, [having just expeienced a wild flight on top of a huge crow and after ingesting some mescaline mushroom], askes his Mentor, donJuan what he would have expwerienced IF the crow would have had a large ball and chain fasened to it’s leg/
    Without missing a beat the old medicine man stated plainly wih a straight face … ” you would have experienced the same great ride … and the heavy ball and chain would no doubt sailed along with you”.

  9. Hmmm…perhaps you did not give an in-depth analysis of the books, however I would beg to differ with you on the “review” aspect. You read them, liked them and recommended them. Call it the Siskel and Ebert review method…thumbs up or thumb down.

    Your thumbs up recommendation for these books is more than enough for me.

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