Got thirst?

I got thirsty today from working outside (not good). We trimmed, pruned, cut grass and mulched some leaves. Wow! What a great byline for the national nightly news! Applause But it was a lot of fun. Yea, Pam and I are both aching now…………where’s that aspirin??

The last week or so has been much better. In fact, it feels like I did all summer long. I’ve never been able to achieve my baseline since becoming ill but nonetheless I’m OK with that. This LBD truly is cunning, baffling and powerful! One day they will have an answer to all the mysteriousness of the symptomatic fluctuations of Lewy Body Dementia.

So back to being thirsty. I remembered blogging about dehydration last fall. Particularly with regard to the elderly. And in the winter……not just summer (whenever we think of dehydration the most). So I thought I’d cheat and repost it again since winter is right around the corner. Hope it is helpful to someone.

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Signs and Symptoms of Winter Dehydration in the Elderly and 8 Ways to Avoid Them

It’s Winter! Dehydrated? How could I be? Dehydration can occur anytime of the year. We think of summer time as being a time to avoid the sun as well as heat stroke and heat exhaustion. Here are some tips to keep you and your elderly loved ones well hydrated this winter. And to better health!

Dehydration can kill. It is crucial for anyone to stay properly hydrated but it is even more important for seniors who have other comorbidities as well as dementia like diseases. One of the reasons that the dehydration threat is higher for seniors is because of thinner skin that comes with aging. The thinner skin makes a person more prone to losing fluid. Another issue that makes seniors more open to fluid loss is their medications, some medicines can cause you to become easily dehydrated.

A wide array of medical issues can lead to dehydration. Considering that our bodies are made up of 50% to 65% water, this element is critical to virtually all our physical functions. Every organ and system of the body depends on water, so a shortage of fluid can naturally lead to serious health consequences. Dehydration is one of the most frequent causes of hospitalization among people over the age of 65. Worse, at least one study has found that about one-half of those hospitalized for dehydration died within a year of admission. Older people are at greatest risk for dehydration because the mechanism that normally triggers thirst becomes less sensitive with age. In addition, as we age, a lower percentage of our body weight is water, so dehydration can occur more rapidly. Those elderly individuals most vulnerable to dehydration live alone, especially when they are ill. In addition to fluid lost from fever from flu, or diarrhea from a stomach virus, sickness usually interferes with normal eating and drinking patterns.   We lose water in many ways.

  1. Breathing results in humidified air leaving the body
  2. Diarrhea is the most common reason a person loses excess water. A significant amount of water can be lost with each bowel movement. Worldwide, dehydration from diarrhea accounts for many of the deaths in children.
  3. Vomiting can also be a cause of fluid loss; as well, it makes it difficult to replace water by drinking it.
  4. The body can lose significant amounts of water when it tries to cool itself by sweating. Whether the body is hot because of the environment (for example, working in a warm environment), intense exercising in a hot environment, or because a fever is present due to an infection, the body loses a significant amount of water in the form of sweat to cool itself. Depending upon weather conditions, a brisk walk will generate up to 16 ounces of sweat (a pound of water).
  5. In people with diabetes, elevated blood sugar levels cause sugar to spill into the urine and water then follows. Significant dehydration can occur. For this reason, frequent urination and excessive thirst are among the symptoms of diabetes.
  6. Burn victims become dehydrated because water seeps into the damaged skin. Other inflammatory diseases of the skin are also associated with fluid loss.
  7. The inability to drink adequately is the other potential cause of dehydration. Whether it is the lack of availability of water or the lack of strength to drink adequate amounts, this, coupled with routine or extraordinary water losses, can compound the degree of dehydration.
  8. One common side effect of many medicines is increased frequency of urination. You need to compensate for these additional lost fluids by drinking more than usual. Medications that often cause this problem are diuretics, blood pressure drugs, antihistamines and psychiatric drugs.
  9. The aging process can diminish our natural sense of thirst, but if you also suffer from incontinence, you may be reluctant to drink fluids throughout the day. Sipping often in small amounts is essential to avoid becoming dehydrated.

The body’s initial signs and symptoms of dehydration are:

  • Thirst
  • Decreased urine output. The urine will become concentrated and more yellow in color.
  • Fatigue
  • Headache
  • Dry nasal passages
  • Dry, cracked lips dry mouth the eyes stop making tears sweating may stop muscle cramps nausea and vomiting lightheadedness (especially when standing). weakness will occur as the brain and other body organs receive less blood.
  • Coma and organ failure will occur if the dehydration remains untreated.
  • Irritability & confusion in the elderly should also be heeded immediately.

Here are some easy remedies and ways to prevent dehydration:

  1. As is often the case in medicine, prevention is the important first step in the treatment of dehydration.
  2. Fluid replacement is the treatment for dehydration. This can include: water, juice, soups and clear broths, Popsicles, Jell-O, ice cream, milk, puddings, decaffeinated beverages, Kool-Aid, nutritional drink supplements (Ensure, Boost, Sustacal, Resource and instant breakfast drinks), and replacement fluids that may contain electrolytes (Pedialyte, Gatorade, Powerade, etc.)
  3. Reduce or eliminate dehydrating beverages such as coffee, tea and soft drinks (unless decaffeinated). But even decaffeinated drinks can contribute to dehydration. Beware of alcohol intake too. Alcoholic beverages increase risk of dehydration because the body requires additional water to metabolize alcohol and it also acts as a diuretic.
  4. If you drink the unhealthy beverages, you need to add even more water to you daily total. The dehydration caused by those drinks must be compensated for by increasing the water.
  5. Eat lots of fruits and vegetables. Most have a high water content.
  6. Drink water all day long in small amounts. It is not good to suddenly gulp down 64 ounces of water. You can fill a 24-32 ounce tumbler in the morning, refill it by late morning and refill again for the afternoon. Consume that by 5 PM. Most people need to start limiting fluids 1-3 hours before bedtime.
  7. Individuals with vomiting and diarrhea can try to alter their diet and use medications to control symptoms to minimize water loss. Acetaminophen or ibuprofen may be used to control fever.
  8. If an individual becomes confused or lethargic; if there is persistent, uncontrolled fever, vomiting, or diarrhea; or if there are any other specific concerns, then medical care should be accessed. Call 911 for any patient with altered mental status – confusion, lethargy, or coma.

Remember that the lack of a sense of thirst is not a reliable indicator of the need for water. You need water long before you feel thirsty.

Warmly………….David

Dementia and Alzheimer’s Caregivers Make the Holidays Wonderful

I wish a very Happy Thanksgiving to all!

I found this article to be powerfully helpful! http://www.articlesbase.com/elderly-care-articles/dementia-and-alzheimers-caregivers-make-the-holidays-wonderful-656355.html

 

David

Signs and Symptoms of Winter Dehydration in the Elderly and 8 Ways to Avoid Them

It’s Winter! Dehydrated? How could I be? Dehydration can occur anytime of the year. We think of summer time as being a time to avoid the sun as well as heat stroke and heat exhaustion. Here are some tips to keep you and your elderly loved ones well hydrated this winter. And to better health!

Dehydration can kill. It is crucial for anyone to stay properly hydrated but it is even more important for seniors who have other comorbidities as well as dementia like diseases. One of the reasons that the dehydration threat is higher for seniors is because of thinner skin that comes with aging. The thinner skin makes a person more prone to losing fluid. Another issue that makes seniors more open to fluid loss is their medications, some medicines can cause you to become easily dehydrated.

A wide array of medical issues can lead to dehydration. Considering that our bodies are made up of 50% to 65% water, this element is critical to virtually all our physical functions. Every organ and system of the body depends on water, so a shortage of fluid can naturally lead to serious health consequences. Dehydration is one of the most frequent causes of hospitalization among people over the age of 65. Worse, at least one study has found that about one-half of those hospitalized for dehydration died within a year of admission. Older people are at greatest risk for dehydration because the mechanism that normally triggers thirst becomes less sensitive with age. In addition, as we age, a lower percentage of our body weight is water, so dehydration can occur more rapidly. Those elderly individuals most vulnerable to dehydration live alone, especially when they are ill. In addition to fluid lost from fever from flu, or diarrhea from a stomach virus, sickness usually interferes with normal eating and drinking patterns.   We lose water in many ways.  

  1. Breathing results in humidified air leaving the body
  2. Diarrhea is the most common reason a person loses excess water. A significant amount of water can be lost with each bowel movement. Worldwide, dehydration from diarrhea accounts for many of the deaths in children.
  3. Vomiting can also be a cause of fluid loss; as well, it makes it difficult to replace water by drinking it.
  4. The body can lose significant amounts of water when it tries to cool itself by sweating. Whether the body is hot because of the environment (for example, working in a warm environment), intense exercising in a hot environment, or because a fever is present due to an infection, the body loses a significant amount of water in the form of sweat to cool itself. Depending upon weather conditions, a brisk walk will generate up to 16 ounces of sweat (a pound of water).
  5. In people with diabetes, elevated blood sugar levels cause sugar to spill into the urine and water then follows. Significant dehydration can occur. For this reason, frequent urination and excessive thirst are among the symptoms of diabetes.
  6. Burn victims become dehydrated because water seeps into the damaged skin. Other inflammatory diseases of the skin are also associated with fluid loss.
  7. The inability to drink adequately is the other potential cause of dehydration. Whether it is the lack of availability of water or the lack of strength to drink adequate amounts, this, coupled with routine or extraordinary water losses, can compound the degree of dehydration.
  8. One common side effect of many medicines is increased frequency of urination. You need to compensate for these additional lost fluids by drinking more than usual. Medications that often cause this problem are diuretics, blood pressure drugs, antihistamines and psychiatric drugs.
  9. The aging process can diminish our natural sense of thirst, but if you also suffer from incontinence, you may be reluctant to drink fluids throughout the day. Sipping often in small amounts is essential to avoid becoming dehydrated. 

The body’s initial signs and symptoms of dehydration are:  

  • Thirst
  • Decreased urine output. The urine will become concentrated and more yellow in color.
  • Fatigue
  • Headache
  • Dry nasal passages
  • Dry, cracked lips dry mouth the eyes stop making tears sweating may stop muscle cramps nausea and vomiting lightheadedness (especially when standing). weakness will occur as the brain and other body organs receive less blood.
  • Coma and organ failure will occur if the dehydration remains untreated.
  • Irritability & confusion in the elderly should also be heeded immediately. 

Here are some easy remedies and ways to prevent dehydration: 

  1. As is often the case in medicine, prevention is the important first step in the treatment of dehydration.
  2. Fluid replacement is the treatment for dehydration. This can include: water, juice, soups and clear broths, Popsicles, Jell-O, ice cream, milk, puddings, decaffeinated beverages, Kool-Aid, nutritional drink supplements (Ensure, Boost, Sustacal, Resource and instant breakfast drinks), and replacement fluids that may contain electrolytes (Pedialyte, Gatorade, Powerade, etc.)
  3. Reduce or eliminate dehydrating beverages such as coffee, tea and soft drinks (unless decaffeinated). But even decaffeinated drinks can contribute to dehydration. Beware of alcohol intake too. Alcoholic beverages increase risk of dehydration because the body requires additional water to metabolize alcohol and it also acts as a diuretic.
  4. If you drink the unhealthy beverages, you need to add even more water to you daily total. The dehydration caused by those drinks must be compensated for by increasing the water.
  5. Eat lots of fruits and vegetables. Most have a high water content.
  6. Drink water all day long in small amounts. It is not good to suddenly gulp down 64 ounces of water. You can fill a 24-32 ounce tumbler in the morning, refill it by late morning and refill again for the afternoon. Consume that by 5 PM. Most people need to start limiting fluids 1-3 hours before bedtime.
  7. Individuals with vomiting and diarrhea can try to alter their diet and use medications to control symptoms to minimize water loss. Acetaminophen or ibuprofen may be used to control fever.
  8. If an individual becomes confused or lethargic; if there is persistent, uncontrolled fever, vomiting, or diarrhea; or if there are any other specific concerns, then medical care should be accessed. Call 911 for any patient with altered mental status – confusion, lethargy, or coma. 

Remember that the lack of a sense of thirst is not a reliable indicator of the need for water. You need water long before you feel thirsty.  

[This Article was written for Ezine Articles]

 

David

Personal Review of “Life in the Balance” by Thomas Graboys, M.D. with Peter Zheutlin

Life in the Balance

A Physician's Memoir of Life, Love, and Loss with Parkinson's Disease and Dementia

Today I thought I would write a little bit about the book “Life in the Balance” written by Thomas Graboys, M.D. with Peter Zheutlin.

I must remind myself that I am not an expert professional book reviewer. The following is strictly my personal opinion seen through the eyes of another physician. I am fully aware that many will disagree with me.

The thought that leaped at me as I read the book was the tone rather than the content of his writing. It is a book of his memoirs which permits him to express himself in anyway he chooses. Dr. Graboys and Peter Zheutlin are direct and honest.

They nicely describe part of his background of being in a boarding school, part of his college days and his love of sports. The description of the Boston medical community is superb! There is a pervasive belief among physicians that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions). The sense of self-importance seems to reign high as well as the need to be recognized as superior and successful. They tend to avoid their weaknesses and work hard for prolonged periods of time under colossal fears of failure, anxieties, expectancies and stress. I have attended many medical conferences in Boston. The majority of the speakers and lecturers appear to require excessive admiration. It appears that they give off a false sense of modesty. These characteristics are also seen in other medical communities around the country as well as in many physicians working in the private sectors, perhaps to a lesser degree. When discussing these leading experts, many physicians attending the meetings would refer to them as “snobs” and as being pretentious.

As a psychiatrist, I highly suspect that this is a defense mechanism to skirt their feelings of flaws, shortcomings and imperfections. I ask myself, “Are they ever satisfied with themselves?” Part of me feels sorry for them for having to maintain the status quo. Their internal naggings must be considerably excruciating.

Beginning with the forward, there seems to be a bright portrayal of Dr. Graboys being the “perfect” physician. A godlike physician on a pedestal. Having an “Ozzie and Harriet” like family. However, to his credit, Dr. Graboys openly discusses his insecurities and his strong sense of pride, e.g., not easily being able to tell others in public that he has Parkinson’s disease which results in embarrassment as he fumbles with his hands or stumbles as he walks. Many people see these as weaknesses but I sense Dr. Graboys is attempting to turn them into his friends and strengths as he grapples with the devastating symptoms of Parkinson’s disease and Lewy Body dementia.

He has an illusive style of teaching. Although he aptly describes Parkinson’s disease there seems to be a paucity of details of his probable Lewy Body symptoms.

He has a phenomenal support system and credit must be given to his wife and his family. He also has a strong support system with friends and professional colleagues. He clearly refuses to surrender to the painful effects of his disease. He is honest with his feelings. I like his self sensitivity as well as his profound sensitivity for others. He has not given up and perseveres daily to maintain a sense of balance and of well being.

Why does he continue to drive? Why does he put himself and others at risk? Even if he is driving only short distances. Why does he continue to go to his office? Perhaps it is to help preserve his sense of self and sense of importance. Something we all need. Even though he may not be prudent in driving a car given the severity of his symptomatology, I applaud him for exploring many other avenues of daily living. Spinning seems to soothe him intensely. Forcing himself to continue to socialize and going to parties is an asset even though difficult to do.

His ponderings and reflections on marriage, friendships, love and children enlighten me on how important they are. Something which many of us take for granted. The ongoing ruminating description, however, tended to bore me. I had to put the book down too many times. Not because of the content of the book but because of the lack of movement and provocation for me. Dr. Graboys suggests that he is able to live one day at a time. However, I did not feel uplifted with hope by the time I finished reading the book.

Overall, the book is a persuasive and heartrending depiction of a physician who disallows his illness to pilfer his joy and dignity.

 

Please feel free to post a comment.

 

David

Adorable Photographs of Our Baby: Meaningful, Mind Stimulating Activities and More for the Memory Challenged, Their Loved Ones, and Involved Professionals

The author, Susan Berg, is donating a portion of the proceeds of the sale of this book to the Alzheimer’s Association.

In light of recent research, activities should take on a whole new dimension in long-term care. Activities can no longer be thought of as leisure time fillers, but rather, as opportunities to provide mental stimulation. If done thoughtfully, activities can help those with Alzheimer’s disease hold on to their remaining cognitive skills longer and enhance mood. In a word, activities should be “therapeutic”. Susan Berg’s book is a treasure-trove of therapeutic activities that can bring joy and purpose to those with a cognitive impairment.

Paul Raia, Ph.D, Director of Patient Care and Family Support
Alzheimer’s Association, Massachusetts Chapter

 

Susan Berg’s book is a must have for the Activities Professional and anyone who is caring for an individual with dementia. The baby pictures are delightful. The discussion questions will stimulate many memories, and the additional activity ideas will aid in holding the attention of dementia persons. This is a great tool for someone who has never assisted an individual with dementia, and it is also beneficial to the seasoned Activities Professional.

Brenda Bogart, A.D. Activities on a Shoestring
http://www.angelfire.com/in/shoestring, Crawfordsville, Indiana

 

Therapeutic activities are what we should all strive for when doing activities. I was very impressed with the involvement you created with the dementia population in this book. I am going to incorporate these ideas with the population I serve. God bless you for your caring and concern for others with such a tremendous need. I plan to share this information with caregivers.

Lisa Patton CSS Technician, Adult Life Programs
Hickory, North Carolina

 

Brenda I have had the pleasure of using Susan Berg’s book with residents having various stages of Alzheimer’s disease in both large and small group settings. This book is full of great ideas for discussion and reminiscing groups. I recommend this book to Activity professionals, caregivers and family members, alike.

Patrick, Dementia Unit Activity Coordinator
Beverly, Massachusetts

 

The book was very insightful. I especially enjoyed the pictures that the staff and family can use. They will help me communicate with the memory challenged and provide a personal touch while I am doing it. The ideas were also very helpful because they can involve people with all stages of dementia and can easily be adapted for verbal and nonverbal individuals. I give the book two thumbs up.

Vernessa LuShaun Burgess, CNA
Delray Beach, Florida

 

Susan Berg’s book is filled with heart-warming pictures of endearingly adorable babies that will leave any person feeling pleased and enchanted. The pictures reflect on many daily routines accompanied by discussion ideas that may help guide you through a therapeutic conversation with a person(s) affected by dementia. The book can be used as a tool in providing mentally stimulating one-to-one and/or group discussions.

Andrea Wolfram, Recreation Facilitator
Winnepeg, Manitoba

Age and Anecdotes

bird-of-paradise

 

I’m with the world again today. Friday evening I only slept about 4 hours. Yesterday I had a headache, was confused and very tired but couldn’t seem to be able to even take a nap. I could barely knit. Just amazing what sleep, or the lack thereof, does for us! I’ve added two new blogs to the Blogroll today. Check them out at http://alzact.today.com/ and http://dementia.today.com/

Did you know that McDonald’s did away with its spoon-shaped coffee stirrers because people were using them as cocaine spoons?

As we grow older, our bodies get shorter and our anecdotes longer. Robert Quillen

David

Update from the Lewy Body Dementia Association

This is from the LBDA’s email update to me yesterday:

Greetings!

 The Fall 2008 Issue of the Lewy Body Digest newsletter is now available. In this issue you will find:

– News of an LBDA publication for people newly diagnosed with LBD and those still seeking answers

– A great story on how the right treatment for LBD can improve the quality of life

– A reported breakthrough in LBD scientific research

– And much more!

Please visit us online today to view the Fall 2008 issue of the Lewy Body Digest. Click on http://www.lbda.org/category/3477&cfid=117027-lbda-newsletter.htm where you can view, download and print this issue, as well as previous issues of the Lewy Body Digest. We hope you enjoy this edition of the Lewy Body Digest!

Warm Regards,

The LBDA Team

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