Move it, Move it

What is all the fuss about staying active? 

If you search Physical Health on the internet, you get about 868,000,000 results in .26 seconds. It seems that everyone has something to say about it. Being active can help prevent or lessen chronic health problems such as heart disease, diabetes or arthritis. There is also evidence that exercise improves brain function as we age. There are four exercise categories that work together to improve overall quality of life: endurance, strength, balance and flexibility. (NIH) This gives a whole new meaning to 'use it, or lose it!'

It is amazing how fast we can lose it if we don't use it. After five weeks in the hospital, my mother was moved to a skilled nursing center for wound care and physical and occupational therapy. Physical therapy focuses on the four categories of endurance, strength, balance and flexibility, where occupational therapy focuses on mental and mechanical coordination like sitting up, dressing in the proper order, combing your hair, eating etc.  Before her illness, she could do moderate to high physically demanding work; yard work, house work, moving furniture, washing windows, climbing ladders, trimming, painting, hanging wallpaper. There wasn't much she asked for help with. Not bad for a 78 year old. When she arrived at the skilled nursing center she could not walk, go to the bathroom, or sit up in bed on her own. The physical therapy sessions were emotionally draining. The first time she put full weight on her legs she cried. I had never seen my mother so weak, and paralyzed with fear and anxiety. She was so willing to give up, but the physical therapists coached, pushed and encouraged her every step of the way. There wasn't a physical reason why she couldn't gain her mobility back.   

Mom on her daily walk

The physical therapists explained that for every day we are in bed (with a cold or whatever), it takes 2.5 days to physically regain our strength. Muscle atrophy starts to set in that fast. Muscle recovery takes even longer for someone over 65. So if you do the math under the best of circumstances...she was hospitalized for 87.5 days. That requires about 219 days to recover... that is without any other complication like a massive incision or battles with infection! The therapists gave her a goal in order to go home. She had to walk 100 feet with a walker. Goals can be a powerful motivator. She came home after three and a half months. She still wasn't able to lift her legs into bed, needed a wheelchair/walker to get around and needed assistance with showering and dressing. Regaining her strength accelerated when she was able to sleep uninterrupted, had a better diet (high protein) and continued her exercise routine. Her will had returned and a little over a month later, she climbed the stairs on Christmas day. 

Notice we are talking about physical activity not necessarily getting 'fit.' Muscle loss in the elderly is called sarcopenia. It starts in our 40's and 50's and progresses at .6%  each year. Adults in the US over the age of 50, participating in resistance exercise is very low (NCBI). According to the US Center for Disease Control and Prevention,  adults 65 years and older require a minimum of two and half hours of moderate aerobic exercise and muscle strengthening exercises each week. Preferably, broken down into 30 minute increments each day. If you think you can't afford that commitment, you can still benefit in three 10 minute intervals. Increasing that to five hours each week will increase the benefits even more. How many of us spend more time than this on the phone, watching television or just sitting quietly?

I had three different conversations with people this week that went something like this: 

"if he/she was living such a healthy lifestyle and still got sick, what is the incentive to work so hard at it if you are still going to get disease?" 

Some of it is genetics, but I'm going to steal the explanation from one of my mothers doctors. "If you didn't take such good care of yourself, you wouldn't be here at all." Bad stuff is going to happen. If you can prevent or lessen the impact of chronic disease, why wouldn't you?  

History is making a case that extreme lifestyles are not good for us. Our great-grandparents were pre-industrial age and wore themselves out in their 40's. Life-expectancy wasn't so good. Fast forward to the technology age and this is the first time medical experts are predicting that children will not live as long as their parents because of sedentary lifestyles. Genetics will only get us so far. We need the pendulum to swing back to center to a work-life balance. I know that term is way over-used, but firmly believe there is truth in this. I was working 16-18 hour days sitting at a desk in a high stress position. Some days I would only walk about 1400 steps (10,000 is the recommended minimum) and that was mostly due to the fact that I had to walk to and from the parking lot. I had trouble standing, sleeping, my balance was off and had become an unhealthy weight. I was going down a path of self destruction and needed to set some boundaries around personal time and dedicate a commitment to my own health. While others around you can help, you have to do the work.

Physical activity is the basis of physical and mental well-being, especially as we age. It has to become part of our life-style. Check out some of the reference site links in this discussion. You don't have to hire a personal trainer. You don't have to dedicate large chunks of time. Just find something you enjoy that gets you and your family off the couch, or out from in front of the computer.  

Here is a motivating song to put a pep in your step. I love the Madagascar series and made this my theme song the first time I heard it...love the dancing granny. ;-)

https://www.youtube.com/watch?v=z0qkUIFEtXM

The Golden Rule

Have you ever had an epic, turning-point week? Maybe you passed a big test, had an important doctor's appointment, received good news about a job interview, or someone came home safely after a long journey. Our family had all of these things happen!

I think the most inspiring conversation that happened this week was with my mother's surgeon. She had her sixth month assessment to determine if she was ready to have the second phase surgery to have the ostomy reversed. The doctor didn't recognize her. The last time she had been to see him, she was in a wheelchair and honestly looked pretty rough. She was told to gain weight and work on getting her strength back. He made it very clear that she wouldn't have the second surgery if she wasn't, at least, as strong as she was before her illness. When she came home, I had to lift her in and out of bed, help her dress, prepare her food, dispense her medicine and assist with basic hygiene needs. Today she does almost everything on her own. We've returned the wheelchair and she takes her dog on a walk at least once a day. Because she had worked so hard, it was a little disheartening that the doctor had to leave the room to read her history to continue our discussion. This appointment was the single goal my mother had for the past 7 months. It was her first thought in the morning and the last thought before she fell asleep. ~He returned after only a few minutes and said, "now I remember you!" He recalled many of the horrible details of being in the ICU for 3 weeks. That is when he told us about the Golden Rule.

"So in everything, do to others what you would have them do to you..."     Matt 7:12

I think it is important to understand a doctor's mindset and his philosophy about having someone's life in their hands. Is it a speed competition or does he see himself and his patient as being one? He proceeded to tell us that his peers often criticize him for being so slow with his surgeries. He said he doesn't care what they think, because of the Golden Rule. And, if they are going to give him such hard time, they need to get it right. He isn't slow, he is thorough. His anxiety, confidence, and success are his patients anxiety, confidence and success. He was once asked if he could operate on his child and he said "yes, because I have the same approach with everyone. There isn't anything I would do different for my child than what I would do for one of my patients." This boils down to trust.

He was open and honest about the complexity of the surgery and discussed potential complications with a backup plan if any problem became a reality.  We didn't feel rushed, we had our questions answered in detail and walked out satisfied that we found the right person to do this. We see him as a person, a partner, not just the surgeon that was on-call.

I think the take-away from this is, do you trust your doctor? Do they follow the Golden Rule? It is critical to have this Golden relationship with your doctor, your caregiver, your financial advisor. Don't settle for anything less.

Have a Remarkable Day

I think about losing all of my precious friends and family and it makes me think of how hard it would be to live in this world under those conditions. I was reminded of a letter of thanksgiving I had posted on my FB page last October. My mother was finally well enough to be asked how to respond to my Grandmother's delusions and depression. She told me that she gathers a bunch of mail (mostly advertisements and cooking magazines) and has her open it with a cup of tea and a couple of cookies. This seemed to help. I had been throwing out the mountains of junk mail and election advertisements in anticipation of moving them and didn't have anything for her. So, I reached out to my FB friends and asked if they would take a moment to send her a simple card for her 101st birthday. It didn't matter if she knew them personally or how much the card cost. She was overwhelmed with the responses. Every day for several weeks she received well wishes. After awhile, I had to lock the front yard gate because she was going to the mailbox on her own checking for mail and I was worried she would fall on the loose gravel. These acts of kindness brought her hours of joy. These wonderful friends of mine also remembered her on Halloween, Thanksgiving and Christmas. She was an adopted Grandmother of my friends and their friends.

Thought for the day:  Can I take a few minutes to reach out to someone that needs an ear to listen, a shoulder to cry on or a smile to get them though a difficult time? Celebrating is easy, but lifting someone up when they need it is remarkable.

Open letter to family, friends and friends-of-friends...
 

Thanks to all of you that sent my Grandmother the heart-felt birthday wishes. It really made a difference in her spirit. For the past month, I have been packing my mother's belongings (trust me, she doesn't have the word down-size in her vocabulary) so that we can move both of them in with my husband and I. I think for someone that is completely dependent on the familiarity and routine of her environment and the caregivers that surround her, my Grandmother is probably suffering from the changes in her life as much as my mom is.

~A special shout out to Cathy. Caregiving is a special calling. You have my admiration.

~An over achievers award goes to my cousin Lorraine. The 80 something cards and letters from the 1st and 2nd graders at St Hedwig school was genius. The drawings and well wishes are priceless as well as my Grandmothers comments. They are all her personal friends now.

~Andrea, thank you for the royal purple "papoochees" (polish for slippers). They match her tiara. wink emoticon
 

I believe that when we feel we are valued and have loved ones that help dry our tears, give a soft pillow to ease our tired bones, or to take the time out of our busy lives to say hi, it gives a little energy and happiness to that person.

BTW, Grandma participated in the group physical therapy session today at my moms skilled nursing center. She was an inspiration.

These acts of kindness don't take much effort on our part, but make a huge impact on those we touch.

 Thanks again, and have a wonderful weekend.

Money, Money

When it comes to money, my parents philosophies are on opposite ends of the financial spectrum. My father was a young teenager in Holland when Germany began its occupation during WWII. There were ten children in the family and extreme measures were required to keep the family alive. In 1945, the last year of the war, they were living on one loaf of bread, per person, per week. People weren't just starving in the concentration camps (- thank you American Red Cross for saving so many). He immigrated to the U.S. in the late 1950's where he was sponsored by his brother and a Dairy farmer (working as basically an indentured servant) for a year. Then he took a factory job where he had an accident and lost two fingers on his right hand. He had formal training in the flower hot-houses in the Netherlands, so he decided to start his own landscaping business. He paid his taxes quarterly and bought business licenses in all the cities he worked in. Everything by-the-book. I'm skipping all the good stories for a later time, but he worked hard, saved and did some investing that helped his nest egg. He is a planner. He has a Family Trust, knows how he wants things handled and has made all the legal arrangements. He's talked to my siblings and I, and flat-out told us that if anything is contested, you are "cut out." He wants his body donated to science and then cremated. No fuzzy questions here. ~Dad, have I told you that I love you lately?

My mother hasn't been so disciplined. She came from a working class family that, until her and her sister's generation, had little education. I describe her as a free spirit. She's a cross between a  'flower child' and patriot. She made good money as an RN, but started her retirement fund late in life as being a single mother to 3 children, then supporting my sister and her two children, brought other priorities. When the economy went bad and my Grandmother came to live with her, she used her savings to maintain her lifestyle. When you are active, independent, living life how you want... able to support family, church and other charitable organizations, the last thing on your mind is catastrophic illness, long-term care, how the bills will get paid if you can't make sound financial decisions. --Right?  

When you are healthy is exactly when you should think of these things!

I'm not a professional in this area, but I do know as an executor, rescuer, caregiver, responsible party etc., how overwhelming it is to step into this role not knowing where the paperwork is, or who has had access to it. About 7 year's ago, my mom came to my house and announced that she wanted me to be a signer on her  bank account. I had reservations about this. Would I have to pay taxes on her balance? Would it hurt my credit if she became overdrawn? Would I be responsible for charges incurred? I was happy that my mom was preparing for her future and was hoping it would be enough. I didn't protest and naively signed my name on the dotted line. I say naively, because I didn't push her to do more. Understand that my mother wasn't irresponsible, but she was too trusting of people that took advantage - multiple times. Frankly, I completely forgot about being a signer until her illness. Boy, was I glad I was on the account when she couldn't manage anything for over 7 months! Two weeks before her emergency surgery she started a will, but had no witness' signature, so it really wasn't valid. Only the DNR (Do Not Resuscitate) order was notarized. Every medical facility wanted a copy of that!

I cautiously state my opinion in this matter because I don't want to come across as insensitive, harsh, or that I'm throwing my mother under the bus. She is a fierce prayer warrior, loyal friend and the worlds best encourager.  I'm not giving professional advice but want to paint a picture of the anxiety of stepping into someones shoes without official instructions and not really knowing their wishes. It is not OK to be passive or procrastinate in the area of financial planning or authorization boundaries. So many things, of a legal and harmonious nature, are dependent on this (see conversation starters below). If you are an independent adult, you must make decisions and have crucial conversations with the adults in your immediate family (children should grow up hearing these conversations too). Many Senior Centers have volunteers that do this paperwork legally and for little to no-charge. I read an article the other day that said people in their 20's are starting retirement accounts where their parents didn't do much until their 30's. I guess our kids are smarter than we are at times! There are other low-cost options where you can get advice and legally binding forms. Google it.  Since I'm stepping out here, I also want to say that it is not OK to have your children as your intentional financial back-up plan. Even though my husband and I were willing to step-up for whatever was needed, I wasn't working, lived in another state, became my Grandmother's caregiver (meaning I could not work outside the home), was my mother's advocate and was driving 1-2 times a day to the hospital and skilled nursing center, renovated a house for handicap accessibility and basic move-in readiness. Then moved my mother's belongings and my Grandmother all in 3 months. While even the best laid plans would have been tested, not having the ability to pay moving, utility expenses, rent and my mother's insurance co-pays would have brought two house-holds down.

A wise man once said, "Hind sight is crystal clear." I look back on the past year and see our heavenly father's hand of protection and provision in every event and every step we took.  Faith in God brings perspective and hope. Everything was orchestrated down to the letter for my mother's recovery. That is a blessing that I'm going to claim. All I had was faith because I didn't have foresight. 

These are some things to get a conversation going:
Disclaimer: Some of these topics are from our personal story. Discussions are unique and personal. They should be held before a crisis occurs and should strengthen family ties rather than tear them apart. The important thing is to not hold back and have open and honest conversations.

• Forget death, you don't know the day nor the hour. It just doesn't work like that. If something happens where you are not able to make competent decisions, who do you want to be your financial or medical representative?
• Do they know where your written instructions are?
• Are the instructions complete or are there unaddressed items?
• Once you select a representative, (and they agree by-the-way) how will you transition the responsibility back once recovery has happened? This can be controversial. My mother didn't come to me and my husband saying she was ready to take back control. For some reason she had an acquaintance take her to the bank to get balances and statements. We had changed everything to online banking and she was upset that she didn't have any checks. We had set up email and text notifications whenever threshold activity was exceeded because of prior fraud activity, so it wasn't long before we knew she was moving money into her savings from checking. The bank statements didn't show itemization on why money was moved or withdrawn. When we provided her an itemized breakdown of everything that went in and out of her account, she said she was "devastated." Her focus is on getting a car so that she can be completely independent again. She didn't have a nest egg, so this goal is going to take considerably longer than she was expecting.
• I think most people would want to recover at home. But, what if your -condition requires more care than your loved ones can provide or that your insurance provides coverage for? 
• Most insurance coverage has a 90 days per year cap for skilled nursing rehabilitation. How will you plan for this?
• Are you aware that Home Health and Insurance providers will try to pass off some medical treatments to the family? Do you know your rights and have your really looked into your medical coverage?
• Most of this conversation has been directed toward Parent/Child relationships. Spouses are part of this equation and typically a package deal. Are they participating in these conversations? These situations are very stressful and relationships can be tested.
• Our story was complicated by the fact that my mother was my 101 year old Grandmother's caregiver. She had dementia, kidney disease, digestive sensitivities and advanced osteoporosis. I had no playbook to deal with her issues. Is there anything that you are exclusively doing that is critical for the safety, security and comfort of someone else?
• What about a pet? My mother's dog was untrained, spoiled and had the run of the neighborhood. He marked his territory wherever he fancied. But, was a constant companion for my Grandmother. She remembered his name, but had no clue who I was. We made obedience training a priority and learned to hold our tongue in front of my mother. 

Do you have any other topics that should be brought up in a family meeting? I've elaborated about my mother and Grandmother, but my husband and I need to have the same discussions with our kids. Considering they are in their early to mid-20's, it's going to be interesting.