This week in pathophysiology we are studying endocrine functions. More specifically, we are focusing upon which structures secrete particular hormones, what triggers the release, and how the hormone affects bodily function. With some hormones, a releasing hormone from the hypothalamus is necessary for their secretion to begin. These hormones travel through the blood stream to initiate the action of their target cells (structures).
These hormones regulate changes/challenges called stress responses. When exposed to repeated stress, these response mechanisms become depleted and reach levels of diminishing return, therefore rather than the restoration of normal function, damage results. The ways in which these organ systems can be affected are by way of: the Immune defense system, Cancer (tumor growth cells), Cardiovascular disorders, Metabolic disorders, GI disorders, Reproductive and sexual disorders, Respiratory disorders, Musculoskeletal disorders, Pain, and Sleep patterns.
A friend of mine has chronic pain associated with rheumatoid arthritis. Acute pain is considered adaptive and in response to specific trauma or tissue injury, whereas chronic pain lasts beyond 6 months, and is no longer just adaptive, and can influence other functioning. The cycle of stress, inflammatory response, and pain are evident. Her painful episodes trigger the hypothalamus to release epinephrine and norepinephrine via the sympathetic nervous system, which in turn initiates the secretion of releasing hormones that reach the pituitary and the pituitary gland secretes other hormones that travel to the inflamed tissues. Although each time we respond to stress or pain we don't normally think about the body's endocrine responses, its helpful to look back and take the time to consider the complexity of our mind and body connection.
Sunday, February 8, 2009
Chronic stress and biologic responses
In the blog I posted yesterday reference was made to the first two stages of the general adaptation syndrome. The first being: Alarm (response of the body to stress--epinephrine release) and the second Resistance (adaptive responses to the stressor--appraisal and coping).
In instances where the stress is prolonged the body reaches the third stage of Exhaustion. Exhaustion refers to the inability of the body to maintain the adaptive responses needed to maintain functional equilibrium. Any condition of change or challenge that places tension/strain is considered stress, and when this interferes with normal functioning, illness and disease can result.
Recently I was able to interview a patient who had an autoimmune disease. That patient, when exposed to prolonged stress would exhibit signs of being in the exhaustion stage and would suffer inflammatory responses/flare ups as a result. The patient was able to effectively maintain optimal health when careful consideration was given to diet, sleep, and compliance to medications.
In instances where the stress is prolonged the body reaches the third stage of Exhaustion. Exhaustion refers to the inability of the body to maintain the adaptive responses needed to maintain functional equilibrium. Any condition of change or challenge that places tension/strain is considered stress, and when this interferes with normal functioning, illness and disease can result.
Recently I was able to interview a patient who had an autoimmune disease. That patient, when exposed to prolonged stress would exhibit signs of being in the exhaustion stage and would suffer inflammatory responses/flare ups as a result. The patient was able to effectively maintain optimal health when careful consideration was given to diet, sleep, and compliance to medications.
Saturday, February 7, 2009
Stages of General adaptation syndrome
As noted on page 112 of our test, Hans Selye was among the first researchers to present the notion that the body's response to stress, which are healthy, when endured for extended periods of time can cause homeostatic imbalance and lead to illness and disease. Stress defined as a condition of change, strain, or disequilibrium has been found to affect both the body and mind through various interacting domains such as genetic or biologic response, behavior (coping), cognition, sociocultural values, and life events (environmental).
Theory suggests that the disequilibrium in any of the above mentioned domains will affect the other in some interconnected way. When chronic stress affects an individual to the point that they can not return to a normal individual range of balance between their five domains, it is likely that the body will naturally respond to maintain this equilibrium. An example of the biological response domain would be a direct surge of incoming sensory information.
One day this week it snowed, and the back roads I drive to class are often covered by shade. Several icy patches were left, even after the sun melted most of the snow. During my drive I was very cautious when I spotted icy patches ahead. A small truck that was directly in front of me hydroplaned on one of the patches and I had to compensate by carefully pumping my breaks. Aware of the epinephrine that my nervous system secreted rapidly and the surge of hormones secreted by my endocrine glands, I recognized this as the flight or fight response (biologic and cognitive). It was brief and necessary stress needed to adapt to the situation. Since it was brief, my body quickly adapted. It is understandable how continued responses without return to homeostasis could lead to chronic stress and illness.
Theory suggests that the disequilibrium in any of the above mentioned domains will affect the other in some interconnected way. When chronic stress affects an individual to the point that they can not return to a normal individual range of balance between their five domains, it is likely that the body will naturally respond to maintain this equilibrium. An example of the biological response domain would be a direct surge of incoming sensory information.
One day this week it snowed, and the back roads I drive to class are often covered by shade. Several icy patches were left, even after the sun melted most of the snow. During my drive I was very cautious when I spotted icy patches ahead. A small truck that was directly in front of me hydroplaned on one of the patches and I had to compensate by carefully pumping my breaks. Aware of the epinephrine that my nervous system secreted rapidly and the surge of hormones secreted by my endocrine glands, I recognized this as the flight or fight response (biologic and cognitive). It was brief and necessary stress needed to adapt to the situation. Since it was brief, my body quickly adapted. It is understandable how continued responses without return to homeostasis could lead to chronic stress and illness.
Saturday, January 31, 2009
Interpersonal verses Impersonal thoughts about death and dying
In this blog I'll continue to focus on the text reading from this week. In particular the section about the role of the health care provider in the process of their patients who may be facing death. Often patients and their families express discouragement and disappointment in the way their health care provider has notified them of terminal illnesses, their treatment during the progression of the disease, and even the actual transition to death itself.
There is a necessary balance that health care providers should maintain so that they are able to express to their patients and patents' families that they are connected to them personally, yet not so personally connected that their professional judgement is altered in any way. It is important to keep the focus on the needs of the patient and their family, so that they don't feel responsible for consoling the health care provider.
This concept is presented in the text as intrapersonal death over impersonal death. Impersonal death would be when a health care provider simply goes through the motions of reading a chart, making rounds, or visiting with the patient routinely without expressing or showing any degree of understanding or connection to the person as a whole. Often this is a coping mechanism, yet it is not best for those going through the stages of dying: denial, anger, bargaining, depression, acceptance. As noted on page 82, it is the truly gifted practitioners who is able to attain intrapersonal and impersonal balance when conveying emotional connection without compromising the needs of the patient or his/her own personal judgement.
There is a necessary balance that health care providers should maintain so that they are able to express to their patients and patents' families that they are connected to them personally, yet not so personally connected that their professional judgement is altered in any way. It is important to keep the focus on the needs of the patient and their family, so that they don't feel responsible for consoling the health care provider.
This concept is presented in the text as intrapersonal death over impersonal death. Impersonal death would be when a health care provider simply goes through the motions of reading a chart, making rounds, or visiting with the patient routinely without expressing or showing any degree of understanding or connection to the person as a whole. Often this is a coping mechanism, yet it is not best for those going through the stages of dying: denial, anger, bargaining, depression, acceptance. As noted on page 82, it is the truly gifted practitioners who is able to attain intrapersonal and impersonal balance when conveying emotional connection without compromising the needs of the patient or his/her own personal judgement.
Absence of grief
In many cultures the loss of a loved one is followed by a traditional ritual in which family members, friends, and other supportive circles recognize the death of the individual, celebrate their life, and with dignity, provide those close to the deceased with support. These rituals allow family and care givers to grieve without feeling that it is not socially acceptable or that something is pathologic if they don't immediately (within weeks) return to life as usual. Allowance of this process therefore promotes the natural progression of grieving and also through the various stages of mourning. If the process of grief is halted for whatever reason, it is possible that there will not be normal healing and return to optimal functioning. This can become pathologic if not addressed.
Just as customs vary among cultures, as do the end of life ceremonies/rituals. In the Italian/Catholic culture it is acceptable for a person to mourn the loss of a loved one by wearing black garments for one year. This is an indication to others that the person is to be respected and allowed to mourn in his/her own way without judgement from others. In addition the mourner is treated with kindness and compassion above and beyond the norm, without expectation of any return of favors such as meals, financial help, or household assistance during that entire year. It is also unlikely that the widower or widow will date or marry during that time. Mainland tradition has been altered by Americanism, however there are a number of decendents who carry on the tradition of their greatgrandparents and grandparents because they believe that the healing process is essential for optimal growth and health.
At the Hospice house a ritual is practiced with the passing of every one of their patients, which allows the family members to grieve and celebrate their loved one's life. Respect and dignity for the patient is of utmost importance. It begins when the lights of the entire living area are dimmed. All of the staff members; administrative, chaplain, and medical alike, accompany the lost person and their family members to the hurst with a candle lighting their journey. After their loved one is taken from the home, the staff presents them with a hand made prayer shawl and rosemary tied in a ribbon. The prayer shawls are knitted or crochetted by surviving cancer patients, family members of those lost to terminal disease, or others who want to contribute in some way. During the time of the knitting or crochette process the craftperson prays for the family members who might receive the prayer shawl. My sister is one such person. Last week I talked with her about the ritual and she has already begun a shawl and is going to continue making them in memory of our mom. Contributing to others who are experiencing grief or who are mourning will hopefully give back, in some way, what others did for us during our time of loss and will give them freedom to mourn and eventually regain joy again.
Just as customs vary among cultures, as do the end of life ceremonies/rituals. In the Italian/Catholic culture it is acceptable for a person to mourn the loss of a loved one by wearing black garments for one year. This is an indication to others that the person is to be respected and allowed to mourn in his/her own way without judgement from others. In addition the mourner is treated with kindness and compassion above and beyond the norm, without expectation of any return of favors such as meals, financial help, or household assistance during that entire year. It is also unlikely that the widower or widow will date or marry during that time. Mainland tradition has been altered by Americanism, however there are a number of decendents who carry on the tradition of their greatgrandparents and grandparents because they believe that the healing process is essential for optimal growth and health.
At the Hospice house a ritual is practiced with the passing of every one of their patients, which allows the family members to grieve and celebrate their loved one's life. Respect and dignity for the patient is of utmost importance. It begins when the lights of the entire living area are dimmed. All of the staff members; administrative, chaplain, and medical alike, accompany the lost person and their family members to the hurst with a candle lighting their journey. After their loved one is taken from the home, the staff presents them with a hand made prayer shawl and rosemary tied in a ribbon. The prayer shawls are knitted or crochetted by surviving cancer patients, family members of those lost to terminal disease, or others who want to contribute in some way. During the time of the knitting or crochette process the craftperson prays for the family members who might receive the prayer shawl. My sister is one such person. Last week I talked with her about the ritual and she has already begun a shawl and is going to continue making them in memory of our mom. Contributing to others who are experiencing grief or who are mourning will hopefully give back, in some way, what others did for us during our time of loss and will give them freedom to mourn and eventually regain joy again.
Friday, January 30, 2009
Grief and Mourning
The most recent focus of our reading covered the subjects of dying, death, and grief. In conjunction with my recent volunteer training at Hospice and the reading for this week, the focus of this blog will be the areas of grief and mourning. As the authors, Wedding and Stuber state, grief and mourning are natural emotional healing mechanisms (p. 85) that promote a return to normal living after a person experiences the loss of a loved one.
This section was of particular interest because I have just completed 11-1/2 hours of Hospice training for helping terminally ill patients and their families deal with the process of grief and mourning. Last night there were five volunteers who have each worked for Hospice for 20-35 years. Hoppice offers bereavement counseling to the care givers and families of their patients.Their accounts and memories of the patients that have touched them and who in turn they were blessed to have known, was moving beyond explanation with words. In line with our text the processes they described were the initial or acute grief and intense emotional distress, followed by the three stages of mourning that take place after the acute grief. The three stages of mourning as described by John Bowlby are: protest, despair and finally detachment.
The initial phase of protest is a normal, expected, and spontaneous reaction of disbelief. The second phase of despair is the realization that their loved one is indeed gone, which may lead to floating anxiety and depression. It is believed that this step is necessary for the stage that will lead to resolution of their loss. The final stage of mourning is a time when the mourner reorients his/her focus from the lost loved one to other people and activities until they reach a point of acceptance of the loss and resume normal function. Bowlby summarizes that the process usually takes from three to 12 months. As the experienced volunteers pointed out last night, this varies from person to person taking into account different situations. An example mentioned was one patient who lost her husband and son within a few hours of one another. When the families are able to witness and accept death as a normal part of life and the patient is treated with dignity and respect during their transition from life to death, the progression of grief and mourning can be very healthy, so much so that many have described it as a time of intense spirituality and closness with the patient and with God.
This section was of particular interest because I have just completed 11-1/2 hours of Hospice training for helping terminally ill patients and their families deal with the process of grief and mourning. Last night there were five volunteers who have each worked for Hospice for 20-35 years. Hoppice offers bereavement counseling to the care givers and families of their patients.Their accounts and memories of the patients that have touched them and who in turn they were blessed to have known, was moving beyond explanation with words. In line with our text the processes they described were the initial or acute grief and intense emotional distress, followed by the three stages of mourning that take place after the acute grief. The three stages of mourning as described by John Bowlby are: protest, despair and finally detachment.
The initial phase of protest is a normal, expected, and spontaneous reaction of disbelief. The second phase of despair is the realization that their loved one is indeed gone, which may lead to floating anxiety and depression. It is believed that this step is necessary for the stage that will lead to resolution of their loss. The final stage of mourning is a time when the mourner reorients his/her focus from the lost loved one to other people and activities until they reach a point of acceptance of the loss and resume normal function. Bowlby summarizes that the process usually takes from three to 12 months. As the experienced volunteers pointed out last night, this varies from person to person taking into account different situations. An example mentioned was one patient who lost her husband and son within a few hours of one another. When the families are able to witness and accept death as a normal part of life and the patient is treated with dignity and respect during their transition from life to death, the progression of grief and mourning can be very healthy, so much so that many have described it as a time of intense spirituality and closness with the patient and with God.
Sunday, January 25, 2009
Middle years are not marked by illness
In a study done by Verbrugge (1986), the symptoms requiring rest, work absences, self-medication, M.D. office visits, or hospitalization were not higher when compared to the same variables in younger people. This finding is contrary to what many would expect (Wedding & Stuber, p. 54).
It is common for many people who are are approaching middle age or who are in the midst of these years to experience worry and concern due to the physical changes and possibility of physical decline they witness in themselves. The realization of eminent mortality faces this age group. As a provider it is necessary to understand and sympathize with patients who may be overly concerned or preoccupied with the changes in their appearance, bodily functions, and sensations. These concerns are normal and valid; a supportive and sympathetic provider can make a tremendous contribution to the progress their middle aged patients might make when they begin lifestyle modification programs to improve their newly diagnosed health problems.
Chronic illness often presents during this cycle of life, yet if it is managed successfully the middle aged person will better cope, tolerate, and accept the illness and undertake the adaptations necessary to maintain their self-image and satisfaction with life. This period is also a time of evaluation of personal worth, values, and new goals (career, relationships, and lifestyle change). The above mentioned study found that 78% of middle -aged women and 79% of middle-aged men noted their overall health as good or excellent.
It is common for many people who are are approaching middle age or who are in the midst of these years to experience worry and concern due to the physical changes and possibility of physical decline they witness in themselves. The realization of eminent mortality faces this age group. As a provider it is necessary to understand and sympathize with patients who may be overly concerned or preoccupied with the changes in their appearance, bodily functions, and sensations. These concerns are normal and valid; a supportive and sympathetic provider can make a tremendous contribution to the progress their middle aged patients might make when they begin lifestyle modification programs to improve their newly diagnosed health problems.
Chronic illness often presents during this cycle of life, yet if it is managed successfully the middle aged person will better cope, tolerate, and accept the illness and undertake the adaptations necessary to maintain their self-image and satisfaction with life. This period is also a time of evaluation of personal worth, values, and new goals (career, relationships, and lifestyle change). The above mentioned study found that 78% of middle -aged women and 79% of middle-aged men noted their overall health as good or excellent.
Saturday, January 24, 2009
Semi-empty nest syndrome
Our text (Wedding & Stuber, p. 40), defines "empty nest syndrome" as a personal crisis marked by depression and loss of identity, and further suggests that this phenomena affects some women more than it does men. This time of change that occurs within the family dynamics is usually resultant of the transition of children physically moving out of the home. Though this is by some parents, is a perceived time of welcomed relief, it can be a time of awareness of one's own inevitable change in lifestyle.
All situations are unique and it is without doubt that parents experience a variety of emotions, realizations, and periods or readjustment. Such is the case within our home. Depression and loss of identity aren't factors in my personal situation; however I absolutely and without question have been in the process of adjusting to the changes as a result of my eldest moving into a house with her roommate while she is in college. In my situation there is no other adult within our home, to communicate these transitions with. So many years were joyfully spent within the role as "housewife". Never was there a stagnant (or dull) moment. I have full recognition of this process and the thoughts that accompany the transition are understood, yet some of you may perceive this as melancholy; it is more the sorting through of what must be done from here --forward (introspection), and the conscious energy it takes in order to place more focus on the future of self, rather than my girls (one of which is still at home-thus the reason for my title: semi-empty next syndrome). The normal excitement that couples anticipate once they are on their own again doesn't exist. For me, it is the hope and promise of what is unknown that can be a bit frightening at times and at others, thrilling.
It was very important to me to be provide security, basic needs, and availability to the girls; not just because I was a parent and it was natural, but because they had to endure divorce, and I was especially sensitive of their needs and emotions. As my eldest grew into early adulthood and my younger daughter is rapidly approaching the same, the transition was/is gradual, as they had to be very independent when I returned to college. The text narrows this section (understandably) and suggests a very limited perspective, probably because there is only so much information they can put into 350 pages. If I were to chart the progress of the transition process, with I as a separate category (divorced empty nest syndrome), it would constitute a chapter or three....better stop here.
All situations are unique and it is without doubt that parents experience a variety of emotions, realizations, and periods or readjustment. Such is the case within our home. Depression and loss of identity aren't factors in my personal situation; however I absolutely and without question have been in the process of adjusting to the changes as a result of my eldest moving into a house with her roommate while she is in college. In my situation there is no other adult within our home, to communicate these transitions with. So many years were joyfully spent within the role as "housewife". Never was there a stagnant (or dull) moment. I have full recognition of this process and the thoughts that accompany the transition are understood, yet some of you may perceive this as melancholy; it is more the sorting through of what must be done from here --forward (introspection), and the conscious energy it takes in order to place more focus on the future of self, rather than my girls (one of which is still at home-thus the reason for my title: semi-empty next syndrome). The normal excitement that couples anticipate once they are on their own again doesn't exist. For me, it is the hope and promise of what is unknown that can be a bit frightening at times and at others, thrilling.
It was very important to me to be provide security, basic needs, and availability to the girls; not just because I was a parent and it was natural, but because they had to endure divorce, and I was especially sensitive of their needs and emotions. As my eldest grew into early adulthood and my younger daughter is rapidly approaching the same, the transition was/is gradual, as they had to be very independent when I returned to college. The text narrows this section (understandably) and suggests a very limited perspective, probably because there is only so much information they can put into 350 pages. If I were to chart the progress of the transition process, with I as a separate category (divorced empty nest syndrome), it would constitute a chapter or three....better stop here.
Friday, January 23, 2009
Challenges that face single women
According to Blumstein and Schwartz (1983), a displaced homemaker is one who is suddenly made vulnerable by divorce or widowhood and found herself unprepared to provide for her income. In addition, some women postpone marriage to complete their education and focus on their careers, and when they approach their 30's experience the "ticking of the biological clock", and find that there are few single men available to become possible marriage partner (Wedding & Stuber, p.52).
Interestingly, both of these scenarios are all to familiar. Not only have several friends fit into both of these categories, yet I too would qualify. Though I was married, it wasn't until age 29 that I gave birth to my first child. This was not out of the norm, as many of my colleagues choose the same path. One person in particular comes to mind as I recall our conversations of her frustration because most of the men her age were married.
After working for many years in my given profession, my spouse and I agreed that it would be in the best interests of the family that I give up my position and career advancement opportunities so that he could take a ex-patriot offer from his employer. Our family (two children 8 and 11 at the time), moved overseas, and subsequently made several moves all for the purpose of his career advancement. Due to my strong beliefs and faith in our marriage this was an easy choice. After 12 years together and divorce lurking around the corner (never imagined possible), the displaced homemaker title befell me, as it had been several years since I worked outside the home (with the exception of volunteering and a few business ventures). Upon my return to the workforce, it was evident that with childcare costs, low salary, no retirement, and no parents (both deceased at that time) or siblings nearby to help with the children, it was without question that it was a necessity to further my education and focus on my career. That was in 2003....and today I am still on the path of the goal that was set then. Age and lack of available time contribute to the sense of discouragement I experience about dating and the possibility of marriage in my future. Though this is something I would like, the statistics alone are less than encouraging. Perhaps the right person, the right age :), at the right time....God only knows.
Interestingly, both of these scenarios are all to familiar. Not only have several friends fit into both of these categories, yet I too would qualify. Though I was married, it wasn't until age 29 that I gave birth to my first child. This was not out of the norm, as many of my colleagues choose the same path. One person in particular comes to mind as I recall our conversations of her frustration because most of the men her age were married.
After working for many years in my given profession, my spouse and I agreed that it would be in the best interests of the family that I give up my position and career advancement opportunities so that he could take a ex-patriot offer from his employer. Our family (two children 8 and 11 at the time), moved overseas, and subsequently made several moves all for the purpose of his career advancement. Due to my strong beliefs and faith in our marriage this was an easy choice. After 12 years together and divorce lurking around the corner (never imagined possible), the displaced homemaker title befell me, as it had been several years since I worked outside the home (with the exception of volunteering and a few business ventures). Upon my return to the workforce, it was evident that with childcare costs, low salary, no retirement, and no parents (both deceased at that time) or siblings nearby to help with the children, it was without question that it was a necessity to further my education and focus on my career. That was in 2003....and today I am still on the path of the goal that was set then. Age and lack of available time contribute to the sense of discouragement I experience about dating and the possibility of marriage in my future. Though this is something I would like, the statistics alone are less than encouraging. Perhaps the right person, the right age :), at the right time....God only knows.
Saturday, January 17, 2009
Changes in Family and Community over the Past Fifty Years
During the past 50 years the dynamics of the family unit have changed considerably (Wedding & Stuber, p. 21). First, the average family size has decreased, with just over two children being the median norm. Secondly, due to divorce and less young people partaking in marriage, the two-parent family is no longer prominent. Lastly, many extended families are displaced because one or more family members' jobs require them to move to other cities, states, or countries.
Both sets of my grandparents moved to the United States with their parents as young children, making me a second generation American. They grew up in areas of the city where most all of the immigrants from European countries lived and had businesses. The social network was vast and everyone seemed to know one another and share in community activities and celebrations as a unit. Weddings were considered a significant event and it wasn't unusual to attend a wedding with a completely filled church and 300 to 500 people in attendance at the reception. The receptions consisted of full course meals, live music, and dancing; a joyous time of celebration with friends and relatives that generally went on until late into the evening and early morning hours.
The impact of these social networks was significant in my life and I must say that I really miss that sense of community. The number of aunts, uncles, and cousins alone would constitute filling an entire church. On the maternal side; my mother was one of five siblings. On the paternal side; my father was one of nine children. I myself, was born into a family of five children. All of my aunts and uncles had large families, so you can imagine the shear numbers of cousins and second cousins. Into my adulthood, with the advances in technology and an the expanding job market many of the younger people were moving away from their extended families and their birthplaces. Such was the case with me. Within my lifetime I have not only witnessed, yet have experienced many changes within the nuclear and extended family, neighborhood, and workplace.
Both sets of my grandparents moved to the United States with their parents as young children, making me a second generation American. They grew up in areas of the city where most all of the immigrants from European countries lived and had businesses. The social network was vast and everyone seemed to know one another and share in community activities and celebrations as a unit. Weddings were considered a significant event and it wasn't unusual to attend a wedding with a completely filled church and 300 to 500 people in attendance at the reception. The receptions consisted of full course meals, live music, and dancing; a joyous time of celebration with friends and relatives that generally went on until late into the evening and early morning hours.
The impact of these social networks was significant in my life and I must say that I really miss that sense of community. The number of aunts, uncles, and cousins alone would constitute filling an entire church. On the maternal side; my mother was one of five siblings. On the paternal side; my father was one of nine children. I myself, was born into a family of five children. All of my aunts and uncles had large families, so you can imagine the shear numbers of cousins and second cousins. Into my adulthood, with the advances in technology and an the expanding job market many of the younger people were moving away from their extended families and their birthplaces. Such was the case with me. Within my lifetime I have not only witnessed, yet have experienced many changes within the nuclear and extended family, neighborhood, and workplace.
Friday, January 16, 2009
Geriatricians, the patient, and the social network
Physicians are advised to not treat patients in isolation from their families and community. A wise doctor knows when and how to work with the beliefs and social support to provide the best medical care possible. Geriatricians and pediatricians alike, are careful to assess the support network of their patients as part of the activities of daily living (Wedding & Stuber, p.28). Often an older person's or adolescent's- parents , spouse, adult children, siblings, or even neighbors, and grandchildren might be helpful in providing pertinent information. Yet, the provider must be extremely discerning when making this decision, for on occasion it has turned out that the alternative source was out of touch, uninvolved or misinformed regarding the patients life, medications, and activities. The person who appears to be an alternative source of information my have only seen the person twice in three years or less than a decade, and live across the country. Ultimately it is the patients choice who they would like to have share information that the physician relays. If the patient is cognisant, an authorization to share medical information, then a power of attorney must be part of the patient chart.
Especially with older people a physician can talk with the social network member(s) and determine the best people to be with the patient and help them stay organized, to keep track of their questions, as well as to follow instructions for treatment. This method has been found to reduce the possibility that the patient will sabotage the treatment plan through disagreeing with the recommendations.
Some young people are more open when they do not have to ask specific questions when a parent is in the exam room. It is a good practice to have the parent leave the room briefly, to allow the adolescent to discuss private issues free of stress or embarrassment. This is a subject of contention among some parents, especially if the patient is 16, and in some states it is legal to receive medical treatment without a parents input, yet the child may be too inexperienced, emotionally distraught, or simply chronologically immature.
Some families may prefer that all medical information be conveyed to one specific person other than themselves. The seemingly organized patient may wish to have another person present to keep track of their own question, as well as the doctor's answers and instructions. A support person can help remember what was said and to further encourage compliance.
This all sounds so simple and straightforward,yet when it comes to siblings making decisions during periods that their parents are not capable, it can be a tine of much confusion, disorganization, and mistakes may inadvertently be made. My friend works as the director of residential living at a long term care facility and has told me about several of the "unusual circumstance" situations she has had to deal with from time to time. Many of which could have been prevented. She among anyone I know , could certainly give feedback about this sensitive issue.
Especially with older people a physician can talk with the social network member(s) and determine the best people to be with the patient and help them stay organized, to keep track of their questions, as well as to follow instructions for treatment. This method has been found to reduce the possibility that the patient will sabotage the treatment plan through disagreeing with the recommendations.
Some young people are more open when they do not have to ask specific questions when a parent is in the exam room. It is a good practice to have the parent leave the room briefly, to allow the adolescent to discuss private issues free of stress or embarrassment. This is a subject of contention among some parents, especially if the patient is 16, and in some states it is legal to receive medical treatment without a parents input, yet the child may be too inexperienced, emotionally distraught, or simply chronologically immature.
Some families may prefer that all medical information be conveyed to one specific person other than themselves. The seemingly organized patient may wish to have another person present to keep track of their own question, as well as the doctor's answers and instructions. A support person can help remember what was said and to further encourage compliance.
This all sounds so simple and straightforward,yet when it comes to siblings making decisions during periods that their parents are not capable, it can be a tine of much confusion, disorganization, and mistakes may inadvertently be made. My friend works as the director of residential living at a long term care facility and has told me about several of the "unusual circumstance" situations she has had to deal with from time to time. Many of which could have been prevented. She among anyone I know , could certainly give feedback about this sensitive issue.
Thursday, January 15, 2009
Social Support and Wellness
Studies have found that people who have extended and available social support networks, consisting of friends and/or family members, are less anxious, and less likely to become depressed or develop posttraumatic stress disorder (Wedding & Stuber, p.25). People who have chronic or acute illnesses were found to have better emotional well-being when they had a supportive social network. The key word here: supportive. In contrast to support and wellness, individuals whose family members or friends were highly critical experienced more relapses and required more medication (Wedding, p. 25). One of my very dear friends (won't mention your name), has had fibromyalgia (FMS) for many years. Currently her family is experiencing a tremendous amount of turmoil for reasons beyond her control and her life is changing very rapidly as a result.
Sunday past, she and I made time to get together despite both of our busy schedules. We visited with my daughters; who she hadn't seen since they were in middle school, then went out for a meal so that we could spend some time in conversation. During the evening we shared stories of a few humorous recent experiences, talked about old times, as well as exchanged with one another about her current situation. When I was doing the reading about social networks, thoughts or her came to mind. Though I could never know exactly how difficult it must be to live with fibromyalgia, I sympathize and want her to know that I'm here for her whenever she needs to talk or spend time with someone who will support her. Someone who has been through what she is going through in her personal life and understands.
When I thought about writing this blog I wanted to be sure to encourage her with the information about positive support and wellness. Additionally, I couldn't blog about supportive social networks without mentioning another dear friend (you know who you are). We've known each other over 20 years and have been supportive of one another through numerous parallel hurdles. A formal study this is not, yet through personal experience I can confirm the validity of the direct relationship between wellness in general and "supportive" social networks. Thank you both for the privilege of your friendship.
Sunday past, she and I made time to get together despite both of our busy schedules. We visited with my daughters; who she hadn't seen since they were in middle school, then went out for a meal so that we could spend some time in conversation. During the evening we shared stories of a few humorous recent experiences, talked about old times, as well as exchanged with one another about her current situation. When I was doing the reading about social networks, thoughts or her came to mind. Though I could never know exactly how difficult it must be to live with fibromyalgia, I sympathize and want her to know that I'm here for her whenever she needs to talk or spend time with someone who will support her. Someone who has been through what she is going through in her personal life and understands.
When I thought about writing this blog I wanted to be sure to encourage her with the information about positive support and wellness. Additionally, I couldn't blog about supportive social networks without mentioning another dear friend (you know who you are). We've known each other over 20 years and have been supportive of one another through numerous parallel hurdles. A formal study this is not, yet through personal experience I can confirm the validity of the direct relationship between wellness in general and "supportive" social networks. Thank you both for the privilege of your friendship.
Friday, January 9, 2009
Communication and neural functioning
This blog entry is regarding the importance of proper balance of the body and of the brain to create optimal neural synapses that are essential in memory, learning, emotion, through our communication with others. The brain is a social organ and the way we communicate with others directly affects neural functioning, thus promotes the ability of a person to deal with stress more effectively (Hogrefe, p. 21).
Blogging yesterday prompted me to reflect on the past semester for purposes of conscious awareness, and in doing so, it also made me objectively aware of several reasons for the feeling of lack of organization I felt. One reason I discussed in the blog was technology and the other, which I will discuss today, was the very limited communication with friends and family that I had time for. Although each of my classmates were there for support, each of them were dealing with the same class stresses as I, and they also had to deal with their own personal issues. Perceptive of their internal stresses, I often chose to keep things to myself so that I wouldn't overload their minds. In addition, I was chosen to be the class chaplain and I felt it was my responsibility to be there to encourage them and not the other way around.
A major change occurred in my social life, (which I expected) due to the amount of time I had to dedicate toward studying. As a result I wasn't able to spend much time communicating with friends outside of class. Being the only adult in my home also contributed to the limited communication. Knowing now, that these interpersonal relationships are not only healthy, but essential for optimal brain function, I plan to set specific time aside to focus on this area during the current semester. Although none of you are right here in front of me, this method of blogging, at least, makes me feel as if I'm talking to you.
Blogging yesterday prompted me to reflect on the past semester for purposes of conscious awareness, and in doing so, it also made me objectively aware of several reasons for the feeling of lack of organization I felt. One reason I discussed in the blog was technology and the other, which I will discuss today, was the very limited communication with friends and family that I had time for. Although each of my classmates were there for support, each of them were dealing with the same class stresses as I, and they also had to deal with their own personal issues. Perceptive of their internal stresses, I often chose to keep things to myself so that I wouldn't overload their minds. In addition, I was chosen to be the class chaplain and I felt it was my responsibility to be there to encourage them and not the other way around.
A major change occurred in my social life, (which I expected) due to the amount of time I had to dedicate toward studying. As a result I wasn't able to spend much time communicating with friends outside of class. Being the only adult in my home also contributed to the limited communication. Knowing now, that these interpersonal relationships are not only healthy, but essential for optimal brain function, I plan to set specific time aside to focus on this area during the current semester. Although none of you are right here in front of me, this method of blogging, at least, makes me feel as if I'm talking to you.
Thursday, January 8, 2009
Conscious awareness
When reading about conscious awareness this week, it seemed fitting to reflect on some past experiences that have influenced certain feelings and beliefs that I have had in the past or currently have, that I desire to be change for the better. Altering these established habits of behaving and thinking will hopefully lessen the stress I felt last semester. Under normal circumstances I am very orderly and seem to function at my best when I feel organized.
In knowing this about myself, it is difficult to look back at my first semester at Wingate. The visualization is not a good one. Most every day I felt much of my time was spent trying to figure out a way to be organized with my computerized notes, my new laptop computer, Vista navigation, and studying for tests from power points in addition to text reading. I felt very proficient with my desktop at home and its internal software; it took some time to adjust to the laptop and the sensitivity of the cursor. Often I became frustrated with myself because it took awhile to adapt-occasionally I'd quietly sigh from frustration with self.
Consciousness about the need to re-organize and re-plan an effective study pattern helped me to "wake up" and change some of the study patterns I developed during the first semester. Christmas and the entire break was very relaxing. From time to time I would take out one of the new texts or some articles and read more leisurely and in a state of less internal chaos. Starting the second semester feeling more organized has been much more enjoyable and without question less stressful. Hopefully my conscious awareness of the problem, the need for change, and taking the steps to follow the plan will help me to feel like my old self again.
In knowing this about myself, it is difficult to look back at my first semester at Wingate. The visualization is not a good one. Most every day I felt much of my time was spent trying to figure out a way to be organized with my computerized notes, my new laptop computer, Vista navigation, and studying for tests from power points in addition to text reading. I felt very proficient with my desktop at home and its internal software; it took some time to adjust to the laptop and the sensitivity of the cursor. Often I became frustrated with myself because it took awhile to adapt-occasionally I'd quietly sigh from frustration with self.
Consciousness about the need to re-organize and re-plan an effective study pattern helped me to "wake up" and change some of the study patterns I developed during the first semester. Christmas and the entire break was very relaxing. From time to time I would take out one of the new texts or some articles and read more leisurely and in a state of less internal chaos. Starting the second semester feeling more organized has been much more enjoyable and without question less stressful. Hopefully my conscious awareness of the problem, the need for change, and taking the steps to follow the plan will help me to feel like my old self again.
Wednesday, January 7, 2009
New interpersonal relationship with my laptop, hehe :)
Here it goes...my first blog
Since I'm new to blogging my blog is just in the construction phase :) Its been a very interesting year and I believe it will be a good semester. Interesting in the sense that I've learned so much; about medicine, MEDICATIONS (my favorite class....jk...since I used to be pretty much holostic in my approach to medicine for myself...that was until I really needed hypertensive medication (go figure).
To begin this assignment, I'll first talk about my most recent introceptive experience. Since childhood (earliest memory : Grade One), I have had test anxiety. Of course I didn't understand the reasons I felt anxious during tests, all I knew then was that from Day 1 of Grade 1, I felt I didn't measure up....specifically, I recall the moment of the first "panic" feeling. The placement of desks all faced one another in a group---several groups of desks were within the class as it was a 1st/2nd grade combined class). Mrs. Sullivan was the teacher (a matronly woman with bright read hair, not much taller than I...at age 6). I sat right next to a brilliant girl named Robin King. Robin was from a very wealthy family in town, lived in the largest home in town. Ours was large too....however, it wasn't because mom and dad were wealthy and owned the most exclusive woman's clothing store on Main Street (which Robin's parents did...), it was because we had five children, one of which needed lifts, a wheelchair, and many other large pieces of equipment. Robin was an only child and her parents spent quite a lot of time reading and schooling her before Kindergarten. Back then, 1964...(wow), Pre-school was not common. The first experiences with social interaction-aside from family-was in Kindergarten, and that is exactly what it was-a social experience. the three R's (reading, writing, arithmatic), were not taught. We painted, listened to stories read by the teacher, looked at picture books, sat in a big circle on the floor, painted on the easel (my favorite), played games, and sang. If you were really "good" you were chosen to go to the teacher's lounge with one other classmate, load the crate with milk cartons for the class, and bring them back into the room and give them out....seemed like I did this quite often. Needless to say when my Mrs. Sullivan (Grade 1, Day 1, first time sitting at the Great Big desk with the Big chair) asked the class to write a sentence.......I FROZE right in the chair. I knew how to print my name, but a sentence...Oh my....I managed to print my name (VERY BIG). I glanced over at Robin's paper and it was cursive and there were so many words.......the next feelings; I'll never forget. Hot, afraid, red in the face. Wish I knew then what I know now (embarrassment). One problem...I still have the same feelings at age 50, even though I know the material...often I still freeze or choose the wrong question, only to later look at it, and think....OMGosh, how stupid was that. I soon learned learned that Robin was the only person who could write the darn sentence and I was among the few who could write their names. Guess this gives you an idea what I think about pre-testing to "see where the students are at". Nevertheless, Robin and I became very good friends. Often we played together outside of school. I really liked her playing at her house because it was so quiet and she had every toy and gadget you could imagine....especially liked her electronic car stering wheel with gears that sat on the table and made speeding sounds when you put your foot on the attached gas petal that was on the floor...that's another introception blog altogether. Better stop here or I'll never get my reading done for my tests (can't wait) tomorrow......unitl next time......
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