THINK F.A.S.T

May is National Stroke Awareness Month. According to the CDC, 700,000 individuals each year experience strokes. Stroke is the leading cause of long-term disability in adults. It's the third leading cause of death. One out of every 16 Americans die from stroke each year. Currently, 25 percent of men and 20 percent of women have a stroke by age 85. Although stroke risk increases with age, strokes can—and do—occur at any age. Nearly one quarter of strokes occur in people under the age of 65 (American Stroke Association Advocacy, 2010). Heart disease is commonly thought to affect men more than women, in reality, more than half of all people who die of heart disease and stroke are women. Women are twice as likely to die from stroke then breast cancer, but only 27 percent of women could name more than two of the six primary stroke symptoms (National Stroke Association: Information on Stroke Prevention, Stroke risk facts, 2010). After losing my mother to a stroke in 2004 I began to research stroke in order to learn more about cause and prevention. There are several risk factors that can increase ones risk of having a stroke, some of them are: Tobacco smoke and exposure to second-hand smoke, high blood cholesterol, high blood pressure, physical inactivity, obesity and overweight, diabetes mellitus. Factors that cannot be controlled are: Increasing age, sex (Gender), heredity (family history), previous heart attack or stroke or TIA (transient ischemic attacks). Stroke is the most preventable cause of disability in the United States. Knowing the sign and symptoms of a stroke can save someone’s life. The F.A.S.T technique for recognizing stroke symptoms is being used as an awareness campaign by the Stroke Awareness Foundation, http://www.strokeinfo.org/ . F.A.S.T stands for face, arms, speech, and time.

An addition to the FAST symptoms it is important to recognize the TIA (transient ischemic attacks). TIA's are often described as a mini-stroke happens when blood flow to part of the brain is blocked or reduced, often by a blood clot. After a short time, blood flows again and the symptoms go away. With a stroke, the blood flow stays blocked, and the brain has permanent damage. Unlike a stroke however, the symptoms can disappear within a few minutes. By definition, a TIA resolves within 24 hours, the majority of TIA's resolve within 60 minutes, and most resolve within 30 minutes (Stroke Awareness Foundation Home Page). At least 15 percent of the time, a TIA (transient ischemic attacks) precedes a full-blown blockage-related stroke, and most likely, the full-blown stroke will occur within 48 hours of a TIA. So, TIAs are perhaps the most important stroke warning sign. A TIA is a warning: It means you are likely to have a stroke in the future. If you think you are having a TIA, call 911. Early treatment can help prevent a stroke. My mother experienced many TIA’s before she died, unfortunately we did not know what they were, so if you or someone you know suddenly cannot remember what just what happened and whatever it was, it's gone away, or experiences the worst headache of their life, then, please get them checked for a TIA. If you get to an emergency room within three to four hours after experiencing any of these signs, doctors can do a number of things to improve or restore circulation. F.A.S.T can save lives so please remember to THINK FAST. Please watch my you-tube video, created for a class project and became a tribute to my mother, thanks Michael!

American Stroke Association Advocacy. (2010). Retrieved May 5, 2010, from American Stroke Association: http://www.strokeassociation.org/presenter.jhtml?identifier=1200037
National Stroke Association: Information on Stroke Prevention, Stroke risk facts. (2010). Retrieved May 2010, from National Stroke Association:  http://www.stroke.org/site/PageNavigator/HOME?cvridirect=true
Stroke Awareness Foundation Home Page. (n.d.). Retrieved May 2010, from Stroke Awareness Foundation:  http://www.strokeinfo.org/

Life Lessons

As I sit here thinking about my blog and topics of interest, my passions and my experiences, I am reminded of the greatest lessons I have learned. Although these lessons came from an incredibly difficult journey it changed my life in a positive way. We are trained to assess needs and provide tools to help people through life transitions, difficult situations, and crisis. Some of us may become experts in a field of study in which people turn to you for guidance and education. What happens when you become the victim, when you hurt, when you need help? Can you use the tools you offer others? Can you do the things you ask others to do if it happened to you? I couldn’t. This is my personal grief experience.It was about 5:30 AM when the phone rang. “Damn phone is going to wake the baby”, I mumbled in a whisper. Then I realized what time it was and thought this can’t be good, who calls at 5:30 in the morning. Somewhere in the back of my mind I thought it was my father calling to tell me he needed me to take my mother to the E.R., her stomach again, the ulcer is acting up and she is in pain. My father lost his eye sight a few years earlier and could not drive so when my mother was unable to drive, I would. She had trouble with her stomach ulcers for years so it would not have surprised me if it was her stomach acting up again. That’s not what he said, “She’s dead, your mother is dead!” What? I can’t breathe for a moment and then the baby wakes up. I grab him to comfort him or for him to comfort me and began to shake. The baby giggles, he thinks I’m playing because I am shaking and crying, but I’m trying to catch my breath. I manage to get dressed and leave to go to my father who needs my help. I help people all the time who are grieving, this isn’t any different, is it? But when I got there, I couldn’t look at her. That’s what I remember more than anything, I did not look at her. We bathe and dress our patients before they leave the home, but I couldn’t, I was not prepared. I couldn’t remember what to do, or who to call, which mortuary to use, my mind went blank. It’s been six years since she died and I can still smell the propane heater that was lit in the living room when I arrived. You might be wondering why I’m sharing this and I’ll explain. After she died I buried her, the experience, the memories, the pain, deep within. I did not cry after that morning, I did not speak about her to anyone, I went on living or should I say pretending. The thing to know here is that my mother and I did not have a good relationship. I carried a lot of anger and resentment. I blamed her for the pain of my childhood. If she was paying attention, if she cared things wouldn’t have happened and I would have been protected. We had a strained relationship for years and I could not communicate with her. I separated myself from her and always thought she should have done more. She tried at different times to say she was sorry and that she cared but the words were not easy for her and I wasn’t listening. Things started to change after I had my son. She wanted to be part of his life and she was different now. We began spending more time together and she began building a relationship with my son. It was nice. I realized I didn’t do much to show her I cared and  I could do more for her and I would, someday. Here is part of the lesson I learned, you don’t have tomorrow, you have the present moment. I thought I had time and that we would work it out, someday. I realize now how heavy the pain of unfinished business can be. The burden of guilt is paralyzing. The pain if you allow it to enter your mind even for a second will take your breathe away like a punch in the stomach, so I didn’t allow it to enter my mind, I couldn't. For two years I went on pretending I was fine. Carrying pain and guilt is like carrying hundred pound bag of sand, the longer you carry it the heavier it gets and eventually your knees buckle. It is easy to not deal with pain, it is not easy to allow it in. About two and a half years later I traveled to Santa Rosa to attend a bereavement facilitator’s training for work. By this time I’ve moved on, at least I thought so. In this training we learned about different techniques for working with people who are grieving. Along with the techniques we where asked to participate in a couple activities that we could use in our work. This is the part that changed my life. The first exercise was to write for ten minutes about someone you’ve lost beginning with the words I remember. I began cautiously writing a few things about my mother and before I knew it I was sobbing and had written three pages. I looked up from the paper embarrassed because I had been crying and I noticed everyone else at my table was crying too. We went around the table and discussed what the experience was like and how we were feeling. I felt exposed and vulnerable but also a bit relieved. The experience was powerful for everyone at the table who were all remembering someone special who had recently died and some who had been gone for years. After a discussion we were asked to participate in another exercise. This exercise began as a visualization exercise. I don’t remember the instructions word for word but I remember the basic idea. Visualize a familiar safe place, stay there awhile until you can almost smell the room and you are warm and content and safe. Now visualize your loved one as they were when they were healthy and strong, they enter the room and they are happy, happy to see you, they cannot talk to you, they are there to listen, what do you what to say? Now I decided at the beginning of this exercise that I had done enough emotional work and I wanted this one to be lighter, besides it’s just for educational purposes, right? I decided to visualize my grandfather; I could remember his house clearly. I saw his large worn and battered brown recliner, I could even smell the scent of his tobacco, but I could not visualize him in the recliner. Instead as if in an actual dream my mother sat down. I don’t know how to put into words how real this experience was for me in that moment. I was completely focused on this visualization, I could see her and she looked good, she was smiling. Then we were asked to write what we wanted to say to them and they would listen. The letter I wrote that day released me from my pain and guilt. You might wonder how that is even possible and I wouldn’t have believed anyone that it would work but it did. This exercise allowed me to apologize. I was able to say everything that I never said when she was alive. It was powerful. I didn’t realize until a few days later that I had been freed from the weight of my grief, it was gone, I felt lighter, happier and at peace. I was able to talk about her again and I truly believe it was because of the experience at the conference. This sparked my interest into journal writing. I began to research the benefits of journal writing and how it can be incredibly useful in trauma therapy. This is why I developed the journal group that I facilitated in my first internship. A couple of the participants described a similar freeing experience like the one I had. Not everyone will have this experience but for some it may be life changing. I believe journal therapy is a powerful tool in the work that we do as social workers and can be utilized in many different areas of social work and research has proven it.

The lessons I've learned are to live in the moment, life is short and anger is wasted energy. I try to make sure my family and my children know everyday that I love them. The important lesson I was given was quoted best by Robert Frost, “The best way out is always through.”

 

My reflection about "The Original Patriot"

I have always had an interest in WWII and I often have the pleasure of hearing many stories from veterans through my work, so when I heard about this book I was immediately interested. Chag Lowry’s book about Native American WWII veterans is an interesting book that is well worth reading. Informative, well written and a true treasure, Chag’s book revealed accounts by a population often forgotten and rarely acknowledged. The stories told in this book were fascinating and truly inspiring. The men and women in this book fought bravely for a country who destroyed their way of life, massacred their ancestors, and repeatedly exploited they’re people. The stories are a true example of resilience and perseverance. The attitudes depicted in this book are inspiring and difficult to truly comprehend. When I think about everything the Native American’s went through, I am amazed that some of these men and women chose the path they did. To answer this question Jimmy James stated it best, “We are people who live in a nation. We have our nation inside another nation. We live with our laws and abide by their laws” (Lowry, 2007). After reading this book I researched Native American Vietnam veterans and found evidence of higher rates of PTSD. I assumed I would find historical trauma to be a factor in the higher rates of PTSD however I did not find a lot of supporting information. It is estimated that over 42,000 Native American servicemen were stationed in Southeast Asia during the Vietnam War. This means that per capita, nearly three times as many Native Americans served as non-Natives. What long-term impact would this leave on an already wounded people? According to statistics reported by the National Center for PTSD, Native American Veterans are significantly more likely to suffer the effects of combat-related trauma than are most other veterans. There may be many reasons for this finding. The first reason for this variance may be the way that Native American cultures view war. Traditionally, the warrior in these cultures has been honored; seen as a person who has sacrificed his physical and spiritual well-being for the better of the community. Warriors were often honored upon their return from combat through the use of herbal remedies and traditional healing ceremonies that were used to cleanse and heal the spirit of the warrior prior to re-entering the community. During the Vietnam War, high levels of political and racial tensions in our local area prevented this from happening. Warriors were often returned home one at a time and were faced with hiding their veteran status for fear of attack or retaliation by those who were not in support of the war. Alcohol is a second factor that has made it difficult for most veterans to recover from their combat-related traumas. Alcohol plays a strong role in the culture of military life. Often equating with status, bravery or manhood, in the context of the war, many soldiers began using alcohol as a form of numbing and self- medication. According to the, Report of the Working Group on American Indian Veterans, Native American Veterans faced high levels of racism within their own units and they were often believed to have keen senses and an innate warrior spirit (Shore H. Jay, 2004). This misconception let to a disproportionate number of Native American veterans being placed in highly dangerous positions in the infantry. On returning home, veterans, who had been forced to use alcohol as a tool for survival and protection from their peers, re-entered tribal communities who were already struggling with their own alcohol-related issues. This made for a dangerous, and sometimes deadly, combination, resulting in an alarmingly high level of abuse, violence and suicide. In the video, “Wounded Spirits, Ailing Hearts, PTSD and the legacy of war among American Indian & Alaska Native American Veterans,” by the National Center for PTSD website, they point out difference in treating Native American Veterans with PTSD (National Center For PTSD). This video is very helpful when working in Native Populations as a non-native. Along with western medicine treatments they state that traditional medicine is the best and most effective treatment. In April of 1998, the Department of Veteran’s Affairs reached a memorandum of understanding with the Navajo tribe. The report they had received in 1992, clearly demonstrated that some of the reasons that Native American Veterans gave for not utilizing VA services were as follows:

• High levels of distrust

• Too much red tape

• They wanted to solve their own problems

• Their issues weren’t serious enough to seek treatment

• Didn’t believe the dominant medical model of treatment would work

• Didn’t know services were available to them
• Didn’t know if they were eligible for VA services

• Geographic/ transportation barriers which limited access to services

In response to these findings, the VA forged an agreement with the Navajo tribe to reimburse them for a portion of the costs associated with the use of traditional healing for their Veteran’s. This is monumental, in that the recognition was made on a formal level that there are many ways in which healing can begin to happen for our warriors. I have always enjoyed hearing stories from the past. Being invited to listen to people tell their stories from the past is a honor and a gift. The stories told in ‘Original Patriots’ are powerful accounts from people who were proud to fight for their country, for their land and their dead. For those of us who are not Native the true magnitude of their sacrifice can never fully be understood.

To purchase Chag Lowry's book please visit his website:  http://www.originalpatriots.com/

Bobo, K., Kendall, J., & Max, S. (1991). Organizing for Social Change: Midwest Academy Manual for Activists. Santa Ana, CA: Seven Locks Press.

Wounded spirits, Ailing hearts: PTSD and the legacy of war among American Indian and Alaska Native Veterans. American Indian Vietnam Veterans Project. Retrieved November 13, 2005 from   http://www.ncptsd.va.gov/wsah_bopklet/ws_video.html

Lowry, C. (2007). The Original Patriots. Eureka: Chag Lowry.

National Center For PTSD. (n.d.). Retrieved 2 28, 2009, from Is PTSD different for Native Veterans?: http://www.ncptsd.va

Shore H. Jay, M. M. (2004). The american Indian Vteran and Posttramaunatic Stress Disorder: A Telehealth Assessment and Formulation. Culture, Medicine, and Psychiatry , 231-243.

Footprints

Tonight when I tucked my seven year old son into bed he asked me, "take me to the beach." This may seem like a simple request from a little guy who wanted to go play at the beach but it was much more that that. For the past four months I have noticed my son struggling with anxiety and irritability. More than normal. He also began grinding his teeth at night which may be an indication that he is experiencing some kind of stress or anxiety. He is my sensitive child who is very loving and emotionally driven. He is definitely dramatic. I have been working with him to think positively and have a little perseverance because he often gives up on things if he is not instantly good at the task. This is the complete opposite of my other son who will not give up and is extremely strong willed and determined. I often tell my sensitive child to keep trying, practice makes perfect but it is still a struggle. It can be anything from trying his shoe to riding his bike, he doesn't want to try. Two weeks ago I decided to try a mediation or visualization with him to help him quiet his mind before bed hoping this would decrease his teeth grinding. I began by making sure he was comfortable an then I asked him to close his eyes. I began describing the beach, the warm sand as it tickles our toes, he quietly said," but mom what if there is glass in the sand?" So we moved along the beach with our flip flops until we reached the sand with no glass, and I asked him if he could feel the warm sand and he could, we then ran to the edge of the water and felt the cold wash over our feet, " but mom will the water wash us away?" Assuring him that I would hold his hand we continued on, finally we lay exhausted in the sand feeling the warm sun on our cheeks, he whispers, "but mom we will get sun-burned." I gently remind him that we put on sun screen before we left the house; finally we lay quietly feeling sun as it warms our skin. The next night I asked him if he wanted to go to the beach again and he did but this time I addressed all his concerns so that he could relax and he did. The next night it it was even easier. The thing is tonight he asked me to take him to the beach. He wanted to do the visualization. I hope to keep this going and that it will eventually help him and ease his racing mind so that he can sleep peacefully. The discussion and information provided by Michael in class has been been very helpful. I didn't realize mediation could be done by young children but I have seen that it can and it is helping my son. I appreciate the introduction into different aspects of social work so that we may utilize what speaks to us and incorporate it into our practice, and even into our lives.

The cost of Medicare Part D

On January 1, 2006 congress and the Bush administration created a new program designed to assist Medicare beneficiaries with prescription drug costs. Never before had Medicare covered prescription drugs and as a result of prohibiting the government from negotiating for the best drug prices on the behalf of the 43 million eligible people on Medicare, the Medicare Part D program was placed in the hands of private health insures. A program that was marketed to help seniors and reduce cost actually penalized the most vulnerable group receiving Medicare benefits, the low income and disabled seniors who previously received Medicaid assistance for prescription drugs at no cost, now have to apply for a subsidy and begin paying for their medicines. This population is referred to as the dual eligible’s; Medicare beneficiaries who are dually eligible for Medicare and Medicaid programs. Medicare handled this transition by randomly assigning dual eligible’s to average cost prescription drug plans, most of which do not cover all drugs used by this population. Let me explain in detail how Medicare part D works so you can better understand the impact of this change on this population. Each state offered private insurers and opportunity to implement a Medicare Part D drug plan. Each insurance company could decide which drug they would and would not cover. They would charge a premium for their plan some of which had deductibles and some did not. The plans offered coverage on specified drugs at a co pay amount. The co pay could be as low as $0 to $30 per drug. Premiums varied as well any where from $5 a month to $150. In addition the plans only cover total drug costs up to $2250, and continue to not cover drugs until the out pocket cost reach $5100. Then the plans will again begin to pay a percentage. This is referred to as the “Donut Hole,” a gap in coverage where plans pay nothing but beneficiaries must continue to pay their prescription drug plan premium. Many people did not realize how this worked and how it would affect them. These plans did not count the cost of the drug at the co pay amount, they added the full cost of the drug, so if someone was receiving a 30 day supply of Prozac and paying $30 and the full cost of the drug was $150 for a 30 day supply then the amount added up would be the full price. Many people take drugs that are over $100 for the full price. This means if a person took 6 different medications with co-pays of $10 and a full cost price of $100, the person would be paying $60 but the amount considered would be $600. This means this person would hit the Donut Hole in only four months. Then they would have to pay the full price of the drug until the dollar amount reached $5100. This affected a population which did not qualify for Medicaid but had been utilizing pharmaceutical programs for their medications. Most brand name pharmaceutical companies had offered free medications to folks who where low income but not eligible for Medicaid, however when Medicare adopted Part D these programs discontinued, forcing people to join a drug plan they could not afford.

The recently passed Health Care Reform bill has many similarities to the poorly designed Medicare Part D program. Although this bill will help many people who were previously without health care, it is not a public option and ultimately puts millions of dollars into the hands of insurance companies. Jon Walker from firedoglake which is a progressive political website writes about this issue in his blog here is the link:
http://fdlaction.firedoglake.com/2010/03/15/democrats-who-once-railed-against-medicare-part-d-now-insist-members-must-vote-for-strikingly-similar-senate-health-care-bill/.
With the bill now in place there are a few improvements for the Medicare Part D program. For seniors, the bill will immediately expand the Medicare drug benefit and, effective July 1, provide a 50 percent discount on brand-name drugs for the low-income elderly and the reconciliation package (a revised section of the bill)would also gradually close the gap known as the "doughnut hole" in Medicare prescription drug coverage, which leaves many seniors to pay the full cost of expansive medications. Ultimately I would have liked to see a public option which would have forced insurance companies to lower their costs. In our current capitalistic society it will be a monumental day when every American can share the same health care coverage, and bills are not influenced by lobbyist with bottomless packets. Here is one more link to another blog from Jon Walker providing some food for thought:  http://fdlaction.firedoglake.com/2010/04/27/reduce-the-deficit-by-expanding-medicare-not-cutting-it/ .

Oscar the Cat

This is an interesting story that made it's way around the office last year so I thought I would share it. In 2007 Dr. Dosa a geriatrician and assistant professor at Brown university publicized and article in the New England Journal of Medicine describing cat named Oscar and his ability to predict death. During the time this article was written in 2007 Oscar had predicted at least 25 deaths in the nursing home where he lived in Rhode Island. Since then he has gone on to predict 50 cases by curling up with a resident in their final hours. I love animals and have seen the power of their presence in patients homes, but I can’t help being a bit suspicious. Maybe the staff is placing the cat into the pt’s bed in their final hours. Dr.Dosa’s book describes an instance when staff place Oscar on a resident’s bed and the cat ran out and went to another bed. The resident that the staff thought needed Oscar died two days later and the resident Oscar visited died that night. Dr.Dosa and the staff in the nursing are convinced of Oscar’s accuracy and even alert family members if Oscar is visiting their loved one. The staff report that Oscar is not a social cat and spends little time with the residents who are not dying. If Oscar is left outside the door of a dying resident he will scratch on the door until he is let in. In Dr.Dosa’s book “Making rounds with Oscar: the extraordinary gift of an ordinary cat”, he offers no scientific explanation for Oscar’s behavior. Dr Dosa suggest that possibly Oscar can detect ketones, the distinctly-odored biochemical given off by dying cells, apparently dogs also have the ability to smell ketones. With no scientific proof one may be skeptical, but as we all know there are many things in life that cannot be scientifically explained.

Henry, R. (2007, July 27). oscar the cat predicts parients' deaths. Retrieved April 30, 2010, from Washington Post: http://www.washingtonpost.com/wp-dyn/content/article/2007/07/27/AR2007072700578.html

Pet Peace of Mind

 In recent years the interest and study in the field of animal assisted therapy has grown dramatically. Many hospices and acute care facilities are integrating animal assisted therapy into the services they provide. The most common trend in hospice is the utilization of their large patient care volunteer staff to bring animals to visit the terminally ill patients. Many hospices have found this to be therapeutic for the patients by reducing stress and anxiety as well as decreasing depression. Therapy animals can also be a source of comfort for family members following the death of a patient and be a tool in bereavement counseling. Personally I have seen the benefits first hand, one example that comes to mind is a patient who had severe dementia and was extremely anxious. She refused to get out of bed and would not let the nurses help with personal care which she desperately needed. One of the nurses happen to bring in her dog and the woman immediately lit up. She got up and sat for a long time petting the dog and after a while she was able to allow the nurse to assist her, after that the dog became a part of the care plan and visited this patient every time the nurse did. For many patients one of the biggest areas of concern is what will happen to their pet when they die. It is important for the hospice social worker to discuss this with the patient and family and make a plan about where their pet will go after they pass. In addition to this worry patients commonly have a difficult time managing the care needs of their pet. As patient’s decline it is increasingly difficult for them to schedule and arrange vet care or grooming appointments, or keep up with pet supplies and maintenance such as feeding and cleaning liter boxes. A nationally recognized program started in Tulsa Oklahoma by a hospice chaplain and former veterinarian Delana McNac called Pet Peace of Mind helps ease pet concerns for terminally ill patients and their families. Pet Pace of Mind assists hospice patients who are unable to maintain appropriate routine health care and nutrition for their animal companions due to medical expenses or caregiver disability. Locally Hospice of Humboldt has begun a Pet Peace of mind program as well. Pet Peace of Mind allows patients to complete their end-of-life journey without worrying about their pet's current or future needs. Services include providing food and litter, volunteers to help with pet care and grooming, routine medications, vaccinations and routine veterinary visits, boarding or foster care during emergencies and guidance in finding new homes for pets when the time comes.

Hospice of Green Country, Inc. (n.d.). Retrieved April 30, 2010, from Pet peace of mind.org: http://www.petpeaceofmindtulsa.org/