History does have a habit of mimicking a favorite recipe, with the passage of time. For example, some periods of history need to be set aside for rest - George Floyd and the racial reckoning, in a pressure cooker. Other historical events are better presented after being chilled, like a freshly assembled fruit salad - Emmett Till memorials in Mississippi being desecrated by bullets, anyone? When historians are afraid of a historical epoch becoming lost to the national discourse, they might spice it up - ergo, a recent book on Lincoln that focuses on the 16th President's influencers. Other historical times, they might be pepped up by garnishes and textures. When you look at that sweeping cinematic period in the US's recent history, you can't not think of World War II, and the famous retort an American general gave a German general - when faced with the prospect of surrender:
An account of General McAuliffe's message to his troops can be found at:
We in the CSD professions are affected by, adorned with, weighted by, dragged down under, swept along by, and uplifted with events of history. Whether we like outside events infiltrating our therapy environments, they do and they will. Your school may have experienced a mass shooting, or it could have happened at the mall a few blocks away. Surges in respiratory diseases with cold weather restrict the movements of your senior clients, and sometimes you, if you work in assisted living or memory care. Your hospital may be crippled by a stenosis of cash flow and dehydration of supply stores, because reimbursements are being returned to your healthcare facility at the speed of Congress.
To borrow from the Honorable Elizabeth Warren: yet, we persist. Our charge from the professions, and our guidance given by our mentors, teachers, colleagues and our support circles, include finding hope in every day we share with our consumers. They include giving the gifts of patience and insight; of persistence, humility and grace; of strength, joy and vision. Every instance we have to help people we serve, move closer to that quality of life they desire - that's the greatest gift we can want - ever. In the face of often seismic startling cataclysms that often do rock our everyday worlds, we dedicate ourselves to being that stability our consumers need. We in the professions offer that hospitality, that sanctuary and that energy that persons we serve, might need.
And so amongst the hierarchies of metaphors that come from history - a therapy room might be a machine gun nest from World War I. The room could also be seen as the suffragette march of 1913, when Ida B. Wells taught a lesson of true courage. History also holds the story of Anne Sullivan, Helen Keller's hero; Fabi Hirsch, Gabby Giffords' SLP, is another. Was Roald Dahl a hero for his wife, Patricia Neal, and then his son? See: https://www.theguardian.com/books/2016/sep/12/roald-dahl-medical-pioneer-stroke-hydrocephalus-measles-vaccination. Dahl's legacy is rather tarnished by some parts of his documented belief system. See: https://www.bbc.com/culture/article/20230530-roald-dahl-the-fierce-debate-over-rewriting-childrens-classics. Perhaps the author's life needs a tenderizing with an acidic agent, so that we can know what's important to recognize in history, and what can be strained out.
The professions teach that we often act as history's strainer - that we help our consumers and their supports decide what to keep, what to give away and what is needed. During the holiday season in the US, let us all let anxiety, depression, fear and hopelessness take a holiday. Often. Stay stalwart.
(Blogger's note: this post is loosely based upon the series "Note to Self", as featured on CBS News. You can find examples of these stories at https://www.cbsnews.com/cbs-mornings/note-to-self/ . No blame can be attributed to the network, for what has happened here to taint the series).
"Hello, boy! I'm glad you came to visit; otherwise it's very quiet at this end of the hall. The staff come to find me at meal times, they sprint with my wheelchair down the hall for dining, then whisk me back down that long hall you walked up - so damned fast, I feel like I'm gonna fly through a window!
"You do look like me. I feel fairly comfortable talking with you, to tell you what I hope you can do, to avoid what's happened to me. Before I start:
"It is very quiet here. As I said. The nurse comes in and berates me for eating a Reese's Fast Break, right after breakfast. I had barely picked up my dog-eared copy of TRISTRAM SHANDY when she last burst in, proclaiming my diabetes would make me drop lifeless by Fourth of July next! Every word, every syllable of her screed cut through the quiet, before I laughed her way and raised the paperback to try again.
"OK: first, make sure it's the right time and place to hear something important. You may keep YouTube mixes of Tupac or Blake Shelton or Queen B., playing louder than Jeez in your house, because you don't like to be alone! Poo! When you can't hear yourself think, you don't THINK! Oh, sorry for yelling....
"But you gotta watch how long you're around loud noise - ever hear of Return to Forever, that fusion jazz group from long ago - I like to make you smirk at my musical tastes - ?? I saw those guys at the old Memphis Mid - South Coliseum, back when you could normally hear after a concert - they blew out my ears for three days! https://youtu.be/aN_Y7aNgvhs?si=4xl0v7jhQGjCbIqI
"Can you hear me? Please do that.
"RTF's speakers were cranked up to the max that night. You don't need that, but if they are - get farther away. If I'm in the dining area here and there is that insipid classic rock music they ALWAYS play, I don't talk with anybody there - can't hear 'em! They'll occasionally hear me in the office, and switch to that 'Easy Listening' arrangement of Zeppelin that I like. Then I can flirt with Josie who's at my table, like I mean it.
"Please do that. Hear me, boy?? Don't ruin your ears with noise!
"Hearing aids????? You know I lost most of my cash in that Crypto kerfuffle some years ago. Medicaid keeps me fed and housed, yeah - but if I had learned my lesson and did what I've told you to do...and that ain't all of it....wouldn't need tech - naw - luh - gee!
You hear me? C'mon over here, and give me a hug - there. Glad to see you - look into my eyes so I'm sure you'll hear me - come, back, soon - bye now!"
Since Banting, Macleod and Best confirmed insulin as essential for modulating blood sugar levels in the 1920's, physicians have had a steadily growing arsenal of tools for controlling diabetes in their patients. I've written elsewhere, about how seeing the severe complications of diabetes in rehab patients had supercharged my interest in disease prevention. Not only do persons with diabetes face bodily impairments to their extremities, their vision and their hearts, but they also appear to struggle with cognitive function - their brains are exfoliated from the inside.
In addition to the challenges to their attention, recall and higher cognitive functions, persons with diabetes also have their skills impaired for visual acuity and perception, for dexterity, for their fine motor control, and their eating/drinking/swallowing. Not an easy way to meet the day, when your speaking, thinking, reading and writing, and also hearing, eating, drinking and swallowing might be limited!
Tomorrow- November 14 - is World Diabetes Day. If you are tempted to celebrate the day by running errands, taking a good walk or run, or by completing a round of household chores, and you are concerned about your blood sugar, - you may need to take some steps to maximize your fitness.
*HAVE THE RIGHT PLAN: Your healthcare provider is an important partner in a fitness plan, for managing your blood sugar levels and coordinating your lifestyle components contributing to fitness (e g. diet, sleep, tobacco use). Do you need help managing your plan? Trust in a friend to accompany you in your activities. Is your health status changing with the plan? Tweak your plan.
*HAVE THE RIGHT EQUIPMENT: Do you have the best footwear? The right way to track your blood sugar levels? All the nutrition/hydration support that you might need for your exercise? All the human support you might benefit from, if your activity challenges your body and mind?
*HAVE THE RIGHT PERSPECTIVE: Talk to people in your support circles, including your healthcare provider, about your program and how you feel it's progressing. Learn to trust the advice you get as your fitness program evolves with your needs. Keep your prize uppermost. Keep your dreams realistic and show your pride, as you approach your goal.
Good sleep is more than essential to healthy cognition, communication and swallowing. It feels good! When you are living with a healthy sleep pattern, you may echo Shakespeare: "O sleep! O gentle sleep! Nature’s soft nurse, ..." (Hylton, 1993). Recent research indicates that effective sleep habits help a person sustain essential nerve conduction functions, flush the nervous system of toxic material, and assure retention of the sleeper's memories (NINDS, 2023). Yet many, many of us struggle with getting the recommended quantity and quality of sleep to stay healthy (CDC, 2022). Outside of medical management of severe sleep problems, one of the better weapons in the sleep-deprived person's arsenal is sleep hygiene.What is sleep hygiene? The practice of sleep hygiene uses a collection of strategies and routines that allow most persons to get their maximum potential from a good night's sleep (Suni and Vyas, 2023). The reader can review the Sleep Foundation article, as well as other reviews of the practice (Irish, 2015; Breus, 2023; MGH, 2023) to develop and implement such a skill set.
It's then kinda a no-brainer for CSD clinicians like ourselves, reader, to support the consumers who need help to sleep better. What makes this extra-clinical activity fairly easy, is that clues to a better sleep can be found with the calendar! I'll give you an example. November 13 (tomorrow as I write this) is "World Kindness Day"(Random Acts of Kindness, 2023). Some sleep hygiene activities that you might have at the ready, to advocate for sleepy people everywhere, could include:
* CONTROL NOISE - there are construction sites in most urban areas, where noise is evidence of progress. Unfortunately, residential areas near the site suffer the consequences of piledrivers at dawn, or jackhammers in the heat of summer. An example is the Hyde Park Labs, a planned multi-story adjunct of the University of Chicago (Hyde Park Labs, 2023), which is scheduled to open in 4th quarter of 2024. To even the odds that nearby residents might get the best sleep, stop by a morning treat shop to bribe the construction crew to start an hour later. For this example, the Dat Donut store is approximately 5 miles away from the construction site, and a neighborhood treasure for their "Big Dat" pastry (Dat Donut, 2023).
* MAXIMIZE COMFORT - older persons often find that they might fall asleep anywhere, at any time (ask me how I know this!). When a senior wakes up from a sudden nap, she will most likely have aches in the head, neck and shoulders. You can advocate for new residents of congregate living facilities, be they independent care, assisted living or memory care units, be issued annually one new neck pillow for use in improving their sleep comfort. Most pillows of this type and size retail for less than $40.00 USD (Imbler, 2023). An example of a senior congregate living facility, amenable to supporting resident sleep hygiene is the Clarendale of Algonquin, IL (Clarendale of Algonquin, n.d.).
* TEACH, TEACH, TEACH - young people are caught up in the tornado of becoming an adult while in high school. Education and training after high school graduation can only perpetuate poor sleep habits, that a teen might take on to experience their school, work, leisure experience. Consider for your neighborhood high school a health class' unit on SLEEP: for example, the Lincoln Way Community High School District 210 of suburban Chicago, offers health education to high school freshmen.Yet teaching good sleep hygiene is not supplementing curricula for mental/emotional health, relationships, sexual reproduction, infectious and non - communicable diseases, drugs and nutrition (LW210, 2023). An e-learning platform piloted for Australian schools is only one example of the possibilities of improved sleep hygiene for this vulnerable population (Davis, Blunden, and BoydPratt, 2022).
"When I first met Mr. C* in our speech clinic, he had been just discharged from outpatient therapy at the University hospital. His wife commented that Mr. C* had been three months an outpatient, after six weeks in acute rehab for his stroke, and two weeks in the acute hospital before that. Already such a long time away from home, but at least he's finished seven weeks of home health care and re-acclimated to his home. Already such a long time....12 weeks, 18 then, 20 - 27 after home health: almost SEVEN months from onset. Mr. C* still wasn't producing more than single words at this stage, so I had to rely upon the wife's commentary, as well as the case history forms she had filled out.
"Mr. C* had been a truck driver for nearly twenty years before his stroke. Because he enjoyed family life so much, having raised three children and now, there were six grandchildren nearby that dropped in anytime - he rarely took long haul, 'over the road' hauls. What did he carry in his trailer? Wheat, soybeans, corn, rice - it was an agricultural market that he worked...and he was home every night, after two to three loads carried to one of three grain elevators, built to accommodate river barge traffic. To keep up the pace that the grain producer demanded; that is, to get the highest number of loads delivered to the elevator per day, Mr. C* kept his schedule tight. A good breakfast at home; the usual, eggs and sausage, toast, coffee - then the rest of the day was fueled by either a package of cheese/peanut butter crackers, or a bottle of Coke with peanuts poured in, or a bag of chips. Fast, tasty and convenient!
"Mr. C* had worked hard, all his life....and driving and maintaining a truck was a lot of work. There was not only the routine maintenance to keep the rig running, but also there were the vigilance and energy it took to respond to surprising breakdowns during a trip; be they blown tires, burst belts, or the help it might require to straighten out a 'jackknifed' rig. Those hours where he hadn't been piecing together the well - worn cab + trailer, you could see him pushing it down the highways, and along gravel and dusty roads. When he drove home and came into his house, his body bore effects of the forces imposed by the rigid cab seat. Eating a big meal, then sinking into his high - backed recliner to watch TV immediately afterwards, he often needed a "Go to bed!" from his wife within the hour to get fruitful sleep.
"Now Mr. C* is here, and the evaluation is almost done. I explained all my observations, and I reviewed the assessment data to draw a conclusion. 'I think that you might benefit from working with us, sir. The records from your prior treatment suggest, that the odds are fair to good that you'll continue to make progress with us for using your speech. Do you have any questions?' I looked to both Mr. C* and his wife.
"But as Sue Storm (Richards) would have said, way back in the history of the FANTASTIC FOUR comic, 'what does it all mean?'.
"Speech - language pathologists can, with considerable skill, describe impairments of cognition, communication and swallowing, and then provide skilled interventions based upon the latest scientific knowledge about these skill sets, to help all who come to them sustain the highest possible quality of life. With Mr. C* and so many others like him, the goals of treatment are to prevent worsening of disability. But, what if Mr. C* had had the opportunity to manage his lifestyle and lower the risk of this disability? This is what we'll continue to explore."
Now, let's see - where were we? It's been a stressful summer, and fall could be a portent for a fall I need to anticipate. But the question still remains - how do I incorporate primary prevention into the daily regimen of a practicing speech - language pathologist? Who will buy?
To fend off any rejection of primary prevention by the CSD (communication sciences and disorders) professions, the answer to "Why do it?", is - our professions mandate it. Our consumers and their advocates are healthier for it. The healthcare industry is inexorably being drawn to carry prevention on its back. We want less and less occurrences of disability and death. Our moral and ethical selves should embrace prevention for their professional lives.
The goal of primary prevention activities is "to prevent a disease from ever occurring" (Kisling and Das, 2023). Most of us might think that preventing disease is the physician's job, but we all have had personal experiences - that we, or those we know well, once arrived at a doctor's office or emergency room very sick. Your doctor may often be ignorant of risk factors for disease that you're carrying, until you show full - blown symptoms of the disease.
We know that both presymptomatic and predictive testing for a growing number of medical conditions, through laboratory and radiological means, are evolving to become more everyday tools in the medical clinician's toolbox (LifeLineScreening, n.d.; Dagonnier, Donnan, Davis et al., 2021; Lawrence, 2004). Though major medical centers with precision medicine emerging in their product lines, declare their intent is to make healthcare "predictive, preventative, personalized and participatory" (Flores, Glusman, Brogaard, et al., 2013), the state of the science does not yet empower all the persons served, to better their health.
Large medical research centers have the cachet that will attract many health consumers to share their DNA with laboratories. Their growth from the time of World War II to the present, has brought together sterling resources for medical education, clinical and basic research, patient care and health policy advocacy (Coleman and Dang, 2023). But if you want to make big consequential changes in how people can stay healthy throughout their lives, is it easier to turn a luxury cruise ship, or a Mini Cooper?
Not only must a prevention intervention be effective, or do what is intended; be safe to the consumer and her circles of support; but also, efficient for delivering the best possible outcome at the best possible cost. A counterpoint to "precision public health" (Khoury, 2018; Thaler, 2019), which employs big data sets, genomic sequencing and precision laboratory interventions, might be a human scale involvement in risk reduction, by members of a population. This type of intervention would attempt to connect the cultural influences upon a population's health status, with the outcomes for intervention they desire. This intervention might include, in the case of primary prevention for cardiovascular disease:
* baseline and serial assessment of individuals' cardiovascular risk
* analysis of the cultures in which each participant exists
* education via printed material developed from the cultural interviews, surveys and observations
* education via publishing monthly cardiovascular (CV) risk reduction activities in a community, upon a web-based/hard copy calendar
* education via participation in dedicated lectures on the major domains for CV risk
* assessment of individuals' active involvement in learning management strategies for CV risk
* periodic assessment of the satisfaction of population members with the prevention intervention
* replication of the prevention program within different cultural communities
This intervention does not mandate for participants a sole method for reaching their CV risk goals. It allows the individual to develop insight for what she/he might control to gain/retain a healthy CV system, and act as she finds it possible within her means and her culture. Studies done over the past decade (Winham, 2009; Stuart-Shor, Berra, Kamau and Kumanyika, 2012; AHA, 2023) may echo the sentiment of a contemporary comedy movie: "It's just culture; that's all" (Chadha and Nayar, 2003). There's the future - perhaps! The future will tell whether primary prevention based on a culturally - sensitive model will attract the energy of more speech - language pathologists. Will you buy?
REFERENCES
1. Kisling, Lisa A., and Das, Joe M. Prevention Strategies, In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.. Retrieved 11/7/23 from https://pubmed.ncbi.nlm.nih.gov/30725907/
2. LifeLine Screening: The Power of Prevention. n.d. Retrieved 11/7/23 from https://www.lifelinescreening.com/ppc-149?sourcecd=WGBS101&utm_source=WGBS101&utm_medium=cpc&utm_campaign=11845162922&utm_term=lifeline%20screening&gad_source=1&gclid=CjwKCAiA3aeqBhBzEiwAxFiOBr37IradPa2SDZgpn_3tUISRICNkHnxoW1Hm_xlDACr-3bkaSiiyhxoC8DAQAvD_BwE&gclsrc=aw.ds
3. Dagonnier, Marie, Donnier, Geoffrey A., Davis, Stephen M., et al. Acute Stroke Biomarkers: Are We There Yet? Frontiers in Neurology, 12, 2021. Retrieved 11/7/23 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902038/
4. Lawrence, Bill (executive producer). "My Fault", Season 3, Episode 20 of Scrubs. Originally broadcast on 4/22/2004. Retrieved 11/7/23 from https://www.youtube.com/watch?v=R9hEa8LKG4c
5. Flores, Mauricio, Glusman, Gustavo, Brogaard, Kristin, et al., P4 Medicine: How Systems Medicine Will Transform the Healthcare Sector and Society. Personalized Medicine, 10(6), 2013, 565 - 76. Retrieved 11/7/23 from https://pubmed.ncbi.nlm.nih.gov/25342952/
6. Coleman, Kara, and Dang, Donna. 37 Scientists Pionerring the Future of Biomedical Research. Pew Trusts, June 13, 2023. Retrieved 11/7/2023 from https://www.pewtrusts.org/en/research-and-analysis/articles/2023/06/13/37-scientists-pioneering-the-future-of-biomedical-research
7. Khoury, Muin J , Bowen, M. Scott, Clyne, Mindy, et al., From Public Health Genomics to Precision Public Health: A 20 - Year Journey. Genetic Medicine, 20 (6), June 2018, 574 - 582. Retrieved 11/7/23 from https://pubmed.ncbi.nlm.nih.gov/29240076/
8. Thaler, David S., Head, Michael G., and Horsley, Andrew. Precision Public Health to Inhibit the Contagion of Disease and Move Toward a Future in Which Microbes Spread Health. BMC Infectious Diseases, 19(1), February 6, 2019. Retrieved 11/8/23 from https://pubmed.ncbi.nlm.nih.gov/30727964/
9. Winham, Donna M. Culturally Tailored Foods and CVD Prevention. American Journal of Lifestyle Medicine, 3(1), 2009, 64S - 68S. Retrieved 11/8/23 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2782861/
10. Stuart - Short, Eileen M., Berra, Kathy A., Kamau, Mercy W. and Kumanyika, Shiriki K. Behavioral Strategies for Cardiovascular Risk Reduction in Diverse and Underserved Racial/Ethnic Groups. Circulation, 125, January 3, 2012, 171 - 184. Retrieved 11/8/23 from https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.110.968495
11. American Heart Association. Culture, Diet, Economic Factors and More Affect CVD Risk Among Asian Americans. Newsroom, May 8, 2023. Retrieved 11/8/23 from https://newsroom.heart.org/news/culture-diet-economic-factors-and-more-affect-cvd-risk-among-asian-americans
12. Chadha, Gurinder, and Nayar, Deepak (Producers). Bend It Like Beckham. Original release March 12, 2003. Retrieved 11/8/23 from https://www.rottentomatoes.com/m/bend_it_like_beckham
A relative of a person I recently served -I was thinking about it in retrospect - shocked me initially after I had completed that person's evaluation. I was boring, the relative passed along to me. Bang! Pow! - and that ultimate of Marvel Comics sound effects that rocked me - TTHOKK! - now, THAT is a criticism of my work that rocks me to my core. My audition had been a seeming failure, and I was on the cusp of being cast aside for a more 'entertaining' clinician. Horrors!
Losing business is no joke. Even with the supposed national shortage of CSD (communication sciences and disorders) professionals, there is always some colleague in your area, glad to welcome a disgruntled customer into their fold - for as long as it takes. I've got to sharpen up my customer service saw, I thought - the neon words "sharpen it! Sharpen it! SHARPEN IT!" flashing hot, like an epileptic engram in my brain. "HOW COULD YOU MAKE A MISTAKE LIKE THAT??"
Boring, maybe - I could rightly be accused of being in my head at times; whether checking a source from my memory banks after seeing a certain customer behavior, or just pacing the session activities, without revealing to the customer my reactions to what had happened - not giving a clue, not seemingly engaged. But there was a method behind it all....
Reviewing this customer's history, I found that he had suffered numerous episodes of agitation when interacting with all persons, familiar or otherwise. The customer had cursed, kicked, bitten, urinated on, screamed at, threatened, run from and punched at friends, family and helpers alike, when he was engaged. Definitely worth keeping my own interaction style cool. In my rehab hospital days, I had called myself "The Quaalude Kid", impervious to threats, shocks or injuries, to interact with an irritable customer. They deserve quality service, too!
The customer's family and I moved on from that temporary disagreement. Learning the threshold of the customer for sustaining attention - it was critical for planning the range of interventions I'd have available, identifying the reinforcers that worked, and gauging when goals would be met.
