I would prefer not to (fall)

  (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!"

Communication Wellness: Sweet Fitness

 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. 

 

Communication Wellness: Be Kind, So They Can Sleep

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). 

Get some rest, then get busy tomorrow!

 

 

 

 

 

Hearing What's Coming....

 

 

Thanks to the GRAMMY nominations for inspiration: 

"I once was the size of your beating heart

Resting over it and feeling it loud

But now I'm no more than a pea, squirreled deep inside your ear

Wanting to help you, but you're still too proud

 

------------------------------------------------------------

"So many bucks and so many smarts

To get me close to you

I'm left, still, up on the shelf

 

(And you're gone)

You're out the door, I have a muddled view

-------------------------------------------------------------

"It's me, BEEP BEEP BEEP BEEP, I'm your hearing aid

I guess you've gotten bupkis from me, with the cash you've paid

A short time at your ear, and you'd have clarity today

 

But I'm a game that you just don't want to play!"

 

-----------------------------------------------------------------

 

What Does It All Mean?

"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."