Bob's Story

When Bob lost his wife of more than 40 years to cancer, he felt lost.  His life was turned upside down and he struggled to get through the days.  A few months after Marjorie’s passing, his friends gently nudged him to get help to work through the pain and despondency he was feeling.  Bob said he was “not really a therapy person,” but he was willing to try something a little different and joined a Pathways Hospice grief support group.

At first Bob just listened.  What he learned was hugely reassuring: Grief is unique; each person experiences it differently.   Some people initially feel disbelief and expect to see their loved one who is gone.  Others express anger at being “abandoned” by their loved one.  Some describe feeling guilt—either for feeling anger, or for still being here, or for things they might have said or done (or didn’t say or do).  Some just have profound sadness like Bob was feeling.  He learned that it’s all normal.  

Bob was comforted by the clear message that there is no right or wrong way to grieve and that there is no set timeline.  He received encouragement not only from the group’s facilitator, but increasingly from the others in the group.  He was relieved and reassured to meet people even more distant from their loss that were still grieving.   Shared bereavement can give hope of getting through this time and learning positive ways to deal with the pain of loss.

Photo credit: jessica.diamond / Foter / CC BY-SA

Bob could see that although his family would never be the same, he would be able to accept the changes in his life and create a “new normal” with time.  He envisioned that eventually, instead of crying at memories of Marjorie, he’d be able to smile.  He learned to expect that his grief might come and go and that birthdays, anniversaries and holidays could bring it rushing back. And that all of that is normal.

Death, loss, mourning, grief—the concepts make many people uncomfortable.  Because the experiences are so different for each person, others don’t always know how to react.  They are not sure whether you want to talk about your loved one or not—so often they say nothing.  In a support group, everyone there knows what you are going through. 

Bob describes his progression as part “eye-opening discovery… and part learning from others farther down the path.”  He now finds himself more involved and more upbeat.  Bob likens his life before participating in the support group as a black and white photo, and that now the color is trickling back in; he has begun the transition into his “new normal” life. 

Pathways opens its bereavement services to anyone in the community, regardless of whether a family member received our hospice care. See Pathways grief support services on our website, pathwayshealth.org/grief-support/.

The Healthiest Emotion May be AWE

Photo credit: Satterwhite.B / Foter / CC BY

There is lots of research about the adverse health effects of negative feelings such as depression, anxiety and shame: more heart disease, cancer and premature death. But less is known about how certain cheerier emotions affect overall health, feelings like contentment, joy or pride.

To delve deeper into happier feelings, researchers at the University of California at Berkeley and other schools looked first at a variety of positive and negative emotions in 94 Berkeley freshmen. They filled out questionnaires about how frequently during the previous month they had experienced everything from enthusiasm and inspiration to hostility.

Next they analyzed saliva samples from the students, looking for the amount of interleukin-6 (IL-6) present. This is a molecule associated with inflammation and poor health. As expected, the IL-6 levels correlated with the emotions: students with positive emotions had the lowest levels and the converse was true for those with more negative feelings.

In the next step the investigators had 119 students fill out questionnaires about seven positive emotions: amusement, awe, compassion, contentment, joy, love and pride. Again they examined saliva levels. It turned out that the more often a student recorded feeling a sense of awe, the lower the IL-6. The students reported experiencing awe three or more times a week.

“There seems to be something about awe,” said Dacher Keltner PhD, senior author of the study and director of the Greater Good Science Center at Berkeley. “It seems to have a pronounced impact on markers related to inflammation.”

Keltner said that an awe-inspiring event “will pass the goose-bumps test.” Awe is different for each person. “Some people feel awe listening to music,” Dr. Keltner says, “others watching a sunset or attending a political rally or seeing kids play.”

The study was published in the January 2015 edition of the journal Emotion.

Managing Heart Failure

People diagnosed with heart failure (HF) usually have medications to increase how much their hearts can pump.  But as with most conditions, many approaches are needed to best manage heart failure.

A daily weight is essential because it is an early indicator of fluid retention from HF.  The best time to weigh yourself is in the morning, after urinating but before breakfast.  A weight gain of around 3 pounds in a day should be reported to the doctor since it indicates fluid may be backing up in various organs.

Generally people with HF are on salt restricted diets.  Salt contributes to water retention, which makes the heart work harder and causes shortness of breath and swelling in the ankles and legs.  Those with severe heart failure may have fluid restrictions.

Mild exercise can improve circulation, as long as it does not overly tax the person.

When we feel anxious or upset, our hearts beat faster and we breathe more heavily.  This can make HF worse.  Reducing stress helps manage HF.

Lying flat may cause shortness of breath. To improve sleep, it may be helpful to raise the head of the bed 45 degrees, or even sleep in a recliner.   And if the person uses oxygen, be sure the tubing is correctly in place and the nasal prongs are in the nostrils.

Dementia and the Holidays

As fun as the coming holidays can be, they can be packed with hazards for people with dementia. It means caregivers and families need to be especially vigilant about the safety.

Many decorations look like food and may even smell like the real thing. For instance, a Christmas tree decoration that looks like a gingerbread man may be even scented with gingerbread smell—making doubly appealing to try to eat. Other small decorations can be choking hazards. Artificial fruits, vegetables and nuts can look very real.

Candles that smell like pumpkin or apple pie can be a fire hazard if tipped over if a person reaches into it. Poinsettia leaves, contrary to popular belief, are not poisonous—but they will make a resident nauseated if he or she eats them.

People with dementia need routines—the same activities, in the same place, at the same time. Families should consider this carefully before deciding to take a loved one home for a holiday. The excitement, the car ride, change in surroundings and many people talking can cause the confused person with dementia to become agitated or upset.

Here are some tips for family members planning to take a loved one home for a holiday.

Planning

• Plan ahead. Let the facility staff know several days ahead so they have time to obtain medications and clothes.
• Allow extra time for everything, don’t rush the person.
• Try to keep as much as possible to their daily routine.

Decorations

• Use ribbon instead of sharp hooks when hanging decorations.
• Holly and mistletoe can be poisonous and berries pose a choking hazard.

Festivities

• Begin new traditions by letting another family be the host but try to go to a place familiar to your loved one.  
• Assign tasks to other family members so you do not become overloaded and stressed, which in turn causes your loved one to be stressed.
• Provide a nap before festivities. If you know the day will be long, you may want to attend only the most important part of the event.
• Plan for a quiet place for your loved one to go to if he or she becomes overwhelmed.
• Avoid alcohol.
• Be aware of their diet and diet restrictions. Cut up food into small bites.

Visitors

• Let your loved one know who is coming to visit.
• Have visitors and family call ahead to determine best time to visit.
• Small groups of visitors or family is advisable. Have them wear name tags as this might help with recognition.
• Reintroduce yourself as necessary. “Mary, my name is Betty.” And when she asks, “Are you my granddaughter?” say “yes” and shake her hand and act very comfortable about this introduction.
• If your loved one begins talking about the past, try not to reorient him or tell him he is wrong. Enter his reality and live his truth. Ask about the past memory.

Activities

• Reminisce about the past.
• Play holiday music familiar to your loved one.
• Read holiday cards aloud.
• Stuff stockings, watch a holiday video, look at family slides or pictures or albums, read scriptures, etc.

The Kitchen

• Monitor your loved one while in the kitchen.
• Give your loved one task to help with baking or decorating. Try baking cookies, making pudding, folding napkins, polishing silver, etc.
• Always check the microwave before turning on in case something was put in that is flammable.
• Check all trash cans before throwing out garbage

Shopping

• Don’t leave your loved one in the car or in the front of the store.  If you can’t take them in with you, try to arrange for someone to stay with your loved one.
• Shop during hours when stores are less crowded.
• Dress your loved one in a bright yellow shirt which is easy to see if you become separated. Be sure they have a purse or wallet with identification.
• Shop in smaller stores rather than the mall.

Travel

• People with dementia should never travel alone. Hire a personal care aid to travel if a family member is unable to accompany the resident.
• Be aware of balconies and other hazards in hotels.
• Travel may not be appropriate even with a companion if the person has:

1. Consistent disorientation or agitation in familiar settings
2. Wanting to go home when away from home on short visits
3. Delusional, paranoid, aggressive or disinhibited behavior
4. Problems managing continence
5. Teary, anxious, withdrawn behavior in crowded, noisy settings
6. Agitated or wandering behavior

Additional resources for caregivers.

Curried Lentil & Carrot Soup

One of the challenges of living with Chronic Obstructive Pulmonary Disease (COPD) or high blood pressure is maintaining a low sodium diet. Just because you have to limit your sodium intake doesn't mean you have to eat bland, boring food.

Our Pathways Recipe of the Month is Curried Lentil and Carrot Soup from a staff member in our Foundation department. This savory soup takes very little time to make, is very flavorful, and is healthy all around. It's a win-win recipe in my book!

If you have trouble finding red lentils, check your local health food store like Whole Foods, or an Indian market. I found them in Target in the ethnic foods aisle.

Curried Lentil and Carrot Soup

1 tablespoon oil
1 large onion, chopped
2 large carrots, peeled and chopped
1/2 cup red lentils
2 teaspoons curry powder
4 cups low sodium vegetable or chicken broth
1 bay leaf
4 cardamom pods (optional)
3/4 cup coconut milk or evaporated milk
1 tablespoon cornstarch mixed with 2 tablespoons water

In a Dutch oven, heat oil over medium heat. Saute onion and carrot until onions begin to color. Add lentils, curry powder, broth, bay leaf, cardamom pods, and coconut milk. Bring to a boil and then lower heat and simmer for about 15-20 minutes or until lentils are soft. Remove the bay leaf and cardamom pods (which should be floating on or near the surface).

At this point, you can either use an immersion blender to puree the soup, or you can leave all the chunks. Increase heat under the soup to high and add the cornstarch slurry (or as much as you need to get the soup to the right consistency for you). Top with sour cream if desired.

Serves 4.

By Mandi Cacioppo

Avocado Salsa, Low on Sodium but High in Flavor!

Pathways is starting a recipe of the month post on our blog to promote a healthy living lifestyle. Each month will feature an original healthy recipe from our employees. To start us off, I am presenting a recipe titled "Señora's Avocado Salsa".

You will need the following ingredients:

1 package (16 oz) frozen corn, thawed
1 can (15 oz) black beans (look for low sodium)
1 medium sweet red pepper, chopped
1 small onion, chopped
1 bunch cilantro, finely chopped
3 fresh tomatoes, chopped
3 garlic cloves, diced
1/4 cup lime juice
3 tablespoons cider or white vinegar
1 teaspoon dried oregano
1/2 teaspoon or less salt
1/2 teaspoon pepper
4 medium ripe avocados

In a large bowl, combine corn, black beans, red pepper, onion, cilantro and tomatoes. In a small bowl, whisk together the garlic, lime juice, vinegar, oregano, salt and pepper.

Mix well. Pour over corn mixture and toss to coat. Cover and refrigerate overnight.

Just before serving, chop avocados and stir into salsa. Serve with low sodium tortilla chips or as a side dish. Yield about 7 cups. Tip - if you place the avocado pit into the salsa, the avocados won't turn brown.

This is delicious. I was hesitant about a salsa with no spicy peppers in it, but this is really tasty. I tried it in tacos and it's great because you also get all the healthy benefits of the tasty veggies in the salsa. Next time I would add a bit less garlic because it was really strong, but that depends on your preference. I also added green onions because I prefer them in my salsa instead of a regular onion.

By Mandi Cacioppo, Sr. Marketing & Communications Coordinator at Pathways Home Health and Hospice. Recipe credit goes to my cousin Lynn Fors.

Living the Low Salt Life as a Heart Failure Patient

When you have heart failure, it is important to decrease the amount of sodium in your diet. Salt acts like a sponge, making your body hold on to extra water.

Eating too much of it can cause weight gain, increased blood pressure, make legs and feet swell and cause water to go to the lungs.  This makes your heart work harder and worsens heart failure systems. 

Check with your doctor to see how much salt you can have in a day. Most doctors recommend less than 2,000 milligrams (mg) or salt each day.

How much salt in a teaspoon?

• 1 teaspoon of salt = 2000 mg of sodium
• 1 teaspoon of baking soda = 821 mg of sodium
• 1 teaspoon of baking powder = 339 mg of sodium

Read food labels to help figure out how much salt is in the food. A good rule of thumb is to choose foods with less than 250 mg of sodium per serving.

Remember, a serving size is not necessarily an entire container of food. If a can contains 3 servings and you eat the whole can, multiply the sodium per serving by 3.

Read the Label - Serving Sizes

•  A can of soup has 300 mg of sodium per serving
• The can has 2 servings.
• You eat the whole can, or 2 servings.
• So you would have 300 mg x 2 or 600 mg of sodium.

Compare salt (sodium) in foods you eat often, especially processed foods like soup, lunch meat, cheese and frozen meals.  Sort the foods into higher or lower sodium groups.

To lower your sodium intake, stop adding salt to food during cooking. Try taking the salt shaker off the table and add other seasonings to add flavor such as lemon juice, onion or garlic power, or herbs.

Avoid high sodium foods like canned foods, hot dogs, cheese and cheese spreads, deli meats, bacon,  ketchup, soy sauce, salad dressings, barbecue sauce, and frozen meals that are high in sodium.

Replace high sodium foods with fresh fruits and vegetables, lean meats, low fat milk, reduced sodium cheese and cereals low in sodium. When you go out to eat, choose food on the menu marked “healthy choice” or “low sodium”. Ask for sauces and salad dressings “on the side” and ask the waiter for low salt recommendations.