I think that we would all agree that breathing is essential to living.  When our bodies do not get enough oxygen, what happens? The most common reaction to a lack of oxygen is a sensation of panic, because our brain is very smart.  Our brains tell our lungs to respond with small, quick breaths to compensate for the feeling that we do not have enough air. Loss of oxygen and/or breathing problems make us pay a big price when it comes to our health.  One of the most common breathing problems is Chronic Obstructive Pulmonary Disease (COPD).

There are many places on the internet that explain the process of how oxygen is carried from the lungs throughout the body.  If you currently have breathing problems you know from your Priimary Care Physician and/or Pulmonologist that once your breathing problems start to affect your ability to function, they can no longer be ignored.  Your physician and treatment team have many medication options to choose from, with the primary goal being; to open up your lung capacity to breathe more easily.Some people think that if they take off their oxygen when they do activities and "test their lungs," that they do themselves a favor and are strengthening their lung capacity.  For most people the reverse actually happens.  The lungs have to work harder and the person becomes more fatigued.  If you have been told to wear your oxygen for a certain number of hours per day, or specifically when you are doing activity, please follow your physician's advice.  Not wearing your oxygen does not make your lungs stronger.  It makes you feel weaker.My concern is your ability to function (as always).  What type of functional limitation do breathing problems impose on you?  The most annoying limitation that patients complain of is Fatigue or Decreased Energy.  It makes sense though.  With a decrease in your ability to oxygenate your body; your muscles, nerves, brain and all vital organs do not get to the same level of strength you used to have.  So the plan to manage these conditions functionally is to CONSERVE ENERGY.You need to conserve the energy you do have, and not waste it all on the necessary activities you HAVE to do, but try to save some energy for the things that you LIKE to do.Please realize that your physician and treatment team know your needs better than I do, and this advice NEVER should take the place of what you have been told to do by them.  But, here's what I want you to try.  I want you to modify your approach to your Activities of Daily Living (ADL'S). We call this; Using Energy Conservation Techniques.

This is something that most Occupational Therapists preach to their patients.  Some listen and some don't.  I am just asking you and your care-partner to try a few of these ideas and see if they help:   

Start out by preparing your area:

Get your underwear, clothes, (including shoes and socks) 2-3 hand towels, shampoo, soap and any other things you need.    
     
      1.  Sit to shower. (Look under the HOME MANAGEMENT TAB for specific equipment ideas)

      2.  If you are on oxygen, wear your oxygen in the shower; remove the nose piece to wash your face, but otherwise keep it on.

      3.  Have your towel within easy reach of your seated position, and stay seated to dry off. *  Use 2 or 3 small hand towels to dry
          off instead of one large towel.  They are easier to manage and require less strength to use.

     4.  If you don't already have grab bars in your shower, you need to have at least 2 installed. 

         Refer to the HOME MANAGEMENT SECTION for more ideas on Home Safety. 

    5.  Place a chair in your sink area, that has a back and arms (not a stool) and SIT to shave, groom, apply make up and brush your teeth.*

    6.  Put your clothes on SITTING DOWN.   STAND ONLY TO APPLY YOUR UNDERWEAR AND PANTS.

         *   If you are on oxygen; wear it throughout all of these steps, only removing it when it is in the way.Once you have completed all of these steps, see if you feel less tired than you normally do.  If so, it is just because standing requires energy and consumes more oxygen than sitting.  Now, the goal is that you should be able to spend your extra energy doing something that is more enjoyable than just getting dressed and showering...."Now let's get going!" 
                                                             

 If you would like to learn more about Sally Thimm OTR/L Occupational Therapy Services visit: Professional Case Management of SWFL

"If you're going through hell, keep going."Winston Churchill

When it feels like you are living your worst nightmare, you probably are. After all, for most people experience is what you get, when you weren’t expecting the result you were looking for.

Everyone has a different level of spirituality. I personally think that being spiritual is very helpful when we are doing our best to search for answers to life’s complex situations.

Most people come up pretty disappointed when they feel lost and alone. If you haven’t developed your spirituality, it may be a great time to start looking into that. Whatever religion you were brought up in, or if religion was not part of your history, you might find it helpful to start visiting some churches for support.

I never look at religion as a sign of weakness. Some people think that it is. I believe that when we acknowledge that this world and all that it holds is certainly amazing, we have to realize that we are a part of what can make things better or worse. Choosing a church can be intimidating, but look for churches that have support services.

There are many support groups that meet in churches as part of a community outreach. If you don’t go to a church right now, look for one that is involved with your community. There you will usually find people that are interested in offering services to help people who are struggling with different issues; finances, caregiving, child care, illness, and more.

At Sallycares.com we want to help you find resources in your area that may be of service to you. If you choose to join the Sallycares.com Community, and are finding helpful support groups or resources in your county that you would like to share with others, please send us a message through Contact Us, and we will get your information posted on Sallycares.com.

Never give up the hope that your circumstances will improve and you will find peace. You can do this! “Now, let’s get going!” xo Sally

If you would like to learn more about Sally Thimm OTR/L Occupational Therapy Services visit: Professional Case Management of SWFL

Alzheimer's Disease (AD) is a very challenging disorder that affects the brain's nerve cells.  Many brain functions can become impaired in the process.  Thinking skills, memory, and the development of behavioral changes are often the most obvious symptoms of the disease.  Due to our aging population in the United States, this disease has been recognized as having a major impact on our social and healthcare systems.

There are stages of this disease where the symptoms can be mild, and a person may have functional limitations with their short term memory for example, and then there are those cases that evolve into a person requiring one on one care and monitoring 24/7, to avoid problems with safety in the home. Many informational resources are available on line. Some counties offer support groups and adult day care programs.  If you do not have resources in your area we can try to help you locate options closest to you.  The following list of suggestions may help you manage the care of a person with memory problems.  Also look for specific suggestions under the Home Management Tab, associated with ways to assist a person manage their ADL's (Activities of Daily Living. ie. bathing, dressing and/or self care), when they have dementia.

1. Routine - Try to stick to a routine when managing daily activities.  It helps the patient identify what is expected of him or her and can make the outcome more successful.  Try to consistently approach activities the same way; getting into the shower, getting out of the shower, sitting on the same seat to dress, etc
2. Rituals - Maintain habits that the patient has had. If the patient showers every morning before breakfast, try to continue that habit. Changes to long standing behaviors can cause confusion and fear.
3. Reassessphysical health if there is a behavioral change. Many times people can demonstrate more confusion or agitation when they have a physical change.  A UTI (Urinary Tract Infection) is a good example of a physical change that can inadvertently cause a behavioral change.  *Just because a person has dementia, or is labeled with a disease like Alzheimer’s, it does not mean that they won't continue to have colds, urinary tract infections, the flu, cardiac changes, etc..
4. Redirector change a person from repetitive thought patterns. If a person asks you "When can I go home?" (whether they are home or not), you can offer the person another activity to do or a snack.
5. Real questions-may be difficult to decipher if the person with AD has difficulty communicating.  Increased agitation, for instance could be his or her way of telling you a trip to the restroom is needed.  Learn to read body language.
6. Reconsider the behavior. Is it really a problem, or is it just upsetting to you?  Does it present a danger to the person with AD? If the person talks to his or her reflection in a mirror as if it was another person, is that a real problem?  Does it please the person with AD or does it upset or frighten him or her?
7. Respect the person with AD. Laugh with, not at the person.  Never talk about the person as if he or she is not there.  And remember, the person with AD will know how you feel by your body language and tone of voice.
8. Reassure the person with AD often that you love and will care for him or her.  A gentle pat, stroking the hair, or holding a hand all say, "I care for you."
9. Remember the person with AD is still a human being. Treat him or her the way you would want to be treated if you were suffering from dementia.

Managing a loved one with AD or dementia requires patience and commitment.  The caregiver needs to recognize their limits and work on establishing ways to care for themselves as well.  It is very hard to provide care for someone if the caregiver is tired and overwhelmed. Make sure that the caregiver is well cared for too! 

Find some helpful ideas under Care-Partner's Corner section of our website !  Now Lets Get Going!  xo - Sally                      

If you would like to learn more about Sally Thimm OTR/L Occupational Therapy Services visit: Professional Case Management of SWFL

It is becoming more frequent to see medications distributed in blister packs, rather than in pill bottles.

Skilled nursing facilities and other medical facilities tend to use them to avoid medication distribution errors. For the elderly, this packaging style can be very difficult to manage, if the person has problems with fine motor or hand coordination and/or arthritis.

If you are helping a loved one manage their medications, and this is a struggle for them, you can organize their pills one week at a time in a pill organizer and minimize self- medication errors, by putting all of the bottles and sheets of medication in a separate place.

To help the overall understanding of what medication is used to treat what type of condition, you can make a chart, that includes a picture of the pill, what it is used for and when it is taken. You can copy a picture of the pill from the internet, or take a picture of the pill, and apply it to the chart. The chart will serve to reinforce and remind the person about their medications, and reduce the potential for errors.

Here is an example:

If you are challenged with how to manage a loved one’s medications, let us know what the issue is, and we’ll see if we can help you problem solve your issue! - Now "Let's Get Going" xo Sally

If you would like to learn more about Sally Thimm OTR/L Occupational Therapy Services visit: Professional Case Management of SWFL

Being a caregiver is a challenge, when the behavior of your loved one involves confusion, and behavioral changes.

People with Alzheimer’s disease and memory loss frequently have behavioral problems. When brain tissue changes and your loved one demonstrates behavior that is “not like them at all,” it is important to seek out treatment to get the behavior addressed.

Do not be afraid to discuss the issue of behavior, and the desire to improve your loved one’s ability to function. Aggressive behavior affects the care your loved one receives. You just can’t be an effective caregiver if your loved one lashes out, verbally and/or physically.

If the primary care physician is not able or willing to address it, then head to a neurologist that manages dementia related behavior. Geriatric psychiatrists may also be able to help, if you have someone in your area with that specialty.

Two medications that are commonly used to manage aggressive behavior and hallucinations, are Seroquel or Quetiapine (generic) and Klonopin or Clonazepam (generic). Both of these medications are well tolerated by people with Parkinsons Disease and related movement disorders as well.

It is hard to stand by and watch loved ones suffer mentally. Why some doctors focus on the cognitive management, when there is unfortunate continued decline, that medication is geared toward trying to stall…rather than recover lost cognition…and it can leave caregivers feeling somewhat cheated, because the hard problem is not addressed.

When a loved one’s behavior changes, and it keeps you from being able to manage your loved one effectively…there can be some options for treatment. If we can help you locate someone in your area to help you, send us an email through contact us.  " Now Let's Get Going"   xo Sally

If you would like to learn more about Sally Thimm OTR/L Occupational Therapy Services visit: Professional Case Management of SWFL

Dystonia is a form of movement disorder that has evolved into its own specialty area for treatment.

The definition of Dystonia is:
A movement disorder that causes the muscles to contract and spasm involuntarily. The neurological mechanism that makes muscles relax when they are not in use does not function properly. Opposing muscles often contract simultaneously as if they are 'competing' for control of a body part. The involuntary muscle contractions force the body into repetitive and often twisting movements as well as awkward, irregular postures. There are multiple forms of dystonia, and dozens of diseases and conditions include dystonia as a major symptom.
(Def.-Dystonia Medical Research Foundation)

As noted above, there are different forms of dystonia. Some forms evolve as a primary diagnosis for some people, and others develop dystonia as a secondary clinical feature apart from a primary diagnosis of another condition, (for example) Parkinson's Disease.

There are treatments available that can be life changing for people struggling with dystonia.Medication, chemodenervation and deep brain stimulation are a few that you can look into.

It is very important to know that you are not alone with this disease. Cervical dystonia is a very common form of dystonia and can be an underlying cause of severe muscle tension headaches. It is helpful to see a neurologist who treats movement disorders for an accurate diagnosis and treatment options. Many times people will complain of neck and shoulder pain and receive muscle relaxers and massage therapy prescriptions from their primary care physicians. No long lasting improvement is noted and it is a vicious, frustrating cycle.

The Dystonia Research Foundation has a video on their web site associated with starting a Dystonia Support Group, which is proof that "regular people" can start a support group and help one another. You can see this video here and let us know if you would like more information. Send us your comments through "Contact us!" "Now, let's get going!" xo Sally

If you would like to learn more about Sally Thimm OTR/L Occupational Therapy Services visit: Professional Case Management of SWFL

Cortico Basilar Degeneration (CBD) or Corticobasal Ganglionic Degeneration (CBGD) is a rare, progressive neurodegenerative disease that involves the cerebral cortex and the basal ganglia.  It is often referred to as one of the neurological disorders that falls under the title of "parkinsonism" because as the disease evolves, a person begins to demonstrate characteristics that can be confused with Parkinsons disease.  In fact there are many patients who are initially diagnosed with Parkinsons disease, only to be told "down the road" that they don't have true or ideopathic Parkinsons disease, but rather one of the "imitators," which CBD is sometimes called.

You can find information about this disease on the internet, but one of the frustrating things about being diagnosed with a condition like CBD, is that the symptoms are not as consistently similar from patient to patient, like the symptoms that most Parkinsons patients have, and the disease does not respond to the use of Carbidopa/Levodopa, like Parkinsons Disease does.

So, the primary challenge in managing this condition is the need for the patient and the care-partner to keep a watchful eye on how the medication the patient is given, changes the symptoms that the patient experiences.  For example; if a medication is prescribed by your doctor, you can go to the Forms Tab and download a Symptom Tracking Chart. With this chart you can circle the time you take your medication that is supposed to improve your function, and then monitor if your ability to function improves or seems to worsen.  The bonus with this approach is that you can take concrete information back to your physician or medical treatment team and show them which symptoms improve or worsen or stay the same. 

There are some medications that can give more side effects than benefits.  That is what you want to be able to determine.  The reason why this is so important is because you need to manage these diseases.  Usually there are no quick fixes for these conditions.  The goal has to be to maintain the best quality of life possible, while experiencing functional changes. 

For example if you are taking Carbidopa/Levodopa and have been told by your doctor that they are not sure if you or your loved one actually has Parkinsons Disease, then all the more reason for you to follow your symptoms after taking the medication to see if the medication improves your condition.  If not, report it to your doctor. Let them decide whether or not to try to reduce your medication, and see what happens to your symptoms.  You have to have an open line of communication with your medical providers.  If the medicine isn't helping, you need to let them know, and let them advise you on how to reduce the medication and see if you feel better off the medication (or on a smaller dose). 

There are different symptoms that occur with this condition, that separate it from Parkinson's Disease.  A few features of this condition that are not like Parkinson's Disease would be the development of a lack of awareness of a limb (usually one arm), to the point that when a person walks, they actually may experience that they unconsciously hold one of their arms behind themselves.  In fact, when you point out that their arm is not along their side, it is something that they don't recognize as happening.  The separation of one arm from the rest of the body can also have a noted increase in sensation or sensitivity.  Many patients feel that they have an increase in pain and stiffness in the arm that they have difficulty "controlling." Some patients will have problems controlling the movement of the leg that is on the same side of the body.   Balance is commonly affected.  Depression is common as well.

Go to the Home Management Tab and see if you can get some ideas as to how you might be able to improve your ability to function at home.  Remember that different adaptations work for some people and others need to modify things in another way.  NEVER sacrifice your safety.  Always remember that SAFETY IS OUR FIRST PRIORITY.  Remember that if you are having problems walking now, just think how hard it is to rehabilitate a person and teach them to walk again, when you already have a balance problem.  We want to avoid falls, and if you need to use adaptive equipment to avoid a fall, like a wheelchair, walker or a type of power mobility device, it is more important to be safe than worry about what you look like..or what you THINK you look like.  We are usually harder on ourselves than our friends and family are toward us.  Our Goal is to help you manage this condition and have the best quality of life possible..."Now let's get going!" xo Sally

If you would like to learn more about Sally Thimm OTR/L Occupational Therapy Services visit: Professional Case Management of SWFL

“We can't help everyone, but everyone can help someone.” Ronald Reagan

Do you have anything left to give? Do you feel that your days are filled with giving, and you don’t think you could possibly do more?

There is a saying from somewhere that you may be familiar with and it goes something like this:  

“If you need something done right away just ask someone who has a lot to do. They will get it done.” Why would that be a good idea?

People who are actively involved in organizations, whether it is a non-profit group that does a good service for a community, like Meals on Wheels, or your local humane society, they are busy people.

They don’t add one more commitment to their list because they have little to do. To the contrary, if you ask someone who is an active volunteer, what they do all day, they will give you a list.

I have found that when people retire, and their schedules revolve around their golf game tee time, when they get their hair or nails done, or watching TV, eventually there is an emptiness that they never had when they “worked.”

We all need a purpose. We are at our best when we have something to focus on outside of ourselves and our current circumstances.

I know many caregivers that continue their volunteer work, even if their loved one at home requires a great deal of care. Why?

Getting out and providing a service is motivating to many people. It fills the soul with a sense of changing someone else’s situation. That alone is healing for the person doing the giving and the person who is receiving.

Consider looking around your community and see what you could do to help someone else.

Get up and Get Out!        Get out of your own way!

Don’t allow your present circumstances to promote negativity! You’re the one that controls that!

Send us your thoughts through “Contact Us” and let us know how you are doing.  Join the www.Sallycares.com Community.

Together we can support each other and accomplish AMAZING things!   “Now, let’s get going!” xo Sally

If you would like to learn more about Sally Thimm OTR/L Occupational Therapy Services visit: Professional Case Management of SWFL

This article will start a new series of general information to answer different questions sent to us by you! Please submit your questions through the web site at Contact Us.
Always remember that the thoughts expressed at Sallycares.com are never intended to take the place of the advice of your treating medical professionals.

I often hear people say things like: "Why are there so many more people getting Parkinson’s Disease now, than you ever heard about years ago? You never used to hear about Parkinson’s Disease so much."

From my experience it does feel like the diagnosis is seen more often, but it is happening for at least three reasons.
• There is more awareness of the disease on the part of general practitioners and internal medicine professionals.
• We have an aging population that will start to demonstrate symptoms that look like Parkinson’s Disease, by default – associated with changes in the brain.
• People are frequently misdiagnosed and told they have Parkinson’s Disease, when they might have another condition that looks similar to it.

It is not really unusual for neurologists who specialize in Parkinson’s Disease and the class of conditions called Movement Disorders, (which Parkinson’s Disease is included in), to see patients that have been diagnosed with Parkinson’s Disease and be on placed on medication to treat it, and actually have Essential or Familial Tremor or one of the imitators of Parkinson’s Disease.

One of the reasons this happens is that there still isn't an objective test that's readily available that separates the diagnosis of Parkinson’s Disease from other conditions that are similar. That makes it a challenge for the physician who is doing the diagnosing, and because the condition changes and new features develop that may or may not be consistent with Parkinson’s Disease, what starts out looking like Parkinson’s Disease may evolve into another condition.

Knowing that, it is very important for you and your family to pay attention to what is happening to you. It is critically important to start a journal where you objectively write down physical changes, changes in personality, changes in thinking skills, and anything else you see. Take that information to the medical appointments you have. It will help your treatment team monitor treatment and make adjustments in medications.

Stay on top of any physical condition you have. Learn how to be your own ADVOCATE whether you are a patient or caregiver. Start your JOURNAL today! Join Sallycares.com. Send us a message at Contact Us and let us know if this helps you, and what you are interested in learning about. You are important to us!

Know that we are here to help you! xo Sally

Simplify the organization of your medications by using containers that separate your pills into compartments that best describe the time of day that you take them.

For example; one of my favorite types of medication containers is pictured below.  They come marked for medications to be taken 4 times per day:  Breakfast- Lunch- Dinner- Bed time.

Sometimes those descriptions don’t fit the timing schedule that you follow.  A good example of this is when some patients that take medication for Parkinsons Disease four times per day, take them every four hours.  To make the pill organization easier, I take a label maker and cover the printed words on the boxes, and put the time that the pills are supposed to be taken over the wording.  See below:

This particular pill organizer has 7 different compartments labeled with each day of the week.

There are 4 individual sections in each compartment that are labeled with the time the pills are to be taken in each section.

This allows the patient or caregiver to take the supply of pills for the day in a compact carrier, and be reminded about the time to take the pills, just by looking at the top of the box.

Let us hear from you through Contact Us, and share how you manage medications that are timed.  A web site you may find interesting is www.epill.com .  They have a number of electronic pill reminder gadgets that may help you to remember to take your pills on time!

“Now let’s get going” xo Sally

If you would like to learn more about Sally Thimm OTR/L Occupational Therapy Services visit: Professional Case Management of SWFL