Wednesday, February 20, 2019

Summary: GETTING TO YES WITH YOURSELF


Getting to Yes with Yourself: (and Other Worthy Opponents)
Expert negotiator and best-selling author Dr. William Ury gave the following advice in his recent book Getting to Yes with Yourself: And Other Worthy Opponents, a sequel to the Getting to Yes book he co-authored with Roger Fisher three decades ago, one of seven other books he wrote or co-authored.  “Getting to yes” means reaching an agreement. His six major points are as follows:

1.    Put Yourself in Your Shoes: From Self-Judgment to Self-Understanding
To get what you want, you must know what you want, not a trivial task. If you think you want something, ask yourself why. After you have answered that, ask yourself why about that answer, etc. Observe your “inner critic” and feelings to determine what you really need.

2.    Develop Your Inner BATNA: From Blame to Self-Responsibility
Your BATNA in a negotiation is your Best Alternative to a Negotiated Agreement, what you can have if the deal falls through. Do you really need what you are fighting for? Take responsibility for your choices rather than blaming someone else for your situation.

3.    Reframe Your Picture: From Unfriendly to Friendly
Is it a friendly or unfriendly world? Your answer will shape much that you do. You are wise to assume the world is friendly, or at worst neutral. Otherwise, you present a hostile face to the world and the world will likely mirror that. Find a way to be grateful, positive about the world you are in.

4.    Stay in the Zone: From Resistance to Acceptance
When you are in “the zone,” you are performing near your best. You are not regretting the past nor worrying about the future, but you are succeeding in the present. You go with the flow.

5.    Respect Them Even If: From Exclusion to Inclusion
Instead of having antagonistic relations with others, find ways to view them with respect and understanding. Try to imagine “living in their shoes.” Draw your circle to include, not exclude, them.

6.    Give and Receive: From Win-Lose to Win-Win-Win
You have got to give to get. You need to find a way for those you interact with to win, also. Ideally, you win, they win, the world wins. It helps if you do not view this as a world of scarcity, but rather one where opportunities abound to “grow the pie” that is to be shared.

Ury’s book is a Kindle ebook $1.99 bargain at amazon.com:

         

Saturday, February 16, 2019

MANAGE NURSING CARE AT HOME, "Ch. 11 Respiratory System"



   How to Manage Nursing Care at Home

    
The nasal passages, pharynx, larynx, trachea, main bronchus and bronchial tubes, and lungs make up this system.  All these organs provide respiration, the exchange of gas, or air, between the environment and the body and the process of making it usable for the body.  The byproduct of respiration, carbon dioxide, is eliminated by exhaling.  Inhaling provides oxygen; it is then exchanged on a cellular level, via the alveoli, and transported to all cells via the blood pumped by the heart.  It is the alveoli, the main functioning cellular pieces of the respiratory system, along with the bronchial tubes and organs, which connect the inside of the body to the outside environment – and perform gas exchange providing pulmonary functionality.

A wide variety of illnesses and disorders are accompanied by problems with breathing. Often the need for respiratory intervention and assessment is what distinguishes patients who need skilled nursing care at home from those who do not. Some of the various respiratory systems conditions and care considerations are described below.

Chronic Obstructive Pulmonary Disease (COPD): is a long-term (chronic), debilitating, irreversible, and progressive group of lung diseases that results in air-flow resistance into and/or out of the lungs, noted by increased expiration time along with an abnormal decreased elasticity of the lungs further decreasing the air flow.   This group of pulmonary diseases includes chronic bronchitis and emphysema.  Asthma is also included in this group but will be addressed separately. 

Chronic Bronchitis is a widespread inflammation and/or infection of the lungs causing narrowing and blockage of the bronchial tubes due to increased mucous, and that is the hallmark of the disease:  airflow obstruction due to mucous.  While it can be acute, if increased mucous and cough are present over a period and occurs over consecutive years, it is classified as chronic bronchitis.   It is characterized by airway resistance affecting the smaller “limbs” or tubes of the bronchial tree.  It does not directly affect the smallest functioning units of the lungs, the alveoli – rather, it is mucous that blocks the smaller tubes, hampering receipt of oxygen to the cellular level, as well as blocking carbon dioxide exchange.  Because the airways are obstructed, oxygen transport to the body via the arterial blood system is reduced.    Patients with this condition often show productive (phlegm-producing) cough, cyanosis (blueness) of extremities due to decreased oxygenation, and hypoventilation (breathing in an unusually slow and shallow fashion) due to mucus production that blocks enough oxygen into airways.

Emphysema is very severe; it causes recurrent damage at the cellular level (the alveoli) rather than affecting the bronchial tubes.  It is characterized by permanent and abnormal gaps or spaces between alveoli due to alveolar wall destruction.  Without these walls, large air spaces (bullae) result, creating an inability for gas exchange to occur: the gaps are too large to permit efficient transport.  Ultimately, pulmonary functioning cannot be achieved.  Carbon dioxide cannot be released, and oxygen cannot be consumed and made useful.   Airflow obstruction is not from mucous, as is the case with chronic bronchitis, but from cellular tissue damage of the lung.  Patients with this condition show long and slow exhalation to get rid of trapped carbon dioxide.  They are often described as having “barrel-chests,” and they tend to use respiratory and abdominal muscles to force air out of their lungs.  These patients tend to hyperventilate (breathe especially deeply and rapidly) because they have trapped carbon dioxide and tend to be hypoxic (low on oxygen). 

Care Considerations for COPD (Chronic Obstructive Pulmonary Disease):
1) Muscle fatigue often occurs, due to trapped carbon dioxide that results in an inability to inhale oxygen.  This can result in “air hunger.”  To treat this condition, promote exhalation and inhalation.  Monitor for nasal flaring and use of accessory muscles.  Other signs are difficulty speaking and trouble breathing (dyspnea) during exertion or at rest. 
2) Position patient to ease in breathing.  Place in “tripod” position, where patient rests forearms on a high table and lean forward to expand chest.   When in bed, place head of bed to as upright a position as is tolerable, but ensure patient has ability to expand both diaphragm and abdominal muscles essential for deep breaths. 
3) Monitor respirations for rapid rate and shallowness, indicating hyperventilation.  Have patient perform pursed lip breathing to expel carbon dioxide:  breathe in through nose and exhale very slowly through pursed lips (lips drawn into a kissing position).  Avoid fatigue and faintness. 
4) Provide supplemental oxygen at the medically prescribed level only.  Too much oxygen can cause oxygen toxicity and resulting carbon dioxide toxicity.  (Oxygen is a drug to be maintained at prescribed levels.)
5) Monitor vital signs, such as percentage oxygen saturation, heart rate, and respiration rate.  These should be within normal range for your patient. 
6) Monitor for loss of appetite which could occur if mucous is being ingested and causing nausea. 
7) Promote fluids intake to decrease mucous thickness (and viscosity) and promote expelling mucous. 
8) Perform chest physiotherapy, including “cupping” of back to loosen secretions. 
9) Ensure medications are taken as prescribed; these may include bronchodilators, inhalation therapy, diuretics, antibiotics, or steroids.   Compliance with instructions is essential. 
10) Reassure the patient, who may mourn the difficulty in breathing and feel he can no longer participate in life, becoming hopeless.  To prevent the experiencing of a loss of self, encourage interaction with others.  
11) Obtain portable oxygen, if it’s needed all the time, to encourage leaving the home and combat isolation. 
12)  Provide assistance with care while promoting self-care as much as possible. 
13) Do activities in short bouts to decrease fatigue and allow periods of rest in between them.  Learn the signs of weariness and exhaustion. 

Asthma: is a form of chronic obstructive pulmonary disease (COPD) but is often discussed separately from chronic bronchitis and emphysema because episodic symptoms often result from triggers or environmental stimuli and the patient may be asymptomatic between episodes.   Airway obstruction can be caused in three different ways, acting separately or collectively:  bronchospasms, mucus secretion, and mucosal edema. 
Bronchospasms are the narrowing of the bronchial tubes due to contractions of the muscles, causing coughing and wheezing. 
Increased mucus production is the result of inflammatory responses to allergic reactions due to outside allergens, causing the release of histamine (extrinsic reaction) or due to effects of non-allergic causes such as emotions or cold weather (intrinsic reaction). 
The thick over-production of mucus, along with edema (swelling due to fluid build-up) of the bronchial tube lining further constricts the opening of the bronchial tubes.  When the patient inhales, the bronchial lumen (space within the tube) is only partially open.  However, due to pressures within the body, the lumen closes when the patient exhales, trapping carbon dioxide, and gas exchange at the alveolar level is impaired.  Asthma triggers may include anything that causes an allergic reaction, such as dust, pollen, food allergies, as well as conditions including stress, fatigue, exercise, and temperature changes. 

Care Considerations for Asthma: 
1) Learn the triggers of the asthma attacks and limit the triggers as much as is possible.  While it is difficult to eliminate extrinsic triggers such as cold weather, minimizing contact, using scarves, or entering warm cars may discourage attacks.        
2) Proper use of medications, whether daily or for attacks, is essential.  Bronchodilators help to decrease the bronchial constriction and edema while promoting ventilation.  Corticosteroids act like bronchodilators but also help to decrease the inflammatory and immune response to the allergen. 
3) During attacks, supplemental oxygen may be necessary if the patient has difficulty breathing (dyspnea) or shows signs of insufficient oxygen intake with increased respiratory rate and depth.  Be sure to use proper amount of oxygen, as too much can be as detrimental as too little.  Beware of carbon dioxide air trapping. 
4) Pursue effective relaxation techniques, which could prove vital during an exacerbation.  Imagery, yoga, or focused breathing may help to calm patient and decrease anxiety and fear during an attack when he is unable to breathe.
5) Promote fluids, especially after an attack, to help thin secretions and help expel them. 
6) During an attack, position patient to assist in breathing.  He should sit upright and lean forward to promote chest expansion. 
7) Because attacks can be episodic, fear may be constant, especially if triggers are unknown or unable to be avoided.  Teach and reinforce that medications will assist.  As the time the patient has been enduring the disease increases, so will his ability to understand and recognize the early signs of an asthma attack. 

Sleep Apnea:  This is defined as temporary absence of breathing during sleep, absences that may last more than 10 seconds and occur thirty times or more in a seven-hour sleep period.  When breathing stops for a prolonged period, oxygenation decreases, and carbon dioxide levels increase.  Sleep is fragmented, and the patient often wakes many times a night.  In the morning, he feels he had unsatisfying sleep, may feel drowsy and fatigued, or suffer a morning headache.  It is a common condition, and partners are often the first to observe the situation.  There are three distinct types of sleep apnea: 
Obstructive sleep apnea is caused by an inability to keep the upper airway open (patent); the structures in and around the mouth and pharynx collapse or become obstructed.  This is usually accompanied by snoring, as the airways start to close, and snorting, which then opens them up. 
Central sleep apnea does not have sounds associated with it, because it is not due to obstruction but rather is from lack of nervous system communication.  This type of apnea strictly involves the part of the brain center that controls respiration and the respiratory muscles that perform the work of breathing.  Proper signals are not sent by the brain and thus not directing the muscles to act.  Simply stated, the brain has not told the muscles to breathe for the body.  This results in no breathing, no movement of the chest, and no breath sounds. This is further marked by excessive daytime sleepiness, such as falling asleep during meetings or while driving, as the body has been deprived of oxygen during these episodes. 
The last type is mixed apnea, the combination of the two types.

Care Considerations for Sleep Apnea: 
1) Diagnosis is made in a formal sleep study lab.  Encourage participation.  Fear of positive diagnosis or embarrassment may prevent patient from undergoing study. 
2) If apnea is due to obstruction, surgical remedy may be available.  Help patient understand the ramifications of surgery, the potential benefits or curative possibility (whether partial or complete).  Learn post-surgical complications and healing actions.  Provide honest feedback of results. 
3) Many sleep apnea patients are obese, causing or increasing the incidents of the apnea.  Encourage weight loss.  Promote healthy foods, increased non-caloric fluids, and exercise.  In addition, changes in some underlying conditions, such as type-2 diabetes or hypertension may occur. Prior to initiating, discuss with physician. 
4) After confirming diagnosis and weight loss does not remedy the condition, treatment may be obtained using a continuous positive airway pressure (CPAP) machine.  Used at night, this machine, with a device that covers the nose and/or mouth, provides a constant mild stream of air that forces the airway to remain open.  Ensure that face apparatus fits properly and comfortably, has ample tubing, is set correctly, and functions optimally. 
5) If patient is using a CPAP machine, he may be uncomfortable initially.  Provide support but do not pressure usage.  Encourage use by noting positive benefits such as increased energy in morning and during the day, as well as enhanced mood and disposition due to getting a restful night’s sleep.

Respiratory Treatments and Therapies:  Effective respiration occurs at the cellular level when carbon dioxide and other wastes are exchanged for oxygen via the blood.  For this to happen, inhaled oxygen from the environment proceeds within the lung structure comprised of increasingly smaller tubes (the bronchial tree) to the smallest functional unit in the lungs (the alveolus), where gas exchange takes place and transported via the venous system.  If there is an inadequate amount of oxygen available in the blood (hypoxemia), then there will be insufficient oxygen to meet the needs of tissues and cells (hypoxia).  Any blockage or obstruction, such as mucus, inflammation or infection, prohibits this from happening, and, therefore, decreases pulmonary function.  Forms of treatments and therapies to promote respiration include suctioning, eliminating mucus plugs, lavage, chest percussion, and controlled coughing and positioning.

Suctioning is used to eliminate excess secretions from a part of the respiratory system to maintain an open airway.  Secretions that could cause obstruction may be thin and watery or thick and tenacious.  This will vary dependent on location and underlying disease and ventilation assistance that the patient may have.  All types of suctioning require attachment to a suction machine via long tubing.

Oropharyngeal suctioning uses a rigid plastic catheter with openings, often called a Yankauer suction catheter, to remove oral secretions.  It is inserted into the mouth to remove excess liquid; it is often required for patients who have inefficient gag reflexes and an inability to swallow these secretions.  Yankauer suctioning removes saliva and mucus that could enter the lungs.  Depending on the awareness of the patient, this suction can be done directly by him, as it is much like handling a toothbrush. 

Nasotracheal suctioning is used to clear secretions from the trachea and lower airways when a patient cannot do so himself.  It requires a sterile technique even though the airway access is obtained from the nose.    Secretions can range from as thin as saliva to being much thicker in nature. 

Endotracheal and tracheostomy suctioning is used when there is a direct access to the lower airways, either by intubation or permanent placement of a tracheostomy tube, respectively.  This type of ventilation and suction completely bypasses the respiratory system above the trachea.  Strict sterile technique is necessary, and often a closed suction tubing suctioning system is used to promote sterility, as well as not requiring the patient be disconnected from a ventilator.

Care Considerations for Suctioning: 
1) Sterile technique is essential for all suctioning, except oropharyngeal, as the area below the pharynx is a sterile area.  Patients requiring suctioning usually have compromised pulmonary systems and are at risk for respiratory infections. 
2) Ensure proper technique is used.  Insert catheter into airway until resistance is felt or the patient coughs.  Pull back slightly and then apply intermittent suction until the catheter is removed.  Never apply suction while inserting the catheter. 
3) Patient should be well oxygenated prior to suctioning, especially if a closed suction system is not used.

Mucus Plugs are merely accumulations of mucus, tissues, cells, and dirt that block or obstruct an airway or tube.  Patients with artificial airways are more susceptible, because the tubes can stimulate or cause stasis of secretions. In addition, air bypasses the usual defenses, filtration, and humidification of normal airways.  However, replacing equipment, such as an inner cannula, or carrying out lower airway suction, often relieves the obstruction.  Removing plugs in patients with natural airways are difficult and requires strong forceful coughing, abdominal thrusts, and suctioning.  Regardless of the type of airway, mucus plugs must be removed.

Care Considerations for Treating Mucus Plugs: 
1) Maintenance of and compliance to scheduled equipment usage is vital to optimal functioning, filtering, and minimizing buildup of secretions. 
2) Increased hydration and humidification may assist in keeping mucus from hardening.  Use caution to prevent fluid overload. 
3) Suctioning, as prescribed, eliminates the stasis (pooling) of secretions, which minimizes the formation of a mucus plug. 
4) Lavage may (or may not) help to loosen secretions.  (Strictly follow physician’s and/or pulmonologist’s guidelines.)

Lavage (washing out) is a treatment that is not universally recommended and not definitely a commonplace, accepted practice. During lavage, a small amount of normal saline is instilled to stimulate a cough.  Once the fluid is delivered, the patient is suctioned.  The thought behind lavage is that instilling a small amount of sterile, normal saline into the bronchial tubes will loosen secretions, thereby making them easier to suction and prevent mucus plugs.  However, research has not indicated whether this is true.  Some theories suggest that instilling fluid, while loosening secretions, may disperse bacteria throughout the lung.  Alternatively, more humidification and hydration may relieve the mucous plug condition.

Care Considerations for Lavage: 
Consult your medical professionals and follow their guidelines.  Inquire about humidification and hydration for the patient.  Follow recommendations concerning care of the equipment.

Chest Percussion, also known as Chest Physiotherapy is done to loosen and help remove secretions that accumulate in the lungs especially in the bases.  It involves using numerous techniques. 
Clapping, or percussion, is performed by thumping the hands, held in a cup-like position, against the patient’s back.  After clapping, postural drainage is then utilized.  To achieve this, the patient’s body is tilted so his head is lower than his lungs.  This aids in the drainage of secretions due to gravity.  If a patient is unable to be tilted, suctioning would then be performed. 

Care Considerations for Chest Percussion: 
1) When cupping, ensure clapping is not too forceful.  The thumping should be strong but should not cause pain or discomfort.  Massaging the back with lotion in an upward motion after cupping also aids in movement of secretion as well as provides comfort after the procedure. 
2) Use caution when placing a patient in a head-first downward angle.  Depending on quality of his oxygen status, the patient may be at risk for dizziness and fainting.  The angle of the body does not need to be great for adequate postural drainage.

Controlled Coughing and Positioning:  Correct positioning helps to keep airways clear by promoting ability to expand chest, breathe deeply, and use muscles.  While the patient is sitting, the head of the bed should be at a 45- to 60-degree angle (semi-Fowlers) to a 90-degree angle (high Fowler’s position).  This enables chest expansion, full use of the diaphragm muscle and other respiratory and abdominal muscles.  If the patient is standing, and having difficulty breathing, support his body against a wall.  This will provide safety as well as support for his back to promote chest expansion.  If the patient is lying in bed on his back (supine position), use two or more pillows or raise the head of the bed to a 30-degree angle to promote deep breathing.  This is often a better position for patients who have a large abdominal girth. 

Controlled coughing is an exercise and technique to clear secretions and maximize the coughing effort.  Coughing that does not expel secretions is not effective, causing additional coughing ultimately leading to discomfort and fatigue.  Position the patient in a Fowler’s position.  Often it is more comfortable for the patient to support his abdomen with a pillow.  He then takes two slow, deep breaths in through the nose and exhaled through the mouth.  At the third breath, inhale through the nose and hold the breath, count to three, then without inhaling between, cough deeply two or three times pushing the air out of the lungs.

Care Considerations for Controlled Coughing and Positioning: 
1) Ensure patient safety at times.  If the patient is not mobile, ensure turning and positioning is done every two hours to decrease risk of pressure sores. 
2) Be mindful of patient comfort.  When in discomfort, less effective breathing is performed and is exhibited by shallow breaths, increased or decreased rate, and ultimately a decrease in oxygen saturation. 
3) Monitor oxygen saturation to provide actual verification of the effectiveness of the position. 
4) Encourage ingestion of fluids to thin secretions for ease in their expulsion. 
5) Practice controlled coughing exercises.  Count the repetitions and advise patient on steps to perform technique.  Support and encourage practice, even if immediate results are not seen. 
6) Observe for correct use of incentive spirometer.  The goal is to maximize exhalation – not inhalation.  Patient should take a deep breath in through the nose, and then exhale though the mouth of the machine to make the device’s indicator rise.  The higher rise of the indicator demonstrates that a deeper exhalation was accomplished.



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Contact information:
Diane R. Beggin, RN
40 Sycamore Drive
Montgomery, NY 12549


WHAT EVER HAPPENED...? "Recommended Books, III"




Change Your Brain, Change Your Life: The Breakthrough Program for Conquering Anxiety, Depression, Obsessiveness, Anger, and Impulsiveness, by Daniel G. Amen, M.D.
Though I have not finished reading this book, what I've read so far is excellent! Here are some of the quotes I've highlighted.
·       “You cannot be who you really want to be unless your brain works right. How your brain works determines how happy you are, how effective you feel, and how well you interact with others.”
·       “…the temporal lobes, underneath the temples and behind the eyes, are involved with memory, understanding language, facial recognition, and temper control.” [Boy – do I have to work hard on that last one!]
·       “My research and the research of others had implicated the left temporal lobe in aggression.”
·       “My colleagues and I have observed that left-side brain problems often correspond with a tendency toward significant irritability, even violence.”
·       “…top middle portion of his frontal lobes…. This part of the brain allows you to shift your attention from one thing to another. When it is overactive, people may end up getting 'stuck' on certain thoughts and behaviors.”
·       “Willie found that the 'minor concussion' was wreaking havoc with his life. Normally a friendly person, he found himself suddenly losing his temper at the smallest things. His whole attitude and demeanor began to change. Where he had once been patient, he now had a short fuse. Where he had once been amiable and calm, and he was now always angry. His irritability and constant flares of temper began to alienate his friends and family.” [Remember – even mild concussions can produce brain-injury-like behaviors!]
·       “Unfortunately, there are many professionals who lack sophisticated information on how the brain actually works.” [How true! I have been asked to speak at a hospital to help change this.]

Dr. Amen's research has been broadcast on the PBS channel. It's an excellent way to learn from him!

The Mild Traumatic Brain Injury Workbook: Your Program for Regaining Cognitive Function & Overcoming Emotional Pain, by Douglas J. Mason, Psy.D.               
    This self-help workbook was wonderful for me to use even though my brain injury was medically labeled non-traumatic. The exercises and activities helped me grow emotionally and cognitively after my surgery. Below I list some quotes and observations that helped me:
·       “The exercises have been tested by more than a hundred patients with different levels of brain injury….”
·       Excellent warning signs related to brain injury from concussions and other traumas are listed thoroughly.
·       Excellent descriptions of all parts of the brain to help better understand behavior changes and much more (for example – damage to the frontal lobes can cause a lack of emotional control).
·       Thorough lists of physical aspects of brain injuries such as: headaches, poor balance, fatigue, anxiety, attention deficit (for example: “Things like… simple math problems may seem much more difficult.”)

      To sum up, this workbook helped me understand and realize a ton about why I do what I do. The best part of the book is the story of “The Meaning of Life” that the author put in his closing. I reread this example repeatedly when I'm having a bad day. Thank you, Dr. Mason, for putting this workbook together for those of us who have suffered a brain injury. You are a present from God!

Fully Alive: Discovering What Matters Most, by Timothy Shriver.
    This is an excellent book about one of my favorite topics – Special Olympics. Though I attend some games now and then, the coaching and volunteering time has dwindled completely since I no longer teach and therefore, spend my “free time” trying to improve my social skills – a daily struggle. Here are some great quotes:
·       “…you can see another view of the world if you turn your lens around. Keep your eyes open, and you will see both what is close and what may seem far away.”
·       “I needed to be able to use my mind to see the real stuff in the physical world but also to quiet all the distractions of my mind to see the equally real stuff of the heart that lay beneath them.”
·       “But with a strong relationship, learning is the endlessly exciting process of pursuing the questions and dreams that animate teacher and student alike.” [My brain tumor got in the way of my once-animated teaching style. Those students that I taught at the very end of my career really lost out!]

Special Olympics Oath: Let me win. But if I cannot win, let me be brave in the attempt.

The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science, by Norman Doidge, M.D.
This was a helpful book and so I read it two times – once in February 2011 and then again in June of 2015. Here are some of the key points for me:
·       “There are many kinds of worriers and many types of anxiety…. But among the people who suffer most are those with obsessive-compulsive disorder, or OCD, who are terrified that some harm will come, or has come, to them or to those they love.”
·       “Obsessive-compulsives, so often filled with doubt, may become terrified of making a mistake and start compulsively correcting themselves and others.” [See my Ms. Corrector chapter, for example.]
·       “It would seem that the most frightening thing about brain disease is that it might erase certain mental functions. But just as devastating is a brain disease that leads us to express parts of ourselves we wish didn't exist. Much of the brain is inhibitory, and when we lose that inhibition, unwanted drives and instincts emerge full force, shaming us and devastating our relationships and families.” [So true for my life!]
·       “Regression…can be problematic, as when infantile aggressive pathways are unmasked and an adult has a temper tantrum.” [I've had too many tantrums to count since my surgery, but luckily, they have decreased substantially.]
·       “Sometimes regression is quite unanticipated, and otherwise mature adults become shocked at how 'infantile' their behavior can become.”

This is another PBS program based on this doctor's research.

The Brain's Way of Healing: Remarkable Discoveries and Recoveries from the Frontiers of Neuroplasticity, by Norman Doidge, M.D.
Another “brain book” by the author I just quoted. Here's some more:
·       “The reader will find cases, many very detailed, that may be relevant to someone who has, or cares for someone who has experienced…traumatic brain injury, brain damage, Parkinson's disease, multiple sclerosis, autism, attention deficit disorder… Down syndrome….” [All of these are part of my life story, in one way or another.]
·       “In many brain problems, we now know, neurons are firing at the wrong or unusual rates.…and brain injuries, among others: they create a noisy brain because so many of the signals are out of sync.”
·       “Sound – as is often the case for people with brain injuries – posed a special problem. She was hypersensitive to all sounds, which now seemed unbearably loud. Shopping malls with piped-in music…drove her crazy.” [Once, at a fundraiser walk for brain injury, I went right over to the DJ blaring music from the booth that was one of our sponsors and told (not asked) her to turn it down, because the people there are brain-injured, sound-sensitive, and it's too loud. This is just one more example of people, even those involved with the cause, who don't “get” brain injury.]
·       “Indoors, the flickering, pasty hues of ‘energy-conserving’ cool-white fluorescents illuminate us with a ghostly glow that is so unnatural that some sensitive patients feel ill when bathed by them.” [In some places, I have to wear sunglasses indoors because of this.]
·       “He had realized that brain-injured patients, like children with developmental disorders, have energy, sleep, attention, sensory, and cognitive problems.” [So, the patience I once had with my students I now must have with myself.]

Write Your Book with Me: Payoffs = Plan x Prepare x Publish x Promote, by Douglas Winslow Cooper, Ph.D.
This is another book by my editor, and here are the quotes that helped me the most:
·       “Authors are authorities. Memoirs mold memories. Completing the 'memoir marathon' doesn't quite make you rare, but certainly makes you stand out.” [And, it made me exhausted!]
·       “…to write a memoir, the story of part of your life, as you experienced it, it will not be the whole truth, but some of it, and none of it should be false, although nobody's memory is perfect.” [I did the best I could with my brain damage.]
·       “Nonfiction Books: The Truth, Approximately”
·       “Memoirs: Part of the Truth, How You Saw It…. It tells the truth, not necessarily all the truth.”
·       “...as most books lose money.” [I have never been in this project to make money. If that happens, great. I'll share it with worthwhile organizations and charities. But, the reason I wrote this was pretty simple: brain injury is not understood by the majority of people, and it needs to be, so those of us who have one will be treated better by our caregivers, family, friends, and the world-at-large. That means – please try to: understand us better, rather than avoid or ignore us; not correct us about our mistakes (since we usually know what we've done wrong all by ourselves); don't point out what we once were able to do (we miss it way more than you realize); embrace us with love and warmth (that many of us are starving for since we're so different now)].
·       “Changing minds, thanking those who have helped you, criticizing those who have fallen short…all add to your sense of well-being.” [I hope I've changed minds, thanked as many people as I can remember, and I realize I've done quite a bit of criticizing here….]

No Stone Unturned: A Father’s Memoir of His Son’s Encounter with Traumatic Brain Injury, by Joel Goldstein [I know this author and not only is he an excellent writer, but he is one of the best advocates for brain injury because he speaks eloquently about his family’s story.]

Chicken Soup for the Soul: Recovering from Traumatic Brain Injuries: 101 Stories of Hope, Healing, and Hard Work, by Amy Newmark and Dr. Carolyn Roy-Bornstein [There are remarkable stories written by many survivors of brain injury.]

A Guide to Approaching Mild/Moderate Brain Injury: Fourth Edition, June 2017, A Survivor’s Guide, by Brent D. Feuz. [This is an excellent resource and notebook to help those of us who can navigate after a brain injury but who still need help figuring out how to deal with our “new normal.” I have met this author, and I love how directly honest and well-spoken he is. He “pulls no punches,” and he reminds me of me because he tells it like it is!]

The Traumatized Brain: A Family Guide to Understanding Mood, Memory, and Behavior after Brain Injury, by Vani Rao, MBBS, M.D., and Sandeep Vaishnavi, M.D., Ph.D. [I’ve heard excellent comments about this book, and I cannot wait to read it and then share it with others in my life who HAVE TO understand me better!]





I (Douglas Winslow Cooper) have been excerpting, weekly, material from this almost-final version of the fine book by Janet Johnson Schliff, M.S. Ed., which she wrote over a three-year period with some coaching and editing help from me, through my business, Write Your Book with Me.

Her memoir is now available in paperback and ebook formats from Outskirts Press  and amazon.com




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BOOK TALKS AND SIGNINGS


More talks are being planned for the spring of 2019… she can be contacted at 845.336.7506 (home) or 845.399.1500 (cell).

Janet Johnson Schliff spoke at the Oblong Books Bookstore in Rhinebeck, NY, on Tuesday, February 6 at 6 p.m.

Janet was on WKNY Radio 1490 in Kingston, NY, on Thursday, March 1 at 9:10 a.m. 

Janet spoke at Barnes & Noble in Kingston, NY, on Saturday, March 3 at 1 p.m. 

Janet spoke at the Starr Library in Rhinebeck, NY, on March 6 
at 7 p.m. 

Janet spoke at the Golden Notebook Bookstore in Woodstock, NY, on March 17 at 2 p.m.

Janet spoke at the Morton Library in Rhinecliff, NY, on March 28 at 6:30 p.m. 

Janet spoke at RCAL in Kingston, NY, on April 3 at 4 p.m. [They gave her an impromptu book-launch party.]

Janet spoke at the Parkinson's Support Group at the Starr Library in Rhinebeck, NY, on April 4 at 2:30 p.m.

Janet spoke at the Stone Ridge Library in Stone Ridge, NY, on April 27 at 5:30 p.m.

Janet spoke at the Hurley Library in Hurley, NY, on May 4 at 6 p.m.

Janet spoke at the Kingston Library in Kingston, NY, on May 9 at 6 p.m.

Janet spoke at the Staatsburg Library in Staatsburg, NY, on May 14 at 7 p.m.

Janet spoke at the Clinton Community Library in Rhinebeck, NY, on May 31 at 6:30 p.m.

Janet spoke at the Mountain Top Library in Tannersville, NY, on June 9 at noon.

Janet spoke at the Gardiner Library in Gardiner, NY, on June 11 at 7 p.m.

Janet spoke at the Marbletown Community Center in Stone Ridge, NY, on June 20 at 6 p.m.

Janet was interviewed on radio station WTBQ-FM (93.5) on June 29 at 12 p.m.

Janet spoke at the Esopus Library in Port Ewen, NY, on July 13 at 7 p.m.

Janet spoke at the Pine Plains Library in Pine Plains, NY, on July 20 at 6 p.m.

Janet spoke at the Ulster Library in Kingston, NY, on July 23 at 5:30 p.m.

Janet spoke at the Northern Dutchess Bible Church in Red Hook, NY, on August 11 at 1 p.m.

Janet spoke at the Inquiring Minds Bookstore in New Paltz, NY, on September 6 at 7 p.m.

Janet spoke at the Adriance Library in Poughkeepsie, NY, on September 15 at 2:30 p.m.

Janet was interviewed on radio station WRIP-FM (97.9) on September 21 at 8 a.m.

Janet again spoke at the Mountain Top Library in Tannersville, NY, on September 22 at noon.

Janet spoke at the Enchanted Cafe in Red Hook, NY, on September 28 at 7 p.m.

Janet spoke at the Hyde Park Library in Hyde Park, NY, on October 4 at 7 p.m.

Janet participated in an Author Weekend at the Barnes & Noble in Poughkeepsie, NY, on October 14 from 11 a.m. to 3 p.m.

Janet spoke at the Tivoli Library in Tivoli, NY, on October 22 at 5:30 p.m.

Janet’s interview for the TV program Wake Up with Marci on the You Too America Channel aired on Monday, November 5, and Friday, November 9. It can now be found on the Internet.

Janet spoke at the Germantown Library in Germantown, NY, on November 7 at 6:00 p.m.

Janet participated in the Red Hook Middle School's College and Career Cafe in Red Hook, NY,  on December 19 at 10:30 a.m.

Janet will speak at the Poughkeepsie Brain Injury Support Group at the Poughkeepsie Galleria Mall in Poughkeepsie, NY, on Saturday, February 23 at noon. 

Janet will speak at the Stanford Free Library in Stanfordville, NY, on Saturday, March 9 at 10:00 a.m.

Janet will speak at the Howland Library in Beacon, NY, on Wednesday, March 20 at 1:00 p.m.

Janet will speak at the West Hurley Library in West Hurley, NY, on Saturday, March 23 at 1:00 p.m.

Janet will speak at the Dover Plains Library in Wingdale, NY, on Friday, April 5 at 6:00 p.m.

Janet will participate in an Author Talk at the Saugerties Library in Saugerties, NY, on Saturday, April 13 at 1:00 p.m.

Janet will speak at St. Timothy's Church in Hyde Park, NY, on Sunday, May 5 at 11:00 a.m.

Janet will speak at the Moffat Library in Washingtonville, NY, on Saturday, May 11 at 1:00 p.m.

More signings will be coming up. A fine feature about Janet by John DeSantos [845 LIFE] appeared in the Middletown Times Herald-Record on Monday, March 12, as part of Brain Injury Awareness Month. An article about her book was just published in the May 2018 Living Rhinebeck Magazine. An article about her book appeared in the May 14 Daily Freeman of Kingston, NY. and another in the Family Life section of the Poughkeepsie Journal on June 8th. The Millerton News published an article on Thursday, August 2, about her talk at the Pine Plains Library.