Monday, December 17, 2018

REVIEW of 7 Thoughts to Live Your Life By


author I.C. Robledo

This book deserves to be widely read. I’ll summarize it here, and I’ll recommend the author make it less expensive to get it a wider audience. As a Kindle ebook, it is convenient to read and inexpensive to reproduce. A lower price might even prove more profitable (depending on the elasticity of demand).

Engineer/author I.C. Robledo has already penned several helpful non-fiction books. This one may be closest to his heart, as it has come from his own struggle with depression, augmented with his deep reading of the relevant literature and serious thought about the issue of how we can have happy, worthwhile lives. Here are the 7 Thoughts, italicized, with his comments and mine.

Thought #1: Focus on what you can control, not on what you cannot control. Robledo identifies this as his most important point. We waste our energies if we focus on things over which we have no control. I think of the legendary King Canute of Britain who had his courtiers join him at seaside and observe the tide coming in, while he commended it to stop, as he demonstrated to them there are forces beyond his and theirs. Robledo includes other people among those entities beyond our control, though perhaps within our influence.

Thought #2: Focus on the positive, not on the negative. A fine old song told us, “You’ve got to accent the positive, eliminate the negative, and don’t mess with Mr. In-between.” Norman Vincent Peale’s classic book The Power of Positive Thinking taught that same lesson to millions. Robledo identifies as the most important thing for us to control, something we can control: the thoughts we harbor. The Old Testament Bible‘s Book of Proverbs says, “As a man thinketh in his heart, so is he….” To inhabit a positive world, one must think positively. The New Testament advises we think and speak about “whatsoever things are true…honest…just…pure….” We are not what we eat, but what we think.

Thought #3: Focus on what you can do, not on what you cannot do. This chapter starts with a quotation from Martin Luther King, Jr., exhorting us that if we cannot fly, then run; cannot run, then walk; cannot walk, then crawl; “…keep moving forward.” Yoda of Star Wars urges, “Don’t try, do.” Positive thinking is a start, but actions trump thoughts and words. Our thoughts can help produce our results; “self-fulfilling prophecies” reflect this truth. The labels we affix to ourselves should be affirmative to harness this.

Thought #4: Focus on what you have, not on what you do not have. Count your blessings, we have been advised. Of the billions of people on this Earth, you are likely among the most fortunate if you can obtain and read this book. Appreciate that. Use what you have to make tomorrow better, for yourself and for others. Wanting more may inspire productive action, but it can also cause foolish regret. Robledo cites Buddha as identifying this desire for more with disappointment and unhappiness. Is there ever enough? You must learn that there is enough, and we almost certainly already have enough. We all have minds, life, possessions, loved ones, values…. “our task is to learn to want what we already have.” Practice gratitude as your attitude. Eschew envy!

Thought #5: Focus on the present, not the past and future. Another life counselor advises, “Be here now.” Be mindful of the present, paying little heed to the past and worrying little about the future. One is done, the other almost out of our control. While having goals is necessary to orient our actions, it is better to concentrate on having a system you use to pursue your goals;  then, whether you get there or not, you can at least be pleased with how well you are carrying out your system, and you can enjoy the journey. I “enjoy” doing the exercise routine I schedule for even-numbered days: I am at least pleased to carry out my planned efforts, without worrying a lot about whether I am getting stronger or adding to my endurance…though I know I am. “The trick then is to focus on the enjoyment of a process.”

Thought #6: Focus on what you need, not on what you want. The more we seek, the more unhappy we will be if we do not get it. Fortunately, we can focus primarily on what we need, a much smaller set of things and conditions than the nearly infinite list of our possible “wants,” a list that advertisers and other influencers help lengthen daily. Remember that, in some ways, “less is more.” Our needs are crucial; our wants, optional. The advice, “know thyself” includes knowing what we need and what we can do without.

Thought #7: Focus on what you can give, not on what you can take or receive. Giving is noble and can be satisfying. When we think about our lives, we can be proud of what we have given, as well as happy about what we have received. To some extent, one must give to get, but giving is its own reward. Enlightened self-interest is defensible, but it is even more attractive when coupled with generosity. As you satisfy your needs and some of your wants, there will likely come a time when sharing with others will seem appropriate.

There you have the “7 Thoughts.” All good. All worthwhile. The author fills each chapter with stories and explanations that enhance these simple Thoughts. He is personal and profound. He writes well, and humbly. His book is a treasure.

As I started to write this review, I visited the Amazon page featuring this book. I was surprised no other reviews were yet posted. The book seems to be selling well in its categories, but I think the author should reduce the price from its current $7.99 for the Kindle to, perhaps, $2.99, not because the book is not worth the higher price, but because a lower price will get more people to read and profit from this fine work. I, myself, borrowed the book (legitimately), as I usually do not pay this much for the Kindle books I get. (I don’t bother to review the books I don’t like.)

I hope I have given the prospective reader the information needed to decide on buying 7 Thoughts, a book I strongly recommend.

Thursday, December 13, 2018

MANAGE NURSING CARE AT HOME, "How? Part 1"


   CHAPTER 6     HOW? PREVENTING, PRESCRIBING, CHARTING,         EXPLAINING, TRAVELING

PREVENTING INFECTIONS:  FLU SHOTS (Cooper, 2011)

A major threat to quadriplegic patients like Tina is infection, especially respiratory infection and, secondarily, bedsores. If Tina gets the flu, certain antiviral medicines may help, but basically she is on her own—her immune system must create the antibodies that destroy the viruses.

Each fall, flu vaccinations are made available to combat the current version of flu, which is different every year. In 2009, a second version, H1N1, became a threat as well.

Tina and I each get vaccinated. For people in their 60s, as we are, it reduces our risk of catching the flu by roughly 50 percent. We require our nurses to get the shots as a condition of employment, made clear in the interviews we do in selecting new hires. This reduces their risk by 50 percent or a bit more, except that some of them are in contact with large populations of institutional patients who are more likely than most to catch the flu.

In 2010, there was controversy surrounding the safety of the H1N1 vaccine, which controversy seemed to me to be overblown. Regardless, we required this second flu shot, not for the benefit of the nurses, but for the benefit of Tina. Nursing means you take certain responsibilities and some added risks, for example, you drive to work when the roads are slippery. Four of our nurses strung us along several months, not indicating they would not get the H1N1 shots. When they did not get the shots after a month’s warning of our deadline, they were fired.

PREVENTING INFECTIONS:  BEDSORES

Your skin protects you from infection. Remove even a modest fraction of it and microbes will overwhelm your immune system and kill you. Antibiotics can wipe out some of these organisms, but some have evolved to be multiple-drug-resistant strains that we cannot yet defeat.

Lying in bed (or sitting) motionless keeps pressure on portions of the skin near the supporting bones. Blood to these areas is not supplied or removed in normal amounts, so cells begin to die. Altering the patient’s position frequently can prevent this. Urine and fecal matter can irritate the skin, making it more likely to fail. Sliding associated with being moved can exert shear forces that can tear the skin. Once such a sore, a bedsore, develops, the patient is at risk for systemic infection and death; thus, bedsores must be prevented, and treatment started at the first sign of a developing problem.

We had one such sore during Tina’s paraplegic period (1994-2004) and one during her current period of quadriplegia (post 2004). The first was due to inadequate attention by a home health aide and me. We should have changed her position more frequently and taken greater pains to keep her clean and dry.  The second bedsore resulted during hospitalization, with unusual urinary and bowel incontinence as contributing factors.

At home we have taken many steps to prevent bedsores. We have an air mattress with a checkerboard pattern of air pockets: when the “black” squares are up, the “red” are down and vice-versa, thanks to the action of an air pump that every few minutes changes from inflating one air path and suctioning the other, to the reverse. We also put her on her side a total of a few hours each day. Being placed on her side is less than optimal for Tina, because she cannot rest as well or see the TV as well, but it works out, especially during daytime naps and some periods in the overnight shift.

Our staff has told me horror stories of fist-size bedsores down to the bone on nursing home patients who received inadequate care. By that stage the sores are deadly. Too many patients, too few staff, poor morale among the staff all can contribute. Once a bedsore starts to develop, it is admittedly a challenge to reverse.

Christopher Reeve was the well-known actor (Superman) rendered quadriplegic by the severing of his spinal cord in an equestrian accident in 1995, the year after Tina became bedridden. We closely followed developments in his case. Until 2004, he wrote and spoke as though he believed his spinal injury would someday be cured. That year he stated that he had lost that faith; bedsores recurred, despite presumably the best of care, and he died from the infection or from a reaction to the antibiotic given to treat it. Small, but deadly are bedsores.

We care for Tina’s skin very, very diligently.

         Bedsores, also referred to as “ulcers” or “decubitus ulcers” develop because of lack of blood flow to the skin tissues that are pressed between bony prominences and relatively hard bedding or chair surfaces or because of shear forces from sliding contact between the skin and such surfaces. In her treatise for Continuing Medical Education for nurses, Treating Pressure Ulcers and Chronic Wounds, Maryann Mamou (2014) goes into detail. She cites the Centers for Medicare and Medicaid Services (CMS) support for her statement that “a pressure ulcer can develop in at-risk patients within 2 to 6 hours of the onset of pressure.”
    
           Such sores are serious. “There is a 2 to 6 times greater mortality risk for patients who develop pressure ulcers. In acute-care hospitals, patient risk for acquiring a pressure ulcer is estimated to range from 14% to 20%.” (Mamou, 2014)  Indeed, during our younger patient’s 100-day stay in the critical care unit, she quickly acquired such ulcers on her heels. Immobility raises the risk greatly. Mamou (2014) cites research showing “At any given time, 17% to 39% of the spinal cord injured population has a pressure ulcer.” Once one develops, it often recurs, “between 40% and 80% of patients who have had pressure ulcers will develop another one.”

         The sores can range from Deep Tissue Injury through Stages 1 to 4 in increasing degrees of seriousness. Any indication of a bedsore should trigger remedial action, including increased frequency of change of position, upgrade in mattress design or materials, additional padding and bandaging at the site. The availability of help in treating and transporting the patient will influence the choice of treatments as well. While the development of such sores suggests inadequate care, this is by no means always the case. Elderly patients, especially, may have such fragile skin that even skilled nursing treatment is insufficient to prevent such sores. Patients with cognitive deficits will be unlikely to be able to care for themselves.

         Mamou (2014) notes “Many respiratory problems can lead to wound development.” This makes sense, as a major factor is inadequate oxygen supply to the tissues at the site, accelerating damage and retarding healing. Steroid use can slow tissue repair, as well. It follows that cardiovascular deficiencies can also accelerate development of the sores and impair healing. 

         Gastrointestinal problems complicate matters (Mamou, 2014): not only does reduced nutrition slow healing, but the presence of loose stools or even diarrhea causes chemical damage to the skin. Similarly, efforts must be made to keep the skin clean and dry, difficult where incontinence is encountered or where the patient is dependent on disposable diapers. Too little water has its own negative effect (Mamou, 2014): “Dehydration impairs wound healing by decreasing the blood volume available to transport oxygen and nutrient to healing wounds.”

        Diabetes raises blood sugar levels and impairs the immune response, thus slowing healing. Obesity puts added pressure at the contact point, and fat tissues are poorly supplied with blood vessels. Information on wound assessment and wound healing is of importance to the nursing staff, less so to the manager. The most common wounds are “partial-thickness wounds,” and (Mamou, 2014) “the most important consideration with partial thickness wounds is to keep the area moist and clean. It is important to remember that a dry cell is a dead cell.” This goes against one’s initial thinking: if moisture can contribute to causing the wound, why would it be beneficial? Apparently, the key is protecting the sore from the irritating moisture of urine or damp feces.
    
        Managers should expect that dressing changes will be accompanied by cleanings. “The Agency for Health Care Research and Quality (AHRQ) recommends that all pressure ulcers be cleaned when first diagnosed and then with every dressing change.” (Mamou, 2014) The goal is to remove loose skin and prevent the growth of bacteria. Normal saline is fine for cleaning, squirted with a syringe, perhaps with a wound-cleansing agent. Dilute bleach or dilute iodine can be used for disinfection, although potentially irritating.  
     
        Mamou (2014) notes that pain management is important. Analgesic can be given about half an hour before the treatments. Certain elements, such as dressing removal, should be done at a pace acceptable to the patient. “Tape should be avoided on fragile skin.”
     
        Wound dressings provide cushioning and a barrier to microbes but must both wick moisture from the surface, yet not make it too dry. A nurse with a wound-care specialization is likely to be needed for all but the least severe cases.
    
        This treatise by Mamou we highly recommend for nurses and managers involved in a situation involving wound care. It is available as an ebook from Amazon.

DOCTOR TRIPS

We see a pulmonologist four times a year, a throat surgeon four times a year, a general practitioner as needed, typically several times a year. If something is amiss, there will be tests and scans, hither and yon. We bring our most recent records. We record the results of the visit in a book dedicated to doctor visits.

Each trip requires the life-support equipment. Each trip is an adventure, because if the specialized van breaks down somewhere, we’ll have major trouble. The van’s lift requires electric power, without which Tina is trapped in the van. If the van’s doors jam, the same problem results. Even if we get her out, what next? Call 911 and transfer her to a stretcher and take her home. Don’t forget to bring the cell phone.

The consequences get more serious if we are brought to a halt during a summer trip. Heat is very hard on MS patients, as it aggravates the deficiencies in the insulating properties of the myelin covering the nerves. In the winter, cold is the threat. We try to schedule most of our trips for the spring and fall, the more temperate seasons.

DOCTOR TRIP FROM HECK 

The doctor trip from hell would be one where our special van breaks down on a lonely road in the winter or the summer, with an electrical failure. No heat, no air-conditioning, no power lift for entrance or exit from the van, with Tina stuck inside. As I write this section, on April 25, 2011, we had just had a somewhat-less-than-hellish trip.
 
The multi-specialty doctors’ practice in Middletown is about twenty miles away, typically a forty-minute ride, plus loading and unloading time. We allocate an hour each way. For this trip, we had originally scheduled back-to-back appointments with two doctors in the group, a pulmonologist and a new gastroenterologist, to save us from having to make two trips. A few days previously, we were told we had to postpone one of the appointments, because Medicare does not pay for two doctor visits to the same practice on the same day. We put off the pulmonologist for a few days.
 
The van’s motor started up well, despite not having been used for a few days. The horn was strangely anemic. The power lift rose more slowly than usual in getting Tina into the van and descended more slowly in delivering her to the doctors’ parking lot. An electrical problem? Stay tuned.
 
We waited almost an hour for the gastroenterologist. When we saw him—presentable, articulate, speaking rather good English, though a bit too softly for my poor hearing—it became clear that Tina’s feeding tube was not going to be changed then and there, as we thought it would be. No, no. You can't have fed her within five hours of the procedure (which itself is often done by nurses and takes about five minutes). No one had warned us of this. Furthermore, they had no gastric tubes on hand. You have to bring your spare, then they use it and give you a prescription for one or two more. No one had told us this, either.
 
When I explained the inconvenience of making two trips, the doctor informed me about the Medicare reimbursement rules, emphasizing that he would not lie for us and claim we had come a different day. Charming. I might have said I would not lie for him and tell someone else that I thought his practice was well run, but I did not. I’m more charming than he is, surpassing a low standard. We used this man because his predecessor gastro kept us waiting a couple of hours without a warning of any kind. What is it with the gastro guys?
 
After making a new appointment for a week later, we packed up our gear to take our van home. I turned on the ignition—and nothing happened. No gauges moved, no radio came on, certainly no starter motor was motivated. Dead. We tried jump-starting, with the help of the kindness of strangers. No luck. I called AAA. The van’s electrical system was too complex for local garages, because of the power-lift modifications for the wheelchair. We called an ambulance and got Tina into it, transferring her from wheelchair to stretcher and folding up the wheelchair to squeeze it into the vehicle. We had wanted an ambulette (wheelchair, not stretcher) service, which would take us all and leave Tina in her chair, but the listing in the Yellow Pages was not sufficiently clear.
 
Much waiting ensued. Tina, our nurse, and I all were patient. We were in the temperature-controlled waiting area of the office building containing the medical practice, safe and sound. We had two oxygen bottles with us. Nothing really bad happened. Of course, nearly a thousand dollars in ambulance and towing fees were put on the credit card. It’s only money. Better yet, it’s only plastic.
 
In a few days, we were scheduled to return to the same practice, this time for a pulmonary check-up. We could hardly wait.

Postscript: We junked that van and bought another, newer, used van, one whose exit access was not dependent on electrical power, so that we could get Tina out of it even without battery power.





    ###

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


Our book is available from amazon.com, bn.com, and OutskirtsPress.com: How to Manage Nursing Care at Home

WHAT EVER HAPPENED...? "Clothing with a Message"




Years ago, I actually took time and effort into dressing up and looking good. Nowadays – my favorite thing to wear is sweatshirts and T-shirts with funny sayings on them (when I’m not wearing my Mickey Mouse “wardrobe” or attending a special event). The day I handed this chapter in to my editor, Dr. Cooper, I wore the T-shirt that said: “Grammar Police: to Serve and Protect the English Language,” because my nicknames for him are “Comma King,” and/or “Dr. Comma.” I have learned how infrequently I used commas before I met him! (I write like I talk: run-on sentences.) Here are some of my favorite shirt sayings [with my add-in comments]:
·       Careful, or you’ll end up in my novel [Lots of folks ask me if they’re in my book.]
·       Dinner is ready when the smoke alarm goes off [Purchased when I actually cooked years ago.]
·       Listen and silent have the same letters – coincidence?
·       Messy hair – don’t care
·       Peace. Love. Books.
·       Book Nerd
·       I’m the crazy aunt everybody warned you about [Aiden scolded me if I packed this when we went to Florida to visit my family.]
·       I need my reading time
·       Lord – keep your arm around my shoulder and your hand over my mouth
·       I have CDO. It’s like OCD, but all the letters are in order like they should be
·       There and Their – They’re not the same [Like a chapter here in this book.]
·       Warning – Extremely Annoying [Worn on days when I’m very agitated.]
·       God is good all the time [front] All the time God is good [back]
·       Keep calm and eat bacon
·       What if I don’t want to keep calm
·       Sassy Lassie [In memory of Grandma McColl, who called me that.]
·       I gave him the skinniest years of my life
·       Red Shirt Fridays – Support Our Troops – Land of the Free Because of the Brave
I also have great aprons with funny sayings (which is humorous in itself since I don’t cook). Here are some of what they have to say:
·       The last time I cooked, hardly anyone got sick!
·       I kiss better than I cook
·       Feast today – shop tomorrow [A Thanksgiving apron.]

Besides clothing and aprons, I also have bracelets, buttons, soap bars, mugs, pillows, blankets, and oh, so much more of things to read each day to cheer me up. Here are some of those…
·       Laugh [A purple bracelet I wore for five years to help me enjoy life more.]
·       Laugh, laugh, laugh… [On a mug to help me the same way the bracelet did.]
·       You are a woman of wisdom, courage, strength, compassion, and creativity
·       Amazing Grace [I sing this song when I sip my coffee or tea from the mug.]
·       Think big!
·       Got milk? [On a mug with a picture of a chocolate chip cookie. It’s my personal law that I need milk each and every time I eat chocolate.]
·       Dog MOM
·       breathe in. breathe out.
·       Professional Marshmallow Roaster [I love s’mores!]
·       Keep your big mouth shut [On a luxury soap bar.]
·       Super Sunday School Teacher [Receiving recognition is so sweet.]
·       Trust in the Lord with all your heart
·       Enjoy the little things and the big things take care of themselves

·       Here lives a wild, wacky, wonderful woman
·       Those who can, teach. Those who cannot, pass laws about teaching
·       I will not obsess! I will not obsess! I will not obsess!
·       God keeps His promises
·       Teachers rule
·       I make grown men cry
·       So many books…so little time.
·       Jesus. Coffee. Bacon. Naps.

Almost everything I own sends a message.



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



                                              ###

BOOK TALKS AND SIGNINGS


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