Loving Someone Who Has Dementia – by Dr. Pauline Boss
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We previously reviewed Dr. Boss’s excellent book “Loss, Trauma, and Resilience: Therapeutic Work With Ambiguous Loss”, which partially overlaps in ideas with this one. In that case, it was about grief when a loved one is “gone, but are they really?”, which can include missing persons, people killed in ways that weren’t 100% confirmed (e.g. no body to bury), and in contrast, people who are present in body but not entirely present mentally: perhaps in a coma, for example. It also includes people are for other reasons not entirely present in the way they used to be, which includes dementia. And that latter case is what this book focuses on.
In the case of dementia, we cannot, of course, simply focus on ourselves. Well, not if we care about the person with dementia, anyway. Much like with the other kinds of ambiguous loss, we cannot fully come to terms with things while on the cusp of presence and absence, and we cannot, as such, “give up” on our loved one.
What then, of hope? The author makes the case for—in absence of any kind of closure—making our peace with the situation as it is, making our peace with the uncertainty of things. And that means not only “at any moment could come a more clearly complete loss”, but also on the flipside at least a faint candle of hope, that we should not grasp with both hands (that is not how to treat a candle, literally or metaphorically), but rather, hold gently, and enjoy its gentle light.
Dr. Boss also covers more practical considerations; family rituals, celebrations, gatherings, and the idea of “the good-enough relationship”. Particularly helpfully, she gives her “seven guidelines for the journey”, which even if one decides against adopting them all, are definitely all good things to at least have considered.
The style is much more tailored to the lay reader than the other book of hers that we reviewed, which was intended more for clinicians, but useful also for those of us who have been hit by such kinds of grief. In this case, however, her intention is first and foremost for the family of a person who has dementia—there are still footnotes throughout though, for those who still want to read scientific papers that support the various ideas discussed in the book.
Bottom line: if a loved one has dementia or that seems a likely possibility for you, this book can help a lot!
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Sometimes, Perfect Isn’t Practical!
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝10 AM breakfast is not realistic for most. What’s wrong with 8 AM and Evening me at 6. Don’t quite understand the differentiation.❞
(for reference, this is about our “Breakfasting For Health?” main feature)
It’s not terrible to do it the way you suggest It’s just not optimal, either, that’s all!
Breakfasting at 08:00 and then dining at 18:00 is ten hours apart, so no fasting benefits between those. Let’s say you take half an hour to eat dinner, then eat nothing again until breakfast, that’s 18:30 to 08:00, so that’s 13½ hours fasting. You’ll recall that fasting benefits start at 12 hours into the fast, so that means you’d only get 1½ hours of fasting benefits.
As for breakfasting at 08:00 regardless of intermittent fasting considerations, the reason for the conclusion of around 10:00 being optimal, is based on when our body is geared up to eat breakfast and get the most out of that, which the body can’t do immediately upon waking. So if you wake and get sunlight at 08:30, get a little moderate exercise, then by 10:00 your digestive system will be perfectly primed to get the most out of breakfast.
However! This is entirely based on you waking and getting sunlight at 08:30.
So, iff you wake and get sunlight at 06:30, then in that case, breakfasting at 08:00 would give the same benefits as described above. What’s important is the 1½ hour priming-time.
Writer’s note: our hope here is always to be informational, not prescriptive. Take what works for you; ignore what doesn’t fit your lifestyle.
I personally practice intermittent fasting for about 21hrs/day. I breakfast (often on nuts and perhaps a little salad) around 16:00, and dine at around 18:00ish, giving myself a little wiggleroom. I’m not religious about it and will slide it if necessary.
As you can see: that makes what is nominally my breakfast practically a pre-dinner snack, and I clearly ignore the “best to eat in the morning” rule because that’s not consistent with my desire to have a family dinner together in the evening while still practicing the level of fasting that I prefer.
Science is science, and that’s what we report here. How we apply it, however, is up to us all as individuals!
Enjoy!
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Head Over Hips
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We’ve written before about managing osteoarthritis (or ideally: avoiding it, but that’s not always an option on the table, of course), so here’s a primer/refresher before we get into the meat of today’s article:
Avoiding/Managing Osteoarthritis
When the head gets in the way
Research shows that the problem with recovery in cases of osteoarthritis of the hip is in fact often not the hip itself, but rather, the head:
❝In fact, the stronger your muscles are, the more protected your joint is, and the less pain you will experience.
Our research has shown that people with hip osteoarthritis were unable to activate their muscles as efficiently, irrespective of strength.
Basically, people with hip arthritis are unable to activate their muscles properly because the brain is actively putting on the brake to stop them from using the muscle.❞
This is a case of a short-term protective response being unhelpful in the long-term. If you injure yourself, your brain will try to inhibit you from exacerbating that injury, such as by (for example) disobliging you from putting weight on an injured joint.
This is great if you merely twisted an ankle and just need to sit back and relax while your body works its healing magic, but it’s counterproductive if it’s a chronic issue like osteoarthritis. In such (i.e. chronic) cases, avoidance of use of the joint will simply cause atrophy of the surrounding muscle and other tissues, leading to more of the very wear-and-tear that led to the osteoarthritis in the first place.
So… How to deal with that?
You probably can exercise
It’s easy to get caught between the dichotomy of “exercise and inflame your joints” vs “rest and your joints seize up”, which is not pleasant.
However, the trick lies in how you exercise, per joint type:
When Bad Joints Stop You From Exercising (5 Things To Change)
…which to be clear, isn’t a case of “avoid using the joint that’s bad”, but is rather “use it in this specific way, so that it gets stronger without doing it more damage in the process”.
Which is exactly what is needed!
Further resources
For those who like learning from short videos, here’s a trio of helpers (along with our own text-based overview for each):
- The Most Underrated Hip Mobility Exercise (Not Stretching)
- Overcome Front-Of-Hip Pain
- 10 Tips To Reduce Morning Pain & Stiffness With Arthritis
And for those who prefer just reading, here’s a book we reviewed on the topic:
11 Minutes to Pain-Free Hips – by Melinda Wright
Take care!
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Breathe; Don’t Vent (At Least In The Moment)
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Zen And The Art Of Breaking Things
We’ve talked before about identifying emotions and the importance of being able to express them:
Answering The Most Difficult Question: How Are You?
However, there can be a difference between “expressing how we feel” and “being possessed by how we feel and bulldozing everything in our path”
…which is, of course, primarily a problem in the case of anger—and by extension, emotions that are often contemporaneous with anger, such as jealousy, shame, fear, etc.
How much feeling is too much?
While this is in large part a subjective matter, clinically speaking the key question is generally: is it adversely affecting daily life to the point of being a problem?
For example, if you have to spend half an hour every day actively managing a certain emotion, that’s probably indicative of something unusual, but “unusual” is not inherently bad. If you’re managing it safely and in a way that doesn’t negatively affect the rest of your life, then that is generally considered fine, unless you feel otherwise about it.
A good example of this is complicated grief and/or prolonged grief.
But what about when it comes to anger? How much is ok?
When it comes to those around you, any amount of anger can seem like too much. Anger often makes us short-tempered even with people who are not the object of our anger, and it rarely brings out the best in us.
We can express our feelings in non-aggressive ways, for example:
and
Seriously Useful Communication Skills!
Sometimes, there’s another way though…
Breathe; don’t vent
That’s a great headline, but we can’t take the credit for it, because it came from:
Breathe, don’t vent: turning down the heat is key to managing anger
…in which it was found that, by all available metrics, the popular wisdom of “getting it off your chest” doesn’t necessarily stand up to scrutiny, at least in the short term:
❝The work was inspired in part by the rising popularity of rage rooms that promote smashing things (such as glass, plates and electronics) to work through angry feelings.
I wanted to debunk the whole theory of expressing anger as a way of coping with it,” she said. “We wanted to show that reducing arousal, and actually the physiological aspect of it, is really important.❞
And indeed, he and his team did find that various arousal-increasing activities (such as hitting a punchbag, breaking things, doing vigorous exercise) did not help as much as arousal-decreasing activities, such as mindfulness-based relaxation techniques.
If you’d like to read the full paper, then so would we, but we couldn’t get full access to this one yet. However, the abstract includes representative statistics, so that’s worth a once-over:
Caveat!
Did you notice the small gap between their results and their conclusion?
In a lab or similar short-term observational setting, their recommendation is clearly correct.
However, if the source of your anger is something chronic and persistent, it could well be that calming down without addressing the actual cause is just “kicking the can down the road”, and will still have to actually be dealt with eventually.
So, while “here be science”, it’s not a mandate for necessarily suffering in silence. It’s more about being mindful about how we go about tackling our anger.
As for a primer on mindfulness, feel free to check out:
No-Frills, Evidence-Based Mindfulness
Take care!
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How To Stay A Step Ahead Of Peripheral Artery Disease
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Far less well-known than Coronary Artery Disease, it can still result in loss of life and limb (not in that order). Fortunately, there are ways to be on your guard:
What it is
Peripheral Artery Disease (PAD) is the same thing as Coronary Artery Disease (CAD), just, in the periphery—which by definition means “outside of the heart and brain”, but in practice, it starts with the extremities. And of the extremities, it tends to start with the feet and legs, for the simple reason that if someone’s circulation is sluggish, then because of gravity, that’s where’s going to get blocked first.
In both CAD and PAD, the usual root cause is atherosclerosis, that is to say, the build-up of fatty material inside the arteries, usually commensurate to LDL (“bad”) cholesterol, especially in men (high LDL is still a predictor of cardiovascular disease in women though, just more modestly so, at least pre-menopause or in cases of treated menopause whereby HRT has returned hormones to pre-menopause levels).
See also: Demystifying Cholesterol
And for that about sex differences: His & Hers: The Hidden Complexities of Statins and Cardiovascular Disease (CVD)
Why it is
This one’s straightforward, as it’s the same things as any kind of cardiovascular disease: high blood pressure, high cholesterol, older age, obesity, smoking, drinking, diabetes, and genetic factors (so, a risk factor is: family history of heart disease).
However, while those are the main causes and/or risk factors, it absolutely can still strike other people, so it’s as well to be watch out for…
What to look out for
Many people first notice signs and symptoms that turn out to be PAD when they experience pain or numbness in the foot or feet, and/or a discoloration of the feet (especially toes), and slow wound healing.
At that stage, chances are you will need to go urgently to a specialist, and surgery is a likely necessity. With a little luck, it’ll be a minimally-invasive surgery to unblock an artery; failing that, an amputation will be in order.
At that stage, under 50% will be alive 5 years from diagnosis:
You probably want to avoid those. Good news is, you can, by catching it earlier!
What to look out for before that
The most common test for PAD is one you can do at home, but enlisting a nurse to do it for you will help ensure accurate readings. It’s called the Ankle-Brachial Index (ABI) test, and it involves comparing the blood pressure in your ankle with the blood pressure in your arm, and expressing them as a ratio.
Here’s how to do it (instructions and a video demonstration if you want it):
Do Try This At Home: ABI Test For Clogged Arteries
If you need a blood pressure monitor, by the way, here’s an example product on Amazon.
- A healthy ABI score is between 1.0 and 1.4; anything outside this range may indicate arterial problems.
- Low ABI scores (below 0.8) suggest plaque is likely obstructing blood flow
- High ABI scores (above 1.4) may indicate artery hardening
Do note also that yes, if you have plaque obstructing blood flow and hardened arteries, your scores may cancel out and give you a “healthy” score, despite your arteries being very much not healthy.
For this reason, this test can be used to raise the alarm, but not to give the “all clear”.
There are other tests that clinicians can do for you, but you can’t do at home unless you have an MRI machine, a CT scanner, an x-ray machine, a doppler-and-ultrasound machine, etc. We’ll not go into those in detail here, but ask your doctor about them if you’re concerned.
What to do about it
In the mid-to-late stages of the disease, the options are medication and surgery, respectively, but your doctor will advise about those in that eventuality.
In the early stages of the disease, the first-line recommend treatment is exercise, of which, especially walking:
Lower Extremity Peripheral Artery Disease: Diagnosis and Treatment
Given that this more often happens when someone hasn’t been walking so much, it can be a walk-rest-walk approach at first (a treadmill on a low setting can be very useful for this):
See also: Exercise Comparison Head-to-Head: Treadmill vs Road
Take care!
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Lucid Dreaming – by Stephen LaBerge Ph.D.
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For any unfamiliar: lucid dreaming means being aware that one is dreaming, while dreaming, and exercising a degree of control over the dream. Superficially, this is fun. But if one really wants to go deeper into it, it can be a lot more:
Dr. Stephen LaBerge takes a science-based approach to lucid dreaming, and in this work provides not only step-by-step instructions of several ways of inducing lucid dreaming, but also, opens the reader’s mind to things that can be done there beyond the merely recreational:
In lucid dreams, he argues and illustrates, it’s possible to talk to parts of one’s own subconscious (Inception, anyone? Yes, this book came first) and get quite an amount of self-therapy done. And that hobby you wish you had more time to practice? The possibilities just became limitless. And who wouldn’t want that?
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F*ck You Chaos – by Dominika Choroszko
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We’ve all read decluttering books. Some may even have decluttering books cluttering bookshelves. This one’s a little different, though:
Dominika Choroszko looks at assessing, decluttering, and subsequently organizing:
- Your home
- Your mind
- Your finances
In other words
- she starts off like Marie Kondo, and…
- phases through doing the jobs of Queer Eye’s “Fab Five”, before…
- sitting us down with some CBT worksheets, and…
- finally going through finances à la Martin Lewis.
By the time we’ve read the book, it’s as though Mary Poppins has breezed through our house, head, and bank account, leaving everything “practically perfect in every way”.
Of course, it’s on us to actually do the work, but as many of us struggle with “how” and the ever-dreaded “but where to begin”, Choroszko’s whirlwind impetus and precision guidance (many very direct practical steps to take) really grease the wheels of progress.
In short, this could be the book that kickstarts your next big “getting everything into better order” drive, with a clear step-by-step this-then-this-then-this linear process.
Don’t Forget…
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