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Thursday 24 October 2019

The spouse who came in from the cold

The mourning period is waning and I can see through the mist. Now my only problem is boredom which is something I abhor. Really, we are alive in an amazing world. There are things to see, to do, to understand. How dare we be bored! I have got to get out and check things out. Perhaps I will go to the forest, Sunday, Thursday at the latest

The Parky parade continues to haunt me. I have pain in my stiff legs and both biceps. The pain in my legs is minimal and their stiffness is more of a problem. When I wake up and head for the bathroom, I walk like an old man(hold on there, I am an old man). A round of qigong and stretching usually takes care of that. As for the biceps, my boxing comrades have convinced me that a session of pounding the heavy bag is the cause of the pain. Who am I to disagree? I am letting my arms rest and on Friday I will take a chance and return to punching.

Anyway, I can now see the light at the end of the tunnel.

Let's hope it is not a locomotive!

Monday 21 October 2019

Gut Wrenching

gut-wrenching: informal causing great mental or emotional pain

How appropriate! It describes the death of a spouse to a "T".

The pain is starting to subside and I am ready to post my eulogy as a few have requested.

She is gone

I am happy to see such a crowd. Sharron didn't want a formal funeral. She wanted a small gathering to send her on her way. As the news of her death became public, we realized a funeral was required and so here we are to celebrate Sharron and her gentle spirit. I assure you she would have no problem with the present arrangement. Welcome to all and I thank you on her behalf.

It was inevitable that one of us should go first. I have always prayed it would be me. Now she has gone to life's next level, an afterlife that promises peace and tranquility. I believe she will be there when my turn comes and you know it won't be my heaven if she is not there waiting to take me home.

How can I explain Sharron? It is difficult because she was so complex and so much more than I had ever hoped for. I first met her when she was on a blind date with a friend of mine and I was in a fairly serious relationship with a friend of hers. I was smitten, but I don't think she was too taken with me. She refused to see me at first. EventualIy, I think she must have felt sorry for me and she finally gave me a break. We went out and the rest is history.

If you want a happy marriage, there are several important ingredients and we had them all, well or at least most of them: honesty, loyalty, compromise, fidelity, fun times and Sharron's favourite, deception for the greater good. When she had an idea, she made me think it was my idea and then she agreed with my idea, which was her idea in the first place. Deception for the greater good. I learned that very early when Sharron cooked a chicken casserole and I ate it. It was delicious. Later she told me it was a fish casserole. I HATE FISH! Deception for the greater good, or words to that effect, she explained. I had to admit it was well played.

Sharron showed me the way.  She had the best ideas, carried them through and deserves all the glory.  I was just along for the ride and what a ride it was.  We recognized we were in this for life and we shared the happiness and the sadness, and all the other sentiments  that serve to support a successful marriage.  We grew together joined by the bonds of love and we became one metaphorical person as our thoughts and our goals merged. Our marriage was a successful partnership which gave us our three children, all our blessings and many beautiful memories. I will miss her lilting laughter. And what a laughter it was, sure to make the other angels jealous, I will also miss her tears of sadness in difficult times and her unrelentable joy in our children and their children.

What greater accomplishment is there for two human souls than to understand that they are one person. To smile with each other in the good times and to minister to each other in the bad. Sharron was there through it all, a leader and advocate for the whole of the family. She was our secret weapon, a heat seeking missile when the family needed protection.

Woe betide anyone who messed with her children or grandchildren. She was a wonderful mother and wife and life is empty without her.

Part of what is keeping me alive and sane is knowing and believing that people you love never die. They don't die. Not completely. They live in your mind, the way they always have. Keep her light alive and she can still guide us boldly into the future; just like the shine of a distant star in some faraway galaxy can still guide ships to safety in unfamiliar waters.

You taught us well Sharron so please don't worry about us. We will all BE OK, just not today.

Sunday 20 October 2019

drugs drugs & more you-know-what

WINNIPEG FREE PRESS (online)

Doctors warn seniors about multiple meds Treatments for a wide variety of conditions can open the door to negative drug interactions

By: Joel Schlesinger Posted: 10/15/2019 3:00 AM

Rick Simpson needs his drugs.

His medication for Parkinson’s disease, that is.

Without taking it to boost levels of the neurotransmitter dopamine in his brain, the 67-year-old retired public servant struggles to move.

His muscles become rigid, his balance wobbly and his limbs often cold to the touch.

"Especially first thing in the morning, it takes him five minutes to get out of bed because his feet don’t move," says his wife and caregiver, Bette Palmquist, 63.

His medication is beneficial, but it is also time-sensitive.

If he misses a dose, the symptoms quickly return.

What’s more, the Parkinson’s medication, levodopa, is often taken several times daily.

So missing a dose can happen easily, particularly when the responsibility falls on patients who often experience clouded thinking, one of the illness’s common symptoms.

That’s one reason why Parkinson Canada launched a campaign called Act on Time — a resource for patients, caregivers and health-care providers to better manage medication needs.

Lorri Apps, managing director of Parkinson Canada in Manitoba, says timely doses of levodopa greatly reduce symptoms and improve quality of life.

But the campaign addresses other equally important issues, including one extending beyond patients with the illness.

And that’s the challenge of drug management, or more precisely polypharmacy — taking multiple drugs for multiple conditions. "We’ve long recognized this as an issue and spent two years developing this program so people with Parkinson’s aren’t running into issues with... contradictory medications."

This problem, however, applies to more Canadians than the approximately 55,000 who live with Parkinson’s.

A 2018 study by Canadian Institute for Health Information found two in three Canadians age 65 and older take at least five different medications, while one in four take at least 10, putting them at higher risk for negative drug interactions and other unwanted side effects.

"There’s a lot of polypharmacy going on," says Dr. Barry Campbell, medical director of the geriatric psychiatry program at St. Boniface Hospital.

"Elderly people represent about 15 percent of the population, and yet they’re taking about 30 percent of the medication."

Campbell, a geriatric psychiatrist who treats dementia patients, says many individuals he works with suffer from multiple health problems and consequently may take many different medications.

That can lead to patients and caregivers struggling to manage medications, ensuring they are taken at the right time, as well as understanding how one drug can potentially negatively affect another.

Although Campbell is quick to note prescription drugs are beneficial, as meds are layered on top of one another, doctors and patients must ask whether more is indeed better.

Jamie Falk, a clinical pharmacist and an assistant professor of clinical family medicine at the University of Manitoba, also has concerns about rising polypharmacy among seniors.

Falk is among many health-care experts who belong to the Canadian Deprescribing Network, which aims to ensure Canadians take only medications they truly need.

He notes individuals most at risk of over-medication are those with serious illnesses — such as Parkinson’s or dementia — who are often of advanced age and have other conditions treated with medications. "Part of the problem is we have different clinical practice guidelines for each condition," he says, adding these protocols are often developed "in silos."

Consequently, patients might receive a drug for Parkinson’s, which they need, along with medications to prevent heart attack and stroke, for example.

Yet science supporting preventive medication often pertains to long-term health problems, and these drugs may be less beneficial for an elderly patient facing a shorter lifespan compared with the general population, Falk says.

But the potential negative side effects from these meds — which may include dangerously low blood pressure and blood glucose — may be more concerning, he argues.

That’s because these conditions cause dizziness, which can lead to falls, and among seniors falls are the leading reason for hospitalization, according to the Canadian Deprescribing Network.

And the prognosis is often dire. As many as 30 percent of people who fracture a hip — the most common break from a fall — die within a year, the organization says.

Falling is indeed a going concern for patients of Dr. Sean Udow, co-director of the Movement Disorder Clinic, which treats Manitobans with Parkinson’s.

"People with Parkinson’s are naturally prone to low blood pressure when they stand, and if you don’t get enough blood to the brain, you faint."

Additionally, levodopa lowers blood pressure while, at the same time, patients may be taking blood pressure-lowering medications, prescribed by another doctor long before the Parkinson’s diagnosis.

Udow says eChart Manitoba helps eliminate the problem of contraindicating medications, an online database of prescribed medications for every Manitoban.

But information is limited. "All you know is the prescription has been filled."

Consequently, a discussion with patients about medications is critical, Udow says, adding he frequently deprescribes drugs treating high blood pressure for Parkinson’s patients.

He further notes much of the "quarterbacking of care" is done by family doctors, often challenged for time and resources to get the full picture of patients’ treatment plans.

Recognizing this, the health region and the province have moved toward a multidisciplinary approach for individuals with chronic illness. Over the past few years, for instance, the Winnipeg Regional Health Authority’s My Health Teams initiative has brought together family doctors, occupational therapists, nurse practitioners, social workers and specialists to provide multidisciplinary care for about 261,000 people.

Among their roles is a drug review assessing affordability, dosage and even whether to deprescribe, writes Doug Thidrickson, clinical pharmacist with My Health Team in an email to the Free Press.

Under care of a team or not, Udow and others advise patients and their families to be proactive.

"Stay informed, ask your doctors questions, bring lists of the medications... and concerns, and bring a family member or friend," he says.

Certainly, Simpson and Palmquist abide by that advice now more than ever after Simpson recently fell, broke his hip and spent many weeks in hospital.

"After he got out, his family doctor looked at his medications and canceled everything except the Parkinson’s medication," Palmquist says, adding among those prescriptions was blood pressure medication.

"She said, ‘It just gets too complicated, and you probably don’t even need this stuff anymore.’ So our life is much, much simpler nowadays."

joelschles@gmail.com

Managing medication

  • Keep an undated list of prescription drugs you take as well as over-the-counter medications.
  • Stick to one pharmacy; this way, a pharmacist can help you check for negative interactions.
  • Don’t start a new drug alone in case of a severe allergic reaction.
  • Be aware of prescription cascade, in which you might be given a new drug to treat symptoms such as stomach upset caused by another medication.

Saturday 19 October 2019

The tune of a different drummer

I once taught a young Aspergers boy, Brett. My class was at the National War Museum and a military fellow was describing warfare in the first world war. He was a good speaker and he used his voice to emphasize the dark parts of the battles and the class hung on his every word. Silence reigned in the darkened room as the presenter professionally kept 130 14-year-olds ensconced in his or her own mental version of no-man's-land.

Then the speaker described how in the darkest night the Germans, for example, would crawl across no-mans-land and kill their unsuspecting enemy. Here the speaker paused for effect but the silence and solemnity, the majesty of the moment, was broken.

"YOU MEAN THEY CHEATED!?!" Brett's innocent voice echoed off the walls of the armory.

His dignity shattered and now faced with 130 restless teenagers competing to see who could laugh the loudest, the speaker very wisely cut his presentation short and turned the rostrum over to the teachers to restore order.

What has that got to with PD?

Nothing, but....

I rolled out of bed yesterday and lying prone on the floor, I discovered that my left arm was too weak to support my efforts to get back on the bed. Too high! I realized that a stool in the living room was the correct height to enable the use of my right arm to leverage me to a standing position. I cannot tell you how I was able to get to that stool.

The arm was too weak to assume the traditional crawl but somehow, I made it and ended up with carpet burn on my forehead. I think I must have "squirmed" my way to my objective.

For some reason Brett's cheating Germans came to mind and I had to smile.

That's all. Except for a lesson learned, Get a Victoria Lifeline. I did.

Oh, I am back to "normal" (my definition).

Monday 14 October 2019

For those in high places

I am grateful to all who turned out for the funeral during a blizzard - about 80 of you, but I would like to mention a few and why they are special to me:
  • Gale M- a very special close friend who is nothing, if not absolutely loyal. Through happy times (water pistol fights) to sad times (onset of PD and, obviously today), she has always been the best.
  • Cindy and Wayne in spirit. Wayne died last October. We knew each other for 56 years and were the best of friends. From a '57 Chevy, through "Mert & Toads" we managed to survive to become a teacher/principal (Wayne) and teacher/lawyer/teacher (your scribe). Cindy was Wayne's wife and good friend also, with a slightly Texas accent (my American "cousin")
  • Dr. Craig- a former grade 8 student of mine who went on to become a top psychiatrist and did wonderful things for an associate of mine.
  • These people who supported Sharron through the tough times and were the reason Sharron maintained a state of Grace until leaving us (if I miss some from RCC and Cross-fit forgive me): Marsha Katz & Jane Daniels - two selfless, caring people, Patricia Hadad, Gerri Weigle, Bev Bristow, Chrystal, Linda Keiback
  • Gayle and Ken Pember and family - I hope you found some comfort in my eulogy
  • From Mississauga, my sister and her husband & From Vancouver, my brother and his wife. We relive old memories every time we meet.

Saying "goodbye" troubles in my heart and my sanity so I will just say "jusqu'à ce que nous nous revoyions" (till we meet again).

VADE AD DEUM

Sunday 13 October 2019

When a Loss Becomes a Gain

The death of a spouse sure takes the wind out of your sails. You flounder about stopping every so often to burst into tears. It has been 2 weeks now with the funeral held on the 11th; hence, the lack of entries. I tried to raise money for boxing (a registered charity in Canada) and received some, but not enough. There is still time to donate, in memory of Sharron Jordan, at

www.uturnparkinsons.org

A ll will be explained on that website. I shall write more anon. Thanks to all who emailed their condolences, or attended the service and a special thanks to those who donated.