ASK KURT…Home Care 101 Archives

The Lesson of Thalidomide for Covid19, Look Before You Leap – My youngest daughter will say in the most excruciating terms that I am old, especially when I am trying to make a point based on some ancient piece of information that I remember to support an argument I am trying to win. She calls me ‘Lesson Plan Dad.’ It’s not a term of endearment. I usually go off and shake my head because she will sometimes ignore me or dismiss me from existence. But a funny thing happened as she was going out recently, she whispered to me before I had a chance to ‘advise her’ about following Covid19 precautions, “don’t worry Dad, I remember everything you said I had to do to remain safe. I hear your voice all the time.” This pleased me to no end because, 20 years after the death of my own Mother, I still hear her ‘voice’ warning me and giving me good advice. I’m sure some of you have that same experience.

The proverb, ‘Look before you leap’ has been a form of advice that has been given for centuries. This proverb was first noted in a 1380 manuscript and then captured in a collection of English proverbs by John Heywood in 1546; describes unintended actions and reactions that can lead to untoward results. The first use of this term in America is associated with a failure in diplomacy in the late 1600’s that occurred in New England during the time of the colonists and a war that caused significant damage of property and loss of life for both the Native Americans and many colonists who had previously coexisted uneasily (King Philip’s War). As defined, both sides in this tragic circumstance did not take-into-account all the consequences of their actions and could not avert the turmoil which befell them all.

In 1957 West Germany, a medication that was hailed a wonder drug and was marketed as a treatment for, nervousness, anxiety and morning sickness and distributed over the counter (OTC), turned into a nightmare for the German people. Many side effects of this medication included horrendous birth defects in the guise of malformation of the limbs, still born babies, tumor development and many other conditions. This medication was named Thalidomide. This drug was prevented from being introduced to the American market by a pharmacist, Frances Kelsey at the Food and Drug Administration (FDA), because of her concerns for the safety of our population. Because of the horrific birth defects noted in the so called ‘Thalidomide Babies,’ greater constraints and regulatory oversight of medications before their use in the public space has become one of the hallmarks of our American medical and pharmaceutical model. Appropriate oversight by the FDA has saved lives. We are looking before we leap!

During these dangerous times, in the Age of Covid19, our well-founded fear and concern for the lives lost and the lives at risk could have the effect of eroding the lessons of the past when it comes to the manufacture and distribution of a vaccine before the necessary due diligence has been implemented. I understand this rush for a cure, but I am reminded and informed about the possible consequences of not performing the work needed to safeguard ourselves from a malady of our own making. There is a reason why there isn’t a Corona vaccine in the world’s arsenal, its hard to create. Mutagenesis (DNA mutations that are engineered secondary to induction by an external factor) and Carcinogenesis (the result of agents capable of developing malignant tumors by inducing cellular changes) are the untoward effects that can result from the introduction of an external, uncontrolled factor into the population. I am not a fear monger, nor am I a scientist, microbiologist or anything remotely approaching an expert in the field on immunology or virology. I am a nurse by profession with a healthy appreciation for the rule of unintended consequences.

Let’s do this by the book! I am informed by the ethical boundaries of not experimenting on animals and conducting animal studies but in this most hazardous of times, please employ ethicists to conclude if utilizing an animal for determining if generational impacts can be averted in the human hosts who will be the final recipients of any vaccine that is developed can be averted. I am not a ‘Night of the Living Un-Dead Roach Avengers’ kind of guy but take a look at our oceans and see the harm we have done by introducing plastics to that environment and see the fish that have plastics in their systems that we are eating now. You get my point. There are potential downstream repercussions to our actions that must be considered and explored. For our children’s sakes, let’s not muck this up any worse than it already is by allowing political expedience to be determinative for the science that is necessary to figure this out and arrive at the best course of action to take.

Yes, this is Lesson Plan Dad saying, we better LOOK BEFORE WE LEAP!!!

Ask Kurt, Home Care 101: How to cope with Sundowning

Ask Kurt: Is a new column by Professional Homecare expert Kurt Leggard, a registered Nurse Chief Clinical Officer -Director of Patient Services for a Licensed Home Care Services Agency in NYS. Each week Kurt will be answering your questions regarding Home Care.

Home care, is supportive care provided in the home. Teamed with physical alterations to the home such as having mobility wet rooms fitted, it’s a great way to allow your dependent relatives to stay in the comfort of their own home while still getting the help they need. Care may be provided by licensed healthcare professionals who provide medical care needs or by professional caregivers who provide daily care to help to ensure the activities of daily living(ADL’s) are met. Also, very similar to RIGHT ACCORD HOME HEALTH CARE, In-home medical care is often and more accurately referred to as “home health care” or formal care. If you’re looking for an elderly care facility, The Hermitage of Northern Virginia has very nice assisted living facilities in Alexandria VA.

This weeks question is from Stephanie in Sag Harbor, NY

Question: My question is this: What do you recommend to cope with “sundowning” , a condition of extreme irritability of older people between 5pm and 7pm…hard time for caregivers to handle.

ASK KURT:

Kurt: Thank you for the question Stephanie. As defined, ‘Sundowning’ is characterized as a spectrum of behaviors of individuals with a diagnosis of Instant Coupons! Alzheimer’s Disease or other dementias with the individual presenting as agitated, extremely confused and sometimes combative beginning toward the end of the afternoon to early evening sometimes extending through the entire night. Basically, when the sun goes down.

I tend to begin any recommendations with addressing ‘Sundowning’ as a condition that is very stressful for the caregiver as well as a potential safety risk for the sufferer. It is imperative that the caregiver takes care of their own health care and emotional needs and gets appropriate rest and respite to handle the rigors of caring for the individual suffering with ‘Sundowning.’ Please get support if you can. Companies can Immanuel can provide lakeside assisted living to help reduce the physical and emotional load.

The immediate things you can do for the sufferer is to ensure that a recent medical examination has been conducted to determine if there are any medical conditions that may be the underlying cause for the ‘Sundowning.’ If an individual is in pain, this may cause ‘Sundowning’ to start or become more pronounced as will severe constipation, Urinary Track Infections, poor nutrition, dehydration and many other conditions.

If the sufferer tends to wander (a possible secondary affect), it is very important to conduct a complete environmental review of the client’s home. Remove safety hazards (loose carpets or rugs, telephone or lamp wires, use night lights, etc) to prevent falls. If the client is at risk for wandering out of the home, safety door locks should be installed out of the reach of the client but easily accessible to the caregiver. Visible signs inside and outside of the door to identify where the lock is located can be helpful if there is a need for an emergency evacuation, as in the case of fire.

There is nothing more frightening than a love-one wandering outside and lost. Safety locks can prevent this. Do not lock a sufferer indoors without appropriate supervision. If a lock is needed, then there is a great chance that ongoing supervision is indicated (consider the many Homecare options available but be cautious to consider caregiver compatibility and costs).

The following are my recommended interventions: Maintain a routine for the sufferer. Stress will exacerbate ‘Sundowning’ and routines reduce stress. Maintain or increase the activity status of the sufferer during the day and avoid naps if possible. Naps can tend to disrupt the clients nighttime sleeping pattern. As the sun light in the sufferer’s home decreases through the afternoon to the evening, increase the amount of lighting used in the home. The use of lights will reduce one of the triggers of ‘Sundowning.’ Reduce foods that have caffeine and sugar during dinner and snacks. Keep snacks light prior to going to sleep. Ensure that the sufferer has had adequate hydration during the day (the elderly are prone toward dehydration) but reduce fluids at night to minimize nighttime urination (nocturia). Minimize disturbances during the night This seems pretty reasonable but is sometimes difficult to manage, depending on outside traffic, neighbors, etc.

I read in Healthline.com (http://www.healthline.com/ ) that each sufferer has triggers that lead to ‘Sundowning’ and they recommend keeping a journal, recording all triggers to be avoided. Great recommendation!

A final or perhaps initial intervention may be to medicate the sufferer based upon their symptoms and behaviors. Interestingly, some medications may themselves be the cause (trigger) for what appears to be ‘Sundowning’ but may actually be causing medically induced insomnia and confusion. Review all medications the sufferer is taking with their physician or nurse practitioner to determine if medication may be the cause of the problem.

Ultimately, this is a very difficult and challenging circumstance for caregivers to handle. It can be very exhausting and frustrating for everyone involved. A combination of the recommendations offered will hopefully provide some answers and work for you. Get plenty of rest and support if possible. (please review Web MD (http://www.webmd.com) and the Alzheimer’s Association ( http://www.alz.org/nyc/ ) for excellent information.

Each week I will be answering your Home Care Questions: Email your questions to HamptonsMouthpiece@gmail.com