Wednesday, May 31, 2017

Ruth and Esther

Sunday my wife and I attended the 11:00 am video presentation of The Crossing church in the large screen theater on the third floor on Provision Living at Columbia. This was our third consecutive attendance. She did not identify with the same type of service on our TV or the big activity area TV from The Community Bible church in San Antonio, Texas. We had attended this service several times when visiting relatives in past years.

The Crossing singing and speakers seem to capture her attention. The music is familiar. The message is simple. They have the ability to bring scripture to life in the world as it is today without having to know much about theology or history.

My wife wanted to wander after the evening meal. We toured the entire first floor. Then she headed for the front door. We sat down with several other residents near the waterfalls. A number of topics were reviewed.

“And what have you two been doing today?” We mentioned we had been to church for three Sundays in a row. “What is different?” I related the above and added that the sermon was based on one of the woman in the Bible.

“Which one?” “Ruth.” My mind went blank. I had an aunt Ruth, but that was not right.

It was one of those “most embarrassing moments”. I knew the name was the same as a relative. I could not recall it. I also could not recall anything about the sermon.

Back in our apartment, I picked up Maggie’s mother’s 1978 New International Version: the book of Esther!! Maggie’s mother’s name is Esther!!

Two strings of information became entangled. The result was embarrassment, paralysis and anger.

I wish the BASIS body monitor had not been recalled. It would have recorded skin temperature, heartbeat, and sweating. I have avoided reactions like this most of my life by being “scientific”.

Feelings and emotions lead to a world I could never trust or feel comfortable in, with one exception: marrying Maggie. I always plant more than one plant or more than one variety in our milkweed garden. The truth is in the comparison.

 [The new meditation class takes me to the world of feelings three times a week. I can relive many moments of my childhood. Floating on a spider web held up by my breath carried me back to when I could see myself from a perspective of being above, behind and to the right side of my head. I played this game many hours.]

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The sermon emphasized that God is at work in our lives even though we are not aware of it. The book of Esther does not include the word God. Esther took some time to realize that the sequence of events going on around her were not just chance or a lucky set of coincidents.

 [Just now (1:46 pm) as I am writing, a caregiver returned Maggie to our apartment for a rest. I glanced out the window as I cleared the daybed for her to lie down. The repotted milkweed plants we raised from seed where in full sunlight on their first day outside. I went out and moved them to the east side of the pine tree in the shade.

Maggie wanted the door propped open. I knew where it was as I had just helped another caregiver search Maggie’s four sorting boxes for the erasable marker missing from the laundry. Found it in the last box she was working with.

Is this coincidence? Or is there a hand at work here? Our caregivers seem to show up at exactly the right time on many unique occasions.]

From the sermon, I got the impression that Esther and Mordecai were talking to one another, “. . . came to her and says . . .”. In the Bible they were trading messages because of the limited access to the palace. This does not change the message; just the style of the storytellers has evolved.

My first reading of the Book of Esther many years ago impressed me with the 75,000 people killed by the Jews. That is how things were done in Old Testament times. (And still are in that part of the world.) God’s work (evolution) is taking a long time to civilize human beings. It took two world wars (where Christians fought Christians) to produce the European Union.

Somehow I did not get it; that one of the most important Jewish celebrations, Purim (March 9-12, 2017), helps Jews to remember the fact that the entire Jewish nation may have been wiped out except for Esther’s actions. The sermon got it.

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For a moment, I thought that I may be experiencing what some memory care residents do on a daily basis; a degree of being lost, loneliness, and anger in an inability to understand and to express in words what they are experiencing.

Fortunately for me, I can still read, use the Internet, and relearn (update) what is now appropriate for our times. An inability to do this, for many valid reasons across the nation, may have produced the votes needed to elect our president in training.

Now to see what God does next. I would pray that the time for wars (that created the digital age and smart robots) is about over.

What is in our brain may be stored for eternity within the lifetime of the next generation. The ability to activate this information then ends the need for quarrelsome humans on earth to continue evolution (God’s work}.

Most of the plants and animals that ever lived on earth are gone. They prepared the environment for the present plants and animals, including human beings (creations that are aware of God).

Are huge masses of human beings the final information, awareness, climax? I doubt it. An all-powerful, unlimited, God, that I believe in, must have other plans that we can only dimly discern.

Saturday, May 27, 2017

Milkweed and Monarch Therapy

Milkweed and Monarch Therapy

Slope Flowers Looking Northeast
This field of Coreopsis at Provision Living at Columbia in the spring of 2017 is the result of two years of succession; the natural process of plants competing. The first arrivals in the area create the conditions for other species to thrive. 

It is beautiful to most people. At $7 per plant in a nursery, this is what several thousand dollars looks like today and for several months to come.

The beauty was so overpowering that two caregivers made table decorations for memory care.
Table 1
Table 2

Table 3
Table 4

These decorations cost about $20 each from a florist. They last about a week.                         

What happens on this slope will also now follow two paths with very different costs. Past tradition is a bulldozer, haul in good dirt, and plant whatever is in fashion. This is high maintenance. Water, water, and water. Only a few people can now afford to live in an artificial world that defies succession year around.

The new tradition is to learn what belongs here; what has evolved to thrive here. Engineering is being replaced with husbandry. Invasive non-native plants must be carefully removed. Engineering still plays a role in killing everything above ground and starting succession over again.

[However this construction site filled a valley over 70 feet deep with an 18-foot mound on top. Any seed bearing soil was either removed or deeply buried. What is growing here now comes from a prairie seed mix applied in the fall of 2015; and a truck load of dirt added on top of the mound (the lighter area on the east side of the property). Succession then starts with this seed mix and dirt containing unknown species.] 
Pre-Provision Living at Columbia (Mapquest)
Provision Living at Columbia (2017)

The contractor did not clear, in any way, a three-acre area along the north boarder that was approved for clearing. This kept the view of neighbors from the north being a fortress on a hill and kept the view of residents in the building as a natural woods on the cliff side (with no extra charge).

A Couple of Plants
The sloping field of yellow Coreopsis points out the need for a canvas of appropriate size for each desired effect; thousands on a hillside, a dozen in a vase, and only one or two plants in a garden or a small naturalized area.         

Our next job is then to remove any undesired plants and to add plants that can compete with little maintenance. Each plant has more interactions with the environment than just its contribution to the beauty of a landscape.

The milkweed is a good example. There is one species where one plant can feed many monarch butterfly caterpillars. There are several that are ornamental and currently becoming popular in landscaping. It may take several of these to feed one caterpillar; that is, if they have not been treated with a pesticide to protect the landscape investment ($7 to $37 plus planting).

[Treated plants kill the caterpillars. The expensive beautiful poisoned plants become death traps. An attempt to help, has the opposite effect! The eggs are wasted. Poisoned host plants reduce the population of monarchs.]
Milkweeds Ready for Fall Migration Monarch Generation

My wife and I raised, indoors, enough monarchs, on our two best years, to tag 100 butterflies. Each year one was found in Mexico. We had over 300 healthy common milkweed (Asclepias syriaca) plants each year. [The author of the scientific name thought the common milkweed, a native of North America, came from Syria.] 

The Monarch Butterfly Sanctuary would return to a forest if left alone; just as it did when the fields were no longer farmed in the past. Milkweeds would be a part of that succession. In time the native trees would prevail; as they did before being cleared for the current use of the land. A stable, climax, community would return. There would be few if any milkweeds. But this will not happen.

Non-native invasive species now disrupt normal succession. Invasive species crowd out, out compete, other species; other plants and the animals that feed on them. Diversity is reduced. We need to manage succession in such a way that milkweeds can thrive in a stable environment.

My understanding is that this is not difficult for this plot of land. Just mow in the spring and again in the fall, at the proper time; before the milkweeds are up in the spring and after the plants are going dormant in the fall (drought, freeze, or deer).

Crown Vetch from Top of Coreopsis Field
The Community Conservationist for the City of Columbia provided invasive species literature on crown vetch and bush honeysuckles. The crown vetch has been pulled from the sloping field of Coreopsis (some root parts still remain). The deer are feeding down the crown vetch on the upper flat northeast area. Both of these areas will require repeated inspections and plant removal until crown vetch is no longer in the community.

The bush honeysuckles are on neighboring property. Their invasive behavior can be managed by mowing, by removing seedlings and by having neighbors replace them with native alternatives. Native Alternatives to Bush Honeysuckle by Alan Branhagen in the spring 2017 Missouri Prairie Journal, Volume 38/Number 1.

A plant survey will determine what is growing now in all areas from the 2015 seeding and new dirt. These plants then serve as indicators of what other plants to add for a stable, low maintenance environment that includes milkweeds, and nectar plants; that turns a weedy area into more than a monarch rearing milkweed patch. It becomes an attractive self-sustainable sanctuary for monarch caterpillars and butterflies, and other pollinators. Residents can have a hand in growing plants for many years.

Milkweed seedlings were provided by the city of Columbia, May 19, from Monarch Watch. Memory Care residents transplanted the 50 plugs under the direction of Danielle Fox, Community Naturalist. The resident's active participation and expectations of what is yet to come was a well-intended result of this project.

Meanwhile we can wait for the fall monarch butterfly migration to lay eggs and feed on these plants. This generation will then fly to Mexico. The plants will then be put out on the sanctuary this fall where they can go dormant and be ready to bloom in 2018; ready for the spring monarch butterfly migration heading again toward Canada.

Monday, May 22, 2017

Communication Within and Between Performance Levels

(Written two weeks ago.)

The events of yesterday again highlighted the success and failure of communication between residents and their loved ones and caretakers.

A past post reported my observation (at South Hampton Place where seven refugees from the flood at Provision Living spent three months) of my wife and another resident to seemingly communicate without words. I have now seen this happen twice here.

We were seated at a table for four; my wife to my right and another resident across from me. He said something to me. She looked at him and grinned.  Then in several small increments their smiles slowly turned into a full-face grin. My wife nodded her head and they both burst out laughing. Their faces then returned to normal.

The second time, we met a resident in the activity area. On meeting, without a word spoken, this grin and chuckle occurred. The two then went on their separate ways; seemingly feeling much better for the encounter. 

Then later in the day, a caregiver shared her observation. “M___ is such a good helper. I was just at the point of leading R____ to the dining area when M___ touched the back of his hand with hers: he stood almost straight up and the two walked the rest of the way.”

My wife has resumed walking her two patients up and down the hall, but to a less amount than before the flood. The three have something in common at the lower end of the performance pick order of residents. This is a fact, but it is still hard for me to accept.

Each has developed a unique dementia personality that swaps in and out of “normal”. Living in this memory care environment, they can be happy most of the time.

Now, in contrast, is the communication failure between memory care, assisted-living, and independent living levels, in and out of residence and the resulting mental anguish. I still eat breakfast in the main dining hall.

I mentioned to the person seated across the table from me, that I had seen his silhouette, against the glass doors, across the memory care activity area, on a prior day, as we were eating. “Yes, I was getting my wife out of prison (memory care). I just do not understand her anymore.”  He was reading all he could find and had attended ALZ meeting in his hometown.

His problem and mine have been the inability to apply generalizations and policy statements to our specific situations. We need a frame of reference that fits two very different worlds. One has a clock where time is predictable across minutes, hours, days, and years. The other has, as I have now come to realize, is not a case of no clock or a broken clock, but a matter of several clocks.

Memory care is not a prison. The only differences between memory care and non-memory care residents are that memory care residents cannot remember the door code and they get lost when they wander. Memory care is more like living in a big family, that shares dining and activity areas, than assisted living, which is more like a five star hotel where people can hid in their apartments.

He must stop relating his wife’s behavior to past behavior. He needs to attend to what will make her a happy day, today and tomorrow. She is who she is today. And that is hard to accept, if you are continuing to compare now with the past or what might have been. It can promote grieving each day rather than enjoying each day or part of day.

He must also find things to occupy his own mind and physical needs so that he can continue to share an apartment with his wife. I have this blog, the physical fitness program, and the monarch butterfly project. We still have 250 cubic feet of storage full of boxes I find difficult to sort and pitch.

“She does not seem to mind me or care about me any more.” I told him how we have visitors come to the common area in memory care. We greet my wife and then sit down at a table where she can see us. In time she will come over and visit. In time she will get up and continue her trademark activity of randomizing everything she can pick up. In time she will again rejoin us. She is in her world. We are in ours. At times they mesh.

She is fully aware of what is being said, but with a very limited past (immediate and distant) for referencing, finds any discussion meaningless with the exception of the current moment; unless there is sufficient repetition or time for her to switch between different clocks.

[Caregivers take advantage of this situation by timing diversions and distractions to fit into that two to five second space between clocks (fixations on activities). A skilled and experienced caregiver can anticipate these changes between fixations that run on different clocks. This is the main reason you want the same effective caregiver as much as possible.]

For those who can, our task is to take part in and build an environment in which we, and our spouses, can be as happy as possible. My wife and I did that in our home for a year with well-matched Home Instead caregivers three times a week. My back problem put us in residential care. We are still building the best environment here in our apartment, the common areas (indoors and outdoors) and in the fitness center (gym).

[I was up before 5:00 am this morning to write this. I have the iPhone set to ring after 20 minutes. Time to get out of this chair. Next to find a repeating timer or chime I can set for 25 minutes (20 for work and 5 for exercise) as I forget to restart the iPhone timer. This is just one more step in creating an effective health care program.]

[StretchClock allows me to set the time between short stretching exercises: 25 minutes of work and a 5-minute set of yoga exercises (stretching as we do in the fitness classes), for example. I do not have to remember to reset it. Google “repeating looping timers” for dozens to select from.]

A Most Unusual Day

(Written two months ago.)

My wife woke up under the control of the “worries”. We used to call it that before we heard of “sun downing”. But the worries happen at any time. It has a stern expression, a determined effort, and a quick slap or strong hit if challenged when it is in nearly complete control of my wife.

We needed to leave for her brother, Bob’s, funeral by 10:30. She moved at double speed in packing everything in the apartment into something. There was no interrupting her in her work. There was no time to get out of her nightgown and into her cloths. At 9:00 I discussed our situation with a caregiver. She was ordered out of the apartment with a hand signal.

The business manager (also a degreed caregiver) stopped by with equal success. Attending the funeral was problematic. “She may have been over stimulated at the family gathering yesterday evening in the (partially restored) Hearth Room”. (A group of 15 relatives lasting 3 hours from which she left in her usual way about half way, “Time to go.”)

Now several other caregivers considered a calming pill. By now even drawers from my old clothes chest were resting on the sleep number bed next to the bathroom. This has never happened before.

Packing even the Pillows
Clothes Chest Drawers

I continued without forcing her to get changed or to leave things in place. I did put many things back only to have them migrate again. And then at 9:30 she sat down to rest. No order, of removing or dressing, one would normally use had worked.

And then again, “We need to get dressed to go to church.” “Oh!”, in that soft voice of recognition and understanding. The calming pill was ordered. I held out her pants. She put them on. “Lets wait on the pill.” Socks. Shoes. She put them on. The worry spell was over. No medication needed.

There was no taking off her nightgown. No putting on her brassier. I next held out her blouse. Off came the nightgown. On went the brassier followed by the blouse. I have to get things in the right order in her world.

When we stood to sing a hymn, she saw two of the picture books her younger brother and his wife made of Bob’s life, in the pew before us. One has a high school picture and the other a collage picture on the cover. She again showed for a few seconds the same reaction as when I was finally able to tell her that Bob was gone.

I had shown her Bob’s picture on the TV that was posted on Facebook yesterday, by a family member, and then asked her if she knew who that was. “Yes, Bob”. “Now read what is beside the picture.” Obituary . . . .  A two second winch of anguish and then back to the present.

The service seemed uneventful for her. The slide show afterword did connect. Between about the third and fifth showing she watched intently and responded to many of the slides that are in the family reunion picture books that have been made for us. 

(These picture books tell a story as will as bind a collection of pictures that appear to be able to withstand a lot of use for her and for sharing with all the residents.) [They are perfect for memory care.]

She responded well to a large number of people we knew well. I have been told several times that this may just be an act. It may be, in part, but she never asked to leave the service.

The dinner after the service was a second crowd. We stood still looking for seating. A complete plate was placed on the table in front of us and my wife was directed to that chair. My wife never asked to leave.

We ate supper in memory care while other family members visited restaurants. She was content visiting with our two sons afterwards and with their departure for the airport. Everyone seemed in good spirits.

This is then another time in which my wife has gone from “highly agitated and over stimulated” to normal behavior solely in response to not forcing her to perform by the clock. At no time did she jump up, “It’s time to go”, or signed, “No. I am not doing that.”

She has spent almost three hours playing with her keepsakes this evening. At 9:00 pm she is still not ready to let a caregiver help her into bed. She is now busy putting a few things right in the apartment rather than randomizing them. (I know this happens in the night at times, but have never seen her do it before.)

A most unusual day made possible by a number of family, friends, and caregivers. A thank you to each one.

This day presented the interplay between skilled, radiant, caregivers at all levels and my wife’s behavior at any one time. A significant time period can be as little as two seconds. The same behavior can support many stories; all of which can be wrong and all of which can be true for a moment.

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Bob’s wife passed one month later. She was watching TV and playing solitaire. She was Bob’s Alzheimers caregiver for over 10 years.

Sunday, May 21, 2017

Sitting Correctly

"Sit up straight." " Relax." How is that possible? What does it feel like? How can it be done without a trainer observing you?

After almost a year of nearly daily classes, I am beginning to find answers. The complete answer comes when you can do this by yourself.

For decades I thought I was sitting up straight. Then I found the sitz, sitting,  bones. Then I became aware of where my shoulders should have been. And lastly, I learned to balance my head, relaxed.

None of this could be done until I could sense, feel, something related to the right and wrong way of positioning, one muscle at a time. This sensation can be the same or different from pain. Pain sets the 
limits for that day.

Pain is tricky. Where one feels pain can be far removed from the cause. Several causes can produce the same pain.

My experience with weigh training, chair yoga, and tai chi has provided three views of the same situation. “If it hurts, stop. Stay within your pain free zone. You can go further in the next session.”

The reason for caution is simple: Irritated nerves, muscles and joints may take several days to heal before progress can again be made in training these parts.

We cannot sense body parts and movements at the lower, quieter, level needed to experience training that is appropriate for seniors, if pain is present.

[I attended my first meditation class yesterday. This now provides a full set of experiences from feeling great to physical pain and to mental anguish.]

So, how to sense sitting up straight and relaxed? The answer borrows from all three [four] training methods.

Sit in a hard chair to make it easier to sense your sitz bones. Mine immediately hurt. I therefore use my vest as a cushion in class.

Roll back on your bottom to feel your tailbone. I don’t feel mine, but this is not sitting up straight. It is how I have been sitting for decades to avoid pain from my sitz bones.

Next to stack your backbone in the correct relaxed position. Start with sitting on the sitz bones. Then to find where “up straight” is.

Lean to the right. Center. Lean to the left. Center.

Lean forward. Center. Lean backwards. Center.

Repeat as needed to get all four centers at the same place.

Lift your shoulders as high as you can and then DROP them. Repeat 2-3 times.

If all goes well, you are now sitting up straight and relaxed, except for your head.

Relax your neck. Your head will probably fall forward. Repeat the above four centering motions with your head. Find the point where your head remains balanced on your backbone. This may require positioning your neck as if your head is being pulled up by a string.

Take a deep breath, fully expanding you chest. Sense how this alignment feels for several seconds. 
Repeat 2-3 times.

Now stand up as a proud owner of a properly aligned body. Practice walking this way. I back up to a wall for realignment in the hall when I feel I am loosing my proper balance.

The body and head centering motions are both stretching exercises and show you where your proper posture is. Practice establishes this position in your muscle memory. Pain related to improper posture may be eliminated or reduced for a period of time. Your attention is being diverted from pain to learning how to feel good.

The most frustrating part of this is to be totally pain free for minutes to hours and then have it return with such intensity as to almost take me off of my feet. Such a violent return generally takes place as I am walking down the hall in memory care. I have yet to fall, but my right knee can buckle.

Or the back pain starts as I lure my wife out of our apartment. That can take up to 15 minutes for her to touch and set everything in place, or a caregiver comes by and assists me.

Allergies, stress, improper posture? Plastering and painting? At any rate, the fitness classes are allowing me, in general, to fee good by the time each one ends. Each new set of exercises seem to make something snap in a new location in my back and then feel better.