All posts by David Moseman

Disability Interventions, when?

Disability fears, In the News

When someone recognizes their disability and is open about it as Capt. William Swanson the most recent Medal of Honor winner, it is easy to know that assistance will be appreciated. When we see someone struggling to do what had been in easy task, deciding to intervene is harder. Often we see a friend or family member misinterpreting what is said because they are hard of hearing. The question then becomes should I correct them or answer for them?

We all struggle to do some things. At times the struggle gets us down. In frustration we may give up. This morning I was trying to pay some bills. I first went online to use my bank’s electronic system. After several tries in which I could not find the company I was going to pay in the bank’s list, I shouted a few angry words. I pulled out the checkbook. There were no more checks. I pulled out the credit card and filled in the information on the bill. One down and one to go! I was on a roll. Then I found the next bill did not have the option to pay by credit card. I went back online and eventually succeeded. With struggles like this I realize why it had taken me so long to pay these bills.

Paying bills is one of many chores that people who become disabled struggle with. I recall many instances where people either made poor decisions or failed to pay bills. It was the consequence that brought the problem to the family’s attention. Lights would get turned off, and the person would turn to family or friends to get them turned back on. Someone was alerted to a problem. They were willing to assist. They set up an alternative method for getting the bills paid.

In the absence of a crisis when should you intervene in someone else’s affairs?

This month I’m looking at the issue of intervening in someone else’s affairs because they are disabled. In the issue of driving we worry about safety. Safety is also an issue in cooking and doing some personal chores like bathing. There is embarrassment when someone misreads or mishears something. Often they or the other party will realize there’s miscommunication and try another way. People don’t like being told they can’t do things. We saw this in the responses to one of my posts on Facebook. When I asked what you do when others say you can’t, several people said they just try harder. There is a degree of anger and frustration when we do try harder. This came out when I was trying to pay bills today. Do you risk becoming the focus of that anger by suggesting you step in to help the disabled person?

In my next blog I will explore some ways we can step in. In the meantime if you have some additional thoughts on how we might decide when to step in please share them. I am always open to new ideas and perspectives. If you know others who would like to ponder this question please get them involved.

As All Ways, Seek Joy,

Coach Dr. Dave

Author of the forthcoming book, “recipes for lemonade (thriving through disability): Dr. Dave’s personal recipe “

www.www.bsmk-med.com

Intervening in another’s disability?

Disability fears

Should you intervene when someone else is disabled? When a family member is becoming increasingly disabled deciding when to intervene is difficult. This is especially a problem when it impedes the freedom of that person. Driving provides so much freedom, that to inhibit that is a major blow.

As teenagers we can’t wait to get behind the wheel. As parents we look to that day with mixed feelings. We will no longer have to be taxi driver, on call for our children’s needs. But then we worry about what they’re doing and their safety. Once the children have shown a competence we both relax, some.

As we age many things happen to our bodies. Our reflexes slow, our eyes develop cataracts and for some our memory and concentration fail. We compensate for some of these naturally. The thrill of speed and power gives way to a desire for safety and comfort. When I became a parent our family car became a van. Honestly, the four of us couldn’t fit in the sports car.

As my eyesight started failing, my family began to worry. My kids did not like me driving the car pool. My one son avoided riding with me. But they never openly confronted my ability to drive.

In retrospect I know they struggled with the question of when to intervene in my driving. This was a dilemma that many families brought to me as a physician. Often I had a patient who couldn’t remember what day it was or where they were. Yet, somehow they always seem to find their way home. With them rational conversations were likely to end up only in hurt feelings. The solution often came in hiding the car keys or getting rid of the car. For someone who is aware of what is going on it is still an emotional issue.

 

How much are we responsible for the behavior of others?

 

Family members have responsibilities that friends don’t have. There is a mutual dependence that will be changed. If you stop somebody from driving, you will have to provide another way for them to get around. Most of us do not live where there are good and accessible alternatives to the car. That was one reason we moved to a city. I now live within an easy walk of four bus lines. With an electronic bus pass I can walk on and off any bus any time. With a phone app I can check the bus schedule while I’m walking down the street. On nice days I enjoy taking a long walk.

While we don’t like confrontation, we also don’t like to see people hurt. That includes the person whose abilities are failing, and those who might be hurt by their actions. At one point I was working as a member of a kitchen crew. We had more people than jobs. I started ladling out the soup. I was a little clumsy. A friend noticed, and offered to take over. He had the courage to risk my hurt pride.

We often see people having difficulty doing things. Sometimes it’s just finding directions. Sometimes I can guess what they’re looking for and point. I appreciate people telling me when the light has changed, and it is safe to cross the street. Other times it may be in carrying something. I have found that most people like a question like, “How may I help you”.

There are many times when we probably should intervene in what a friend or family member is doing. I have shared a couple of personal examples, but am sure you have many more stories. I would love to hear about them and your reasons why you did or did not intervene. Please feel free to leave those comments here.

If this blog has helped you, I would appreciate you at least “liking” it. If you know somebody who might be interested in it please “share”.

 

As All Ways, Seek Joy,

Coach Dr. Dave,

Author of the forthcoming book, “recipes for lemonade (Thriving through disability): Dr. Dave’s personal recipe”

www.www.bsmk-med.com

Disabled, who me?

Disability fears

What prompts us to consider ourselves disabled? From the time we are children and realize we are individuals we begin to take stock of who we are. Small children don’t seem to worry about what they can’t do. When they fail they pause and try to figure out how to succeed. When do we lose the joy of finding new ways and new abilities?

When I started wearing glasses in elementary school I began to have to pay attention to what I was doing. Wrestling with other kids would invariably get my glasses hit.  I would have to take them off. Since I was rather myopic when playing football, catching and passing the ball were no longer an option. Since I was big for my age I could play in the line and often centered. Years later I played rugby, and found the same problem as when we played football. Playing on the wing I was the last person to realize the ball had been kicked to me. That is scary when you have guys bigger than you running full speed at you, and no one’s blocking. I moved to the scrum, and later got some contact lenses.

 

Wearing glasses didn’t seem strange to me. Both my parents wore glasses and later my sister and brother wore glasses. Many other people were glasses so that problem was not unique.

 

When I was in my mid-20s I was diagnosed with glaucoma. At that point I felt I could see as well as anyone else. Being a doctor I realized that someday that might change. A few years later I was doing physicals for people to drive trucks. One of the requirements is that they can see to the side. I realized that I could not pass that physical any longer. I like to think that I could do anything but this was not something I had set my hopes on. If my livelihood depended upon my driving a truck this would have ended my career.

 

Over the years my vision changed very slowly. There were a number of accommodations I made to see as well as possible. I got antiglare sunglasses. I would let my wife drive when possible. And eventually I tried to plan my route so that left turns were less often. Later I learned to check from side to side on the road ahead of me. Looking across the road from one shoulder to the other assured me that I had seen everything ahead of me.

 

When I finally met the requirements for legal blindness I do not know. For many years I had trouble with the eye test to get my driver’s license. My eye doctors would always sign the note so I could get my license. I got scared the last time I went to get a driver’s license. I looked in a machine and saw nothing. It was testing my sensitivity in lowlight conditions. Again, my eye doctor gave me a note that allowed me to continue to drive.

 

Was it safe for me to continue to drive?

 

Driving is not just a right but for most a necessity. Many families came to me concerned about the ability of my patient to drive safely. There were many reasons and many stories why they were concerned. In many cases the patient was demented and it was surprising they could find car keys let alone finding their way home. I think that the autopilot that sometimes takes us home when we wanted to stop on the way was active. Like walking, driving can become second nature. In upcoming blogs I plan to talk more about how to have these difficult conversations.

 

If you or someone you know has had to change their way of doing things would you share that with us?

 

As All Ways, Seek Joy,

Coach Dr. Dave

Author of the forthcoming book,” recipes for lemonade (thriving through disability): Dr. Dave’s personal recipe “

www.www.bsmk-med.com

 

Food Stamps and Tough Love

Featured, Stress

In Thursday’s New York Times article “On the Edge of Poverty, at the Center of a Debate on Food Stamps” the author talked about how the food stamp program was being used as an instrument for tough love. Those in Congress who want to cut funding feel most of the people should return to work. The author gave several examples of people who are disabled and dependent upon food stamps.

If they are disabled how can less nutrition make them more able?

“What you eat is what you will become.” If we make people starve or choose calorie dense junk foods over a variety of healthy food we will not help them be healthier. We knew know that good nutrition is important for the body to function. We also know that if people are stressed the body will function poorly.

Our bodies use food to replace and restore the tissues. It is not just a source of energy in the short term but the building blocks for our future body. Our cells are constantly turning over in periods from days to weeks. I recently saw the effect good nutrition can have when my cats became ill.

We have two cats that are 17 years old. Over a period of months they stopped eating solid food and even stopped eating moist food. They lost weight; their previously soft fur became matted and knotted. After a visit to the vet and removal of some bad teeth they started eating again. Now their fur has returned to its normal soft consistency. No longer do we have to cut the gnarls out of their hair.

Similar things happen to our bodies. What we eat affects our cholesterol, blood sugar, and blood pressure in a fairly short time span. We are aware of the effects coffee has on us. Most parents can tell when the kids have gotten too much sugar. With my restless legs I have to avoid chocolate and caffeine in the evenings or my feet won’t settle down.

Emerging research in nutrition shows that what we eat determines what bacteria grow in our guts. These bacteria (and yeasts), help us to digest our food and either produce toxins or prevent them from getting into our bodies. Thus people talk about using diet to affect our mood and even treating depression. Some forms of arthritis can be helped by glycogen supplements or reducing the toxic load in our diets.

How do you function under stress?

I know I don’t function well under stress. My 91-year-old mother became ill on New Year’s Eve and died in May. I am now picking up the pieces from things I did during that period.  With the stress declining, I now feel more creative and energized than I did for the first half of this year.

Is the tough love approach creating a vicious cycle, poor nutrition leading to poor health leading to poor functioning and for thinking? If so isn’t it time to come up with a better way?

I would love to hear your thoughts and comments which you can post below. If you know anybody who might like to consider this please share.

 As All Way, Seek Joy,

Coach Dr. Dave

Author of the forthcoming book, “Recipes for Lemonade (Thriving through Disability): Dr. Dave’s Personal Recipe “

Www.www.bsmk-med.com

Loneliness: how to overcome Loneliness

Featured, In the News, New, Spotlight

Everyone feels lonely some time, but how can we stop feeling lonely? Researchers investigated this in a study recently reported on by NBC news. The question was does loneliness make us seek things or do things make us lonely? They found for some it works both ways, but not for all. Do you use shopping as a way to combat loneliness?

Loneliness is surprisingly common, with 20% of Americans saying their lonely at any one time. About one third suffer from chronic loneliness. Loneliness increases stress high blood pressure and possibly premature death. So how can we combat loneliness?

In this study they divided people’s approach to material items into three groups. There were those who liked having things for the sake of the things themselves. Second group like things for the social status they brought. And the third group never felt they could have enough stuff.

Those who like things for the sake of the items tended to be happier and not as lonely. For them getting new things did not make them lonelier nor did loneliness seem to make them want more stuff.

For the second group that sought items for social status shopping brought only short-term gains their increase in social status was short livedВ and they soon felt lonely again. В This seem to be a recurrent spiral. Loneliness made them seek things. Things eventually made them lonely again.

The third group seemВ to beВ stuck in loneliness. Buying things did not make them happier. And being unhappy seem to cause them to be alone with the things. They could neither have enough stuff or enough friends.

How can you become less lonely?

We can think of several ways to be less lonely. Shopping was the example in this study. But we can think of the lonely man sitting in a bar. Or “all those lonely people” sitting in a church in the Beatles song. These may be attempts to get ourselves out among other people but are they really satisfying our need?

What lonely people seek this connection with others. While watching a movie in a theater may seem more connected than watching at home is it really satisfying our need? Isn’t what we really need, getting together with those people and talking about how we feel about the movie and how the movie made us feel?

It would seem that the solution to loneliness is in connecting with people and sharing with people. Not in just being around people. How do you connect with others?

As always feel free to comment and share this blog.

As All Ways, Seek Joy

coach Dr. Dave

author of the upcoming book “Recipes for Lemonade (Thriving through Disability): Dr. Dave’s personal recipe”

www.www.bsmk-med.com

Nice guys, Do they make us all winners?

Featured

In a recent Christian science Monitor blog  James Norton referred to research done at Michigan State University. It suggests that nice guys make us all winners. It even suggests that being nice is a winning strategy even if you don’t finish. What has been your experience?

We are all aware of the old adage nice guys finish last however if we think about it for a minute being nice is probably a better strategy than trying to win at all costs. Only one can come in first. We all know there are risks in running the race. We might need help along the way. Who is apt to get the help the nice guy or the greedy guy?

I recently noticed this on the city bus. As I got on with my white cane a woman said, “to your right”.

A little girl said,  “right here”, tapping the seat next to her. As I sat down next to her I noticed how contented she was. Her mother settled their fare and join her on the seat. This preschooler seem very happy and contented. Her mother did not need to entertain her. The girl had ribbons and curls in her hair. Yet, her shoes lacked laces.

This nice little girl lives in a nice world. By some standards the world was nice to her, but obviously there were material things she lacked. Was she a winner or a loser?

Looking at the girl I think she felt like a winner. I see many other children her age who are always needing attention. They whine, and keep moving around on the seats and require the attention of an adult. This little girl seemed very contented in her own little world. In our materialistic and competitive world I doubt anyone will ever consider her to really be in the race. However, I doubt she will ever feel deprived for long.

In college I played in the band. To promote the University we would take a bus tour during spring break. We would sleep in the homes of high school students where we were performing. I remember one warm and friendly home in particular. They seem to be one of the poorer homes but one that I felt more comfortable with than most. I was raised in an upper middle class suburban family. Yet this family, which obviously didn’t have the education or opportunities that I had enjoyed, enjoyed great love. This was something my parents also strived for.

The researchers at Michigan State University were considering evolutionary biology. They had concluded that niceness in the forms of cooperation and forgiveness helped individuals and communities survive. Personal greed and self-interest leaves the individual vulnerable to those groups that can organize themselves.

We all remember the childhood game of King of the Hill. Everyone strives to be the king and keep everybody else off the hill. Soon two or more attack at the same time. This overwhelms the king. If the new Kings cooperate they are much less vulnerable to the next round of attack. If however it was just coincidence, then they start fighting among themselves, and the cycle continues.

So would you rather be the king or a nice guy?

As All Ways, Seek Joy,

coach Dr. Dave

author of the forthcoming book, “recipes for lemonade (Thriving through disability): Dr. Dave’s personal recipe”

www.www.bsmk-med.com

Trauma from Healthcare

Featured, Health caring disciplines, Stress

 

 We all know some things in healthcare can be traumatic such a surgery. However to articles in the New York Times suggests healthcare is more traumatic than we expect.” Nightmares I.C.U.

“and the related letter “Diaries Aid Mental Recovery” suggests as much more common than I would’ve been expected. Have you experienced nightmares after healthcare?

In my years as a physician I was often called upon to manage delirious patients. Sometimes I could calm them down the path that of I by just talking to them. Often I had to physically restrain them, until medications could do the job. I thought little of how the patient might remember this. I probably should have known better.

As an infant I came to hate shots. Then age 3 a bout of whooping cough landed me in the ICU. The pain from a shot of penicillin got me to take a deep breath. I coughed out the mucus and breathe better. after I returned home I experienced night terrors for a wild. I can still recall some of the content of those nightmares. I still do not like getting poked with needles, but decided to not let it bother me when I started drawing blood and starting IV’s.

The New York Times articles suggest that some of the things we do are not as helpful as we think. As a geriatrician I tried to look for the cause of delirium as soon as possible. After the anesthesia from surgery we usually figure it’s the residual sedation from the anesthesia. Thus we would strive to avoid additional sedatives. In an ICU setting especially with the respirator the treatment can cause major panic. Patients have told me it’s next to impossible to breathe with the machine. As we try to get the patient off the respirator we set the machine to breathe with the patient. When this doesn’t work we use a variety of drugs some of which are supposed to cause amnesia.

These drugs do not cause a perfect amnesia. Often their use for such common procedures as colonoscopies. Many patients have told me they remember the whole thing. At least they don’t recall any pain. So I guess they’re effective when used this way.

Does healthcare cause other traumas?

When I was confronted with a new illness that might be cancer, I was never quite sure what to tell the patient. Even when I would’ve bet the lump was cancer, I hesitated to say so. This situation has been discussed much among physicians.

The idea of posttraumatic stress occurring from healthcare offers much room for study and improvement. This study can also be expanded to veterinary medicine. My cat in the associated photo was Seeking refuge on top of the kitchen cabinet. I was about to take her to the veterinarian. She had serious dental problems and would not eat or drink. She is about to get her teeth extracted. I have found she will eat cooked chicken  and drink chicken broth.

Healing from Healthcare Trauma

Most people get over the trauma of healthcare fairly quickly, but not all. There are several things you can do if you are wondering about what might be after effects of healthcare. First, talk to your provider. He or she can review the official report and explain what happened. This will allow you to compare your recollections with that history.

If your family of someone set up a Caring Bridge site for you there will be another record of your stay in the hospital. This can be helpful to family and friends as well.

If these leave you needing more a coach or councilor can help. Because they are attuned to your feelings and not the system that caused the trauma they may be better. SAs always You can consult me about your options thru my website.

As All Ways, Seek Joy,

coach Dr. Dave,

author of the forthcoming book, “recipes for lemonade (thriving through disability): Dr. Dave’s personal recipe”

www.www.bsmk-med.com

Feeling inferior?

Disability fears

So you think you’re not as good as someone else. What’s new? We all feel this way sometime. Don’t settle for the platitudes of friends and family. Friends and family are well meaning. Often what they say is honest. But does it really satisfy your need?

When we are feeling inadequate what is really going on? It is not just a question of the glass half empty or half full. Either we haven’t lived up to our own expectations or we fear we won’t live up to our own expectations. Where did our expectations come from?

My expectations come from my self-image. I would like to excel in everything. I think for some reason I should be able to excel in everything. When I put my mind to it I have excelled at most things. Yet, honestly I’m not the best there ever was, at anything except maybe being myself. Does that realization make me feel adequate? Not really.

What then makes me feel adequate? Sometimes it is simple things like straightening the house and making the bed. Today it’s getting this blog written. I thought about this idea for several days. Now that I am writing it is taking a form different than what I thought it would. This is not the first time a blog has written itself and come out differently.that I didn’t have enough to say. That what I would say would sound trite. Now I see those fears were away for my unconscious to come up with a new answer. The answer for me to have felt adequate seems to go ahead and just do it. That means figuring out what you are afraid of, and finding a way to approach it.

When we feel inadequate we are also feeling overwhelmed. Yet, a monumental task like putting a man on the moon wasn’t done in a day. When President John F. Kennedy tasked the nation with doing that in 10 years, it took a week for a group of engineers and scientists to outline a plan. It took thousands of people working over a decade to make it a reality. The overall tasks seemed impossible. Yet when they broke it down into doable parts it was accomplished.

So, when we feel inadequate how should we approach it? It would seem we need to define the task, break it down into doable parts, and get started.

This may seem appropriate when were overwhelmed by a future task. How about a past event.? I would use a similar formula. Define the task, to find my expectations, review the outcomes, look for lessons learned, and celebrate my successes. We can always claim we tried. We can always identify factors outside and within our control that prevented us from reaching our expectations. Then we can design new strategies to prevent those things from happening again. This process is easier if you have somebody help you work it through. That is one of the tasks of a coach.

What in your life is making you feel inadequate? How have you cope with your feelings of inadequacy in the past. Do you take issue with anything I’ve said here? What wisdom can you add?

As All Ways, Seek Joy,

Coach Dr. Dave,

author of the forthcoming book “recipes for lemonade (thriving through disability): Dr. Dave’s personal recipe “

 www.enjoyhealthandlifecoaching.com

Chiropractic, medicine or voodoo?

Health caring disciplines

Years ago when I graduated from medical school it was unethical to have any professional contact with chiropractors. After seeing how ineffective we were at managing lower back pain I considered learning some chiropractic techniques. Does chiropractic therapy have anything to offer those with chronic illnesses?

Chiropractic therapy was founded in the United States in the late 1800s. It was one of several approaches to health care that emerged at this time. Unlike mainstream medicine otherwise known as allopathic medicine chiropractic medicine assumes all illnesses originate in a single source. Allopathic medicine assumes that therapy can come from many sources and their current model of disease can be referred to as a bio psychosocial model. Thus to me osteopathy  seems like a cardiologist claiming that all the ills one can suffer can be treated by treating the heart.

The other tenets of chiropractic medicine sound more familiar.. A conservative approach using the least harmful therapy we can all ascribe to. Unfortunately most professionals believe in what they’re doing and have only limited understanding of what others can offer their patients. If a patient came to me I was apt to prescribe medication because that was what I was trained to do. Over the years I learned others might have better options. We now expect a healthcare provider to attempt to explain the options and make referrals as the patient chooses. I have seen the good and the bad medications and surgery can do.

The third tenant of chiropractic medicine is the concept of homeostasis. This means that the body will try to heal itself. This was the point I was attempting to make in my blog, “your doctor won’t cure you”. If our bodies didn’t have an innate ability to heal itself life would not exist.

How do chiropractors approach illness?

Chiropractors initially believed that all illnesses could be traced to derangements of the spine. The spine contains the spinal cord through which the brain communicates with most parts of the body. thus if those communications are altered or interrupted the body would be out of alignment. We have all seen people with pinched nerves or major spinal cord injuries. Chiropractors however assume that subtle now alignment of the spine can cause illnesses that have little if anything to do with the spinal cord. In the United States it would be illegal for a chiropractor to claim he was treating diabetes. Studies have however, have shown that chiropractic medicine can be a helpful adjunct in treating lower back problems. There is more controversy about how effective they are treating other musculoskeletal problems.

Besides the spinal manipulation there is a therapeutic  benefit of interpersonal contact and of touch. There is a concept of therapeutic personality. I had several patients tell me they felt better just coming to see me. I was also convinced that many people suffering with the flu were at the point where they were going to get better when they decided to do something about their illness. Taking charge of your health can be therapeutic in and of itself.

Humans are also tactile animals we love to be held and touched. As we grow older we have experienced touching that was not so pleasant. But at times I felt a hug could be therapeutic. After dealing with the carnage of an horrendous accident, in which two kids were killed I had to hug my children.

Could chiropractors be therapeutic and other ways? Could they be therapeutic just because they’re not MDs? What have been your experience with chiropractors?

As All Ways, Seek Joy,

Coach Dr. Dave

author of the forthcoming book,, “Recipes for lemonade (thriving through disability ): Dr. Dave’s personal recipe”

www.IhJoyHealthandLifeCoaching.com

www.enjoyhealthandlifecoaching.com

Finally, Obama will make Americans healthier

In the News

For much of his presidency, president Obama has been focusing on providing health care for Americans. As a physician I know that saving one life at a time does little for making Americans healthier Obama care will just make Health care more lucrative. . This was the main outcome of Medicare and Medicaid, which started in the 1960’s.

In the 20th century Americans and others living in developed countries saw great increases in life expectancy. In 1900 the average life expectancy was in the mid-40’s, now it is in the mid-70s. Most of this has come from public health efforts and better nutrition. The public health at efforts included indoor plumbing and public sanitation. These we have come to expect wherever we go. Pub. Health efforts in food safety have also helped. We often hear of foodborne epidemics and recalls of certain food products.

However over the 20th century certain illnesses have become more common. When I went to school nobody had asthma. Now if your child doesn’t have asthma, several of their friends will. The increase in childhood asthma has been linked to air pollution. There are numerous examples of this throughout the world. But when air pollution increases we all suffer. How has air pollution affected you?

Doctors have long known that air pollution causes many health problems. That is why air pollution is now monitored and alerts given when it gets bad. When air pollution gets bad it is not just children that suffer. Air pollution irritates our eyes and makes it harder to see. Heart attacks and heart related deaths increase along with those of asthma and chronic lung disease. These illnesses cause absences from school and work. America and other industrial countries lose a lot in productivity.

Most of the pollution we suffer comes from the burning of fossil fuels. The burning of fossil fuels has allowed us to live better. But who hasn’t noticed the exhaust from a car or truck? Air pollution also comes from the burning of coal to produce electricity. Thus electric cars will pollute less only of their electricity comes from clean sources.

Thus, America will be healthier not because of Obama care but because of the environmental initiatives he took this week, the press has made much of the global warming consequences of these actions. However, a much quicker benefit will be to the health of Americans. We will be able to breathe easier in our cities and towns.

As All Ways, Seek Joy,

coach Dr. Dave

author of the forthcoming book, “recipes for lemonade(thriving through disability ): Dr. Dave’s personal recipe”

WW enjoy health and life coaching.com