Fifty, and counting…


Bob at 240#

Bob at 240#

Actually, this image is closer to where I am now…


While it is some 15 years older, it’s closer to my current look. The weight is right, but I am MUCH more grey… As Billy Pilgrim would say, “So it goes.”

For the first time in the better part of a couple of decades, when I walk towards the mirror in the bathroom, I don’t cringe; in fact, I’m pleased with what I see. While not at the goal I’d set, I’m on the right side of the curve, and feeling I just may make it back to what I weighed back when a college student. FWIW, that’s still heavier than what the BMI charts indicate are “correct” for my height. However, those charts have wide error ranges. If I get down to 170+, I will be ecstatic. As it is, I am able to see parts of my anatomy that have been hiding for quite some time. And, more importantly, my wife is very, very pleased with my new, reacquired physiogonmy.
In short: On Track.

Stay well,


NurseBob and Politics

NurseBob_1I have avoided talking about the political aspects of health and health care on this blog, and will continue to do so; I don’t want to have discussions regarding peoples’ health get bogged-down in side discussions.  However, I am launching a new website in the near future – The site is a work in progress at the moment as I sort out the initial design, along with what the focus should be.  For now, I’m considering an approach similar to a news magazine, where the focus is on success stories of united groups addressing social issues.  I also believe it should serve as a resource and clearing house for groups in the process of organizing.

To give credit where credit is due:  I heard the phase as a closing comment from Gayle McLaughlin during her interview with Bill Moyers on his Moyers & Company program.

If you have thoughts, projects, stories to share, etc.  Please drop me a note, or comment on this post.

Stay Well



The Search For Long Term Care – Mom, Dementia, & Me

Previously posted on openplacement’s blog

Mom-3-17-2013The Beginning

Six years ago my mother was the primary caregiver for her elder sister. At the time she was eighty-six, and her sister was eighty-eight. Her sister’s health had been slowly declining, with increasing difficulty in her ability to manage not only her activities of daily living – mobility, hygiene, dressing, but also other tasks such as grocery shopping and meal preparation. Their time together up until then had been both pleasant and successful. However, as my aunt’s short term memory began failing with the onset of dementia showing, their relationship suffered. My mother could not understand why Lil couldn’t remember what they had just agreed upon, and Lil, when challenged about her failing memory, would become angry and verbally abusive.

The situation hit the breaking point when my mother feared for her safety and dialed 911. When my sister and I found out about the state of our mother’s relationship with her sister, we were compelled to step-in. My sister took on the challenge of finding an appropriate longer term care facility for our aunt. Happily, she’d worked for the same employer virtually all her adult life, and had a reasonable retirement income, and perhaps more importantly, excellent long term care insurance. Finding an appropriate long term care facility was not too difficult given her financial situation.

I faced a more challenging situation. My mother had also worked her entire adult life, but had moved from one temporary job to another. Those positions had not included any long term benefits. Furthermore, her one long term employer, a small art college, had offered very little in the way of retirement or long term health care benefits. In short, all my mother had to work with was her social security benefit, and later, state benefits for her health and housing (Medicaid). It was our good fortune that while in training as an RN, I’d had the opportunity to visit a number of assisted living facilities within a short drive from my home, and not too far for my sister to drive when she wanted to visit. After a review of the available long term care facilities within reach of my mother’s budget, we settled on the one that offered the best combination of services and social programs for our mother.

The Move to Long Term Care

The physical move, about 50 miles from her old apartment to the new long term care facility, wasn’t too challenging, except for my mother’s upright piano. Having played all her life, that was the one item that she felt she needed to keep her feeling good about herself. Since neither my brother-in-law nor I were interested in adding piano moving to our resumes, we found a firm to accomplish that move (if I remember correctly, about $200), the rest of her possessions my sister and I moved into her new apartment.

After relocating to long term care, the first challenge for my mother was getting to know her new neighbors. This went fairly smoothly, or so my sister and I thought. One aspect of my mother’s personality is her profound desire to avoid any confrontation. She’d told me in past conversations that her approach potentially confrontational situations was to “smile, nod my head, and then do as I wanted.”

Transition to Long Term Care and Discoveries

I ran across this behavior on numerous occasions as my mother would agree with plans, and then ignore them, or actively, but surreptitiously, subvert plans. Since our contact was mostly by phone it was easy for her to do as she pleased in most situations. I would only find out after the fact that she’d made contrary decisions and had acted on her whims, which were not necessarily in her own best interest. This tendency put her in the hospital twice after falls that were initiated by her failing to use her walker or cane as her gait became increasingly unsteady. I know in my experience as a nurse that this is not an unusual behavior. I’ve had numerous patients over the years who would say, “I hate using that thing. I’m OK without it.” Of course with my Mom, if I wasn’t in the room to remind her, she’d choose to believe she was OK too, until she fell. Her first fall led to a week in the hospital with a hairline fracture of her hip. Painful, but luckily, not requiring more than rest and rehab. She then spent a month in a skilled nursing facility for the follow-up rehab.

It was during this stay in long term care that we got the first strong hints about changes in her mental status and memory that had not been particularly apparent before. I got several panicky phone calls in the middle of the night with all sorts of seemingly wild claims. I realized that my mother was “Sundowning,” a phenomenon commonly seen in hospitals, where patients who are relatively lucid during the day, become increasingly disoriented as the night progresses. There were not only calls to me, but 911 calls as well. When her rehab was completed and she went back to her apartment, I’m not sure who was more relieved, my mother, the facility, or myself…

Progressive Changes – Onset of Dementia

After that initial fall, my mother began a slow decline and showing signs of dementia. On about a weekly basis I would get angry phone calls accusing me, or my sister, of not caring about her, followed by tearful, embarrassed apologies, sometimes within minutes, or perhaps the next day. She repeatedly insisted on moving back to her old apartment and resuming the care for her elder sister. When we talked about the situation that triggered the move, it was met with a range of responses from acknowledgement, to enraged denial. Her mood swings were becoming more labile and profound.

After a visit to her doctor, which included a brief mental status exam (MMSE), her daily regimen included both Donepezil and an anti-depressant. Her behavior improved and mood swings were less extreme, but the phone calls and outbursts still continued, just at a reduced frequency. And, her apparent feelings of guilt about having “abandoned” her sister continued, with an increasing level of denial that there had ever been a problem. However, during this period, she had a second fall while hurrying to dress for breakfast, falling backwards into a filing cabinet and fracturing three ribs. The hospital and nursing home stays were repeated, with similar experiences. I did feel a need to intervene when I discovered that the nursing facility was allowing outside lab personnel to come in at 3 a.m. to perform lab draws. This was extremely disorienting and frightening for my mother, and I had to insist that her labs be drawn after she’d awakened for the day.

While there was a grumbling acceptance by the long term care facility management, I felt it was a necessary step for my mother’s well-being. Furthermore, I’m sure the night staff and the local police where happier as their nights were not interrupted by unnecessary disruptions and phone calls. During this time my mother decided that in addition to being her designated power of attorney for her health care, that I should also be designated her financial power of attorney as well. This was a fortunate choice. For the first 4+ years, my mother had been successfully managing her own funds. While I had joint access to her account, I had no authority over her spending, but not long after my change in status, I found she was writing checks she couldn’t cover, and which she didn’t remember.

Failing Short-term Memory

At this point in time her failing memory was becoming increasingly apparent. With her inability to safely manage her accounts, I stepped-in and removed checkbooks and debit cards from her possession (with her cooperation), and also directed that the bank was not to advance funds to her without my approval. Her having granted me legal authority over her finances was a critical piece in my ability to protect her from herself. Without those documents in place, I could not have limited her access to her accounts. Once again, enraged phone calls, but now accusing me of having taken her account without her consent, and obviously not caring about or loving her. These were terrifically hard calls to receive.

I won’t claim that over the years we haven’t had our “issues,” but there had never been any question about care or love. What was particularly frustrating from my perspective was that my training and experience as a nurse seemed to vaporize in those moments. It didn’t matter that I was in my 60′s and she in her 90′s; once again I was her little boy, and I was deeply challenged to respond and act as an intelligent, trained, health professional. This situation lasted for close to a year. I not only had numerous painful conversations with my mother, I also had encounters with the local police (she called them claiming I’d abandoned her and stolen her money), emergency responders (calls triggered by her anxiety, leading to hyperventilation syndrome and related symptoms), and both calls and visits to the local emergency room.

Current Situation & Long Term Care for Mom

Currently, we have a caregiver who follows checks-in with my mother several times per day, making sure she takes her medications appropriately, attends meals and facility activities, and most importantly, that she’s safely in her room at the end of the day. My mother’s short term memory is non-existent. It’s not uncommon for her to forget in mid-sentence that she initiated a phone call, and instead thank me for contacting her. When she leaves her room for a meal, upon her return to her room she’ll call me to let me know she’s “moved back in” to her old place. Sadly, her long term memory is beginning to show signs of significant deterioration as well. She calls me upwards of a dozen times a day, often asking how to contact her parents, and it’s been clear on more than one occasion that she’s confused me with her late brother, or even my late father, both on the phone and in person.

At this point, the saddest aspect of her deterioration is that she is unable to recognize her grandchildren, and has no recollection that she also has great grandchildren. I’ve supplied our caregiver with an abridged version of her life and family, so that she can reminisce with my mother about experiences she’s had. According to the caregiver, she enjoys hearing these stories, and to either relive, or better, remember.

My wife, sister, and I feel fortunate that my mother is in a safe environment, and one that we could not as safely provide if my mother were to live with us. Our home would be unsafe for her due to bedrooms located up a flight of stairs, access to the stove, and our location in a semi-rural situation where she could easily wander while my wife and I are off to work. In her current living situation her housing and meals are provided, and her caregiver is able to see and assess her situation several times per day, as well as arrange for appointments with her healthcare providers.

NurseBobStay Well

Disclaimer: This information is not intended to diagnose or treat any condition, or to replace the advice of a doctor. NurseBob disclaims any liability for the decisions you make based on this information.

Let Them Eat Dirt?

In the U.S. we are increasingly obsessive when it comes to cleanliness.  Just take a moment to analyze the T.V. ads, if the subject isn’t cars, food, or booze, it seems they’re focused on  killing those damn germs; OMG, they’re everywhere!  Ahhhg!!!  I swear, many of the ads remind me of my college roommate’s mantra:  When in danger, when in doubt, run in circles, scream and shout.
I know the marketeers are shouting to push danger and doubt regarding those ever-present microbes to increase sales, but I believe the true danger lurking in the shadows resides in not allowing our immune systems, and more importantly, our childrens’ immune systems to develop as nature intended – learning which microbes are benign, which are our allies, and fighting the good fight against pathogens.
Not all germs are BAD; in fact, many are beneficial and most are neutral. We each have more microbes in our gut than there are stars in the Milky Way. Increasingly, current research points to a possible link between the health of our internal microbiome and our physical and mental health.  There is also a growing body of evidence that the increase in allergic conditions and autoimmune diseases may be connected to our near-obsessive efforts to kill-off all the invisible organisms in and around us.

I know you wouldn’t wish these maladies on yourself, and  most certainly not on your children.  I’m even willing to guess you wouldn’t wish them on your enemies.  So, what to do?  I’m not actually encouraging you or your children to eat dirt; I don’t really believe that  pica, which has a somewhat negative reputation, is the solution.
What we need to accomplish is to let go of our compulsion for attempting to sterilize our environment; it’s neither a healthy nor healthful practice.  Of course, in the kitchen, if you’ve been preparing any meats or eggs, a cleaning of the work surfaces and hands is in order.  For the hands, just a thorough wash with plain soap and water.  By thorough, I mean a vigorous effort for a minimum of 15 seconds and a rinse under running water.  As to the work surfaces, following a wipe-down, use of a spray bottle filled with a dilute solution of bleach is an excellent choice, it’s effective, inexpensive, and doesn’t lead to the creation of superbugs.  And, a weak bleach solution can be used in the bathrooms as well for the final pass.

My point is to use common sense.  While it’s not true that if it looks clean, it’s clean. It is true that the effort used to clean the kitchen, dining areas, and bathrooms doesn’t need to be excessive.  Furthermore, I believe the use of anti-bacterial hand soaps and cleansers is detrimental to both the environment and public health.  These products put sub-therapeutic levels of antibiotics into the environment, and can contribute to the creation of antibiotic resistant bacteria.  So, stay well, stay clean (reasonably so), and enjoy.

NurseBob – Stay Well

Disclaimer: This information is not intended to diagnose or treat any condition, or to replace the advice of a doctor. NurseBob  disclaims any liability for the decisions you make based on this information.

I Quit Drinking for This?

I’ve been sober 90 days now, and I guess I didn’t know what I expected from sobriety, but I really didn’t expect what’s happened.  All the feelings I used to escape: the hurt, the anger, the frustrations of everyday life, everything I’ve tried to avoid most of my life, is in my face!
I know that drinking is not the answer, at least I know it in my head, but my gut keeps telling me: “Have a drink! Get rid of those nasty, painful, feelings.”  It’s not easy.
What to do?  Go to meetings, for one.  But even at a meeting it’s hard to admit to wanting a drink.  That’s a topic that rarely comes up, at least at the meetings I attend.  The topic of drinking, what it’s done in the past, what it could lead to in the future, all fine and dandy.  But admit to wanting a drink?  Apparently risky territory.
What else? Call my sponsor.  Good idea, but if I’m really willing to call my sponsor, I’ve found that I’m not really at the greatest risk for taking that first drink, buying a bottle…

Continue reading

Another new voice – InRecovery



Today I’m introducing yet another author – InRecovery. Actually, there will be several anonymous authors using this nom de plume. Most in recovery want or need to protect their true identity, so these posts will be the only posts on the site that are not directly attributed to the actual authors. Also, where I plan to use only licensed and/or certified authors in any of the other disciplines that I choose to represent on the blog, this one area will depart from that model and instead follow the peer counseling model used by many recovery and self-help organizations.
So, if you are in recovery, on the cusp of entering recovery, know someone in recovery, or want to know more about recovery, as well as the impacts of substance abuse on those involved, their loved ones and relationships in general, tune in.

Stay Well -NurseBob

A New Voice on NurseBob’s Other Blog



I want to welcome Franziska Spritzler as new health blogger on NurseBob’s Other Blog. She is both a Registered Dietician (RD) and a Certified Diabetic Educator (CDE), and she runs her own blog on Nutrition and Diet at Happily, she has generously consented to sharing some of her blog entries here.
Health and Health Care are topics with both a broad scope, and great depth.  No single person can hope to effectively cover all the information, and misinformation, that abounds on the net.  It’s my goal that NurseBob’s Other Blog can become a resource for sound, researched information.  By seeking out other authors who have expertise in their disciplines, this blog can better serve that goal.

Stay Well -NurseBob

It’s HIPAA, not Hippo! – Protecting your private health information in the Electronic Age



Is your personal health information at risk of being shared with the world? Unfortunately, the answer is Yes!
are some interesting parallels between federal acts, icebergs, and hippos, all three keep their bulk and associated dangers submerged and out of sight.  Of course, most of us are familiar with the fate of the Titanic after its encounter with an iceberg, and I don’t think it’s too hard to find scary stories of hippo encounters if you follow stories of African safaris or some of the reality shows.  But, what are the risks associated with the Health Insurance Portability and Accountability Act? (HIPAA)  Wasn’t a primary goal to protect the privacy of your personal health information?  Well, sometimes the best intentioned legislation goes awry, especially when there are competing, and perhaps even contradictory goals contained in the same act.  Anyone remember the reason the HAL 9000 computer murdered most of the crew in Stanely Kubrick’s film of Arthur C. Clarke’s 2001 – A Space OdysseyConflicting directives! Continue reading

Mom’s Acting Crazy! – The Elderly and Urinary Tract Infections



Unexpectedly, your mom, dad, granny, is actingly strangely.  They seemed fine yesterday, but today they’re calling the police to find out why you’re not visiting anymore (you were there yesterday), making plans that make no sense at all (“I think I’ll drive across country to see all the sights I missed as a kid.”), accusing you of stealing from them (of course you’re NOT!), etc.  It’s not commonly known that seemingly minor infections, such as Urinary Tract Infections (UTIs), can cause profound changes in behavior for the elderly.
As our population ages, and as many of us find ourselves caring for our increasingly elderly and frail parents, we are faced with situations which we are neither trained to reconize, nor handle.  So, if you’re in charge of the care for an elderly parent, I have some thoughts on what to look for. Continue reading

Heart Attack! What is it? What causes it? What’s going to happen to me?



What is a Heart Attack? My very short description would be: A reduction, or complete loss of blood flow to some or all of the heart, which causes the heart tissue to begin to die. The longer the loss of flow lasts, the more tissue that dies.
Pretty general, don’t you think? Doesn’t tell you much, such as what caused it, or more importantly, what’s going to happen to you.  The flippant answer to that one is: It Depends…  As always, the devil is in the details.  What does it depend on? Well, what caused the loss of flow? How  complete is the is the loss of flow?  How much of your heart is affected?   How healthy is your heart?  How healthy are you? Continue reading