Blog - Coleen P. Kenny

Speaker Training, post-lunch fatigue…Noel Gardner,MD, MDiv. from the University of Utah takes the stage. Thinning blonde hair, lanky, plain clothes; he’s left his daughter’s thirteenth birthday and his son’s championship b-ball game to speak to the speakers about Depression.

I wonder about his priorities, until he speaks with quiet passion about the disease.

Yes, Depression is a disease, a physical disease. As real as heart disease or lung disease; just as disabling but more disheartening in it’s lack of physical appearance to the outside world.

Dr. Gardner tells a half-hazy audience of a mentor who could evaluate a heart murmur with his ear instead of a stethoscope to a patient’s chest. He says as health care providers we should “learn to put our ears against the chests of our patients and listen to their hearts, to their heart stories, to the broken heart places inside.” Thinking about the 80 and 90 year old hearts I love and treat for pain and depression on a daily basis almost brought me to tears…

He points out that each patient with depression has a story that encompasses their past/present/medical/social/relational/spiritual/etc aspects. And each health care provider has a story–the chapters we bring to the patient through book learning and life experience. And even the molecules we prescribe have a backstory. Those of you who know my Storyteller side know this grabbed my attention …

He then describes the isolation of depression, quoting that we experience our joys with others but our misery tends to be solo. He explains the ripple effect of depression on every aspect of life–our appetite, activity, mood, sleep, sex drive, and our connection to God and others. And the impact is not just in the present but can run between generations.

But Dr Gardner believes, and I do also, that depression treated into remission creates its own ripple…and that if we can get folks to remission, we can impact everything in and around their lives.

There is hope. There is treatment. And it’s not all in the shape of a pill. I’m not talking about specific medications here, though they have their place, but if any of you may be suffering or know someone who is, read this blog carefully and contact your doc or Nurse Practitioner, or minister or a Social Worker… Because as Dr Gardner, the post-lunch-wake-em-all-up speaker concludes, after depression comes “a depth, a certain wisdom and power, a real compassion.”

And from newfound strength we can launch ripples of hope in all we say and do…

For more information about the symptoms of depression, check this link: http://www.webmd.com/depression/guide/detecting-depression

The FDA (Food and Drug Administration) issued a warning this past week about Maalox Total Relief… apparently people were buying it thinking it was their everyday Maalox, Turns out Maalox Total Relief contains bismuth subsalicylate (think Pepto-Bismol).

So what’s the big deal??

Well, people buying the product don’t realize it’s not their ordinary Maalox. They’re reaching for simple antacid relief but they are also getting a diarrhea med that can interact with drugs like Aspirin and increase the risk of bleeding in the stomach or intestine.

This ties closely into a Facebook friend’s post about insomnia. One of her friends suggested Benadryl.

So what’s the big deal??

Benadryl (the brand name for diphenhydramine and the “PM” in so many pain and cold medications) is an excellent medication if you have hives or a bad case of poison ivy or other type of allergic reaction. But the way it works to stop an allergy attack can also cause several side effects: dry mouth, low blood pressure, dizziness, constipation, urinary retention, and a hangover effect, to name a few.

These are bad enough if you’re young and healthy. Give them to an elderly person and you may see falls. You may see behavior issues from constipation or bladder infections. You may see what looks like depression or even dementia due to the hangover effect.

So when you’re picking something out to treat your indigestion or headache or cold symptoms, especially if you take other medications, consider running your choice by the store’s pharmacist or give the nurse in your doctor’s office or at your health insurance company a call—that’s what they’re there for!! And remember, just because you can get it without a prescription, doesn’t make it safe!

PS… What makes me an expert?? Thirteen years prescribing medications to ill and frail patients, not to mention the trouble I have, even as a Nurse Practitioner, in choosing my own cold medicine…. Be safe out there, and don’t forget to ask your doc or pharmacist, or of course, your Nurse Practitioner!!

My National Speaker’s Association meeting has fallen on Valentine’s weekend, leaving me time to reflect on the love-hate relationship of my life…

I’m talking about my on-again, off-again fling with Technology.

You see, Technology is like the BMOC (big man on campus), and I am the shy chick in the hiking club.

And Technology looks pretty good to me, especially with Valentine’s and Sadie Hawkin’s in the air, so I flirt.

I smile big on Facebook. I wiggle my brows on LinkedIn. I giggle on Twitter.

And Technology responds. Contacts increase. Events start moving.

But I get tired or bored or plain overwhelmed trying to keep up with T. I cut and paste my heart out and Technology whispers in my ear asking for more: “Wouldn’t a little Ping be fun tonight, Pumpkin?” or “How’s about you ‘n me Skype after supper tonight?”

I know that for any relationship to succeed I need to work my half of the deal, and I do try. I attend conferences to learn the latest and greatest and must haves and must do’s. Alas, Technology and I do not always see eye-to-eye… I don’t have the time to do and learn it all…

So I ask myself, What parts of this relationship am I willing to work on? What can I leave behind? and How can I make the most of the time I have to spend with Technology?

At day’s end, we stand in the doorway. I kiss Technology good night and step away.

“But can’t we blog just a little, Babe?”

Maybe tomorrow, Sweetie…

This week’s question has two parts:

Q1: My dad finally got out of trauma ICU after 13 days. He is slowly improving but can’t feed himself, eat, sit up or really anything by himself. Mom said he was talking about being released to a rehab hospital tomorrow–that sounds absurd! What can you tell me?

A: Once your dad is medically stable, the acute care hospital will move him out of as quickly as possible.

He will need strong rehab to get used to simply being upright again; are they getting him out of bed sitting in a chair? Even so, standing will make the blood pressure drop and make the person feel lousy until they readjust. Is the staff moving his limbs for him so they don’t tighten up? Is he in pain?

Will your mom get to look at places before they transfer him? If he’s going to a Sheltering Arms type hospital, that’s encouraging because it means they think he can tolerate therapy.

Q2: Pain-yes. And he is not sitting in a chair or his bed, nor is he standing. They are moving his limbs. The hospital hasn’t spoken with my mom about what rehab hospital to send him to…they are talking to dad, which for many reasons, is not a good idea. Mom is calling the hospital to get some answers- I told her to keep talking to people until she gets some answers.
Thanks Coleen, i really appreciate it

A2:
1. The staff must manage his pain or he’s not going to move

2. They need to start sitting him on the side of the bed to let his legs dangle… our bodies “forget” how to respond to gravity and the blood rushes to our legs instead of our brains and we fall over. It’s tougher on older folks because the sensors in the blood vessels are less sensitive and react more slowly. So they feel worse and are more likely to fall, but the only “cure” is advancing time upright.

3. Your mom and dad can ask the staff to put a note on the chart to make sure she’s present when they discuss the plan of care… (whether at the hospital or rehab hospital); providers sometimes move too fast and talk to the patient who may be with it enough to talk in the here and now, but not remember it later or make good decisions without help. And that’s not just older folks, that’s any of us.

4. Kudos to you and your mom for advocating and caring for him… I know this isn’t easy… available anytime if you need me!!

—Coleen

My soapbox led me to post on Facebook, “If you could ask a geriatric expert a healthcare question about your aging parent or grandparent, what would it be?”

This is the first question and answer in what I hope becomes a blog series useful to all those struggling…

Q: How do you get patients motivated to get up and move around without getting them upset?

My mom is having this problem with my grandma. When my mom tries to get her out of bed, my grandma gets upset with my mom and then it’s hurt feelings all around.

My grandma is 87 and used to doing everything herself so i am certain she has got to be struggling with having to depend on someone to take care of her. Her broken arm is healing well, but I’m sure she is stiff and achey just from being 87!

The staff at the rehab hospital don’t have any ideas, and they are going to discharge her in the next week or two, so this information is going to help my mom when she brings grandma home… and me when my parents need care!

Some ideas to make it less stressful for everyone would be great!

A: My answer is threefold for this complex and not unusual situation.

1. Is her pain managed?

You hit the nail on the head when you mentioned “stiff and achey just from being 87.” Her arm may be healing well, but generalized pain is often overlooked. The frail elder may be comfortable lying still in the bed, but try to move those stiff old muscles and bones, and it hurts. In the hospital, nursing home, or at home, we need to assess pain during movement and not just at rest!! Then one key is timing the pain medication 45-60 minutes before therapy or getting up for the day.
Pain management in the frail elderly is a complex topic, and I will discuss it in a future blog.

2.Depression must be treated!

Anyone in a hospital or rehab loses both function and control; add pain into the mix, and your grandma has every right to, and every likelihood of, a clinical depression.

This depression is not something you or your mom or the staff can pep talk her out of or hug away or tell her to get over, or as one of my patient’s sons did today tell her, “There are people a lot worse off than you.” (I almost kicked him in the shin!)

There are new excellent anti-depressants with fewer side effects than ever before available; I have three medications of choice with my LOLs (little old ladies) depending on other factors such as appetite and pain. Again, in the interest of blogging brevity, depression in the frail elderly is another day’s topic, but please note I do not use fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft) in my frail elder patients.

3 Medical issues must be considered.

Is she uncomfortable due to constipation? Does she have a bladder infection? Is she dizzy when she gets up? Dizziness can be due to several issues but blood pressure should be checked lying, sitting, and standing (if standing is tolerated) and reported to the doc or Nurse Practitioner.

And finally, and yes, fourth-fold, sometimes the family member has to stop pushing. A dignity/control issue may develop with a “Who is the parent?” scenario. I acknowledge this becomes more difficult if your mom will be taking her home.

My thoughts and prayers are with my friend who sent this question, and with each of you reading this blog. Please pass it along if you find it useful, and be sure to comment and send me your questions!

—Coleen

How many of your Facebook “Friends” have you met?

How many of them are you reconnecting with after twenty years apart?

How many did you think you’d never in this lifetime connect with…since you never connected in high school or college or at work?

Yesterday I met some new folks face-to-face I’d only chatted with via FB IM. The chats led to my first Indy car race (I picked the winner),  learning to play dominoes (115 points my first game), great food, and warm hugs before joining the mob wars to exit the parking lot.

Posting comments about my work as a Nurse Practitioner and Speaker has led to people asking about their elderly mom’s or dad’s medications and health conditions, and I’ve been able to provide feedback that has made a difference.

Connecting with Professional Speakers who share FB has led to on-line learning opportunities I wouldn’t have otherwise known about, and will help me connect names and faces at the National Speaker’s Association conference in Phoenix next month.

And I’m headed to Myrtle Beach for July 4 weekend to stay with a high school acquaintance turned friend via Facebook. We had a blast over Memorial Day and the upcoming holiday should be just as fun.

So how many of you are amazed at the growth in your world and real relationships since joining this addicting site? I’d love to hear your stories, because the relationships are what it’s all about!!

I joined Facebook a week ago as the Social Networking part of my speaking business marketing plan.

And I found a million memories among all the faces.

People I babysat for when I was fifteen and they were five. People I met in first grade and hardly knew in high school. The Captain of the Safety Patrol in fourth grade at Grafton Elementary…ahhh, the power behind our day-glo orange sashes and silver badges to say, “Hey Mister First Grader, where’s the fire?”

And today, while walking in the park on an unusual 70 degree February day, I remembered Billy Lugnut and the Hubcaps…my then future brother-in-law’s high school band. Thoughts of Stafford High’s original Spicoli led to visions of checkered Vans, thin ties and leather pants from Chess King, a sunshine yellow VW beetle (how many cans of Krylon???) with electric blue lightning bolts painted on the sides and Van Halen blaring from the stereo.

And my sweetest memory of Billy Swaggerty…the Thanksgiving he was still my brother even though we’d dropped the “in-law.” Our old friend Billy woulda been 41 this Feb 14 and he is still missed.

So as our Facebook “families” grow, I hope the good and happy memories continue, that new relationships are forged, and forgotten ties are reconnected for all of us. Because it’s about so much more than just business.

Have a blessed day–
Coleen

Mom called last night to say she has to have shoulder surgery this coming Thursday. Could I be there?

“Of course. No problem, Mom. I love you.”

So I emailed the two docs I work with and the office staff to say I’d need two days off from work. Then I emailed the Education Coordinator and asked her to reschedule the Interns who were slated to spend three hours with me. Then I emailed my Nurse Practitioner student and told her I’d try to find someone else to take her that day so she wouldn’t lose 9 of the 145 clinical hours she needs this semester. Then I emailed the Director of the VCU Adult Day Center and told her I’d need to reschedule the storytelling I’d promised.  And I’ll need to let the nurses at Beth Sholom Nursing Home know I won’t be available to see patients those two days. I haven’t decided yet whether to reschedule the next day’s  dementia talk in Newport News.

“No problem, Mom. I love you.”

And truly, I do love her, and so far, in terms of long-distance caregiving, I have it easy. Mom lives independently. She still  works and drives and does her own laundry and grocery shopping. She takes care of her house and bills and she eats well. And she attended the Orthopedic appointment alone.

And, Mom only lives an hour north of my home. 

But the occasional episodes when I become Caregiver give me pause to think about those of you doing it from farther away and with much more fragile aging parents or family members. As a Nurse Practitioner specializing in long term care, I’ve spoken to many of you on the phone and when you’ve driven or flown hours to check on your moms and dads and friends.  

And I just want to say I’m in it with you and for you—contact me if I can give you an answer, a prayer, or just a little encouragement.

Coleen

…a speaker/writer/storyteller started a blog. In November. This is January. Where did the time go, and what the heck happened to the s/w/s?

Time. Laziness. Excuses.

But today I’m back to blog. And I commit to touching base weekly. To telling you where I’ve been and what’s on tap. While hopefully providing some useful insight or information.

So, where have I been?

In November, I flew to Scottsdale, AZ for a National Speakers Association conference and turned in my professional membership application. I met so many wonderful and encouraging folks that I didn’t want to come home. I felt I’d “found my people,” and I look to forward to seeing several of them again at the Orlando conference in February.

In December I spoke one day to the Nurse Practitioner council at VCU Hospital about safe prescribing for the frail elderly, and the next day drove to a nursing home in Galax, Virginia (the southwestern tail of the state) to repeat the presentation.

The following Saturday found me in Lynchburg, Va. for a Virginia Storytellers Association board meeting (great group), and five days later I was in Chesapeake for a speaker’s association meeting and spent the night with friends I met at a B&B just this July.

Christmas and New Years: saw my mother and caught up with my cat. Poor Tilly is feeling neglected and has learned to sit by my purple suitcase  and pout. She even hissed at the cat sitter on my last trip…

…which was to Miami for four days just last week. Virginia was experiencing a record cold snap while I got a sunburn sitting on the dock of Biscayne Bay. Funny, but I didn’t get a lot of sympathy when I returned to work.

And oh, Miami? It was a speaker’s bureau training full of like-minded geriatric Nurse Practitioners who share my passion for caring for little old ladies and men. I just want to teach the world how to take care of aging parents, patients and friends. 

Just to make sure I wouldn’t be bored, I am also teaching at the VCU School of Nursing this semester; adjunct clinical faculty with my own group of Nurse Practitioner students. I read their clinical logs, grade their notes and papers, and I’ll be visiting each at their precepted clinical practice site. One Wednesday night a month, we meet to go over a simulated patient condition which they present to the rest of the class. I felt like a proud mom when my students were up front.

I am also precepting a student who is graduating in May and eager to learn, so I think  she’s a great match for the site. As I told her, long term care is never dull and always a great challenge. Not to mention the heart strings my patients pull on a daily basis.

I hope all is well in your world—keep me posted—

Coleen

November 12, 2008

First day on my first website, trying my first blog,

Exciting as a first kiss, sans kissing any frogs.

Mouth dry, hands shaking,

chest breathless, knees quaking,

the whole worldwide web ahead,

Look forward to your feedback

in the days and months ahead.

Okay, so I haven’t written poetry in a while, and I used ahead twice, but I’m new at this. I hope you find the new website useful; it only took three years and five days to get off the ground. Bryan Dunn of www.WebDunnRight.com did a great job in a short amount of time, and I’m very grateful.

I am headed for Scottsdale, Arizona, on Wednesday, Nov 19, for my first National Speaker’s Association meeting. Four days of meeting, networking, and handing out the new business cards. See my speaker’s page on the website to learn how it all got started!

This Saturday night I’m telling a story for the Richmond Christian single’s chapter of Meetup.com, and I’ll be with my Tell Tale Hearts Sunday, November 16 to listen to rehearsal for our next show November 22, which I will sadly miss due to my Arizona trip.  Details about the show are available at www.TellTaleHearts.org

My next speaking engagements are:

 December 3 at Woodmont Nursing Home in Fredericksburg, Va, where I will speak on dementia in long term care.

 December 9 at St. Mary’s Woods Assisted Living Facility in Richmond, Va, where I will be fair game for a resident’s geriatric question and answer session.

 December 16 I will speak to the Advanced Practice Nursing Council at the Medical College of Virginia in Richmond about prescribing for the elderly.  (Advanced Practice Nursing= Master’s- and PhD-prepared nurse practitioners, clinical nurse specialists, faculty)

And I have a few scheduled in January but that planner is home at the moment.

So thank you for reading, and I’ll keep you posted. And you keep me posted too!

Coleen (with one L)