Incontinence Care: Insight from Maureen McGrath

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In the July/August edition of the Family Caregivers’ Grapevine, we published an article featuring tips and resources for incontinence care. A reader pointed out that VCH’s Continence Promotion and Management Program is no longer in operation.

Not sure of where to redirect readers, we connected with North Shore’s own Maureen McGrath, a nurse continence advisor with Doctors Stephen Kaye and Carolyn Donnelly, for some more information on this important topic. It became apparent quite quickly that McGrath is passionate about getting help for those suffering and that she has a wealth of knowledge to offer. Read on for Maureen’s tips and resources.



McGrath shared that there are only three bladder and bowel clinics care programs in BC covered by MSP, and they are located at St. Paul’s Hospital, Abbotsford General and Richmond General Hospital. The wait is anywhere from 4-9 months for clinics covered by MSP. A patient can receive care in McGrath’s clinic within a week or two.
 
”It has been my experience that although speaking to a family doctor may be a good first step if he/she is trained in diagnosis and treatment of urinary incontinence but referral to a specialist such as a gynecologist or uro-gynecologist may be necessary. Patients may also self-refer to a Nurse Continence Advisor (NCA),” says McGrath. “Urinary incontinence is complex and diagnosis is key to treatment.

There are 5 different types of urinary incontinence:

1. Stress
2. Urge
3. Overflow
4. Functional
5. Mixed

Bladder Health education is integral to success. That said, diagnosis through proper assessment is key and which is within the scope of the NCA. “We do a history, medication review, ascertain contributing factors, provide diagnosis and treatment recommendations.”

Here are a few recommendations for caregivers:

  1. Dilute urine is less irritating to the bladder than concentrated urine. Drink enough water based fluids so your urine is clear 90% of the time.

  1. Treat constipation by increasing fibre, ensuring adequate fluids and taking advantage of the gastrocolic reflex. Constipation is a contributing factor to urinary incontinence.

  1. Moisturizing your vagina is just as important as moisturizing your face. Upwards of 75% of women lose estrogen, the hormone regulator of the urogenital tract and vagina. Personal moisturizers like Gynatrof or low dose localized estrogen treatment is important for vaginal health and may help to reduce the risk of a urinary tract infection (UTI)I (which may lead to leakage of urine). It is very dangerous for women over the age of 65 to get a UTI as it places them at risk for sepsis.

  1. Kegels are important but must be done appropriately by squeezing the rectal muscle (the muscle that prevents you from passing gas) to the count of 3, holding it for 3 and releasing it to the count of 3.

  1. Bladder irritants in moderation. (bubbly drink, spicy foods, tomato, chocolate, citrus, vitamin C, caffeine (limit coffee to1 cup/day) to name a few.

  1. For stress urinary incontinence (leaking with cough, sneeze and/or exercise) or a pelvic organ prolapse that results in urinary retention, leakage or discomfort, a pessary which is a small medical grade silicone device to support your urethra, bladder or uterusis a great conservative option that resolves the issue immediately and gets a woman back to her regular activities!

McGrath thinks the most important piece of information is that THERE IS TREATMENT! “Leaking urine is never normal. One doesn’t have to suffer needlessly.”

Maureen is in private practice in North Vancouver at #103-1221 Lonsdale. To book an appointment email her directly at: nursetalk@hotmail.com 

For more information on Maureen McGrath and her work, visit: http://www.backtothebedroom.ca

or listen to The Sunday Night Sex Show on News Talk 980 CKNWhttp://globalnews.ca/bc/program/sunday-night-sex-show

Thank you so much for your insight, Maureen!

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Mindful Monday no. 56 – Random Acts of Kindness

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I live with my small family in a small apartment in North Vancouver. We are lucky enough to live close to the mountains, to grocery stores stocked with healthy foods, good coffee shops, clean parks, and good public transit. Unfortunately, we do not have a balcony or a yard, which means we don’t have access to space for growing flowers or food. Last summer while walking with my then tiny baby, I noticed a neighbour who lives in a big, beautiful home had left out buckets filled with bundled bouquets. There was a sign next to the buckets that said, “Take a bunch.” I smiled, picked a colourful bunch, and carried it home. It made me so happy that these generous neighbours continued to offer free bouquets this summer. I keep an eye out for the red buckets on their lawn every time I pass by their home, and recently have started collecting bouquets to hand out to other locals on my walks. I love watching the smile that spreads across someone’s face when they’re offered flowers with no expectation for payment and for no reason at all.

Receiving a random act of kindness, like a free bouquet of flowers, can change someone’s day. Choosing to deliver a random act of kindness will change yours.

Have you ever been having a tough or stressful day and then made eye contact with someone as you’ve held the door for them? How did you feel after that small interaction? Maybe you exchanged a smile or they nodded in appreciation. Did you feel differently than before?

Today, I invite you to do one random act of kindness for someone else. How did you feel before? How did you feel after? Write your observations down, or share them with a loved one.

Need some ideas for ways to provide random acts of kindness? Here’s a few:

hold the door open for someone

tell a joke

leave a kind note on a stranger’s windshield

pick some flowers for a neighbour

buy the person in line behind you a coffee

 

What kinds of random acts of kindness have you provided or received? We’d love to hear from you.

 

Cassandra Van Dyck

 

 

Foodie Friday – A Simple Fall Meal

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A friend introduced me to the simplicity and deliciousness of this meal years ago and I return to it every fall when the days start to cool. It is inexpensive, quick, nourishing and won’t create stacks of dishes. It easily makes extra so you can eat it for lunch for a few days after. Read on for the recipe and enjoy!

Autumn Bake

Ingredients

root vegetables such as potatoes, yams, squash (acorn and butternut are great choices), carrots, beets, garlic, and onions

quinoa

olive oil

salt & pepper

Process

Pre-heat oven to 375F. Chop vegetables in big pieces and place in a large casserole dish. Toss with olive oil and salt and pepper. Place in the oven and stir every 15 minutes or so for approximately 45 minutes, or until vegetables are soft and browned.

Make quinoa on stove top.

Combine quinoa and vegetables in a bowl. Eat as is or add avocado or a boiled egg.

 

Cassandra Van Dyck

 

Pain, inevitable; Suffering, optional

The other day I was reading Anais Nin’s diaries and came across this quote:

” The secret of joy lies in the mastery of pain.”

Of course, as the saying goes: “Pain is inevitable, suffering is optional.”

It is not the pain, but the aversion to pain, that causes suffering.

It works out too this simple equation: Pain + aversion=suffering.

In the Buddha’s 4 Noble Truths, individuals are prompted to acknowledge the simple inevitability of suffering.  That said, in the Western world, we have access to treatments for both physical and emotional pain, and we have every right to seek them.  For me, I take an over-the-counter medication called ‘Antistax’ for achy legs.

And oddly, in my experience at least, it is not my own pain and suffering that is so unbearable, but the pain and suffering of the loved ones in my life.  Is this true for you also?

Wishing you well,

Calm Pond

 

 

Things I do to decompress

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Whenever I get home from work or volunteering I take the time to change into comfortable clothing.  In the process, I shed my work/volunteer self and re-enter my home/family self.

Also, sometimes cooking a dish from scratch can help create a pause between the workday and the evening family time.  Why not try the following recipe for Carrot and Garlic Soup (copied from ‘Good Times’ magazine)?  If you feel like it, add a teaspoon of curry powder for Curried Carrot and Garlic Soup, which tastes delicious!

You’ll need:

2 heads garlic, 1 tbsp. olive oil, 1 chopped onion, salt and pepper, 5 cups vegetable stock (but you can use cubes), 3 cups chopped carrots (I used a bag of baby carrots), 1 potato peeled and chopped, 1/4 cup sour cream or yogurt, minced chives if you have them.

Fry onion, garlic, salt and pepper, stirring until onion is softened, about 5 minutes. Add stock, carrots, potato and one cup water, bring to a boil. Cover, reduce heat, and simmer 20 minutes.  Using immersion blender or batches in blender, blend until smooth (I like to leave some chunky bits for that rustic feel.)  Serve, top with chopped chives, and sour cream or yogurt dollop.

(Makes 6 servings)

Bon Appetit!

Calm Pond

3 Ways to Gain Perspective

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Have you ever felt like you’ve thought or talked yourself in to a corner you can’t get out of? When you’re caring for a loved one and you’re struggling, it can be hard to gain perspective.

Part of what makes it hard to gain perspective and think yourself out of your corner is your important role in your loved one’s life. If you are the shoulder your loved one cries on, or the person who helps them out of bed, or the one who drives them to appointments, cooks their meals, and tidies their home, your place in their life may seem irreplaceable. If your loved one is suffering, the emotions you’re experiencing can mound and you might not think that you could feel any other way but sad, angry, or frustrated. When you do not have perspective, you might feel a lack of control over your life or your feelings.

Perspective is important for caregivers. It helps you to take a step back from your caregiving journey and see where you’re thriving, and where you could use some help. Being able to take inventory and make adjustments where necessary is crucial for preventing burnout. It will not only help you, but it will help your loved one.

Whenever I think of the quintessential way to gain perspective, I envision Julia Roberts praying in India in Eat, Pray, Love or Reese Witherspoon’s inadequately prepared hiking journey in Wild. If you’re a caregiver, travelling for months or embarking on a back country hiking trip is not likely not in the cards. The good news is that it doesn’t have to be. There are lots of ways to gain perspective in a short period of time without spending money or sacrificing your feet to blisters.

GET SOME SLEEP | The first and possibly the most important tip for anyone who needs or wants to get perspective is to get some rest. Fatigue clouds our judgement and intensifies emotions. There is a reason that you likely feel the most overwhelmed in the evening – your body is sending you signals to lie down and sleep! If you are overwhelmed, ask yourself how you’ve been sleeping lately. Take steps to assure you’re getting the rest you need, and leave any big decisions for after you wake up. If you’re having trouble sleeping, read our tips for practising sleep hygiene. 

TAKE A MINI VACATION | No need to book a plane ticket or hop on a train! Just set aside a few hours to do something that makes you feel relaxed. Look in to short-term respite for your loved one if having care for them is an issue.

TAKE INVENTORY | There are many ways to do this. You might feel comfortable debriefing with a friend or professional, thinking while you’re on a walk, or writing it down in a journal. Whatever way works best for you, make sure to ask yourself the following questions:

What is going well? What is not going well? How is my health – both physical and mental? What am I scared of? Who are my supports? Am I getting the support that I need?

Asking yourself these questions can help you to get perspective on your situation. When you become aware of where you need support, it’s time to take action. This could mean connecting with a local network group to meet with other caregivers so you have some more support, or meeting with a counselor or therapist. It could mean scheduling time to exercise or cook healthy meals. Maybe you’re noticing that you can’t do it all and that it’s time to look to other services to help with driving your loved one to appointments or to assist with personal care.

If you are struggling to gain perspective, remember to reach out for support. Your caregiving journey may take many twists and turns and can feel overwhelming at times. Getting support can help give you the support you need to care for your loved one and for yourself as well.

How do you gain perspective? We’d love to hear from you in our comments!

 

Cassandra Van Dyck

 

 

 

 

Mindful Monday no. 55 – The Decompression Routine

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As a caregiver, you likely play many roles in your day. You might be providing personal care or assisting your loved one with their errands. You might be caring for your own children in addition to caring for a parent or a spouse. There’s a good possibility that you fill all these roles and more throughout the day.

Have you ever thought about how you transition from one role to the next? What about when you finally find yourself alone at the end of the day… how do you transition from caring for others to caring for yourself?

Your roles may seem to blend together seamlessly. Blurred lines might help you cope with all you have to do, but creating boundaries and a decompression routine can help you to be present and to “turn off” your brain at the end of the day.

I was first introduced to the idea of a decompression routine by a dear friend who worked as a massage therapist. This friend told me that after her clients left, she would carefully and mindfully wash each hand and arm. The routine brought her closure to the session and helped her leave whatever came up in the appointment behind her. This helped her to be present with the following client, or to move on from her work day to her personal time. Another friend would turn off her work cell phone in her drive way and spend a few minutes in her car reflecting on her day before closing the door and entering her home. This conscious choice allowed her to be present with her partner without letting her work day influence her mood once she was home.

Depending on what your life and days look like, your decompression routine could look a number of ways. You might practice the routine multiple times a day or have different rituals depending on what you’ve been doing or what you’re going to be doing. I encourage you to try out different things and see what works for you. Practice whatever you choose to do for a few days and pay attention to your mood. Does the routine make a difference?

If you’re unsure of where to start, here are a few ideas:

Take a warm bath half an hour before bed. A cleansing ritual can relax you and prepare your body and mind for a restful sleep.

Write in a journal first thing in the morning. Note a few things you’re grateful for and reflect on where you’re at. Writing regularly can help you to be more present because you’re allowing yourself time get perspective.

Take a page out of my friend’s book at wash your hands mindfully. Spending a few extra seconds or minutes to really focus on what you’re doing can calm your mind and give yourself a moment to pause in your day.

Spend one or two minutes before each new activity and do a mindfulness or breathing exercise.

Do you have a decompression routine? We’d love to hear from you in our comments!

 

Cassandra Van Dyck

Foodie Friday – 3 Quick Snack Ideas for Caregivers

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You probably know the feeling well. You’ve eaten breakfast, but it’s not quite time for lunch, or you’ve had your mid-day meal, but there’s still a few hours before dinner time. Maybe you’re busy, and you just can’t quite fit in the time to make a full, but you need to eat something to keep you going. You’re hungry, and you need to eat something quick! But what to eat? Read on for a few healthy, quick snack ideas for caregivers!

Nut Butter on Fruit

There are so many possibilities depending on what you have on hand! Here’s some of my favourites:

peanut butter on sliced banana

almond butter on apple slices with cinnamon

almond butter on figs

pumpkin seed butter on strawberries

Smoothie

We’ve shared some wonderful recommendations here, but I’ve got a secret smoothie hack to share with you today! If you’re like me, you may have made smoothies before and felt hungry 30 minutes after finishing it. If you struggle with this too, add fat! A teaspoon of coconut oil or butter, some nut butter, or half an avocado should do the trick.

Yam Toast

Slice yam thinly and pop it in the toaster! You might have to toast it a few times, depending on what sort of consistency you’d like to achieve. Top with avocado and salt and pepper if you’d like something savoury, or (you guessed it) nut butter, if you’d prefer a sweeter snack.

What snacks do you reach for when you’re hungry? We’d love to hear from you in our comments!

Cassandra Van Dyck

 

‘Lessons from a Caregiver’ Book Review

Every time I read a caregiving or self-care related book I learn something new to add to my caregiver’s toolbox.  It’s a real education,  self-education, self-paced.  ‘Lessons from a Caregiver’ by Laurel A. Wicks (2009), was such a book.

She begins by quoting from Harper Lee’s book ‘To Kill a Mockingbird’:

‘…you never really understand a person until you consider things from his point of view.. until you climb into his skin and walk around in it..’

I’m happy to share with you what I’ve learned, just as I have these past few years since I started contributing to the blog.  I hope it has been helpful for you, as helpful as it has been for me.

Wicks teaches me how to recognize the signs of a stroke:

First, ask the person to smile.

Ask the person to talk.

Give a simple sentence and ask the person to repeat it.

Ask the person to raise both arms.  If they have any trouble doing these things, call 911.

Still another test is to ask him to stick out his tongue.  If the tongue goes to one side and then the other but not straight out, it is another sign of a stroke.

I also learned about two tests for diagnosing Alzheimer’s.  One is the MMSE (Mini Mental State Exam)  or the more comprehensive MoCA test: (Montreal Cognitive Assessment).  When  I tried to download these tests I found I couldn’t but I did find one short 5-minute assessment test for the non-health professional.  If you’re interested I’ll give you the URL, just leave a comment.

Finally, Wicks recommends two books  by Buddhist author Pema Chodron (excuse me for not putting the dots over the ‘o’s’, I don’t know how to do that.)

These books are:

‘Awakening Love and Kindness (Boston: Shambala Press, 1996)

“Comfortable with Uncertainty : 108 Teachings on Cultivating Fearlessness and Compassion’ (Boston: Shambala Press, 2003)

I hope my brief review has proved helpful. I plan to do more reviews in the next while. Just to give you a heads up, one of my reviews is about the timely topic of resilience, and the other is on loneliness.  If you have any books you’d like to suggest I read and review, just leave a comment. They have to be available at the library, however.

From, blogger and bookworm

Calm Pond