3 Ways to Build Resilience

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“You’re imperfect, and you’re wired for struggle, but you are worthy of love and and belonging.” – Brene Brown

How do you react when times get tough?

Your loved one’s health is declining. You have a growing to-do list and feel that you have no support. Money is tight. You’re having trouble finding respite. You’re having a hard time getting enough sleep. 

There are so many stressful situations and obstacles that come with your caregiving role that are not within your control. Although you can’t always prevent tough situations from occurring, you can decide how to respond to them.

The ability to recover and respond to a challenging situation is called resilience. Some people seem to have it in spades, while others struggle to bounce back from setbacks. Your ability to be resilient is based on lots of things – the way you were raised, your unique disposition, and your current challenges. Some days you might feel very resilient, and others you think you can’t handle one more thing. You might be going through a particularly hard time because of recent changes or challenges. There are a lot variables.

No matter where you’re at, there are things that you can do to boost your resiliency. Read on for 3 suggestions.

CRY | No, really. Remember that resiliency does not mean that you are not effected by the tough things that are happening in your life. You do not need to shut out emotions or pretend that everything is okay when you  feel underneath that it is not. In fact, doing so can make things worse. It is important to be able to express emotions and to be able to reach out for help when you need it. Resiliency is the ability to bounce back; it is not the denial of emotions. Resiliency requires vulnerability. The better you are able to experience and feel tough emotions, the easier you will be able to move on from them and reach out for support.

CONNECT | Who do you call when you need to talk? If they’re not available, who’s your back up? Try creating a plan for yourself to refer to when you feel that you’ve reached the end of your rope. Write a list or create a map of your support network. Add family, friends, professionals, and network groups. Resiliency does not mean going it alone. Having support when you need it will help you to work through hardships so you can move forward.

PRACTICE SELF-CARE | We talk about self-care a lot, and for good reason! You cannot expect to respond to challenging situations with resiliency if you are not taking care of yourself. Make sure you are getting enough sleep, eating well, and exercising. Make time do the things that you love.

Cassandra Van Dyck

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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!

What I Wish I Knew Back Then: George

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Our blog writing team gets together each season to discuss what’s working, what’s not, and what we need to post more of. At our most recent gathering, we talked about breathing some life in to the What I Wish I Knew Back Then series. 

In our May/June Family Caregivers’ Grapevine, George shared some insight in to his journey caring for his father before he passed away. George was quoted in Navigating New Terrain: The Male Caregivers’ Journey, but we thought it would be pertinent to publish some more of his thoughts and tips, since they may help some of you on your caregiving journeys. 

Thank you so much for sharing your story, George!

Who did you care for?
My father
For how long?
2 years
What kinds of things did you do to help?
Daily check-ins to see how he was doing as he had a progressive disease of dementia. I also took him to doctors appointments, specialist appointments and eye appointments and frequent trips to emergency. Getting his medication and making sure he was taking it was also on the list. I visited him and my mother frequently to ensure everyone was safe and secure. I also had to monitor my Mother who was having a very difficult time with his health physically and emotionally. I took him to the Emergency room several times as his illness progressed and had to help to try and make an informed decision on whether to go ahead with two surgeries.
What impact did caring for your parents have on you emotionally?
It’s emotionally devastating and depressing to see a loved one slowly disintegrate physically and mentally before your eyes. It also alters your relationships with other family members. It was very difficult. The biggest challenge was not having a plan and not having the training to develop a plan. Once we understood what we were dealing with it was much better. Complicating the progressive nature of my fathers dementia was that he developed a potentially fatal aortic aneurysm and if not treated he could die at any moment when the aneurysm burst. We were lucky in that I had taken Dad to emergency and while we were there he asked why his chest was bumping up and down. The Dr did a cat scan and found the aneurysm. Luckily, the ER doctor had a mentor who was just starting an experimental procedure that may provide a relief for the aneurysm. We signed up for this and so now we were working on two life altering problems. There was a good possibility that the pins from the stent might cause the aneurysm to break while they were doing the surgery so this was very stressful. When Dad had his operation with this new experimental procedure unfortunately he had a heart attack but they were able to bring him back. Once that was under control we went back to the dementia problems. As dementia progresses the thought processes get more dysfunctional. In my father’s case he was not connecting with reality any more. I remember getting a call from my Mom at 3 am saying she couldn’t cope any more as my father was trying to climb out his bedroom window. When I got there, he refused to go to the hospital. People with dementia can be very suspicious and I had to talk him into going in to get his back looked at as he said it was hurting. On the way to the ER he was hallucinating and seeing people on the road in front of the car and he grabbed the wheel a few times to avoid hitting these imaginary people. So seeing your father who was totally in control all his life acting in this odd fashion was extremely stressful and I was in survivor mode as I didn’t know what was coming up and he was going to do minute to minute. The 30 minute drive to the hospital ER was the longest drive of my life. Dementia is a challenging disease as the patient will frequently stay up all night and sleep during the day. Also, they may decide to go for a long walk at 3 am thinking they are in some other part of the word.  With a disease like progressive dementia, there is another challenge. Basically when your parent gets a progressive dementia, the parent you knew and loved is gone. It is replaced by a new person who looks just like your old parent but comes with a brand new set of perspective, values and memories. So on top of caregiving you must go through a grieving process just like they had died already while at the same time providing the care that everyone needs.

Another impact was when we left after a visit at the care home, he would always ask “Can I come home today?” It was heartbreaking on a daily basis. I also had to aggregate information in order to make some extremely difficult decisions on whether he should have surgeries or not at his advanced age. These were both terrible decisions to make as in both cases the alternative to not having surgery could be fatal or the surgery itself
could be fatal. What a horrible decision to have to make.
What kinds of support did you have in your caregiving journey?
Support was very limited really. The doctor shortage doesn’t help anybody. Being confronted with a disease without training is kind of like the ridiculousness of having a
baby without any training. Babies don’t come with a manual. Why not? The biggest challenge which drains you emotionally is first not knowing what to do and then wondering if you’re doing the right thing. Not knowing where to go for help is a problem. Also, when there is a problem at 2 am where can you get the help you need? The challenge of caring for someone with severe health challenges also means it’s a 24×7 responsibility and something can go wrong at any time. And if someone is prone to running away there are other challenges. Without the internet, our family would have been totally lost as there are so many factions that require examination and execution.
Complex care is challenging as you don’t know what to do and you often have to help treat the patient as well as the loved ones around him. In my case this meant not only helping my father but providing emotional support with my mother and sister. Often times, other family members have completely diametrically opposed ideas on what the care should be and this makes a bad situation even worse. In addition some family members tend to downplay how sick. Once diagnosed, there can be a problem with wait times to get into a care home and then there is the financial hit that the family takes of 80% of their income going to the government. Also the amount of paperwork involved with all of this is overwhelming. Once he was admitted to a hospital he tried to escape several times so had to have a security guard on the floor to keep him in. He was in a room with 3 other men with dementia. When we went back 6 months later at least one of the men was still in the room. The fear of the unknown is huge for these situations. At hospital a social worker gets involved and then you’re told that there is a lottery for where the person ends up. In our case, my father may have been placed in a home over 30 miles away which would have made it impossible for my Mom to visit regularly. All of a sudden a very normal life is turned upside down for both my Mother and Father.
What helped most?
What helped most was getting educated in order to build an effective care plan which was overwhelming at first. When a loved one is struck with a disease it is extremely challenging to know what to do as the disease is complex and needs care and attention from many sectors. In my case, I had to navigate the physical disease as well as the mental disease and I was trained in neither. There is also the emotion of knowing that your father is alive but is gone so another patient added to the list is yourself. Grieving his death while he is still alive is a very strange experience. In order to get help you have to navigate the health care system which is extremely difficult when it comes to intangible problems like mental health. Extensive research online provided us with several practical educational aids to get educated. In the beginning you don’t even know what questions to ask. Then, drilling deeper I found practical guides on how to deal with dementia patients and specifically how to answer many of the hard questions that they will ask you. This was a great help. But often the patient just won’t cooperate and it really rips at your soul. The mental health system is even more complex to navigate. I can understand how difficult this is for practitioners as the patient appears normal but isn’t.
What hurt?
Nobody including yourself understanding the scope of the illness and how to care for it
effectively and practically. The lack of mental health resources was also a problem. The other challenge is family members blaming you for the wrong care, lack of care or other reasons. Often the other family members are suffering and just need to focus the blame on someone and the person leading the care is often the target of this.
What kind of positive things did you get from caregiving?
Knowing that you were taking care of someone in their darkest hours and that they had taken care of you all your life. It was nice to be able to give back even though the sorrow was often overwhelming. Once I realized that I had to grieve that my father had gone even though he was still alive, things got better. It was like there was a new chapter of the book and I could work on that in a positive way.
What were some of the challenges?
The scope of illness was huge and not knowing where to go for help and once knowing where to go how you could manipulate the system to get what you needed out of it.
Things like wait times were challenging. Psychiatric drugs are also incredibly challenging to the non-healthcare person. Many drugs are used and it is not known at the time if they will make the patient better or worse. Adding to this is that many of the drugs take 3 to 6 weeks to become effective. Side effects can be very dangerous to both the patient and the caregiver.
What sorts of things did you do for yourself to help cope? 
I kept researching looking for the tools and the answers so that I had an idea of what it was I was trying to manage.
Is there anything you needed that could have helped that you didn’t get?
It seems to me that a package of education would be very effective. In my case, there was the emergency, the hospital stay, the ongoing treatment, the acquisition of the care home and then having to help my Mom emotionally and financially. This involved lots of people, lots of forms and lots of worry on how to pay for it all.
As a male, do you feel that you faced any particular challenges or obstacles?
As a male providing care to another male I don’t believe I encountered any major obstacles. That being said, I think that anybody who is a Mom has years of valuable training and experience that many men don’t have as they lack that experience of caring for someone. However, if I rewrote this paper about the care we gave a female member of the family then it would be entirely different as often the health issues can involve personal, physical and hygiene issues that a male would not be able to effectively deliver.
Do you have any advice for men starting out on their caregiving journey?
My only advice would be to try and gather all the practical information about the care of the specific disease as you can and build an effective plan. Getting the right documents from an experienced source is gold. However, one of the problems is that you don’t know what questions to ask if you’re starting from scratch.
I think that finding a caring social worker or care worker will save everyone a lot of headache and heartache.
Anything else you’d like to add? 
I think a good package (education) would be very helpful:
1. A description of the disease
2. Symptoms
a. Memory
b. Thinking and Reasoning
c. Making Judgments and Decisions
d. Planning and Performing Familiar Tasks
e. Changes in Personality and Behaviour
3. Causes
4. Diagnosis
5. Treatment
a. Drugs and Expectations
b. Complications of Drugs
6. Creating a Safe and Supportive Environment
7. Complications
The above covers the patient, but what about the family members impacted by the disease. This can also be very complicated and gut wrenching. A practical guide tailored to the disease would be very useful which might include things like the hourly routines and log books of medicines administered, etc. Also, emergency numbers that can help 24 hours a day. How to get in touch with a social worker for guidance and to find out what assistance might be available would be very valuable as the healthcare world is huge and unknown to someone like myself. Also a practical package of what to do when something happens in the day of the patient or how to conduct a conversation with the patient so you don’t cause extreme stress to him ie. Don’t ask them what day or time it is or what they did today, instead talk about the weather as it is now. I think having access to a flight plan is the most important thing that can be offered in a case like this.
Any other comments? 
This comment is related to when I helped my Mom. If the disease is terminal and the patient wants to stay at home, explore the Hospice options that can provide excellent care at home (my Mom used this – she suffered congestive heart failure) and the nurse and doctor resources were wonderful.

 

Everybody needs somebody

For anyone, including older adults, that sense of connection is crucial. According to the magazine ‘Mind over Matter’ (put out by the Women’s Brain Health Initiative) “loneliness increases the risk of dementia in older adults by as much as 64%”

That said, human beings also require solitude or what is often called: ‘me time’ or ‘alone time’.  The point is to have a balance : some ‘in’ time, some ‘out’ time–and not all one or the other.

You will find that as a caregiver (see ‘Caregiver’s Guide for Canadians’ by Rick Lauber, published by Self-Counsel Press) you must forego some of your social obligations, in favor of precious time alone. Obviously though, not to the point of isolating yourself.

Here are two quotes I’ve gleaned on the subject of loneliness and that need for connection:

“We need other human beings in order to be human” Desmond Tutu

“Oak trees just grow stronger, Rivers grow wilder every day, Old people just grow lonesome, Waiting for someone to say: ‘Hello in there, hello.'”

John Prine in : ‘Lessons from a Caregiver’ by Laurel A. Wicks (book review forthcoming).

Who was it that said: ‘Only connect.’? The name escapes me, if you know it, post a comment.

Here’s a toast to your health and well-being!

Calm Pond

3 More Tips for A Good Night’s Sleep

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We’ve written about sleep a few times before on the blog – and for good reason! So many people struggle to get a good night’s sleep and the lack of rest can wreak havoc on our ability to thrive. We’ve done some searching and have found more tips to help you get the zzz’s you need. Read our past posts here, here and here.

Eat a banana. “sometimes—especially mid-sleep wakeups—the simplicity of eating half of a banana will fill my belly and relax me right back into a peaceful and calm sleep due to their generous amounts of magnesium, potassium, and tryptophan content.  This is a relaxing blend with tryptophan converting into serotonin and melatonin (the brain’s key calming hormones).” – Free & Native

Legs Up The Wall. “This is an excellent pose for grounding at the end of a long summer day. It is a simple yet deeply restorative posture. Often times, if we’re not getting adequate sleep going to bed can increase anxiety because we’re so worried about not sleeping. Taking five or ten minutes to put your legs up the wall can make a huge difference. Learn more about this healing pose and all of its incredible benefits (from promoting sleep to increasing beauty).” – Ashley Neese

Worry intentionally during a specific “anxious hour. “Many caregivers have difficulty falling or staying asleep because they have a head full of worries about their loved one’s care. Rather than worrying at night when it’s time for sleep, you can purposely worry at more convenient times during the day. Set an hour during the early evening to write down a to-do list as well as all the concerns that are troubling you. Then put the writing away in a drawer until the next morning. This simple action may have the effect of depositing your anxieties for the night, helping you relax and fall asleep.” – Barry J. Jacobs

Getting Through Crisis Situations

When you face a crisis situation, you are really too upset to do proper CBT (Cognitive Behavioral Therapy).   Instead, what you need to do is ground yourself first:

Notice 5 things you can see, 5 things you can hear, 5 things you can touch or feel against your skin.

Next, take a few slow, deep breaths.

You can say a coping statement, some phrase that helps you get through tough situations.  Write your coping statement on a 3 X 5 card and keep it with you.  Some examples of coping statements are:

‘This is upsetting, but I can stand what I don’t like.’

‘I can’t change what happened, so I’m not going to let it get to me.’

Or try: ‘I know this is hard, but this too shall pass.’

Finally, say to yourself: The crisis I have to deal with is (fill in the blank). The feelings I’m having are A, B, C. The thoughts I’m having are D, E, F. And the actions I can take to deal with the crisis are G, H, I.

(Adapted from: ‘The Happiness Trap’, by Russ  Harris, 2008.)

As the French say: ‘bon courage!’ (Roughly translated as: ‘May you be courageous’)

Calm Pond

PS You can also try something simple to distract yourself such as reciting the alphabet or some familiar children’s nursery rhyme.

 

Depression and Seniors: Signs to Look Out For and How to Get Help

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Depression is not a normal part of aging, yet it effects a great deal of seniors. Although statistics report a large number of people suffering, most do not seek treatment. There are many reasons for this. Depression may present differently in the elderly than in younger adults and can also be overlooked because of the prevalence of other health concerns, sleep problems, lifestyle, or grief.

When is it depression?

You may suspect depression in a loved one if:

they have lost interest in activities they used to enjoy

they express feelings of hopelessness or helplessness

they have a lack of motivation or energy

they have lost weight/interest in eating

These symptoms may also be present with certain health conditions or when a loved one is grieving. While you can’t diagnose the person you’re worried about, you can look for signs, ask them questions about what they’re going through, support them, and get support.

What do you do if you suspect your loved one is depressed?

Realising a loved one may be battling depression can be very hard for caregivers. You may feel frustrated or lost and unsure of how to help. Your care partner may be resistant to seeking help and might not want to talk about what they’re going through. So, what can you do?

Ask questions. 

You may be noticing some symptoms of depression, and you’ll want to ask some questions to get some clarity. These conversations can be tough. Try using phrases like, “When did you start feeling like this?” “What can I do to help?” Use active listening so your loved one knows they’re being heard.

Encourage your loved one to get help. 

It takes a lot of vulnerability to share with someone that you are feeling depressed, so your loved one may be reluctant to talk to a health care professional about what they’re going through. Let them know that you care about them and want to support them to get the help they need to feel better. Offer to make an appointment for them and join them for their first visit if you can. If your loved one knows you are willing to walk with them on your journey, they may feel more comfortable asking for help.

If you suspect your loved one is struggling with depression and they’re unwilling to get support, or if you suspect they may be suicidal, reach out for help. Talk to your doctor, or call The Crisis Centre: 1-800-SUICIDE

Supporting someone with depression can be overwhelming and cause stress for the caregiver. If you are caring for someone who may be depressed, make sure you are getting the support you need as well.

Cassandra Van Dyck

Sources:
https://www.helpguide.org/articles/depression/helping-a-depressed-person.htm
https://www.helpguide.org/articles/depression/depression-in-older-adults-and-the-elderly.htm

 

 

Is Your Loved One Safe To Drive? Ten Warning Signs

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Here are 10 warning signs that might indicate that your loved one is no longer safe to drive. ( taken from: ‘Mind Over Matter’ A Woman’s Brain Health Initiative publication 2016)

  • getting lost in familiar territory
  • driving too slow or fast, or stopping for no reason
  • riding the brake, or confusing the brake and gas pedals
  • other drivers frequently honk their horns
  • damage (i.e  scrapes or dents) on the car or garage
  • difficulty with parking
  • failing to notice/obey traffic signs or signals
  • difficulty with turns, lane changes, or highway exits
  • incorrect signaling
  • near misses or accidents

As a caregiver, I have indeed spent some nervous moments in the car with a parent.  Monitoring the situation using these helpful warning signs helps a lot.

Safe driving everyone!

Calm Pond

Guest Post: Finding Balance Between Work and Caregiving

Mud pies in the back garden. Learning how to knit. Being driven to dance, choir, piano or school. Honing my green thumb. Helping me through university. Passing on the family history.

 These are just a handful of things I was blessed to experience with my grandparents over the years. I was fortunate to grow up with all four of them, and I always say – they raised me as much as my parents did. When I became an adult, I gained newfound respect for them; I began to know them as people.

Six years ago, in a full-time job and married, both grandmothers began facing serious health challenges. One was falling deeper into the complexities of dementia, and one had broken her hip – reducing her ability to get out and about the way she used to.
I wanted desperately to throw everything away and be a full-time granddaughter, but my head knew that work was both a financial necessity and ironically, a back door means of self-care for myself.

My mom, who was also still working full-time, said wisely “Work has a routine and ends but caregiving keeps going”.

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Photo: Both of my grandmas

So how did we find a balance between caregiving and work?

There is no one answer, as each caregiving case has its own unique challenges. My advice is always to wholly explore and exhaust all options.

  • Cast your net wide! Do not be afraid to ask people for help; friends, coworkers, church members, etc.
  • Explore all subsidized supports: Home Support, Better at Home, adult day programs, Handy Dart, caregiver tax benefits, supportive housing, etc.
  • Explain your situation to your employer – communicating your challenges is key. Use your sick days, use your vacation time. If you have an Employee Assistance Program, talk to a professional from time to time.
  • Research financial alternatives to assist with caregiving; loans, lines of credit, etc.
  • Dig deep and practice self-care. Even if all that consists of is taking an extra 5 minutes to breathe before you get out of the car.
  • Remember the love. In 2016 I bid farewell to both grandmothers, aged 94 and 101 respectively. An interesting aspect of my grief is that I am remembering them not as frail and sick, as they were in their final days – but as they were before all of that. It was an absolute privilege to have them by my side for all thirty-seven of my years.

Kari Chambers has worked with Seniors for the past twelve years, at Collingwood Neighbourhood House; Tsleil-Waututh Nation; and currently with the BC Association of Community Response Networks. She is also a member of North Shore Community Resources’ Better at Home/North Shore Caregivers advisory board.

De-Stress In 1 Minute

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Here are your instructions to de-stress in a minute:

  1. Close your door. Turn off your phone. Get comfortable.
  2. Lightly spray your favorite perfume or Eau de Toilette onto your wrists or inside your elbows.
  3. To add ambience, play your favorite music.  Alternatively, enjoy silence and disconnect completely.
  4. Close your eyes and slowly breathe in. Count to four. Count to four again as you breathe out, allowing your mind to clear. Let the scent soothe your soul and revitalize your spirit.
  5. After only a minute or two, you’re ready to go about your day feeling renewed.
  6. Remember to pause and breathe.  It only takes a minute to de-stress.

Enjoy your downtime!

Calm Pond

(Thanks to Crabtree & Evelyn for their suggestions.)