Friday, March 21, 2014

LET US THEN BE UP AND WALKING....


We have quite a few patients that fit into the frequent faller category... and so it was with my first patient of the morning.     Let me just say from the start that sometimes a therapist needs a little of her own medicine.

Most times, when focusing on balance, I like to start from the bottom up and that means shoes.  I told my long lanky 91 year old that she needed to get out of her cinderella flats and get into sneaker type support shoes.  She looked at me with fear and said: “I just cannot bend down and tie them.”   Okay second defense I began: “I am sure you could find some with velcro straps.”
“Nope, those make me look like too much of an old lady.”  We both laughed and then I took another shot:  “You have fallen 3x in 3 months,  Time to get serious and support your whole body. “  Next, she gets up and as I have done so many times before I follow  her to the closet as she bends down to pick up some red shoes; ones that she says: “have spiders in them because I have not wore them in so long.”


She realizes she can bend over and tie these red  shoes and  also when  She stood up  she   she was picking up her feet and striking her heel down first ;more or less looking like an old woman walking rather than old woman shuffling..
Okay first mission accomplished.
Now let the games begin:
Therapist: “Lets stand up and hold my hands and start rocking from side to side.
Her knees are turned inward, her hips move as if they belonged to a stick figure, a marionettes version of swaying.
“Now lets lunge forward, think of growing roots underneath your feet” I continue as she clings tightly to my hands.  “Soft body” I say, let the tension fall away.” and yes for a second she is moving easily and getting into the swing of it and then I say to pretend that she has a hula hoop and make bigger circles in her hips.
 I tell her this is the beginning of balance.
When the warm up is over, we move to walking outdoors.

Right foot, left foot, right foot,  left foot; onto gravel, then pavement and then watch that pothole and breathe.
She walks and we talk about slowing down.. about how hard it is not to go into automatic pilot and just  "go thru the motions."
Practice feeling each foot hit the pavement, each stride a little longer than the last, keeping your shoulders loose and breathe.. So easy to say isn't it?  All these things we take for granted that fall away when our bodies lose elasticity in muscle, strength,  balance.
 You can call it purposeful walking.  Paying attention to each movement.... in essence that is what our brains have been designed to do.   They get us going...No movement is possible without signals firing up and down from brain to spinal cord to muscle!

In a funny way, I sometimes think of myself as the fairy godmother in The wizard of Oz..  Sure I cannot tell my patients to click their heels together and close their eyes and have them say: "I will walk again:
But I do say: "YOu always had it in you my dear.. you did not just go thru the motions but you once stood triumphant on those two feet and looked up at your mama and said: "I am free, I am free to roam now."
And roam and roam and roam you did   91 years worth...
You now can say to yourself. "Look ma, I am still here, I am still here.. "

Sunday, March 3, 2013

starts and stirrings...
Here I am at the 6 month marker of my voyage into the wild wonderful world of bread.The more I know, the more I want to know... THAT IS THE ONLY ONE THING i Can say for sure.
My kitchen  has been taken over by canisters of rye flour, whole wheat, cornmeal, spelt, pumpernickel;  various sourdough sponges in different stages of fermentation,  and the two foot wide marble bread board that now sits permanently on the counter.
I feel like that Christmas Carol.. On the first day of Christmas my true love gave to me.. except that I sing: “On the first day of baking,  I gave myself some bread.. but then.. on the second day of baking, I gave  myself some  more bread and a new quarry tile...and on the third and fourth and now it is up to the sixth month of baking.. and what have I given myself all for the sake of the glorious crust, crumb and chew???  
THE TOOLS:  I have bought 4 bread books,  linen cloths(so that dough does not stick after it has risen) baskets in oval, round, rectangular shapes. (better aeration for the dough when it rises) dutch oven (for creating the steam for therackly fissured crusts,  serrated small knife ( for better precise scoring the tops of the breads) kitchen aid mixer( to save your arms and wrists)
 Learned a new vocabulary: autolyse,  pre ferment,  poolish, biga (all words for sponge) oven spring,  hydration percentage(the source of endless online chatting)  
The Joys:  Getting my hands on the dough has become somewhat of a daily ritual.. It might take me back to the time when I first remember how much fun it was to mix water and earth and make a mud pie!  We played make believe and served up several meals sloshing around this pasty concoction.   The suspense of creating a risen dough rather than one that sits heavy like the mud paste is each and every time thrilling.    The smells and colors of baked bread. period.  The sense of slowing down... watching something go thru a  complete cycle is very calming.   What is the temperature?  How does your sour starter look today?  Do you want an open crumb or a closed crumb?  How come the oven did not get hot enough?  Get the picture?  There are variables that make the bread good, better  and the best!  Not to mention the mood of the baker..
The pain-in-the-butt stuff:   Dishes, dishes, dishes,   flour flour everywhere, it gets trapped in your hair, on your clothes, on the walls,    in and on your shoes,  
The tradition of bread in all cultures:   Naan, french sourdough, italian ciabatta, russian rye, jewish seeded rye,  Finnish rye, Danish rye,   arabic pita,   mexican bolillo,  Boston brown bread,
How did these traditions arrive?  What are the wheats like grown in different regions of the world that create these flavors designated to a specific origins?
The voyage continues.   Thanks for coming along on this journey with me.
Keep in touch.  anina

Monday, January 28, 2013

BIT HARD BY THE BREAD BUG

It all started simply enough.  My brother in law said: "How come I cannot find a good hearty rye bread anymore.  Why can't I find those flavors anymore.. the super chewy, sour crusts?"

Yeah  and why do I feel I have to pay the 7 or 8 bucks to buy those  breads when   maybe I could learn to make them myself.  Its the sour taste I love and  crave in many old world breads.

I had never made a sourdough starter before.  The truth is, after 4 months of experimenting with sours or prefement, as some bakers call it,     it is like everything else... you have to know what to look for and watch for before you can throw away all recipes and rely on your own judgement.  But ah... the quest to know what it is you want.. that is the kick, the joy, the fun,  the adventure.

What are the flours like?  What kind of yeast is best?   Should you store starter in plastic, ceramic, glass?  What does "smelling like beer and baked apples" mean to you?  

What I love about making a sourdough starter is that you are working with the natural fermentation process and just trying to coax it along to achieve a flavor that is right balance of sour and sweet.. kind of like wine making and cheese making.  All you need is air, moisture, flour and salt..  and you end up with SOURDOUGH BREAD!


Monday, January 21, 2013

I LOVE MY LAZY-BOY.


“I LOVE MY LAZY- BOY.”
As you hit 80s years old and the great beyond,  chances are you have found that one chair,… 
the favorite chair; it just might be this one, as it is for most of my patients , The Lazy boy. 

This is the one where the mechanical controls are conveniently placed at your fingertips;  Press a button and the chair tilts you up to almost perfectly vertical. Press another button and down you go, and another button;  your lower limbs are lifted up and within seconds you are in a full recline or a modified lying down mode. The next step is most always the lazy-ing around mode.

 Your needs by your trusty “strong” side:  remote control, medications, a beverage,  and a caregiver who will bring you lunch on a TV Tray.
 Then…one day  BINGO, …you are down for the count. You are no longer just relaxing….no it is worse, you have become part of the furniture. That ubiquitous Lazy boy recliner has done it once again: expedited Natures Gravitational pull to NOT GETTING UP... The recliner has seduced you in all its soft upholstered splendor.

When Lazy boy created this chair in the early 70’s its motto was: “Nature’s way of Relaxing.”  As a physical therapist trying to help people maintain  muscle mass, mobility   strength and independence for as long as possible; I say: “Boy oh boy Nature’s way of leaving your body so relaxed it can quickly turn to mush.

Please understand I have nothing against comfort. Remember the three bears?  We all know when someone has been sleeping in OUR bed… our bed alone that cradles  our own bodies smooth curves and rough ridges. 

I am talking about daytime beds!  I am saying DO NOT USE this mechanized chair till you absolutely cannot scoot forward, till you absolutely cannot bend forward, till you absolutely cannot use your arms to push off from a seated position, till you absolutely cannot weight bear too long on either of your legs, till your pain from any number of ailments has left you dependent.

I have become good at the quick scan of the furniture landscape of my patients homes. The fall risks are everywhere.  Is it the all- too- low sofas that nobody can get up from anymore, is it the chairs without arms still surrounding the dining room table, the too high bed or the need for rails by the bed, the toilet seat with no grab bars nearby. 
Many folks  end up living surrounded by the desert of abandoned furniture. But, there in the middle of a livingroom or bedroom is the almightly Lazy Boy to save the day. The kingpin of seating. “

“Lets start by seeing how you get up” I say. The patient takes a ride up as the chair perches forward to the sound of its electronic murmur until it comes to a vertical halt.

“Very good. Now lets try this again using your very own motor power: your arms and legs.”

I take them thru the paces that was once so automatic and yet now they are hanging on my every word:

“Scoot  forward in the chair as  far as possible, hold both hands on the arms of the chair,,, now lean forward and get your nose over your toes, now push off, straighten your knees and look up.. you are UP! Now breathe.”

When we are babies, everything in our motor cortex is conspiring to get us up.  From rolling to crawling to kneeling, to the final triumphant standing and walking. Its the autonomic  nervous system creating billions of neural pathways to get us going. 
In our elder years, It is our memory we have to re-awaken to relearn to stand, to sit, to walk, to turn around, to climb a stair, the many basic patterns of movement  this time with slight revisions.

Next time you are in the furniture store, Do the physical therapist a favor. Buy yourself what is comfortable, but please bypass the Lazy Boy.  I will be the first to cheer you onward and upward  when you can stand alone. 

Monday, October 29, 2012

SNAPSHOT PART 2 CONTINUED


                The next time I came to visit, the two were sitting at the dining room table; the tea cozy was  at the center, and the old man was leafing thru the mail.  They did not look like they were in any hurry to walk.

               We were just sitting here thinking how lucky we are to be  here with all this,”  she gestures with her hands thown up in the air, then points to the adjacent window thru which you can see miles and miles of forests and the great pacific ocean beyond. 
“ain’t that right honey,” she looks over to her husband.

      I was just thinking that I grew up on a farm” he remembers” and we had lots of chickens.  My first job was a door to door egg salesman.  You would be surprised how nice everyone was to me.. I usually had all my eggs sold at the end of the day.

           Do you happen to know how much a dozen eggs costs now in 2012?” I ask.
He looks over to his wife perhaps for some help with the answer but then he decides. “I’d imagine about 60 cents,”
His wife looks down but does not say anything.
“No, its about 4x that much, I say.
“I cannot believe that, he speaks louder than I have ever heard him “ How come?”

               Well honey, everything changes” she says in her most matter or fact voice.

And the next thing that happens is two heavyweights from the past come to the table,

       "You know my dad was there when ,” he stops for a moment to try and remember the name,  “Edison, yeah Thomas Edison turned on the first light switch and that got my dad so excited that he ended up manufacturing all sorts of switches and did really well too.”
“He also happened to be there the day the wright brothers took flight for the first time.”  My dad must have been about 9 or 10.  Think about it. It still sends chills down my spine to know that people can get in the air and fly everyday and my father was there when it all began.

“ I can’t believe it,” she quickly pats the back side of my hand,  “but I am getting lots of calls from my church, everyone wants to know when I am coming back,”  she begins,  
“I think I will let my daughter in law take me to the hairdresser this week and see how that goes.  Who would want to see me looking like this anyway?  I always try to sit in the back of the church so I would not have to far too walk.”
Whats that dear,” her husband leans over to try and pick up the conversation.
“Oh I was just saying to anina, that its time for me to get my hair done.”
He looks at her for a long time with his hands in his trademark resting place crossed on his chest and then looks at me across the table while pointing towards her.

“If it weren’t for this lady, she does everything around here. She sure is smart and knows how to do things.  I really can't thank her enough. "

She gets closer to me and says quietly; “He says that to me everyday .      My first husband was good too BUT so many woman tell me how lucky I am to have a  man that appreciates me.  It makes all the difference in the world.  Believe me.


For better or for worse.  I believe.  

Saturday, October 27, 2012

a snapshot of my day

When I arrived at my 93 year old patients house, she was seated at the dining room table with her husband.
"Would you mind if we took my husband on a walk with us today," she asked,  "My daughter in law would be so happy. "

The husband we are speaking about is 105!!!  Not a thing wrong with him except he sleeps a lot, cannot hear too well, cannot see too well, walks with a 4 wheeled walker and as his wife always tells me; "his favorite thing is opening the mail and sorting it in piles and re reading it over and over. "

I am here to see her.  She broke her hip and is doing great.  She is so attuned to her husbands every need that it takes awhile for her to realize I have come to help her with her recovery.

"He loves the red grapes.. they are so good."  she says to me as she is looking at her husband. "go ahead honey,  aren't they good this time.  He also likes crackers with honey.. Its a particularly good combination."

And just when I have excused myself for a second, I come back into the room and I see my patient helping her 105 year old husband to stand up    and put on his sweater and that is how I found myself with the wife on my one arm and her husband on the other side of me with his  four wheeled walker going outside to catch the last of the afternoon sun.


We walked and talked as we went up their driveway (he commented on what a lousy job the last guys did who paved the road) His wife added; "yes but we don't care anymore.. We are not driving.."

I told them both how good they were doing with their walking and when we arrived back at the house, she told me that he could now go and sit in the living room and he will have his tea.

She took the tea cozy off the teapot and poured him his tea in cup with a saucer and put it down on a table beside him.  The sugar bowl with the teaspoon was right beside him as were a few cookies.
"Go ahead honey, " she said,  "I'll join you shortly."

He did not answer her but put two teaspoons of sugar in his teacup and stirred and looked at me and smiled and then looked around for his cookies.

"You would be surprised how hot that tea is eventhough I boiled the water over 1 hour ago. isn't that right dear?"

He looked for the saucer on which to put his cup of tea and folded his arms in front on him and closed his eyes.

"He'll fall asleep right here," his wife says as she came around with her own cup of tea.

 As I get ready to leave,  I tell her that I would prefer that she use her cane outside when she walks again:

"Oh no," she responds with well rehearsed timing. "that would be for old ladies."