THE DAILY LOTTE CHRONICLES SEPT 30 95 years old

Tonight I asked Lotte to list some of her favorite books: 

"well of course alan's book Of streets and starts"

She told me she would like some potato salad and this is how you make it:

"chop onions, boil some red potatoes, when the are boiled, chop them up and add vinegar and olive oil you can add whatever spices  you like?" 

 

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.. "

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

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!

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. 

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.  

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."

BREATHING LESSONS

"Don't forget to breathe,"  I remind my patients almost everyday.  It sounds funny but its so true.. I mean deep diaphragm breathing...in through nose and out through mouth  breathing.    

I say: "Smell the flowers and blow out the candle."  and most people laugh immediately and realize that yes they do not know how to breathe.  

Pay attention to your breath:  "Is your breath high up in your chest?"    "Is your mouth open"   "Are you anxious because you have not taken a deep breath today?"  "When you exercise, do you hold your breath some of the time?" 
As a dance teacher once told me;    "Let your body follow your breath."

Respiratory ailments is the catch all phrase for those with severe breathing problems:  Pulmonary disease, emphysema,  asthma, acute respiratory distress and chronic obstruction of the airway passages.  Anyway you want to name it..   IT IS SHORTNESS OF BREATH!

Every  twitch, twang and tweek of your muscle fibers  goes into the job of getting air  in thru the nose down through the trachea, through the bronchi into the bronchioles which  connect into the tiny air sacs (alveoli) containing the capillaries which  distribute  oxygenated rich blood throughout every cell in your body.   

I have seen how this disease looks:  The chest muscles prominently expanded, the shoulders drawn up high,  sallow skin stretched taut,  eyes vapid,   voice waxing and waning in volume.  Even  to force the facial muscles to smile seems like an enormous effort.

 I can get out my tools: the oximeter, the blood pressure cuff, the thermometer and stethoscope and get lots of measurements and we both agree on the numbers and we go through the motions of some sitting exercises to increase the heart rate and improve endurance with activity but still... every breath you take can sometimes feel like it could be your last.   

When I first heard a patient tell me that she will not leave the house without her portable oxygen tank completely full,    I had never even thought about needing to take "air" with you.    You literally  do just enough activity governed by how much oxygen IS  in your  tank...talk about self regulating or you will literally "run out of breath."

So take a slow deep breathe again.. where the air travels to the lower portion of the lungs where the oxygen exchange is most effective.. heart rate slows, blood pressure decreases, muscles relax, tensions relax and the mind calms.. and remeber how it feels to come up for air once in awhile.

"LA DOCTORA"

 No, I am definitely not the doctor, but the Physical Therapy Assistant.  I have been called; "LA DOCTORA" by mostly my Hispanic patients.  Walking thru the door of my patients home,  I feel like I am part of the slowly dying off club of those that make The House Call.  I am dressed in  my starched white lab coat and am carrying my proverbial little black bag. (only this time I have to sling it around my shoulder because it is  loaded down with so many more paper forms as well as necessary tools of the trade) I like to imagine myself as the Country Doctor of years past, coming to pay my respects to the family and to the  patient; bringing all the cures tucked away in my little black bag.   

I have the names of many diseases shuffling around in  my mind as I try to keep them all straight.  Lets see Who was the Hip replacement?  the Congested heart failure? the nurse that worked for 30 years in emergency rooms and now has esophageal cancer?  the woman who owned the candy store I used to go to...has frequent falling?  early onset alzheimers? parkinsons like gait, tremors of unknown origin,  and on and on and on...

I reach into my black bag, pull out the stethoscope to take your vitals, listen to your breathing,  look at an incision from a knee surgery, put my hands on your forehead, ask you your pain level,  make you grip both my  hands as hard as you can... "Come on harder, you can do it more, more," I say, and then I stop and file away this data and let you, the person,  tell me your story.

 I sit next to you usually on the couch or else on your bed with you.  You begin from the usual drop down menu: (in no particular order)  the onset of illness, what hurts, what makes it better,  medications you do not understand, hospital stays where knowone answered your call light for hours so you just took yourself to the bathroom even though the doctor stated strictly that you must never get up alone,   the nurse that got mad at you because you did not eat enough,  the caregiver who brought you clean fresh sheets and smoothed them down so flat you felt you could sleep like a baby again, the family member that chose not to come to visit,  your job.. how long will they hold it..and the beat goes on (as the song goes)

As I sit and listen, I think of the expression  "a laying on of hands."   


In religious terms, it is called "the divine healing. the placing of the hands of the healer upon the person to be healed... or  more specifically; the consecration: setting someone apart for the service of god; next, the transmission of a divine gift and finally the anointing with a healing oil...
In some ways this expression conjures up the pentecostal healings that still continue today... where  the almighty leader sets his hands on shoulders or head of a parishioner and behold the person would be able to walk again...or talk or any such bigger than life magic!


    We have our modern day charlatans, Hood winkers, hucksters, fraudsters, swindlers of the traveling medicine shows, disguised as the big bankers and insurance companies,  who lay claims to being able to cure anything while emptying out your pocketbooks at the same time.."the too good to be true" idea that will never fail to dazzle your wounded and tired souls   BUT,   I am talking about the laying on of hands as a metaphor for the art of  re-assurance,  conferring faith on another that things are destined to be better and that if you feel I have heard you out, have listened well, that you the patient and me "la doctora" have entered into some sort of an unspoken pact...and we  both get to feeling much better  as I reach out to shake your hand and thank you for your time...

THE EXERCISE LADY

In the exercise class 5 days a week at the Cypress Alzheimers facility,  three ladies sit next to eachother on a very large sofa in the front row.  One  tilts so far to the right as she sits and another sits very straight but both can follow right along with the teacher.

 Another lady cannot seem to stay on the beat but is transfixed by the movement.  The only man in the whole class sits way apart from the others at the back of the room and  does not smile at all.

 The rest of the people  are in various states of sleeping and waking and mumbling to themselves or sitting staring straight ahead not at anything or anybody it seems.  At the front of the class is the exercise lady; Hannah


"UP, DOWN, OUT, IN..up, down, out, in," Hannah speaks clearly and strongly as she demonstrates the arm movements to the twelve residents sitting in wheelchairs, sofas and recliners.


"Okay try to keep going," she continues," I am not going to tell you what to do: one, two three, in very good Janice, one, two, out, four."

She wears an extra large cap to cover her long thick braids which she occasionally flips behind her as if to dramatize  starting and stopping  each exercise sequence.  She speaks with a Carribbean accent ending each sequence of exercises with the word PER....fect...lingering a split second longer on the first syllable.


"Okay Mrs, Mackenzie, thank you for joining us," says Hannah as she acknowledges a woman who has stood up and does not know where to go. "Dya have ta leave us now then?" she asks and then back to the other exercisers who are still working hard, "Keep those legs marchin now.

"I know it getting harder when it makes my legs burn a little ya know? We gonna work just a bit more then we can relax alright."  A caretaker has come to help the lady who is looking stranded and takes her hand and leads her out of the exercise area.

"I see some people who need just a little help,"  Hannah  stands up, walks over to a lady in black and white spotted sweater, buttons in the front, who must weigh only 95 pounds and is perched on the edge of a giant chair looking like she might fall off any minute but miraculously she does not.

Hannah kneels  down in front  and holds her face in her hands as if she is cradling a baby and helps her move her neck from side to side:  "Excellent, there you go Marion...one, two, three, four five six, seven eight and relax.." then gets up to return to the front of the class again.

"Now take a few minutes to rest.  Let your bodies relax so that we can do this again. Breathe in," she says as she lifts her arms above her head, "and breathe out.. PER....fect.

IF THE SHOE FITS, WEAR IT!

                                                

"Your pedal extremities are colossal" crooned Fats Waller in his 1940's humorous song about a woman he loved with big feet.  "Yes your feets too big," he wailed,  "from your ankles down you  just gots too much feet."   but what he did not say (natch)  is that your  feet can also be too TINY,  have gout, plantar fascitis, fallen arches, mallet toes or my favorite: MORTONS NEUROMA .

The foot, with 26 bones, 33 joints and more than one hundres muscles ligaments and tendons,  truly needs good protection.       Many of my patients do not want to give up the "slipper shuffling" and there comes a time where I have to put my foot down (sorry)  and say:    "Get out of those small shoes for them there humongous feet.    I know you love those slippers but its time to lose them and start truly walking.

We all have our favorite shoes.  Think of the choices you have when you get dressed in the morning.  Isn't it true that there is  a favorite pair that you tend to want to wear?  The ones that also describe how you are feeling that day  Maybe sporty in those tennis shoes, or playful in a mid heel open toe,  sexy in your red high heels..                                                          

When you get to be in your 80's and 90's though,   the slippers begin to look really good.  I mean think how simple.. No more tying the laces, no more bending down,  no more finding socks to match.....Yep,, I find myself being a shoe salesman to my patients.

 Remember them? those guys you can't find anymore; the ones that actually measured your foot, then went to the back of the store,  pulled  from the shelves various shoes sizes and styles, brought them back, stayed there while you tried them on while you said  how you felt and looked in each pair. You had an accomplice.  Thats me on my job.

   After having knee replacement, this field worker would not give up his cowboy boots. I insisted he put on the tennis shoes that his wife had bought for him probably the only time he ever put on a pair.  He would never want to walk very far and after a few sessions he told me that he felt horrible without his boots on and even though  he knew it was not good for his knee, he could never give up wearing his boots..

Another woman who also had knee replacement told me she had no shoes that were comfortable anymore.  She was used to going out a lot with her very successful business man husband to lots of local high society  events.  She always dressed up.   When we went to her closet, there were about 100 pairs of shoes!  She said: "I cry when I come here because with my knees hurting, I cannot wear any of these..."  They were all quite expensive, modern, chic.... I told her its time for comfort.  She looked at me as if I just told her her house was burning down and then said: "Who should I give all these shoes to?"

When I met John, an 89 year old, he had diabetes, blood pressure problems and just general weakness.  He loved the kinds of shoes he wore now and had bought three pairs.    He had begun to cut through the tops of the leather of the shoes tto relieve the pressure as his feet had widened and he had a pressure sore on one toe.  We went online together, found the shoes he liked and ordered a larger pair.  He was thrilled.
     
I loved when one of my patients gave me  a pair of brand new high- top- super- white- ultra- suede -super padded tennis shoes.  I was hoping they would fit this 79 year old hispanic man, suffering from hip problems whom I knew could never afford them.   When I presented them with these shoes,  I was praying to god they would fit..He put them on and kept saying: "Esos, si son buenos,, esos si son buenos (these are good, these are real good) He showed off how well he could walk and even showed me he did not need his cane anymore!
  

There is just something about putting on the right pair of shoes.  Of course,  it certainly  helps when it is prince charming and he has come to find you to return your long lost slipper so that you both can live happily-ever-after....                                  

MY ODE TO RHUBARB

ON  an  autumn night with the pink and white moon overhead, sitting outside listening to jazz piano and drinking Honduran coffee with a slice of freshly pulled-from-the-oven rhubarb crisp.

Rhubarb picked from the soil for the first crop of the season.  It is the first time I have tasted rhubarb that is only two hours old.. two hours from being snapped from its
tightly wound center..and so, when I add the sugar and the lemon and apple juice, then bake, it immediately tenderizes and becomes a texture I can only describe as gooey, thick, piquant, not at all stringy...kind of like the texture of baked eggplant.  The oats on top and the butter and the cinnamon have just enough richness to offset the tart/sweet of the rhubarb.. the perfect mix in a fruit.  Oh my, I better stop.

When will the next crop come around again?  Those dinosaur leaves and their long thick magenta stalks.. I must wait.   I will wait.. I will  wait.

DO I HAVE A WITNESS????

"I told Glenda that the day will come when she will walk into New Hope
Baptist chuch with just the cane and her nice walking shoes.. Ain't that right sis?," says Kathryn looking at her  sister and putting away the leftovers from  lunch.
"I have faith in you, yes I do." she says to me as I get ready to work with Glenda, " You will make her walk good again.. I can just feel it."

  I had been working with Glenda for 3 weeks  after her hip replacement.  She had suffered a stroke 10 years ago but was able to get around with a cane until this last surgery.  Accoding to Kathryn, Glenda was also very depressed since her job as full time caregiver for their mom had come to an end. She had moved to California from Texas to live with her sisterover 1 year ago and Kathryn kept reminding her... Mom was dead.  It was time she looked after herself and started eating what she was supposed to... No more fried foods and sugary sodas like she was used to back home.

 "I think if we could get Glenda to the church,, I know it would do her good.  I bought her some crossword puzzles,  she helps me with the laundry and I make her get dressed every day."   Kathrn has posted notes all over the house with such sayings as:  Yesterday is gone, tomorrow is not here yet and today is a present."  or    "Don't let your thoughts tell you who you are."   or  "take it one hour at a time."   Glenda does not seem to notice any of this.. She  repeats to me only that the medications for the depression made her worse.  It was the devils work, she said.

When Kathryn was not around, Glenda did very well. She did all of the exercises without tiring, insisted on walking outside, talked about getting dressed up again, even looked proud of herself when I complimented her on being able to do the ankle circles without the whole bottom part of the leg moving.

"I never knew my foots could do that," she answered without hesitation.  In fact, Glenda was out of her large smock dresses the past few visits and was wearing slacks and shirts in bright solids with scarves to match. I insisted it was time to step out of her house slippers and so She had tennis shoes now which she could not believe were "so comfortable."      "I made you something," she said, as she handed me a bright pink crocheted cap with a red flower sewed onto the side, "I know that our therapy  ends soon" she said.

        "We sure would like to do something more special for you," said Kathryn  whileGlenda was doing standing exercises counting them out to herself.   We stayed in the kitchen inside because the house was filled with stuff everywhere you turned: a large fish tank, vitamin and nutrition books, plastic flowers, macrame hanging baskets, family photos... Glenda had not confessed yet to her sister that one day she would like to live in her own place.  Kathryn might be offended, she thought.

On the last day of therapy, Glenda opened the door and was standing there with only her cane.  She looked tall and radiant.  When she invited me in, I saw three men sitting down on the mantle of the fireplace.  They smiled huge  grins at me when I realized these were the deacons from her church that she always talked about.
"Do I have a witness" shouted one,  "God you are great" said another. and "Praise the Lord." as Glenda paraded from room to room with bright blue tennis shoes on, concentrating on her stride, striking her heel first, gaze  forward (not down as she had done for so many years) mouthing the words, right foot , left foot, right foot, left foot. When she turned around she took a deep breath, checked to see that her scarf turned right side up and began again looking as if she had never taken a step before in all of her blessed 65 years.
                                                                              AMEN.

"You put your right foot in , your put your right foot out.."

       "Legs come with a high price...  The motors controlling a leg have to alternate between keeping the foot on the ground while it bears and propels the load and taking the load off to make the leg free to move..All the while they have to keep the center of gravity of the body within the polygon defined by the feet so the body doesn't topple over"

from HOW THE MIND WORKS by steven Pinker

      I love this quote. Its a miracle that we walk without toppling over.
     "I was just getting out of the shower when the next thing I knew I was on the floor." is what I hear from so many people I visit in the homes. I often see the words "FALL RISK" on many patient  history reports.   What is most humiliating is when it is tactlessly posted on the  wall of an inpatients room in an effort to communicate to all other medical personnel that this patient is not safe to walk alone. When I was very new in Physical Therapy,  I  thought the sign meant that  I  risk falling by entering into the room..like maybe the floor was slippery or something...
         One of the hardest things to tell a patient is that they have to continue to use a cane or walker eventhough they think they are ready to go solo. Didn't  we all love to utter: "Look Ma no hands"  when we were children and realized we could walk without holding onto anything!!!   Its still a mighty thrill when one can leave crutch, walker, cane in the dust and take long solid strides by oneself.
Maybe that is what the hokey pokey was all about... you know that dance that we learned in kindergarten.  We celebrated each part of our bodies.. Remember?
"You put your right foot in
You put your right foot out
You  put your right foot in and then you shake it all about
You  do the HOKEY POKEY and you turn yourself about
Thats what its all about!

The leader or teacher would then call out various other body parts like: finger, toe, nose, chin elbow.. of course we all loved the bottom the best... especially the shaking it all about...

Trust me... Its almost alway best to put one foot in front of the other,.look ahead to where you are going and  as Nat King Cole said: "  Straighten up and Fly right"

    
    
              
  

HE JUST KEEPS ROLLING ALONG....

  Ah gits weary am sick of trying
am tired of livin'
am skeered of dyin"

I was told by the nursing supervisor that the 89 year old man was even too scared to sit up at the edge of his hospital bed.  It had been 4 months since  he had taken his third fall in a year and was recovering from a broken hip.   The first time I ever peeked in on him, he was all one big head,  his body  skinny and shapeless underneath the heap of blankets.  Classical music was coming from his bedside radio.  
        "You cannot make me walk today,"  he said, "Absolutely not,  I know I am not ready...My body is not strong."
  As I approached the bed to greet him and introduce myself, he kept his gaze straight ahead.     "I had one of you guys try to help me walk recently and the guy looked away for one second and I slipped and fell on the floor now I am worse than ever....that was in another one of these homes.  No way am I getting up.  "
      After he realized, I was not mentioning walking, he somehow got into lecturing about music,his family, his newfound 90 year old companion that he had met in the retirement home and how they  had both  discovered they could play piano duets.. on two pianos.. He could not wait to get back to that.  They might even get married.
       As he talked, I prompted him to move his ankles, lift his legs straight out and show me that he coud roll from side to side. 
      He told me all his kids were musical and that they would be coming to visit him tomorrow.  He loved when his oldest daughter sang to him.... show tunes mostly but she could sing opera too.  Then he began to sing:  "Old man River,   Old Man River...
     When I came back the next time, he was in his wheelchair.  Two of the nursing aides had told me that it was really hard but they had transferred him into the chair by heaving him up under his shoulders and muscling him into the chair.  He wanted to be out of bed when his children arrived.
      "I'll wheel you down into the exercise room ," I said matter of factly and began steering the chair forward while his long legs dangled way over the leg rests since there never is the proper size equipment for the proper sized human.. but hey!!! he was UP! I was determined to try to walk him but had no idea how it would go.
       His kids arrived with the over -the-top exclamations of astonishment each one trying to outdo the other: "Oh dad, you look fantastic,"  or "Dad... you'll be out of here in  no time."   or the one heard in nursing homes across America:  "Wanna race?"
     He greeted them with the tune he had been humming;  "Old man River,  he just keeps rolling, keeps on rolling along...
       Within a few seconds his kids chimed in along with  him and started singing the song in  large voice sending this man into complete excitement and I could see something was about to happen so I grabbed my gait belt and cinched it around his waist and said: "Go ahead stand up..please"   and then with the Showboat chorus trailing behind and me holding onto the belt.HE..RISES UP and takes one step for each line as they sing:
                                      
You an'me, we sweat an' strain,
Body all achin' an' racket wid pain,
Tote dat barge!
Lif' dat bale!

Old man river he just kept on rolling and just kept rolling along till the very last line of the song.   
                            
      

WHEN YOU GOTTA GO... YOU GOTTA GO

      
    I would say that aside from the freedom of no longer being able to drive, the freedom to no longer be able to walk to the bathroom and "go"  in the privacy and comfort of your own throne just stinks. (no pun intended) The subject of toilets is under the heading: BATHROOM SAFETY in the catalogue I use when patients need to order equipment for home.

   Little did I know how dangerous toilet talk can be.There is The Big John toilet seat, the Uplift commode assist, the three in one (can be used as a shower chair or bedside commode) the best value: the economy elevated toilet seat,  and my alltime favorite:  The TOILEVATOR described as "an aesthetically pleasing alternative to raised seats adds height at the base of the toilet..3 1/2 inches to the heights of standard 14".  

       Between the strengthening and stretching and ambulation, there is almost always the talk about ones intestinal tract and all that goes with  it: which toilet the pts insurance will pay for,  when is it time for the adult diaper pad, how many times is one up during the night, what is the best laxative,  how come one pt can leave the house all day and not have to go only to return to her front door and not be able to "make it without an accident"  and then  there is the real danger  of getting stuck. Yes.. getting stuck.
     I was working at a hospital in a small agricultural town in California on the orthopoedic floor helping an obese man get up out of bed to his bedside commode.  As soon as the man stood up, I could see the magnitude of his posterior reached way beyond the size of the porta-potty.  I ran flying out of the room with my assistant standing gaurd by patient while asked anyone and everyone if they knew where I might find an extra extra large bedside commode.   I shortlly flew in with the larger equipment in tow and helped the pt accomplish his first order of business.  What comes down, must come up right?  Well..yes and everything that comes with it!!!.. because right before my very eyes stuck to this mans bottom was this bedside commode and he was just about to start walking when I yelled out:  "Don't move, we have got to get the toilet off your butt!.  Keep breathing,  bend over, breathe.. , "  I was yelling out orders as my helper and I huffed and puffed and yanked this  hard plastic surface away from this mans behind till thankfully we heard a slight popping noise which almost set us flying across the other end of the room.   When I gained some sort of sense of what had just happened,  the patient had moved so quickly to get himself back into bed, you would never have known he had just come from getting a total knee replacement and I was just glad that this bathroom trip did indeed end safely.
     
            

JOY TO THE WORLD

ME CATCHING THE BOUQUET AT A DEAR FRIENDS WEDDING.  MY PARENTS ARE IN THE BACKGROUND..(MAN WITH CAP AND WOMAN WITH BLUE SUIT) SHARING A JOKE WITH FRIENDS AS THEY SIP THEIR WINE.  IT LOOKS LIKE I SHOULD BE AN EXTRA IN "FIDDLER ON THE ROOF.."  I JUST THOUGHT THIS PICTURE WOULD BE THE RIGHT TONE TO SET THE MOOD FOR THIS BLOG.