Archive for May, 2018

May 28, 2018

You May Need a Nap

If you’re eating well and exercising, but everything feels like a bigger deal than usual, you may need a nap. You may need more than a single nap. You may need more sleep on a regular basis. If you’re under a significant amount of ongoing stress, you may need a good night’s sleep, a nap, and additional down time.
nap
My father-in-law swore by the 20-minute power nap. One of only 3 physicians in a town of 7000, he worked long hours. Every day at lunch, he’d come home to eat and then sleep in his recliner for 20 minutes. He didn’t set an alarm. He just woke up ready to go back to the clinic. He seemed to take the long hours in stride, so I guess naps worked for him.

Each of us has individual sleep needs. A regular 20-minute power nap may work for some while others need a full 8 hours each and every night. Others may function well on 6 or 7 hours during the week supplemented by 10 to 12 on the weekend. Because the particular rhythm is individual, it can be difficult to determine when a lack of sleep first begins to cause problems.

Like many conditions, the effects of sleep deprivation compound slowly over time tricking us into thinking we’re experiencing something normal rather than problematic. Failing to recognize and correct the problem slowly erodes emotional resiliency, the immune system, and our overall health. Early signs could be that you notice feeling more than tired or irritable. Perhaps you feel foggy, forgetful, or have minor hallucinations. Perhaps you feel more anxious than usual or seem to lack the joy that you previously felt. Any of these can be indicators that you are not getting enough rest.

We all have long to-do lists and such an expectation of immediacy that it can be tempting to ignore our bodies’ signals until we reach the point of exhaustion or other health concerns. Obviously, it is better to recognize the signs early and remedy the problem before it affects our immune systems or leads to a chronic condition like diabetes, high blood pressure, or heart disease.

Making the time to slow down is a constant challenge. Meditation and yoga can help, but where can you find time to work them in? And the more pressure you put on yourself, the harder it is to let your mind rest.
big deal
If this were easy, we’d all get enough rest, but according to the CDC almost a third of us are sleep deprived (defined as less than 7 hours per 24-hour period). This is especially true in the eastern and southeastern United States. In my particular state, the lowest rates of sleep seem to fall in the poorest counties.

Most of us think that we can catch up by sleeping late on a Saturday morning here and there. If we still feel exhausted, we assume there must be a different problem. This can mean we continue to exhaust ourselves.

It can take weeks to fully recover from sleep deprivation. Adding an hour or two per night over a longer period of time will give you the most benefit and if you can sustain the extra hours, prevent the problem from recurring.

That doesn’t mean there aren’t times you just need to shut things down. If you have reached a point at which you cannot function well, it is time to take more drastic action. Pretend you have a 24 or 48-hour virus. Go to bed and don’t do anything you would put aside if you really had that virus. Giving yourself permission to do this will help quiet your mind and put it in sync with your intention of resting.

Temperature, bed quality, light, and noise can all affect sleep quality. I learned long before smartphones existed that a digital clock with a red display disturbed my sleep. I had to go back to a clock with a face with hands. Now I move the laptop out of the room because the pulsing sleep indicator is disruptive.

Alcohol will give the illusion that it helps you sleep because you may fall asleep more easily, but it can interfere with REM sleep resulting in daytime sleepiness and performance impairment. I’ve heard plenty of self-diagnosed insomniacs complain about their lack of sleep while touting alcohol use as the solution to the problem. They don’t seem to realize that they’re still complaining about insomnia. If alcohol were fixing the problem, wouldn’t that complaint be gone?

I fall asleep easily and usually sleep well, but during times of extreme stress, I require additional hours of rest. I can’t get by with 6 or 7 hours for two nights followed by 8 for two nights. I need a full 8 – 9 hours each night and maybe a nap or two on the weekend. I don’t know whether my need is more physical, mental, or emotional, but I know it’s important to shift all systems into neutral in order to feel restored.

The irony is that I most need more rest when I least feel I can afford the time. Nonetheless, I am learning to tell myself the minute I feel I have to push myself, “You may need a nap!” 

https://www.livescience.com/52592-spooky-effects-sleep-deprivation.html

https://www.nhs.uk/live-well/sleep-and-tiredness/why-lack-of-sleep-is-bad-for-your-health/

https://www.cdc.gov/sleep/data_statistics.html

https://hbr.org/2006/10/sleep-deficit-the-performance-killer

https://pubs.niaaa.nih.gov/publications/arh25-2/101-109.htm

http://www.cooking2thrive.com/blog/wrap-it-up/

May 23, 2018

Travel Tip #20: Use a Travel Agent

Travel Tip #20: If you’re ready to book a much needed vacation, use a travel agent. No, I don’t mean a web based travel search engine, I mean a real person. I know it’s tempting to book everything online. I do it all the time, but if you’re truly needing a break, there are benefits to having a knowledgable professional with good connections handle your travel plans.
travel agent
Planning a trip can be time consuming. If you’re already taxed from long hours, illness, or caregiving, that time can be better used for restorative activities like sleep, walking in the park or on the beach, yoga, or visits with friends. Using a professional will give you access to options you may never have considered. And if you run into a problem during your trip, a travel agent can find a solution while you relax. And that’s the key — relaxing.

Believe it or not, there are still thousands of travel agents in the US. The Bureau of Labor & Statistics listed 81,700 in 2016. Some agencies are available 24 hours per day (just like the internet) and many offer agents who speak foreign languages. A well-matched professional will offer a level of service technology just can’t duplicate.

I’m pretty independent and I don’t enjoy hiring a company that I have to beg to be responsive or do a good job. Because of that, I’m often tempted to just do things myself. I’m not kidding. I’ve cut my own hair, repaired my toilet, sold my house, repaired my washing machine, and other things I don’t know how to do. I suppose my get-it-done determination has some advantages, but it has some drawbacks as well.

Doing it myself can sometimes be the one thing that puts me past the point of exhaustion. It can be the thing that interrupts a project that’s more important. It can be the thing that keeps me from feeling that great feeling of being taken care of. I was recently reminded of that feeling when I hired a childhood friend to sell my cousin’s farm.

I thought it would take months to move that thing. The top part of the 109 acres was rocky and unusable. There’s no road through the property, no fences, and scrub trees have been running amok for a few years. I was very, very wrong. My friend sold it in a week for the price we wanted. Then, she gave me a gift certificate to my favorite store in that town. The whole thing felt great!

Last summer, I wanted to take a week off. I freed up the time, but ended up staying home. Planning a trip was more than I could muster. Did I know I could use a travel agent? Yes, I’ve had wonderful experiences using them before. The thing is, I sometimes make things harder than they could be. It’s not my best habit.

In the past two days, I’ve hired 3 new people to help me while I split my time between work, landlord, and caregiving duties. Next up, a vacation — time to call a travel agent!

https://www.theatlantic.com/business/archive/2016/06/travel-agent/488282/

https://www.bls.gov/ooh/sales/travel-agents.htm

http://www.cooking2thrive.com/blog/travel-tip-19-pack-light/

May 16, 2018

Feeding An Infant With Down Syndrome Can Require Tough Choices

Feeding an infant with Down Syndrome can require tough choices. I’m writing this post between trips to the hospital to see my new granddaughter, EM, and taking care of her 22-month-old brother, DJ. EM was born on April 24 and had her first heart surgery May 1. She’s currently living in CVICU trying to learn to eat from a bottle while struggling with oxygen levels and respiratory rates the doctors can’t quite regulate. Alongside the significant medical events, the fact that she has Down Syndrome feels somewhat like an afterthought.
room
There’s so much equipment, so much beeping, and such a high level of activity in EM’s room, it’s impossible to simulate the typical newborn experience. Soft soothing sounds, cuddling, and nursing are often limited, sometimes impossible. Everything is geared toward surviving.

Critical to survival outside the hospital is EM’s ability to take in nutrition. Right now she is being fed breast milk through a feeding tube. Twice a day, she attempts to nurse from a bottle. We’re lucky. Her sucking instinct is still strong, but a side effect of the surgery was damage to her vocal cords and now she cannot swallow breast milk. She needs something thicker.
feeding
If you’re interested in healthy eating, good nutrition, and real food, you probably agree with the American Academy of Pediatrics that breast milk is superior in providing nutrients for rapidly developing bodies and minds. A child with Down Syndrome already has some obstacles, so superior nutrition seems especially important for EM.

The problem is, how do you prioritize getting breast milk and being able to swallow? It seems like the intuitive idea is to thicken breast milk with some natural substance. You’ll find this idea promoted on plenty of websites.

As it turns out, thickening breast milk safely and effectively isn’t as easy as it sounds and our doctor doesn’t feel comfortable with any of the thickeners available on the market. There’s a lack of data showing gel and gum thickeners are safe for use in infants. At least one of these products has been associated with necrotizing enterocolitis, a bacterial infection of the intestine which can cause death of intestinal tissue possibly leading to blood poisoning (1).

Some web forums will recommend thickening breast milk with rice cereal or oatmeal. This may work for feeding through a G tube (feeding tube), but is impractical for nipple feeding in an infant with difficulty swallowing. The enzymes in the breast milk quickly break down the cereal. These infants eat slowly. The purpose of using cereal to thicken is defeated soon after a feeding begins.

What that means for babies like EM, is they must rely on formula thickened with rice cereal or oatmeal. Our occupational therapists use rice. They conducted a swallow study through which they determined the consistency of nectar is EM’s best option. I have no idea how to describe the consistency of nectar, but they’ve converted that to mathematical ratios so we’ll know how to create it.

If you have a baby with Down Syndrome and difficulty swallowing, you may have some difficult decisions to make. Will you switch to thickened formula and supplement with a few drops of breast milk each day to provide antibodies while working toward the possibility of breast milk alone? Will you give up pumping and switch to thickened formula until you can begin solids? Will you thicken with rice cereal or oatmeal? Will you try to stay in the hospital longer to see if feeding can progress or will you accept a G tube and/or portable oxygen to go home sooner?

It’s a tough spot to be in. All you want is to provide the best possible nourishment for your child so he/she can develop and you can’t use the most nutritional food available because the baby can’t swallow it. And there are other considerations.

Research has shown a higher incidence of Celiac Disease in patients with Down Syndrome than in the general population — possibly as high as 18.6% as compared to 1%. Currently, the US does not screen infants with Down Syndrome for Celiac Disease, and thickening formula with oatmeal could be harmful to a baby with undiagnosed celiac disease.
formula
The issues don’t end there. Rice cereal may contain arsenic. Some brands of formula have ingredients like soy or gums including carrageenan which is banned from infant formula in Europe per recommendations from the World Health Organization and the United Nations.

With my children, I was adamant about only feeding breast milk for the first 6 months and then introducing foods one at a time. I felt really strongly about it. As it turned out, this process helped us quickly determine that each of them had an allergy to cow’s milk. My middle grandson shares this allergy. None have suffered ill effects at length.

This is often not the case. Many children endure sneezing, coughing, congestion, swelling, nausea, vomiting, dizziness, tummy pain, rashes, or diarrhea for months or years due to food sensitivities. It can be difficult to pin down the culprit.

Of course we don’t want any of these complications for an already vulnerable infant, but we have to keep things in perspective. If a baby has congenital aortic valve stenosis, immediate surgery may be required. Although surgery will interrupt feeding, it will only be recommended in order to save the baby’s life. If that surgery leads to extra difficulty with bottles if is unfortunate, but choosing feeding over surgery makes no sense.

Babies with other common heart defects associated with Down Syndrome will tire easily when nursing and may have to be fed more frequently. Some of these babies will have surgery when they’re a few months old. This can help endurance, but may detrimentally affect swallowing. Still, surgery is a better option than the extreme fatigue experienced without it.

Not every baby born with Down Syndrome will need heart surgery, but most will have less neck and muscle control than other babies. They may also have a thicker tongue. This combination can make eating difficult. Breastfeeding may be possible although proper latching may take some time and patience.

Bottle feeding poses similar latching problems, but has the advantage of a variety of nipple options and the possibility of dispensing thickened formula if your baby tends to aspirate breast milk. A swallow study may be needed to determine the best solution.

The overall goal has to be getting nutrition into the baby’s system. If we do not accomplish that, it doesn’t matter what we’re feeding. When EM can finish a tiny 10 ml bottle, it feels like such a triumph that it’s hard to be upset by the fact that there’s formula and rice cereal in it.

Sometimes reasonable, healthy goals don’t line up with available options. This can be frustrating and difficult to accept, especially if we’re planners. Remaining a flexible advocate for your baby when presented with difficult choices requires courage, character, and grace. It is not easy, but it is important.

1)https://well.blogs.nytimes.com/2013/02/04/warning-too-late-for-some-babies/

https://medical-dictionary.thefreedictionary.com/necrotizing+enterocolitis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5535317/

https://www.ncbi.nlm.nih.gov/books/NBK52687/

https://www.ndss.org/resources/the-heart-down-syndrome/

May 8, 2018

It’s Strawberry Season, Now What’s a Shortcake?

It’s strawberry season, now what’s a shortcake?

The farmers market in my neighborhood just opened for the season with a strawberry festival. I love strawberries! As a child, I picked tiny wild ones from my great aunt’s yard. Now I enjoy medium sized locally grown or gigantic shipped-in berries. My favorite way to eat them is right off the stem, but strawberry shortcake makes me happy as well.
strawberries
My grandmother and mother called traditional pie crust sprinkled with sugar shortcake. Thin, flaky, and crisp, it played well against partially mashed, sweetened strawberries and whipped cream. There’s a restaurant in my area that serves this style of shortcake two layers tall. It is divine!

I can’t say crust-based strawberry shortcake is widely known. My grandmother’s house, my mother’s house, and that one restaurant are the only places I’ve eaten it. I suppose in the strictest sense, sweetened crust fits one of the original requirements of shortcake in that it contains fat that has been cut into the flour. The only problem is that it’s not really a cake.

But is shortcake really cake or is it a scone or biscuit? The first recipe for shortcake appeared in an English cookbook in 1588, but I don’t know what it said. That makes it difficult to determine exactly what sort of crumb it had.

A quick scroll through several culinary guides failed to find mention of shortcake. Shortbread is often included, but not shortcake. Perhaps that’s because there are too many versions to narrow down a definition. Or perhaps it’s because perfectly ripened strawberries sweetened and topped with whipped cream are so good they don’t really need any sort of biscuit, cake, or crust. Anything that absorbs and delivers that scrumptious juice will be appreciated and well received.

When shortcake is mentioned in culinary articles, it is often differentiated from sponge cake. This is sort of amusing because I’ve probably been served strawberry shortcake made with sponge cake more often than any other kind.

So what’s a shortcake? Whatever vehicle you prefer to deliver sweetened strawberries and whipped cream. Most of us probably gravitate to the version of shortcake that is most familiar. I prefer pie crust to squishy cake. I’ll take a sweetened biscuit in a pinch. You may prefer a butter-rich cake or corn muffin.

Whatever you place it on, a combination of fresh strawberries and cream sweetened or not, whipped or not, will provide a delicious summer treat!

https://en.wikipedia.org/wiki/Shortcake
http://bakingbites.com/2009/09/what-is-a-shortcake/
http://www.cookthink.com/reference/1990/What_is_shortcake