Alex Demetris is an illustrator, cartoonist and maker of comics. He completed an MA in Illustration in 2012, which resulted in a comic based on his family’s experience of coping with his father’s dementia: Dad’s Not All There Any More – A Comic About Dementia. Here he shares a little about the process of creating the comic and some of his pre-publication sketches (click to enlarge the images). Alex also co-authored Grandma’s Box of Memories: Helping Grandma to Remember. Continue reading
By Stephen Rath with Marcia Rath, certified Qigong instructors and writers of Qigong for Wellbeing in Dementia and Aging
The author Frank Herbert observed in Dune that when we ponder choices in the future we see doors, perhaps many; but when we peer into the past we see a long corridor. And so it seems with the journey that my wife, Marcia, and I took as we traveled through the corridor that led to the publication of Qigong for Wellbeing in Dementia and Aging. Continue reading
Ageing seems to be the only available way to live a long life (Daniel Auber). In fact, some would say that the business of ‘getting older’ brings so many benefits that we should positively embrace it.
Ageing is certainly high on the current news and political agendas. As a nation, we’re heading for an unprecedented population shift towards older people. (The King’s Fund predicts that within 18 years, the number of 65-84 year-olds and those aged 85+ years will rise by 39% and a staggering 106%, respectively, whereas the number of people in the 15-64 year-old age group is set to increase by a paltry 7%).
The problem is, we don’t appear to be ageing very well. And this hampers our ability to see the benefits and enjoy the ‘golden years’. For too many people, mid- and later-life is dominated by the pain and disability of degenerative diseases like CVD, cancer and dementia. Recently, for example, Diabetes UK told us that 700+ people are diagnosed with diabetes every day.
So what, if anything, can be done? Is there a secret to healthy ageing?
Well, yes, there may be: it’s called anti-inflammation. As you age, you gradually become more predisposed to the type of low-grade yet chronic, insidious inflammation that promotes degeneration and disease. As the lifestyle medicine authority Dr Gary Egger describes in his paper ‘In search of a germ theory equivalent for chronic disease’, our environment has become increasingly more inflammatory since pre-Neolithic times. Pre-Neolithic individuals lived within a predominantly anti-inflammatory mileu of low calorie intake (compared to the level of energy expenditure), a low omega-6-to-omega-3 ratio and good levels of monounsaturated fats, fish, fibre, vegetables and nuts. In today’s environment, these are typically replaced with inflammatory triggers (‘anthropogens’) like pollution, endocrine disrupting chemicals, being sedentary, a high omega 6-to-omega 3 ratio, saturated and trans-fats, sleep deprivation, chronic stress, junk foods and obesity. Indeed, the medical journals are stuffed to the gills with scientific papers demonstrating that most, if not all, age-related chronic diseases are driven in part by inflammation. And this applies not only to classic inflammatory conditions like autoimmune arthritis, but also to Alzheimer’s disease, cardiovascular disease, diabetes, cancer, osteoporosis, depression and others.
Hence, the trick to a long, healthy life is to stay out of the ‘inflammazone’.
But, hang on, this isn’t necessarily as simple as it sounds. It’s not just about taking anti-inflammatories, whether pharmaceutical (like ibuprofen) or nutritional (like curcumin from turmeric), as these offer merely allopathic, ‘sticking plaster’ remedies. The only effective long-term approach is a systems-based one, in which the focus is on identifying the pattern of inflammatory antecedents, triggers and mediators that is unique to the individual in question.
By all means, remove Egger’s anthropogens from the environment, and reinstate the anti-inflammatory inputs of pre-Neolithic times. This is an excellent start. But look also at the functioning of the key body systems. For all body processes, when they are in a state of dysfunction, become drivers of inflammation. Microbial imbalances in the gut, for example, can cause gastrointestinal hyperpermeability and immune dysfunction, leading to systemic inflammation. Poor detoxification processes can lead to an accumulation of toxic, inflammatory metabolites. Failing mitochondria (the batteries of your cells) can leak electrons that cause free radical damage and inflammation. Problems with glucose and insulin control mechanisms can result in sugars attaching to proteins in the body (a process called glycation), damaging these proteins and triggering inflammation. Exhausted adrenal glands can fail to produce sufficient cortisol to moderate any over-reactive inflammatory responses. And so the list goes on…
And, let’s face it, all chronic diseases are foreshadowed by years of decline in one or more body systems. Alzheimer’s, for example, is preceded by years of elevated homocysteine levels (which may be inflammatory), indicating a problem with a biochemical process called methylation. Methylation is crucial to healthy ageing in the brain. In fact, elevated homocysteine is such a strong predictor of future cognitive decline that every ‘healthy ageing’ strategy should include a homocysteine check. If you find your blood level is elevated, you should work on your nutrition and lifestyle to get it down to 7-8.
Now, you might ask, where is the evidence that it’s possible to exert some control on this sinister type of inflammation, that is, that you really can take action to change the way you age?
The evidence lies in the fast-developing area of science known as epigenetics. In recent years, epigenetics has taught us that the rate at which you age (and your propensity to specific diseases) is not limited to how your parents and grandparents aged, what diseases they got and how long they lived. Rather, it is more to do with how your lifelong environment, essentially your diet and your lifestyle, is influencing the ways in which your genes behave, including which genes are switched on and off. (Only a small proportion of your genes are active (expressed) at any one time; and this is determined by the way you live your life.)
Of particular interest to healthy ageing is the discovery that environmental inputs (such as those proposed by Egger above) promote inflammation at an epigenetic level, that is, by directly increasing the expression of inflammatory genes. Environmental inputs can also down-regulate genes that produce energy; they can silence genes that supress tumour growth; and they can speed up the rate at which telomeres get shorter. (Telomeres are the physical ends of chromosomes on DNA; and they get shorter, the faster you are ageing.)
What’s really exciting is that scientists think that such changes to gene expression are likely reversible – meaning that we may have more control over our destiny than was previously thought.
Unsurprisingly, the search is now on for interventions that can reverse such harmful changes in gene expression – and thus slow down the ageing process. To date, the intervention with the most evidence is the practice of eating less than normal, either by restricting calories daily, or by fasting intermittently.
Certain special nutrients (‘epigenetic nutrients’) have also recently been discovered to mimic the healthy ageing effects of eating less. These nutrients are found in grape skins, green tea, turmeric and cruciferous vegetables, to name but a few. Some of them, however, are notoriously hard to absorb, so for a truly therapeutic effect, their dietary intake may need to be supplemented.
The best approach to healthy ageing, then, is one that promotes anti-inflammation, by preventing or even reversing harmful (epigenetic) changes to gene expression; and by optimizing the function of the key body systems. These ideas form the central theme of my recently published book Eat To Get Younger, (co-authored with colleague Christine Bailey). In it, we bring together the current thinking on the best changes to make for healthy ageing. Chapter topics include staying lean and preventing diabetes, supporting connective tissue health (skin, bones, gums, etc), keeping energised, making the most of your mind, memory and mood, staying as pain-free as possible, experiencing a trouble-free menopause transition, and keeping your digestive and immune systems in good working order.
The opening chapters explain exactly why fasting is better than eating little and often; and how you can set about eating less without feeling deprived. You can then pick which of the remaining chapters to focus on, depending on the areas of ageing that are of most concern you. Each of these chapters contains advice on why things can start to go awry as you age, and what you can do about it, with advice on diet, lifestyle and nutritional supplements. The advice is supported by references to relevant scientific studies. And, to make it truly practical, we’ve also included meal plans and over 100 recipes. Ultimately, the recommendations are designed to support your key biological systems, reducing your overall inflammatory load and preventing your genes from misbehaving.
Looking at the balance of the evidence, there is more reason now than ever before, to positively embrace the ageing process, for there is so much that can be done to support vigour and wellbeing into your later years. And, for anyone who’s concerned that living a clean life is boring, that it can all too easily cramp one’s style, I’ll venture the view that pain, disability, fatigue and low mood, not to mention the endless hospital appointments and repeat prescriptions – they sound pretty boring to me!
Lorraine Nicolle MSc is a nutrition practitioner with a regular clinic in London. She has developed and taught on undergraduate nutrition and health degree programmes at British universities, and currently teaches on two university-validated courses. She also works with a dietary supplement company, delivering nutrition education sessions for healthcare practitioners; and she runs workplace nutrition programmes for businesses. She is a recipient of the CAM Award. www.lorrainenicollenutrition.co.uk
This article was originally featured on Bite the Sun.
Niamh van Meines is a nurse practitioner, currently self employed as a nurse consultant. She is also a licensed massage therapist, and a skilled clinical leader and educator in oncology, homecare, hospice and palliative care. Together with Barbara Goldschmidt, she has written the new book, Comforting Touch in Dementia and End of Life Care: Take My Hand.
Here, Niamh explains why touch is so essential to care.
Can you tell us a bit about the paths that led you to massage therapy, and to its applications in integrative health and palliative care?
I was a homecare nurse and wanted to offer therapy that would be comforting to my patients in ways that nursing did not routinely provide care. While massage therapy is within the scope of practice for nurses, I did not feel prepared to perform massage effectively, especially with patients who had chronic and terminal illness. I decided to go to the Swedish Institute of Massage Therapy and my interest in incorporating massage into nursing practice came from there. There are multiple studies that show the beneficial effect of massage therapy on the symptoms associated with disease, so I believe massage can be utilized as a symptom management technique. This is very useful in palliative and hospice care where multiple therapies, treatments and modalities are used to alleviate the distress that patients experience.
How did the new book come about, and what is it about, generally?
Barbara asked me to join her in writing this book as she had developed the hand massage protocol and implemented it in a nursing home. My expertise in hospice and palliative care and perspective on providing comfort for patients through multiple avenues resulted in a wonderful collaboration with this book. We both had an interest in providing ways for caregivers to help and to feel that their efforts are effective in providing comfort, so teaching hand massage to caregivers is a great opportunity to change not only the patient’s experience, but also the caregiver’s experience too.
How does the book reflect your general philosophy about care?
I believe that caring for any person who is ill begins with compassion which can be delivered in many ways. Touch is one of the most fundamental ways to offer support and caring and is often underestimated or disregarded in healthcare settings. Touch is often mechanistic and task oriented, so teaching healthcare practitioners to incorporate hand massage redirects their actions to that of a caring activity, which also has an affect on their perspective on helping to “heal”. A hand massage is a wonderful, easy introduction to using touch. From a caregiver’s perspective, they often feel disconnected from the person who is ill or weary of touching them, so it’s a wonderful way to approach the ill person and provide care in a manner that is satisfying to the ill person and to the caregiver, and safe. The hands are the most logical place to start as it often is the first place that we touch when communicating with and meeting people for the first time.
What are the benefits of touch as a way of connecting with people, as opposed to other methods of communication?
Touch can convey so many things that other forms of communication do not. Touch can be directed in many ways. It can have a calming effect or a stimulating effect that can be tailored to the goals of the touch experience. The hands are one of the easiest ways to approach someone; merely by shaking hands, you can have a dramatic effect. Touch can be more powerful than other forms of communication especially when someone is sick. Touch directed in a caring way can have more meaning than words, which makes it a useful tool when teaching caregivers to express through touch what they cannot often express through words.
What are some common obstacles people encounter when trying to use hand massage?
Caregivers often feel inadequate or unprepared to do massage. They have fears of being awkward or ineffective. They are not sure if they are doing it right. The beauty though, is that any touch whether awkward or not, can positively influence the giver and receiver. People often have difficulty slowing down and paying attention to energetic influences. This also comes with practice, so people need encouragement to keep practicing and over time, how they feel about the massage will change.
How can the book help caregivers overcome this and other obstacles?
This book touches on many areas that most people do not think about, especially from an energetic perspective and from an eastern approach to touch. It teaches people about the simplicity of touch and how it can have a dramatic effect. We hope that the framework in the hand massage protocol allows people to take the first step towards incorporating massage into their everyday caregiving.
This book can be used as a guide to doing a hand massage protocol. We encourage caregivers to have the book with them when doing massage, so that they can reference the steps and view the illustrations. It can also be used as a teaching tool in a classroom setting.
What are some examples of best practice?
Best practices always put the receiver’s needs first. Safety and comfort are a priority, so the giver must ensure the receiver is not suffering or in distress before performing massage. We also encourage caregivers to discuss the use of massage with the healthcare team to obtain permission, but also to find out if there are cautions and contraindications to massage. Because the receivers often have significant illness, it’s always best to err on the side of caution and pay attention to the receivers reaction to massage. This is truly a client-centered approach. And lastly, don’t take it too seriously. Massage should be light-hearted and friendly, an experience to be enjoyed not just by the receiver, but by the giver too.
Copyright © Singing Dragon 2011.
By Barbara Goldschmidt, teacher, researcher, licensed massage therapist, and co-author with Niamh van Meines of Comforting Touch in Dementia and End of Life Care: Take My Hand.
My passion for integrative health care began 30 years ago, when I travelled to California to recuperate from a car accident. I was a seeker, looking for solace and a new path. Southern California offered warmth, reasonable rents, and ways of living that seemed open to many possibilities. It was commonplace there to focus on fitness, and easy to find gyms, yoga teachers, health food stores, and book shops filled with Eastern philosophy and self-help. Then there was the Pacific Ocean, like a big glittering mirror, reflecting who you were and at the same time inviting you to look deeper.
This was all very different from life in New York City at the time, where a focus on fitness was not so commonplace. In fact, friends on the East Coast often looked down on some of these pursuits. They’d ask, ‘Why is California like a breakfast cereal?’ Answer: Because it’s full of fruits, flakes and nuts! Maybe they thought it was foolish, but I felt I was finally becoming sensible.
During my seven years in Los Angles I completed my bachelor’s degree at UCLA, but my most meaningful studies were outside of traditional academia. I explored ‘alternative’ therapies, as they were called back then, because they were not part of the mainstream. Fortunately, I found reliable teachers who were masters in their field. I practiced yoga every day in Bikram Choudhury’s classes. Thanks to Jack Gray, whose energy work was studied by Dr. Thelma Moss at UCLA’s Parapsychology Lab, I learned how to direct my thoughts to help the healing process and to use my hands to do what Mr. Gray called ‘transfer of energy’. Dr. Grace Brunler demonstrated how she had used color light in her medical practice with her husband Oscar Brunler. With Jon Hofferman, a grad student from the UCLA film department, we made a short documentary about her work.
It was an exciting time, because it felt like a real movement in personal well-being was taking place. It wasn’t being led by doctors, but by ordinary people who were looking for more than symptom relief. They wanted therapies that were natural and non-toxic, and a way to be involved in the healing process. That was a key—becoming an active participant in wellness and illness instead of being a passive recipient of care. The quest for ways to be involved in the healing process, and for tangible ways to share it, became the continuing thread of my studies, writing and teaching.
When I moved back to New York City I wondered if I would be able to maintain the gentle practices I’d learned. As it turned out, I discovered deeper and more specific ways of practicing. With Catherine Shainberg, director of the School of Images, I studied body-centered imagery for many years. Dr. Shainberg doesn’t give answers, but leads students to the answers within themselves. My sessions with her led me to study massage therapy at the Swedish Institute, a college of health sciences in Manhattan. This allowed me to go from just writing about this field to becoming a practitioner.
After working for a few years as a licensed massage therapist, a desire for a more effective ways to engage with the body led me to Jeffrey C. Yuen and the study of Chinese medicine. I began to understand that energy, or Qi, infuses all of life, and that it is fundamental. Qi is our energetic program; it creates the body and directs our growth, development and everyday processes, including healing.
While I appreciate that there exists some controversy around the idea of Qi—it has no standard definition, it’s not readily visible, and can’t be quantified—I embrace its usefulness as teachers and practitioners have done through the ages. Directing Qi through the use of meridian points became the foundation of my practice, which often included teaching people to move their Qi from within through imagery.
Today, ‘alternative’ therapies are not just for Californians and even in New York City there are plenty of gyms, as well as stores selling organic food. Yoga, massage, meditation and acupuncture are now part of an integrative approach to cancer care, palliative care or chronic conditions in medical institutions around the world.
Comforting Touch for Dementia and End of Life Care: Take My Hand, is an integrative approach that will hopefully inspire people to explore touch as a way to share the radiant energy of their care. I was fortunate to have as co-author Niamh van Meines, who brought in her expertise and passion as a massage therapist and nurse practitioner working in hospice and palliative care. In the book, we introduce people to the idea that their touch involves the physical aspects of skin, muscles and bone; the energies of warmth, electromagnetism and Qi; and the inner quality, or spirit, which they bring to it. All will have beneficial effects for both the giver as well as the receiver. And in the spirit of integrative care, we encourage caregivers to become part of a team—whether with a doctor, nurse, social worker, psychologist, massage therapist, acupuncturist or pastoral advisor—so they will not feel alone, inhibited by initial awkwardness, or unnecessarily fearful.
I was happy when our book proposal was accepted by Jessica Kingsley Publishers, because they are so dedicated to the healing arts and to books that people can use to help one another. When Lisa Clark, our sponsoring editor, told us we would be part of the Singing Dragon imprint, it seemed especially fitting, because the energy of nature and the Eastern philosophy that teaches ways to engage with it have been a big part of my life. I hope that this book will be useful for the many people caring for someone with dementia or at the end of life, and that it will provide a meaningful way to discover both a tenderness and a power that we all have in common.
Copyright © Singing Dragon 2011.