Self Care for the Hospice Caregiver

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Taking care of someone with a terminal illness is overwhelming and exhausting. There is so much physical labor involved in caring for a hospice patient. Add to that the devastating grief insidiously creeps into your bones. Self-care is critical to your well-being as a caregiver. When you take care of yourself, you will be physically and emotionally healthy enough for the work of tending, loving, and caring for another human being. It will also help you to stay healthy, grounded, and kind. I wish I had been more cognizant of this when I cared for my mom during her battle with lung cancer. But I plowed through, did my best, and probably drank too much red wine. Here are some ideas to maintain your own health and wellness while increasing your capacity to be a compassionate caregiver.

During my time with my mom, I remember feeling so tired I wanted to cry. I took time off work, left my husband behind in Portland, and moved into my childhood home with my year-old son Jack. I remember one morning I put Jack down for his nap. Then I went straight to Mom’s room to help with her shower. When I got her safely back in bed, I told her I was going to check on Jack. I walked quietly into my childhood bedroom and lay down next to the playpen where he slept. As soon as my body started to relax, he uttered his only word… “Dada.” I silently cursed his dada, who was up in Portland…and not here to relieve me…I kept my eyes closed, pretending that if I could not see Jack, he could not see me. Jack started yelling and banging his damn binkies on the edge of the playpen, and my rest was officially over. I wanted to cry. 

Don’t go it alone.

The most important way to care for yourself is to ask for help. Ideally, set up a schedule to have others involved in the care of your loved one so you can anticipate your time off and plan outings. Caregiving is a 24/7 commitment. Even when the patient does not directly need you, there is still plenty to do. Keeping up with shopping, finances, cleaning, and trips to the pharmacy is an added load. People want to help, but sometimes they do not know what to do: You need to tell them specifically. This is an important aspect of self care for the caregiver.

I believed my way of caring for my mom was infinitely better than anyone else and therefore had a hard time leaving her side. And when I did leave, I felt guilty. I even skipped an important wedding, when my siblings could have easily tended to my mom. Over the years I have seen that caregiving inequity can lead to bitterness and resentment among family members, and it also deprives others of the gift of caring for a dying loved one (even if they don’t do it “perfectly”— ahem, “my way”). If you can step back and see this time as a gift for everyone, it may help you to share the load.

Make time to care for yourself.

Even if it’s just one hour a day, an afternoon a week, or maybe five days in a row. Alternate days with family members or friends so everyone gets an opportunity to care for your loved one, and everyone gets some space to breathe. Ideally, develop a daily practice that can help center you: breathing practices, yoga, naps, stretching, meditation, or walking in nature. Yoga and time in nature can increase your capacity for altruism. A daily meditation practice can foster equanimity and help you feel more centered and less reactive. Intentional breathwork can elicit the body’s relaxation response, which counters your fight-or-flight response. All good aspects of self care when you are a caregiver.

Connect with your family and friends.

It is easy to feel isolated when caring for someone you love. Connection is critical and allows your friends and family to steep in your reality, which often brings people closer. Invite your friends and family into your house and into your world. I always need another human to help me reposition a patient in bed, change a brief, or give a bath. When more people are involved in the care of your loved one, you will share stories, laughter, and tears. This is an important part of your grief journey and the integration of this loss. 

Utilize the hospice team.

Families often forget that the hospice team is there for the patient AND the family. While the nurse cannot provide medication for your anxiety (I have been asked many times), they can educate you about the disease process and medication management. This can help to minimize your anxiety as a caregiver. The social worker is an excellent resource for processing your grief and finding caregiving services, alternative living situations if needed, or financial resources for your loved one. The CNA can alleviate some of the physical burden by bathing your loved one 2-3 times a week. Getting the CNA involved in the patient’s care early on allows them to establish a relationship, which will increase the patient’s comfort. Hospice chaplains can help you process the murky mysterious questions and find meaning in this experience. 

All emotions are normal and ok.

It is easy to bottle up your emotions—especially anger and grief—because these feelings can catch you by surprise and leave you feeling out of control. When you start to feel overwhelmed by your emotions, take a little break. Finding a quiet place to sit with your emotions for even five minutes may help them to soften and subside a bit. Compassionately be with your emotions (“Oh, there you are again anger”; “Ooh, exhaustion, hi honey”). Take intentional breaths and imagine breathing into whatever body spaces these emotions are occupying. My emotions land in my throat and my jaw. When you give your emotions the time and attention they deserve, you may find you just need to take a walk, take a nap, or call a friend. If some emotions are a little too sticky, perhaps seek out a counselor or friend to process your feelings. You will be a more effective caregiver when you invest some time into self care.

Self care for the caregiver is NOT selfish!

The most important thing is to not feel guilty about caring for yourself at this time. When you feel rested and grounded, it will make you a much better, kinder, and more loving caregiver. We only get one shot at sending off our loved one; we want to do this with as much grace and compassion as possible. 

Beth Cavenaugh is a certified hospice and palliative care nurse and educator with over 14 years of experience in caring for terminally ill patients. She has been a registered nurse for over 24 years and holds a bachelor’s degree in nursing from Creighton University. Beth has supported hundreds of patients and their families at inpatient units, in the home setting, and behind the scenes in hospice care. Compassion, patient autonomy, and transparent communication are at the core of her care philosophy. Check out Beth’s book, Some Light at the End: An End-of-Life Guidebook for Patients and Their Caregivers.

You can also hear more from Beth on episode 118 of the Lindsey Elmore Show: Death, Grief, and the Legacy We Leave Behind.

Need a little emotional support? Check out this post for Essential Oils for Overcoming Grief.

Sugar: The Everyday Toxin

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Sugar is the everyday toxin. While we are constantly bombarded with messaging that sugar is bad for us, the reality is more severe. The truth is that sugar is likely the number one toxin human beings we consume.

Sugar is a carbohydrate that the body uses as fuel to make energy in our cells. All carbohydrate-containing foods are composed of some form of sugar, and many different types of sugars exist. These include glucose, maltose, lactose, fructose, and dextrose. Ultimately, the body converts all forms of carbohydrates into glucose, which is the primary fuel source for our cells. And the body will not differentiate if you are consuming “good” sugars (like fruits, vegetables, and grains), or “bad” sugars (like processed foods, sodas, candy, crackers, and baked goods). Ultimately, your body converts any form of sugar you consume into glucose.  

What’s the Big Deal About Sugar

Humans have thrived on sugar for centuries, and to an extent, sugar is essential for energy production in our cells, especially brain cells. Without a constant supply of glucose to the brain, one may not survive. So what is the big deal about sugar? We are consuming way too much of it. In fact, the average American eats 152 pounds of sugar annually. This is a stark rise from 1882 when we were eating just 6 pounds per capita. Just in the past 50 years alone, sugar consumption has tripled.

The reasons for our obsession with sugar are not surprising, given the highly addictive nature of sugar. The sweetness of sugar stimulates the reward pathways in the brain and has you coming back for more and more. In fact, research done by Serge H. Ahmed shows that the sweet taste is 8 times as addictive as cocaine. Rats offered IV cocaine versus sweetened water always chose the sugar. Furthermore, even previously cocaine-addicted rats switched to the sweetened water. If that’s not enough to confuse your sweet tooth, in a 2012 publication in Nature, “The Toxic Truth About Sugar”, Robert H. Lustig argues that sugar should be a controlled substance like alcohol and tobacco. 

The Long-Term Effects of Too Much Sugar

We have known for years that diets higher in sugar and carbohydrates increase one’s risk for metabolic disorders, like diabetes and metabolic syndrome. However, a wealth of research is now linking blood glucose levels with risks for brain-related disorders, including dementia. Research shows that type 2 diabetes doubles your risk of developing Alzheimer’s disease. The main focus of this research relates to the effects of higher carbohydrate consumption and particular areas of the brain involved in learning and memory, like the hippocampus and amygdala. Even higher normal fasting blood glucose (not even in the diabetic range), seems to be associated with atrophy of the hippocampus and amygdala.    

And it is not just glucose that is the culprit. Insulin, your fat-storage hormone involved in the transfer of glucose into the cells, plays a significant role as well. Particularly, deregulated brain signaling of insulin seems to be a key player in the pathogenesis of Alzheimer’s Disease. This deregulated signaling of insulin in the brain occurs once insulin resistance sets in. The higher carbohydrate and sugar consumption, the higher the risk for insulin resistance. Insulin resistance and ultimately diabetes are among the known risk factors for Alzheimer’s disease. Research also reveals how higher sugar diets change gene expression in the brain in ways that promote more cognitive decline. In particular, the expression of one of the most important growth factors involved in neuroplasticity, brain-derived neurotrophic factor (BDNF), seems to be reduced in the setting of higher sugar diets.

So, a combination of higher glucose concentrations, impaired insulin signaling in the brain, coupled with impaired gene expression of vital growth factors creates the perfect storm for brain atrophy and ultimately cognitive decline and frank dementia.

Practical Steps to Reduce Sugar

However, all is not lost! Now is the perfect time to make some easy, healthy swaps in your diet. First and foremost, get more knowledgeable about where sugar is hiding. Believe it or not, sugar masquerades in dozens of hidden places, from condiments, salad dressings, alcoholic beverages, and of course: carbohydrate-filled pasta, bread, crackers, and more. Eliminating processed foods will significantly reduce your consumption of hidden sugars. Your goal should be to eat a mostly plant-based diet, high in vegetables and fruits with some grains, fish, and organic, pasture-raised meats as condiments. Sticking to the 75/25 rule helps keep perspective on this. Fill 75% of your plate with colorful vegetables, while loading the remaining 25% with meat, fish, and grains. Also don’t forget to incorporate healthy fats throughout the day.  

Choosing the Right Carbs

Complex sugars that occur naturally in starchy vegetables, fruits, and whole grains are a wiser choice than simple sugars. Complex carbohydrates are higher in fiber, making them more slowly digested, with a slower and steadier release of insulin. Fiber is a superstar in and of itself too since it is beneficial for the microbiome or gut ecology. And a better microbiome equates to a better metabolism, less inflammation, and a better gut-brain connection. Lastly, complex carbohydrates are coupled with anti-oxidant and anti-inflammatory bioflavonoids and phytochemicals which synergistically help to optimize health and fight disease. 

But before you simply switch to artificial sweeteners — beware! As already reviewed, artificial sweeteners are highly addictive. On top of that, research suggests that even sugar alternatives increase your risk of obesity, diabetes, metabolic syndrome, and cardiovascular disease. And if that’s not enough, since these sugar alternatives are infinitely sweeter than actual sugar, they end up confusing your metabolism by revving up insulin production and release. Sound advice would be to avoid most artificial sweeteners. The one exception may be stevia which comes from the leaves of the stevia plant. However, you should use it sparingly. A little in your morning tea or coffee should be fine, but make sure to choose a product that is 100% stevia without any additives.  

So, while a treat here and there isn’t a disaster, to optimize your cognitive health for years to come, aim for a diet low in sugar and carbohydrates. However, think of sugar as a recreational drug. If you find it difficult to break habits, be judicious about your choices.   

I promise, there are plenty of healthy and delicious alternatives. Even better, your body and brain will thank you!

Learn More

Dr. Rana Mafee is dual board certified in Neurology and Integrative Medicine. She is passionate about using functional and integrative philosophies to prevent & reverse a host of chronic conditions. Dr. Mafee is particularly focused on helping patients work through neurodegenerative disorders. Head over to her website to learn more.

You can also catch her episode on the Lindsey Elmore Show, Understanding Cognitive Decline, here.

The Power of Preventive Medicine

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So many people think that their health will naturally decline as they age. While we can’t stop the process of aging, we can be proactive to prevent many health issues before they even occur. The truth is, the better we care for our bodies in our 20s, 30s and on, the fewer symptoms and conditions we’ll experience later in life. Often this includes finding a healthcare professional trained in preventive medicine. This is someone who can look at your risk factors and lifestyle, and environment, and guide you to making positive changes to prevent future illness.

The following is a post written by my friend and colleague, Dr. Tamyra Comeaux. Dr. Comeaux is an OB/GYN with a master’s degree in Holistic Nutrition and a medical degree in Naturopathic Medicine. She has a passion for preventive medicine and teaching people steps to improve their health and remove or reduce medicines and drugs. Come check out Dr. Comeaux’s episode on The Lindsey Elmore Show about Staying Younger Longer.

Don’t Wait for Symptoms

I saw a patient this week who came to see me for natural options to improve her bone loss. Seven years ago she had a bone density test and it was normal. Then four years later she had another test which revealed osteopenia (loss of bone but not yet osteoporosis). Then two years later, she had progressed to full blown osteoporosis. It was at this point that a physician offered her medication. She was not excited about taking a prescription medication. 

So what would’ve happened if seven years ago she had started a bone supportive regimen? 

She did not take calcium, magnesium, or vitamin D. If she were aware of a deficiency in any of these nutrients and had replaced them, would she have progressed from normal bone density to osteoporosis in seven years? Likely not.

This highlights why I am so interested in menopausal therapy. Things start evolving rapidly as we approach middle age. But if we stay ahead of the changes, it is exciting to see how can we avert some of the common pitfalls.

Once I diagnose a person with a particular condition I often think, “If I could have intervened 5 or 10 years ago with preventive medicine, would the patient have this condition today?” And very often the answer is “probably not!”

For example, suppose you knew you were going to get diabetes in 10 years. You could reduce your sugar intake and start using a glucose-regulating tea or supplement regularly. Would you still get diabetes in the same time frame, or at all? Maybe not.

As we age and go through menopause our cholesterol levels steadily increase. What if you ate a high fiber cereal or salmon regularly prior to menopause? 

I could go on and on!

Overcoming a Genetic Disposition with Preventive Medicine

With patients entering their 40s and 50s, we look for clues about what may happen as they get older. We look at the health histories of parents, older siblings or grandparents and use that knowledge in our preemptive planning. Beginning a preventive medicine approach early gives them the best chance of overcoming a genetic disposition to illness.

What commonly happens in the real world is that we don’t we don’t look for ways to prevent conditions. Instead, we just accept the fact that at some point we’ll end up on whatever medication is covered by our insurance plan. People often say to me, “It’s just genetic, everyone in my family had it, and that is my fate.” 

More than 100 types of genes may play a small role in a person’s risk for heart disease, but by far the biggest factor is lifestyle. Nowadays it is common for people to have access to their genetic information. So if you know that you have a gene for something, you can use that information to make a better plan and possibly avoid the expression of that genetic programming. Food is powerful information to your genes. Finding foods that work best for your body BEFORE you receive any type of diagnosis could be advantageous.

There are many things that we can do to alter our health path. How you take care of your genes is important. It is not always what you START doing that makes a difference in your aging pathway, but what you STOP doing. I often encourage my patients to evaluate their cosmetics, deodorant, cleaning products, and reduce their exposure to chemicals. 

And that is why I was drawn to taking care of the needs of menopausal women, because the list of things that is on the horizon gets longer and longer, and we do have options. Sadly, many women don’t find out what the options are until it is too late!

Once you start taking one medication, it does not stop you from ending up on several more. You never really found out WHY you needed the medication, did you? However, sometimes changing your diet and addressing your vitamin deficiencies can have an impact on how much money you will spend on prescriptions and medical procedures in the future.

Learn More

In my book, Menopause Essentials, The Ultimate guide to Optimal Aging, I examine many potential options and strategies to incorporate into your daily life that might help you deal with the pitfalls that can come with aging. Small actions done daily and over time can add up to create a longer health span. If you have not realized your full health potential, it is time to begin the journey!

Follow Dr. Comeaux on Instagram or Facebook @drcomeaux and @menopauseessentials, or on her website.

The book is available on Amazon and Growing Healthy Homes.

Want to learn more about preventive medicine and taking control of your health? Download this free eBook, 5 Steps to Take Control of Your Health.

4 Steps to a Healthy Mouth

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“Brush and floss twice a day. Rinse with a mouthwash to remove hidden debris.” We’ve heard a similar mantra for years, and yet, how do we really know if those steps truly prevent cavities, gum disease, and other issues of the mouth? It may be time to change your dental care routine to get a healthy mouth.

Stop Cleaning Your Mouth!

In toothpaste and mouthwash commercials, there is a huge push to “clean the mouth.” But harsh chemical ingredients like alcohol, artificial sugars, artificial colors, SLS, DEA, and fluoride can do more harm than good.

Detoxify the Mouth

Throughout the day, odor-causing bacteria can accumulate in the mouth. This build up is the biggest enemy of a healthy mouth.

Tongue scraping is a traditional Ayurvedic technique that cleans the tongue from the build up of bacteria, fungus, dead cells, and food debris. This technique detoxes the mouth, freshens breath and stimulates metabolism as well. Choose a scraper with a durable and bacteria-resistant copper material to last for long time.

Oil pulling with coconut oil also helps to pull away toxins, and can reduce gingivitis, and cavity-causing bacteria. Simply swish for 10-15 seconds and spit to remove toxins from the mouth.

Hydrate with green tea. The catechins in green tea reduce inflammation and bad bacteria in the mouth, leading to a healthier smile.

Essential oils can be a part of daily dental care routine. Apply essential oils, like diluted clove or peppermint, to the gums or choose an essential oil and activated charcoal imbedded dental floss.

Remineralize the Teeth

Demineralization occurs when the mineral content of the tooth enamel decreases. Demineralization softens enamel, leading to cavities down the line. Once the tooth is demineralized, it is easier for bacteria-laden plaques to penetrate into the center of the tooth where the sensitive root lives. Demineralization must occur before cavities can happen, so avoiding demineralization and using products that specifically remineralize teeth is ideal.

Bonus: A healthy, well-mineralized tooth is a more comfortable tooth. Brushing and flossing are easier, and the tooth has the satisfying smooth, slippery surface inside the mouth.

The primary cause of most tooth demineralization is sugary, acidic beverages. Limiting intake of sodas, juices, and sports drinks can help prevent losing precious minerals.

Brushing with a tooth powder with mineral-rich ingredients, like bentonite and kaolin clay and fulvic acid, allow you to apply minerals directly to the teeth, and have a mild abrasive polishing action as well.

Balance the Microbiome

Inside the mouth are more than 700 different species of bacteria, viruses, protozoa, and fungi. These microbiota play a commensal role in health, aiding in nutrient absorption and warding off harmful pathogens. But when the balance of microbes is off, plaques may form. These plaques meet every definition of a biofilm, and when further challenged by an overloaded or weakened immune system, it can affect both local and systemic health.

There is evidence that artificial sugars like aspartame, xylitol, sorbitol, and erithrytol alter the gut and/or oral microbiome. These common ingredients in toothpastes get mixed reviews. Some studies have shown that xylitol can inhibit bacterial adhesion to the surface of the tooth, but there is also evidence that gut bacteria is significantly altered. Sorbitol alters mouth levels of streptococcus, so it is best to avoid.

Most importantly to the microbiome balance is that you need to avoid mouthwash. The high alcohol content is too harsh on the microbiome and can lead to imbalances.

To optimize the microbial balance in the mouth, avoid:

  • SLS
  • DEA
  • Fluoride
  • Triclosan
  • Microplastics
  • Artificial colors and dyes
  • Artificial sugars, and
  • Mouthwash

Focus too on getting a diverse mix of probiotics and prebiotics in the diet, staying hydrated, breathing through the nose, and keeping the mouth closed while sleeping.

Alkalinize for a Healthy Mouth

Many tooth products don’t take into account the pH level of the product. This is not good because the normal pH of a healthy mouth is similar to water or blood (about 7.4). If pH drops below 5.5, teeth start to demineralize.

Once again, we see sugary, acidic beverages as the primary cause of high acid (e.g. low pH) in the mouth. If you have to drink juice or soda, be strategic. Consuming the entire beverage in one limited-time sitting is better that sipping slowly throughout the day.

Check of some of my favorite dental care products in this post, or makeover your entire dental routine with this easy kit.