Heads Up for Fall 2012 Workshops ...

Hello, dear readers! I know it's early for fall photos but I want to give you a heads up about two great workshops I'll be offering in greater Vancouver this fall. Do mark your calendars now and, when I return from vacation in early August, I will have registration forms available for everyone who would like to attend.

1.  Caring On Empty: Creative Tools for Compassion Fatigue Transformation & Resilience - A Workshop for Family Caregivers, Foster Parents & Home Share Providers

This is a one-day special version of Caring On Empty for those of you who provide care in your home for family members or others. (Also welcome are family caregivers whose care recipients are currently living in a facility.) 

Date:  Friday, October 19, 2012  9:00 - 3:30

Location:  Accent Inn - Burnaby (1 blk south of Lougheed and Boundary)

Cost:  $139  (Includes HST, beverage breaks, lunch, handouts & book draw)

2.  The Enneagram for Everyone: An Introduction for Beginners

This entertaining and informative 1 1/2 day workshop will introduce the Enneagram (see the description on the column to the left) to adults interested in an adventure of self-discovery, an adventure that can lead to greater self acceptance, understanding and acceptance of others, compassion for others' world views, and a direction for your personal growth.

The workshop will help you identify your personality type and begin a personal growth plan that will expand and enrich your self care.

(**Note:  This fall, in response to requests to include friends or family in the workshop, this workshop will be free-standing, without the prerequisite of a Caring On Empty workshop).

Date:  Friday November 16   7:00 - 9:00 pm  - and -

                     Saturday November 17   9:00 - 4:00

Location:  Accent Inn - Burnaby  (1 blk south of Lougheed and Boundary)

Cost: $ 179  (Includes HST, beverage breaks, lunch Saturday, handouts and text)

3.  For those waiting for the next Caring On Empty Workshop for Helping Professionals, I will be experimenting, this fall, with offering the workshop through Jack Hirose and Associates.

The workshop will be held at Kwantlen Polytechnic University, Richmond, BC, on Friday December 7th.   Registration is through Jack Hirose and Associates.

That's it for now. I hope you all find a way to enjoy a restful and refreshing break this summer. More workshop information on my return from Ontario in the first full week in August.

    

Life After Long Term Caregiving ...

Had my husband not died, this past Friday would have been our twenty-seventh wedding anniversary. It is almost eight years since his death and, although I had been feeling twinges of sadness for several days, I woke on Friday morning feeling mellow and happy.

The sun was shining and the air was cool and fresh and I rose early, gathering my journal and market bags, (and my ubiquitous green smoothie) and headed out to the Granville Island Public Market, for many years a favourite "day-off" place to visit.

I sat at "our" round wooden table with a large cup of tea and a toasted blueberry scrumpet (once shared, but now left half finished) and browsed through copies of Common Ground and the Georgia Straight. In my imagination, Derrick sat across from me, suntanned grey head bent over his book until something sparked his interest and he looked up, blue eyes shining with curiosity, to ask, "What do you think about this ...?". It's those moments that I miss the most. The times of shared ideas, interests and excitement.


After a while, I bought a second cup of tea and began to read my journal. It was good to look back and to see how far I'd come since the exhausted, bereft days after Derrick's death. Some of my anniversary entries were achingly sad and others, blazingly angry or scared, but Friday's note had more nuance, more complexity, more integration, a weaving of good and bad memories peppered with goodly amounts of forgiveness - both for him and for myself. I have grown and changed beyond measure through seven years of care-partnering and eight years of recovery and, while I would never wish the long term caregiving journey upon anyone, I am grateful for the "new me" and the things I have learned.

I believe we err in thinking that the caregiving journey ends with the death of our loved one. There is another important phase in the journey, a phase of recovery and the creation of a new life. This phase often takes longer than we might expect. (As I've written elsewhere, a wise acquaintance once said that it would be five years before I truly knew who I was without Derrick and she was correct, almost to the day.)

The length and the quality of this last phase of caregiving is different for each of us, of course, but there are commonalities in the experience - layers of profound grief, loneliness, the slow healing of compassion fatigue and burnout, rebuilding our physical wellness, the Rip Van Winkle syndrome, learning new roles and responsibilities, becoming financially secure, rebuilding a leisure life, learning to trust ourselves and our strengths in new areas of life. As we work through each step (often several times) we become not just well, but weller than well. (ie Not only returned to our pre-caregiving state but having developed new talents, new effectiveness, new strengths, new horizons.)

Because I believe this recovery phase of family caregiving is so important, I will begin a series of posts on life after long term caregiving in August, when I return from vacation. Watch this space for the first post sometime in mid-August.

Six New Articles of Interest ...

Hi Everyone! I've been perusing the internet this week and have come across some articles I think will be of interest to any one of us who cares for others, whether professionally or personally.

The first of these is a wonderfully well written report on young caregivers created by three UBC researchers for the Vanier Institute of the Family. Entitled, Young Carers in Canada: The Hidden Costs  and Benefits of Young Caregiving, this article explores topics including the incidence of young caregiving in Canada, the exceptional nature of the work, the age range of young carers, the ways in which early caregiving can disrupt "normal" development, factors that mediate the young carers' experience, the consequences of early caregiving, ways of supporting young carers and their families, and the need for public policy to respond to their plight.

The second article, Doctor and Patient: Can Doctors Learn Empathy?, was published in the New York Times blog. It cites new research on empathy training for resident physicians and finds that physicians like other helping professionals can, of course, learn empathic responsiveness.

A third piece, When It's the Nurse Who Needs Looking After, also from the New York Times blog, speaks of the extraordinary financial consequences of nurses' stress on the American health care system.

Fourth, is a thought-provoking Wall Street Journal interview, The Medication Generation, with Katherine Sharpe, author of Coming of Age on Zoloft,  about the long term effects of antidepressant use on adolescents.

A fifth article, from the New York Times, written by a health psychologist from SickKids in Toronto, focuses on the accumulated grief of physicians and it's impacts on patient care and on the physician's life and family.  When Doctors Grieve cites a recent study of oncologists' responses to patient loss in the Archives of Internal Medicine.

And, finally, an article on exercise prescriptions from healthzone.ca, Physicians Turn to Exercise Prescriptions to Prevent and Treat Chronic Conditions, caught my eye. It's emphasis on reducing symptoms and risk factors through exercise rather than medication, and its link to Toronto's Dr Mike Evans' new-to-me website, My Favourite Medicine, made it worth the read.

May these articles stimulate new thoughts and discussions as we move through the summer whether we're reading in a hammock by the lake, riding the Skytrain to work, or relaxing on the deck with a cup of iced tea. Cheers!

Summer Reading List 2012 ...

So summer's finally here - though in BC, with the coldest, rainiest June in memory, it might be hard to recognize! We can look forward to better days, though - sunny days at the beach, at the cottage, hiking in the mountains, or resting on the back deck, hopefully with a new book or an old favourite close at hand.

I'm a true traditionalist when it comes to reading. I want a comfortable chair, a good cup of tea or a cold drink, classical music playing softly in the background and a real book in my hands. Talk about a relaxation response!

I will be doing a lot of writing and research for writing this summer but, between projects and during my three weeks away from work, I'm planning to immerse myself in a number of exciting new books. My good friend, Janet, and I will  choose a book to share at their cottage in northern Ontario but otherwise I intend to enjoy a really eclectic mix, most of them published over the last year.

Here's my list - I'm hoping you might enjoy some of them, too. If you have read any of these titles or have others you think the rest of us might enjoy, why not post a comment to let us know your thoughts?

1. Quiet: The Power of Introverts in a World That Can't Stop Talking by Susan Cain.

More than half of Canadians are introverts (a significant difference between us and our neighbours to the South where extraversion reigns supreme). Introverts are not necessarily shy people, rather, they are those who, when depleted, prefer to refresh by withdrawing alone to their rich inner worlds of impressions, ideas and feelings. Extraverts, on the other hand, are rejuvenated by interacting with the outer world of conversation, relationships and activities. (Understanding this difference has made a tremendous difference to the health and wellness of many a partnership!)

In, Quiet, Susan Cain, an American, puts introversion under a microscope, pointing out the hidden strengths of introverts and their potential contributions to and difficulties with current organizational strategies, identifying "successful" introverts, and suggesting how to better negotiate introvert-extravert differences. I've been waiting for this book for years! I hope it will help folk to understand, among other things, why the repeated, well-meaning intrusions of helping professionals into the homes of introverted family caregivers and their care recipients can be so terribly depleting.

2.  Calm Kids: Help Children Relax with Mindful Activities by Lorraine Murray.

This little book looks to be a very practical, hands-on guide to helping children recognize and cope with stress and tension. Lorraine Murray, a meditation and relaxation teacher and the managing director of a Scottish holistic health company called, Feel Good Therapies, offers simple explanations of meditation and stress, teaching tips, and age-specific exercises to use with kids. She also offers specific discussions of meditation for children with ADHD and autism spectrum disorder.

3.  Tiny Homes: Simple Shelter by Lloyd Kahn.

I can hardly wait to read this one - in fact, I skimmed much of it at Granville Market over a latte before I even got home from the bookstore! I've always been fascinated with the idea of simplifying sufficiently to live comfortably in a very small space. (This interest was fuelled by a 6 month adventure spent travelling 23,000 miles around North America in an ingeniously-outfitted Volkswagen van in the mid-1970's.)

My dream, now, as I get a little older, is to build a tiny home on half an acre of wilderness somewhere not-too-far from Vancouver. The dream may never come to fruition but books like this collection of homes under 500 square feet can literally make my toes curl in anticipation.

4.  A Lady Cyclist's Guide to Kashgar by Suzanne Joinson.

Described as, "a tale of two journeys - two sisters embark on a bicycle trip on the Silk Road in 1923; a present-day Londoner befriends a homeless Yemeni man"( LA Times) and reviewed, thus, by Sara Wheeler of the New York Times Book Review, - 

" ... The dramatic opening of Suzanne Joinson's thrilling and densely plotted first novel offers only a suggestion of the tumult to come ... Joinson, who has herself travelled widely on behalf of the British council, controls her narrative with skill: this is an impressive debut, its prose as lucid and deep as a mountain lake ... Through Frieda and Eva and their companions, she explores notions of freedom, rootlessness, dislocation."

- this novel looks like the beginning of a great career for a new novelist.

5.  Freedom From Pain: Discover Your Body's Power to Overcome Physical Pain by Peter Levine and Maggie Phillips.

I am a great admirer of Peter Levine's contributions to our understanding of trauma healing. In this new book, he partners with pain specialist, Maggie Phillips, to offer a process for addressing unresolved emotional trauma held within the body, trauma that underlies much of our chronic pain. 

This book includes a CD of guided practices for healing, in addition to chapters on suffering, neutralizing factors causing chronic pain, the journey back from unmanageable pain, preventing and resolving the pain of medical trauma, and resilience, continued recovery and restoring the deep self.

6.  The Kaleidescope by Gail Bowen.

This is the thirteenth of the Canadian mystery series about, Joanne Kilborne, once a police officer, then a political commentator, and now a retiring political science lecturer at a Regina university. She is smart, direct, emotionally honest and struggles with all the issues that plague any working mom (and a few besides) so if you're looking for a new-to-you mystery series to start at the cottage, I would highly recommend this one.

7.  The Book of Kale: The Easy-to-Grow Superfood, 80+ Recipes  by Sharon Hanna.

I love and use kale, one of the world's most nutrient-dense foods, in just about any form but this new cookbook takes the eating of this superfood to a whole new level - kale chips, kale and potato torta, scalloped kale with browned butter and sage - mmm-mmmmm! Sharon Hanna not only offers 80+ recipes, she gives directions for growing kale organically, and for teaching kids to love to eat it (- a challenge for many mom's of kids who "don't like vegetables" but not for Hanna who has spent many years as an award-winning coordinator of an inner-city school garden program.) 

8.  Wild Hope: On the Front Lines of Conservation Success by Andrew Balmford.

At last, a collection of encouraging stories about our efforts to protect the natural world. While it is important to continue to assess the areas in which we are failing, I am grateful to my young friend, Alie, (currently collecting Master's thesis data on orangutan conservation in the forests of Borneau), for her reminder that we sometimes need hopeful stories in order  to fuel our continuing efforts. This looks like a book that will fuel many to continue their work and, perhaps, motivate others to begin.

So, there's my list. I hope that, no matter what you choose to read this summer, you will find refreshment and rejuvenation between the pages of a great book! Happy reading!

    

              

Recognizing Double-Duty Caregivers ...

Is this a picture of a helping professional or of a family caregiver? Both, you say? Then you're absolutely right. This is the picture of a double-duty caregiver (DDC), a helping professional who also cares for a family member or friend who is frail, mentally or physically ill, addicted or disabled.

Double-duty caregivers (DDC's), as you can imagine, are at increased risk for compassion fatigue. Most significantly, their primary and secondary trauma exposure is high, leaving them vulnerable to the posttraumatic stress, diminished empathy and emotional disengagement that comprise compassion fatigue. Additionally, they may work in depleting professional environments with inadequate staffing and resources and/or with insufficient human resource support for caregivers.

At home, these same helpers can experience the stress of being "on call" 24/7, of watching loved ones suffer and knowing better than most the meaning of that suffering, of being pulled in different directions by conflicting personal and professional roles, of being expected to take over the bulk of at-home caregiving because they are "the professionals", and of having to make urgent caregiving decisions in situations where they may not have clinical expertise or appropriate resources.

As DDC's, many of us cope with our double-duty workloads by pushing ourselves to work harder. When we ignore the impact of double-duty caregiving in this way, we put our personal health and that of our personal and professional care recipients at risk.

Last weekend, I was invited to attend a national meeting of clinicians, educators, administrators and policy-makers interested in creating policy recommendations to support the needs of a discreet group of double-duty caregivers - healthcare professionals who also care for elderly family members.  It was wonderful to meet with such a diverse group of colleagues, colleagues with the power to effect change who obviously cared about the welfare of caregivers in general and DDC's in particular.

Although not the primary focus of our discussion, the workshop content reinforced my belief that compassion fatigue must be addressed at three major levels - individual, organizational and societal.

• First, we must remember that CF is, at its core, a trauma response incorporating primary and secondary trauma exposure. Individual trauma work is thus the core intervention for healing CF. 

• Secondly, organizations can do much to create DDC-friendly environments (with resultant reduction in sick time, long term disability claims and attrition, to say nothing of improved patient/client care). Educating all levels of the organization regarding compassion fatigue and double-duty caregiving and providing flexible scheduling, access to unpaid leaves, and access to adequate, caregiving-aware EFAP programs can go a long way toward easing the dis-stress of DDC's. Then, we need to create adequate staffing ratios and pools that will allow DDC's to take advantage of such supports. 

• And, thirdly, at a societal level, we need to recognize and value the significant contributions and sacrifices of all family caregivers, to advocate for their needs, and to provide adequate and flexible funding and services appropriate to individual needs. (eg Flexible respite care delivered by professional caregivers who have sufficient training to make assessments and deliver appropriate care while the DDC is away at work.)

When we work to make changes at all three levels, we positively affect the health and wellness of DDC's, both in the workplace and at home.

A Celebration of Gratitude ...

In daily life we must see that it is not happiness 

that makes us grateful,

but gratefulness that makes us happy.

Br David Steindl-Rast

Hi everyone! It is no secret that one of the themes of this blog is gratitude, gratitude as a means of balancing and offsetting the compassion fatigue and chronic sorrow of caregiving, and gratitude as a core value in life. 

So, imagine my pleasure in finding that  Sounds True, (the folk who offer recordings on music, health and healing, and spirituality that you find in many bookstores), and Gratefulness.org, (Br David Steindl-Rast and his worldwide network of folk "dedicated to gratefulness as the core inspiration for personal change, international cooperation, and sustainable activism in areas of universal concern"), are joining together to offer a FREE live video event from San Francisco on Saturday June 23rd.

A Celebration of Gratitude is a gathering of a diverse group of experts from differing cultures, nationalities, faith traditions and occupations joined together by a shared interest and belief in the power of gratitude. Some of the speakers, discussants and performers include:

• Brother David Steindl-Rast:  Founder of A Network for Grateful Living
• David Whyte: Poet and Author
• Angeles Arrien:  Author and Anthropologist
• Fritjof Capra:  Physicist
• Anthony Chavez:  Cesar Chavez Foundation
• Barrett Ersek:  Entrepeneur and CEO, Holganix (A bionutrient, organic lawn care products company)
• Dr James Gordon: The Centre for Mind Body Medicine
• Chungliang Al Huang:  Living Tao Foundation, Author, Philosopher, and Artist
• Michael Lerner, PhD:  President, Commonweal (Health & environmental institute running residential retreats for cancer patients)
• Joan Halifax:  Zen Buddhist Roshi, Ecologist, Civil Rights Activist
• WS Merwin:  Pulitzer Prize-Winning Poet Laureate
• Toni Powell:  Founder, 30daygratitudechallenge.com
• Emiliana Simon-Thomas, PhD:  Science Director, Greater Good Science Centre, UC Berkley
• Lynn Trojahn:  Philanthropist, Vice President of Advancement for ACCION (International microfinance)
• Dr Philip Watkins:  Gratitude Researcher
• Orland Bishop:  Community Activist and Social Change Innovator, Founder of Shade Tree Multicultural Foundation  (Pioneering approaches to urban truces and mentoring of at-risk youth)
• San Jose Taiko:  Japanese Drumming Troupe
• Lawrence Beaman:  Bass Baritone Vocalist
• Destiny Muhammad:  "Harpist from the Hood"
• Kai Hazelwood:  Ballet Dancer, Fitness Trainer, Choreographer, and Producer
• Dr Brenda Wade:  Psychologist, TV Host, and Author

You can register for this free video event at A Celebration of Gratitude and, if you are busy on June 23rd, you will be able to access an on-demand streaming edition a few days after the event. Enjoy!


  

Stand Up and Save Your Life ...

For many helpers, the day can pass without their posteriors ever touching a chair. For others, exactly the opposite is true; they sit in a chair all day long. And, for still others, the work of the first part of the day leaves them so exhausted that when they finish, (if they ever finish), all they can think about is having a nice, long, relaxing sit.

But, sitters beware! Research over the past five years indicates that sitting too long can have major health consequences, regardless the amount of exercise you get during your workout time. There is compelling evidence to show that we need to alter our sitting behaviour if we are to avoid weight gain, metabolic disorders, various cancers, cardiovascular disease and even early death.

In a 2009 editorial for the British Journal of Sports Medicine, N Owen et al reported:

Research, policy, and practice on physical activity and population health has focussed largely on increasing the time that adults spend doing moderate to vigorous intensity activities; 30 minutes a day is generally the target. However, recent evidence from biomarker studies and objective-measurement studies (and also from some prospective epidemiological studies) highlights the importance of focusing on the balance of light-intensity activities and sedentary behaviours - particularly the high volumes of time that adults in industrialized and developing countries spend sitting in their 15.5 "non-exercise" waking hours.

What does this mean, exactly? Well, basically, that we're sitting too much and need to find ways of reducing or breaking up prolonged sitting time. It means becoming aware of how much time we actually spend sitting (during transportation, at work, at home and in leisure time) and then discovering the most effective ways of shrinking that time.

It sounds easy, but I have to admit that, in spite of the research I've been doing to write this post,  I've just realized that I've spent the last hour and ten minutes sitting in front of the computer! (Excuse me while I get up and do a little walk about!)

Back again (and feeling much brighter and more alert).

So, let's start there - with the awareness bit. I challenge each of you to write down your sitting time in a log for a few days to see how much total time you spend sitting and which periods of the day need your attention most.  If you find you are spending most of your waking hours sitting, it's time to stand up and move to save your life!

Some great solutions for prolonged sitting are:


1.  Going NEAT. Dr James Levine, MD, PhD of the Mayo Clinic, recommends spending 10 minutes of each hour in "nonexercise activity thermogenesis" (NEAT). This means remembering to integrate nonexercise activity throughout your day - bending, turning, stretching, short walks. (eg  walking as you talk on the phone, delivering messages in person vs by email, standing and doing stretches 5-6 times throughout the day).

2.  Rethinking your notion of exercise to mean physical activity spread throughout the day rather than an hour of fitness at lunchtime.

3.  Shifting back and forth between sitting and standing. Doing either for too long will cause you problems. Try standing for a few activities for which you would normally sit.

4.  Trying to have walk and talk meetings instead of sitting around a boardroom table. Or taking care recipients out for a walk. Or booking respite so you can go for a walk on your own.

5.  Being active while you watch TV.  Only allowing yourself to watch TV while you're moving - ie tidying the room, marching on the spot, pacing, riding a stationary bike. Or, if this seems too much, try exercising during commercials to begin with.

6.  Interrupting craft and hobby times for 10 minutes activity every hour.

7.  Consider commuting by mass transit. It's not safe to exercise in the car, but you can do a lot of muscle clenching and relaxing and stretching while standing in the bus or Skytrain. You could also start parking several blocks from home and walking.

8.  Dancing while you sweep, vacuum or wash the dishes.

9.  Getting an adjustable workstation and anti-fatigue mat so you can move from sitting to standing and continue working.

10. Keeping a small water water receptacle with you as you work and walking (the long way round) to refill it as soon as it's empty.

12. Keeping a white board in your work area and standing up to use it for problem-solving or thinking through concepts or outlining a report.


These are just a few ideas. If you have other ways to add activity to your sedentary hours we would all love to hear them!