Dementia and A Call To Return To The Village

When my dad was at his worst, I was desperate for friends and family. I moved back to El Paso on two occasions to try to help him, but mostly provide respite for my mom who was his main caretaker for 13 years at that time. I was proud, too proud, a trait carried on from the women in my family, so asking for help or assistance was not in my operating system. My mom wasn’t asking for help either, we felt we could carry the burden forever.

Until we couldn’t. The second return back home showed me how badly my dad needed outside help. That is when I began to write, vigorously, in journals, on this site, on the socials. I realized my need for others was greater than my pride and suffering alone. The moment I reached out, my village found me. I was helped on all sides. If we had an issue with the VA, experts told me step by step what to do to solve my problem. If he ran away, I posted on FB and called out to my police officer cousin to send out the troops. When he became manic, my mom’s neighbor called me up and told me that it was time to give up care and find a safe place for him and my momma. The village ran to our rescue, time and time again and it brings me to tears in gratitude, knowing they saved us.

Dementia is an interesting monster. In someways, I feel the person with the disease intends to forget their demons. In the case of dementia or at least in my dad’s case, his illness was more for us. It was for me to learn how to let go of pride, to be vulnerable and allow others to render aid. For my momma, I know the lessons were vast, but she can tell her story when she’s ready.

What I also learned is that I need others. That it truly takes a village, for any and all circumstances. My friends, family, strangers in person and online allowed me to find peace in company and it provided a sense of community that I now work so hard to establish wherever I go. My dad was like that, he was the community builder of each and every connection. In Chicago, we would host parties and gatherings all the time. When we moved to El Paso, they were less frequent, but he still always loved a good time among people.

A month after he passed, the meeting I was hosting went on, though I couldn’t be there. I wrote a letter to the attendees, doctors, medical students, nurses, PAs, PTs, energy workers, healers all types who came together and ate, drank and shared stories. I heard it was great. Here is part of the letter that my co-host Melisa read:

“Community as medicine, that’s my passion these days, that’s why I told James Maskell I would start this meet-up in Austin. My dads sole purpose and proudest days were spent working as a medical social worker in Chicago coordinating care that included doctors, nurses, home health aides, dieticians, physical therapists and other modalities coming together for the benefit of the patient. This is what I hope to accomplish with our group, creating a cadre of like-minded professionals who connect, consult, share best practices, refer and build relationships for the benefit of our patients. Reach out to the stranger next to you, learn stories, exchange information and find out how you can help each other and your patients.”

I’ve always been fascinated with Redwood Trees. They are the tallest known species of tree in the world and can grow up to 350 feet, some historically even taller. Redwoods, born of resilience, have a strong line of defense against disease and fire. They stand strongly from a few hundred years up to 2,000 years. The most amazing part about them and perhaps the reason they resonate so loudly with me, is their roots. Their root system can extend outward up to 100 feet, creating connections with their brothers and sisters around the forest, making them stronger, more resilient and ready to take on the world sharing it’s magnificent and powerful glory along the way.

Let’s take a cue from nature on this one. And from the disease that will take over in less than a couple decades. I believe that my dad’s Alzheimer’s disease was a call to return to the village. If we had a community, if more than our two neighbors knew him, his disease, his inclinations and how to keep him safe, it would have saved us so much pain and heartache. I see it all around me, I see my friends, my patients, their suffering, they’re inability to understand this terrible disease and their need for community.

But above that, we need community, connection and compassion now more than ever. We need to get out of our comfort zone and turn off our pride and really get to know each other. Have peaceful and open conversations about the future, our fears and our vulnerabilities. Like I said in my letter to that man who sits in the president chair, “In fact the immigrants from all parts of the world that you speak of are actually the kindest, most compassionate, salt of the earth folks that I have had the pleasure of working with and treating. Actually, most patients, immigrants and American-born, have this disposition. They are all human beings and when you peel back their skin, they want the exact same that everyone else on this planet wants, love, validation and a chance to make a life for themselves and their family.”

I believe with my entire heart this can be done with acceptance, compassion, community and allowing our roots to reach out to those around us, carrying us through the flood, the fire and overwhelming fear into the love and the light.

Good Girl Gut

We know you well, good girl gut. It’s the gut that took us through our pre-teens full of belly aches galore. The one that had you under chronic care of a doctor who called it ‘functional abdominal pain’ and pumped you full of reflux drugs and maybe some pain medicine. It’s the reason I stayed home almost every Monday from school, for my otherwise symptomless belly pain.

For many of us it was abdominal pain. For others it was nail biting, hair picking, throat clearing, super acne, teeth grinding. Some manifested throat issues early on, thyroid, chronic tonsillitis, strep throat or cancers. And finally some of us came in strong in our power center with crazy painful cramps, endometriosis, chronic cystitis, dysplasia, HPV. But most lived through a combination of the above suspects, always coming and going, often dissipating for a moment leaving us wondering how we could capture calm again.

We grew up ready to please the world, not wanting to make too much noise, rock the boat, squeak the wheel. We were the quiet ones with good grades and an aim for perfection. A single disparaging word destroyed our world. The ultra-sensitives, the black sheep, the feel too much, we were. Our schedules were full of the activities we thought would make our parents most proud. We followed the path most traveled and dreamed of the well-known life.

We aspired to be doctors, lawyers, CEOs, and presidents. Or maybe the stay at home wife, life. Wanted the perfect husband, the 2.5 kids, the picket fence, the Dior purse, the Benz. We had our lives planned out before we hit puberty and our wedding dress picked out once we did.

Me, I wanted the Lakeshore Drive condo with floor to ceiling windows and a view of Lake Michigan. I wanted to wear the white coat, marry the Chicago Bear or Bull, drive the beamer, send my kids to an academy among princes and celebrities. I dreamed of dinners at fancy restaurants with four dollar signs and tiny plates.

I wanted to work with animals at age five, but knew by age nine that zoologists didn’t make enough money to buy my high rise life. So my sights were set on gold and I pursued it passionately until it became my obsession.

We worked our minds and bodies to the bone. We excelled in every aspect of life, made everyone proud. Got the nod from society that all was right and we showed them. Meanwhile, we slowly repressed our true desires and dreams. The wanderlust, the free spirit, the fickle, the wild, the passionate was quelled at every debut. Eventually we placed them into box, locked it up, stored it deep into a closet and said goodbye. We asked it to stay put until the day we died.

Until we reached our 20’s and everything we believed about life was challenged. All those milestones we aimed to meet from the day our bellies began to ache seemed impossibly far away. The stress of life came down hard, the expectations from inside of us, came in even harder. Perhaps drugs entered the equation or alcohol. Maybe boys and seduction. Probably a combination of all. We searched for fulfillment and success from others. We won more accolades, more degrees, more ‘acceptance’ from the world. We craved another life, a life that never existed, the life of perfection.

Or maybe we outsourced our wisdom. We started consulting with therapists, counselors, doctors, mentors, psychics, energy workers. We spent our days with chiropractors or acupuncturists, adopted mommas and poppas. We looked outside of ourselves for the details and the job description about the way to ride this wave called life. Sometimes as they talked to us or treated us, threads of the voice in our gut said, “oh yes, you know this, that’s what I’ve told you a few times, that sounds familiar”

Then it hit us, like a ton of bricks. That good girl gut couldn’t handle it anymore and it began to fire up. But now, with stress, life, work, school, debt, kids, marriage, mortgage we didn’t know what to do. Maybe we’ll suppress for another few decades? What if you kept quiet just a little bit longer? But deep down we knew the truth. We knew we could no longer keep that box in the closet.

For me, an autoimmune disease to remind me that I was not loving myself, so my body attacked itself in revolt. It called me to say, ‘you’re hiding your truth’. As long as I felt unworthy, my own antibodies would be there to confirm it. My power center screaming at me and I just ignored it, praying it would go away. I told it to shut up and continued on the path I had trained myself to believe I had to walk.

I changed my food to the cleanest I knew. I started exercising regularly, pushing myself like I did as a gymnast. I continued following the rules, coloring inside the lines of the life most traveled. I did all the things those outsiders tell you to do.  Still I suffered, still my gut told me ‘you’re deviating from your truth once again’

But I continued on. My good girl gut would not get the best of me, knowing deep down that eventually it would.

And then it did. I had to change or live a painful existence denying my truth. A little tiny voice from far inside of my gut whispered to go within. I remembered that all the answers were still there, in that box stored away long ago. It told me that no amount of outside love, attention, food, approval, awards, success, accomplishments, purses, cars, homes, or money would make me whole. Not a single thing would heal my good girl gut until I got right within.

So I listened. I abandoned ship. I surrendered. I let go.  I left that relationship and those friends. I left the life I worked so damn hard to build and set out to rediscover my truth. I slowly opened the box to reveal what it had inside and it was beautiful and terrifying. Until I realized that the only limits and the only judgements had come from me and the reality I decided to create for myself.

Good girl gut and I worked through the madness together. We pieced together the cosmic contract we had signed long ago. It was the hardest work I’ve ever done, but the most worthwhile. I explored, I dug, I cried, I failed, I walked to the brink and almost jumped, I reached the highest highs and the lowest lows, but we’re still here. And we continue to heal, always checking in with my GGG to make sure we’re on the path less traveled, the one that was meant for me.

Our truth, the most powerful of medicines. If you can get back to yours, you’ll never want to leave. It’s not easy (or it’s as easy as you will it to be). It takes time, due diligence, dedication and desire. But it’s there and waiting for you to open it and give it life once again.

The world is waiting for your boldness and your brilliance. The choice is up to you, it always has been, good girl.

Why Do We Continue To Medicate Instead of Educate?

I remember a time I looked down at my schedule for the day and it was a whopping 23 patients. You may say that’s not very many, particularly if you’re in deep with the assembly-line medicine world. 23 is cake. In fact, my Ob/Gyn friend he said he had 60 on his 8-hour Monday and there is a legendary NP in East El Paso who sees 80 patients in a 12-hour day. But for me 23 was a ton, especially in a rural internal medicine practice with highly complex and vulnerable patients. That meant that I had 18 minutes with each patient with an hour lunch.

18 minutes to:

  • review their chart, their meds, their labs, if they had been in the hospital, what they were there for
  • to get their history (after not seeing them for 3, 6, 9 or 12 months), document their acute and chronic concerns
  • examine them thoroughly based on their chief complaint or if they’re there for a physical
  • titrate, change, discontinue, add medications
  • order labs, imaging, home health, screening tests
  • sign disability papers, prior authorizations, work/school notes
  • educate them on a myriad of lifestyle changes, their medications and side effects or their newest chronic disease diagnosis
  • answer any questions they may have about their health and disease or their overall life and wellbeing
  • get to know them, understand them, listen to their worries, stressors, concerns
  • finish up chart, get them set for their next steps, say goodbye

Oh, that’s why we don’t educate instead of medicate. It makes perfect sense. There is no time in the big bad world of the business of assembly-line medicine.

Screw that. This has to change. It is changing. When we go into medicine, we’re in it to help others heal. Doctor comes from the word in latin for “to teach”. That’s what we’re supposed to do as clinicians, TEACH!

You ask me how to do it, you just do. I was the same as you not too long ago. I worked in Urgent Care in a rural clinic. During the flu season we would see anywhere from 40-60 patients between two PA’s. It was brutal. In my first year there, there was no lunch, no bathroom breaks, no time to breathe.

And now I work at a community urgent care with the same patient load, sometimes more with two advanced practice providers and a doctor. But instead of running around like a chicken without a head dealing drugs in a pill mill, I sit and educate. I have a five step program I follow and quickly assess where my patients are in the stages of change. If they just want a script, it’s theres. If they’re hungry for something more, I provide that too. If they’re somewhere in the middle, we work with them at that point. You have to meet your patients where they are. Change doesn’t come from your directions, authority, expertise, it originates from them.

So I can tell you with full confidence that it is possible to educate instead of medicate. I can also tell you that patients are now changing and craving this type of interaction. In my clinic, about 70% of my patients ask me about healthy food choices, apple cider vinegar, essential oils and breathing techniques. They talk about their sister or neighbors who use home remedies over medications. Things like cinnamon for blood sugar, chamomile tea bags for eye swelling, turmeric raw honey salve for abscesses. I encourage them to take control of their health by trying these tools, but if something goes awry then check in with us.

You also have to be an advocate for your patient. Take the time to be present with them and watch how time expands. That’s how I made my change, I just took it. I thought about my desired end result, happier, healthier patients and I began to just take the time to educate them and listen to their stories.

I understand I operate in a different realm. I’ve paid off my loans, I have some credit card debt and all I really have is my mortgage. I don’t live in constant fear of being fired. I’ve had enough jobs to know that clinics need PAs and I’ll always have opportunities as one. Once you start to work from this perspective, fear dissipates and you begin to do what’s best for you and your patient.

But until then, help your patient take those baby steps. The educational changes are small and simple, but significant. Adding vegetables into their diet 4-5 times a week vs. never, is one tiny step to success. Drinking more water, the forgotten nutrient, is another way to give their body and mind a little boost. Checking in with their breath, another favorite. Adding in 1 tablespoon of apple cider vinegar in a cup of water twice a day, yet another.

I wish you the best on your journey towards practicing real medicine again. It’s possible, you just have to set the intention and go for it.

CILANTRO!! Yo!!

There was a time I hated cilantro. Before I was re-introduced to my Mexican roots, I really disliked the herb. It tasted like soap to me, which makes sense as it is a great detoxifier. Now I won’t say I love it, but I am very apt to adding cilantro into my diet on a regular basis. I’ll add it to my pesto, my morning tea, smoothie or on top of a salad. It’s a really wonderful, easy way to boost your methylfolate (a biologically active form of folate), calcium, potassium, manganese and iron. It’s also high in antioxidants and is part of a common regimen for heavy metal detox. Cilantro extracts metals out of the bones and tissues to be removed by liver and bowels. It is especially helpful in pulling out Mercury which is found in dental fillings, vaccines and large fish. Early on in my dad’s Alzheimer’s journey, my momma tried everything fringe and conventional to get him well. She took him to a doctor that started my dad on cilantro, oregano and chlorella in the 1990’s.

You want to add in chlorella to your regimen as well, because once you start mobilizing the metals out of your bones and tissues, they need to get the heck out of the body. Chlorella binds the metals and facilitates them out.

There can also be side effects to detoxing with cilantro and chlorella, so if you start noticing some strange changes, check in with your healthcare professional before you continue.