Health & Wellness: Death & Dying

From the Grace Church Health and Wellness Committee, February 2008

Chronic diseases require us to adapt our lifestyles, endure the discomfort and pain associated with the disease and its treatments, and sometimes, consider the likelihood of death. Some health conditions reach the point where a “cure” is no longer possible and death is imminent. In these circumstances, organizations offering Hospice Care can help to assure that maximal quality of life is achieved during the final days and weeks. Your Rector and/or health practitioner are the best sources of information about how to prepare for death.

Coping with Death: Irrespective of our age, the process of dying often involves medical, familial, psychosocial and spiritual as well as financial demands and conflicts. Successfully addressing these demands and conflicts requires active coping strategies that may outpace our personal resources. Hospice represents a continuum of end-of-life care that “provides comfort and support for persons with life-limiting conditions as well as their families. Hospice care aims to make the person comfortable and relieve their symptoms and pain for the entire length of their illness” (www.caringinfo.org).

Effective Pain Management is a critical element of Hospice Care. We have all experienced many types of pain, from the pain of a sprained ankle, achy joints, a headache, an infected tooth or in the lower back. Some psychosocial disorders such as depression, moderate to severe anxiety, and other emotional problems can cause pain or they can make the experience of existing pain worse. While we have learned to cope with most of these kinds of pain with our existing resources, some diseases such as cancers cause pain that exceed our personal abilities to cope. Hospice care is likely to be of benefit here. For example, experts tell us that with proper medical intervention greater than 85% of cancer pain can be controlled. Effective pain management results from the development and application of a pain management treatment plan. Such a plan often involves the combination of treatments and medications and a proven evaluation plan that tells the team what is and what is not effectively controlling the pain. Adjustments can then be made as needed. Cancer patients and health care professionals should work together to develop this plan - the cornerstone of effective pain management.

· Hospice may also make the following types of care available, as needed:

o Emotional and psychosocial support for the patient during the course of dying.

o Specific Prayer – asking God to help you and your team manage the pain and symptoms associated with your disease(s) and prayer for acceptance of conditions you are powerless to change. Requesting the prayer intercession of others for your comfort.

o Marshalling extra familial support by teaching family members critical skills to help them to care for you.

o Providing short-term inpatient care to help you and your family manage pain and symptoms when they overwhelm your ability to manage them at home or if family caregivers need respite.

o Providing grief support and counseling for loved ones.

Should you have concerns or want additional information about the material presented above, please contact your local health care provider, the Rector, or someone on the Grace Church Health and Wellness Ministry Committee (chaired by Mrs. Florence Poyer, R.N.)

Prepared by: Walter S. Handy, Ph.D., member, Grace Church Health and Wellness Ministry Committee

Health & Wellness: Illness & Aging

From the Grace Church Health and Wellness Committee, January 2008

The theme for January is coping with illness and aging. Chronic diseases often require us to adapt our lifestyles, endure the discomfort, pain and/or disabilities associated with the disease and its treatments, or consider the likelihood of death. Your Rector and/or health practitioner are the best sources of information about how to get and stay prepared for a healthy life.

Coping with Life’s Changes: Irrespective of our age, the business of living often requires struggles with internal and or external demands, conflicts and potentially distressing feelings. Successfully addressing these struggles requires us to cope, to actively manage these demands, conflicts and feelings with resources that exceed those that are routinely available to us. While some of us may be more successful at coping with certain types of situational demands than others, behavioral scientists tend to agree that coping is a learned skill. The list presented below is not a cookbook; no one or combination of these strategies is necessarily effective for each of us in the variety of circumstances we face.

Optional Coping Strategies:

• Gathering additional information - If you are newly diagnosed with diabetes, go to the library or bookstore and obtain books discussing the disease process, its prevention and treatment or, if you are about to undergo a biopsy of a suspicious “growth” find out more from your physician or other credible source of information about what you may need to do before you get to the hospital, exactly what the biopsy procedure entails and what, if any, recovery issues you may face.
• Praying – ask God (through direct prayer) to heal you where you and your medical specialists cannot and/or pray for acceptance of conditions you are powerless to change. Asking for the prayer intercession of others for your healing.
• Marshalling extra social support - Asking for words of encouragement from members of family, church and friendship circles. Physical touch from caring others often soothes the soul and bolsters morale when words fail.
• Maintaining a sense of optimism - Practice disputing “self-statements” that suggest that a medical setback is singularly your fault, pervasive in every arena of your life and permanent (for all time).
• Learning to tolerate, endure or accept the health condition – accepting that a physically disfiguring, lifestyle altering, or even an “end stage” circumstance is not your fault.
• Adopting more health promoting behaviors – Sometimes more focus on the practice of health promoting behaviors (e.g., improving diet and exercise) can reverse or slow the progression of a dangerous health condition.
• Enlisting the assistance of additional health care professionals – some health conditions reach the point where a “cure” is no longer possible and death is imminent. In these circumstances, organizations offering Hospice Care can help to assure that maximal quality of life is achieved during the final days and weeks.

Should you have concerns or want additional information about the material presented above, please contact your local mental health care provider, the Rector, or someone on the Grace Church Health and Wellness Ministry Committee (Chaired by Mrs. Florence Poyer, R.N.)

Prepared by: Walter S. Handy, Ph.D., Member, Grace Church Health and Wellness Ministry Committee

Health & Wellness: Self-Regulation & Optimism

From the Grace Church Health and Wellness Committee, December 2007

The liturgical themes for December are repentance, preparation, anticipation and hope. The Committee Offerings for the month will focus on self-regulation, as a form of preparation, and optimism, as a component of hope.

Whether the health topic is immunization, diabetes prevention, stress management, fitness or food safety, if you believe that you can take appropriate action to prevent or to solve a problem, then you are more likely to do so. Such a belief in one’s adaptive abilities to effect a change in a situation is not an illusion or an unrealistic sense of optimism. Such beliefs are based on experience.

A good self-regulatory strategy combined with strong experience-based beliefs in that strategy for achieving a healthy lifestyle together with being optimistic that the plan will work are the three key elements of any preparation. Your Rector and/or health practitioner are the best sources of information about how to get and stay prepared for a healthy life.

Self-Regulation: Health promotion literature is replete with research supporting the importance of self-regulation in living a healthy lifestyle. Adopting behaviors consistent with a healthy lifestyle and refraining from health-threatening behaviors is difficult. Temptations abound to forgo that brisk walk after dinner and instead to kick-back in front of the T.V. and watch Monday Night Football. Experts say that the likelihood that we will adopt a health-promoting behavior (such as physical exercise) or change a detrimental habit (such as quitting smoking) rests on three sets of beliefs: (a) the belief that my “unhealthful behaviors” are putting me at risk ("My risk of developing heart disease because of my sedentary lifestyle is above average"), (b) the belief that adopting behavioral change would reduce the risk ("If I begin and maintain an exercise program, I will reduce my risk"), and perhaps most importantly for this discussion (c) the belief that I am capable of adopting a health-promoting behavior or refraining from a risky habit.

• Self-Regulatory (Goal Setting) Strategies– most experts agree that goal setting is an integral part of self-regulation. Key strategies for successful self-regulation are as follows:
• Establish goals for desired self-regulatory outcomes.
• Subdivide long-term goals into short-term subgoals.
• View the goals as reasonable and commit to attempt to attain them. Provide verbal encouragement (e.g., "You can do this.") to yourself to help in staying motivated to accomplish their goals. Encourage others to provide similar verbal encouragements to you.
• Monitor your own progress toward goal achievement. Keep written records.
• Develop strategies for coping with difficulties (e.g., set-backs and plateaus). Don’t be afraid to re-evaluate goals and/or timelines.
• Periodically reevaluate your own capabilities. The perception of progress will often strengthen your belief in your own efficacy. This is critical for continued motivation and self-regulation.

Optimism: Increasingly, articles in the popular press and health journals point to depression as a significant risk factor for premature death when paired with chronic disease (e.g., diabetes). Chronic diseases are health conditions that require us to adapt our lifestyles, potentially to disabilities associated with the disease or to the undesirable side effects of the treatments. So it is no surprise that such conditions are often paired with personal, pervasive and sometimes permanent feelings of despair, helplessness and hopelessness. Experts agree that the most damaging effect of such feelings and self-talk is the loss of the will to act. As we discussed earlier this month, if you believe that you can take appropriate action to prevent or to solve a problem, then you are more likely to do so. If you are optimistic that your behavioral efforts to achieve optimum health will work, you are more likely to persist in the face of early setbacks and disappointments. Your Rector and/or health practitioner are the best sources of information about how to get and stay prepared for a healthy life.

• Learning to be Helpless: Behavioral scientists note that having pervasive feelings of helplessness can become a habit and even generalize from one arena of our lives (e.g., school or work) to other arenas (e.g., our self-care). Over time we can learn to talk to our selves using pessimistic words. We sometimes learn such pessimistic “self-talk” from our parents, teachers and perhaps others in positions of authority over us after we have had a setback or failed to reach a desired goal (e.g., I failed that test; I am not a good student; I have never been a good student; I will always be a poor student; I not a very good worker either; I cannot keep track of the medicines I am supposed to take; I am just not a very worthwhile person; All the ills that befall me are my fault!). Do you ever catch yourself saying these kinds of words to yourself? Do such words promote action on your part or rather do they promote paralysis? Learning to be helpless can be unlearned!
  
• Learning to be Optimistic: Experts say that a sense of optimism leading to a different type of self-talk can inoculate us against feelings of helplessness. Such learnings have a number of key components including:
• Accept that “failures” and/or negative occurrences are a part of the act of living;
• Forgive yourself and or seek forgiveness from others for your shortcomings;
• Practice disputing “self-statements” that suggest that a setback is singularly your fault, pervasive in every arena of your life and permanent (for all time).
• If you find yourself in a “loop” of self-deprecating statements (personal “put-downs”), say out loud to yourself (or sub vocalize) the word, STOP!
• Write down a list of the concerns underpinning your personal “put-downs” for further consideration at some specific appointed time in the future.
• Allow yourself the freedom to act. Over time, optimistic self-statements will become a habit. Such optimism taken together with the self-regulation discussed earlier this month will promote the adoption and maintenance of health-promoting behavior and avoidance of risky habits.

Should you have concerns or want additional information about the material presented above, please contact your local mental health care provider, the Rector, or someone on the Grace Church Health and Wellness Ministry Committee (Chaired by Mrs. Florence Poyer, R.N.)

Prepared by: Walter S. Handy, Ph.D., Member, Grace Church Health and Wellness Ministry Committee