My Day Zero Discharge Post Hip Replacement

I went on a wait list for an elective total hip replacement in October 2017. I had nagging pain in my right hip for about three years and was surprised at the amount of damage shown on X-rays. I was still active and working full time but my surgeon warned me that hip degeneration can progress quickly. I completed a few weeks of physiotherapy treatment in the summer and then reluctantly went on the surgical wait list knowing my turn would not come up for a year.

By April 2018 the hip pain was interfering with my daily activities and sleep. I rapidly lost range of motion in spite of regular exercise and biking and work became more of a challenge. In July 2018 I received a surgical date for September 28, 2018. I arranged for a six month leave of absence starting in mid-September and began counting down the days until the procedure. I continued to exercise as much as possible but my ability to walk recreationally was limited. My routine was work, mat exercises, biking in the evening and then a restless sleep.

On September 27, 2018, I received a phone call from the hospital stating that my surgery the next day was cancelled due to bed shortages. I was devastated! I had discontinued my anti-inflammatory medication a few days before and was in a lot of pain. A new surgical date of October 16 was assigned but it was possible that surgery could be cancelled again. 

A week before the rebooked surgery, I was contacted by a hospital manager who asked if I would be interested in being the first patient at this hospital to try a same day discharge following hip replacement surgery. I knew this was a new initiative at some Toronto hospitals and was eager to be the test patient locally. After a couple of days, the surgical team agreed that I would be a good candidate for a Day #0 discharge and was informally assured that my surgery would not be cancelled again.

A few procedural changes were implemented to make the day a success. My spinal anaesthetic did not contain morphine and I was given a couple of IV boluses to help maintain my blood pressure during early mobilization after surgery. Preoperatively, my nurse calmed me with warm blankets and a reassuring approach rather than using Ativan. I was given the option of being conscious during surgery but left the decision to the surgical team and was sedated. 

Daily walks on my street are now up to 400 m

My surgery was at 8 AM and at 9:30 AM I was awake in the recovery room. Within 30 minutes I was able to move my feet and was transferred to the surgical unit. I walked to the bathroom with supervision at 11 AM and had lunch at noon. So far things were going exceptionally well and I was very confident! In the early afternoon I went up and down a flight of stairs with crutches and took a couple more walks in the room and hallway with a walker. Later in the afternoon I had an episode of low blood pressure while sitting up in a chair but recovered quickly after the nurse helped me back to bed. This is a common but alarming postoperative event that can lead to fainting and falls but it was good to bring my over confidence down a few notches.

I was discharged home at 6 PM and transferred easily into the car with my husband’s help. At home, I had the best sleep in months. My surgeon phoned in the evening to see how I was doing and I had calls from the surgical nurse practitioner the next two days. A home care physiotherapist visited the next morning. 

I am now 17 days post op and am making daily gains in strength and function. The first week had its ups and downs with pain control, but I had support from the surgical team at the hospital and my RN daughter who travelled from Ottawa to be with me for a few days. I am grateful to all my family for being available to me 24 hours a day at first and would not have been successful without them.

I have been a physiotherapist in this community since the mid-1970s and have seen literally thousands of post-operative hip patients, particularly when I worked in the home care sector. Early in my career, patients stayed in hospital for two weeks and went home after their incision healed. They spent the one week on the surgical floor and the second week on the rehab unit. Length of hospital stay for elective hip and knee surgery shortened over time to one week, five days and then one to three days as surgical techniques improved.

My knowledge and experience as a physiotherapist was very helpful of course, but being a joint replacement patient and dealing with pain and medication side effects first hand was a new experience. I am not keen on doing exercises that hurt and need to be encouraged like anyone else. I am attending a physiotherapy clinic as an outpatient because I can not assess myself objectively. I cannot drive for another month and require several months of healing and rehab to achieve my maximum potential. My goal is to return to work.

Wait times for joint replacement surgery have increased significantly in the last year in south-western Ontario and people are now waiting up to 20 months for elective orthopaedic procedures at some hospitals in this region. (Other hospitals in Ontario have much shorter wait times and this information is available online from the Ministry of Health.) My cohorts in the baby boomer generation will increase the numbers of people waiting for joint replacements for many more years. Earlier discharge from hospital after surgery allows for improved bed flow and potentially more surgeries could be accommodated. 

Good preoperative preparation is very important. I attended two clinics before surgery. At the first one a physiotherapist reviewed the equipment I needed and went over my exercises. The second was a medical assessment and teaching with the nurse, pharmacist and anaesthesiologist. It is important to have the right equipment set up at home and to understand your medications before surgery.

I had a followup appointment at the hospital yesterday and am doing very well. I am grateful to an excellent surgeon, the entire surgical team, community partners and my family for making this Day #0 discharge a success! 

Reintroduction

18 months….

• the age difference between me and my eldest brother
• 1/42 of my life in years
• time enough to welcome a beautiful granddaughter who will be 1 year old this month
• a time of waiting for elective orthopaedic surgery
• the length of time that has elapsed since adding a post to this blog

June 2017 was the month I had medical investigations that eventually landed me on a wait list for a total hip replacement. I had the surgery 16 days ago. In Canada's publicly funded health care system people often wait for elective surgical procedures. (It is good to know that urgent medical conditions receive more timely treatment) I was able to function well enough in this period of time to keep working and enjoy family as well as some vacation time this summer. Walking became increasingly painful and it was most comfortable to ride my bike for exercise. I missed birding and trail walking this year. 

This is a season of recovery and I have much to be thankful for. My surgeon told me that hip replacement and cataract surgery are two procedures that add the most quality of life to recipients. In a past generation I would be using a cane and a rocking chair for the rest of my days. 

I have been keeping a hand written journal over the past few years but want to share some thoughts on how life has been evolving lately. Change is challenging but resistance to change stems from an inflexible attitude that hinders new learning. Critical thinking, questioning, contemplating history, and being open to new ideas should not stop at any stage of life. 

And I have the time right now for reflection! 

Circles of Control, Influence and Concern

I like to think of myself as a calm and rational person, and people who see me may believe that to be true. What they do not see is the turmoil I sometimes internalize which leads to distraction, fatigue, insomnia, inner turmoil, stress and anger. The amount of information we have to process in real time is often overwhelming and our responses can be emotional “knee-jerk” reactions. Complaining is a popular past-time at work and elsewhere, and too much whining is done about things that are not in our control

Stephen R. Covey described circles of concern and influence in his classic book The 7 Habits of Highly Effective People. He wrote,

”Instead of reacting to or worrying about conditions over which they have little or no control, proactive people focus their time and energy on things they can control."

In response to some stressors in my life this year, I drew three circles;-

Control, Influence and Concern. 

There are things in my life that I can control. 

There are circumstances and people that I can influence. 

There are areas of concern that I have no control or influence over at all. 

I have tried to manage my time based on what I wrote in my circle of control. An over-reaction to events we cannot control- 

a bad driver, a long check-out line, negative behaviour of other people, the weather report, the value of the dollar, and so on- 

drains our energy and darkens our mood. We have influence over people in close and casual relationships, but it is important to resist controlling others who are capable of being responsible for their own decisions, particularly our children and spouses. 

I recently returned from Mexico where I spent time caring for my father who is dependent in all aspects of his care. His inability to do things for himself due to advanced Parkinson’s Disease causes frustration and anger at times. We discussed this topic and talked about how his circle of control has become much, much smaller.

 

Like a child, he is increasingly controlled by his caregivers, leading him to ask what purpose there is in living with such a disability. He still has control of his words and reactions. He can influence the people he interacts with in a positive or negative way. It is within our power to control our attitudes, even in circumstances that are not ideal.

My three year old great-nephew came to visit while Dad was walking around the house for exercise. I watched as Great-Grandson pushed his scooter at the same pace that Great-Grandfather walked with his walker. Youth and old age, both with limited control but with significant influence on each other.

Here is the template for the circles I filled in with very personal situations and concerns. The exercise brought increased awareness of what things are most important for me to "centre" on.

Scars and Tenacity

Franconia Notch State Park, New Hampshire

She is the same age as me and has been a patient at the hospital for over 100 days. We walked outside in the late summer sunshine as she shared her story. Whether all the details were exactly true or not doesn’t matter as past memories are easily distorted by emotion and time. 

“I have gone through life with a pickaxe, pulling myself up a rock face,” she said. 

Above average intelligence, education, and good looks did not smooth the scarring from abusive relationships, years of mental and physical illness, job loss and community disconnection. Life was a struggle but she was still fighting to make it to the summit. She talked about life “outside the village” and her “misfit” faith which was not understood in any church she had attended.   

I marvelled at her insight and her inability to find an easier route on her journey. Surely there was a paved road somewhere on that mountain. In comparison, my life is a peaceful cruise in a small, seaworthy vessel. I have encountered a few storms but the sun quickly appears through the clouds as I follow the beautiful shoreline.

We live in a country that is at peace, with good social services and free medical care. I have no metaphors for the life journeys of people who live where there is war, who are displaced and surviving without their basic needs being met. Every day I see how unexpected illness and injury can change the world of an individual or family. My life could be altered in an instant too. We never know when we might need that pickaxe.

Light, Darkness, Hope and Despair

She sat in the chair with her knees to her chest and her feet on the seat. She was so thin it seemed possible to fold her up and put her in an envelope. Her struggle with anxiety had gone on for decades and she craved medication more than food. Multiple investigations in the hospital revealed no specific pathology but she was too ill to function on her own.

He sat on the ground, his deformed, paralyzed legs folded beneath him. Spina bifida had left him this way from birth. He moved around in the dirt, pushing and lifting his body with his strong arms. He had no wheelchair or mobility aid. I watched as he sat in the shade in the courtyard of his home, singing and playing his guitar to no one in particular. Contented and part of a family and community in a poor Mexican fishing village, he had no complaints. 

All creatures are designed to survive in the best of times and the worst of times. It is normal to store fat in times of plenty to sustain life in times of famine. Animals, birds and other creatures are in a constant struggle with the elements and predators. Humans have always dealt with uncertainty. Natural disasters, wars, economic crashes, plagues and other illnesses have been present throughout recorded history. The human spirit is resilient and heroic human behaviour is usually born in adversity. Challenge and struggle is necessary to attain our full potential and strength;- emotionally, spiritually and physically. 

Canada is a country free of war and famine, a country with free medical care and social assistance. We have a democratic government and a fair judicial system. We have a better standard of living than the majority of people in the world, past and present. Most people I know are generally happy but there is an undercurrent of cynicism, criticism and dissatisfaction in our affluent society that is pervasive and destructive. Too many people struggle with addiction, depression, anxiety, lifestyle related illness, autoimmune diseases and a lack of purpose and hope. It is as if we expect life to be perfect making it difficult to cope with adversity in a healthy way. 

I watched a discussion recently where Bono and Eugene Peterson discuss the Psalms. In it, Bono says: “I would love if this conversation would inspire people who are writing these beautiful voices and writing these beautiful gospel songs — write a song about their bad marriage, write a song about how they’re pissed off at the government, because that’s what God wants from you. That truth — ‘the way, the truth’ — and that truthfulness — know the truth, ‘the truth will set you free’ — will blow things apart.”

Praise is meaningless if we have never experienced pain. We cannot appreciate light without experiencing darkness. It is important to face trouble with honesty and hope, not blame and cynicism. We need to make sure our children learn early that life is not always easy, maturity develops though adversity, and that perseverance is essential. Happiness and fulfillment comes from an attitude of gratitude, cultivating meaningful relationships, proper care of the body and soul, having achievable goals, and developing the ability to handle stress. 

Steve Bell is one of my favourite musicians (as well as being a Canadian) and I find his lyrics very meaningful and honest. Here is part of his adaptation of Psalm 90.

Psalm 90- Steve Bell 

Satisfy us in the morning with Your love

That we may sing for joy

And be glad in all our days

Satisfy us in the morning with Your love

Match the days Lord of our sorrow with Your joy

May Your deeds be always known

To the ones you call your own

Match the days Lord of our sorrow with Your joy

May the favour of the Lord

Rest upon us and our land

And establish for us all

The work of our hands

Yes the work of our hands

Logos and Mythos

Trent Evans was a Canadian involved in making the ice for the hockey tournament at the 2002 Salt Lake City Winter Olympics. He secretly placed a “loonie”- our dollar coin- under the surface at centre ice. He did tell the players of the Canadian men and women’s hockey teams about the talisman and both teams went on to win gold medals. The “lucky loonie" was retrieved and is now in the Hockey Hall of Fame in Toronto. Similar coins have been placed beneath the ice at subsequent international hockey tournaments and the Royal Canadian Mint has released a commemorative edition "lucky loonie" for each Olympic Games since 2004. 

Logic would tell us that the teams won gold medals because of skill and hard work. But adding Mythos to the formula added confidence and initiative which may have contributed to the victory. Having a ritual or physical lucky charm can decrease stress and anxiety, give a more positive focus and an illusion of control. Superstitions can provide meaningful psychological benefit, giving a sense of power thus diminishing negative emotions such as helplessness. 

My best friend from childhood is a tenured professor at a Toronto university who has published several books and is one of the most intelligent people I have ever met. We had brunch together this past weekend and she shared how the number “5” or better still, “55” had significant meaning for her. Both of us were born in 1955. When applying for her doctorate program her application form had her special number on it. She sets her alarm for x:55 AM and goes to bed and x:55 PM. When she bought her current home, she knew it was the right place because the street address was “55”.  And of course her vanity license plate includes the number 55. I have known her for over 50 years and was not aware of her private idiosyncrasy. 

Medicine is an interesting field where Logos and Mythos go hand in hand. Medical practitioners are well educated scientifically but patients are emotionally vulnerable and need more than facts. When we visit a doctor we expect a diagnosis, adding great pressure to quickly provide a name for our ailment and a prescription for an appropriate remedy. Imagine going to a doctor and coming out without a diagnosis and a concrete treatment plan! Misdiagnosis is a huge problem and the overprescription of antibiotics and pain medication is at crisis levels. Using inert formulas as medication can bring about real physiological cures in what is known as the placebo effect. Placebos were used frequently when I first worked at a hospital but they are now only given with patient consent, which erases their value in my opinion. Brian Goldman is a Canadian doctor who has an interesting show and podcast on CBC Radio One called “White Coat, Black Art”. He explores the “art” of medicine which has not changed all that much over the millennia. 

Most of us have some interest in mystical and supernatural phenomena. I wrote a post a few years ago about the ghost, Francine, who supposedly haunts our hospital. We blame all unexplained events on her, from call bells that go off in empty rooms to consistently similar visions reported by patients at night. I do not have Logos to accept or refute the presence of ghosts so Mythos prevails.

Is faith different than superstition? Many times religion becomes “religistition” - a mix of faith and superstitious belief and ritual. There are people who seek indulgences, works, or a trail of “signs and wonders” rather than focusing on a faith that quietly sustains the soul in good times and bad. I see God at work around me and use prayer as preparation for my day. But it is easy to slip into rote prayers, expectations of blessings, and pronouncements of finding "God's will".

The human mind is very susceptible to suggestion. Superstitions change the way people behave either by increasing fear and anxiety or by boosting confidence, performance and positive outcomes. Knowledge is a combination of logic and intuitive insight which is not always present in balance. Mythos varies culturally and from person to person and helps explain the gaps in Logos which we all experience. How boring would life be with nothing but logic?

Falling, Fear and Fortitude

Trail companions- Raven and nordic poles

I have been afraid of heights as long as I can remember. Very afraid. I am uncomfortable on a balcony higher than the third floor or climbing more than three rungs up a ladder. Seeing someone stand on the edge of cliff makes me feel physically ill. For many years I could not look at a photograph of a waterfall without my stomach doing a loop. Sky diving, bungee jumping, zip lining, and rock climbing have never been on my bucket list. 

As a physiotherapist working in geriatrics, fall prevention is an important part of my job. I see many people who are admitted to hospital as a result of falling and sustaining a significant injury. In taking a good history, it is very important to determine the reason for a fall. Was it due to a medical condition or the physical environment? Does the patient need a gait aid? Our goal is to prevent further falls in hospital and after discharge. 

Whatever the cause, falling aways does one thing. It creates an increased fear of falling. And that fear keeps people at home, decreasing their participation in activities in the community and can even create walking disorders. Canadians endure long winters with lots of snow. We have a few ice storms each season which are far more treacherous than snow storms. Inclement weather is one reason people here can become increasingly isolated as they get older. This increases their risk of depression, physical and cognitive decline, placing them in a downward spiral functionally. 

I am surprised at the resistance I frequently get when trying to get someone with a history of falling to use a cane or wheeled walker. They don’t buy my argument that a gait aid will help them get more exercise, making them more independent and less likely to fall. I tried to get a family member to use a walker after she fell and broke her shoulder because of poor balance. A year later she fell and broke her hip and had no choice but to use one. (Family members are often most resistant to advice!)

Tackling my fear of ice and waterfalls at Niagara Falls

I had two bad falls on ice resulting in a broken wrist and a broken elbow. They happened over 20 years ago and when I see ice, I still feel some panic. Initially I was inclined to want to call in sick at work rather than walk across an icy parking lot after a storm. Instead, I bought ice grips for my boots and a pair of nordic poles which stay in my car at all times. Every time I succeed in walking across a slippery surface, my confidence increases. Nordic poles are also my constant companion when walking on trails and prevent stumbles on tree roots and uneven ground. 

Over the years I have come to understand the source of my fear of heights and my panic is under more control. Fear protects us but is debilitating in excess. Depending on our experiences, added years bring new anxieties which alter or replace childhood fears. We can fall down physically, professionally, socially, or in close relationships, but in each case it is important to learn from the fall, to put aside fear, get up and try again. Other people may have insight into the reason for our fall and may we never be too proud to ask for guidance and advice on our journey. 

Two people are better off than one, for they can help each other succeed. 

If one person falls, the other can reach out and help. 

But someone who falls alone is in real trouble.

Ecclesiastes 4:9-10 NLT

Career Stories: Suicide Threat

The news this week brought discussions about employee mental health, medical confidentiality and fitness to work to the forefront. What prompted a young co-pilot to deliberately crash a plane full of innocent passengers and crew into a mountain? Could this tragedy have been averted?

The most difficult experience in my career involved a co-worker. At the time, I was the professional practice leader for a group of therapists at a private company. Each January I met staff individually for a performance review and goal setting exercise. One therapist was a gifted practitioner but was indifferent to the bureaucratic processes we had to follow. A free spirit, she struggled with personal and professional relationships and boundaries. She garnered the most thank you notes from patients and the most complaints from management.

During our interview she told me she was planning to end her life but also told me not to tell anyone. I did not know how to respond at the time to her comments which made me very uncomfortable. After she left I called a social worker as well as the owner of the business and they both advised me that I could do nothing without her consent. 

Two weeks passed and I kept in contact with her at work but still wondered what to do. I contemplated calling her family physician but in the back of my mind I hoped she would get over her melancholy and get on with life. 

We had a staff meeting one afternoon and she did not show up. I knew something was wrong and drove to her home in another town after asking the office staff to contact her next of kin. It was mid January and her car was in the driveway. There were no footprints or tire tracks in the fresh snow and I walked around the house looking in all the windows. Her next door neighbour, who was a policeman, saw me and came over with a key to the house. I was very afraid when I entered the house with him but we did not find her. I opened her work appointment book and saw that she had scheduled no patient visits after the previous morning. 

I called the police. Her closest friend who lived two hours away arrived later in the day. 

The neighbour found her body. She bled to death, alone, in the snow in the wood lot behind the house. I sat in the back of a police cruiser that cold, dark night completing a written report while responding to questions from the detective. In disclosing my conversation with her earlier in the month, I was asked by the officer why I didn’t do anything. 

I was devastated and immobilized with guilt and grief for weeks. I sought counselling and was told again that there was likely nothing I could have done to prevent her well planned suicide.

I still cannot accept or believe that. 

Well over a decade has passed and I can now drive by that house without crying. I have learned much more about mental illness and suicide in my current work on a mental health unit. With the explosion of information on the internet since this event, it is easier to access helpful resources.

If I found myself in a similar situation now, I would not promise confidentiality and would pursue help far more aggressively. The advice I received did not feel right and I would trust my own instincts instead. More than one life could depend on it.

Here are some suicide prevention resources:

Waterloo Region Suicide Prevention Council  

Canada Suicide Hotlines - (links to international hotlines too)

Career Stories: Centenarians

Doll on display at the Dickinson House in Manotick, Ontario

Over the years I have the honour of meeting a few centenarians who aged with grace and dignity. Most of the patients I work with are aging badly with any number of chronic and degenerative diseases. We all want to know the secret to growing old well, maintaining our independence, health and quality of life in later years. 

Marija was a 99 year old lady who lived independently in a city apartment. She shopped, cooked, cleaned and looked after her 93 year old sister who had dementia. Marija was elegant with erect posture, a long braid around her head, and a beautiful face. She grew up in Eastern Europe and lived through harrowing times during World War 2. She worked hard when she and her husband came to Canada in the 1950s and raised her family while holding down a domestic job. 

Marija tripped over the edge of a step and broke her hip in a fall. She had surgery and returned home in a few days, quickly learning to get around with a walker. She would be in the kitchen cooking homemade soups and stews when I visited and never had a complaint about pain or misfortune. I discharged her from service after a few visits but received an invitation later in the year from her daughter to attend her 100th birthday party. She recovered well from her fracture and continued to live independently in the community.

I met another 100 year old lady who also returned home following a hip fracture. (Hip fractures were  my bread and butter when I did home visits!) Her hospital course was more complicated after surgery but she had a cat at home and that motivated her to get walking again. Clara had fallen off the toilet in the middle of the night but was wearing a Lifeline device and was able to call for help. She laughed when she described the good looking young firemen who came in and lifted her from the floor. 

On Clara’s wall was a framed certificate presented on her 50th anniversary of using insulin. It bore the name of Sir Frederick Banting, the Canadian physician, researcher and Nobel laureate who first used injected insulin to treat diabetes in humans. Clara developed insulin-dependent diabetes in the 1950’s and followed her diet and medication plan faithfully in the years before home blood sugar testing and fast-acting synthetic insulins were available. To reach 100 years of age, almost 60 years of them as a diabetic, is amazing considering the many people who manage this illness poorly and suffer debilitating complications in their middle years.

Both Marija and Clara lived routine lives, ate simple, wholesome meals, had interests outside of themselves and accepted life’s ups and downs without fear or bitterness. They obviously had inherited some good genes as well!

Recently I met a 99 year old man who had a productive life and currently resides in a minimum care facility. He gets around independently with his walker and enjoys a good conversation as well as several short naps throughout the day. He told me it didn’t matter if he celebrated his 100th birthday or died tomorrow. He had a successful career building large high rise apartments but life had gradually ground to a halt after he retired in his 80s. He had outlived his friends, wife, siblings and some of his children. He was cheerful and matter-of-fact but recognized we only live one day at a time. In the end our quality of life is of more value than the quantity of years we may accumulate. 

Synchrony

With the switch to Standard Time last night along with November days which shorten quickly, the opportunities to enjoy sunshine outside of work hours are now limited. This autumn has been very wet and a day like today was a treat indeed. Perhaps this was my last opportunity for a bike ride and the switch to an indoor stationary bike for exercise is almost here.

My life over the past several months has been out of sync in many ways. One year ago today I was on a plane returning to Canada from Mexico. I made two more trips south earlier this year to be with my family. Just over a year ago my work schedule increased from four to five days a week with a weekend rotation every seven weeks. This week I work seven days in a row which is not as easy physically as it might have been twenty years ago. The balance between work, home, leisure, rest and social activities has been hard to find at times. Time has accelerated as days and weeks turn into months at break neck speed. 

Northern Shovelers perform a synchronized swim

I sauntered around the neighbourhood on my bicycle in the sunshine until my hands and feet felt like blocks of ice. The air is cold! There are patches of lingering fall colour but signs of winter are here. I saw my first flock of Juncos although I am sure they have been around for a while now. I enjoyed the balance and synchrony around me today and hope to incorporate more in my life again.

Great Blue Heron roosting high in the trees

Cycling

I used to walk 5 km every evening until my knee surgery almost 4 years ago. Pounding pavement after work is not kind to my joints so I tend to meander along natural trails at a slow pace when I go for a walk. My aerobic fitness level took a big dive so this summer my husband and I each got a new bicycle. A co-worker recommended a certain bike shop and for the first time in my life I was fitted for a bike by people who really know and love bicycles. This Giant Suede is a cruiser with a slightly recumbent frame. I started slowly by going around the block a couple of times and then through the neighbourhood park. At the end of the first week, my knees were swollen and painful and I wondered if I had wasted money. But after another couple of weeks of gradual training, the pain was gone and my strength and endurance increased daily. I have worked up to 10 to 12 kilometer rides at this point.

I found the web tool geodistance.com where joggers, walkers and cyclists can plot their routes. I enter my postal code to zoom into my neighbourhood and all the local trails are well marked on the map. The bike allows me to explore linear trails like the one above that are too long to round-trip on foot. 

We are fortunate to have many kilometers of well groomed trails in our region. This one used to be a rail line along the Grand River. The scenery is beautiful and wild life is abundant. I saw many birds today and deer and other mammals are often about.

Northern Flicker

The days are getting shorter and cycling season will soon be over as winter approaches. We have a stationary bike but you cannot coast down a hill and feel the cooling breezes before you pump up the other side. And nothing on a television screen compares to the discoveries made on a trail.

I will have to use the indoor bike through the winter in order to avoid another painful initiation to pedalling in the spring. There are a few more weeks of beautiful fall weather to enjoy and I hope get out frequently before the snow comes. Toronto Island, the Niagara Parkway, the city of Ottawa... My list of places where I want to cycle is getting longer. It isn't hard to keep up something you love to do!

The other bike- A Giant Sedona- (distorted perspective)

Broken

The old lady had a severe reaction to drugs prescribed to treat a nasty infection. Delirious and weakened, she quickly developed permanent nerve damage and was transferred to another hospital. Three months later she was still unable to sit, stand or walk.

Her elderly husband walked the long corridors from the main entrance at noon, slowly, painfully with his cane. He sat by her side until she went to bed in the evening and then walked slowly, painfully with his cane back to the car.

Every day…waiting, watching, hoping that she could walk again and come home.

We worked with her in the mornings, flexing stiff limbs, encouraging normal movement, trying to get her upright again.

He waited one day for the doctor, wanting answers, wanting assurance that she would recover. Accusations, anger, angst spilled out in the words that echoed in her room.

The next week he waited again for the doctor.

“I was talking to you from my heart and you were talking to me from your head. That is why we clashed and I am sorry," he said.

The doctor replied compassionately, “It’s all right, I have been there too.”

The old man had no way of knowing the pain in the doctor’s words, spoken as a father who was unable to save his own child’s life.

Broken bodies can't always be fixed but broken hearts meld together.

Festive Foods

 

I usually get only one cold a year and it is invariably at Christmas time. My immunity is lowered by eating sweets, over-tiredness and stress. So I aim to make Christmas food this year that is festive yet healthy. Yes, we have done a little baking, but there is no freezer full of cookies and squares. I look forward to seasonal boxes of clementines and juicy, red pomegranates. And when I eat this salad for breakfast, I feel good all day long. 

And I am (almost) full when treats like this star cookie Christmas tree tempt me when I come home from work!

We Are What We Eat

I see the health effects of poor lifestyles every day at work. Excessive smoking, abuse of alcohol, street and prescription drugs all cause predictable problems. But our biggest health threat is undoubtedly food. I was taught that smoking and drinking were sinful habits, but somehow gluttony never made the list. We receive daily messages in the media about the dangers of too much fat, salt, sugar, processed food and too few vegetables, fruits, whole grains which contain essential nutrients. But for many people, the advice falls on deaf ears even when they suffer from diabetes, arteriosclerosis, fatty liver disease and a host of other food related ailments.

From Feeding Frenzy

Our dietary department is small and the dietitians are kept busy looking after people with exceptional needs such as tube feeds and special textured diets. There is little time for education and “food therapy”. One of my patients who had a severe stroke recently was enjoying a fast food hamburger and a large poutine for lunch this week. Her family brought it in as she didn’t like the hospital meals. Our daughter is a RN on a cardiac surgery unit in a large teaching hospital. Patients receive little or no teaching about heart healthy diets. Instead, medications are dispensed to patch up symptoms rather than dealing with root causes of problems. We expect that people will resist lifestyle changes.

The hospital provides staff treats for special occasions. This week our newsletter reminds us to buy cupcakes for a local charity. The cafeteria has a special Halloween menu of Bat Wings (chicken wings), Spider dogs (hotdogs), Witches Brew (chili), Ghostly Cupcake and Graveyard Pudding...definitely a graveyard menu for staff, visitors and patients!

From Family Fun

Our neighbour is a middle-aged man of German background. He was raised on sausage, schnitzel, the best cheeses and rich desserts. He had an inevitable heart attack a few years ago and had a stent inserted in a narrowed artery. He was on a load of medication and still experienced angina regularly as well as negative side effects from his drugs. He read The China Study as well as books by Dr Esselstyn and Dr. McDougall and decided to eliminate all meat, dairy, fat and processed food from his diet for 12 weeks. I could not imagine a more unlikely person to try a low fat vegan diet. He lost weight his excess weight quickly and with his doctor’s blessing, was able to come off ALL his medications. He feels energetic and healthy and plans to continue his eating plan forever as he really enjoys his new food choices. He is enthusiastic as he shares his journey when people ask why he looks ten years younger and is getting so trim.

His doctor told him to write a book but he stated, “The book has already been written. You just have to read it.”

People can change. They just need to know how to do it.

Some of our backyard vegetables this summer

I wish I could go back and feed our children differently. I would have more courage to eliminate the sweets, processed foods, hotdogs, much of the cheap meat, unhealthy fast food, and the holiday excesses. We always ate plenty of healthy foods, and plenty of unhealthy foods. There are many fun and delicious ways to reward youngsters and celebrate special days that will not set them up for chronic illness. Fortunately it is seldom too late to make changes that will benefit us for the rest of our lifetime.

Easy to make, fun to eat

Fear Not...

She walked into the coffee shop and sat at the table next to me.

“Hello!” she smiled brightly in my direction.

I looked past the bright pink jacket, fashionable sunglasses and short, stylish white hair and recognized an old patient who was headed for the obituary column the last time I saw her.

“This is the first time I have driven myself into town,” she said proudly.

She was a loner, crusty and irritable at times with staff. Untreated cancer gnawed her flesh and spread to her brain... two falls, two broken bones and two surgeries to fix them. But she refused any treatment for the cancer.

We recommended a move to a nursing home but she insisted on returning to the old farm house and her cats. She had run the farm alone since she found her young husband dead under the tractor decades ago. There were no children, just neighbours down the road who could not be there at her beck and call. She was not religious, nor was she delusional, but fear was a stranger to her. She was accepting of life or death on her own terms.

“I don’t think about what is inside me,” she said.  “The doctor told me the cancer is not growing...”

 “You know,” she said, “I do my own cooking, cleaning and shopping.”

Behind her smile she reminded me that we predicted she would always need help with these things.

She ordered lunch as I finished mine. I could not stop looking at her, sunken flesh filled out again, healthy, strong and independent.

We thought she was in denial of the reality of her prognosis. Maybe we were in denial of the power of fearlessness and determination in the face of a dreaded diagnosis.

I gave her a hug as I left and returned to work, less inclined to judge based on facts and appearances alone. Some things cannot be explained. 

The human spirit can endure a sick body, but who can bear a crushed spirit?
Proverbs 18:14

Water, water everywhere

World Water Day was observed earlier this week on March 22nd. Water- so essential to life yet so abundant in Canada that we take it for granted. According to Nature Canada "each (Canadian) uses about 57 gallons (260 litres) of water each day - about 10 times the global average."

This month we have had days of rain, warnings about dangerously swollen creeks and rivers, and our largest snowfall of the season. My tap water is safe to drink and our water pressure is always good.

 

I downloaded Samuel Taylor Coleridge's epic poem The Rime of the Ancient Mariner to my Kindle. Most everyone has heard the line,

Water, water, every where, 

Nor any drop to drink.

The parched Mariner, cursed by Night-mare Life-in-death, lived on after all his ship mates died. He survived the harshness of the ocean's 'too much-too little water' and went on to roam the countryside telling others his story of death and redemption.

This wetland is located adjacent to one of our city's water treatment facilities. I come here often to look for birds who are drawn to the shallow swamp during migration or as a home to raise their young. A city subdivision surrounds it and a few irresponsible people use it as a trash dump. But local schools teach students about the life these waters bring to fish, birds, amphibians, mammals and people.

I am certain our family does not use 57 gallons of water per person a day. But heavy water users in our community add to our daily average.

Industry, agriculture, energy production, car washes, supermarket produce sprays, hospitals...

We wash our hands 100 times or more a day at the hospital. Infection control monitors stand in the halls with clipboards checking staff compliance with hand cleansing each time we enter and leave a patient's room. Now we use alcohol foam rather than soap and water but large amounts of water are used in health facilities daily. I watch a patient, hands feeble, mind dulled by dementia as she cleans her dentures at the sink. The tap runs for 10 minutes. I say nothing as she goes through one of the few rituals she remembers.

Some patients I see can no longer swallow water, their throat muscles weakened by strokes and degenerative disease. We scoop sweet flavoured and thickened goo into their mouths when they ask for a drink.

Water, water, every where, 

Nor any drop to drink. 

It is good to be reminded of things we take for granted. I am grateful for health. I am grateful for the abundance of fresh water in Canada, the beauty of our lakes and rivers, and will be a responsible steward of our resources.

Here is Nature Canada's website with more information on water supply and conservation.

How to Make Greek Yogurt

Plain yogurt has been a favourite food of mine for many years. It was about 1970 when a friend gave Mom some bacterial culture and taught her how to make yogurt in a thermos with sterilized milk. Later, I bought an electric yogurt maker which was used for years until the plastic exterior deteriorated. I visited Israel around 1977 and remember the delicious pots of thick, white, creamy yogurt which were staples at the breakfast buffets we enjoyed. I never developed a taste for sweetened versions, many of which are thickened with other starches. My dairy consumption is down to a minimum in recent years but I do eat cultured milk products from time to time.

There is a Greek yogurt craze at the moment. Containers of no fat Greek yogurt boast 20g of protein per 175 g portion and grocery stores cannot keep them in stock. We used to call Greek yogurt “yogurt cheese” and I made it as a substitute for sour cream or cream cheese. Yesterday I ran into a friend at the grocery store who was looking for Greek yogurt as it was recommended at her Weight Watchers group. There was one 500 ml container on the dairy shelf and it cost over $5.00.

So I decided to make some for myself and it was well worth the effort and was considerable cheaper too.

A 750g container of plain no fat yogurt cost me $2.99 at a discount grocery store. This plain yogurt is better tasting than similar products sold by our major dairy companies.

I lined a fine sieve with 3 thicknesses of cheesecloth, placed it over a bowl and dumped the plain yogurt into the sieve.

Within two hours, a little over 250 ml of whey was in the bowl and 500 ml of delicious Greek yogurt was in the sieve. It tasted even better after sitting overnight in the refrigerator and in my opinion, was superior to the container of Greek yogurt I did purchase.

What can you make with Greek yogurt? It is delicious as a parfait with fruit and granola. It can be used as a base for dips like tzatziki or raita. Or you can eat it in a traditional fashion, drizzled with honey and sprinkled with fresh nutmeats. A little goes a long way. Yummy!!

Hunger

The feeders are very busy these January days as the birds eat as much as possible during daylight hours to maintain the energy needed to survive the bitter winter temperatures. Most people in the First World eat for pleasure first, not for survival. There are those cannot go for a drive, sit at a desk, attend a meeting, go for a walk or talk on the phone without a drink or snack of some sort in hand. I would venture to say that most people I know go no more than two hours during the day without some sort of oral intake.

Our society has come to expect instant gratification. We buy what we want now, even if we do not need it or cannot afford it. Our children are savvy consumers who quickly learn how to influence the purchasing habits of parents. Advertisers keep us constantly aware of what we must have to enjoy life. Few of us really know what it is to hunger for anything in a material sense.

Most, if not all world religions encourage periods of fasting for spiritual reasons. For a long time I was under the impression that fasting was a sure way to get God to answer our prayers and petitions. Fasting is not a way to earn God's favour, but is a way for us to turn our focus from the material things of life to a hunger for the spiritual realm and an increased recognition of the needs of others. The health benefits of intermittent fasting are also well documented and it has been shown that decreasing caloric intake slows the aging process. Yet some practitioners encourage several smaller meals a day as a way to health rather than giving the body a rest from the digestive process. Fasting has lost favour as a spiritual and physical discipline in our materialistic society.

I had a long 40 hour period of time to think about this as I fasted prior to a routine colonoscopy this week. While my stomach rumbled a little, and my awareness of the sight and smell of food was heightened, I missed the routine of eating more than food itself. A lot of time is freed up in a day when you do not prepare or eat meals. By day two I felt energetic and absolutely pain free. I remembered how a chronic itchy rash my husband had for weeks cleared up completely when he fasted for the same procedure a few years ago.

I have been more mindful and appreciative of my food today. And I won't wait for another colonoscopy (if there ever is another one!) to choose to practice the discipline of fasting again.

Blessed are those who hunger and thirst for righteousness, for they will be filled.

Matthew 5:6

This Year I Resolve to... Enjoy Life's Small Pleasures

My guilt-free New Year's Trifle

I reduced my New Year’s Resolutions to one word or phrase over the last couple of years. In 2009 my word was “simplify” and it is still a daily goal for me. Last year I resolved to make “the best choices” knowing they are not always the easiest ones.

As years go by it is apparent that it is rare to experience “the best year ever”. Good health, prosperity and happy relationships require ongoing perseverance and in spite of our best efforts, we will not experience success in all areas. Life comes in a mix of good and bad, and events will happen which are beyond our control. I am glad I do not know what is ahead for me in 2011. It is enough to live one day at a time.

So this year I resolve to take time to notice and enjoy life’s small pleasures. I bought an inexpensive kit of pre-cut wood to make a small platform bird feeder. Juncos, Doves and Cardinals are some of the birds who do not really like the perch feeders in our yard. Yesterday I glued the pieces according to the instructions before nailing them together. Even with a pattern and the right materials my feeder is not perfectly constructed. There are a couple of bent nails which went off course due to knots in the wood and my poor aim with the hammer. But the feeder is functional if not perfect and the birds do not mind the irregularities in the structure. 

I too am far from perfect and realize that my efforts to achieve “perfection” in this life will certainly fail. I am a work in progress and have some bent nails and knot holes, but it is possible to be useful and fulfilled just the way I am. Words from 2 Corinthians 4 are printed on a plaque in the bathroom. Our treasure is in fragile jars of clay and while outwardly we may be breaking down, inwardly we can be renewed each and every day. That renewal comes through God’s life in us and an attitude of gratitude, of giving thanks in all circumstances.

So I wish everyone a Happy New Year and hope you discover the joy in life's small pleasures.

January 1st was dull and rainy but I enjoyed

• building a feeder
• watching the birds at my new feeder
• having tea and trifle with two of my daughters
• talking to my other daughter and mother on Skype
• seeing the movie The King's Speech