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Archive for August, 2009

(By Dr Esther G. Ebenezer, ADFM-Alzheimer’s Disease Foundation Malaysia Panel of Medical Advisers)

The Burden of Dementia on Caregivers and Loved Ones:

IT would be appropriate to begin this with a real account of how a caregiver struggled to take care of her husband who suffered from Alzheimer’s disease before he passed away recently.

Mrs X felt lost when her husband was first diagnosed with Alzheimer’s disease. Initially, she had no clue about the disease, but she learned a lot along the way. She single-handedly took care of her husband. Support groups did not exist in her locality at that time and both her children were settled overseas. As she went through each stage of the disease with her hubby, she became well versed in handling the associated difficulties inherent in Alzheimer’s disease.

She considers moderate stage Alzheimer’s disease to be the toughest period to go through. She cites some of the incidents and her experiences as follows:

“One night, when I thought my husband was fast asleep, I switched on the TV for a moment to relax. I was sewing at the same time. I was startled by a shout right beside my ears, and found him standing close by, raving something about me having killed his two sons. ‘Where are my two sons, show me my sons, you have killed them …’ ”

“My husband did not recognize me at all. Gripping the pair of scissors I used for sewing, he pointed it at my neck. He dragged me towards the wall and began to bang my head against it, again and again. I felt a cold shiver my spine. I managed to convince him that they were alive, living abroad, and I could get them to talk to him.”

“He seemed to comprehend that … so I ran to phone to call the boys to talk to him. For the next few hours, the boys phoned back a number of times to talk to him until he calmed down completely. He was also tired out by then and wandered back to bed to sleep.”

“For the rest of the night, I stayed outside the house, inside the car. It was only later I learnt that this kind of behaviour of mistaking someone to be an imposter is known as ‘Capgrass syndrome’.”

“When my husband became aggressive and abusive verbally as well as physically, his anger outbursts came unexpectedly, during odd hours of night. Life became unbearable. Some nights, when he was unusually restless, I slept in the car as I felt safer there.”

“Now he is no more, and I still feel that I had not done enough for him when he was alive. I never thought I would miss him that much. In the past, I wished he would die, but now that he is gone, it is hard to face.”

Elderly Concerns:
The number of elderly people in Malaysia is increasing at a rapid pace – those aged 60 years old and above constituted 6.5% in 2000, and this is expected to double by the year 2020. The number of dementia-like diseases such as Alzheimer’s disease increases with age. Currently dementia is estimated to affect some 60,000 Malaysian elderly, and by the year 2020, this figure is also expected to double.

People with dementia suffer mainly from poor memory; impaired cognitive functioning such as planning, organizing, and judgment; and personality changes, disorientation, and behavioural disturbances. Persons with dementia go through different stages where they need different sort of care.

A Caregiver is someone who offers help to a family member or friend with dementia, either part-time or full-time. Caregivers provide many services that include transportation to the doctor, paying the bills, help with bathing or dressing, shopping, meal preparation, and coordinating with outside agencies for assistance.

The Four Stages of Care-giving:

Stage One : Getting Started
Recognize the impact of care-giving on your life and family, learn how to be a Caregiver, and find out more about the demented person who needs care. In the early stages of dementia, activities of daily living are impaired, and the sufferer needs constant supervision.

Stage Two : Finding Help
As the disease progresses, behavioural disturbances set in; this is considered the most difficult stage to handle and is a testing period for caregivers. Demented persons at this stage often end up being sent to institutions or to nursing homes as the caregiver can no longer cope. DO NOT hesitate to ask for help – from family, friends, and support groups.

Stage Three : Heavy Care
Finally, the sufferer will become wheelchair-bound or bed-bound. Here they need basic nursing care.

Stage Four : Letting Go
Resolve relationships, complete end-of-life decisions, utilisz hospice care, let yourself grieve after the demise, care for yourself, and have a plan for your life after care-giving has ended.

Caring for someone with Alzheimer’s disease or dementia impacts every aspect of daily life. As the patient loses one ability after another, Caregivers face tests of stamina, problem-solving, and resiliency. During this long and difficult journey, communication diminishes, rewards decrease, and without strong support, caretakers face challenges to their own well-being. Grief, depression, and anger are common, but learning about the disease can reduce one’s frustration, foster reasonable expectations, and help prepare for new challenges.

Maintaining emotional and physical fitness is crucial. Prepare and protect yourself by understanding your loved one’s experience and getting help from others. This can minimize the stress and enhance the joys of one’s care-giving experience.

The cognitive and physical regression of the patients will ultimately require 24-hour care. Although medical advances can slow down the decline, Alzheimer’s remains a terminal disease. Research carried out among Caregivers have found that they experience significant emotional disturbances. They visit their doctors more often, and are more prone to psychological distress.

Poor social support where there is lack of family and friends to facilitate care, lack of community health-care services, social isolation, and even lack of knowledge of the disease can adversely affect the caregiver.

Seek professional help if you have warning signs of Caregiver burnout. If you’re not getting enough sleep, eating poorly, and feeling lonely or crying, losing your temper more, it is time to reach out for help.

Because care-giving is such hard work, the following simple strategies will help protect the Caregiver against the pitfalls of excessive stress:

– Schedule mini-workouts throughout the day. Regular exercise not only keeps you fit, it releases endorphins that help keep you happy.
– Make time to play. In the early stages of Alzheimer’s disease, include your loved one in short walks, board games, or jigsaw puzzles. A daily dose of fun is good medicine, and doesn’t require money, a car, or huge amounts of time.
– Try something new. Challenge yourself to learn a new skill while you are “on the job”.
– Keep laughing. Humor is a well-known antidote to stress, sadness, illness, and boredom. Hence, envelop you and your loved one with laughter. Get hearty belly laugh DVDs at the video store. Your infectious good mood will replenish your inner resources and sooth your loved one.
– Ask for help. Take regular time away to recharge yourself.

Some Recommendations:
– Put staying healthy at the top of your list.
– Have a back-up plan in case something unexpected happens to you.
– Take one day at a time.
– Keep your sense of humor.
– Pat yourself on the back for the good job you are doing.
– Get enough rest and eat right.
– Make time for the things you like to do.
– Talk to others about how you feel.
– Listen to your friends.

If you have family members who live close by, ask them to share some of your burden. A couple of hours a week away from care-giving can be a lifesaver for you. Use this time to do the things that you used to do in your life, such as:

– Get away from the house
– Go out for a walk
– Meet friends for lunch
– Go to a prayer meeting
– Listen to music
– Work in your garden
– Read a book

Medical, legal and financial planning should be done early, while options are still available. Once decisions are made, communicate them to people who need to know, both family members and professionals. Plan ahead on how care would be provided in the event of illness, hospitalization, or death of the Caregiver.

Avoid isolation. Being a Caregiver can be a wonderful experience, but it can also be a lonely one. Caregivers can express love, loyalty, and affection for those in their care, but it can also be a time when guilt, anger, and frustration surface. Caregivers need people with whom they can share their pain, in person or by phone. Look for support groups as a source of encouragement and information.

For some help and information, the book, “The 36-Hour Day : A Family Guide to Caring for People with Alzheimer Disease and Memory Loss in Later Life” is an excellent guide, with vivid illustrations and clear information. It’s worth buying.

Alzheimer’s Disease Support Group:
When you’re caring for someone with dementia, it can be all too easy to ignore your own needs and to forget that you matter, too.

Support groups can be of assistance. One example is the Alzheimer’s Disease Foundation Malaysia (ADFM), a non-profit, non-governmental organization registered in July 1997. There are ADFMs operating in Penang, Perak, Melaka and Johor Bahru. The main objective of this organization is to assist dementia patients and their families. They can offer encouragement, the latest information, and helpful suggestions for caring of Alzheimer’s patients.

Support groups usually consist of family members who provide a caring, non-judgmental support network. Support groups usually offer guidance on legal advice, respite care, financial and insurance information, state medical assistance, placement issues, handling feelings of guilt and anger, elderly benefits, clinical research, latest drugs that are available, companionship, comfort, and much more. Though support groups in Malaysia are not equipped to offer the full range of support, they still provide ample aid.

Respite Care:
Respite care is short-term care used as a temporary alternative to a person’s usual care arrangements. People who care for someone with dementia often carry on without realizing how tired or tense they have become. A break or holiday can help them relax, recharge and rejuvenate their minds and bodies.

Different types of respite care are available, ranging in duration from hours to days or even weeks. The most frequently utilized form of respite care service is the day care centers. Day care benefits the demented person through social interaction and diversified activities. It benefits the Caregivers by giving them a much needed break. Research has found that day care centers have favourable effects on a demented person’s behaviour and helps reduce Caregiver stress.

In Malaysia, dementia day care centers are run by NGOs. Volunteers are always welcome for various needs such as drivers, persons providing information and legal advice, physiotherapists, social workers, general helpers, and also individuals who can raise funds to run the center.

Anyone who is interested to learn more about Alzheimer’s disease can get a copy of the handbook Playbook for Alzheimer’s Caregivers by Coach Broyles for free through the internet. This book won the 2008 Caregiver Friendly Award and provides a wealth of tips on care-giving. You can also visit the website at: http://www.alzheimersplaybook.com.

I would like to conclude the topic on dementia with a poem from a demented person’s perspective:

Do not ask me to remember.
Don’t try to make me understand.
Let me rest and know you’re with me.
Kiss my cheek and hold my hand.

I’m confused beyond your concept.
I am sad and sick and lost.
All I know is that I need you
To be with me at all cost.

Do not lose your patience with me.
Do not scold or curse or cry.
I can’t help the way I’m acting,
Can’t be different ’though I try.

Just remember that I need you,
That the best of me is gone.
Please don’t fail to stand beside me,
Love me ’til my life is done.

– Author unknown-

(Source: thestar.com.my/health, published 23 August 2009)er

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MONEY TALKS IN CANCER

A Breast Cancer Survivor reveals its painful burden on family resources and how having health insurance saved her life.

YOU’VE just been diagnosed with cancer, and the doctor is discussing treatment options. Should cost be a deciding factor?

The prices can be staggering. Consider this scenario: There are two equally effective options to battle cancer, the kind spreading through the body – but one costs RM$60,000 more than the other.

One in eight people with advanced cancer turns down recommended care because of the cost, according to a new analysis from Thomson Reuters, which provides news and business information. Among patients with annual incomes under RM$40,000, one in four in advanced stages of the disease refuse treatment. Do they pay out of their own pockets, sometimes in the thousands of ringgit? Or do they forgo the therapy to preserve what modest assets they may have for their families’ futures?

CANCER CARE IS EXPENSIVE:
My first encounter with cancer was when my dad was diagnosed with stomach cancer in 1998. Our battle lasted six months before he succumbed to it. But our financial woes lingered long after that.

Dad was a 70-year old pensioner when he was diagnosed with advanced stomach cancer. It was a dreadful disease to have. Upon his diagnosis, we were determined to give him the best medical care possible and do everything we possibly could.

It was a big commitment, and we soon realised that our means to fulfill that commitment were rather limited. The six months after diagnosis was a very trying period for all of us. In those six dark months, all our savings were depleted and credit cards used to the maximum.

I still remember it as though it were yesterday. My family and I were gathered in uncomfortable chairs in the gloomy hospital lounge. It was late in the evening and we were at our wit’s end. Dad had a terrible two days of pain and the doctors informed us that we were fighting a losing battle. “Take him home,” they said, “you’re wasting your money.” We were physically tired, emotionally drained, and financially exhausted.

We had by then exhausted our resources. Yet we were unwilling to take him home … it sounded so final. We hoped, in his last days, to keep him as comfortable as possible. How were we going to proceed? Our bank accounts were dry and credit cards used to the limit.

We considered many options – mortgaging the house, applying for personal loans, borrowing some money from friends and relatives …

We decided the next morning we were going to do something about it.

But the next morning, dad passed away. It was as though he knew that we had reached the end of our resources. It took us a few years after that to emerge from the financial crisis that the cancer had caused.

We had overlooked and underestimated the financial burden of cancer and its impact on my dad, the patient, and us, the family. An individual does not face cancer alone, a family does. My dad’s stomach cancer had cost him his life. We all miss him dearly. At the same time, the cancer had cost us a substantial amount of money, for my dad did not possess a health insurance or medical policy.

Having witnessed our struggles, my church member, an insurance agent, got our whole family insured. And what a blessing it was.

In 2008, I was in Wellington, New Zealand, working on my doctoral thesis when I was diagnosed with aggressive, advanced breast cancer after a needle core biopsy. Having discussed my options with the breast consultant over there, I decided to return home for treatment.

All the bad memories of the dark moments we had battling with my father’s stomach cancer came rushing back. I remembered the physical fatigue, emotional pain, and the financial drain cancer can cause. I shuddered. It took us so long to climb out of the financial hole cancer had caused and now I was being sucked into it again. I knew financial cancer could mentally kill me faster than breast cancer.

Being a civil servant, I first explored my treatment options in our public hospitals. Because of the large number of patients they were already servicing, I was put on a three-month waiting list. As I explored other avenues, the deciding factor for treatment was cost. Each doctor discussed my treatment options and the cost. It was a grim picture they painted.

By now I was feeling so lost and overwhelmed. I couldn’t think. My family was frantic.

I felt like I was drowning. I was lucky; I had a cushion to fall back on. My health insurance came to the rescue. My medical card enabled me to get prompt treatment, which is an important factor in fighting cancer. My medical card gave me the freedom to find the best doctors and best treatment available in town. My medical card helped save my life.

I soon discovered that there is much more to the cost of treatment than hospital, physician, and medication bills. Out-of-pocket expenses for transportation, food supplements, over-the-counter medications, distractions, telephone bills, complementary medicines, and many other hidden costs can be a significant drain on finances. The total financial damage came close to RM80,000. Because my medical card absorbed the bulk of the cost that was incurred during the treatment, the out-of-pocket expenses were more manageable.

I am so very thankful to my insurance agent who got me insured. Because of my medical card, I could focus on getting better and not waste my energy worrying about finances and the astronomically expensive treatment.

Having triumphed over my cancer, I truly believe that God, and my dad, are watching out for me. They are doing that through the blessings of family, friends, my doctors, and most importantly, health insurance.

(Source: The Sunday Star, August 9, 2009)

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STUDIES conducted in the United States have found that 50% to 60% of parents reported their children having feeding difficulties. A closer look at the studies revealed that only 25-35% of the children have real feeding difficulties.

For such parents, mealtimes are charged with anxiety or coercion, which often shows up in the way they feed the child, and the child responds by losing his appetite. The more the parent urges or tries to force the child into eating, the more the child will reject the idea of eating.

Hence, it is important for parents to realize that there are many other factors which can affect the child’s appetite, not just feeding difficulties.

Parental support is crucial for a child to develop healthy eating habits.

The Common Factors?

Oral-motor development – Effective eating depends greatly on your child’s readiness and adequacy in oral-motor skills such as sucking, licking, biting, and chewing. You need to be critically aware of this developmental milestone to avoid difficulties during feeding.

Fear of new foods – Also known as neophobia, this developmental stage of rejecting new or novel foods is common for children between the ages of two and three. If this is not managed well, the child may show further signs of distress and anxiety.

Environmental factors – Chaotic work schedules and cultural beliefs of eating are some of the environmental factors that can significantly influence the eating patterns of a child. For example, unpredictable mealtime schedules may create inconsistent eating habits.

Social development – The time when a child starts to assert his independence begins to peak between the ages of two and three to four years old, causing him to have more interest in other things other than food alone. As a result, your child may assert his independence by refusing to eat or insisting on eating only one type of food for days on end.

Unfortunately, many parents are often quick to point the blame at feeding difficulties the moment their children aren’t eating or do not meet the basic expectations of physical growth. This may affect how they react or behave during mealtimes. This can further compromise:

(1) The child’s eating behavior. When a child is forced to try a new food, anxiety may heighten, causing him to remember the uncomfortable experience the next time he is offered the same food. This occurs because the child has associated eating with feelings of distress.

(2) Parent and child relationship. The relationship between the parent and the child can significantly be affected when both go into a nerve-wrecking tug-of-war during stressful mealtimes. Studies have consistently shown that the stronger the parent-child bond, the more likely a child will show interest in eating.

(3) Growth and development. If eating problems persist as a result of coercive feeding techniques, a child’s potential to grow and develop into a healthy and well-rounded individual is compromised.

(4) Nutritional imbalance. The child may be deprived of certain nutrients that are vital to his growth. In rare cases, if the child suffers a lack of certain important nutrients, it may be more difficult for him to fight certain illnesses or disease.

To prevent all these from happening, the cycle of parental pressure during mealtimes should be broken. Instead of feeling anxious, which could result in forceful feeding techniques, you should:

(1) Say goodbye to anxiety! If you are impatient and nervous during a feed, your child may also feel anxious and withdrawn. To avoid anxiety during mealtimes, you can try starting a conversation with your little one by discussing the taste, texture, and smell of the food.

(2) Create a supportive and nurturing environment. A comfortable setting is one where the child feels respected, nurtured, and trusted, allowing him to explore and learn new eating skills without fear of coercion or punishment. This will help your child and you relax and eat better.

(3) Have a little patience. The key to introducing new foods is being a little bit more patient than you normally are. You should also give your child adequate exposure to new foods, and make sure that it is given systematically and gradually so that your child may get used to it.

(4) Never discuss your child’s eating habits during the meal. You should not focus on your child’s eating problems during family mealtimes.

(5) Take control, but be flexible.
As a caring parent, your ultimate goal is to make sure that your child enjoys his food without having to deal with unnecessary stress or anxiety. This is possible when you are relaxed and calm at all times!

(Source: The Sunday Star, August 9, 2009-http://thestar.com.my/health. By Associate Professor Dr Thomas Linscheid)

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(By Professor Dr Philip Poi Jun Hua, Consultant Geriatrician from University Hospital-UMMC, Malaysia & ADFM Panel of Medical Advisers)

THERE are an estimated 50,000 to 60,000 people with significant memory impairment in Malaysia. As a result, there is a silent, unrecognized band of Malaysians – mostly women (daughters) – who have chosen to take care of a loved one with such a condition, e.g. Alzheimer’s disease. This is a demanding job in itself, but many are not only care-giving, they are also raising their own children – and may be working – at the same time.

For anyone in this situation, squeezed between the responsibilities of parent and caregiver, days are spent preparing lunches and making sure medications are taken, checking homework, and filling out health insurance forms. For the caregiver, his or her marriage, family, career, and health will be tested.

Being a caregiver does just mean taking care of a loved one 24 hours a day. If you are helping a parent out with the basics of living, and your visits have stopped being social and become a necessity, you have become a caregiver.

Taking care of someone with Alzheimer’s is too much for one person. You’ll need caregiver support from your spouse, siblings, doctors, local and national organizations; and of anyone else who offers it.

The Long Haul

There are seven things you need to accept about your future as a caregiver.

Your loved one may live for many years. The life expectancy of someone with Alzheimer’s depends on the age at which the diagnosis was made. Many people with Alzheimer’s disease live eight, 10, or more years. Becoming a caregiver is a serious, long-term commitment.

The demands of care-giving will increase. As the disease progresses, your loved one will need more and more help. In the early stages of the disease, caregivers spend about 14 hours a week on average caring for the person. In the advanced stages, it becomes a full-time job.

Being an Alzheimer’s caregiver will affect your family. There may be ways to get your children involved that will not only give you, the caregiver, support, but will benefit your loved one and transfer the care ethic to your children.

Care-giving will affect your finances. This is usually due to the cost of medications and the need to have an extra hand in the form of domestic help or a nurse.

Do not try to do it alone. Taking care of someone with Alzheimer’s is too much for one person. You’ll need caregiver support from your spouse, siblings, doctors, local and national organizations – and from anyone else who offers it.

Care-giving requires skills. Caring for someone with Alzheimer’s disease does not come naturally any more than lecturing on physics comes naturally. Care-giving for someone with dementia is not like looking after another child. Sometimes the logical, natural thing to do is the wrong thing.

The common problems faced by children looking after parents with memory impairment are usually a result of a lack of information on how to handle this new situation. You need to learn about the disease, its treatment, and the legal and financial issues. Consult Alzheimer’s disease web sites (see below), books, health care professionals, and other caregivers. Do not try to muddle through on your own. Both parent and caregiver will suffer the consequences!

Dementia causes memory impairment, but in the early stages of this illness, the forgetfulness noted by both your parent and the family might be innocuous. Many children attempt to correct the mistakes the parent makes in the hope that it improves the memory of the event. Some become irritated by the repeated questions asked. It is useful and important to appreciate that the reality experienced by those with memory loss is not your reality. They may insist a long gone relative is still alive or that someone is stealing their money. By persistently insisting that they are wrong in their perception can cause your parent to suffer from a loss of confidence and experience distress and possibly depression.

One solution is to distract your loved one with another interesting activity or to bring them to another room where there are no triggering cues. Try not to confront or correct, but to diplomatically distract to avoid creating a drama.

Later in the illness, when your loved one becomes increasingly dependent on you, there is a tendency to assume control over all activities. Prompting your memory impaired parent to change his or her clothing, or to bathe or eat may be necessary. They may react to your attempts to help in a way that you might find inappropriate, or irritating. When your parent behaves erratically, look for possible triggers as listed below:

– Physical discomfort: They may have an infection, a headache, lack of sleep, a toothache, or even simple constipation that could affect even your behavior!

– Activity related: In the past, your parent might have been the queen of the kitchen, and because of her worsening memory, you fear that she might harm herself and bar her from accessing the kitchen. You might find that your loved one becomes increasingly agitated as mealtime approaches, and this could be her intrinsic desire to prepare food for the family.

Distracting her with another meaningful activity or involving her in the kitchen whilst monitoring her activity might reduce her feeling of helplessness. In a similar situation, cessation of driving may be very disturbing and has to be handled with care and tact.

– Intrinsic personality: Some parents have in the past, docile temperaments, and some may have fiery tempers. One should anticipate amplification of their past behavior if they experience distress.

– Depression: A common association, which may precede or follow the onset of memory loss and can present with agitated behavior or restlessness.

When you feel overwhelmed, it is easy to get locked into your habits, to keep doing things the same way even if they are not working. Try to keep some perspective and think of creative ways to get help. At the very least, reach out to some of the local and national organizations for Alzheimer’s caregiver support (see below)

Family Issues

Explain the situation to your children. The chances are that your children have already noticed that something is amiss. So explain that it is a disease that is making grandpa or grandma behave strangely – and that it is not contagious.

Involve your children. Young children can provide entertainment; older children can help out by doing more chores around the house. Your children might not like to do this, but sometimes circumstances give you little choice. And if the household functions better as a result of their help, everybody benefits.

Develop a plan of care. If possible, bring the family together for a meeting. Decide with the older person what the primary needs are, who can provide assistance and what community resources would help. Summarize your agreement in writing. Keep in mind that family difficulties are common. Involve your family and siblings in the decision making process as early as possible.

Discuss legal and financial issues. These topics may be difficult to talk about, but they help ensure that the older person maintains decision-making authority even when incapacitated. Pre-planning will also lessen family disagreements and protect family resources. Do not delay addressing this item.

Sometimes, exclude grandma. A person with Alzheimer’s tends to become the center of attention, which can leave children – and other adults – feeling overlooked. So although you might feel guilty about it, you need time away. A weekly dinner out with just your spouse and children to reconnect as a family might be all you need to recharge your batteries.

Taking Care of Yourself

If you want to keep taking care of your family and your loved one, you need to keep physically and mentally strong. You need to give yourself breaks. If you have siblings, make a deal where they take over for the weekend, or even for a longer period.

Getting other people to help out does not only help you, it gives you the opportunity to interact with your friends, go shopping, or just to get your hair done. So stay fit. Eat in moderation. Activity is the key for physical and mental health. Try to squeeze in 20-minute walks or have a home exercise programme.

Long-Distance Caregivers

If your mother lives in Penang and you are in Hong Kong or even Johor Baru, how do you help take care of her?

Get organized: Take care of necessary paperwork. Find all legal, financial, and insurance documents, including birth and marriage certificates, wills, and power of attorney. Identify bank accounts, titles, sources of income and obligations, and all relevant insurance papers.

Review these documents for accuracy and update them if necessary. Store documents in a secure place such as a safe-deposit box or a fireproof box.

Identify your informal network. Ask for help from people in the older person’s community, such as relatives, neighbors, long-time family friends and members of religious, civic, and social organizations. Ask them to call you if they spot a problem.

Investigate travel alternatives. Be prepared to “care commute” for any emergencies. Investigate travel options in advance.

Finally, maintain good health, make time for yourself, set limits, and allow others to help. Remember that the person with memory impairment has a different reality and it is easier to be non-confrontational and develop the patience of an angel.

(Source: The Sunday Star, August 9, 2009 – http://thestar.com.my/health)

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You can feel good for no reason at all. In fact, you can choose to feel any way you wish at any time and in any situation.

Whatever you desire, you desire because of the way you think it will make you feel. Whatever you avoid, you avoid because you don’t wish to experience the feelings that you assume it will bring.

Yet the fact is that your feelings are not controlled by your circumstances. Those feelings are determined by how you choose to respond to various situations and events.

Your feelings in any moment are yours to choose. You can choose to feel the wonderful reality of your most treasured dreams long before those dreams have been fully achieved.

And when you do, you put yourself in a positive, powerful place from which you can surely make those dreams real. When you feel good for no reason, you immediately begin to create the reasons.

Choose each day to feel the way you wish to feel, no matter what is going on around you. And let your feelings pull you toward the fulfillment of your destiny.

(Source: By Ralph Marston)

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Did you greet your day with a smile or with a frowning face?

Our day is dictated by how we welcomed it with.
And the magic formula is to SMILE .

“A smile costs nothing but gives much. It enriches those who receive without making poorer those who give. It takes but a moment, but the memory of it sometimes lasts forever. None is so rich or mighty that he cannot get along without it and none is so poor that he cannot be made rich by it. Yet a smile cannot be bought, begged, borrowed, or stolen, for it is something that is of no value to anyone until it is given away. Some people are too tired to give you a smile. Give them one of yours, as none needs a smile so much as he who has no more to give.”

“A smile is a very simple and easy thing to do. It not only makes the person in front of you better, but it also makes you feel better as well. Let your smile be an invitation for others to get to know the great person behind the smile. Then let people see that your smile doesn’t stop at your mouth. It goes all the way to your heart. Smiles are free – don’t save them. Someone might smile back.”

“You’re never fully dressed without a smile.” – Martin Charnin
” A smile is a light in the window of the soul, indicating that the heart is at home.”
” Smile, it’s the second best thing one can do with one’s lips.”
” Brighten the world with your smile.”
” A smile can open a heart faster than a key can open a door.”
” Smiling makes you feel better about yourself, even if you don’t feel like it. ” – Lauraine Snelling
” Today, give a stranger one of your smiles. It might be the only sunshine he sees all day.” – H. Jackson Brown, Jr.
“People seldom notice old clothes if you wear a big smile.” – Lee Mildon
” A smile is a curve that sets everything straight.” – Phyllis Diller
” The world always looks brighter from behind a smile.” – Author Unknown
” Start every day with a smile and get it over with.” – W.C. Fields
” A smile is an inexpensive way to change your looks.” – Charles Gordy
” If you smile at someone, they might smile back.”
” Everyone smiles in the same language.”
” I’ve never seen a smiling face that was not beautiful.”
” Every time you smile at someone, it is an action of love, a gift to that person, a beautiful thing.” – Mother Teresa
” A friendly look, a kindly smile, one good act, and life’s worthwhile.”
” A smile is the universal welcome.” – Max Eastman
“· It takes seventeen muscles to smile and forty-three to frown.”
” Of all the things you wear, your expression is the most important.” – Janet Lane
” Peace begins with a smile.” – Mother Teresa
” The face is the mirror of the mind, and eyes without speaking confess the secrets of the heart.” – St. Jerome

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The thing that goes the farthest
Towards making life worthwhile,
That costs the least, and does the most,
Is just a pleasant smile.
It’s full of worth and goodness too,
With manly kindness blent,
It’s worth a million dollars,
And it doesn’t cost a cent!

– Wilbur D. Nesbit –

“Life hugs us all. The problem is that it can’t tell if it’s hugging us with clouds or thorns. It hugs us with beauty, and all are beautiful.”

A merry heart makes a cheerful countenance – Proverbs 15:13

The world is like a mirror: Frown at it, and it frowns at you; smile at it and it smiles too – Herbert Samuels

Most smiles are started by another smile – frank A. Clark

If you’re not using your smile, you’re like a man with a million dollars in the bank and no checkbook – Les Giblin

A smile is the lighting system of the face and the heating system of the heart – Barbara Johnson

A smile is a light in the window of the soul indicating the heart is at home – Author Unknown

Wear a smile and have friends; wear a scowl and have wrinkles. What do we live for if not to make the world less difficult for each other? – George Eliot

Smile – It’s free therapy – Doug Horton

Nobody needs a smile so much as those who have none to give – Author unknown

What sunshine is to flowers, smiles are to humanity – Joseph Addison

A smile is worth a thousand words – Author unknown

When you smile at someone, nine times out of ten the other person will smile back and you’ve made two people’s days brighter and better – Author Unknown

Wrinkles should merely indicate where smiles have been – Mark Twain

Smiles are the language of love – David Hare

Smile at each other, smile at your wife, smile at your husband, smile at your children, smile at each other—it doesn’t matter who it is—and that will help you to grow up in greater love for each other – Mother Teresa

There are hundreds of languages in the world but a smile speaks them all – Author Unknown

A winning smile makes winners of us all – Author Unknown

“It took me quite a while to realize that a simple smile and short greeting could truly make a difference in people’s lives. I did not smile much as a teenager or young adult. Once in a while someone would say, “Smile”, and I would want to tell them to mind their own business. As I grew up and was able to get out of my own head , I began to realize that it was not what I got but what I gave that would ultimately make me smile with autenthicity. Even when life is rough, I remember that others might be having a tough time too and I always try to rise to the occasions and brandish a smile.” – Author Unknown

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