The Physical Toll of Caregiving Nobody Talks About

Foreign. Like to welcome everybody to today's presentation on the physical impact of caregiving on mental health. This is the first in a series of burnout prevention videos. In this video we're going to define caregiving, explore physical impacts of caregiving and how they impact the caregiver and the caregivers mental health. And we'll identify strategies for minimizing the negative physical impact of caregiving. Again, today we're going to focus on the physical, we're going to focus on the physiological. Next week we're going to focus on relationships and interpersonal and then we'll move on to emotional and cognitive, you know, down the road. But today we're really focusing on healing that body to heal your mind. Start out by defining who are caregivers? Caregivers are those who spend a significant amount of time each day providing assistance or care, you know, giving care to someone or someones. This includes but is not limited to counselors, social workers, doctors, dentists, veterinarians, emergency medical personnel, teachers, parents, family caregivers of elders, if you're taking care of your mom or your dad, for example, and hired or institutional caregivers, this could be a caregiver that's hired to come in, or it could be somebody who's working in a nursing home or an alf. So caregivers are in a lot of places. And yes, I've got teachers there because teachers are caring for children during the day, all day long, and they're caring for a lot of children, God bless them. Caregiver stress impairs their ability to function effectively in each piece of life. This reduces the caregiver's quality of life, physically, interpersonally, emotionally, cognitively and even environmentally. It also reduces care quality to the caregiver because when a caregiver is stressed out, is having difficulty getting the basics done, they're going to have more difficulty providing care. Think about a teacher who has 30 children, 30 second graders in their room, and they're trying to manage this classroom and it's exhausting trying to manage all the different personalities and the different needs and it can get tiring. And when that teacher starts to become tired, it's harder to be patient, it's harder to problem solve and pivot to address unique needs as they arise in the classroom. And the caregiving quality of life is going to be reduced because if they're not receiving the same level of care that they had once received from an unburned out caregiver, then they're probably, their quality of life probably declines. And we don't want that. We are caregivers for a reason, because we care and we want to make sure that we are able to. To be there and do what we can to help the individuals. Physical impact of caregiving really centers around increased sympathetic nervous system activity due to stress in each piece of life. Physical, interpersonal, cognitive, cognitive, environmental and emotional. Sorry, I did that out of order. But recognizing that caregiving has a lot of different types of stresses, and today we're going to talk about the physical stresses that a lot of us ignore or minimize and that is faulty. When we do that, we are not being mindful of ourselves and we are not paying attention. It's kind of like when you're driving your car for 100,000 miles. If you've never gotten your oil change, that's going to be a problem. Or you're driving your car and you just ignore all those little rattles and squeaks and everything because you got to get to work. Well, yes, you've got to get somewhere, but if the car breaks down, you ain't going to get there very fast. One of the first issues that we see in caregivers, and I'm going to talk particularly about counselors in home caregivers and teachers, that is not. Those are not the only caregivers, but they are very different in their caregiving experience. So I wanted to kind of highlight those, obviously, ems and veterinarians. I'm not minimizing your impact, but if I went through everybody, we'd be here for like six hours anyhow. Circadian rhythms, if you remember from prior videos, regulate our stress hormones and our nervous system. So it regulates our cortisol, Circadian rhythms regulate our sleep. And our sleep hormones, like melatonin. Circadian rhythms actually directly impact and regulate our gonadal hormones, our estrogen, our testosterone, our progesterone. It regulates both directly and indirectly our neurotransmitters. When our gonadal hormones are higher, certain neurotransmitters are more available. When our go nadal hormones are lower, certain neurotransmitters are less available. And it's important to remember the thing I harp on all the time. If you alter one hormone or neurotransmitter, it's going to alter everything in the system. It's going to alter all of its buddies. Circadian rhythms actually also regulate the gut microbiome. Circadian rhythms help call in the night crew. When you're resting and digesting and repairing. You have a different microbe composition than you do necessarily at night or at during the day and circadian rhythms regulate, believe it or not, thyroid hormones. Reduced thyroid hormones exacerbate fatigue, cold intolerance, bradycardia, which is slow heart rate and sleep disturbances, creating a vicious cycle of circadian rhythm dysregulation, thyroid hormones. When the sympathetic nervous system, our stress response is kicked off. Cortisol goes up, glutamate goes up, adrenaline goes up, thyroid hormones go up, and blood sugar goes up. All of those things are designed to give us energy to fight or flee or protect. We talked last week about oxytocin and how when we feel safe, when we feel relaxed, when we feel empowered and we increase oxytocin, it increases bonding. But when we're in environments where we may not feel safe or we feel disempowered in some way, then increases in oxytocin can actually increase the stress response. Example, when my son was in the neonatal intensive care unit, oh boy, you know, Mama Bear was there. And I didn't agree with some of the things that the nurses were doing or the way they were doing them in particular. And it was really difficult for me because I wanted to protect my little, my little nugget was sitting there in an incubator and I wanted to protect him. And so that oxytocin, that bonding actually worked to bring out Mama Bear instead of to bring out relaxation. If you are in caring for somebody who's in hospice care, for example, you may want them to feel calm, to feel safe, and you may not agree necessarily with how the doctors are, are doing things. And again, instead of increasing feelings of calm, that oxytocin, that bonding you have with that person that you are protecting may actually increase the stress response. It's not to say that oxytocin is bad, but we don't want to overgeneralize. And caregivers, by virtue of the fact that we are giving care, are increasing oxytocin. We are increasing our bond, our desire to care for and protect whoever it is we are working with, whether it's a veterinarian and a dog or a teacher with a classroom full of kids, or a counselor with an individual or an in home caregiver. You know, we're going to bond with those people who are whose care we are charged with. It's important going back to circadian rhythms before we move on too much that we pay attention to our circadian rhythms. And we, for the counselor or the teacher, for example, we see people, we'll assume bankers, hours, whatever. But if you go to bed at night and or you stay up late doing notes so you're not getting enough sleep, or you go to bed at night and you're just dwelling on that one child or that one patient that doesn't seem to be making progress or that is relapsed or whatever that can disrupt your circadian rhythms and keep you from getting good sleep. More often than not, both counselors and teachers, often my experience has been stay up really late or get up really early to do lesson planning, to do treatment planning, to do notes, whatever. There's a lot of stuff that doesn't get done during the day because during the, during eight hours of the day we are caregiving and all of that administrative stuff gets pushed to the side. And there are ways that we can do collaborative noting and collaborative treatment planning. So we're doing a lot of that stuff in session. For counselors, for teachers, it's not so easy. You can't just say, okay, everybody do your thing and I'm going to work on my lesson planning. Especially if you're caring for, you know, first, second, third graders. There are times where you may be able to do it, but there's just never enough time. It seems. It feels like there's never enough time and then that bleeds over because you want to spend time with your family. So you do family stuff in the evening, then after the kids go to bed, then you start your charting or your lesson planning or something. If you do that, you know, and, and I commend your responsibility. But if you do that, you need to recognize the give and take. You need to recognize how sleep loss and circadian rhythm disruption is going to impact you in the long haul. Being able to provide quality care during the day. Circadian rhythms are set by routine. They're set by light and they're set by temperature. Do as much as you can to try to maintain a stable circadian rhythm. It makes a world of difference. If you're an in home caregiver, you may have somebody who wakes up three times, five times during the night to go to the bathroom, or somebody who's sundowning, who gets agitated at 11 o' clock at night. And it's this big thing to get them settled down. There's a lot of things that can disrupt your circadian rhythms. If you have a new baby at home, they don't sleep well. They do, but not for long periods. They need to get up and eat and be changed. That disrupts your circadian rhythms and that is one of the significant contributors to postpartum depression In a Lot of people, because not only do they have hormones kind of going all over the place anyway in recovery, post birth recovery period, but they're also disrupting their circadian rhythms, increasing their stress hormones, which alters their gonadal hormones and their neurotransmitters and their gut microbiome. So we see people developing PPD and having more difficulty attending to, focusing on connecting with the infant. Pain is another thing that we see in caregivers. Whether, you know, if you just had a baby, you know, it can hurt, especially if you had a C section. I didn't have a C section, so I don't know exactly what it feels like, but it looks pretty dreadful. You can have muscle tension just from being stressed out. I volunteered in my kids classroom a few times when they were, when they were younger and I enjoyed it, but I was exhausted and I was only there for a couple of hours because my head was on a swivel. There were children running around everywhere. This was in preschool, kindergarten. And so I had a lot of muscle tension because it was my watch and it was my job to keep them safe. And you know, I actually was sore picking children up or picking adults up. You, if, if you are working with an adult who is not able to ambulate anymore or who needs help in and out of bed, you can get injured. You can get muscle injuries from doing it the wrong way, or, you know, maybe you're doing it the right way and they're just too heavy for you to handle. There's an increased perception of pain when we get tired, when our circadian rhythms get out of whack, it actually alters our pain receptors and our endogenous opioids, our natural painkillers, go down. Our body's ability to suppress inflammation goes down. So we've got more inflammation and we start feeling more pain. That is physiological. It is something that actually happens, not just all in your head. I already mentioned injuries. They're possible when you're caregiving. There are a lot of in home caregivers helping people ambulate, teachers dealing with children, trying to pick them up or, or what have you, counselors, less overt injuries like that. But we can see the occasional problem, especially with ergonomic issues. Headaches, tension headaches, big. If you're stressed, you tend to hold. You guard this area because this area is naturally weak since it doesn't have a lot of bony support to it. You naturally tend to guard your neck and tend to have more tension, which can lead to headaches. Even if you don't have migraines or something. People tend to have more pain. It's hard to sleep when you're in pain, Whether it's from muscle tension, from injuries, from headaches, or ergonomic issues, it makes it hard to sleep. It disrupts your circadian rhythms. It wears you down, being in pain during the day. It's more difficult for most people to be patient when they're already in pain, to think clearly when they're in pain, because pain triggers the stress response. Ergonomic issues also cause pain. Sitting too much. There are a few counselors that I know that actually started developing low back problems because even though they had a good chair, they were just sitting too much and it started causing. Causing problems. Time spent in uncomfortable positions. If you're a caregiver and you've got a baby or an adult, whatever, and you're napping on a sofa or chair next to the caregiver, there are a lot of different permutations of how you could be in a weird position where you need to be there for them. And having gone through hospice with both of my parents, you know, I can attest that there are times when they are in their environment and you are trying to be there to make sure their needs are being met. But there's no comfortable place to sit or to rest. And it can get exhausting. Even sitting in a chair, playing on your phone or your iPad, if you're whoops, if you're looking down all the time is going to put stress on your neck and it can start causing headaches and other pain. Being mindful of your pain and figuring out what's causing it and what can I do to mitigate it? Stretching, movement, setting alarms or reminders on your phone, for example, to get up and walk around and stretch for a minute can be super helpful. Anything that you can do if you have a weak back, wearing a back brace, talking with a physical therapist about modifications that you can make to make it easier to do your caregiving duties without getting hurt. Now, again, for counselors, a lot of it is muscle tension, increased pain perception, and ergonomic issues. And we need to note that and figure out how can we prevent those poor sleep. And this is different than circadian rhythms. Circadian rhythms control our entire body. They control our hormones and everything else that we went through it. They also control our sleep hormones. But poor sleep will throw your circadian rhythms out of whack. Now, why do we have poor sleep when we're caregivers? As I mentioned earlier, racing thoughts can make it really difficult to sleep. We're laying there and we're trying to figure out what is it that's blocking this person's progress or what do I need to do when I see this particular client tomorrow? We need to train ourselves to shut our work brain off before we lay down. Guided imagery, progressive muscular relaxation. Those things can be really helpful for distracting us. Guided imagery is not anything super fancy. It's definitely not new. Think back to counting sheep. When I was little, my mother used to tell me to count sheep and I was like, oh, okay, whatever. But when you're doing that, you're envisioning the little sheep jumping over the fence and you're counting it. You're not thinking about the math test tomorrow, you're not thinking about so and so that did such and such to you at school. So guided imagery doesn't have to be complicated and it can be very helpful for turning your brain's attention away from this thing over here that we can't deal with right now and helping you get quality sleep. High cortisol. If you're stressed out probably, and your cortisol remains high throughout the day, probably means your circadian rhythms are getting out of balance. Because circadian rhythms tell your body to have the highest level of cortisol first thing in the morning and the lowest level of cortisol last thing at night. As cortisol goes down, melatonin starts getting secreted. So if your cortisol is high at night when you're laying down to try to go to sleep because you're stressed about your caregivers, then you may not get the adequate melatonin release and relaxation response to get good quality sleep. You may sleep, but it may not be good quality sleep. And as I mentioned, poor sleep disrupts circadian rhythms due to sleep disruptions. If you're in home caregiver, you may get awakened a lot through the night. If you're a teacher, probably not going to get awakened in the middle of the night. If you're a counselor, you may get that call occasionally in the middle of the night with somebody who's in crisis and then caring for somebody on a different clock. Again, this doesn't apply as much to counselors and, and teachers, but, but definitely for in home caregivers. If you are caring for somebody who typically gets up at 9 in the morning, 10 in the morning, and then stays up until midnight or one o', clock, and you're one of those people like me who gets up at 4:30 in the morning and really likes to be in bed about 8:30, that can really be problematic. It's kind of like switching time zones in a big way. Flying from New York all the way to California, it's going to put you in a fog until your circadian rhythms get reset in order to sync with your careg. Energy use is another thing we ignore. We don't think about how much energy it takes to care and it takes a lot physically. We use energy. Lifting, bending, kneeling, walking and doing for others. Whether it's cooking or, or you know, house cleaning or whatever you're doing for that person in addition to all the stuff you got to do for your own self care. That's more stuff. Yeah, you're doing it voluntarily. It doesn't mean it takes any less energy. It takes energy being a teacher. You're in the classroom and especially. Well, I don't even want to say that, but especially for younger kids, you're doing a lot more lifting, bending, kneeling. You're kneeling down beside their desk to see what's happening. You're walking over to them. Older kids can come to you. That's a whole different set of stressors. But for the younger children there is a lot of physical activity involved in it and hyper vigilance. If you are caring for someone who is ill or if you feel like there is a threat to your caregiving in some way, you may be hyper vigilant. There was a little boy in my son's first grade classroom that had a really bad, explosive anger issue. And when he wouldn't get his way, he would pick up chairs and throw them at other students and at the teacher. So I can only imagine how stressful it was for that teacher. Being hypervigilant for when little Sammy is going to, you know, explode. When is this going to happen? It's not if for that child. It typically was a when. And obviously there were lots, lots of other issues involved that pulled at your heartstrings that were leading little Sammy, and of course that wasn't his name, were leading little Sammy to act this way. And that in and of itself was heartbreaking. But then the teacher also had to be aware of the safety of all the other children and being hypervigilant to those sorts of things. When I was little, little when I was in school, we used to pass notes. We didn't have smartphones and there was something of an art to passing notes because you'd fold them up in certain ways and you'd pass them down. But a lot of teachers, it felt like they had eyes in the back of their head because they knew when somebody was doing it. And that was part of the hyper vigilance. For counselors, we don't lift Ben Neal that much, probably unless you're doing equine assisted therapy or working with kids. If you're working with kids, you may be doing a lot more of that. But just doing for others in addition to ourselves and being somewhat hyper vigilant about what's going on with that person takes a lot of energy. And I've told people many times that once I got out of community behavioral health, it was wonderful because I don't feel that I can do more than four individual sessions in any one day and be effective. By the time I get to my fifth or my sixth, I'm getting exhausted and I'm not providing the highest quality of care. So the other hours of the day, I'm not doing individual. I can do group, which I find takes a lot less energy, or I can do intakes, which I find takes a lot of less energy, or it's different energy. But it's important that we recognize how much energy it takes. Our brain is one of the biggest utilizers of blood glucose. It actually takes energy to think. And if you are focused, if you are honed in on somebody, that's going to take energy interpersonally. It takes a lot of energy to nurture these caregiver relationships. If you're working in hospice, the person may be lucid or not, or may be really angry. My mom went through a period before she went into hospice that she. She, you know, had some level of delirium, but she would just be nasty to the hospital staff, which was not like my mother. My mother was a very nice person, and she would just be hateful to them. And I'd be on the phone with my stepfather and he's like, I gotta go. I gotta reign your mother in. But that's figuring out how to navigate those. Changing caregiving relationships can be exhausting. The beginning of the year for a teacher can be exciting, exhilarating, and exhausting at the same time. Because you're trying to establish relationships with. With all these children, with counselors, when you get new clients. Yeah. I mean, you don't get 30 at a time, I hope, but it can be. It can be tiring. And recognizing that your caregiving relationship, nurturing that relationship so you can provide that care does take energy. Going into a new home, if you're a CNA and meeting somebody that you're going to be taken care of and trying to establish rapport and trust. Any counselor will tell you and any nurse will tell you it's exhausting because you don't know what you're going to get. Sometimes they're thrilled to see you and it's easy peasy. Other times not so much. And so there's an element of apprehension sometimes going into new situations with new clients, which ones are going to be easy and which ones are going to be difficult. Relationships with friends and family takes a lot of energy. And just because you're caregiving for this person over here, even if they're living in your house, maybe Meemaw moved in with you. Great. Okay, so you have that caregiving relationship, but you're also still trying to nurture the relationships and make sure that you're maintaining contact and connection with your spouse, with your kids, with your friends, and oh my gosh, with yourself. How about that? And a lot of times it's kind of in this order where caregivers prioritize the caregiver and then friends and family who don't need them as much right now and their own self care is gone. They don't do anything that they enjoy anymore. Maybe they're getting enough sleep, maybe they're eating okay, but that's about it. Emotionally. Takes a lot of energy for vigilant empathy and for counselors, that's one of the most draining things because we have to be able to empathize with the people that are in our presence without getting stuck there when pe somebody is feeling devastated. As we empathize with that, we take on, we feel some of that devastation again. We have to be able to pull ourselves out of it. But it's exhausting, it really is. And I wouldn't trade it for the world. But I need to acknowledge that if I'm working with clients, you know, I said earlier, four clients max. And then the, the other out billable hours, I do something else. If I'm working with clients who have really intense trauma histories or who have CPTSD or borderline personality traits, I tend to try to back off and only do and do fewer individuals on the days I see those patients because I know it takes a lot. I had one client who had bipolar disorder and because she was pregnant and in our pregnancy and postpartum unit she was unmedicated and wow, staying with her because she was all over the place, staying with her and being empathetic and understanding what it was like in her head was exhausting. And you know, you can't help but empathize with Her. There's a emotional roller coaster when you're caregiving. Whether it's a student, a, a counseling patient or a parent who may be struggling with dementia or cancer or something else. It's a roller coaster. There are, you can't say that it's always going to be a good day. There are good days and there are bad days. You never know which one's going to show up. And we have frustrations. We have frustrations about things that we can't face fix. It's not our job to fix it and we can't change another person or we can't fix the condition. If you have a older adult who is really struggling with advanced stages of dementia and they periodically have terrifying hallucinations, your goal is, your desire is to help them feel safe, to help them be safe. But sometimes you can't prevent those hallucinations from totally happening if you don't want them completely sedated all the time. And that can be really frustrating. Or maybe the care caregiver doesn't want to do what they're supposed to do. They for some reason are continuing to try to strip off their clothes. This is a common thing with older adults that have dementia. We need to ask ourselves again, what's going on? Do they have a uti? That might be, they might be trying to communicate. But there are a lot of things. If you're a teacher, think about the things that you get frustrated about. I imagine my son's first grade teacher got really frustrated. That little Sammy that we're calling him was in her class and was being disruptive and was scaring other students and, and there was nothing she could do about it. In general, at least in our district, they had the. She did everything she could, but it still wasn't enough. And that was really frustrating. Not having the resources that you need for counselors, having to keep your therapy sessions to 50 minutes, not being able to run over feeling like you've just got absolutely too much to do and you want to focus on the patient, what you went to school for a million years for. But then you also have all this documentation over here that's frustrating. And acknowledging those frustrations. Yes, some of them dialectics. We got to embrace the good with the bad and figure out how to minimize the amount of distress and frustration it's causing us. Cognitively, we need extra energy required to think clearly due to sleep deprivation and stress related brain fog. Not only are we probably as caregivers, hyper vigilant, we're thinking a lot, we're Empathizing a lot. That's taking a lot of energy. We may not be getting adequate quality sleep because of stress, because of pain, because of disruptions, and all of that leads to brain fog. And when we have brain fog, it's even harder to think more clearly. And that can be frustrating. Paying attention to what Hayes talked about with dirty discomfort, and that is not getting distressed over your own distress. If you feel distress, it's important to acknowledge it, to accept it. Okay, it is what it is right now. What do I do about it? Instead of feeling frustrated and then feeling guilty that you're frustrated with the patient and then feeling angry, that about something else, that just adds piles it on. So acknowledging being mindful and acknowledging how you feel in the beginning can be really helpful if you are sleep deprived. If you've got brain fog, acknowledging, hey, I'm not going to be as fast on my feet today, just knowing going in that it's going to take me a minute. And not getting angry with yourself when you're not Johnny on the spot, because getting angry with yourself is only going to increase cortisol, increase inflammation, and increase brain fog. Extra energy is used. Problem solving for other people, if you have, well, counselors, caregivers, teachers. A lot of times we're in positions where it's our job to help people figure out how to solve problems. When you're with some, in some situations, the people, whether it's a young child or somebody with dementia or a person with a mental health issue that you're working with, they may not have any idea how to solve the problem. They're like, that's why I'm here. Help me figure out how to solve it or tell me what to do to solve it. And in that case, they're not giving you a lot of input. So you're drawing from your own experience and trying to figure out how to help them. Is it rewarding? Heck, yeah. But it's also exhausting and environmentally cleaning up after the people. In counseling, we don't do that as much, except for in animal assisted therapy and art therapy and a few of the groups that I do where we've got balloons or balls or other props. That doesn't take a whole lot of time. If we do groups, a lot of times the chairs are pulled out and put into a circle or a semicircle. And then when group is over, I got to put the chairs away. Again, not a big deal, but it takes energy and it takes time that I could be spending doing documentation or something. So cleaning up after your caregivers takes energy. Managing light, temperature and sound for the additional person or persons in the environment can also be stressful and require energy. If you're caring for somebody. My mother in law is caring for my husband's grandparents right now. And my husband's grandparents like it a sauna in there. I mean just absolutely like 85 degrees. They think it's just perfect. And my mother in law is just dying in there. She's you know, wearing a T shirt and it's, she's very modest so she's still wearing a lot of clothes but as little as she can get away with. And she's hot. And when we're too hot or when we're too cold, our body body registers that as a stressor and uses more energy to try to regulate our temperature. But also paying attention to what we need to do. Especially if there are multiple caregivers involved like in group therapy, residential treatment, a classroom or a hospital. Figuring out how to manage the light to meet everybody's needs so one person is not getting overly stressed and can be exhausting. Worsened nutrition, a lot of caregivers, counselors in home caregivers, teachers, parents, you know, the whole thing. We want to care, we want to be there to provide these services. So we ignore our own self care. We grab on the go instead of sitting down for a proper meal. Well, I don't have time for that. If I, you know, I can go do notes right now instead of sitting down and like actually chewing my food. Which takes us to eating too quickly again. I'll give the example of my son. When he was little, he had GERD really bad. And there was a very small window of time where one of us, either myself or my husband had to eat before he needed to be picked up again and, and you know, carried around because of his acid reflux. Once he got on medication it was great. But during that period where he was undiagnosed, I learned to eat really, really fast because I knew as soon as he finished eating somebody had to keep him upright for the foreseeable hour. Poor digestion. Well, when we don't chew well, when we are doing something else like doing notes or, or lesson plans while we're eating, we're probably eating too quickly, we're probably not chewing our food well. But also when we're stressed, we got that sympathetic nervous system going wild. That means our rest and digest our sympath. Parasympathetic nervous system isn't doing its job which means we're not digesting Food as well. When you are stressed, when you are in the fight or flight or even what you would consider just stressed out, your body is not directing energy to doing what it needs to do to process that food. So even if you're eating great, it may not be being absorbed by your body. A lot of us, because of sleep deprivation, circadian rhythm alterations, frustration, lots of reasons, may gravitate toward comfort foods that will trigger the release of serotonin, dopamine and endorphins. Remember I said earlier, when your circadian rhythms get out of whack, you actually start feeling more pain. When your neurotransmitters are altered by stress, you start feeling more pain, you start feeling more exhausted, your dopamine levels and serotonin levels go down. So it makes sense. People try to self medicate with food. And these foods are typically inflammatory, highly processed, so they make your blood sugar go way up really fast. But they are, they taste good and they may be highly processed, so they're easily digested. And a lot of times our comfort foods are also associated with positive times in our past where we did feel comforted. So people grab gravitate towards these. In addition to being inflammatory and really bad on your blood sugar, they're also typically very low fiber. So they are not feeding the gut bacteria. They're not, there's no prebiotics there. Eating an anti inflammatory diet that's high in prebiotics, different types of soluble and insoluble fiber and probiotics, things like yogurt and fermented foods does a lot for helping your gut make the neurotransmitters and keep everything balanced. Remember, part of our mood is impacted by our gut. We have the gut brain axis that's connected by the vagus nerve. And when our gut is saying, hey, there's stress out there, then our vagus nerve sends that message up to the brain. And if we're not eating foods that feed the healthy bacteria in our gut, then the unhealthy bacteria in our gut are going to proliferate. We're also going to have looser junctions in our GI tract, in our wall and we can have leaky gut. I think I'm going to get there in a minute. Dehydration. It's really easy to forget to drink. When you're caregiving, use a water bottle. Keep a water bottle with you so you can sip throughout the day. If you won't remember to refill it, then start with a really big one. Excessive caffeine, because you're not Getting enough sleep can is number one will cause dehydration or contribute to dehydration. But it also increases your stress response and increases inflammation and increases blood sugar. And if you drink it too close to bed, will impair your circadian rhythms because it's increasing cortisol. Paying attention to that caffeine, I'm not giving mine up. You know, I'm not saying you should, but paying attention to how much you drink and when you drink it and try to substitute decaf for in between, you know, go 75 caffeinated, 25 decaf, then 5050 and then kind of wean yourself off the caffeine if you can. You'll notice that your sleep is actually better. And avoid alcohol consumption before bed, especially ideally anytime but during. When caregivers are feeling stressed, they may come home and want to have, you know, a couple of beers or a bottle of wine. That contributes to systemic inflammation. Alcohol is a toxin. If you're going to drink, which some people are, okay, no, no harm, no foul there but well, harm maybe, but make sure that your blood alcohol concentration is 0.00 when you're going to bed. If your blood alcohol concentration is higher that than that when you're going to bed, then you may go to sleep quickly. But as that alcohol leaves your body, your stress response goes way up and even if you don't wake up, it's going to impair your quality of sleep. Worsened chronic diseases are also seen in caregivers. Delayed care seeking. You know, maybe I have this, this knot in my stomach that you know, I've been feeling for the past month but I just don't have time to go to the doctor. I've got to take care of my caregivers. Okay? It's not unusual to hear something like that. Sometimes we don't want to go so we look for excuses. But sometimes we don't prioritize. Unfortunately, if our chronic diseases get worse, eventually we may not be able to take care of our caregivers. And we need to remember the long term consequences of lack of self care. And I know I don't usually put 1, 2 and 3, but there were enough articles on these things that I thought were important in this area that I wanted you to have access to. Cancer has been shown to be higher in caregivers. They associate the increased inflammation and increased oxidative stress of associated with caregiving as contributing to kicking off that cancer or impairing the immune system. So cancer can get a foothold however you want to look at it. But it is well documented and diabetes is very common even in people who are average weight. Because stress, every time you get stressed, even if you're not eating, every time you get stressed, your body dumps blood sugar. As a result of that high blood sugar, then you have to put out some insulin to get that blood sugar absorbed into the muscles and whatever. So then you start. People who are stressed chronically start developing insulin resistance again, even if they're normal weight, even if they're eating a reasonable diet. We can see this stress and stress related sleep disturbance in caregivers, specifically in this study was shown to contribute to metabolic dysregulation and insulin resistance. Caregivers. When they compared non caregivers to caregivers, caregivers were found to have higher fasting glucose, higher insulin levels and insulin resistance, independent of other risk factors that they looked at. So they determined that this metabolic dysregulation was actually due to caregiving stress, which tells us what to be, pay attention to, recognize when we're feeling stressed and trigger that vagus nerve, use our distress tolerance skills, strengthen that parasympathetic nervous system so we don't start becoming insulin resistant as a result of our caregiver stress. That way we can be there and we can continue to do what we value. Dementia, increased inflammation. Systemic inflammation that results from stress actually causes neurotoxicity, which causes cognitive impairment to progress and is strongly associated with the development of dementia. Autoimmune disorders, we know are highly correlated to stress. Stress goes up, immune system goes down or haywire depending on the person. And we know that stress in people with autoimmune disorders will kick off an episode. And if you have an autoimmune disorder like lupus or rheumatoid arthritis and you start getting stressed out, then that is going to kick up, which is going to impair your ability to care for the caregiver. And it's going to impair your quality of life. Let's just face it, it's going to contribute to stress and burnout in you. It's going to get frustrating. And hypertension, you know, increased inflammation, increased stress, we're going to see potentially increased hypertension. All I can say in these things is being mindful of what your body's telling you. Seek care, get regular checkups, get your blood work done at least once a year and really work on strengthening that parasympathetic nervous system and recognizing what's important in your rich and meaningful life. And what is going on right now that you can control and Acknowledging what you can't control. You can grieve, you can say it sucks, whatever. You know, I'm not saying ignore that. But in order to turn down that stress response, we, we need to feel safe and empowered. We need to recognize what aspects we do have control over. Increased inflammation and impaired immunity. Chronic stress from caregiving increases pro inflammatory cytokines and reduces immune responsiveness, so the immune system doesn't recognize problems nearly as effectively. This increases susceptibility to infections and autoimmune flares. If you've been caregiving for a while, I mean, there's always the beginning of every semester when the kids go to school and everybody's been out visiting and they've gotten all these strange bugaboos from all over the place. I almost got, almost always got sick at the beginning of every semester that my kids were in school. And that was just kind of expected because those were germs that I hadn't developed a response to. But for people who are stressed out, who are worn down, their immune system isn't awake, if you will. So when they're exposed to germs, even germs that they may have a responsiveness to, the immune system is not nearly as effective at handling the infections or handling whatever's triggering the autoimmune response. And, and that again is going to contribute to a reduced quality of life for the caregiver and the caregiver. And then there's gut dysbiosis, leaky gut and neurotoxicity, which I already touched on. Back to stress. Stress alters your gut motility. So how quickly food moves through your gut, your microbiome diversity. Because of a change in the gut environment, the, we'll call them bad microbes tend to flourish and the good microbes tend to start to lose ground. This can cause irritable bowel syndromes, dysbiosis, upset tummy and imbalance in the gut microbes and reduced nutrient absorption. The microbes break down the food so we can absorb the nutrients. If we don't have the right microbes in there, then ain't nothing getting broken down and absorbed. We have disruption of circadian rhythms as a result of caregiving, which alters microbial diversity. And as I mentioned earlier, the permeability of the gut wall. When this happens, when we have gut wall permeability, then all of the toxic byproducts, if you will, are can leak out of the gut and create what we call endotoxemia, internal toxic environment. And cytokine release and neuroinflammation because the body, the immune system starts going, oh, we've got invaders here. There's, you know, toxins we need to handle. So they kick into high gear, which increases inflammation. But if we have too much inflammation, especially for too long, then we start creating an environment that is neurotoxic and we literally start killing brain cells. Neuroinflammation increases neurotoxicity and it also reduces neurogenesis. So not only are we killing brain cells, but we're preventing new brain cells from forming. It's an unhealthy environment, so we're not making any new ones and we're continuing to lose them. Physiological stress experienced by caregivers bidirectionally impacts stress in all other areas of life. And we're going to talk about all those other areas. But it's so important to understand how your body factory plays into your emotional reactions, your ability to interact with others and empathize, your ability to think clearly and effectively, problem solve. All of that is supported and sustained or not by the body factory. Caregivers should consider the following interventions to maintain mental and physical health so they can provide a consistent quality of care and avoid getting burned out. Prioritize your circadian rhythms. Whatever you gotta do, make sure that you're prioritizing. You're going to bed about the same time each night and you're trying to get seven to nine hours of quality sleep each night. And I know you're like, oh, my kingdom to have seven solid hours of sleep. It makes a huge difference in your ability to function the other hours of the day. It seems like for people who feel like they've got too much to do all the time and they're like, oh my gosh, I can only get four hours of sleep. That's all I got. Well, okay, what can you eliminate? What can you combine? What can you simplify so you can get seven hours of sleep? When you get that seven hours of sleep, you tend to be exponentially more productive during your awake times because you're refueled and your body has been able to clear the adenosine out of your brain. And you, your body is not saying, hey, you're sleep deprived and I'm stressed. Because anytime you're sleep deprived, you're stressed. So prioritize those circadian rhythms and your sleep hygiene. If you've got allergies, don't let the cat sleep in the bed with you. If you get a hepa filter that runs whatever you need to do. If there's noise Consider that keeps you awake. Consider white noise or earplugs, whatever you can do. Eat an anti inflammatory diet, high in pro and prebiotics. Now that sounds dreadful when you say it like that, but that basically means eat whole grains, eat, you know, relatively unprocessed proteins. So your, your eggs, your beef, your chicken, your turkey, your fish, your, your quinoa, whatever type of protein you like. Tofu, all of those are great, but they're not overly processed. They're not. I always used to kind of liken the, the chicken patties at a particular sub store as being pre chewed. You know, it was just, it was all this stuff that was just mushed together, kind of like chipboard that's too processed. We want to make sure that we're getting as unprocessed as possible. Stay hydrated and minimize caffeine, especially close to bed. Address pain and use good ergonomics. Practice mindfulness. Strengthen that vagal tone. Oh, that is so helpful to strengthen your vagal tone. So when you start to feel distressed, you feel like you have the ability, you feel confident in your ability to downregulate that stress response, to slow your breathing, your heart rate and lower your blood pressure. Get regular blood work done to monitor your gonadal hormones, your thyroid hormones and your basic nutrients, your vitamin D, your iron and your B12. And use purposeful action so you can focus on using energy on those things that are important in your rich and meaningful life that can be controlled. Focus on what you can do and you'll be amazed at how much more empowered and hopeful you feel in a situation. Are there any questions? Healing energy suggests listening to subliminals and that can be great. I've never tried it, but I have heard, you know, a lot of people rave about subliminals. Lisa has a wonderful suggestion about meal prep being a key to success. Taking food to work with you so you don't have to find time to get out. But even if you are an in home caregiver, meal prep. When my kids were little, one day a week I would pre prepare the rice, the pasta. I know if you're Italian, you're cringing right now and I'm sorry, but it was going to be what it was going to be. The rice, the pasta, anything that would take time, you know, more than like five or ten minutes to cook. I try to pre cook so I could combine things throughout the week and wouldn't have to spend a lot of time A cooking and B cleaning. So Lisa raises a wonderful point. And if you've got healthy food pre cooked. It's a lot less tempting to reach for something like that good old macaroni and cheese with the powdered, powdered cheese in it. Mark, you've got a lot going on. And, and please know that there is probably, I don't know exactly where you're at, but there is pro. There are probably resources for you that can help with respite. I would encourage you to reach out to the local United Way to see if there are organizations that can help you out. If your parents are on Medicare or Medicaid, there are very likely resources that can help you get some brief respite. They won't be able to provide ongoing care, but they may be able to give you, you know, an hour to get out sometimes. So please make sure that you're investigating those things. Always good to see you, Lisa. Narina. I gotcha. Gloria. I am really glad that it was helpful for you. And effective next week, we will be talking about the interpersonal aspects of caregiving and preventing burnout. You're always welcome, Jim. Always glad to see you. You are quite welcome, Claire. Wow, NATO, that blood pressure is super high. I'm assuming that you are working with your doctor on strategies to reduce it using strengthening your parasympathetic response. Your vagus nerve may be helpful. It's not going to do everything. It sounds like there's some underlying issues that are contributing to that high blood pressure, but the fact that you are aware of it and addressing it is wonderful. All right, everybody, if there are no other questions, I will see y' all next Monday for the AMA and next Wednesday for the CEU presentation.