Thursday, March 29, 2007

life is a chronic condition

Living a Healthy Life with Chronic Conditions: Self-Management of Heart Disease, Arthritis, Diabetes, Asthma, Bronchitis, Emphysema and others (Third Edition) by Kate Lorig, RN, DrPH, Halsted Holman, MD, David Sobel, MD, Diana Laurent, MPH, Virgina Gonzales, MPH, and Marian Minor, RPT, PhD (so glad i’m not handwriting that~writer’s cramp~big time!) is the text we use for a class i took back in February in Chronic Disease Self-Management. It’s a four-day course in which we take the class and learn to lead/facilitate the class (which instead of being four days will be spread our over six weeks in two and ½ hour sessions. In order to be a course facilitator you must suffer from a chronic condition yourself (so the class members can relate to you).
We use a standardized program created at the Stanford School of Medicine. I took the course through our Aging Services Department. In order to meet the completion and certification requirements you have to facilitate a class and i was hoping to do one at my library (i was also hoping to consider all class time as work time) but everything became a bit problematic once i started attending. First there was the whole volunteer/employee thing which i won't go into~basically having to do with the fact that you need to be volunteering but we happen to work for the same government body~just different agencies; and then some discussions with my personnel director led to the compromise that i could do the initial training ½ vacation time and ½ paid time as long as i committed to do at least one class at my library which was fine, since it was part of my plan anyway; but then i felt somehow obligated to sign up for one of the already scheduled classes through aging services~so i signed up for the only one i had time availability for (most of the other people in this training were retired volunteers or were employed at the senior centers they were going to teach at). So far so good.

At the end of March i got a call from the Outreach Coordinator for Aging Services and she can't find a co-facilitator for an upcoming class (did i mention it takes two to facilitate each class?) can i possibly do it? I have to be at work before the class is scheduled to be over. That will probably be okay as the classes don't go the full time but she'll call Ms. Co-Facilitator to be sure. Unfortunately she called me back to say that Ms. Co said that would be fine. So now i'm committed to three classes in my copious free time (actually it's not so much the time itself as the time that i can actually manage to leave my dark quiet house and drive a car and talk to people over the raging pain in my head~thus my chronic condition)

During the first three sessions i rather uncharacteristically, submissively sat back and let Ms. Co take over the class, feeling like if she wanted to do all the work she could (also since i had a full eight hour day ahead of me i really couldn't afford to let myself feel my usual rampageyness towards being ordered around). The problem (that i didn't know about) was that the independent seniors at our senior center did not take too kindly to her grade-school-teacherly manner, and over-enforcement of the rules (although i could have told them she strayed quite a few times and didn't understand the standardized program as well as she should have). When the cute and perky outreach coordinator called me to ask if she could drop the snacks for the next class off at my house i thought nothing of it as she happened to life just down the street from me. But when she showed up she had all sorts of leading questions about how the class was going and how Ms. Co was doing. My diplomatic answer was that she was okay, that she had a tendency to take over and run on, but overall it was okay. If i had known that she was asking because there had been class member complaints... So CuteandPerky says maybe she should stop by just to observe and i say sure...

Class morning i show up my usual fifteen minutes before class is scheduled to start (which is usually fifteen minutes later than Ms. Co shows up) and there is no one there, which is odd. I'm thinking "this is odd, this is the right day, right???" I start to set up, still no one. I walk to the Director's office and ask if she's seen Ms. Co. "Who's Ms. Co?"

"She's doing the Chronic Conditions Class..."

"I know no one likes her.

that is not so good. "You had a couple more dropouts last week," she continues.

I wander back to the lounge/classroom, my mouth doing it's anxious little twisty thing. Two class members approach me books in hand, wanting to return them. "It's not you, YoSafBridg," one of them says. Eventually CandP shows up, stops by the Director's office to say she's here to observe today's class, i step in and tell her that there probably isn't a class, explaining the situation. Just as the three of us are discussing things i see Ms. Co walking in the door.

"Oh, i'm not good with confrontation..." says CandP (somehow that doesn't surprise me...

We go into the room and Ms. Co, CandP, and i have a little chat about the class (which was not the most comfortable discussion i've ever been a party to, but it had to be done, and then it was done.) Though we did discuss a few of the issues people had (and Ms. Co demanded to know who those people were, i demurred) i tried my most diplomatic resources and she left, i believe, completely unaware that she had a problem, her fondest desire of teaching still in tact (that wasn't necessarily our intention, but people will only hear what they will hear). So i left thinking "at least i have That morning free for a little while."

That, of course, was not to be. CandP called the next week saying she had talked to the director and that the class members would like to continue the class if CandP and I were teaching (so they did like me "they really liked me!!!"). So this morning, its back to class i went (a much more enjoyable experience, i might add~tho it did involve more work, being an active facilitator and all ...)

And after that extremely long, saga-like introduction and peek into my ever-so exciting life, i'll tell you of the book itself: it is basically what the title says it is, a manual focusing on self-management of chronic conditions to lead a healthy, fulfilling life (and wouldn't i love to throw wealthy in there~not only for its rhyming possibilities but also because i'm feeling the pinch at the moment.)

The book covers every aspect of disease/life self-management starting with understanding your symptoms; using your mind to manage symptoms; exercising for fun, fitness, strength, and endurance (including tips for specific illnesses); communication skills; sex and intimacy; making your wishes known (advance directives, DNRs, living wills, etc); healthy eating; managing medications; and making treatment decisions; as well as chapters dealing with specific conditions; it ends with planning for the future. The book and the class are both very useful tools for those dealing with chronic conditions or caring for those who are.

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