MEDICAL NOTES Valerie J. Shereck, MSN, ANP-C

SUNDOWNING

Sundowning or sundown syndrome is a neurological occurrence that is associated with increased confusion and restlessness in individuals with some form of dementia. It is most commonly associated with Alzheimer’s disease but can be found in other forms of dementia. The word “sundowning” was coined due to the timing of the individual’s confusion as the fading light, which occurs in the evening or when the sun is setting, seems to trigger symptoms. Approximately one out of five people with Alzheimer’s disease gets sundown syndrome. Other research shows that 20% - 45% of individuals with Alzheimer’s will experience this behavior. Sundowning seems also to occur more frequently in the middle stages of Alzheimer’s disease and mixed dementia. The symptoms seem to subside as the person’s dementia progresses. CAUSES AND TRIGGERS Some scientists believe that changes in the brain of the individual with dementia can affect the “inner clock” or what is called the circadian rhythm. Normally, in humans, sunset causes a reduction in levels of the neurotransmitter dopamine in our brain and an increase in levels of melatonin, another neurotransmitter. The area of the brain that signals when a person is awake or asleep breaks down in individuals with Alzheimer’s disease and can cause sundowning due to decreased production of melatonin. Other causes or triggers of sundowning include being too tired, being hungry or thirsty, having sleep disturbances, daytime sleeping or napping, too much caffeine, having pain, or being bored. Also, less light and increased shadows in the home can cause confusion and fear. The individual with sundown syndrome may also have difficulty separating dreams from reality, thus causing disorientation. SIGNS AND SYMPTOMS Symptoms of sundowning may have a wide range but may include the following: › Increased general confusion as daylight fades › Agitation and mood swings - This may be due to frustration with their own confusion. It also may be provoked with noise. Individuals may yell or pace. › Mental and physical fatigue as daylight ends - This may increase irritability. › Tremors may occur or if already present, may increase. › Increased restlessness which may also lead to pacing and wandering › Disorientation › May become demanding and suspicious › May see or hear things that are not there (delusions or hallucinations) › May sometimes exhibit violent or aggressive behavior Prior to treatment and management of sundown syndrome, it is important to distinguish it from delirium or other medical illness (such as a urinary tract infection). Consultation with a primary care provider or neurologist to diagnose sundown syndrome is important. A thorough review of the person’s medication, physical examination, and review of symptoms and triggers should be performed. In some individuals, laboratory studies may be ordered to rule out any other causes of symptoms. TREATMENT AND MANAGEMENT The treatment and management of sundown syndrome should be aimed at reduction of symptoms and behaviors, as well as to provide safety for the person and caregiver.

THANKSGIVING DAY

November 28, 2019

Pegi Schlis, CTRS, ACC, AC-BC

HISTORY

The first national Thanksgiving proclamation was issued

by President George Washington in 1789. November 26,

1789 was a day set aside for “Public Thanksgiving and

praise, and duty calling us devoutly to express our grateful

acknowledgements to God for the manifold blessings he

has granted us.”

Thanksgiving, as we now know it, is largely the result of the hard-working efforts of Godey’s Lady’s

Book editor, Sarah Josepha Hale. Hale started her one-woman crusade for a Thanksgiving celebration in

1827. In her editorials, she encouraged the public to write to their local politicians. Over a period of 40

years, she wrote hundreds of letters to governors, ministers, newspaper editors, and each President. She

always made the same request that the last Thursday in November be set aside to “offer to God our

tribute of joy and gratitude for the blessings of the year.” In an attempt to strengthen spirits during the

Civil War in 1863, President Lincoln declared the last Thursday in November as a national day of

thanksgiving starting in 1864.

In 1939, 1940, and 1941, President Franklin D. Roosevelt thought the day was too close to Christmas

(some sources say he wanted to lengthen the Christmas shopping season) so he proclaimed

Thanksgiving as the third Thursday in November. In 1941, Congress passed a joint resolution for

Thanksgiving to be celebrated on the fourth Thursday in November, starting in 1942.

FIRST THANKSGIVING DINNER

The Wampanoag tribe of Native Americans helped the Pilgrims survive their first year in the New

World, and they celebrated together in the autumn of 1621 with a holiday feast. Information about the

first Thanksgiving comes from a letter written in December 1621 by Edward Winslow. He was one of

the people who sailed from England in 1620 that founded the Plymouth Colony in Massachusetts.

According to Winslow, it was considered a harvest celebration and took place over three days sometime

between late September and mid-November in 1621. The celebration included feasting, games, and

military exercises. They ate wild turkey, venison (Native Americans brought this), fish, and shellfish and

native wild plants including Jerusalem artichokes, garlic, cranberries, grapes, walnuts, and chestnuts.

They also ate food from their gardens including cabbage, carrots, cucumbers, leeks, parsnips, and

pumpkins.

PUMPKIN TRIVIA

› Pumpkins were on

the menu at the first

Thanksgiving as

stewed pumpkin.

› Pumpkins have been

grown in North

America for more than five thousand years. They are native to Central America and Mexico.

› Pumpkins are grown on six of the seven continents, with Antarctica being the sole exception.

› Pumpkins are a fruit and member of the squash family which includes cucumbers, honeydew melons,

cantaloupe, watermelons, and zucchini.

› Pumpkins are 90% water.

› The largest pumpkin ever grown was 2,323.7 pounds.

› The largest pumpkin pie weighed 3,699 pounds and was 20 feet in diameter.

› Native Americans fed pumpkins to their horses.

› Pumpkins were once recommended as a cure for freckles and used as a remedy for snake bites. Eating

the seeds was thought to help men avoid prostate cancer.

SIMPLE IDEAS FOR USES FOR SMALLER PUMPKINS

§ Serving Bowl cut off the top making it wide enough that a small bowl can be inserted. Use a spoon to

hollow it out. Place a bowl inside.

§ Candleholder Follow the same procedure for a serving bowl but place a tall candle inside.

§ Turkey Fruit Kabob Holder Make skewers of fruit leaving room on the pointed end to insert into a

pumpkin. Use a pear to make the turkey’s head; connect the upside-down pear to the pumpkin with a

toothpick. Use two cloves for eyes and a strip of red pepper for the nose / wattle.

§ Pumpkin Vase Follow the same procedure for a serving bowl but place a vase inside to hold fall

flowers.

PUMPKIN CRANBERRY CAKE Cake • 1½ cups flour • 1¼ cups sugar • 2 tsp. baking powder • 1

tsp. baking soda • 2 tsp. cinnamon • ½ tsp. ginger • dash allspice • 3 eggs • 1 tsp. vanilla • 15-oz. can

pumpkin • ¾ cup butter, melted • ¾ cup dried cranberries, chopped Brown Butter Frosting • ½ cup

butter • 4 cups powdered sugar • dash salt • 1 tsp. vanilla • 4 to 6 Tbsp. milk 1) To make the cake,

combine the flour, sugar, baking powder, baking soda, and spices in a large bowl. In another bowl,

whisk the eggs, vanilla, pumpkin, and butter until blended then stir into the dry ingredients until

combined. Stir in the cranberries. 2) Spread the batter in a greased 15" x 10" or 13" x 9 pan. Bake at

350° for 20 to 25 minutes or until tests done. Let cool on a wire rack. 3) To make the frosting, heat the

butter in a saucepan over medium heat until golden brown, about 7 minutes. Remove from the heat and

let cool for 5 minutes. Stir in the powdered sugar, salt, vanilla, and enough milk to reach a spreading

consistency. 4) Spread the frosting over the cake before cutting.

VETERANS’ DAY

November 11, 2019

Michele Mason, BA

HISTORY

Armistice Day was first celebrated on November 11, 1919. It

was the one-year anniversary of the end of World War I. (Major

hostilities formally ended at the 11th hour of the 11th day of the

11th month of 1918 when the armistice with Germany went into effect.) The U.S. originally observed

Armistice Day with a congressional act that was approved on May 13, 1938 that made November 11 a

legal holiday. The name was changed by President Dwight D. Eisenhower in 1954.

VETERANS’ DAY TRIVIA

› There are more than 21 million veterans in the U.S. today.

› California is the state with the most veterans, more than two million followed by Texas and Florida,

each with more than 1.6 million.

› The Tomb of the Unknown Soldier in located at Arlington National Cemetery in Arlington, VA. The

tomb has remains of soldiers from World Wars I and II and the Korean War. It is guarded 24 hours a

day, every day of the year, and in all types of weather. Volunteers from the elite 3rd U.S. Infantry

Regiment guard the tomb. The guard is changed every hour on the hour from October 1 to March 31,

and every half hour from April 1 through September 30. Visit

www.arlingtoncemetery.mil/Explore/Tomb-of-theUnknown-Soldier for more information.

› Flags do not fly half-staff on Veterans’ Day since it is a day of celebrating those who have served and

are serving in the Armed Forces

MILITARY QUOTES

› “The soldier above all others prays for peace, for it is the soldier who must suffer and bear the deepest

wounds and scars of war.” -Douglas MacArthur

› “Duty, Honor, Country. Those three hallowed words reverently dictate what you ought to be, what you

can be, what you will be.” -Douglas MacArthur

› “There is a certain enthusiasm in liberty, that makes human nature rise above itself, in acts of bravery

and heroism.” -Alexander Hamilton

› “Never was so much owed by so many to so few.” -Winston Churchill

› “Bravery is the capacity to perform properly even when scared to death.” -General Omar Bradley

› “I learned that courage was not the absence of fear, but the triumph over it.” -Nelson Mandela

This Was the Year...1949 Pegi Schlis, CTRS, ACC, AC-BC

U.S. PRESIDENT & VICE PRESIDENT: Harry S Truman &

Alben W. Barkley

TIME MAGAZINE PERSON OF THE YEAR: Winston

Churchill

COST OF LIVING: • New House - $7,450 • Average Income - $2,959 • Minimum wage jumped from

40¢ to 75¢ / hour • New Car - $1,420 • Average Rent - $70 per month • Gasoline - 16¢ per gallon •

Harvard Tuition - $600 per year • Movie Ticket - 60¢ • Postage Stamp - 3¢ • One Ounce Gold - $31.69 •

Year End Close Dow Jones Industrial Average - 200.52

COST OF FOOD: • Granulated Sugar - 85¢ for 10 lbs. • Milk - 84¢ per gallon • Ground Coffee - 65¢

per pound • Bacon - 50¢ per pound • Eggs - 24¢ per dozen • Ground Beef - 47¢ per pound • Fresh Bread

- 14¢ per loaf

NATIONALAND WORLD NEWS: • The Soviet Union tested its first atomic bomb. • North Atlantic

Treaty Organization (NATO) was founded. • The National Basketball Association (NBA) came into

being. • The first automatic streetlights were used in New Milford, CT. • Geneva Conventions (an

agreement on the treatment of prisoners) was enacted. • Snowfall was first recorded in Los Angeles. •

Newfoundland joined the Canada Confederation. • The Emmy® Awards for U.S. television were first

presented.

TECHNOLOGY NEWS: • Popular Mechanics predicted that computers in the future may weigh no

more than 1.5 tons. • RCA perfected a system for broadcasting color TV. • RCA released the first 45

rpm single record. • The first Polaroid® camera was sold for $89.95. • The first Volkswagen® Beetle,

the “People’s Car,” was sold in the U.S.

POPULAR QUOTES: • “Meep Meep” -Road Runner • “Made it, Ma! Top of the World!” -White Heat

• “What a dump.” -Beyond the Forest

POPULAR MOVIES: • All the King’s Men (Academy Award® winner) • Adam’s Rib • She Wore a

Yellow Ribbon • On the Town • The Third Man • Twelve O’Clock High • Knock On Any Door • It

Happens Every Spring • Kind Hearts and Coronets • The Third Man • Sands of Iwo Jima • White Heat

FADS • Men’s argyle socks • Canasta • Silly Putty® • Watching Death of a Salesman • Kewpie® dolls

SPORTS CHAMPIONS: • New York Yankees (baseball) • Philadelphia Eagles (football) • Bill

Holland (Indianapolis 500) • Toronto Maple Leafs (hockey) • Kentucky (NCAA basketball) • Ted

Schroeder & Louise Brough (singles at Wimbledon) • Cary Middlecoff (golf U.S. Open) • Mazelaine

Zazarac Brandy, Boxer (Westminster Dog Show)

MUSIC: • Some Enchanted Evening (Perry Como) • Forever and Ever (Russ Morgan) • Baby, It’s Cold

Outside (Esther Williams & Ricardo Montalban) • Cruising Down the River (Blue Baron) • Diamonds

Are a Girl’s Best Friend (Carol Channing) • I Can Dream, Can’t I? (The Andrews Sisters) • If I Had a

Hammer (The Weavers) • I’m So Lonesome I Could Cry (Hank Williams) • Riders In the Sky (Vaughn

Monroe)

BORN THIS YEAR • Vicki Lawrence • Lionel Richie • Jessica Lange • Jeff Bridges • Billy Joel •

Meryl Streep • Bruce Springsteen • Richard Gere

La demencia es una pérdida de la función cerebral que se presenta

con ciertas enfermedades. El mal de Alzheimer (AD, por sus siglas en

inglés) es la forma más común de demencia. Este afecta la memoria,

el pensamiento y el comportamiento.

Causas

Se desconoce la causa exacta del mal de Alzheimer. La investigación

muestra que ciertos cambios en el cerebro conducen a esta

enfermedad.

Usted es más propenso a presenter el mal de Alzheimer si:

Es mayor. El desarrollo de esta enfermedad no es parte del

envejecimiento normal.

Tener un pariente consanguíneo cercano, como un hermano,

hermana o padre con Alzheimer.

Tener ciertos genes ligados al mal de Alzheimer.

Los siguientes factores también pueden aumentar el riesgo:

Pertenecer al sexo femenino

Tener problemas cardiovasculares debidos al colesterol alto

Antecedentes de traumatismo craneal

Quiero hablarles de Villa de Este Colaboración de Hector Roberts

Es una villa situada en Tívoli, cerca de Roma. Declarada Patrimonio de la Humanidad en 2001, pieza maestra de la arquitectura italiana y especialmente del diseño de jardi-nes. Fue encargada por el cardenal Ippolito d'Este (1509-1572), hijo de Alfonso I de Este y Lucrecia Borgia, y nieto del papa Alejandro VI. Había sido nombrado gobernador de Tívoli por el papa Julio III, con el regalo de la villa preexistente, la cual reconstruyó por completo siguiendo los diseños de Pirro Ligorio, bajo la dirección del arquitecto e ingeniero ferrarés Alberto Galvani, El pintor jefe de la ambiciosa decoración interior fue Livio Agresti de Forlì. Desde 1550 hasta su muerte en 1572, cuando la villa estaba casi acabada, el cardenal de Este creó un edificio palaciego rodeado de unos espléndidos jardines aterrazados en un estilo manierista propio de la última etapa del renacimiento, que se aprovechó plenamente de la espectacular ladera pero que requirió innovaciones para traer agua suficiente para abastecer todas las fuentes, cascadas y juegos de agua que decoran los jardines. El resultado es una de una serie de grandes villas del siglo XVI con estructuras de juegos de agua en las colinas que rodean la Campiña romana, como la Villa Lante, la Villa Farnesio en Caprarola y las Villas Aldobrandini y Torlonia en Frascati.

Su planeamiento del jardín y sus rasgos acuáticos se imitaron a lo largo de los dos si-glos siguientes desde Portugal hasta Polonia. Cogiendo la inspiración (y muchas esta-tuas y gran parte del mármol usado en la construcción) de la cercana Villa Adriana, el palaciego retiro del emperador Adriano, y reviviendo técnicas romanas de ingeniería hi-dráulica para proporcionar agua a una serie de fuentes sin precedentes, el cardenal creó un elaborado jardín de fantasía cuya mezcla de elementos arquitectónicos y jue-gos de agua tuvieron una enorme influencia en el diseño de paisajes europeo.

Recuerdo que la segunda visita, de noche la guía se cayó a una fuente, por un acci-dente, y yo la aplaudí mucho y le dije que era muy buena y que si lo hacía todas las noches al final del tour, se puso muy enojada y no me habló más en toda la noche. Si van a Roma es una visita MARAVILLOSA . Espero les guste el artículo., Su Profe Héctor Roberts .

Mes Nacional de Concientización sobre la Enfermedad de Alzheimer

Colaboración de Marta Moreno por los 500 años de la Habana

SI ME OBLIGAN, ME ROBARÉ LA HABANA... Eliseo Alberto Diego

Si me obligan, me robaré La Habana.

La romperé, verás, con un martillo.

Traeré de contrabando, en el bolsillo,

la noche, nuestro mar y tu ventana.

Si me obligan, me robaré el pasado.

Me llevaré mi calle y sus portales,

tu juventud, un verso, las postales

de esa islita que el odio me ha negado.

Si me obligan, me robaré La Habana

piedra por piedra, amor, pena por pena.

Mi vida rompo, guardo los pedazos.

Escapo antes que sea de mañana.

Me verás dando tumbos por la arena

como quien lleva a su mujer en brazos.

Todo comenzó un 16 de noviembre de 1519 cuando Diego Velázquez de

Cuéllar, bajo la sombra de una ceiba, celebró una misa conmemorativa de tal

fundación. La bautizó como San Cristóbal de La Habana, aunque con el paso

del tiempo se quedaría para la posteridad con uno más corto y sonoro: La

Habana. Al parecer, proviene de una derivación fonética del nombre de un

importante cacique indio, dueño de aquellas tierras, llamado Habaguanex.

En todo caso, este medio milenio que ha dado mucho de sí. La impronta

española, presente durante siglos, queda reflejada en los más variados

aspectos de la vida cubana: arquitectura, idioma, religión, literatura,

gastronomía… Y es que La Habana seguirá teniendo en su corazón de

manera imperecedera un pedacito de España.

He vivido: amado, sufrido; escogí mi camino, con aciertos, errores,

fracasos y éxitos. Sentirlo todo plenamente me ha permitido llegar

a “mi hoy” feliz, en paz, con familia, amigos y la dicha de aun poder

dar...... Marta Moreno

EN PAZ Amado Nervo

Muy cerca de mi ocaso.

yo te bendigo, vida,

porque nunca me diste

ni esperanza fallida,

ni trabajos injustos, ni

pena inmerecida;

porque veo al final de mi

rudo camino

que yo fui el arquitecto

de mi propio destino;

que si extraje la miel o

o la hiel de las cosas,

fue porque en ellas puse

hiel o mieles sabrosas;

cuando planté rosales,

coseché siempre rosas.

Cierto, a mis lozanías

va a seguir el invierno;

tu nunca me dijiste

que mayo fuese eterno!

Hallé sin dudas largas

noches de mis penas;

pero no me prometiste

tener sólo noches buenas;

y en cambio tuve muchas

santamente serenas.

Fui amado, el sol

acarició mi faz.

!Nada me debes, vida!

!Vida, estamos en paz

El 11 de noviembre se celebra en Estados Unidos el Día de los

Veteranos, una fiesta nacional para rendir homenaje a aquellos que

han servido a las Fuerzas Armadas del país en tiempos de guerra. En

este día se conmemora el aniversario de la firma del armisticio en

1918 que terminó con los combates entre las naciones Aliadas y

Alemania en la Primera Guerra Mundial.

Originalmente se festejaba el Día del Armisticio, para recordar el fin

del conflicto y a todos aquellos soldados que murieron por servir a

Estados Unidos en esa guerra, sin embargo, la Segunda Guerra

Mundial (1941-1945) obligó a las Fuerzas Armadas estadounidenses a

movilizar un gran número de soldados, marines y aviadores para

defender a la nación y otros muchos, alrededor de 21 millones de

personas, tuvieron que servir en la Guerra de Corea (1950-193). De

esta forma, el Congreso sustituyó esta festividad por el Día de los

Veteranos, honrando así a los militares experimentados de todas las

guerras.

En Estados Unidos, se celebra cada año en el Día de los Veteranos una

ceremonia oficial de ofrenda floral en la Tumba del Soldado

Desconocido en el Cementerio Nacional de Arlington, en el estado de

Virginia, y desfiles y otras conmemoraciones se llevan a cabo en los

estados de todo el país.

Noviembre 2019