"Be careful. There is now a diagnosis for Caregiver Fatigue." (It is also referred to as Caregiver Stress Symptom.) My Doctor told me this as I was back for another infection. One thing that is rarely considered when a person becomes a caregiver is the stress that this situation causes. I became caregiver to both my Mom and now my brother Reid because of necessity. My Mom asked me to come and live with her because she knew she needed someone who could help her and there were things a daughter could do that a son could not. With Reid it was either lose another brother to death or take him under my wing.

Caregiving didn't start out overly stressful. I always knew I wasn't Mom's favorite because I wasn't a typical daughter. I was a tomboy and was the one throwing footballs with my Dad. I was into science fiction and not into being nothing but a housewife and mother. I just hoped in time she would realize what I was worth and she did. Her death was hard but I moved down South to be with Mike's daughter and grandchildren. No one let me know that he started drinking heavily and I went up to bury him and sell the parent's house.

With the money from the house sale I brought Reid out and had to fight the battle of the corrupt moving company. It started with his going to have his own apartment and realizing he had let himself go for so long that it wasn't going to be feasible for him to be on his own. It went from hospital stay to hospital stay. It went from battling to keep his leg because he didn't let me know in time that there were sores that weren't healing to finally losing the leg. Now we are dealing with a stroke in his right eye and severely diminished sight and fighting to keep his left eyesight.

I had to deal with a crooked apartment house owner to getting a dream place because they knew of them and finding the new place has a mold problem. So now we are battling that. At least these people care and are doing something.

So yes stress and I are on a first name basis. Fatigue and I are too intimately acquainted. So what is stress and fatigue when it comes to caregiving and what comes next.

Fatigue. If you are a caregiver get use to it. It will be with you as long as you remain a caregiver. Stress is another word for caregiving. Burnout? Those close to me are starting to see that as a real possibility. What are these and what can you do about them?

Fatigue is defined as extreme tiredness, typically resulting from mental or physical exertion or illness. It is a feeling like someone found the energy tap and drained it but somehow you have to keep pushing the body to keep going. It comes when your body instantly reacts to a sound. I can tell by a glance and a sound if something is wrong with Reid. Sometimes he will call out "Michele" or "Sissy" and I check to see what is wrong. Unfortunately he talks in his sleep and my nights are frequently interrupted by jumping up and going to see what is wrong only to find him sound asleep. This exasperates the real physical fatigue that working all day to care for someone causes and is now linked with not getting the sleep needed to keep from getting tired.

Fatigue can also be mental. Sometimes I am so tired I can't remember why I came into a room. I am juggling so many things in my mind that I can't hold them all. If my little electronic Pocket PC ever gives up the ghost I am going to be lost because everything goes in there from doctor's appointments, to grocery lists, and everything in between. Without writing it down it becomes too much for me to remember.

Recently the medical profession has started to recognize that there is a state after stress and that is burnout. HelpGuide,org defines caregiver stress and burnout this way.

Common signs and symptoms of caregiver stress
· Anxiety, depression, irritability
· Feeling tired and run down
· Difficulty sleeping
· Overreacting to minor nuisances
· New or worsening health problems
· Trouble concentrating
· Feeling increasingly resentful
· Drinking, smoking, or eating more
· Neglecting responsibilities
· Cutting back on leisure activities

Common signs and symptoms of caregiver burnout
· You have much less energy than you once had
· It seems like you catch every cold or flu that’s going around
· You’re constantly exhausted, even after sleeping or taking a break
· You neglect your own needs, either because you’re too busy or you don’t care anymore
· Your life revolves around caregiving, but it gives you little satisfaction
· You have trouble relaxing, even when help is available
· You’re increasingly impatient and irritable with the person you’re caring for
· You feel helpless and hopeless

So now what? You realize you are stressed and working towards burnout. For many we are caregivers to family members because quite simply we are the only family member willing to do it. It comes to sticking him in a substandard nursing home because that is all that can be afforded or taking on the task yourself. I couldn't put my brother in a nursing home. I needed to help my Mom. I was the only girl among four boys so of course it was up to me to take care of things. That was the way it has been all my life.

The only family here is my niece, her husband, and three children. They are having a real hard time financially. I get the kids over to help when I can and I would never have been able to move without Tristen and his friends. If Reid can ease up on health crisis after health crisis I might be able to turn to some of the senior and handicapped services around here. Part of the problem is that on paper it looks like we make too much money for some services but the doctor bills are eating us alive. I barely manage to pay bills and sometimes I feel I am robbing Peter to pay Paul. Right now I'm trying to see where we can come up with $3,000.00 to get Reid an artificial leg. We are in the situation where Medicare pays 80% and we have to come up with 20%. You know very well that there is no way Medicare is paying 80% of $15,000.00 but that is what they are charging. We aren't being charged what is left over from Medicare payments we are charged 20% of what they are charging originally. If I don't have $500.00 and payment arrangements for $2,500.00 he doesn't get a leg. This is the kind of caregiver stress that we have to put up with.

Some things that are suggested to keep stress at bay is to find some time for yourself. Fortunately Reid goes to bed early while I'm a night owl. That means I can grab a glass of wine and some chocolate and curl up with Pixie and read a book. I love mysteries however Pixie thinks that the culprit is always the "smelly old dog." We may have a few too many dogs here including "Twinkle Toes" upstairs who is the world's clumsiest Great Dane. You can hear him running around and into things at all hours. I've met him and sweet and dumb as a box of rocks do come to mind. The first thing his owner said as he ran over to me was "be careful he doesn't step on your foot!"

Try to get some help if you can. I've got several places book marked for when Reid's doctor appointments ease off. I would love to have someone come over for a couple of hours so I could go to a movie or just window shop. I can get the older kids to help but they can't drive because they can't afford the insurance so it means me driving over to get them.

Trying to eat right is important. Fortunately I love to cook and cook diabetic and heart healthy. Cooking is relaxing and now I know that he will eat almost anything (hold the extra spicy) I can build my meals on what is on sale.

The one thing that I made the mistake of ignoring is my own health. You would think with COPD that I'd know better. I have been battling one infection after another for months. I am now on a three week regime of antibiotics to see if I can knock this infection off.

Have something that is just yours. For me if I didn't have my crafts or art I'd go nuts. I have always been creative so I work on my crafts when I have a few minutes to myself.

They encourage exercise. I lift weights. Usually 132 pounds at a time as I'm moving my brother to and from the wheelchair. I also lift weights bringing groceries to and from the car, cleaning house, pushing a wheelchair, etc.

Try to keep a sense of humor. Trust me it is hard but find something that makes you laugh. Pixie is one of my main sources of laughter. She is a little clown. She knows when I'm down and will deliberately do things she knows will get me laughing. She also has a magical purr and will lay next to me and purr. She sleeps with me and gets up when Reid starts talking in his sleep and I run to check to see whether something is wrong. Her little flip of the tail as if to say "he is asleep and he woke me up!" is priceless.

Music! I can't say enough about how important music is to me. If I could take only one thing with me on a dessert island (with one recharge outlet) it would be my MP3 player. On many nights when I'm having problems sleeping it is my MP3 player that I'll put on. I frequently wake up hours later with the earphones still on and check to see what was the last thing I listened too. I can probably sing the entire Les Miserables soundtrack if you like.

I think the biggest thing to remember is that you are not alone. Their are other caregivers out there. We need to be there for each other.