Wednesday, December 4, 2013

Suffering and Self Exploration

 I recently attended an opioid training class and heard a statistic that I found interesting; apparently, the number of people who die from accidental drug overdoses is equal to the number of people who die in car accidents. I wasn't shocked by this statistic; every time I turn around I'm taking care of some poor soul who took too many pills. Regardless of the reasoning behind all this drug abuse, whether it be emotional or physical pain, I believe the urge to anesthetize our suffering has become an epidemic among the general population.
According to James Davies, Author of The Importance of Suffering, a negative view of suffering, which labeled all suffering as harmful and should be avoided, arose in the 1980's. It was then that the medical community decided that emotional suffering, like physical suffering, comes from a biological process and should be treated the same as physical suffering; with medications. And so it began, whenever you have a problem, you can fix it with a pill. Now we are coming to a point in medicine that whenever you have a problem we can fix it with surgery. The practice of treating patients solely with medication or surgery has devalued the importance of exploring any of the other possible causes of people's suffering, such as psychosocial, spiritual and other implications of human distress. I believe this lack of exploration and accountability has enabled people completely. What bothers me the most is that the healthcare system benefits financially from the exploitation of people's suffering. According to James Davies "when individuals are unable to understand and manage their own suffering, they become vulnerable to certain authorities who claim to have the knowledge and expertise to help" (pg 74); making it easier for hospitals to market their "new and improved" surgical techniques to patients with the promise of taking all their suffering away. I am not saying that all patients can solve their own problems and should never rely on the expertise of their physician, but I do think the majority of the patient's I take care of can benefit from a little suffering and self exploration.
Some of you may think, "this crazy nurse just lets people rile in pain all night." I bet some of my patients would agree with you. There comes a point in my job where I have to decide whether or not the pain medicine I give you is going to benefit or harm you. Let me share with you the factors I include in my pain assessment and what you should expect when you are having pain in the hospital.

  1. For a majority of the patient population I can tell you now that we cannot take away all of your pain. There comes a time in the hospital when someone will ask you what level of pain is tolerable for you from 0-10, with 10 being the worst you have ever felt. If you tell me you cannot tolerate absolutely any pain (meaning your tolerance will be a 0) than I will most likely tell you this is unrealistic. With all surgical procedures, acute illnesses and well life in general there is going to be some kind of pain. The best thing for you to do is come up with a plan, with the help of your doctor and nurse, on how you are going to deal with this pain. 
  2. If you tell me you are experiencing 10/10 pain but you cannot keep your eyes open for more than 10 seconds or hold a conversation with me, I will not give you more pain medicine. This my friends is for your own safety. If I were to give you pain meds in this state, there is a good chance you might end up a statistic. You see, most pain medications cause your breathing to slow down. In some instances your breathing can stop, leading to a respiratory arrest and possibly death. At this point we would have to find an alternative like hot/cold packs, re positioning, dimming the lights, etc...
  3. If you are a person who has chronic pain and is dependent on multiple pain meds at home, this does not change because you are in the hospital. Many times you are experiencing what we like to call acute on chronic pain which means that you now have something else causing you pain on top of what has already been ailing you. It is especially important that I know your tolerable pain level and what you do at home to manage your pain. If you are taking pain pills every hour I can tell you now that we cannot do that for you in the hospital; we have to follow guidelines. We will do our best to take care of your acute pain while managing your chronic pain but we cannot take it all away. 
  4. If you think that sleeping your hospital stay away will make your life easier, you are wrong. Just like in life, anesthetizing all your suffering only leads to what we like to call secondary suffering. If you are so sedated that you cannot get up and walk around, feed yourself, take deep breaths, go to the bathroom and so on..., there will be other complications that come around. A lot of patients develop pneumonia from over sedation, muscle weakness, difficulty swallowing, and prolonged hospital stays. 
  5. We do not want our patients to have a bad experience in the hospital. We will do our best to make you feel comfortable and not afraid. Everything we do whether you like it or not is for your own safety. It is for your own safety that we have reasonable expectations surrounding pain management. 

Allowing yourself to experience pain can provide you with insight that could possibly change your life. Chest pain associated with a heart attack may be a reminder to yourself to put down that cigarette; the pain of a kidney stone may remind you to drink more water; withdrawing from alcohol (if you remember it) may prevent that next drink. Suffering provides us with an opportunity to change our lives. Depression forces us to want to be alone, to over analyze, to question ourselves. It provides us with the opportunity to change our situation. Pain is a sign from our body that something is wrong. Maybe we need to slow down and take it easy, maybe we are eating food that is causing us discomfort, maybe our lifestyle choices such as smoking or drinking are causing us emotional and physical pain. Whatever ails you, there is a reason. Instead of anesthetizing the pain with medications, alcohol or drugs, dig deep and ask yourself "why am I feeling this way." We have the answers to most of our questions; we have intuition; we know ourselves better than anyone else. Instead of turning to drugs, alcohol or your doctor, try turning to yourself.

Friday, October 25, 2013

Living above the Line

Is it just me or did nursing school make anyone else feel like they had to be a saint upon graduation? Maybe it's because I went to a catholic university ... I don't know. Regardless, the more and more I do this job the less and less I feel like a saint. I recently got report from someone telling me about my 35 year old patient who is an alcoholic and is dying from end stage liver disease. Now, I agree that this is a sad case. I'm sure there was something in his life that he couldn't handle and he turned to the bottle to make himself feel better; I get it; but in reality the first thought that came to my mind when she told me this was "well this is what happens when you drink too much." I know to most, especially for those not in the medical field, I probably sound like a cold hearted you know what, and that's okay; I was recently called that by someone so it's not a big shocker; I think compassion fatigue is what I'm suffering from (that sounds a bit nicer than cold hearted you know what); or maybe I am just being a realist.

I once worked with this wonderful nurse at St. Anthony North hospital in Colorado named Marsha Parker. She was an ex-army nurse, head of the quality department and one of my many mentors at that hospital. She introduced me to a term "living above the line." Living above the line means you take responsibility for your own life and you stop blaming things outside yourself for your situation. I usually refer to people who are living "below the line" as victims. Below the line thinking is when you are consumed with the problems, drama, and excuses for why something can never get done. There is always a problem, even with the simplest tasks such as picking up groceries or getting your mail. You are continuously consumed with the “why” something happened rather than “what” can be done to move forward. There’s a comfort with staying where you are, and you’ve conditioned yourself to offer excuses instead of overcome them. It’s a mindset. Below the Line living leaves your frustrated, angry, unsatisfied, defeated, fearful, defensive, stressed, resentful, and anxious much of the time. People who live below the line are constantly blaming others for their behaviors as well as their suffering. Sound familiar?

I think this type of behavior is very common in the world of medicine. Many of our patients are in the hospital as a direct result of their own bad behaviors. What bothers me the most about these patients is that most of them seem shocked that they are sick; like no one ever told them that drinking, smoking and eating poorly is bad for you. Healthcare has now become a customer service industry where the "customer is always right." You can't say anything to a patient that might make them upset in fear that they might choose another hospital to go to; I once got in trouble for telling a woman her breathing problems were related to her obesity. How can we help people get better if we can't hold them accountable for their behaviors. I know there is a time and a place to bring up accountability and often times the hospital can be a challenging place to do so without getting in trouble. So I choose to bring it up here and now.  Here are a few examples of preventable behaviors that often lead to a whole lot of suffering:
  • Smoking cigarettes will eventually lead to some form of lung disease. When you get older you will most likely experience some shortness of breath with activity or at rest, will require frequent visits to the hospital where we will most likely either put a breathing tube in your lungs or place you on a breathing mask for days on end. You will most likely be very anxious and feel like you are suffocating because your lungs are no longer functioning and there is nothing we can do about it. The only thing you can do is quit smoking before this happens. 
  • Drinking alcohol in excess for many many years will eventually lead to liver failure. Your eyes and skin will turn yellow, your belly will fill up with fluid, your kidneys will shut down, you will become very confused, lethargic and eventually unconscious. There is nothing we can do for you at this time. You are not a liver transplant candidate. Seek help early before its too late.
  • Eating in excess to the point of morbid obesity. You will most likely develop diabetes, heart disease, sleep apnea and possibly cancer. You will have many skin issues and have a hard time healing when you get sick. Food is an addiction, get help.
  • Non-compliance: If you are diabetic and you don't watch what you eat and take your medications appropriately, you can expect that dialysis, blindness, neuropathy, loss of limb, foot ulcers and a heart attack will be in your future. 
  • Being lazy: Exercising is key in preventing a whole host of chronic diseases. Get off the couch and go for a walk.
These are just a few of the many bad behaviors I see that can lead to suffering. Fixing these behaviors and living above the line requires hard work but that's just a part of life. You cannot take the easy road all the time. Using alcohol or drugs to avoid suffering will only lead to more. It's time to stop making excuses and start taking responsibility for your actions. If something in your life isn't going the way you want it to then change it.  If you know your fate is being a one legged man spending three days a week on a dialysis machine and that doesn't sound appealing to you, then do something about it before its too late. 






Thursday, October 3, 2013

Acidosis and Osteoporosis

Osteoporosis, alongside hot flashes, is every menopausal, skinny, white woman's nightmare. According to the National Osteoporosis foundation, osteoporosis is responsible for 2 million bone breaks a year. For most of us in the biz of healthcare we know that breaking a hip, in most cases, is a one way ticket into a nursing home (if you are lucky enough to actually leave the hospital).  According to the CDC, in 2010 there were 258,000 hospital admissions for hip fractures among people aged 65 and older and one out of five of these patients died within a year of their injury. If you weren't scared of breaking a hip before, I hope you are now; this, my friends, is a serious issue. We usually think of osteoporosis as an old person's disease but what we don't realize is that the process of building strong bones and preventing osteoporosis is a continuous cycle that starts when we are children. 
I recently had my annual physical and was pleasantly surprised that my physician addressed osteoporosis prevention with me. Now, I appreciate the time and effort she put in explaining to me the importance of calcium and exercise in osteoporosis prevention but I felt like the information she provided was seriously lacking in very important areas. Preventing osteoporosis is not as simple as drinking milk and exercising; if it was, the United states alongside the United Kingdom, Finland and Sweden, would not have the highest rates of Osteoporosis in the world. The dairy industry has spent millions of dollars convincing the general population that "milk does the body good." The dairy industry has so much influence that the new food pyramid/plate still has a glass of milk on it. I can tell you that after receiving my most recent certification in holistic nutrition and reading numerous books on bone health, that milk actually has the exact opposite effect on the body that it claims to have. According to Vivian Goldschmidt, founder of the Save our Bones Program (http://saveourbones.com/osteoporosis-milk-myth), milk creates an acidotic state in the body therefore, depleting calcium from the bones.
As an ICU nurse I have come to appreciate the body's need to maintain an acid base balance. Acid base disturbances can cause a multitude of symptoms including headache, dizziness, irritability, nausea, confusion, gait disturbances and sometimes death. The body will do whatever it takes to keep the pH balance in your blood between 7.35 and 7.45. In only a few circumstances do people ever become alkalotic (pH above 7.45) so for the purpose of this blog I am going to focus on the acidotic state. 
In an acidotic state the body will increase respirations to remove CO2 from the body, the kidneys will secrete bicarbonate to buffer the blood as well as excrete urine to remove acids, and the bones will release calcium and other buffering minerals into the bloodstream;  so, it would make sense that being in a chronically acidotic state would cause osteoporosis since the bones would have to be continuously releasing calcium into the bloodstream to buffer the blood. Now that we have that down lets talk about what foods/substances can push the body into an acidotic state. This website http://www.vegan-raw-diet.com/alkalinefoods.html has a great list of acidic/alkaline foods. They recommend eating 60% alkaline foods and 40% acid forming foods to keep you body in balance. The general idea is to increase the amount of fruits, vegetables and whole grains and decrease the amount of meat and dairy in your diet. I'm not saying turn yourself into a vegan but if you can at least entertain the idea of "Meatless Mondays," you might actually save yourself from a broken bone and maybe even a heart attack. 

Wednesday, August 14, 2013

How Conscious are You?

One of the first things I do when I enter my patient's room is assess their level of consciousness.  If the person is awake, I usually start by asking him/her their name and date of birth, the month and year, who the president is and if they know where they are. If my patient is sedated or on a ventilator, I ask them to open their eyes, squeeze my hands, wiggle their toes and if they can speak, tell me their name. We score these actions on what is called a Glasgow Coma Scale.

12345
EyeDoes not open eyesOpens eyes in response to painful stimuliOpens eyes in response to voiceOpens eyes spontaneouslyN/AN/A
VerbalMakes no soundsIncomprehensible soundsUtters inappropriate wordsConfused, disorientedOriented, converses normallyN/A
MotorMakes no movementsExtension to painful stimuli (decerebrate response)Abnormal flexion to painful stimuli (decorticate response)Flexion / Withdrawal to painful stimuliLocalizes painful stimuliObeys command

You can see by this scale that the medical community doesn't have a lot of expectations and still gives you points for being conscious even if you are laying there doing nothing; a person who isn't even alive can score a 3.  Now, there are numerous definitions of consciousness. The free online dictionary defines conscious as "Having an awareness of one's environment and one's own existence, sensations and thoughts." I like this definition a little better; at least there is an expectation that you are actually aware of your own existence. There are many activities in our daily lives that require us to be conscious; working, communicating with others, raising children, exercising, driving, shopping, etc... The activity I want to talk about today focuses on what we put in our mouths.
First of all get your mind out of the gutter, this isn't that kind of blog; second, lets be serious. Think of all the things that can enter a person's body through their mouth on a daily basis; food, drinks, toothpaste, pills, alcohol, cigarettes, gum, pollution, bacteria, our fingers, other people's finger's (or other body parts), bugs; if you are a baby or have pica, the list goes on. How often do you stop and think to yourself, "why am I putting this particular substance in my mouth and how is it going to affect my environment, sensations, thoughts and my existence?" What we put in our mouth has everything to do with our level of consciousness; our mere existence relies on food and water.  What can we do to make ourselves more conscious of the substances that are entering our body?
  • The food you eat on a daily basis will probably be one of the most important choices you make and will most likely have the biggest impact on your health and happiness now and in the future.Most people put more thought into the TV they buy than the food they consume. Here are a few questions to ask yourself before you take a bite: Why am I eating this? Am I really hungry or am I maybe just thirsty or bored? How does this food make me feel? Will it make me feel sluggish or give me energy? How will my body benefit from eating this? Is it rich in vitamins and minerals or is it just empty calories? Where did this food come from? Is it local, organic or flown in from New Zealand? (I still can't believe our food flies all the way from New Zealand). How many vegetables have I eaten today? Vegetables are the most missed food in the standard american diet today. They are full of vitamins and very beneficial to your body. Please eat more vegetables. 
  • Alcohol not only alters your level of consciousness but it also takes a toll on your heart, liver, pancreas, immune system and is linked to certain cancers; not to mention legal fees associated with DUI's and other drama you may have caused while you were intoxicated. The CAGE questionnaire is a short 4 question assessment form that is used to help people identify if they have a problem with alcohol dependence. This website http://counsellingresource.com/lib/quizzes/drug-testing/alcohol-cage/  has the questionnaire for those of you who might questioning your drinking habits (The fact that you are questioning them is probably a sign that you should visit this website). Even if you are not questioning them I still encourage everyone to take the quiz anyway in the name of consciousness. 
  • Smoking cigarettes is one of the most deadly habits you can possibly have. Like alcohol, many people use smoking as a coping mechanism making it highly addictive. Some questions to ask yourself are, "why, when and where do I smoke." If you are smoking because you are stressed out, try and find another coping mechanism like exercise, meditation, counseling, drawing or writing. Try using suckers to fulfill your oral fixation or those electronic cigarettes to get your fix. I don't know how safe they are but if it helps you quit then I'm all for it. Some people smoke when they drink; try drinking less. I don't know a single person who smokes for fun so dig deep and find the root cause. Here is a website from the American Cancer Society on how to quit smoking  http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/guide-to-quitting-smoking-toc
  • Pills, pills and more pills. I am absolutely astounded at how many medications people take. What shocks me even more is the fact that most of the time people don't even know why they are taking them. Get familiar with your medications. Learn the names of them and the reasons you are taking them. If your physician prescribes you a new medication please ask him/her the following questions: what is the name, why am I taking this, what will it do to my body, and what are serious side effects that I should look out for? If your physician doesn't have time, you can also ask your pharmacist or even google it. Maybe there is an alternative to taking certain pills; for example, changing your lifestyle or diet. The next thing you should do is keep an UPDATED list with the name, dose and how often you take your pills with you so in the event you get admitted to the hospital we know what you are taking. The hospital can be a dangerous place. The more information we know about you the safer you will be.

  • I think it's important to remember that your body is an amazing machine. Your body loves you and is doing everything in its power to keep you alive; the least you can do is take the time to think about the substances that you are putting into it and how they are going to affect your very existence. Try enjoying your conscious behavior while you have it because you never know when you will end up scoring a 3 on the Glasgow Coma Scale.



Monday, July 1, 2013

Spirituality and Death

Recently, I cared for a 90 year old woman who was transferred to me from another facility because she had suffered a massive head bleed. For those of you who know a little about neuro, "massive head bleed" is not good, especially when you are 90. When the patient arrived she was unresponsive. Over the years I have learned to instantly recognize when a person is near death. It is a very distinct look and most nurses who work in the ICU are very familiar with it. Taking care of dying patients has become an increasingly large part of an ICU nurse's work and many of us spend 36 hours a week watching people and their families struggle with this inevitable event . This woman was obviously near the end of her life and it was imminent that I had a discussion with the patient's husband about end of life. We explained to him that nothing we do will change the outcome of his wife's prognosis; despite this conversation, her husband still wanted us to do everything. As I was talking with him a phrase he spoke of stuck in my mind and actually confused me just a little bit. He stated that "his wife's fate was in God's hands." We immediately had to put a breathing tube in this woman's lungs, 3 hours later her heart stopped and we ended up doing CPR on her two different times. For those of you who have not witnessed CPR it is very violent and we ended up breaking many of her ribs in the process. This woman eventually passed away.
I struggled more than usual with this particular case because in my eyes the decision to let this woman pass away peacefully and pain free seemed so obvious; I feel like a head bleed at the age of 90 and your heart stopping is a significant sign that death is your fate at this moment; why would her husband allow us to do these things to her? If he was truly a religious man then why would he not let her meet her full union with God? To me there is an obvious disconnect between the healthcare world and the spiritual world and I needed clarification.
Because I consider myself more of a spiritual person than a religious person, I enlisted the help of my friend and hospital chaplain Stephanie Wright. Stephanie's job is to help patient's and their families who are struggling with spiritual and end of life issues (she is also a pseudo-therapist for nurses too). After talking with Stephanie and doing a little research myself, I have determined that people and their religious communities have not caught up with constantly changing medical technologies. The general population does not understand what it means to be intubated (be on a breathing machine), what artificial nutrition entails, what happens when you have a stroke or heart attack. Most people don't even know what a heart attack or stroke is. How can we entrust them to make good educated decisions about themselves and the future of their family members if they don't fully understand what's going on? Many people turn to their faith to guide them when they don't know what to do but nowadays most religious communities don't even know what to do. It's like the blind leading the blind.
Not too long ago death was something that was experienced in the home. People would gather around the dying individual praying, singing, performing sacraments and rituals, welcoming death as this person's full union with God. Death was not foreign and was considered just a part of life. Nowadays, people spend their last days in the hospital laying in an insanely uncomfortable bed, being poked multiple times a day for lab draws and IV's, attached to monitors, eating really unhealthy hospital food, probably on some form of life support, and surrounded by doctors and nurses who I guarantee are not singing or praying. What I find more interesting is that studies show 7/10 Americans say they would prefer to die at home but only 25% of people actually do; 70% of people die in the hospital and the remaining 5% , I guess, die outside. Here is the website with the facts and figures http://www.pbs.org/wgbh/pages/frontline/facing-death/facts-and-figures/.
There is a huge disconnect between what patients say they want for themselves at the end of their life and what actually happens to them when they get there. I think there are various reasons for this mass confusion in the decision making process (later blog topics) but today I am only going to focus on spirituality. How do we help people and religious communities clarify and start addressing end of life decisions?
  • If you are a religious individual I think it is especially important to understand how your particular denomination addresses end of life issues. Stephanie has informed me that in her practice as a chaplain she has noticed that many religious leaders and pastors are not comfortable talking about death and dying with their patrons. If this is the case in your spiritual community maybe it would be a good time to bring up the topic and start the conversation. Stephanie has begun end of life discussions in many of her local churches and finds that there is a great need for education.
  • Educate yourself and ask questions. What does it mean to be on life support? What is artificial nutrition? Do I want CPR and a breathing tube if my heart stops? What are the risks of certain procedures and are the risks worth it? What are my options? Ask your religious leaders how they feel about life support and death and dying. If you are uncomfortable with their answer then seek out other spiritual practices that might have a more definitive answer that suits you. The link mentioned above is a great source of information in the area of end of life. 
  • If you are in the hospital, ask the nurse to speak with the hospital chaplain. Hospital chaplains are trained specifically for patients struggling with spiritual and end of life concerns. They are excellent listeners and play a significant role in the holistic approach to patient care. 
  • Nurses, fill in the religion box in the admission history and ask the patients if they want a hospital chaplain to visit them. Recognize when your patients or families are struggling with end of life issues. Are they worried about dying? Have they been diagnosed with a terminal illness? Are they not getting better? If you have a palliative care team in your facility utilize them. 
  • The most important step of all is to determine what "quality of life" means to you. How do you want to spend your last days? This is especially important for people who don't follow some form of organized religion or spiritual practice. When you feel like you know what you want, write it down in the form of a living will.
Pope Paul VI said "science without conscience can only lead to man's ruin. Our era needs such wisdom more than bygone ages if the discoveries made by man are to be further humanized. For the future of the world stands in peril unless wiser people are forthcoming." It is time for us to be the wiser people and educate ourselves and our communities in the area of medical technology and end of life. We must use our hearts, minds and moral principles when making such decisions in order to prevent technology and not spirituality from determining our fate. 

Wednesday, June 12, 2013

The Potential Threat of Diabetes

You know what scares me more than a crazy North Korean man with nuclear weapons?...  Diabetes. Yeah that's right, the extreme poor health of our citizens scares me more than having missiles fired at my house. This may sound absurd to some, but for those of us who work in the trenches of healthcare this my friends is a reality. As a nurse you start to worry about things that most other people wouldn't pay attention to; like washing your hands before and after you go to the bathroom, just to be safe. I was at the beach the other day just relaxing when I noticed a group of school children getting off a bus. For a moment I had trouble determining who were the children and who were the teachers because virtually every one of them was obese. I eventually discovered that the children were all wearing the same color shirt... Smart on the teachers part (I'm sure I am not the only one who has noticed this phenomenon). I was extremely bothered by this but didn't quite realize why.  I didn't think too much more about it until I went to work the next day and met one of the nicest young ladies I have ever met. This young lady came in to the ER complaining of shortness of breath, fatigue and that she was peeing a lot (which are all hallmark signs of diabetes). Now, because she is only 21, no one, including her doctors even considered diabetes as a potential diagnosis. Not only was she diabetic, but she was also suffering from DKA (diabetic ketoacidosis) which is a potentially life threatening complication of diabetes. DKA occurs when there is not enough insulin to transport sugar into the cells; if the sugar doesn't make it into the cells than the body assumes that there is no sugar present and begins to breakdown fat as an alternative fuel. This may sound awesome for those trying to lose weight but I promise you this is not the way to go. The breakdown of fat causes a build up of acids in the body, causing a whirlwind of life threatening problems. DKA usually occurs in patients who have type 1 diabetes but it can also occur in type 2 diabetics in some instances. This patient was officially diagnosed with type 2 diabetes and a urinary tract infection, which is what most likely caused her to be in DKA.
This patient was very aware of what diabetes was because her father had it but was unaware of how serious the disease really is. I truly believe that most people do not understand the seriousness of diabetes and all the potential health complications associated with it; such as losing their eyesight and limbs, increased risk for infection and slower healing, increased risk for heart attack and stroke, chronic pain from nerve damage, vascular disease, kidney disease leading to dialysis and even death. A survey completed in 2006 indicated that a substantial number of people with prediabetes were unaware that they even had it. Prediabetes means that you are already starting to have higher than normal blood sugars but aren't officially diabtetic. How are we suppose to prevent people from going into full blown type 2 diabetes if they don't even know that they are going down that road? How do we recognize the risk factors for diabetes and prediabetes before it's too late?

Risk Factors We Can Control
  • Obesity - BMI and Waist circumference are commonly used screening tools to identify weight problems and associated health risks. BMI calculators and charts are available online. A "normal" BMI is considered 18.5 and 24.9. Waist circumference can be done at home. Place a tape measure around the bare abdomen just above the hip bone. Excess waist circumference is considered 40 inches for men and 35 inches for nonpregnant women. If you have a BMI greater than 24.9 and you have excess waist circumference you are very likely to develop diabetes and cardiac disease. If you are concerned that your child is overweight please seek the help of someone who can help you improve your nutritional habits. Fast, processed and sugary foods are the main reason for childhood obesity.
  • Sedentary Lifestyle - I think most people know in the back of their minds whether or not they are exercising enough. There are different types of exercise and finding the one that fits your lifestyle is going to be the most beneficial. A lot of people go "all or nothing" and become easily discouraged when starting. Instead, try easing into an activity such as walking. 
  • Low HDL cholesterol and high tryglyceride levels - To improve your HDL score you have to exercise. Some studies show eating Omega 3 fatty acids also helps. To decrease your trigylceride levels avoid sugary foods such as soda and pastries as well as trans fats, which are identified as hydrogenated oils on a food label and are also found in fried foods. 
  • Polycystic Ovarian syndrome - Many physicians believe that this cannot be prevented but I have heard of and know a few woman who have reversed this disease with proper nutrition so I am going to count this one as one we can control.
Risk Factors Out of our Control
  • Age older than 45 years
  • Family History of diabetes (parent, brother or sister)
  • Belonging to certain racial and ethnic groups, including African Americans, Hispanic/Latino, Asian Americans, Pacific Islanders, American Indians, Alaska Natives
  • History of gestational diabetes
  • Women who have delivered a baby weighing 9 pounds or more
  • History of cardiovascular disease
  • Receiving antipsychotic therapy for schizophrenia or bipolar disorder
It wasn't until after I left work that day that I realized the significance of those school children at the beach and my patient. Seeing those kids was like seeing the life of the healthcare system flashing before my very eyes. Not only is there a large amount of baby boomers getting older but now there is even larger amount of young people getting sicker. Most of those obese schoolchildren are or will suffer from diabetes at some time in their life. The annual economic burden of diabetes in the U.S. exceeds $200 billion and spending is expected to triple in the next 25 years. If we don't do something about this sometime soon this country will not only be broke, we will also be unproductive, unemployed, not motivated, and unhappy; in other words North Korea has nothing on diabetes. 

The first step to prevention is recognizing what puts us at risk and becoming mindful of our bodies and our lifestyle. We often know in the back of our minds and our bodies will often tell us exactly what we need to be doing to stay healthy. You cannot wait for government to provide you with healthcare to make yourself healthier. Many of these changes only require education and motivation. There are many healthcare professionals and health coaches, including myself, out there for those of you who need guidance in the areas of nutrition and lifestyle changes. Find someone to inspire and support you in this process. Now is the time to improve your health. 

I will be hosting monthly online webcasts starting next month on how to improve your health. I'm looking for suggestions on topics for my webcasts. Feel free to comment on this blog with any suggestions.






Monday, June 3, 2013

Savor the Flavor: Why you should Enjoy your Meal Now

Have you ever thought to yourself "what would I do if I could never eat again"? If you are like the majority of people in the United States, this unfortunate situation has probably never crossed your mind; So lets take the time to think about it now. How would you feel if someone told you that you could never enjoy the refreshing taste of a cold glass of water or the sweetness of fresh strawberries (if you don't like healthy foods then you can imagine cold beer or ice cream). This unfortunate situation happens to many patients in the hospital on a daily basis. I recently took care of a gentleman who was unable to swallow after we removed the breathing tube from his lungs. Now this is not an uncommon occurrence in the world of ICU. If you are on a breathing machine this means you are not eating or swallowing. If you do not use your swallowing muscles they tend to get weak just like any other muscle and when you swallow food, liquid or even saliva it tends to go into the lungs instead of the stomach; we call this aspiration. It causes a nasty pneumonia and is often the cause of death for many elderly people. When this gentleman found out he did not pass his swallowing test he was devastated. I think many people associate their last meal with death row or Jesus, not the hospital. Many of his physicians found it odd that he was so devastated by the thought of never eating or drinking again. This made me realize how out of touch we are with the importance of eating. I will not get into  the details of nutrition on this blog, but I do want to discuss the importance of how we eat.
 People eat in a variety of ways: standing up, driving a car, watching television, reading a book, eating at the nurses station (yes JAHCO we eat at the nurses station). What we don't realize is that we absorb not only vitamins and nutrients in our food but also the energy that is happening in the environment around us. If we eat quickly or in an ugly, noisy environment that energy is going to penetrate us. This negative energy can present itself as acid reflux, irritable bowel syndrome, diarrhea, constipation and more. It is the nature of our bodies to "rest and digest." Our body likes to be relaxed, inactive and in an peaceful environment when eating. It does not want to be in "fight or flight" mode ( I feel like nurses and patients are in this mode in the hospital). So how can we learn to really experience and enjoy our food on a daily basis?

  1.  If you are at work, try to find a quiet place to eat your meal. I prefer to sit outside and play some music on my phone. I find that sitting in the break room at work is the worst place to break. If you are home, turn off the television or computer and really pay attention to how you eat. You will find that you will feel more satisfied with your meal. 
  2. Apply a simple ritual to your mealtime like lighting a candle or saying a blessing before eating. 
  3. Eat meals with your family. There is a reason for the saying "families that eat together stay together." If everyone is eating different foods at different times, there will most likely be different levels of energy and moods. Experiment with eating a home cooked meal once a week and see what difference it makes. 
  4. Focus on Chewing. Chewing prepares your entire gastrointestinal system for the digestive process. It enables you to breakdown your food better and also allows you to taste more of it. Try chewing your food 20 times before swallowing or setting your utensils down before taking the next bite. 
  5. Try not to get intubated or have a stroke. I know this sounds far fetched but in some circumstances you do have a choice in the matter. I will get into the details of life support in a later blog but what I can say is that if you are elderly, like over the age of 70, or have some chronic disease like COPD or emphysema from smoking cigarettes please consider all of the risks for having a breathing tube put into your lungs. The likely hood that you will recover 100% is small and often you will be left with a feeding tube of some sort. As far as stroke goes eat healthy, exercise, don't smoke and recognize the symptoms of a stroke and if you have an irregular heart rate, take your blood thinners as ordered. 

Now is the time to really start thinking about what kind of food you are putting into our bodies and how you are doing it. The food you eat is the single most important decision you make on a daily basis. It is more important than the clothes you wear, the car you drive or what the Kardashians are doing. Now is the time to appreciate the fact that you have a choice in the type of food you consume and when you consume it. Appreciate that you do not have a tube down your nose or in your stomach with Jevity tube feeding infusing; if you're lucky you will get a side of 2 scoops of protein powder twice a day. I can tell you it smells horrible and I'm sure it doesn't taste good. If this doesn't sound enjoyable to you, then write it down. Make a living will or five wishes that states that you do not want a feeding tube placed. More importantly, take the time today to make better food and lifestyle choices because you never know when these choices will be taken away.

P.S. I have a five wishes that states that I never want a feeding tube. If it so happens that no one is around and I get one I want you to know that I am really intolerant to soy and if you give me that crappy tube feeding I will probably blow up like a balloon and have really bad diarrhea. I have also stated that I do not want a rectal tube either. Instead I expect top of the line smoothies with veggie protein powder. I will have the recipe written out. Also, I am really bony so make sure you turn me every two hours.

Thanks

Tuesday, May 28, 2013

A Patient's Guide on Keeping your Voice

A few weeks ago I had the pleasure of taking care of a very spry 89 year old man who suffered from a stroke. For those of you who do not know what a stroke entails, let me explain. There are two different kinds of stroke; Ischemic and hemorrhagic. Ischemic is where you have a blockage in an artery preventing blood flow to parts of your brain and hemorrhagic is when one of those arteries breaks and bleeds into your brain. Both of these can be potentially life threatening. This young man suffered from an ischemic stroke and was fortunate enough that his wife recognized the symptoms and called 911 immediately. We were able to remove the blockage in his artery and he eventually gained full function again (this is not always the case, believe me). Prior to this man's recovery he suffered from what we call expressive aphasia; this means that he is able to understand what you are saying and also form his own thoughts, however when he tries to speak, the words come out garbled. This man has lost his voice, literally. He has just found himself in a very vulnerable situation and unable to communicate his wants or needs. Now there are multiple ways, especially in the ICU that you can lose your voice. You can be intubated on a ventilator (breathing machine), you can be sedated with drugs, if you are elderly sometimes your family members will automatically assume you cannot make your own decisions even if you are of sound and mind and speak for you, you can be an alcoholic or drug addict going through withdrawal and be totally out of your mind, or you can have a doctor or nurse who just doesn't listen to you. So what can you as a patient do to keep your voice while in the hospital?
  1. Prepare a living will or five wishes form before you get to the hospital. If you do not want to be put on life support and have feeding tubes, and other tubes (we have a tube for everything nowadays) put into your body and be left in a vegetative or bed bound state for the rest of you days then please write this down. It is not fair to your loved ones to leave them with this decision. I know that some people will state that they do not want to live this way and they do have this discussion with their spouse but that is not good enough, it must be written down. Here is a link to download the five wishes form http://www.agingwithdignity.org. This is the easiest way to let your medical providers and family members know your wishes. You can also ask for a living will form from your local hospital or download it off the Internet as well. 
  2. Designate someone to advocate for you if you are unable to speak for yourself. You can do this by obtaining a medical durable power of attorney. These forms are state specific and can be downloaded from the Internet. To make it legal just have it witnessed and notarized. Try to choose someone who is not intimidated by medical professionals, who can ask challenging questions and who can put aside their own feelings in order to ensure your wishes are carried out. 
  3. If you find that your doctor or nurse is not listening to you, ask to speak to the charge nurse or patient advocate in the hospital. Tell them your concerns, calmly, and maybe they can help address them. If this doesn't work you can always resort to firing your nurse or doctor. You have what we call patient rights and that's one of them. 
  4. For some reason when elderly patients come into the hospital, people, including family members, tend to treat them like children. Do not let this happen to you and try not to do this to your family member. If you or your loved one are capable of making decisions then it would be best if they were involved in the decision making process. I have seen many occasions when patient's family members push a medical intervention on them just to show that they are not "giving up." 
It is always best to have these discussions before entering the hospital system. Being a patient can be one of the scariest and most challenging events in a person's life. Making decisions under this amount of stress can just make situations more difficult. I know thinking about and addressing end of life decisions may seem like a far fetched way to spend your free time but the truth of the matter, is that death is inevitable and cannot be predicted. People's poor dietary and lifestyle habits are causing them to be more sick and at higher risk for disease and death at a younger age. Take the time this week or month to talk with your loved ones about end of life decisions. While your at it, may talk to them about their current life decisions as well:)

Monday, May 20, 2013

Grassroots Prevention: How to stay out of the hospital and protect yourself when you get there: How to Find Your Voice and Influence Change I had ...

Grassroots Prevention: How to stay out of the hospital and protect yourself when you get there: How to Find Your Voice and Influence Change I had ...: How to Find Your Voice and Influence Change  I had a comment on my previous post about how difficult it is in the world of healthcare to...

How to Find Your Voice and Influence Change

 I had a comment on my previous post about how difficult it is in the world of healthcare to have your voice heard and I have to say that I do agree with this statement, for the most part. There have been numerous times in my career that I have questioned current practices, suggested new ways of going about things and have been ignored. These failed attempts to influence change on a larger level have left me feeling hopeless and resentful; which is perfect for a travel nurse! I no longer have to get involved with the BS hospital politics. If they want to waste taxpayer dollars on flushing NG tubes with sterile water and placing everyone and their mother on the sepsis protocol then so be it. I am here to take care of my patient and that's it! Through this separation between myself and administration I have learned that the best way to have your voice heard is to speak with people who actually want to listen to you. This means avoiding those people who attempt to assault you with holy water because it's your fault their son is an alcoholic; this person is not a good candidate for influencing change. There are many people in this world who care about themselves enough to open their ears and listen to what we have to say. You may not find these people at work. This person might be your spouse, your child, your neighbor, a friend, or even a complete stranger. I have learned through my studies in nutrition that the most powerful way to influence change starts with the individual. Healthcare professionals as well as other professionals have a wealth of knowledge that can benefit the population as a whole. We have the ability to teach people about their bodies, how to take better care of themselves, the warning signs of heart attack and stroke and even save their lives. This information should no be kept to ourselves. It is time to stop trying to change the system and instead change ourselves and our community.

Opportunities for Change
  • Feed your children healthy food and show them how to play
  • Teach your children about the dangers of smoking, drinking alcohol and drugs
  • Take the time to educate your patients and their families
  • Volunteer 
  • Teach a class to your neighbors on the signs of stroke and heart attack
  • Set up a health fair at your church
  • Educate yourself on proper nutrition and exercise, then spread the word

Thursday, May 16, 2013

Today is the first post of my official Blog. To let you know I actually had to Google what a blog was before I even started so that lets you know the extent of my knowledge. I had recently been following the Zen Habits blog (which I didn't even know was a blog) and took the author, Leo Babauta's advice on the benefits of writing daily. I had also recently listened to a webinar from the Institute of Integrative Nutrition, where I am currently becoming certified in holistic nutrition, on the practice of "morning pages." The practice of "morning pages" involves writing every day as soon as you wake up in the morning. This daily practice is suppose to unleash your inner creativity and also serve as an outlet for stress. I found this to be very beneficial, but as most of you who know me personally, I like to share my opinions with the world, even if the world isn't exactly ready to hear about them. So here I am. Now according to a few websites on blogging, apparently you are supposed to write about something you are passionate about and that might interest others. I know I am passionate about health and wellness but telling people what to eat every day gets a little boring. So I asked myself what do I constantly complain about and guess what came to mind? The healthcare system. Yes my friends, and most likely co-workers, we all do it. Rather than going into the med room to complain about our crazy patients, their families, administration, physicians, other nurses and if Phil is involved the government, I have decided to bring my issues to the table to hopefully effectively start conversations and slowly change the way we practice healthcare. This is why the title of my blog is "Grassroots Prevention." We cannot sit around and wait for the government to change the system. The new healthcare reform act just passed which actually has nothing to do about people's health, only their health insurance. The government has no flippin idea what goes down in the real world. The people in the trenches, because that is what it is beginning to feel like, have to start changing the system. We the people have to start taking responsibility for our own health by eating better, exercising, educating ourselves about our diagnoses and medications, taking control of our own health, and preparing for end of life issues. These are just a few ways to improve the state of our healthcare system and it starts with the individual. I hope to spark conversation across the board. This will hopefully be an open forum for healthcare providers and patients, so remember to make sure your comments actually have a purpose and are respectful. Wish me luck. This is about to get interesting!!!