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.