Diabetes, Candy and Soda?

April 8th, 2014
What if I told you that healthcare providers were having patients with diabetes eat candy bars and drink soda? You’d say I’m crazy! Read my new article with Dr. Samuel Nwafor on the mechanism by which patients being treated with hyperbaric oxygen therapy (HBOT) experience a reduction in blood glucose levels compared to prehyperbaric oxygen treatment levels and the protocol we suggest. This is an important topic that doesn’t get much attention but has been very important to me for many years!
Our article is published in the April issue of the journal Ostomy-Wound Management and you can read it here http://bit.ly/1irBY8z

Take the Challenge: Three New Recipes You Can Make

November 19th, 2012

It is my pleasure to introduce guest blogger Nick Sitney. Please take a few moments to read a young adult’s perspective on scratch cooking, healthy eating, and how to become inspired to do more of both this coming new year. Please encourage Nick with your comments!

Take the Challenge: Three New Recipes You Can Make

Nick Sitney

Imagine never needing to pay for fast food again. You would have fresh ingredients in your hands the moment you want food. However, there is one stipulation—you would need to make all of your meals from scratch, and that takes time. You also would need cooking skills for some meals, skills that most of us are lacking.

That is why we often settle for buying the easier things to make or something that is already prepared. I admit that I do this, because more often than not when I do not have the time, I will buy fast food. However, I have less of an excuse to eat so unhealthy and spend that kind of money with the resources that I have.

My number one resource is my father, who has spent most of his life making food. More often than not, I have a home-cooked meal that I take for granted. People I work with are jealous of what I have, which makes me realize how they would probably struggle to learn how to prepare food successfully. Sure I may fail a few times at making something, but these skills are invaluable.

When I was a child, we did not have many ingredients in the refrigerator. I did not think we had anything to eat with just a carton of eggs, milk, and some vegetables. Now as an adult, I see an omelet that will take all of 5 minutes to make, which will taste great.

Perhaps more teens should try cooking or at least get interested in learning how to throw a meal together. I regret not doing this at a younger age, when it would have stuck easier and given me a chance to make more mistakes. However, I see no reason not to start now by learning one favorite meal at a time.

With that said, I challenge anyone and everyone to learn how to cook three new recipes before the year ends. Perfection is not required, but make the meals at least passable in your own eyes. Choose three new recipes—your favorite breakfast, lunch, and dinner—and learn how to make them.

For breakfast, I will choose French toast, hash browns, and bacon. For lunch, I will select shepherd’s pie. Finally, I hope to make a Monte Cristo sandwich for dinner. Maybe I will even end up making dessert by the time all of this is over.

Whether you learn one meal or three, you will have at least gained some new skills and have a jumping-off point for more learning. In addition, it is always great showing off something that you made yourself.

With all this said, good luck learning and happy eating.

“What’chu talkin’ ‘bout, Willis?”

March 27th, 2012

“What’chu talkin’ ‘bout, Willis?”

Catchy title, but I know many of you are going to stop reading after the first few lines once you figure out what I am writing about. I promise you that it is worth your time to keep reading!

Convergence. Transparency. Interoperability. HIE. TIGER. MU. OMG! The Healthcare Information Management and Systems Society (HIMSS) held its annual conference last week, and these terms were casually tossed around by attendees like we toss around cachexia, dysphagia, and BMI. Just like the titular famous catch phrase from the television show Diff’rent Strokes, I was not sure what many people were talking about. The only thing I was sure about is the fact that we all need to get up to speed pretty quickly, because health care as we know it is ending and a new era already has begun.

The HIMSS exhibit halls were filled with vendors offering every aspect of health care technology imaginable, as well as those you have never even dreamt about. Many of these will change the way we do our jobs or perhaps even eliminate our jobs, just as switchboard operators and travel agents have come and gone, unless we can prove our worth and value with outcome measurements.

So while you may think that this technological revolution does not pertain to you, trust me when I tell you it does. Every aspect of health care is undergoing change. Rather than resist it, it is time to embrace it. Some of these things will make our jobs better!

Here is an example. I worked at a nursing home where one of the residents required dialysis. She was sent by medivan three times a week to a dialysis center located only 1 mile from the nursing home. This seems simple enough, and I am sure this is routinely done in nursing homes across the country. My frustration came every time I had to do a quarterly review for this resident. I never found any lab data in her chart. Obviously, labs were done at the dialysis unit, and I wanted them! I called repeatedly to ask for copies, but rarely got them. I was told that they sent them with the medivan driver, they would fax them later, they would remember next time, and so on. It was a constant problem that seemed so simple to fix. I could have walked the mile to the dialysis center and picked them up myself in the time it took to discuss this repeatedly with the team.

Now consider something called the Health Information Exchange (HIE). HIE provides the capability to electronically move clinical information among disparate health care information systems, while maintaining the meaning of the information that is exchanged. A slightly different version of this is called the Direct Project or simply Direct. Simply put, Direct is a secure e-mail system that allows providers to communicate with one another and their patients. I get secure e-mails from my banker all the time, so why not from my doctor?

The key to all of this high-tech communication is compatibility. Imagine if the dialysis center sent me my resident’s lab work, but when I received it, I could not open the file. I am sure we have all tried to download a file and gotten the dreaded error message that our computer could not open it. It is maddening when it is only a photo of my nephew. Imagine if it is important health information or test results. The word for this function is interoperability.

HIE, Direct, and interoperability will solve some other common problems as well. One problem that arises in many of the lawsuits that I review is lack of continuity of nutrition care. For example, consider the elderly wound-care patient living in a nursing home with an order for a regular diet (according to the facility’s liberalized diet policy), an amino-acid product for wound healing, and thickened liquids to honey consistency for a swallowing problem. The resident is transferred to the hospital at the family’s urging, because they feel her cognitive status has deteriorated and she has become disoriented. After a 48-hour stay at the hospital, she is returned to the nursing home with orders for a 2-gram sodium diet, but with no orders for the amino acids or thickened liquids. The registered dietitian assesses that patient on the 4th day of this new admission and puts in a request to the physician for the regular diet, the amino acids, and the thickened liquids. These orders are written 2 days later or on the 6th day of admission.

This is a common occurrence and a legal liability. Now imagine utilizing technology that can speak a common language understood by whatever electronic health record (EHR) the nursing home and the hospital uses. If the core data (pertinent information, including demographic data) are ported from the nursing home to the emergency room (ER) before the resident even leaves the nursing room and is waiting on arrival at the ER, the resulting care is more continuous. Our job now is to make sure the people in our facilities understand how important it is to include nutrition information in every aspect of this as they build these systems.

Hopefully, you now understand a bit about how information will travel with the patient. If you do not know where your facility is on this, just ask and show an interest. The other thing I am 100% certain of after attending HIMSS is that not enough trained personnel are currently available to handle the growth in this area. I am sure your facility would welcome your interest and input.

‘First Impressions Say the Most’ —But does the same apply in a wound care center?

February 24th, 2011

According to MindTools.com, it takes just a quick glance, maybe three seconds, for someone to evaluate you upon meeting for the first time. In this short amount of time, one can quickly form an opinion about another. As professionals, we are well aware that first impressions are important for various reasons not the least of which is the fact that they are incredibly difficult to change. But what about the first impressions of a wound care center? Do these first impressions count?

Allow me tell you about a recent visit I made to an outpatient wound clinic so you can judge for yourself. The center is affiliated with a hospital but located in an offsite medical office building. Upon opening the door to the suite, I scanned the empty waiting room and immediately noticed it was dark and dirty. I walked up to the reception desk only to find the receptionist face down on her desk. She greeted me with a big yawn and outstretched arms after I tapped her desk and said “Hello!” “Wow… I didn’t get much sleep last night,” she grunted. I asked for the doctor and she directed me to sit down. The waiting room was sorely in need of thorough cleaning and a coat of fresh paint. The chairs were all narrow armchairs set too closely together. I thought about my overweight patients with diabetic foot ulcers and how the seating certainly wasn’t appropriate for anyone with a body mass index greater than 30. I picked up what I thought was a recent issue of TIME to occupy myself as I waited, only to find out the issue was two years old. I did not form a very good first impression of this place. In fact, I started to get a sinking feeling in the pit of my stomach as I tried to understand how a wound center directed by a colleague with a stellar reputation could appear so bleak and dismal. I felt so badly for the patients who were probably nervous about coming in the first place and to make matters worse were subject to this.

To pass the time, I began to ponder. I imagined what I could do with a small budget to spruce up the atmosphere. I envisioned aesthetic color on the walls and several framed educational posters illuminated by brighter lighting. I saw some new wider chairs, a table with current reading material, some nice plants or maybe a fish tank. A big empty wall was perfect for a rack filled with educational materials. Patient nerves would be instantly calmed with light music serenading a more relaxed atmosphere. A water cooler to combat the Florida heat and humidity would also be appreciated. Last but certainly not least, the suite door would have a bell so that as soon as it was opened the staff would be alerted to greet every newcomer with a smile.

Budgets are tight and we are all doing more with less but how much is it costing you when patients don’t return because of a neglected physical plant or a poor first impression? Take a look around your wound care center and view it from the patient’s point of view. See if you like your own first impression. A trip to the wound center for debridement is not most people’s choice of how to spend the afternoon. With a small effort we can at least make it as pleasant as possible.

How Much Pain Can You Bear?

March 12th, 2010

Have you ever been in so much pain that you wished you would die? Imagine that you are an 88-year-old man with lung cancer that has spread to both your brain and your spine. You attempt to sleep but the pain keeps you awake. You resort to the recliner but that feels no better than the bed. You pace the floors trying to get away from the pain but there just does not seem to be any way to get comfortable. You are faced with such trying agony day after day. Some people may not think that this scenario actually occurs in America with our bounty of modern medical techniques. Others may be more willing to accept this scenario but perhaps only if the situation involves an individual who is uninsured or lives in the inner cities— certainly not in wealthy Boca Raton, Florida. Let me assure you that the mismanagement of pain happens everywhere and is no respecter of persons. This 88-year- old man happened to be my uncle and when he finally gave in to the pain, he asked me to phone the doctor to “see what you can do.”

My first call to the doctor was placed at on a Tuesday at 11:00 AM. Of course the doctor was not available so I left a message explaining the situation. Several hours later, a nurse called back and asked me to explain the situation again, which I did. She said she would speak with the doctor and get back to me. The nurse called a second time and indicated that the doctor felt my uncle should not be in “that much pain” and wanted my uncle to get a bone scan. While I agreed to the bone scan, I was quick to indicate that he would immediately need stronger pain medicine. I was denied and we were told to take the medicine we had on hand and wait to hear from the scheduling department for the bone scan. To make long story short, we managed until that Thursday but by then the pain was so bad, my uncle was incapacitated and insisting he wanted to die. This was uncharacteristic as my uncle was a fiercely independent and strong willed man who was living alone until 10 weeks prior to this event.

On Thursday I telephoned the doctor again and explained the situation in another voice mail message. The nurse called back and again informed me that she would speak to the doctor. When she called back, she informed me that the doctor said we would have to go to the emergency room if the pain was “really that bad.” She said there was nothing the doctor could do, but I had to wonder why an oncologist was not prepared for patients with pain issues. So off to the emergency room we went. The emergency room personnel questioned why we were there since in their view, we really did not have an emergent situation. After nearly 12 hours in the emergency room, they finally decided to admit my uncle. Essentially, he sat in the hospital over the weekend without any significant medical care being rendered and without any active pain management care plan. When Monday arrived, the only other advice we were given was to consider hospice care. My uncle eventually died after being transferred to the hospice service but probably sooner than he would have if he had been given proper pain management from the beginning.

How can an oncologist working in a premier hospital be so insensitive to a patient’s pain? Have they seen so much pain that they’ve become immune to it? Have we as wound care professionals also become immune to the pain? I remember when CMS revised federal regulation 314, the regulatory requirements for pressure ulcers, to include a pain assessment. Many colleagues scoffed at this and wondered what pain had to do with wounds. I have repeatedly heard colleagues dismiss a patient’s pain complaints when changing wound dressings, repositioning, or performing bedside debridement. Please let this be a reminder that you cannot judge another person’s pain, and the presence of pain must be assessed and addressed before treating a wound. One day, you or a loved one may be the patient in need, so treat your patients today as you hope you will one day be treated yourself.

Reflections on ASPEN’s Clinical Nutrition Week

February 17th, 2010

I just returned from ASPEN’s Clinical Nutrition Week (CNW) in fabulous Las Vegas, NV. When I told friends and colleagues that I was going to CNW for the first time, I heard the same thing over and over from those who had attended CNW in the past. They all remarked that I would quickly notice how different CNW is when compared to ADA’s Food and Nutrition Conference & Exhibition (FNCE). They all seemed to imply that different in this case somehow meant better but when I pressed them for specifics, all I really heard was vague ideas about CNW being “scientific” and “just different.” I took all the comments in stride and figured I would soon see for myself and make my own judgments but to be honest, I really love FNCE and didn’t really see how much different a meeting could be. I have presented lectures at more than 400 scientific meetings and most meetings are essentially similar so I was eager to see what happened out in Vegas. And contrary to the philosophy of ‘What happens in Vegas, stays in Vegas’, here are my observations.

Attendees: CNW had a much more diverse group of attendees than FNCE. I was surprised at the number of international attendees. I spoke to people from Brazil, Columbia, Japan, Sweden, Russia, Bahrain, Israel, Mexico, Canada, and about a dozen more places. These people didn’t happen to be vacationing in Las Vegas; they traveled great distances solely to attend the meeting. It was very interesting to see how different health care is in other countries and this aspect of the meeting really got me out of my USA-centric thinking. The next thing about the attendees was the number of males. While FNCE is almost an exclusively female event, this was at least 50-50 male-female. Perhaps there was even more than 50% males. At FNCE almost everyone is a dietitian but here there were plenty of physicians and pharmacists and researchers in addition to the dietitians. I did encounter far fewer nurses than I expected. And finally, at FNCE I notice a great number of students. While I did see some students here, it was mainly advanced level practitioners.

Lectures: There were many, many lectures to select from but my schedule only allowed me to attend five sessions. Of course, the sessions I attended were mainly about lean body mass, protein, and my other pet topics. The lecture content was generally more advanced than anything I have ever attended at FNCE. I even have to admit that several portions of the lectures involved topics that were over my head. This was technical medical research delivered directly from the people actually conducting the research. Many of the faculty were from countries other than the USA and a few had such strong accents that it compounded my problems in keeping up with the content but I tried. The lectures were all evidenced based and cutting edge.

Technology: CNW was using technology to the fullest and even allowed virtual participants. I am not exactly sure how this all worked out but in several lectures, the screens were full of questions from participants who were attending from their home or office in real time. There was also a CE Pavillion, places to check email, and a general sense of technology being embraced and utilized. While I think ADA and FNCE are beginning to catch up in the technological world, I got the feeling that ASPEN was a few years ahead.

Exhibit Hall: The exhibit hall at CNW was considerably smaller than the exhibition at FNCE. The FNCE exhibition is one of my favorite annual activities and I really look forward to it. This was a much more serious exhibit hall. I know many FNCE attendees make a meal out of the free samples in the exhibit hall; they could not do this here as no one had food samples. There were no overstuffed exhibit hall bags filled with the usual give aways but plenty of article reprints and textbooks for sale.

Schedule: The schedule was packed and a week long! When they say Clinical Nutrition WEEK, they mean a full week. FNCE has gotten shorter over the years but CNW is still the entire week. I was able to see everyone’s energy dwindling by week’s end and I felt badly for the late Thursday and Friday speakers. I wondered if everyone had had enough by then.

My conclusion is that they certainly are two different meetings, just as I was told. I am blessed that I was able to attend both this year because I had two different experiences. While CNW was more scientific, FNCE is more practical application. I am not sure one is better than the other; it depends on what type of information you need and want. I tend to lean towards practical application because I work with front line staff. But I certainly appreciate the cellular level science behind it all as well. All in all, I think I will renew my ASPEN membership after attending and broaden my horizons.

My Adventures Using the ActiFry to Make Low-fat French Fries

January 27th, 2010

Many of you know I am a gal who loves her gadgets! I have a new gadget (well, really a new kitchen appliance) called the ActiFry. You may have noticed that I am promoting the ActiFry machine on RD411.com. Many colleagues have contacted me to ask if it really cooks fries as well as it says. So I decided to document my fry making adventures here for you. The instructions says to cut 2 pounds of potatoes into fries. I decided to leave the skin on. I washed the potatoes and then cut them into fries using my regular kitchen knife.

The next step is to plug in the machine and set the timer. I started with 35 minutes but added an additional 5 minutes to brown them more.

After that, all you really need to do is place the potatoes in the machine.

Drizzle with one tablespoon of oil. Yes, that is it for two pounds of fries – just one tablespoon!

Then close the cover and watch the arm move the fries around as the hot air is circulated. I have to say it was really fun watching them move around!

By the time my chicken was ready, the fries were ready too. Here is my finished product. They tasted light and fluffy and delicious! The fries had only 3% fat, which is certainly much less than traditional fries. The entire family loved them and it was a big success! I will make an entree in my ActiFry this weekend and post it here so keep reading for more delicious ActiFry recipes.


January 14th, 2010

Welcome to my new blog. I will be posting here regularly so please check back.