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.

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.

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.

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