Nurse Nancy Cooks...with Silpat!

So I noticed today, with a slight bit of embarrassment, that the only blogs I link to are cooking blogs.  Yes, Nurse Nancy cooks!  Cooking is my therapy - sad, happy, can't afford a therapist - let's cook!  The methodical act of scooping cookie dough and placing it on a cookie sheet; slicing red potatoes into quarters to roast...it is so soothing.

My awesome hubby bought me a Silpat a couple of weeks ago.  A Silpat is a non-stick silicone mat that is reinforced with a fiberglass weave in the middle.  The mat fits in a large cookie sheet, and you need not use any fat to grease it.  I use it as I would parchment paper - NO broiling, though!  The directions that came with the mat made me laugh out loud - reminded me of the Saturday Night Live "Happy Fun Ball" skit: "Warning: Happy Fun Ball may suddenly accelerate to dangerous speeds" and "Do not taunt Happy Fun Ball".  There are seven "do nots" or "nevers" on the instructions.  I steeled myself and pressed forward with Silpat experimentation.

I discovered that biscuits burn easily on Silpat.  I decreased the oven temperature 25 degrees F and cooked for the minimum amount of time for the next round...perfect.  Tonight, I compared peanut butter cookies on Silpat vs. parchment.  I must say I believe the parchment round came out prettier and more evenly done.  The Silpat seemed to encourage the edges of the cookie to splay out and burn prematurely.  My family ate both and enjoyed them; they insisted there was no difference in the taste.

Glad I Decided to go Virtual!

I've often seen the confused, scared look on a patient's face as they leave the clinic or hospital with a new diagnosis.  They wonder, "What is atrial fibrillation?  How do I manage this?  What's my next step?  Will I die?"

I find physicians woefully inadequate in the patient education department.  Nurses seem better able to meet this need, and are able to work it in as part of patient care.  For example, when a nurse enters the hospital room to give a bed bath or hang an IV medication, we can provide patient teaching that is diagnosis and situation-specific, as well as tailored to fit the amount of time we have and the patient's attention span.

The following article details how physicians can use the internet to enhance their practice.  Of course, nurses can too.

http://www.linkedin.com/news?actionBar=&articleID=543134156&ids=0QdzgTej8UczkIcjsNc3ARczgRb3oRcjgPcjcQdiMPejgUe3cPd3kIcPgVcjARcjgR&aag=true&freq=weekly&trk=eml-tod-b-ttle-14

Op-ed: Social media can enhance the doctor-patient relationship

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in Social media

A version of this op-ed was published on January 27th, 2010 in the USA Today.
Raise your hand if you’ve ever left a physician’s office without fully understanding what the doctor just told you.
Studies show that half of patients admit to not understanding what their doctor told them during an office visit; and more than 75% of emergency room patients acknowledge not fully grasping instructions given to them.
As a primary care physician, being unable to clearly communicate with patients is frustrating. The typical, 15-minute office visit often is not sufficient for a thorough discussion of health issues, let alone to clarify any patient confusion. A better way to connect with patients is needed.

Perhaps that is why more patients are turning to the Internet. A recent survey from the Pew Internet & American Life Project estimates that 61% of American adults surf the web for health information, with the majority looking for user-generated content written by others with similar medical conditions.
Social media websites that encourage reader interaction and conversation are playing an increasingly large role in providing information tailored to online patients. There are thousands of blogs and Facebook groups, for instance, where patients discuss their experiences living with cancer, HIV or depression. And patients use Twitter to share tips on battling diabetes, or give advice on finding the right doctor or hospital.
But like a lot of the information on the Internet, not all medical content is credible. In fact, acting on inaccurate web information can be dangerous. That’s where medical professionals can help patients interpret and decipher what is accurate on the web. And with 57 million Americans reading blogs, combined with 120 million monthly U.S. visitors to Facebook and Twitter, social media presents a compelling opportunity for doctors to better interact with patients.
I regularly blog and use other forms of social media; both to provide patients with a physician’s perspective on breaking medical news and to guide readers to reputable sources of medical content. But when you consider that more than two-thirds of doctors don’t even e-mail their patients, it’s probably safe to say I’m in the minority of physicians who use Facebook or Twitter.
One reason deterring more physicians from using the Internet is because professional standards of care are unclear on these platforms. Should physicians diagnose patients who “friend” them on Facebook? Or would a doctor be held liable if he missed a patient who Twittered that he had chest pain? Because few have looked at social media’s impact on patient care, there is little guidance on how physicians can incorporate it into their medical practice.
Dr. Daniel Sands of Harvard Medical School co-wrote a seminal set of guidelines on doctor-patient electronic communication. Sands says that “the only commodity physicians have is time. Doctors don’t want to introduce new technologies of unknown value, which is why something like Twitter is going to take longer to accept.”
Another drawback is that most insurers only pay doctors who talk to patients in the examination room, giving physicians little financial incentive to reach out to patients over the web.
But doctors who are not active online risk being increasingly marginalized. Facebook and Twitter users, half of whom are under of age of 34, rely on the web for most of their information. As this demographic ages, it’s conceivable that they will consult social media first to answer their health questions, rather than schedule an appointment with a doctor.
Already, patients are seeing how social media can improve their care. Hospitals are posting emergency department wait times, as well as updating family members on the status of their loved ones during surgery, on Twitter.
The Centers for Disease Control and Prevention use their prominent Facebook following to keep the public abreast of dynamically changing events, like the status of the H1N1 influenza pandemic. And doctors can blog and disseminate analysis on breaking medical studies, instantly informing patients of their impact.
Quality health care requires a doctor-patient dialogue that doesn’t simply end once the physician leaves the examining room. While ultimately standards of care online need to be established by professional medical societies, in the meantime doctors should embrace social media as a way to continue the conversation, and to provide patients with the trusted health information they’ll need.

Excellent Health Prevention Article

I have always maintained that active prevention behaviors could contribute to decreasing healthcare costs.  Nurses are an excellent means to that end: patient education is second-nature to most nurses.  It is up to nurses to help define our roles in this process on national and local levels.

http://www.kaiserhealthnews.org/Columns/2011/May/052411thorpelever.aspx

Prevention: The Answer To Curbing Chronically High Health Care Costs (Guest Opinion)

Topics: Health Costs, Public Health, Health Reform, Politics

Kenneth Thorpe, Ph.D., and Jonathan Lever, Executive director of the Partnership to Fight Chronic Disease and vice president for health strategy and innovation at the YMCA of the USA

May 24, 2011

View all previous columns »

While Congress tries to control health care spending, lawmakers should be careful to make choices that are pennywise but not pound foolish.
In April, the House voted 236 to 183 to repeal the health law's prevention and public health trust fund. Republicans said they opposed giving the Secretary of Health and Human Services wide discretion on how to spend this money. But the result is a setback for the first dedicated source of funding for national prevention efforts and could be a missed opportunity to reduce spending even further by preventing the largest driver of health care costs -- chronic disease.
Largely preventable and highly manageable chronic diseases account for 75 cents of every dollar we spend on health care in the U.S. In contrast, we spend less than 5 cents on prevention, even though the World Health Organization and the Centers for Disease Control and Prevention have estimated that 80 percent of heart disease and type-2 diabetes, and 40 percent of cancers, could be prevented by doing three things: exercising more, eating better and avoiding tobacco.
Yet, we are headed in the other direction. One in five adults still smoke and one in two adults -- and a tragically large number of children -- are overweight or obese. Without a dramatic change, a third of American adults will have diabetes by 2050 (up from 1 in 10 today). Obesity already accounts for 10 to 20 percent of the rise in health care spending and obese adults cost 35 percent more than their normal-weight counterparts because of their risks for diabetes, high blood pressure and other related chronic conditions.
The status quo is expensive, but our future on the current course is unsustainable.
The silver lining is that we have evidence that we can prevent the onset and progression of diseases, including diabetes. These are exactly the types of efforts that the prevention fund should be used to support.
Case In Point: The YMCA, in facilities throughout the country, is offering a group-based diabetes prevention program modeled after the landmark National Institutes of Health /CDC Diabetes Prevention Program. The NIH initiative proved that, with modest weight loss, it is possible to reduce the risk of developing type 2 diabetes among those with pre-diabetes by nearly 60 percent. So far, the YMCA's effort has been getting similar results, at costs that are dramatically lower than that of the NIH program. And the Y has scaled this program to communities in more than 20 states. Investing in the prevention fund could add the program to even more communities throughout the country.
Given that $1 out of every $10 spent on health care is related to diabetes and that people with diabetes have medical costs 2.3 times higher, preventing diabetes is a bargain. In fact, enrolling at risk adults aged 50 in this type of program could reduce the chance they would develop diabetes from 85 to 65 percent.
The NIH diabetes program is just one of the many evidence-based prevention programs vital to preventing chronic disease and curbing rising health care costs if made available nationally. It exemplifies how prevention works to not only improve health, but also to lower cost. Yes, Congress should be working to reduce costs, but lowering health care costs long-term depends on addressing what drives those costs – diabetes and other chronic diseases. We have to make the investment in the ounce of prevention to realize the pound of cure.
Kenneth Thorpe, Ph.D., is the executive director of the Partnership to Fight Chronic Disease. Jonathan Lever is the vice president for health strategy and innovation at the YMCA of the USA.

Cholesterol Basics - Treating High Cholesterol

So your healthcare provider has diagnosed you with high cholesterol.  What now?  Here are some ways to lower your cholesterol:

1. Lose weight/eat a healthy diet: your body is capable of producing cholesterol.  Outside, or exogenous, sources of cholesterol increase the amount of cholesterol in your body.
2. Exercise: exercise increases HDL, or good cholesterol.  HDL is the truant officer of cholesterol: it takes bad cholesterol (LDL) back to the liver.
3. If you are diabetic, keep your blood sugar within normal limits.  This minimizes the damage to the inner walls of your body's vessels.  Less damage means fewer areas for cholesterol to easily attach and harden.
4. Don't smoke.  Smoking increases the chance for atherosclerosis, or hardening of the arteries.
5. Medicine: your healthcare provider may prescibe a daily cholesterol-lowering medication.  The most common of these medicine are referred to as "statins".  Examples of these medicines include simvastatin (Zocor) and atorvastatin (Lipitor).  Statins help slow down the liver's production of cholesterol, while improving the liver's ability to remove LDL cholesterol already present in the body.  Liver function tests are performed to make sure your body is tolerating the medicine well.  You should notify your healthcare provider immediately if you have unexplained muscle aches or tenderness, dark-colored urine, or fever/flu-like symptoms.

Open and ongoing communication with your healthcare provider is essential to insure your best health outcome.  Active participation in your own health by eating right, exercising, and taking other steps to improve your overall well-being will contribute to that outcome.

Cholesterol Basics Part Deux

There are four basic types of cholesterol commonly listed on a fasting lipid profile.

1. Total cholesterol: this is the total amount of cholesterol in your blood.  This number alone is meaningless without a breakdown of the other cholesterol types.
2. HDL (high density lipoprotein): this is good cholesterol.  Think of it as a truant officer; HDL picks up extra cholesterol from the body's tissue and takes it to the liver for disposal.  Exercise increases HDL levels.
3. LDL (low density lipoprotein): this is bad cholesterol.  Deposits extra cholesterol in vessel walls, thereby contributing to hardening of the arteries and heart disease.
4. Triglycerides: the major form of circulating fat found in the body.  The function of triglycerides is to provide energy for cells.  These levels increase directly after a meal, which is why a lipid profile should only be drawn on a fasting patient.

Maintaining an appropriate weight, eating a healthy diet, exercising and not smoking are all factors that will help keep your cholesterol levels within healthy levels.  But what if you're already doing all of these things and your cholesterol levels are out-of-range?  Stay tuned for a discussion of other ways to treat your high cholesterol.

Cholesterol Basics

Cholesterol is a waxy, fatty substance that is found in your body and many foods.  Your body is capable of making all the cholesterol you need.  In fact, the body requires cholesterol to function properly. 

If you consume too much cholesterol, your body will collect and deposit cholesterol.  When cholesterol accumulates in your vessels, it creates "plaque".  These plaque deposits cause narrowing and hardening of the vessels.  This narrowing restricts blood flow, and in the case of restricted blood flow to the heart, chest pain.  If the vessel is completely blocked, a heart attack occurs.

Plaque Build Up in Artery from the NHLBI Diseases and Conditions Index

What are risk factors for high cholesterol? 

• The trump card is genetics.  If you have family members with high cholesterol, you may be genetically predisposed to high cholesterol as well. 
• Age, weight, diet and physical activity levels are also risk factors.
• Diabetes.  High blood sugar levels can cause damage to the inner lining of the body's vessels.  This damage creates an easy foothold for plaque to attach.

What can you do to lower your cholesterol levels?

• Talk with your healthcare provider about testing your fasting cholesterol levels.  You and your provider can discuss different treatment options, such as medication and lifestyle changes if your test results are not optimal.
• Maintain a healthy diet and weight.
• Increase your physical activity levels.
• Don't smoke.
• If you have diabetes, keep your blood sugar within optimal levels.

Stay tuned for more cholesterol basics!

Skeletal Muscle Rebuilding

I just have to brag on UT Austin today.  Another excellent research project from Dr. Roger Farrar, one of my kinesiology professors, on rebuilding skeletal muscle in patients with limbs injured in accidents such as shark bites and IEDs (improvised explosive devices).  This is something that has never been accomplished before.

Dr. Farrar's research was funded by a 3-year, $550,000 grant from the U. S. Army and will greatly benefit wounded soldiers.

Dr. Dixie Stanforth - Get Back in that Prom Dress!

An excellent article from the University of Texas, my alma mater, features Dr. Dixie Stanforth from the Department of Kinesiology and Health Education.  Dr. Stanforth reminds us that loss of muscle mass and lower fitness levels are not the inevitable result of aging.  She is working with Fox Sports and the Gatorade Training Council to promote fitness, especially for those who were althletes in high school.  The television program is called "Replay", and allows those former high school athletes a chance to relive sports experiences such as high school rivalry games.

It is a great reminder for those of us in our, ahem, thirties that fitness is the result of hard work.

These Feet Were Made for Walkin'...

"I've just worked a 12-hour shift, and boy are my dogs barking!"  When your feet hurt, you are miserable.  Foot health is important for everyone.  Here are some tips to maintain your tootsies:

1) Do not go barefoot.  Wear appropriate shoes for the situation.  I have seen many a toe injury (including crushing injuries and fractures) from wearing flip-flops while moving a couch that would have been avoided by wearing shoes.  When working around the house or in the yard, wear socks and closed-toe shoes.  Applying lotion before donning socks can also soften callouses and cuticles.

2) Cut and file your toenails straight across to avoid ingrown toenails.  Few things are more painful than foot surgery, even if it's a simple procedure.  If you feel as if you have the beginning of an ingrown toenail, you can try taking a small piece of a cotton ball and inserting it under the corner of the toenail to lift it up.  However, you must replace the cotton daily and closely monitor for signs and symptoms of infection, which include fever, presence of discharge, a foul odor, or red streaks running away from the site.  If any of these are present, do not use the cotton and get to a healthcare provider immediately.

3) If you workout, make sure you purchase proper workout shoes.  This helps stabilize the foot and ankle, as well as protect your feet.

4) If an area of skin on your foot is slightly reddened from a pressure point, such as a strappy sandal, but the skin is not broken, you can try moleskin to protect the area from further breakdown.  Moleskin is a flannel material with a sticky back that you purchase in sheets from the foot care section of a grocery or drug store.  This sheet may be cut to size and applied, and each application is thrown away after use.  For example, I bought a strappy heel to wear as a bridesmaid.  I wore the shoes around the house for about an hour, and noticed where the red marks were on my feet.  I applied moleskin to the previously reddened areas before the wedding and was able to stand and dance in the shoes all night.

5) If the skin is blistered, try not to pop the blister.  A blister is nature's bandaid and, if left intact, will usually heal well on its own.  If you feel that the blister will shear open by force, it is better to make a small hole at the base with a sterilized needle, drain and then bandage.  I find that eye patches work well to cushion blister repair under a large bandaid or paper tape.

6) Wash feet with soap when you bathe and dry thoroughly.  Using a blow dryer set on a cool, low setting will help you dry in-between your toes to avoid fungal infection such as athlete's foot.  Clean, dry feet are much less suceptible to infection.

7) If you have been diagnosed with diabetes, your foot health is of supreme importance.  See your podiatrist regularly, and don't forget to examine the soles of your feet nightly.  Diabetics can suffer "peripheral neuropathy"; this occurs when the elevated blood sugar negatively affects nerve endings, especially in the feet.  This can cause loss of sensation, which is why diabetics are advised to examine the soles of their feet.  They may find a cut or foreign body they can't even feel.

8) Get pedicures at a reputable salon.  This will help keep your toenails and feet infection-free.  There's nothing like pretty, painted toenails to make you feel good about yourself and lift your spirits!

To Maintain and Elevate the Standard of My Profession...

"I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care."

Composed in 1893 by Mrs. Lystra E. Gretter and named the Florence Nightingale Pledge to honor the founder of modern nursing, this pledge has launched many a nursing career.  The weight of these words, however, is not always apparent to the graduate nurse.  This May will mark my fifteenth year as a registered nurse.  I will never forget the first time I saw "RN" after my name, engraved on the back of a caduceus necklace.

I establish this blog with the goal of maintaining and elevating the standard of my profession.  I am a registered nurse: a teacher, a healer, a shoulder to cry on, someone to laugh with, a soul to hold the space next to you when you need me.  I am traditional and modern, strong and soft.

I dedicate this blog to Florence Nightingale, and all my fellow registered nurses.