Christmas through the eyes of those who care for your loved ones...

This is the time of the year where people worldwide pause to celebrate and share with their families and their friends. Regardless of anyone's personal faith, the seasonal message is one of peace, love, and thanksgiving. It would be hard to argue the notion that those kindly and worthy sentiments can get lost amid all the technology and demands in the health delivery world. After all, what does an MRI have to do with peace? Or an angiogram with sharing? How does the blaring siren of an ambulance jive with Christmas carols? If you've ever needed health care during the Christmas season, you could answer these questions. You see, the meaning of Christmas isn't about the parties, the gifts, the lights, the glitz...think about the sick, the damaged, the dying. Think about all the people - from security guards to nurses to techs to food handlers - who gave up their parties and their family time to tend to the needs of those people less fortunate. Think about how they spend their holidays - ministering to the sick and the dying. These caregivers embody the very meaning of the holidays - "good will towards men." So next time you're in a hospital, say "hello" or "thanks" to all the workers that stand ready to meet your/our health needs. Their giving and commitment makes every day of the year a special holiday.

- Dr. Joe Prosser
Chief Quality Officer

Winter Weather and Christmas Safety

“It’s the most wonderful time of the year” … and so the familiar song goes. It is true that December brings lots of people together for parties, reunions, and festivities. There are memorable smells, tastes, sounds and sights. I especially love the tastes! There is just something about beautifully decorated sugar cookies with sprinkles that makes my mouth water. Never mind what they do to my hips.
Something else wonderful happens during this season. People smile at each other and wish one another a” Merry Christmas”. Even strangers in crowded malls exchange greetings. The lines to see Santa are always long, but the folks don’t seem to mind.
All of this holiday cheer brings me to my point in this month’s blog. While we are busy preparing, cooking, eating, singing, shopping or however you mark this season, here are a few tips on making it even more meaningful.
• Consider an elderly neighbor. Pay a visit and make sure their heat is on. Sit and listen to their stories about Christmas‘s past. If it is cold outside, bring in their newspaper and mail.
• Living in Texas in the winter often brings the experience of sleet and ice. Keep your (and that elderly neighbor’s) walkway salted. Think about staying home instead of being out on the roads during inclement weather.
• Be mindful of young guests in your home. Poinsettias are poisonous, and Christmas trees can easily topple. Small toys can find their way to toddler’s mouths.
• Dogs and chocolate don’t mix. I discovered this several years ago. Thank goodness for veterinarians who take emergency call! Be aware of all the goodies that Santa brings.
• Shiny new bikes, scooters, skateboards and roller blades should all come with flashy helmets. And make sure they use the helmets!!
When you are out and about, looking at the radiant holiday lights and lovely displays, remember that a seat belt is always your best defense against an impaired driver.
Have a blessed Christmas,

Mary Ann

Aromatherapy for a sleepless night

Are you thinking about getting a bit more sleep next year? Well, eating an entire holiday turkey for the tryptophan effect may not be the best idea. The use of essential oils may just do the trick. Something called Lavandula angustifolia (True Lavender) may be a nice addition to your bedtime ritual. Many studies have shown L.angustifolia has calming and relaxing effects on the mind and body. Two chemical properties in this oil, linalol and terpineol, have been linked to relaxing the central nervous system (CNS).

Most patients could benefit from using this oil if they are suffering from insomnia or just having a sleepless night. Just adding a few drops on a cotton ball placed on a bedside table or pinned to their gown for direct or indirect inhalation. You can also mix True Lavender with a carrier oil. Add 1-2 drops of the essential oil into a teaspoon of "cold" pressed grapeseed or sweet almond oil, then apply the mixture by using the M® technique. This light touch technique, mentioned in a previous blog, is very relaxing and can send you into dreamland. We have also blended other oils, like Sandalwood, Mandarin, and Ylang Ylang with the True Lavander for a more restful sleep. You only need to add 1 drop to increase the relaxation effect of the blend.

Now you have to be sure you use the correct "Lavender". The chemical properties in Lavandula angustifolia (True Lavender) are completely different from Lavandula latifolia (Spike Lavender). As, I had stated, True Lavender is more calming and relaxing, but Spike Lavender is a stimulant and expectorant. So, you need to make sure you have the right one or it may add to your insomnia.

Make sure and keep aromatherapy in mind if you, a friend, or a patient are experiencing a sleepless night.

- Erin Munoz, RN

Want a FREE stocking stuffer that may save a loved one's life?

On December 17th, Texas Health Harris Methodist Hospital Fort Worth is having a Vial of LIFE drive thru. What better gift to give a loved on than an item that could potentially save their life?

What is it?

The Vial of LIFE is a project designed to place vital, medical information in the hands of first responders in the event of a medical emergency. Originally started in California more than 25 years ago, the Vial of LIFE is now available to Tarrant and surrounding counties!

How does it work?

The Vial of LIFE is a simple idea that can have lifesaving results. Medical information such as allergies, chronic conditions, medications, and contact information is stored is a medicine vial that is marked with a special sticker and placed on the top, right shelf of the refrigerator. The same sticker is placed on the entry door and refrigerator door.

In the event of an emergency, the first responders know to bring the vial of LIFE along with the patient to the emergency room.

How can you get one?

Texas Health Fort Worth employees will be outside of the main entrance of the hospital (the corner of Henderson St. & W. Cannon Avenue in Fort Worth). We are extending an invitation to the community to drive by and allow us to give you this FREE gift just in time for the Holidays. If you need a larger quantity, you can call ahead (1-877-THR-WELL) and the employees will have the Vials ready for you. The drive thru will be open from 10am-1pm and then again from 4-7 pm.

Even Santa is planning on coming by.

Special thanks to the Texas Health Harris Methodist Foundation who is funding this project so that the community can receive the vials free of charge. This is one way the hospital continues it's mission to improve the health of our community.

- Juanita Hernandez, RN
Medical/Surgical Nurse
Texas Health Fort Worth

Is your hospital "Baby Friendly?"

It seems like a silly question to ask when you are trying to decide where to deliver your baby. Isn't any hospital that delivers babies "Baby Friendly" by definition? Surprisingly, the answer is no.

The Baby Friendly Hospital Initiative is a worldwide effort by the World Health Organization and Unicef to support and promote breastfeeding. Hospitals must apply for accreditation as Baby Friendly, a lengthy and involved process.

In order to be considered for Baby Friendly Accreditation, hospitals must:

1. Have a written breastfeeding policy that is routinely communicated to all health care staff

2.Train all health care staff in skills necessary to implement this policy

3. Inform all pregnant women about the benefits and management of breastfeeding

4. Help mothers initiate breastfeeding within 30min of birth

5. Show mothers how to breastfeed and maintain lactation even if they are separated from their infants

6. Give the newborn no food or drink other than breast milk (no sugar water, no formula) unless medically indicated

7.Allow mothers and infants to "room-in" together 24 hours per day

8. Encourage breastfeeding on demand (whenever the baby shows signs of hunger like rooting, sucking on hands)

9. Give no pacifiers to breastfeeding infants

10. Foster the establishment of breastfeeding support groups and refer moms to them upon discharge from the hospital.

Many of these requirements sound like common sense, but most maternity hospitals in the United States were not designed with breastfeeding as a primary focus. Historically, in many hospitals, infants were separated from their moms for the first 4-6 hours of life to be observed in the nursery for problems with breathing or staying warm. In addition, sugar water was often given as the first feed to "make sure it was tolerated" before infants were given breast milk or formula. An unintended consequence of these practices was that moms were not able to breastfeed in the first hour---often the most alert time for a newborn in the first 24 hours. In addition, these practices sent mom the message that supplements were an acceptable alternative and possibly even better than breast milk for their infants.

Texas Health Harris Methodist Fort Worth is currently working toward accreditation as a Baby Friendly Hospital. As of September 2009, their were only 89 Hospitals and Birthing Centers with the Baby Friendly designation in the United States, and only THREE in the entire state of Texas.

I am proud to be a part of a facility that has put so much time and effort into such a worthy endeavor that will ensure a better tomorrow for our most precious gifts---our babies.

- Fran Lynch MD, Neonatologist
Associate Medical Director of NICU
Texas Health Harris Methodist Fort Worth

Healthy Holiday Baking…Recipe Substitutions

Do you love to bake, but hate the calories that come along with holiday goodies? I would encourage you to branch out when you grocery shop and find some healthy substitutions that will cut some of the calories, fat and sugar from your recipes. Now, it is important to note that you should not substitute EVERY single ingredient, but make some substitutions will improve the healthfulness of your baked goodie.

There are a couple of things you can do to reduce total fat in recipes. One option is to replace half the butter or shortening in a recipe with applesauce or prune puree. You can also use cooking spray or non-stick pans instead of butter or margarine to grease your pans. Next, two egg whites or ¼ cup egg substitute can take the place of one whole egg. The yolk is where the fat and cholesterol is so removing the yolk takes that out. Finally, other ways to reduce fat are to use low-fat milk instead of whole milk, evaporated skim milk instead of evaporated milk, low-fat sour cream or cream cheese instead of their full-fat alternatives and even using fat-free creamy soups or half broth/half creamy soups will help reduce calories.

Many baked goods are loaded with sugar! To reduce the sugar content of your recipe you can substitute half the sugar for baking Splenda® or Equal®, two artificial sweeteners that are calorie-free. You can even add fiber to recipes! Try using whole wheat flour for ½ the All-Purpose flour or substitute rolled oats/crushed bran cereal for bread crumbs.

Top your desserts off with a bang! Try using low-fat whipped topping instead of cream cheese icing or add fresh fruit instead of a high-sugar fruit drizzle. You will get the same great taste for a lot fewer calories!

If you have a question for the dietitian, visit www.texashealth.org/askamy

Amy Goodson, MS, RD, CSSD, LD
Registered Dietitian
Ben Hogan Sports Therapy Institute
Executive Health Program

Making Sense of Mammography Recommendations

Now that the U.S. Preventive Services Tasks Force has reversed its position on screening mammography for women in their 40’s: the group no longer recommends routine screening for average risk women in this age group and the ACS has stated that it will continue to recommend annual mammograms starting at the age of 40, this controversy has a big number of women very confused.

How are you supposed to respond to this? With calmness and communication with your physician. Ask your physician, what are the risks and benefits? What is the right decision for you? Each woman needs to consider the individual benefits and risks and discuss them with her healthcare provider before making a decision about when to start screening mammography and how often to get one.

It is important to emphasize that the new guidelines are for women considered at “average” risk at developing breast cancer. Women with a family history or other factors (a positive BRCA gene mutation, for example) are considered to be at a “higher” risk of developing breast cancer and are likely to receive a recommendation for more frequent mammography screening or beginning screening at an earlier age than the average woman.

We know this issue raises concerns, especially for young women. Regardless of your age or history of breast cancer, if you notice unusual changes in your breasts, you should consult a health care provider and discuss whether or not a mammogram or other testing is necessary.

- Dana McGuirk, RN
Breast Nurse Navigator

The Proactive Patient

Being a hospital patient is not on anyone’s “Top 10 List” of places to visit, (unless you’re having your beautiful baby, that is), but it’s a part of life, so we might as well make the most of the opportunity to improve our health. While the Patient Advocate Department at Texas Health Harris is ready to help if you have any concerns during the hospital stay, the #1 patient advocate will always be …YOU, the patient.

There are many understandable reasons for you to hesitate before speaking up to correct an issue while staying in any hospital. For example, you are: in a new place and out of your routine; surrounded by unfamiliar nursing staff and physicians; nervous about initiating verbal conflicts; coping with fatigue, pain, and fears about your future. All these reasons and many more could add up to not speaking up about your preferences, questions, and concerns.

Conversely, what is the main reason why it is important to speak up as a patient? Proactively speaking up will give hospital staff the knowledge needed to offer you a personalized hospital stay, which will then increase your satisfaction so you may then feel better faster. As described in this previous blog nursing staff play a key role in helping the patient feel safe enough to speak up by using “proactive communication techniques.”

Sometimes I hear concerns from patients whose hospital stay was seen as a negative experience due to something that happened a week before, and now they’re being discharged home. The patient may say something similar to “I want to tell you about this issue so the next person won’t have the same experience.” While it’s important to improve our services for future patients, our #1 focus is in the present tense - to hear and take action on all your comments when they occur. Nursing staff and Patient Advocates are on your side as we work together to reach your optimal health goals.

While it’s established that no hospital stay is on your “Top 10 List” of get-away destinations, speaking up for your health’s sake can be the most important thing you can do for yourself this side of Hawaii.

- Craig Pomykal
Patient Advocate

Talking about abstinence?

Between AP Biology and the last home football game of her senior year my daughter and her friends dash off to the hospital to visit their teen friend who is about to give birth. Texas teens rank number one in the nation in having babies. Although the U.S. teen birth rate has dropped by one-third, Texas has only dropped by 19%. Other states have seen a decrease in teen births by 47%. What is the difference? Is it the fact that Texas teaches an abstinence only curriculum? In Texas public schools sex education does not have to be offered and if it is offered the focus must be on abstinence. There are many great programs out there discussing abstinence as the preferred choice for unmarried young people. The state spends about $5 million a year just on education grants to contractors to come in to the schools to teach abstinence programs. While I am extremely pleased that my daughter and many other teens have chosen abstinence, what about the girls and boys that are not making that choice? During my six years on the health advisory committee for the school district, I learned that no one wants to talk about teens having sex. Is this why we are number one in the nation? We assume that teaching teens about contraception encourages them to have sex. That is not what the research shows. Many teens plan on not having sex, however we are talking about real life and sometimes, real life fails. Do teens need to be educated about how to avoid risky sexual behavior and how to use contraceptives correctly? Do they need to develop skills in communication and sexual decision-making so that sex does not just "happen?" Do they need information on disease prevention? Texas’ policy is to deny contraceptives without parental consent wherever possible. Low-income teens are protected by the federal government and can get birth control without parents consent under Medicaid, however many of them do not know this.
Yes we can help reduce the teen pregnancy rate by educating young people about the consequences of premarital sex and promoting abstinence. Could we reduce the teen pregnancy rate further by educating teens on contraception? As I talked with teens many say by the last couple of years of high school they have tuned out the abstinence talks because that is all they hear. In the time it took you to read this, a teen in Texas gave birth. Talk to your teens about sex, yes it is a difficult topic but one that needs to be discussed.

- Becky Law, RN
Childbirth Educator

Are you hanging Christmas lights? If so, read on...

The month of November marks the beginning of many holidays. With this brings lots of preparation, decorations, parties, food, celebrations, and get togethers. It seems as if we begin this prep work earlier and earlier each year. Stores already have the Christmas sales and mark downs posted, turkeys are everywhere in the grocery isles, and I’m sure Santa will be in the mall any moment now. Don’t get me wrong, I love this season, especially the light displays in my neighborhood.
When I think of holiday lights, I am a bit remiss remembering Chevy Chase in the movie “Christmas Vacation.” “Clark’s” competitive spirit of hanging 250 strands of lights, each with 100 bulbs, totalling twenty five thousand bulbs—enough to cause the electric company to turn on their auxiliary nuclear generator spurs many enthusiastic folks to do the same. I suppose now isn’t the time to tell you about the year I tethered my teenage son to the chimney so he could place the lights on the second story of my house….Of course that was BEFORE I became the Injury Prevention Coordinator.
But seriously, hanging lights should be taken seriously. Every year emergency rooms treat about 12,500 people for injuries related to holiday lights, decorations, and Christmas trees. In the last few years THFW has admitted over 200 patients during this festive season for falls alone!
So, a few things you can do to stay safe this holiday season:
• Never use electric lights on a metallic tree- the tree can become charged with electricity from faulty lights and someone touching a branch could be electrocuted
• Have someone stabilize the ladder while you are hanging lights
• Check each set of lights for broken or cracked sockets, frayed wires or loose connections
• Use only three standard-size sets of lights per single extension cord
• Keep children and pets away from light strings and electrical decorations
• Keep children buckled up—even on those long night time drives to family events
• Remember to extinguish candles
• Keep trimmings with small parts out of the reach of children
• Test your smoke alarms!
• Poinsettias are poisonous to humans and animals
• Turn off all lights when leaving the house or going to bed
Enjoy your friends and family this season, stay safe and make this holiday bright so you can take pleasure in the many more to come.

- Mary Ann Contreras, RN
Injury Prevention Coordinator

Texas Health Fort Worth "Goes Purple"

Tomorrow, Texas Health Harris Methodist Hospital Fort Worth employees, physicians, volunteers and babies are "going purple" in honor of TCU's football team. Stay tuned to the blog for fun pictures from our "purple push."

Holiday Nutrition…Maintain, Don’t Gain!

Did you know the average person gains 7 pounds throughout the holidays?! From Halloween candy to Thanksgiving pies to Christmas baking to New Year’s cocktails…it is easy to add a few pounds. So let’s check out how you can avoid common nutrition holiday pitfalls this season!

Eating on the Run
The holidays bring lots of errands, lots of shopping, and thus lots of eating on-the-go. From drive thrus to mall food courts it is easy to grab a bite and get back to the shopping. So here are some ways to eat fast and eat healthy.
 Order a grilled chicken sandwich, wrap or salad and get the sauce on the side
 Substitute a salad, fruit cup, yogurt parfait or carton of milk for French fries
 Skip the soda, milkshake, and sweet tea and go with water

Parties and Family Gatherings
The holidays also bring lots of parties and gatherings of family and friends. The challenge is that all of these events usually revolve around food and cocktails and it is easy to over-eat bite-size foods. So in order to control your cravings at the party, prepare throughout the day.
 Do NOT skip meals all day. Eat small meals and snacks all day so you are not starving upon arriving
 Eat a small healthy snack with carbohydrate AND protein right before the party. This could be a small energy bar, whole grain crackers and a string cheese, a handful of nuts and berries, etc.
 Use the “small” plate at the party and don’t stand by the food table. Get your food and leave the area.

Office Goodies
Many people bring “goodies” to work around the holidays which makes it harder to “be good” nutritionally. Be the healthy person in your office by bringing the fruit or veggie tray and nibble on that. Here are some other office-eating tips…
 Eat a good breakfast of carbohydrate, lean protein and healthy fat so you are not hungry when you get to work and you can avoid the doughnut and pastry table
 Bring your lunch and snacks so you will not graze through the office kitchen all day looking for food
 Pick one day you will “treat” yourself on office goodies and be satisfied with that one day

Cocktails
Wine, martinis and champagne…oh how the calories can add up! Alcohol is full of empty calories, which means it has a good amount of calories with no nutrients. The real problem, however, is that alcohol does not make you full like food does so you keep drinking those extra calories. Make your first goal to drink water when you get to the party. Then have a drink or two throughout the evening and alternate water in between.
 4-5 oz wine or champagne = 100-120 calories
 12 oz light beer = 110 calories (avoid the regular that has more than 150 calories per serving)
 Avoid things like margaritas and fruity drinks as they can have anywhere from 250-600 calories per drink

- Amy Goodson, MS, RD, CSSD, LD
Registered Dietitian
Ben Hogan Sports Therapy Institute
Executive Health Program

Grief, Loss and Change during the Holidays

The holy days are upon us. The next two months are filled with both religious and secular holidays—days designated to celebrate, reflect, respond, and gather with family, friends and communities of faith. The holidays can be times of great joy and renewal of mind, spirit and body. They can also—often at the same time—be sources of stress, sadness, and frustration. In my experience and research, I’ve found that being mindful of the stressors and sources of sadness and frustration allow me to deal more effectively—and healthily—with them, thus aiding the original intended enjoyment and renewal of the holiday.
A major source of sadness can be if a family member or close friend with whom one is accustomed to sharing the holiday is no longer around. This separation may be caused by divorce, illness, distance (such as being deployed in the military or a family member being far away and unable to come home due to financial constraints), or death. Each of these circumstances in itself is a source of grief and/or putting one in a state of unfamiliarity. Traditions build up around the holidays and become familiar and effective ways of connecting individuals to other people as well as to the Object of Faith around which the holiday is structured and for whom it was originally designated. Any of the sources of sadness listed above—and perhaps some that are not on the list—can interrupt the practice of the very traditions that help make these important and renewing connections. In some cases, individuals avoid celebrating at all due to the stressors involved. Taking charge of the unfamiliar can ease some of the stresses, help one acknowledge or honor the source of the grief and promote healing.
Be creative. Take a look at the way the holiday has been structured in the past and identify wherein the loss will be most keenly felt. Then restructure appropriately. The following are examples of how others have dealt creatively and effectively with some of the stressors:
• In the case of divorce, children may be away from one parent in order to spend time with the other. Plan ahead how that time will be spent in a healthy way and plan ahead—with the children’s input if they are old enough—for new traditions. For instance, one mother I know had found great joy in preparing and sharing traditional foods before and after Christmas Eve worship. Her teenage children were scheduled to spend Christmas Eve day and night with their father. She and the children sat down together ahead of time and identified what could be done to touch on each of the important aspects of the tradition. The teenagers identified the aspects of the celebration that were important to them also. The list they came up with included the following: gathering; opening gifts; sharing food; worship. They identified that mother and children would be together. Gifts would be given, although financial considerations dictated that they be more practical than perhaps they had been in the past. Menus were planned and excitement grew around making the Christmas breakfast—when they would first get together—a new tradition. They discussed the fact that their church did not have a service on Christmas day and they discussed attending another church service that day or setting aside a time during the day to have a home worship service with all the components of the communal one. While the day was different—and the fact of the divorce was not ignored—the family was able to celebrate together. The mother also planned ahead how to creatively and constructively spend the time that she had while her children were away from her.
• In the case of a loved one being unable to be with the group, arrange some type of communication that will include him/her for even a short time. It’s helpful when the group and the missing individual can find something to do in common at some point in the day. For instance, if one is deployed overseas, he/she can arrange with family to read a certain piece of scripture or look up at the sky at a certain point in the day, thus knowing that something has been shared. It will not be the same as being together, but it will ease the strain of being apart.
• In the case of a loved one’s death, remembrance and, hopefully, reminiscing with others who may be missing that person are important aspects of the celebration, especially on the first year of holidays following the death. Set aside a time during the day to personally or communally remember that individual and what he or she brought to celebrations in the past. If the deceased traditionally said the blessing and is no longer there to do so, acknowledge his/her gift of the past and the blessing that he/she has been to the group. Even if his/her role has not been such a formal one, those who are missing him/her can still contribute a “Remember when . . . “ that will affirm his/her place in and influence on the group gathered. The remembrances do not have to feel contrived or formalized. Looking at photos of past holidays can make this time of remembrance more natural. In my family, Thanksgiving is yet to go by that the conversation doesn’t start with a certain dear aunt and her particular spin on pumpkin pie. From there, the conversation flows to others with whom we have shared the holiday and are now departed. Shared laughter and tears are much more healing than suffering in the silence of thinking that you are the only one who misses the person absent.
These examples, I hope, will set the stage for you to ponder the upcoming holidays for you and those with whom you share them. Is some advance planning in order that can enhance the group’s experience of the holiday and make it the holy day it was intended to be? Don’t let loss, grief, or resentment keep you from truly celebrating holidays. Celebrating is a spiritual discipline that is so very important to emotional and spiritual health, and those of us involved in health care know how closely intertwined emotional, spiritual and physical health are. Happy Holidays! Be renewed, refreshed and enriched emotionally, spiritually and physically.

- Candace Stroup
Chaplain

Weight Loss and Recipe of the Month

Obesity is a complex and chronic disease, involving many factors. Therefore, losing weight on a permanent basis requires multiple approaches for success. There is no perfect diet or single pathway to successful weight loss and maintenance. What works for one person may not work for someone else.

In researching long-term weight loss maintenance, I found a great source of information:

The National Weight Control Registry
Brown Medical School/The Miriam Hospital
Weight Control and Diabetes Research Center
www.nwcr.ws

The NWCR is a database of people who have successfully lost between 30 to 300 pounds and have kept if off for at least one year. It was established in 1993 and follows there successful people annually with questionnaires to determine their weight maintenance techniques.

Through these yearly questionnaires, the NWCR has identified 8 trends or factors that this population has found to be successful for their weight loss maintenance. They are:

1. Eat a low kcalorie, low fat diet: Women eat about 1400 kcalories a day; Men eat about 1700 kcalories per day.
2. Eat fewer meals out.
3. Eat breakfast. (75% of the registrants eat breakfast every day)
4. Practice dietary restraint 7 days a week, including weekends and holidays.
5. Keep a food journal or diary.
6. Weigh yourself frequently. (75% weigh themselves weekly)
7. Limit TV time.
8. Exercise more. (90% of the registrants have some kind of physical activity at least 60 minutes a day)

Wow! That’s a lot of permanent lifestyle changes. Successful weight loss and maintenance does not include adopting temporary eating habits. It includes improving all areas of your life. It is not a simple process. That is one reason that the THFW Bariatric Services is an interdisciplinary group that includes a registered dietitian as part of the program. I am available for the patients’ in the program, at now cost for as long as they need me.

Our patients still have to develop the best type of lifestyle for them but thanks to the information from the NWCR, they now have some guidelines to follow that have been proven to be successful in this specific population. I feel that just knowing that other people have lost the weight and kept it off is great encouragement for my patients.

Next time, I will go into more detail on some of these guidelines.
Remember, healthy eating does not happen by chance.

Below is a recipe that is also on the THFW Bariatric Services Website. It includes a scoop of protein powder. Whey protein powder is essential in the diet of bariatric patients during the time of rapid weight loss to provide enough protein that the body needs to maintain muscle mass and manufacture all the substances necessary for daily protein metabolism.

Recipe of the Month:
Pumpkin Spice Latte

Ingredients:
• 1 scoop vanilla protein powder
• 1 tbsp canned pumpkin
• ¼ tsp Pumpkin Pie Spice (cinnamon, nutmeg, allspice)
• ½ cup skim milk
• 2 tsp Splenda or Equal
• ½ cup water
• 1 tsp Instant Coffee
Directions:
• Heat water in microwave then mix in instant coffee
• Add coffee, milk, pumpkin, protein powder, and spices
• Blend until combined
• Heat in microwave until warm or serve over ice

- Jamie Bass MS, RD/LD
Clinical Dietitian, Bariatric Services
Texas Health Fort Worth
jamiebass@texashealth.org


PS - Next month's recipe will be for a caramel/cinnamon latte! Keep checking back for that!

Traveling during the holidays?

November is the beginning of a busy driving season. Many of you will be taking road trips to visit families and friends. I have an upcoming trip scheduled and am planning to let my 16 year old handle most of the driving. It will be a good learning experience for her. If only the auto-makers could install the passenger side brake….. With that thought in mind, here is a top ten list of injury prevention tips that I have learned from being a passenger with a teen driver.

10) Seat belts are your best defense against impaired or distracted drivers
9) Keep loose items secured in the car
8) And do pull off the road to take a break and enjoy a meal
7) DVD’s are for back seat passengers only!
6) Dogs are our best friend, but NOT in the driver’s seat
5) And NO grooming of any kind—human or pet
4) Truck pick up beds are for carrying non-living objects
3) And make sure those objects are safely tied down
2) Program your GPS BEFORE leaving the driveway

And the top injury prevention driving tip this holiday season—
1) NEVER TEXT WHILE DRIVING

Thanks, and have a safe Happy Thanksgiving!!!

- Mary Ann Contreras RN
Injury Prevention Coordinator

What to Expect When You are Expecting…to Breastfeed Your Baby

Mothers want to give their children the best of everything. Without question, the best method of feeding infants is the milk that comes along with the baby; breast milk. Not only that, but it is absolutely free, comes in attractive reusable containers, and not only is it best for baby, it is also good for mom and the family as a whole.

Breast milk has everything your baby needs to be strong and healthy, and babies who are breastfed have fewer illnesses. Mother’s milk is always fresh and immediately ready; it saves time and money, and aids in getting mom back in shape. As your baby grows, your milk will specialize and change for your particular baby at each stage by increasing in quantity and changing in content to meet your growing baby’s needs. The more your baby nurses, the more milk your body makes. Conversely, the less your baby nurses (for example substituting formula feedings), the more your body will suppress the production of milk.

The World Health Organization (WHO) recommends that all infants be exclusively breastfed from birth to six months of age, and following this with a gradual introduction of other forms of nutrition and continued breastfeeding into the second year and beyond. In the United States approximately 70% of women initiate breastfeeding, but by six months of age, less than 40% of infants receive any breast milk at all.

The following practices help to insure the successful initiation and continuation of this important and healthy gift for your baby:
• Before your baby arrives arm yourself with knowledge about breastfeeding; attend classes or breastfeeding support groups, read, talk to women who have successfully breastfed their babies, and discuss your desire to breast feed with your midwife or obstetrition.
• Nurse early and often—put the baby to the breast within one half hour of birth. Keep baby close by rooming in and maintaining skin to skin contact as much as possible.
• If you experience difficulties or just have concerns or questions, ask the nursing staff for help and/or a lactation consultation visit.
• If you have to be separated from your infant request support and help to initiate and maintain your milk supply. Request a lactation consultation and a breast pump as soon as possible if your provider has not ordered this for you.
• Give your baby no other food or drink other than breast milk unless medically indicated.
• Allow the baby to nurse on demand. Watch the baby, not the clock for cues that he is satisfied and ready to end nursing sessions.
• Give no artificial nipples or pacifiers.
• Continue to seek encouragement and support for breastfeeding after you are discharged home from the hospital. Call your health care provider, lactation consultant and breastfeeding support and resource groups to maintain the good start you have initiated for your baby.

Remember, your breast milk gives your baby the very best start in life, so breastfeed for a full six months before initiating other foods. Only YOU can give your baby this gift and it is worth it!

- Gloria Glidewell, CNM, MS

Attention Burleson Residents: A special kind of Fitness Center is coming your way soon!

Texas Health Resources is dedicated to positively impacting the level of health and wellness in the communities we serve. As a leader in providing health care to the region, we know that health and fitness go hand in hand. Maintaining a regular exercise regimen can provide you with increase strength, added energy, reduced stress, improved heart health, weight loss, a decrease in symptoms of many chronic conditions, and an overall increase in self esteem. With that in mind, we are bringing a top notch fitness facility to the residents of Burleson and surrounding communities. Our staff and services will offer the expert assistance you need to make your workouts productive, safe and fun.

Some of our amenities will include:

· Energetic, motivating, non-intimidating atmosphere

· Top of the line strength training equipment that are user-friendly, yet very effective

· Spacious Free Weight training area

· State of the art Cardio equipment featuring built-in TV monitors

· Full Group Fitness schedule including cardio, aqua, stretching, and cycle based programming

· Clean, spacious locker area featuring complementary towel service

· Babysitting services available for your children while you exercise

· Café area serving a variety of smoothie options as well as coffee, healthy food options and gift items

· 25 meter, 3 lane lap pool. This exquisite pool is available for both group aqua classes and individual lap swimming.

· Highly qualified staff of fitness trainers

Fitness Navigators available on the floor to assist you as needed with your fitness plan at no charge

We are excited about helping the residents of the Burleson area establish and maintain a healthier lifestyle. Our facility will cater to the general public, and is scheduled to open in April of next year.

Competitively priced memberships will be available starting in November of this year.

Please call 1-877-THR-Well for more information.

Service with a Smile...

Vickie Debbs began her commitment to serve through compassionate care almost eight years ago here at Texas Health Fort Worth in the Nutrition department; since then, she has come to be known as ‘Ms. Vickie’. You see “Ms. Vickie has the presence of a dignified elder and makes you feel like smiling” (Anonymous Patient). I asked Ms. Vickie what she liked most about her job, and without hesitation she replied in her own sincere and passionate way, “the patients….I love the patients…I like to see them smile”.

Her principle of service is grounded in something she learned from Dr. King. "Everyone has the power for greatness—not for fame, but greatness, because greatness is determined by service (Martin Luther King Jr).”

As a hostess Ms. Vickie deliver’s bed side meals and snacks to patients, as well as assists them in making menu choices. She also “enjoys meeting new people”. “Sometimes I get pastors and really spiritual people and we spend time talking about the Bible.”

That is what service with a smile looks like.

"He who is greatest among you shall be your servant. That's your new definition of greatness. … It means that everybody can be great because everybody can serve. … You only need a heart full of grace. A soul generated by love. And you can be that servant." — Dr. Martin Luther King, Jr.

- Chef Hugh Gittens

The Skinny on Soda

The proposed Soda Tax has been a hot topic on several prominent websites dedicated to nutrition. I’m not an expert in Food & Obesity Policy (see www.yaleruddcenter.org for all statistics in this article and very interesting reading) for educated experts talk about these issues, but as a health care provider, I do have an interest in reducing childhood obesity and improving the overall health in my community.

A 2004 study reports that the average person drinks 50 gallons of soda a year! So if you do the math, that is approximately 533 cans of soda per year. Not far reaching if one is drinking 1-2 sodas per day. That doesn’t even touch the stories of teens who drink 1-2 liters of soda per day.

Soda is the single largest contributor of calorie intake in the United States. We know what that means…extra calories, extra weight, and soon obesity related health problems. For children, each extra can or glass of soda consumed per day increases their chance of becoming obese by 60%. A 2009 California study found that adults who drink one or more sodas per day are 27% more likely to be overweight or obese than those who do not drink soda.

The marketing geniuses for soda companies recognize that traditional carbonated drink sales are down, and have been marketing beverages sports drinks, energy drinks, and sweetened waters and teas. Sales of these non-carbonated sweetened drinks are up. That brings up the recommendation that all sugar-sweetened beverages be taxed.

You may scoff at soda if you have more sophisticated tastes (yes, I’m talking to you foodies). But what about those sugar-laden coffee or juice drinks that are available at most fast food markets, coffee houses, or gas stations? The bottom line is everything we eat and drinks needs to be analyzed. Empty calories in any form can affect the bottom line…your health.

- Tiffany Norris, MSN, RN, BC, PMHNP
Bariatric Nurse Coordinator

What Brazelton Touchpoints Means to Your Family...

The Center for Women and Infant's Health at Texas Health Harris Methodist Hospital Fort Worth is a Brazelton Touchpoints Recognized Program. For you as new parents this means the staff will collaborate with you and empower you to have the ability to maintain your child's health and the health of your family. By using the Touchpoints values, principles and practices as guidance each caregiver will work with you to provide the care and support your baby needs to be healthy and ready to learn. Touchpoints are predictable periods in a child's development that can disrupt family relations. These are times of disorganization that we value as opportunities to support family strengths and optimize children's development Did you know you are an expert on your baby’s behavior even before birth? Think about what you know about your baby before he/she is born. What is his/her activity level? How does he/she respond to noise or touch? Our staff has received special training in child development and is here to help you recognize your baby’s individual strengths and cues. From the moment you arrive at The Center for Women and Infants' Health you are in contact with Touchpoints trained caregivers. Investment in and commitment to the Touchpoints model gives our staff the opportunity to build relationships and influence your bond between you and your baby.

For more information on Brazelton Touchpoints visit www.touchpoints.org

Thanks to T. Berry Brazelton, MD for his work with over 25,000 children and parents. Dr. Brazelton is also the author of over 40 books on pediatrics and child development.

- Becky Law, RN
Childbirth Educator

Real Life Nurses...Not Reality TV Nurses

I don’t watch a lot of television, but I’m always interested in viewing programs that feature nurses in key roles. Unfortunately for our profession, nurses are almost always cast in an unfavorable light, either as lovelorn incompetents, physicians’ handmaidens, or mean Nurse Ratcheds. So far this TV season has been no different and I feel I need to speak out against the way nurses are stereotyped on TV. If you know a nurse you know these images are far from true…and oft times insulting.

You don’t see it on TV, but before a Registered Nurse begins to practice they spend years in college gaining the classroom and clinical skills needed to be able to deliver quality, safe patient care. Once they graduate from their nursing program, they must pass a comprehensive exam to obtain their license to practice…and believe me, it is not something you can prepare for by standing around chatting about your love life…like they do on TV.

Professional nursing is most assuredly a science, but it is also an art. Nurses care for the whole person and know that what we do not only impacts the individual patient but their family and community, and it is not just in thirty minute or one hour segments like it is on TV. It is a 24/7 profession, and to borrow an old phrase, a nurse’s work is never done. Professional nurses work in a variety of disciplines and settings, and then specialize even further. For example, Neonatal Intensive Care Unit (NICU) Nurses have specialized knowledge and training and care for our tiniest and most vulnerable patients. And they don’t just care for their tiny patients, they also provide care and support for the whole family. They listen and provide encouragement daily for worried family members as they sit by the incubators of their precious babies. They teach those families how to care for their babies when they are discharged, and how to keep them safe.

Here is an example of the wholistic approach of nursing. If one of those vulnerable babies were to get the flu, it could cause very serious problems for them. To help decrease that risk, the NICU nurses came up with the idea of providing free flu shots to families while they are visiting their babies. By providing immunizations to the families, they decrease the risk of exposure for the babies in the nursery, and in the community. Mom and dad, grandma and grandpa, don’t have to leave the NICU to find a provider for their immunization and don’t have to add more expense or worry to a difficult situation.

Giving out free flu shots may not have enough romance or drama for TV network executives, but to a worried mom or dad whose baby is in NICU, it is a “true life” story worthy of “reality TV”.

- Devonna McNeil, RN, MS
Nurse Educator

Have you checked yourself lately?

October is a busy month for Breast Cancer Awareness. Whether you are in the store, watching TV, watching professional sports or college sports, or reading the newspaper, there is something PINK in the midst of it all. It is awesome that something as simple as a color can bring a reminder to each and every one of us. PINK= Breast Cancer.
I know that most of us have a sister, mother, aunt, friend, wife, or yourself, that has been touched by breast cancer. The facts are astounding and the message is HOPE.
An estimated 182,000 new cases of invasive breast cancer are expected to occur in the U.S. this year, according to ACS. Breast cancer is the most common cancer in women. The second leading cause of death among women, (lung cancer is first), and breast cancer is also the most common. Fortunately, breast cancer deaths have been decreasing since 1990 as detection and treatment improve, reducing the mortality rate to 3 in 100.
Early detection and treatment are keys to breast cancer survival. When breast cancer has not strayed outside the breast, the five year survival rate is close to 100%! Mammography is the most reliable way to detect breast cancer. Now, most women are diagnosed at early stages. Still, 25% of breast cancers are detected through a breast exam, about 35% by mammography and 40% through a combination of exam and mammography. Performing routine breast self-exams is still essential.
Here are some ways to check for possible signs of breast cancer. The 3 most common symptoms are: 1. changes in the look or feel of the breast. 2. Changes in the look or feel of the nipple. 3. Nipple discharge. Lumps do no necessarily mean you have cancer; most are benign. Changes to the skin include redness, darkening, puckering (a pulling that causes an indentation), or dimpling. An inverted nipple – one that pulls inward-may be another sign. Nipples may also become itchy, scaly, sore, or have a rash or discharge.
In addition to mammograms, other imaging options include stereotactic imaging, ultrasound, PET scans. None of these are standard screening methods, and some are still experimental.
Many factors are associated with an increased risk of breast cancer. One of the most important factors is aging. The older you get, the greater the risk. At age 20 your risk is just 1 in 1,985. But at age 70, your risk increases to 1 in 24. If you live to 85 years old, your odds increase to 1 in 8. The lifetime risk of breast cancer is 8%, or 1 in 12.
About 5%-10% of breast cancers are due to inherited genetic mutations, like BRCA1 and BRCA2. People with these mutations have a 40%-80% risk of contracting breast cancer and a high risk of ovarian cancer. Other factors that increase risk are:
-First period before age 12; menopause after 55; excess weight after menopause
-first child after age 30; no children’ taking birth control pills for 5 years or longer
-drinking more than one alcoholic drink per day.
Diet and exercise make a difference. Weight gain after age 18 and after menopause is a risk factor. In turn, losing that added weight may decrease your chances of getting breast cancer. Diet combined with exercise can be important for managing your risk. Physical activity also helps maintain a healthy immune system.
HRT or hormone replacement therapy can raise breast cancer risk. Lifetime exposure to estrogen provides a constant stimulus to breast cells. Early onset of puberty, late onset of menopause and having children after age 30-all events associated with increased estrogen production are risk factors. This does not prove, however, that estrogen causes breast cancer.
What is the biggest risk?? BEING A WOMAN. Although a small percentage of men develop breast cancer too. With better screening processes for early detection, breast cancer doesn’t have to be fatal.
So, with all of this said, be a friend and an advocate for yourself and others. Practice your self breast exams and get your yearly mammograms. If you find or see something unusual with your breasts, contact your physician. It could save your life.

- Dana McGuirk, RN
Breast Nurse Navigator

A time to give birth and a time to die...

Let me start out by saying that this was not just any patient. This particular patient had frequently been in our hospital several times.

This patient and family had spent the better part of the month with us. Needless to say, all of our nurses on the unit had cared for this patient.

On an afternoon, I walked out for report that morning, I immediately recognized the name written on the room, but couldn’t put a face to it. A short while later the patient’s family came from the waiting room to ask if we knew
anything at this point. As soon as I saw the family, all the details flooded back to me. With the help of the a few clinicians, I began to call all of the patient's previous doctors. We are blessed at Texas Health Fort Worth to have very talented physicians to work with. Within 30 minutes one of the patient's doctors was in the room and had talked to the family. He came back from the private waiting room they had been put in, and said they wanted to withdraw life support once all their family was there.

The orders were written to make the patient a DNR (do not resuscitate) and all of the withdrawal orders were in place. While we waited for the rest of the family, one of our patient care technicians said that the family asked her if we could wait to withdrawal until the patient was outside. I will admit the ICU nurse in me said ”WHAT?! We can’t take a ventilator outside!”

Once I returned to the unit, the family was in the room along with their priest. One of our palliative care nurse practitioners came by and we began to talk about the situation. I think just having her around makes you calmer and more compassionate. We talked for a while about how we could make this possible.

We then had to think of ways to get to the meditation garden without having to go straight through the lobby. She made a call to the palliative care unit and the nurses there as well as our PCT began to make calls to figure out how to get the back gate of the garden open. After endless phone calls, we had it figured out. We had the code to the gate and within a short amount of time the stretcher
was there as well as the two palliative care RNs.

We all decided we needed to do a test run to make sure the stretcher would fit through the gate as well as be able to get it where we needed it. We completed our test run successfully. The palliative care nurses went to set up their privacy screens for the small areas we would have to go by before we got into the garden. Once back upstairs, we set up the stretcher and I told the family the plan. They were going to go down to the garden and we would meet them there momentarily. The five of us moved the patient to the stretcher, got him comfortable and started on our way to the garden.

There were a few small bumps,but we made it and it was a beautiful
80-degree Texas day. There was a light breeze making it the perfect afternoon.
All of the patient's family was gathered in the shade next to the waterfall. The patient's next-of-kin said they were ready, and I extubated the patient. Through their tears, the family told the patient that he/she was loved and that the family kept their promise not to let him die in the hospital. We all stepped away to give the family alone time with the patient in these final moments. As we stood at the main entrance to the garden, I looked at the wall and saw the plaque that read “There is an appointed time for everything. And there is a time for every event under heaven. A time to give birth and a time to die…” It was perfect. Within a few minutes, the patient took one last breath and passed away in the arms of a loving family.

We have to deal with many deaths as nurses in the ICU, most of which are
unexpected and terribly traumatic. While no death happens without sadness, this was the perfect way for this patient to finish life. It was not in the hospital, as the family had promised the patient, and in the arms of a wonderful and caring family.

- An ICU Nurse
Texas Health Fort Worth

The Skinny on Weight Loss

Do you dread the holidays and the never ending feasts? Do you gain the dreaded 7-10 pounds, only to start your New Year swearing to lose it? Though that number may be slightly exaggerated, the average adult does gain 1-2 pounds per year and doesn’t take it off. That estimate is often doubled for those who are already overweight.

Over the years those extra pounds turn into significant weight gain and can cause health related problems, such as Type 2 diabetes, high blood pressure, heart disease, sleep apnea, infertility. And the list goes on and on… Getting on the scale and having another talk about weight loss is often the reason most overweight and obese patients avoid medical follow up in the first place.

Weight loss isn’t simple. There is no quick fix solution for weight loss, but there are options for those who have tried again and again to lose weight and cannot do it on their own. Surgical weight loss or bariatric surgery has been proven to improve diabetes, high blood pressure and other obesity related health problems.

Texas Health Fort Worth offers several surgical weight loss options.
• Roux-en-Y Gastric Bypass
• Adjustable Gastric Banding
• Sleeve Gastrectomy

A free seminar will be presented by Dr. Douglas Lorimer and Dr. Antonio Castañeda on Monday, November 2nd at 6:00 p.m. in the Education Center. There is also a webinar available that addresses the most frequent questions about weight loss surgery.

For more information, visit our web.

- Tiffany Norris, MSN,RN,BC,PMHNP
Bariatric Nurse Coordinator

Dealing with Grief?

Grief is commonly related to what one feels after the death of a cherished one. It's defined by Webster’s dictionary as “deep and poignant distress caused by, or as if by, bereavement.”As human beings we experience grief in many ways. Grief is complicated and different for everyone.

When we lose a loved one, we not only miss that person, but we deal with a whole cloud of emotions, including, but not limited to, regret, frustration, anger, sadness, worry, and anxiety. We mourn the loss of a future with that person. We mourn the things we should have said and done. We struggle with the reality of the things we said, and now regret. We struggle with the truth of the present, and the void that is left by that person no longer being with us.

As a hospital chaplain, I find myself confronted with several types of grief:

* The grief of families when a loved one dies in the hospital.

* The grief of hospital staff when a patient dies.

* The grief patients experience when they are diagnosed with a serious illness.

Grief can revolve around the loss of hope, the loss of innocence, and the loss of dreams. The personal grief of everyday life in the community of a hospital environment is abundant. Grief is troublesome, scary, and unpredictable. Grief is unavoidable, and there is no instruction manual for getting through it.

I often fight with my own grief. I experience anticipatory grief of losing my own family members as I work day in and day out with death and illness.I hope and pray that as we deal with the grief that exists in life, we can seek out each other through relationships.

One helpful way to deal with grief is to talk about it in an appropriate and safe environment. Our families, friends, and even professionals are helpful resources. Support groups within the community can provide listening ears, and support from others who may be at different stages of grief. We must not lose hope in the future even through our grief.

Here at Texas Health Harris Methodist Fort Worth Hospital, we offer a variety of support groups. Four times a year we offer a group called “Life After Loss.” It is a program developed by the American Cancer Society. It's a six-week free seminar for anyone who has experienced the death of a loved one. We explore the process of grief, expectations, what you need when you are grieving, living with loss, and the "what do I do now?" of life after losing someone.Grief, if avoided, will not just magically disappear. Losing a loved one, or a loss of something significant to you, is not something that you just “get over.” It's something you will get through.
If you find yourself swallowed or drowning in your grief, whether it is from a recent loss or one that occurred many years ago, taking time to journey through the valley of grief might be helpful. Seek out a group or someone to journey with you.I would like to leave you with an ancient Irish blessing.

As we each deal with various kinds of grief, may we know that we are not alone….

May the road rise up to greet you

May the wind be ever at your back

May the sun shine warm upon your face

May the rains fall soft upon your leaves

And until we meet again

May the good Lord hold you in the hollow of God’s hand

AMEN



Dora E. Saul, MDiv., BCC
Staff Chaplain
Texas Health Harris Methodist Hospital Fort Worth

Healthy Halloween Goodies

It is almost October 31st. Halloween candy is appearing and about to linger for months! This year try some healthy candy alternatives for yourself and your neighbors!

The holiday season starts in October with Halloween candy and lingers all the way through February with Valentine’s chocolate. If you eat sweets the whole way through, you are sure to gain weight! However, there are many healthy alternatives to sugary candy so let’s take a look.

Individually Packaged Goodies
Halloween candy should be individually packaged goodies for trick-or-treaters and parties. This helps with food safety and also allows for storage. Throw out the chocolate KISSES and Butterfingers and pick up mini boxes of raisins that are nutrient-rich and high in fiber. Other healthy alternatives include 100 calorie packs of whole grain trail mix and low-fat favorites like graham crackers, Teddy Grahams and Goldfish.

Toss the chocolate bars and grab some whole grain, individually packaged granola bars. Quaker® makes a variety of oat-based granola bars with chocolate and peanut butter flavors. Fiber 1®, Kashi® and Nature Valley® also have healthy choices for crunchy and chewy whole grain granola bars.

Other sweet, yet healthy favorites might include low-fat pudding cups (not already refrigerated), natural apple sauce cups and even whole fruits. Even healthy fats can be a Halloween treat. Try 100 calorie packs of almonds and peanut butter crackers.

So the key here is to think outside the box, look for some healthy options at the grocery store and provide your family and neighbors with some nutrient-rich Halloween goodies this season!

- Amy Goodson, MS, RD, CSSD, LD

Registered Dietitian

Trick or Treat - Safely!!!

It is hard to believe that October has arrived. Halloween is fast approaching, and I can already hear the doorbell ringing and see my little Jack Russell running wildly through the house with uncontainable excitement! I am down to only one child in the house, and she is 16, so I won’t be making any fun costumes for her to trick-or-treat in. Having been a mother of four, I do miss those days. But over the years I have learned a few tricks on my own to have a fun and safe Halloween.

• Be a “shining” example in your neighborhood—wear reflective clothing and carry a bright flashlight.


• “It’s ten o’clock; do you know where your kids are?”—set a “check in” time, even if they go out foraging for more goodies again later.


• “Got young kids?” ---go with them.


• Have a word with your teen drivers about being extra cautious in neighborhoods.


• Pick out your favorite treat from their stash, and while you are looking through it, make sure all candy is wrapped and sealed.


• Churches and community centers throw great parties—consider a fall festival if trick or treating isn’t your bag.


• Remind your gremlins not to go between parked cars or dart across the street.


• Make sure Halloween costumes fit properly, if they are loose, or drag the ground, your goblins may trip and fall.


• Pumpkin carving always requires supervision! If you put candles in them, make sure your walkway is clear to avoid a fire hazard.


• Have a plan in case your child gets separated from the group—a safe location to meet.


• Walkie talkies and cell phones are great tools for keeping in touch.


• Tell your child to only go to homes that have their lights on and never go inside a stranger’s house
  

Of course these are just a few tips. Don’t forget the camera and the photos. The days of princess’s and pirates will sail by before you know it.

Mary Ann Contreras, RN
Injury Prevention

When to come to the hospital during a flu outbreak

With all of the news about H1N1 deaths, the public is scared. Education and knowledge is a huge step into staying healthy through this flu season.

I want to talk a little bit about when to go see your doctor or local urgent care clinic and when you might consider going to the hospital.

First, individuals who think they have symptoms of the flu should call or go see their primary care physician. If you do not have a primary care physician, you should go visit your local urgent care clinic.

Individuals with flu-like symptoms (body aches, fever of 100 or 101 degrees or coughing) rarely need to go to the hospital. However the following symptoms might indicate the need for hospital/ER evaluation:

• Difficulty breathing or breathing too fast


• Feeling confused or unable to stay awake


• A high fever that will not break


• Anyone who suffers from organ disease (liver, heart, brain, lung, etc.)


• Anyone who suffers from cancer


• Women who are pregnant


• Any patient who is immuno-compromised (eg. HIV patients, organ transplant recipients)


• Patients who are elderly (65 years or older)


• Anyone who feels sicker than they usually do with the flu
  

If you have children who have flu-like symptoms, you may consider visiting your local children's hospital when:

• They have a fever of 101 degrees or higher


• They are struggling to breathe, experiencing rapid breathing or spells of not breathing


• If they display bluish discoloration of the skin, specifically in the fingernails, toenails and lips
  

These symptoms are not complete or exclusive. As always, listen to your body. A primary care physician is equipped to treat flu-like symptoms. People often times think running to the emergency room is the best option. It is a good option for people who have serious flu-like complications. However, if you just feel kind of bad and want flu medicine, the ER is not the best place for you. What many don't realize is that the ER is still taking care of really sick patients (trauma patients, heart attack patients, etc.) who do not need to be surrounded by people who have the flu. I am not discouraging you from coming to the ER if you feel like your flu case is serious, but you might consider your local doctor first.

Also, one more important thing to remember - it is very important that children and individuals who are sick refrain from visiting loved ones who are in the hospital!

More to come tomorrow on the flu. Please leave any comments or questions you might have and we will do our best to get a response to you!
-

- Whitney Jodry
Public Information Officer

Proper flu etiquette

The big topic of the local news is H1N1 (or Swine Flu). I anticipate that it is something that you all are concerned about too! So, we are going to start dedicating more time on the blog to answering your questions about the H1N1 virus and what you can do to keep yourself healthy.

I sit on a committee comprised of doctors, nurses and medical personnel who know their stuff. A commitment I will make to you is to take the information I am receiving from this flu committee and keep you in the loop.

Our first meeting is today at 10 a.m. In the meantime, I wanted to give you a few helpful hints on how to stay healthy during this flu season:

1) Wash your hands! Wash your hands! Wash your hands! Hand sanitizer and washing your hands for the length of singing "Happy Birthday" is a good rule of thumb. Keeping alcohol-based hand foam on you at all times will help you keep hand-washing top-of-mind.

2) Cough or sneeze into your sleeve or into a tissue. Sneezing and coughing in your hand only spreads germs!

3) Practice social distancing. People think this is odd, but if you are in public try to stay at least 3 feet away from others.

More to come on the H1N1 front. Hope this will keep you going until I can give you more of an update.

- Whitney Jodry

Public Information Officer

Would you consider a vaginal birth after cesarean (VBAC)?

Over the last ten years, the Cesarean section rate in the United States has risen to nearly 27%. With the increase in numbers of primary C-sections, there is also an increase in the number of women who may be considering vaginal births after cesarean (VBAC). Our group of Nurse-Midwives are supportive of women's birth choices and their right to make educated decisions regarding birth, including chosing a VBAC. If you have had a previous Cesarean Section and are interested in whether or not you are a candidate for a VBAC, please consider scheduling an appointment with your provider to discuss your specific case.

- Lindsay Kragle, RN, BSN, CNM

Certified Nurse Midwife

I want to share a patient testimonial with you on VBACs.

My first daughter was born by scheduled c-section in 2004 because she was breech. Although I had a good c-section experience, I desired, for several reasons, to try to have a vaginal birth after cesarean (VBAC) with my second child. I also decided that I wanted a natural, pain-medication-free birth, if possible. After I got pregnant with my second child in 2007, I decided that I wanted to use a midwife for the delivery because I learned that midwives are specially trained in natural birth and that they typically spend a great deal of time with their patients both at prenatal appointments and during labor itself. After my doula recommended the practice of Lindsay Kragle, CNM, I switched to Lindsay, and was thrilled to find that her practice embodied all of the great things I'd heard about midwifery. Lindsay took a lot of time with me during my prenatal appointments. Not only did she provide helpful information in response to all of my questions, she took the time to get to know me and learn the details of my first birth experience as well as my hopes for the second one. The labor and delivery of my second child was incredible. I could not have hoped for a better birth, and the main reason for that was the care I received from my midwife. Lindsay was with me virtually the entire time I labored in the hospital. Aside from ensuring that all was proceeding well medically, she kept me company, rubbed my back, held the heart rate monitor in place while I moved around to cope with the contractions, and advised different labor positions and techniques to keep me as comfortable as possible. She, my doula, and my husband worked seamlessly as a team to accommodate my needs. I had written out a birth plan, and was delighted to see that Lindsay remembered it better than I did. She was happy to accommodate my requests to delay cord clamping, to leave the baby on my chest for a very long time, and to initiate breastfeeding within a short time after the birth. She also stayed with me for a long time after the birth and visited with me for an hour the next day. As for the VBAC itself, I was blown away not only at the magic of the birth, but also the ease of my recovery. I was able to take a shower later the day of the birth and was walking around normally that day. Although I thought the recovery from my c-section was easy, it was nothing compared to how quickly I recovered from my VBAC. A year and a half later, I still reflect fondly on that birth experience every day. Words cannot express how grateful I am for Lindsay's care during that pregnancy and birth and how much I appreciate the midwifery model of care. I am so glad I chose to VBAC with a midwife and will definitely do it again with our next child.

- Leigha Simonton Horan