Nutrition Support in Critical Care

When patients cannot help themselves in any capacity, there are professionals that step in and take the necessary steps to ensure that they receive the type of care that will sustain and nourish them back to the point where they can do it on their own. In the clinical nutrition field, professionals like Debbie Foster do just that.
Debbie’s career as a licensed and certified nutrition support dietitian began with Texas Health HEB and Texas Health Fort Worth.
“When I was a student working part-time, day after day I observed a culture of compassion, care and professionalism at both hospitals. It had a strong impact on me and I knew this is where I wanted to be.”
When asked about her daily motivators, she said “My satisfaction comes from having a direct impact on improving my patient’s overall outcomes”.
“I enjoy being able to use nutrition as part of the healing process that helps to get patients back to a productive and healthy life.”
Family members find it comforting to know that when their loved ones may be unable to eat on their own, there is someone ensuring that they are receiving the best source of nutrition.
Healthcare and science have always been a passion for Debbie. The profession allows her to use her passion to help others. She enjoys being part of a multidisciplinary healthcare team dedicated to the improving the health of the community mind, body and spirit.

Debbie Foster

Registered Dietitian

Get Your Metabolism Fire Burning!

Alarm rings, kids won’t get out of bed, you forgot to iron your clothes for work, dog is barking…eat breakfast? Ya right! This is a typical morning for many families in the United States. They run out the door without fueling for their day. So what is the problem? A nutrient-rich breakfast is key to helping people feel energized, stay focused and feel less hungry later in the day. Research shows that people who eat a complete breakfast typically manage their weight better and children think better, problem solve more efficiently and stay focused on their school work.

September is National Breakfast Month and we would like to encourage you to get your metabolism burning with breakfast! Think of your metabolism like a fire…in order to get a fire going you have to use a sufficient amount of wood. Same with your metabolism fire…you need to fuel your body with a sufficient amount of nutrition to get the fire burning. Try to wake up five to ten minutes earlier and make time for breakfast whether you are a mom, dad, single adult or teenager…everyone needs breakfast!!! Here are some examples to get you started…

5 Quick Breakfasts for YOU and your KIDS:

2 slices 100% whole wheat toast each with 1 Tbs. natural peanut butter and top with slices banana
1 scrambled egg, 2 oz turkey sausage, 1 whole 100% wheat mini bagel with 2 Tbs. 100% fruit jelly and 8 oz low-fat milk
1 cup cooked oatmeal topped with ½ cup fresh blueberries and 2 Tbs. chopped pecans, 8 oz low-fat milk
Yogurt Parfait: 6 oz low-fat Greek yogurt, 1 Tbs. honey, ¾ cup whole grain cereal and 2 Tbs. chopped nuts (or flaxseed)
Non-traditional breakfast: 1 – 100% whole wheat tortilla rolled with 2 oz turkey and 1 slice 2% cheese in addition to a pre-made yogurt smoothie

Breakfast Check List:

Make sure your breakfast consists of complex carbohydrates (ex: whole grain cereal, wheat bread, fruit, low-fat milk), protein (ex: eggs/egg whites, lean meat, nuts), and some healthy fat (peanut butter, nuts, light cream cheese)
Look for whole wheat bread and grain products
Choose low-fat (skim, 1% or 2%) milk and dairy products
Limit your intake of fried foods, grease, and extra gravies & sauces
Aim to get fruit into your breakfast either as a juice or as a whole fruit

Amy Goodson, MS, RD, CSSD, LD

Registered Dietitian

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

The journey has speed bumps…

Well I have been pretty busy over the last couple weeks. My stress level reached an all time high, but finally settled down a little bit last Friday. I changed careers with little to no notice, went out of town a couple times, posed for a photo shoot, got sick and scared myself senseless, and the list just keeps on going.

So I am a big believer now that stress and bariatric surgery do not mix well. I went to the Bariatrics support group a couple weeks ago and was not feeling all that well. I talked with our dietician Jaime Bass about what was going on and she suggested that I give Dr. Lorimer a call the next morning. Little did I know that before I could make it home that all hell would break loose and I would start panicking enough to make me call the doctor. For those who don’t know me very well, I avoid calling doctors at all cost and very rarely will even take aspirin if I can help it.

On the way home, I started feeling worse than when I was at the hospital so I pulled over on the side of the road to give myself a moment. Next thing I know I was vomiting uncontrollably on I-30 and feeling like I was about to die right there next to my truck. After calling my dad (who is also a bariatric patient) to get his thoughts, I got back in the car thinking the worst was over. This was probably a very bad idea, as it got worse the longer I drove. I got home and called Dr. Lorimer and talked things through. I took it easy all weekend eating mostly soup until I got a chance to go see Dr. Lorimer this last week. Last Wednesday, I got in to see the good doc and we talked everything through further and then I went over to see a gastro doc. The appointment was short and sweet and I am now scheduled for Friday September 16 to have another procedure to get to the bottom of some of these recent issues. I am a little nervous about it just because I am a little worried about knowing what is really going on inside. I will admit though that I am excited about potentially being able to expand my diet further than soup menu!! I will update everyone after I find out more on Friday.

Another exciting thing I did last week was I became a model (Fashion Week, here I come). Only temporarily, but I drove to downtown Dallas to pose for photos for an upcoming article the Dallas Morning News and Fort Worth Star Telegram are doing in a special section for Texas Health Resources. There are going to be some amazing articles in the section. I brought in a bunch of my old clothes from before surgery and diligently stood between them, laid on top of them, and manipulated myself through them for about an hour. It really made me take a look back at how big I had really gorwn just over a year ago. One of the biggest eye openers during this experience was holding a photo of my son and I this past spring from our t-ball team. I don’t think I really ever realized how big I looked until last Friday. I am proud to say that I can now see a huge difference from before.

-Casey Armstrong

Bariatrics Patient

Giving the Gift of Life

My name is Claudia and three years ago I was diagnosed with Good Pastures Syndrome, an autoimmune disease that attacks the kidney and lungs. As I was told by one of the doctors, it was simply my “bad luck” that I contracted this disease because the odds of getting it are very rare. The disease took both of my kidneys, but thanks to the wonderful team of doctors at Texas Health Fort Worth, its progression was stopped before any further damage could be done.
As a single mom it impacted not just me, but my son as well because I am the only family he has. Through everything he was so scared that he would lose me. But I knew the Lord would get us through this. I do often think and say a special prayer for my donor and their family. I sent them a thank you letter for being so thoughtful. While my family and I rejoiced over receiving the gift of life, they were grieving the loss of a loved one. I only wish they knew how much I value them and am so grateful for everything because if it wasn't for them, my son wouldn't have his Mommy.
On June 30, I will celebrate the one-year anniversary of my transplant. This whole experience has changed my life completely. It gave me back my life; my independence and most important, more time to cherish with those I love the most, my family and friends.
I have always lived a good, healthy Christian life, but now I go to the extreme! I exercise regularly and pay more attention to my diet. And most importantly, I enjoy every day. If you are a donor or the family of a donor THANK YOU and if you are not, please consider becoming one. This decision can many lives!

Fall into Nutrition with Winter Squash

Shop seasonal this fall! Winter squash is available from August through March; however, they are at their best from October to November when they are in season. Winter squash, members of the Cucurbitaceae family and relatives of both the melon and the cucumber, come in many different varieties. While each type varies in shape, color, size and flavor, they all share some common characteristics. Their shells are hard and difficult to pierce, enabling them to have long storage periods between one and six months. Their flesh is mildly sweet in flavor and finely grained in texture. Additionally, all have seed-containing hollow inner cavities.

Winter squash are also rich in a variety of vitamins and minerals. It is a great source of Vitamin A in the form of beta-carotene which has powerful antioxidant and anti-inflammatory properties. Beta-carotene is able to prevent the oxidation of cholesterol in the body. Since oxidized cholesterol is the type that builds up in blood vessel walls and contributes to the risk of heart attack and stroke, getting extra beta-carotene in the diet may help to prevent the progression of atherosclerosis. Winter squash is also an excellent source of Vitamin C, potassium, dietary fiber and manganese. Potassium may help lower blood pressure and Vitamin C is known for its ability to strengthen the immune system. In addition, dietary fiber is significant in helping lower bad (LDL) and total cholesterol.

Get to know your 5 winter squashes:
Butternut Squash: Shaped like a large pear, this squash has cream-colored skin, deep orange-colored flesh and a sweet flavor
Acorn Squash: With harvest green skin speckled with orange patches and pale yellow-orange flesh, this squash has a unique flavor that is a combination of sweet, nutty and peppery
Hubbard Squash: A larger-sized squash that can be dark green, grey-blue or orange-red in color, the Hubbard's flavor is less sweet than many other varieties
Turban Squash: Green in color and either speckled or striped, this winter squash has an orange-yellow flesh whose taste is reminiscent of hazelnuts
Pumpkins: The pumpkin with the most flesh and sweetest taste is the small sized one known as sugar or pie pumpkin, the latter referring to its most notable culinary usage

Amy Goodson, MS, RD, CSSD, LD

EHP Registered Dietitian
Ben Hogan Sports Medicine Dietitian

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

The Role of Palliative Care to Improve Quality of Life

Why do only cancer patients get Palliative care? This is often the question posed by many patients and family members with other terminal illnesses such as Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), or neurological diseases with difficult to manage symptoms. The fact is, end-stage COPD typically results in debilitating dyspnea, poor quality of life, and increased morbidity and mortality. Patients frequently require several hospital admissions a year for relief of acute exacerbation of COPD symptoms. This negatively impacts patient’s quality of life as they enter the final chapters of their life. Additionally, COPD sufferers become increasingly homebound with limited mobility and ever reliant upon family members to assist with everyday care and ADLs.

Palliative care has been proven to improve perceptions of quality of life and decrease health care costs to patients with terminal cancer. The same positive influence can be utilized in those with end stage COPD, CHF, or any terminal illness. Unfortunately, patients suffering from these conditions typically are not as prepared to face end-of-life decisions, discuss dying, or prepare for death with family members in comparison to those same patients entering the end stages of cancer. This has as much to do with the unwillingness of patient’s to engage in end-of-life care planning, as it does the uncertainty of general practitioners to relay poor prognostic features of the disease or shrinking survival rates.

Palliative Care can be of great assistance in this setting by providing holistic care, active listening to fears, anxiety, and concerns of the patient and family members alike, improve perceptions of quality of life, and assist in end-of-life preparation. Palliative care’s role in symptom management for the end stage COPD patient is crucial in regaining modest amounts of self care, facilitate energy conservation, and maximize function.


Amy Lunsford, RN, MSN, ACNP
Palliative Care Nurse Practitioner

The Special Grief that Follows a Miscarriage

Typically, when a pregnancy is realized, the mother and father begin to dream of this new one to be added to their lives, to their family. The mind allows us to imagine what it will be like to first hold this baby, to bring this little boy or girl home from the hospital. We wonder what this little one will look like; will this child have mama’s hair, or daddy’s toes? Sometimes we even project out, dreaming about the first holiday with a baby, considering what it might be like when this child goes to school. All of this is a normal part of pregnancy.

But not every pregnancy develops normally. And not every dream becomes a reality. During my year of residency as a chaplain with Texas Health Fort Worth,I was assigned to the Women and Infants unit. With my anxiety about providing pastoral care to those who experience loss through a miscarriage, I wrote to family and friends and asked them to share with me stories, feelings, and grief associated with the loss of an infant. To my surprise I received many responses, some from family members who for years had silently been carrying this hidden grief . I soon learned that many women and men remain silent about the pain of a miscarriage. And, I learned how the pain of grief does not go away, even when it is ignored.

Through my ministry with grieving mothers and fathers, children, grandparents, and staff, I am learning the importance of recognizing the significance loss that occurs through a miscarriage. I encourage folk to mourn and to expect a variety of emotions. There may be numbness and shock initially. Seeing and holding the baby is an important option to give each person who experiences a miscarriage. For some, naming and blessing the baby are sacred rituals that help to recognize the child’s worth and spirit. In addition having a funeral or memorial service is an important option. If it is determined to have a funeral, then waiting until the mother is able to attend is important.

Rev. Denise Hill

Supervisor Candidate/Chaplain in Pastoral Care Department

Planning to Have A Baby?

Taking care of your baby doesn’t start the day they are born. It starts long before.

WHAT YOU NEED TO KNOW WHEN YOU ARE TRYING TO GET PREGNANT:

Most women don’t know they are pregnant until they miss their period. The baby is often 4-5 weeks gestation at that time and many of the vital organs are already in critical stages of development. Alcohol and other drugs (even over-the-counter remedies) can cause problems for your unborn child. It is wise to avoid alcohol and other unnecessary medications if you are trying to become pregnant. One thing that you should NOT avoid is folic acid. Folic acid is a vitamin that plays an important role in the development of baby’s brain and spinal cord. Deficiencies in folic acid are known to cause neural tube defects (also known as spina bifida). Spina bifida is a birth defect in which the backbone and spinal canal do not close before birth. The spinal cord is exposed at birth and these children do not have normal function of their bladder, bowels, or legs. Many are confined to wheelchairs. This birth defect is largely preventable by taking 400mcg of folic acid per day. All women of child-bearing age are encouraged to take 400mcg of folic acid daily, either as part of a multivitamin or by eating cereals or grains with added folic acid.

I’M PREGNANT-WHAT NOW?

Once you find out you are pregnant, you need contact your obstetrician to start prenatal care. Prenatal care is EXTREMELY important for the health of you and your baby. Your doctor will prescribe prenatal vitamins to be taken throughout your pregnancy, and will send screening tests for infections that may compromise the health of your baby if untreated. In addition, your doctor will perform at least one complete ultrasound of your baby to screen for birth defects or problems with the baby’s growth. All expectant moms are screened routinely for the development of diabetes and the development of high blood pressure during pregnancy. Both of these disorders are often asymptomatic and can be very dangerous for the health of mom and baby if untreated. Last, your obstetrician can help you to prepare for the birth of your baby. They will have recommendations about prenatal classes, can discuss options for pain control during labor, and can give you important information about the benefits of breastfeeding your baby. Prenatal Care is the most important gift you can give your unborn child.

Fran Lynch, MD FAAP

Neonatatologist