Be Safe for Halloween!

Halloween is just a few days away. Which reminds me that I need to buy more candy. Why is it that I can remember where I hide the candy, (yum) but I can’t remember where I put the car keys? And speaking of car keys, did you know twice as many children are struck by cars on Halloween than on any other day in the year? So as you venture out on this spooky night, remind your children when crossing the street to look left, and then right, and then left again. Streets should only be crossed at the corner. Try to stay on sidewalks, but if there are none in your neighborhood, walk on the left side of the street, facing oncoming traffic. It is much easier for a driver to see your goblin with reflective gear such as glow in the dark bracelets, necklaces and reflective tape.

Turn on your full headlights between 5:30 and 9:30, which is the most popular hours for trick-or-treaters. Of course you should obey all traffic signs. In residential areas, drive slower than usual where children will be out. Pay special attention when going in and out of driveways. Be mindful of any distractions such as talking on cell phones, or eating to better concentrate on driving. If driving trick-or-treaters through the neighborhood, remember to use seat belts and exit the vehicle on the passenger side.

Halloween is an exciting time for children. They look forward to dressing up and getting heaps of candy! As parents we are responsible for checking out the candy (especially the chocolate ones), and keeping our little ghouls safe and sound. This includes reminding your teens (the scariest ones of all) about attentive driving, no matter how many times they roll their eyes.

MaryAnn Contreras, RN
Injury Prevention Coordinator

Who needs a flu vaccine?

Influenza, commonly referred to as the flu, is a highly contagious viral infection. Symptoms often include a quick onset of fever, muscle ache, sore throat, cough and headache. Influenza symptoms are usually mild to moderate in severity and last for 2 to 3 days. In more serious cases however, the flu can lead to further complications such as pneumonia or even death. Each year more than 200,000 hospitalizations are flu-related. Flu season usually peaks in December and continues through March. The flu vaccine provides protection against contracting the flu. There are two types of influenza vaccines available for the 2010 season, the traditional “flu shot” and a nasal vaccine.

The flu shot is a yearly vaccine that can be given to adults and children as young as six months of age. This vaccine contains three different inactivated strains of the flu virus. One of the strains in the 2010 influenza vaccine will be the 2009 H1N1 virus. Because the peak flu season begins in December, the optimal time to receive the influenza shot should be during October or November. The flu shot is usually recommended for all persons that are high risk for complications such as those 50 years of age and older, healthy children 6 months through 18 years of age, residents of long term care facilities, pregnant women, and those 6 months of age and older with chronic illnesses (such as pulmonary or cardiovascular illnesses). Common side effects are redness and soreness at the injection site that usually lasts for 1 to 2 days. Less than one percent of people experience fever, muscle ache or tiredness. Some individuals have not been able to receive the influenza vaccine in the past because of an allergy to eggs. However, in 2011 a non-egg based vaccine will become available.

Another option for protection against the flu is the nasal vaccine also known as FluMist. FluMist is approved for healthy persons age 2 through 49 and it is given as a nasal spray. Unlike the influenza shot, the nasal vaccine may be given as soon as it is available in the late summer or fall. FluMist contains a live attenuated virus, which is a weakened form of the flu virus. The most common side effects of the nasal vaccine are runny nose, cough, nasal congestion, chills, sore throat and headache.

Visit http://www.flu.gov/ for further information on the vaccines.

~Nicole Day, PharmD

Grateful for Small Miracles

After learning that we were pregnant with twin girls our excitement was beyond measure. We were so excited to share our lives with not one, but two precious babies. Unfortunately, God had other plans for our family. Pre-term labor reared its ugly head in the 19th week of my pregnancy, and I was rushed to Texas Health Harris Methodist Hospital Fort Worth where I would remain for three days.

After my third night at the hospital, my water broke, and our first sweet baby, Lily Grace, was delivered…too soon for any chance of survival. Miraculously, my labor stopped after Lily was born, and Dr. Bradford and her nurses did everything they possibly could to keep our second twin safe for another 25 days. Isabelle “Izzy” Eden was born at 23 weeks and 6 days gestation, weighing 1 pound 9 ounces and measuring 11.75 inches long.

She was immediately rushed to the Neonatal ICU after her birth, and she ended up spending the first four months of her life there. She was released to come home the day after her original due date. Izzy was under the care of Dr. Miao and Dr. Brann, and they both took excellent care of her. And we just can’t say enough about the NICU nurses. They were wonderful! They went out of their way to make us feel at ease while we were visiting Izzy, and they were so patient with all of our questions. It was hard to walk away from our baby every night, but we knew we were leaving her in very capable hands, and most importantly, that she was loved. We are forever grateful to our doctors and nurses at Texas Health Fort Worth for taking such excellent care of our little girl. She wouldn’t be the picture of health she is today without them.

~The Babb Family

Brandon’s Story

My name is Brandon and I would like to share my story with you on how being a tissue recipient has impacted my life. In 2003, I started working at Community Tissue Services – Fort Worth as a customer service representative. My job was to help surgeons and patients get the tissue they needed for surgeries such as ACL repairs, hip surgeries, burn grafting, and many other types of surgeries that helped people walk, work, and live a full life. Seeing the impact that donation made every day for recipients and donor families, I became an avid supporter of donation.
Like most boys in Texas, football is a way of life. I played football my entire life and was given the opportunity to play college football for the University of Pennsylvania. During four years of playing Division I football, I never sustained any injuries.

While playing soccer in 2005, I came down on an opponent’s cleat and completely tore my Anterior Cruciate Ligament (ACL), one of the most important of four strong ligaments connecting the bones of the knee joint, damaged my lateral meniscus, a cartilage-like band that covers the lateral side of the interior of the knee, and tore a ton of cartilage. Needless to say, my knee was in disrepair. When I met with my surgeon, Dr. William Coleman, I told him without any hesitation that I wanted to use a donated ligament. As an employee of CTS, I knew of all the advantages using a donated ligament would bring me. When Dr. Coleman performed my surgery, I was given a “new” ligament.

One of the most important decisions I have ever made was to use a donated graft to repair my knee. Because of the tissue transplant, my knee is as “good as new”. Today, I am a football coach at North Side High School, and my coaching style revolves around being able to show my athletes how to play the game, getting on the sled and bags and being a “hands on” coach. I also have a three –year old son that loves to play, run, and do all the things a wild three-year old does. Without question, receiving my tissue transplant has allowed me to live my life the way I want!

I owe this all to the person that decided to donate the tissue of someone they loved. Soldiers, firemen, police officers, and so many others that come into harms way benefit from the tissue, skin, and bone donated by the families of those that have passed. The decision to “give” can be life saving to some, and can allow others to continue their way of life. This also keeps the memory and spirit of the donor alive.

I am a supporter of donation and plan to become a donor. My family is aware of my decision to “give”. We can’t all be heroes, but we can all help each other by giving the gift of life, the gift of giving someone’s life a second chance, and the gift of helping a family that has lost a loved one carry on their memory.

Too Much of a Good Thing

Acetaminophen is the generic name for the commonly used over-the-counter (OTC) product Tylenol®. Since acetaminophen is most often used to reduce pain and fever, it is found in many combination OTC and prescription medications. Many consumers have the misconception that acetaminophen is extremely safe because it is so easily available and unlike ibuprofen, aspirin, or naproxen, it does not cause stomach pain or bleeding.

Acetaminophen can be most dangerous when the daily recommended total dose of 4 grams is exceeded. An overdose of acetaminophen can lead to liver damage. Patients with liver disease should probably receive less than 4 grams of acetaminophen per day, but should consult their physician for the recommended daily maximum dose.

A study in 2005 showed that acetaminophen poisoning accounted for 42 percent of acute liver failure cases. Many of these cases were caused by unintentional acetaminophen overdose. The FDA held a meeting in June 2009 to help decrease the number of consumers who experience liver toxicity through acetaminophen use. A public education campaign has been started to educate consumers.

Consumers can do their part by reading all of the ingredients in combination products. On OTC medications, check the “Drug Facts” label under the “Active Ingredients” section. On prescription combination products, it can be listed as acetaminophen or APAP, a well known abbreviation for acetaminophen.

Common prescription medications that contain acetaminophen:

Acetaminophen and Hydrocodone (Vicodin®, Lortab®, Norco®)
Acetaminophen and Oxycodone (Percocet®, Roxicet®, Endocet®)
Acetaminophen and Propoxyphene (Darvocet-N®)
Acetaminophen and Tramadol (Ultracet®)
Acetaminophen and Isometheptene and Dichloralphenazone (Midrin®)
Acetaminophen and Butalbital and Caffeine (Fioricet®)
Acetaminophen and Codeine (Tylenol #3®, Tylenol #4®, Tylenol Elixir with Codeine)

Common OTC medications that contain acetaminophen:

Acetaminophen and Diphenhydramine (Tylenol PM®, Excedrin PM®, Tylenol Severe Allergy®)
Acetaminophen and Aspirin and Caffeine (Excedrin® Extra Strength, Excedrin® Migraine)
Acetaminophen and Pamabrom (Midol®)
Acetaminophen and Phenylephrine (Alka-Seltzer Plus® Sinus Formula, Sudafed PE® Sinus Headache, Vicks® DayQuil® Sinus, Excedrin® Sinus Headache)
Acetaminophen and Dextromethorphan and Doxyalamine (Vicks® NyQuil® Cold and Flu Multi-Symptom)
Acetaminophen with Chlorpheniramine (Coricidin HBP® Cold and Flu)

Make sure you are checking your medication lists twice so that you aren't doubling up on your medications. And as always, speak to your family doctor regarding any medication changes.


Alisia Baker, Pharm.D.

Tips for Halloween Safety

Just a little over two weeks to go before the big night of “trick or treat” commences. Personally, I have bought two bags prototype candy. Of course the treats must be tasted and tested before I hand it out to my neighborhood goblins. I am a responsible neighbor after all. I have also checked and made sure my front porch and driveway are clearly lit and there are no tripping hazards (such as garden hoses) for the galloping ghosts. I have a plan for my alarmingly energetic Jack Russell that includes being secured in the house to avoid any potential escapes she might attempt with the overactive ringing of the doorbell.

Now that the basic arrangements are made, I have started talking with my teenage daughter. It is an ongoing dialogue about being aware of her surroundings while driving. Certainly this conversation is frequented often, but as Halloween nears it is even more important. Remember how excited these little ghouls get questing for candy—they run right out into the streets and don’t even think to look both ways. Many costumes are dark and scary, and difficult to see from a driver’s point of view. Extra caution is the answer for everyone, especially the teen drivers.

Remind the witches and warlocks to be wary of parked cars. Crossing the street with an adult or in a group is always a safer approach. And speaking of groups, trick or treating in packs is a sure way to have a more enjoyable evening. Remind the kids to get their goodies from the front door and never go inside the house. Lastly, before they gobble those goodies, they should be inspected by an adult, making sure the candy is securely wrapped and not tampered with. It’s often tough being a parent, but during this time of year, how sweet it is.

Mary Ann Contreras, RN

Injury Prevention Coordinator

Breakfast tips: feed your kids and YOU

Alarm rings, kids won’t get out of bed, you forgot to iron your clothes for work, dog is barking…eat breakfast? Yeah 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.

I would like to encourage all MOMS to feed themselves while feeding their kids! So many moms make breakfast and pack lunches for their kids and husband, but forget to fuel their own body. As women age, their metabolism slows down and skipping meals makes it worse! So no, the thought that “less is better” is not always the case, especially not with nutrition. In order to get your metabolism up and running, you have to eat breakfast, more than a yogurt or piece of fruit! Think of it like this…eat breakfast like a king, lunch like a prince and dinner like a pauper!

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 instead of white/refined 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

What is your go-to breakfast for yourself and your kids?

Amy Goodson, MS, RD, CSSD, LD

Registered Dietitian

For more tips and stories about moms in the Dallas/Fort Worth area, visit www.texashealthmoms.blogspot.com.

The Road Less Traveled

“Two roads diverged in a yellow wood,
And sorry I could not travel both…” -Robert Frost

Life is unpredictable. Just ask anyone in the medical field. As we travel down the road of life we have to make decisions as to which way to go when we come to a crossroad. But what if you couldn’t tell us that decision? Does your family know what you want? What if you could no longer care for yourself? What if you could no longer feed yourself? Sooner or later this is a crossroad we all must face. In many cases, we as medical professionals can’t always provide our patients and families with immediately clear answers regarding a prognosis on a disease or injury, so knowing which direction your loved one would want to go helps ease the decision-making process during difficult times.

As healthcare providers we often have to help families through these troubled times of “guessing” and “assuming” what a loved one would want because they simply had never had this difficult dialogue. You are never too young or to healthy to have this vital conversation. Questions to consider and discuss with your family could include (but are not limited to):

1) Who you want to make health care decisions for you when you can no longer make them yourself? We should all choose someone to make difficult choices for us. It is vital that this person be able to agree to respect your wishes.

2) What kind of medical treatment do you want or not want? Life is precious. We all want to be treated with dignity, especially during difficult times. Dignity also means that your loved ones know your wishes and respect them when you are unable to communicate them yourself.

3) How comfortable do you wish to be if you have a chronic or life limiting disease? Most people wish to spell out for physicians and care givers that they want to be kept free from pain, nausea, and shortness of breath. Clearly identifying what you want treated and don’t want treated will make these choices that much easier.

4) How you want people to treat you? Do you want to be surrounded by your loved ones as the hours of your life draw to an end? Do you enjoy music and want your family to play music for you? Do you want to have pictures for special memories and share stories of the past? Do you want spiritual support from a church or chaplain? What customs and rituals would you like to have honored?

5) What do you want your loved ones to know as they care for you? It is also important to discuss feelings with loved ones during this time so that the ones you care about know how you feel about them in case you are unable to communicate those feelings at a later date. Leaving a letter with your last will and testament is a very moving way to let your loved ones know how important they were to you if you are unable to voice this in the end.

As an individual it is your right to make these decisions for yourself. Most of us have considered this at some point in our lives, but have we communicated it to those who care about us? If you come to a fork in the road about making life decisions do you and your family know which way to go?

Kenneth Ellis, RN; Ashley Hodges, RN; Jennifer Nelson, RN

Palliative Care

Healthy Harvest Bites…

A healthy cookie twist!

More than just a decorative Halloween candleholder or a pie filling to be eaten only once a year, pumpkin is one of the most nutritional foods available year round. Rich in antioxidants, vitamins, minerals, and low in fat, both the flesh and seeds of the pumpkin provide many health-boosting nutrients. Check out some of the nutrients in pumpkin:

Alpha-carotene
Beta-carotene
Fiber
Vitamins C and E
Potassium
Magnesium
Pantothenic acid

Pumpkin is an excellent source of fiber; one-half cup serving contains 5 grams of fiber. Fiber helps reduce bad cholesterol levels, protect the body against heart disease, control blood sugar levels, promote healthy digestion, and plays a role in weight loss. In addition, alpha-carotene and beta-carotene are potent antioxidants found in pumpkin and are pro-vitamin A carotenoids which converts to vitamin A in the body. Vitamin A promotes healthy vision and ensures proper immune function. Not to mention, the Vitamin C in pumpkin also boosts immunity! Pumpkin also contains Vitamin E which promotes healthy skin by protecting the body from sun damage. So, stock up on pumpkin this fall and start by making the Pumpkin Protein Cookies!

“Pumpkin Protein Cookies” Recipe

3/4 cup SPLENDA® Granular
1 cup rolled oats
1 cup whole wheat flour
1/2 cup soy flour
1 3/4 teaspoons baking soda
1/2 teaspoon baking powder
1/2 teaspoon salt
2 teaspoons ground cinnamon
1 teaspoon ground nutmeg
1/2 cup pumpkin puree
1 tablespoon canola oil
2 teaspoons water
2 egg whites
1 teaspoon molasses
1 tablespoon flax seeds (optional)

Directions:
Preheat oven to 350 degrees F (175 degrees C). In a large bowl, whisk together Splenda®, oats, wheat flour, soy flour, baking soda, baking powder, salt, cinnamon, and nutmeg. Stir in pumpkin, canola oil, water, egg whites, and molasses. Stir in flax seeds, if desired. Roll into 14 large balls, and flatten on a baking sheet. Bake for 5 minutes in preheated oven. Cookies will turn out dry if overbaked.

Nutrition Facts per Serving:
Calories: 89, Carbohydrate: 15 gm, Fiber: 2.5 gm, Protein: 4 gm, Fat: 2 gm, Cholesterol: 0 mg

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

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

Halloween: Part One

What are you going to be for Halloween? My children used to pull out the box of costumes to see what would work for that year. There was always lots of princess attire as well as witches and a few odds and ends that could be transformed into aliens, ninja turtles and pirates. This year’s top costumes revolve around pop-culture icons such as Lady Gaga and movies like Avatar and Toy Story 3.

As you prepare for the big night out, remember to keep those costumes safe. Not too long as to cause a tripping hazard. Be careful with candles inside of pumpkins. Masks and head gear should not obstruct the gremlin’s vision. And speaking of vision, remember to take a flashlight, especially when crossing streets. Until next week, happy costume hunting!

Mary Ann Contreras, RN

Injury Prevention

Mother and Babies Need Skin to Skin

Recent studies support what mother’s have known instinctively for generations. Mothers and babies belong together from the moment of birth. Skin to skin contact between mothers and babies immediately after delivery has many benefits for the new family.

Skin to skin contact involves drying the infant and placing him/her immediately from the womb to the bare skin of the mother’s abdomen, then placing a warmed blanket over the two of them. According to mammalian neuroscience, the intimate stimuli inherent in this kind of contact evokes neuro-behaviors ensuring fulfillment of basic biological needs and may program future behavior. Thirty studies involving 1925 participants found the following positive effects to keeping mothers and babies skin to skin immediately after birth.

Benefits to Baby:

· Stabilization of the baby’s heart rate with a decrease in bradycardia episodes
· Improved regular breathing patterns and a decrease in apnea episodes
· Improved oxygen saturation rates
· Improved temperature regulation
· Increased restful and deeper sleep
· Increase in weight gain
· Shorter hospital stays

Benefits to Parents:

· Improved bonding supports closeness to baby
· Increase in breast milk supply
· More successful breastfeeding episodes
· Increased confidence in the ability to care for the baby

Gloria Glidewell, CNM, MS