I Didn't Know... Did You?

Did you know that for three decades November has served as National Hospice and Palliative Care Month? I didn’t know, and I work in Palliative Care. So now I am here to spread the word…NOVEMBER IS NATIONAL HOSPICE AND PALLIATIVE CARE MONTH.

Why is this significant?

In 1978, President Jimmy Carter signed the first proclamation designating November as hospice month. At that time, hospices served several thousand patients and their families. Current data from the National Hospice and Palliative Care Organization (NHPCO) shows that a record 1.56 million people with life-limiting illness and disease (41.5 percent of those who died in the US in 2009) were served by hospice and palliative care organizations.

What is palliative care?

According to http://www.getpalliativecare.org/, “Palliative care is the medical specialty focused on improving overall quality of life for patients and families facing serious illness. Emphasis is placed on intensive communication, pain and symptom management, and coordination of care.”

In July 2009, Texas Health Harris Methodist Hospital Fort Worth opened North Texas’ first Palliative Care Unit. We are a 16-bed unit that focuses on providing quality care to patients and their families. We see patients at many points during their disease process and should, ideally, become involved as part of the care team when a patient first receives a chronic disease diagnosis.

Why palliative care?

Palliative care at Texas Health Fort Worth provides a holistic approach to treatment. Our interdisciplinary team works together to coordinate a plan of care that best meets the patients’ and families’ wants and needs. Our goal is to relieve the symptoms that may come along with a disease and to improve quality of life.

Many of you may have a personal experience with palliative care or hospice. I know that my family benefitted greatly when we had a loved one in need. I hope that you will take a moment this month to remember those you have lost and thank those that may have cared for them along the way.

References:
http://www.getpalliativecare.org/
http://www.nhpco.org/

Ashley Hodo, RN

Palliative Care Unit Manager

Thanksgiving…Indulge without guilt!

Does your Thanksgiving meal leave you stuffed and on the couch watching football all afternoon? If so, you might just need to “fine-tune” your indulging. There are a variety of Thanksgiving dishes that are scrumptious, but lower in calories. Take a look at how you can treat yourself without killing your waistline!

Before the Meal

Many people make the mistake of “saving up their calories” for the big meal. The problem is that when you skip meals you end up feeling starving and thus overeat. So to prevent overeating:

- Eat breakfast!
- Do NOT skip meals all day. Eat small meals and snacks all day so you are not starving upon arriving at Thanksgiving dinner!
- Drink water throughout the day as dehydration can make you believe you are hungrier than you actually are!

The Table Setting

The best way to prevent over eating is make it “difficult” to get food…if the food is within arm’s distance, typically people eat more because it is convenient! So what can you do?

- Leave the food in the kitchen instead of placing it family style on the dinner table
- Use the “small” plate at the meal and if you are hungry, you can go back for more
- Only put one serving of each item on your plate; don’t create a mountain of food

Drink This, Not That!

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 then have a drink or two throughout the day and alternate water in between.

- Drink red wine INSTEAD of a red fruity cocktail
- Drink light beer INSTEAD of regular beer
- Drink hot chocolate or coffee INSTEAD of eggnog

Eat This, Not That!

Thanksgiving dishes are known for their calories, but there are many healthy choices you can make at the meal and even with dessert. Check out the TOP 10 healthiest decisions you can make at dinner:

- Choose a green salad or raw veggie appetizer INSTEAD of chips and dip
- Choose skinless, white meat turkey INSTEAD of fried or dark meat turkey
- Choose fresh green beans INSTEAD of green bean casserole loaded with creamy sauces
- Choose brown gravy INSTEAD of creamy gravy on your mashed potatoes
- Choose a sweet potato INSTEAD of a sweet potato casserole loaded with marshmallow & sugar
- Choose bright colorful veggies INSTEAD of a plate loaded with white starches
- Choose a whole wheat roll INSTEAD of a croissant or flaky biscuit
- Choose water as your beverage INSTEAD of an alcoholic beverage, sweet tea or soda
- Choose desserts that are fruit based INSTEAD of chocolate or cheesecake based
- Choose pumpkin pie INSTEAD of pecan pie

Amy Goodson, MS, RD, CSSD, LD
Registered Dietitian

Words of Holiday Wisdom

Well, it’s almost Thanksgiving already. With the changing color of the leaves comes heightened expectations of holidays, parties, gifts and more. A couple of thoughts on fall and winter holidays:

1. Be patient. Don’t let crowds get you blood pressure up. Plan to give yourself more time, whether at the airport or in the mall.

2. Be active. Even though its dark early, and temperatures have dropped, don’t stop exercising. Walking, jogging, biking…whatever you want. Push yourself to burn a few more calories to keep up with the eating extravaganzas…oh, and have you ever wondered why so few people take the stairs – even for a single flight? Fifteen steps up to the next floor isn’t too many. Get going!

3. Get plenty of rest. All the hype and excitement will upset your sleep patterns. There is plenty of evidence that a good night sleep reduces cardiac risks, as well as other conditions. Don’t forget to take care of yourself even as you enjoy the many social occasions.

4. Eat right. Enough said.

5. Don’t go to gatherings if you are feeling sick. Why offer your bug to everyone else? That’s not the kind of present most people want…

6. Get your flu vaccination. It’s not too late, and it protects you…should you be on the receiving end of someone else’s sneeze…

7. Be thankful. There will always be those who have more than we do, and that will never change. But we have much. And giving thanks is good for the spirit, the heart, the soul.

Joseph Prosser, MD

VP, Chief Quality Officer

Ode to breastfeeding mothers!

My hat goes off to all the women who are reading this blog. As a childbirth educator and lactation consultant for the hospital, we are confronted with moms at many stages of the breastfeeding process. Some have a very positive experience and seem to transition into breastfeeding smoothly while for others, well... I'll let you read for yourself.

"I truly believe breastfeeding is the best for your baby and that is why I continue to stick with it. But let me tell you, it has not been an easy road.

Breastfeeding was a choice and the best choice I feel I have made as a mother yet. Studies show, and I have to agree, that breastfeeding gives your child the healthiest start of life possible. I always knew I wanted to breastfeed my children for as long as I could, but never knew of the dedication and mental toughness this part of motherhood would require. Here is a snippet of my journey...

Breastfeeding is one of the most special bonds a mother and baby can share. You carry this baby for 10 months and bond with it during that time and when he or she is born, breastfeeding is an extension of that bond that you have in utero.

What I was not prepared for is how painful breastfeeding can be and how time consuming it is. The lactation experts at the hospital do a great job of educating you and showing you technique, which is important. The wild card in breastfeeding is how your child will respond and how they will latch.

My baby latched just fine, but has always had poor technique while nursing.
Poor technique=sore nipples!

I was very consistent with my visits with the lactation nurses. You never know the importance or value of the lactation nurses until you have a screaming baby and sore nipples.
After many consultations and working on his technique, I got on the right track. Or so I thought...

This is the part where mental toughness comes into play. After 2.5 months of nursing, I still struggle at times with sore nipples. That is no fault of any ones. I have anatomy that has not complied and a baby who continues to battle poor technique.

I decided long before my baby entered the world that I was going to be successful with breastfeeding. That determination, coupled with a breast shield and lots of nipple cream, has lead to a mental toughness to get through the sore nipples and the occasional discomfort associated with breastfeeding.

On to the issue of time. I am an active person who hates to sit still. Breastfeeding forces you to sit still, enjoy your baby and let them eat - ON THEIR TIME TABLE. This has been a challenge for the "do it" mentality I have. Good news - we live in a world of technology and AWESOME breast pumps. When you need to give your breasts a break and you need to feed your child more efficiently - just pump.

Lactation nurses will tell you that only pumping can lead to a decrease in your milk supply. So, I don't recommend solely pumping. However, I have used pumping as a tool to alternate between breastfeeding and pumping to give my breasts a break and feed more efficiently at times. Just an option!

Bottom line - the benefits of breastfeeding far outweigh the negatives. I have always heard that you lose a lot of weight while breastfeeding. That fact is very true. I also heard that it was more cost-effective to breastfeed. That is also true.

When you go to the grocery store next, price formula. $23 a can for formula that might last a week gets expensive very quickly.

The satisfaction that I know I am giving my baby the very best is mostly what continues to remind me that I CAN do this breastfeeding thing - it is simply a choice.

Must run - baby is screaming and ready to eat."

- Breastfeeding mom

Becky Law, RN, IBCLC, LCCE

Childbirth educator/Lactation consultant

If you have any tips or stories to share, please comment.

Holiday Eating:Cook With This and Not With That

When thinking about the holidays, most people imagine their grandma’s homemade pie, their mom’s scrumptious casserole and their aunt’s candied sweet potatoes. Umm mm! However, all of these foods have one common denominator: lots of calories! And lots of calories can lead to unwanted weight gain. The average person gains 7 pounds over the holidays because typically people eat higher calorie foods and exercise less.

It is not that you have to cut these foods totally out of your holidays, but making some key substitutions can lower the fat and calories in recipes while keeping the same great taste! Remember, it is not just baked goods that are full of calories, some of your favorite dishes are also loaded with them!

When cooking, substitute:

Cook with this - 1 cup oats or crushed whole wheat crackers
Not with that - 1 cup bread crumbs

Cook with this – 1 cup 2% mozzarella cheese
Not with that –1 cup cheddar cheese

Cook with this – ¼ egg substitute or half banana mashed with half teaspoon baking powder
Not with that - 1 egg

Cook with this – 1 cup low-fat sour cream or plain yogurt
Not with that – 1 cup mayonnaise

Cook with this – 1 cup cooked barley, bulgar or brown rice
Not with that – 1 cup cooked white rice


When baking, substitute:

Bake with this – 1 cup yogurt
Not with that - 1 cup buttermilk

Bake with this – 1 cup natural honey
Not with that – 1 cup corn syrup

Bake with this – 1 cup frozen light whipped topping (thawed)
Not with that – 1 cup cream (whipped)

Bake with this – 1 cup low-fat cottage cheese (pureed)
Not with that – 1 cup cream cheese

Bake with this – 1 cup apple sauce or fruit puree
Not with that – 1 cup oil

Note: Don’t substitute every single ingredient because you might alter the taste and integrity of the end result. However, making a few substitutions will help lower the fat and calorie intake of your product!

Amy Goodson, MS, RD, CSSD, LD

Registered Dietitian

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

Breast cancer awareness all year long

Breast Cancer Awareness Month is officially over, but as the manager of the Kupferle Comprehensive Breast Center at Texas Health Harris Methodist Hospital Fort Worth, it’s ongoing. For those of us who work in the breast center, spreading awareness is an everyday priority.

Regular screening mammograms are an important weapon in the fight against breast cancer. At the Kupferle Comprehensive Breast Center we follow the American Cancer Society’s (ACS) Guidelines for the Early Detection of Breast Cancer which are:

· Yearly mammograms for women starting at age 40 and continuing as long as a woman is in good health.
· Clinical breast exam every 3 years for women in their 20s and 30s and every year for women 40 and over.
· Women should know how their breasts normally look and feel and report any breast change promptly to their health care provider. Breast self-exam (BSE) is an option for women starting in their 20s.
· ACS recommends that some women -- because of their family history, a genetic tendency and other factors -- be screened with MRI in addition to mammograms. Talk with your doctor about your history and whether you should have additional tests at an earlier age.

It is also important to have your screening mammogram at a healthcare facility you trust with your life, because mammograms save lives. When choosing a mammogram facility, take a moment to ask yourself “what if?”

“What if they find something during my mammogram?”

“What if I have breast cancer?”

At the Kupferle Comprehensive Breast Center, if something is found during your screening mammogram, you are not alone. If it turns out to be breast cancer, you are not alone. If you have questions or need guidance from people who have been through breast cancer, you are not alone. We are here with the support through your journey from beginning to end.

Lesley Kibel, RN

Manager Kupferle Comprehensive Breast Center

Bariatric Diary # 8: Things are looking up

Good day, kind readers!!

Last time I wrote I was about to have an endoscopy due to some internal issues. I had the procedure and thankfully, we found the problem. I had at some point developed a stricture at the bottom of my stomach where the new pouch connects to the intestine. My body essentially overcompensated during the healing process and almost closed off the stomach pouch at the bottom opening. Unfortunately it could not all be repaired in the one procedure. On Tuesday of this week, I had a second procedure and I am glad to report that things are back to where they should be with one small exception. During the 2nd endocscopy they found a small stomach ulcer so I will be taking medicine for awhile until that can be taken care of. No fun, but hey its better than the alternatives.

I did find it very funny my experience with the endoscopy. It really is painless and no big deal. However, both times I had weird experiences in the recovery room. Apparently both times, everybody wanted to tell me very important information while I was more or less in a comatose state of mind. Thankfully, I had my dad with me the first time and my sister the second time. If not I very well might have given away everything I own. The nurses were great, the doctor was great, and I am much better off now.

So other than the medical side of things, life has been good. The job is good, the family is good, the Rangers made it to the World Series (Antlers Up!!), hunting season start next weekend, and life seems to be going in the right direction. As of today, I am proud to say that I have lost approximately 141 lbs and glad that my weight is staying fairly consistent now.

I encourage everyone to come out to the Bariatric Support Group tomorrow, Thursday, November 4. It should be a good time and much knowledge to be shared by all.

The journey continues…..

Casey Armstrong