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

Teen Talk: Underage Drinking

We are now in the middle of another sizzling Texas summer. Yard work and grilling on the back porch are weekly events in my neighborhood. There are children outside in the evenings chasing dogs and soccer balls. Students that graduated from high school have already headed off to college. A recent study from the University of Rhode Island has shown that this is a time when teens tend to increase their alcohol consumption. In fact, many American teenagers begin to drink at the age of 15. By the time they leave for college, most have considerable drinking experience. Parents should take the opportunity to have conversations about alcohol throughout high school, but it is never too late to begin a dialogue concerning drinking. More than 1800 college students die each year in alcohol related crashes. 750,000 are involved in alcohol related physical or sexual assaults. It is important for parents to make known their beliefs and guidelines as well as to provide clear and fair consequences associated with crossing the line. Research shows this combination of factors decreases alcohol use and problems all through adolescence and into college. Parents have so many tools available to communicate with their students now. I proudly admit to texting 748 times last month. Of course that is nothing compared to my 17 year olds 2332 rambling banters. Adolescents tend to increase their alcohol use the summer before entering college and during their first semester at college. Research has proven that parental involvement influences the decisions students make. This internalization of values, attitudes and expectations continue to exert a positive effect. These students are less likely to transition to heavy drinking or experience alcohol-related problems. This same research also shows students overestimate how much their peers are drinking, and correcting this false impression results in lower levels of alcohol use and alcohol problems. So go ahead and be bossy but informative. Set the standard and then hold firm. Let your teens know you care by communicating in a way that they will listen. Who knows, I may just twitter or update my Facebook status to get their attention…


MaryAnn Contreras, RN
Injury Prevention Coordinator

Bariatric Diary # 7: Frustration sinks in

You remember that time when your parents told you not to stick your finger in the hole because it might get cut off? As a child we always did it anyways, just to find out. Well now I am faced with same dilemma after having weight loss surgery. I really want to be on the full foods diet like I should be at this point post surgery. Well everyone keeps telling me to take it easy and take it slow. Everyone has some tidbit of advice on what I should or shouldn’t eat. Do I listen? Kinda sorta, but not really.

This month has been extremely busy. By the end of the month, I will have gotten so frustrated that I actually called Tiffany in bariatric services, traveled for almost two weeks throughout Texas and Oklahoma for work, been sick, been to the hospital, be banished to a week of liquids, do an interview for the newspaper, and turned another year older. Sounds like fun but this has been one of the most frustrating months I have had since I had my surgery in May.

So let’s break this all down.
Frustration- Yes, I admit it. I sometimes want to scream I get so frustrated. See 2, 3, 4, 5, 6, and 7 below. Then I realize I got myself into this situation and I have to grab the ole boot straps and keep trucking. One of the nice perks of having surgery at Texas Health Fort Worth is that you get to call and voice questions and concerns with Tiffany Norris and Jaime Bass in bariatric services. I sometimes wonder why they have not reached sainthood for dealing with everyone’s whining… Oops I meant answering everybody’s questions and addressing concerns. I am kidding of course; every question is a good question!!!
Work- Aren’t we glad we are all grown up and get to be responsible? HAHA. It was actually kind of nice to get out and meet some of my new clients and make new ones.
Sick- Had a few rough weeks with food not agreeing with me. I talked with Dr. Lorimer and we game planned, which lead to both the liquid diet for a week and the trip to the hospital. The last week has proven that the plan is working fairly well. I guess that is why they call him a doctor.
Liquid Diets- At least it wasn’t clear liquids. Seven days of full liquids to give my stomach some time to try and recalibrate its thingy-ma-bob so it would quit rejecting anything solid that entered it. Not too horrible actually.
Hospital- Well shortly after the liquids wore off; I found a couple things that still made me sick, so I went to have an Upper GI performed at Texas Health Fort Worth. Barium breakfast is something that I highly recommend passing off if ever given the opportunity. The good news is that it came back normal and now I just need to stick to what my body will allow until I can advance things.
Interview- While on my way back from my first work trip, I did an interview with the Fort Worth Star -Telegram about minimally invasive bariatric surgery and my experience. I should probably apologize for all the dropped calls that almost resulted in my phone becoming a casualty on the highways of Paducah, TX. Maybe if one person reads about my experience and is able to make a life changing decision, I will earn some brownie points with the big guy upstairs
Birthday- I turned 31 this week. I am starting to get old. I still remember kindergarten when I was not willing to let 0+0=0.

So in summary, when the staff at the hospital tells you take it easy, don’t charge forward full steam. I have learned my lesson several times now. This is a huge adjustment for every patient who goes through the procedure and just because something works for one person doesn’t mean it will work for everyone. You have to listen to your body when it says stop and not your eyes and taste buds. Nobody said this was supposed to be all fun and games!!

Overall things are going well. I have slimmed down to a much more aerodynamic 238 lbs. I feel relatively strong and my energy to do different things in the yard and around the house seems to be better than ever. Since I started this journey in January I have now lost 116 lbs. Keep in mind about 20 lbs of that was before I started the liquid preoperative diet in May. Nonetheless, I am happy as a clam in the sand.
The journey continues……


Casey Armstrong- bariatric patient

Eating to Live Healthy

Recently, I read an article suggesting that fast food restaurants provide statins (a class of cholesterol-lowering medications) to their customers. The idea is that taking a statin with a fatty meal would help prevent some of the harmful effects of that meal. Statins are essential in the fight against heart disease, diabetes, and stroke. They prolong survival and improve quality of life for many.
Has our society’s health conscience waned so much that we now dress our burger with extra cheese, the special sauce, and an extra shot of Simvastatin? The authors appear to equate taking a statin before a fatty meal to safety measures like wearing your safety belt when driving or wearing a helmet prior to riding a bike. These medications are intended to treat high cholesterol when lifestyle changes like exercise and diet have failed. Statins, nor any other medication, should be taken so that the patient can make poor health choices and “get away with it”. The truth is no one can “get away with it”. Poor food choices cause so many other health problems that are unrelated to cholesterol. If you really wanted to premedicate prior to a massive fast food binge, the condiment tray needs to include a statin for cholesterol, a blood pressure pill, a diuretic to get rid of all of the added salt, and don’t forget to top it all off with a shot of insulin to help digest all of the extra sugar and simple carbohydrates. If this sounds ridiculous, that’s because it is!
If your doctor has prescribed you medication to treat cholesterol, diabetes or other health problems, it is in your best interest to keep taking such medication as prescribed. Remember that good health requires us to make good lifestyle choices. Medication to treat cholesterol, diabetes and high blood pressure is not an excuse to reject a healthy lifestyle – Instead it’s a second chance for many to start making new ones. Ask your doctor or pharmacist about lifestyle changes you can make to improve your overall health.

Randy Martin, Pharm.D.
Pharmacy Department

A Lesson in Celebration

With the palliative care unit having been opened a little over a year, this is a time to celebrate and reminisce. What a year! The palliative care unit is a special unit with very special patients and families. One thing we have all learned is that “Life doesn’t stand still, even when you are ill.” We have witnessed weddings, baptisms, deaths, and many other memorable events on our unit.
One of the most special events that come to mind was the birthday of an “elderly” gentleman turning 103 years old. Minus him being hard of hearing, he was relatively healthy!!!! The Palliative Care (PC) Team of Harris 2nd floor worked above and beyond the demands of their daily jobs to ensure this would not be an ordinary day for this beloved man. The staff purchased streamers, banners to decorate his room as well as birthday hats, party blowers, plates, napkins, and birthday cake. They even made arrangements for his son to retrieve his wife so that she, too, could participate. To make this occasion even more memorable, the patient’s wife of 64 years arrived to our unit walking with the use of her walker (she was just 97 years old, herself). The party was complete with decorations, singing, laughter, and cake and the whole Palliative Care team! I do not think this 103 year old birthday party is one that the patient, family, or staff will ever forget.
Although there is quite a bit of sorrow within our specialty, we also see a lot of joy. We learn to celebrate each day that we are fortunate to have and share with others. We have learned from our patients and families to embrace life with death and refocus our priorities daily. What a wonderful blessing it has been to share in these life lessons and experiences on this unit and with this INCREDIBLE staff of friends!!!

Hayley Brown, RN,MSN,ACNP-BC

Palliative Care Nurse Practitioner

Medical snippets

There is even more evidence from recent medical publications that nearly all patients hospitalized are at increased risk for blood clots. Fortunately, there’s also ever-growing evidence that current pharmacological approaches to prevention have reduced the risk of blood clots in hospitalized patients. Unfortunately, the evidence of protection is not as strong for non-pharmacologic approaches, but when used in combination with medications to prevent blood clots, the overall results are quite satisfactory. One of the more exciting developments is the growing awareness that the use of medications to prevent blood clots in patients who have undergone surgery rarely results in bleeding from the operative site. Earlier applications of medicines to reduce blood clots will improve outcomes in our patients.

More good news: evidence now exists that suggests hospitals that use automated processes for early detection of infections have better outcomes when compared to hospitals that use manual processes. Texas Health Resources hospitals use automated electronic processes for infection surveillance. Early detection leads to quicker treatment and better outcomes.

There’s mounting evidence that many women who have had children by C-section may still be able to have natural vaginal deliveries if they subsequently become pregnant. These results offer a choice to mothers who want to experience natural childbirth.

Remember that each patient we touch is someone special. If we treat each patient as if they were our mom, we will advance exceptional outcomes.





-Dr. Joseph Prosser
Chief Quality Officer

Healing Through Artwork

The hallways that lead up to the Texas Health Harris Fort Worth surgery area can be an anxious place at times. Before major surgeries, it’s common to see loved ones kiss the patient in the hallway before they go into surgery. In order to create the most peaceful environment possible, these high traffic hallways recently got a “therapeutic upgrade” with the addition of many beautiful pictures and original paintings. Perioperative Services Director Megi Ball and her department coordinated this initiative with a number of physicians.

One of the many art work contributors is E.L. Young. E.L. works in the Surgery Department and is also a brilliant painter who was kind enough to loan some of his original works of art to the surgery area. E.L. is known by many for his quick smile and kind words and it’s my privilege to offer this short interview question and answer (Q and A) with him:

Q: How long have you worked at Texas Health Harris?
A: October 1990, so around 20 years.

Q: When did you start painting?
A: Since 1960. My elementary teacher saw that I stayed in the lines better than the other kids and helped me get started out. I’ve enjoyed honing the craft since then and my passion is drawing pastels. I also love to draw realistic paintings of people that end up looking like real photographs.

Q: What would you like for patients and families to get out of your pictures?
A: A sense of peace so people can focus on what’s important in life and not get carried away by their circumstance. For instance, in one picture there’s a storm cloud overhead but the pond’s waters are still and confident that things will be ok.

Q: Do your paintings have any common theme?
A: Yes, all my pictures tell different stories but the underlying theme is that I like to show the celebration of life even through adversities.

Q: Any other comments?
A: I just hope people stop for a minute and look at the paintings and are grateful for ourselves and one another. I hope that people feel this during their challenging time with the surgery.

Thank you E.L. for giving this personal part of yourself and touching the lives of many people during their time of need. I also wish to thank the many other Perioperative staff and physicians who donated other works of art as just one of many initiatives Texas Health Harris Fort Worth uses to make sure patients and their families have a very satisfied experience.

- Craig Pomykol
Patient Advocate

A 3-year-old embarks on a space ship journey to recovery!

Most people would give up when faced with insurmountable odds, but then again, Bella isn’t like most people. Bella Counts is a three-year-old leukemia patient who developed necrotizing fasciitis, otherwise known as flesh-eating bacteria, as a result of her weakened immune system. She was sent to Texas Health Fort Worth for hyperbaric wound treatment to heal skin grafts that were unsuccessfully healing.

Hyperbaric wound treatment exposes patients to 100 percent oxygen at below sea-level pressure. The oxygen is forced into the bloodstream at a quicker rate to promote quicker cell growth. It is a therapy typically used to treat elderly diabetic and carbon monoxide poisoned patients. Bella is the first child to undergo treatment for these types of wounds at the hospital. For her parents, the forty treatments have meant a chance to save her tiny legs from amputation.

For 40 treatments, Bella climbed into her “space suit” and “space ship” to begin the healing process. Without any complaints, she embarks on the two-hour treatment with a smile on her face and brightening the staff and other patients around her. Her bravery has been an inspiration to others and has been a big part of her healing process.

If you know a child or individual who you believe might also benefit from wound care and hyperbaric treatment, leave us a comment and we will be happy to get into contact with you!

Tissue Donation

Every year thousands of lives are saved or enhanced from the gift of tissue donation. Whether it’s a burn patient who has received countless skin grafts to heal or a athlete receiving a donor tendon so they can play their favorite sport again, tissue donation is the ultimate gift of life to those in need.

One full tissue donor can save and enhance the lives of more than 50 people with the various grafts that can be made. In 2009 alone, nearly 1,000 tissue grafts were recovered from 57 donors at Texas Health Harris Methodist Hospital Fort Worth. These grafts included skin, bone and tendons, heart valves and veins.

Skin grafts save the lives of thousands of burn patients every year. Grafts recovered are about the same thickness of a sunburn peel. They are processed and meshed to provide greater surface area. These grafts aid burn victims by preventing fluid loss and infection. The average donor yields nearly 3.5 to 4 square feet of skin, while the average severely burned patient requires nearly 40 square feet of skin. Skin is recovered from the back and front and back of the thighs. Burn victims require so much skin because the body will continuously reject skin grafts, so they have to be replaced every few days.

Bones from the upper and lower extremities are used in many different ways. They can be cut into small rings to alleviate severe back pain in spinal fusions. These bones also can be cut into cubes or crushed for orthopedic or dental surgeries. Tendons recovered from the lower extremities are used most commonly in ACL repairs. Bone and tendon grafts from one donor can enhance the lives of up to 50 people with the various grafts that can be made.

If the heart cannot be transplanted, it can be recovered for valves. These valves are used in children with congenital heart defects. Saphenous veins from the leg can be used for dialysis access in dialysis patients.

One of the most common myths about organ and tissue donation is that one cannot have an open casket viewing. However, the donor is treated with the utmost respect and reconstructed so there is no difference in appearance so an open casket is possible.
There is also no cost to the donor family for any cost related to donation.

“You have the power to donate life. Be an organ, eye, & tissue donor.” You can register your decision at www.donatelifetexas.org and to hear stories of hope from tissue donation go to www.communitytissue.org/miracles/recipients

- Amanda Williams, transplant coordinator

Bariatric Diaries 6: The dog days of summer!

The last few weeks have been HOT!! July has brought things into perspective for me on the whole recovery process from my surgery that I had in May. Over the July 4th weekend, things were business as usual with a few minor changes being made for my recovery. We went to lovely Junction, TX for some good times on the Llano River and relaxing at the ranch for the weekend. Unfortunately, there were no hot dogs and adult beverages for me this year but I was ok with that. I made due with the things I could eat and had just as good of a time. On Monday, we were headed back home and all the sudden something just wasn’t right. I was starting to feel sick and had not interest in even drinking water. By the time I got home, things were really not going to well. I tried food, and that didn’t work out. I tried water and Gatorade, and that did not work out either. The thing that scared the heck out of me was that when I got sick, I was vomiting black coffee grind type material. Just for the record, I have not eaten anything black since my surgery so you can imagine what was running through my head. I called Dr. Lorimer in a state of panic and he instructed me to not eat or drink anything the rest of the day and that I was throwing up dried blood. The real question is where the heck it came from. The next morning, I was not feeling well so I called back and moved my appointment up a day. We came to the conclusion that this sometimes happens and I needed to take it easy on food for a few days and see what happens. He also gave me a medication for stomach ulcers in hopes of being able to coat my stomach before eating. Let me be the first to admit that I hate taking pills, but it is a part of the recovery. This pill he gave me is approximately the size of a small baby so I was even less thrilled. In all seriousness, it is big but I was able to break it in half and get it down the ole windpipe. Blood work and a little but of chaos later, I am all good. Dr. Lorimer did tell me during the appointment that he felt like I was losing weight a little too fast. I am glad to report that it has now slowed down.

I also thought I would share with you the top things that I am convinced I will never be able to eat/drink again:

1. Potatoes of any kind. Complete mental block on them right now.
2. Cream of Wheat. This was my dining choice immediately after surgery. Just can’t do it.
3. Chicken Nuggets. This is my son’s favorite meal, he is sad that I don’t get to share it with him anymore.
4. Beans. I have tried several times in many different consistencies and they just don’t agree with me anymore
5. Grand Prairie Water. I am officially a water snob now. I keep a case of cold bottled water handy at all times.

I feel so much better after a little over 2 months since surgery. I get constant reminders from my wife and 6 year old about things I should and shouldn’t be eating. That gets a little old after some time, but I know they are doing it for my own good. My son thinks it is funny to remind me before we go anywhere to eat that I can’t have one thing or another and tries to make his food choices based on what I can have. Speaking of food, I think I am becoming a pregnant woman. I have these cravings that are so odd sometimes, but I am a little hesitant to try them out. For example, I really want lemonade one minute and then I think I just have to have a pickle. I have tried the lemonade and it has become a drink of choice this summer, I bought pickles at the store yesterday but I will try those slowly in the near future.

Other than some really bad decisions on my part a couple times, surgery has been a huge success so far. I have learned from my mistakes and try my best to not repeat them. I am stubborn and I admit that, but most of the mistakes I made have taught me that I don’t necessarily get my way when it comes to food anymore. Drink your water and lots of it. The dehydration factor is in full effect on these 100 plus degree days. As of today, I have lost a grand total of 101 pounds.

The journey continues…..

- Casey Armstrong, bariatric patient

Proper Drug Disposal: An Environmental Concern

In recent Associated Press report, over just a five-month period of time, twenty-four metropolitan areas across the U.S. were found to have detectable levels of drugs in their drinking water. Philadelphia reported fifty-six different pharmaceuticals, including pain medications, hormones, and antidepressants. The report also included data on the feminization of fish in waterways, presumably from estrogen-containing drugs, and various pharmaceuticals found in earth worms.

A common misconception is that the body absorbs all drugs introduced to it with no waste byproduct, when in fact, many of the drugs we take are excreted unchanged where they then make themselves in the wastewater system.

While much of this problem is a result of natural elimination by humans and animals, the issue of pharmaceuticals found in the environment is due to improper disposal as well. This happens most commonly by pouring or flushing unused drugs down household drains.

Most know not to throw car batteries in the trash, or motor oil down the drain, but when it comes to proper drug disposal most are unaware of the proper procedure. However, there is also little literature on how to properly dispose of medications. The Environmental Protection Agency is currently working on recommendations for patients and institutions on how to properly dispose of drugs.

Currently, there are occasional “drug take-back” programs in the community. Some are provided through participating pharmacies. Many states across the U.S. are utilizing law-enforcement in this process through organized drug “take-back” events. These programs will continue to arise as more attention is placed on drug disposal and the environment.

If no drug take-back programs are available in your area, there are recommended disposal procedures found on the Federal administration’s website:

http://www.whitehousedrugpolicy.gov/publications/pdf/prescrip_disposal.pdf

Drugs flushed down the toilet can damage the environment and eventually end up in drinking water. In order to minimize our impact on the environment, encourage those needing to dispose of medications to utilize these resources and stay aware of community events involving drug take-back programs.

Lance Ray, Pharm.D.

Reading and Interpreting Food Labels

As part of nutrition education for the Bariatric Program, I often include how to read and interpret food labels. Most of us are familiar with the Nutrition Facts Panel; however, there are two areas that bear review.
1. Serving Size: My son bought a $5.00 candy bar from a little girl who was selling candy for a fund raiser. Five dollars seems high for a candy bar, even for a fund raiser, but it was a really big candy bar. I casually looked to see how many kcalories it contained. The label said 220 kcalories. Not really that bad, then, I looked at the number of serving sizes: 2 ½ servings in this bar meaning that the entire bar contained 550 kcalories. I did notice this morning that my son, not a big sweet eater, had saved most of the bar in a zip-lock bag (not the sandwich size bag but a quart size bag.)
Lesson learned: remember to look at the serving size and the number of servings on the label.
2. Trans fat: The FDA has required food manufacturers to list trans fat on the Nutrition Facts Panel since January 1, 2006. A food can be labeled as having zero trans fat but still contain .5 grams of trans fat per serving. Therefore, it is possible to eat more that the AHA recommends (2 grams a day) by eating several servings of these foods without realizing it.
Even if you are able to decipher the information on the Nutrition Facts Panel, sometimes the “front of the package” labels can be misleading. In fact, a commentary in a recent issue of JAMA reported that the front of package labels may so thoroughly mislead the public that eliminating “all nutrition and health claims from the front of processed food packages” should be considered. This action may seem drastic but I agree that something needs to be done to protect the public from these misleading claims.
The FDA is aware of this problem. Indeed, FDA commissioner, Margaret Hamburg announced last fall that her agency would be taking nutrition and health claims on packaging seriously. She stated, “some nutritionists have questioned whether information is more marketing-oriented than health-oriented”.

- Jamie Bass
Dietitian, Bariatric Services

Sunscreen 101

Sun exposure and sunburns have been linked to the development of melanoma, a deadly form of skin cancer. All skin types, from those that are fair and burn easily to those that never burn are at risk for developing skin cancer if not properly protected. The best way to protect sun-exposed skin is with sunscreen.

There are numerous sunscreens available, so how do you know what to look for? When choosing a sunscreen make sure it protects against UVA and UVB rays. UVB rays are primarily responsible for sunburns. UVA rays can cause wrinkles, leathering, and photo aging. Many people assume they are protected from the sun’s harmful effects when indoors but UVA rays can penetrate windows.

Another important factor when selecting a sunscreen is the SPF or Sun Protection Factor. SPF is the ability of the sunscreen to prevent UVB damage. The American Academy of Dermatology recommends wearing at least an SPF of 30, which blocks about 97% of UVB rays. There is currently no measure for protection against UVA rays, but this is currently being evaluated by the FDA and may lead to changes in the future.

For maximum protection sunscreen should be applied one half hour prior to sun exposure and should be reapplied every 2 hours. Water proof and sweat proof formulations are available but should also be reapplied frequently. Most people do not apply enough sunscreen. It must be applied generously to exposed skin, then rubbed in completely.

Some medications such as diuretics, certain antibiotics, and chemotherapy drugs can make the skin more sensitive to the sun. Commonly used antibiotics including Levaquin, Cipro, Bactrim, and doxycycline and diuretics like furosemide and hydrochlorothiazide are known to increase photosensitivity. While taking medications such as those, people should protect their skin by covering up, wearing sunscreen, and limiting sun exposure.

Wearing sunscreen is an easy way to decrease the risk of skin cancer. According to the American Academy of Dermatology, everyone regardless of skin type should wear sunscreen of at least SPF 30 year-round. All of this information and more can be found on the American Academy of Dermatology website: http://www.aad.org/media/background/factsheets/fact_sunscreen.htm.

Lacey Mullins, Pharm. D.