Monday, January 31, 2011

Hawaii House Blog: Qualified nurses seek authority to provide primary...

Hawaii House Blog: Qualified nurses seek authority to provide primary...: "The following op-ed was published this morning in The Honolulu Advertiser: Trained nurses can ease doctor shortage By Marilyn Lee A bill t..."

Monday, August 23, 2010

Age-related Macular Degeneration (AMD)

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We all know that eating large amounts of dietary fat not only puts on the pounds, it can increase our risk for heart disease. But here’s a surprise – a high fat diet can also speed up age-related macular degeneration (AMD).
I’ve told you that AMD is the leading cause of irreversible visual impairment and blindness in people over the age of 50). I have also told you how devastating this disease is for its victims and their families. So anything that can slow down the progression of this disease is indeed good news – especially if it’s something as simple as changing the way we eat.
Out of sight
Just to recap: There are two forms of AMD, dry and wet. The most typical form of the disease is the dry variety, which occurs when the light-sensitive macular cells break down. This type of AMD can take years to develop and the most common symptoms are a gradual shift in perception (normally straight objects appear bent or wavy) and a dark or blurry spot in the center of your vision.
Less common, but much more debilitating, is wet macular degeneration. Wet AMD occurs when new blood vessels behind the retina grow toward it and leak blood and fluid. This form of macular degeneration causes a very sudden – and severe – loss of central vision.
And while family history can up your risk of developing AMD, researchers have also known that bad habits (smoking and too much sun) can also increase your odds. But according to this new study, you can now add another bad habit to the list: eating too much fat.
Fat chance
The study, which was conducted by researchers at the Massachusetts Eye and Ear Infirmary in Boston, involved 261 patients over the age of 60 that all had some signs of AMD in at least one eye. Participants were followed for an average of 4.6 years and completed food frequency questionnaires designed to measure the amounts and kinds of foods eaten in the previous week.
After reviewing the data, the researchers found that higher levels of dietary fat intake were associated with the progression of AMD to the advanced stages associated with visual loss. The biggest culprits were saturated, monounsaturated, polyunsaturated and trans-fats. The very fats we eat everyday!
Ok, so we know that saturated and trans-fats are bad for us on a number of levels. But monounsaturated and polyunsaturated fats; these fats are supposed to be good for you. And they are – in small amounts. These beneficial fats play a critical role in building cell membranes, producing hormones and helping the body absorb and utilize fat soluble vitamins (A, D, E and K). But Americans have trouble practicing moderation – especially when it tastes so good.
The problem is, say the researchers, foods with higher levels of these fats, particularly processed baked goods, increase the risk of accelerating AMD by about two-fold.
Whether or not limiting these fats also prevents AMD is something the researchers didn’t explore. But, as I’ve said before, for optimum health, it’s wise to limit the amount of saturated and polyunsaturated fat you consume – and try to completely avoid the synthetic trans-fats found in many processed foods.
Fish in a nutshell
The news isn’t all bad though. According to the study, the fat in nuts and fish were the exception with protective effects on eye health. That’s not surprising since nuts are rich in eye-friendly zinc and vitamin E. And fish is loaded with omega3 essential fatty acids (EFAs) – specifically docosahexaenoic acid (DHA).
A few years ago, a study by Harvard researchers found that, while consuming large amounts of linolenic acid (found in corn and safflower oil) increased the risk of AMD, eating fish high in DHA four times a week actually lowered the risk of developing the disease by 35 percent.
If you suffer from AMD and want to retain your vision longer, try adding omega3-rich fish like salmon, tuna or mackerel to your diet at least four times a week. But for maximum protection, supplement with essential fatty acid capsules containing both DHA and EPA fatty acids. By boosting your intake of these healthy fats, you may just be able to say “Here’s looking at you” for years to come.
One last thing . . .
The Massachusetts researchers also noted that the carotenoids zeaxanthin and lutein are powerful weapons against AMD. In fact, these two nutrients can slash your risk by 40 percent. One reason, according to a recent study in the Journal of Nutrition, is that supplemental lutein and zeaxanthin can enormously increase macular pigment density. By boosting the pigment, and hence the thickness of the macula, these two nutrients protect the eye from light damage.
While egg yolks, kale, spinach, broccoli and collard greens are good sources of these carotenoids, you would need to eat massive quantities to get the 6 mg. a day you need to stave off AMD. You can, however, get this protective amount by taking supplements. But don’t look for a separate zeaxanthin supplement. Since this carotenoid can’t be chemically separated from lutein, all lutein supplements contain zeaxanthin.

Bone RA, et al. “Lutein and zeaxanthin dietary supplements raise macular pigment density and serum concentrations of these carotenoids in humans.” Journal of Nutrition. 2003;133:1953.
Brown NA, et al. “Nutrition supplements and the eye.” Eye. 1998;12:127-33.
Cho E, et al. “Prospective study of dietary fat and the risk of age-related macular degeneration.” American Journal of Clinical Nutrition. 2001;73:209-218.
“Dietary fats may increase the risk of age-related macular degeneration.” Reuters. 8 Dec 2003.
“Drugs ‘don’t work on many people.’” BBC News. 8 Dec 2003.

Friday, August 20, 2010

The Dark Side of Health Foods

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We all want to live longer and maintain good health. So, most of us try to follow sound advice from our medical professionals and one major topic that is always in the spotlight is eating healthy. We go to great extremes to purchase those health foods that are pleasing to our palate while at the same time is supposed to benefit our bodies; but there can be a dark side in health foods if your suffering from certain medical conditions as sited below.

Can you believe there is a dark side to eating foods such as: whole-wheat bread, pomegranate and grapefruit juice, oatmeal, sushi, grapes, green leafy vegetables, soy, dark chocolates, and turkey; what’s that you say – I cannot believe these foods are bad for you. Well, think again and consider this as I go through this small list just sited.

Whole-Wheat Bread
Fiber can be a sharp thorn in the gut for people that suffer from intestinal problems like Crohn’s disease. Patients that suffer from this bowel disease must limit fiber because their intestines are narrowed and prone to developing blockages that may end up requiring them to having to have emergency surgery.

Yet, fiber-filled breads are the health requirement always noted when it comes to putting together a nutritious healthy sandwich; the very qualities that benefit most of us can literally cause grave damage to others with Crohn’s disease.

Grapefruit and Pomegranate Juice
Have you every heard that you should not consume grapefruit juice with certain drugs like the statins that doctors prescribe to lower your cholesterol. You know the ones I’m referring to; their brand names are Zocor (simvastatin), Lipitor (atorvastatin), Mevacor and Altocor (lovastatin), Lescol (fluvastatin), Pravachol (pravastatin), and Crestor (rosuvastatin). But, grapefruit juice is not the only juice that can create harmful interactions in the body; people should also avoid pomegranate juice as well.

On a list of items for the “Breakfast of Champions”, grapefruit juice is the outlaw of the list for beverage choice. No only are the statin drugs a problem, but research has revealed that approximately 50 drugs interact with grapefruit juice, including the disease-modifying drug cyclosporine. The anti-anxiety drug Diazepam (Valium) is another one that interacts with grapefruit juice.

Here is why you should not consume these two juices with any statin or certain other drugs. Both juices, pomegranate and grapefruit, contain a specific enzyme that causes the drug to stay or linger in your body’s system that can cause serious side effects such as muscle pain, and in extreme cases, liver damage. Grapefruit juice slows their elimination from the body, causing them to rise to potentially dangerous levels in your system.

What’s the one thing that doctors check your blood for while you’re on statin drugs besides your cholesterol and triglyceride levels? That would be liver damage they are looking for. This is why they want to check your blood work frequently while on statin drugs.

In other drugs such as the allergy drug fexofenadine (Allegra) or the beta blocking agents (blood pressure and / or heart drugs) such as celiprolol (Cardem) and talinolol, grapefruit juice blocks their effects the body is trying to use them for.

I remember not so long ago I had to explain to a doctor one time as why statin drugs should not be taken with grapefruit juice; actually he was a Physicians Assistant (PA) and my primary care provider at the Veterans Administration. He actually did not know that you shouldn’t be taking Zocor with grapefruit juice. How we actually got on the subject – I don’t remember.

The moral of the story is that the more grapefruit juice that you consume, the more likely you are to experience some sort of problem if you’re taking medication. Even a single glass of grapefruit juice can affect how your body deals with medication up to three days.

Tip: When taking your medication, your best bet is to take them with a glass of water.

Tip: Want to get a more accurate reading on your fasting lipid profile or cholesterol blood work? Then if your health condition will allow, ignore the orders when the lab technician tells you not to eat anything after midnight for your morning blood work tests. Instead, you should be fasting for a minimum of 12 hours; so, I would turn the clock back another six hours to 6:00pm rather than at midnight. And yes you can consume water and black coffee that should not affect the results.

Continuing with the cholesterol topic, oatmeal is a great source for lowering your bad (LDL) cholesterol levels. I do not know of a better source of lowering your LDL or Low-Density Lipoprotein. However, if you have reduced renal (kidney) function, oatmeal is a bad choice because of its protein rich and phosphorus content.

The problem is that the kidneys filter and help rid the body of waste products along with excess minerals. So, if your kidneys are not functioning like they are supposed to be, they cannot effectively do their job of ridding the body of these excess minerals and waste. This can lead to phosphorus buildup in your body and causes the body to deplete its calcium from your bones. As a result, your bones become weaker that can cause poor circulation to occur, arteries to harden, and heart problems ultimately may develop.

Eating undercooked or raw animal protein food sources will increase your risk of food-borne illness. You should especially skip the rice-wrapped raw fish if you are infected with HIV, undergoing chemotherapy, are pregnant, or fall within the geriatric category. Even though sushi can be a healthy food source that is low-fat, high in protein, and great for trimming down your waistline – sushi can be a hazard for certain groups of people that may possess a compromised immune function.

A bad choice when it comes to people suffering from diabetes because grapes are loaded with sugar and as a result, your blood glucose will spike if you consume grapes. Grapes are mostly considered a health snack, and diabetes patient may falsely think they are following a healthy diet, but grapes and grape juice would only be a good source to use if you’re diabetic and if that was all you had available, to consume, if you or someone may be showing signs of going into a diabetic coma.

If you’re one of those individuals whose blood glucose goes from high to low rapidly and at random, then you should be keeping some sugar available; personally I would keep cake icing that would easily dissolve in the mouth. Giving sugar is exactly what I do when I find patients who are unconscious and a random glucose tests tells me their blood glucose is in the 20’s (in many cases) or below 60 – I administered D50 or what we jocularly refer to as “Sugar Water” directly into their veins to bring them back around again.

Staying away from candy, cookies and cake is not the only food source that a diabetic patient should stay clear of; grapes contain more sugar than most fruits. Does that mean that you should stay clear of fruit altogether if you’re diabetic? The answer is no. Diabetes and good food sources is a complex topic and far beyond the scope of this article. What you should do is talk with your doctor, and if they cannot give you the answers you’re seeking as to what foods or fruit sources you should avoid by being diabetic, then have them refer you or give you a consult to a Dietitian that can properly advise you of the correct fruit source to avoid and why. Or, that could very well be a good topic or tidbit for another article here.

Green Leafy Vegetables
In its simplest form, Vitamin K is the culprit or bad guy here; especially for those patients that may be suffering from heart disease and most especially those that are taking drugs like Coumadin (warfarin) to help thin their blood. Vitamin K causes the blood to clot; and green leafy vegetables are high in Vitamin K but are a good source of other vitamins, folate, calcium and fiber.

Those on Coumadin therapy mostly know why they are required to get regular blood work to check their coagulation (PT/INR) studies about every month. To high of an INR means the blood is to thin and your risk of bleeding is increasing; while a low INR means the blood is too thick and is clotting. A normal range for a patient on Coumadin therapy that most doctors shoot for is for their patients to have an INR around 2.5 and they are happy. Eating green leafy vegetables will cause that INR to trend downward and the blood is clotting.

Tip: I’ve seen first hand what Vitamin K can do to and for patients. Vitamin K is mostly administered orally, but does come in other forms, for example to administer Intravenously (IV) in a critical care environment. If ever given IV ensure that the infusion rate is extremely slow. Giving Vitamin K IV is extremely dangerous for both the patient and healthcare provider. I’ve witnessed first hand, a young nurse not knowing what she was doing, rapidly infuse Vitamin K IV Push (IVP); the result was instant cardiac arrest. Of course I didn’t know it was Vitamin K that she was pushing at the time or I would have stopped her and given her proper counsel on how to administer Vitamin K intravenously. Be careful giving Vitamin K IVP!

The dark side of soy is that it can mimic estrogen in the body and its choice questionable at best for those that are being treated for or who have breast cancer. Soy products like soy milk and tofu and soybeans are considered a healthy choice for protein supplement when it come to diet choices. Nevertheless, if you’re being treated for breast cancer, check with your healthcare provider before consuming soy products.

Dark Chocolates
Oxalates are a type of salt crystal that, according to the National Kidney Foundation, can promote stone formation and is found in many foods including dark chocolates. Thus, those that have a tendency to suffer from calcium oxalate kidney stone’s would be wise to avoid foods rich in oxalate like: dark chocolate, nuts, strawberries, wheat bran, rhubarb, spinach, beets, and tea.

Food high in purine content do not mix well with gout and is the problem here in which uric acid builds up in the body and causes severe joint pain and swelling to occur. Organ meats fall within that category that is considered a high-purine food to include: turkey, red meat, and pork. Other products that are considered high-purine food include: beer, some seafood, including sardines, trout, scallops, anchovies, and mussels. If you suffer from gout, you would be wise to try to avoid these product food lines.

Saturday, August 14, 2010

Did You Know That Honey Promotes Healing?

In ancient times, honey was used to treat infected wounds; now, many studies confirm honey's ability to clear infection, promote healing, and protect against bacteria and fungi.
Honey can also ease nighttime coughing in children.
Of all the sweeteners, raw, unfiltered honey is probably the closest to nature and the least refined.
Use it to sweeten beverages, in baked goods, or as a spread on toast.
Personally, I love to eat the honey cone alone by itself; and, to pour honey directly on my Honey Nut Cheerios with skim milk.

Source: Amazing Wellness, Spring 2010, page 54.

Friday, August 13, 2010

Good News for Patients Who Suffer From Atrial Fibrillation and / or Atrial Flutter

Recently, about one month ago, I had the opportunity to administer a drug that I had never heard of before with a middle aged lady in her fifties. She presented to me with a Rapid Ventricular Rate (RVR) or rapid heart rate and was in Atrial Fibrillation.

I had received word that the cardiologist would be accompanying her and that I was going to need to prepare this lady for cardio-version. Automatically, I’m thinking Conscious Sedation with Versed and Fentanyl because I was assuming that I was going to have administer drugs for Conscious Sedation on her while the Cardiologist zapped her with electrical shock; which turned out to not to be the case at all.

Three doctors arrived shortly after this lady arrived; a Cardiologist, Resident, and an Intern. The Cardiologist asked if the drugs she ordered where here yet. My response was, if you mean the Versed and Fentanyl, I have it ready to sedate her with. No, said the Cardiologist; we are not going to do that. I’m going to show you a trick that very few ever do or even know about.

I’m now thinking – ok, this will be something new for me because I thought I had seen or done it all at one time or another. In short, I was astonished at what I witnessed on my monitors as I seen all kinds of electrical activity in this lady’s heart transpire over a fifteen minute period and she converted back into Normal Sinus Rhythm in approximately 15 minutes and never felt one thing. In fact, she laid and watched herself on the monitor, as we four also did as I administered the drug very slowly.

The name of the drug is Corvert (ibutilide). Ibutilide is an anti-arrhythmic heart medication that corrects irregular heart rhythms like Atrial Fibrillation or Atrial Flutter. However, in some cases, ibutilide may not work on some patients, or your hearts irregular rhythm may occur again or even get worse after you’re treated with ibutilide. This is more likely to happen if you are also suffering from conditions such as Congestive Heart Failure (CHF).

Ibutilide is administered directly into the vein at a very slow rate (0.1mg/min) due to it concentration. Ibutilide comes in 1mg vials of 10mL or (10mL/1mg). The entire 1mg is given very slowly over a course of 10 minutes (0.1mg/min). If the patient does not convert back into normal rhythm, wait 10 minutes and you may repeat another 1mg dosage over another 10 minutes; again only giving 0.1mg/min over 10 minutes or until the patient converts to Normal Sinus Rhythm (NSR).

Nevertheless, this procedure should never be attempted unless there are knowledgeable doctors (preferably a cardiologist) at the bedside and you are watched closely with heart monitoring equipment so that in the event other problems occur, they can be treated quickly. In addition, you should be monitored with cardiac monitoring equipment for several hours after the procedure to ensure no further complications arise.

There are some other minor issues that may need to be addressed before using ibutilide; for example, your Potassium should be greater than or equal to 4.0 with specific readings with your Coagulation studies.

As I said, this was a first for me; and, I was amazed to see the Electrophysiology I witness transpire over a 15 minute period without any discomfort to the patient whatsoever with this drug ibutilide (Corvert).

Just a tidbit of information that may help you if you or someone you may know suffers from Atrial Fibrillation and / or Atrial Flutter; have them speak to their doctor or cardiologist about the use of ibutilide for cardio-version.

Teddie Joe Snodgrass, RN, MBA

Thursday, August 12, 2010

Top 10 Foods You Need To Consume

  1. Tomatoes: A study done in 2003 revealed a strong link between tomato consumption and lower risk of heart disease in women.
  2. Spinach: Spinach contains compounds like neoxanthin and kaempferol that are kryptonite to cancer cells.
  3. Quinoa: Quinoahas a mineral content that blows barley, wheat, and other grains away. Plus, it's low in fat and calories.
  4. Nuts: Nuts are loaded with heart healthy fats, including oleic acid and omega-3s that work to raise good cholesterol.
  5. Lentils: High in fiber and protein, with zero cholesterol and nearly zero fat, lentils help manage blood sugar and lower cholesterol.
  6. Fish: Many studies have shown that the fats in fish lower blood pressure, quell inflammation, and prevent heart damage from triglycerides.
  7. Cabbage: Cabbage is plush with a unique set of nutrients (including sulforaphane) that fight off cancer causing toxins with elegant precision.
  8. Berries: Blueberries, raspberries, and blackberries top the list when it come to free radical scavenging antioxidants.
  9. Beets: Among its potent pigments is betalain, which can protect the body from the oxidative stress that leads to aging and disease.
  10. Avocados: They contain zero cholesterol. In fact, they work to lower cholesterol with only 150 calories in a half avocado.
Source: Amazing Wellness, Spring 2010, pages 64-65