(BPT) – Salt, or sodium chloride, is essential for life. In fact, no mineral is more essential to human survival than sodium because it allows nerves to send and receive electrical impulses, helps your muscles stay strong, and keeps your cells and brain functioning. However, sodium chloride (salt) is a nutrient that the body cannot produce, and therefore it must be eaten.

The average American eats about 3,400 mg per day of sodium, according to The National Health and Nutrition Examination Survey. You may have heard that this is too much, but according to new research, it may actually be on the low side of the healthy range. A 2014 study, published in the New England Journal of Medicine, tested sodium consumption in more than 100,000 people in 17 countries. The study found that the healthy range for sodium consumption was between 3,000 and 6,000 mg per day. Eating more than 7,000 mg per day of sodium increases your risk of death or cardiovascular incidents, but not as much as eating less than 3,000 mg per day. The low salt diet was significantly more harmful than the high salt diet.

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Salt Has Many Health Benefits

The other component of salt, chloride, is also essential to survival and good health. It preserves acid-base balance in the body, aids potassium absorption, improves the ability of the blood to move harmful carbon dioxide from tissues out to the lungs and, most importantly, it supplies the crucial stomach acids required to break down and digest all the foods we eat.

Because the level of salt consumption is so stable, it is an ideal medium to use for fortifying other essential nutrients such as iodine. Iodized salt first produced in the U.S. in 1924 is now used by 75 percent of the world’s population to protect against mental retardation due to Iodine Deficiency Disorders (IDD). Iodine is an essential element in healthy human life, enabling the function of thyroid glands to produce needed hormones for proper metabolism. When children in the womb don’t get enough iodine from their mother, fetal brain development may be impaired. During pregnancy, iodine deficiency can cause a child to develop learning disabilities and mental retardation as well as developmental problems affecting his speech, hearing and growth.

Salt is also a vital component of hydration. After exercise, it is critical to replace both water and salt lost through perspiration during exercise. That is why all athletes make sure they are consuming sufficient salt during and after a workout. Expectant mothers and seniors, in particular, need to guard against under-consumption of salt. Higher-salt diets have also been used successfully to combat chronic fatigue syndrome. Asthma sufferers, particularly in Eastern Europe, are often treated by having the person spend time in salt mines or salt caves. This is because the unique microclimate, containing ultrafine salt particles helps clear the lungs.

Low Salt Diet Myths

Low salt diets can be especially harmful for the elderly. In older people, mild hyponatremia (low sodium concentration) is the most common form of electrolyte imbalance in the blood. Indeed, several recent medical papers found a direct relationship between hyponatremia and unsteadiness, falls, bone fractures and attention deficits. Elderly people on low salt diets often experience lack of thirst which leads to dehydration and they experience loss of appetite that leads to a host of health problems.

Falls are one of the most serious problems for the elderly and about a third of people older than 65 fall at least once every year. Fall-related injuries in the elderly are associated with numerous psychological and physical consequences and are a leading cause of bone breakage and hip fractures, which can lead to complications and permanent disability or death. More than 5 percent of all hospitalizations in people older than 65 years are due to fall-related injuries. Sadly, the research shows that in assisted living facilities where almost all residents are given low-salt diets, the rate of falls and fractures are three times as great as in the normal home environment.

Salt and Life Expectancy

It is well documented that the Japanese and the Swiss enjoy some of the longest life expectancy rates of anyone in the world. It is less known however, that they also have among the highest rates of salt consumption. A review of peer-reviewed medical research around the world indicates that if people were to actually consume the low levels of salt recommended in the U.S. Dietary Guidelines, they would put their health at risk. Fortunately, most Americans – including the elderly – when left to their own choice consume salt within the healthy range.
Courtesy BrandPoint Content

11-20-2015 4-03-52 PMLast edition of Athens Now, I began to explore the role of nutrition in mental health. I quickly became aware that this would be a series of articles, not just a one-time topic like I usually do. In the article, we explored the fact that depression is a result of inflammation in our bodies, not just a chemical issue. This edition, we will take a further look at neurotransmitters and how they are affected by what we eat. As we discussed, “traditional” diets (those that were common prior to the 20th century) can decrease the incidence of depression by as much as 25-30%.

Some examples of traditional diets include Mediterranean, Japanese, and Hunter-Gatherer diets. As we discussed last edition, Mediterranean diets are high in fruits, vegetables, olive oil, some cheeses, oily fish and red wine (modest amounts of alcohol, especially red wine, can decrease the risk of depression). Japanese diets are rich in rice, green tea, eggs (raw), lean meats, vegetables, fish, high-quality soy, and sake. Hunter-Gatherer diets are typified by meats (grass fed beef, lamb, etc., fish, and poultry), eggs, vegetables, oils (coconut, olive, avocado, etc.), fruits, nuts, and tubers like sweet potatoes.

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Inflammation is combated by antioxidants, which are mostly found in fruits and vegetables. We also get important nutrients from meats, nuts, and dairy products. Research suggests that fermentation magnifies the known benefits of these foods and influences their bioavailability and the activity of their chemical makeup. (Bioavailability is simply the degree to which whole food nutrition gets down to the cellular level where it can be fully utilized.) According to a study appearing in the Journal of Physiological Anthropology, “the consumption of fermented foods may be relevant to emergent research linking traditional diets and positive mental health.” Also, fermentation may intensify specific nutrients (sources such as proteins, fats, vitamins, and minerals) and phytonutrients (nutrients that come from plants) which directly and indirectly affect brain health.

A study done on unhealthy maternal and postnatal diets (diets high in processed and refined foods, high sugar beverages, and high sodium snacks) showed an increased risk of behavioral and emotional problems in those children. Depression risk is also increased in those exhibiting insulin resistance and elevated fasting glucose levels, which are precursors to Type 2 Diabetes Mellitus. In addition, your gut microbes affect glycemic control and contribute to glucose tolerance.

Below is a list of specific items contained in traditional diets that are individually associated with protection against depression:

• High-quality soy
• Turmeric
• Cocoa
• Green tea
• Coffee
• Blueberries
• Pomegranates
• Honey

Some specific nutrients in the above mentioned items include magnesium, zinc, vitamin C, folic acid/folate (vitamin B9), and vitamin B12.

Nutrients from foods are precursors to neurotransmitters, which are chemicals in the brain. The lack of which is often associated with depression and other mental health problems.

Serotonin is a neurotransmitter that helps with constriction of smooth muscle, regulating cyclic body process (i.e. sleep/circadian rhythm, etc.), contributing to well-being and happiness, and mood stabilization. Foods high in tryptophan, which is converted into serotonin, include:

• Meat
• Poultry
• Fish
• Dairy products
• Walnuts
• Flaxseed
• Sprouted grains
• Bananas
• Plantains
• Pineapples
• Kiwis
• Plums
• Gooseberries
• Tomatoes
• Spinach
• Dark, leafy greens
• Dates
• Figs
• Grapefruits
• Melons
• Eggplant
• Avocados

Dopamine is a neurotransmitter that aids in movement, memory, attention, behavior, hormonal processes, cognition, pleasure, sleep, mood and learning. Foods that contain tyrosine, which is converted into dopamine, are as follows:

• Eggs
• Poultry
• Cottage cheese
• Plant-based proteins

Gamma-aminobutyric acid (GABA) is a neurotransmitter that helps regulate anxiety, and is known to match the effects of benzodiazepines such as Ativan, Xanax, Valium, and Klonopin. Foods rich in this amino acid include:

• Fish
• Walnuts
• Brown rice
• Spinach
• Broccoli
• Lentils
• Bananas
• Oranges
• Almonds
• Oats

Emerging studies now show that the normally selective intestinal barrier might be compromised in depressed patients. Even mild chronic inflammation of the intestinal lining can increase the risk of depression. Things that increase the permeability of the intestinal tract (allowing waste products and inflammatory chemicals to pass through it and damage other tissues) include stress, exhaustive exercise, and the contemporary Western diet.

Some of these chemicals that are released due to the increased permeability of the membranes negatively impact neurotransmitters and elevate oxidative stress, a key component of depression and anxiety. One study shows that adherence to a traditional dietary pattern for ONE month can begin to reduce the chemicals that attack neurotransmitters by up to 38%. When this limitation of intestinal absorption is conquered, it curbs the breakdown and mirrors the proposed mechanism of prescribed antidepressants.
Oral probiotics and fermented foods can help build your gut microbiome and decrease anxiety and the perception of stress, as well as increase mental outlook. Fermented foods may increase the body’s ability to use magnesium, zinc, vitamin C, folic acid/folate (vitamin B9), and vitamin B12, and possibly even vitamin D. Fermentation is an ancient art that has value for health in many areas, including digestion and mental health.

Remember, you can choose a good mood by choosing good food.
By: Rachel Clark, RN, BSN

11-6-2015 10-59-00 AMFew of us are aware of the connection between nutrition and depression, despite the fact that we understand to some extent the relationship between nutritional deficiencies and physical illnesses. Depression is still thought by many to be a biochemical or emotional based issue, however nutrition can determine the extent and duration of depressive symptoms.

Neuroscience research conducted by clinicians like Dr. Caroline Leaf and others suggests that nutritional factors are very much intertwined with emotions, cognition, and behaviors. Some of the most common mental health issues include obsessive compulsive disorder, depression, schizophrenia, bipolar disorder, anxiety disorders, and ADD/ADHD.

Numerous studies show that the dietary intake pattern of most American and Asian populations as opposed to Mediterranean countries are often deficient in nutrients such as essential vitamins, minerals, and omega-3 fatty acids. Also, evidence now suggests that the pathology of Major Depressive Disorder (MDD) may be rooted either primarily or secondarily to oxidative stress in the body (A. Sarandol, ET AL.).

Our brains are more sensitive to oxidative stress and free radicals than other tissues. The brain is only about 2% of the weight of the human body, yet it uses approximately 20% of its energy. MDD is also distinguished by the activation of an inflammatory response system, thus increasing free radical production.

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What is interesting is that inflammation shows up in different people as different symptoms. Some people may exhibit cardiovascular disease, others diabetes, or an autoimmune disorder. Still yet others manifest depression, anxiety and mental illness. It is no surprise that these things are often listed as comorbidities (the presence of two or more chronic diseases) since they have the same root: inflammation. What was interesting in the study relating MDD to oxidative stress was the conclusion: the drug combination used had no effect on measurable oxidative stress markers in the body at the end of 6 weeks.

So what is the solution? Many people think vitamins will help their nutrient deficiencies, but according to a study done at John Hopkins University, vitamins are at best a waste of money, providing no clear benefit. At worst, they can do more harm than good, with high concentrations of isolated and fractionated vitamins E and A, as well as beta carotene, could increase the risk of death in certain individuals. Therefore, use vitamin supplements judiciously, or avoid them altogether.

This still leaves the question as to how to nourish our bodies, and therefore our brains. The solution is a diet that is high in the various micronutrients we need to keep our bodies functioning such as vitamin C, vitamin E, vitamin B6, vitamin B12, folate (or vitamin B9), zinc, and omega-3 fatty acids (EPH/DHA). The Mediterranean Dietary Pattern (MDP) which is high in fruits, vegetables, olive oil, and oily fish is now thought to reduce inflammation due to its richness in antioxidants that come from these whole foods.

“Optimizing our nutrition is a safe and viable way to help avoid, treat, or lessen the symptoms of mental illness. Poor nutrition is a significant and modifiable risk factor for the development of mental illness,” said Julia Rucklidge, a PhD professor of clinical psychology in Christchurch, New Zealand, who has studied the treatment of ADD/ADHD and other mental health issues with micronutrients for the last 10 years.

We rely on medications, but honestly we need to stop visiting the “pharmacy” and start visiting the “farm” to decrease the prevalence of mental illness. I am not dismissing the effectiveness of medications on some severe forms of mental illness, nor advocating that you should stop treatments prescribed by your healthcare practitioner without first consulting them. They can be very effective for some people in the short term, but on a long term basis have lasting effects on our bodies. Despite our reliance on these drugs, our outcomes are no better than they were 50 years ago.

The research is clear: the well nourished brain is better able to withstand stress and recover from illness. Sixty to eighty percent of people will respond to better nutrition. Let’s get serious about the role nutrition plays not only in our physical health, but also our mental health.
By: Rachel Clark, RN, BSN

10-17-2015 10-27-14 AM“All disease begins in the gut.”-Hippocrates

Hippocrates was a classical Greek scholar born in 460 B.C. His wisdom is over 2,000 years old, but has stood the test of time. He has become one of the most outstanding contributors to medicine, and is even counted the “Father of Western Medicine.” In fact, every doctor who graduates from medical school takes the Hippocratic Oath, one of the oldest binding codes of ethics that exists.

This quote on the relationship between disease and gut health isn’t just a nice saying. It is backed up by science. It is thought that three quarters of our immune system resides in the gut, with over 500 different species of bacteria that live there. The number of microorganisms present in the gut alone is 10 times the number of cells in the entire human body. Research now suggests that this is not merely a peaceful co-existence, but more of a mutual relationship. Without a healthy immune system, you are susceptible to all kinds of disease, thus the reason Hippocrates said, “Disease begins in the gut.”

In modern times, we have severely harmed the health of our guts. Between overuse of antibiotics, sanitizing EVERYTHING, a lack of proper nutrition, eating highly processed foods and sugars, we have effectively destroyed gut bacteria. Old World, or traditional diets around the globe include the use of raw and fermented foods that are full of bacteria. These cultures aren’t afraid of it; they understand its beneficial relationship with their gut.

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We are born with completely sterile digestive tracts because while in utero, we have no need to break down nutrients since our mother is doing that for us. We become colonized with various strains of bacteria (good and bad!) from our mothers during the rather messy but necessary process of vaginal birth. Breastfeeding also supports this process in infancy, due to strains of immune-boosting bacteria found only in breast milk, and provides a balance.

This is not to say babies who are born via c-section and/or are formula fed have no hope from the beginning. These babies just need a little extra help with supplementing what they didn’t get through vaginal birth and/or breastfeeding. Also, toddlers put everything in their mouths (dirt included), which helps build up the relationship of good bacteria in the gut if given proper resources for it to flourish, and thereby boost immunity.

Unfortunately, we don’t do a very good job at this anymore. We clean with bleach and make our worlds sterile. We eat too much sugar, starch, and processed foods, which alter the balance in the gut, leading to all kinds of problems with the integrity of its lining. This in turn allows the harmful bacteria to get into our bloodstream and deposit toxins throughout our cells and tissues. Problems with poor gut health have been linked to Irritable Bowel Syndrome (IBS), Chron’s disease, Celiac disease, colitis, allergies, and even some mental illnesses.

Preventing a problem is always easier than treating it once we have it. Below you will find some tips to prevent the depletion of the good bacteria in your gut, and ways to increase the balance if you haven’t been so proactive in the past.

Ways to Prevent Good Bacteria Depletion:

• Careful use of antibiotics and other prescription drugs
• Limiting use of antibacterial soaps
• Avoid overuse of harsh cleaning chemicals
• Adequate self care to reduce the amount of stress on the body that is the result of a lack of sleep, overexertion, etc.

How to Boost Probiotic Balance:

• Cut down on sugars, grains, starches, and vegetable oils. These things quickly destroy good bacteria, suppress the immune system, and can lead to a plethora of health problems.
• Eat real food. Fruits, vegetables, protein and fats help support the beneficial bacteria. Certain bacteria are needed to help break down fiber from fruits and vegetables, and support the body to culture more of the same.
• Consume fermented foods and drinks. Sauerkraut, kombucha (a fermented tea), kimchi (a spicy Korean form of sauerkraut), fermented salsa, kefir (a fermented milk drink), yogurt and naturally aged cheeses are all good sources of foods with naturally occurring probiotics that help build beneficial bacteria in the gut.
• Natural soaps and water instead of antibacterial. Antibacterial soaps are now thought to be a part of the problem with drug resistant bacterial infections like MRSA and C. diff. Instead, use good quality natural soaps like Bronner’s or goat milk soap.
• Begin gardening. A little dirt won’t hurt you! In fact, it’s good for you. You will get your Vitamin D from the sun, probiotics from the dirt (bacteria can enter through your skin), and you are growing your own food and/or flowers. What’s to lose?
• Take antibiotics only when absolutely necessary. While there certainly are times when antibiotics are needed, many illnesses can be left to run their course, like the stomach bug, colds, or ear infections. Antibiotics don’t just target harmful bacteria, they also kill all the good stuff. In addition, antibiotics don’t work on viruses, only on bacterial infections.
• Take a probiotic supplement. This should be done in conjunction with a change in your diet, otherwise you are just throwing your money away. Make a few simple changes, one at a time, and consider supplementing your new habits with a probiotic source other than foods or drinks. It is also a good idea to help replenish your gut after a round of antibiotics by adding the supplementation of oral probiotics in addition to the fermented sources already in your diet.
By: Rachel Clark, RN, BSN

10-2-2015 3-04-11 PMPregnancy and Infant Loss Awareness covers miscarriage, stillbirth, SIDS, and any unexpected death of an infant. The movement began in 1987, and on October 25, 1988, President Ronald Reagan designated the month of October as Pregnancy and Infant Loss Awareness month.

The movement was organized without the aid of cellphones, computers, or the Internet by Sherokee Ilse, Susan Erling, and Rhonda Wintheiser. They wrote letters and called other groups with similar missions and invited them to write letters congress. In the spring of 1989 as a celebration of the success and declaration by President Reagan, hundreds of bereaved families traveled to Washington, D.C. and carried 500 baby quilts displaying the names of thousands of babies.

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In addition, October 15 is Pregnancy and Infant Loss Remembrance Day. This campaign began in 2002 and was spearheaded by Robyn Bear, Lisa Brown, and Tammy Novak. They petitioned the Federal and State governments and by October 15, 2002, 20 states had signed proclamations. Since that time several other countries have also adopted proclamations, including Canada and Italy.

International Wave of Light is a campaign for people to light a candle at 7pm on October 15 in each respective time zone and leave it burning for at least an hour in remembrance. The goal is to have a continuous chain of lights spanning the globe for a 24-hour period.

Here are some shocking statistics. Every year, there are approximately 4.4 million pregnancies confirmed in the US alone. Almost 1 million of those pregnancies end in miscarriage, more than half of which occur before 20 weeks gestation. Twenty-six thousand are termed still born, which refers to babies lost after 20 weeks gestation. Another 19,000 infants die in the first month after birth. Thirty-nine thousand more occur within the first year of life, mostly as a result of SIDS (Sudden Infant Death Syndrome) which has no single identifiable cause despite years of research on the subject.

The emotional fallout from this kind of loss poses an additional problem. According to a study discussed in US News and World Report, miscarriage and its repercussions is an area in our culture where we have an unfortunately high level of ignorance and low level of skill when it comes to comforting parents regarding their loss. Sometimes, there are things that are said that are downright cruel. For example, a couple had announced their pregnancy on Facebook before the usual 12-week mark, then also shared their loss. One person said that people should respond to these types of things with “congratulations on your miscarriage.”

So, what can a caring person do to help a couple who has experienced a miscarriage, still birth, or loss of an infant (either from SIDS or a traumatic event)?
• Allow the couple the opportunity to grieve and talk about the loss on their terms
• Give their loss the respect it deserves
• Do not speak to the medical issues unless you are qualified to do so AND have been asked to do so

If you are a someone who has experienced pregnancy loss, whether it be early in your pregnancy, in the middle, at the end or after the child is born, there are resources and support available through local crisis pregnancy centers and through an organization called First Candle. Their mission is “helping babies survive and thrive,” but also to provide grief support to families when they don’t. Their grief support hot line can be reached by calling 1-800-221-7437, with counselors available 24/7. There are also specific bereavement support groups available. For more information on pregnancy loss, please visit www.nationalshare.org or www.firstcandle.org.
By: Rachel Clark, RN, BSN

Medical Update – Just A Nurse

9-18-2015 4-45-47 PMThere has been a lot of controversy in the last couple of days concerning Joy Behar’s comments on The View about the nursing profession. Facebook has “blown up,” and in a good way. Nurses, doctors, and other medical professionals have come out of the woodwork in support of nurses.

In the 2016 Miss America pageant, Miss Colorado was a nurse named Kelley Johnson. While other contestants sang, danced, played instruments or demonstrated other talents, Kelley told a story about being “just a nurse.” She came out on stage in her scrubs, stethoscope around her neck. She told of a patient called Joe who had been diagnosed with Alzheimer’s and experienced night terrors. She spoke of calming him by sitting with him and holding his hand. She relayed how he wanted to talk, and asked her about changing his treatments and medications. She responded, that no, she couldn’t do these things because she was “just a nurse.” But she was able to connect on a different level, a more personal one.

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They would talk about her volleyball, his grandbabies, and they enjoyed a lot of laughs together. One night she found him crying. She told him she understood that it was hard, but that he was not defined by his disease, his life was not “just Alzheimer’s,” that he was still Joe. His response was beautiful. He said “Nurse Kelley then the same goes for you. Although you say it all the time, you are not just a nurse. You are my nurse, and you have changed my life because you have cared about me.”

Nurse Kelley’s story highlighted that you are not just a room number, a diagnosis, but first and foremost you are a person, and you have a family and friends. She didn’t want to be a nurse that pretends. Joe reminded her that she was a lifesaver, and would never be “just a nurse.”

The cohosts of The View were discussing this story, and their tones were mocking. Joy Behar asked the question “Why does she have a ‘doctor’s’ stethoscope around her neck?” This ignited one of the most viral social media campaigns to date. There are approximately 3 million nurses in this country, and many of them have come out against this offensive comment by Behar.

We have told thousands of stories about patients, our jobs, and have banded together. It has amazed me. As nurses, we often “eat our young.” There is sometimes an attitude of one department being better than another (i.e. Emergency department nurses being better nurses than floor nurses). But suddenly, the bickering has stopped. Rather than fight amongst ourselves to try to prove something, we have banded together. We have united.

And it’s not just the nurses. Doctors are backing us up, explaining how they couldn’t do their jobs if we didn’t do ours. It has been amazing to see this, and in my opinion Joy’s words followed the “law of unintended consequences.” Her comment was made in mockery. But just like in the story of Joseph in the Bible, the Lord took the comment that was meant for evil and has used it for good instead.

The nursing profession is a special one. There are days that are hard, in which we hold our bladders for hours on end to make sure that our patient has the best possible care. We put off caring for ourselves so we can care for others. But make no mistake, we love what we do, and we make a difference every day.

I’d like to share here the comment I also posted on my Facebook page:

I am a #nurse, and proud of that fact. I didn’t become a doctor because I didn’t want to, not because I am not skilled or talented enough. I became a nurse because I wanted to change people’s lives the way I have been able to over the last 4 years. I have been the first hands to touch a newborn baby, and the last to touch the dying. I have spent countless hours on my feet, day in and day out, even on some days when I’ve been sicker than some of my patients. I don’t wear a “doctor’s” stethoscope. I wear MY stethoscope. It is one of my most important tools.?#?JoyBehar?, I think you owe us all an apology. #?nursesunite? ?#?justanurse? ?#?TheView?

One of my favorite comments came from Dr. Jeffery Hallazgo, and this is what he had to say:

Standing proudly beside my nursing colleagues from a very proud long time Emergency Department (and now Urgent Care) physician, unashamedly wearing around my neck the badge of honor of caregivers everywhere. To the yentas on that worthless program The View, Michelle Collins and Joy Behar, you have poked the bear. You have awoken the sleeping giant. (And as a result, you have sh*t the bed.) GIVE ‘EM HELL, GANG! #NursesRock

So, I say with pride, I am “just a nurse.”
By: Rachel Clark, RN, BSN

9-7-2015 10-45-10 AMNurse burnout is a huge problem in this country, and is projected to become even more so in the future. Despite the fact that enrollment in bachelor’s, master’s and doctoral nursing programs is up, there is still projected to be a shortage of registered nurses (RNs) by the year 2030. There are many factors that drive the shortage, including the high burnout rate. Contributing factors to the burnout rate include staffing problems, sicker patients, and working long hours.

The term “burnout” was coined by American psychologist Herbert Freudenberger in the 1970s. According to an article from the American Nurses Association (ANA), he used it to describe the consequences of severe stress and high ideals experienced by people working in the “helping” professions.

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It is difficult to tell how many people may actually be affected by burnout, because this term is no longer exclusive to those in healthcare. However, no matter the career path, the symptoms of burnout seem to be the same.

Symptoms

Constant fatigue. You should not go to bed tired and still wake up tired in the morning. When you find yourself without the energy to do common everyday things like exercise, spend time with family or friends, or read a good book, this physical exhaustion could be an early symptom of burnout.

Feelings of being overworked and under appreciated. If you are feeling this way, it may be time to re-evaluate and figure out why you are feeling this way. If you are working too many hours, it may be time to cut back. If you are taking on too much, you may need to figure out how you can cut back. Feeling frustrated and resentful about your job is not good for you, your co-workers, or your patients. If you feel this way, you may need to step back and see how or if being a nurse still fits in with your plans and goals for life, and it’s ok if it doesn’t.

Lack of enthusiasm about work. When you are “just going through the motions,” can be another sign of impending burnout. If you are at home dreading going to work, or are at work and can only think about going home, this can adversely affect patient care since it is vital that you are able to concentrate on what needs to be done for your patient(s) moment by moment. It can also spill over into other areas of life.

Compassion fatigue. This is when you become detached from patients, feel cynical about your work, or feel that you are a failure as a nurse. It is often after years of emotional stress, physical stress, and the experiences on the job.

Contributing Factors

Lack of social support. Many people don’t understand the demanding nature of being a nurse. They aren’t aware of what happens on a daily basis, or the strain that it puts on a person to be able to deal with multiple complex patient care scenarios. Often times, family members expect the nurse to leave his or her work at work, and not to talk about it at home. Many hospitals have an employee assistance program in place, but many nurses don’t use it. Some out of fear that their discussions will be shared with their supervisors. Others don’t use it because of the stigma of “going to see a counselor.”

Inability to control schedules or assignments. Many places set a nurse’s schedule for them, and they have no say in it. Some set schedules force nurses to work 3 days in a row, giving little time to recuperate in between work days. Not everyone can handle this type of scheduling, yet there is little that can be done about it.

Chaotic environment. On any given day in a hospital, things are extremely chaotic. Ask any person who has ever been a patient! If they feel overwhelmed by what is happening in this environment, imagine being responsible for 4 or more complex patients and managing their care! In addition, hospitals are being paid on satisfaction rates by patients’ perceptions. Trying to keep up with everything every one wants exactly when they want it can be extremely daunting.

Work-life imbalance. Sometimes you have issues going on at home that affect your performance at work, and vice versa. When this happens, you aren’t able to give your full attention to one arena or another, and the other suffers.

Staffing issues. This is one of the biggest contributing factors, if not the biggest. Despite enrollment being up, the shortage of nurses persists. Sometimes this is due to budgeting, which often backfires because then patient safety becomes an issue. Other times it is due to the fact hat you can’t keep staff in a department. No matter the reason, it is vital that staffing problems be addressed. Continually running on a “skeleton crew” adversely affects not only nurses, but patients as well. Fixing this one issue has the potential to offset most of the others.

What To Do About It

There are many things that you can do personally to take care of yourself and decrease the stress and likelihood of burnout.

Stretching. Sometimes, just stretching out your muscles helps relieve the tension in them. This can improve strength, flexibility, and posture. You can even teach simple stretches to your patients, giving good self-care at the same time.

Meditation or Prayer. Taking a short break to be able to clear your mind helps tremendously. Even if it is just five minutes. Quiet your mind and spirit. Focus on your breathing and being still, and teach your patient(s) to do the same.

Emotional Freedom Technique (EFT). This is simply a sequence of tapping on different meridian points on the body that can help clear out stuck electrical energy, negative emotions, and stress chemicals. For more information on EFT, you can visit www.thetappingsolution.com if you are interested in learning the basic techniques. If you would be interested in a more in-depth program and coaching, you can visit www.donmilton.net.

Breathing Exercises. Just practice taking long, slow, deep breaths in through your nose and out through your mouth. I’ve often done this with people, patients included. Teaching your patient to become more aware of their breathing is a great way for you to get in touch with your own, and you both benefit.

Nurses, I would be interested in knowing if this has been helpful for you. Let’s beat back burnout together! You can contact me at rachel.athensnow@gmail.com.
By: Rachel Clark, RN, BSN

8-23-2015 1-13-33 PMWell, it’s that time of year again: time for kids to go back to school after a fun-filled summer. I know that many schools around Limestone and Madison County have already opened their doors to students, and that for most the learning has already started in full swing. I remember as a kid being excited on the last day of school, and at the end of the summer dreading the first one back. But as I’ve gotten a little older, I’ve found that I miss those days much more than I’d like to admit.

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It’s important to focus on ways to keep your child healthy this school year, not just at the beginning. Below you will find some tips to help you do that, and keep your little ones (or not so little ones) on top of their game all year long.

Nutrition
I start with nutrition because it is the building block of all the rest. We’ve all heard that a healthy breakfast can help students concentrate better, and studies show that this is actually true. If your child doesn’t eat breakfast, they may not get another chance to eat for several hours, and their academic performance may suffer because of this.

Cooking Light says that a healthy breakfast “contains a mix complex carbohydrates and protein.” They also suggest “pairing whole grains such as oatmeal, whole-wheat toast, or whole-grain cereal with a protein source such as milk, yogurt, peanut butter, eggs, or cheese. Add a side of fruit for a boost of vitamins and minerals.”

Also, pay attention to the meal calendars your child’s school sends home or posts online. This may help you plan which days you want your child to eat in the cafeteria or which days you want to pack them a lunch. I would suggest packing a lunch most days rather than buying something from the cafeteria so that you can save money and pack something nutritious for your child.

Here are 8 tips from one mom’s online blog (www.brightonyourhealth.com) that she incorporates when packing healthy lunches for her kids:

1. Variety and color-changing it up ensures that your child gets different sources of vitamins and minerals from the food they eat. Color makes the meal more appealing. If there is something your child simply will not eat, try hiding it in smoothies.
2. Whole grains-increased fiber as opposed to white breads and rices
3. Fresh fruits/vegetables-the US government recommends that fully half your plate at each meal should be comprised of fresh, raw fruits and vegetables.
4. Food safety-your child’s lunchbox will be unrefrigerated for several hours, so it is important to keep things cold that need to be kept cold. A good insulated lunch bag or blue ice may help.
5. Taste-involve your children in the selection of their lunch. Choose foods that they like to eat and that taste good to them. If they won’t eat the lunch you pack, it is a waste of time and money.
6. Water-water is the best choice for kids. If your child dislikes plain water, then try adding lemon or other fruits/juices to it to make it more appealing.
7. Fun desserts or snacks balanced with healthy options-at least one day a week, give them a treat that isn’t quite as healthy as some other choices. It’s a balancing act. Give them something to look forward to.
8. The less processed the better-though these options may be convenient for you and desirable for you kids, they aren’t as nutritious as things you make at home from scratch.

Backpack Safety
It is important to choose the right backpack for your child to prevent injury and problems later on in life. Here are a few guidelines from the American Academy of Pediatrics (aap.org):
1. Wide, padded shoulder straps and a padded back
2. Pack light-use all of the backpack’s compartments, and pack heaviest items closest to the center of the back. BACKPACKS SHOULD NEVER WEIGH MORE THAN 10-20% OF THE CHILD’S BODY WEIGHT.
3. Always use both shoulder straps, slinging over one shoulder can cause muscle strain and injury.
4. Consider a rolling backpack if the school allows them. There are downsides to a rolling backpack though, including being carried upstairs, not rolling as well in water/snow/ice, and may not fit into some lockers.

Transportation Safety

No matter what venue of transportation your family chooses, it is important to review basic safety rules with them (aap.org).

• Walking: Choose a safe route with a responsible and well-trained adult to accompany your child. Identify other children who might be walking with them. Identify whether or not your child is a good candidate for walking as small children may not be as careful.
• Biking: Your child should always wear a helmet and ride in the same direction as traffic. Use appropriate hand signals and obey traffic lights and stop signs.
• Car: Always wear a seatbelt and use child safety seats as indicated for your child’s height and weight. Children under 13 years old should ride in the back seat. If your teenager is driving, always use a seat belt, restrict the amount of other teens in the vehicle, and don’t allow eating, drinking, or cell phone usage of any kind while behind the wheel.
• Bus: Always enter and exit the bus safely. Wait for the bus on the curb, not in the street. Ensure that your child is where she can see the driver, allowing the driver to also see him or her. The child should not stand up or walk while the bus is in motion. If the bus has seat belts, encourage your child to use them when available.
By: Rachel Clark, RN, BSN

8-7-2015 3-12-19 PMAs is my usual habit, I have picked a topic based upon national health observances that are getting media attention each month. August just so happens to be National Breastfeeding Month. August 1st-7th is World Breastfeeding Week, which has been celebrated for 22 years, and is recognized in over 175 countries around the globe. The mission of the World Alliance for Breastfeeding Action is to “focus and facilitate actions to protect, promote and support breastfeeding.”

According to a call to action supported by the Surgeon General of the U.S., breastfeeding is “one of the most highly effective preventive measures a mother can take to protect the health of her infant and herself.” This breastfeeding campaign, which is sponsored by the U.S. Department of Health and Human Services, has a goal to “empower women to commit to breastfeeding by highlighting new research showing that babies who are exclusively breastfed for six months are less likely to develop ear infections, diarrhea, and respiratory illnesses and may be less likely to develop childhood obesity.”

In many states in the U.S., breastfeeding is no longer the choice of new mothers for meeting the nutritional needs of their newborns. This is especially true in Alabama. The national average of women who have ever breastfed is 76.5%, while Alabama reports only 60.4%. This number is lower in only 4 other states, 2 of which are in the “Deep South” and includes Mississippi (50.5%) and Arkansas (57.7%). In addition, the number of Alabama mothers still breastfeeding exclusively at 3 and 6 months is low at 23.5% and 11.9% respectively.

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So why is breastfeeding so important? Is it really any better for your baby than pre-packaged formula at the grocery store? With so much information readily available at our fingertips and the click of a few buttons on the Internet, it can get overwhelming to find good sources. There is always “new research” coming out on every topic under the sun, and breastfeeding is no exception. So let’s take a look at what some of the leading scientific researchers in the U.S. have to say.

Health Benefits of Breastfeeding1
• Breastfeeding protects babies from infections and illnesses that include diarrhea, ear infections and pneumonia.
• Breastfed babies are less likely to develop asthma.
• Children who are breastfed for six months are less likely to become obese.
• Breastfeeding also reduces the risk of sudden infant death syndrome (SIDS).
• Mothers who breastfeed have a decreased risk of breast and ovarian cancers.

Economic Benefits of Breastfeeding2
• Families who follow optimal breastfeeding practices can save between $1,200 and $1,500 on infant formula in the first year alone.
• A study published last year in the journal Pediatrics estimated that if 90% of U.S. families followed guidelines to breastfeed exclusively for six months, the U.S. would annually save $13 billion from reduced medical and other costs.
• For both employers and employees, better infant health means fewer health insurance claims, less employee time off to care for sick children, and higher productivity.
• Mutual of Omaha found that health care costs for newborns are three times lower for babies whose mothers participate in the company’s employee maternity and lactation program.

Why isn’t breastfeeding more common, then? Below are some key barriers, as discussed by the U.S. Surgeon General3:
• Lack of Knowledge: While breastfeeding is considered a natural skill, some mothers may need education and guidance. Providing accurate information can help prepare mothers for breastfeeding.
• Lactation Problems: Sometimes babies have a tough time getting good at breastfeeding and an experienced lactation specialist can provide assistance. Most of these are avoidable if identified and treated early, and need not pose a threat to continued breastfeeding.
• Poor Family and Social Support: Fathers, grandmothers, and other family members strongly influence mothers’ decisions about starting, continuing, and accommodating breastfeeding.
• Social Norms: Many people see breastfeeding as an alternative rather than the routine way to feed infants.
• Embarrassment: The popular culture’s view of breasts as only having a sexual purpose compels some women to avoid breastfeeding. Improving support for women to breastfeed can help them better accommodate the demands of everyday life while protecting their infants’ health and can be accomplished at no risk to their own modesty.
• Employment and Child Care: Employed mothers typically find that (1) returning to work and (2) lack of maternity leave are significant barriers to breastfeeding.
• Health Services: Health care systems and health care providers can improve mothers’ breastfeeding experiences by pursuing and obtaining the training and educational opportunities they need in order to fully support their patients.

There are many ways to help new mothers increase their knowledge and skill in regards to breastfeeding. An excellent book written on the subject is “Ina May’s Guide to Breastfeeding,” written by world-renowned midwife, Ina May Gaskin of The Farm in Summertown, Tennessee. There are certified lactation consultants and breastfeeding support groups in many areas, including North Alabama. To find a La Leche (which is Spanish for “the milk”) League group, visit http://www.lllalmsla.org/lll-groups/alabama-groups/. Another great resource for breastfeeding support is an International Board Certified Lactation Consultant. Visit www.ilca.org to find a provider in your area.

Protect your newborn by committing to breastfeeding him or her for at least 6-12 months, or longer if you can!

1http://www.surgeongeneral.gov/library/calls/breastfeeding/factsheet.html
2http://www.surgeongeneral.gov/library/calls/breastfeeding/factsheet.html
3http://www.surgeongeneral.gov/library/calls/breastfeeding/executivesummary.pdf
By: Rachel Clark, RN, BSN

7-17-2015 1-48-39 PMMany of us (as many as 90% of adults before age 40) have felt that annoying tingling sensation on or around our lip. If you’ve had more than one of these episodes, you already know what is coming next: the unsightly, painful blister that breaks and oozes before crusting over and eventually sloughing off. They typically take 7-10 days to completely heal and are contagious until that time.

Cold sores, also commonly called fever blisters, are the result of a virus. The most common strain is herpes simplex type one, but they can also be caused by the herpes simplex virus type two. The most common sites for them to appear include the outside of the lips, nose, cheeks or fingers. Though viruses have no permanent cures available, many people develop antibodies after the first infection and never develop another cold sore. However, for as many as 40% of those infected, cold sores are a recurrent problem.

For most people, cold sores are not a serious problem. However, for those who are immunocompromised (such as cancer patients, chemotherapy recipients, transplant recipients, and AIDS patients), cold sores can be severe and even life-threatening. Unless you have one of the above conditions, there are many options available to help with the symptoms of cold sores.

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Cold sores are generally transmitted by direct contact such as kissing, sharing cups or eating utensils, towels, razors, or sexual contact through sexual contact. Common triggers for an outbreak include menstruation, pregnancy, stress, fevers, colds, flu, allergies, sunburns or any other illness that potentially taxes the body.

There are four stages of cold sores: before an active outbreak (prevention), first sign of impending outbreak, active outbreak, and recovery. Treatment depends upon figuring out which stage you are in. Below, you will find some strategies for dealing with each stage.

Prevention:
During this stage, it is important to perform good self care. You should get enough sleep, support your body with adequate nutrition, prevent sunburn, and recognize/avoid common triggers that you have noticed personally.

Herbs
There are also various herbal remedies for preventing outbreaks. Two categories of herbs include what are know as adaptogen herbs and immunomodulating herbs. Avoiding stimulating nervines such as coffee and tea could help decrease frequency of outbreaks. Adaptogen herbs strengthen the body’s response to stress, and combined with diet and lifestyle changes maximizes the prevention of cold sores. Immunomodulating herbs make the body less vulnerable. Antiviral herbs, taken both preventatively and during an outbreak, can help minimize from replicating and attaching to cells.
• Adaptogen herbs: ginseng, codonopsis, astragalus, holy basil, ashwagandah, shatavari, eleuthero, rhodiola, schizandra, reishi mushroom, and licorice.
• Immunomodulating herbs: astragalus, reishi, cordyceps, shitake, and tulsi.
Three other very powerful herbs for cold sores include St. Johns Wort, Balloon Flowers, and Lemon Balm.

Dietary
Eating foods rich in lysine and avoiding those high in arginine can also help prevent an outbreak. The virus needs arginine to replicate, and lysine blocks arginine. Foods high in lysine include meat (turkey, beef, chicken), milk, cheese, eggs, and fish. Foods high in arginine include wheat, oatmeal, brown rice, nuts, chocolate, and beer. Many people also take lysine supplements that can be found at most herb stores. Some nutrients/vitamins that can be helpful include Vitamin C (found in rose hips, pine needle leaves, dandelion leaves, citrus fruits and green leafy vegetables), Magnesium (found in leafy greens, but most people need supplements), and Vitamin D (for which sunlight is necessary to absorb).

First signs of an outbreak:
For best results, action should be taken at the first sign of outbreak. These include regular teas or tinctures of immunomodulating herbs, large doses of lysine supplements, topical treatments of vulnerary (healing) herbs to help heal the wound more quickly (such as calendula, aloe, plantain, comfrey, chamomile, and turmeric), topical St. Johns Wort oil or tincture applied liberally and frequently, topical treatments of lemon balm oil or tincture, and essential oils such as tea tree, lemon balm, and Thieves.

During an outbreak:
Get enough rest and eat a diet that supports your body during illness. Also continue taking antiviral herbs such as St. Johns Wort and lemon balm, as well as vulnerary herbs mentioned in the previous paragraph. You can also apply ice to reduce pain and swelling at the site. Many people will make teas and freeze them for that added kick.

Recovery:
Rest and proper nutrition (a diet high in fruits and vegetables) are essential during this time. This period can last anywhere from 7 to 10 days. When the acute stage is over, sores heal and new skin forms. You can also use herbs during this period to assist your body. Relaxing nervines such as cramp bark, valerian, California poppy, milky oats, skull cap, chamomile, passionflower, lavender, St. Johns Wort, lemon balm, and vervain all help relax the nervous system, promoting calm and sleep. Trophorestorative (balancing) herbs such as milky oats, goldenseal, nettle seed, milk thistle, yerba mansa, hawthorn, and St. Johns Wort can help bring balance.

There are also medications such as prescription Valtrex and over the counter Abreva available to help lessen the symptoms of an outbreak. For more information, contact your healthcare provider to discuss which options might be best for you.
By: Rachel Clark, RN, BSN