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PLANNING FOR GOOD NUTRITION: COMMUNITY PROGRAMS FOR OLDER PEOPLE

2010-07-07T03:48:00.001-07:00

The Older Americans Act includes funding for a nutrition program that provides one meal a day for at least five days a week for elderly persons who can come to a center for senior citizens. Each meal is planned to furnish at least one third of the recommended allowances. Provision for modified diets can usually be made in these centers. Nutrition education, periodic health checks, and recreational activities are important components of this program.
Two programs provide meals for persons who are home bound. One of these is federally funded and originates in the centers for older Americans. At least one hot meal is delivered five days a week. In some circumstances arrangements are made for two daily meals, including weekends. "Meals on Wheels" is a program that provides a hot noon meal and a cold evening meal. The program is sponsored by community agencies, for example churches or hospitals. The recipient pays for the meals on a sliding fee scale according to ability to pay.

PROTECTING YOURSELF AGAINST COMMON POISONS: STRONTIUM 90

2010-07-07T03:47:00.000-07:00

World-wide nuclear tests and explosions have now contaminated the whole globe with toxic Strontium 90. Scientists say that everyone has already dangerous amounts of radioactive Strontium 90 in their bones. It stays in the body throughout the lifetime, emitting radioactive rays, like x-rays.
Anemia, leukemia, sarcoma of the bones (bone cancer) and many other cancers are believed to be caused by Strontium 90.

Protection
1. Algin. Extracted from giant brown Pacific kelp, this non-toxic substance can effectively remove radioactive Strontium 90 from the body. Algin can be used in the daily diet instead of such thickening agents as gelatin or cornstarch, or mixed with milk or other drinks.
2. Pectin. It binds radioactive Strontium in the intestines and reduces its absorption and deposition in the skeleton. Only the pectin derived from sunflowers was found effective. Eat plenty of raw sunflower seeds daily.
3. Calcium and magnesium. Both help your body to pass off Strontium 90. When selecting your mineral supplement, make sure it is not made from American animal bones which contain large amounts of Strontium. The best bone meal supplements are made from South American bones, which are not so contaminated. Bone meal with bone-marrow is the best. Deep-mined mineral supplements, such as dolomite and others, are advisable. Dr. Linus Pauling says that heavy calcium supplementation will reduce strontium absorption by 50 percent.
4. Yogurt and other soured milks help to neutralize the radioactive chemicals in the intestines and excrete them safety from the body. Up to 1 quart a day of soured milk can be consumed.
5. B-complex vitamins, or Brewer's yeast. It has been shown in animal studies that brewer's yeast affords protection against radiation.
6. Kelp. Sodium alginate in kelp reduces absorption of Strontium 90 by 50 to 80 percent. Take 1 to 2 tsp. of granules daily, or 5 to 10 tablets.
7. Lecithin. Lecithin in daily diet can counteract the effects of radiation.
8. The following vitamins can help to guard against radiation toxicity: E, C, and B-complex.
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PSYCHOLOGICAL AND PHYSICAL REST

2010-07-07T03:46:00.001-07:00

There have been few surgical classics. Mr. Hilton, of Guy's Hospital, London, England, wrote one about a century ago on The Therapeutic Influence of Rest and the Diagnostic Value of Pain. He pictured the expulsion from the Garden of Eden, the first wound, and resulting dismay; and, "the original promptings of nature to man for the alleviation of his altered condition. Pain was made the prime agent. Under injury, pain suggested the necessity of, and, indeed, compelled him to seek for, rest."
His thesis was that nature could heal the injuries caused by wounds or disease only when the affected part was allowed to rest. And by rest he did not necessarily mean lying in bed or sitting in a chair. He spoke of physiological rest. A piece of dirt lodges under the eyelid and soon there is a conjunctivitis. Nature cannot cure this as long as there is no rest for the tissues because of irritation. Remove the dirt and rest will soon effect a cure even without silver nitrate.
Compound fractures in recent years have been treated by good cleaning, and putting up the affected parts in plaster casts where they cannot be disturbed by dressings or movements. This does not mean that the patient cannot tire himself out by traveling about on crutches. The patient with appendicitis gets physiological rest when the sick organ is taken out. Even a male can appreciate that a woman who was pregnant has achieved physiological rest when her constant companion of nine months is safely in the nursery.
On the other hand sometimes physical rest is needed. A physician caring for a rheumatic fever case may feel that he is putting extra work on the heart by allowing the patient to move about. He may doubt that this is compensated for by the aid to circulation that muscular activity gives. The liver is the largest organ of the body with a multitude of chores to do. Extra activity on the patient's part undoubtedly increases these chores. So Dr. Chester Jones, of the Massachusetts General Hospital, speaking to us a few years ago on liver diseases, stressed, next to diet, the importance of physical rest in treating these conditions. At about the same time Dr. Thorndike, of the same institution, depicted to us the dangers of staying quietly in bed. His patients were started walking within twenty-four hours of abdominal operations, women were up and about forty-eight hours after childbirth, and even people with heart trouble were let out of bed promptly.
How do we explain these apparently divergent views emanating from this shrine of Aesculapius? First we must remember the human propensity to swing upon a pendulum, and that in nearly all matters we go in cycles from one extreme to another. A short generation ago obstetrical patients spent several weeks of convalescence in bed, especially if they were well-to-do and could afford the care. The modern shortage of hospital beds and the general enthusiasm for acceleration programs have tended to demonstrate that this is not at all necessary. But analysis may show that the two methods are not so divergent in results when considered from Mr. Hilton's point of view.
Mr. Hilton had a patient who broke his leg and when put to bed developed jaundice. So Mr. Hilton reasoned as follows, I believe the congested liver which leads to the jaundice results from the forced rest to which the liver is subjected by the recumbent position; the circulation through the organ up to the period of the accident having been aided by active respiration and ordinary exercise. The withdrawal of these leads to congestion of the liver and hence jaundice." It may well be that when a patient is too inactive and the circulation slows down, actual physiological rest is thus lost.
We all believe in physiological rest. In each case we must decide whether complete bodily rest will give this. As Hippocrates said in his first aphorism, "Decision is difficult."
Although we will all accept rest as beneficent - and possibly my arguments may have produced a grumbling acceptance of pain - nevertheless it is with diffidence that I now ask you to include inflammation in this blessed category of protective devices. The word is, of course, closely related to inflammable, and refers to what Celsus, a hundred years after Christ, called the first of the four cardinal signs of inflammation: calor, rubor, tumor, and dolor (heat, redness, swelling, and pain).
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MENTAL HEALTH: LIGHT TREATMENT

2010-07-07T03:41:00.000-07:00

In 1979, Dr. Al Lewy, now professor of psychiatry at Oregon Health Sciences University in Portland, and Dr. Wehr began work on a hormone called melatonin, released by the pineal gland in the brain. Their studies revealed that light plays an important role in triggering and setting the biological clocks in animals. Other studies showed that exposure to light stops nighttime production of melatonin in the pineal gland. Dr. Lewy, Dr. Wehr, and their colleagues have found that nighttime melatonin production in humans can be stopped with 2,500 lux-intensity light. (Lux, Latin for light, is the unit of measure for brightness.) This suggests that such brightness could be used to reset human biological rhythms.
It was their melatonin work that brought Herb Kern to the National Institute in 1980. He asked Dr. Lewy to measure his melatonin levels. Mr. Kern, an engineer, had an undiagnosed case of SAD. He had kept records on his mood changes for 15 years and had told his doctors that, as the days got shorter, he "just wanted to crawl into a hole and hibernate." Mr. Kern recalls, "I finally latched on to the thought that sunlight was the key. When the days got longer in summer, the wheels of my brain would spin again." But, he says, his doctors didn't listen to him.
Dr. Lewy suggested lengthening Mr. Kern's winter days by sitting him in a room under bright fluorescent lights for 6 hours - three before dawn and three after sundown. Within days, Kern reported feeling as if springtime were around the corner. He still takes 2 hours of light treatment at 6 A.M. from fall to spring. "Since using the lights, I have been able to manage my depressions very nicely," he says.
The doctors spent the next few years focusing on the effects of light on mood and wanted to extend the study with more patients. Dr. Rosenthal told a reporter from the Washington Post about Mr. Kern and another patient. When the article was printed, thousands inquired about treatment. That was the first hint that SAD was a common disorder. With a selected group of patients, the doctors showed that light relieves wintertime depression. They also found that the brighter the light, the shorter the SAD treatment. Since then, studies worldwide have demonstrated the same, and the American Psychiatric Association now lists seasonal mood swings as a form of mental disease.
In New York, Dr. Terman has a new computerized approach: creating an artificial dawn. In phototherapy, "we were turning on very bright light suddenly after the patient wakes up," he says. "But when the eye is adapted to the dark while sleeping, it is 'looking' for a gradual transition to dawn. We put computer systems in a patient's bedroom to gradually turn on a light from very dim to bright, like a sunrise. Within a few days, we got results equal to any effect of bright-light therapy. The patients wake up spontaneously, refreshed. "
Dr. Terman says he tried it, because he detects seasonal changes in energy level and sleep in himself: "I maintained a summer sunrise throughout winter and was not groggy. It is a natural alarm clock."
Scientists already have shown that exposure to light can reset the biological clock if work shifts change or jet lag strikes. Some people have delayed sleep - biological clocks that won't let them go to sleep before 2 A.M. Others have advanced sleep and can't keep their eyes open after sundown. Light treatment can reset both.
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NUTRITION IN SURGICAL CONDITIONS: TUBE FEEDINGS

2010-07-02T04:53:00.000-07:00

A tube feeding is a nutritionally adequate allowance of liquefied foods that can be administered through a tube in the stomach or duodenum. A tube feeding is used in paralysis or obstruction of the esophagus, in anorexia nervosa, following mouth or gastric surgery, in severe burns, for unconscious patients, or in any situation where the patient is unable to chew or swallow.
Most hospitals now use commercial tube feedings, including blenderized feedings, milk-base formulas, lactose-free formulas, and synthetic residue-free formulas.
A milk-base formula may be prepared in the hospital or home. It is a calculated recipe that consists of whole or skim milk, eggs, some form of carbohydrate such as strained cooked cereal, sugar, or molasses, and vitamin supplements.
The protein content is sometimes increased by adding nonfat dry milk, and the calories can be increased by substituting cream for part of the milk.
A blenderized formula consists of strained baby meats, fruits, and vegetables in addition to the foods used in a milk-based formula. These formulas are generally better tolerated than milk-based formulas. They may also be varied from day to day to change the flavor, which many patients say they can taste. When there is intolerance to milk, an adequate formula can be developed that is milk-free.
Tube feedings are generally planned to supply one kilocalorie per milliliter. Thus a daily intake of 2 liters will furnish 2000 kcal.
The nurse should observe the patient carefully for the first few days after initiating a tube feeding, and be aware of complaints such as a feeling of fullness, gas, regurgitation, cramping, and diarrhea. Most if not all of these can be avoided by taking certain precautions. Initially tube feedings should be given at half to two-thirds strength, and in small volumes such as 30 to 60 ml every hour. When it is evident that the patient tolerates the feeding, the concentration and the volume can be gradually increased until the desired calorie level is reached.
Some tube feedings are not well tolerated because they contain excess sugars, amino acids, and electrolytes that draw fluid from the blood circulation into the intestine. The patient complains of weakness and distention. When the protein intake needs to be high it is important that adequate fluids be supplied so that the nitrogenous wastes can be efficiently excreted by the kidney. Some patients do not tolerate lactose and require feedings that do not contain milk.
Tube feedings are an excellent medium for bacterial growth. Feedings should be kept under constant refrigeration once they have been prepared or when a proprietary product has been opened. Any formula remaining at the end of a 24-hour period should be discarded. The tubes must be thoroughly flushed out.
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