Did you know that one out of every three adults age 65 or older fall every year? More than 95% of hip fractures are caused by falls. To remain independent and reduce the risk of falling, seniors can:

• Exercise regularly. You'll improve your leg strength and standing balance.
• Review your medications. Talk with your doctor or pharmacist to identify whether any of your medicines cause side effects or interactions, such as dizziness or drowsiness.
• Check your vision. Have your eyes checked by an eye doctor at least once a year.
• Make your home safe. Make sure you have adequate lighting, reduce tripping hazards, add grab bars inside and outside your tub or shower and next to the toilet, and add rails to both sides of stairways.

March is National Nutrition Month, and Methodist Registered Dieticians are answering your questions. 

Q: Can drinking a lot of carbonated water have a negative impact over time? 

A: There is no evidence that regular water is healthier or that carbonated water is more nutritious than regular tap water. Carbonated water has no fat, calories, protein, carbohydrates or fiber. It has no vitamins and no significant amounts of minerals. Different brands of sparkling or carbonated waters may each have a distinct taste, thanks to the amounts of trace minerals that vary among source locations. The amounts of these minerals are so slight that they do not make an appreciable difference in the nutrient value of the water.  

The most important nutritional benefit of carbonated water is hydration. Water makes up 60 percent of your total body weight. Carbonated water is as effective as regular spring water or tap water in replacing fluids lost in urine or sweat.  Conventional wisdom advises everyone to drink eight 8-oz. glasses of water per day. This can be achieved with tap water or carbonated water.

Claims have been made that carbonated water erodes teeth and bones, leaches calcium and increases acidity in the stomach. These claims have not been borne out by experiment. In a healthy human, carbonation of water does not lead to ill health effects. 

(Answer provided by Laura Blair, MS, RD at Methodist South Hospital.)

Registered Dietitians can provide Medical Nutrition Therapy related to blood pressure, blood sugar, preventive care, gluten free needs and some GI disorders, food allergy, decreased kidney function, weight loss/gain and more.

Most insurances cover the cost of nutrition therapy at the request of your physician. Check with your insurance company to find out if your plan covers classes, and talk to your doctor about providing a written request.

More Information:
Contact Amanda Carmichael, BS, RD, LDN, 901.516.6357
Fax physicians requests: 901.937.3334

March is National Nutrition Month, and Methodist Registered Dieticians are answering your questions.

Q: Are there certain foods a person with Graves' Disease should avoid (in relation to their metabolism)?

A: Individuals who have not had their thyroid removed typically require a high-calorie (especially from carbohydrates, i.e., grains, fruit, milk, starchy vegetables, sugar) and high-protein diet. To prevent weakened bones, adequate phosphorus, calcium, and vitamin D should be included in the diet with a multivitamin-mineral (without iodine).

Limit iodine-rich foods like seaweed wraps (nori) on sushi or shellfish/seafood, iodized-salt (meat tenderizer and MSG), E-127 Erythrosine food coloring (Red Dye #3), dairy and milk chocolate, and egg yolks. Keep in mind that some meats (especially poultry) are injected with broth (i.e., salt) to maintain the juiciness of the meat. Processed meats are often sodium rich as well, and the food label will not differentiate between iodized and non-iodized salt ingredients.

Avoid alcohol and caffeine (coffee, tea, cola soft drinks, and chocolate). Raw cabbage, Brussels sprouts, kale, cauliflower, soybeans, and peanuts may compound the side effects of anti-thyroid medications. Non-iodized salt is permitted.

Q: What diet advice do you have for someone with Hashimoto's Disease?

A: A calorie restriction is often needed to prevent weight gain. Calorie needs are based on age, sex, height, and activity level. Thus, they are specific to the individual. Generally, reduction of 500 calories per day from one’s current intake will result in safe weight loss. Weigh yourself frequently to determine if weight change is true or due to fluid retention/loss. You should monitor your vitamin B12, folic acid, and iron and supplement them if you're deficient. Raw cabbage, Brussels sprouts, kale, cauliflower, soybeans, and peanuts should be avoided. Avoid dietary supplements, like kelp tablets, unless discussed with your physician first. Iodized salt is permitted.

Please contact a Methodist dietician at the information below for additional information regarding these issues. 

(Answers provided by Allison Kent, MS, RD, LDN, CNSC at Methodist Germantown Hospital.)

Registered Dietitians can provide Medical Nutrition Therapy related to blood pressure, blood sugar, preventive care, gluten free needs and some GI disorders, food allergy, decreased kidney function, weight loss/gain and more.

Most insurances cover the cost of nutrition therapy at the request of your physician. Check with your insurance company to find out if your plan covers classes, and talk to your doctor about providing a written request.

More Information:
Contact Amanda Carmichael, BS, RD, LDN, 901.516.6357
Fax physicians requests: 901.937.3334

Q: Are there any diet recommendations for a person recently diagnosed with psoriatic arthritis?

A: According to the National Psorias Foundation, manipulating the diet has not been found to be useful for psoriatic arthritis. The Foundation does state that there are some dietary supplements that have been found to help some people with arthritis. Supplements mentioned included chondrioitin, methylsulfonylmethane (MSM) and S-adenonosylmethionine (SAM-e). Since osteoarthritis may occur with arthritis, calcium supplements along with Vitamin D may be of benefit.

(Answer provided by Lucy Ridley RD, LDN  at Methodist Le Bonheur Germantown Hospital)

Q: What are the best types of foods for preventing or fighting inflammation, such as that associated with autoimmune disorders?

A:  The best types of food that help fight inflammation are:

• Foods with omega-3’s (salmon, trout, herring, flaxseeds, and walnuts)
• Antioxidant-rich foods (strawberries, blueberries, raspberries, cantaloupe, kale, spinach, sweet potatoes, and bell peppers)
• Olive oil
• Spices
• Green tea (3 to 4 cups a day to see benefits)

Some foods that contribute to inflammation are saturated fats, trans fats, added sugar/table sugar, and refine/processed carbohydrates. Always think bright, colorful, and fresh!

(Answer provided by Jessica Wootton, RD at Methodist North Hospital)

Registered Dietitians can provide Medical Nutrition Therapy related to blood pressure, blood sugar, preventive care, gluten free needs and some GI disorders, food allergy, decreased kidney function, weight loss/gain and more.

Most insurances cover the cost of nutrition therapy at the request of your physician. Check with your insurance company to find out if your plan covers classes, and talk to your doctor about providing a written request.

More Information:
Contact Amanda Carmichael, BS, RD, LDN, 901.516.6357
Fax physicians requests: 901.937.3334

March is National Nutrition Month, and Methodist Registered Dieticians are answering your questions.

Q: What are the benefits of a vegan or vegetarian diet?

A: Studies that look at people and their habits have linked vegetarian diets with a decreased risk of heart disease, diabetes, high blood pressure, obesity, and colon cancer. Basing one’s diet on plant foods—grains, beans, vegetables, and fruits—is the best way to keep saturated fat intake low and to avoid cholesterol completely. A vegan diet is free of all animal products and yields the lowest risk of heart disease. One study showed that people who adopt a vegetarian diet reduce their saturated fat intake by 26 percent and achieve a significant drop in cholesterol levels in just six weeks. Besides the very low levels of fat eaten in a typical vegetarian diet, vegetable protein also helps decrease risk for heart disease. Studies have shown that replacing animal protein with soy protein reduces blood cholesterol levels even when the total amount of fat and saturated fat in the diet remain the same. Soluble fiber helps to slow the absorption of some food components such as cholesterol. It also acts to reduce the amount of cholesterol the liver makes. Oats, barley, beans, and some fruits and vegetables are all good sources of soluble fiber. There is no fiber in any animal product.

(Answer provided by Audrey Justus MS, RD, LDN at Methodist South Hospital)

Registered Dietitians can provide Medical Nutrition Therapyrelated to blood pressure, blood sugar, preventive care, gluten free needs and some GI disorders, food allergy, decreased kidney function, weight loss/gain and more.

Most insurances cover the cost of nutrition therapy at the request of your physician. Check with your insurance company to find out if your plan covers classes, and talk to your doctor about providing a written request.

More Information:
Contact Amanda Carmichael, BS, RD, LDN, 901.516.6357
Fax physicians requests: 901.937.3334

March is National Nutrition Month, and Methodist Registered Dieticians are answering your questions.

Q: Can you take too many vitamins?

A: Yes, there are a number of vitamins and, for that matter, minerals that can lead to toxicity if taken in large doses. Vitamins A, D, E and K (the fat soluable vitamins) and many minerals such as iron can lead to serious side effects if taken in amounts exceeding the Recommended Daily Allowance (RDA).

The best way to meet your nutrient requirements is to eat a diet including five servings of fruits and vegetables daily. If you still feel a supplement is necessary, consult a registered dietitian who will be able to guide you on the proper amount to meet your needs.

(Answer provided by Sara Estabrook MS, RD, LDN at Methodist Le Bonheur Germantown Hospital)

Registered Dietitians can provide Medical Nutrition Therapy related to blood pressure, blood sugar, preventive care, gluten free needs and some GI disorders, food allergy, decreased kidney function, weight loss/gain and more.

Most insurances cover the cost of nutrition therapy at the request of your physician. Check with your insurance company to find out if your plan covers classes, and talk to your doctor about providing a written request.

More Information:
Contact Amanda Carmichael, BS, RD, LDN, 901.516.6357
Fax physicians requests: 901.937.3334

With the winter months quickly approaching, the weather this season brings with it can prove to be dangerous to those with physical challenges. It’s important for patients and their caregivers to be aware of the potential dangers colder weather may bring, specifically to those confined to a wheelchair. Road & Travel Magazine shares a few helpful tips for overcoming these challenges.

• Use the buddy system. Have a friend or family member travel with you when it’s snowing or while there is snow or sleet on the ground. Doing so makes you less likely to slip when transferring into a mobility vehicle or going into a store. Keep someone nearby to help out during the winter months to ensure your safety and comfort in your travels, whether you’re going to the store or to a friend’s house.
• Prepare, prepare, prepare. Many wheelchair and scooter users own mobility vehicles that they can drive. If you are one of those drivers, there are several things to consider during the winter time. The snow may be beautiful, but it can also be inconvenient and dangerous when it comes to driving. Whether the forecast calls for heavy rain, lake effect snow or ice, you should always feel safe and secure driving your wheelchair-accessible vehicle.
• Check for snow or puddles. If you have to back your wheelchair or scooter through the snow or a puddle, be sure to do it slowly so you don’t splash yourself or the scooter and ramp.
• Keep an emergency kit. In addition to an old towel, keep essentials such as a light blanket, some bottled water, a cell phone charger and a fully-charged battery for your scooter. In addition, keep an extra bottle of wiper fluid and make sure you have half a tank of gas at all times to ensure your safety in the event that gas stations are closed. These items will keep you safe and secure throughout the winter time and even into the spring.

If you or your loved one is in need of a new wheelchair, Methodist Healthcare now offers power wheelchairs. Power wheelchairs provide the ultimate combination of style, comfort and safety for people on the go! For ordering information, or to learn more about referral criteria, call Methodist Home Medical Equipment at (901) 516-1999.

Adult and pediatric standard wheelchairs are also available through the Methodist Home Medical Online Store. Click here for complete product and ordering information of standard wheelchairs.

Methodist Home Medical Equipment
Phone: (901) 516-1999
(800) 541-8277
Fax: (901) 382-1979
www.methodisthealth.org

Sources:
Road & Travel Magazine

Continuous positive airway pressure, or CPAP, is the standard treatment option for moderate to severe cases of Obstructive Sleep Apnea (OSA) and is a good option for mild sleep apnea. CPAP blows air into a person’s windpipe at a set, steady pressure. This airflow keeps the airway open, preventing pauses in breathing and restoring normal oxygen levels.

Patients who require CPAP supplies can order them conveniently online by clicking here.

Whether you are a patient who has just started CPAP treatment, or a patient who has experienced the benefits of this treatment for many years, it’s important to have a clear understanding of how to clean and disinfect your respiratory equipment. Check out these tips from CPAPStation.com for how to keep your equipment in pristine working order.

Cleaning and disinfecting your respiratory equipment is essential to the life of the equipment and to your health. Whenever moisture is present, from water supplies, from body humidity, or any bodily fluid, bacteria can grow. If your equipment is not properly cleaned and dried, bacteria builds up and can lead to infections in your body, especially in your airway passages. Also, the oils in your skin and the minerals in tap water can cause premature breakdown in the materials used to manufacture your CPAP equipment, especially your mask. Therefore, we recommend the cleaning and disinfection schedule be followed diligently.

Daily cleaning removes dirt and oils that may harbor germs. Disinfection actually kills germs that may lead to infection. Remember to always wash your hands prior to handling your CPAP equipment.

To wash your CPAP equipment:
Only use a mild, non-lotion detergent. Do not use soap or strong dish washing detergents such as Dawn or Joy. Avoid detergents that use strong perfumes or dyes. We recommend using a dishwashing detergent like Ivory Clear, Palmolive, or Dial Anti-Bacteria for cleaning your equipment.

To disinfect your equipment:
Mix 1/2 oz. (1 tablespoon) of Control III with 2 quarts of water in a plastic container. The solution can be reused for up to 14 days. If the solution becomes visibly dirty, make a fresh batch. First wash and rinse your CPAP equipment, then soak it in the Control III solution for 10 minutes. Rinse thoroughly (allow water to run for 3 minutes) with tap water and then allow to air dry. Cover dried parts with a clean towel until the equipment is reassembled. To dry your CPAP tubing, hang over a doorknob or hanger. Alternative to Control III - Wash equipment with warm, soapy water, rinse and then soak equipment in a 50/50 solution of white distilled vinegar and water for 15 to 30 minutes. Rinse well and dry as instructed above.

Drying Hints:
Always hang tubing away from direct sunlight, as this will cause the tubing to become yellow, brittle and crack over a period of time. DO NOT attach the wet tubing to your CPAP unit to blow-dry it. The moisture from the tubing can drain back into your machine. Moisture in your unit can cause sudden pressure increases or short circuits.

Cleaning the CPAP unit:

• Unplug the unit before cleaning it.
• Never immerse the unit in water.
• Using a cloth slightly dampened with water and dish detergent, wipe the outside of the unit.
• Using a cloth dampened with water only, wipe the outside of the unit again.
• Use a dry cloth to wipe the unit and then let it air dry.
• Make sure the unit is thoroughly dry before plugging it in.

Cleaning and Disinfecting the Humidifier:
DAILY

• Empty any remaining water after each use.
• Never immerse the unit in water.
• Wash your hands.
• Immerse the humidifier in warm, soapy water.
• Fill the humidifier with the soapy water and shake the humidifier vigorously.
• Rinse with clean water and allow to air dry.

WEEKLY

• Mix disinfecting solution (1 tablespoon disinfectant per 2 quarts water).
• Soak the humidifier in disinfectant for 10 minutes.
• Be sure the disinfectant completely covers and fills the humidifier.
• Remove the humidifier and shake out the excess solution and rinse with distilled water.
• Allow to air dry.

DO's and DON'Ts:

• Don't use alcohol-based products to clean your mask, because it can cause the materials to become hard and brittle.
• Do follow the recommended cleaning schedule.
• Don't use any caustic or household cleaning solutions such as bleach on your CPAP equipment.
• Do change your disposable filter frequently.
• Don't put headgear in the washer or dryer.

CPAP Equipment Cleaning and Disinfecting Schedule

If you or your loved one requires CPAP supplies or any other home medical equipment, please visit the Methodist Home Medical Equipment Online Store at www.methodistmedicalequipment.org.

While we’d all like to think that a discharge from the hospital leaves us at 100 percent, often recovery time and medical equipment is needed for complete recovery at home.

Your medical care team, which includes physicians, home health aides and social workers, can give you a list of equipment and supplies you will need. It also might be beneficial to look into a care coordinator for your family. A care coordinator can take stock of your situation, help you access the right services, counsel you and your family, then monitor your progress with an eye toward channeling your energy and abilities as effectively as possible. Having the help of a care coordinator (often called a care manager) could make your life easier and less lonesome, and help you be a more capable family caregiver.

Depending on your condition, the following are possible medical supplies that your loved one could need at home:

• Aerosol supplies
• Apnea monitors
• CPM machines
• Crutches
• Group 2 mattresses
• Hospital beds
• Incontinence products
• Oxygen
• Portable Oxygen concentrator
• Patient Lifts
• Tens Unit
• Urological Products including bedside commodes
• Volume & Pressure supported Ventilators
• Power Wheelchairs
• Wheelchairs & Accessories
• Walkers

All of these supplies are available online, at www.methodisthealth.org/hme. Methodist Healthcare accepts most major insurance plans, including:

• Medicare
• Medicaid
• TennCare
• Worker’s Compensation
• Most private insurance

It’s a good idea to have the required equipment delivered and in working order before your discharge from the hospital. The Methodist Home Medical Equipment office is open for equipment pick-up from 8 am to 5 pm, Monday-Friday (with the exception of major holidays). Delivery is available 24 hours a day for new referrals.

By having everything ready in advance for your loved one's return you will help ensure a more comfortable transition home.

Methodist Home Medical Equipment
Phone: (901) 516-1999
(800) 541-8277
Fax: (901) 382-1979
http://www.methodisthealth.org

Sources:
http://www.caregiverstress.com
National Family Caregivers Association

Methodist Healthcare offers medical alert service that helps enable continued independence for seniors by improving access to help in the event of a fall.

Lifeline with AutoAlert can detect falls—with high rate of detection and low rate of false alarms—and automatically call for help

Methodist Healthcare now offers Lifeline with AutoAlert, an enhanced medical alert service.  This integrated solution offers an added layer of protection by combining the industry-leading Lifeline medical alert service with automatic fall detection capabilities. Lifeline with AutoAlert features the only pendant-style help button that can automatically call for help if a fall is detected and a senior is unable to push his or her help button.  According to an internal laboratory study of simulated falls, Lifeline with AutoAlert detected 95 percent of many types of falls and had a low rate of false alarms.

Seniors are living longer and remaining in their own homes; however, falls have become an epidemic problem that jeopardizes seniors’ chances to live independently. Every year in the U.S., one out of three people age 65 and over will fall.¹ This statistic translates to one person falling every 2.3 seconds on average.² 

Among seniors, falls are the leading cause of nonfatal injuries and hospital admissions for trauma, as well as injury-related deaths.³  Close to 50 percent of seniors can't get up from a fall without help⁴ and lying on the floor for an extended period of time can lead to serious complications, including: pressure ulcers, muscle necrosis, dehydration, hypothermia, and pneumonia.  The care and treatment of these potentially preventable complications are costly to the healthcare system and negatively impact quality of life for seniors.

Lifeline with AutoAlert is designed to help reduce the risk of long lie times.  If a fall victim receives help more quickly, that may reduce emotional distress and potential costs of extended treatment, rehabilitation and supported living.  With AutoAlert, if a fall is detected, subscribers still have the opportunity to receive quick access to assistance even in situations where they can’t push their button, for example, if they lose consciousness, become immobilized, forget to push their button or won’t push their button because they feel they can manage the situation independently. Just as important, the service can provide added confidence and peace of mind to the 22 million seniors who fear falling.⁵    

“One of the greatest threats to seniors’ health is falls and associated injuries,” said Methodist referral relationship executive Mary Franks.  “For the cost of a cup of coffee a day, Lifeline with AutoAlert can help seniors maintain their independence and provide their caregivers even more peace of mind.”

For more information about Lifeline with AutoAlert, please click here, or call 901-516-1999 to order the service.

References

1. CDC, National Center for Injury Prevention and Control, Fact Sheet on Falls. http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html. Original Study as noted in CDC report: Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community–living older adults: a 1–year prospective study. Archives of Physical Medicine and Rehabilitation 2001;82(8):1050–6.
2.  U.S. Census Bureau, Population Division, Interim State Population Projections, 2005.  Interim State Projections of Population for Five-Year Age Groups and Selected Age Groups by Sex: July, 1 2004 to 2020.
3. CDC, National Center for Injury Prevention and Control, Fact Sheet on Falls. http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html. Originally from: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005)
4. Falls, fractures, and injury, Merck Manual of Geriatrics, Section 2, Chapter 20, Topic: Falls. p.1. www.merck.com/mkgr/mmg/sec2/ch20/ch20a.jsp.
5. Jette, Alan, PT, PhD, Fear of falling in older persons, White Paper published by Philips Lifeline, 2008, p 2.

Exercise seems like the last thing you want to do when you are depressed or feeling blue. But once you get motivated, exercise can make a big difference.  Exercise helps prevent and improve a number of health problems, including high blood pressure, diabetes and arthritis. Research shows that the psychological and physical benefits of exercise can also help  improve mood.

How does exercise help depression? Exercise probably helps ease depression in a number of ways, which may include:

• Releasing feel-good brain chemicals that may ease depression (neurotransmitters and endorphins)
• Reducing immune system chemicals that can worsen depression
• Increasing body temperature, which may have calming effects
• Doing something positive to manage depression is a healthy coping strategy.

What kind of exercise is best?
The word "exercise" may make you think of running laps around the gym. But a wide range of activities that boost your activity level help you feel better. Certainly running, lifting weights, playing basketball and other fitness activities that get your heart pumping can help. But so can gardening, washing your car, or strolling around the block and other less intense activities. Anything that gets you off the couch and moving is exercise that can help improve your mood.

You don't have to do all your exercise at once, either. Add small amounts of physical activity throughout your day. For example, take the stairs instead of the elevator. Park a little farther away at work to fit in a short walk.

Take time to take care of yourself and do activities that you enjoy that will get you moving and make you feel better.

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Dawn Caldwell is a Physical Therapist in Memphis, Tennessee with Methodist Healthcare. All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice. Call 888.777.5959 for more information.

Frequently Asked Questions About Bariatric Surgery

1. Which procedure do you recommend?
   There are three main procedures performed currently in the US. The Lap Band, the gastric sleeve, and the gastric bypass. All three procedures work and have good results when performed by an experienced surgeon and on a patient willing to follow instructions and make lifestyle changes. The most common procedure performed in America is the Lap Band.
2. How much weight can I lose?
   The first order of business is to determine how overweight a patient really is. The average patient will lose about 60-70% of their excess weight after surgery. This means that if someone is 100 pounds overweight, the average patient will lose and keep off about 60-70 pounds. Of course, some patients lose more and some less, depending on their willingness to stick to lifestyle change.
3. Why am I overweight?
   Everyone's weight basically comes down to how much you eat, what you eat, and how much real exercise you do. In general, it has little to do with your job, stress level, family life, etc. Our job is to help educate our patients so that they understand proper portion size, how to eat, prepare, and recognize appropriate foods, and on how to perform proper exercise.
4. Does my insurance cover the surgery?
   Most patients have coverage through their insurance. Look at your policy and see if 'bariatric surgery' or 'treatment of obesity' is a covered benefit. We can help you to figure this out. After an office evaluation we can determine your coverage status and help to get you approved if you are a candidate. Some patients are covered but only after they fulfill certain requirement set forth by their insurance company.
5. How much does surgery cost?
   Most patients are covered under their insurance plans. However, approximately 20% of patients do have to 'pay out of pocket' for their surgery/hospital stay. Surgery is not inexpensive, but when compared to the alternative of paying for the complications of obesity down the road, the cost is reasonable. Because we do a high volume of cases and have good results, the hospital makes every effort to keep the costs as low as possible for our patients. This can be discussed on an individual basis in the office, as each patient has different needs.
6. How long do I stay in the hospital?
   Lap band surgery usually requires a 4-6 hour outpatient hospital visit. The sleeve and bypass procedures usually require about a 2 day hospital stay. Most patients are back to normal activities within 2 weeks, some within 2 days.
7. Why should I have surgery at a Center of Excellence?
   When you make the decision to have bariatric surgery, make sure that it is performed by a surgeon and/or facility that is associated with a Center of Excellence. This is a designation given based on a high volume of cases, good outcomes, and following appropriate protocols that help to optimize good patient outcomes. It has been shown that bariatric surgery performed at lower volume centers have higher rates of complications.

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Dr. George Woodman is a bariatric surgeon and director at MidSouth Bariatrics. Dr. Woodman has performed over 3500 laparoscopic bariatric procedures to help those patients lose over 200,000 pounds. All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice. Call 888.777.5959 for more information.