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CRNA Wellness: Beverages are Making Us Fat

Driven to Drink?
The 6:30 a.m. drive-through line is long but the beverage baristas inside have got the gig down.  Take the order, take the money, write on the cup, hand it off and move’em forward.  Just across the overpass to our medical center, Starbucks customers line up bumper to bumper on their way to work.  And another of the Seattle-based ‘bucks right inside the entrance to the med center picks up the slack.  Mmmmm, creamy, sweet, warm…what’s not to like about lapping up your favorite frap on the way to tackling a heavy work schedule?  Answer:  The heavy part. Beverages are making us fat.

Getting Juiced
Let’s start with juice.  Orange juice and the members of its expanding family, are loaded with sugar.  They may be fortified with vitamin C, added calcium, or may contain those magical anti-oxidants that didn’t make it into your lunch bag, but most juices are also fortified with sugar, frequently over 15 grams of sugar per 8-ounce serving.  An 8-ounce glass of Tropicana original orange juice has 114 calories.  70 calories are sugar and though it may satisfy 96% of your daily requirement for vitamin C, there is only a tad of added calcium and a smaller tad of vitamin A.  Ounce for bounce, the payoff isn’t there.  A fresh orange, however, has a much lower 62 calories of which 48 are natural sugar(fructose), and it provides 116% of your necessary vitamin C.  An orange supplies twice the natural calcium as juice, three times the vitamin A plus 3.1 grams of natural fiber.  Plus, you get to chew!

There are entire aisles devoted to fruit- flavored beverages in bottles, boxes and cans in your shiny, upscale grocery chain, but nothing satisfies your body’s needs like fresh, whole fruit, the more color and the more variety, the better.  If ya just hafta have your bananas and berries in a beverage, get out the blender and give it a whirl.  You won’t need to sweeten the pot.

Smooth Move 
Blenders are used for making the smoothie. Originally, the smoothie was a fruit and ice beverage, sometimes with added sugar.  Although it debuted as a beverage in the 1930’s, Wikipedia says that the term smoothie/smoothy was actually conjured up by the hippies, though I don’t remember seeing any at Woodstock, and that California, with its ready access to fresh seasonal fruit was the original venue for vending it.  Now we blend smoothies choosing from yogurt, protein powder, kale, carrots, blueberries, strawberries, milk…the list is endless but the calories are increasing with the options.  It isn’t difficult to find a smoothie shop right around the corner from your produce market, only you’ll drink close to 300 calories if you buy it already made.  Go back around the corner, concoct your own smoothie and you take control.  To get through a busy day in the OR and still get your nutrients, a smoothie is a great choice. Opt for low fat, no sugar-added, skimmed-milk, light yogurt or water-based, make either fruit or veggie drinks, and avoid expensive, high-calorie add-ins.  If your smoothie is meant to enhance your work-out, a tablespoon of protein powder is a fine idea.  If dessert is a smoothie, go back to the original 1930’s recipe by using simply fresh fruit and ice. Eliminate the sugar and pour it in a six-ounce wine glass. Now that’s a juice bar!

Are You a Soda Jerk?
Coke, 7-up, Pepsi, Dr. Pepper, Sprite, Mountain Dew, Orange/Strawberry/Grape/Teenage Crush(just checking to see if you’re reading closely), Cream soda and Root Beer are just a few of today’s and yesterday’s beverages-that-make-you-belch.  For some reason, we get a kick out of slugging down that nutrient-free, sweet, fizzy bev and emitting a healthy g-blurp! within seconds after downing the drink.  But colas do not satisfy thirst.  They are wet and sometimes wild, but the ingredients are more de-hydrating than satisfying.  If you choose a caffeine-loaded, high-sugar cola bathed in dark dyes, you are headed for more thirst after drinking than before.  And you just slurped up at least 96 calories per 8 ounces.  A 12-ounce Classic coke is 144 calories and the same fluid measurement of Pepsi or Dr. Pepper weighs in equally at 150. Don’t forget, there’s sodium in them thar streams of sugar and diet sodas have even more. When you just want a little something sweet, a clear soda is the better choice, and a tall, glass, glass of iced cold water is best of all.

The Buzz
Alcoholic beverages are a whole other fast track to fat.  We try to jump-start the day with coffee; we imagine we’re getting a nutrient-dense kick with juice; we substitute meals and assume we’re enhancing exercise with smoothies; we pretend to quench our thirst with sodas; but there’s no denying the reason for consuming that 16-ounce margarita or two 6-ounce glasses of Menage e Trois…red or white.  It’s recreation.  Recreational drinking isn’t a sin, but be aware and compare.  One 4-6 ounce glass of red wine is typically 120-150 calories, no worse than a large serving of crunchy, sweet, juicy, red seedless grapes full of fiber and dessert-like qualities, but hey, I only said, “Be aware!”  White wine, though lower than red in calories by 25%, does not supply the same number of nutrients as red wine, obviously.  Think spinach and mushrooms, dark and light.  But neither red nor white is great for metabolizing fat… it’s alcohol, after all.  You’ll still need to drink plenty of water and skip the sucrose to avoid those heart-pounding chest rhythms.  And do you really want your morning mouth to feel like a cardboard balloon?

Hard liquors are worse for you than wine.  If you insist on preserving your right to imbibe the hard stuff, keep these things in mind.  On a regular diet of hard drink, Your tummy will get soft fast and your red nose may qualify for holiday hire.  Above the others in calories ounce for ounce, more toxic to your internal organs, completely free of nutrients, and potentially more addictive than adult beverages with lower alcoholic content, hard stuff is a poor choice all the way around. Particularly if you are on a wellness program that includes weight loss, deep six the Ten.

There are those who think that a nice cold one quenches the thirst after a nice hot one.  It doesn’t.  You will not cool down by drinking two pints of Fat Tire after mowing the yard or after playing baseball for two hours. But you can get a fat tire.  Beer does not re-hydrate; it doesn’t even hydrate; it is not a substitute for water.  What’s not to understand?  And if you have any interest at all in a flat tummy, fresh, sweet breath, skin that isn’t sticky and smelly and sweaty at bedtime, and if you’d like less opportunity to make a fool of yourself during Sunday afternoon’s TV Testosteronathan, then load up on water before watching the game, drink at least a quart before playing in one, and don’t touch a beer after mowing until you’ve fully re-hydrated with agua fria.  That beer-belly syndrome?  It’s nasty-looking, it’s high-risk and it’s for real.   Try Sparks.

Be-hold!
Here’s a last word about the extent to which industry here in the States has embraced the beverage boom. Behold the cup holder!  We are so dependent on doing something with our hands that nothing with wheels passes market inspection unless it sports a holder for a cup.  Nothing with wheels is exempt.  There’s a cup holder in your car, your truck, your child’s stroller, your grocery cart, your golf cart, your bicycle(okay, safety issue, fair enough), your yard wagon, your oversized cooler, your computer bag, your rolling backpack, your commercial bus, train or plane tray, and your beach roller bag, not to mention purses, fanny packs, exercise belts, cardboard drink holders…the list is endless, but not surprising, at least in the USA.  In Germany, a Bavarian Motorwerks standard issue comes cup-free, but in Spartanburg, SC, BMW assembles the high-end European parts and adds cupholders, “nur fuer uns!”

You Can Lead a Person to Water, but Can You Make ‘em Think?
When you are offered “something to drink,” do you think coffee, water, or a shot of Jack?
Okay, so that may depend on what kind of day you’ve had in the OR and whether it’s
6:00 a.m. or p.m., but, truthfully, if you are a two-fisted cola consumer, a caffeine dependent addict, a juice bar fly, or a regular consumer at Friday Nights Live, it may be time to balance your beverage accounts.  Click on some of the links below to read some nutrition facts and beverage tips’info.  Start thinking about what, why, and how much you drink BEFORE you drink it.  A flat tire is a lot easier to fix than a fat one.  Prost!

Compare the Keurig Chai Latte to the Starbucks Frappuccino

Click here for Smoothies

How many calories in a glass of wine?  Click here

How many calories in a non-alcoholic beer?  Click here

What drinks cause dehydration?  Click here

The truth about green tea…Click here

Please visit Liz at www.bdyfrm.com to read the daily Lizlines and Friday Lizlimerick.  Discover

Liz’s Bands In The Park mobile browser, a perfect companion for your walking or running group.

Research: Steep Trundelenburg and Postoperative Visual Loss

Postoperative visual loss is a rare but catastrophic event that has an increased in frequency with robotic surgery in the steep head-down position.    Studies have been conducted and reported in the literature relating intraocular pressure to postoperative visual loss.   One study conducted in the steep head-down position with laparoscopic surgery demonstrated increased intraocular pressure as time progressed.  Normally, cerebral and ophthalmic circulatory autoregulation prevent increased intraocular pressure, however, this may not be the case during general anesthesia in the steep head-down position.

Research conducted by Bonnie Molloy, CRNA, PhD  (A Preventive Intervention for Rising Intraocular Pressure: Development of the Molloy/Bridgeport Anesthesia Associates Observation Scale) and published in the AANA Journal (AANA Journal, June 2012, Vol. 80, No. 3) is a “must read” for any anesthesia provider administering anesthesia to patients in the steep head-down position.  This comprehensive review of postoperative visual impairment following head-down surgery details the pathophysiology and describes observable, physical changes that will alert the observant provider that intraocular pressures are increasing.

Data obtained by the author revealed that increasing intraocular pressure in the patient in the steep head-down position correlates to increasing eyelid and conjunctival edema.   These physical signs can be used to determine when it is advisable to level the patient and allow the intraocular pressures to decrease.

The result of this excellent, well documented study was the development of the Molloy/Bridgeport Anesthesia Associates Observation Scale.   Using the signs of eyelid and conjunctival edema, the anesthetist can predict when intraocular pressures are increasing.  The original work is complete with illustrations to guide the anesthetist in the use of the observation scale.

This original work was funded in part by a grant from the AANA Foundation and is essential knowledge for anybody routinely doing cases in the steep trundelenburg position lasting greater than 2-3 hours.  Click here to view the original publication.

Chief CRNA: CRNA supervision requirement reviewed by CMS

Physician supervision of CRNAs has been an ongoing topic of debate within the Anesthesia community for decades.  Under current law, CRNAs are required to be supervised by a physician unless the individual State “opts out” of the requirement.   To date, 17 States (Kentucky the most recent) have opted out of the requirement.

In a post on The Anesthesia Insider, blogger Neda Mirafzali, Esq  (Anesthesiologists Targeted in CMS’ Review of Existing Rules)  states that Health and Human Services (HHS) has been directed to review all existing rules related to health care and make them more effective, efficient, flexible and streamlined.   As a part of the review, CMS is looking at the issue of CRNA supervision as a condition of participation in the care of Medicare and Medicaid patients with the possibility that the supervision requirement be removed on a Federal level.

The blog post includes a brief but excellent review of who may supervise a CRNA and what constitutes supervision.  Changing the regulations would have no effect on the states that have already opted out of the requirement for supervision.  The remaining 33 States would, in essence, be automatically opted out by virtue of the rule change

Click here to read the original blog post and return to procrna.com to make a comment.

Clinical Topic: Glucose Control in the OR

The intra-operative management of the Diabetic patient poses many challenges to the anesthetist.  Theories abound related to the advantages of “tight control” using an insulin infusion versus a less strict approach using bolus dosing.   Regardless of your beliefs regarding blood sugar control, being informed and having a plan is essential for the safety of your patient.

An excellent review article by Joseph F. Answine, M.D. titled Peri-operative Diabetes Management for Dummies: Just Check the Sugar! and published by the Pennsylvania Society of Anesthesiologists discusses the foundational points to be considered when administering anesthesia to the diabetic patient.

From Dr Answine: “What do we know about peri-operative glucose control? We know that infection rate, length of hospital stay, overall cost for the hospitalization, and morbidity and mortality are directly proportional to peri-operative blood glucose levels. We also know that there are numerous studies demonstrating improved overall outcomes with improved glucose control.”

The article goes on to advise the anesthetist to know the patient’s normal and work to keep the intraoperative blood sugar as close to the patient’s normal as possible.  The use of the glucometer intraoperatively is essential as is documentation.  When the patient comes with an insulin pump it is best to leave it on and check glucose levels frequently.

Other basics of managing the diabetic patient:

  • Do diabetics first case of the day
  • If outpatient, discuss post op glucosecontrol both  pre op and again before discharge
  • Test glucose pre-op
  • Know when patient last took diabetic medications
  • Know your patient’s history for self-control of diabetes
  • Intraop….infusions are better than a bolus
  • If the patient tells you how to manage their diabetes…..listen carefully

The bottom line is to know your patient’s history and glucose level.  With that knowledge, treat the patient appropriately.

The Full article continues with a chart showing the types of insulin, peak, and duration of action.  Click here to read the full article and return to www.procrna.com with your comments.

 

Feature SRNA: Judith Arrington

Name:  Judith A. Arrington

Email address:  judy.arrington79@gmail.com

Anesthesia School:  NorthShore University School of Nurse Anesthesia

Graduation Date:  August 24, 2012

CV:  Click here to view CV

Preferred geographic region:  Central TX

Major work as SRNA:  Perceived Anxiety of the Nurse Anesthetist of
Parent Presence during Induction of Anesthesia.

Parent presence during induction of anesthesia (PPIA) is a fairly new concept that is being implemented in order to incorporate family involvement with the pediatric patient in the operating room. Previous studies have not researched PPIA’s effect on the anesthetic provider, specifically nurse anesthetists.

Objectives: This study examined the nurse anesthetist’s perceptions, attitudes, and emotions regarding PPIA; and possibly past experiences which can affect the anesthetic provider’s peri-operative anxiety possibly impacting the outcome.

Click here to read the abstract of this original SRNA work.

Special Interests:  boating-that’s why I need to move so I can actually get some use out of our boat!

SRNAs…The future of our profession.  
Available to join your group in the Fall of 2012.

Clinical Topic: Handwashing Standards

New patient safety guidelines require increased vigilance in handwashing by healthcare providers.  Previous guidelines established by OSHA required soap and water handwashing between every patient contact.  Over the past few years, alcohol based handwashing agents have been introduced to the hospital setting raising the question about their efficacy and risk.

An article By Gina Pugliese, RN, MS; Judene Bartley, MS, MPH, CIC; Tammy Lundstrom, MD, reviews the topic of the use of alcohol based handwashing solutions.  They state:

“The evidence is clear; HCW compliance with hand hygiene can reduce the 2 million healthcare-associated infections that occur in patients annually, as well as reduce the risk of infections transmitted to workers. But the use of these waterless alcohol-based hand antiseptics, the centerpiece of the new CDC guideline, has been perceived to be in conflict with existing healthcare safety regulations. These include, for example, handwashing requirements from the Occupational Safety and Health Administration (OSHA), flammability issues from the National Fire Protection Agency (NFPA), and corridor obstruction issues from Centers for Medicare and Medicaid Services (CMS).”

The article goes on to discuss the fire risk related to the use of alcohol based handwashing solutions.  As CMS tightens enforcement of handwashing in the healthcare workplace, this information is essential for CRNAs.  Click here to read the article and return to PROCRNA.COM to share your comments.  ( If the link takes you to an ad, wait about 5 seconds and it will go on to the article)

CRNA Wellness: Nutrition

Gary, Gary, quite contrary
How does your garden grow?
With onions, tomatoes,
Vine-ripe sweet potatoes,
And lima beans all in a row.

April is the time to plan ‘n’ plant the garden.  The delightful thing about your garden is that it will provide a solitary escape after a 50-hour work week.  Or it will serve as a dual retreat for you and your partner.  And, it’s sure to be a family affair in which everyone can select some favorite veggies to coax and encourage to fruition. When you grow things, you grow, and when you grow, your body heals.

Sweet potatoes are an amazing garden food, big on nutrients and huge on color.  There are lots of varieties but pick one that grows well in your soil.  Beta carotene has enjoyed solid mag’ rap in the last ten years having been praised and criticized nearly equally.  The truth about  sweet potatoes is that in addition to the starch and sugar, the abundance of A, C and beta carotene make every sweet sensation worthwhile.  I recommend that my clients consume at least one serving of a variety of sweet potato each week.  Prepare it clean – bake without butter, boil and peel, microwave in a potato bag and slice, cut into strips and bake as fries.  You don’t need salt, fats, or seasonings of any kind to enhance the flavor of this already sweet, generous source of nutrients.   Click here to learn about Sweet Potato nutrients.

Green beans provide a rich supply of vitamins A and C that do not stick to your ribs or add unwanted calories to your spring plate.  You can plant pole beans or traditional snap beans in a raised garden.  But if you have room for rows and rows of snaps, haricot verts or favas, go ahead and plant the seeds, fertilize, water, watch for worms, harvest and enjoy.  Eat them fresh-steamed next to your grilled tuna, or stir fry them with onions and mushrooms.  Cut and drop raw into veggie soup or snip, steam and eat them with your fingers in front of HGTV.  If you get at this early in the season, you may have time to plant a second crop.   Click here to learn about Green Bean nutrients.

Yellow zucchini is becoming more and more expensive to purchase, so you may as well grow your own and eat the best.  Like sweet potatoes, the vines take up some space but vertical gardening is always a space-saving option.  Packed with vitamin A and plenty of C, this vegan delight is so low in calories that you can eat a bowlful of sunshine several times a week.  Stir fry it, steam it, slice it and grill it with olive oil or flavored Pam, and use the leftover slices on a fresh veggie sandwich.  Watery and lightweight, zucchini begs to be undercooked.  Your lean machine will love both  yellow and green.  Click here to learn about Zucchini nutrients.

Tomatoes are a thing of beauty in your diet and on your table.  By now most guys know the health benefits of lypocene to the prostate, and both genders are continually reminded through research studies of the cancer preventative capacity in a snappy tomato.  There is some proof that cooked tomatoes are a better option than raw but all kinds, sizes and methods of prep are tasty and healthful.  Think A (B) C then go ahead, prepare a big old ground white turkey burger, slap on a thick slice of Beefsteak tomato, put on a layer of avocado and support it all with an unbuttered whole wheat bun and some leafy lettuce…serve steamed broccoli florets as a healthy side, and indulge. You’re a Garden Gourmet!  Click here to learn about tomato nutrients.

Mary, Mary, quite contrary,
How does your garden grow?
With orange, green, yellow, red,
A rainbow in the bed,
With rich vitamins all in a row.

Gardening is an art form that delivers pleasure to every sense. Feel the cool rich earth slipping between your fingers, see the tiny sprouts and watch them flourish, hear the sweet songbirds nearby, then smell and taste the results of your labor.  There is no place on earth like a garden for feeding both mind and body.  This, you understand, because you’re a healer.

Read Liz’s daily column lizlines at www.bdyfrm.com

CRNA Fitness: What goes Up, Must Come Down

What goes up when the rain comes down?  Answer:  Your weight.  If you thought the correct answer was “an umbrella,” then you probably heard it from your kids or grandkids.  March does bring rain, but even more than moisture, March brings a change of seasons.  And as the season changes, so do your fitness opportunities.

If you have been walking on a row of treadmills all winter, hiking virtual trails while listening to gym-girl Greta’s visions of grandeur, aka gossip, on the machine next to yours, you’re more than ready to hit the pavement, wet or dry.  Asphalt streets, dirt trails, and school tracks exist in nearly every community and only really nasty weather should send you back to Greta.  Fitness experts often claim that outdoor cardio actually burns calories faster just because of the elements of wind, breathing outdoor air, and dealing with natural changes in elevation.  Yes, on Lion days, you can go back inside and adjust your treadmill to outdoor standards, but it would be a shame to miss watching that Bartlett pear tree on the corner of Magnolia and Vine go through its spring metamorphosis. Don’t forget to take drinking water.

 Bands work-outs are a fantastic source of strength-training and once you’ve taken them to your favorite park, you just might opt to stay outside in the wind and rain if only to enjoy the freedom and flexibility of the work-out.  If you’ve been going to the gym three mornings a week to lift weights, or to do Body Pump, or to zip through the circuit of machines, taking your bands outside to a park will provide a nice break in the winter routine AND if you walk there, you can keep checking on that Bartlett pear.  When the nitrates start falling from the sky, you can always take the bands inside at home or at the gym.  Is there a fitness center at the hospital where you work?  Is there a children’s outdoor area with some poles that support swings or climbing apparatus?  Perfect for bands.  How about doors with hinges.  If there is a low-traffic area inside the hospital where some infrequently used doors with hinges are hanging around, that’s another perfect place for anchoring bands. Maybe you’ll need “permission” to use the space or maybe you’ll need the chief’s approval, but if you really want to do your work-out, you can work it out.  Don’t forget your water.

March brings a variety of weather to your exercise routine – rain, wind and even some stubborn snowfall.  You will probably need to do a blend of trail walks and treadmill, outdoor cycling and indoor elliptical, and you may need to tote the Totes.  But it’s a great time, a hopeful time of year when as the season changes, you can take advantage of the change.  Then when April arrives and the rain comes down, the only thing that will go up is your umbrella.

Learn more about the Bands In the Park work-out on mobile browser at www.bdyfrm.com.

Feature SRNA: Adrianne Collazo

 

Adrianne Collazo

SRNA

Adriannejc@gmail.com

Mercer University

Will graduate December 2012

Click here to review my CV

Click here to review my student work

Why you should hire me: Team player, people person, eager to learn, teachable, hard worker with a good work ethic. Clinical experience in diverse cases (general and sedative) at Level one trauma center. Excited to become part of an organization that promotes autonomy and self growth.

Chief CRNA: How to balance your life

Life has many demands at home and at work.  As CRNAs, we are expected to provide first time value to patients with each encounter and we are expected to be available 24/7.  As Chief CRNAs, we add the responsibility of department management to the clinical responsibilities.  After a long day at the Hospital, we often go home to a long list of “must do” items leaving little time for rest and relaxation.  Over time it takes a toll.  As professionals, we must balance our lives if we are to avoid burn out.

In a blog posted on Rock the  post, the author presents 7 key tips for bringing your life back into balance.  The author concludes, “If you don’t have a sense of harmony between your personal and professional life, things can take a toll on you mentally and physically.”  Taking simple approaches, like those listed in the blog, can help you get your life back in balance so that you can be productive at work and have fun with your family and friends.

Click here to go to the blog and read the 7 tips.  Return to www.procrna.com and leave your comments.

Chief CRNA: Negotiate Your Salary

In business, everything is negotiable.  As a Chief CRNA, you are responsible for not only setting the Corporate climate and enforcing the standards in your work group, but you also must attend to the business of Anesthesia.  Being fairly and adequately compensated is foundational to being a loyal and engaged employee.  Negotiation is essential both when you are being compensated and when you are hiring new people to work in your group.

An article written by Linda Jenkins on the salary.com web site details some of the elements of successful negotiation.  In a negotiation, each party should fulfill the needs of the other party.  In order to do so, you must know your strengths and resources and be able to respond to the needs of the other person.  She stresses preparation prior to the negotiation.

Click here to read the article in a PDF format or click here to link to the article published on salary.com.

The Chief CRNA area of procrna.com is a forum for those interested in Anesthesia Department Management to share ideas.  If you are a Chief CRNA, please use the guestbook on this page to let us know who you are and where you work.  Please pass this web site along to your colleagues.