CYRUS YOU ALRIGHT?

Called the silent killer; hypertension has struck down large number of people over the years. The worse thing is that we let it go unchecked and undetected for year and the next thing we know…its Hydrochlorothiazide and Lisinopril for us. Sound like I know what I’m talking about? Let me help you understand then. Before I took this course, I was on a crash course to doom, and didn’t even know. The worst part is I felt like I was doing fine. I stuffed supplements down my gullet and eat everything in sight, then in August of 2006; I was getting in my last airborne mission before deployment and broke my right leg on a jump. I broke the tibia and the fibula, as well as doing a syndmosis tear of the ligament around the ankle. Talk about bad!! As I sat on my rump for 6 months and still deploying, did some half cocked workouts, my blood pressure unbeknownst to me had gotten worse. It was in August of 2008 that I had my blood pressure recorded at 160/100!!! I was horrified, and began an unbelievable workout regiment, but I still ended up on medication. I hope someone takes this to heart. I know this introduction was long, but this subject is very near and dear to me as it should be to all of us. By the way I went from 248lbs to 210 and I am still going, thank God!!




Cyrus is a 52 year old male, who has come to us for advice. Our concerns are about his blood pressure which reads 180 mm Hg systolic over 120 mm Hg diastolic. Cyrus definitely has hypertension and the first thing we need to do is get Cyrus to consult with a physician immediately. There are certain points when a potential client’s overall health and well being must be taken into the consideration of a health care provider. Hypertension is a very serious medical condition that will require our potential client to consult with an Internal Medicine Health Care Provider, where he can get the right classes. Although we may be able to offer some education, he will need the five day blood pressure check. The five days check up may result in Cyrus have to take medication. These are decisions that cannot and should not be made by us. Cyrus faces the possibility of a stroke, heart attack, aneurysm, and renal failure. Hypertension with type 2 Diabetes will result in further treatment. If not controlled this individual’s life expectancy will be shortened. There is no one identifiable cause for Hypertension, but age, genetics, obesity, insulin resistance, sodium sensitivity and a few more to name does contribute to Hypertension (Anon, 2006. ("Complications of Hypertension" Retrieved from the worldwide web on 5/28/08). This is very bad news for Cyrus, but there is good news. We know that with proper exercise and good dieting, we can help to lower his blood pressure to a safe level. Here is one program that has been doing wonders for prevention of hypertension; the DASH diet. The DASH diet (Dietary Approaches to Stop Hypertension) is a step by step program designed for people with hypertension to get it under control, rich in fruits and vegetables; the DASH diet is enjoying a good success rate as of date. The DASH eating plan has been proven to lower blood pressure in just 14 days. Best response came in people whose blood pressure was only moderately high, including those with pre hypertension. For people with more severe hypertension, who may not be able to eliminate medication, the DASH diet can help improve response to medication, and help lower blood pressure (Champagne, C.M. (Dietary Interventions on Blood Pressure: The Dietary Approaches to Stop Hypertension (DASH) Trial Nutrition Reviews, 64(2:2), S53-57s). Aerobic exercise, such as walking is great way to get you back on the path to healthy living. Remember; don't try to conquer the world the first time out. Be patient, start slowly and gradually increase frequency and duration. During the planning phase carefully consider what barriers might stand in the way of consistency; then develop strategies and accountabilities to assist in eliminating these barriers. You’ll want to start off with exercises such endurance activities such as walking, swimming; cycling and low-impact aerobics should be the core of the exercise program. Exercises that include an intense isometric component that can cause extreme and adverse fluctuations in blood pressure should be avoided. Overall we want to wish Cyrus all the blessings and when his physician gives him the go ahead, and let him know we are here and ready to help out in anyway possible.
References:
Azadbakht, L., Mirmiran, P., Esmaillzadeh, A., Azisi, T., & Azisi, F. (Beneficial Effects of a Dietary Approach to Stop Hypertension Eating Plan on Features of the Metabolic Syndrome. Diabetes Care, 28(12), 2823-32.)
Elmer, P.J., Obarzanek, E., Vollmer, W.M., and Simons-Morton, D (Effects of Comprehensive Lifestyle Modification on Diet, Weight, Physical Fitness, and Blood Pressure Control: 18-Month Results of a Randomized Trial. Annals of Internal Medicine, 144(7), 485-496.)
Schulze, M.B., Hoffman, K., Kroke, A., & Boeing, H. (Risk of Hypertension among Women in the EPIC-Potsdam Study: Comparison of Relative Risk Estimates for Exploratory and Hypothesis Oriented Dietary Patterns. American Journal of Epidemiology, 158(4), 365-373)
Meenu Mirilles PA-C (Controlling Hypertension)
Major Wendy Gray FNP US ARMY (The Healthy Soldier)
Curtis Aberle FNP (Diet, Hypertension, and Weight Management)
John Cadrain PA-C (Cardiovascular Health and Aging)
Rebecca K. McArthur FNP (Lowering Your High Blood Pressure)
The American Heart Association
The 2005 Dietary Guidelines for Americans
(Note: some of the references and citations are taken from courses given at Fort Sam Houston for work reference)

But it tastes Soooooo Good!!

According to this WebMD article; “Vitamin D for Cancer Prevention?”, getting enough vitamin D might cut colon cancer and breast cancer in North America, according to a new research review. The reviewers also suggest that adults should daily take 2,000 international units (IU) of vitamin D -- in a form called vitamin D3 (cholecalciferol) -- to help prevent some cancers, including colon cancer and breast cancer. But that's not a prescription or a guarantee. The review is based on observational studies, which didn't directly test vitamin D for cancer prevention. (By Miranda Hitti, WebMD Health News and Reviewed by Louise Chang, MD). Substantial information exists about the links between certain types of cancers and nutrition. It is important to note that other lifestyle factors, such as smoking, alcohol use, exercise level and obesity also play a role in the risk of developing cancer. With all of this information on how lifestyle contributes to the factors which result in getting cancer, and ways to the risk of getting cancer; can vitamin D help prevent cancer? There are studies that suggest vitamin D has a role, but in the end the evidence is all but conclusive; and we do know many Americans Lack Enough Vitamin D. The next case presents the age old question of Quantity vs. Quality when eating a “well balanced meal”, in which we always seem to have a dilemma. (American Cancer Society: see citations below) It is most certain that in the case of disease prevent and what good nutrition hold for us, we always push toward the latter of the two; for example: it may be smart to that life styles that involve diets high in fruits and vegetables have been associated with reduced risk of cancer, can be beneficial to many of us attempting to achieve this type of lifestyle. On the flip side those of us who are taking the opposite route will not. The quality of the food we eat is very important in one aspect as is the quantity of the food we are eating. It does not help to eat vegetables one day of the week and fast foods the rest of the week , thinking we have our fill of nutrients. We only benefit when we combine both quality and quantity. So when we think about disease prevention and the diet we have, there are many critical factors to pay attention to. How much are we getting from our whole foods and are we getting any whole food at all? When rushing around do we automatically rush to fast foods or can we plan and prepare better to eat healthier foods? How much exercise are we getting, how much rest are we getting, and are we taking into account of use of time to get foods that are properly prepared? These are just some of the factors we need to consider and be sure that quality and quantity don’t clash as a result of our own nutritional mismanagement.

References:
American Cancer Society (2007). Food and Fitness.
Citations: "The Role of Vitamin D in Cancer Prevention." Published online Dec. 27, 2005 and in the February, 2006, American Journal of Public Health (Vol. 96, No. 2:9-18). First author: Cedric F. Garland, DrPH, Department of Family and Preventive Medicine, University of California, San Diego.
"Vitamin D and prevention of colorectal cancer." Published in the October, 2005, Journal of Steroid Biochemistry and Molecular Biology (Vol. 97, No.1-2:179-194). First author: Edward D. Gorham, PhD, MPH, Department of Family and Preventive Medicine, University of California, San Diego.

BIG Jim

It is always better to explain to your client the nature of their condition, or ailment if you are a doctor. However as a Nutrition counselor, we must be able to educate our clients on their responsibilities and help them to achieve the goals they are moving toward. In the case below we will assist our client on how to live a healthy lifestyle. Obesity and overweight need to be recognized as chronic and multifaceted conditions. Treatments that are not lifelong or for the long term and that do not address many or all etiologic factors are unlikely to succeed. The approach to obesity should be akin to that of many other chronic health conditions, such as hypertension and CAD. Successful treatment starts with overcoming the perception of futility that has pervaded physicians' attitudes toward obesity in the last few decades. Fewer than 50% of obese adults report being advised by their healthcare provider to lose weight.11 (Reference) This statistic contrasts with the fact that, as with smoking, targeted counseling of even short duration can result in substantial increases in physical activity or attempts to lose weight. Our client is Jim, 47 year old former weight lifter who was injured during his training. This scenario is very common for many folk, we tend to over work ourselves and eventually injure ourselves. Upon meeting Jim we must give a proper assessment. With that we can move on to begin to put the pieces of a good program together for him. Once we gather information from the client we will give him the proper tools and education needed to improve his lifestyle. Because Jim has a BMI of 31, we must inform him of the dangers that come with being overweight. A good example of what some of the risk factors are diabetes, hypertension, and CAD. The stress alone that one puts on their body form being obese can be a severe disadvantage to healthy living and managing a comfortable lifestyle. As we age, our bodies tend to change. It is very important that Jim understands he may find it a little difficult to change certain things about himself. It may have been a while since he last did any form of training and that could appear as a demotivator in most cases. That is were we come in, we are going to help Jim achieve some realistic goals and have a healthier lifestyle. At 47, Jim’s BMI and weight make him a prime candidate for those factors right out of the box. It is important that Jim understand the nature of these diseases and make plans to change his lifestyle. We should note if Jim is taking any multivitamins, or if he is on any physician prescribed medication, by looking into his medical history. It would be also wise to recalculate and record Jim’s BMI for the purpose of progression. The biggest key to all this is the fact that Jim mentioned to us that he “tends to snack on chips lately, and hasn’t been eating fruits and vegetables” is a noteworthy suggestion that Jim may have a poor diet and nutrition program. Having said this we have to steer this person in the right direction and explain the food pyramid to him, as well as how proper exercise along with good nutrition will be in his best interest. The food pyramid is a great guide which can help Jim find what are the right foods to eat and which ones to avoid, fortunately for him the pyramid is readily accessible via internet. We must also ensure that Jim understands the simplest change in his lifestyle for the better, can result in a beneficial long term effect coupled with proper exercise regime!! Knowing that Jim was once a weight lifter gives us some idea of his ability to perform a good exercise regime, now we need to understand the nature of his injury or injuries, and how they affect him working toward a good program. By coupling both programs together, we can help Jim “get it together”. Once we have sat down and explained to Jim all of the factors working against him and ways to change them through healthy living, we could begin putting together a journal which would chronicle Jim’s progress. We need to ensure that we involve Jim in the decision making process throughout each phase of his transformation. Even though we are their every step of the way, ultimately it would fall on Jim to have the motivation to continue forward progression.
References:
Christopher B. Ruser, MD, Daniel G. Federman, MD, and Susan S. Kashaf, MD Dr Ruser and Dr Kashaf
Shiriku Kumanyika
American Dietetic Association
Harvard Health Journal