Tuesday, 24 June 2014

Care of a patient with ED

I was inpatient once for my eating disorder...and...well, let's just say that it wasn't my favourite experience. Why? Was the problem in me? Was it the staff there? Or both? How do nurses and doctors care for patients with ED?

There is a lot of evidence that is now focussing the relationship we have with patients with ED. When I say 'we', I mean healthcare providers. I am lucky because I got to see this from both ends: from being a patient, and now, as the nurse. I can tell you that one thing that I hated about inpatient (IP) was being treated like a baby or child. The staff made me feel like I was...inferior because I had an ED. I felt that despite being 18, I was not treated as such. In addition, I felt that no one there cared about me. Sure, the staff did their jobs. But in the end of the day. there is definitely room for improvement. What is interesting is that this advice can even go beyond how to treat someone with ED - it all comes down to understanding how we, as society, should treat anyone in general...especially those who are ill and need compassion and support.

As a nurse, I am aware of how my attitude and mannerisms can affect patients. If I am angry, this can make the patient feel sad or uncomfortable. If I am happy, I can do my best to comfort the patient. Helping patients with ED is not any different. Sure, nurses and doctors are simply 'doing their job', and I am not expecting every healthcare professional to love their patients. But I AM expecting that you treat them with respect and dignity. That, during your time at work, you for your best o help patients and to advocate for them.

I can see how doing this can be hard. Caring for a patient with ED means that you need to be careful with what you say and do. You need to take careful assessments of their body systems to recognize complications and to keep them safe. You need to understand that sometimes, the patient will not be able to understand how ill she or he is, despite being so thin and frail. As a nurse, I see this all the time with patients with ED. But because of my experiences as a patient. I also realize that this is not their fault. Patients CANNOT see that they are ill. They are sick, but they don't FEEL it. At the same time, patients may be smart, funny, or appear to be healthy. This is why caring for ED patients is so hard - you need to be mindful that looks can be deceiving, and that intellect is different from illness. ('Caring for the hospitalized patient with an eating disorder' (2003) by Gimby and Wolfe is a pretty good article about how to assess a patient with ED).

What I particularly want to point out is that as nurses, we need to be mindful that patients with ED need a lot of care. They don't just need to be fed, weighed, and monitored for exercise or self-harm. They need to feel cared for, and they need to learn how to care for themselves. They need to understand that you are doing your best to keep them healthy, even if they do not want this now. You need to tell them that despite their discomfort now, they will get better and recovery is possible. You know how hard they are working, and you realize that eating and gaining weight is the hardest thing that they will ever do in their lives. But you also know that this is worth it, and that they are strong enough to overcome this. You know that this is not their fault; that recovery is on its way and that it will take time. Mistakes happen, and they are human. Even with relapses or mistakes, you know that they can muster up the strength and devotion to continue on their way towards recovery. You know that they are more than their eating disorder - that the ED does not define them, nor does it say anything about their character, personality, manners, beliefs, etc.

Again, this is easier said than done. I was a patient with ED before, and I know how stubborn and firm I was. But again, I know that this wasn't my fault. I was ill, and I needed my nurses and doctors to understand this. instead of blaming me, I needed support and motivation. Instead of making me feel stupid for being sick, I needed someone to tell me that I was being strong. instead of treating me like nothing more than an eating disorder, I needed someone to make me feel that I was human and I had a life outside of this illness. The main point, in the end of the day, is to remember that all patients, with any illness, are not at fault for their disease. And regardless of what they are ill with, or how this came to be, they deserve to be treated with respect, love, care, and dignity. No blame, no shame.

Monday, 16 June 2014

Bone Health

You have probably heard many different things about bones and how to keep them strong. Your parents likely told you to drink your milk, and your physician may have instructed you to take calcium, or vitamin D supplements. We all hear that bones need calcium and vit D to be strong...but why? Are supplements better? Is milk the only cure? How much do we need? (Please note: I am not in any position to give individual medical advice because I am not aware of your personal health and needs. Please contact your medical team for definitive advice that will be tailored to you! This blog is not a substitute for medical attention).

First, let me give you some background information on bones. Structurally, they are made of calcium and phosphorus, with some magnesium. Two hormones control calcium levels in the body: PTH from the parathyroid glands, and calcitonin from the thyroid gland. This is not necessary to know, but I will include it here so that if you are interested, you can look for more information. Now, you must understand that calcium is important for other processes in the body as well, such as muscle contraction, hormone release, and more. Thus, our bodies need to ensure that blood calcium, levels are not too high nor too low - they must be just right. When the calcium levels get too low, PTH is released. PTH acts on the bone to release calcium from bones, thus making more calcium available in the blood. This is important because we just learned that our bodies need calcium, levels to stay just right for normal processes. BUT PTH breaks down the bone to release this calcium into the blood. So, if you don't have enough calcium, PTH will break down the bone to ensure calcium levels are stable.

This is largely why we need to ensure that we are eating enough calcium, in our diets. If we don't, PTH causes the bone to break down, thus weakening our bones and depriving them from the calcium that makes them sturdy and strong. How much calcium do we need? People over the age of 18 generally need around 1000 mg a day, while women over 50 and males over 70 need 1200 mg a day. Children typically need 1300 mg a day. The picture has some sources of calcium and how much they contain.

When women reach menopause, changes in hormones occur - namely, estrogen and progesterone drop. This causes many changes, but for the sake of this post, we will focus on what it does to the bones. Estrogen and progesterone maintain bone health in females. So, when they drop at menopause. women are at greater risk for osteoporosis. By the way, osteoporosis is when the bones are no longer as strong as they should be, characterized by decreased bone mass density. This puts them at greater risk for fractures as well. This is why females really need to ensure they consume enough calcium!

Supplements are often needed because the modern day diet doesn't contain enough calcium. There are SO many different calcium supplements out there, so please speak to your physician and/or pharmacist before taking one. You should ensure that you need the supplement, as too much calcium is not desirable either. Also, calcium pills should generally be taken two to four hours within other medications because they can impair the absorption of other medications.

Equally important is vit D, which is needed in the intestines for calcium, to be absorbed. This is why you will hear that vit D and calcium, are needed together. We need about 600 IU of vit D a day, which is VERY hard to get from the diet alone. Vit D is not very plentiful in foods except for some fish and fortified dairy products or orange juice. Vit D supplements can also be taken, and they are usually very small pills (which is nice, b3cause calcium pills are usually big!). Again, talk to your medical team before taking any supplements.

I hope that clarified some myths or questions some of you had about bones and calcium! As usual, I am open to researching or providing any information about health or mental health, etc that you are curious about, so let me know. Being a nursing student has made me that much more interested in these topics, so please ensure that you are informed!  In the end of the day, ensure you are getting enough calcium for your needs, as this is extremely important for bone health and will prevent future complications such as osteoporosis, falls, fractures, and more. Remember, a healthy life begins with a healthy mind and a healthy body!

Monday, 9 June 2014

What does 'healthy' mean?

What does it mean to be healthy? To different people, health means many things. The most widely accepted or popular definition of health is that of the World Health Organization, which states that health is spiritual, mental, emotional, and physical - and not simply the absence of disease. 

I like that definition, mainly because it sums up what I have learned to see health as. When I was sick, I didn't really care what health was. Was I underweight? Yes. But I felt good, didn't i? I was still religious. I was getting good grades. So, technically, I thought I was okay. Looking back now, I see that I wasn't. Health is more than just physical, but being physically healthy is important too.

Unfortunately, society today has somewhat changed our perceptions of health. Sometimes, we don't even know what 'health' is - and why it's important. Take a look at commercials for diets or any product. Do they advertise health as important for happiness and success? No. Diet products show that losing weight is important so that you can look good. Yes, some of them say that this will help you feel good. But they miss the point that feeling good doesn't come simply from being at a certain weight. Or, consider the example of a commercial for a dating website. Emotional health is important, right? So wouldn't a relationship be important too? Yes! But is this the only thing about health? No. Again, society doesn't give us a compete picture of health. And if we aren't careful and alert, we won't be aware of what health really is.

Being healthy is important because it helps us maintain an optimal quality of life. Being healthy helps us love life fully. We can then set goals and strive to achieve them, always persevering and feeling successful. We can eat and drink in moderation and feel strong physically. We need a good education so that we can work, feel accomplished, and bring something important to the world. We need healthy relationships so that we can communicate and live peacefully with others. We need to feel at peace and to feel safe so that we can complete our daily tasks and be proud of ourselves, feeling safe and confident. Therefore, all aspects of health are important. We can't be healthy physically and expect that this alone means we are 'fine', because perhaps emotionally we are struggling. We can't be healthy mentally and expect that we will be alright, as we may in fact be struggling physically and therefore suffer. What's the 'take home' point? Health encompasses many aspects of our lives - and one isn't more important than the other.

But society will try to tell you what it wants you to believe - that one aspect alone implies a state of health. Be aware and alert, and take time to define what health means to you. When you know how you define 'health', you will be able to determine what aspects of health you have in your life, and what remains. And remember, life isn't perfect. It's nearly impossible to be 'healthy' in the compete sense, because challenges always appear. The difference - and what's important to recall - is that you have the power to change your life. You may not be able to control what happens to you, but you CAN change how you respond to it and how you let experiences impact you. Take each moment and each experience as am opportunity to learn and grow. When you do this, you can start to see that although being fully 'healthy' may be difficult, having an awareness of health will allow you to pick yourself up after every struggle and remind yourself that you alone have the power to control how life's obstacles influence you. Will you let your troubles make you or break you?

Tuesday, 3 June 2014

Published on NEDIC: Learning to 'love' food

I am again blessed to say that my work has been published - this time on NEDIC. The topic? Loving food. Well, at least, learning to 'accept' food as a normal part of everyday life. http://www.nedic.ca/blog/learning-love-food

As someone who has been VERY (very. very, very) sick with an eating disorder, I can tell you first hand how terrible food seems to be with ED. Food becomes something to be feared, something to be despised for fear of weight gain. The desire to remain thin overpowers all feelings of hunger and any possible enjoyment of food. It is not that I wasn't hungry. I was. But I couldn't eat.

Now, on the other side of the spectrum - as someone who is recovered - I can tell you that things are a lot different. But yet again, I have a tiny secret for you. I still do not LOVE food. I don't day dream about food, nor do I necessarily get excited when I am about to eat my favourite foods. But you know what? It doesn't matter whether or not I LOVE food. Because I like food. I understand that I need it to be healthy. I try my best to try new foods, to enjoy a variety of foods, etc. I can sit down and eat a meal and not think about the scale. I can see food in front of me and not get frightened. I am healthy. And that is all that matters.

So, please take a look at the NEDIC blog! I hope this message brings you some wisdom and hope: recovery from any illness is possible. I was SO ill, and here I am today, alive, healthy, and a published author, as well as with my blog. I am defying all odds that said that I wouldn't recover; that I would never live a healthy and happy life. 'Loving food' is not necessarily important now - as long as I can eat what I need to be healthy and well. Will it ever happen? Maybe, maybe not. Regardless, I am recovered, healthy, and strong. And I am eating my meals, keeping my body in shape and well. That is true recovery. And I will never ever look back at my days of being ill and regret my decision to recovery. It was the hardest thing I ever did in my entire life. And it was definitely worth it.