Type 2 Diabetes - Hemoglobin A1c: A Useful Test for Diabetes Control

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It is widely acknowledged good Type 2 diabetes care rests on a foundation of patient knowledge. Knowing what care you should receive is vital, since not even all doctors are aware of the guidelines set by the American Diabetes Association. A survey published in the Annals of Internal Medicine in the year 2002, estimated only 30 percent of people with diabetes had a hemoglobin A1c, (HbA1c), test during the previous year. This is a crucial test which should be given to all people with diabetes at least twice a year.

Are you a diabetic? Does your doctor advise you to have your hemoglobin A1c taken every three months? Are you wondering why you still need to have your hemoglobin A1c examined when you already check your blood sugar level regularly? What is Hemoglobin A1c? What is the importance of having this laboratory test?

The hemoglobin A1c is the stable glucose portion on the beta-chain of the hemoglobin, the oxygen transporters of red blood cells. It is formed by an irreversible reaction when red blood cells become exposed to glucose. And because it is irreversible, no diabetic can ever alter or manipulate the results of his or her hemoglobin A1c. Therefore, it is the single best test to monitor a diabetic's overall blood sugar control for the past three months.

Hemoglobin A1c values are a strong indicator for the development of long-term complications of Type 2 diabetes. In fact, the risk for diabetic retinopathy, neuropathy, and diabetic nephropathy can be easily projected by just looking at the previous HbA1c results. Cardiovascular disease, another complication of diabetes, is also another risk seen with the rising values of HbA1c through smoking, hypertension and increased blood lipid levels can also trigger its development.

What are the usual indications for hemoglobin A1c monitoring? Everyone with diabetes who needs constant monitoring and tight blood sugar control need to have their HbA1c level checked once every three to six months. However, it can be performed more often in cases where treatment management is changed rapidly or drastically. As well, anyone who is known to be at high risk for developing Type 2 diabetes should also undergo this laboratory test according to the Johns Hopkins Point-of-Care Information Technology Center.

How do you interpret your HbA1c results? The HbA1c percentage is the average blood sugar control for the past three months. It accounts for all the highs and lows of blood sugar spikes and troughs, this test is a better indicator of your overall status than the fasting blood sugar test. Non-diabetics usually have a HbA1c value of 4 to 6 percent. People who have a result of 8 percent have poor blood sugar control while those with a reading higher than 10 percent have uncontrolled Type 2 diabetes. Diabetes is considered controlled when the reading is less than 6.5 to 7 percent.

What are the limitations in HbA1c monitoring? Anything that can possibly decrease the survival rate of red blood cells also affects this value. Therefore, people with hemolytic anemia, a condition where individual red blood cells burst, have lower HbA1c values. In contrast to this, an increase in the lifespan of red blood cells, such as in aplastic anemia can also increase the hemoglobin A1c value independent of the blood sugar level.

A report published in the Lancet, May 2009 reported that diabetic patients who lowered their hemoglobin A1c value by just 1 percent over 5 years can reduce the overall rate of heart attacks by 17 percent and fatal and non-fatal heart attacks by 15 percent. It seems worthwhile to me in order to savor life longer!

To discover answers to questions you may be asking yourself about Type 2 Diabetes, click on this link... Natural Diabetes Treatments

Clicking on this link will help you to learn more about Type 2 Diabetes Solutions ... Beverleigh Piepers RN... the Diabetes Detective.

Beverleigh Piepers is the author of this article. This article can be used for reprint on your website provided all the links in the article are complete and active. Copyright (c) 2010 - All Rights Reserved Worldwide

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What Is Hemoglobin And How Does It Affect Your Health?

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Hemoglobin in essence is what transports oxygen from the lungs to the other cells in the entire body. Oxygen is the most basic element of human life and its need in the body is very important. There are many health conditions that in particular have to pay very close attention to measuring the amount of oxygen that is actually in their hemoglobin. Such conditions as asthma, COPD, and other respiratory conditions require that there be a constant monitoring of the oxygen levels in order to ensure that the body is getting enough. In the medical field the measure of the amount of O2 in the blood is referred to as SpO2 or also known as blood oxygen saturation. It is this blood oxygen saturation that those that have various kinds of respiratory conditions need to keep an eye on and to closely monitor. The primary medical device that is used to measure the SpO2 is a pulse oximeter.

The way that hemoglobin can affect your health directly is when not enough of O2 is being transported to the cells in your body and as a result you will begin to have various detrimental health affects that are not so easily fixed. If for example you have asthma then one of the biggest concerns is always the fact that you need to keep a very close eye on your oxygen levels in order to make sure that you prevent an asthma attack. When there is not enough of it in your system then you run the risk of an attack which can be very dangerous to your health. One way to measure this and to prevent an attack is to closely monitor it with the use of a pulse oximeter. What the device does in fact is that it uses special infrared technology to measure the percentage in the bloodstream.

The latest can be found at http://www.pulseoximetersupply.com of pulse oximeter technology.

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The Hand: Anatomy and Medical Issues

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Basic Anatomy
The hand has a very complex anatomy. There is a fine balance between the flexor tendon system, principally from muscles in the forearm that bend the fingers into a grasp, the extensor muscle tendon system from the extensor muscle side of the forearm, and the intrinsic muscles in the palm and proximal portion of the hand.

The tendons that originate from the muscles in the forearm all pass through tunnels. On the extensor side of the wrist, the extensor retinaculum is a thick sheath of fibrous tissue which keeps the tendons from bowstringing, and allows the tendons to function effectively in extending the hand. The forearm muscles that generate the flexor tendons pass through the carpal tunnel, and then in the hand pass through multiple tunnels, which are easily described best as located at every place in the palm where there is a skin crease, in the middle palm and at the base of each phalangeal joint.

Every finger including the thumb, has nerves, arteries, and veins on each side of the digit. This supports the circulation and the sensation to those fingers. Knowing where the neurovascular is would allow at the time of laceration or injury the physician to know the risk to the nerve or the circulation that any particular injury has caused.

A finger can usually get by with one artery and one vein, because the circulation from the opposite side of the finger will usually be sufficient and cross over and fill the need. But if the nerve is lacerated one must expect loss of sensation distal to that laceration. The most important sensation of the fingers to preserve or attempt to restore by surgical repair would be both sides of the thumb, the radial side of the index and long finger, which is necessary for effective sensory pinch, and the ulnar side of the ring and little finger, which commonly are in contact with the surface. It is not that the other areas of sensation are not useful, just not as important.

Laceration / Amputation
Lacerations of flexor tendons can be serious injuries and may need special skills of a surgeon and then special physical therapy for the hand, usually also with a hand therapy specialist. Extensor tendon lacerations and repairs are more "forgiving', and are commonly repaired, even in the emergency room, followed by appropriate splinting and then appropriate therapy.

Amputation of fingertips or phalanges beyond the mid of the middle finger are seldom "reimplanted". They are usually treated with a primary wound closure, or treated "expectantly" with continued wound care of the amputation site (which is left initially open), but does require continued wound care for 4-6 weeks. This is a technique that has the advantage of preserving the maximum length possible of the digit that has been partially amputated. This technique is time consuming and does require a very cooperative patient, but will usually offer a benefit.

Reimplantation means re-attaching the amputated part, finger, or other part of an extremity to the remainder of that extremity or hand. It is usually done by a very specialized surgical team at a referral center. Everything must be ideal. The surgery takes many hours and the recovery takes many months. The results are seldom perfect and almost always a compromise after significant trauma and investment of a great amount of time, cost, and effort. This effort is usually considered primarily for a dominant hand, a thumb, an index finger particularly in a younger injured patient where activity function and job function makes the effort and the commitment reasonable. Reconstruction must be considered an exceptional and not a common procedure, and the choice for reconstructing the amputation site, as opposed to reimplantation, is generally most preferable in a working person and early return to function is highly desirable.

Fractures of the Hand
Fractures of the hand usually require an attempt to achieve close to anatomic or anatomic realignment. The type of reduction can be closed, or non-surgical, just by manipulating the fracture externally. It can surgically open. There can be multiple types of fixation devices used internally surgically, screws, and plates; externally there can be pins applied through the skin and casts and external fixators. It remains important to allow the hand, wrist, and forearm to regain function and use as early as possible, but safely.

Fractures do need to be assessed, however, in 3 planes: the front plane, the side plane, and also the rotational plane. If a fracture heals with a rotational deformity of the metacarpal or finger, it will underlap or overlap the adjacent fingers. It is an issue like this that will commonly force one toward a more aggressive and even surgical approach in treating a hand fracture.

An exception to the above is known as treating the "boxer's fracture." This is a fracture of the distal end of the fifth metacarpal commonly angulated 20-45 degrees usually occurring either in a fight or hitting a hard surface, such as a wall with one's hand. A study done over 30 years ago demonstrated that reducing a boxer's fracture surgically does not give as good a result as just splinting the fracture, as long as it does not exceed an acceptable degree of flexion deformity, with that splint maintained for approximately 3 weeks. Then early function is attempted, and early movement encouraged. This noninvasive technique and treatment has given very good results with very few complaints, very little stiffness issues whereas the surgical approach had far less desirable results, though surgery may be considered for an exceptional case.

The phalanges are notorious for having hyperextension and twisting injuries, and it is common to see minor chip fractures about the joints of the fingers. Though these fractures seem minor, they are always accompanied by damage and injury to the ligaments, the capsules of the joint, or the tendon attachments to the joint. These injuries should be evaluated and a treatment plan established by a skilled practitioner. They should not be ignored or just treated with extension splinting or buddy taping. Dislocations of the joints of the digits are common in sports, and they, too, need to be assessed clinically and radiologically to be certain that there is no more serious injury that needs to be addressed.

Fractures of the distal joint are commonly caused by having a ball hit awkwardly off the extended finger. This may cause either a fracture of the tuft of the phalanx, or can cause a hyperflexion of the distal joint tearing the extensor tendon, usually with a flake of bone off its insertion site. This is known as a mallet finger, and can usually be treated simply after an x-ray to demonstrate that there is no deformity of the joint by a hyperextension splint that needs to be worn until there is evidence of healing. Occasionally surgery is necessary to repair the tendon and the bony fragment into its normal site. Epiphyseal fractures through the growth plate in children need special attention to minimize deformity, which sometimes cannot be avoided, depending on the damage to the epiphysis (growth plate) and should not be ignored by the parents.

Diagnostic Tools
The mainstay of diagnosis is the physical clinical exam by a physician skilled and knowledgeable in hand anatomy and function. X-rays are the primary line of diagnostic study. As most x-rays are now principally digital, they can be reviewed by a consulting physician on an almost-immediate basis. By accessing the films online, there is little excuse for having potential complex injuries not identified as the injured party passes through the emergency room. Computerized x-ray scanning such as CT scan is generally used in the hand solely to identify complex fractures of the carpal bones and/or the wrist in anticipation of surgical reconstruction.

MRI, magnetic resonance imaging is helpful in several ways: one is identifying soft tissue injury, as the MRI is more specific for soft tissue injury than a CT scan or x-ray; another is evaluating the rare risk of tumor or deep infection; also MRI is useful for identifying the subtle circulatory changes and the response of the bone that has been injured; and, it can be a useful diagnostic tool for the complicated wrist or hand problem, acute or chronic, when diagnosis seems very elusive.

Medical-Legal Considerations
Clearly, the hand functions with its tendons, its nerves, its vascular circulation, its multiple carpal bones, metacarpals, and phalanges as a very complex part of our body, needing particular care. That care should include proper diagnosis in an early and timely way and skilled treatment for an ideal result.

Dr. John Toton is an Orthopedic Expert for American Medical Forensic Specialists. Visit AMFS to get more information on Medical Expert Witness articles and opinions.

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Bone Cancer Metastasis

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An estimated 60% to 84% of patients with cancer develop bone metastasis. Of these 70% experience pain syndrome which is difficult to manage, of which 50% die without adequate pain relief with a poor quality of life. It is therefore necessary to have accessible and effective medications for the management of this condition. One of the most common pain syndromes in patients with advanced cancer is bone metastasis. This is difficult to manage and control in clinical practice. Currently, scientific advances in cancer detection and treatment have prolonged life expectancy in patients. Unlike the case with the phenomenon of bone pain in cancer, where current treatment strategies are not significantly effective. Most palliative treatment of bone pain are based on clinical studies on pain management in patients or in experimental models is not well designed this could explain why the drugs used are partially effective. Today, one of the main obstacles in developing new, safe treatments to control bone pain is the absence of basic science knowledge in the physiology of bone pain.

Epidemiology

The pain in cancer patients is usually multifactorial, may arise from the process itself, treatment side effects or both. For these reasons the approach and management of this symptom should be multidisciplinary. Pain syndrome occurs either by local proliferation or tumor invasion of a metastatic tumor from a distance. With metastatic bone pain often reflects the presence of a tumor in breast, thyroid, prostate, kidney, lung or adrenal.

Physiology of bone pain

Bone pain is associated with tissue destruction by osteoclast cells. Normally, osteoclastic bone resorption are in balance with bone formation mediated by osteoblasts. In neoplastic osteolytic activity is increased and there are substances such as cytokines, local growth factors, peptides similar to parathyroid hormone and prostaglandins. Autacoids are also released other owners as potassium ions, bradykinin and osteoclast activating factors. These tissue substances play an important role in sensitizing the neural tissue against chemical and thermal stimuli, lower thresholds for discharge of the neuronal membrane, produce exaggerated responses to stimuli above the threshold and result in discharges of tonic impulses normally silent nociceptors. This phenomenon is called peripheral sensitization and primary hyperalgesia and is understood as events occurring within the ranks of the injured tissue and stimulate peripheral nociceptors (C fibers and A delta fibers) translating pain. In bone tissue of the sensory receptors are located primarily in the periosteum, whereas the bone marrow and bone cortex are insensitive. This phenomenon of peripheral sensitization results in abnormal sensitivity to pressure surrounding skin (allodynia and hyperalgesia), pain in muscles, tendons, joints and deep tissues in contact with bone. This is limited to ensure that the peripheral ends have a greater capacity for alarm response to injury.

The constant presence of harmful process, stimulating nociceptive receptors gives the introduction of a subacute pain that tends to be chronic with the growth of bone metastases. These stimuli lead to another prevalent phenomenon called central sensitization important which includes abnormal amplification of incoming sensory signals to the central nervous system, particularly the spinal cord. The phenomenon occurs because of the persistent input stimulus through the fibers C. This spinal cord triggers a temporary increase in the power of silent synaptic terminals. In this process plays an important role of glutamate receptor N-methyl-D-aspartate (NMDA). The resulting amplification of the signal generated in the postsynaptic neuron sends a message to the brain which is interpreted as pain. In short central sensitization amplifies the sensory effects of both peripheral nociceptive inputs (C fibers of pain) and non-nociceptive fibers (A of touch).

In practice the two phenomena come together in the genesis of metastatic bone pain and peripheral sensitization occurs acutely metastatic lesions to appear nociceptors and translate the information conveyed through the afferent myelinated A-delta or unmyelinated C fibers to the spinal cord where the information is modulated by various systems. With the set up process subacute begins the process of central sensitization which sensory synapses begin to activate silent. And there is a state of increased central perception. By becoming chronic pain phenomenon becomes even more complex because all that is in contact with the area of injury becomes a powerful generator of pain. The touch, muscle movement or joint pain result, manifesting the phenomena of allodynia and hyperalgesia much more marked.

With progression and growth of metastatic disease can appear phenomena of compression of peripheral nerves, nerve roots or spinal cord. Then the pain can refer to other dermatomes, further complicating the initial picture painful. This condition becomes a debilitating factor for the patient and to be inadequately controlled could trigger the phenomenon of total pain detailed below.

I M Currently doing my doctorate and felt immense need to help the people about the Bone Cancer

Web Url: http://www.bonecancerprognosis.org

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Vitamins For Hair Growth Offer Beautiful, Natural Locks

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Some vitamins used as supplements to a balanced diet may improve hair growth. Below, find a list and description of vitamins that can help you grow hair faster and thicker naturally.

B Complex Vitamins

The top vitamins for hair growth in the B complex vitamin group are B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B7 (biotin), B9 (folic acid) and B12. These vitamins are found in foods like bananas, avocados, potatoes, legumes, oatmeal, nuts, tuna and some enriched cereal or bread products. B complex vitamins promote cell development, help the body convert food to energy, promote tissue development and in the case of B12, promote the growth of red blood cells and provide energy. All these types of B vitamins help stimulate thicker, healthier hair.

Vitamins E, C and A

Vitamin A plays a role in sebum production on the scalp and the regulation of synthesis or retinoic acid inside hair follicles, directly stimulating faster hair growth. Vitamin C improves blood circulation and aids in maintaining connective tissues. Vitamin E increases blood oxygen levels improving circulation and cell growth. A and E are fat soluble vitamins which are stored in the body and taking more than the recommended dose can lead to health problems. However, the right amount of the best vitamins can lead to maximizing your hair's potential, when combined with a healthy diet, regular exercise, and proper hair care products and techniques.

Minerals That Help Hair Grow

In addition to vitamins, several minerals are thought to help stimulate hair growth when added as a supplement to the diet. Zinc, magnesium, iron and silica are believed to be necessary for hair growth. These minerals, particularly zinc and magnesium, are not readily available in most foods. Vitamin and mineral supplements, like multi-vitamins, provide an easy and convenient way to add these nutrients to the diet. Since minerals are also stored in the body it is important not to take more than the recommended daily dosage.

Other Ways To Make Hair Grow Faster

In addition to a nutritious diet, exercise increases blood flow, cell renewal and rejuvenation. Getting enough exercise will improve both hair growth and overall physical health. On another note, sleep deprivation causes hormonal imbalances which are known to cause weight gain and may also inhibit your hair from growing properly. The body renews itself during the sleep cycle and sleep deprivation may cause decreased cell production, which would slow the natural growth cycle of your hair.

Furthermore, stress has been proven to inhibit hair growth, so managing stress is also important. You can lower your stress levels and promote hair growth by getting a scalp massage. By using your fingertips to massage your scalp in a circular motion, you relieve stress levels and improve blood circulation to your scalp and hair follicles. This hair growth tip will help make your hair grow faster and longer, and certainly encourage you to live a healthier lifestyle.

Multivitamin Supplements

It is best to get advice from a medical professional or licensed pharmacist when seeking vitamin supplements to help hair grow faster. There are harmful side effects from over dosage of a number of hair growth vitamins and minerals. The recommended daily dosage is based on a balanced diet that provides some of the nutrients, but those who eat a lot of foods which are high in vitamins A and E, and beta carotene should be careful with dosages of these vitamins since too much can be harmful.

In addition to taking good care of your hair, the hair growth vitamins mentioned above can help to keep it healthy and grow thicker and stronger, faster. Just remember that the vitamins to make your hair grow faster cannot replace a healthy diet, exercise, and sleep.

Ashley is a writer and blogger specializing in health and beauty topics. For more information on hair growth for longer and thicker natural locks, check out Ashley's blog at http://www.HowToMakeYourHairGrowFaster101.com. There, you will learn everything there is to know about ways to make hair grow faster.

The Key to Career Success: Networking!

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As a freshman I did not think a whole lot about networking because it did not seem all that important at the time.  By my senior year I realized what I wish I had known as a freshman; that networking is not only important, but also key to career success. The sooner you understand the power of networking, the sooner you can reap the benefits.  This past weekend I attended a regional school nutrition conference where I had the chance to network with school nutrition professionals. It is always important to put your best foot forward and make the best impression you can!  Here are some effective networking tips:
§  Dress the part.  You never know when you have the chance to network but for the occasions that you can prepare for, make sure you are wearing professional attire.  You want to look “put together” but aim for a more classic look rather than something trendy. 
§  Smile!  You may think this tip is just common sense, but it is so extremely important.  Communication between two people is much more than just an exchange of words.  Be conscious that your body language is sending the same message that your words are. 
§  Make a business card.  Being able to exchange business cards with the people you are networking with will show that you are prepared and professional.  There are many online sites where you can order unique business cards.  The site that I have used is www.zazzle.com. There are many templates to choose from and for under $20 you will get 100 cards. 
§  Follow up.  This may mean shooting a quick thank you e-mail, getting together to discuss professional opportunities over coffee, or sending them more information about something you discussed during your conversation.  Whichever way you choose to do it, make sure to follow up and continue correspondence to build and enhance your professional network.  

Me with a fellow intern, Heather, at a conference we attended.  The theme of the conference was "Saddle up with Nutrition".

What Textbooks are Best to Keep from Undergrad? Lindsey Tells us her Opinion!

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I know textbooks are expensive, and unfortunately, when you get to grad school you will only have to spend more money to buy even more books. But I do find that having a reliable source of information close by is extremely helpful to look up quick facts, or use as a reference when writing papers.

Introductory Books: I kept two basic introductory nutrition books, and I must say, that was probably not necessary since the level of reading is so basic. However, I think it’s a great idea to have at least one basic level nutrition book on hand for quick DRI references or definitions.
Anatomy and Physiology: This has helped me since the typical dietetics student usually takes only one anatomy and physiology course, and yet, our entire major is based around what happens inside the human body! This book has helped me a lot to get a better understanding of the exact location and function of our organs, bones, muscles, and systems.
Medical Nutrition Therapy: I will not be taking Advanced Medical Nutrition Therapy until next fall, along with my clinical rotations; however I had been given advice from previous interns to keep my MNT book. I know that when taking Advanced MNT, I will be required to buy a different book; but there is always a chance that the book you have is sufficient enough! This book is the most in-depth source I have regarding nutrition and specific diseases and conditions. I have used it multiple times as a reference.
Special Topics: I have also kept books that were of personal interest to me; such as an applied approach to sports nutrition. If you know that you are going to enter into food service management, it would be beneficial to keep a food service management book; if you want to enter into childhood nutrition, you may want to keep a book on nutrition across the lifespan.  I also kept books that I truly felt had great information or were a pleasant read. I can’t say I use them all the time, but I enjoy having them since I know they have valuable information. It is easier to reference a source you already know and trust than trying to find a reliable source from the internet.
Quick References: Over my 4 undergraduate years I acquired multiple reference booklets that are a great way to brush up on knowledge: I have a flip book on food and medicine interactions, a pocket guide to nutrition and diet therapy, an exchange list for diabetes, as well as the Penguin Handbook from freshman year (this has helped with citations, references, and grammar when writing papers).

Notes: I kept my notebooks from nearly all my courses; however I only brought a few of them with me to graduate school. I brought notebooks from courses that were jam-packed with information, or that were of special interest to my field, sports nutrition. This included by MNT notebook, Nutritional Problems in the US, and Energy Metabolism. 
If you are tight on money, remember:  you are studying so that you can eventually get a job and make money. A $200 book seems pricey, but it’s hardly anything in the grand scheme of things!   

It's Not Just Meat and Potatoes: The Diversity of the Dietetics Profession

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By: Jill Merrigan 
I am constantly asked, “What do you want to do when you finish school, and complete a dietetic internship?”  For me I am asked this weekly but find that I have a monthly response. One of the most exciting pieces of my return to school is the inspiration I have as I continue to learn about all the possible career opportunities I’ll have as a registered dietitian.
The career field for a registered dietitian offers a colorful plate, it not just meat and potatoes. From clinical dietitians, foodservice managers, research dietitians, educators, outpatient nutrition counselors, consultants. It is encouraging and motivating to remember that all my hard work in the classroom will expose me to a broad path of experiences within the dietetic profession.  When I was in the process of leaving my job in ad-sales and transitioning into my new life in Boston at Simmons College I took the time to meet with many registered dietitians, educators, and professors. One of the most important observations I took away was that in the dietetic profession we are not limited to one career path. Many times an RD will choose a position that meets their specific needs and in time branch into another position that suits them, and continue to make changes as it feels appropriate with time.  Some of the unique careers I have discovered that RDs are pursing include a RD – Food stylist, RD – Psychotherapist, RD – Medical Doctor, and RD – Farmer.
The nutrition and dietetic field is versatile, allowing diverse ways to educate and help people eat right. If you are considering a career change into nutrition and dietetics but now sure where the path will lead you then be sure to take some time, learn about the many opportunities that are available, and compare them to your own personal goals, strengths and interests and begin to see yourself living your career dream. 

Amanda's Cardiology Rotation

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I had a great past couple weeks in my cardiology rotation.  I had the opportunity to meet and work alongside an inspirational RD who is not just a clinical dietitian but also an outstanding community leader who holds leadership roles in numerous organizations including the local dietetic association.    Of course I also learned how to plan and educate patients about heart healthy diets, make notes in the charts of patients, and do nutrition assessments on patients with CHF.

One of the main things I have learned is that nutrition care is hardly one-dimensional.   Although a patient may come into a hospital with the initial diagnosis of chest pain and shortness of breath, they may also have diabetes, renal failure, cognitive impairment, trouble chewing/swallowing; the list goes on.  When assessing a patient, it is important to look at the “big picture” and not just the diagnosis that the patient was admitted with.  This is especially important when completing a case study. 
Case studies are some of the best opportunities to learn during clinical rotations.  They give you the opportunity to apply all the information you learned in your MNT classes to a real-life scenario.  Scanning charts and comparing lab values made me feel like a detective; it was up to me to figure out where the patient was nutritionally deficient and what nutrition interventions were needed to restore their health. 
One tool that was especially helpful was my MNT book from college.  This book is filled with so much detailed information that was helpful when completing my cardiac case study.  If you are planning on completing an internship I would definitely recommend resisting the urge to sell your MNT book at the end of the year and hold onto it as it will prove to be a valuable tool during your internship.  
Question (to other past/present dietetic interns): What other resources have you found to be helpful during your dietetic internship rotations? 

Amanda's Career Goals and Reflection over 1st half of DI

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Half Way There!
It is amazing for me to think that one year ago at this time I was putting my dietetic internship application packets together, not even sure which internships I was going to apply to.  Now I am five months into my internship, with only five months to go until I am eligible to sit for the RD exam.  The internship so far has challenged me and prepared me for a career as a dietitian in ways far beyond what I learned in the classroom.
One of the best things I have learned thus far is that I am certain that pursuing a career in school food service is the path I want to take.  The rising need for dietitians in schools and the regulatory changes facing school nutrition programs are two reasons why this career path appeals to me.  Here are a few of the benefits that working as a dietitian in a school nutrition program offers: 

• You get to work with kids!  There were so many people in my college classes who were interested in pursuing a career as a pediatric dietitian.  Rather than working with kids who are already sick, school dietitians can work with kids proactively by promoting nutrition education and nutrition integrity in the meals offered in school. 

• The variety of positions available to dietitians.  As a dietitian you can get a job as a nutrition educator, a manager of school kitchen, an area supervisor for a district or the director of food service for an entire school district.  No two school districts are alike so you can also have a variety of options in the type of school food service program you would like to work in.

• Opportunities for career advancement.  Depending on where your strengths and career goals lie, school nutrition programs can offer many opportunities for professional growth.  This is especially true if you are interested in nutrition management and business.

• Great work schedule.  Depending on the position, school dietitians may get the summer months off and for sure the holidays as wells as most weekends (nutrition conferences may take up a weekend day or two). 

If you are interested in a career as a school dietitian or would like to know more about why I think it is such an exciting career path, please feel free to reach out to me with any questions you may have!  I hope finals are wrapping up well and that the holiday break brings some much needed time for rejuvenation and relaxation.  

Raisin Bran Muffins

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Raisin Bran Muffins Recipe
Thisis the easiest muffin mix ever!  If you are thinking that the recipe is soeasy that the muffins taste like cardboard, you are wrong.  With orwithout a little butter, these muffins are moist and are a delight to eat whilesipping a nice cup of hazelnut coffee.
4-cups of Raisin Bran Mix1-Egg1-Cup of water
Pre-heat your oven to 400^o.  Grease (or use cooking spray) muffincups.
Place the muffin mix in a bowl.  Beat the egg and water; stir into mix just until moistened.
Fill greased muffin cups 2/3 (two-thirds) full.
Bake at 400^o for 15 to 17 minutes or until atoothpick comes out clean.  Coolfor 5 minutes before removing from pan to a wire rack.
This fast and easy treat makes one batch of 12 muffinsthat can be frozen for up to 2 months.

Don't forget to preview the upcoming Sunday paper couponinserts.

Mad Bananas December 2011

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Mad Bananas December 2011
If you happened to catch the “Mad Money” post last month, then you know that Our Banana Moments decided tomonetize. Below is how much cash Our Banana Moments raked in last month aftertrying out a variety of monetizing methods.
Mad Bananas: December 2011

	Escalate Network	$164.31
	Google Adsense	$14.74
	Sponsored Tweets	$4.55
	My Savings Media	$0.00
	Sponsored Reviews	$0.00
	LinkShare	$0.00
	Commission Junction	$0.00
	Brandcaster	$0.00
	Swagbucks	$0.00
	Amazon	$0.00
	Total Bananas in the basket	$183.60

As you have probablynoticed, there will be no first class round the world tour in the foreseeablefuture; however, it was fun and challenging, but, make no mistake, it is not aseasy as it may seem.  Additionally,I noticed that figuring out how various methods work, I started neglecting my writing. I hope that January will find that Our Banana Moments makes a few morepennies while having a whole lot of fun.

I look forward to how many bananas will be collected this month.  Please, if you have any tips, I am open, just respond to this post or email me at followthebanana@ourbananamoments.com 

 

My Top Ten Freebies - Tuesday 1/17/12

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Today is TopTen Tuesday Freebies.  Just as lastweek, I searched online yesterday and today to find a crap load of freebies.  There are literally hundreds offreebies and samples just for the taking everyday.  Because it would be near impossible to list each one, I amlisting the top ten of my haul here, for you. Please browse below and click on the itemsthat interest you.  Top Ten Tuesdayis a weekly event, so check in again next week for more.
Grab Your Choice of Free Splenda Essentials SweetenerSamples
Curves  - Get your FREE one-week guest passtoday!
Join the IKEA Family Program for Free Items In-Stores
Free Kindle Download -Naturally Skinny: 100 OrganicRecipes
Grab Free Neo-Energy and Neo-Carb Bloc Sample Packs
Panda Express -Free Firecracker Chicken with Coupon on1/23 Only
Get a Free 7-Day Sample of Lancome Genefique &Visionnaire
Send an Email for a Free Align Probiotic SupplementSample
Nescafe Taster’s Choice - 6 Free Flavor Samples
Join & Get a Free Medium Beverage from Dunkin Donuts
Thank you for visiting and don't forget to take a peek at what coupons will be in the Sunday newspaper coupon inserts. Sunday Coupons Preview

Smart and Healthy Grocery Shopping

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At the grocery store,it is tempting to focus on special deals such as buy one get one free cerealdeals. These deals can distract you from buying products based on theirnutritional benefits for yourself and your family. It is important to savemoney on weekly shopping trips without sacrificing the health of your family. Make smartergrocery shopping choices by following these tips.
Try to spend more time shoppingfor fresh products and buy only minimal purchases from the dry food aisles andfrozen food sections of the store. Buy fresh by focusing on shopping in theproduce department and the meat department. If it would help, create a grocerylist that starts with visiting the produce aisle.  In general, you will also want to skip the deli departmentbecause many of the foods that you could buy in this area are processed justlike dry foods and frozen foods.
Plan your meals. Forexample, buy enough fresh meat, not frozen, by counting the number of dinnersthat you need to cook for the week, and then buy meat accordingly. In addition,if you need to, buy larger packages and cuts of meat and then split them upinto smaller portions and freeze for later in the week.
Also, try to buyorganic as much as your budget will allow.  Organic fresh fruits and vegetables are not just emptycalorie products like lettuce and cabbage; they are also potatoes, carrots,apples, oranges, bananas, beets, onions, peppers, and so forth.

Ugly Stretch Marks, Help!

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Is there anything more unflattering than stretchmarks?  Worse, just about every onehas a stretch mark or a few somewhere on the body, and goes to considerablelengths to cover the unsightly marks. This post will confront squarely the issue of stretch marks, what theyare, and how to get rid of them.
Stretch marks (striae) are scars that develop when skinundergoes continual or rapid changes usually related to hormonal flux.  For instance, puberty is typically atime when hormones are in flux and bodies are experiencing growth spurts.  During the time of puberty, it iscommon to discover a stretch mark or two on the thighs, hips, breast, andbuttocks. Another time many women developabdominal stretch marks is during pregnancy when the skin is stretching toaccommodate the little one growing inside.  In addition to growth spurts and pregnancy-related changes,stretch marks can appear because of a medical condition such as Cushing’sdisease.  No one is immune tostretch marks, and the ugly scars occur regardless of race, age, and sex; however,they do tend to occur more frequently in women.

Since, it is known why stretch marks appear, are theyreversible? Fortunately, there is treatmentoptions with most focused on topical creams.  Before starting any treatment, it is important to consultyour health care provider because although stretch marks are common, there existthe possibility of stretch marks occurring because of a medical diagnosis suchas Cushing’s disease.  Best stretchmark creams can range from products with natural ingredients to those,which contain more powerful retinoid products. In addition to topical creams, dermatologistshave seen improvement of stretch marks with laser treatments. 
When considering to seek treatments for your stretchmarks, it is important to do research to discover what methods are availableand as always, before starting any treatment regimen contact your health careprovider to determine if your chosen method of treatment is right for your.
We know one good thing about stretch marks, they appearto fade and become less visible with time.

It's Not Just Meat and Potatoes: The Diversity of the Dietetics Profession

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By: Jill Merrigan 
I am constantly asked, “What do you want to do when you finish school, and complete a dietetic internship?”  For me I am asked this weekly but find that I have a monthly response. One of the most exciting pieces of my return to school is the inspiration I have as I continue to learn about all the possible career opportunities I’ll have as a registered dietitian.
The career field for a registered dietitian offers a colorful plate, it not just meat and potatoes. From clinical dietitians, foodservice managers, research dietitians, educators, outpatient nutrition counselors, consultants. It is encouraging and motivating to remember that all my hard work in the classroom will expose me to a broad path of experiences within the dietetic profession.  When I was in the process of leaving my job in ad-sales and transitioning into my new life in Boston at Simmons College I took the time to meet with many registered dietitians, educators, and professors. One of the most important observations I took away was that in the dietetic profession we are not limited to one career path. Many times an RD will choose a position that meets their specific needs and in time branch into another position that suits them, and continue to make changes as it feels appropriate with time.  Some of the unique careers I have discovered that RDs are pursing include a RD – Food stylist, RD – Psychotherapist, RD – Medical Doctor, and RD – Farmer.
The nutrition and dietetic field is versatile, allowing diverse ways to educate and help people eat right. If you are considering a career change into nutrition and dietetics but now sure where the path will lead you then be sure to take some time, learn about the many opportunities that are available, and compare them to your own personal goals, strengths and interests and begin to see yourself living your career dream. 

Launching Your Dietetics Career Book Review by Amanda Bot

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This past week I finished up the first week of a two week cardiology rotation.  It has been a nice change of pace being back in the hospital but I will wait to tell you more about it until next week.  This week I am writing a review of the book Launching Your Dietetics Career by Kyle W. Shadix, MS, RD and D. Milton Stokes, MPH, RD. 
If you are in high school and thinking about a career in nutrition, already in college enrolled in a DPD program or a dietetic intern who may be just months away from the RD exam, this book is for you.   The authors break down each step in the process of becoming a registered dietitian with explicit detail.  The authors provide insight and advice that will not only answer your questions but also direct you towards the next steps you should be taking in your journey towards becoming a RD.  I wish that a resource like this book had been available to me when I decided I wanted to become a registered dietitian my freshman year of college and especially when I was preparing my dietetic internship applications! 
 I was fascinated by the amount and variety of outside contribution provided by registered dietitians practicing in various areas of dietetics.  The book featured advice from internship directors, interviews with recent dietetic interns, suggestions about how to excel in the area of dietetics you are interested in and more.  The inspiring stories and bios provided by registered dietitians ignite excitement and enthusiasm for the wonderful opportunities available to young dietitians looking to make their mark in the expanding nutrition field.
The wealth of knowledge gathered and laid out in this 222 page book makes it a valuable tool for anyone looking to become a dietitian.  Launching Your Dietetics Career expands beyond what you can learn from a college professor or a DPD program director.  This book will serve as your personal pocket guide towards career success as a registered dietitian no matter where you are in the process, or what area of nutrition you are looking to build a career.    

Volunteering Is SO Important --Lindsey Tells Us Why

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Last week I had a wonderful opportunity to volunteer at Food Day in Tallahassee. Upon arrival to Florida, I have been getting acquainted with the city and getting adjusted to the school. However, it has been difficult to truly get involved since the networks I had built up during my undergraduate career are 2,000 miles away!
Finally a few classmates and I were able to volunteer at Food Day. We got out into the community on a Sunday afternoon and educated locals on exercise and nutrition. We created posters and games and gave away educational handouts.
It reminded me of all the volunteer work I did in undergrad. All the little things truly do add up. Every bit counts on the DICAS applications and graduate school applications. Once you get accepted, though, the volunteer work shouldn’t stop there!

My classmates posing by our booth (having some fun with the food models)

Me posing with a local sustainable farmer at Food Day

Graduate school and intern preceptors want to know that they have chosen a person who will contribute to their program; somebody who will enrich their program, their community, or their school. The volunteer work doesn’t stop upon acceptance. So while participating in your undergraduate, don’t volunteer solely for the purpose of writing it on your application; do it to gain experience and knowledge that you can bring with you in the future. By Food Day 2011, I had no problems  whipping together a poster board of fun facts, and I felt totally comfortable socializing and educating the public. 

Amanda's Cardiology Rotation

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I had a great past couple weeks in my cardiology rotation.  I had the opportunity to meet and work alongside an inspirational RD who is not just a clinical dietitian but also an outstanding community leader who holds leadership roles in numerous organizations including the local dietetic association.    Of course I also learned how to plan and educate patients about heart healthy diets, make notes in the charts of patients, and do nutrition assessments on patients with CHF.

One of the main things I have learned is that nutrition care is hardly one-dimensional.   Although a patient may come into a hospital with the initial diagnosis of chest pain and shortness of breath, they may also have diabetes, renal failure, cognitive impairment, trouble chewing/swallowing; the list goes on.  When assessing a patient, it is important to look at the “big picture” and not just the diagnosis that the patient was admitted with.  This is especially important when completing a case study. 
Case studies are some of the best opportunities to learn during clinical rotations.  They give you the opportunity to apply all the information you learned in your MNT classes to a real-life scenario.  Scanning charts and comparing lab values made me feel like a detective; it was up to me to figure out where the patient was nutritionally deficient and what nutrition interventions were needed to restore their health. 
One tool that was especially helpful was my MNT book from college.  This book is filled with so much detailed information that was helpful when completing my cardiac case study.  If you are planning on completing an internship I would definitely recommend resisting the urge to sell your MNT book at the end of the year and hold onto it as it will prove to be a valuable tool during your internship.  
Question (to other past/present dietetic interns): What other resources have you found to be helpful during your dietetic internship rotations? 

Amanda's Career Goals and Reflection over 1st half of DI

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Half Way There!
It is amazing for me to think that one year ago at this time I was putting my dietetic internship application packets together, not even sure which internships I was going to apply to.  Now I am five months into my internship, with only five months to go until I am eligible to sit for the RD exam.  The internship so far has challenged me and prepared me for a career as a dietitian in ways far beyond what I learned in the classroom.
One of the best things I have learned thus far is that I am certain that pursuing a career in school food service is the path I want to take.  The rising need for dietitians in schools and the regulatory changes facing school nutrition programs are two reasons why this career path appeals to me.  Here are a few of the benefits that working as a dietitian in a school nutrition program offers: 

• You get to work with kids!  There were so many people in my college classes who were interested in pursuing a career as a pediatric dietitian.  Rather than working with kids who are already sick, school dietitians can work with kids proactively by promoting nutrition education and nutrition integrity in the meals offered in school. 

• The variety of positions available to dietitians.  As a dietitian you can get a job as a nutrition educator, a manager of school kitchen, an area supervisor for a district or the director of food service for an entire school district.  No two school districts are alike so you can also have a variety of options in the type of school food service program you would like to work in.

• Opportunities for career advancement.  Depending on where your strengths and career goals lie, school nutrition programs can offer many opportunities for professional growth.  This is especially true if you are interested in nutrition management and business.

• Great work schedule.  Depending on the position, school dietitians may get the summer months off and for sure the holidays as wells as most weekends (nutrition conferences may take up a weekend day or two). 

If you are interested in a career as a school dietitian or would like to know more about why I think it is such an exciting career path, please feel free to reach out to me with any questions you may have!  I hope finals are wrapping up well and that the holiday break brings some much needed time for rejuvenation and relaxation.  

Looking Good With Skin Vitamins

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Signs of vitamin deficiencies show up firstly in the skin, hair and nails. The reason this occurs is due to the fact that in times of stress or low intake the body preferentially provides nutrition to the critical organs such as the heart, lungs and brain rather than the skin. So irritating skin issues such as cracks in the corners of the mouth or peri oral dermatitis may actually be signalling a nutrient deficiency rather than a disease state or skin condition.

Underlying causes for nutrient deficiencies are many and various but often come back to reduced intake or excess demand. Inadequate intake of water-soluble vitamins such as the B group and vitamin C is more common due to the fact that our body doesn't store these vitamins. Any excess passes out on a daily basis. It makes sense then that an inadequate intake of B group and vitamin C rich foods could eventually lead to signs of deficiency. Fat-soluble vitamins such as vitamins A, E, D and K are slower to show up as deficiency sigs as our body stores these nutrients in some cases for long fairly long periods. However, lack of dietary intake (or sunshine) will eventually use up stored resources and again eventually lead to lower levels.

The other factor that may lead to skin signs of deficiency is placing excess demands on our vitamin resources. Stress, environmental toxins, dietary excesses and ill health will all use vitamins up, sometimes faster than we are taking them in. Again the net result is lower levels.

A good dietary intake of both water and fat-soluble vitamins will help to maintain healthy and vibrant skin. For specific skin signs, the nutrient association and the food sources see the table below.

Nutrient
Possible Skin Sign
Food Sources

Vitamin A
Rough, dry and scaly skin - particularly on the back of arms, thighs and buttocks. The carotenoid form of vitamin A will also help to improve skin colour i.e. give you a healthy glow.
Liver, cod liver oil, yellow, orange and red vegetables (plant source is carotenoids)

Ascorbic Acid (Vitamin C)
Bleeding gums, rough skin and easy bruising, poor wound healing, pinpoint broken capillaries particularly where extensive sun exposure has occurred e.g. face, neck and chest
Kiwi fruit, green capsicum, citrus fruits, paw paw, strawberries, berries, broccoli, sprouts

Riboflavin (Vitamin B2)
Inflamed eyelids, cracks and redness at the corner of the mouth (caution, this may also related to low iron so get your iron levels checked if B group supplementation doesn't improve within 2 weeks), facial skin lesions with greasy scales, peri-oral dermatitis
Almonds, salmon, spinach, milk & milk products, eggs, oats, whole grains

Pantothenic Acid (B5)
Excessive sebum production particularly associated with acne
Avocado, mushrooms, lentils, milk & milk products, eggs, almonds

Pyridoxine (B6)
Scaly dermatitis, peri-oral dermatitis, cracks and redness in the corners of the mouth.
Bananas, tuna, avocado, spinach, mackerel, brown rice, Brussels Sprouts

Folates (B9)
Peri-oral dermatitis, cracks and redness in the corners of the mouth.
Lentils, spinach, green leafy vegetables, asparagus, paw paw, yellow corn

Vitamin D
Worsening of inflammatory skin conditions due to imbalanced immune function e.g. eczema and dermatitis
Cod liver oil, salmon, oysters, whole milk, egg yolk

It is important to note that because fat soluble vitamins build up in the body, it is advisable to speak to a health care professional such as your doctor, naturopath or nutritionist before taking supplemental forms.

Please comment if you have any questions.

For more information about natural & organic skin care products contact Ananda Mahony ND at http://www.vitalenatural.com.au or at info@vitalenatural.com.au

As a naturopath Ananda has been involved in the natural skin care industry for many years. She specialises in the treatment of skin disorders such as acne, eczema, rosacea and dermatitis as well as anti-aging.