RN ONline Now Available for Live Consultation

I have some great news! RN ONline is now available for online consultation. This means that I can take the time to personally answer all of your medical questions in the comfort and privacy of your own home.

Check out my virtual office here:

http://www.liveperson.com/debbye-leader-rn-bsn-phn

Dealing with Insensitive Comments About Your Disease

There seems to be an invisible stigma attached to the diagnosis of COPD, or any other disease caused by smoking. It's almost as if being a smoker, or having been a smoker, makes a person "deserving" of getting a disease. "So, how long did you smoke, anyway?" "You knew that smoking was bad for you. Why didn't you quit a long time ago?" "Why did you start smoking in the first place when your own father died of COPD?"

Indeed, people can make some truly insensitive remarks which, for the most part, aren't meant to hurt you, but are made without the presence of forethought. Instead of letting a nasty comment ruin your day, the following article asks the question:

How Do You Deal with Insensitive Comments Made About Your Disease?

While the article provides some excellent tips on how to deal with harsh comments, About.com has just launched a new type of interactive article type, entitled User Answers.

What does this mean? Well, after reading the article, not only will you be able to share your story which will be included as part of the article, but you'll be able to read other people's stories as well.

Share Your Story

Read Responses

MDI versus Nebulizer - And the Winner Is?

When it comes to treating respiratory illnesses like asthma, or COPD, the battle between the metered-dose inhaler (MDI) and nebulizer is still going strong. And, while most people think the nebulizer is better, the MDI is packing a mean punch as studies show it is just as effective or even better than wet nebs.

Learn more about their differences so you can appreciate their similarities:

Comparing Metered-Dose Inhalers to Wet Nebulizers

How to Protect Yourself from Secondhand Smoke While Traveling

Last year, I attended an About.com Guide Event in Las Vegas, Nevada and was overwhelmed by the secondhand smoke I encountered, in spite of a non-smoking room. The air ducts in the hotel actually allowed for the smoke to enter my room, making all of my clothes stink to high-heaven! When I returned, actually, before I returned, in a restaurant at the airport awaiting my plane, I started the following article:

How to Protect Yourself from Secondhand Smoke While Traveling

Would love to hear from you about how you protect yourself from secondhand smoke, traveling, or at home!

Let's Talk About Sex, Baby!

If you have COPD, lung cancer or any other type of respiratory illness, shortness of breath may by your worst enemy when it comes to your sex life. Fear not, however, because having a chronic lung disease does not mean the end to your sex life.

Learn how to spice things up in the bedroom and rekindle the flame that once burned so brightly:

Sex and Chronic Lung Disease

Pills and Dollar Bills: How to Save Money on Your Prescriptions

Economy got you down? When times get tough, the tough have to find ways to fight back! And, what better place to start, especially if you take a lot of them, than your medications. Learn:

10 Ways to Save Money on Your Prescriptions

The Importance of Oral Care in Intubated Patients

You may have seen it - a hospitalized patient who is intubated whose mouth looks drier than the Sahara Desert. Nothing is more irritating to me as a critical care nurse. The importance of oral care for intubated patients should not be overlooked, by nurses, doctors, or family members. Why? Because along with other steps, providing oral care every 6 to 8 hours can help reduce the incidence of ventilator-associated pneumonia (VAP).

VAP is a totally preventable, secondary consequence to intubation and mechanical ventilation. Studies have shown that the initiation of certain steps, including proper oral care, can help reduce the incidence of VAP in hospitalized patients. Learn what steps you can take as a nurse, doctor, or family member to help reduce the risk of VAP in your loved one:

The Importance of Oral Care in Intubated Patients

Discover Your Real Age - The Results May Amaze You!

Yesterday, a friend of mine called and said she was down in the dumps. When I prompted her as to why, she told me that she had just discovered that her real age was in essence, 8 years older than she really was. When I asked her how, pray tell, she figured that out, she told me that she had just taken a rather lengthy quiz at RealAge.com which examined her physical and mental health history, as well as her health habits, fitness level and a few other things. She then encouraged me to take the quiz myself, which I did. And, you know what - I am actually 11 years older than I really am - and I am a nurse. Now, I am happy to say that I am bummed out too!

What I liked about taking the quiz, was that after you are done, they e-mail you your results, along with a host of valuable tips to help reduce your real age to a younger one. So, go ahead, take the plunge and find out what your real age it today!

And, be sure to leave a comment letting us know what your results were:

Find Out Your Real Age

Fewer Calories Mean Less Weight

From Medscape:
News Author: Shelley WoodCME Author: Charles Vega, MD, FAAFP

Because weight loss is so important to many of us, myself included, and, I am unable to provide a link to this article, (it is for members only), I decided to include the article, in its entirety for your review:

March 2, 2009 — It may be one of the most commonsense observations ever to be validated in a diet study: people lose weight if they eat fewer calories, regardless of where those calories come from [1]. That's the upshot of a two-year study by Dr Frank Sacks (Harvard School of Public Health, Boston, MA) and colleagues, published in the February 26, 2009, issue of the New England Journal of Medicine.

After two years, 811 overweight adults randomized to one of four heart-healthy diets, each emphasizing different levels of fat, protein, and carbohydrates, showed similar degrees of weight loss. On average, patients lost 6 kg in six months, but gradually began to regain weight after 12 months, regardless of diet group.

According to Sacks, the research should help quell some of the debate — fostered by decades of research and fad diets — over what types of foods should be emphasized to produce weight loss.
"Research has looked at whether carbohydrate is more satiating than fat, or whether protein is more satiating than carbohydrates, or whether overeating fat puts more fat in the belly than overeating carbohydrates, etc," Sacks explained. "So what's concerned colleagues of mine on the nutrition guideline panels in the past is the possibility that if we say that a 40% fat diet is okay, that maybe that would lead to weight gain. But where this study is going to be helpful is in saying 40% fat, 20% fat, it doesn't matter. If people can maintain a calorie deficit no matter what type of diet they were on, they're going to lose weight."

Sacks, who is incoming chair of the American Heart Association's (AHA) Nutrition Committee, acknowledged that nutrition advice in the past has worried too much about fat in the diet. "I'm very concerned that we maintain the focus on calories and keep the focus off percent calories from fat," he said.

Another important, if unsurprising, finding from the study was that people who regularly attended counseling sessions over the two-year study were significantly more likely to lose weight.

The findings should remind physicians to hammer home the importance of losing weight. "Physicians really should, visit after visit, keep encouraging patients to eat a heart-healthy diet that they can stick with, that will help them lose weight, and try to get them involved in some kind of support group or to see a dietitian," Sacks said.

Commenting on the study for heartwire, Dr Robert Eckel (University of Colorado Health Sciences Center, Denver) said he wasn't surprised by the study findings. "I think you can lose weight in a number of different ways, and this study simply affirms that people who are successful are the people who adhere to a program. . . . Ownership, by the patient, of the weight-loss program is what proves successful, not the type of diet you chose."

Diet Details

The diets tested in the study included the same types of foods, but in different proportions, and were tailored to patients such that overall calorie consumption was reduced by approximately 750 calories per day, with each diet including a different macronutrient composition:

High-fat, average protein: 40% fat, 15% protein, 45% carbohydrate.

High-fat, high-protein: 40% fat, 25% protein, 35% carbohydrate.

Low-fat, average protein: 20% fat, 15% protein, 65% carbohydrate.

Low-fat, high-protein: 20% fat, 25% protein, 55% carbohydrate.

Participants were advised to exercise for at least 90 minutes per week, at a moderate level, and were offered counseling sessions every eight weeks, with group sessions held weekly or biweekly over the course of the study.

In all, 80% of subjects completed the trial, and 14% to 15% of subjects managed to lose at least 10% of their initial body weight. Subjects randomized to different groups reported similar degrees of satisfaction, hunger, and satiety. All the diets reduced risk factors for diabetes and cardiovascular disease at six months and two-year follow-up. At the two-year mark, the low-fat diets and the highest carbohydrate diet fared better than the high-fat diets and low-carb diet in terms of reducing low-density lipoprotein (LDL) cholesterol. By contrast, the lowest carbohydrate diet improved high-density lipoprotein (HDL)-cholesterol levels more than the highest carbohydrate diet. All of the diets produced slight improvements in blood pressure and decreased the number of patients with metabolic syndrome. All, with the exception of the highest carbohydrate diet, decreased fasting serum insulin levels.

External and Internal Motivators

An editorial accompanying Sacks et al's study applauds the duration of the study and the low dropout rate but takes a dimmer view of the weight loss achieved in the study and the ability of dieters to adhere to their diets over time [2]. "Even these highly motivated, intelligent participants who were coached by expert professionals could not achieve the weight losses needed to reverse the obesity epidemic," Dr Martijn B Katan (VU University, Amsterdam, the Netherlands) writes. "The results would probably have been worse among poor, uneducated subjects. Evidently, individual treatment is powerless against an environment that offers so many high-calorie foods and labor-saving devices."

Sacks, speaking with heartwire, defended what he insisted was "clinically meaningful" weight loss in his study, emphasizing that many people achieved far greater losses than the average figure. Eckel, by contrast, was less sanguine, pointing out that an average weight loss of 3.5 kg at two years represents the best-case scenario, since real-life interventions rarely live up to the research setting.

Katan, however, argues that "like cholera, obesity may be a problem that cannot be solved by individual persons but that requires community action." He cites a French study that profoundly reduced obesity rates in children by having everyone in the town commit to getting children to eat less and move more, building sporting facilities and playgrounds, giving cooking workshops to families, creating walking itineraries, etc.

"It is an approach that deserves serious investigation, because the only effective alternative that we have at present for halting the obesity epidemic is large-scale gastric surgery," he writes.
In response, Sacks said simply that community wide changes won't absolve individual responsibility. "It's two factors. There's what each person puts into his or her mouth, and there's what's out there for people to choose to put in their mouths."

The National Heart, Lung, and Blood Institute and the General Clinical Research Center, National Institutes of Health, supported this study. Drs. Sacks and Katan have disclosed no relevant financial disclosures. A complete description of other disclosures for the other study authors is available in the original article.

Many adults have tried to lose weight through low-carbohydrate diets in the past several years, and there is some evidence that these diets may be more effective than traditional low-fat diets. In a study by Samaha and colleagues, which was published in the May 22, 2003, issue of the New England Journal of Medicine, a low-carbohydrate diet was associated with greater weight loss among a small cohort of obese patients with a high rate of diabetes or the metabolic syndrome. In addition, the low-carbohydrate diet was associated with superior results in serum triglyceride levels as well as insulin sensitivity among participants without diabetes. The 2 dietary interventions were similar with respect to their effects on levels of total and LDL cholesterol.The current study compares the efficacy of reduced-calorie diets featuring different macronutrient profiles.

Study Highlights

Study participants were between the ages of 30 and 70 years and had a body mass index of 25 to 40 kg/m2. Individuals with diabetes, unstable cardiovascular disease, or who were judged to have poor motivation on screening interviews were excluded from study participation.
All study diets included 8% or less of the total calories from saturated fat, at least 20 g of fiber daily, and 150 mg or less of cholesterol per 1000 kcal. All diets restricted baseline individual participants' daily caloric intake by 750 kcal.

Participants were randomly assigned to 1 of 4 diet groups. The macronutrient contents of these diets were as follows:

20% fat, 15% protein, and 65% carbohydrates (low-fat, average-protein)

20% fat, 25% protein, and 55% carbohydrates (low-fat, high-protein)

40% fat, 15% protein, and 45% carbohydrates (high-fat, average-protein)

40% fat, 25% protein, and 35% carbohydrates (high-fat, high-protein)

Blinding was maintained by the use of similar foods for each diet.
Participants attended 3 group sessions for diet counseling per month during the first 6 months of the trial and then every 2 weeks from 6 months to 2 years. Individual counseling sessions were held every 8 weeks.

The goal for physical activity was 90 minutes per week for all participants.
The main outcome of the study was the change in body weight at 2 years, particularly comparing low-fat vs high-fat and low-protein vs high-protein diets. Researchers also followed waist circumference, participant satisfaction with diet, and laboratory markers of cardiovascular risk.
811 adults underwent randomization, and 80% completed the 2-year trial. Baseline characteristics were similar between the randomly assigned groups. The mean age of subjects was 51 years, 64% of the study cohort were women, and 79% were white. The mean body mass index was 33 kg/m2, and the mean waist circumference was 103 cm.
Weight loss at 2 years was similar in the 4 diet groups. Mean weight loss among participants in the 25% and 15% protein groups was 3.6 and 3.0 kg, respectively. The mean weight loss among subjects in both the low-fat and high-fat groups was 3.3 kg.

The level of carbohydrate in the diet did not significantly affect weight loss.
Waist circumference decreased by approximately 4 cm in all study groups.
Most weight loss occurred in the first 6 months of the trial. After 12 months, all groups, on average, slowly regained weight.

At 2 years, 14% to 15% of participants in each diet group had lost at least 10% of their baseline body weight.

Low-fat diets were associated with greater reductions in LDL cholesterol levels, whereas the lowest-carbohydrate diet promoted higher HDL cholesterol levels. All diets reduced fasting serum insulin levels, and blood pressure decreased modestly with all diet interventions.
Craving, fullness, and scores for hunger and diet satisfaction were similar among diet groups at 6 months and at 2 years.

Attendance at group sessions strongly predicted weight loss at 2 years.
7% of participants experienced severe adverse events. There was no difference among diet groups in the rate of severe adverse events.

Pearls for Practice

A previous study found that a low-carbohydrate diet was superior to a low-fat diet in weight loss, serum triglyceride levels, and insulin sensitivity. However, total cholesterol and LDL cholesterol levels were similar between groups.
In the current study, macronutrient concentrations of reduced-calorie diets did not significantly affect the amount of weight loss, the reduction in waist circumference, patient ratings of satisfaction with the diet, or the rate of severe adverse events. Greater attendance at group sessions predicted higher degrees of weight loss.

Questions? Comments? Be sure to leave them below!

A List of the Most Common Inhalers

If you have asthma or COPD, you probably know what it is like to use an inhaler as part of your treatment. But, did you ever wonder what that inhaler does to make you breathe better and, if you have been prescribed more than one, are you confused as to which-is-which, and what-does-what as far as inhalers are concerned. To help you understand their differences, is a list of the most common inhalers and what they do to your lungs:


A List of the Most Common Inhalers

Vitamin D and Respiratory Infections

Did you know that low levels of Vitamin D are associated with an increased risk for respiratory infections, like the flu or common cold? And, that people with respiratory diseases, like asthma and COPD are at an increased risk for this association?

If you have COPD, there is a new COPD clinical trial designed to test the hypothesis that increasing levels of Vitamin D in the body will lead to better COPD outcomes:

Vitamin D as Treatment for COPD Clinical Trial Study

How can you increase your levels of Vitamin D in your body? Here are some helpful tips:

• Eat salmon, with the bones
• Drink 3 cups of milk daily
• Get 15 minutes of sunshine each day, or, if you don't live in a sunshine infested state,
• Take a multivitamin with at least 200 international units of Vitamin D

Do you have some interesting ideas about how to add Vitamin D to your diet? Please be sure to leave a comment!

Should You Get a Pneumonia Vaccine?

Many of us are ready, willing and able to get an annual flu shot to keep us from getting that nasty flu virus. But what about the pneumonia vaccine? Should everyone get one? Or, are there certain groups more susceptible to bacterial pneumonia who would therefore benefit more than others from the vaccine? Learn more about the answer to these questions here:

The Pneumonia Vaccine: What Every Patient Should Know

Patients' Bath Basins Potential Source of Infection in Hospitals

If you, or a loved one, has ever been hospitalized, you have probably seen those little, (generally) pink bath basins that health care workers use to give their patient a bed bath. Well, the next time you see one of those, you may want to ask the health care worker to sanitize it first before using it. Or, better yet, you would be far safer not using them at all, and using pre-packaged bath towelettes. Why? Read more:

Patients' Bath Basins Potential Source of Infection in Hospitals

Bacterial Pneumonia: Are You at Risk?

Do you have a chronic disease like COPD, diabetes or heart failure? If so, then your immune system just "ain't what it used to be". But did you know that having a chronic illness can put you at risk for developing bacterial pneumonia? Find out more about how bacterial pneumonia and chronic disease sometimes go hand in hand:

Bacterial Pneumonia: Are You at Risk?

RN Online Poll: Are you Happy?

I have to admit, I am (sometimes) depressed). With that in mind, I seem to associate with other depressed people who can truly understand what being depressed is really all about. Today, I was speaking with a friend of mine on the phone and we were talking about the nature of happiness. As our conversation ended, and we both came to the general conclusion that happiness for most people, is, but alas, very elusive, and if experienced at all, is only experienced in rather brief, fleeting moments, I started to wonder if we were mistaken, and if happy people were truly happy all of the time?

In my quest to find out about happiness, I felt compelled to learn more about happiness, or lack-there-of it, from great philosophers who came before me. Here is what I found out about happiness:

Martha Washington:

The greatest part of our happiness depends on our dispositions, not our circumstances.

Helen Keller:

Happiness cannot come from without. It must come from within. It is not what we see and touch or that which others do for us which makes us happy; it is that which we think and feel and do, first for the other fellow and then for ourselves.

Mark Twain:

The perfection of wisdom, and the end of true philosophy is to proportion our wants to our possessions, our ambitions to our capacities, we will then be a happy and a virtuous people.

M. Ghandi:

Happiness is when what you think, what you say, and what you do are in harmony.

Ramona L. Anderson:

People spend a lifetime searching for happiness; looking for peace. They chase idle dreams, addictions, religions, even other people, hoping to fill the emptiness that plagues them. The irony is the only place they ever needed to search was within.

So, do you know how to find happiness. Why not share your secret with the rest of us!

RN ONline is Officially Back in Business

Hey, ya'll. How the heck are you? I have been gone for quite some time and wanted to let you know that I am officially back in the business...of writing that is! A lot has happened and I have missed my calling, but I assure you I am back and hope to continue to provide you with titillating web content to tantalize your reading taste buds!