Lifestyle Medicine vs. Cancer

An illness may result in the loss of something of greatest value, namely some aspect of one’s health.  When considering cancer, you may think “I am at risk of losing my health and there is nothing to be done about it.”  But, is this really true?  According to research by Mingyang Song, MD, ScD and Edward Giovannucci, MD, ScD, “about 20-40% of cancer cases and about half of cancer deaths can be potentially prevented through lifestyle modification.”1  Yet, individuals continue to believe there is nothing preventative to be done under the mistaken notion that cancer is about non-modifiable—“nothing I can do about them”–risk factors such as genetics, age, or race.

Enter the good news, Lifestyle Medicine has evidence-based information on modifiable risk factors and the actions you can take to help counter them:

What you put in or on your body, and what you do for your body.

Someone is already thinking, “If that were true, then why do picture-of-heath individuals get cancer”?  Generally speaking, information about disease and its etiology, complications, etc., fill medical school libraries and is profoundly beyond the scope of this article.  Further, certain details of an individual’s life, e.g., childhood and workplace environmental exposures, may never be known and therefore impossible to factor into the individual’s equation.   However, it is generally agreed that 40% of cancer diagnoses are preventable with changes to lifestyle.  Before you write off lifestyle consider the following: 

EXPOSURE

Smoking has long been linked to lung cancer, sun exposure to melanoma, radiation to thyroid cancer, and Human Papilloma Virus (HPV) to cervical and other cancers.  And, have you seen the legal advertisements on TV with regard to asbestos exposure and Mesothelioma?  Most of us are aware of at least some cancer/exposure links.  Lesser known associations include alcohol’s link with six different kinds of cancer.  Another is Diethylstilbestrol (DES), a synthetic estrogen used during pregnancy between 1940-1971, which resulted in cancer in some of these women and their offspring.  Studies are now ongoing in their grandchildren.  So, the message here is avoidance of exposure to limit your risks.

IMMUNITY

White Blood Cells Attacking an Invader

Think of the immune system as your body’s own little army of “soldiers.”  A “foreign invader” such as bacteria, a virus, or even an abnormal cell forming inside the body sends the “soldiers” into action to prevent invasion, replication and dispersion.  But, as with certain illnesses like HIV/AIDS, impairment of the immune system can occur.  Transplant recipients require immunosuppressive medication to prevent the “soldier” cells from mistakenly attacking the new organ.  These “soldiers” also may not be able to destroy unrelated cancer-causing infections or cancer cells, hence the restrictions placed upon these patients regarding crowd exposure, etc.

INFLAMMATION

When an injury occurs, the body’s immune system sends white blood cells and chemicals to heal the area.  This will present as a warm, red area around the wound.  However, sometimes after the injury is healed, the inflammation remains.  It is even possible to have inflammation without an injury or infection; this chronic inflammation can damage healthy cells and weaken the immune system, leading to development and growth of cancer cells.

EXAMPLES FROM EACH OF THREE AREAS

Viruses, bacteria, and parasites are all part of the problem.  By exposure, they enter the body.  Some disrupt the cell communications; others weaken the immune system, decreasing the body’s ability to defend itself against other cancer-causing infections; and a few lead to chronic inflammation.  Some like H. pylori (best known as causing stomach ulcers) and Hepatitis C have treatments available.  Others such as Hepatitis B and HPV have vaccines available for prevention before exposure.  Your doctor will guide you regarding appropriateness of vaccines for yourself and your family.  When traveling, educate yourself about the geographic area and the preventive measures you can take to reduce exposure to pathogens.

SO, HOW TO AFFECT THESE AREAS

Every time you eat, it is an opportunity to put something into your body to make it function better.  Does this mean supplements?  No, real food!  Blueberries for example, are showing amazing potential in studies to not only prevent cancer from forming but to assist in cancer therapy by making the cancer cell more susceptible to treatment.  To see other ways foods can positively affect your health refer to the “The Nutrition Rainbow2.

So, what else can I do?  Shown below are other activities you can incorporate and their cancer-busting potential.

Hopefully, this article has given you a brief introduction to the relationship between lifestyle changes and their ability to perhaps lessen potential cancer risks, all presented in a way that is understandable to those not seated at the science nerd table.  Or, maybe you are still caught up in the “this is too much trouble; this is too unlikely; this is not do-able in a family of five; this isn’t going to mitigate the strong history of “x” cancer in my family,” etc. But, you read the article…all the way to the end.

In a nutshell, Motivational Interviewing, a counseling technique, defines five stages of change:

  • Pre-contemplation—“Leave me alone.”
  • Contemplation—“I’m thinking about it, but on the fence.”
  • Preparation—“I’m going to do it.”
  • Action—Do it.
  • Maintenance—Ongoing monitoring.

Remember, you read the article…all the way to the end, so you may well be at Stage 2 or even 3.  Continue to digest the information and maybe even look up some additional sources online or chat with your primary care doctor or Lifestyle Medicine physician.  Should you undertake to make changes, remember perfection isn’t expected or being broadcast on social media.  Any change, however small, you undertake to promote better health can only help.

References:

  1. Song M and Giovannucci E. JAMA Oncol. 2016;doi:10.1001/jamaoncol.2016.0843.
  2. “The Nutrition Rainbow” by The Physician’s Committee for Responsible Medicine. Link

A Study of Studies

Photo by Pixabay on Pexels.com

“Butter is Bad.” “Butter is Back, Baby.”  “Red Meat is Bad.” “Red Meat=Beneficial Nutrients.”You get the point.  

In our 24-hour news cycle, anything can be touted for “clicks” and “likes.”  From time to time, studies which support writers’ personal biases are sought out. And, perhaps most importantly, today we are overwhelmed with the magnitude of available information, leaving one to scratch his or her head while it spins in confusion.

So, how do we narrow down all this info to make it meaningful? Consider going back to the source of the information and evaluate the studies yourself. Not a scientist? You can still find useful needles from the haystack by keeping in mind a few ideas:

1. Am I willing to invest the necessary time? Plan to read the entire study, not just the abstract (summary) of the paper. It will take some time. Have a notepad handy to jot down any ideas or questions the study prompts.

2. What kind of study is it?
a. A double-blind, random, controlled study (where neither participant nor researcher knows to what group the participant is assigned) is considered the best experimental model.  
b. Observational studies typically observe a controlled environment, but results can be influenced by the participants’ awareness of the groups to which they are assigned. Conclusions in this case may be inferred but not necessarily proven.  
c. Metanalysis examines multiple studies to look for consistent results.

3. Who funded the study? If the Widget Council funded a positive study on widgets, it may be a good study…or, it may be one good study among several unpublished ones that did not support their product.  What about a study sponsored by American Gadget Association? A look at the sponsors may reveal funding for the study from the Widget Council.  (A list of any researcher’s conflicts of interest should be listed.)

4. Where was the study published?  In some journals the author can pay to have a study included regardless of the quality.  Look for academic, peer-reviewed journals.

5. What are the researchers’ credentials?  A neurobiologist with several advanced degrees and 15 years’ work experience studying the microscopic changes of a nerve probably has a great deal of credibility.  An English major’s biology paper written to satisfy a graduation requirement might not contain the best criteria upon which to base a life-changing decision.

6. What is the study trying to prove?  This information should be found in the Abstract or Introduction.  A recent news article cited a study in the fats vs. carbs weight loss debate. However, the study’s Abstract revealed that the study topic regarded metabolism not weight loss.  

7. How large is the study?  A study of 10,000 participants will control for many more variables than a study of 100.  Keep in mind though, under rare conditions ten participants may be a large sample size.

8. How many participants did the study start and end with? Suppose a study started with (a very reasonable) 1,200 screened participants, yet only 300 eventually participated. What was the elimination criteria? Was this a drug trial and participants quit taking the medicine due to side effects? Was it a diet that was too hard to follow?  Did the scientists only include results that support one viewpoint?

9. How long did a study last?  Two years for a chronic disease drug trial rather than a week could provide considerably more useful information. Conversely, the deaths of 10% of the sample within 5 days of study commencement is very telling.

10. Was this a cell culture, an animal or human study?  

11. Do the results answer the question the researchers set out to prove?  Can you think of any alternate reasons for why these results were obtained?  Do the authors look at alternate reasons for the results they obtain? Don’t forget reader bias; are you willing to change your mind if the evidence is strong enough?

12. Good at statistics?  Run the numbers.  If not, then look for study critiques.  Many journals have other researchers that will evaluate the study and explain the numbers as well as the study design, sometimes with different conclusions.  Compare to other similar studies. Look at the references.  They can shed new light on how the scientist is approaching the problem.

Like any other skill, learning to read this type of material takes time and patience. But the more you read the more you will learn, and this may help you to sort the wheat from the chaff the next time a new blockbuster study is rolled out in the media.  For a more detailed study plan with additional questions to guide you, click here.

Whole Food Plant-Based

Becoming Plant Powered

It is exciting to run into people who haven’t seen you for a while who comment “you look great; what are you doing”?  The problem? How to describe a plant powered lifestyle in just a few words.

Vegan? Vegetarian? Plant Strong?  While a little wordy, Whole Food Plant Based really describes what we do and what I promote.  It is not a diet but a lifestyle. So how does it differ from other approaches?

Vegetarian — plant based meals which may include eggs and/or milk.

Vegan — eschews the use of all animal products.  If it has a face or a mother it will not be consumed or used.  For many vegans, this way of life is as much or even more about animal and environmental concerns. 

Keep in mind that your diet may still be unhealthy with either of these approaches.  If you subsisted on chocolate cream cookies and beer it would be vegan, but would it be good for you?  NO!!!

How Does WFPB Set Itself Apart?

Start with the first part – Whole Foods.  Eating food in its least processed form.  It does not have to be raw; some foods are more nutritious cooked, but try to minimize processing.  Examples:

Most processed:  Apple juice lacks fiber and other substances which blunt the quick absorption of the sugar.

Better, less processed:  Apple sauce without the peeling contains only about ½ of the fiber and polyphenols.

Best:  The whole apple contains all the available polyphenols and fiber.

Plant-Based.  Someone invariably jokes that cows eat plants so beef is plant-based.  It always gets a chuckle from the group until we discuss how multiple large studies link red meat as a cause of colon cancer.  Another point is how meat-based proteins (but not plant-based proteins) cause stress to the kidneys in renal failure patients.  This potentially means meat is stressful to healthy kidneys as well.  So, plant-based means just that—it comes directly from the plant. 

Frequently, someone says “I don’t like vegetables.”  The plant world is much more varied than people believe.  Take a look at this non-exhaustive list of items we can find in stores and farmers’ markets in the North Alabama area.   Most people can find something on each list that they like. The items may not be listed botanically, but rather in how they nourish the body.

WHOLE Grains:  brown rice, oats, wheat, corn, farro, quinoa, amaranth, barley, rye, buckwheat, bulger, millet, sorghum, spelt, triticale

Nuts, Nut Butters, Seeds and Seed Butter:  walnuts, pecans, almonds, pistachios, sunflower seeds, peanuts, hazelnuts, pine nuts, cashews, flax seeds chia seeds, pepitas (pumpkin seeds), sesame seeds

Vegetables:      

Greens/Cruciferous:  lettuces, kale, collards, bok choy, Swiss chard, turnips, spinach, arugula,  broccoli, cauliflower, brussel sprouts, cabbage, broccoli rabe, Chinese cabbage, kohlrabi, mustard greens, radish greens, rutabaga, tatsoi, watercress

Tubers/Roots:  potatoes, sweet potatoes, yams, carrots, beets, onions, parsnips, turnips roots, radish roots, rutabaga, jicama, taro, Jerusalem artichoke, leeks, garlic

Other:  asparagus, celery, rhubarb, sweet and hot peppers, cucumbers, eggplant, okra, pumpkin, squash, snap peas, green beans, tomatoes, zucchini, mushrooms, bean sprouts,

Fruits:  cantaloupe, watermelon apples, pineapple, oranges, grapes, bananas, raisins, plumes, prunes apricots, peaches, cherries, avocado, kiwi, clementine, dates, figs, grapefruit, honeydew, jackfruit, kumquat, lemon, limes, mango, olives, nectarine, papaya, pear, persimmons, pomegranate, paw paw, quince, tangerine

Berries:  blueberries, blackberries, cranberries, mulberries, raspberries, strawberries, currents, grapes, muscadines, scuppernongs

Beans:  English peas, black beans, black-eyed peas, field peas, purple hulls, crowder peas, broad beans, lima beans, chickpeas, kidney beans, lentils, navy beans, pinto beans, split peas, soy beans

Spices and Herbs:  Too numerous to name, but wonderful sources of additional plant benefits

Returning to the claim of not liking vegetables, I would ask have you tried every plant fixed every conceivable way?  Those with children can relate to the expression, “eat your food, it is good for you” and “how do you know you don’t like it, you haven’t tried it.”  So often as adults we fall into a trap of saying “I am an adult and I don’t have to eat it since I don’t like it!”  But you really need to think about your health.  Try new items.  Try old items fixed new ways.  One client disliked cooked kale, but tried kale as a salad and enjoyed it.  One person loved the consistency and flavor of our cornbread but almost spit it out upon finding it had her hated food group BEANS in it.  She overcame the mental obstacle toward eating them and asked for the recipe to make for her family.

Look at this as a food adventure and see what you can do to add more plant-based foods to your diet!

Lifestyle Medicine

Reprint of my article as printed in Inside Medicine magazine August 2018 edition.

The old expression–”there is nothing new under the sun”— may indeed be true.   But, old ideas sometimes can be explained in a new way.

Many people are already aware that their habits can affect their health.  The news is full of “don’t eat this,” or a new study on exercise.  And, yet, we as a nation appear to be getting sicker.  It is difficult for doctors to discuss health given our current illness-based insurance model.  With genuinely caring physicians having such limited time with each patient, the recommendation for a one-size-fits-all diet and exercise approach is often the norm.

Fortunately, out of established research a new branch of medicine has emerged with the focus on helping people improve their health and prevent chronic diseases.  Based on improving six areas of health, Lifestyle Medicine uses many non-drug modalities to treat, improve, and sometimes even reverse chronic health conditions. Medication, while still used, becomes the supplement to these lifestyle changes.

These six areas are:

  1. Nutrition—getting vitamins, minerals, protein, fiber, phytonutrients, etc., from a predominately whole-food, plant-based diet
  2. Movement—consistent daily movement that works all the muscles, including the heart
  3. Sleep—improving the quality of rest
  4. Substance use—eliminating the use of tobacco and other potentially harmful substances
  5. Relationships—establishing and nurturing supportive social connections
  6. Stress management—leading to improved health and productivity

Why focus on so many things? In addition to the fact that individually each of these areas can produce health issues (e.g., tobacco and cancer), they also can affect each other. Improved sleep may assist in weight loss.  Moving may reduce stress. And, if you don’t fuel your body with a good quality diet, it’s little wonder you don’t feel like getting off the couch.

Would you like to feel better about your health? The process starts by deciding what your goal is and perhaps even writing it down.  Maybe you would like to run a 5K or simply be able to play on the floor with your grandchildren.  Next is to identify areas you are willing to change.  Maybe the coffee creamer will not be eliminated, but you will eat an extra serving of a green vegetable each day.   An earlier bedtime is not feasible, but you are willing to encourage deeper sleep by turning off your phone and leaving it in the kitchen overnight. Successes are celebrated and failures are put to good use as you learnto analyze, re-adjust, and overcome.

So, while the message is not new—your mother may have told you to eat your vegetables and get plenty of sleep—life has a way of intervening and sending us down another path.  Now is the time to learn how to manage that stress, get some quality rest, develop a strong emotional support system, avoid substance use, and become active while being mindful of your food choices.  It may just be exactly what the doctor ordered!

Elizabeth McCleskey, DO Board Certified Family and Lifestyle Medicine; Member, American College of Lifestyle Medicine; HealthStylesDr.com

You Are Getting Sleepy…NOT!!

Well, you have accomplished another busy day. Meals prepared, work completed,

grayscale portrait photo of shocked woman

laundry done, kids ferried, and pets tended. Now, you can’t wait to fall blissfully into bed and drift off to sleep. Until you think of your to-do list while a heat wave moves down your body, your bed partner snores like a chain saw, and the panic sets in about that forgotten urgent task. What is a person to do?

Before you head for a sleeping pill, ask yourself some questions that will help identify causes:

  • • Am I having trouble falling asleep or staying asleep?
  • • Is there physical discomfort such as back pain, indigestion, or achiness or stiffness overall?
  • • Listen to the environment. Was there a noise that woke you up? Examples might include a neighbor leaving to work a night shift or the cat dashing across the bed on a secret errand?
  • • Are you hot or cold?
  • • What did you have to eat or drink that day, especially within a few hours of bedtime?
  • • Do you feel anxious and, if so, why? Was it a nightmare or unfinished task?
  • • Are you tired during the day, as though you haven’t had good sleep?

analysis blackboard board bubble

Now see if your solution is here!

Be Touchy Feely

Pain or daytime fatigue? You spend 7-9 hours with your mattress, and as much as you may love it, it may be time to break up. A broken-down mattress can cause you to sleep hot or wake up achy. As you get older, lose or gain weight, or have a pregnancy, the type of support you need can change. Do you need a traditional, hybrid, foam, or pillow top? A split bed which allows for use of different linens on each side may be the answer. (Note: A split bed can be difficult to make up.) Adjustable beds can be helpful for orthopedic issues, reflux, and even some snoring conditions (especially if you control your snoring partner’s remote). Linens and mattress pads can be made of various materials that impact sleep differently. A helpful (but not all inclusive) chart can be found at https://www.cuddledown.com/ResourceCenter.aspx?article=14.

red and white bed pillows

Pillows should support the head and neck without the chin tucking or raising toward the ceiling. Designed for back, stomach, and side sleepers, they are available in a variety of materials. Leg pillows align your body to relieve lower body pain.

Tackling Temp
Best room temperature has been shown in studies to be 65 degrees F. But try adjusting the temperature to see what is right for you.

For Those Who Sleep Hot                                         

Thread count 200-400                                                
Ice pack                                                                          
Gel cooling pillow                                                        
Dehumidifier                                                               
Iced drink in insulated cup by bed                        
Lightweight, moisture wicking fabrics                 
Blinds drawn during the day to reduce heat      
Ceiling or portable fan                                              
Spray bottle of water to mist body                     
Extra set of PJs or sheets                  

For Those Who Sleep Cold

Thread count 400+ or flannel fabric
Hot pack or heating pad
Socks
Humidifier
Hot drink in a thermos by the bed
Heavier sleepwear and sheeting fabrics
Open blinds during the day to warm the room
Electric blanket to warm the bed

Snoring

This could be due to something as simple as allergies (see below) or something as serious as sleep apnea. Sleep apnea can have potentially serious health implications like heart disease, stroke, or reflux (https://clevemed.com/what-is-sleep-apnea/), but people fear the screening procedure or possible treatment regime. Fortunately, advances such as in-home sleep studies and newly designed masks and quieter machines make this a much more comfortable proposition. If you or a loved one snores, check out this screening questionnaire: https://clevemed.com/what-is-sleep-apnea/patient-sleep-apnea-screener/. Don’t know if you snore? Consider taping yourself while you sleep. (Or, you can check out an app like SnoreLab, but a humorous heads up: A friend of mine told me about this app. She was taping herself over time, and was quite alarmed one morning to listen and find an “odd” sound to her breathing. Turns out, the cat had rested on her chest near the phone overnight and his purring was recorded.)

Allergies                                                  
short red hair woman blowing her nose

  • • Launder bed linens weekly in 130 degree F+ water and use automatic dryer.
    • Dehumidify the room to below 50%.
    • Air out the bed before making it up (dust mites like moisture).
    • Cover mattress and pillows with dust mite covers.
    • Vacuum the mattress monthly, and if desired, sprinkle baking soda on mattress 10 or so minutes before vacuuming to draw out moisture.
    • Vacuum and dust the bedroom weekly, and don’t forget air vents, blinds, and curtains.
    • Consider HEPA air filter.
    • Keep pets out of the bedroom.
    • Keep windows closed to keep pollen outside.

The Light and Dark of the Matter

Light wakes up the brain by affecting hormones the body makes. Unfortunately, the body does not know that light from the TV, smartphone, or streetlamp isn’t day light. Gadgets should be put away 1-2 hours before bedtime, preferably in another room because they still can emit small amounts of light while charging, notification alerts, etc.

macbook air beside notebook and camera
How Not to Sleep

Use window treatments such as blackout curtains to prevent leakage of outside light. Consider a sleep mask (a friend tells me hers makes her feel like a glamourous 1930s film star.) These tips are especially important in shift workers. In the morning, getting outside for 20 minutes of natural sunlight also helps to reset your sleep cycle.

To Sleep, Per Chance to Dream: Sleep Assistance

  • • Start the morning with an exercise routine. Exercise helps to reduce extra energy, but undertaken too late in the evening it may prevent sleep.
    • There is an old adage: “Eat breakfast like a king, lunch like a prince, and dinner like a pauper.” Consuming and expending most of your calories during the day are best; night-time consumption can cause reflux and restlessness.
    • Alcohol and caffeine will disrupt sleep. Cut off the caffeine early in the afternoon, and coffee-cup-working-happy.jpgnever use alcohol to “help” you go to sleep.
    • Keep the bedroom tidy, the bed made, and decorate with comfortable colors and furnishings. Calm surroundings will contribute to calming the mind for drifting off to sleep.
    • Before lights out, commit to paper the to-do list to release it from your mind as you fall asleep.
    • Induce sleep by heating the body with a warm drink or bath then let it cool down.
    • A regular daily bedtime and wake time is important. Lost sleep is just that…lost. Don’t expect to make up several days of sleep deprivation. Unless made up within a few hours, the damage is already done.
    • Noise—
    »Turn the TV off. The frequent volume changes prevent deeper stages of sleep
    »Use white noise such as a fan running or white noise machine which is good at masking noises such as traffic.
    »Try ear plugs.
    »Music with a beat of 60 beats per minute may assist in bringing the heart rate down and causing sleep. BUT put the music on a timer for 30 minutes. Much longer than that and it, too, can wake the brain.
    • Some people swear by lavender or other essential oil scents. While these may be helpful for some, others may experience allergic reactions.  Also be aware that pets can be harmed by them in very low doses.
    • Breathing exercises such as 4-7-8 breathing or focusing on relaxation of each part of the body progressively are often helpful.
    • Should you wake during the night, have a large tablet and pen by the bed to write down in one or two words what is bothering you, preferably without turning on a light. Don’t worry about spelling, grammar, or staying “in the lines.” This is just to get the thought on paper so you don’t focus on it to the detriment of further sleep.
    • Should you wake up and be unable to go back to sleep for 20 minutes, go ahead and get up. Find a quiet activity such as reading to occupy your mind. Sleep cycles take about 90 minutes, so when you start to feel tired, go back to bed.

Sweet Dreams!!  

baby beautiful bed child

Additional information can be found at:
https://sleepfoundation.org/bedroom/index.php

 

Cooking 101

“I need fast” one will say. “Flavor is what is important” says another. “Appetizing look!” “Alas, I don’t know how to cook.” And the ever popular ‘I don’t like ____________ (fill in the blank).” Well you get the picture. Everyone has a perception of what it means to make a “good” meal.
Personally I did not learn to cook until I was an adult. The way my mother (an excellent cook) prepared food was incomprehensible to me. What is a handful or a dash? Cook until done means what exactly? Enter Martha Stewart. Think what you will of her, she provided a framework for cooking that was understandable. It reminded me of chemistry class where everything was precise and the chemical reactions made sense.
Fast forward a few years and now I understand how my mother cooks. Precision is great when you start cooking but variety in taste comes when you become open to experimenting. Don’t believe me? Google a favorite dish and see how many distinct recipes you can find.
So in honor of summer, I am writing about a favorite meal. One that can be changed up in numerous different ways and adapted to meet the need for both fast and flavorful.

Pasta Salad 2.0
4 servings

Basic recipe-remember if you don’t like an ingredient, substitutions will be suggested below.

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1 package of Barilla Ready Pasta – any style
22 oz (2 packages) of frozen California mix vegetables microwave in the bag
2 Tablespoons of Italian dressing

Cook the Barilla as directed on the package. Put ¼ of the bag on each plate. Cook the vegetables as directed, divide into four servings and mix with the pasta on the plates. Add ½ Tablespoon of dressing to each serving. Putting this directly on the plate saves a mixing bowl and will help cool the vegetables and pasta quicker.

For a side dish, while cooking the vegetables wash some fresh berries and serve with plain yogurt. Or to skip the sides, make this dish into 2 servings rather than 4.

It depends on your microwave, but I made this version in 10 minutes start to finish.

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Don’t care for this warm, or want to use it for a lunch? Cook earlier in the day. Put the dressing in the bottom of a bowl or Mason jar, then layer the firm vegetables, pasta then soft vegetables like tomatoes (a listed option below) and put in the refrigerator. Stir before serving.

 

Now for some variationsimgp9469.jpg

With no Italian dressing on hand, I used a tablespoon of olive oil and a ½ tablespoon of vinegar. Different vinegar types will work, just remember the stronger the vinegar the less you need. The nice thing about Italian dressing is the spices are already included so there are no extra ingredients. Don’t care for Italian? Check the chart at the end for alternatives.

 

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Vegetables make this dish for me so adding more is always an option. Here I used tomatoes, bell pepper and black olives.

 

 

 

Special tools can help save some time and dishwashing but are not necessary.

I find a corer faster to remove stems from tomatoes and peppers and even the pepper seeds. Food processors quickly chop food, but increase clean-up time. Cutting with a knife is sometimes a bit precarious for me so I invested in a chopper-the manual kind-to quickly coarse-chop items such as olives and bell peppers.

IMGP9476

 

In the bowl they go.

 

imgp9498.jpgNow for added flavor. There is always salt and pepper to taste. Dried herbs are easy to keep around and adding Italian seasoning can work wonders. But you can really kick up the favor with fresh herbs. Yes they can be expensive, but ask around and see if you can find someone who is growing some. Better yet, consider growing some yourself! You can grow a variety all in one planter.

 

Here we have fresh basil, parsley and oregano as well as dried herb options.

imgp9474.jpg

After washing the fresh herbs, here are two quick methods of cutting.
imgp9478.jpg                                           Roll the leaves up into a tight roll and

 

 

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Chop with a knife-Note the poor hand placement

Or cut with scissors-safer

 

The leaves may turn brown in the cutting process. Just leave this for the last step so the leaves stay green until consumed.

imgp9490.jpg

And there you have it! Total time: 18 min.

But what about those things that you don’t like to eat or don’t have on hand?

Here are some helpful additions or substitutions you can use. You may want to increase or decrease the seasonings to your taste. Play with the pasta shapes and ingredients.

For cost savings buy dried pasta and cook yourself. Look for in season and on sale vegetables. Potted vegetable plants require little work and can yield lovely low cost fresh produce.

Now be adventurous and enjoy!

Proteins
Precooked Chicken
Feta cheese
Parmesan cheese
Romero Cheese
Provolone
Hardboiled Eggs
Chickpeas

Vegetables
Cauliflower
Broccoli
Carrots
Tomatoes- Cherry tomatoes may be easier to cut
Celery
Different colored bell peppers
Black or green olives
onion
Zucchini
Artichoke Hearts

Flavorings
Basil 3-4 leaves fresh or ¼ teaspoon dry
Oregano ½ teaspoon of fresh or dried
Parsley 2 Tablespoons fresh or ½ dried
Dried Italian seasoning mix 1 teaspoon
Italian dressing dry mix
Salt
Pepper

Dressings
Italian Dressing 2 Tablespoons
Olive oil 1 Tablespoon with Vinegar ½ Tablespoon
Mayonnaise 1-2 Tablespoons
Another type of dressing such as Panera Poppyseed which is sweeter and less tangy

 

 

 

Farmers’ Market

Ahh…spring, when a young lady’s fancy turns to thoughts of…Farmers’ Markets! Yes, the Markets are open again and I find it amazing the number of people who have never visited one.

So, maybe a littlestrawberry and lettuce primer to help encourage you to explore one of these wonderful places.  The photos have been provided by Kevin Stallings and were taken at the Madison City Farmer’s Market, Madison, AL.

Let’s start with some definitions:

Organic—a farming method that avoids the use of pesticides, herbicides, or man-made fertilizers, any of which may leave a residue on the food. Many farmers employ organic growing techniques but, to avoid raising the costs of their products, do not become certified.

Conventional—methods that employ pesticides, herbicides, or man-made fertilizers resulting in higher yields and potentially lower cost. The advantage over conventional store produce is that it is picked at the peak of freshness, taste, and nutrition and brought right to you.

Raw (Straight out of the cow) Milk—has been neither pasteurized (heated to kill harmful microorganisms) nor homogenized (the cream floats to the top and will need to be shaken for best flavor). In Alabama, the sale of raw milk is legal for farmers with a commercial feed license only for pet consumption.

Unlicensed Kitchen—any kitchen (e.g., one located in a home) that has not been breadinspected or licensed by any agency.

Genetically Modified Organism (GMO)—when the DNA of the organism has been artificially changed.

Grass-finished Meat—results from livestock fed exclusively grass during the last few weeks or months prior to being processed.

Grain-finished Meat—results from livestock fed grains during the last 90-160 days prior to being processed. Resulting in more marbling of the meat, many feel this enhances the flavor aeggs 5nd tenderness but may also be less healthy.

Pasture-raised Livestock—livestock that lives in pastures, or may even forage in woodlands, but have access to shelter. Their diet may be supplemented with grain.

So, now that you know some of the lingo, how do you approach shopping? First, youbird 2 neecatd to understand that this is not the grocery store chore. Think of it as an outing. At our local Market in Madison, AL, you can stroll through the Market or have a seat and listen to the local musicians play while sipping coffee or tea sold by a local vendor. Well behaved, leashed pets are welcome. When they dogare not busy, chat with the vendors about new products, farming methods, food storage, produce selection, or recipes. They love to share their knowledge and will get to know you by name and tastes.

Civility, which seems to be generally in decline, is delightfully present at the Market. Patrons patiently wait for the Market to open and quickly leave at closing. Lines magically form as each person waits to purchase especially popular or scarce items. If someone appears to be contemplating a purchase, it would be very poor form to band 2grab the item without asking. Occasionally, I have selected the last of an item only to find someone behind me came early to purchase that very thing. Handing it over to another just seemed the right thing to do, and yes, this gesture has been reciprocated!

While it is not an uncommon practice to purchase from wholesalers and resell at low cost roadside stands, this is not allowable at most farmers’ markets. Many of today’s local farmers who share their crops at the Market not only farm organically (producing less quantity) and harvest (sometimes by hand) but also transport (requiring time away from the fields) their wares. In my opinion, this produces a better quality product brought to us in a timely way, and prices have to reflect costs of running the business. Vendors areradishes and turnips not used car salesman and do not price their wares expecting to haggle. Happily, you may find they offer a discount for bulk or throw in a new product for you to try. But, if price if an issue, walk around and take a peek at what other vendors have to offer.

If samples are not samples 2available and you really want to try something, don’t grab…ask! Many times it will be provided. Produce is gently handled and never squeezed which may cause bruising preventing a future sale. Instead politely sniff for an enticing aroma, and examine with the eyes for size and spoilage. At the Market, food is usually picked ripe because it is brought to sell within hours, unlike the supermarket offerings which are picked to ripen along the journey across the country or around the world.

While some vendors have credit card processing capacity, start by bringing smaller bills until you get to know the ins and outs of who’s selling how. This will also allow you to move quickly through the Market without having to wait for change. Best variety is at opening with limited items going fast. Regulars know this and will head to these vendors first.

So next Market day, slap on the sunscreen and your wide-brim hat, pick up those reusable shopping bags, and head out to your local Market. I will see you there!

Want a bit more information? Join Dr. McCleskey for Shop-with-a-Doc Farmers’ Market edition at the Madison Farmers’ Market, 1088 Hughes Road 7:45 am May 26, 2018. RSVP 256-280-3990.  We will meet at the east end of the Market.

Before Disaster Strikes

When Before Disaster Strikes Part 3 –Evacuation

14. Is your vehicle adequate to transport people, pets, luggage, AND medical equipment? If not, with whom can you make arrangements for shared transport?
15. Can all members of the household survive without heat or A/C, given their medical conditions? (For example, severe respiratory symptoms could occur in 100o heat/80% humidity or extreme cold for COPD or asthma patients, respectively.) If not, evacuation may be the best choice.
16. Think ahead about accommodations outside your local area. If applicable, call hotels and learn about availability of handicap-accessible rooms and equipment such as bath chairs, raised seats for toilets, etc. Record this info (and the date it was obtained) and keep it with your emergency papers so it is at the ready if needed. If advance warning of an event occurs, reserve your room(s) early, because most hotels have only a few handicap-accessible rooms.
17. A question for some real soul searching: Are you able to travel? Nobody wants to leave home or evacuate to a shelter. But if you must leave your home, are you realistically physically and medically able to travel outside your area, perhaps a great distance? If not, your best option may be a special-needs shelter with medical staff to assist you. Since not every shelter provides for special needs, you may want to contact your local emergency management agency for assistance in finding one or look at the resources provided at the end of this blog entry. Also, ask how you register with the local EMA as a person possibly in need of transportation should evacuation become necessary.
18. Neighboring states may open a shelter as was the case for Hurricane Irma. Find the zip codes for your chosen evacuation areas and add this information to your disaster plan file. These zip codes will help you in determining if a shelter in that area is available should the need arise.
19. Many will assume they can stay with friends or family. Let’s say Aunt Matilda offers a welcome into her 1930’s style house with two bedrooms, six entry-door steps, and tiny doorways. What is your plan to get your wheelchair-bound parent up the steps and into the bathroom? Will the house accommodate four adults, two teenagers, one child with a seizure disorder, and a service animal? Gratitude in the moment and a miserable time for all might well be replaced with a more suitable evacuation experience if some forethought is given.
20. Pets and service animals will require their own “luggage,” including, but not necessarily limited to, food, bowls, medications, leashes, collars/tags, service vests, documentation of vaccination, note of microchip numbers and provider phone numbers, contact information for veterinarian, crates, bedding, and toys. Pets, especially cats, may become very stressed by the change experience and need additional attention to their emotional needs and oversight to prevent their escape.
21. If you are receiving dialysis, home-health, or hospice services, ask about plans for patients who desire to evacuate. For example,
a. If I evacuate to City-State, with which provider can you arrange for me to receive services? If none, ask what options are available per the agency’s policy/procedures.
b. How long can treatments, etc., be safely interrupted if patient shelters in place?
c. What are the criteria by which the home health or hospice agency will no longer allow their personnel to visit patients, e.g., wind >50mpg, flooding.
d. Does the agency have a tentative plan/date for restoration of limited or full service?
22. Speak with your doctor, pharmacist, or other health care provider for additional suggestions.

By no means is this an exhaustive list. Each individual has his or her own unique resources and needs, and this should be a starting point to begin examining yours. We want you to be best prepared to act in the best possible way if “that” day comes.

The following resources include much more extensive information regarding sheltering and how to make an emergency family plan. A short internet search will also yield resources in your specific city/county, so recruit a grandchild or neighbor’s kid if you need someone to search and print information from the Internet, but please–take a few minutes to plan ahead.

ReadyAlabama.gov
Ready.gov
Redcross.org
FEMA.gov
Disasterassistance.gov

–BE SAFE AND BE HEALTHY–

Before Disaster Strikes

When Before Disaster Strikes
Part 2 – Medical Equipment

7. Don’t forget fresh batteries for hearing aids and wheelchairs, remote monitoring devices for pacemakers, etc. Small medical devices such as spacers for inhalers should be stored with medication. Colostomy bags, urinary catheters, and the like may need to be readily accessible. Perhaps someone in your household uses a product such as a thickener to assist with swallowing; if evacuating, this may be necessary during the journey, so keep some handy. Some of these items are available in single-use packages for handy pocket/purse or emergency kit use.
8. Are any special foods or food preparation equipment necessary? While hot dogs may taste great, a diabetic needs something better suited to her dietary needs. What about those who require a soft diet; no electricity means no blender. At least three days of non-perishable food that meets specific medical needs can be very important. (Don’t forget to periodically check those expirations dates and replace if necessary.) The stress of the event is enough; the body doesn’t need to be further taxed by depriving it of nutritious food.
9. In the event of a tornado or similar situation, have you identified and prepared a safe place which can be reached by a loved one who is confined to a wheelchair or hospital bed? If not feasible, do you have an alternative plan regarding how and where to move him so as to keep him and yourself as safe as possible?
10. Utility companies sometimes provide expedited relief to patients with documented severe health issues, especially in cities which have programs that pre-register them for prioritized repairs. Check with your utility companies now; don’t wait until the next disaster is knocking on your door because they will not have the manpower to evaluate and act on the request at that 11th hour.
11. If medical equipment is supplied to you by a medical supply company or your loved one receives services of hospice or home-health providers, know their emergency policies. For example, ask:
a. Will the medical supply provider deliver a supplemental oxygen tank (which does not require electricity) to my loved one in advance of the oncoming storm for his use should loss of electrical power render his oxygen concentrator unusable?
b. What is the plan to provide service to patients during and after the event?
c. How is patient status prioritized with regard to deliveries, etc., after the event?
d. How are patients contacted if phone systems are out of service?
e. If your work site experiences facility damage or destruction, what is the back-up source for supplies and delivery?
12. Do you have a C-pap machine, oxygen concentrator, etc.? Smaller equipment could be run on battery power IF the patient has the resources to purchase and a way to recharge it. Some choose to have a generator for their home. While a good option for some, especially professionally-installed models, keep in mind that all have maintenance tasks/costs, some can be difficult to operate, and all are potentially dangerous. NEVER operate a portable generator inside a structure, as carbon monoxide poisoning can easily occur. Fires are also potential dangers, and electrocution of homeowner or utility company line workers can occur if improperly used. (Note: NEVER connect a portable generator directly into the home’s wiring; feedback can electrocute line workers!)
13. A few example questions for rehab and long-term care facilities should you have a loved one in residence:
a. Does the facility have back-up generators? If so, where are they located and to what extent are they protected from flooding, wind, etc.?
b. What is the procedure regarding assessment for adequate staffing and where are the staff physically located in the facility throughout the emergency event?
c. What is the policy regarding moving patients to the safest location within the facility?
d. Is a family member allowed to stay with her loved one?
e. How will food preparation be accomplished during a power outage, especially if the patient is on a special-needs diet?

Before Disaster Strikes

When Before Disaster Strikes
Part 1 – Medicines & Papers

Wildfires to the west; hurricanes to the south; blizzards in the north; and tornadoes in the Midwest: Wherever you live a natural disaster can occur, an evacuation might be ordered, or a disruption of medical services could result. Are you prepared? While all possible medical scenarios and preparations are well beyond the scope of these three blog entries, hopefully the information presented will help you organize your thoughts, research further, and proactively prepare for the future emergencies we hope never arise.

Part 1 – Medicines & Papers

1. The stress of an emergency situation can impede your thought process and make difficult the collection of needed supplies. Create a list of necessary medical supplies prior to the event. It will decrease the time necessary for their collection and packing and minimize forgotten items. Be sure to set a reminder to update the list semi-annually or when the medical history of any family member changes.
2. If you take medication, don’t run out. Keeping a three- to seven-day supply of your medications on hand at all times can literally save your life. Some sources suggest even longer reserve supplies, i.e., up to 30 days, although many third-party payers will not authorize such extremely early refills. Most will, however, allow you to refill a few days ahead of schedule, giving you the reassurance of having a few extra doses on hand.
3. Some folks put their extra medicine in an emergency “grab bag” for easy retrieval in the event of an evacuation. If you don’t choose this approach, try as much as possible to store all your medicines together so you can gather them quickly. Consider keeping a sealable plastic bag folded up with them to facilitate packing. However you choose to consolidate your medications for travel, leave them in their original bottles. This can prove helpful in many ways, not the least of which is if you need an unfamiliar physician or pharmacist to refill your medicines. Outside your own home it is best to be discreet about your medications, especially if they are of the type desired by those who suffer with substance abuse issues.
4. Do any of your medicines need to be refrigerated, and if so at a specific temperature? Ice in a cooler is hard to regulate; you may want to invest in a thermometer to insure that the correct temperature remains constant. Don’t assume your neighbors with generators will be willing to assist you. Talk to them in advance about willingness and comfort level regarding keeping your medications in their refrigerator. And, always have a back-up plan, in case Neighbor #1 with whom you have made the arrangements is not available.
5. Paper copies of your medical paperwork, insurance cards, health history sheet (we discussed in a prior blog), vaccination records, etc., should be included with your other important papers that will be evacuating with you. Don’t forget information about medical equipment or implants (pacemaker, etc.).
6. Although not specifically related to medical history, you will need to gather birth certificates, social security cards, marriage/divorce certificates, banking information, etc., so you will know exactly where they are and can quickly retrieve for packing.