Acute Traumatic Brain Injury (TBI) Treatment

Acute TBI Treatment

By:  Helen Rousso

Acute treatment of a Traumatic Brain Injury (TBI) initiates several metabolic processes that can aggravate the injury. Therefore, management focuses on stabilizing and preventing a secondary injury. Ultimately, the goal is to assess and stabilize the airway and circulation, maintain sufficient blood and oxygen supply to the brain, stop intracranial bleeding and prevent an increase in pressure within the skull.

However, full neuro-monitoring including intracranial pressure measurement are rarely available before the patient’s arrival to the intensive care unit. Mechanical intervention (ventilation support) assists in breathing while alleviating pressure on the brain.  Traumatic brain injury (TBI) is a major health and socioeconomic problem that affects all societies. Research shows that worldwide, TBI is a leading cause of death and permanent disability.  In the United States alone, there are approximately 1.4 million reported cases of TBI each year.

Unfortunately, there is difficulty in recording the real incidence of TBI’s since many patients refuse to report the incident and seek medical care. Half of those who die from TBI do so within the first two hours of injury, it is now known, however, that all neurological damage does not occur at the moment of impact (primary injury) but rather evolves over the ensuing minutes, hours or days. This secondary brain injury can result in increased mortality and disability.

Consequently, the early and appropriate management of TBI is critical to the survival of these patients. Emergency Medical Services (EMS) personnel are often the first health care providers for patients with TBI. Thus, prehospital assessment and treatment is a critical link in providing appropriate care. Treatment begins in the field and continues during transport by EMS providers who have varied skills, backgrounds and qualifications.  Over the past 30 years, EMS has become progressively sophisticated, resulting in improved outcomes, particularly in cardiovascular and trauma resuscitations.

However, many challenges remain, especially in recognition and management of TBI in the prehospital setting.  There are three different stages of treatment for traumatic brain injuries. These include the acute phase where the patient is stabilized immediately after the injury; subacute phase, to rehabilitate the patient to their potential to return to the community and the chronic phase to continue rehabilitation and treat any long-term impairment.

Initial treatments will be provided at the scene of the accident by emergency personnel if they are summoned. Occasionally individuals in an accident or athletic injury may determine that it is quicker to transport themselves than it is to wait for an ambulance. However, more commonly an ambulance and paramedics are dispatched to treat the individual at the scene of the accident.

Treatments offered to the patient will vary with the type of injury. Commonly the head of the stretcher or bed will be slightly elevated, and the neck of the individual kept straight.  This position can help decrease any intracranial pressure by allowing blood and cerebral spinal fluid to drain using gravity. It is also imperative to maintain the neck and back straight to minimize the risk of further injury to the spinal column that may have been suffered during the trauma.

Paramedics will never give fluids by mouth to an individual who has undergone a dramatic events area. The brain is like a sponge and will absorb any extra fluid that is delivered. Limiting fluids can help control swelling. An IV is started at the scene of the accident to give the paramedics and doctors intravenous access for emergency medication. Emergency medical professionals will also assess the individual’s ability to breathe on their own. If the accident victim is unable to maintain oxygenation of their bodies, then medical professionals will assist until they reach the hospital.

Once admitted to the hospital, professionals will begin treatment of the brain injury. Using imaging studies and clinical assessments they will check for and surgically remove any life-threatening blood clots. Swelling in the brain (edema) is monitored and treated using either clinical evaluation or an intracranial monitor attached to the head.

This swelling can cause an increase in intracranial pressure (ICP) that will squeeze the soft tissue of the brain against the skull. This will damage the brain tissue and cause further harm.  A buildup of fluid can also occur within the ventricle of the brain. This is called hydrocephalus and is treated using a shunt. This too is placed within the ventricle and then allows the cerebral spinal fluid to drain in the ventricles to shrink stores normal functions of brain cells.

Seizures can also occur in a week or a month after a traumatic brain injury as the damaged brain cells begin to heal. These seizures can result in minor twitching of a finger or limb or lead to a complete loss of consciousness accompanied by involuntary movements of the entire body. Seizures are very dangerous during the acute treatment phase of a traumatic brain injury, so most patients who have experienced a moderate or severe injury will receive medications for the first few weeks prophylactically.

Another important aspect of the acute care of a traumatic injury is monitoring of other medical problems.  Abnormally high or low levels of sodium, calcium, sugar or other chemicals in the blood, which are released during a traumatic event can worsen confusion and precipitate seizures. Individuals who suffer from a traumatic brain injury are also at high risk for infection, such as ammonia, urinary tract infections, and sinusitis.

Medications which may be used to treat the brain injury can include diuretics to decrease the amount of water in the patient’s body, anticonvulsants to prevent seizures, and barbiturates to help control intracranial pressure. Surgeons may also choose to use a shunt or ventricular drain placed in the ventricle to help control cerebral spinal fluid. A ventilator, machine used to support the patient’s breathing, may be used to help control intracranial pressure.

Several surgeries may be required to assist in controlling the increased pressure within the brain. A craniotomy may be done to open the skull if there have been fractures in the bone, large blood clots or swollen brain tissue. Smaller blood clots will be removed to help relieve pressure or to place an intracranial pressure monitor. A bone flap removal is when a piece of bone is removed from the skull to make room and relieve tension that is caused by swollen brain tissue.

Once patients are stabilized in the acute setting, they will be transferred to a subacute dramatic brain injury treatment center where their rehabilitation will be initiated.  At the specialized care facilities, medical staff will fully evaluate the patient’s impairments, disabilities, and probability of recovery. Doctors will also outline a course of treatment, and healthy patients and their families build the right team of medical professionals necessary for successful rehabilitation.

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Did you say “Perfect Body”?

What would you consider to be the “perfect” female or male body? Instead of embracing diversity in all body types, shapes and sizes, we are often far more preoccupied with appearance. That is, how dissatisfied we’ve become with ourselves rather than appreciating our individual uniqueness. Far more emphasis is placed on how we appear to others, placing us at a much greater risk for engaging in dangerous behaviors to control weight and size.

We are constantly being bombarded with messages pertaining to body image and what the “perfect body” should be. Advertising and mass media have had such a great influence and are definitely amongst the biggest culprits. It should come as no big surprise then, that instead of our focus being placed on a healthy self, we worry about how we will appear to others. Our body image is often based on others looks, we examine how that relates to our own personal goals and aspirations for our bodies. These images become incorporated into our self-perception. Airbrush anyone?

Body image is not a concept that is static as there is constant change. It is not based on facts, but rather influenced by our self-esteem and psychological nature. Our body image is sensitive to our emotions and our moods. We learn how to perceive our body image to the interaction we have with our own families, friends, peers and coaches, but it is only a reinforcement of what is learned from the culture.

Receiving negative feedback as we age can give us a distorted perception of our body shape. One can perceive parts of their body to be unlike they really are. They are convinced that other people are attractive and that body size or shape is a sign of personal failure, which can lead to behaviors such as extreme dieting, exercise compulsion, laxative abuse, vomiting, smoking and use of anabolic steroids – These practices are associated with negative body image.

Many people can become so conscious of their body image they will go the extra mile to achieve the same sculptured body like those that are splashed in the pages of the magazines, billboards, TV, and movie screens. Others try to find sensible and sustainable ways to achieve and maintain a physically fit body, yet overlook another important aspect of their well-being: their emotional health.

If you’ve ever lost weight and managed to reach your dream goal, do you recall what your emotions were like? Were you as happy as you initially anticipated you would be? Although dieting in a manner which uses unhealthy practices such as starvation dieting may result in substantial weight loss, it will certainly affect your overall emotional well-being.

Not all experts agree that human beings are born with a full range of emotions. Instead, some theorize that people were born with instincts and urges, along with an innate capacity for feeling. As people grow older, they develop personalities and nurture relationships with others, which are valuable experiences that help them expand their feelings into full-fledged emotions. Having a complete range of emotion is important for overall health and well-being. We must be aware of our emotions.

Emotionally healthy people are in tune with their emotions and can identify and acknowledge them as experience. After connecting with your emotions, emotionally healthy people will typically develop appropriate ways of expressing them – we must be able to process our emotions. The ability to identify with one’s own emotions enables emotionally healthy people to identify emotions in others and to have an intuitive sense of what it feels like to experience them – showing sensitivity to others and to their emotional state while having the ability to empathize.

Emotionally healthy people honor their emotions which in return empower them to fulfill their goals. As the saying goes, a healthy body cannot be divorced from a healthy mind or a healthy spirit. Emotional health is considered an integral part of an individual’s overall wellness, if neglected, it can certainly cause damage to your physical health in the process. Research has shown that one of the leading contributing factors to illness is stress caused by unresolved emotional issues.

Emotions course through our conscious and unconscious mind at critical junctures or during seemingly inconsequential moments of our lives. Emotions such as grief and anger can be far more difficult to control or reason with. The interplay of various emotions makes that form of “reasoning” not an easy one. Just as emotional health can affect a person’s physical health, the same is true with one’s lifestyle making a direct impact on emotional health. It is important to take vitamins and minerals as they stimulate the production of chemicals in the brain. These are known as neurotransmitters that regulate our physical and mental health functions, including the way we process emotions. Minor deficiencies of these nutrients can lead to depression and irritability, as well as hamper our ability to concentrate and stay motivated.

Unhealthy foods can adversely affect emotional health. An excess amount of caffeine intake can demonstrate many of the same physiological and psychological symptoms as people suffering from anxiety, while a diet with high sugar content has been linked to depression, aggression, and impaired judgment. The real goal in altering your body image must always be health related. Whether an individual is trying to attempt to achieve a healthy weight or a healthy, toned body, the goal must be to achieve good health.

Individuals who desire to change their body image and self-perceptions do not need to change the way they look, feel, act, or live. Instead they must change the way they think about themselves and how attractive they believe themselves to be. Each of us are individuals. We cannot duplicate the current top model and they cannot duplicate us.

The first step for individuals who want to change their body image is to be sure that the weight is within healthy limits by checking with their primary care physician. We must learn to appreciate the diversity that we bring to the human race with our own individual interpretation of our bodies.

When you hear yourself, saying negative things – STOP!  You can be your own worst enemy or your own biggest fan. You need to be realistic about the size you are likely to be based on your genetic and environmental history. By staying active (biking, walking, dancing, yoga, etc.), regardless of your size, you can expect normal weekly and monthly changes in weight and shape. Work towards self-acceptance and self-forgiveness; be kind to yourself.

Make no mistake my friends, children are watching their parents or people dear to them very closely to learn what body image is and how to integrate it into their own lives. When children are learning from parents whose body image is tied to what they see as perfection, it results in raising a generation of children who aspire to perfection to the point that they become anorexic, starve themselves, are constantly dieting and never eat a nutritious well-balanced meal.

Do NOT be afraid to ask for support and encouragement from friends and family or a professional – especially when life is stressful. Most importantly, decide how you wish to spend your energy – do you spend it on making positive changes to yourself? Or, is it spent on focusing on a negative body image? Would you rather spend your valuable time pursuing the “perfect body” or enjoying family, friends, school and life? Clearly, the latter is the healthier choice that can and will lead to a happier and healthier you.

Obesity Trends Anyone?

Even though this report may seem a little dated, it is the most recent from the Center for Disease Control (CDC) as it takes a while for them to compile and analyze all the data.

I can tell you that the numbers here are a little conservative.  Obesity is skyrocketing.

 

Diabetes and (Medical) Exercise

Perhaps the most distinguishing characteristic in the field of medical exercise is its application to patients with metabolic or cardiac abnormalities. The top three leading causes of premature death in the United States are heart disease, cancer and diabetes.

Despite their prevalence and economic burden, there should be more rehabilitation efforts directed to these conditions in terms of exercise prescription and post-rehabilitative care. There is a substantial amount of evidence that exercise may not only assist in the prevention of these disorders but that it also plays an intricate part of the treatment plan.

There are two types of Diabetes. Diabetes is defined as the body’s inability to metabolize carbohydrates. Insulin dependent diabetes mellitus [IDDM], in which the pancreas loses it’s ability to produce or secrete insulin. The second is non insulin dependent diabetes mellitus [NIDDM], where there is an inability of the muscle cell to uptake insulin from the blood stream making it necessary for the administration of medical intervention.

The medication used by many diabetics is insulin. Insulin is commonly injected under the skin into fatty tissue on the triceps region, abdomen, front of thigh and hip. The medical exercise specialist must inquire about the type of insulin(s) taken during the course of the day, number of injections per day, time of injections to determine appropriate time for exercise, body site preferred for injections (necessary for site specific exercises) while both the patient and fitness specialist must be aware of the times of peak insulin action.

Each type of insulin has an onset, a peak, and a duration time. The onset is how soon the insulin begins to lower your blood glucose once it has been administered. The peak is the time the insulin is working the hardest to lower your blood glucose. The duration is how long the insulin lasts (the length of time it keeps lowering your blood glucose).

For instance, long-acting/fast-acting forms are taken in the morning and evening to to cover the patients insulin requirements. Regular insulin (short acting type) is taken with meals covering glucose peaks which is dependent upon the carbohydrate content of the meal consumed. The correct combination of these types is necessary as it simulate’s the body’s response to a meal naturally. Since a person’s onset, peak, and duration times may vary, it is best to work with your health care team to come up with an insulin plan that works best for you.

The principle of individual differences must be applied when creating an exercise program for the client with special medical concerns and cannot be compared to that of the generally healthy individual. Specific guidelines must be adhered to, if overlooked, it can result in a serious medical emergency.

Studies show that long term physical conditioning lowers one’s blood glucose levels and makes the body more sensitive to insulin which then helps reduce overall resistance. When progress is monitored on a continual basis, the benefits will be noticeable. The main areas of focus with any conditioning program should include aerobic capacity, flexibility, muscular strength/endurance and motor skill development.[1]

Depending upon the type of exercise performed and the conditioning level of the participant, the blood glucose response will differ from one person to another. The diabetic client is constantly battling to avoid hypoglycemia on one hand and hyperglycemia on the other.

Hypoglycemia is a condition that occurs when the body’s blood sugar (glucose) falls below normal. Most healthy adults maintain fasting glucose levels above 4.0 mmol/L (72 mg/dl), and develop symptoms of hypoglycemia when the glucose falls below 4 mmol/L.[2]

Hypoglycemia is of great concern. One on one training is beneficial for all special medical population groups because the specialist can provide assistance in the event of a medical emergency. The client should carry some form of carbohydrate with them at all times to prevent low blood sugars when symptomatic.

Hyperglycemia, or high blood sugar (not to be confused with hypoglycemia) is a condition in which an excessive amount of glucose circulates in the blood. This is generally a glucose level higher than 11.1 mmol/l (200 mg/dl), but symptoms may not start to become noticeable until even higher values such as 15–20 mmol/l (~250–300 mg/dl). A subject with a consistent range between 100 and 126 (American Diabetes Association guidelines) is considered hyperglycemic, while above 126 mg/dl or 7 mmol/l is generally held to have diabetes. Chronic levels exceeding 7 mmol/l (125 mg/dl) can produce organ damage.[3]

There can be secondary abnormalities due to long standing high blood glucose levels (hyperglycemia). It can cause deterioration to tissues, becoming more severe around the ten year mark. These complications include retinopathy (eye disease), neuropathy (nerve disease commonly affecting the feet first), myopathy (muscle disease/stiffness), microvascular disease (increasing the risk of heart disease).[4]

Interestingly, exercise allows glucose to get in the cells having a glucose lowering effect. Secondly, stored glycogen* in the muscles and liver can be converted into glucose through what is called gluconeogenesis to provide fuel to muscles during low blood glucose periods. A conditioning effect is usually evident after approximately the first 6 or 7 sessions.

Exercise prescriptions created for the diabetic client must include two important elements, intensity and duration.  The intensity of the fitness routine will equal how fast your heart rate increases and for how long.  The amount of time (duration) which is chosen for the exercise program will relate to an individual’s lifestyle, overall health, amount of weight required for loss and motivation factor.

If the initial level of fitness doesn’t allow the individual to exercise for more than 10 minutes, then incorporating a 10 minute fitness plan three times throughout the day will give similar benefits to doing 30 minutes all at once.  Then, as your fitness level improves, you will be able to maintain a greater intensity for an extended length of time.

It has been my experience through various case studies that conditioning sessions should depend on blood glucose levels. In other words, the higher levels constitute a far more vigorous and longer training session (more sugar to burn). Lower levels constitute a less vigorous session for less time, thus, assisting in the prevention of medical emergencies – highly unlikely if guidelines are followed correctly.

Perhaps the two most fundamental aspects of an ideal weight management program are dietary modifications and regular exercise. When starting ANY weight loss and exercise program, one MUST address all aspects of a person’s physical makeup, lifestyle concerns and behavioral components. There are many factors in determining what will work for each person.

Exercise and weight management programs will improve the quality of your life, it will motivate you as you continue to see positive results.  Incorporating a fitness program into your lifestyle benefits all as there is a lower risk of heart attack, stroke, peripheral vascular disease, heart disease, vascular disease, inflammatory disease and cancer.

Special medical concerns require special attention, please take it seriously because your life can depend on it. Find a specialist that will develop a safe and effective program that does not require the supervision of a licensed medical professional for exercise, however utilizing the parameters that are established by a licensed physician would be highly recommended and the safest way to go.

*Glycogen: Most carbohydrates are broken down in the body to a type of sugar called glucose, which is the main source of fuel for our cells. When the body has extra glucose, it stores it in the liver and muscles. This stored form of glucose is called glycogen. Glycogen is like your backup fuel. It releases glucose into the bloodstream when the body needs a quick energy boost or when a person’s blood glucose level drops.

[1]Family Doctor: Diabetes and Exercise http://familydoctor.org/familydoctor/en/diseases-conditions/diabetes/treatment/diabetes-and-exercise.html
[2]Cryer, Philip E. (2001). “Hypoglycemia”. In Jefferson L, Cherrington A, Goodman H, eds. for the American Physiological Society. Handbook of Physiology; Section 7, The Endocrine System. II. The endocrine pancreas and regulation of metabolism. New York: Oxford University Press. pp. 1057–1092.
[3]http://www.diabetes.co.uk/Diabetes-and-Hyperglycaemia.html
[4]The science and practice of rehabilitative exercise FT/ISSA
http:// kidshealth.org/kid/word/g/word_glycogen.html

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Pssst…..The History of Diets Anyone?

In order to understand the “shape” of weight-management, today, it’s helpful to know the evolution of the industry. World-wide obsession with dieting has been around for hundreds of years. The ideal figure has been sought since it was painted on vases.
Now, of course, it’s plastered on billboards and printed in magazines. The following is a recap of some of the more interesting and famous diets.

1917 Diet and Health is first published by Lulu Hunt Peters, a chronically overweight person. Peters teaches readers about “calories,” a term previously used only in physics, and advises a low-fat, high-carbohydrate diet.

1930s Movie stars popularize the Hollywood 18-Day Diet. It consists of grapefruit, melba toast, green vegetables and boiled eggs.

1933 Mayo Clinic’s scientific diet, the Mayo Food Nomogram, is mistaken for a complicated word game and fades into obscurity.

1939 Miracle diet pills, a.k.a. amphetamines, generate sales of $30 million annually before the FDA steps in. Bathing-suit ad slogan: “Suit by Jantzen. Body by Dexaspan.”

1943 Metropolitan Life publishes Ideal Weight Table for women.

1947 Psychoanalyst Hilde Bruch says the glandular theory of obesity is not true. “The blubbery patient belongs not in the gym, but in the psychiatrist’s office.”

1951-1952 The New York Times claims overweight is our number-one health problem. Reader’s Digest admonishes wives to “Stop Killing Your Husband.”

1959 The New York Times now reports that Americans suffer “a dieting neurosis.” Gallup Poll finds 72 percent of dieters are women. Metracal, the first liquid diet proclaims: “Not one of the top 50 U.S. corporations has a fat president.” Girdle sales reach record highs.

1960 Stillman Diet, requiring eight glasses of water and filet mignon every day, is introduced. Overeaters Anonymous, inspired by AA is founded.

1961 A Queens, New York, housewife, Jean Nidetch, starts dieting discussion group. Seventeen years later, sells her Weight Watchers empire for $100 million.

1963 Coca-Cola introduces TAB. However, men won’t drink from a pink can.

1966 Atkins Diet published in Harper’s Bazaar. Eggs, bacon even pork rinds allowed; broccoli is restricted.

1967 Twiggy, 5’7″ and 91 lbs., appears on cover of Vogue four times.

1970 Seventy percent of American families using low-cal products; 10 billion amphetamines manufactured annually.

1977 Liquid protein diets banned after three deaths.

1979 The Complete Scarsdale Medical Diet becomes a best-seller. Success is short-lived for creator, Dr. Herman Tarnower.

1982 John Hopkins University researchers calculate that Americans have swallowed more than 29,068 “theories, treatments and outright schemes to lose weight.” NFL endorses Diet Coke for men.

1990 Oprah Winfrey loses 67 pounds on Optifast; one year later, Oprah gains back 67 pounds and declares, “No more diets!”©Copyright 2010 / 2011

1992 The National Institutes of Health champions moderation and daily exercise as the best diet. Extreme obesity declared a disease.

1995 Fen-Phen (fenfluramin and phentermine) introduced to the market place as the new magic pill solution to weight-loss.

1997 Mayo Clinic releases report claiming fen-phen causes heart valve deterioration and possible permanent brain cell damage. Manufacturer voluntarily withdraws fen-phen and Redux from the market.

2000 American Home Products continues to defend against more than 2,000 class action suits brought against the company by parties claiming damaged from the company’s fen-phen-based products. Weider Nutrition settles with the FTC for “Unsubstantiated Claims for Dietary Supplements” for its Phen Cal products.

2002 Atkins returns along with South Beach as they and other low-carb diets become the new trend in weight-loss. Body Solutions, another quick-fix diet pill, file bankruptcy.

2003 Ephedra-based products are banned in California and other states as research points to overuse and abuse
causing serious injury and or death. Obesity reaches highest levels in U.S. history.

2004 Cortislim is charged by the FTC for “claiming, falsely and without substantiation, that their products can cause weight loss and reduce the risk of, or prevent, serious health conditions.

2005 Weight Watchers and Jenny Craig continue to dominate the commercial weight-loss industry with new claims and new games. The USDA introduces the new MyPyramid. It creates even more debate among food experts and fitness professionals.

2006 Hoodia, a plant-based appetite suppressant, begins heavy marketing to U.S. markets without much success. Jenny Craig introduces new weight-loss programs starring celebrities including Kirstie Ally, Vallerie Bertinelli and Queen Latifah.

2007 TrimSpa agrees to pay $1.5 million in January to settle allegations of false and misleading advertising brought by the Federal Trade Commission. In February, TripSpa spokesmodel, Ana Nicole Smith is found dead from a drug overdose.

2008 NutriSystem introduces new Advanced Program with pre-packaged foods delivered to consumers’ doors. Endorsees include former Miami Dolphins Quarterback, Dan Marino, Coach Don Shula as well as several other sports celebrities.

2010 Weight Watchers, NutriSystem and Jenny Craig continue to dominate commercial weight-loss industry. Bariatric or Lap Band surgery increases to become almost mainstream with its advertising campaign: Let your new life begin with 1-800-GET-SLIM. Several insurance companies cover the procedure. New diet drugs awaiting FDA approval include: Lorcaserin, Qnexa and Contrave. Obesity reaches new record levels in U.S. as 12 million Americans are considered severely obese, defined as more than 100 pounds overweight. Costs are estimated at $147 billion per year.

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An Emotional Eater? Me?

Have you ever lost complete control and downed half the chocolate cake in the fridge? It was staring you in the face after all, what else could you do? Do you recall what was going through your mind when you reached out and grabbed that cake?  Were you hungry because it was actually dinner time, or was there a deeper issue troubling you?  That pink elephant in the room is what we call emotional eating.

There are many contributing factors that precipitate emotional eating; happiness, sadness,  celebrations, depression, anger, fear or shear frustration.  After all, what could be better than that candy bar?  Unfortunately, the problem is all too common amongst us, yet rarely spoken about.

For addictive habits like binge eating or emotional eating, I would have to agree that triggers are typically stress-induced.  Through years of subconscious conditioning by our families, friends and advertising exposure we have learned that food is used repeatedly for comfort.  I’m sure we’ve all heard “sit down dear, I’ll make you some hot chocolate and you’ll be all better”.  Although these triggers fill a real biological need so that the body has energy to burn, we often use food as a means to fulfill an emotional void.

Many individuals aren’t conscious of hidden or accumulated stress, and if they are, they find it difficult to resolve or let it go.  It isn’t unusual to recognize the various factors that impact whether or not we pick up a piece of food in response to our emotions.  In fact, you may also not have known that most of our decisions have an emotional component attached to it signaling our bodies well before we have had the chance to make a rational decision.

Interestingly, there is a fine line between emotional eating and a full-blown eating disorder.  There are specific characteristics evident in people who have a full-blown eating disorders that may not be as apparent to the emotional eater. Emotional eating will typically fill a void that isn’t related to eating for fuel, (you crave a specific food, such as pizza or ice cream, and only that food will meet your needs at that time).  Emotional hunger needs instant gratification whereas physical hunger can wait.

There are various degrees of severity for all eating disorders. Many people, especially women are concerned about their eating habits and it is hard to depict what behaviors are associated with real eating disorders.  Starving to the point of emaciation, binge eating, vomiting or taking laxatives for weight control (purging), excessive exercising, chewing food and spitting it out, and obsessive dieting are some examples.

There are people who have both an eating disorder and who are avid emotional eaters.  Unfortunately, these individuals may have experienced some form of trauma in their lives, (physical or sexual abuse) which can often lead to eating disorders.  An individual who has experienced this type of abuse has a greater percentage of having an eating disorder vs. the emotional eater. While people who have significant emotional eating habits are not in any immediate medical or psychological danger, they do not suffer any less.

Controlling eating habits can only begin with self-awareness which will ultimately lead to self-management.  Self-awareness is the most difficult part since it involves accepting that you have all the signs of an emotional eater.

• Do you often feel guilty or ashamed after eating?
• Does eating make you feel better when you’re feeling down?
• Does eating help you lessen your focus on problems when you’re worried about something?
• Do you often eat alone or at odd locations, such as being parked outside a fast food joint?
• Do you ever eat without realizing you’re even doing it?
• Do you feel the urge to eat in response to outside cues like seeing food advertised on television?
• Do you eat because you feel there’s nothing else to do?
• Do you crave specific foods when you’re upset, such as always desiring chocolate when you feel depressed?

If you answered yes to any of these questions it is possible that you have emotional eating issues.  Make the necessary changes by keeping a short diary.  Write down each time you consume food, what food you consumed, what time was it?  Elaborate on how you were feeling each time you reached for another morsel of food.

You must first acknowledge there is a feeling, something that is causing you to trigger the emotional eating before you can actually discover what causes that response in you.

Through acknowledgment, self-discovery and persistence identifying those emotions will become easier each day. It is time to find what works for you to remedy the problem.  At the end of the day, record the number of times you ate, include the time of day, record any pertinent information and any  emotion that seemed to be involved in the automatic reach for food.  Be extremely honest because you are not hurting or helping anyone else but yourself.

The next step is self-management.  Like all other things in life, the longer you do something the easier it gets.  Practice really does make perfect and it becomes habitual.  Get some help, you will be far more successful if you enlist the assistance of a partner.   As you are forced to document this journey, you will be encouraged to put that food down when you’re angry, depressed or on an emotional high.  The act of emotional eating itself will dissipate in time and you can eat for the right reasons .

Aside from emotional eating to feel that hormonal high, some of us also eat to cope — that is, to reduce emotional distress.  Eating for pleasure or eating to reduce daily stresses are two sides of the coin and our minds divides this coin in half.  On one hand, we are encouraged to slow down and enjoy the food we eat.  On the other hand, we are told by popular culture to never eat for emotional reasons.  If this sounds a bit like hypocrisy, it’s because it is.  What do you think?

 

 

 

RESOURCES KidsHealth.org: Emotional Eating http://kidshealth.org/teen/your_mind/emotions/emotional_eating Eating Disorders: Psychological Determinants of Emotional Eating in Adolescents http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859040/Temple University: Study Identifies Triggers for Emotional Eating http://news.temple.edu/news/study-identifies-triggers-emotional-eatingMayoClinic.com: Weight loss help: Gain Control of Emotional Eatinghttp://www.mayoclinic.com/health/weight-loss/MH00025

Overweight Children and Peer/Parental Pressures – PLEASE READ!!!

It is very important to me that I am selective when deciding on what topic to write about.

We’ve all heard the wise cracks and jokes about overweight individuals. Generally, we’ve all been on one side of the fence – some having to listen to the hurtful and disparaging remarks, while others are guilty of expressing negative comments without any forethought as to how it may affect that person.

There is no safe place from cruel words and taunting assaults to those who struggle with weight. If you happen to be a person who carries extra weight, you know how horrible some people can be. The adolescent and teenage years are often considered the most difficult in life, particularly in the latter’s case.

The Centers for Disease Control and Prevention (CDC) estimates that 15 percent of children and teens ages 2 to 19 are considered to be obese. While maintaining a healthy weight is an important skill for teens to learn, it is also important to remember that a teenager does not have the emotional and mental developmental level of an adult. The teenager must be approached with caution, in a patient and compassionate manner, coupled with a healthy attitude. We must keep in mind that teenagers are already in the throes of hormonal surges, which can impact their emotional balance. It is a very sensitive subject.

One would assume that such remarks come from other teens or total strangers. Having worked with and spoken to teens (as well as living it myself) about this very subject almost always leads to the same story. It’s their mother, father, sister, brother, grandparents, best friends, and/or teachers, among others, that make such remarks. Many peers of overweight children do not accept them, further fostering negative self-perception.

Teenagers can be annoyed with excess fat on their body and they often have a distorted body image as it is. When weight loss is addressed to teenagers these issues must be included in the plan. Without better knowledge and understanding, teens see themselves differently than they really are, you will not be able to help motivate them to continue to make healthy life choices. Negative and hurtful remarks certainly will not help matters.

Teens often suffer from poor self-esteem and poor self-motivation. It is a parent’s job to help gently encourage them. Research shows that parents who nurture a positive attitude and actively show their child qualities of resilience and optimism will make a dramatic difference that continues into successful, healthy adult years.

Teenagers continue to require appropriate nutrition to feed their growing body. As a parent, believe in them! To foster optimism and resilience in a child who struggles with weight issues, assure them that you are on their side. Assure them that you expect them to be the best person that they can be, although you don’t expect them to be the best at everything. After all, no one person is perfect.

It is necessary to find other adults who also legitimately believe in your children. Teachers, aunts, uncles, neighbors and friends can help you make a positive difference in your child’s life. Other adults that can see beyond the weight and also believe in him/her can help your child take control of their life. We must encourage our children to stay interested in activities. Let them know that their interests are valuable and deserve to be developed, whatever it is. Celebrate your children’s winning experiences and help them to accept defeats graciously.

Knowing you appreciate their efforts and positive attitude to win or lose is crucial to a child’s growth. Positive attitude and effort is far more important than any victory. Be a role model for perseverance. Be sure your children hear you say that some tasks are difficult, but that you are not a quitter.

Some teens may need to see a nutritionist to evaluate their eating and determine how to change their habits. Professionals can often give teenagers advice that they accept rather than from their families and friends. However, professionals are more distant and do not have as much invested in the relationship. Weight loss plans designed for teenagers should be approached in a supportive family environment.

It is so much easier to achieve your goals when you are working with like-minded and supportive people. Even though you are able to change the foods that are brought into the home, teens can eat improperly outside the house. That’s why education about healthy nutrition and good food choices are so important to the success of any weight loss program. Keep nutritious snacks in the home. Teens snack constantly! They will reach for what is available and if chips and dip are handy that is what they’ll be eating.

Try keeping snacks like celery, peanut butter, bananas, apples, or other various fruits and vegetables in the refrigerator to serve as healthier alternatives.

While many people are searching for weight loss plans to achieve fast, easy and painless weight loss, it is important to note that any plan should be initiated with the long-term effects in mind. Making strong, healthy lifestyle choices will eventually lead to permanent weight loss and a healthier life.

Each individual person is unique. Genetic make-up varies from individual to individual. Lifestyle and exercise habits also impact the body’s ability to lose weight. Please, please, think before you speak – your words have the power to affect a person’s life forever. Everyone is the son or daughter of somebody.

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Overweight Children and Peer/Parental Pressures – PLEASE READ!!!

It is very important to me that I am selective when deciding on what topic to write about.

We’ve all heard the wise cracks and jokes about overweight individuals. Generally, we’ve all been on one side of the fence – some having to listen to the hurtful and disparaging remarks, while others are guilty of expressing negative comments without any forethought as to how it may affect that person.

There is no safe place from cruel words and taunting assaults to those who struggle with weight. If you happen to be a person who carries extra weight, you know how horrible some people can be. The adolescent and teenage years are often considered the most difficult in life, particularly in the latter’s case.

The Centers for Disease Control and Prevention (CDC) estimates that 15 percent of children and teens ages 2 to 19 are considered to be obese. While maintaining a healthy weight is an important skill for teens to learn, it is also important to remember that a teenager does not have the emotional and mental developmental level of an adult. The teenager must be approached with caution, in a patient and compassionate manner, coupled with a healthy attitude. We must keep in mind that teenagers are already in the throes of hormonal surges, which can impact their emotional balance. It is a very sensitive subject.

One would assume that such remarks come from other teens or total strangers. Having worked with and spoken to teens (as well as living it myself) about this very subject almost always leads to the same story. It’s their mother, father, sister, brother, grandparents, best friends, and/or teachers, among others, that make such remarks. Many peers of overweight children do not accept them, further fostering negative self-perception.

Teenagers can be annoyed with excess fat on their body and they often have a distorted body image as it is. When weight loss is addressed to teenagers these issues must be included in the plan. Without better knowledge and understanding, teens see themselves differently than they really are, you will not be able to help motivate them to continue to make healthy life choices. Negative and hurtful remarks certainly will not help matters.

Teens often suffer from poor self-esteem and poor self-motivation. It is a parent’s job to help gently encourage them. Research shows that parents who nurture a positive attitude and actively show their child qualities of resilience and optimism will make a dramatic difference that continues into successful, healthy adult years.

Teenagers continue to require appropriate nutrition to feed their growing body. As a parent, believe in them! To foster optimism and resilience in a child who struggles with weight issues, assure them that you are on their side. Assure them that you expect them to be the best person that they can be, although you don’t expect them to be the best at everything. After all, no one person is perfect.

It is necessary to find other adults who also legitimately believe in your children. Teachers, aunts, uncles, neighbors and friends can help you make a positive difference in your child’s life. Other adults that can see beyond the weight and also believe in him/her can help your child take control of their life. We must encourage our children to stay interested in activities. Let them know that their interests are valuable and deserve to be developed, whatever it is. Celebrate your children’s winning experiences and help them to accept defeats graciously.

Knowing you appreciate their efforts and positive attitude to win or lose is crucial to a child’s growth. Positive attitude and effort is far more important than any victory. Be a role model for perseverance. Be sure your children hear you say that some tasks are difficult, but that you are not a quitter.

Some teens may need to see a nutritionist to evaluate their eating and determine how to change their habits. Professionals can often give teenagers advice that they accept rather than from their families and friends. However, professionals are more distant and do not have as much invested in the relationship. Weight loss plans designed for teenagers should be approached in a supportive family environment.

It is so much easier to achieve your goals when you are working with like-minded and supportive people. Even though you are able to change the foods that are brought into the home, teens can eat improperly outside the house. That’s why education about healthy nutrition and good food choices are so important to the success of any weight loss program. Keep nutritious snacks in the home. Teens snack constantly! They will reach for what is available and if chips and dip are handy that is what they’ll be eating.

Try keeping snacks like celery, peanut butter, bananas, apples, or other various fruits and vegetables in the refrigerator to serve as healthier alternatives.

While many people are searching for weight loss plans to achieve fast, easy and painless weight loss, it is important to note that any plan should be initiated with the long-term effects in mind. Making strong, healthy lifestyle choices will eventually lead to permanent weight loss and a healthier life.

Each individual person is unique. Genetic make-up varies from individual to individual. Lifestyle and exercise habits also impact the body’s ability to lose weight. Please, please, think before you speak – your words have the power to affect a person’s life forever. Everyone is the son or daughter of somebody.

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The Myth that Sells – Localized Fat Loss

Have you ever been so desperate to lose weight you jumped on the  infomercial crazy train without giving it a second thought? Unfortunately, and often enough, there appears to be a  purposeful disregard  for facts (physiological) on the part of those who profit from the sale of “muscle-specific exercise gadgets”.

Think about all the “ab-isolating” devices the marketing gurus promote with repeated false claims  stating their product will result in targeted fat loss (and a six-pack).  Unfortunately, these claims target the innocent individual so desperate to lose weight that any insight through education that dispels these otherwise believable myths falls by the wayside.  Knowledge is power, and education is the key.   Better knowledge and understanding will hopefully lead to the design of a no-nonsense, effective overall program catered to your specific needs.

To clarify truth vs. fiction, performing abdominal exercises or doing appropriately prescribed sit-ups will do little or nothing to rid the waistline of fat as is so often stated.    The use of one of these many currently marketed “ab-isolating” devices  may have  value in conditioning your muscles, (the abdominal region) but constitutes only a small portion of an effective overall fat loss exercise prescription.

Let’s examine the biceps curl (keeping in mind that this would be the only resistance exercise performed).  An innocent and misguided individual new to exercise (struggling with their weight) might be inclined to believe that performing the exercise for several months would result in lean hard biceps.   Would runners give credibility to the theory of localized fat loss?  Initially, overweight runners rarely sport an unchanged upper torso or well conditioned legs.   Aren’t the lower extremities involved in this exercise? There is no difference between these ridiculous considerations and the claims made that training your abs will ultimately result in fat loss around the waistline.  It simply does not work that way.

Fat is lost evenly throughout the body, the areas where the least amount of  fat is accumulated will typically be the first areas one will notice visible results.   This occurs not because you are losing fat faster in one part of your body over another, it simply means that this area will be most visible.

Sadly,  little can be done to discourage the purchasing of these marginally valuable (and inappropriately) marketed devices. Since these infomercials are so professionally produced with advertisements that tout credible endorsements, it is definitely an uphill battle to educate any consumer to the contrary.

Achieving fat loss is a particularly  stubborn and challenging proposition, especially among those individuals who have a very slow metabolism or a genetic predisposition to gain weight more easily than others.

There is twelve billion dollars being spent on misleading or faulty commercial weight loss products or programs annually.  We  can certainly blame the advertisers who have unlimited budgets for misrepresenting these “miracle” devices but it would be a waste of our precious time.   I am yet to see a genuine effort on the part of the weight loss industry attempt to offset the barrage of misinformation thus far, have you?

Helen Rousso
Medical Exercise Specialist/Nutritionist
Post-Rehab Therapist

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Exercise Plays An Important Role in Acquired Brain Injuries

Contributor/Writer

http://www.ptrs.ca (Post Traumatic Rehabilitation Services)

NOVEMBER 1, 2011 

Following a brain injury, individuals who exercise are typically less depressed and report better quality of life than those who don’t exercise.

A safe and effective exercise program can play a very important role in the rehabilitation process following a brain injury.  Regular physical activity can help improve your balance and coordination, reduce reliance on assistive devices, and enhance your ability to do daily activities and thus remain independent.

The key is to determine what type of exercise is best for you and to follow a program that accommodates and addresses your special medical concerns.

Range of motion exercises are a type of physical therapy that keeps the joints mobile and functioning. Range of motion exercises can be done by the individual, or with help from physical therapies in a method known as passive range of motion. Range of motion exercises help maintain strength and can be separated into short or long-term goals.  Such exercises as simply extending and flexing the forearm or the lower leg help to maintain muscle tone and functioning ligaments and tendons that enable you to gradually regain strength or function of the limb over time.

One may recover from a traumatic brain  injury (TBI) more quickly if they exercise. As “The New York Times” reported in 1997, TBI patients who exercise are “significantly less depressed, better at cognitive thinking and physically healthier” than those who do not. Neuropsychologist Wayne Gordon indicates that patients who maintained their exercise routine had to display discipline, focus and motivation – attributes that carried over to the rest of their rehabilitation.

In one of his studies, A sample of 240 individuals with traumatic brain injury (TBI) (64 exercisers and 176 non-exercisers) and 139 individuals without a disability (66 exercisers and 73 non-exercisers).

It was found that the TBI exercisers were less depressed than non-exercising individuals with TBI exercisers reported fewer symptoms, and their self-reported health status was better than the non-exercising individuals with TBI. There were no differences between the two groups of individuals with TBI on measures of disability and handicap.

Getting Started

• Talk with your healthcare provider before starting an exercise program and ask for specific programming recommendations.
• Take all medications as recommended by your physician.
• The goals of your program should be to improve cardiovascular fitness, increase muscle strength and endurance, improve flexibility, and increase independence, mobility and ability to do daily activities.
• You may find that it is easier to focus on your exercise if you avoid busy, crowded locations.
• You may need to do some exercises such as cycling or walking with a work-out buddy if you have difficulty with balance or with finding your way throughout a community.
• Choose low-impact activities such as walking, cycling or water exercises, which involve large muscles groups and can be done continuously.
• Start slowly and gradually progress the intensity and duration of your workouts.   If your fitness level is low, start with shorter sessions (five to 10 minutes) and gradually build up to 20 to 60 minutes, three to five days per week.
• Perform resistance-training and stretching exercises two days per week.
• Take frequent breaks during activity if needed.

Exercise Cautions

• Avoid exercises that overload your joints or increase your risk of falling.
• Begin each exercise in a stable position and monitor your response before proceeding.
• Reduced motor control in your limbs may restrict your ability to do certain exercises.
• Exercise equipment may need to be modified to accommodate your specific needs.
• Always wear protective headgear when cycling or doing any other activity in which a fall is possible because the rate of a second head injury is three times greater after you have had one head injury.
• Don’t hesitate to ask for demonstrations or further explanations about how to perform exercises properly.

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References:

http://www.exerciseismedicine.org/

New York Times, 1977