1. Set a rack in the center of the oven and preheat the oven
to 350 degrees. In the bottom of a roasting pan, arrange the carrots, celery,
leek and onion to serve as a bed for the turkey.
2. Slide on hand under the turkey breast skin near the neck
and gently pry it from the meat. Use the other hand to gently lift up the skin
until all the breast skin is loosened from the meat.
3. Sprinkle the salt on the exposed breast meat, then add the thyme. On one side of the breast, insert a
lemon slice, slipping it to the back. Add an orange slice to the same side,
then a second lemon slice, keeping the herbs underneath the citrus. Repeat on
the other side of the breast. Gently pull the loosened skin back in place and
pat it down so it almost reaches the neck.
4. Coat the skin with cooking spray and set the breast on
the bed of vegetables. Place the pan on the oven rack and add broth. Roast
until an instant-read thermometer registers 165 degrees. Remove the breast to a
platter and let it rest 20 minutes.
5. Meanwhile, pour the juices from the pan into a measuring
cup. Chill to allow fat to rise. Transfer vegetables to a blender and puree.
Skim the congealed fat and stir in the vegetable juice, then reheat.
6. Remove the skin, citrus and herbs from the turkey and
carve into slices to serve with juices.
Recipe yields six servings. Each serving provides: Calories
180; Protein 36 g; Sodium 358 mg; Carbohydrate 6 g; Dietary Fiber 1 g; Total
Fat 1g; Saturated Fat 0 gram.
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The following article was written and submitted by Nelle Kearns, RN, MSM, a nurse
from the United Methodist Church of Bethel Connecticut. Mrs. Kearns has
previously attended the 2004 Annual Convention of the National Multiple
Sclerosis Society.
Parish Nursing for the Person with Multiple
Sclerosis
This
article was purposely titled the “person with multiple sclerosis”, not the
“patient with multiple sclerosis”. These
are usually normal people who want and need to live a normal life for as long
as possible, and that may be a very long time.
Only about 25% of people diagnosed with multiple sclerosis (MS) will end
up needing a wheelchair. MS is more
common in women (so I am mostly using “she” in this article) and is usually
diagnosed between the ages of 20 – 50.
This means they are in the prime of life and are planning or have
already started a family.
There are 4 types of MS. Most people (85%) are diagnosed with
relapsing-remitting MS which has acute attacks followed by full recovery or
recovery with some residual deficit.
Between relapses there is usually no disease progression. Some (about 50% within 10 years) will progress
to secondary-progressive MS in which disability progresses. Less common are two other types: primary
progressive and progressive relapsing.
It is both a disease of the nervous system and a disease of the immune
system. In MS the immune system is attacking the myelin sheath of the nervous
system.
When I was
first diagnosed, I went to a web site that defined MS as a “devastating”
neurological disease with progressing disability. This lead to some lack of confidence in the
physician’s reassurance that I would do “fine”.
People diagnosed with MS will respond in different ways. Some will be relieved to find an explanation
for what have been strange symptoms experienced over a period of time and they
also may be freed from a feeling that the physician considers them to be
hypochondriacs. Others will go through
all of the usual stages of grief similar to those that are related to death –
denial, anger, bargaining, depression, acceptance.
What does
all of this mean to you as a Parish Nurse when someone in your congregation is
diagnosed with MS and comes to you for support?
You may be needed to help her reach acceptance and a realistic approach
to treatment. They will need your
emotional support and education more than anything, possibly for years before
any physical support is needed.
Since 1998, the Medical Advisory
Board of the National Multiple Sclerosis Society has recommended that as soon
as possible after diagnosis with relapsing remitting MS, treatment with a
disease modifying therapy should be started.
These drugs have been called the ABCR drugs (based on the trade names – Avonex, Betaseron, Capaxone, Rebif). Each has its own side effects and
complications and the choice must be made by the person with MS working with
the physician. All are injections - 3
are subcutaneous and 1 is IM. The woman
(or man) usually must learn to self-administer the injections or have a family
member do it. For those on Medicare or
Medicaid they may have to receive it in a physician’s office in order to
receive reimbursement. And reimbursement
is a major concern because these medications can cost as much as $18,000 a
year. Do not let the person decide to
skip the medications based on cost. Each
of the manufacturers has financial assistance plans available and you may be
able to assist her in researching this.
Contact information is usually available on a web site or in the
informational brochures given by the physician.
A newer drug (Tysabri) has been released in
November of 2004 and requires IV administration every 4 weeks at a cost of
about $23,000 per year.
Many of the symptoms of MS are
hidden from the view of other people. They are not the obvious symptoms of
physical disability. And to make things
more difficult, not everyone’s symptoms are the same. In addition, the same
person may not have the same symptoms all of the time. The following is a list
of some important symptoms and suggested interventions for the parish nurse.
- Fatigue
is a problem for 88% of MS victims.
These people need to reduce their commitments and activities. You may need to help them learn to
refuse to take on added tasks and committees and leadership roles. The family may need
some help from other volunteers in the congregation with child-care during
busy times.
- Cognitive changes can occur and lead to
disorganization, forgetting appointments and decreased processing
speed. A cognitive therapist can
help to develop coping strategies and should be encouraged. Here again, help may be needed in
seeking insurance coverage.
- Bladder
dysfunction, when present, can lead to urgency and frequency. This can lead to a fear of attending
long meetings or services as she wants to stay near a bathroom. She could also develop a failure to
empty completely and the potential need for intermittent
self-catheterization, which may be more daunting than the self-injection
of medications. The neurologist
should refer the person to a urologist for
treatment and follow-up.
- Bowel
problems can occur such as constipation or incontinence. These should be referred to her
neurologist who may offer solutions or refer her to a gastroenterologist.
- Sensory
problems can occur such as tingling, pain, numbness or electric shock
sensations. In addition to the
discomfort, such problems can interfere with sleep, thus increasing the
already present fatigue. The
neurologist can offer medications to relieve these symptoms.
- Depression
can occur. In fact, as many as 50%
of persons with MS will experience at least 1 major depression
episode. This is a higher rate
than for people with other chronic diseases and may be related to MS
activity in the brain. The degree
of depression does not seem to be related to the degree of
disability. She should not be
ashamed of a referral to a psychiatrist or psychologist, but should obtain
a referral to a mental health professional with experience in working with
people with MS.
- Visual
problems can occur. One of the most
common visual problems is optic neuritis which is frequently the first
hint of a diagnosis of MS.
Depending on the severity, the person may lose the ability to
drive, leading to the loss of employment options and to isolation. To help with the isolation, other
members of the congregation can provide rides to recreational activities,
shopping, Bible study or other Church events. The visual problems can also cause
employment problems if they must use a computer or other visual equipment
in the workplace.
Despite the positive outlook made
possible by the new therapies, many victims will progress to severe
disability. They will need even more of
your support. If there are problems in
the workplace, he or she should contact someone with experience with the
Americans with Disabilities Act that requires that the workplace make
reasonable accommodations to allow the person to continue to work. There are also programs through the MS
Society or other agencies for retraining for more feasible work. In many cases, the MS related fatigue makes
employment outside of the home impossible.
This becomes a more pronounced problem as physical disability makes even
normal grooming a tiring chore.
As disability increases, the
person will probably become more homebound and lonely. The parish nurse should encourage other
members of the congregation to take MS victims out to lunch or stop by and
bring a picnic lunch. They can use new
books to read and videos to watch or if vision is too impaired new books on
tape. Some will become severely disabled
– possibly unable to move any extremity to call for help. The MS Society can help here too, helping to
pay for the life-line type call system.
There are systems that can be operated with minor head movement if a
call button cannot be used. Even if the
person and family have avoided the use of the Society’s services prior to this
point, they should definitely all for help at this point. It is not a sign of weakness and the problems
are probably beyond what you and your fellow congregants can do. That is why there is an
National Multiple Sclerosis Society – to help those who are dealing with the
disease.
Many people will feel that they or
their spouse are now trapped in a job since they will be unable to obtain
health insurance in a new company. And,
with the cost of the medications, insurance is something to keep if you already
have it. As more systems become
affected, the number of medications multiplies.
About 2/3 of
people with MS use an alternative therapy. These may range from herbs to
magnets to bee stings. The best advice
to give a person considering an alternative therapy is to check a reliable
reference such as Dr. Bowling’s book, (cited
below). Some alternative therapies are
helpful and safe and others can be dangerous or just useless and
expensive. The neurologist may not be
encouraging or knowledgeable about these agents. Just be sure that you advise her to use such
a reference to check the safety of the agent.
Many people use the alternative therapies in addition to conventional
medications, so we call them complimentary therapies.
Overall, MS can be a very
overwhelming diagnosis. Your parishioner will need plenty of emotional support
and education about the need for medications and referral to the specialists
necessary for treatment. If she is
having cognitive problems she may need assistance in scheduling and tracking
all of the physicians from the multiple specialties to which she has been referred. Help others to understand when she refuses
requests to help on multiple projects.
The person with MS should contact
the local MS society to find a support group.
She may not be the usual “joiner” type but here is a chance to discuss
feelings that no one, not even family members, understands. Most groups will welcome spouses as
well. Even if she attends only for a
short time, it will be very helpful.
Some newly diagnosed people are
upset when attending a meeting to see other people in electric wheelchairs or
scooters. For this reason, if possible,
she should attend a group for the newly diagnosed first. If the only group available is one with more
disabled people in it, offer the encouragement that they have probably had the
disease for a long time and were most likely diagnosed before the disease
modifying drugs were on the market to slow the progression of the disease.
While MS in children and teens is less common,
it does exist and has its own set of concerns.
For information on this topic, contact the MS Society.
And let us not forget the power of prayer in
helping anyone face a difficult diagnosis.
With God’s help we can face much difficulty with more strength.
www.nationalmssociety.org
or 1-800-FIGHTMS
For professionals – www.nationalmssociety.org/prc.asp
or 1-866-MS-TREAT
Bowling, Allen C. (2001). Alternative Medicine and Multiple Sclerosis. Demos, NY.
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Nutrition Talk
More than ever, people are realizing that what they eat does make a
difference, not only in the way they look and feel but also in the length and
quality of their lives. Throughout the life cycle the body requires different
amounts of calories and nutrients. Therefore, we must learn how to feed the
body with essential nutrients in order to achieve and maintain optimal health.
I like to use the phrase, Healthy Aging. So why are we having such a
difficult time in making the necessary lifestyle changes? Each individual must
answer that question for him or herself. However, our modern lifestyles have
gotten us off the right track, with fast foods, alcohol abuse, lack of physical
activity, and high-tech stress.
Many months ago, you once again made your New Years Resolutions. You have
set your goals for the year. Know doubt they include going on a diet - right? I
know you mean it this time. OK! Let's get started. For starters eliminate the
word diet. I believe the word diet sends an internal negative message to the
brain. Instead use the term "healthier lifetime changes."
The more we take it upon ourselves to learn about nutrition, the better prepared
we will be to take an active role in our health. Develop an attitude for good
health, maintenance and healing. Being knowledgeable about different food
groups and the nutrients they provide will put you in front of the prevention
ball and not behind.
Carbohydrates
Carbohydrates seem to be getting a bad rap these days. However, this food
group supplies the body with the needed energy to function. Without it we will
run out of steam. Carbohydrates converted into glucose are the major fuel
source for all of the body's cells.
There are two types of carbohydrates- simple and complex. Simple
carbohydrates, sometimes called simple sugars, include fructose (fruit sugar),
sucrose, (table sugar), lactose (milk sugar) as well as several other sugars.
Fruits are one of the richest natural sources of simple carbohydrates. Complex
carbohydrates are made up of longer chain sugar molecules. Complex
carbohydrates include fiber and starches. For example vegetables, whole grain,
peas and beans.
When choosing carbohydrate-rich foods select unrefined
foods such as fruits and vegetables, beans, or whole grain products.
Break away from refined foods as much as possible (soft drinks, candy and
sugar). Refined foods offer few, if any vitamins, minerals, and phytochemicals. The total amount of carbohydrates you need
is determined by your energy expenditure.
Protein
Protein is essential for growth and development. It provides the body with
energy, and is needed for the manufacture of hormones, antibodies, enzymes and
tissues. In the body, proteins are broken down into amino acids, the building
blocks of all proteins. Amino acids are classified either as nonessential or
essential. Non-essential amino acids are those that do not have to come from
the diet but can be synthesized by the body from other amino acids. The
essential amino acids are those that cannot be synthesized by the body and
therefore must be obtained from the diet.
There are two types of proteins- complete proteins and incomplete proteins.
Complete proteins are those that contain ample amounts of all essential amino
acids. These proteins are found in a variety of foods such as meat, fish,
poultry, cheese, eggs, and milk. Incomplete proteins contain only some of the
essential amino acids. These proteins are also found in a variety of foods such
as grains, legumes, and a variety of green vegetables.
It is important to consume a full range of proteins, both the non-essential
as well as the essential proteins. As a reminder, the body does not require a
large amount of protein. Reducing the amount of animal protein and increasing
plant based protein can be healthier for the body.
Fat
Like carbohydrates, much attention has been given to reducing our fat
intake. However, the body does require fat. Throughout the life cycle, fat is
needed for growth and body function. Fat is the most concentrated source of
energy. The concern is that the average American consumes far too much of it.
Excessive fat consumption can lead to obesity. Clinical research has linked
obesity to a myriad of diseases, such as cardiovascular disease, diabetes, certain types of cancer, osteoarthritis, gout and many more.
There are three categories of fats or fatty acids- saturated,
monounsaturated, and polyunsaturated fats. Saturated fats are found primarily
in animal products, including dairy items. Because the liver uses saturated
fats to manufacture cholesterol, it is important that your diet limit the
amount of fat. Most experts recommend that the daily intake of saturated fats
be kept below 10 percent of the total caloric intake.
Monounsaturated fats are found mostly in vegetable and nut oils, such as
olive, peanut and Canola oils. These fats appear to reduce blood levels of
low-density lipoproteins (LDLs or "bad
cholesterol") without affecting the high-density lipoproteins (HDLs or "good cholesterol") in any way. Dietary
guidelines recommend that these should not exceed 10 percent of your total
caloric intake.
Polyunsaturated fats are found in greatest abundance in corn, soybean,
safflower, and sunflower oils. Certain fish oils are also high in
polyunsaturated fats. These fats have been found to lower your total blood
cholesterol level. The dietary guidelines recommend that these fats also should
not exceed 10 percent of your total caloric intake..
I must note that some experts believe that our total daily fat intake should
not exceed 25 percent of our total caloric intake. Most foods, including
plant-based foods, contain a combination of all three types of fats, although
in each food one of the types usually predominates. In making a healthy choice
of which fats to use, monounsaturated fats appear to be the healthiest oil.
Let's not forget the trans-fat. These are altered polyunsaturated oils. The
process is called
hydrogenation. The oils are hardened into a solid such as margarine and
shortening. Most of our baked goods and snack foods contain hydrogenated oils.
There have been several studies that have shown that trans-fat can behave as a
saturated fat, which can leave the body vulnerable to pre-mature heart disease.
Before purchasing a food item read the food labels nutrition information. Look
for the words hydrogenation or hydrogenated. I call this a fake fat.
Vitamins and Minerals
Like carbohydrates, protein, and fats, our micronutrients (vitamins and
minerals) are essential to life. They are considered to be micronutrients
because they are needed in relatively small amounts. Vitamins are classified as
water- soluble (Vitamins B and C) and fat-soluble (Vitamins A, D, E, and K).
Recommended Daily Allowances (RDAs) have been established by the Food and
Nutrition Board of the National Research Council of the National Academy of
Science. The RDAs have become the primary nutrient standards used in the United
States since 1943 and these are updated every
five years. The RDAs are dependent on gender, age, weight and height. The RDA's
are estimates of nutrient needs for healthy people.
Vitamins are non-caloric nutrients produced by living organisms and they
participate in a variety of life-building processes. Each vitamin has a
specific role and can act synergistic with other essential nutrients. Vitamins
are often referred to as catalysts, igniting the sparks to keep the engine
going.
Minerals originate from the soil and they too are essential to life. There
are 22 minerals that are essential to human health. Although I will not discuss
the specific role of each mineral these minerals are divided into two
categories: major minerals and trace minerals. Both categories of minerals are
equally important in maintaining optimal health.
Minerals can work together or against each other. Some minerals compete for
absorption, so a large intake of one mineral can produce a deficiency of
another. The best source of minerals can be found in plant based foods. Eating
a variety of plant based products will ensure that the body is receiving all 22
minerals.
Water
Water is the most abundant nutrient in the body. It is an essential nutrient
that is involved in every function of the body. Water helps to transport nutrients
and waste in and out of the cells. Water is necessary for the utilization of
water-soluble vitamins. It is also needed to maintain proper body temperature.
Drinking at least eight 8-ounce cups of water per day should maintain proper
hydration.
Try drinking an 8-ounce cup of water before you eat and the water will give you
a feeling of. fullness. Remember coffee will cause you
to excrete more water, and soda will add more unwanted calories to your daily
intake, so let's not count these two beverages as part of your water intake.
Selecting a variety of foods in proper amounts from each food group will ensure
that the body is receiving the nutrients needed to promote and maintain optimal
health. Who's responsible for your body? You are responsible for your body-
right. You and I are responsible for feeding and nourishing the body to promote
a longer and healthier life.
Lets eat to live, not live to eat.
Elaine Williams Nelson, RD, CDN.
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Taming Holiday Feasting
Beginning with Halloween and
continuing through Thanksgiving, Christmas, Valentine’s Day and the chocolate
Easter bunny season, people are inundated with an abundance of special foods,
feasts and sweets.
In humans’ complex biochemistry,
food is more than just fuel to energize bodies. It is related to emotions,
memories and relationships. Food is a connection and symbol of the past and
identity.
On the average, people gain just
one pound during the holiday season. But, if you add into the equation our
decreased physical activity during January and February, that pound may
multiply.
Here are some guidelines for
healthier eating and celebrating during the holidays:
- Don’t skip meals on
the day of a party. Under-eating early in the day results in
over-eating later of the wrong kinds of foods.
-Take the edge off
your appetite by snacking on an apple or orange 30 minutes prior to
a feast.
-Eat like a gourmet:
Take small portions of a variety of foods and chew slowly.
-Instead of sugar-laden punches and drinks, mix mineral water or club soda with low-
calorie cranberry and other fruit juices.
-Include fresh fruit
and vegetable trays in your buffet line.
-Season steamed,
fresh or frozen vegetables with herbs and lemon juice instead of
creamy
sauces and butter.
-Position yourself
away from the appetizers and dessert buffets. Take one or two
items that
you really want to enjoy.
-The day after the
feast, eat healthfully and lightly.
-Schedule a non-food
reward for yourself as you maintain your weight during the
holiday
season, rather than trying to lose.
-Keep a schedule of
regular physical activity.
-If you overindulge,
forgive yourself and start over after the holidays.
Most of all, remember we are feasting to celebrate our love and
connectedness with each other and God’s blessing and presence.
Written by Kae Tritle, RN, wellness
coordinator for the Iowa Annual Conference
Reprinted from
“Interpreter Magazine”, a publication of United Methodist Communications,
(Nov.-Dec. 2006)
The
holiday season is fast approaching. There will be lots of food preparation and
cooking. Here are some tips to keep our food safe during and after cooking.
·
This seems obvious to most people, but it is
very important: Wash hands before
handling foods and between handling raw and cooked foods.
·
Defrost foods on the lower shelf of the
refrigerator.
·
Avoid defrosting foods at room temperature. Long
exposure to room temperature promotes rapid bacterial growth.
·
Use separate cutting boards for raw and cooked
foods. This will help in minimizing the possibility of cross contamination.
Give the same attention to your knives and utensils.
·
Cook all foods to an internal temperature of 140
degrees.
·
Avoid leaving cooked foods at room temperature
for more than 30 minutes.
·
Place leftover foods in the refrigerator in a
shallow dish. This will allow the temperature to move into a safe zone within 2
hours.
·
Keep all perishable products at 40 degrees or
below.
·
Reheat foods to an internal temperature of 165
degrees.
Knowing the tricks of proper food handling can add to a
successful fun filled holiday season.
Elaine Williams Nelson, RD, CDN
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‘All
Inclusive:’ Holiday
treats to fit special diets
You’ve
worked hard preparing the ultimate Christmas treats for the annual church
holiday reception. Tables are set, decorations festoon the room and the scent
of pine fills the air. Everything is perfect, right? Not if everyone can’t
enjoy the goodies.
Allergies,
other medical conditions and even personal preference can keep some from
enjoying the festive food. These individuals are used to managing their diets,
but you add a special dose of hospitality to your event by including foods and
snacks that accommodate a wide range of special dietary needs.
BEING MINDFUL
The most
frequent need is for sugar-free or wheat free choices and selections for
vegetarians or vegans. Also remember that some are lactose intolerant and need
to avoid milk and dairy products. Others may need caffeine-free coffee or soft
drinks.
If any
baked goods include alcohol, they should be clearly marked as such so none are
surprised. Baking alone will not boil away the alcohol in a flavoring, so offer
alcohol free equivalents as well. Celebrations that include people from other
faiths may require attention to religious customs.
PLANNING AHEAD
How can you
know who needs what in advance? Whenever possible, ask. Most people with dietary
needs will be pleased that you care enough to ask. Also be aware of the
ingredients used for the dishes on hand.
Bon Appetit, Joyeux
Noel!
This article is from
the November/December issue of Interpreter, produced for the church by United
Methodist Communications:
(‘All Inclusive:’ Holiday
treats to fit special diets. (2004). Interpreter, 48
(8), 9.)
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Managing the
“Holiday Blues”
Holiday
celebrations can be busy times with things to do, people to see and the
expectation that one should “feel” a certain way.
As Christians, these seasons of
celebration should take on sacred meaning. But for many, the holidays
stir uncomfortable memories of broken relationships, lost loved ones or
traditions and places no longer a part of our annual celebrations. The blur of
activity can become a source of stress or even depression.
Here are some ways to combat the
“holiday blues” and to help others see the spiritual richness offered in these
special times.
SURROUND YOURSELF WITH OTHERS:
Even with bustling activity, people
can feel isolated and alone during the holidays. Make an effort to get out and
join others for activities. Whether joining a conversation in the kitchen,
participating in a group service project or inviting a friend for a movie,
interaction often helps us feel better.
STAY POSITIVE:
Depression can build when one fails
to confront painful feelings and find a productive way to deal with them. Some
issues, such as family dynamics, cannot be dealt with quickly. But during
holiday gatherings, we can lay aside confrontation and instead use energy to be
with positive people. Surrounding oneself with joyful
activities, like those involving children, can rekindle gratitude and a sense
of wonder.
MANAGE HOLIDAY
EXPECTATIONS:
Even with good intentions,
over-extending oneself isn’t healthy. Find ways to
simplify the past traditions without diminishing their value. Responsibilities
for cooking, shopping and even volunteer church duties can be shared.
This article is from the November/December
issue of Interpreter, produced for the church by United Methodist
Communications:
No flu shot? – This may help!
You should check with
your physician or nurse practitioner to see if he or she recommends a flu shot
for you. However, the following information may help in reducing your chances
of getting the flu regardless if you were able to get a flu shot or not.
Tips for Flu Relief and Prevention:
·
Wash your hands frequently, using soap
and hot water for a minimum of 15 seconds, and when water is not handy, carry a small bottle of alcohol-based hand sanitizer (Purell type).
·
Avoid touching your nose, eyes, mouth, and face
area. That’s where germs enter and exit.
·
Cover your nose and mouth when coughing and
sneezing, using the bend of your elbow (sleeve, not hands).
·
Use disposable tissues, wiping your nose in a way
that keeps secretions off your hands.
·
Get plenty of rest – slow down! By expending
less outward energy, your body will devote energy to fight infections.
·
Drink lots of fluids and juices. Chicken soup
really does help.
·
Keep the air moist – use a humidifier. Avoid
crowds.
·
Stay at home if you feel ill – no one wants to
see you that badly!
·
Wash your hands – and maybe skip the friendly
handshake for the next few months. WASH YOUR HANDS!!!!!!!
Pat August, RN
Parish Nurse, Trinity United Methodist
Church
Windsor,
Connecticut
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