Nutrigenomics

This is a picture of my father-in-law, Mark, giving me a goofy look at my husband's birthday party a year and a half ago. At this time, we did not think he was an unhealthy man, however, about 6 months after this picture was taken, he began having some scary symptoms, chest pain, nausea, dizziness...etc. Luckily, my mother-in-law who is an RN, had drilled into his head the importance of not ignoring the signs of heart attack. Mark, only 52 years old at the time ended up having triple bypass surgery. His Left Coronary Artery (known as the widow maker) was 90% occluded and he had 2 other blockages that were almost as severe. We have thanked God for the last year that he gave Mark warning signs. I cringe at the thought of what would have happened to him without those warning signs.

The Ferguson family has poor family history. Mark's mother died at the age of 52 from what they think now was a heart attack. His father did not live to be much older than 60-65 when he died from complications from heart disease and diabetes. From discussing this with my in-laws, the Ferguson's were active people and not overweight. Mark was raised on a farm and reports to eating a lot of country, home cooking (lots of meat, potatoes, but also a lot of produce). We know that disease prevention takes more than simply being active and not overweight, however to be only 52??.....I often think about how many people I know who eat just like this, but were not cursed with Mark's genetics. (And my husband wonders why I am so particular about what I "encourage" him to eat?)

Nutrigenomics is, to explain it simply, the study of how nutrition impacts our genetics. Individuals respond in varying ways to the different nutrients in foods. Some people who were raised on the exact same foods as Mark, may never have heart disease, others may not ever be diagnosed with health problems until much later in life. We have known all along that nutrition is not "one size fits all." Everyone is different and will require a different nutrition regimen to optimize their health. This is what nutrigenomics is all about. The human genome is 99.9% identical, meaning your genetic makeup is 99.9% identical to all other humans. It is in that 0.1% that our genes differ. The hope is that nutrigenomics research will be able to identify the differences among a healthy person's and an unhealthy (disease stricken) person's genome. Once scientists identify these genetic differences, which researchers have identified some, they begin to reserach how different dietary factors, such as more fruits & vegetables, omega 3 fatty acids, or even how lifestyle factors such as alcohol consumption, exercise, or cigarette smoking, impact the expression of our genes. We are all born with a particular genetic potential, however environmental factors impact how our genes will be expressed, or in other words, the outcome of our health.

Nutrigenomics shows a lot of promise for the future in being able to personalize nutrition recommendations based on an individuals genetic potential of developing disease. We will hopefully be able to optimize one's health and prevent disease by recommending a specific eating regimen. (Getting our patients and clients to comply to our recommendations is a whole different challenge.) At this point, even though several genes have been identified as genes of interest, there are many more genes that have not yet been identified and much more research needs to be conducted on how nutrition impacts our gene expression. We have a long way to go before we will be able to actually apply nutrigenomics research to nutrition counseling.

I think that this topic holds an opportunity for RDs to gain knowledge and further show their value in healthcare and disease prevention. This opportunity will be what we make of it and what we put into it. One fear I have is that another profession will claim nutrigenomics as its own and that RDs will miss out on this opportunity. I think to prevent this, we need to be teaching basic nutrigenomics in undergrad and encouraging students to go this route after graduation from undergrad. Another worry that individuals have on this topic is that if a genetic test reveals that they have a higher risk for disease development, insurance companies will reject them. I think this is a logical worry, however, maybe this fear will help motivate people to live healthier lives in the future.

I am excited about this new topic, nutrigenomics, and hope that applicable recommendations will follow its research on ways to really help my patients and even friends and family prevent heart disease and live longer and healthier lives. I know that this probably will come after my time as a dietitian. However, I hope that I am wrong and that research in nutrigenomics moves along at a fast pace and surprises me!

The Legal Environment

The Legal Environment is very important to our profession of Dietetics. As Paula explained in class, it "is important for governing in groups or society, and providing them with the guidelines which determine how they will operate within the society." I think that people need rules and guidelines to keep them in check. However, as we discussed in class, people lose site as to why the rules were put in place. For instance, in the new reality TV show, Jamie Oliver's Food Revolution, the foods that our children are getting at their schools are not healthy foods. The guidelines that were put in place originally with the Child Nutrition Act, were not implemented so that our children would be fed almost all processed foods. Over the years, the budget for foods at schools got tighter and children's food preferences changed-included more processed, convenient food items with high calorie densisty, and less produce, and nutrient dense foods. This change in children's food preferences is, in part, due to the changes in lifestyle and food intake of their families. Because children's food preferences have changed, I believe they don't like the taste of fresh or unprocessed foods. Now, we are in a situation where congress is willing to budget more money, but it will be a HUGE challenge to change the food preferences of the kids. The kids on this show could not even identify a fresh tomato!

Healthcare reform will also have a big impact on our profession. We hope that it will present us with the opportunity to provide more preventative services rather than nutrition therapy for a disease state. It will be interesting to see what takes place.

Without some of the state and federal funded programs, such as WIC, there would not be an opportunity to help those in need. I feel the government has our best intentions at heart, but not always the means to give us everything we need. And sometimes, I feel that they lose site of why they implemented the programs in the first place. Maybe I am just naive, but I still have faith in our political system...at least for now.

How we can impact our legal environment at a local level is by seeking out opportunities to share our knowledge and worth. Also, I have found that the administrators at my facility are some of my biggest advocates. It they feel you are invaluable, then they will tell the community so. At a state and federal level, one of the best ways to impact the legal environment is to contact your state representative--writing letters, making phone calls. Attending public policy workshop is one of the best things that we can do for our profession.

Getting involved in the legal environment is an idea that overwhelms me and rather scares me. I feel that there is so much that I need to learn within politics and the legal environment. This class has definitely opened my eyes to the importance of such issues, however. Life brings us many overwhelming situations and I do not want to rely on other Dietitians to do my dirty work. I need to "suck it up" and get involved. Public policy should be every Dietitian's job, mine included.

Ethics in Dietetics Practice

Ethics impact our lives on a day to day basis in ways that we are not even aware. We are tempted to be unethical daily. Whether our temptations be to not speak up when a cashier gives back too much cash or to tell our boss a "half-truth" to make ourselves look better. I consider myself a Christian. Many of the beliefs that come from being a Christian are considered ethical- for instance, honesty, integrity and fairness. Principle 1 of the American Dietetics Association Code of Ethics states: The dietetics practitioner conducts himself/herself with honesty, integrity, and fairness. As I grow in my Christian faith, I am made aware of situations that may not be considered "Christian" but are considered OK socially. I am thankful that I have the Bible to turn to and to learn from to keep me on track. As humans, it can be easy to sacrifice our beliefs because "everyone else does it." I believe we need boundaries and rules to stay on track. If we, as a society, did not have standards as to what is socially acceptable and what is not, our world would be even more disorderly than it is.

Because this is our human nature, I am also thankful to have been educated at an ethical University. I had the opportunity to learn under ethical professionals. If I had been taught unethical practices as a young, impressionable student, this could have had a very negative impact on me as a Dietitian. I am glad we have the Code of Ethics to turn to to hold us accountable. If the Code of ethics did not have these principles in place to hold us accountable, and consequences for unethical practitioners, who knows what situations would be acceptable in our Dietetics society.

As I was reading and studying for the assignment this week, one of the unethical scenarios from the ADA's videos was about a Nutrition Support Dietietian who lacked confidence to confront the other members of the Nutrition Support team about how the team's previous recommendations were not documented in a patient's chart and therefore not carried out with this patient. This is unethical based on principle #8: recongnizes and exercises professional judgement within the limits of qualifications and collaborages with others, seeks counsel, or makes referrals as appropriate. This really stood out to me because as a fairly new RD (1.5 years) and a fairly new RD to Wright Memorial Hospital, the physicians and other health professionals at the hospital are not used to having access to a full-time RD. They did not utilize me very much at first. Because they were not open to my recommendations and techniques at first, I was not confident in approaching them with my recommendations. I almost dreaded having to approach some physicians, and still do at times. Because I feel this way, I sometimes am tempted to not approach the physician at all. It is tempting to only do what is "required"- solely an assessment within 72 hours of admission. In order to make the physicians aware of my recommendations, I cannot simply leave my recommendations on my assessment notes becauase they will not read them. I have to communicate with them in different ways. One physician absolutely hates it when there are notes left on a patient's chart for him. This is how I communicate with most of the physicians, however with this particular physician, I either need to call the Doctor's nurse and leave a message or speak directly to the Doctor. This is a time consuming process to do this with all physicians, but if I do not do it, my recommendations will not be carried out. It isn't convenient, and it is tempting for me to think, "oh the patient will be discharged in a few days anyway" just so I don't have to communicate in one more way with a physician, but this would not be ethical because I am not putting my patient's needs before my inconveniences. Situations like this come up a lot in my job and I just remind myself that I have higher expectations for myself and that I am not only representing myself, but my profession and I am striving to prove my worth at my facility and I think I am slowing making progress.

Another ethical situation that arose at my facility was when one of the administrators at my facility approached me and explained that we were expecting a particular patient at our facility and gave me further details on the situation. She went on to explain that this patient was very important and we needed to do everything we could to make them comfortable and give them the best care we could. I relayed her message to my staff. It did not strike me as unethical until one of my staff members replied, "and we don't do this with every patient?" I don't think that our administration was encouraging unfairness, however, it could definitely be perceived this way. I learned from this situation and have been encouraging fair and equal treatment to all patients since. I never encouraged anything different, but in a small town, often your patients are people that you know and with that comes special treatment at times. Knowing your patients on a personal level opens up a whole new set of challenge for employees on HIPPA confidentiality. People in my town know I work at the hospital and will sometimes ask me questions about patients. Of course, I always respond that I am not allowed to discuss such matters.

Ethics is about doing the right thing, not the most popular thing. Doing the right thing can somethings be challenging, but worthwhile in the end.

The Economic Environment

The Economic Environment has mostly affected me in a positive manner. Despite the recession, my husband and I were fortunate enough to have been offered jobs in our hometown community. Mine was a newly created position, which is not common in times like today. Accepting these jobs was almost a scary thing for us because we gave up 2 secure, great jobs that offered us wonderful benefits. Giving up something that we were happy doing, to move on to something else, in which we were uncertain as to what the future would hold for us was scary. We ultimately decided that we were going to make the move home eventually, so we might as well do it when all the stars were aligning for us. It has proven to be a great move financially.

We were aware that the housing economy was ideal for buyers, so we began looking for an adequate house that would meet all of our initial needs - big enough to eventually start a family, nice enough that we would not have to spend a lot of money or TIME fixing it up, but still affordable. We found what we thought was a perfect house for us. It was priced a little higher than we thought we could afford, but luckily the owners came down a little for us. We might even stay here for the rest of our lives. As we were going through the buying process, we were told by our realtor that we qualified for the federal stimulus bill for first-time home owners. Of course we were very excited about this and have been saving the money we got from the bill to do a few renovations to our house.

Like I mentioned previously, my job at the hospital is newly created. When I hear of people getting laid off from jobs that they have had from years it makes me feel very fortunate. Most businesses have not had the luxury to add new positions during this economy. Since I began this job, I have been offered promotions and raises that I feel unworthy for. Honestly, over the past year, if I didn't already know that the economy was in poor condition, I would have no reason to believe it because I have not felt many effects from it.

My first job as a Nutrition Counselor at a YMCA proved to be a very tough one in such an economy. The poor economy, among many other obstacles faced, proved to be too big of a challenge to hold any long-term goals at the YMCA. I thought this type of setting would be the best fit for me, but since I have found that I excel much more in different settings. This is one example of how the economy negatively impacted me.

I look around the community and at friends and family and see how the economy has added stress to their lives. One of the ladies at my church sobbed all through Sunday School a few weeks ago and she said money was just so tight in her house. She said her house was falling apart and she had been out of a job for several months. She and her husband have 2 children. I can only imagine the stress they must have been feeling. The awesome thing about this story is that she applied for a job in my department and she was the right candidate for the job! She now has great benefits and better hours than she has had in her past jobs. Her kids are loving that she is home more with this job. I am so happy that a job in my department is going to be such a blessing for her and her family!

I have given a presentation at the local food pantry and am getting to know the food pantry manager and the statistics she gave me on how many people are utilizing the services provided at the food pantry. It made me very sad. My husband and I plan on making a donation to the pantry some time soon. Of course the donation given will not feed very many people, but hopefully it will be far stretched! Since I moved back to this community, I have been asked to give presentations throughout the community. I hope that people will continue to ask me to do this. I can hopefully provide insight to members of the community on how to stretch their food dollar and how they can do this and still eat nutritious foods. The food pantry is planning on starting a community garden. I hope that this will be an opportunity for me to be used more in the community also.

Global Issues

The readings and videos assigned to us this week were fabulous. I learned so much. I have never been the kind of person who paid much attention to the global world. Unfortunately, I am guilty of selfishly becoming glued into my own world and not deviating from what it presents to me. Don't get me wrong, I follow the news enough to be made aware of the big events, but most other topics escape my thoughts completely. This class has really challenged me to think outside of my normal box and I have already adopted new interests.

First of all, I consider myself a very compassionate, empathetic person. When my professior in undergrad covered the importance of acquiring this trait as a Dietitian, I already had it covered. I am not trying to sound boastful, but many people often refer to me as "Sweet." In fact within the Nutrition Services Department, I was recently granted the "Dietary Sweetness Award." At times, I know that my soft-spoken self has them fooled. :) However, the issue of poverty, and unequal access to health care has been a topic close at heart. When working my former WIC position and even with my current position, I am often humbled at just how great I have had it in my life. Growing up, I never had much, but I came from a loving, supportive family and we always had what we needed. It breaks my heart when I cannot provide education or help to someone in my community because of lack of money. Our hospital does not allow me to educate for free, unless of course, the patient goes through the proper channels--applying for financial assistance and then qualifying. And you can't blame them....they are just another hospital trying to survive! In general, just being aware of global issues such as poverty and unequal access to healthcare, make me a more empathetic Dietitian and a more caring and driven person.

The concepts presented in the Shift Age explain how technology will continue to get better and better and therefore, I will most likely have to keep adapting and changing my processes because my work environment will require it. I have talked about how my facility is building a new facility. With this change comes, new and better technology. I will have to learn it and then when it is obsolete, relearn.

I really enjoyed learning the concepts Thomas Friedman presents in the video, The World is Flat. He really stretched my mind and made me view technology and our history in a whole new light. The concepts he presented about the Green Revolution or the Green Party, as he calls it, that we are currently in are very interesting. I have joined the Green Team at my facility. In about 8 months, our goal is to become a much more green facility. This impacts me a lot as Nutrition Services Director because the disposable products we currently buy are mostly styrofoam. We have not yet made the switch to more eco-friendly disposables because the cost for this is more than double the amount of our foam products. I am anxious to make the change, but am also waiting on guidance from my supervisors above me. This is a concept that I plan to carry over into my personal life. My husband and I will be more green in 2010. :)

Lastly, we all are anxiously awaiting the effects of the new Healthcare reform that we talk so much about. This will most likely impact me more professionally than personally. I have a better understanding of why our healthcare system is the way it is after watching the documentary, Sick Around the World. If the US does not put more limits on the profits that drug and medical companies, practitioners, facilities...etc make, our government is going to be spending more and more on healthcare and our taxes will get higher and higher. We are in need of a more efficient system and a big change. One thing is for sure, I am thankful it is not my responsibility to come up with such a change.

Until next week,

Christina

Health Care Trends

Many of the health care trends that will affect me are easy for me to identify currently because we are building a new facility. The thought of moving to a brand new facility with state-of-the-art equipment and space is so exciting! Part of this transition is our move to electronic medical documentation and charting. Currently, many supplements and nutrition orders that are ordered "slip through the cracks" and disappear off of the MAR because the processes in place with paper charting create challenges for Nursing when administering supplements. This is only one example of how the electronic medical documentation will affect my job and benefit our facility and our patients.

Building a new hospital in such a poor economy sounds unnecessary to some, especially in such an economy. Our CEO explained our need for a new facility in a way that made a lot of sense. She talks about the importance of physician recruitment and how small, rural hospitals struggle to recruit and retain physicians because of lack of attractions to the area, among other reasons. Rural hospitals with outdated equipment and facilities really struggle in this area. We have had success in this area recently, but this was mainly because of the plans in place to build a new hospital. She went on to explain if you can't recruit physicians then you cannot provide health care and therefore, there is no hospital and no hospital jobs. This made me realize how much this new facility will impact not only our patients or Wright Memorial employees, but our community. If we want to stay alive as a hospital, we have to be competitive with hospitals from surrounding counties. A new hospital, we hope, will give us an advantage in competition with surrounding hospitals, which means more revenue. More revenue means we can add more services to serve our patients, such as a Diabetes Center in the future, among other things.

Because health care costs will continue to rise, the number of people who are under-insured or uninsured will increase and therefore we will have more patients who will not be able to pay their bills. As a Director, when census is low, I am to flex my staff accordingly. This means that I cut the hours of my staff by a small amount in order to cut expenses.

Currently, many patients refuse my service as an outpatient because their insurance does not reimburse for nutrition counseling unless the patient is diagnosed with diabetes or renal disease. I hope that the health care reform will provide more coverage for preventative heathcare measures, which would include nutrition counseling. The new health care reform will no doubt affect us all. We will have to wait and see what all those changes will mean to us.

I was unsuccessful posting pictures and will hopefully learn to do this better in the near future.

I am not a lunch lady!

I am the Director of Nutrition Services at Wright Memorial Hospital in my hometown of Trenton, Missouri. I have worked at WMH for about 8 months and was recently promoted to Director. WMH is a 25 bed, critical-access hospital, and I feel very fortunate to have come on board when I did because we are currently building a brand new facility and it is a great time of growth. I began my position last June as a part-time (32 hours per week) inpatient/outpatient RD. My job then grew to 40 hours per week and I became Director shortly thereafter. I never thought that I would work in the clinical setting, but it has proven to be a great fit for me. I work very well with the aging and elderly population and in our hospital, a large percentage of our patients are elderly.

I graduated from the University of Missouri in May 2008. My first job was as a Nutrition Counselor at a YMCA. This was a very challenging job, especially in a struggling economy. My second position was at a WIC clinic in the tiny town of Tuscumbia, Missouri. I loved my work there and especially love the promotion and education of breastfeeding. I only worked this position a short time because I was offered a position at my current facility.

Change is something that I have underwent a lot of recently. Change is having to adapt or implement a different attitude or process for some reason, whether it be because you chose to change or because you were forced. Fortunately, most of the changes in my recent life have been by choice and were for the better. :) I graduated in May 2008, moved into the home that I would soon share with my husband, got married in June, and passed my RD exam in August. Almost a year after graduation (after changes jobs a few times) my husband and I moved back to our hometown of Trenton, Missouri, bought a house and a puppy. Since our move, my job description has also changed a few times and I have began pursuit of my Master's Degree. In a few months, my husband and my life will change again when we become a first time aunt and uncle. My brother and his wife are expecting 1 baby, and Jordan's brother and his wife, are expecting twin girls...all to come in April. We are so excited!

A fad is a passing fashion-something that will not remain popular forever. A trend is the direction of where a concept or process tends to go over a period of time...a "where the river flows" concept. An example of a trend in my life is the direction that my husband and I are headed with our future family. We fell in love, got married and the next step in this situation tends to be kids. Someday, we hope to have children (God willing). A fad in our life right now is drinking red wine every night. We probably will not continue this fad because we are spending almost $20 extra dollars on this weekly. Someday in the future when money is more tight, we will probably give up this fad. Another fad of ours is playing Mario Brothers 3 on the Wii. :) We will eventually lose interest in this.

Being that I have only been a Dietitian for a short time, I have not yet seen a lot of change within the profession. One reputation Dietitians have had in the past is "lunch ladies" or glorified cooks. In school and in my previous 2 jobs, I was able to escape this reputation because the environments that I was in were relatively modern in their thinking. However, after moving back to a rural community and accepting a newly created position at a small hospital, I have had a lot of trouble escaping this reputation. Many of the hospital employees came up to me my first week of work and asked if I was going to miraculously improve the cafeteria menus. (I wanted to say, "Yes, by eliminating the fried foods that you so love," but I bit my tongue. ) Upon introducing myself to patients, I was referred to, "as the lady that cooks your meals." :( This was a very maddening experience for me. I did not go to school and work so hard for 4 years to be viewed in this light. I became interested in Nutrition because of my participation in athletics and competitive sports, not because I wanted to work in food service. Oh well...slowly, I have been able to change how those around me view a "Dietician." And I hope to continue to do so.

I have not underwent many changes within my profession, however there are several changes that I look forward to within my position. One being the construction of our new facility. This is a huge asset to our community and it will be amazing to have brand new, state of the art equipment and space. I also look forward to hopefully beginning a Diabetes Program in our community, which is very much a dire need.

Dietetics is an ever-changing field and I am prepared to change and adapt along with it. I hope most of these changes will be fun, but I imagine some of them will just be "part of the job." That is ok. I am determined and ready for them when they come!