Surgery Increases Protein Demands in the Body

Here’s a little something I learned about the extra nutritional demands for protein on the body post-surgery following my own four shoulder surgeries. My co-author, Dr. Foetisch shares this simple equation for optimal post-surgical healing. And, it’s good to remember that the best outcome begins with good prior planning and preparation.

Getting extra protein is especially important after surgery because the body needs it to make immune cells and antibodies, to reduce inflammation and to mend the wound at the site of incision. Without enough protein from food, the body must make its own by breaking down muscle and organ tissue, and sapping immunity. As a result, poor nutrition can delay recovery.

Recommended daily protein requirements for average individuals follow:

A healthy person should consume .08-gram protein/ kg of body weight.

A quick equation to remember is 1-gram protein for every 3 pounds of body weight.

40 grams for a 120-pound person
50 grams for a 150-pound person
60 grams for 180-pound person

Protein Needs after Surgery Increases

The highest protein demand for healing purposes is in the first few weeks post-op. Approximately 60–80g/ protein per day is recommended for nutritional adequacy and for wound healing after surgery, depending on the extent of your surgery.

Protein Requirements for Post Surgical Patients

1.5-2.0 grams protein/ kg of body weight.

A quick equation to remember is 1-gram for every 2 pounds body weight.

60 grams for a 120-pound person
75 grams for a 150-pound person
90 grams for a 180-pound person

The Physician Assistant: Your Doctor’s Newest and Best Secret Weapon

Last week, a reporter from the Toledo Free Press interviewed me for our new book, Burdens Do a Body Good, and one of her questions took me back a few years. She asked me what was the first article my co-author, Dr. Foetisch and I collaborated on…it took me a minute to remember! Then, it hit me. It was this article on the value and importance of physician’s assistants. As I’ve personally benefited from these professionals…thought you might like to know more about who they are and what they do (for you).

The Physician Assistant: chances are your doctor has one. If he doesn’t, then a colleague of his certainly does. Eventually, you’re going to come face to face with one; but if you’re not sure whom you’re dealing with, there could be confusion, frustration, and some irritation tossed in for good measure. So what’s this illusive, often-misunderstand and occasionally maligned medical mystery component? It is your doctor’s new best friend. It is his colleague, trusted confidante and loyal partner. In short, it’s his PA (physician assistant).

Sweeping across the country as the fourth fastest growing career is the physician assistant and if your physician or specialist doesn’t have one yet, he soon will. These skilled individuals contribute to excellence in patient care in multi-faceted ways by shortening patient wait time, ordering diagnostic tests, performing therapeutic procedures, instructing and counseling patients, and sometimes prescribing medicines with their physician’s approval. In sum, a physician’s assistant makes everyone’s life better.

Not convinced? Consider this all too familiar scenario. You injure yourself and the dreaded trip to the local emergency room is required. Once you’ve been evaluated by the attending doctor and the appropriate protocol has been followed for your particular case; tests are run, x-rays taken, medicines are prescribed. You’re now handed the release forms with instructions to make a follow-up (or for further treatment) appointment with your own physician within the next few days. No problem, so far. That is, until you try to get that coveted time slot within your slim timeframe. Frequently, patients requiring quick follow-up care end up waiting much longer than is recommended, even after being instructed by the medical professionals by whom they’ve just been treated.

Sadly, scheduling backup doesn’t limit itself to the currently ill or newly injured; it’s just as widespread for the bulk of patients seeking appointments for their regular check-ups as well. Waiting an additional month or two for an annual check-up is now commonplace; yet it is not nearly so frustrating or risk-ridden as when the need to be seen by a physician is urgent and ordered by another health care professional for optimizing the healing process. Therein lies the beauty of the physician assistant service to patients needing either preventative or palliative care.

If and when you are placed in the position of needing immediate, non-emergency care (and one day, you will be), your most advantageous edge at getting the promptest care may well come through your physician’s trusted PA.

From the every vantage point, it only makes sense for doctors to co-labor with a physician assistant as their job function is both comprehensive and complementary in easing the burdensome workload of the physician as well as that of the staff. Physician assistants likewise communicate with respective coordinating hospital and secondary technical facilities to provide faster care to those initially skeptical, but eventually won over, highly satisfied and grateful patients.

Specifically, what does a PA offer? Perhaps first and foremost in every patient’s mind is the speed to which they are able to get an appointment. Timeliness and flexibility in patient scheduling is a primary benefit. Says Dr. Christopher A. Foetisch, orthopedic surgeon at the Toledo Clinic, “When my PA is out of town, we schedule about fifteen less patients per day.” Additionally, given that Dr. Foetisch is only in his office two days a week, his patients are able to secure prompt care through his PA who offers faster admittance to this practice’s expertise. Once in the office, patients can then be confident that the PA has access to all tests, x-rays, and prescribed medicines as well as any other pertinent medical information. The PA also confers with the doctor on the primary care plan while getting initial treatment started sooner.

So why then, after considering the above clear benefit to all concerned, do some physicians’ assistants run into initial resistance from patients? Sadly, a few patients react with a certain measure of skepticism when their doctor’s PA enters the room. Why? From a purely practical standpoint, people don’t like repeating themselves and after the nurse completes her brief survey of questions the very next person a hurting patient longs to see is his physician. But as Dr. Foetisch points out, “Patients should look at the PA as the door and not the barrier to seeing the doctor.”

Another more subtle bias that PA’s must overcome arises from the patient’s desire to be attended by someone he has built rapport and over time, trust. Most individuals select their doctors by word of mouth from someone they trust and respect. Thus, in a very real sense patients invest in their choice of doctor by way of making themselves vulnerable and open to personal questions as they subjugate themselves to his medical judgment. Once established, patients very understandably prefer their own doctor’s care to anyone else’s. And yet as the general public becomes better educated on how PA’s bring greater immediate and long-term benefits to their overall healthcare experience, they will begin thanking them for their input and expertise and welcoming their contributory role to their overall health care process. As Dr. Foetisch notes, “The reality is that there is a physician shortage and physician extenders are going to be more and more commonplace.”

The Right to Give Life: An Insider’s Perspective on Organ Donation

During the rush of the holiday season, I had the privilege of sharing coffee and a great conversation with a procurement coordinator from Columbus, Ohio. Jeff Blitz and I sat at a local Starbucks and I listened, took notes, and taped our interview on his experience as an organ donation coordinator. What impressed me most was the personal level of care brought to this highly developed “system” by Jeff and his colleagues. This story ran in the Toledo Free Press this past weekend and I’m including it in full here for anyone who missed it. Enjoy!

The Right to Give Life: An Insider’s Perspective on Organ Donation

We’d like to believe we’re equipped to handle even life’s toughest challenges. We like to think that if we’re prepared enough, schooled enough, experienced enough, that we’ve got what it takes to enter any situation and handle come what may. And it’s true enough.

Preparation, schooling, and experience all weigh in on whether we are able to meet and overcome adversities. But there are some situations, those life and death matters, where no amount of pre-anything can fully ready a person to deal with the intensity and aftereffects of such highly charged moments.

Case in point. Procurement coordinator of Lifeline of Ohio, Jeffrey Blitz, encountered just such an intersection. After only four months in his position at Lifeline, Jeff (then only thirty years old) had to meet with the parents of a seven-month-old infant girl who had died from complications originating from a respiratory illness.

Two days before Thanksgiving, this young couple was traveling over the holidays when their daughter contracted an illness that took her life only five days later. Within the confines of his responsibilities, Jeff had to meet, counsel, and discuss the possibility of organ donation with this suddenly grief-stricken family. Prepared as he could be, Jeff hit an internal snag en route to the hospital to ask for permission from this suddenly much smaller family.

Like anyone in his position, Jeff felt torn. How exactly do you ask a parent to donate a precious integral part of life such as an organ from one they loved so dearly? Ask Jeff; it is never easy. And yet, multiple times, week after week, this is what a procurement coordinator must do in order to pass on the gift of life.

Jeff and his colleagues continue to work within the confines of such highly emotional settings with grieving dads, moms, sons, daughters, friends, colleagues, and neighbors because they know the difference it makes, the life and death difference. For every individual whose life ends there are countless others who are similarly struggling to survive and perhaps grieving their own loss of minimally good health and the ability to live a functional life. Looking at it this way, we understand why Jeff does what he does, but what exactly does the process of organ donation look like step by step?

Jeff explains. Organs become “available” for donation only after a person has been officially declared “brain dead.” This legal form of death as defined in the (Uniform Determination of Death Act of 1981), cites that when, “An individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.” Depending upon the situation and the circumstances surrounding the illness/accident of the patient, it sometimes takes between two and three days before the attending physician will do brain death testing. While most people are familiar with the term, “heart death,” “brain death” is also a legal form of death in every state.

Brain death can occur when a person suffers from a stroke or hits her head and considerable swelling takes place. Think of it as a “brain in a box.” Our brains are encased in a bony structure and when the swelling can’t be controlled, the brain has nowhere to go but into the spinal column. This is called herniation. The brain and brain stem move all the way down and cut off all the arteries so there’s no room for any blood flow back to the brain. After this happens, doctors will do testing to confirm brain death. Once brain death has been declared, the families will be approached for their consent and permission to begin the testing process for organ transplantation.

After consent is given, the procurement coordinators will initiate the process of evaluating the patient for possible organ donation. This process will include chart reviews, comprehensive types of testing for organs determining heart/lung/liver/kidney function and eventually a thirty-page patient medical/behavioral history questionnaire must be filled out before an organ is entered into the system for possible matching with an individual awaiting an organ.

The now prospective donor will have her blood pressure and heart rate monitored closely to ensure the organs stay at peak condition while awaiting a match with a recipient. Fluids and various drugs are now administered to make certain each organ is oxygenated and the organs are kept in optimal health during the transition. Jeff confers with the appropriate transplant surgeons during the entire process as well.

After all the necessary testing is completed, Jeff enters the information into the database that opens up to a 500-mile bubble radius surrounding area if no match is found in his city. He “offers” the organs to three doctors within the database one at a time and in 1,2, 3 order (usually within an hour) each surgeon will say yes or no. Jeff continues to work down his list until he has a taker. Immediately upon receiving a positive response, Jeff must then work on getting the organ to the transplant surgeon. Depending on the organ and the location of the recipient, these precious gifts are sometimes transported by air.

The organs are packaged carefully and given over to the transplant team where they take each donation and prepare it for the transplant surgery. Once the actual handover of the organ has taken place, Jeff files paperwork and subsequent follow-ups with the donating family are scheduled. Counselors are also working with both the family of the deceased patient and the recipient of the organ to answer questions, receive support, and acting as liaison between the families and the medical staff.

Generally, the donating family will receive an update approximately six weeks after the transplant takes place. In some cases, when both families are interested in meeting, facilitators will arrange a private conference perhaps a year later. As Jeff notes, organ recipients are above all very grateful for this gift of life, but they also carry tremendous guilt knowing they lived because another person died. It takes time and lots of emotional and mental work to prepare to meet the loved ones who might still be grieving the loss of their family member, and not all recipients choose to meet, it is strictly voluntary.

While everyone longs for a happy ending, Jeff recalls this story of the seven-month old girl who died as particularly bittersweet. Because of her parents’ caring act, her kidneys gave life to a two year old and her liver was given to another infant. This little girl who passed away also had a twin brother to whom Jeff asked the parents to pass along the message in years to come, “Your sister was a hero!” Life does indeed beget life.

What to Know About Organ Donation (and Some Facts You Probably Don’t)
· One organ donor can save up to eight people
· One tissue donor can help up to fifty people
· Approximately 104,000 people are on a waiting list with only 10,000 available donors a year
· Heart/lungs need to be transplanted within four hours
· Liver/pancreas need to be transplanted within twelve hours
· Kidneys need to be transplanted within twenty-four hours
· Eye donations may indicate only the cornea, or at other time, the whole eye
· Being an organ donor does not prohibit an open casket funeral
· Many of the donated skin grafts go to the Texas burn hospitals for wounded soldiers
· Most major religions are in favor of organ donation or leave it up to individual practitioners to decide
· Register to be an organ donor through your Secretary of State or DMV website

A Reviewer Reads…The MommyMDGuide to Pregnancy and Birth

A Reviewer Reads…

The MommyMDGuide to Pregnancy and Birth
Rallie McAllister, MD, MPH and Jennifer Bright Reich
Momosa Publishing
Pregnancy and Birth
June 2010
$17.95
512 pages
ISBN: 978-0-9844804-0-1

The MommyMDGuide to Pregnancy and Birth is such a unique concept and an unbeatable combination of reliable (livable) resource of practical helps and suggestions for coping with all the bodily changes during pregnancy and the life changes of impending motherhood. What group of women better suited to offer such dynamic (and often side-splitting real-life antidotes) than sixty female physicians who reminisce on their own pregnancy and birth experiences?

Co-authors Rallie McAllister, MD, MPH, and Jennifer Bright Reich, have compiled more than 900 tips and suggestions for soon to be moms and dads. Written in a week by pregnant week style, every chapter opens with what’s happening in your baby’s development followed by what’s happening in mom’s body (and what to do to make mom and baby both healthy and comfortable).

Reading a chapter a week is like opening a present every seven days and discovering how much your baby has grown and developed…it provides a fresh dose of wonder and a boost of encouragement through the sometimes-exhausting experience of carrying a little one. Readers will appreciate the honest and candid remarks relating to each chapter’s topic by these physicians as they tell it like it is and then tell readers what they did (or didn’t do) and what they learned with each pregnancy. This resource will give moms and dads lots to think about, discuss, and ponder…and every page is sure to bring a smile and a burgeoning sense of excitement at the miracle of pregnancy and birth.

Writing or Marketing, Which is More Labor Intensive?

This week I was given the opportunity to speak with two experienced and gifted women who told me some hard facts. Given that most books take at least six months to write, add in editorial revisions, and some lag time, generally a writer commits at least eighteen months of time to a book effort. And well before the book sees the light of a bookstore shelf or gets purchased at an online book seller, the author is working hard (very hard) to get people interested in the text. Meanwhile, the publisher is working hard as well to market and present the book in the most attractive and favorable light to the reading public.

It would be a logical conclusion to assume that once the book is “out” the majority of the author’s work is complete, but everyone in the publishing industry knows better. So writers keep writing, keep talking, keep sharing their stories…just plain keep on. I expected this…I signed up for it and I’m not complaining. However, when an expert in marketing told me that we (the publisher and me) have one month to prove to the bookselling community that our book is worth their shelfspace (and maybe even a second glance), it was pretty sobering.

In my mind, I started thinking about the past eighteen months…all those hours, and days, and weeks, and months of outlining, referencing, quoting, editing, checking and rechecking…I thought, “What’s wrong with this picture?” How could all that effort be reduced to four short weeks of evaluation? Then, I realized it doesn’t matter how I feel about it, I just need to spend the next month (and the forseeable future) doing all I can to tell people about something I believe will help them.

Which is why I started social networking in the first place (to connect with people) and why when asked by my agent, Les Stobbe, I wrote an article Marketing With What You’ve Got describing what I’ve done and am doing to connect with readers. Thanks Les, for nudging me to make a list of how anyone can use the social utilities to tell the world about their work.