Category Archives: Weekly Tips & Tricks

Slips, Trips and Falls–Are You At Risk?

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Falls Prevention Risk Assessment & TipsFalls (1)

 Welcome,

 

Slips, trips, and falls can be scary and even change someone’s quality of life and life expectancy–especially later in life.  With that in mind, I want to provide some fall risk assessment tools as well as some tips to decrease the risk of falls based on each of the assessment tools.  Should you have any questions, please feel free to leave a comment/question below and I will respond within 48 hours.

1.  How many times can you stand without using your hands from a folding chair?

 

When you stop using your hands to stand up, you force the muscles in your legs to do all the WORK to stand up.  If your legs are too weak to stand up without using your hands, you have an increased risk of falling.  According to STEADI (Stopping Elderly Accidents, Deaths & Injuries) established by the Centers for Disease Control and Prevention, there is an increased risk for falls based on an individual’s age, gender, AND how many times he/she can stand up from a folding chair in 30 seconds without using his/her hands.  In general, men and women 60 to 84 years old should be able to stand a minimum of 10 times in 30 seconds without using their hands, to be at a lower risk for falling!

 

Therefore, to decrease falls associated with weakness during hands-free Sit to Stands, I recommend completing sit to stand exercises from different surfaces such as a swiss ball, couch, toilet seat, bed and rocking recliner.

 

2. Do you have weak ankles causing weak balance strategies?

 

When your feet hit the ground, everything changes!  In other words, your feet and ankles are the 1st part of your body contacting and interacting with the ground.  If your ankles are weak (you cannot maintain standing before, during or following 20 standing heel raises and toe raises without holding onto a walker, counter, or someone else for support), then your fall risk is high.  Have you watched people working out at a gym?  Most of the time, you see people working out their stomach, legs, arms, and back.  Few people spend time strengthening their ankles–the first joint responsible for standing balance–and then they wonder, “Why am I falling?” Your feet/ankles are just like the tires on a car:  1) to run/walk properly you need good shoes (tire tread), 2) keep your ankle balance strategies in good condition (tire/wheel alignment), 3) and expect changes in the terrain such as gravel, loose floor rugs, water, etc (snow/rain/road construction) to require increased strength and balance to safely walk.  Just like poor tires or faulty alignment in a car can result in an accident, weak ankle strategies, and poor foot/ankle support can result in an increased fall risk.

 

 

What is a balance strategy?  When the feet contact the ground, the ankles absorb and adjust to the terrain by movements in 4 directions: up, down, and sideways to the inside or outside of the foot.  In other words, the ankle normally moves in a circular motion, unlike the knee that only bends and straightens.  Therefore, when the foot hits the ground, the circular movement of the ankles work to keep you up (balanced in standing/walking) against gravity.  If you are pushed or walk on rough surfaces (dirt, hills, thick-padded carpet, etc…), the ankles respond and attempt to keep you upright.  However, if you are pushed a little harder or walk on rougher terrain, the ankles transfer the extra balance demands from the ankles up to the hips because the hips are the only other joint in the legs capable of circular movements.

 

The movements of the ankles and hips to keep you upright during standing and walking are known as the ankle and hip balance strategies.  However, there is another balance strategy known as the “stepping balance strategy.”  When the ankles and the hips are weak or can’t move due to stiffness/injury/surgery, the last resort for maintaining balance and not falling comes from the “stepping strategy.”   In other words, you use the “stepping balance strategy” by taking quick steps to decrease the risk of falling and try to correct/maintain your balance when the ankles/hips cannot overcome the effects of gravity and loss of balance.  Consequently, keeping the ankles/hips strong and flexible as well as using appropriate footwear is very important for fall risk management.

 

Therefore, if you have an increased risk of falls associated with weak ankle and hip balance strategies, I recommend doing standing exercises with VERY limited use of the hands.

 

3.  How many times have you fallen in the past day, week, and month?

Anyone is capable of tripping, slipping and falling once in a while.  However, if you are falling multiple times over a short period of time (i.e. 2 or more times in a day), the risk for additional fall(s) is higher!  Changes in medications, diabetic complications (hypo/hyperglycemia), inner ear infections/vestibular disorders (BPPV), infections and other medical problems can increase the frequency and risk of falls in the elderly.

 

Having increased frequency of falls due to medical conditions should be addressed by your doctor.  Do not change your medications without consulting your doctor.  I also recommend an evaluation by an Ear, Nose, and Throat Specialist to rule out any inner ear based balance deficits (BPPV).  Being able to crawl or move around on the floor is a skill I teach in the home so my patients don’t get TRAPPED on the floor if he/she falls, HAS NOT sustained an injury, and needs to either access a phone or get off the floor.

 

 

3.  Anemia and Urinary Tract Infections

Anemia, low iron, can increase your fall risk.  Think of iron as a tug boat and oxygen as the large ship needing to get to port.  When large boats are too large to safely enter a harbor/port, they use a tug boat.  Oxygen is carried/delivered in the body by “clinging” to iron in your blood–just like a tug boat! So, if you are anemic (have low iron levels), then you do not have enough tug boats to carry/deliver the cargo ships full of oxygen to your body’s muscles and vital organs.  It does not how much oxygen is available–have large quantities of ships needing to get to port–if you do not have enough iron–tug boats in your blood–to deliver the ships (oxygen) throughout your body.  How do low iron and low oxygen levels increase the risk for falling?  Low oxygen from low iron causes symptoms such as muscle fatigue, muscle weakness, shortness of breath, and possible dizziness–especially during higher oxygen-demanding activities such as standing and walking.

 

 

Another common illness that can increase the risk of falls is urinary tract infection. The kidneys and urinary tract system filter (clean) the blood and then “flushes” the dirty contents out of the body through the urine.  If you have an infection of your filtration system (the filter is clogged and dirty), the blood is not effectively cleaned.  The dirty blood circulates all over the body to all the muscles, brain, and organs.  Poorly filtered blood associated with having a urinary tract infection can cause confusion in the brain, fatigue/weakness in the muscles, and increased opportunities for falls because of frequent/often fast trips to the bathroom.

A urinary tract infection is similar to an air conditioner with old and clogged up filters.  Air conditioners operating with dirty filters still work but it takes more energy and increased time to cool the air.  Similarly, the body will continue to move and operate with dirty blood associated with a urinary tract infection, but there are consequences (symptoms) of poorly filtrated blood.

 In the aging adult, unexplained and sudden confusion or decreased concentration can be the first sign of a UTI even before the other symptoms (burning, foul/strong urine odor, urinary urgency and increased frequency of urination) are present because the brain does not like to operate on dirty (poorly filtered) blood.  If my patient has a hard time following directions, requires increased time to read their home exercise program, or is easily distracted from one treatment to another, I suspect a urinary tract infection because the brain is running on dirty blood.  I also suspect a urinary tract infection if my patients complain about feeling really tired, are moving slower, and need frequent rests because the muscles including the muscles responsible for breathing are operating on dirty blood as well.

 

If my patients have an increased risk for falls associated with anemia or a urinary tract infection, I recommend appropriate medical intervention followed by a gradual resumption of physical activity that includes frequent rests.

 

 

 

Like Taking Candy From a Baby…Why Dizziness Occurs When Standing Up

Medical conditions, such as heart-related problems both with and without breathing disease/disorders (COPD, Emphysema, Asthma) can increase your risk for falls.  If you get dizzy when you stand up and walk, then the risk of falling is higher–especially if you start to walk before the dizziness goes away.  The easiest way to explain what is going on is this:  When you are lying in bed, your heart beats easily because it is not fighting/competing with the force of gravity.  When you sit up, the heart must react and overcome the effects of gravity by either beating with more force (pressure) or by increasing beats per minute (heart rate).  In the same manner, your lungs are under the same demand against gravity to supply the brain with oxygen.  The weaker your heart/lungs, the longer the dizziness lasts because it takes more time for your heart/lung to adjust and overcome/overpower the effects of gravity to get oxygen-rich blood to the brain.  Once the brain gets the oxygen it wants/needs, the dizziness goes away! Dizziness is usually worse when you stand up because the force of gravity on your body is larger when you stand up compared to when you rise from lying down.

Your brain is like a toddler and oxygen-rich blood is the brain’s candy!  When your brain has all the candy it wants, it allows all the other organs and muscles to have the extra oxygen-rich blood (candy) for digestion, walking, and other activities.  Let’s say the brain wants 80% of candy and allows 20% for the rest of the body.  When you stand up and get dizzy, the toddler is getting less than 80% so the brain throws a fit!  To appease the toddler, the heart and lungs increase the rate and/or effort to supply the toddler (brain) with more candy (oxygen).

If you start to walk while the toddler (the brain) is still not getting 80% of the candy (you are still dizzy), the toddler throws a worse fit and starts STEALING the candy (oxygen) from the rest of the body.  For example, imagine the toddler looking at the legs and saying, “Hey the leg muscles are really big and by walking those big leg muscles are taking lots of my candy from me–especially when the heart/lungs are trying to overcome the effects of against gravity.  So, I am going to take what is mine.”  As a result, the brain STEALS/DIVERTS oxygen to itself away from the leg muscles and the legs start to feel weak.

If you insist on walking and using more oxygen, the toddler will resort to making you pass out!  By making you pass out, the brain (toddler) quickly gets more oxygen because 1) the muscles in the legs are no longer moving and using as much oxygen, and 2) the heart/lungs no longer have to fight against the force of gravity to supply the brain with oxygen.  Ultimately, the toddler (brain) gets what it wants even with poor heart and lung health;  however, the brain has caused an increased fall risk either by making the legs weak (forcing you to sit down) or making you pass out! Obviously, there are other illnesses and medical conditions that increase the risk for falls, trips and slips such as Parkinson’s, Alzheimers, Stroke, etc…

 

 

5.  What might cause a fall in the home or residential care facility?

 

 

Poor lighting, loose rugs, wheelchair footrests, oxygen tubing, broken wheelchair brakes/medical equipment, poor quality footwear, and not setting up the environment (medical equipment)/yourself if you are transferring a loved one/or positioning your loved one safely before transferring, lifting and walking can increase the risk of falls.

 

 

 

 

FALL FACTS & STATISTICS: Healthcare Settings Outside of the Home

 

There are several reputable sites that provide statistics and data related to falls and the cost of falls in the healthcare industry.  According to OSHA (Occupational Safety and Health Administration), “Fall protection is the #1 OSHA violation resulting in 1.7 million WC (Workmen‘s Compensation) claims.” Similarly, Medicare.gov’s website states, “failure to ensure fall risk management with adequate resident supervision and assistance to prevent accidents” is the most common deficiency observed in patient care facilities resulting in increased fall rates in both state and governmental care facilities  Moreover, the website for the Center for Disease Control and Prevention, highlights “1 out of 5 falls results in a hip or head injury” and “2.5 million elderly adults are hospitalized every year due to falling.” 

 

Below I have provided a Table with a summary of the information you can access when you visit the website.  I wanted to provide a resource for accessing fall risk measures and quality of care measurements in different patient care settings (i.e. Nursing Homes, Assistive Living Facilities, etc…) because there are falls risks associated with the quality of care and the staff to patient ratio when patients are not able to stay in his/her home.

 

Obviously, falls are expensive and multidimensional, so it’s important to know if you have an increased risk for falling!   Please click on any of the links below for additional information available on each of the above-mentioned sites.

 

Website Name Brief Overview/Description of Website Content Quick Link to Website
Medicare Browse/Compare Quality Measures (Fall Rates)and Staff details for different patient care settings (ALF, SNF, NH) Click Here
Healthcare Blue Book Research recommended costs for medical treatments and surgical procedures Click Here
CDC-Falls/Prevention Browse fall statistics and fall prevention programs for elderly adults NOT in a Nursing Home, ALF, hospital, or SNF Click Here

Falls, slips and trips can occur at any time; however, I hope I have explained some common risks and provided you with some helpful information regarding falls. Please leave a comment or ask a question below and I will be honored to respond as soon as possible. Also, be sure to check my website frequently because I will be adding more helpful tips, tricks and information on falls.  You can click HERE to see a video showing how to lift a loved one from the floor if he/she is not injured. I want to thank you again for visiting my site and I look forward to any questions, comments or ideas for future pages, posts, and blogs!

 

 

Until then, Stay Safe!!!

 

Shawna, PT, MPT

Categories: Weekly Tips & Tricks

What To Know When Choosing A Nursing Home

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Welcome,

This page is dedicated to providing helpful tips to caregivers faced with deciding where his/her loved one would receive the BEST care when living at home is no longer an option.  Learn alternatives to nursing home placement, how to choose a nursing home if that is the BEST option, and the differences between Nursing Homes, Skilled Nursing Facilities, and Assistive Living Facilities.

The Primary Caregiver Shift

 

Illness, injury, disease, and or surgery can trigger the caregiver shift. For example, one moment your loved one was independent, capable of driving, preparing meals, completing household chores, bathing, dressing, and walking without any falls or concerns. Then you receive an unexpected call from the hospital or your loved one’s doctor because he/she suffered a STROKE, massive HEART ATTACK, substantial FALL with a BROKEN HIP/INJURY, and/or diagnosis of ALZHEIMER’S DEMENTIA, PARKINSON’S DISEASE, or CANCER. Life changes drastically in a moment’s notice and you realize you now have to make numerous decisions regarding the most appropriate setting for your loved one to either recover, rehabilitate and/or permanently reside based on:

  •  his/her potential to achieve their prior level of function
  •  future fall risk
  • and level of care needed to provide the optimal quality of life, functional independence, and safety.

 

Researching and deciding on an alternative residence for your loved one can be emotional, physical and mentally exhausting. Perhaps you experienced a similar decision-making process for your own children when you had to consider childcare in a home, church or daycare center; however, instead of dropping your child off and picking them up in 5-8 hours, you might be dropping your loved one off at a Nursing Home for the remainder of his/her life– hence the additional anxiety, fear and stress into your already busy LIFE!

 

Decisions…Decisions…Decisions….Picture of a Question Mark in Red

 

Where do you start and what should you know when faced with possible placement of a loved one? As a Physical Therapist, I am going in and out of different settings (Assistive Living, Nursing Home/Long-Term Care, Residential/Community Living Homes, Skilled Nursing and private homes) every day and at various times of the day. Coordination of care with nurses, bath aides, other therapists and doctor’s appointments results in unexpected arrival times and behind-the-scenes insight. Therefore, I recommend the following tips when looking and choosing a care home or facility for your loved one.

 

1.  Friendly Advice – You are neither the first nor the last person in this situation. Talk to friends, co-workers,and church members.  Listen to their experiences, concerns, and tips–especially if you have someone in your inner circle that works as a C.N.A, nurse, or therapist in one of the settings you are having to consider.

 

2.  Unexpected Visit – Be an undercover investigator! Walk in unexpectedly to any setting and get a first impression “feel” for yourself. Listen to your internal radar – does the environment feel warm, inviting, LOVING or do you feel like an intruder?

Get a “sense” of the environment. What does it smell like? Hopefully, it does not smell like bleach, ammonia, urine, or burned food. What does it look like? Take notice of the furniture, walls, other residents, and the employees. Pay particular attention to the last two: other residents and the employees. The residents should be groomed, using equipment that is not FILTHY or BROKEN, and fairly content/social if they are out of their rooms. Are the clients/patients and employee interactions appropriate? The employees should be actively engaged in providing care, managing fall risks, and pleasant/welcoming when interacting with fellow co-workers and residents. In other words, the employees should not be on private cell phones, ignoring call lights, avoiding care and fall risk management opportunities, demeaning or short-tempered, and appearing “put out,” apathetic, or inconvenienced with co-workers or residents. In the same manner, do you see someone roll their eyes when waiting for a resident that requires increased time to transfer, move in his/her wheelchair or walk? Do you see anyone walking around with dirty shirts/pants either from eating or having an accident? Do you see stains on the floor, holes in the walls, or “OUT OF ORDER” signs throughout the facility?

 

3.  Too Good To Be True – If you get the sense that you are observing “Top Notch” facility operations and patient care, be sure to intentionally look for a group of individuals with clipboards, dressed in business attire, and interviewing or closely observing the facility–this is a clear indication the facility is currently under STATE inspection. The Centers for Medicare & Medicaid (CMS) a division of the U.S. Department of Health and Human Services conducts an inspection of every patient care facility every 12-15 months. The inspection process can take several days and can be a “surprise” visit, but some of the process includes:

 

  • Touring/Observing the facility’s daily operation
  • Interviewing/Observing a sample (several residents) selection of clients and employees
  • Monitoring the Kitchen/Food preparation and quality
  • Observing Medication preparation and administration
  • Reviewing the Abuse Prevention protocol
  • Evaluating Quality of Life Measures and Assessment procedures
  • Determining/Document any below standard care or deficiencies

There will be a NOTICE on the door when INSPECTORS ARE present in the building; however, if you are walking into a facility that is BUSY and FRANTICALLY completing repairs, cleaning, and taking care of patients–the facility is most likely EXPECTING or ANTICIPATING an audit or inspection. Sometimes facilities are reviewed more often than 12-15 months as a result of numerous filed complaints or increased frequency of falls, slips, trips and injuries. For a more in-depth explanation of the Inspection Process, you can click on this link: [PDF] The Nursing Home Inspection Process – Office of the Legislative Auditor.  You can ask employees if you suspect you are observing “Too Good To Be True” patient care and facility operation, but you might not get a straight answer.  Therefore, I recommend waiting it out and returning several times over a period of a few weeks.

 

4.  Utilize the power/convenience of Web-based Research – If you want to look up specific data on specific care facilities, you can click on these links:

 

Medicare.govMedicare insignia

ProPublica.org

 

 

These websites provide information regarding patient care facilities and their State inspection data related to Quality Measures (statistics about falls, pressure sores, urinary tract infections, etc…) and how facilities compare to the STATE and NATIONAL average. In addition, you can compare specific facilities with the STATE and NATIONAL averages regarding how much time per day a patient spends with each discipline (Nurses, Certified Nurses Aides, and Physical Therapists).

 

INTERESTING TREND: I reviewed several facilities using these 2 websites.  Facilities with Higher Star Ratings (4 or More) in both Quality Measures (Falls) and Staffing (Time spent with each discipline), had less than the average number of falls when patients spent more time with Physical Therapists and Nurses! In other words, if a patient spent more than the state and national average time with C.N.A’s and less with Nurses/Therapy, the fall frequency INCREASED!

 

5.  Loved One Follow-up and Feedback – Listen and Observe your loved one for any signs/symptoms of neglect, abuse, failure to thrive, complaints/compliments to ultimately determine if your loved one’s needs and quality of life are being met.  Remember YOU can relocate your loved one at any time! Red flags and common warning signs/symptoms can be reviewed by clicking on this link:  HELPGUIDE.ORG

 

Proper placement of a loved one also depends on the level of care and rehabilitation potential of your family member.  For instance, if your loved one just had surgery and is slow but able to stand up, walk short distances, get in/out of bed, go to the bathroom, shower and dress, then placement in a Long Term Care Facility is NOT appropriate!  

 

 

The Difference Between Each Facility/Setting

Type of Facility

Long Term Care/Nursing Home

Skilled Nursing/Rehabilitative Facility

Assistive Living Home/Facility
Brief Description  On-site full staff including nursing (RNs, LVNs, CNA’s), full-service medication administration/management and business staff (Administrator, Director of Nurses, Maintenance, etc…) to provide skilled care 24 hours/7 days a week On-site full staff including nursing (RNs, LVNs, CNA’s), full-service medication administration/management and business staff (Administrator, Director of Nurses, Maintenance, etc…) to provide skilled care 24 hours/7 days a week Limited to no nursing (RN/LVN) staff on-site, full-service medication management to assist patients with medication administration/management.  On-site business staff (Administrator, Director of Nurses, Maintenance, etc…) available in the facility but less likely in a residential-based assistive living site.
Rehab Services Generally offers limited or NO rehabilitative services (Physical, Occupational/Speech Therapy) Readily available, daily rehabilitation services by Physical Therapy, Occupational Therapy and Speech Therapy depending on the patient’s needs.  For example, a patient admitted for total knee replacement rehab does not require Speech Therapy, but a patient with the diagnosis of a recent stroke would benefit from PT/OT and ST.  Physical therapy evaluates and treats any deficits involving the legs (walking, transferring, bed mobility, and standing balance).  Occupational therapy evaluation and treat any deficits involving the arms (dressing, bathing, toileting, eating, meal preparation).  Speech therapy evaluates and treats any speech, swallow, and cognitive deficits. Rehabilitation is offered by either on-site therapists or contract (off-site) therapists through Home Health Agencies.  Therapy requires a doctor’s order and rehab is NOT a daily service.  Generally, patients receive therapy either twice or three times per week.
General Patient Rehab Potential Poor.  Poor rehab potential means an individual either cannot or will not benefit from skilled therapy based on physical limitations (quadriplegia, advanced Parkinson’s Disease with contractures, unresponsive/coma), mental impairments (advanced Alzheimer’s/Dementia) and/or personality/emotional barriers (refuses to participate in therapy, becomes physically/verbally aggressive with therapy, is content with his/her level of independence/dependence). Fair to Good.  Initially patients require MAX (patient completes 25%, caregiver 75% or more) ASSISTANCE.  However, the patient is expected to progress with skilled therapy and eventually discharge home with home health services or home with doctor’s orders for outpatient rehabilitation. Fair+ to Good.  Initially, patients require MINIMUM (patient completes 75%, caregiver 25%) to CGA/Contact-Guard Assistance (caregiver touches the patient but the patient completes 100% of the transfer/bed mobility).  If patients receive therapy, the patient is expected to progress with skilled therapy and eventually discharge at indirect SPV/Supervision (patient completes 100% mobility and transfers and staff “watches” intermittently or as needed to decrease fall/injury risk) or MI/Modified Independence (patient completes 100% mobility and transfers but uses medical equipment such as a walker, wheelchair, or power chair)
General Patient Care Needs  High – Patients/Residents require TOTAL (patient completes 0%, caregiver provides 100%) to MAXIMUM (patient completes 25%, caregiver provides 75%) assistance from 1 or more caregivers for bathing, toileting, dressing, eating, transferring, walking or wheelchair-based mobility Initially High to Moderate but as the patient progresses with therapy, he/she generally discharges home at MODERATE (patient completes 75%, caregiver 25%) to MINIMUM (patient completes 50% and caregiver 50%) ASSISTANCE levels. Mild initially and eventually LOW.  Residents can transfer without assistance, get around using a wheelchair, scooter, walker, or cane without caregiver assistance, and are generally able to continue driving and/or enjoy planned community-based activities (shopping, BINGO, movies, etc…)

NOTE:  

These are general descriptions, the level of care guidelines, and some facilities will provide higher levels of care regardless of  the patient’s rehab potential.  For example, I have provided treatment to a patient in an ALF (Assistive Living Facility) that required MAX A (the patient could not transfer, walk, or get in/out of bed without a great deal of efforts and consistent 75% or greater caregiver-assist level).  Generally, patients in an ALF should be able to transfer without the skilled assistance of a caregiver, nurse or therapist because most ALF’s DO NOT have or provide ON-SITE, SKILLED NURSING or REHABILITATION!  If your loved one requires assistance every time he/she transfers, walks, or gets in/out of bed, I recommend an SNF (Skilled Nursing/Rehab Facility) or Home Health with therapy until he/she is able to transfer, walk and get in/out of bed with less assistance.
Thank you for visiting my site and I sincerely hope you learned something to make the decision for placing your loved one in an alternative care setting easier.  However, if you have any questions or need further advice, please contact me.  If I do not know the answer, I will put forth my best effort to find the answer or tell you I do not know the answer.  I am honored to have you visit my site, and I honestly strive to make caregiving easier and safer.  

 

Til next time,

 

 

Shawna PT, MPT

Categories: Weekly Tips & Tricks

Diabetic Chocolate Chip Cookie Recipe

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Diabetic Chocolate Chip CookiesDiabetic Chocolate Chip Cookie Recipes are becoming more and more popular.  Here is a Kid Approved, Healthy, and Easy Diabetic Chocolate Chip Cookie Recipe.

 

 

Delicious, Soft and Kid Approved these cookies have No Flour, Very Little Butter, and one of the Easiest Homemade Chocolate Chip Cookies I have ever made.
I have been asked more than once for my personal healthy alternative Sugar-Free Chocolate Chip Cookie recipe so here it is for one and all!  As a Physical Therapist, I endeavor to promote health and often times I have to “think outside the box” for alternative solutions to a problem.
I felt very hypocritical when I was 75 pounds overweight and my career was based on promoting healthy, safe, and independent lifestyles.  The ANSWER:  lose weight without giving up one of my sweet addictions.  Now I can eat these cookies, share these cookies with diabetic patients, and remain compliant with my goal to promote optimal health, safety and independence.
So enjoy and feel free to share or leave me a comment after you try a batch!
P.S. if the cookies turn out flat, you need to decrease the amount of butter!

 

Ingredients:

No Flour Chocolate Chip Cookie Ingredients

 

3 1/4 – TBSP Stick Butter

1/3 – Cup Splenda Brown Sugar

1/3 – Cup Splenda Sugar

1 – Tsp Baking Soda

2  – Tsp – Vanilla Extract (I highly recommend Watkins Double Strength Clear Vanilla)

2 – Eggs

2 – Heaping cups of Almond Meal (I buy this in bulk at Sprouts)

1 – 8 oz bag Hershey’s Sugar-Free Chocolate Chips

 

 

Instructions:

 

Preheat oven to 350ºF.  Beat butter, brown sugar, sugar, and vanilla extract in a mixer until creamy. Add the eggs and baking soda and mix well.  Add almond meal at low speed.  Stir in chocolate chips (I have a Kitchen Aide mixer and I use “Speed 2” to mix the dough and “Stir” to add the chocolate chips).

Bake 8-9 minutes or until edges are slightly browned.  Allow the cookies to cool slightly and enjoy the best moist, soft and deliciously healthy treat!

 

Batch of Diabetic Chocolate Chip Cookies

 

I successfully completed the Trim HCG diet and lost 75 pounds.  I created this cookie recipe to be Carbohydrate Free and Sugar-Free as a personal sweet treat.  To this day, my entire family prefers these Healthy Alternative Chocolate Chip Cookies to homemade all purpose flour-based cookies.  Oh and these cookies do not get hard!

Categories: Weekly Tips & Tricks

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6 Steps to Putting on Compression Socks Fast & Easy

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Lower leg swelling

TED/Antiembolitic/Compression Socks

TED hose are very important in the healing process.  Managing pain, swelling and decreasing the risk of blood clots (Deep Vein Thrombosis – DVT) are just a few reasons for loved ones to wear TED hose according to his/her doctor’s orders.  However, putting compression hose on can be HORRIBLE and most caregivers are afraid of the force they are putting on their loved one’s foot/ankle to get these VERY tight stockings on.

 

 

Compression hose are available in a wide variety of colors, sizes, and heights (knee high versus thigh high).  Following a surgery or heart-related complication, many doctors order and expect patients to comply with daily use of properly fit ANTI-THROMBOTIC (blood clot) HOSE.  Patients complain the hose are tight, uncomfortable–especially when there are wrinkles, itching when leg hairs start to regrow, and hot–generally associated with wearing thigh-high stockings.  However, the risk for blood clots and DEATH are much greater if patients do not wear the compression stockings.  Consider the following scenerio:
Construction sign

PROCEED WITH CAUTION

 

 

Having surgery is like new road construction.  As a result of new road construction(heart bypass, joint replacement), cones/barriers are placed to protect workers and re-direct traffic, lanes are narrowed, and the flow of traffic slows down and can even come to a stop!  Gradually traffic starts to move more fluidly as a result of detours (re-routing), improved driver familiarity associated with the road construction site, and repairs allowing the removal of certain cones/barriers. Finally, the repairs are complete and traffic resumes with improved efficiency and smooth flow.

 

 

Now let’s tie this together.  The surgical procedure (heart bypass, knee/hip replacement, etc) is symbolic to new road construction.  The traffic is symbolic of the body’s circulation in response to the road construction (surgical procedure), and the cones/barriers are similar to:  any precautions/restrictions the doctor orders (weight bearing, lifting, driving restrictions) as well as the side effects of surgery (pain, decreased appetite, swelling, muscle weakness, etc).  Until some of the obstacles (cones/barricades) are removed, the body needs help promoting circulation so traffic does not completely stop!  Therefore, patients are ordered to wear tight compression stockings–the HELP needed to promote circulation.  When traffic (circulation) comes to a complete stop, accidents and traffic congestion increase exponentially.  Similarly, when patients do not wear TED hose, circulation stops, swelling in the ankle/feet increase exponentially, and the congestion has an increased risk of producing a BLOOD CLOT!!!!

 

Skull and crossbones

WARNING

Blood clots can be DEADLY.  If a blood clot (essentially an internal scab) dislodges from the blood vessel walls, it is said to be thrombolytic (on the move).  Blood clots that are “ON THE MOVE” are lethal if they reach the BRAIN, HEART, or LUNGS.  Therefore, it is ESSENTIAL for patients to have help and wear the proper compression stockings/hose to not only improve pain and swelling but to prevent blood clots and blood clots from dislodging/traveling in the blood stream.
As stated earlier, compression stockings/hose are intended to be tight-fitting and thus VERY difficult to put on.  Most patients require help to put on the hose, and most caregivers worry/dread putting on the hose!  There is a simple and very CHEAP solution to putting on TED hose:

 

 

 

USE A PLASTIC BAG (Walmart/Target, etc.)

 

 

HERE IS A VIDEO & WRITTEN INSTRUCTIONS:

  1. put the plastic grocery bag on the foot – you only need the bag to go above the ankle
  2. place the TED hose over the bag and it will easily glide over the surface of the bag around the foot and ankle
  3. continue to pull the hose up the leg – I like to have the hose either right under the knee or above the knee before
  4. fold back the opening at the toes
  5.  remove the grocery bag off the foot through the opening at the toes
  6. reposition the toe opening over the end of the toes for comfort.
… and Waalaah!!! You now have the hose on the leg with decreased frowning, sweating, and internal cursing!

 

 

Be sure to smooth out any wrinkles because wrinkles become uncomfortable and impede circulation (similar to putting a kink/bend in a water hose – water might flow but it’s very little) resulting in increased swelling/redness below the wrinkles!

 

 

RELATED PRODUCTS

 

Men

Women

Compression Sock Donner

NOTE:  you can purchase a stocking donner (donner=something to help put the socks on) at your local DURABLE MEDICAL SUPPLY STORE or EBAY as well. You can only use the plastic bag technique if the hose have a toe inspection (open toe) opening.

 

Regardless of whether you put the hose on with a plastic bag or a purchased stocking donner, it is IMPERATIVE patients, loved ones, and clients follow all doctor orders/recommendations–including the proper use of compression stockings/TED hose to promote healing, decrease secondary risks/complications after a surgery, and optimize symptom management.

 

Once again, I strive to make daily care easier and safer.  Therefore, please contact me with any questions, comments or ideas for future advice.

 

Best Regards,

 

Shawna PT, MPT

 

 

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