Clinical Malnutrition (psych notes cont...)

Clinical Malnutrition

     Micro nutrient Deficiencies

- folic acid (important causes of tubal problems)

-iron  (anemia problem in many areas)

- Vitamin A  (too much is not good)

             - vision

             - immune function

-  Iodine (our salt comes with it)

   Critical substance

   Thyroid gland needs it to function or will get hypothyroid

Cretinism

Mental Retardation

Dwarfism

Cerebral Palsy

Deafness

(caused by iodine deficiency)

Birth weight and Gestational Age

3200 grams – less than

.- normal full term birthweight 3200 g

-low birth weight :< 2500 g

(being of low birth weight and being immature are not the same thing.  One can be born early but appropriate size for the time)

-appropriate for gestational age (AGA)

-small for gestational age (SGA)

            Stunting – height for age

            Wasting – weight per height – below 80% from the norm is wasting

                   Common Measures

- weight for age (Gomez Scale)

   How much does four year female weigh?

             Compares the weight of individual to height of individual and sex (Gomez Scale).  If

 lower it is considered malnutrition (very crude).

                      Waterlow Classes

-  height for age (if low – stunting)

-weight for height (if low – wasting)

                       Head Circumference

    Is effected by early non nutrition, as indicator of early nutrition

Does early malnutrition  effect the brain?

   Brain weight for age

Early malnutrition is cause as cause of death is associated with brain weight.

Reduction in nutrients must be very big to have an impact. 

Human Study

 Kwasniokor – not very much.

Maramus AGA about 20% (Maramus worse)

Study on rats

     Peak – 20 days pnatal

- rats were food deprived for first 14 days or x – permanent reduction in myelin.

Next 14 – no permanent effects.

Thymidine Study –  of how many new cells are being formed.  There are fewer neurons cells

 in malnourished in humans right through their gestation.  There might be motor problems as

 a result of nutrition.

continue  

  

  

Respecting creatures

     I tape everything I like to watch on television and then watch it at leisure.  One of the shows I was taping regularly on a temporary free channel was a man who travels around the world and checks out the local restaurants.  He meets up with a local chef or someone else and they check out the localities and sample the foods.  I enjoy travelling to these places with him in my imagination.  I have always enjoyed travelling.
I enjoy watching all travel shows including Scam and Distant Shores (when it is free).      
   In a recent episode, within the USA of all places, he was indulging in an ethnic restaurant.  What bothered me was that a baby octopus or at least it looked liked it was placed in his plate still alive among other food already dead and cooked.  It was wiggling around apparently dying.  Then the chef comes and cuts off his legs.  The host makes a comment that his slow death or something like that was worth it (the taste).  This was so upsetting to me that I deleted all programs I had yet to watch and deleted any future shows.  I don't normally like to write about what I consider cruel because I realise that there are so many copy cats out there.  I don't want to be the cause of any suffering for anyone.
     I started to turn into a vegetarian when I saw a neighour kill a rabbit.  Initially, I thought it was one of my pets.  However, it was not.  I saw the rabbit struggling to live and then saw him resign himself to death.  I felt nauseous and thought I was going to be sick.  I could not eat meat for three months.  Eventually, all I would eat was pepperoni on my pizza and chicken club sandwiches.  Both were my favourite dishes.  Then another neighbour had chickens in his backyard and I sort of adopted them too, encouraging him to let them enjoy my backyard as I have lots of trees for shade and places for them to dig and sit.  I would throw them scraps of food.  Needless to say I can no longer eat chicken.  The chickens are now gone and I do hope he does not bring more.  I was still left with pepperoni on my pizza.  I was stopped at a red light in the city and I saw two cows in one of those transporting vehicles for animals.  I looked into their sad eyes.  It was as if they knew they were going to become pepperoni for my pizza.  I promised them silently that I would never again eat them.
     I was raised in the city and not in the country.  My parents, immigrants from other countries never dreamt of trying to become farmers in the city.  I appreciate multiculturalism but country is one thing and city is another.  I did suggest that country was probably best suited to the bunny killer ( I even called bunny rescue).
      I realise that I decided to become a vegetarian because I no longer could visualize what I was eating as just meat.  I began to see creatures that live and die and have young ones and love just like us at a different scale.  Perhaps they are more humane.  I do not expect people to stop eating meat because I know that it will not happen.  But what we can do is respect what we eat and that includes every living creature.
     I know that the actor does not think he has done anything wrong.  But just stop and reflect for one moment.  Is it necessary to watch something die or cause suffering when it is not necessary and broadcast it on television?   That is one channel I will never think of paying to watch.  What do you think? 

Clinical Malnutrition (psych notes)

Clinical Malnutrition

Severe – life threatening

MARASMUS  -  skin and bones, inadequate intake of calories.

Inc: die of infections or diarrhea

KWASHIORKOR  -  Edema (swelling) retain water, looks chunky.

Moon face

Hair pigmentation

     Breast milk contains nutrients it needs.   When another child comes along before the first is not quite finished – Pecking orders goes to adult men, boys and then very young.  They get fed then with no protein.

They (poor countries – Africa) mix formula with polluted water and water it down.  This

causes two problems.  Not getting food to grow at that age.  Part of the problem is education.  Bananas are growing on trees but they don’t eat it.

Protein  - caloric Malnutrition

- combination of the other two.

-the children are terribly thin and the stomach is bloated.

Cont….

  

Grief

     Grief is something that eventually catches up with us all.  It may be a result of someone dying who is important to us, it may be because we develop a horrible disease and it may be because of a relationship which is terminated.  Eventually, some one or something important to us is no longer there and we grieve. 

    We grieve differently.  Some of us feel a deep profound sadness, others feel like they are on a roller coaster ride that won't stop and others cry or have other responses.  Where do you see yourself in here?
    I have suffered two losses in one week.  I have had time to process one and I was waiting for the other to pass away for quite some time.  One I knew for my entire life and the other was a long time friend who I served with.  He was a priest.  He had served during the war in the Persion Gulf and I was there when he received his medal.  He developed Lou Gehrig's disease after retirement.   When he could no longer live in his residence, he wanted to go to Sunnybrook Veterans hospital.  He was rejected because he was not a WW1 or WW2 vet.  It did not matter that he had served in the Navy in the Persian Gulf war.  It did not matter that he had served his country for over 20 years.  I called Veteran Affairs for him and they said that they could not help.  I explained how important it was for veterans to be with veterans.  The person I spoke with could not agree more, but there was nothing that could be done.  It was the government I was told, the government I had voted for.
     I would visit my friend where he eventually went to.  He was on a different floor from other priests.  He looked at me in earnest and stated "We learn in the military how to be among the people.  I want to be living among the people."  I also knew that he wanted to be living among other veterans, while living among the people.
     My friend died and I did not know until one week later but I know where he is buried and will eventually visit him his burial site.  I saw this strong tall man slowly crumble.
      I have grieved for a few weeks and that is why you did not see any new blogs.  Now I am getting back on the horse so to speak.
      Since I have read so many books on grief and taken many lectures regarding death and loss, I found myself focusing on my feelings and behavior.  I wanted to capture the moment and hold on to it.  I wanted to be a better counsellor for others.  I wanted to be able to retrieve that moment when I empathised.
      Grieving is a time when you re-examine your relationships.  Who is supportive?  Who is not?  Who gave flowers? Who gave cards?  Who telephoned?  Who came to visit?  For some reason, this time around I was more aware of the responses from others and my reactions to it.  Perhaps it is because of my training.
      One precious moment to me was when a few neighbours came with a card each and sat with me.  They shared stories of their own losses while I prepared coffee and cookies to serve.  I connected this to other sharing at other times and have come to realize how healthy group therapy is for those who grieve and do not necessarily have the supports they need.  There were many other moments.   I have found that when people have shared their own losses and I can see their own pain that there is an immediate connection.  What is best to be avoided is to speak up and say how one should grieve.  That is a complaint that is not soon forgotten by many and so that is my advice.  Allow people to grieve and to grieve in their own way.  We cannot base our own grief as the expectations as a stemline for others.  Of course there are also those who say the most stupid things and though I have never suffered fools well, I understand that some times people simply do not know what they are saying.
      I want to give you the opportunity to comment today.  Perhaps you want to share your own loss.  Perhaps you want to share a disappointment, a suffering, a moment of loss?  What do you think?        

 
      
   
         

Eulogy for mom

     Our mother was a strong force in life.  She was not a formally educated woman, but she was more intelligent and learned by most by her excessive reading.  She read each book that I ever brought home from school.  She saturated her hunger for knowledge with books. 

     She left her beloved country and family to marry into the Italian culture which she had no understanding of but she embraced.  It was into that culture at Villa which she continued to love as they her.

    She used to talk about her beloved Switzerland.  She missed her mountains and at Villa we used to go to the library and she would see her beloved country in real time, which today’s technology made possible.  My brother in law too would show her Switzerland and have her listen to the church bells she loved on his cell phone.  She marveled as she grew into today’s technology.

     Our mother was a force with strong ethical beliefs.  She taught us how to love.  She taught us how to appreciate the wild life.  She adopted a squirrel who would come to her each day.  We have carried on in this tradition.  She taught us that prejudice is wrong.  She taught us the importance of freedom.  She taught us the importance of justice.  She taught us that we can be and do anything we want in this life and that opportunities exist.

    But most of all she taught about romantic love and love of family.  She adored her grandchildren and always talked about them.

    She asked me once, “Do you think anyone will come to my funeral?”  I made a joke and laughed.    She cherished every visit she received, every gift she received and every phone call she received.

    She has suffered these past years with the loss of our father who loved her passionately and was always at her side.  She suffered at the loss of her two brothers who always talked to her on the phone and sent her chocolate and pictures of Switzerland.  They remained true to her to the very end of their own lives through cancer.

     Our mother was a strong force for us in life but she will continue to remain strong to us in death.

The developing brain and the environment – psych notes continued.

  .

  APGAR SCALE

v  At one and five months

  Sign                           0                               1                                2

  Appearance             blue                  body pink                         pink

  Colour                                             H  blue           

  Pulse rate                absent               <100                                 >100

  Grimace                  none                 grimace                            cry

  irritability

  activity                   limp                  limb                                  active movement

  muscle tone                                     flexation                                   

  respitory                 none                 slow                                  strong cry

  effort                                               irregular              

§  7-10 = normal

§  3- 6  =moderate hypoxia

Further to snow, snow, snow

     When I finally got the energy to go out to face the snow after writing more of my book, I was pleasantly surprised.  The huge mound of snow blocking my car was gone.  My sidewalk was clean and I only had to shovel around my car.  My neighbour came rushing from across the street to catch up with news.
     "Did you clear my snow?"  I asked.
     "Yes", he replied.  He was excited saying he did not use his snowblower in two years and he told me how many hours he worked.  It sounded like a lot.  My other neighbour from the other side of my house, was clearing the snow from my sidewalk and right around the snowbank on the street clearing all the snow.  I was in heaven.  I suggested we build a snowman but there were no takers.  Another neighbour who had used a shovel to clear his drive stopped and talked to me a bit.  His face was beet red and I feared for his health.  I know enough about the male ego, to know when to keep my opinions to myself.  This was one of those times.  My neighbour commented that our neighbours from the South was getting the worse of it.  I felt bad for my Southern neighbours.  They have had a horrible time of it in recent years.  I am always proud when Canadians go South to help.  We should always help our neighbours.
     It was nice catching up with the neighbours.  During the winter we rarely see each other as we remain hidden inside.  But this day in the aftermath of our storm, we remembered that as Canadians we should be able to play outside.  I tried, but no one wanted to.