IFA News and Opinion
Issue Date:  November 1, 2004

CPR, essential in Emergency Medicine

There are many reasons a person's breathing or heartbeat might stop. They include heart attack, stroke, drowning, electrocution, overdose, and many others.

At that point, it's vital to put oxygen into the victim's lungs by performing rescue breathing, and circulating it through the body with chest compressions. Here's how:

  • Have someone call 911 and check to see if an external defibrillator is available.
  • Open the airway by lifting the chin with one hand and pushing down on the forehead with the other hand.
  • Look, listen, and feel for signs of breathing every five seconds. Moving and coughing are signs of circulation.
  • If the victim is not breathing, pinch the nostrils shut and give two slow, full mouth-to-mouth breaths, making sure a seal is formed and you see the chest rise.
  • If the victim is breathing but unconscious, turn him onto his side and monitor until help arrives.
  • If he is not breathing, moving, or coughing within five to 10 seconds, give 15 chest compressions at a steady rhythm of about two per second. Place the heal of one hand on top of the other and at the center of the breastbone. Lock your elbows and align your shoulders directly above your hands. Push down enough to move the breastbone one and a half to two inches.
  • Repeat rescue breaths and chest compressions and check for breathing.
  • Until circulation and breathing return or help arrives, continue compressions and breaths checking for breathing every few minutes.


    Lettuce wraps get popular

    Lowering the consumption of carbohydrates is on many people's to-do list today, whether or not they are following a special diet. One way to do it: Replace the bread on a sandwich with lettuce wrap.

    Created centuries ago in Vietnam, lettuce wraps are especially appropriate now. A serving of iceberg lettuce has just three grams of carbohydrates.

    Modern chefs say the key to great wraps is the contrast of warm, flavorful fillings with the cool crunch of lettuce. The most familiar wrap is Chinese: minced chicken, bamboo shoots, and mushrooms in a soyhoisin sauce. But Southwestern and Italian fillings work very well too.

    Iceberg is the most common lettuce used, but the wide, strong leaves of romaine, red leaf, or slightly bitter escarole offer surprising changes of pace.

    Wraps are popular as appetizers, but they make a fine main course. For a party, offer a variety of lettuces and a variety of fillings such as cold chicken salad, grilled beef teriyaki strips, Italian sausage, onions, shredded cheese, and water chestnuts.

    To keep iceberg lettuce crisp, cut the core out. Fill the core with cold tap water, then drain for 15 minutes. It will stay crisp for up to two weeks in the refrigerator.

    To store romaine, red leaf, and escarole, you must send it into shock. Cut off one-eighth inch from the stem end. Plunge into 95 degree water for three to five minutes. Drain with the stems up for 10 minutes. An hour in the crisper will make it crisp, and it will stay that way for a week or more.

    Italian style filling: Sausage, Onion, Pepper Wrap

    Put two halves of lettuce on a plate. In a saute pan, place 1 1/2 pounds Italian sausage, 1 chopped onion, 1 clove minced garlic, 1 1/2 cups red and green bell peppers. Saute until cooked.

    Add chili paste (Thai preferred), season with basil and check to see if you need more paste. Put in serving bowl.

    Provide Parmesan cheese or low-fat mozzarella for toppings.


    Long-term benefits of Fosamax

    The bone-preserving benefits of Fosamax persist during 10 years of treatment. And they continue to offer protection from osteoporosis for some five years afterward.

    In those taking the drug for five years, the drug also continued to prevent bone reabsorption for five additional years.

    A weekly version of Fosamax is now the most widely used form of the drug. A similar drug, Actonel, is also available in a weekly pill and offers comparable bone protection. Other options include a once-yearly biphosphonate injection. Other new drugs mimic the actions of parathyroid hormone and estrogen, two key hormones involved in bone health.


  • Safe Halloween

    Parents are pretty good about cautioning children about such things as sharp objects stuck in apples, getting hit by a car, and going only to certain houses. Lesser-known

    Halloween pitfalls include carving injuries, allergic reactions to makeup, and costumes that interfere with mobility or sight.

    Hand Injuries: The American Society for Surgery of the Hand says injuries to the flexor tendons that allow fingers to bend are up by 25 percent around Halloween. Even more disturbing, a high number of patients are between 7 years old and 15 years old.

    These injuries could be from pumpkin carving which, done improperly, can cause serious deep puncture wounds. Parents can make pumpkin carving safer with inexpensive carving kits that provide tiny saws, rather than knives. Kids can also draw faces or designs on the pumpkins and leave the carving to adults.

    Allergic Reactions: Dermatologists say allergic reactions to face paint are common. Problems include symptoms of irritation such as redness and burning. They recommend testing the paint on an arm a few days before Halloween to see if there is a reaction. Always remove the paint before bedtime.

    Dangerous costumes: Each Halloween emergency room physicians see injured kids who tripped on some crazy shoe, cape, or long skirt. They caution that one-size-fits-all costumes may not allow for the running around kids do on Halloween.

    Adding inexpensive reflective tape will help drivers see the child at night, especially if the costume is black.

    Always check to make sure that a costume's label says it's made of a flame-resistant material, such as nylon or polyester. And never let kids use a candle as part of their costume.


    Low-carb eating without the hassle

    If you're interested in cutting back on carbohydrates without following a book or a strict diet, you can.

    Molly Kimbal, a nutritionist with the Ochsner Clinic in New Orleans, says eliminating some highly processed foods is an easy way to reduce carbohydrates in your diet and cut calories.

    First, eliminate carbs with little or no food value, such as pastries, fruit juices, soft drinks, crackers, and pretzels.

    Doctors at the American Council on Science and Health say you should be sure to get plenty of the high-fiber vegetables such as broccoli, zucchini, cauliflower, squash, and asparagus. While bananas are a high-carb food, they are also full of potassium, so don't eliminate them.

    Plan your meals and snacks so you don't shop too often or just eat whatever is available. Ask yourself if you really are hungry or if the food just looks good.

    Eat early and eat often. Eat small amounts frequently. And drink plenty of water.

    Don't deprive yourself of your favorite stuff, or you could quit watching your carbs and your weight. Go ahead and have a glass of wine. If you love chocolate cake, eat a small piece occasionally.

    There are hundreds of low-carb products in the supermarket. Before buying one, check the calorie count.

    If your diet doesn't include whole grains, you will benefit from a B-vitamin supplement in addition to a daily multivitamin.


    Less invasive surgery for GERD

    Most people can control gastroesophageal reflux disease (GERD) with lifestyle measures or medications. Those who have serious symptoms or complications may choose surgery.

    Up until now, that involved major surgery to tighten the junction between the stomach and esophagus.

    A new, less invasive surgical option is endoscopic gastroplication. It involves placing a pair of stitches just below a patient's lower esophageal sphincter and pulling the stitches together to reduce the opening between the stomach and esophagus.

    The patient feels better right away and can usually resume normal activities the next day.


    Medicare recognizes obesity

    After years of review, the Centers for Medicare & Medicaid Services will now provide coverage for a host of weight-loss therapies. The move opens the door to an expected flood of applications from individuals and doctors for Medicare to begin paying for therapies including stomach surgery, diet programs, and behavioral counseling. It's the latest move by the government to fight obesity, but some treatments may not be covered.



    A banker is a fellow who lends you his umbrella when the sun is shining, but wants it back the minute it begins to rain.
    - Mark Twain

    A classic is something that everybody wants to have read and nobody wants to read.
    - Mark Twain

    A lie can travel half way around the world while the truth is putting on its shoes.
    - Mark Twain

    A man cannot be comfortable without his own approval.
    - Mark Twain

    Pilot Instructions:

    It's always a good idea to keep the pointy end going forward as much as possible.

    Q: I Work out five days a week for about 6 hours total. Currently I do a total of 3 hours of cardio kickbox and one hour of high intensity step areobic and two hours total of boot camp per week. I've cut down my calorie intake and am eating healthier mainly vegatables and some fruit! For some reason, I am not losing the weight!

    A: Try dropping your caloric intake down to around 1800 calories a day. Change your workout and do something that you dislike doing. The reasoning being that your body is not efficient at it. You will burn more calories by doing activites that the body is inefficient at performing.

    Q: I have been exercising for 3 months straight, 7 days a week, 50-60 min a day. My problem is, now I feel worse then when I started 3 months ago. I have lost 32 pounds, and have 10 more to go. My body aches most of the time. A benefit is my diabetes is under control, my BP is excellent, and so is my cholestrol. Any advice?

    A: Remember, you don't build muscles in the gym, you tear them up. Rest and sleep is what builds them back. You need a day off. Work out every other day for a while until your strength is built back up.

    Q: I am 55 years old about to take an agility test involving push ups, sit ups, and a 1 1/2 mile run, in one week, is there any excercises which can increase my strength in a short period of time. I found my strength decreasing as I got older. HELP!!!!!!

    A: No, none. If anything, they will make you perform worse on the agility test. Exercising muscles will require a period of rest before they can perform at maximum again. At this age 3 to 5 days may be required for muscles to fully repair. Take the agility test as is so that you know where you stand. This will set a benchmark for future work. You might want to do some stretching exercises in the week that you have. See STRETCHING.

    Q: What exactly is a net carbohydrate in respect to a carbohydrate?

    A: A Net Carbohydrate is the total carbs minus the sugar alcohols and the fiber. In other words the energy bar that has 18 total carbs may be advertised as having only 3 Net Carbs because they don't count the other two above. Incidentally, your body does and so you are consuming 18 carbs.

    Q: I am an American living in London and have been told that my cholesterol level is excellent at 4.11. How do I compare this with the American levels that I was familiar with. Thank you.

    A: Here is a URL that explains the conversion rates:
    Conversion Units. Follow the example column for each of your readings.

    Q: I have always heard that bread and pasta are simple carbs and should be limited or replaces with complex carbs like whole grain dishes. However, the page on Proteins + Carbs say that bread and pasta are complex carbs. Can you clarify?

    A: Sugar is a simple carbohydrate. Pasta and bread are complex. Whole grains are more complex and harder to break down. Carbs are not just two discrete levels of complexity; i.e. simple and complex. There are varying degrees of simple and complex. For example, Glucose is "simpler" than sugar.

    Q: I'm confused about Gylcemic Index. Is it important?

    A: The Glycemic Index is controversial since it is only valid when sugar alone is consumed. Protein and Fat slow the absorption of Carbohydrates. The index was developed as a way to determine dietary guidelines for diabetics. The American Diabetes Association has not endorsed the Glycemic Index.

    According to this theory, a food with a low glycemic index (55 and below) provides a minimal increase in blood glucose, lipoprotein lipase (an enzyme that promotes fat storage), and insulin. A food is with a high glycemic Index (70 and above), reduces sports performance due to large increases in insulin production and can result in low blood sugar (hypoglycemia). Due to the sugar metabolization response. Remember, an onslaught of sugar leaves you high first and then lower than you were before you took the sugar.

    However, many fruits that are classified as having a high Glycemic Index can stimulate lipoprotein lipase production even though they are low in sugar. According to the Glycemic Index, ice cream is considered a low GI and whole wheat bread is a high GI food. Therefore, whole wheat bread would create a higher spike in blood glucose levels and a greater increase in insulin production than ice cream. So it is apparent that Glycemic Index should not be used as a single indicator.