Skinny Green Bean Casserole

Ingredients:

• 1 (14 oz) bag of frozen whole green beans (or about 4 cups fresh)
• 1 cup mushrooms, thinly sliced 
• 1 medium onion, finely chopped
• 1 tsp garlic, chopped

For the Sauce:

• 1 cup plain low-fat Greek yogurt (or low-fat sour cream)
• 1 tsp corn starch
• 1 tsp salt
• 1/2 tsp pepper
• 1 pkt Stevia (or 1/2 tsp sweetener of choice)

For the Topping:

• 1 tbsp minced dried onion
• 1/2 cup grated parmesan cheese
• 1/2 cup panko bread crumbs 

Instructions:

1. Preheat oven to 350 degrees. Spray a large baking dish with cooking spray and set aside. Meanwhile, spray a large skillet with cooking spray. Sautee the onions, garlic and mushrooms in 1/2 cup water, stirring occasionally until the water is completely evaporated. Remove onions and mushrooms from pan and place in a medium bowl.
2. If using frozen green beans, thaw the green beans in the microwave for 5-10 minutes or until thawed. (If using fresh, steam green beans, snip off the ends and place beans in a large pot of boiling water for about five minutes or until tender and drain). Add green beans to the bowl with the mushrooms and onions. Let cool to room temperature before adding sauce mixture.
3. In a small bowl, mix ingredients together to make the sauce. Add sauce to the green beans and toss until everything is well coated. Add everything to prepared baking dish.
4. Mix topping in a small bowl and sprinkle evenly over the top. Bake (uncovered) 35-40 min or until topping is golden brown. Serve warm.  

Nutrition:

Servings: 6
Serving size: about 1 cup
Calories: 110
Fat: 3 g
Carbohydrates: 13 g
Fiber: 2 g
Sugar: 4 g
Protein: 9 g

Recipe and photo courtesy of www.dashingdish.com

The Growing Importance of Advance Care Planning

W. Anthony Riley, MD, pictured
with a patient.

Discussing end-of-life wishes can be an uncomfortable topic, but it is an extremely important one. In fact, it’s a good idea for patients with any serious chronic illness to begin this advance care planning soon after receiving a diagnosis. “Taking the opportunity to initiate this planning early with your healthcare provider will enable you and your family to make educated decisions about treatments you may need to consider in the future,” says W. Anthony Riley, MD, Medical Director of Gilchrist Hospice Care, Medical Director of Gilchrist Greater Living, and Physician Board Chairman of Greater Baltimore Health Alliance. “For patients with advanced chronic illnesses, many of the available treatments have substantial burdens along with their benefits. Engaging proactively on advance care planning gives you, your family and your provider the time needed to consider which treatment approaches will best meet your needs further down the road.” 

This dialogue should result in the completion of Medical Orders for Life-Sustaining Treatment (MOLST) forms. The MOLST order, a medical order made by a physician or nurse practitioner, complements the Advance Directive, a legal document, which provides general guidance on patients’ wishes and allows them to name a healthcare agent.  MOLST forms cover, in detail, wishes regarding everything from CPR and artificial ventilation to blood transfusion, antibiotic use and artificially administered fluids and nutrition. Patients and their physicians should review and update the document periodically. If a MOLST form is on record, it will be treated as a medical order and will be followed accordingly, even if a patient is unable to speak for him or herself. 

Conversations about advance care planning are encouraged and, in fact, expected, in the current healthcare environment. Says Dr. Riley, “We want our patients and physicians/nurse practitioners to engage in open, honest communication and shared decision making so patients will have the right mix of treatments and support available to them at each stage of their illness.”  

Advance care planning has been found to be very beneficial for patients, families and providers alike.  “Many of my patients report feeling a profound sense of relief after engaging in advance care planning,” says Dr. Riley. “They have a better understanding of what their disease course might look like; they feel confident that their provider and their family members understand their wishes; and they feel that they have freed their loved ones from the burden of making difficult decisions in a crisis. I encourage everyone in the GBMC community with a chronic illness to take the opportunity to initiate this important dialogue with their healthcare provider.”

Gilchrist Hospice Care now offers an Advance Care Planning Series, led by W. Anthony Riley, MD, for individuals interested in learning more. The discussions are held the second Tuesday of every month, and include topics such as general, cardiac, pulmonary, and neurodegenerative conditions and dementia advance care planning. For more information about the Advance Care Planning Series or to register for a discussion, please visit gilchristhospice.org/advancecareseries or contact Nicole Conradi, GHC Program Management Specialist, at 443-849-8205 or nconradi@gilchristhospice.org.

Educate Yourself about Epilepsy

Epilepsy monitoring

November is National Epilepsy Awareness Month. Epilepsy is a neurological disorder in which a person has repeated seizures. Seizures are episodes of disturbed brain activity that cause abnormal mental and physical functions, which are commonly manifested in the form of convulsions or shaking. These can last seconds to minutes or, in some rare cases, hours and days, but they typically have duration of less than five minutes. According to the Epilepsy Foundation, a person is considered to have epilepsy after having two or more unprovoked seizures. 

With more than 50 million people worldwide living with epilepsy (approximately one in 26 people in the U.S.), it is likely that you know someone with this condition. In the event that you find yourself in the presence of someone who is having a seizure, you can keep the following tips in mind: 

• Stay calm and encourage others around you not to panic.
• Contrary to what may be intuitive, it is important that you do not attempt to stop the person’s movements or try to hold him or her down in any way.
• Clear the surroundings of sharp objects, furniture or anything that could hurt the person.
• Do not put anything in the person’s mouth.
• Loosen any ties or necklaces on the person’s body. They may make it difficult to breathe during a seizure.
• Gently turn the person to one side, if possible, to ensure that his or her airway is open.
• Pay attention to what the person’s seizure looked like and keep track of how long the seizure lasts – this is important for communicating with medical personnel.
• Stay with the person until the seizure ends and help him or her to remain calm immediately afterwards. Confusion is a common symptom following a seizure.

If you think you have been having seizures, it is important to talk to your doctor as soon as possible. Try to provide information such as frequency, timing and specific details of the symptoms or seizures. If your symptoms are indicative of seizures, you may be referred to a neurologist, who can diagnose the specific type of epilepsy and give directions for treatment, such as medications and behavior modification to consider. 

In need of a primary care physician or a neurologist? Visit www.gbmc.org/mydoctor or www.gbmc.org/neurology to find the one that is right for you. 

Diabetes Fact or Fiction

According to the American Diabetes Association (ADA), more than 25 million Americans (8.3 percent of the U.S. population) have diabetes, a condition that affects individuals of all ages, races and ethnic backgrounds. In recognition of the ADA’s designation of November as American Diabetes Month, we want to share the following facts and misconceptions about the disease.

Fact or Fiction?

1.  All types of diabetes are the same. FICTION.

The three most common types of diabetes are type 1, type 2 and gestational:

• Type 1 diabetes is an autoimmune disease and occurs when the pancreas stops producing insulin. Type 1 affects approximately 5 percent of people who have diabetes. 
• Type 2 diabetes is the most common form of diabetes and affects 90 to 95 percent of those who have diabetes. Type 2 occurs when the pancreas produces too little insulin or the body doesn’t use insulin properly. 
• Gestational diabetes develops when pregnant women have high blood glucose levels during their pregnancy; it does not necessarily indicate diabetes will remain following delivery. 

2.  Diabetes may lead to other health problems. FACT. 

People with diabetes can develop complications with the eyes, nerves, skin, kidneys, feet and other areas. Talk with your physician and diabetes care team to learn how to manage your diabetes and help delay or prevent complications.

3.  Only overweight or obese people get diabetes. FICTION.

There are many risk factors for developing type 2 diabetes, including high cholesterol, high triglycerides, belly fat and inactivity. Other risk factors include: 

• Family history 
• Age>45
• High blood pressure/cholesterol
• Certain racial backgrounds
• Prediabetes 
• History of gestational diabetes

4.  Diabetes can be managed with a proper diet. FACT.

The American Association of Diabetes Educators lists “healthy eating” as one of its Seven Self-Care Behaviors™ for managing diabetes. People with diabetes can eat the same foods as people who don’t have diabetes. As with any healthy diet, a good balance of protein, fat, and carbohydrates, including starches, fruits and vegetables, will help keep blood glucose levels within desired ranges. 

5.  People with diabetes should never consume sugar. FICTION.

It is a myth that people with diabetes can never consume sugar. While it is important that someone with diabetes limits their sugar intake, there are no foods that are completely off-limits; rather, people with diabetes should be mindful of portion control when planning their meals and snacks.  

6.  You should seek information from a licensed/certified medical provider to learn how to properly manage your diabetes. FACT.

When living with diabetes, support from others can be essential in helping you maintain healthy habits. GBMC’s Geckle Diabetes and Nutrition Center and GBMC at Hunt Valley primary care practice have skilled physicians, nurses, dietitians, and Certified Diabetes Educators® ready to provide the services you need, including individual appointments, group classes, nutrition counseling and group support sessions.

To learn more about diabetes care at GBMC, visit www.gbmc.org/diabetes or www.gbmc.org/huntvalley.

Make Thanksgiving Healthier with Small Ingredient Changes

It’s tempting to overeat on Thanksgiving… and after Thanksgiving, too. Between the day-of festivities and all the leftovers, it can be easier than we think to pack on the pounds during the holiday season. Fortunately, there are ways to make Thanksgiving healthier but still enjoyable. 

Simple ingredient substitutions can help to make dishes just as tasty and better for you. For example, one 8-ounce cup of whole milk contains about 149 calories and 8 grams of fat. Instead, swap that with the same amount of skim milk at 86 calories and none of the fat. Or, eat only the white meat of your turkey with no skin rather than the dark meat with the skin left on. It’s lower in calories and fat.

Consider trying the following easy ingredient changes to your recipes this holiday season (or, throughout the whole year!):

Original Ingredient  Substitute Ingredient(s)
1 cup oil for baking  1/4 cup oil, 1/2 cup applesauce
1 cup sour cream  1 cup plain low-fat Greek yogurt
1 cup shortening  3/4 cup olive oil
1 cup heavy cream  1 cup evaporated skim milk
1 lb 80% lean ground beef  1 lb 93% lean ground turkey
Turkey drippings for gravy                      Vegetable oil for gravy
Canned, jellied cranberries  Whole, fresh cranberries
Candied yams  Fresh sweet potatoes
Cooked stuffing inside turkey  Baked dressing in casserole dish
Butter/cream for mashed potatoes         Broth, evaporated skim milk                                                                           or plain low-fat Greek yogurt

While it may seem like a good idea to skip breakfast and lunch on Thanksgiving Day so that you have plenty of room for a big meal, don’t give in! This sets you up for overeating. Also, try not to pack your plate full of food. Leave some space in between items so that you won’t overdo it. Make an extra effort to eat your holiday favorites mindfully – first, note how visually appealing the meal, then focus on the aromas, and finally, enjoy all of the tastes and textures. When eating mindfully, the pace of eating is slowed while the satisfaction is increased. 

Remember, while the holidays are notable for their delicious cuisine, emphasize the time you’re getting to spend with your loved ones. Enjoy the good company and maybe even start a family activity like going on a walk or playing flag football together to get everyone moving.

October is National Domestic Violence Awareness Month

Most people know that October is Breast Cancer Awareness Month, but did you know that it is also Domestic Violence Awareness Month? Research from the Centers for Disease Control (CDC) shows that one in four women and one in seven men will be affected by physical violence from an intimate partner in their lifetime, so this issue might be closer to home than you think. Learn about what GBMC is doing to help victims of domestic violence, and what steps to take if you or someone you know is in an abusive situation.

The Domestic Violence Program at GBMC is one of seven hospital-based domestic violence programs in the state of Maryland. “Nobody wants to ask patients if they are experiencing domestic violence if there is nothing they can do to help them,” says Colleen Moore, Domestic Violence Program Coordinator at GBMC. “That is why we started this program in 2011, with the goal of encouraging healthcare providers to screen for domestic violence and connect patients to resources.” 

GBMC’s Domestic Violence Program wants patients to understand that a healthcare provider is an appropriate person to speak to about domestic violence. When physicians or other healthcare providers truly understand patients’ stressors and safety risks, they are able to make better diagnoses and help them access the specific resources they need. Maryland does not have mandatory reporting laws for domestic violence, so all information is kept confidential. GBMC’s Domestic Violence Program works in conjunction with healthcare providers; once a physician or healthcare provider has identified a patient who is a victim of abuse, they involve the Domestic Violence Program personnel. From there, the program can provide crisis counseling, safety planning and connect the patient with resources like legal support and housing. The program personnel are available to advocate for patients, hospital staff and anyone in the community who is a victim of abuse.

If someone you know is being abused, Ms. Moore offers these suggestions of things you can do to help:

• Be a good listener.
• Remind the person that no one deserves to be abused.
• Reassure the person that abuse is against the law and that help is available.
• Help the person make a plan to stay safe.
• Suggest that the person call a hotline or GBMC’s Domestic Violence Program for assistance.

In the Baltimore area, you can reach GBMC’s Domestic Violence Program at 443-849-3323 or visit www.gbmc.org/dv for more information. The National Domestic Violence Hotline, 1-800-799-SAFE (1-800-799-7233), can also help callers find local domestic violence victim support. 

Stop the Flu in its Tracks with Early Prevention

With the fall season well underway, many are taking time to enjoy the changing leaves, hayrides and apple cider. Autumn is a great time to enjoy beautiful crisp days, but it is also the time to start thinking about preventing winter illnesses like the flu. 

The Centers for Disease Control (CDC) estimates that every year, between 5-20 percent of U.S. residents will develop seasonal influenza, known as “the flu.” It also estimates more than 200,000 people will be hospitalized for flu-like symptoms and complications. Medical professionals have determined that the flu shot vaccine is the best way to protect against the flu. Vaccines are available now for the 2013-2014 winter flu season!

The flu shot is typically available from October through May. It is recommended that you obtain your vaccination as early as possible, as early vaccination has been shown to be most effective. However, it is never too late to protect yourself during flu season. You are 60 percent less likely to get the flu if you have received the flu shot, according to flu.gov. 

Everyone should be vaccinated annually, with the exception of individuals with severe allergies to chicken eggs, those with a history of a severe reaction to the vaccine and infants younger than six months. If you are unsure about whether or not you should get vaccinated, your primary care doctor can help you decide if it is right for you. 

In addition to the vaccination, here are a few best practices recommended for flu prevention:

• Wash your hands often with soap and water. Keep an alcohol-based hand rub with you and use it after visiting public places or being around large groups of people
• Boost your immune system by quality self care: exercise often, stay hydrated, eat healthy, nutrient-rich foods and get plenty of sleep each night
• Stay home for at least 24 hours if you have flu-like symptoms, or longer if fever does not subsist without the use of fever-reducing medicine
• Avoid close contact with sick people or people who have been exposed to illness. Remember that flu is contagious for up to seven days after symptoms begin

If you do not have a primary care physician, please consider visiting www.gbmc.org/mydoctor to find one who is right for you.