In the first of a four part series, Jonathan Behar and   colleagues tell us how to assess patients in the lead up to an   operation Inducing a state of unconsciousness is dangerous   without correct preparation, and it is the role of the anaesthetist   to   assess and optimise the patient's fitness before  operation.   An anaesthetist is also responsible for safe induction into,   maintenance of, and emergence from anaesthesia and for   postoperative care (including sufficient pain management).

                                    

                       In this series we explore preoperative, perioperative, and postoperative care and look at regional anaesthesia. Other key roles of the anaesthetist, such as pain anagement and intensive care, are covered elsewhere. History and examination are crucial in the anaesthetic assessment, as are the appropriate investigations, which depend on the patient's perceived health. These will guide the type of anaesthesia and the timing of surgery. An anaesthetist should have an overall picture of the patient's anaesthetic risk, and any comorbid conditions should be optimised before surgery.

Most people are busy these days. They have less time than they used to for shopping and for planning what to eat. This booklet is designed to make it easy to fit low-fat, high-fiber eating into busy schedules.

Much research in the last few years has shown that the way people eat has a lot to do with how healthy they are - and how healthy they stay. This research has also shown that eating a healthy diet, low in fat, high in fiber, with plenty of fruits and vegetables, may help to lower cancer risk.

People have heard the message. They've begun to make changes in the foods they choose and the ways these foods are cooked and served. Still, most people are eating too much fat ad not enough fiber and fruits and vegetables. And people have questions about which choices to make. Do some of these questions sound familiar?

 

Q&A

Question: What can I eat to help stay healthy and lower cancer risk?
Answer: Experts agree that the best choice is a healthy, balanced diet that is low in fat, moderate in calories, and rich in fiber. It means:

* Eat lots of fruit and vegetables, grains, and beans.
* Include some lean meats and low-fat dairy products.
* Go easy on fats.

Question: How can I do this easily? I want to eat right, but I don't want to give up a lot of foods that I like.
Answer: You don't have to change your whole life's eating habits. A few small actions can make a difference. Here are two examples:

* Switch to reduced - or nonfat salad dressing. Regular salad dressing has about 160 calories and 18 grams of fat in a modest 2-tablespoon serving!
* Next time you have toast, try whole wheat with jelly, fruit spread, or jam instead of white bread with butter. You'll cut back on fat, and you'll get more than twice the fiber.

Question: How do I get started?
Answer: This booklet shows you how to make a few easy changes in the foods you choose.

On the following pages, you will find three action lists that suggest new ways to choose and serve the foods you know and like. The lists follow the dietary guidelines of the National Cancer Institute (NCI). These guidelines are also consistent with the USDA/DHHS Dietary Guideline for Americans.

Choose healthy eating actions to:

• Cut back on fat.
• Increase the fruits, vegetables, and grains you eat.
• Increase the fiber in your diet.

As you read through the lists, you may find that you already are following some of the suggestions. If so, try actions that are new for you. Start with two or three actions that you think you can do easily, and repeat them over time.

They will soon become second nature, and you can add others from the lists. If it helps, keep the action list posted as a reminder.

Action List for Fat

Did you know there are four great reasons to eat less fat?

1. It can assist in weight loss or weight maintenance because you'll be eating fewer calories.
2. It can help reduce your risk of heart disease by reducing saturated fat, which will help lower blood cholesterol levels.
3. It may help reduce your risk of cancer.
4. Eating fewer high-fat foods means more room for fruits, vegetables, grains, and beans.

Here are some actions to get you started and keep you going. Check off two or three actions now and more later.

• Use reduced-fat or nonfat salad dressings.
• Use nonfat or lower fat spread, such as jelly or jam, fruit spread, apple butter, nonfat or reduced-calorie mayonnaise, nonfat margarine, or mustard.
• To top baked potatoes, use plain nonfat or low-fat yogurt, nonfat or reduced-fat sour cream, nonfat or low-fat cottage cheese, nonfat margarine, nonfat hard cheese, salsa, or vinegar.
• Use a little lemon juice, dried herbs, thinly sliced green onions, ore a little salsa as a nonfat topping for vegetables or salads.
• Use small amounts of high-fat toppings. For example, use only 1 tsp butter or mayonnaise; 1 tbsp sour cream; 1 tbsp regular salad dressing.
• Switch to 1 percent or skim milk and other nonfat or lower fat dairy products (low-fat or nonfat yogurt, nonfat or reduced-fat sour cream).
• Cut back on cheese by using small (1oz.) amounts on sandwiches and in cooking or use lower fat and fat-free cheeses (part-skim mozzarella, 1 percent cottage cheese, or nonfat hard cheese).
• Save french fries and other fried foods for special occasions; have small serving; share with a friend.
• Save high-fat desserts (ice cream, pastries) for special occasions; have small amounts; share a serving with a friend.
• Choose small portions of lean meat, fish, and poultry; use low-fat cooking methods (baking, poaching, broiling); trim off all fat from meat and remove skin from poultry.
• Choose lower fat luncheon meats, such as sliced turkey or chicken breast, lean ham, lean sliced beef.

1 oz. of cheese equals

1 inch cube of hard cheese
3 tbsp of grated cheese
1 and a half slices of wrapped cheese (brands differ; check label)

Cutting Back on Fat:

* Use lower fat versions of high-fat foods.
* Use only small amounts of high-fat foods.
* Use high-fat foods only sometimes.
* Choose more low-fat and nonfat foods.

What's a recommended serving size for meat? Experts suggest 3 oz. of cooked meat which is the size of

* a deck of cards
* a hamburger bun

How are you doing on fat?

These days, everyone is talking about the importance of cutting back on fat. Surveys show that we're eating less fat than we used to, but we still are getting about 34 percent of our calories that should come from fat.

The number of calories you need each day varies depending on your body size and activity levels. But someone who needs about 2, 000 calories a day should be eating no more than 65 grams of fat a day on average.

Guide to determining dietary fat

Check below to figure out how to determine your fat intake. Please note that the example below is for someone who needs a total of 2,000 calories a day. But the way you calculate how much fat you should eat is the same for people needing other amounts of daily calories.

1. Take the number of calories you eat each day and multiply it by 30 percent (.30). For example: calories X .30 = 600 calories from fat

2. Divide your answer by 9 because there are 9 calories in each gram of fat. This will give you the number of grams of fat per day that should be your goal. 600/9 = 65 grams

3. You can use the information food labels to keep track of the fat you eat each day. By planning your meals in advance and balancing higher fat choices with lower fat ones, you can keep you day's total at the recommended 30 percent of calories or less from fat. Use the Nutrition Facts Section of the food label to compare the fat content of products before you buy foods. Compare serving sizes when comparing total fat content.

Action List for Fruits and Vegetables

Did you know that there are four great reasons to eat fruits and vegetables?

1. It is easy to do.
2. Almost all are low in calories and fat.
3. They are a good source of vitamins and minerals and provide fiber.
4. They may help reduce cancer risk.

Here are some actions to get you started and keep you going. Check off two or three actions now and add more later:

* Buy many kinds of fruits and vegetables when you shop, so you have plenty of choices, and you don't run out. Buy frozen, dried, and canned as well as fresh fruits and vegetables.

* First, use the fruits and vegetables that go bad easily (peaches, asparagus).

* Save hardier varieties (apples, acorn squash) or frozen and canned types for later in the week.

* Use the salad bar to buy cut-up fruits/vegetables if you're in a hurry.

* Keep a fruit bowl, small packs of applesauce, raisins, or other dried fruit on the kitchen counter, table, or in the office.

* Pack a piece of fruit or some cut-up vegetables in your briefcase or backpack; carry moist towelettes for easy cleanup.

* Keep a bowl of cut-up vegetables on top shelf of the refrigerator.

* Add fruit to breakfast by drinking 6 oz. of 100 percent fruit juice or by having them in soup, salad, or cut-up raw.

* Add fruits and vegetables to dinner by microwaving or steaming vegetables and having a special fruit dessert.

* Increase portions when you serve vegetables and fruits. Season them the low-fat way with herbs, spices, lemon juice. If sauce is used, choose a nonfat or low-fat sauce.

* Choose fruit for dessert. For a special dessert, try a fruit parfait with low-fat yogurt or sherbet topped with berries.

* Add extra varieties of vegetables when you prepare soups, sauces, and casseroles (for example, grate carrot and zucchini into spaghetti sauce).

Add more fruits and vegetables as a snack anytime: mid-morning, after school, before dinner, while watching TV.

Try canned varieties of beans and peas such as kidney beans or black-eyed peas. It's a fast and easy way to use beans and peas without cooking them from scratch.

These ideas and tips should get you started and keep you going with beans:

* Once a week or more, try a low-fat meatless meal or main dish that features beans (tacos or burritos stuffed with pinto beans; chili with kidney beans; black beans over rice).

* Use beans as a dip for vegetables or filling for sandwiches.

* Serve soup made from beans or peas - minestrone, split-pea, black bean, or lentil (once week or more).

* Try black-eyed peas or black beans as a vegetable side dish with meat or fish.

* Add beans to salads. Many salad bars feature kidney beans, three-bean salad, or chickpeas (garbanzo beans).

When my brother and I were kids, my mum's friend offered to infect us with chicken pox by arranging a play date with her affected toddler son. She told my mum that getting chicken pox now would prevent us from something terrible later on-shingles. Except she didn't say "shingles"; the closest translation for the Chinese term would have to be "snake head disease." Two decades later, my mum, aged 53 years old, got shingles. She had intractable pain in her right chest and back that "seemed to come from the inside" and four to five pinkish-red blisters in that same area. To me, the diagnosis was a relief because shingles, although terribly painful, was not life threatening. My mum, however, took the news badly. The family doctor had said "nerve damage." She also said that "it might come back:" "Don't worry, mum. I know it hurts a lot but it'll get better soon." "What if I die?" "You can't die from shingles." "Yes, you can. It's like a snake and if the two ends of the snake meet, you die' � She drew a circle around her waist, meaning that if the pain went all the way around, she would die. Two weeks ago, she had gone to a Chinese herbalist to pick up some abdominal pain pills. When she went to pay, the herbalist stared violently at her hands: "You have a snake's head coming out You have the snake head disease." He was referring to a bump right above the ridge of the nail on my mum's right index finger. That bump (along with others that have come and gone) has been there for years. I am not saying that Western medicine is superior to that of the East. I love those abdominal pain pills; they have cured me on numerous occasions, my dog too. But culture is something that we have to consider when talking to our patients. My mum was uncomfortable telling me about the "snake head disease," but the benefits of my knowing were tremendous. I was able to calm her fears by telling her that she had shingles in the T4 dermatome on her right and that the left side was associated with a healthy normal nerve. She was also worried about my brother and I until I told her that you can only get shingles if you have been exposed to chicken pox. So she was right, 20 years ago, when she said no to her friend and sent us to school, chicken pox free.

few weeks ago, consulting a patient with cystitis, I used one of the classics. I found myself explaining that her infection was due to a "design flaw." Her urethra was too short allowing micro-organisms into her bladder. I heard myself and stopped, pondering the truth in this statement. Are we "design flawed?" Do we, as medical professionals, really spend our time correcting the inherent mistakes in the original construction of the human body?

This includes current drugs (name, dose, route, frequency) and allergies (especially to penicillins or latex). Prescribed drugs may need to be continued, stopped completely, and changed in dose or route of administration.