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Certified Chiropractic Physicians Assistant, 4th Edition

Chapter 10 Communication Skills

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Section 10-1 What is Communication?


Communications: Why do we communicate? Psychological function: We communicate to meet needs We communicate to enhance our sense of self Social Function: 1. We communicate to develop relationships A: B: 2. We Communicate to fulfill social obligations Decision Making: 1. To exchange information

2. To influence others

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Certified Chiropractic Physicians Assistant, 4th Edition Health Care: 1. To educate patients

2.

To provide quality care

3.

To ensure patient safety

4.

To make health care in our office exceptional Without great communication skills, your office will suffer from poor communication to the patient and between staff

What is communication?

What is competent Communication? Being able to send, receive and interpret information through verbal or non-verbal communication The ability to communicate in a personally effective and socially appropriate manner

Elements of competence: 1. Knowledge What do you know about the subject youre discussing?

What does the person(s) youre communicating to know about the subject your discussing? 2011 Copyright, Chiropractic Educational Network 142

Certified Chiropractic Physicians Assistant, 4th Edition 2. Skills

Communication skills are best learned through personal experiences

3. Commitment Great communication skills take hard work and determination to be effective 4. Sensitivity Questions for thought: Does competent communication ever necessitate dishonesty?

1. Communication is a process 2. Communication is sharing meaning 3. Effectiveness 4. Expressing feelings and emotions

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Certified Chiropractic Physicians Assistant, 4th Edition Questions for thought: Do you feel health care office workers have become very "ME" oriented instead of patient oriented?

There are two key elements used to communicate each time you speak: #1 Verbal Communications: Verbal is the message itself #2 Visual & Non-Verbal Practicing Non-Verbal Interpreting Facial Expressions:

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Questions for thought: Do you think a doctor or office manager faced with negative and inefficient workers uses controlling, not problem solving strategies?

Effective communication is mostly A: verbal-what/words you say? B: Vocal- how you say it C:Visual-what you see List what percent you think is correct? Verbal Vocal Visual Correct % is: Verbal Vocal Visual ________ % ________ % ________ % ________ % ________ % ________ %

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Section 10-2 Behavioral skills


1. Eye communication 2. Body language 3. Facial expressions 4. Appearance Do you judge people by how they look? Do people judge your appearance? If you dress poorly does that mean youre a bad communicator? If you dress great does that mean youre a great communicator?

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Certified Chiropractic Physicians Assistant, 4th Edition 5. Non-verbal Use them to put emphasis on your communication Be careful that others watch you Try not to convey the wrong communication by using bad body language

6. Voice clarity 7. Listener attentiveness 8. Believability Questions for thought: Do you think the doctor or office manager should argue or discuss office problems when patients are within hearing range?

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Certified Chiropractic Physicians Assistant, 4th Edition How to talk to the doctor:

How does communication affect your effectiveness in health care? 1. Conveys your educational level Poor communication tells patients youre not too smart Conveys your experience Patients will know that the better you communicate the more experiences you are

2.

3.

Determines if YOU communicate the correct message What you must communicate the patient? 1. What you need them to do 2. How you need them to do it 2011 Copyright, Chiropractic Educational Network 148

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3.

What they will experience

4.

They need to pay for treatment

5.

They must follow the doctors orders

6.

How important HEALTH is to their life

Communicating Bad News to a patient! It is very stressful to communicate bad news to someone. It requires tactfulness, respect and excellent communication skills. How you can help How they must be positive That sometimes you must address the bad to find the good

How will a patient respond to bad news? 1. 2. 3. 4. AcceptRejectQuestionArgue149

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Certified Chiropractic Physicians Assistant, 4th Edition Psychological Barriers of communication: Questions for thought: Should group members learn to become assertive versus aggressive?

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Section 10-3 How we learn to communicate


Infancy: Sounds heard Learning response to sound Responding to touch That when we cry they react

Early Childhood: Adult: Learn from others Experience life Get better as we go Observation Trying things (curiosity) Learning from mistakes Persistent trying Observing others

Communication factors: 1. Culture 2. 3. May dictate values Keeps some people primitive May vary from others Education Formal education instills basics Allows you to understand the rules of communication Provides guidelines Word Choice Never use bad words Try not to be too technical Choice the appropriate word Avoid using slang words 151

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Certified Chiropractic Physicians Assistant, 4th Edition 4. 5. 6. 7. 8. Grammar Is important Shows your knowledge Makes you look bad if not used correctly Personal or Professional use Divide the personal and profession conversation Never burden patients with your problems Dont take business communications personal Life Experience Make you a better communicator Teach you what to avoid saying Builds your vocabulary Social Influence You learn word socially acceptable You learn bad words Bad language not socially acceptable Your sometimes pressured to use key words Negative Influence If you always talk to poor communicators you learn bad habits You can negatively influence others with your words Slang words are negative The tone of your communication can convey negative

Sending the message The correct way

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Certified Chiropractic Physicians Assistant, 4th Edition Problems that occur

Receiving the message The correct way Problems that occur Interpretation of a message The correct way Problems that occur Responding to a message The correct way 2011 Copyright, Chiropractic Educational Network 153

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Problems that occur Listening The correct way Problems that occur Understanding patient communication- Are you listening to the patient? Are you listening to the patient? They are telling you every complaint and concern which ultimately leads to a diagnosis. Why are todays health care workers suddenly becoming highly insensitive to the relevance of great communications? If each patient in your office was surveyed, how many of them would say, "My doctor doesn't listen to me"? Did you know on average, doctors interrupt patients only 18 seconds after they begin to speak? This results from the doctors taking the discussion towards technical terminology which deprives many patients of the chance to tell their whole story. If the doctor or health care team interrupts the patient you will miss important information including the important psychosocial factors.

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What is the "Failure Zone"?

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Certified Chiropractic Physicians Assistant, 4th Edition Skills for effective communication with patients 1. Plan the visit with the patient 2. Create rapport quickly 3. Draw out a patient's concerns 4. Ask the patient's perspective 5. Demonstrate empathy 6. Be open to the patient's emotions 7. Be aware of your own reactions 8. Invest in the end (a wellness patient) 9. Provide education 10. Involve the patient in making decision 2011 Copyright, Chiropractic Educational Network 156

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Section 10-4 Listening Skills

Ask a friend or co-worker if they are a good listener and usually they'll say yes. And they'll say it's easy to be a good listener. However, in health care one reason for errors and internal communication breakdowns result from poor listening skills. Being a great communicator does not mean getting others to do what you want them to do. In general good listening means just that, you listen! Dont forget the basic truth about being a good listener: Listening is a two-way process o Yes, you need to be heard You also need to hear the other person's ideas, questions and objections o If you talk at someone instead of listening you defeat your goal

In a chiropractic office, chiropractic assistants who are good listeners steer conversations towards the patients interests. Further, you will not learn anything about the patient or their condition when you are doing all the talking. Being a good listener also means paying close attention to details relative to the communication. For example, if a patient comes in and you dominate the conversation several things will happen. 1. They feel their concerns are not important to you 2. They will not open up to you and fully disclose all the details you need about their health history and things related to their current condition 3. It creates a psychological barrier It will take practice, determination and persistence to be a good listener. In the end your efforts will provide you with a wonderful tool in your career. You will find that being a good listener is just one step to becoming a better communicator. The art of effective listening includes receiving a message and providing decisive feedback. The process should be very interactive. It involves hearing, decoding what you hear, evaluation of the verbal message and focus on details of what you hear.

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Certified Chiropractic Physicians Assistant, 4th Edition To be a better communicator practices the following:

Listen and let the person finish before you respond Listen , decode the message and respond Focus on nonverbal behavior Defuse emotional situations by maintaining professionals communications

Ways to listen better to patients 1. Let the patient talk without interruption 2. Expand on hints the patient drops 3. Show you are listening 4. Be reflective 5. Determine patient's expectations for treatment 6. Maintain eye contact Keys to convey positive nonverbal messages Acknowledge the patient immediately o Greet and comfort first, do paper work second o Don't let patients wait, even if you are busy o Show that you will assist them shortly and let them know you are aware of their presence Give your full attention to those patients who are present. o If you must answer the phone, do not hesitate to put the patient on the phone on hold while you address the patient in your immediate presence. o If you are talking with another staff member, excuse yourself immediately and address the patient. All staff must recognize that the patient comes first. o End all personal conversations on the telephone immediately upon the approach of a patient. Introduce yourself o You, too, are a person with an identity to which the patient can relate o Give the patient your first name and describe in simple terms what you will be doing o Reinforce the spoken use of your name with a visible name tag, a name plate on your desk 158

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Certified Chiropractic Physicians Assistant, 4th Edition Give the patient your full attention o Staff members should not interrupt when you are with a patient except in emergencies Use appropriate language o Use language the patient will understand o Don't talk about irrelevant subjects Use the time to explain procedures and routine tasks Be discreet o Respect the patient's privacy o Be competent and knowledgeable

Communication Barriers The message gets altered through interference: Not Listening: Causes for not listening: 1. Topic is boring 2. Distracted by other interests 3. In a hurry 4. Dont like the person 5. Tired

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Certified Chiropractic Physicians Assistant, 4th Edition How to be a better listener? 1. Respect them 2. Take time to listen 3. Take time to focus 4. Know its important 5. Practice

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Chapter 9 Review
Critical Thinking 1. Write about a communication experience you have had with a patient that was difficult. Discuss the situation and how you handled it? 2. Write page about how culture can influence a person ability to communicate?

3. List your top 3 trouble areas with communication?

In Review 1. What is the definition of communication?

2. Why do we communicate?

3. How does your ability to communicate affect patient care?

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Chapter 11 Nutrition & Wellness

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Section 11-1 Vitamins


Nutrition What is Nutrition? Eating all fruits and vegetables, having a non-fat diet? Write down what YOU think nutrition is:

An incredible interest has peaked in society as we are taught more about the multitude of important functions those vitamins, mineral and herbs to assist the bodies performance. The attitude towards vitamin and nutritional supplement use is changing as people learn more about the benefits. New studies show that vitamins protect us, not only from deficiency disorders, they may also slow the aging process, and lesson the healing time of illness. There is no doubt that vitamins and minerals are important to good health. Researchers are learning more and more about how theses nutrient are absorbed and used in the body in ways that may prevent degenerate disease, enhance the immune system and slow the aging process in whole. What are vitamins? Organic (carbon containing) substances derived from plants and animals. They are called micronutrients because they are needed in relatively small amounts in the body when compared to macronutrients such as carbohydrates, fats, and proteins that make up most of the diet and provide energy. History of the Vitamin: o The first vitamin was called Vitamine A by scientist in 1913. But the E at the end of the word was eventually dropped. o All vitamins are either water-soluble or fat-soluble. Fat-soluble vitamins are: A, D, E & K These vitamins dissolve in liquid fats not in water. 2011 Copyright, Chiropractic Educational Network 163

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These vitamins are absorbed through the intestinal tract with the assistance of bile
acids and dietary fats and stored in the body.

These vitamins can become toxic if consumed in extremely high doses.


Water-soluble vitamins are:

C B COMPLETE
Water-soluble are absorbed through the gastrointestinal tract without the help of dietary fats and bile acids. Mineral Basics:

Minerals are inorganic substances Minerals can work as co-enzymes helping enzymes to active the bodys biochemical
processes. Common minerals include:

Calcium-Is important for the cells of the body, bone development and the nerves
throughout the body

Iodine-This is a very essential mineral which most people gain by using iodized salt on
their food

Iron-Less than a quarter ounce of iron is present in the entire body, yet iron is found
in every red blood cell. Without iron the body could not survive as there would be no hemoglobin. Antioxidants: Antioxidants protect the body against highly reactive molecules known as free radicals. Uncontrolled these harmful molecules wreak havoc on a healthy cells and tissues, leading the development of degenerative disease.

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Certified Chiropractic Physicians Assistant, 4th Edition Knowing your Vitamins Vitamin A: Helps prevent night blindness

Reduces the risk of eye problems Helps to promote a healthy immune system Protect cells against cardiovascular disease
Vitamins A found in the following foods: Egg yolks Cod liver oil Milk Cheese Butter Ice-cream Fish Fish Oils Organ meat(i.e. liver) How to determine if you are at risk for vitamin A deficiency:

Do you have chronic liver disease? Do you have chronic diarrhea Do you take cholesterol lowering medication? Do you take oral contraceptives? Do you drink large amounts of alcohol? Are you under great emotional stress? Are you pregnant or breast-feeding?
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Certified Chiropractic Physicians Assistant, 4th Edition Vitamin D: Vitamin D is an essential nutrient for maintaining bone density. The body needs vitamin D which allows calcium to build the bones. Vitamins D enhance the adsorption of bone-building minerals, such as calcium and phosphorus. How to determine if you are at risk for vitamin D deficiency:

Do you spend most of your time indoor, secluded from sunlight? Do you have Kidney or Liver disease? Do you take anticonvulsant medications? Do you use mineral laxatives? Do you drink large amount of alcohol? Are you an older person?
Vitamin D found in the following foods: Eggs Butter Oily fish (i.e. salmon, sardines) Liver Cod Liver oil **Green leafy vegetables only contain a small fraction of vitamin D. Vitamin E: Vitamins E are an antioxidant that protects cells against the effects of oxidation. Vitamins E found in the following foods: Vegetable oils Sunflowers Soybean Corn Wheat Germ Cotton seed oils Sweet Potato Nuts 2011 Copyright, Chiropractic Educational Network 166

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How to determine if you are at risk for vitamin E deficiency: Do you take cholesterol lower medications? Do you use mineral oil laxatives? Do you smoke cigarettes? Are you exposed to environmental pollution?

Vitamin K: Vitamin K is the least known of all vitamins. Vitamins K are involved with helping the clotting of blood and bone formation. Vitamins K deficiencies are rare because it is found in such a wide variety of foods. Vitamins K found in the following foods: Spinach/Greens Turnips/Cabbage Cereals Fruits

How to determine if you are at risk for vitamin K deficiency:

Do you have Crohns Disease? Do you take cholesterol lower medications? Do you use mineral oil laxatives? Are you taking antibiotics?
Vitamin B: This is an important for enhanced energy production in the body. It is essential for body growth and the repair of all body tissues.

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Certified Chiropractic Physicians Assistant, 4th Edition Vitamin B found in the following foods: Milk and Dairy product Green vegetables Avocados Cereal with whole grain How to determine if you are at risk for vitamin B deficiency: Do you have diabetes?

Do you take diuretics (Water pills)? Do you take antidepressants? Do you exercise regularly?
Vitamin C: Is essential in the formation and maintenance of collagen, a protein that is a chief component of the bodys connective tissues, including cartilage, bone, teeth, skin, ligaments, and tendons. Vitamins C found in the following foods: Broccoli Brussels Sprouts Turnip greens Sweet Peppers Parsley Strawberries Cabbage Cauliflower Grapefruit Citrus fruits Lima beans Melons How to determine if you are at risk for vitamin C deficiency: Do you have Diabetes? Do you take Aspirin or Tetracycline? Do you use oral contraceptives?

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Certified Chiropractic Physicians Assistant, 4th Edition What is the relevance between diet and nutrition and Health? Malnutrition depresses the ability of the bodys immune system.

The role of nutrition is maintaining adequate immune function, especially in the elderly.

A balanced diet and increasingly strong immune system promotes longevity.

Keeping a constant level of adequate nutrition reduces the changes of loss of health.

Keeping your body full of the correct nutrients promotes a strong and healthy musculoskeletal system.

Proper nutrition allows you to have more energy.

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Section 10-2 Diet


Why people diet? Types of diet supplements How does supplemental diet treatment affect the body? Most common types simply expand the stomach so you feel full Other speed up metabolism to HURRY food through the body

Improper diet techniques: Skipping meals Taking stimulants Not under doctor supervision

Correct Diet Techniques: Consult with your doctor first Diet must include regular meals Incorporate exercise Limit fat intake 170

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Certified Chiropractic Physicians Assistant, 4th Edition Your diet determines your need for supplements: Answer the following yes or no: _____ Do you tend to skip meals? _____ Do you eat fewer than 3 servings of fruits/vegetable per day? _____ Do you have variety in your diet? _____ Do you avoid whole grain, dairy, fish, etc.? _____ Smoke? _____ Drink alcohol daily/weekly? _____ I dont drink milk? _____ I have a poor appetite? _____ I dont take time cook balanced meals? _____ I am always dieting? You are what you eat Why do some people eat more than others? 2011 Copyright, Chiropractic Educational Network

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Section 11-3 Foods the body needs


What types of foods does the body need? In many ways, our bodies can be thought of as chemical processing plants. Chemicals are taken in, processed through various types of reactions and then distributed throughout the body to be used immediately or stored for later use. The chemicals that are used by the body can be divided into two broad categories: Macronutrients o those substances that we need to eat regularly in fairly large quantities Micronutrients o those substances that we need only in small amounts

Carbohydrates: Carbohydrates are the sugar and starchy foods that most of people crave daily. Most carbohydrates are found naturally in the form in which food is stored by plants and not found in animal products. They are mostly found in fruits and vegetables which are for the most part good for the body. Carbohydrates are the main energy source for the human body. Chemically, carbohydrates are organic molecules in which carbon, hydrogen and oxygen bond together in the ratio: The body breaks down carbohydrates during the process of metabolism to release energy. We obtain carbohydrates by eating foods that contain them, for example potatoes, rice, breads, etc. These carbohydrates are manufactured by plants during the process of photosynthesis. Plants harvest energy from sunlight to run the reaction described above in reverse. Carbohydrate facts: Too many carbohydrates may be bad for the body as sugar or starch consumed in excess will convert to fat after your body does not need any more of it. Carbohydrates are needed as they provide quick energy for the body and for most people are easily accessible and inexpensive.

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Certified Chiropractic Physicians Assistant, 4th Edition All carbohydrates are broken down during digestion and changed into a simple sugar called glucose. Glucose is absorbed into the blood in this form where it changes to a substance called glycogen. Glycogen can be used by the body later as it is stored in the liver and muscle tissue.

Carbohydrates come in two basic forms: complex and simple. Simple carbs are one, two, or at most three units of sugar linked together in single molecules. Complex carbs are hundreds or thousands of sugar units linked together in single molecules. Simple sugars are easily identified by their taste: sweet. Complex carbs, such as potatoes, are pleasant to the taste buds, but not sweet.

The Result of Excess Carbohydrate Intake Excess carbohydrates also cause generalized vascular disease. The high-carbohydrate diet which is now so popular causes the pancreas to produce large amounts of insulin, and if this happens for many years in a genetically predisposed person, the insulin receptors throughout the body become resistant to insulin. Because insulin's action is to drive glucose into the cells, this results in chronic hyperglycemia, also called "high blood sugar." A large portion of this sugar is stored as fat resulting in obesity. Excess insulin also causes hypertension and helps initiate the sequence of events in the arterial wall which leads to atherosclerosis and heart disease. Excess fats damage the immune system through irradiation by free radical cells.

Fats:

Fats are a sub-group of compounds known as lipids that are found in the body and have the general property of being hydrophobic (meaning they are insoluble in water). The main purpose of fats in the body is to serve as a storage system and reserve supply of energy. During periods of low food consumption, fat reserves in the body can be mobilized and broken down to release energy. Fats serve as an insulation material to allow body heat to be conserved and fats line and protect delicate internal organs from physical damage. 173

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Certified Chiropractic Physicians Assistant, 4th Edition Fats in the diet can be converted to other lipids that serve as the main structural material in the membranes surrounding our cells.

Fats can be classified as either saturated or unsaturated: The consumption of saturated fats carries some health risks in that they have been linked to arteriosclerosis (hardening of the arteries) and heart disease. Unsaturated fats can be either polyunsaturated (many double bonds) or monounsaturated fats (one or few double bonds). Recent research suggests that the healthiest of the fats in the human diet are the monounsaturated fats, such as olive oil and canola oil, because they appear to be beneficial in the fight against heart disease

Protein: The most important type of food is protein. It supplies not only food to the body but works to repair damaged and create new tissues in the body. Every cell of the body is made up of protein and required continuous supplies to keep cells alive. Can a high protein diet can be effective for someone trying to lose weight and lose fat? Well some studies say yes. Most high protein foods are extremely low in carbs and extremely low in saturated fat (which is the fat that you DON'T want to eat). Therefore, by eating a high protein diet loaded with high protein foods, at the same time you'd end up eating low carb foods and low saturated fat foods. And, if you didn't already know, in order to lose weight and lose fat, eating low carbs and eating little or no saturated fat is a MUST. Some high protein foods are: Chicken Turkey Lean meats and beef Fish (just about every fish is high in protein, anything from tuna fish, to salmon, to shrimp) Egg whites

If you decide on a high protein diet, the most important times to eat high protein foods are: First thing in the morning after you wake up Last thing at night before you go to bed Directly after your workout.

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However, remember that the main point of eating a high protein diet is to give your body the protein it needs all day long, which is why it would be a good idea to eat a meal once every 3 hours or so this way your body will always have what it needs. Note: carbohydrates, proteins and fats are all macronutrients Vitamins: 1. Can be obtained by foods consumed 2. Others are human made and taken as supplemental 3. Are necessary to assist the body to function

Minerals: Are found in foods we eat

Note: Vitamins and minerals are micronutrients

Water: Water is a vital nutrient

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Section 11-5 Nutritional Guidelines


RDA = Recommended Daily Allowance 3 components of food choice include: 1. Proportion 2. Variety 3. Moderation Fiber: We live in a highly toxic world, where what we eat and drink plays a more critical role in our health than ever before. Not only is our food poisoned with thousands of chemicals but also virtually devoid of any nutrients. We try to compensate for this lack by eating much larger quantities than would otherwise be necessary. To make things worse, most of us don t engage in regular physical activity. Role of fiber in the body functions: Binds toxic chemicals preventing their absorption Binds bile acids lowering serum cholesterol levels Increases bulk and softness of feces, reducing pressure on colon walls Decreases transit time of feces

List your eating habits from yesterday: Breakfast: Lunch: Dinner:

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Certified Chiropractic Physicians Assistant, 4th Edition Planning a healthy diet includes many factors such as: 1. How often should you eat? Only when you are hungry When your body needs fuel

2. How much should you eat? Eat your food slowly Never stack your plate If you feel very hungry, let the larger portions be fruits and vegetables

3. Nutritional supplements: Increase metabolism Help with digestions Assist with nutrient absorption

The difference between diet and nutritional supplements: Diet supplements help with losing weight Nutritional supplement help boost the bodys ability to absorb foods or replaces lost nutrients such as calcium

Why are vegetables important? Vegetables provide vitamins, such as vitamins A and C, and folate, and minerals, such as iron and magnesium. They are naturally low in fat and also provide fiber. The Food Guide Pyramid suggests 3 to 5 servings of these foods a day. Why are fruits important? Fruit and fruit juices provide important amounts of vitamins A and C and potassium. They are low in fat and sodium.

Section 11-5 Cholesterol


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Cholesterol is a fat like substance that is normally present in the blood. Most of the cholesterol is manufactured in the body, mainly the liver. The rest comes from foods we eat. Understanding Cholesterol 1. Cholesterol is a paradox: Everyone needs it, but too much of this good thing can spell trouble for some people. 2. A fat-like substance, cholesterol aids vital bodily functions such as building new cells, producing hormones, and digestion. 3. Normally, your liver makes all the cholesterol your body needs. But you also get cholesterol from your diet. Cholesterol is found in foods derived from animal products, although it's possible to remove it through special processing techniques. While foods derived from plant products do not contain cholesterol, they can (like animal products) contain saturated fats. And a diet high in saturated fats can also raise your cholesterol level, especially if you are genetically predisposed to high cholesterol. 4. The cholesterol and fats you eat are absorbed into your blood through your stomach and intestines. Much of the fat is then transported to fat cells, while most of the cholesterol is taken to wherever your body needs it in the form of high density lipoprotein (HDL) particles. Your liver takes up whatever is left. This leftover cholesterol is either used by the body or taken apart to create low density lipoprotein (LDL) which circulates in your blood. 5. LDL cholesterol collects in the walls of arteries, initiating hardening of the arteries. 6. Since no one can predict with certainty which people with high cholesterol will develop heart disease, play it safe and keep your cholesterol levels in check. The American Heart Association recommends that you eat less than 300 mg of cholesterol per day. Who Develops Cholesterol Problems? Some families are genetically blessed with low total cholesterol or high levels of HDL (good cholesterol), regardless of diet or lifestyle. Other families inherit genes that increase their risk for high cholesterol. In these people, eating a diet high in saturated fat can significantly raise cholesterol levels. Stress can also raise blood cholesterol levels, especially since stress can lead to poor eating habits that may increase cholesterol intake.

How high is too high? Desirable Less than 200 2011 Copyright, Chiropractic Educational Network 178

Certified Chiropractic Physicians Assistant, 4th Edition Borderline High 200-239 240 and above

The best way to monitor your cholesterol is have it check yearly. Risk factors of High Cholesterol? Obesity Smoking History of heart disease Not exercising

Bad Cholesterol (LDL): Low Density Lipo Proteins LDL - The "BAD" cholesterol LDL is the most numerous cholesterol carrier found in the blood. It is also the material that contributes most to the buildup of plaque on artery walls. Decreasing the amount of LDL cholesterol in the blood is an important part of decreasing risk of heart disease.

How Medical doctors attempt to lower cholesterol: Chiropractors try changes in diet and exercise Medical doctor initial drugs such as lipitor Cholesterol lowering medications have severe side effects

Natural ways to lower bad cholesterol: Changes in diet Increasing or initiating a regular exercise program

Good Cholesterol (HDL): High Density Lipoproteins 179

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HDL - The "GOOD" cholesterol HDL cholesterol makes up a smaller portion of the cholesterol carriers. HDL removes cholesterol from the blood by carrying it to the liver where it is metabolized. Therefore, it is beneficial to have high levels of HDL in the blood.

Triglycerides: Triglycerides are the chemical form in which most fat exists in food as well as in the body. They're also present in blood plasma and form the plasma lipids.

Triglycerides Normal Borderline-high High Very high Less than 150 150 to 199 200 to 499 500+

How to eat right to lower cholesterol: Avoid excessive fats Drink more water Limit fast foods Eat regular meals, not just snacks

Where is the FAT? 1. Monounsaturated fat (Good fat) 2011 Copyright, Chiropractic Educational Network 180

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Are liquid at room temperature May help lower your total blood cholesterol level Are thought to raise HDL (good) cholesterol and lower LDL (bad) cholesterol levels Are found in greatest abundance in canola, olive, and peanut oils

2. Saturated fat (Bad fat) Are usually solid at room temperature (lard) Are found in many animal products and tropical oils Cause the total blood cholesterol level to rise

Section 11-6 Health Habits


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Certified Chiropractic Physicians Assistant, 4th Edition Personal development of health habits: Dont follow bad examples Like what you eat, dont eat what you like Educate yourself about food Take time to eat right

What are Daily Living Activities? Things like: What Dressing yourself Eating Bathing Cleaning your house interferes with daily living activities? Pain Physical limitations Body Malfunctions Stress

Foods highest in saturated fat: Sausage Bacon Fried Chicken Fried Pork French Fries Butter Fried Chitins Tacos Hamburgers Hotdogs

Diet Downfalls: At the office Snacking 2011 Copyright, Chiropractic Educational Network 182

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No time for a proper meal Working long hours

Making Dinner Tasting the food all the time Cleaning up after dinner Eating one last nibble Eating more so you dont waste it

Watching TV You keep eating until the show is over The big bowl If the bowl is big you will eat everything in it Use a smaller bowl

The Body Blues Sleepy People eat when tired But getting tired can be caused by not eating Eating can make you tired

Hungry Are you really hungry? Did something just look good? Are you stretching your stomach?

Snack happy If you keep snack near, you will eat them Eat healthy snacks 183

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Eat meals to avoid excessive snacking

Why are women at risk? Hormonal issues such as menopause Increases daily stress

Craving sweets Eat Something sour Tell yourself its not that good Dont buy sweets

Creating a well-balanced Diet What is your ideal weight? How did you determine that?

What is your ideal weight?

How did you determine that?

10 Tips for Healthy aging 1. Eat five helpings of fruits and vegetables daily

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2. Exercise regularly 3. Get regular health checkups 4. Dont smoke. If you smoke now QUIT! 5. Practice safe habits to prevent injuries 6. Stay active 7. Avoid overexposure to sun or cold 8. Only drink alcohol in moderation 9. Avoid crash dieting 10. Keep a positive attitude towards life and do things that make you happy

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1. As a health care worker, how do your health habits influence others? 2. What would be the best way to begin a diet?

In Review 1. What is the difference between LDL and HDL? 2. Why do people diet? 3. Describe a balanced meal?

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Chapter 12 Exercise

Section 12-1 Introduction to Exercise

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Certified Chiropractic Physicians Assistant, 4th Edition The hardest part of an exercise routine is getting started. Once you've established a regular pattern of exercise, you'll find yourself following it. So, how do you get started? First consult your doctor o Your doctor can recommend the specific kinds of exercise for your own individual needs Exercise will only become a habit if it's fun! Pick something you will enjoy doing If you like being with a group of people, try a team sport like basketball or soccer. Anyone can exercise Social activities like dancing Walking Bicycling Swimming Pilates Aerobic Be honest about what you realistically think you can do Consider your current state of physical fitness o If you haven't exercised in years, you'll definitely want to start with some modest activities o As you get adjusted, you can increase your activity Consider your schedule Are you a morning person? o Then plan to exercise in the morning. If you're the type that keep hitting your snooze button o Exercise in the evening

Finally, take it easy Make sure that you exercise intelligently and cautiously o Exercise should improve your health, not risk it Exercise is increasing your heart rate, thus forcing the body to work harder. This activity assists with several aspects that help you find better health. These include:

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1. Speeds up the bodys metabolism which aids with burning excess fat from the body 2. Increases the heart rate which provide you with better endurance 3. Rids the body of toxins when you sweat 4. Keeps skin softer 5. Keeps muscles tone and tight 6. Keeps you flexible, which help to avoid injuries Why do you need exercise? 1. 2. 3. 4. 5. 6.

What does exercise do for the body? 1. 2. 3.

How does exercise affect your stress levels? 1. 2011 Copyright, Chiropractic Educational Network 189

Certified Chiropractic Physicians Assistant, 4th Edition 2. 3. 4. How to balance your diet and exercise? 1. 2. 3. 4. 5. 6. 7. 8. 9. Before you exercise: 1. 2. Dress for exercise: 1. 2. 3. 4. FYI: 1. Never wipe off sweat! It's your bodys natural cooling system. 2011 Copyright, Chiropractic Educational Network

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2. Did you know that in a normal lifetime a person would walk 65,000 miles!

Benefits of Exercise: 1. 2. 3. 4. 5. FYI: The average person gains about 7.5 pounds to their weight during the winter months. Keys to Exercise: 1. 2. 3. 4. Common Weight Problems: 1. 2. 3. Can lack of exercise lead to pain? 1. 2011 Copyright, Chiropractic Educational Network

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2.

Why People Avoid Exercise Are you too busy to exercise? Youre not alone as studies show about 60% of Americans do not get the recommended amount of physical activity and about 25% are not active at all. Many people think exercise is walking to the refrigerator for another bowl of ice with heaping amounts of chocolate syrup. Bottom line is that the number of people not exercising is far greater than those who do exercise. Listed below are the top 10 excuses why people do not exercise, which excuse do you use? 10. Dislike exercise 9. Have tried exercise but keep quitting 8. Not able to afford a gym membership 7. Not seeing any changes in your body 6. Do not know how to exercise 5. Want to exercise but have to take care of the kids 4. Not motivated enough to exercise 3. Exercise hurts 2. Not able to stick to a routine 1. NO TIME If you have time to watch TV, you have time to exercise o It all comes down to personal commitment and the desire to stay healthy Excuses come cheap o Staying healthy and in shape is actually a full time job

Section 12-2 How to Exercise


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Certified Chiropractic Physicians Assistant, 4th Edition 1. Know your Limits 2. Do not try to jump in too fast 3. Consult with your doctor first 4. On a regular basis 5. With Someone 6. Good results take time 7. Attitude is important 2011 Copyright, Chiropractic Educational Network 193

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8. All bodies are different

9. Newest trends in exercise

10. Deciding what form of exercise is right for you Precautions for Exercise 2011 Copyright, Chiropractic Educational Network 194

Certified Chiropractic Physicians Assistant, 4th Edition 1. Never start before consulting a doctor 2. Sometime less is more 3. Always stretch before you exercise 4. Be careful of outdoor running/walking 5. Invest in good exercise clothing 6. Invest in good exercise shoes 7. Stop anytime you feel short of breath 8. Monitor your pulse rate to avoid overexertion 9. Avoid exercise that is too strenuous 10. Find YOUR comfort zone

Complete Fitness Complete fitness is a combination of diet, nutrition, exercise and living a healthy lifestyle. Complete fitness will help you be successful in the following areas:

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2. Relationships 3. Financial security 4. Fulfilling and active life 5. Health 6. Personal Happiness Facts: 1. Only you have the willpower 2011 Copyright, Chiropractic Educational Network 196

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2. You must want complete fitness 3. Your progress depends on your desire to achieve 4. You do not have to choose diets with bad tasting foods 5. You can overcome bad habits 6. You can release the guilt 7. You can realize youre potential 8. You can be happy with how you look

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Section 12-3 Warming Up When a muscle is stretched, some of its fibers lengthen, but other fibers may remain at rest. The more fibers that are stretched, the greater the length developed by the stretched muscles. Flexibility is defined as "the absolute range of movement in a joint or series of joints that is attainable in a momentary effort with the help of a partner or a piece of equipment." This definition tells us that flexibility is not something general but is specific to a particular joint or set of joints.

Internal influences
o o o o o o

the type of joint (some joints simply aren't meant to be flexible) the internal resistance within a joint bony structures which limit movement the elasticity of muscle tissue (muscle tissue that is scarred due to a previous injury is not very elastic) the elasticity of tendons and ligaments (ligaments do not stretch much and tendons should not stretch at all) the ability of a muscle to relax and contract to achieve the greatest range of movement

External influences
o

o o o o o o

the temperature of the place where one is training (a warmer temperature is more conducive to increased flexibility) THE WARMER THE MUSCLE THE BETTER THE STRETCH the time of day (most people are more flexible in the afternoon than in the morning, peaking from about 2:30pm-4pm) age (pre-adolescents are generally more flexible than adults) gender (females are generally more flexible than males) one's ability to perform a particular exercise (practice makes perfect) one's commitment to achieving flexibility ITS TAKE LOTS OF PRACTICE the restrictions of any clothing or equipment

Warming up: The general warm-up should begin with joint-rotations, starting either from your toes and working your way up, or from your fingers and working your way down. This facilitates joint motion by lubricating the entire joint with synovial fluid. You should perform slow circular movements, both clockwise and counter-clockwise, until the joint seems to move smoothly. 2011 Copyright, Chiropractic Educational Network 198

Certified Chiropractic Physicians Assistant, 4th Edition You should rotate the following (in the order given, or in the reverse order): 1. fingers and knuckles 2. wrists 3. elbows 4. shoulders 5. neck 6. trunk/waist 7. hips 8. legs 9. knees 10. ankles 11. toes What happens when you exercise without stretching? 1. 2. 3. 4. 5.

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Section 12-4 Patient Exercise Programs


1. The doctor determines which exercise will best benefit the majority of patients 2. Create written directions 3. Provide visual charts to follow 4. Provide one-on-one training 5. The doctor must follow-up to document progress

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Certified Chiropractic Physicians Assistant, 4th Edition 6. Have the patient share with you their concerns Educating Patients 1. Why exercise is part of wellness 2. How they can get started 3. Share your success story 4. Confront their concerns 2011 Copyright, Chiropractic Educational Network 201

Certified Chiropractic Physicians Assistant, 4th Edition 5. Educated them on what happens to the body without exercise

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Section 12 Review
Critical Thinking 1. Write a one page plan to educate patients about the importance of exercise. Include a startup exercise schedule. 2. How does a persons attitude influence their workout?

In Review 1. Why is warming up so importance before exercise? 2. List 3 health benefits of exercising? 3. What is the purpose of sweating?

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