Gary Barg sits down with Terry Anderson Girard MSRD - CEO of Anderson Nutrition Services.
Gary Barg: Why is it so important for caregivers to pay attention to nutrition?
Terry Anderson Girard MSRD: It’s really important to be well nourished and from good nutrition comes good health. So, I think that when people are keyed into taking care of themselves nutritionally and health-wise they’ll do a much better job of taking care of others.
Gary Barg: Tell me about your background.
Terry Anderson Girard MSRD: I started very young in a hospital setting as a dietary aide and worked my up through hospital food service. I was very fortunate to be able to get a master’s degree in nutrition and food management and have been working in all types of settings during my life. My area of interest is behavioural health and I work a lot w
Terry Anderson Girard
ith people on mental health issues including depression and other types of serious mental illnesses and addictions that need help with their nutrition. I work in all different types of settings for example, prisons, schools, elderly type feeding programs. I very much love dealing with nutrition and trying to help people solve their problems as they relate to nutrition.
Gary Barg: How can Anderson Nutrition Services, or any registered dietician, help us as family caregivers?
Terry Anderson Girard MSRD: Most people, as they get older, have many chronic co-morbidities. Maybe they’re depressed. Maybe their cognition is poor, but they also have diabetes, or they have a heart problem. And then they need a therapeutic intervention such as a low sodium diet or a consistent carbohydrate diet. Those types of services are called medical nutrition therapy. They’re best done through your doctor’s referral because in 90% of the cases the insurance will pay for most of it – and you can get one-on-one counselling in terms of seeing the registered dietician. Anderson, of course, does all these things. We do them on a local level. The type of other services that we can provide are more general and have to do with wellness and support for a healthy lifestyle. And our programs that we are developing and producing over the internet are run by behavioral nutrition folks. Their work is, of course, overseen by a registered dietician and they run these support group for people who are caregivers who might need a tip here and there or just some support around trying to have a healthy lifestyle for themselves. When, like you say, they’re heading home a midnight or they’re on the fly and have to stop at a fast food restaurant. So, it’s just an opportunity to get a few tips and learn a little bit more about ways that you might be able to conquer the problem when you’re a caregiver.
Gary Barg: Tell me what I’d be able to find on Anderson Nutrition Services website to help me as a family caregiver.
Terry Anderson Girard MSRD: On our website you’ll get a description of who we are. There’ll be a little blurb about our background, our credentials and so forth and then the types of services that we offer. And then there’ll be a prompt to be able to say, "yes, I’d like to join this internet group." It’s a minimal cost; it’s around five dollars to join a group. And it’s not a program where you would be, "Oh I have to sign up for this package, and it’s so much down, and if I miss it I've lost out." It’s not that type of thing. It’s the type of thing you could do in the spur of the moment where you can join in or if you’ve got an extra half an hour to an hour. It’s kind of an on-demand thing. There are four groups a week that are offered at various times. There's a couple in the morning, a couple in the evening to try to accommodate people that have different schedules.
Gary Barg: That makes a lot of sense to me. Walk me through that. What happens? How long does it last, and what do I learn?
Terry Anderson Girard MSRD: I think it probably would run about an hour. We have a dial-in conference. People would dial in and we would start with a little lecture that talks about whichever topic is posted for the week. After that there is a chance for people to talk about their issues, to say “well, here’s my situation, what would you suggest?” And hopefully we would solve the problems in the course of an hour. If not, everyone had a chance to speak and they might at least hear some things that would be relevant to them.
Gary Barg: By the way, what is the website address?
Terry Anderson Girard MSRD: andersonnutritionservices.com.
Gary Barg: What types of questions do you hear from family caregivers?
Terry Anderson Girard MSRD: The basic concerns for many people have to do with their loved one. Say, for example somebody’s having cognitive issues: “I can’t get my Mom to sit down to eat a meal. What am I going to do about that?” Well, obviously, we want to think about finger foods, things that are easy to walk around and eat so that you might not even think about the fact that you're eating them, and the same for liquids. Types of appropriate utensils, recipes that might help you do things faster and nutritionally. Maybe grab a good bite for yourself while you're at it. That won’t take too much distraction away from caring for someone. Those types of things are frequent questions that we encounter and often, people will ask about exercise. “I'm gaining weight here and I'm not even enjoying it. I'm just grabbing what I can to get through the day.” We have a lot of tips for those types of things.
Gary Barg: We met at Orlando Caregivers Conference a few months ago, and it was a pleasure seeing the caregivers interact with you, which is why I wanted to talk to you about this Board of Directors series.One thing I heard from a caregiver was that his dad always refuses to eat healthy. No salads, no fruits, and he’s dealing with mid-stage cognitive issues. His question was about how he can get the nutrition into his dad.
Terry Anderson Girard MSRD: I would say as cognition wanes, particularly in Alzheimer’s there are different stages, as the disease progresses, interest in food becomes less and less and understanding that process for a caregiver is the first key piece. Once you know that, you're going to keep on trying a lot of different ways to get the person to eat. If they’re not going to eat a really healthful meal where they’re not getting all the vitamins and minerals that they need, then maybe we just have to add a vitamin and mineral supplement. Talk to the physician about what would not interfere with other disease states. Sometimes, if a person is really having trouble swallowing, and if they’re not cognitively aware enough, you may have to help them with either taking food out of their mouth or encouraging them to swallow. Those type of issues are a clue that the person is going to need to see either a registered dietician or a speech language therapist. And speech therapists are just a wonderful resource.
Gary Barg: What are the signs that your loved ones are exhibiting that make you need to consider going to a registered dietician?
Terry Anderson Girard MSRD: The first and most important one is going to be hydration. You can look for signs such as sunken eyes and/or you can take the skin in their hand, pull on it a little bit, and if the skin doesn’t go back to its original normal state and stays kind of peaked up, that’s a sign of dehydration. So, you would definitely want to talk to the physician.Sometimes people need a boost with some IV fluid. Other times, they may need some type of a texture restriction in their fluid. They may need to add thickener to their fluid so that they can tolerate comfortably. If somebody is coughing after they swallow a liquid or they’re chewing too much, or they seem to have trouble swallowing, then these are also a concern.It’s good to check their weight at least every month. And if you notice if their clothes are not fitting properly, they’re starting to get loose, that’s a big sign. You really don’t want to see significant weight loss. By significant weight loss, dieticians are looking at five percent of body weight lost in a month, or ten percent lost in six months. If you're not sure whether it’s significant or not, this is something that a registered dietician can help with.
Gary Barg: Now, I'm not talking about anybody I happen to know, but how about cheating diabetics? What can we do?
Terry Anderson Girard MSRD: Obviously, if somebody has a piece of cake with frosting on it and they’re a diabetic, they’re going to have a spike in their blood sugar. A good serving size is one that is going to fit in the palm of your hand. Because if it fits in the palm of your hand it’s proportional to you and you won’t overdo if you’re using just that much. Take that cake and cut it at least in half before providing it to your loved one. That is the simplest way, and if it’s a special event you want them to enjoy life.
Gary Barg: Terry, what is the one most important piece of advice you’d like to share with family caregivers?
Terry Anderson Girard MSRD: It’s just to do the best you can. I think that most of us have a good idea of what basic nutrition should be. If you don’t, get on our support group. But you can certainly go to choosemyplate.gov to get just the basics of what we got to try to provide. That’s a free government website. It’s fabulous. There are all kinds of free things that you can find on that site. You’ll get cooking ideas, recipes, just a good amount of information on what basic nutrition should be. If you still need help, ask.