Which type of glia generate a myelin sheath?

You are meeting with Mr. Adams in the medical oncology outpatient clinic today. Mr. Adams is a 49-year-old Hispanic male who is currently receiving chemotherapy and radiation for lung cancer. He received a PEG for tube feedings when diagnosed 6 weeks ago because of dysphagia as the tumor was pressing on his esophagus. He has had 3 weeks of radiation and 2 rounds of chemo, which has resulted in the tumor shrinking enough for Mr. Adams to start taking some oral nutrition. He and his wife have an appointment with you today because they would like to know how to best manage his nutrition now. He will have radiation for at least 3 more weeks and will have his last chemo treatment in 4 days – he has been tolerating chemo well. He reports tolerating his tube feedings ok; no problems with nausea, diarrhea or constipation. He doesn’t really get hungry in between feedings. Ht: 5′ 7″     Current Wt: 125 lb.     Wt before starting treatment: 148 lb. (2 months ago) Labs: reportedly WNLs Meds: none besides the chemo. PEG feedings: 4 cans per day providing ~1420 calories & 50 grams of protein; he flushes his feeding tube with 60 mL of water before and after each feeding. The formula is 76% free water. He also drinks about 3-4 oz. of juice in the morning without too much difficulty – it just takes him about 10-15 minutes to get it all down. He is not experiencing any coughing or difficulties with swallowing when he drinks the juice. He is just cautious because if he drinks it too fast he thinks he might aspirate. Labs: not available but reportedly WNLs. Nutrition Assessment (20 points):

You have an appointment in the cancer prevention clinic with GC a 32-year-old Caucasian male. He is concerned about his health since he has been told that cancer runs in “the family”. He knows he needs to make some changes in his lifestyle therefore he has an appointment with you today for some suggestions. He played basketball in high school and club sports in college but now feels like there is never enough time to exercise regularly. He describes his job as very stressful causing difficulty with sleep and additionally reports that he has frequently heart burn. However, he states, “it’s time to make some changes”. Ht: 6’ 3”    Wt: 250 lb. (stable)     Blood Pressure: 142/82 Labs: BMP: normal labs     Lipid panel: T cholesterol: 240    LDL: 132    HDL:  42    TGs: 155 Family History: Dad: stage 1 prostate cancer; Mom: osteopenia   Brother: age 48: stage 1 colon cancer Dad’s family: Uncle with colon cancer; Grandfather: prostate cancer and heart disease; Grandma: unknown Mom’s family: Aunt with pancreatic cancer; Grandfather: heart disease; Grandmother died young Diet history: B: Large bowl of corn flakes with whole milk (~1.5 c); 2 large cups of black coffee (~20 oz. total) L: Fast food typically – burgers, Subway, Pizza Hut, etc., Coke (64 oz.) D: Hamburgers, chicken, casseroles, pizza, French fries, 2-3 of beers with dinner on most nights Snack before bedtime: large bowl of ice cream, chips or popcorn and 6 oz. red wine (helps relieve stress) Design 2 PES Statements (10 points) P:                                     E: S: P: E: S:

Malcolm is a 44 y.o. African American male who just completed treatment for early stage prostate cancer. He would like to reduce his risk for recurrence with lifestyle changes. Based on the following information, which of the following would you recommend? Ht: 5′ 11″     Wt:  230 lb. (stable)    Meds/supplements: none, MVM Diet: B: cold cereal & lots of milk; L: Ham & cheese sandwich, potato chips, milk; D: steak, hamburger, pork chops, mac & cheese, potatoes, corn or peas, milk or a beer.

You are meeting with Mr. Adams in the medical oncology outpatient clinic today. Mr. Adams is a 49-year-old Hispanic male who is currently receiving chemotherapy and radiation for lung cancer. He received a PEG for tube feedings when diagnosed 6 weeks ago because of dysphagia as the tumor was pressing on his esophagus. He has had 3 weeks of radiation and 2 rounds of chemo, which has resulted in the tumor shrinking enough for Mr. Adams to start taking some oral nutrition. He and his wife have an appointment with you today because they would like to know how to best manage his nutrition now. He will have radiation for at least 3 more weeks and will have his last chemo treatment in 4 days – he has been tolerating chemo well. He reports tolerating his tube feedings ok; no problems with nausea, diarrhea or constipation. He doesn’t really get hungry in between feedings. Ht: 5′ 7″     Current Wt: 125 lb.     Wt before starting treatment: 148 lb. (2 months ago) Labs: reportedly WNLs Meds: none besides the chemo. PEG feedings: 4 cans per day providing ~1420 calories & 50 grams of protein; he flushes his feeding tube with 60 mL of water before and after each feeding. The formula is 76% free water. He also drinks about 3-4 oz. of juice in the morning without too much difficulty – it just takes him about 10 minutes to get it all down. He is not experiencing any coughing or difficulties with swallowing when he drinks the juice. He is just cautious because if he drinks it too fast he thinks he might aspirate. Labs: not available but reportedly WNLs. What are your MNT recommendations (formatted in SMART goal format) and plan for follow-up? (10 points)

You have an appointment in the cancer prevention clinic with GC a 32-year-old Caucasian male. He is concerned about his health since he has been told that cancer runs in “the family”. He knows he needs to make some changes in his lifestyle therefore he has an appointment with you today for some suggestions. He played basketball in high school and club sports in college but now feels like there is never enough time to exercise regularly. He describes his job as very stressful causing difficulty with sleep and additionally reports that he has frequently heart burn. However, he states, “it’s time to make some changes”. Ht: 6′ 3″    Wt: 250 lb. (stable)     Blood Pressure: 142/82 Labs: BMP: normal labs     Lipid panel: T cholesterol: 240    LDL: 132    HDL:  42    TGs: 155 Family History: Dad: stage 1 prostate cancer; Mom: osteopenia   Brother: age 48: stage 1 colon cancer Dad’s family: Uncle with colon cancer; Grandfather: prostate cancer and heart disease; Grandma: unknown Mom’s family: Aunt with pancreatic cancer; Grandfather: heart disease; Grandmother died young Diet history: B: Large bowl of corn flakes with whole milk (~1.5 c); 2 large cups of black coffee (~20 oz. total) L: Fast food typically – burgers, Subway, Pizza Hut, etc., Coke (64 oz.) D: Hamburgers, chicken, casseroles, pizza, French fries, 2-3 of beers with dinner on most nights Snack before bedtime: large bowl of ice cream, chips or popcorn and 6 oz. red wine (helps relieve stress) List 4 integrative medicine modalities that you might recommend for him and why? (5 points)

You have an appointment in the cancer prevention clinic with GC a 32-year-old Caucasian male. He is concerned about his health since he has been told that cancer runs in “the family”. He knows he needs to make some changes in his lifestyle therefore he has an appointment with you today for some suggestions. He played basketball in high school and club sports in college but now feels like there is never enough time to exercise regularly. He describes his job as very stressful causing difficulty with sleep and additionally reports that he has frequently heart burn. However, he states, “it’s time to make some changes”. Ht: 6′ 3″    Wt: 250 lb. (stable)     Blood Pressure: 142/82 Labs: BMP: normal labs     Lipid panel: T cholesterol: 240    LDL: 132    HDL:  42    TGs: 155 Family History: Dad: stage 1 prostate cancer; Mom: osteopenia   Brother: age 48: stage 1 colon cancer Dad’s family: Uncle with colon cancer; Grandfather: prostate cancer and heart disease; Grandma: unknown Mom’s family: Aunt with pancreatic cancer; Grandfather: heart disease; Grandmother died young Diet history: B: Large bowl of corn flakes with whole milk (~1.5 c); 2 large cups of black coffee (~20 oz. total) L: Fast food typically – burgers, Subway, Pizza Hut, etc., Coke (64 oz.) D: Hamburgers, chicken, casseroles, pizza, French fries, 2-3 of beers with dinner on most nights Snack before bedtime: large bowl of ice cream, chips or popcorn and 6 oz. red wine (helps relieve stress) List his current risk factors for developing cancer (10 points):

As future health care professionals, why should you be concerned about the types and number of dietary supplements that your patients/clients are taking?

You are meeting with Mr. Adams in the medical oncology outpatient clinic today. Mr. Adams is a 49-year-old Hispanic male who is currently receiving chemotherapy and radiation for lung cancer. He received a PEG for tube feedings when diagnosed 6 weeks ago because of dysphagia as the tumor was pressing on his esophagus. He has had 3 weeks of radiation and 2 rounds of chemo, which has resulted in the tumor shrinking enough for Mr. Adams to start taking some oral nutrition. He and his wife have an appointment with you today because they would like to know how to best manage his nutrition now. He will have radiation for at least 3 more weeks and will have his last chemo treatment in 4 days – he has been tolerating chemo well. He reports tolerating his tube feedings ok; no problems with nausea, diarrhea or constipation. He doesn’t really get hungry in between feedings. Ht: 5′ 7″     Current Wt: 125 lb.     Wt before starting treatment: 148 lb. (2 months ago) Labs: Reportedly WNLs Meds: none besides the chemo. PEG feedings: 4 cans per day providing ~1420 calories & 50 grams of protein; he flushes his feeding tube with 60 mL of water before and after each feeding. The formula is 76% free water. He also drinks about 3-4 oz. of juice in the morning without too much difficulty – it just takes him about 10 minutes to get it all down. He is not experiencing any coughing or difficulties with swallowing when he drinks the juice. He is just cautious because if he drinks it too fast he thinks he might aspirate. Labs: not available but reportedly WNLs. Write 2 PES statements (10 points) P:                                                                                 E:                                                                                  S:      P: E: S:                                                                             

Samantha, a 22 y.o. female college student, has a strong family history for breast cancer thus she would like to reduce her risk. Ht:   5 ‘ 1”             Current Wt:   110 lb.                Usual Wt:   110 lb. Medications/supplements: none Physical activity: does yoga 1-2 times/week Diet history: B: none – usually running too late L: Tuna or turkey/cheese sandwich on multi-grain bread; chips and large soda Snack: apple and string cheese; or Oreos and a large glass of whole milk; occasionally nachos D: usually Mexican food, spaghetti w/French bread & 1-2 glasses of red wine, hamburgers or hot dogs with French fries & a large coke; on the weekends will usually grill something – salmon, pork chops, burgers or shish-kabobs; drinks water or coke for dinner most of the time Night snack: something sweet – ice cream, cookies or peanut M & Ms Based on this information, which of the following would you suggest?