Maya M. Beplat, MSN, NP, FNP

We don't yet know what causes depression, but it's thought that it is a combination of genetic, biological, environmental, and social influences. Because of this, the most effective treatments for depression combine medication with psychotherapy. Therapy, especially cognitive-behavioral therapy, can be extremely helpful in resolving the negative thoughts and feelings that come with depression. It gives patients new tools that they can use themselves to cope when their depression is making them feel down.

Some of the common medications used to treat depression include antidepressants such as SSRI's (Prozac, Paxil, Zoloft) or atypical antidepressants (Cymbalta, Wellbutrin). It's important to remember that these medications have different effects on everybody, and no one medication works right for everyone. Patients may have to try a couple before finding the one that works just right for them. If the first medication they try doesn't work, they should talk to their doctor about trying something else. In extreme cases where medication is not enough, electro-convulsive therapy and hospitalization may be the answer to keeping a severely depressed person safe.

Depression is a difficult illness to deal with, but it is more common than believed and there are many people who can help. With the right treatment, individuals with depression can get back to fully enjoying life again.

At the most basic level, nutrition counseling can be simply a talk with a family physician. Doctors receive training in nutrition as part of their education, and they are generally qualified to make recommendations about diet for their patients. Some doctors take a professional interest in nutrition and become experts by taking extra classes or studying nutrition in their practice. In general, however, complex nutrition guidance will be referred to a nutrition specialist, generally a dietitian.

Registered dietitians are nutrition experts that have passed specific higher education, accreditation, and internship requirements. They may work in hospitals, nursing facilities, or private practices to provide nutrition therapy and advise patients about their health and diet. Like dietitians, nutritionists also work to counsel patients about food and health. Some nutritionists have degrees in nutrition or food science, but the title 'nutritionist' is not protected by law. In the United States, anyone is allowed to call themselves a nutritionist, regardless of their education level.

Nutrition counseling can be useful for anyone who is looking to get to a healthy weight, manage a chronic illness through diet, or simply lead a healthier lifestyle. Some examples of issues that benefit from nutrition counseling include:

• Obesity
• Eating disorders
• High cholesterol
• High blood pressure
• Food allergies
• Kidney disease
• Digestive disorders, such as irritable bowel syndrome
• Cancer
• Pregnancy or lactation
• Participation in competitive sports

During a nutrition counseling appointment, the provider -- doctor, nutritionist, or dietitian -- typically will look over a the patient's medical history and talk to them about their current diet, their goals, what kinds of food they like, and any problems that they are currently struggling with in their health or diet. Then the specialist will help the patient set food goals and create a customized plan to help them meet their nutritional needs. Nutrition specialists may also offer classes, workshops, cooking demonstrations, and more. Their role is not to lecture the patient about what one should be eating, but to offer education and resources to make eating healthy foods easier.

There are several different kinds of VAD. While the controller and power source are always outside of the body, the pump itself can be internal or external. Most pump blood with a rhythm, like a human heart does, but some pump blood continuously. A VAD is usually placed in the left ventricle (to move blood to the body) but can be placed in the right ventricle (to move blood to the lungs) or on both sides of the heart.

VADs with external pumps are for short-term use and can be inserted in different ways. Some are mounted on a catheter (a thin, flexible tube) that is attached to the external pump and motor. This requires minor surgery to thread the catheter through a vein in the groin. Other VADs with external pumps require a larger incision on the chest, where inflow and outflow tubes are inserted. These tubes are connected to the external pump and power source. The chest remains open but covered with sterile material until the patient receives his or her heart transplant, which usually occurs within ten days. The patient must remain in the hospital during this period.

Implantable VADs have pumps that are placed within the chest cavity during open heart surgery. Two tubes are attached to the pump, which is implanted in the upper part of the abdomen. One of the tubes is inserted into the heart, pulling blood into the pump, which then sends the blood into the aorta. The other tube goes out of the abdominal wall to the outside of the body and is connected to the power source, which is worn around the waist. Since placing an implantable VAD requires open heart surgery, both the surgery and recovery are longer and more difficult than for VADs with external pumps. However, implantable VADs have a huge benefit in that they are not hooked up to a large machine -- patients are free to move around after being fitted with one. For this reason, they are more common when heart support is needed long-term. They may be used for patients who are waiting for a heart transplant, or as a permanent treatment for those who do not qualify for a transplant.

VADs come with their set of challenges. For instance, placement of the device can take several hours, and recovery can take as long as two months. Often, people who need VADs have experienced heart failure, and their weakened heart and lungs need careful monitoring and support. Patients with VADs that have external pumps need to sacrifice their mobility, while those who have implantable VADs must learn how to keep their device clean, safe, and working properly. Despite any difficulties of adjusting to life with a VAD, they can be lifesaving devices for those who need them.