Currently, I am working as a “Clinical Nurse Educator” at a local hospital and I’m also a “Celiac Nurse and Gluten Intolerance Consultant” in British Columbia, Canada. I am thrilled to use my book as a resource to help increase awareness in the healthcare system and amongst the public. Also, it is an honor to be able to share everything I have learned to help ease patient’s transition to a new healthier gluten-free lifestyle.

As well as an e-book, Gluten Toxicity can also be purchased as a paperback in Canada, the United States, the United Kingdom, Germany, and Japan.

If you are interested in purchasing a paperback copy of “Gluten Toxicity: The Mysterious Symptoms Of Celiac Disease, Dermatitis Herpetiformis, And Non-Celiac Gluten Intolerance”, then please see the links below.

Amazon For Canada 

Amazon For The USA 

Amazon For The United Kingdom 

Amazon For Germany

Amazon For Japan 

If you would prefer an e-book version of “Gluten Toxicity”, please see the E-Book from my blog.

Thank you very much for your support,

Shelly Stuart, R.N., B.Sc.N.

In the near future, “Gluten Toxicity” will also be available locally at Country Sun Natural Foods in White Rock (BC, Canada) and at Lifetime Organics In South Surrey (BC, Canada). I’ll place a post on my blog once the books are available at these two stores.

My Book is also available as an E-Book.

Thank you very much for your interest in “Gluten Toxicity”.

Link:  http://www.amazon.com/Gluten-Toxicity-Mysterious-Herpetiformis-Intolerance/dp/1453864113

Best Regards,

Shelly Stuart, R.N., B.Sc.N

Let me explain further, some people may go to the allergist, get diagnosed with a wheat allergy (IgE mediated), but not get the full diagnosis of having a gluten intolerance. Once they start to eat wheat free they may feel better since a large percentage of gluten would be removed from their diet. However, symptom relief may not last or be complete since they may still be ingesting rye, barley, and contaminated oats. They may continue to suffer, with only a partial diagnosis, and this could lead to further complications and symptoms associated with gluten intolerance.

Hopefully, people who are still suffering in this situation would would look look for help from a knowledgeable doctor  and get a complete diagnosis. For others, the symptoms may be vague or they may get misdiagnosed with other diagnosis.

With this in mind, I think everyone with a wheat allergy should be screened for a gluten intolerance. Otherwise, the gluten intolerance could be masked and people could be left at risk, only partially diagnosed. What do you think?

I have an IgE mediated antibody reaction to wheat and I have celiac disease. Individuals with a gluten intolerance usually have an IgA or IgG antibody reaction to gluten unless they have an IgE mediated allergy too.

How is tissue transglutaminase involved in a gluten intolerance? With celiac disease (CD), tissue transglutaminase 2 is damaged by antibodies in the bowel, antibodies against tissue transglutaminase 3 occur in dermatitis herpetiformis (DH) and antibodies attack tissue transglutaminase 6 in gluten ataxia. It seems reasonable to suspect that cross reactions to other types of transglutaminases could occur throughout the body in gluten intolerant individuals.

Like celiac disease, dermatitis herpetiformis and gluten ataxia, perhaps, immune responses to gluten and transglutaminase in the gut leads to autoimmune activity against various forms of transglutaminases throughout the body and this could result in different types of diseases. IgA and IgG antibodies against tissue transglutaminase could lead to inflammation and autoimmune damage in organs and tissues with transglutaminase. For example, transglutaminase can be found in the bowel, skin, bone, nervous system, lungs, heart, bladder, liver, pancreas, factor XIII (involved in clotting), prostate, uterus, etc. Theoretically, auto-antibodies against transglutaminases could cause inflammation and damage in these areas.

Hypothetically, immune reactions to gluten and cross reactions against tissue transglutaminase could be the underlying culprit in many types of syndromes, diseases, cancers (through disturbed apoptosis) and conditions. Inflammation and damage could result in symptoms throughout the body. I believe researchers need to take a closer look at the role transglutaminases have in the various areas of the body, how it is affected with different illnesses, and how the ingestion of gluten may be promoting a cross reaction against tissue transglutaminase in those illnesses.

With gluten as the underlying trigger, this type of reaction would be considered a type of non-celiac gluten intolerance if there was no intestinal villi damage. However, this non-celiac label may be questionable since intestinal mucosal changes have been found in patients with DH and in patients with gluten ataxia. Future research will help to clarify the similarities and differences between CD, DH, and non-celiac gluten intolerance. For me, it seems reasonable to suspect that all the various types of reactions to gluten are really just celiac disease presenting itself in various ways. Perhaps, it is time to re-define exactly what celiac disease is, instead of using different labels such as DH and non-celiac gluten intolerance.

For patients with diseases, syndromes, and other medical conditions, testing for CD along with antigliadin antibodies and testing for IgA deposits against transglutaminase 2 on intestinal biopsies may help to clarify if  gluten is involved.

More about tissue transglutaminase can be found in my book “Gluten Toxicity”.

References

1. Hasegawa G, Suwa M, Ichikawa Y, Ohtsuka T, Kumagai S, Kikuchi M, Sato Y, Saito Y. A novel function of tissue-type transglutaminase: protein disulphide isomerase. Biochem J 2003; 373:793-803.

2. Kamaeva OI, Reznikov IP, Pimenova NS, Dobritsyna LV. Antigliadin antibodies in the absense of celiac disease. Klinicheskaia Meditsina, 1998; 76 (2):33-5.

3. Griffin M, Casadio R, Bergamini CM. Transglutaminases: nature’s biological glues. Biochem J 2002;368:377-96

4. Hill ID, Dirks MH, Liptak GS, Colletti RB, Fasano A, Guandalini S, Hoffenberg EJ, Horvath K, Murray JA, Pivor M, Seidman EG. Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr 2005 Jan;40(1):1-19.

5. Shane M. Devlin, MD, FRCPC, Christopher N. Andrews, MD, FRCPC, Paul L. Beck, MD, PHD, FRCPC. Celiac Disease. Canadian Family Physician, CME update for family physicians. May, 2004

6. Mishra S, Murphy LJ. Tissue transglutaminase has intrinsic kinase activity: identification of transglutaminase 2 as an insulin-like growth factor-binding protein-3 kinase. J Biol Chem 2004;279:23863-8.

7. Fesus L, Piacentini M. Transglutaminase 2: an enigmatic enzyme with diverse functions. Trends Biochem Sci 2002;27:534-9.

8. Sakly W, Thomas V, Quash G and El Alaoui S. A role for tissue transglutaminase in alpha-gliadin peptide cytotoxicity. Clin Exp Immunol 2006;146:550-8.

9. M Hadjivassiliou, RA Grünwald, GAB Davies-Jones. Gluten Sensitivity As A Neurological Illness. J Neurol Neurosurg Psychiatry 2002:72: 560-563.

10. Sardy M, Karpati S, Merkl B, Paulsson M, Smyth N.Epidermal transglutaminase (TGase 3) is the autoantigen of dermatitis herpetiformis. J Exp Med.Mar 18 2002;195(6):747-57.

11. Hadjivassiliou M, Aeschlimann P, Strigun A, Sanders DS, Woodroofe N, Aeschlimann D. Autoantibodies in gluten ataxia recognize a novel neuronal transglutaminase. Ann Neurol 2008 Sep;64(3):332-43.

12. Hadjivassiliou M, Sanders DS, Grünewald RA, Woodroofe N, Boscolo S, Aeschlimann D. Gluten sensitivity: from gut to brain. Lancet Neurol. 2010 Mar;9(3):318-30.

Below, I have outlined the highlights that can be found in Wendy’s book. I know from my experience as a RN, that conventional medicine only offers the use of medication and a few procedures to help deal with urological issues. Wendy’s book offers endless ideas and alternative tips to help ease the pain and inflammation associated with chronic pelvic pain and bladder problems. For example, with interstitial cystitis, she describes it as the perfect storm with several overlapping contributing factors. Wendy discusses each factor and provides tips to help heal not only the condition, but your whole body and well-being. If you are suffering and looking for answers, then this comprehensive book about the urinary system, the types of disorders that can occur and how to direct your own healing journey may provide the perfect solution.  Currently, Wendy’s book is available from Amazon.com and Amazon.ca.

Highlights From “The Better Bladder Book”

Comprehensive Symptom Review

Wendy discusses the symptoms and the chain of reactions that lead to the symptoms. She helps the reader to see the big picture and explores new ways of thinking about interstitial cystitis and chronic pelvic pain. Many case studies are included.

Lesson About the Urological System

A simplified lesson outlines the urological system and describes various types of dysfunction. Wendy also discusses other conditions that may contribute to chronic pelvic pain.

In Depth Discussion Of The Tests And Conventional Treatments

Diagnostic tests and traditional treatments are discussed. This includes medications, current available treatments and types of therapy that can be used. People who have suffered chronically with bladder issues and chronic pelvic pain may have been exposed to many of these tests and treatments. Wendy helps to outline the benefits with each test and treatment ensuring that patients are aware of all their options.

Alternative Treatments

This is my favourite part of the book. Wendy discusses various therapeutic diets, nutritional supplements, medicinal herbs, and other complementary techniques that can be used to decrease the symptoms, increase urological health and overall wellbeing. This part of the book helps to provide a sense of hope and control to many who are living with daily pain and empowers patients with many options.

Many Resources

Many resources are provided at the end of the book including organizations, websites, resources for kids, centers for IC research, along with articles and books for further reading.

My Thoughts

I think the information in this book really empowers patients so that they can have knowledgeable discussions with their doctors, make educated choices and direct their own recovery. I firmly believe that every patient with urological problems would benefit from the comprehensive knowledge provided in this book.

As well, turkey that has been seasoned or pre-stuffed can be contaminated with ingredients containing gluten. Check the ingredient list on your turkey and call the manufacturer to clarify whether gluten is in the turkey. Hopefully, this information will help everyone to have a safe gluten-free holiday:)

Have a wonderful Christmas everyone,

Shelly Stuart, R.N., B.Sc.N.

Introduction

Wheat was a staple food in our house. During my childhood, I loved how the lovely smell of fresh pies, bread, cookies, buns, or other treats baking in the oven filled the entire house. Waking up to the smell of pancakes or my grandmother’s Chelsea buns was always a special treat. I grew to love and appreciate the value of making baked products from scratch, using primarily wheat flour, but also rye, barley and oats. In my own kitchen, I frequently made French loaves, cinnamon bread, Chelsea buns, pie crusts, cakes, apple strudel, tarts, homemade pasta, and many other tasty treats from scratch. I never suspected these foods that I lovingly made for myself and my family, could have toxic effects on every physiological system in our bodies. The realization of that reality was quite a shock!

The path of ill health that led to my diagnosis was long, twisted, full of potholes (symptoms), and broken bridges (misdiagnoses). Only after diagnosis, did the path begin to straighten, the potholes filled, and the bridges mended. With this new path, I finally was able to heal myself and truly nourish my body with the gluten-free foods that I was genetically designed to eat.

Even though this journey was a struggle, I know I am very lucky. Currently, only 3% (approximately) of the people with celiac disease are diagnosed. Unfortunately, the other 97% are unaware that their symptoms are related to the ingestion of gluten (wheat, rye, barley, and for some people oats), and are living a decreased quality of life with the risk of multiple complications [7].

As well, many are living with a non-celiac gluten intolerance, which is both very under recognized and under diagnosed. Combined, all the forms of undiagnosed gluten intolerance can lead to unnecessary suffering, increased doctor’s visits, increased hospital visits, and possible death due to all the associated complications. This can drastically reduce an individual’s quality of life and adds an additional strain to an already overstressed healthcare system.

This book will discuss the many elusive ways gluten can affect all the systems of the body in gluten intolerant individuals. I reviewed large and small quantitative studies, case studies, and multiple articles while compiling this book. Also included, are my personal stories, patient’s stories and many other stories from people internationally. These stories help to demonstrate how the symptoms can range from vague to very pronounced and obvious.

While reviewing the literature and conversing with doctors, I noticed that many physicians have different views related to the diagnosis and management of celiac disease, dermatitis herpetiformis, and non-celiac gluten intolerance. Therefore, patients who are consulting their doctor about gluten intolerance may only hear one point of view. My goal is to present all approaches in a collective and objective style. My hope is that this information will empower people so that they can have a knowledgeable discussion with their doctor and co-actively create a plan for diagnosis and a plan of care that is individualized to their needs. My belief is that more patient involvement equals better patient outcomes.

Lack Of Awareness Put Me At Risk

I was misdiagnosed and given a variety of explanations for my vague symptoms for most of my life. Unfortunately, even when the symptoms were obvious, misdiagnosis still occurred. For example, I was misdiagnosed with irritable bowel syndrome when I had classic celiac disease symptoms for 5 years prior to my diagnosis.

Eventually, I diagnosed myself by doing my own research and initiating a gluten-free diet to see if it provided symptom relief. Successful, I approached a gastroenterologist and confirmed my diagnosis.

This lack of awareness put me at risk for complications and at risk for a false negative test result since consuming a gluten-free diet prior to diagnosis can lead to false negatives. Unfortunately, delayed diagnosis is very common in many countries. This often leads to an increased risk of developing other autoimmune diseases, lymphomas, cancers, allergies, complications from malabsorption issues, possible decreased immune response to other illnesses, and many other health complications that will be discussed in this book.

What Inspired Me To Create This Book?

Inspiration #1:

My love for my family has been a powerful motivator for the creation of this book. Gluten intolerance is very prevalent in my family. Therefore, this book is my gift to my current and future family members (grandchildren, great grandchildren, etc). I feel that this guide provides the information they will need to get diagnosed and to help improve their health once diagnosed. For many years to come, my infinite love and guidance can be passed on through this book.

Inspiration #2:

Many are suffering and quite likely many are dying globally due to undiagnosed celiac disease, dermatitis herpetiformis and non-celiac gluten intolerance. This breaks my heart when I think of grandparents being lost due to dementia or illness, couples dealing with infertility or pregnancy issues (potentially leading to loss of a baby), mothers and fathers struggling with illness, children with cognitive disabilities affecting their ability to achieve their potential in life, and many others who are suffering with a variety of misdiagnoses.

This is what I visualized while I wrote this book. I shed tears a number of times just thinking of all the people who are afflicted by gluten intolerance. I am hoping that this book will help others to recognize that a link may exist between their symptoms and the ingestion of gluten. Recognition, diagnosis, and a gluten-free diet may be all that is needed to increase their quality of life and end the suffering.

As time passed, I developed into a tall, but thin child. My low weight didn’t make sense because I ate copious amounts of food. During family gatherings, my relatives would frequently comment about my appetite and my aunts marveled at my slim size. Everyone assumed that my slim build was due to my active lifestyle, growth spurts, and perhaps a high metabolism. No one suspected that it was due to a malabsorption issue, likely, because I didn’t have any gastrointestinal symptoms and I was tall. We now know that many people with celiac disease (CD) do not have gastrointestinal symptoms and many are tall, despite the malabsorption problems. Not everyone with CD has short stature.

In addition to the low weight, I would occasionally get pressure and tightness in my chest that was diagnosed as growing pains. Now, I know that this was likely indigestion, a symptom of CD. I also remember having problems with forgetfulness and sometimes it was difficult to think (I call this foggy brain).

With puberty, came anemia, canker sores, restless legs, leg cramps, brittle nails, low blood pressure, more foggy headed days, ovarian cysts, indigestion and I frequently felt an unusual heavy feeling in my abdomen after eating bread or pasta. The symptoms would exacerbate with any physiological or psychological stress. My mother experienced some of the same symptoms for years so I didn’t think it was that unusual. Our doctor prescribed iron pills for our anemia with no further investigations. I now have labeled this, “The Band Aide Treatment”, since it just addresses the symptoms without diagnosing the cause.

As more time passed, I went to university, graduated with honors (a real struggle on my foggy head days), and naturally started to avoid some of the foods (bread, pasta) that sat heavy in my stomach. This helped me to feel better and I didn’t question it further since I assumed that bread and pasta were very filling foods that made most people feel full and tired.

I married and shortly after I became pregnant with our first child. I had anemia and palpitations during the pregnancy. My daughter was born 3 weeks early due to my water breaking and, luckily, she appeared to be a healthy baby with no apparent health problems. My health problems continued. Three weeks postpartum, I started having loose stools multiple times a day and this lasted a few weeks. All tests were negative (a celiac screen was not included).

With my second pregnancy, I was hospitalized and put on bed rest, due to premature inter-uterine contractions and pain. I also had anemia with this pregnancy and delivered 2 weeks early. My second baby appeared to be healthy. My ill health continued, three weeks postpartum, the loose stools started again and I lost all my pregnancy weight. I was checked for parasites, had a colonoscopy, and investigations stopped there since the loose stools stopped after a few weeks. A upper endoscopy would have diagnosed celiac disease but it was not offered, instead the doctor diagnosed me with hormonal irritable bowel syndrome.

With my third pregnancy, I had inter-uterine fetal growth restriction and had to decrease my activity. I remember adding lots of pasta and bread into my diet to help increase weight (exactly the opposite of what I needed since the pasta and bread had a high gluten content). My third child was born 1 and 1/2 weeks early at 6 pounds, 6 ounces. Three weeks postpartum, the loose stools returned. Again, I was checked for parasites and had a colonoscopy. Since my results were negative, I was told that I conclusively had irritable bowel syndrome. With ongoing intermittent diarrhea, I was loosing nutrients and it was difficult to keep up my breast milk supply. I had to stop breast feeding my third child after six weeks due to poor quality and production. Due to diarrhea and malabsorption, I likely had multiple nutrient deficiencies

This time, my symptoms didn’t subside, only more were added. Muscle weakness, arthritis symptoms, weight loss, various nervous system symptoms, frequent lung infections, fatigue and skin rashes were more warning signs that I desperately needed help. During this time, I also had 3 little girls, ages 10 months, 2 years, and 4 years. It was a real struggle trying to be an energetic creative mother for my children. I remember my mom flew out to visit and she was in tears when she saw me. She said that I looked like I had terminal cancer. In many ways, she was right, my body was deteriorating, but not from cancer. Gluten toxicity was affecting every part of my body leading to inflammation and damage. During this period, I lost quality time with my family, my friends, and time at my work.

After a long undiagnosed journey with many symptoms, I managed to finally link my ill health to celiac disease. A gastroenterologist confirmed a celiac diagnosis and I have been living gluten-free for the last 6 years. Once diagnosed, I had my siblings, parents, and children screened. My mother and daughter also had positive results. My mother had canker sores, restless legs, leg cramps, brittle nails,and anemia. My daughter only presented with occasional stomach aches and pale skin. Finally, we were all able to heal.

My Mission To Increase Awareness

Once I was diagnosed, I learned that only 3-5% of people with CD are diagnosed. This along with my personal experience, inspired me to fulfill a mission to do my part to increase awareness and diagnosis. Working with a variety of patients at the hospital has allowed me to identify potential Celiacs in the hospital population. Many undiagnosed Celiacs have frequent doctors visits and are admitted to the hospital with a variety of diagnosis. I have requested Celiac screening for many patients.

Once my youngest entered grade 1, I knew I could begin writing a blog about celiac disease and gluten intolerance. In addition to my blog, I also began increasing awareness as Celiac Nurse on Facebook, and CeliacNurse1 on Twitter.

As time passed, I began to seek other ways to use my 21 years of nursing (including 5 years of gastroenterology) and 6 years of living successfully with celiac disease to help others. Currently, I am a Celiac Nurse and Gluten Intolerance Consultant at Stuart Healthcare Solutions (my company) in British Columbia, Canada. With this position, I am able to provide support services to assist with diagnosis, education, health assessments, a new lifestyle and problem solving when complication arise. This professional focus has become my passion. Helping others navigate the maze associated with gluten toxicity has become a way of life.

I am an optimist and I believe that change is possible. Imagine, a future with everyone diagnosed, doctors and nurses who are knowledgeable about the full spectrum of gluten intolerance, and all the restaurants, companies, and grocery stores competently selling GF products and meals. This is what I visualize as I start each day. A better future for myself, my children, my future grandchildren, and others who are adversely affected by this little protein called gluten.

Shelly Stuart, R.N., B.Sc.N.

Celiac Nurse & Gluten Intolerance Consultant

Stuart Healthcare Solutions, BC, Canada

Blog: http://www.celiacnurse.com

Blog: http://paleolithicrn.blogspot.com

Twitter: CeliacNurse1, PaleolithicRN, GlutenToxicity

Facebook: Celiac Nurse and author page, Gluten Toxicity

Myspace: Shelly Stuart, Celiac Nurse

“Gluten Toxicity” Highlights

Comprehensive Symptom Review

Chapters 3-14, discuss the many elusive ways gluten intolerance can present as vague or pronounced symptoms. Each chapter focuses on one system of the body and how reactions to gluten can lead to the symptoms in that part of the body. For example, in the gastrointestinal chapter, the book discusses how symptoms can occur in each area of the gastrointestinal tract including the mouth, esophagus, stomach, intestines, liver, pancreas, and gallbladder.

Chapter 14 includes diseases, syndromes, and conditions associated with gluten intolerance and chapter 15 has a comprehensive checklist of symptoms that can be completed and taken with you to the doctor to request testing.

In Depth Analysis Of The Tests

Chapter 17 discusses the panel of gluten intolerance tests, all of the pitfalls with diagnosis and how false negative test results can occur. Special diagnostic considerations with ataxia and other neurological issues is also included.

Differences in doctor’s diagnostic practices is reviewed so that the reader can make informed choices for diagnostic testing. Due to the lack of awareness about gluten intolerance, some doctors do not use all of the tests. This could lead to false negative results or an incomplete diagnosis.

Gluten-Free Diet Information

My gluten-free diet is discussed with tips to improve the nutrient value of the diet. Thirty extra gluten-free diet and health tips help the newly diagnosed to learn a new way of eating.

There is much debate around the use of oats in the gluten-free diet. To help address this issue, I added some information about the pros and cons associated with adding oats into the diet and some recommendations for people who would like to consume pure uncontaminated oats.

Extra Therapeutic Diet Information

Taking the required dietary change a step further, the book discusses the use of other therapeutic diets such as the paleolithic lectin-free diet, the specific carbohydrate diet, the grain-free diet, and the elimination diet. My experience with each diet is included. Sometimes, the gluten-free diet doesn’t relieve all symptoms. Other factors along with the use of therapeutic diets need to be considered. Every patient is unique and requires an individualized care plan to achieve an optimum state of wellness.

Tips To Consider: What If The Gluten-Free Diet Doesn’t Work?

What if you have been on the diet for a while and it doesn’t seem to be working? Also, what if the diet was working, but now it isn’t. If you are dealing with these difficulties, then “Gluten Toxicity” has recommendations that you can discuss with your doctor, gastroenterologist, and other specialists.

Thirty Life Style Tips To Ease The Transition

Initially, the healing phase and gluten-free lifestyle can can present with some challenges. “Gluten Toxicity” offers thirty additional lifestyle and health tips that can help to speed up your healing and ease the transition into a new lifestyle.

Tips To Help Heal Intestinal Villi

Some people with a form of gluten intolerance called celiac disease have intestinal villi damage. Chapter 19 discusses 10 facts about intestinal villi and 10 steps that you can take to improve villi health.

Flow Charts

A helpful flowchart will help you to keep track of blood test results and your progress. Recommended blood tests are included on the chart.

A second flowchart provides a list of tasks to consider once diagnosed. Many recommended tasks are included in this chart as well.

New Theories

The prevalence of celiac disease has significantly increased over the last 50 years. This has inspired me to investigate the possible reasons behind this increase. I dedicated a chapter to discuss 12 theories that may shed some light on this public health issue. Some of the theories are currently being explored, others are just hypothetical possibilities. I look forward to discussing these theories further with readers on my author page at Facebook. Together, as a collective conscious, we can brain storm and may come up with some new theories to be explored.

My book discusses other theories as well, such as emerging theories for non-celiac gluten intolerance, the hypothetical link between the high prevalence of food allergies and gluten intolerance, the possible benefit of using therapeutic diets for other autoimmune diseases and the use of gluten-free diets to increase the health of pets. I think many people have been wondering about these possible connections so I took some time to explore this in the final chapters of the book. I look forward to discussing this with you on my author page.

Support For A New Lifestyle

I dedicated my final chapter, “Support For A New Lifestyle”, to all of the heroic souls who are advocating for those who are suffering from gluten intolerance. Collectively, the people listed in this chapter work tirelessly to promote awareness, diagnosis, and provide tips and recipes to help increase success with the GF lifestyle. They have made generous contributions to help others link their symptoms to gluten intolerance and to help others live a successful gluten-free lifestyle.

This chapter provides links for support groups, celiac disease centers, gluten-free magazines, gluten-free forums, travel and dining resources, food allergy magazines, gluten-free radio, and gluten-free television. A list of gluten-free bloggers and an additional list of helpful books is also included.

Many Empowering References

In the bibliography, many references are available to empower people with the research studies they need to influence their doctor to test them. Unfortunately, many patients have encountered doctors who discourage testing. This is often due to lack of awareness about the symptoms associated with gluten intolerance.

My Mission

Many are suffering and quite likely many are dying globally due to undiagnosed celiac disease, dermatitis herpetiformis and non-celiac gluten intolerance. This breaks my heart when I think of grandparents being lost due to dementia or illness, couples dealing with infertility or pregnancy issues (potentially leading to loss of a baby), mothers and fathers struggling with illness, children with cognitive disabilities affecting their ability to achieve their potential in life, and many others who are suffering with a variety of misdiagnoses. I am hoping that “Gluten Toxicity” will help others to recognize that a link may exist between their symptoms and the ingestion of gluten. Recognition, diagnosis, and a gluten-free diet may be all that is needed to increase their quality of life and end the suffering.

“Gluten Toxicity” will be available as an e-book from my blog within the next week and will be available as a 355 page, 5×10 book from Amazon in a few weeks.

For most of my career as a registered nurse, I was unaware of the elusive symptoms associated with gluten intolerance. This was due to the general lack of awareness in north America and the lack of training about gluten intolerance in my degree program. Unfortunately, this often leads to a delayed diagnosis which can place patients at an increased risk for other autoimmune diseases, lymphomas, cancers, allergies, complications from malabsorption issues, and many other health problems.

I suffered for many years with vague symptoms and for 5 years, I was diagnosed with irritable bowel syndrome. My family doctor, a gastroenterologist, and I didn’t recognize the symptoms because we were unaware about gluten intolerance. Eventually, I diagnosed myself by doing my own research and initiated a gluten-free diet to see if it provided symptom relief. Successful, I approached a gastroenterologist and confirmed my diagnosis. This lack of awareness put me at risk for complications and at risk for a false negative test result since consuming a gluten-free diet prior to diagnosis can lead to false negatives. Unfortunately, delayed diagnosis is common in many countries.

This global public health problem has inspired me to take action to increase awareness, diagnosis, and decrease the suffering associated with gluten intolerance. Currently, I increase awareness on my blogs, Twitter, Facebook, Myspace, and through my business as a Celiac Nurse and Gluten Intolerance Consultant in Vancouver, BC, Canada. I have also written a book, “Gluten Toxicity: The Mysterious Symptoms Of Celiac Disease, Dermatitis Herpetiformis, And Non-Celiac Gluten Intolerance”. It will be launched this week as an e-book (price $9.99) on my blogs and in a few weeks it will be available as a 355 page, 7×10 paperback book at Amazon.

My hope is that this book will increase awareness amongst medical professionals and the public. Too many people are suffering unnecessarily. The treatment, a gluten-free diet is readily available and can relieve symptoms within days to a year or more (some symptoms, such as neurological, can take longer). Currently, only 3-5% of people with celiac disease are diagnosed and the rate of diagnosis with the other forms of gluten intolerance is even lower. I sincerely hope that this book, “Gluten Toxicity”, can put gluten intolerance on the radar of medical professionals and patients. Recognition, diagnosis, and the gluten-free diet may be all that is needed to end the suffering.

Shelly Stuart, R.N., B.Sc.N.

Celiac Nurse & Gluten Intolerance Consultant

Stuart Healthcare Solutions, BC, Canada

Blog: http://www.celiacnurse.com

Blog: http://paleolithicrn.blogspot.com

Twitter: CeliacNurse1, PaleolithicRN, GlutenToxicity

Facebook: Celiac Nurse and author page, Gluten Toxicity

Myspace: Shelly Stuart, Celiac Nurse

1. Primary Prevention

The demand for secondary and tertiary prevention has drained available funding for the primary prevention of disease and illness. Through blogging, Registered Nurses can share knowledge from their area of expertise with blog readers to promote health and decrease risk of illness. Many individuals are looking to the internet for knowledge and answers to their questions. The Registered Nurse’s knowledge of evidenced based health care can provide a credible source to a global audience.

2. Establish Yourself as an Expert

Blogging can include information about your area of expertise with reviews of current literature and analysis of recent research. One of my areas of expertise is with celiac disease. I have been diagnosed with celiac disease for 5 years and have learned a tremendous amount about how to cook gluten-free, how to cope with a new lifestyle, how to raise children gluten-free and how to decrease associated risks.  In May/09, I will start sharing some of my experiences and knowledge at www.celiacnurse.com

3. Sense of Contribution

Sharing your knowledge with blog readers and other nurses provides a sense of contribution. I have found that contribution of knowledge and experiences is abundantly prevalent in the blogs I have read. Blogging can empower both the nurse and readers through interactive dialogue to collaboratively contribute unique ideas, new information, and explore future possibilities. Contributing to others feels good and helps everyone involved to grow.

4. Source of Feedback

Blogs can provide a continual source of feedback from other nurses and from the public. Blogs are interactive so readers can provide feedback about your content and you can respond to to the comments. Questionnaires and polls can also provide feedback to the nurse and the compiled results can benefit the readers. I enjoy the idea of self growth personally and professionally through blogging.

5. Develop Writing Skills

Blogging provides a way of developing your writing skills. I have been very busy for 10 years raising 3 children with allergies and auto-immune diseases and welcome this opportunity to not only share what I have learned, but to re-enter into the world of writing.

6. Therapeutic Value

I have learned a tremendous amount about myself through living  with an auto-immune disease and raising children with immune system problems. Sharing my experiences with others is therapeutic in many ways. It is empowering to share.

7. Marketing

Blogging can be valuable to promote yourself professionally or to promote a business. It could lead to a job opportunity in your area of expertise. It is an interesting addition to your resume.

Through the experience of blogging, nurses can learn more about marketing which may be beneficial if you have a business. I read an informative book recently called “The New Rules of Marketing and PR.” This book is written by David Meerman Scott and he has a website at www.davidmeermanscott.com.

There are blogs that discuss how to market your blog, such as Problogger (see below). I’m sure there are many other good blogs on marketing available. I am discovering new sites and information everyday. Please leave a comment if you are aware of other good blog sites that discuss marketing or if you have read a good book on this topic.

8. Current with Technology

Blogging can help nurses keep current with new technology. Your blog can be enhanced with podcasts, videos, e-books, pictures, and other types of add-in or plug-ins that may enrich the readers experience. Your knowledge of marketing and computer technology will increase as you blog. I am just starting my blogs and have learned a great  amount of useful information already. There are many blogs with content about blogging (I am still discovering more) that can provide great resources. ProBlogger at www.problogger.net is my current favorite site for blogging information. Darren Rowse is the author and he is also on twitter. Please leave a comment if you are aware of other blogs or books that are informative.

9. Share Passions, Dreams, Interests

You can share your passions, dreams, interests, and hobbies. On my “About Me” page I have listed areas I have worked, my education, sports I have tried, places I have traveled, and my favorite nursing theorist. Express yourself and your unique personality.

10. Social Networking

Through the process of blogging, nurses can network with readers who have similar interests from all over the world. Readers may provide insight into a different approach to health care or some new information related to your area of expertise. As well, nurses who blog on the same topics can link to each other (or to other readers who blog on the same topic) so readers can get a variety of opinions and views.

Conclusion

Blogging can benefit nurses in a variety of ways. I believe that blogging can provide Registered Nurses with a powerful tool to enhance their professional growth, promote health, and decrease risk from current illnesses on a global scale. I believe that blogging is a co-active venture between nurse and readers and I’m looking forward to a future of sharing and learning from others.

Introduce Yourself and Reveal Your Intention

I like to first introduce myself by saying my name, job title (RN), and outlining the task, questionnaire, goal or planning session I am hoping to complete with the patient. This helps to mentally prepare the patient and helps to initiate the flow of feedback from the patient.

Keep an Open Mind

Avoid forming an opinion before meeting the patient. Verbal information from other healthcare professionals is valuable, but don’t formulate any conclusions until you have done your own assessment. Previous behavior or conversations may have been influenced by environment, medications, or their previous medical condition. As well, there is no room for bias, stereotypes, or prejudices in accurate active listening. Every patient has had individualized experiences that influence them to express who they are in their own unique way.

Assess Emotions

Is the patient demonstrating non-verbal behaviour indicating they may be sad, angry, anxious, frustrated, happy, worried, or depressed? Body language can convey many different and contradictory meanings so it is important to clarify with the patient that your observation is accurate. The patient may need to discuss their current emotion before addressing your initial intention. Helping the patient to  address these emotions first ensures your listening is patient focussed.

Non-Verbal Behaviour is Contextual

Ensure all non-verbal behaviour is assessed in the context of which it occurred. For example, viewing a patient with arms crossed combined with unhappy facial gestures may lead someone to believe the patient is unhappy, angry, or frustrated. Assessing environmental stimuli (such as a open window and cool room) that may be influencing the patient’s body language and also clarification with questions or verbally summarizing what you see and hear from the patient can ensure understanding occurs. In this example, the patient may be cold and the unhappy facial gestures may be from the discomfort of shivering. Avoid making assumptions, always clarify.

Don’t Interrupt

Don’t interrupt the verbal flow of thoughts and emotions the patient is expressing. Hindering the continuity and rhythm of conversation may cause the patient to forget to share valuable information that may affect their care.

Assess Congruency

Is the patient’s verbal language congruent with their body language? Look for non-verbal clues from the patient. There have been situations where I have asked the patient a question and their answer is not congruent with their body language. For example, in my practice I commonly ask patients if they are experiencing any pain. There have been times when the patient’s answer is no, however, they are grimacing, holding a body part (such as their leg or abdomen), or tensing their muscles. Explaining to the patient what I see and asking the question in a different way can help to clarify the answer.

Some patients have difficulty expressing themselves because of communication issues such as aphasia, dysphasia, dysarthria, apraxia, or confusion. Use of visual aides such as pain scales, pictures, and assessment of non-verbal signals can help to assure you understand their issues.

Assess Choice and Rhythm of Words

Is the patient speaking slowly in a monotone tone that is often seen in depressed patients, or rapidly as seen in patient’s that are excited, angry, frustrated, anxious, or in a manic state? Is the patient using aggressive words, passive words, swearing, or using positive inspiring words? Is the patient forgetful, confused, using repetitive language,or experiencing poor concentration? Listening closely to word choice and rhythm can provide valuable insight into their emotional and cognitive state.

Respiratory status can affect word choice and the rhythm of words. Assess rate and rhythm of breath while listening. Difficulty breathing may cause a patient to use very few words as they may need to reserve their energy for breathing. Any abnormal breathing patterns or rates should be promptly investigated and treated.

Assess Tone of Voice

Is the patient’s voice loud, soft, whispering, slurred, normal for the situation, or are they shouting? Assessing tone of voice can give you clues indicating whether the patient is receptive to questions or conversation about their care. For example, if the patient is using a angry loud tone of voice when you go into his room to introduce yourself, you obviously should first  assess his emotional state before proceeding with other care. Always investigate unusual voice tones such as slurred speech (which could indicate alcohol use or a medical emergency) or a soft whispering voice (could have laryngitis, be feeling depressed or fearful).

Sadly, some patients experience delusions, hallucinations, or periods of confusion due to their medical state or frustration with a roommate or their prognosis and this can cause hostility towards anyone interacting with them. Recognition of non-verbal and verbal behaviour possibly indicating hostility can help the nurse to address the client’s feelings and defuse the situation by helping to re-orientate the patient (if confused) or problem solve to prevent further aggression. Always alert other colleagues if a patient is demonstrating hostility or aggression to ensure a safe outcome. Addressing the patient’s priorities/emotions first and getting help can help prevent a bad situation from escalating.

Objective Listening

In my practice, objective listening involves listening without imposing judgement. For example, reacting to verbal hostility from a patient in an angry defensive way may cause a nurse to miss clues that can lead to the source of the hostility. Investigation may reveal the patient has had a misunderstanding because of their language barrier or a medical problem that may cause disorientation such as a stroke, abnormal blood sugar, infection, abnormal oxygen saturation levels, or another condition leading to a altered cognitive state. Objective problem solving may lead to resolution of hostility in other situations. Cultural influences, age, gender, current medical state, medications, feeling a loss of control, coping skills, psychiatric problems, and available resources can all affect our current values and how people react in various situations.

Olfactory Clues

Noticing smells and odours can alert the nurse to possible factors that may influence behaviour. The scent of alcohol, tobacco, fruity breath from hyperglycemia, odour from various infections, or body odour from someone who is sweating (from pain, fever, myocardial infarction, etc) are all olfactory clues that should be investigated and considered in active listening.

Avoid Distractions

An ideal environment for listening is often difficult to achieve, especially in a hospital setting. Hospital environments can be challenging with many visual and auditory distractions. Other distractions may that may affect the nurse or patient include exhaustion, pain, hunger, nausea, feeling hot or cold, recently receiving bad news, or feeling worried about something.

The nurse can help to decrease distractions for the patient by giving medications, food, adjust the temperature, help the patient to problem solve or lesson any stressors, choose a quiet comfortable area, or promote rest times. Nurses can lesson possible distractions by letting colleagues know that you need some time with a patient, getting adequate rest before shifts, eating healthy high energy foods, finding a quiet space to talk, and focussing on the patient while with the patient. I believe that taking steps to lesson distractions helps patients to remain focused on the conversation they are having with you which may lead to greater insight into their medical and psychological needs. Important information can be missed with frequent distractions.

Conclusions

Avoid making assumptions while engaged in active listening. Assessing all verbal and non-verbal clues collectively can provide valuable information that can help to unveil the current psychological and physical medical needs of a patient. Clarifying with questions, verbally summarizing, and identifying feelings can demonstrate that the nurse understands what the patient is verbally sharing.

Be patient and empathetic. When you genuinely care about people it is evident in your body language. Use your non-verbal body language to let the patient know that you are listening. Eye contact (if culturally appropriate), respecting personal space, nodding your head when appropriate from time to time, leaning slightly forward to express interest, having your arms uncrossed and facing the patient while listening can demonstrate to the patient that you are listening to what they are saying. Many unwell patients feel a loss of control when they are ill and knowing that their nurse understands their medical problems and is advocating on their behalf can help them regain a sense of control and hope.  I believe that active listening empowers both patient and nurse to co-actively problem solve, advocate needs to the healthcare team, and  achieve the  highest state of health possible.

Assess Coherence

Is the client alert and orientated to person, place and time? Is the client cognitively able to make decisions or identify health goals? If the client is found to be confused/mentally incompetent following a cognitive assessment, then is there a family member/caregiver that is legally responsible for the client? I have found psychiatric consults, social work, and occupational therapy assessments to be valuable resources to sort out these issues.

Other factors that may affect a client’s cognitive abilities include infections, abnormal blood sugars, abnormal bloodwork levels such as electrolytes, low oxygen levels, exhaustion, or other diagnosis that can cause an altered mental state such as a stroke or brain cancer. Some medications, such as narcotics commonly used to relieve pain, can also affect decision making.

I have found that nurses can help increase a client’s orientation and decision making ability by checking oxygen saturation levels, blood sugar levels if relevant, and bloodwork results to ensure the results are within the normal range. Investigating acute confusion or worsening chronic confusion, ensuring a patient has adequate rest, assessing for side effects to medications, and assessing what time of day is best for decision making (some individuals have more difficulty making decisions later in the day) are also helpful to increase decision making abilities.

History

A thorough history completed at the time of the client’s admission identifies the client’s physical and psychological health concerns, current medications, types of alternative medicine used, allergies, spiritual or religious beliefs, cultural practices, and includes a current head to toe health assessment completed by the MD and nurse.

During this assessment I like to inquire about their lifestyle (active or sedentary), dietary habits, sleep issues, communication problems, disabilities, and methods the patient uses to relieve stress. Knowledge of this history helps me to customize my approach to co-actively identify goals and create a plan with the patient.

Assess Desire

Does the client have a desire to learn more about their health issues, identify goals, and understand  possible plans or paths to recovery? What are the patient’s priorities? Sometimes patients are overwhelmed by their situation,and are not able to focus on goals. Recent loss of a loved one, a traumatic event, extreme pain, depression, or being in a medically or psychologically unstable state can all influence desire. These issues may need to be dealt with first.

I have found that patients that have a desire to set goals generally have a greater commitment to identifying their goals, creating a customized plan, and have the required motivation to implement their plan.

Assess Physical Abilities

What activities of daily living is the client able to accomplish independently and what is the patient’s current prognosis? This knowledge guides the nurses, healthcare team, and client to set up realistic health care goals.

I personally believe that everyone is unique and that realistic healthcare goals are set with the understanding that anything is possible. I have seen many miracles and believe the human body is very resilient and with the right resources can recover from a variety of illnesses. I believe that keeping an positive open mind is important and that patient’s beliefs can influence their recovery.

Assess Baseline Knowledge

How knowledgeable is the patient about their diagnosis and current healthcare concerns? Are there knowledge gaps that need to be addressed by the nurse or other healthcare professionals. While teaching the patient health professionals should consider the patient’s educational and professional background and ask the client how they prefer to learn? There are many methods of teaching/learning that the patient can choose from to maximize their learning experience. I have found that increasing a client’s knowledge base before goal setting can enhance a client’s capacity to identify their goals and make sound healthcare choices.

Communication Abilities

A sore throat, persistent cough, laryngitis, shortness of breath, aphasia, dysphasia, dysarthria, apraxia, visual or auditory impairments, and inability to speak the local language are examples of health conditions that can make communication a challenge. Consultation with a speech language pathologist or speech and language therapist, can help identify the type of disorder that is affecting a patient’s communication abilities and will provide guidance to the rest of the health care team and caregivers that are communicating with the patient. Use of a interpreter that is fluent in in the patient’s language or that is competent in American Sign Language (ASL) can also help to ensure the patient can express their concerns, knowledge gaps, and desired goals. Lip reading, writing on paper or computer, are additional ways patients can communicate.

I have also found that ensuring the patient has their hearing aides, glasses, and any medicines to lesson persistent cough or shortness of breath also helpful. In my practice, I have found that sitting face to face, maintaining eye contact (if culturally appropriate), listening to a client without interrupting, repeating what I have heard to ensure understanding, speaking clearly and if necessarily loudly (for client’s with some hearing loss), discussing one topic at a time, using language that is easily understood (lesson use of medical jargon or technical terms), finding answers to questions in a timely manner, and use of required consults has helped me to foster a effective communication style with my patients. It is also valuable to listen to the patient’s tone, word choice, and non-verbal behaviour. Ask about their feelings around this experience. Ensuring time for questions and providing the patient with a written copy of their goals and plan of care are other ways to ensure the communication is clear. I believe that accurate communication between nurse, healthcare team, and the client is critically important to ensure the patient is fully supported to achieve their goals.

Tool for Goal Setting

Assess Goal-Setting Environment

I have found that home environments tend to have less distractions than hospitals and are better for goal setting. Hospital environments can be challenging with many visual and auditory distractions. Other distractions may include exhaustion, pain, hunger, nausea, feeling hot or cold, recently receiving bad news, or feeling worried about something.

The nurse can assess for these possible distractions before goal setting and give medications, food, adjust the temperature, help the patient to problem solve or lesson any stressors, choose a quiet comfortable area, or promote rest time prior to goal setting. Additional measures can be implemented for patients with visual or auditory challenges. Ensure the room is well lit to optimize sight. Place a ASL interpreter beside the nurse or the facilitator of the meeting so that they are both in the client’s view. Look directly at the patient for the entire conversation, not the interpreter. Maintain eye contact and keep your mouth visible for lip reading. Graphics, pictures, and hand gestures may also be helpful, when appropriate.

I believe that taking steps to lesson distractions helps clients to remain focused on goal identification and creating a plan. Important information can be missed with frequent distractions.

Identification of Resources

Assessment of the patient’s resources before goal identification can help identify family members or caregivers involved in the patient’s care, spiritual supports, cultural practices that are health promoting and stress relieving, alternative medicine practices, financial resources/concerns, home environment, current equipment utilized, and current specialists, MD’s,and healthcare workers involved in the patient care.

Resources that are required for successful goal achievement can be identified when goal setting with the patient. Additional hospital and community resources such as social work, speech language pathologist or therapist, occupational therapy, physiotherapy, dietitian, religious or spiritual supports, or specialists can be consulted as necessary. I believe that understanding the client’s resources can help to identify gaps and understand resources that are required for optimal health.

Conclusion

Encouraging the patient to identify their health concerns and what is the most important goal to them helps to empower them during a time when many patients feel a loss of control. I feel I can help patients to achieve their goals by linking them with resources, advocating their needs to other healthcare professionals, finding the answers to their questions as soon as possible and helping them to set goals and implement a plan. Maintaining a positive attitude (share stories of inspiration) and imagining myself in their situation helps me to co-actively create individualized goals and a care plan that is customized to their needs. It is important to remember that every patient is unique.