Volunteer Role Awakens Professional Calling

Every year, more than 800 CHOC Children’s volunteers provide nearly 100,000 hours of service. They pursue volunteerism for different reasons, but they all donate their time to help CHOC provide the very best pediatric services in Orange County. Some are retired community members looking to give back, and others, like Brianna, come in as high school students seeking new experiences.

Brianna started volunteering at CHOC when she was just 16 years old. She needed to complete volunteer hours as part of a school project and having grown up in Orange, she thought CHOC would be a worthy place to donate her time. Back then, she didn’t know what her eventual career path would look like. Due to her customer service experience as well as her bubbly and warm personality, she was placed as a customer service ambassador. That placement would eventually inspire her to become a registered nurse at CHOC.

Members of CHOC's customer service team celebrating Brianna's graduation from nursing school.
Members of CHOC’s customer service team celebrating Brianna’s graduation from nursing school.

“We could tell she loved working with kids and families,” says Sandra Schultz, customer service manager at CHOC. “She was a comforting presence in what can be a scary and stressful time. Her good energy was contagious, and she loved our mission statement- to nurture, advance and protect the health and well-being of children.”

She was tasked with enhancing the CHOC patient experience by visiting patients and families to welcome them upon admittance and ensure that their non-medical needs were being met. If a need were identified, she helped facilitate a solution by providing time-sensitive and compassionate communications with the appropriate CHOC department.

Sometimes the opportunity to help a family was as small as getting a parent a glass of water.

“As a nurse now, I know that it’s the little things that matter,” Brianna says.

Her ambassador role allowed to her see a variety of environments in the hospital, which sparked her interest in nursing, particularly the pediatric intensive care unit.

“It was the most complex I’d ever seen medicine before,” she says. “But I felt like those kids were the ones I was supposed to be with, the kids who were having some of the hardest days of their entire lives.”

As a volunteer, Brianna was an avid learner and wanted to learn about every department inside the hospital. That passion for learning helped propel her through challenging coursework in nursing school, and eased her transition from volunteer to nurse when she came back to CHOC.

During stressful moments in a crucial unit of the hospital, Brianna relies on lessons she learned during her customer service volunteer days at CHOC.

“It’s important to be able to take a step back mentally when things get stressful. I’ve learned to remember where we are, what we’re doing and why we’re doing it,” she says.

Even after she transitioned into a nursing role, Brianna remains a part of the customer service family at CHOC. Her former colleagues-turned lifelong friends surprised her in the PICU on her birthday with a card and gift, and they celebrated her nursing school graduation right alongside her family. Every year the group reunites to participate in CHOC Walk in the Park.

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Are Your Daughter’s Unpredictable Periods Cause for Concern?

By Virginia Liu, pediatric resident at CHOC Children’s

The start of menstruation, or menarche, marks the onset of fertility and is often an important milestone in a young girl’s development. The average age of menarche in the U.S. is 12.4 years, although there is a lot of variability, and it can depend on a number of factors such as ethnicity, genetics and nutrition. It is also very common to have irregular menstrual cycles during the first year after starting periods or menses, as the hormone regulation system is still maturing. But how can you know if the unpredictability of your daughter’s periods are a cause for concern?

Primary vs. secondary amenorrhea

 Primary amenorrhea is defined as not having menses by age 15, or more than three years after secondary sexual development (such as breast development). Causes for this may include abnormalities of the genital tract or irregularities with hormone regulation. Though rare, tumors of the pituitary gland may also be a factor. . These are usually associated with symptoms such as headache, vision loss, or inappropriate breast milk production.  

 Secondary amenorrhea is defined as three months without a period after menses has previously occurred. Causes may include pregnancy, underlying eating disorder, stress, or hormone irregularities.

 What to expect during your doctor’s visit

If there is a concern for amenorrhea, consult your daughter’s primary care doctor. If she does not have a primary care doctor, find one near you. Your physician may ask questions about her medical history, family members with delayed puberty or endocrine disorders, medications including birth control use, growth and development, diet and exercise habits, and stressors. Your child’s weight will be monitored carefully during each visit. Endocrine (hormone regulation) problems are a more common cause of amenorrhea in overweight children, while eating disorders or gastrointestinal diseases are the more common cause in underweight children. Depending on your history, physical exam and symptoms, your doctor may perform additional laboratory tests including a pregnancy test or refer you to a pediatric subspecialist in genetics or endocrinology.

What can you do as a parent?

Stressors may contribute to amenorrhea. Pay attention to whether your child may have social or academic pressures, disordered eating habits, dissatisfaction with body image, or mood changes. Additional clues to keep an eye out for include acne, excessive hair growth, changes in bowel movements, abdominal pain, headaches, vision changes, and abnormal breast or vaginal discharge.

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National Prescription Drug Take Back Day is October 22

Orange County parents and caregivers can help prevent prescription drug abuse by anonymously disposing of expired, unused or unwanted prescription medications as part of the U.S. Drug Enforcement Administration’s “National Take Back Day” on Saturday, Oct. 22 from 10 a.m. to 2 p.m. at locations throughout the county.

The most common source for the last prescription pain medication misused by people over 12 years old belonged to a friend or relative, according to the 2015 National Survey on Drug Use and Health. To help prevent this, practice the following medication safety tips year-round:

  • Remove expired, unwanted or unused medications from your home as quickly as possible, preferably through an authorized collection site.
  • Store medication in a cool, dry place. Keep it out of reach and out of sight, and in a locked location. Do not store it in a purse or nightstand, or other locations children can easily get into.
  • Don’t put medication away in front of children or take medication in front of them, as they tend to mimic adults’ behaviors.
  • Remind children that medicine is not candy.
  • Remember that child-resistant medication containers do not necessarily mean child-proof.

If you are unable to attend this annual community event, follow these easy steps to dispose of most medications in your home:

  • Mix medicines (do not crush tablets or capsules) with an inedible product such as dirt or used coffee grounds
  • Place the mixture in a sealed plastic bag
  • Dispose of the bag in your household trash
  • Remove all personal information from the prescription’s label

To participate in National Take Back Day on Saturday, Oct. 22, anonymously drop off unused medications at any of the more than 30 participating locations throughout Orange County.

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Meet Dr. Michael Recto

As an internationally-recognized expert in interventional pediatric cardiology Dr. Michael Recto’s goal is to provide world-class cardiac care. He treats children with serious congenital heart defects, and performs both diagnostic and interventional cardiac catheterization procedures.

Dr. Recto takes great pride in having worked throughout his career with some of the top cardiologists in the field. When he joined the CHOC Children’s Heart Institute in 2013, he witnessed the same level of talent and knew instantly he was in the right place, he says.

Today, Dr. Recto’s approach to delivering care is to treat his patients and their families the same way he would like his family to be treated. He has learned a lot from his patients and their families along the way, and is still surprised at the touching moments he experiences on a daily basis.

“I had a patient just the other day with an atrial septal defect and I explained to this child’s family that this particular hole between the two atria was going to be hard to close. The patient would possibly require open-heart surgery,” Dr. Recto says. “The patient’s father looked at me and said, ‘We have a lot of faith in you.’ I was indeed able to close the defect in the cath lab. When I came out of the procedure and told the entire family the good news, they stood up and applauded and the father gave me a big hug. I was not expecting that. A moment like that is one of the best things you can experience. It was truly gratifying and humbling.”

 

Dr. Michael Recto
Dr. Michael Recto

“Everyone on the CHOC team is an expert in their field. We have experts in echocardiography (fetal, transthoracic and transesophageal echo), cardiac MRI, electrophysiology and cardiac intensive care. I am proud to be part of such a talented team,” he says.

Dr. Recto enjoys spending time in CHOC’s state-of-the-art cardiac catheterization laboratorities, where he is able to diagnose problems and if needed, perform an intervention and help a patient right on the spot, he explains.

Dr. Recto is board certified in pediatrics and pediatric cardiology. He attended medical school at University of the Philippines College of Medicine, followed by a pediatric internship and residency at New York University Medical Center. He completed a pediatric cardiology fellowship at Mount Sinai Medical Center in New York City, and a pediatric interventional cardiology senior fellowship at Texas Children’s Hospital, Baylor College of Medicine in Houston, under the tutelage of Dr. Charles E. Mullins, known as the Father of Modern Interventional Pediatric Cardiology.

In addition, he Dr. Recto is a fellow of the American College of Cardiology and a fellow of the Society for Cardiac Angiography and Interventions, among other professional organizations. He has co-authored numerous articles in publications such as Pediatrics, Pediatric Cardiology, and Journal of the American College of Cardiology, to name a few.

Long before Dr. Recto was treating serious heart conditions, however, he thought of becoming an engineer or architect. His mother asked if he had ever considered a career in medicine. Although unsure about this career path, he decided to give it a try. After his first semester as a pre-med student, Dr. Recto felt that he had never studied as much in his life, he says jokingly, and decided he better continue the hard work he had started. He was eventually accepted to the University of the Philippines College of Medicine, where only a small number of students are accepted every year. The young doctor was first exposed to pediatric patients during his rotating internship at the Philippine General Hospital, where patients with some of the most complex clinical problems are sent for care. That experience solidified his passion for pediatrics.

When Dr. Recto is not caring for patients at CHOC, he enjoys spending time with his wife, a pediatric emergency medicine physician at CHOC, and their three grown children.

Prior to coming to CHOC, Dr. Recto served as both chief of pediatric cardiology and director of cardiac catheterization at Tulane Medical Center in New Orleans. Previously, he was chief of pediatric cardiology and director of inpatient transplant services at Kosair Children’s Hospital in Louisville.

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Conference to Connect Medically Complex Teens, Parents with Peers

An upcoming CHOC Children’s conference will help teens with medically complex connective tissue disorders and their parents learn more about their diagnoses – and connect with others who have similar conditions.

The Dec. 3 and 4 “Connecting the Dots … Diagnosing and Treating Children and Adolescents with Medical Complexity” is geared for parents and their teens with a handful of conditions: Ehlers-Danlos syndrome; pain syndromes; postural orthostatic tachycardia syndrome (POTs); dysautonomia; and mast cell activation disorder.

“One of the goals of this conference is for parents and patients to have a better understanding of their condition, how the diagnosis is made, the symptoms as well as what treatments are available. It also gives patients and families a chance to meet others going through the same experiences and having the same or similar diagnoses” says Dr. Neda Zadeh, a CHOC geneticist who will participate in the conference.

medically complex

Because these conditions are rare and can often take a long time to diagnose, many patients experience feelings of isolation, she says.

“My experience has been that when you tell someone that they’re not alone, that there is a diagnosis, and that there are many other people with this same condition, you can see their body language change immediately usually to a form of relief,” Dr. Zadeh says.

“For many, it is incredibly cathartic for them to hear that there’s a name for this condition, and that it is a real diagnosis and a reason for all of the symptoms they have been experiencing for so many years without knowing or understanding why,” she adds.

Over the two-day conference, parents and teens will hear from a variety of specialists who treat aspects of these conditions, including cardiologists, allergists, pain specialists and anesthesiologists.

On Saturday afternoon, attendees will be broken into two tracks: one for parents and another for teens. During the teens’ break-out sessions, attendees will have an opportunity to anonymously ask specialists questions. The day will conclude with a pizza party, where parents and teens can meet peers who have similar diagnoses and experiences.

Sunday’s session will feature a panel of CHOC experts – including Dr. Zadeh, gastroenterologist Dr. Ashish Chogle, cardiologist Dr. Michael Recto and anesthesiologist and pain specialist Dr. Paul Yost – as well as breakout sessions covering advocacy issues and support systems for raising chronically ill children.

Parents and teens can register for the conference on CHOC’s website.

The conference has a Dec. 3 component solely for the education of medical providers. Parents who think their child’s physician might be interested can also find more information on CHOC’s website.

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CHOC Walk in the Park: Meet Team Timmaree

By Debbie Hicks, CHOC Walk in the Park participant 

At 7 years of age, our daughter Timmaree was diagnosed with a rare form of eye cancer called orbital rhabdomyosarcoma. In the process of enduring extensive chemotherapy treatments, she lost her hair, but never lost her faith, smile, resilience, and trust in us as parents to ensure she received the best possible care. We turned to the Hyundai Cancer Institute at CHOC Children’s.

Timmaree bonded with pet therapy dogs during her time at CHOC.
Timmaree bonded with pet therapy dogs during her time at CHOC.

To help pass the time during her lengthy hospital stays, Timmaree enjoyed painting rocks. Her first piece of art was a butterfly. She drew a cancer ribbon and then began doodling around it. She excitedly shouted out, “This is a cancer ribbon butterfly!” Timmaree’s rock painting quickly caught the attention of CHOC doctors, nurses and volunteers, as well as other patients, who lined up outside her room to get a glimpse of her special creations. Timmaree never intended on selling them, but many people made generous donations in hopes she would buy something extra special for herself.

After fighting a tough and courageous battle for nearly two years, Timmaree passed away on Dec. 21, 2008, just eight days after turning 9. She was a hero to thousands of people who had the opportunity to meet her, helping change people’s perspectives about life. Many feel honored they have one of Timmaree’s limited edition painted rocks with her signature.

A selection of Timmaree’s limited edition painted rocks.
A selection of Timmaree’s limited edition painted rocks.

Timmaree is with us in spirit. To celebrate her legacy and to brighten the day for patients, we bring the Team Timmaree Rock Craft Day to CHOC the last Sunday of every month. By hosting garage sales and bake sales, we raise money to provide 250 rock painting kits each month — for a total of 18,000 kits since we started seven years ago. In addition, we have proudly participated in the CHOC Walk in the Park since 2007. Our team, donning t-shirts with Timmaree’s butterfly art, has raised more than $260,000.

The 2016 CHOC Walk marks our team’s 10th anniversary, and we can’t think of a better way to honor Timmaree and CHOC than serving as an ambassador family. CHOC was our “home away from home” for two years, during which time we witnessed inspiring miracles and courageous battles. For that reason and so many others, we look forward to joining thousands of walkers at the Disneyland Resort on Oct. 30, 2016. Together, we’ll take steps in support of CHOC and the children and families they serve.

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Meet Dr. Gary Goodman

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Gary Goodman, a pediatric critical care medicine specialist and medical director of the Pediatric Intensive Care Unit at CHOC Children’s at Mission Hospital. After graduating from medical school at University of California, Irvine, he served his internship, residency and chief residency training in pediatrics at UC Davis Medical Center. Dr. Goodman completed a pediatric critical care and pulmonary medicine fellowship at CHOC.

Dr. Gary Goodman

What are your special clinical interests?

I am particularly interested in traumatic brain injury, concussions, respiratory failure and shock.

How long have you been on staff at CHOC?

I have been on staff for 30 years.

Are there any new programs within your specialty at CHOC you’d like to share?

We are now utilizing noninvasive ventilation and physiologic monitoring. We have developed improved treatment of ARDS (acute respiratory distress syndrome). We are also proud of our neuro-critical care team.

What would you most like community/referring physicians to know about your division at CHOC?

The division of pediatric critical care provides outstanding and personalized care for children and their families when their need is the highest. We strive to not only provide state-of-the-art medical care, but to also support the emotional needs of the patient and family. Our comprehensive, multi-disciplinary team works together to address every need and concern a patient and family might have.

What inspires you most about the care being delivered at CHOC?

For a pediatric specialist, there is no higher honor and privilege than working at a hospital dedicated to caring for children. I am always surrounded by and supported by other practitioners who share my passion for caring for children and who are all pediatric specialists themselves.

When did you decide you wanted to be a doctor?

I wanted to be a doctor since I was 5 years old, inspired by black and white documentaries about medicine.

If you weren’t a physician, what would you be and why?

If I wasn’t a physician, I would be an architect. I am fascinated by design and how the environment we live and work in can have such positive and even healing effects on us.

What are you hobbies and interests outside of medicine?

I enjoy listening to music (jazz and classical), cooking, photography, collecting watches and traveling.

What was the funniest interaction you had with a patient?

Just recently, I had a patient, who has a mild developmental delay, call me “the boy.”  I would stop in the patient’s room each morning, at which point I’d get asked, “What do YOU want?”

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How to Make Shots Less Stressful

Vaccines represent significant breakthroughs in medical research and disease prevention. When the Centers for Disease Control’s recommended immunization schedule is followed according to plan, it is shown to be the most effective and safest way to protect your child from potentially fatal diseases, according to Dr. Jasjit Singh, medical director of infection prevention and control at CHOC Children’s. However, the process of going to the pediatrician and receiving shots can be stressful, or even anxiety-producing, for young children.

A patient’s relationship with their pediatrician is important, and once you have found the right primary care doctor for your family, it can set the stage for their feelings toward medical professionals or clinical settings later in life. Studies show that preparing your children for vaccinations should ideally include three components: explaining what will happen, how it will feel, and strategies for coping with any related stress or discomfort. Follow these simple steps on how to make shots less stressful.

  • Be honest. Tell children their vaccines may be uncomfortable or bothersome for a second or two, and have them practice slowly counting to two seconds so they get a sense of how long that really is. Tell them what to expect at their appointment, and explain why the procedure is necessary and how it will help them.
  • Use Neutral Language: Request that the health care providers let your child know what will happen and when, using neutral language such as “we’re ready to start,” advises Marni Nagel, a pediatric psychologist.
  • Encourage them to ask questions. Remind them that they can ask any questions they want to of their doctor or nurse.
  • Time the appointment well. For babies and toddlers, scheduling the appointment around their bottle/feeding time may help. Receiving a bottle or feeding right after the shot may help soothe your baby.
  • For infants, engaging in at least 4 of the 5 S’s has been shown to reduce distress after immunizations, says Nagel. These include swaddling, placing on the side/stomach while holding, making shushing sounds, rocking, and sucking. Sucking can be done through breastfeeding, a bottle, or pacifier. For infants, dipping their pacifier in sugar water has been shown to decrease stress associated with immunizations. You can also talk to your doctor about breastfeeding during and/or after the immunization.
  • Topical anesthetics. Ask your pediatrician if topical numbing agents may be appropriate for your child.
  • Control your reaction. Children are increasingly observant as they get older, and they will take careful note of your reaction. Remain calm and be mindful of your demeanor, and it may help send a message to your child that they need not be stressed either.
  • Distraction techniques. These will vary depending on your child’s age and interests, but could include telling stories and jokes, looking at a picture book or finding a hidden picture like “Where’s Waldo,” or blowing bubbles.
  • Positive Rewards/Treats. Consider going out for ice cream, going on a special outing such as to the park or playground, or another small treat after your appointment to encourage good behavior, or to soothe your child.

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Maximizing your Relationship with your Pharmacist

By Patrick Loo and Preetha Abraham, clinical pharmacists at CHOC Children’s

Most people associate the word pharmacist with the person behind the counter at their local retail pharmacy. The profession of pharmacy has grown greatly in the last few decades and now you can find pharmacists in a variety of settings. Let’s take a quick look at how pharmacists help patients in different locations.

Hospital visits can be a stressful time for both adults and children, but families can be comforted knowing that every medication order at CHOC is carefully reviewed by a pharmacist to ensure:

  • appropriate drug for the diagnosis
  • a double-check for allergies
  • correct dose and frequency
  • no adverse interactions with other medications.

Pharmacists may perform a medication history review on new patients, which means that they will go over all your medications with you to make sure that the correct medications and doses are ordered while you are in the hospital. As part of the medical team, pharmacists provide critical drug information to physicians to ensure that medications are used efficiently and safely. If a patient has an adverse drug reaction to a medication, the pharmacist can help determine how to manage the reaction. Hospital pharmacists also monitor patients on intravenous (IV) antibiotics and often recommend switching to an oral antibiotic when in the patient’s best interest. Pharmacists oversee the correct preparation of medication, whether it is to be given orally or through an IV, and make sure it is delivered to the patient in a timely matter.

If you or your child needs to be admitted to the hospital, here are some tips to help with medication safety:

  1. Tell your doctor and pharmacist all the medications you take – this includes prescription, over-the-counter, and herbal supplements. It is helpful to keep a list handy with all the names and doses of your medications so that you always have that information when needed.
  2. Tell your doctor and pharmacist about any allergies you may have had in the past. This includes both medicines and other allergies (peanuts, eggs, latex, etc.).
  3. Have phone numbers handy (physician, specialists, pharmacy, home care agency) in case there are questions regarding medications or recommendations.

Pharmacists who work at your local retail pharmacy are easily accessible and available. Continuing to use the same pharmacy for all your medications allows a relationship to be formed with the pharmacist. They can be a great source of information about medicine, not only including ones that are prescribed to you by your doctor, but also for recommendations for over-the-counter medications. For example, you can speak to them about how to properly take your medication, possible side effects, and what to do if you miss a dose. They will also have a record of all the current medications you are taking in order to help check for drug interactions or duplicates. When starting a new medication, you should always speak to your pharmacist so that you fully understand how this medication will help you and to answer any questions you may have.

Did you know that pharmacists are the main personnel working at the Poison Control Center? While we recommend all medications are stored up and away from children, if your child ever gets into your purse, under your cabinets, etc. and might have ingested something that could be toxic, it is important to know where to call. By contacting the Poison Control Center at 1-800-222-1222, you can get recommendations of whether you need to bring your child to the hospital or if you can continue to monitor your child at home.

Pharmacists are everywhere in our community and a valuable resource. Since 2003, every pharmacist in the U.S. earns a doctorate degree, specifically a Doctor of Pharmacy. Many people think that pharmacists just count pills all day long, but as you can see they have a greater impact on your health care than you can imagine!

 

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Are Your Kids Eating Too Much Sugar?

By Kristen Miller, registered dietitian at CHOC Children’s

New recommendations from the American Heart Association state that children ages two to 18 should have less than 25 grams of added sugars per day and drink no more than one 8-ounce sugar-sweetened beverage per week. But what does 25 grams of added sugars look like?

kids eating too much sugar

Know the Difference: Natural vs. Added sugars

Naturally occurring sugars such as those found in whole pieces of fruit, some vegetables (i.e. corn), or plain dairy products are not added sugars and play an important part of a healthy, balanced diet. So keep eating those apples, berries, peaches and oranges! Whole pieces of fruit provide fiber that helps to evenly distribute blood sugars compared to the “sugar high” (quick spike in blood sugar) that can occur when drinking sweetened beverages or eating candy.

Added sugars include any syrups or sweeteners added to a food and are most commonly found in processed, packaged foods, resulting in an increase in calories without contributing essential nutrients. Consuming large amounts of added sugars may make it difficult for children to meet their nutrient needs while staying within calorie limits. Consuming large amounts of added sugars put children at higher risk for obesity, high blood pressure, high cholesterol, cardiovascular disease, fatty liver disease, diabetes and dental cavities.

Most Common Sources of Sugar

In a child’s diet, the most common sources of added sugars are soda, fruit-flavored drinks, sports drinks, and desserts. Most sodas, energy drinks, sports drinks, and flavored milks have 20-35 grams of sugar per serving!

With Halloween approaching, make sure to be mindful of all of the added sugars in candy! A mere 10 pieces of candy corn has a whopping 16 grams of added sugars!  Some other common candies and their hidden added sugars include:

  • 5 chocolate kisses = 13 grams of added sugar
  • 10 gummy bears = 13 grams of added sugar
  • 2 classic sized peanut butter cups = 21 grams of added sugar
  • 2 vines of licorice = 16 grams of added sugar

According to the 2012 US Census Bureau, the average American consumes 24 pounds of candy in a year- That’s a lot of added sugars!

Reading Food Labels

Added sugars can sometimes be difficult to identify. Look for these items in the ingredient list to determine if the food has added sugars: brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high fructose corn syrup, honey, invert sugar, lactose, malt syrup, maltose, molasses, raw sugar, sucrose, trehalose, and turbiado sugar.

Keep your eyes out for the new food label coming out by July 2018. An ‘added sugars’ row will now be included on the label. Identifying added sugars will be much easier!

Tips for Limiting Added Sugars in the Diet

  • Choose water instead of sugary beverages. If you like flavored beverages, try adding lemon, cucumber & mint, or berries to your water for an infused flavor.
  • Choose club soda or seltzer water for a carbonated drink instead of a regular soda.
  • Choose fruit as a dessert instead of cakes, pies, cookies, doughnuts, ice cream, or candy. The United State Department of Agriculture offers information on when certain fruits and vegetables are in season.
  • Choose plain dairy products instead of flavored milk or dairy such as chocolate milk or sweetened yogurts. Add some fresh fruit to plain yogurt for natural sweetness.

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