Allied Health Care Kaiser

Dietitian Educator Plan to Help Reduce Childhood Comorbidity

Dorian Venable, M.Ed, RD, LD, CHES, NASM-CPT, ACE-CFI

 

 

Abstract

A growing number of youth are becoming vulnerable towards chronic diseases in our community. Identifying childhood obesity is vital to prevent these high-risk groups from developing into comorbidity conditions, which are multitudes of chronic ailments. In the past, social economical factors leading to haphazard planning were considered responsible for poor nutritional outcomes and overweight issues. Current research indicates that comorbidity is more complex and requires educational preventive tools to overcome obesogenic environments. A series of relevant prevention protocols requires that each person find: valid awareness of obesogenic diseases, risk factors, and behavior modifications (16) (8).  Identify childhood obesity, as non-cosmetic problem is the first true step of preventing premature childhood development of chronic diseases.  The next step is to properly address childhood obesity as a critical point to prevent comorbidity, psychological, and social barriers within the community (27).  By implementing specific procedures to overcome diverse health disparities and help reduce health costs in both rural and urban communities (16) (18). Comorbidity conditions are directly connected to multiple morbidity and aggressive mortality. The more overweight the person the higher the risk factor of Comorbidity conditions. Comorbidity consists of the most common and challenging experiences pertaining to Hypertension, Coronary Heart Disease, and Non-Insulin Dependent Diabetes Mellitus. These three conditions develop simultaneously at a young age and are detrimental to ones health. 

 

Key Words

 

Comorbidity, Diabetes, Cardiovascular disease, Hypertension, and Childhood obesity

 

Introduction

The prevalence of childhood obesity in The United States had significantly increased. In the past two decades, the prevalence of adolescent children exposed to obesity status has tripled (23). In 1999, it was reported that the childhood obesity cost $127 million dollars (28). Comorbidity was one of the major reasons that contributed to healthcare cost. When childhood obesity occurs there is a higher risk of the development of more problematic and severe health conditions. These conditions will consist of Hypertension (HTN), Coronary Heart Disease (CHD), Non-Insulin Dependent Diabetes Mellitus (NIDDM), Dyslipidemia, and some forms of cancer. In addition, more immediate concerns of childhood obesity include sleep apnea, slipped capita femoral epiphysis, pseudotumor cerbri, and polycystic ovarian disease. Furthermore, in 1979-1999, as obesity rates tripled, there were more reported childhood cases of gallbladder diseases (28). There is a great concern of the obesity rate in children because it begins in childhood and continues into adulthood. Obesity is harder to control as it steeply increases in related incidents (4). This contributes to the total obesity problem in all ages, which brings about a total of $70 billion dollars a year directly towards healthcare costs (18).  When controlling childhood obesity it is important to identify the different aspects of comorbidity in order to provide a clear path of prevention (19).

Comorbidity awareness starts with addressing the early stages before multiple chronic illnesses become evident. The first step is to create awareness of the multitudes of obesogenic diseases and all of its noncommunicable diseases pertaining to comorbidity (8).  The second step is to acknowledge the importance of interpersonal positive behavioral choices and how they are applied on a daily basis to prevent comorbidity from evolving into full-blown development (2).

 

The Problem

Each comorbidity condition is directly connected to being overweight. There are multiple calculations and measurements to determine if a person is at risk of being overweight such as Percentage of Ideal Body Weight (%IBW), Body Mass Index (BMI), Waist to Hip Ratio (WHR), waist circumference, and skin fold measurements. However, the physical growth chart is the best weight assessment tools for children to help measure their weight status category and percentile range (31). Figure 1 illustrates the different category of weight status according to the percentile range, which will help families to understand the results of physical growth chart. In America the majority of children today are above the 85th percentile for age (26). This indicates that the prevalence of children is at risk of being overweight

 

 

There are two reasons why a person would be at a higher risk factor for comorbidity. The first reason consists of a longer time span of remaining overweight. The second reason pertains to the amount of additional weight the person accumulated in a time period. Both reasons lead to negative conditions, which have preventable risk factors. These diverse negative conditions are aspects of comorbidity that consist of common and challenging experiences such as HTN, CHD, and NIDDM.

HTN establishes when blood pressure consistently remains elevated at high levels of 140/90 mmHg or higher. This condition could increase a person’s risk of heart disease and stroke. The damaging effects of high pressure exert stress along the small arteries, and make the blood vessels rough. These arteries (arterioles) become less elastic and thicker as LDL builds up resulting in Arteriosclerosis, which causes primary hypertension. (1) (32). 

A related cause of CHD is Atherosclerosis; a condition of plaque building up on the arterial walls. The arterial walls will become hardened and thickened over a period of time. Formation of plaque will causes blood clots to form, and decreases the blood flow of circulation. After the blood clot breaks free and start circulating, a hazardous condition known as embolus. When the embolus reaches the brain, it results in a blockage and forms a thrombus occurs. This is a blockage within the head, contributing to the development of an Ischemic stroke. Furthermore, a hemorrhagic stroke is caused by an aneurysm, which is a blood vessel rupturing in the brain from a weakened state (6).

NIDDM, better known as type 2 diabetes, is one of the major chronic diseases among Americans (20). Adolescent children who are diagnosed with NIDDM makeup 45% of all reported cases (28). NIDDM is a chronic disease that usually develops in adults at middle age or older. This condition affects younger age groups each year. Patients that have NIDDM are unable to effectively absorb glucose and utilize insulin. This condition is caused from elevated fat tissue that blocks the efficiency of insulin.  The American Diabetes Association (ADA) recommends a healthy diet, which helps control Blood Glucose Serum (BGS) and a person’s weight condition. 90% of all diabetics experience insulin resistance (17). This condition causes glucose to enter the cells at a slower rate. When insulin is present in the bloodstream some of the glucose goes back to the liver and is converted into triglycerides for adipose storage (fat cells). This action causes additional chronic weight gain.  Therefore, it is important that all diabetic diets incorporate lower fat as well as cholesterol dense food items (22).

Uncontrolled diabetes consists of hyperglycemia and hypoglycemia. These are conditions where BGS is above or below the normal optimal level. Patients experiencing extreme hyperglycemia are at risk of Hyperosmolar Hyperglycemic Non-Ketotic (HHNK). This is a condition that occurs when the BGS is above 600 mg/dl. In addition, uncontrolled diabetes promotes risk factors of multiple chronic diseases, such as macrovascular and microvascular diseases. Macrovascular diseases consist of cardiovascular complications, such as Coronary Heart Disease (CHD). Microvascular diseases consist of organ complications, such as optical atrophy (Retinopathy), nervous system atrophy (Neuropathy), and kidney atrophy (Nephropathy) (17) (3).

            Documented cases of children ranging from five to seven years old show the ability to increase the number of fat cells rapidly in that time period, which is known as advance hyperplastic development (21). In another related study, girls were observed and documented for being at risk of becoming overweight at five years of age, and had a tendency of remaining overweight. In addition, they were prone to self-initiated fad based diets that resulted in further increased weight gain. Girls who are at risk of obesity experience early puberty from being overweight or from rapid weight gain (15). As a result of increased need of proper dietary intake, the U.S. secretary of Agriculture and Health and Human Services introduced the Dietary Guidelines for Americans in 2005. This will help improve dietary intake of children to help manage weight issues and blood lipid serums.

These irregular blood lipid serums are contributed from plausible influences and growing challenges of hyperplastic and hypertrophic obesity. Hyperplastic obesity is the increased number of fat cells. Hypertrophic is an increased size of fat cells.   These conditions are biological factors contributing to elevated visceral fat and lipid bilayer.

 It is vital to help initiate the breakdown of obesogenic built environments in order to help prevent hyperinsulinemia, hypercholesterolemia, and leptinemia from forming and developing into comorbidity conditions (27).

Hyperinsulinmia is another possible factor that children face when they are over weight or obese. This type of metabolic complication provides excessive insulin in the response of glucose. It is due to the abundance of adipose cells interfering with the transfer of insulin to glucose. This puts the person at risk of insulin resistance, which is also known as NIDDM (27). In the mid-1990s there were new multiple cases of adolescent children being diagnosed with NIDDM (26). These new cases contribute to alarming statistics of children being exposed to hyperinsulinemia conditions.

Hypercholesterolemia is a form of dyslipidemia in which elevated LDL- cholesterol concentration becomes apparently chronic. Cross sectional data indicates a strong correlation between cardiovascular disease (CVD) and hypercholesterolemia. Another strong association of hypercholesterolemia is found in the development of children with obesity, which increases the risk factors of CVD. By the time the young child becomes an adolescent child their risk of CVD has significantly increased. By the time they reach adulthood CVD becomes a dominant factor for premature morbidity and mortality (29).

            Leptinemia occurs when fat cells become dense within the body. It acts as a hormone (chemical messenger), which effects proper energy regulation making the body more efficient in storing calories and less efficient in burning calories. Past research indicates that higher levels of fat were found in females, therefore higher risks of leptin concentration are found in females compared to males (31).  

 

Literature Review

A twenty-year span of research observation recorded drastic socioeconomic environmental changes of individuals who relocate to new areas. An example of this is when a person moves to another place without close positive social influences and routines, which causes the person’s dietary and physical activities to become significantly hindered (23).  This is known as an obesogenic environment, which is due to the complex socioeconomic factors, such as community, family, school, peers, and media that influence our daily quality of positive nutritional intake and physical activities (20). Building strong positive socioeconomic procedures is vital to overcoming an obesogenic built environment. Early prevention will help reduce the numerous physical ailments that originated from obesity, which affects healthcare costs (8). However, there are abundant psychosocial consequences from being obese, such as the indirect costs and long-term effects, which are harder to evaluate (23).  Some health professionals are facing childhood obesity by providing bariatric and liposurgery, which are acute procedures that are not meant for long-term results (7) (24).

A large national nutrition survey was used to analyze young children’s eating patterns. It identified that parents are in need of being better educated so they could provide a balanced meal for their children. The survey did not find a significant amount of children at any age that had a consistently balanced or moderate diet. Recent statistics indicate that the lack of nutritionally competent parental supervision has contributed to childhood obesity. Three decades ago, 5% of young children ranging in age two to five were becoming overweight by 2002 (5). That number had more than doubled, resulting in 10.4% of young children becoming overweight. Another study shows 16% of adolescent children ranging twelve through nineteen years of age are overweight and of those adolescent children 50% to 77% of will become overweight adults (30).

The absence of recent elevation of obesity rates indicates genetics is not dominantly responsible. A large national nutritional survey indicated negative findings of children not meeting Food Guide Pyramid and Dietary Guidelines for Americans (15).  The promotion of nutritional facts will help build a stronger nutritional foundation for young and adolescent children (12). Research indicates children with family history of cardiovascular disease eat about the same cholesterol and mean total fat intake as the other children. However, all the children in the study had over consumed cholesterol and total fat from their natural diets by 80 grams per day (13). An increase of cholesterol and total fat intake by children was contributed to lower parental education levels (14).  Over 60% of young and adolescent children had poor dietary habits of consuming elevated amounts of fat especially from saturated fat contents (28).

When utilizing the basic nutritional strategies there are six steps. First step is to establish strong eating patterns for meals and snack time. Second step is to focus on portion size control. Third step is to control better food choices to improve the quality of food intake. Fourth step is to eat less fat and fewer amounts of fried food items (14).  Fifth step is to provide early prevention through building strong parent-child-feeding relationships, which will influence later dietary habits (18). Sixth step is to construct early positive childhood food preferences, which will provide long-term effects on future food choices (25).

The World Health Organization (WHO) recommends and encourages high-fiber foods items as a part of healthy weight management strategy (20). One of the objectives for Healthy People 2001 consists of any person two years of age and older consuming six servings of all types of grain products ever day (11). 39% of children in America consume an adequate amount of fiber (28). In 2003, 22% of all students in America integrated at least 5 or more servings of vegetables and fruits into their dietary routine (28).  A good fiber source is whole-grain food products, which may provide significant reduction in risk of NIDDM, CHD, and certain cancers.

Epidemiologic evidence indicates whole grain helps control cholesterol serum levels and improves mortality rates (11). The second part of healthy weight management strategy is the avoidance of high caloric and fatty food items. It is essential to prevent consumption of any obesogenic agents, such as sweetened beverages or any caloric dense liquid based compound (20). It is also equally important to avoid any foods with high Glycemic index laced with fat, such as potato chips and any other vending machine food items. The majority of young and adolescent children consume about 18% to 20% total calories from additional sugar intake (28). A healthy drink to consume on a daily bases is milk. However, only 17% of American students consume three glasses of milk or more routinely per day (28). Sound nutrition will help young as well as adolescent children to prevent chronic diseases and improve growth and health (16). A family member is capable of logging onto the My Pyramid webpage to learn about the individual needs of each child to help prevent poor nutritional choices and increase healthy food intake. However, if families do not have access to the Internet they could utilize the traditional food guide pyramid to ensure their child is receiving daily proper food servings as seen in figure 2. 

 

 

 

 

Another important aspect consists of physical activities such as exercise, hobbies, leisure walks, or planned sports. However, today’s children spend more time in stationary non-physical activities compared to other children in the past (28). This accounts for over 75% of all children in America who get only twenty minutes or even less from brisk physical activity ever week. Wolf et al documented an inverse relation between increase BMI and decrease of activity levels in girls ranging in age of five to twelve year olds (9).

As a result, after-school programs, daycare settings, and school physical education programs have become more focused for quality physical activities (28).

There are four basic steps to assess children in physical strategy. The first step is to find fun physical activities, such as after school sports, neighborhood bicycling or jogging, and family outdoor games that could appeal to the children. The second step is to limit stationary activities, such as watching television, playing videogames, or any other activities involving electronic devices. The third step is to find activities that are safe and time appropriate to avoid injuries and increase compliancy (20). The last step is to follow the exercise pyramid. It consist of lifestyle activities, active aerobics, active sports and recreation, flexibility and muscle fitness exercise, and avoidance of sedentary activities, all of which will help to increase a child’s healthy lifestyle as seen in Figure 3(28).

     

 

Conclusion

The prevalence of childhood obesity in the United States has been increasing as well as contributing to adulthood obesity. Genetic susceptibility, environmental influences, and interpersonal behavioral choices are complex interrelated factors of pediatric obesity lifestyles (2). The multitudes of diverse long-term nutritional health education could help decrease the massive amount of children who are ill prepared and need medical assistances. Reinforcing positive lifestyle changes will help to prevent development of further comorbidity types of diseases. When providing better prevention techniques through dietary and physical guidelines, healthier lifestyles are inevitable for children to adhere to and help prevent the cycle of obesity. 

 

 

 

 

Reference:

 

 

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Duac (Clindamycin phosphate, benzoyl peroxide) Care System 1.00 $184 Duac (Clindamycin phosphate, benzoyl peroxide) for unbeatable prices at TotalPetSupply.com Today’s trusted online pet store that dispenses the best quality pet medications.

Spotmau PowerSuite Golden Edition $69.95 Spotmau PowerSuite Golden Edition includes key features below and more. PC Health Check provides 360° PC healthy status check. 1-click to check all the most important items of your PC & Windows and 1-click to fix all the weak items affecting your PC health. Windows Recovery provides a complete solution to recover your corrupt Windows. TuneUp Kit cleans your Windows registry; Enables you to choose which programs and services to run automatically at Windows startup; Optimizes your network speed; Cleans your hard disk, Windows and IE/Firefox privacy data; Removes your unwanted applications. Windows Backup & Restore backup and recovery your Windows, partition table, master boot record and registry periodically. Password & Key Finder finds your lost passwords for Email, MSN, IE and asterisks; finds your Windows, Office and IE product or CD keys. Windows Password Finder can easily reset Windows 7/Vista/2003/XP/2000/NT administrator/user password to blank. Security & Privacy clears up all your activity records in your computer to protect your privacy. Data Recovery (Undelete, Unformat, Raw Rescue) recovers files from an accidentally formatted or reinstalled partition/disk; restore files that have been deleted accidentally. Disk Backup/Restore provides all kinds of backup/restore options under Windows or when Windows crashes. Partition Genius is a powerful partition management tool, it can create/delete/format your partitions; convert one partition type to another; resize/move/split/merge your partitions; hide/show a partition; work perfectly under Windows and Spotmau CD.

UVZ Health Systems Portable Toothbrush Sanitizer – White $19.99 Protect yourself and your family by sanitizing your toothbrushes with this sanitizer that kills up to 99.9% of contagions such as SARS, hepatitis, bacillus, staph, cold and flu viruses. The portable design makes it easy to take with you on the go.

Paws & Claws: Marine Rescue PRE-OWNED – Nintendo DS $17.99 SynopsisYour heart goes out to poor little animals whenever you see one sick or injured. Your greatest happiness is when you see a lovable critter nursed back to health. Luckily for you, in Paws & Claws: Marine Rescue, you’ve got the tools and the know-how to heal all sorts of marine animals. Animals everywhere should be able to roam about freely and in full health and thanks to you, they can. Rescue, rehabilitate and release animals in Paws & Claws: Marine Rescue. It’s your job to diagnose, treat and care for any marine animal you find that’s injured. With your loving care, these animals will be healthy and happy again in no time. The biggest reward will be when you can set your animal patients free to swim around and play with other animals.

Paws & Claws: Marine Rescue – Nintendo DS $29.99 SynopsisYour heart goes out to poor little animals whenever you see one sick or injured. Your greatest happiness is when you see a lovable critter nursed back to health. Luckily for you, in Paws & Claws: Marine Rescue, you’ve got the tools and the know-how to heal all sorts of marine animals. Animals everywhere should be able to roam about freely and in full health and thanks to you, they can. Rescue, rehabilitate and release animals in Paws & Claws: Marine Rescue. It’s your job to diagnose, treat and care for any marine animal you find that’s injured. With your loving care, these animals will be healthy and happy again in no time. The biggest reward will be when you can set your animal patients free to swim around and play with other animals.

Lorex LIVE Connect home monitoring system $129.99 The LIVE Connect is a device for parents, families, pet-owners or care-givers that need to stay aware of everything happening in their home

Paws & Claws Pet Vet PRE-OWNED – Nintendo Wii $17.99 SynopsisTaking care of animals is very hard work, but it’s worth it. As a veterinarian, you must use your skills to help injured dogs, cats, horses and more. Treat your patients at your very own clinic using your medical expertise and caring touch, while growing your practice into a thriving business. These animals will receive the best care possible in your hands. Paws & Claws Pet Vet lets you nurse cuddly companions back to health. Treat nine different animals, including cats, dogs, horses and more. Use your Wii Remote to sweep the floor and make sure it’s spotless for your patients. Expand your practice by adding a horse stable and paddock, therapy facility, kennel or give your business a face-lift with a large garden. Grow your pet care business and make best friends for life.

Think Clear™ (60 medium veggie capsules) $20.49 Most complete cognitive support formula available. Think Clear™ utilizes four top-rated nutrients for brain and memory health to effectively support cognitive function. This complex formula enhances circulation and oxygen flow to the brain to promote optimal cell health, as well as supporting information transmission from cell to cell.

Zyflamend™ by New Chapter (60 small/medium softgels) $24.49 Herbal support for COX-2 and Inflammation Health*. New Chapter's Zyflamend represents a scientific breakthrough in herbal, COX-2 support to promote a healthy inflammation response.

Red Yeast Rice 1200 mg by Doctor’s Best (1200mg, 60 tablets) $22.99 Promotes Heart Health. Best Red Yeast Rice contains rice that has been naturally fermented with red yeast (Monascus purpureus) according to traditional methods.

Vitamin K-2 (100mcg, 100 VCaps) $11.49 Supports a Strong Bone Matrix. Promote your overall health with the most biologically active form of vitamin K. Even if you take a calcium supplement, your body may not be able to take advantage of its benefits. Recent research has found that vitamin K-2 is a key factor in regulating calcium in the body, ensuring better bone and arterial health, supporting calcium metabolism in vascular structures, promoting normal blood clotting, and providing important bone health benefits.

Oral-B Professional Care 3000 Electric Toothbrush – White/Blue $79.99 This electric toothbrush features a round brush head that pulsates to break up plaque and rotates to sweep it away. Three cleaning modes include daily clean, sensitive and whitening for a custom routine.

Honeywell Ultrasonic Easy to Care 1-Gal Cool Mist Humidifier – White $59.99 This humidifier features a 1-gal. reservoir capacity that provides up to 24 hours of moisture output per filling and a top-fill design for easy refilling.

Honeywell Easy-to-Care 1 Gal Cool Moisture Humidifier – White $44.99 Keep your home comfortable with this cool moisture humidifier that runs for up to 36 hours on a single filling. The top fill design makes filling easy and an antimicrobial filter prevents the growth of mold, fungus and bacteria for cleaner air.

Honeywell Easy to Care 15-Gal Cool Mist Humidifier – White $59.99 This humidifier features a 1.5-gal. capacity reservoir that provides up to 48 hours of operational time before needing to be refilled. Three moisture-output settings offer multiple humidifying options.

BISSELL Auto Care Proheat Portable Deep Cleaner – Black $99.99 Easily remove tough spots and stains with this vacuum that features a hot water heater for maximum cleaning. The compact design ensures easy portability and the 15′ cord length allows you to reach a large area before needing to move on to another electrical outlet.

Timex Health Touch Heart Rate Monitor Watch – Black $44.99 Track your workout performance with this watch that features a calorie counter and target zone function that monitors your heart rate and alerts you when you’ve reached your target rate during your exercise routine.

Pacific Coast¨ Luxury 600tc Duvet Cover (Cappuccino) – Queen $129.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Cappuccino) – King $149.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Chamomile) – Twin $99.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Chamomile) – Queen $129.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Chamomile) – King $149.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Pale Slate) – Twin $99.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (White) – Queen $129.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (White) – King $149.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Silver Grey) – Twin $99.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Pale Slate) – Queen $129.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Pale Slate) – King $149.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Silver Grey) – Queen $129.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Cappuccino) – Twin $99.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Silver Grey) – King $149.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (White) – Twin $99.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Moss Green) – Twin $99.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Moss Green) – Queen $129.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

Pacific Coast¨ Luxury 600tc Duvet Cover (Moss Green) – King $149.99 New! Our beautiful 600 thread-count Luxury duvet covers are 100% Eyptian cotton and machine washable for easy care.

ExcellentE™ (Vitamin E Tocotrienol) (125mg, 30 softgels) $21.49 Pure, Natural Delta Tocotrienol. Derived from the rainforest plant annatto, our tocotrienol vitamin E has been proven to contain unique health benefits not shared with its vitamin E counterpart tocopherol.

Sea Buckthorn Force™ with Omega-7 (60 softgels) $41.95 Antioxidant Protection, Anti-aging and Digestive Support*. Sea Buckthorn is comprised of both palmitoleic and cis-vaccenic acids and has been used in the ancient tradition for centuries to promote skin, urogenital and digestive health.*

Animal Planet Vet Life PRE-OWNED – Nintendo Wii $24.99 SynopsisYou’re on your way to becoming a world-renowned veterinary doctor. Under the guidance of Dr. Rogers, you will travel the world, volunteering at local vet clinics and performing numerous procedures to save injured animals. With your help, these wild and domesticated animals will be back to good health in no time. Animal Planet: Vet Life lets you take on the role of Jack or Abani as you journey across the globe, treating a variety of animals in different settings. Help more than 40 animals, including domestic and wild animals, as you perform 60 procedures, from routine check-ups to fixing broken bones. Feed, pet and exercise animals as part of their post-operative care and learn valuable facts about them. These animals will receive the best care possible with you as their veterinarian.

Animal Planet: Vet Life PRE-OWNED – Nintendo DS $19.99 SynopsisYou’re on your way to becoming a world-renowned veterinary doctor. Under the guidance of Dr. Rogers, you will travel the world, volunteering at local vet clinics and performing numerous procedures to save injured animals. With your help, these wild and domesticated animals will be back to good health in no time. Animal Planet: Vet Life lets you take on the role of Jack or Abani as you journey across the globe, treating a variety of animals in different settings. Help more than 40 animals, including farm and wild animals as you perform 60 procedures, from routine check-ups to fixing broken bones. Feed, pet and exercise animals as part of their post-operative care and learn valuable facts about animals. These animals will receive the best care possible with you as their veterinarian.

Animal Planet: Emergency Vets PRE-OWNED – Nintendo DS $12.99 SynopsisAs an up-and-coming veterinarian at the Alameda East Hospital, your job is taking good care of animals. From cleaning teeth and medicating to the intricacies of performing operations, your knowledge and skills help keep a wide variety of animals in good health. Show off your veterinary talents when the pressure’s on as you prove you have what it takes to be a real Emergency Vet. In this interactive game based on the Animal Planet series Emergency Vets, you’ll find yourself charged with taking care of 30 different animal species, ranging from dogs and cats to horses and ferrets. Learn real-life veterinary information from Animal Planet and talent from the TV series. Put your knowledge to work as you perform 15 vet mini games, including memory, puzzle and matching games, each with five levels of difficulty.

Discovery Kids: Pony Paradise PRE-OWNED – Nintendo DS $12.99 SynopsisYour greatest wish has always been for a pony of your very own. Now, with Discovery Kids: Pony Paradise, that dream can become a reality. In this charming simulation, you can adopt an adorable pony and raise it from birth to adulthood. Lavish your tender loving care on your pony pal to ensure its health and happiness for the long haul. A world of equine discovery awaits in Pony Paradise. Adopt a pony from any of four realistic breeds, and give your new best friend the care it needs to grow and flourish. Groom your pony, feed it and take it for rides in a variety of cool 3D environments, ranging from a lovely meadow to the bustle of the circus. You can even accessorize your pony with more than 60 unique collectible items to make sure your pet is the most stylish around.

Discovery Kids: Dolphin Discovery PRE-OWNED – Nintendo DS $12.99 SynopsisThe crowd waits with eager anticipation as you prepare for the next performance. At your signal, your pet dolphin leaps gracefully from the water, its body glistening in the sunlight. You’ve practiced for this moment, and your dolphin executes every aspect of your well-planned routine to perfection. You feel pride welling up in you as the audience bursts into excited applause, and your dolphin lifts its head from the water and seems to be grinning right along with you. In Discovery Kids: Dolphin Discovery, you’ll have the chance to care for and train your very own pet dolphin. Raise and nurture it to ensure its health and happiness, and gain its trust through your thoughtful care. Teach your dolphin a variety of tricks and routines, working together to perfect them. Then go in front of an audience for a performance and reap the rewards of the crowd’s applause.

Pet Pals: Animal Doctor PRE-OWNED – Nintendo DS $9.99 SynopsisAnimals need tender loving care to stay happy and healthy, just like people do, and you’re just the compassionate veterinarian needed to bring a variety of animals back to good health. Step into the world of veterinary medicine as an eager young rookie, and do your best to diagnose, treat and heal the many patients who come through your door in order to work your way through the ranks of your chosen profession. With your care and expertise, your patients will be on the road to good health and you’ll be well on your way to becoming a top vet. In Pet Pals: Animal Doctor, you’ll find yourself facing 30 medical cases created by real veterinarians, spanning everything from simple infections to complex broken bones. Tend to 23 different types of animals, including a Yorkshire terrier, a python, a parakeet, a Siamese cat and a hamster, using your DS touch screen to administer more than 40 tests, interact with your patients and their owners and more. Follow up with your patients in the Recovery Room, where you’ll bandage, feed, clean and play with your healing charges, and enhance your veterinary knowledge with a variety of instructive mini games, including Memory, Trivia Quiz and Jigsaw Puzzle.