bunrab: (me)
So I had the defibrillator replaced on the 29th, and it was so painless and easy compared to all the other surgeries I've had these last 10 years that I feel like there's another shoe that's gotta drop - something can't possibly go that well without anything going wrong! And yet that seems to be the way it worked. Went over to the hospital at 11, was home again before 4, even counting the extra time we had to wait while they rearranged the operating room because someone had forgotten to tell the setup people that my device is on the right side, not the left. It was, as expected, local anesthesia and a bit of sedation, with the sedation increased for a few minutes when they had to test the device after putting it in - the sedation caused some mild hallucinations which I recognized as such while they were happening: the blue woven-paper coverings and pads that they use to cover areas, block things off, rest tools on, turned into a vast rolling Avatar-like landscape. And of course I chatted all the way through the thing, uncontrollably - but the anesthesiologist says she enjoyed it, and that constant chatting is in fact quite reassuring to them.
Boring details of easy recovery )

In other news, I am now officially elected to the condo board, not just appointed, and have already started wielding my immense power - which consists of volunteering to do many, many hours of unpaid work on behalf of the 433 owners who /aren't/ on the board, while enduring complaints from them and hassles from the other new board member who is a nutcase, and an exciteable, shouting nutcase at that. Wonder how long he'll last???

We went to the state fair the weekend after the surgery - and I was fine, although, since this year the scooter rental people weren't there, we didn't get to see much of the fair. In general, I'd have to say that for most ag stuff, the Montgomery County fair was larger and better organized than the state fair - the only place where the state fair has it better, and the reason I wanted to go, was the Home Arts building - many more quilts, knitted things, and needlepoint things at the state fair than there were in Mty Cty. This coming weekend we are going to go to the Great Frederick Fair, which is the name for the Frederick County fair. I've never been to that one, but Frederick is  a big agricultural area, just as northern Montgomery county is, so I have high hopes for fancy goats, obscenely-shaped vegetables, and, since it is a month later than the Montgomery one, much, much larger pumpkins. I shall report!
bunrab: (bathtub warning)
Just a quick update for those of you keeping track - I got this ICD/pacemaker September 3, 2006, so I am now pretty much 7 years into a "5-year battery" expected life of the device - it finally dropped down to the replacement level last month. So I am getting the battery - or generator - replaced this Thursday. To explain that quickly - when they talk about replacing the battery on a pacemaker or ICD, they really mean replacing the whole blob of metal that is the device, everything except the leads. The human body is full of nasty fluids, so pacemakers are sealed very well so as not to have the works damaged by their environment, and that means there's no easy-in, easy-out battery slot; the battery is an integral part of the unit. Which is also referred to as a generator, since it generates those little electric shocks.

The upside of this is that, although the generator is the very expensive part of the device (5 figures), it is very easy to install; it's the leads that are a bitch to install. Lead placement is an overnight (or longer) procedure, which, as you all know, I have had remarkably bad luck with. But device replacement is outpatient surgery, local anesthesia with sedation. So I will be in and out again Thursday afternoon. And, since Medicare is now my primary insurer, I will have no problems with out-of-network anesthesiologists billing me thousands of uncovered dollars - we're going into this knowing that anyone who touches me better take Medicare. The EP (electrophysiologist, or pacemaker/ICD specialist) surgeon is someone from my regular cardiologist's practice whom I've talked to several times, and so we're really clear on what we're NOT doing here - no weird attempts to suddenly be the person to succeed in placing a third lead. In fact, we are putting in the simpler device that doesn't have bi-ventricular lead capacity. Smaller and probably longer life than the current device. All the way around, though any surgery is a nuisance, this one I expect will be less of a nuisance than anything else I've had done anytime these last 10 years.

It's Howard County General, just a few miles from my condo. Cindy is driving me there and back. I'll post to Facebook as soon as they let me have my phone back in the recovery room.
bunrab: (sodium)
Every now and then one has to pay some attention even to archival journals, to keep LJ from deleting them, so here's a post in this one.

Battery still holding out above the elective-replacement level on the ICD, but close enough that we expect that at my August device check, it will have fallen into that range, and we'll schedule the replacement for the week after that. Since they don't have to replace the leads, which is by far the most difficult part of placing a device, the whole thing will be outpatient surgery with a minimum of anesthesia, a good thing after my anesthesia-induced bout of extremely low blood pressure on the occasion of last September's try (the fourth try, and definitely the last) at placing the third lead. That was a minor disaster - not a major one, since I'm only slightly worse off than before, but nonetheless not fun and there is that /slightly/ worse off. More details over on my regular blog, I guess, if you care to look there.
bunrab: (me)
I was discussing the phrase "ye gods and little fishes" with boyfriend the other day, and I swear I remember reading a book as a kid, in which a little girl used that phrase frequently to express her impatience with other people. I cannot remember what book it was - this odd notion comes to me that perhaps it was Cheaper By The Dozen??? Could that be right? If not, does anyone else remember such a little girl using that phrase, possibly in connection with walking to get ice cream? It's very odd what scraps the mind remembers.

I am too lazy to go to the library and find Cheaper By The Dozen just to see if that's it.

This year, our anniversary and Mother's Day came on exactly the same dates it did the year we got married, 1985. It would have been our 28th anniversary. I kept busy and didn't think about it too hard, because who wants to ruin someone else's nice Mother's Day dinner by bursting into tears?

My stepmother lost her first husband when she was considerably younger than I was when Steve died - and she had several small children to take care of as well. (If I recall, her youngest at the time was an infant.) I can only imagine how difficult it must have been for her - and I can see why she would have been happy to meet my dad, even though it wasn't that long afterwards, because she must have been so lonely, surrounded by children who were a constant reminder of what she had lost, without being old enough to be useful in helping her cope with his loss. My stepbrothers and stepsisters never talked about their father very much, though I gather he was rather strict, and chronically ill.

Saturday was our condo community's annual group yard sale. Six boxes of books and two boxes of crafts magazines out the door, along with a few miscellaneous items. Steve's three torque wrenches were the first thing to be sold - lots of guys want those, apparently. The crowd, and what they're looking for, is rather different than Austin; fewer books sold than I had hoped (the leftovers went to the charity donation truck that came at the end, not back into my condo) and a lot more people were looking for clothing, which I hadn't even considered bringing because in Austin, it never sold well - only baby/little kids clothing ever sold at all. Here; people who had women's dresses and suits and shoes were doing a brisk business. I did get a few people who each took an armload of crafts magazines, though, and a few science fiction geeks who picked up 10-20 books apiece. Did a bit of electioneering for the condo board elections this summer - I'm serving as an appointed member, right now, filling in a vacant spot, but I need to get elected to a regular term, and, quite oddly for such things, we have 5 people running for the three open spots (usually it's hard to get anybody to run at all) - so I used this as an opportunity to talk to a bunch of neighbors I hadn't met before, and do a few good deeds - things I would have done anyway, of course, but now I mentioned that I was running, after helping people.

I had my quarterly device check today, and it looks like the battery is holding up enough that we don't have to schedule replacement for July - the power level is still a bit above even the "elective replacement" level, let alone the "mandatory replacement within 3 months" level. So we've scheduled the next quarterly check for August, 3 months from now, with the assumption that at that time, the power will have just dropped into elective replacement then, and since replacement is outpatient surgery, it can be scheduled fairly quickly, probably for later that week. The question will be whether I've healed enough to play in rehearsals that start up around Labor Day - I believe the first concert any of my bands have scheduled for next season is something like September 15. By now, my cardiologist is used to hearing that his schedule comes in somewhere less important than my concert schedule :D

Hey, anyone in Maryland: Maryland Community Band Day is June 9, noon to 8 pm, at the Lurman Woodland Theater in Catonsville. Montgomery Village Community Band is playing at 3 pm, and Baltimore Symphonic Band, as the host band, is playing last, at 7 pm. C'mon out and listen!
bunrab: (Default)
The heart stuff first: yes, I did go to the doctor's the next morning, just to confirm that it was a real episode and what I felt was what I thought it was, and test the device just to make sure nothing's wonky with it. And indeed, yes to all of that. And they raised my dose of Coreg again, now all the way up to what it "should" be - I had previously been taking only half the full dose, for years, because it made me so tired and because nothing much was going wrong and the Coreg wasn't helping my blood pressure that much over and above all the other meds I take - the Diovan or enalapril, the diuretics, etc. And for years, that was fine. But now, it appears that I need it for the anti-arrhythmic effects as well as the antihypertensive effects, so full dose it is.


a couple more paragraphs of whine )

Now, books. Part of moving is, I have to de-acquisition a LOT of books.
whining about why I have to give up a few )
One of the things I'm doing is reciting a mantra that goes like this: "The library has this book. The library has this whole series. Every library in Maryland and the surrounding states has this whole series!!" That mantra is useful for a lot of the murder mysteries and some of the science fiction. Of course I am not giving up the Lois Bujolds - I want to be able to reread any Miles book on any spur of the moment! - but the mantra helped me get all the J.A. Jance out the door, because, really, libraries are very good about murder mystery series. And a bunch of Steve's vampire collection that I still had - since vampires have been more popular these last 10 years than they were when I first started reading them or when I turned Steve on to them, more libraries have them, more used book stores have them, and more of them are available as e-books. So I don't need to keep most of them. (The complete Yarbro St. Germain series stays. Don't try to talk me out of that one.)

Another way to get rid of books )
Some of the reading I've done this past 6 months has been new stuff, and there's thoughts on that.
Reading and rereading gets tiring )
So that's the process. I am trying to remember to record all the re-reads on Goodreads as I go along, and also the library books I have been reading interspersed because a body can't read 100% fantasy series 100% of the time. If there's still any of you who I haven't found or haven't found me there, well, I'm easy to find.
bunrab: (Default)
Monday night, after posting on Goodreads, but just as I was about to close Goodreads and come here, I had another v-tach episode. This time, the new programming on the device kicked in so I got "paced" out of the event rather than shocked out of it, which is less violent and less painful, but it's still no less alarming and disconcerting, and it's very, very alarming to have another episode only a few weeks after the previous one. More about how I am coping with this soon.
bunrab: (Default)
A quick summary, for those of you who haven't seen daily Facebook posts and the photos I've uploaded there:
When last seen, I was getting the kitchen in the house in Catonsville touched up, repaired, minorly remodeled, in order to contemplate selling it. It got sold!
Selling the house, buying a condo )
The condo I bought wasn't perfect, but it met my essential requirements: first floor, large enough for me to have a guest room and with room for the critters, pets permitted, safe neighborhood. What I got was a 3-bedroom unit, built in 1982, so not too old by condo standards, though not new. It's in the Long Reach area of Columbia. And this coming Sunday, a Wegman's opens up in Columbia which will then be my nearest supermarket - how cool is that?

More than most people want to know about the condo kitchen )
I am not finished unpacking yet, though I've been here a month and a half. There's still a lot I need to get rid of; cutting down from a house to a condo, even a large condo requires getting rid of a LOT of stuff.  And I had been trying to do a bit too much, so the universe sent me a reminder last week to take it easy, in the form of a v-tach episode that triggered my defibrillator. One emergency room visit later, I have some pretty firm instructions from more people to take it easy, watch how much driving I do (I was forbidden to drive for a week), changed programming in the implanted device, changed dosages of my beta-blocker, which itself is making me tired, and pretty much nothing at all accomplished in the past 10 days.

So of course it struck me as time to whine on LiveJournal!!

And how are all of you?

I will try to post next week: my goodbye pics of the house, some pics of the condo, some pics of the pets, and lots more trivia. Maybe I'll even have time to read a book and mention it!

Could someone please let me know whether the cuts are working?
bunrab: (Default)
http://www.lifebeatonline.com/previous.shtml
Articles from Guidant, now Boston Scientific, about pacemakers and ICDs and the conditions they treat. There's a free email newsletter about ICDs that you can subscribe to, also. Current issue includes a link to video interviews with teenagers who have implanted devices.
bunrab: (Default)
A couple weekends ago, my ICD fired early in the morning, while I was asleep. You've probably read about dreams, about how they aren't really as organized as we think, and most of what we "remember" of our dreams is constructed by our minds in the couple of seconds as we wake up, to attach some sort of frame we can understand to what was actually far more scattered images. It's not that we don't really dream, it's that our dreams are not the things we remember them being. Anyway, as I woke up from the shock, what my mind interpreted my dream as was: I was just stepping off the curb into a street, when a vehicle came around the corner and hit me. The vehicle was, very specifically, a white, Ford Econoline, 15-passenger carpooling van. I have no idea why it was that specific, but that's what it was.

So, most people say it feels like being kicked by a mule. I say it feels like being hit by a white, Ford Econoline, 15-passenger carpooling van. 

No, I did not go to the emergency room; why should I? The device did what it was supposed to, and I woke up a bit shook up, but otherwise OK. I have an appointment tomorrow for my regular data dump - excuse me, telemetry interrogation of the device - and if they tell me when they see the readout that I should have reacted more urgently, then in the future I will, but I didn't see a reason to panic when everything is doing its job.
bunrab: (Default)

Thursday, October 26, 2006

An article from a few weeks ago:
Stomach acid drug may slow heart failure

Sep 26 (Reuters Health) - Treatment with famotidine, which is sold under the names Pepcid and Fluxid as a stomach acid blocker, appears to improve the symptoms occur with chronic heart failure, new research shows.
Famotidine blocks histamine receptors that exist on gastric cells, and this decreases stomach acid production. However, these receptors also exist in heart muscle cells, so Dr. Masafumi Kitakaze and colleagues thought famotidine could benefit people with heart failure.

To investigate, Kitakaze, at the National Cardiovascular Center in Suita, Japan, and colleagues compared cardiac symptoms and function in heart failure patients who were treated with famotidine or with a different type of acid blocker for reflux disease or gastritis.

As they report in the Journal of the American College of Cardiology, the researchers found that famotidine therapy had a beneficial effect on the function of the main pumping chamber of the heart. Moreover, treatment with famotidine seemed to dramatically reduce hospital readmission rates for worsening heart failure.

In a statement, Dr. Gary S. Francis, a cardiologist at the Cleveland Clinic and co-author of a related editorial, sounded a caution: "I certainly would not recommend that patients go out and start taking Pepcid three times a day or anything like that."
SOURCE: Journal of the American College of Cardiology, October 3, 2006.

Monday, October 23, 2006

Hey, did I tell you that my new ICD fired up only 5 days after I got it put in? At the data dump* a couple days later, it showed my fibrillation at about 300 beats per minute, and the doc swears I wouldn't have been sitting there talking to him without this ICD. Odd, though, since the previous ICD had not fired in 2.5 years... We have to wonder a bit if the surgery perhaps acted in some sort of catalytic way to make things a bit worse, even while providing a fix for them.

*Data dump being more formally known as interrogation, carried out by means of telemetry.

It feels odd - not the big thwack in the chest I was expecting from the tests on the previous ICD, but instead just an odd electrical fizzy feeling, as though a small automobile fuse had shorted, and a few sparklies in front of my eyes. Very mild feeling, didn't knock me over, let alone out, but it was a real incident, the telemetry says so!


It may have fired again this past morning, I'm not sure; my next data dump isn't for another 2 months, and unless it fires repeatedly in a short period, one doesn't call the doctor for just one incident.


Well, I've just been busy. Busier than I should be, perhaps - we had houseguests for a weekend, and between the clean-up before-hand, the staying up late talking, and the running around doing stuff, I was wiped out - pretty much slept straight through afterwards, waking up only briefly for lunch and dinner the next day. My sleep schedule is still a bit rocky after that.

On the bright side, my 6 weeks is up since the surgery, so I can now raise my right arm above shoulder level, and carry my saxophone, and get back on the motorcycle. I hadn't been able to put on t-shirts for the 6 weeks - it is possible, though difficult, to get a t-shirt ON without raising one's arm above the head, but it is completely impossible to get a t-shirt OFF without doing so.

The scar is still sort of odd - a very pronounced ridge, although at least it doesn't have the strange tuck under it any more - but the week or so that it took that tuck to loosen up and flatten out some was quite some pain. A great deal of nerve pain, under the shoulder and radiating out along the right arm, feeling like I was being stabbed with daggers. Not fun. But that's gone now. I wish doctors were better about warning one about that sort of thing!!

bunrab: (Default)

Tuesday, May 30, 2006

Ladies Home Journal had a short blurb, which I can't find amongst my clippings right now, about how and why blood thinners help reduce the chances of SCD from atrial fibrillation. I don't remember the details of how it does that, but I do remember the statistics they cited in the column: if you are at risk of atrial fibrillation, and you don't take any blood thinners, you have a 1 in 20 chance of having an incident that could kill you, each year. [Note, my own EP says it's one in 17, not one in 20; I suppose they were rounding off.] If you take low-dose aspirin as a blood thinner, that lowers your risk to 1 in 40 - only half the chance. And if you take coumadin, it lowers your risk to a 1 in 70 chance each year.

So, even if you don't need blood thinners because of clotting risks, apparently you should take them because of fibrillation risks. While taking a strong blood thinner such as coumadin can carry its own risks - I ride a motorcycle, so I'd never take a prescription strength blood thinner, since it could make even a mild accident fatal - taking "baby aspirin" has far fewer risks and apparently accomplishes a lot. And, according to my cardiologist, if you take a proton pump inhibitor, such as Prilosec (available over the counter), it reduced the chances that aspirin will give you stomach ulcers. On the other hand - and isn't there always an other hand? - proton pump inhibitors such as Prilosec and Protonix (one of the newest prescription ones) are in one of the classes of drugs that can lead to increased risk of arrhythmia (see post about 9 posts down from this one). So it sounds like we've come full circle, hasn't it!! Apparently, if possible, to reduce your fibrillation risk in an optimum manner, you should take the low-dose aspirin without the proton-pump inhibitor, if possible.

It gets more complicated all the time.


This week's article:
Common painkillers may raise risk of heart failure

May 23 (Reuters Health) - Patients who use non-steroidal anti-inflammatory drugs (NSAIDs), which include over-the-counter analgesics such as ibuprofen or naproxen, have a small increased risk of experiencing a first hospitalization for heart failure, researchers from Spain report. They also found that for patients with pre-existing heart failure, NSAIDs may worsen the condition, triggering the need for hospital admission. ...

With current NSAID use, the overall risk of a first hospitalization for heart failure was increased by 30 percent after accounting for major heart failure risk factors, report Huerta and colleagues from Centro Espanol de Investigacion Farmacoepidemiologica in Madrid.

The increased risk of heart failure hospitalization associated with individual NSAIDs ranged from 10 percent with diclofenac to more than threefold with indomethacin. The dose and duration of use of the drugs had no apparent effects.

Heart failure hospitalization was also associated with known risk factors including high blood pressure, diabetes, kidney failure, other heart disease and anemia. Obesity, smoking, alcohol use, and recent hospitalizations and specialists' visits -- two indicators of other illness -- were also associated with an increased risk of hospitalization.

However, a prior diagnosis of heart failure was the main risk factor triggering a first hospitalization for heart failure, increasing the risk by more than sevenfold.

The investigators point out that their results are compatible with the findings of other published studies indicating that NSAIDs exacerbate heart failure symptoms, leading to hospitalization among susceptible patients, such as those with a history of cardiovascular disease and, in particular, previous heart failure.

The new study adds the finding that NSAIDs trigger the risk of hospitalization for heart failure in patients without a history of heart failure, the researchers conclude.

SOURCE: Heart, May 2006.

Monday, May 29, 2006

Science News has a short blurb mentioning that they've found out exactly what it is that makes it a bad idea to eat grapefruit or drink grapefruit juice when taking certain medications. Lipitor, for example, and the other statins, which most of us with almost any heart problem seem to be taking. So anyway, it turns out to be certain compounds called furanocoumarins, which are in grapefruit juice but not in other citrus juices, that are the metabolism-interfering compounds. Since the furanocoumarins can be filtered out of grapefruit juice, this may mean that in the not too distant future, those of us on medication can start drinking grapefruit juice for breakfast again! Whee! Don't know as there's any way to do that with fresh grapefruit, though; I guess we'll have to keep on eating those high-in-potassium canteloupe halves instead of grapefruit halves. Oh well.

Friday, May 26, 2006

More ICD news

Boston Sci finds battery problem in some devices

May 16 (Reuters) - Boston Scientific Corp. on Monday said it had notified doctors that some of its implantable cardiac devices, which it acquired as part of its purchase of Guidant Corp. last month, could be at risk for early battery depletion.
Boston Scientific, whose shares fell 1 percent, said the problem occurred in a single lot of 996 implantable cardioverter defibrillators and cardiac resynchronization therapy defibrillator devices that had been implanted in patients globally. No deaths or injuries were reported.

Implantable cardiac devices, or ICDs, are used to jolt a dangerously racing heartbeat back to a normal rhythm. Several models of the life-saving devices have been the subject of recalls or safety alerts by Guidant and other manufacturers in recent years.

Boston Scientific said 30 of its Guidant devices had been returned by May 8, and it had received an additional 46 reports of devices that remained implanted but showed signs of premature battery depletion.

The devices, which contain a faulty component from the single manufacturing batch, are in the Vitality DS, Vitality AVT and Vitality 2 ICD lines and the Contak Renewal 3, Contak Renewal 4 and Contak Renewal 4AVF lines of CRT-Ds.

In information posted on its Web site, Boston Scientific advised doctors to schedule follow-up appointments as soon as possible with patients who had received the devices and contact the company for instructions to determine remaining battery life of the devices.

The battery problem came to light after an overall review of Guidant's product lines, Boston Scientific said.

Boston Scientific swooped in to buy Guidant for about $27 billion after Guidant initiated a series of device recalls and was stung by criticism over its failure to promptly notify physicians and the public about life-threatening defects.

"We understand and acknowledge we have to do a better job of communicating, and this is a step in that direction," Boston Scientific spokesman Paul Donovan said.

Boston Scientific also advised doctors of two device malfunctions linked with implantation of Guidant defibrillators in an unusual position.

Planting one of these devices below the chest muscle, rather than below the skin, can result in mechanical stress to an area of the titanium case that can cause the product to malfunction, the company said. The uncommon technique could affect devices in the Renewal 3, Renewal 4 and Vitality HE product lines.

The two patients whose devices malfunctioned underwent successful replacement procedures, Boston Scientific said.

Morgan Stanley analyst Glenn Reicin said the product notifications stem from an approach adopted by Guidant last year to update physicians regularly about performance issues.

"Investors should view these communications as normal course of business," Reicin said in a note to clients.

Boston Scientific is currently working to resolve a warning letter from the U.S. Food and Drug Administration over quality control issues. The Guidant division also faces its own FDA warning letter over its ICDs.

Tuesday, May 09, 2006

Here's a relatively low-sodium macaroni and cheese recipe. Please note that this recipe is NOT low-fat; I don't know of any way to make mac-n-cheese that is low-fat, low-sodium, and tasty all at once; at most, you can get two of those together. This one is low-sodium and tasty. There are footnotes telling you where some of the ingredients are available.

Macaroni Quattro Formaggio
Cook 12 ounces of elbow macaroni or other small-to-medium pasta (tiny shells, rotini, radiatore, etc.) according to directions on package.
Grate an 8 ounce bar of low-sodium cheddar cheese(1). Dice up 4 ounces of FRESH mozzarella cheese(2). (If you have an ounce or so of leftover swiss(3) (gruyere, emmenthaler) cheese, you can grate that and add it too.) Mix these cheeses with the macaroni, and place in a casserole dish. Over the top of the macaroni, sprinkle about 2 ounces of grated Parmesan and Romano cheese(4), then on top of that, about 2 ounces (1/4 cup) of low-sodium seasoned dry bread crumbs(5), spreading the Parmesan/Romano and the crumbs as evenly as possibly across the whole top of the casserole. Then slice up 2 tablespoons of unsalted butter, and dot the top of the casserole with little chunks of butter. Over the whole thing, pour a can of evaporated milk - depending on where you live, that's somewhere around 8 to 12 liquid ounces; the exact amount isn't critical as long as it's at least 1 cup and not more than about a cup and a half. Place the dish, uncovered, in a 350°F oven, for 25 minutes, then switch the oven to BROIL and 400°F for 3 minutes, to brown the crumbs on top. Let the dish cool for about 5 minutes before serving.Serves 4 to 6 people as a main course, depending on the people.

To fancy it up some, drain a can of no-salt-added diced stewed tomatoes, and add them in when you are first mixing the macaroni with the cheddar and mozzarella.

The leftovers are extremely tasty cold, too; it can be served as slices, along with a salad.

(1) Heluva Good makes low-sodium cheddar; if you can't get your local supermarket to order some, you can order directly from the company. You'd better like cheese though, since it's a minimum of 4 bars.
(2) Most larger supermarkets will carry a national brand of fresh mozzarella, such as Bel Giorno, which has about 70 mg of sodium per ounce. Fresh mozzarella comes in round balls floating in liquid, by the way. If you can find some from a local dairy, though, those fresh mozzarellas often have as little as 15 mg of sodium per ounce. High-end markets such as Whole Foods, Central Market, etc. will usually have local-dairy mozzarella in their cheese assortments.
(3) Swiss cheeses vary greatly in their sodium, so you have to check the labels, but there are quite a few brands that run only 50-75 mg of sodium per ounce, including the house brand from Giant, and the commonly available Alpine Lace brand.
(4) Parmesan and Romano, or any grated cheese intended for spaghetti, can vary widely in sodium, too. This will be the highest in sodium of the cheeses in this recipe. But you can find one that has 75-100 mg of sodium per serving compared to others that have 150-180 mg of sodium per serving, and that's what to look for.
(5) Healthy Heart Market, see the link at right, carries low-so bread crumbs. They also have the canned no-salt added tomatoes, if you decide to add those.

<hr>
This week's article:
How exercise helps heart failure patients
May 04 (HealthCentersOnline) - A small study may help explain why aerobic training helps to reverse the abnormal heart patterns that appear in patients after experiencing heart failure.
Heart failure is chronic condition in which at least one chamber of the heart is not pumping well enough to meet the body's needs. This leads to congestion in the lungs or pulmonary blood vessels and may cause fluid to back up in the lungs, legs and ankles.

Previous research has demonstrated that aerobic exercise can help a person with heart failure feel and function better. Now, new research suggests that this response works by suppressing certain neurohormones that cause many of the severe symptoms of heart failure.

Following certain cardiac events (e.g., heart attack), the body works to protect itself in the short term by increasing its production of certain types of B-type natriuretic peptides (BNP). These neurohormones constrict blood vessels and help heart cells to retain sodium, which allows the heart to continue to pump blood effectively.

However, over a period of time an imbalance of the BNP neurohormones can become detrimental, leading to irregular heart rhythms, tissue buildup and the accumulation of fluid in the heart.

Researchers from Italy have found that aerobic exercise helps to improve the effects of heart failure by lowering some types of BNP. The researchers studied 47 heart failure patients who had entered a nine-month aerobic training program. The 44 patients who completed the program reported an improvement in their quality of life significantly greater than a similar control group (that did not include heart failure patients). Testing also revealed the heart failure patients had lowered levels of three types of BNP.

"Reversing neurohormonal activation by physical training adds to the current clinical practice a novel non-pharmacological aid. Out of 85 patients who completed the protocol, only the 44 randomized to the training program improved functional capacity, systolic function, and quality of life, in contrast to the controls. These beneficial effects were associated with a decrease in plasma level of BNP, NT-proBNP, and norepinephrine, only in the training group," explained Claudio Passino, M.D. from the CNR Institute of Clinical Physiology in Italy, in a recent press release.

The results of the study appear in the May issue of the Journal of the American College of Cardiology.

bunrab: (Default)

Tuesday, August 16, 2005

Cocoa fights heart disease
Aug 12 (HeartCenterOnline) - A cup of cocoa may actually be good for your heart, according to researchers in Great Britain.

Chocolate and cocoa have long been used as medicines. In fact, cocoa was originally marketed as a health tonic in the United States - and it appears there is an element of truth to the folk wisdom.

Cocoa is rich in flavonoids, which have been shown to inhibit blood clotting. This may reduce the risk of conditions caused by abnormal blood clotting, such as heart attack and stroke. Flavonoids are the same substance found in red wine, which also has been shown to have cardioprotective effects.

According to researchers, the discovery that flavonoids may help prevent blood clotting may lead to new medications, or "it may also mean that a nice hot cup of cocoa may take on new importance for people in high risk categories, " according to Dr. Denise O'Shaughnessy, who was quoted in a release describing the study.

The research was presented at the Congress of the International Society on Thrombosis & Haemostasis.

Copyright 2000-2005 (HealthCentersOnline)
Publish Date: August 12, 2005

Surgery extends mortality in cardiomyopathy
Aug 05 (HeartCenterOnline) - Patients with an abnormally thickened heart, or a condition known as hypertrophic cardiomyopathy, appear to live longer after having surgery, according to a new study.

Hypertrophic cardiomyopathy occurs when the walls of the heart, particularly the muscular wall that separates the chambers (the septum) are abnormally thickened. As a result, blood flow in the heart is reduced, causing symptoms such as shortness of breath, chest pain, dizziness or fainting. It severe cases, hypertrophic cardiomyopathy may cause sudden cardiac death. It is the most common cause of sudden death during athletic events.

Hypertrophic cardiomyopathy may be treated with a surgery called a myectomy, in which a portion of the thickened muscle is removed surgically. Numerous studies have shown that patients report feeling better after the surgery, but until now, no studies had been conducted showing a benefit to lifespan after myectomy.

Researchers from Mayo Clinic conducted a retrospective study of 1,337 patients evaluated at the clinic between 1983 and 2001. Of them, 228 had hypertrophic cardiomyopathy and had undergone myectomy. Another 228 had the condition but did not have surgery. The remaining patients had the condition, but suffered from no obstruction to their blood flow.

Researchers found that, within 10 years of diagnosis, almost 40 percent of patients who did not have surgery had died. By contrast, only 17 percent of patients who had undergone surgery had died. This death rate is the same as normal health patients, meaning that the mortality rate for myectomy patients was statistically the same as patients with non-obstructive hypertrophic cardiomyopathy or people in the general population of the same age and gender.

In a release describing the unpublished study, researchers remarked that patients undergoing myectomy can now be assured that the surgery has a good chance of extending their lifespans.

Copyright 2000-2005 (HealthCentersOnline)
Publish Date: August 05, 2005

Tuesday, August 09, 2005

The September issue of CR has a notice about the recall of various Guidant defibrillators.

Luckily, my model isn't among them, but I had to do some searching to find that out - the recall lists everything by the model name, but my wallet card lists everything by model number, and I had to plow through several pages of Guidant's web site to find out the name of mine to match the number. (Model H115
CONTAK CD 2)
(here's the link: http://www.guidant.com/webapp/emarketing/mydevice/listing.jsp this allows you to select a model number from a drop-down box, and then when you go to that page, it lists the model name as well as number.)

Monday, August 08, 2005

When a Heart Device Short-Circuits (NY Times)

August 7, 2005
When a Heart Device Short-Circuits

Defibrillators that shock a chaotically beating heart back to normal and
pacemakers that regulate a heart's rhythm have saved or improved the lives
of hundreds of thousands of people. But every so often one of these
implanted devices fails to work when it is desperately needed. The story of
how the Guidant Corporation, the nation's second-biggest maker of cardiac
devices, handled a flawed defibrillator provides a troubling glimpse into
the murky world of medical device regulation.

The problems came to light after a college student with a genetic heart
disease died in March while he was mountain biking in Utah. When Guidant
analyzed the device, it found that the unit had short-circuited. Worse yet,
the same model had short-circuited earlier in more than two dozen other
patients. Yet when the dead student's doctors asked Guidant officials how
they planned to get the word out, the officials said they saw no reason to.
It was only when The Times was about to publish an article by Barry Meier
exposing the problem in late May that the company issued an alert. The
article revealed that Guidant had known about the flaw for three years but
told neither doctors nor patients.

The company's justification for its reticence won't wash. Guidant said it
corrected the flaw in 2002 but saw no need to inform doctors because the
devices made before then were highly reliable and the surgical risk of
taking them out might outweigh the very low risk of failure. Incredibly, the
company kept selling the potentially flawed devices from inventory for
months after it began making improved versions. To this day it maintains
that all the devices are highly reliable, but surely there are few doctors
who would want to implant a device with a flaw that had been corrected in
more recent units. By failing to disclose the flaw publicly, the company
pre-empted a decision - whether to remove the flawed devices surgically -
that should be made by doctors and patients.

With the company facing heightened scrutiny from regulators and a steady
drumbeat of articles by Mr. Meier, Guidant has issued alerts or recalls on
20 models of defibrillators and pacemakers, comprising tens of thousands of
devices in all. For the future, the company, the Food and Drug
Administration, a heart rhythm medical society and the chairman of a Senate
committee are all pondering ways to increase the flow of information on
flaws in medical devices. It will be equally important to improve the
monitoring of these devices after implantation. Their generally reliable
performance must not obscure the fact that when they fail, the results can
be catastrophic.

* Copyright 2005 The New York Times Company


August 6, 2005
F.D.A. Will Not Release Some Data on Heart Devices
By BARRY MEIER

The Food and Drug Administration said yesterday that it would not release
information that it receives annually from the makers of heart devices
detailing how often and why products fail. The agency called such data a
corporate trade secret.

The F.D.A. took its position in response to a Freedom of Information Act
request from The New York Times, which had sought annual reports filed by
the Guidant Corporation in connection with a defibrillator, the Ventak Prizm
2 DR. From 2000 to 2002, Guidant made thousands of the devices, some of
which had electrical flaws that caused them to short-circuit. In March, a
college student with a flawed device died of cardiac arrest.

The agency's position may put it at odds with Senator Charles E. Grassley,
Republican of Iowa and chairman of the Senate Finance Committee. Senator
Grassley recently wrote to the commissioner of the F.D.A., Dr. Lester M.
Crawford, asking the agency to explain why it did not make product data from
device makers' annual reports publicly available on a regular basis.

Senator Grassley, who last year held hearings on the agency's post-marketing
scrutiny of drugs like Vioxx, said yesterday that he was disappointed by the
latest decision.

"The F.D.A. needs to find reasons to make information public rather than
working overtime to withhold findings that the public deserves to know
about," he said. "Amid the scrutiny of the last year, the F.D.A. has
acknowledged that the public wants and needs to know, but so far the
agency's actions haven't matched its words."

Under little-known F.D.A. regulations, the makers of defibrillators and
pacemakers must provide detailed data each year to the agency, including the
frequency of failure in individual models, the cause of such failures and
the number of deaths and injuries.

A defibrillator sends an electrical charge to the heart to interrupt a
chaotic and potentially fatal rhythm. A pacemaker regulates a heart that is
beating too fast or too slowly.

The product-performance data submitted to the F.D.A. by manufacturers is
more detailed than that they provide to doctors, industry officials said.

The F.D.A. - in responding to a Times request for all annual reports filed
by Guidant in connection with the Ventak Prizm 2 DR - said that it would not
release the product performance data for that device and similar ones made
by Guidant.

The F.D.A. said yesterday that such information, be it from Guidant or
another maker, constituted confidential trade information.

"This information is a trade secret and exempt from release," an agency
official, Joy B. Lazaroff, wrote in an e-mail message.

An F.D.A. spokeswoman, Julie Zawisza, said in June that while the agency did
not make such filings public on a regular basis, it might do so if a Freedom
of Information request was filed.

In addition to the annual reports, makers are also required to file reports
with the F.D.A. on possible product failures, including those related to
potential patient injuries.

A review of the reports filed by Guidant that the F.D.A. recently placed on
its database showed that both the frequency of electrical failures of the
Ventak Prizm 2 DR and its consequences for heart patients were increasing
before the March death of a college student who had a flawed device.

The review also showed that about 14 of the 28 known failures occurred from
January 2004 to this March. In addition, both the death of the student,
Joshua Oukrop, as well as most patient injuries potentially related to the
device's flaw took place during the same period, the filings show.

In 2002, Guidant executives discovered that the device was prone to
short-circuiting, which would render it useless. The company fixed the
problem in 2002 but did not alert doctors for three years until it became
aware that the problem would be disclosed in other public forums. In
addition, Guidant kept selling older versions of the device even as it was
selling an improved version in which the electrical flaw was eliminated.

Under F.D.A. regulations, a company is required to analyze the risks posed
by a device and make an assessment as to how to respond. A manufacturer must
keep records of how it made such assessments on file for review by F.D.A.
officials. Specialists on medical-device regulation said a company was
supposed to regularly review its course of action and possibly revise it if
events, like an increasing rate of product failure reports, warranted it.

Executives of Guidant, which is based in Indianapolis, have said that the
company made all required filings with the F.D.A. regarding individual
reports of device failures and told the agency in 2003 about the
manufacturing change that fixed the flaw. Companies, however, do not have to
file risk assessments with the F.D.A.

A spokesman for Guidant, Steven Tragash, declined to respond to written
questions on the frequency of the risk assessments of the Prizm 2 DR,
including if one had been done in March when Mr. Oukrop died and another
heart patient nearly died. The role of the device in both incidents is not
clear.

Mr. Tragash declined to make the chief executive, Ronald W. Dollens, or the
head of its heart device unit, R. Frederick McCoy Jr., available to be
interviewed. Guidant also did not respond to written questions about when,
or if, Mr. Dollens and Mr. McCoy became involved in discussions on whether
to issue an alert about the Prizm 2 DR to doctors.

In December, Guidant, which derives about half of its revenue from
defibrillator sales, agreed to be acquired by Johnson & Johnson in a deal
worth $25.4 billion.

The exact number of problem reports filed by Guidant each year in connection
with the Prizm DR could not be determined because the reason for a device's
failure is not always readily apparent from the language. But the filings
indicate that Guidant made 2 reports in 2002 about short-circuiting in the
Prizm 2 DR; some 8 such reports in 2003; some 11 reports in 2004; and 4 in
the first three months of this year.

* Copyright 2005 The New York Times Company

Thursday, August 04, 2005

Cholesterol Drugs & Heart Failure
A common cholesterol-reducing drug may lower the risk of death from heart failure. Read the complete article: Statin therapy lowers mortality in heart failure. For more information, visit HeartCenterOnline's Cholesterol Center or Heart Failure Center. Or, view all Cholesterol News or Heart Failure News.

You can also check out the Heart Failure Quiz.

And other articles:
Topiramate lowers weight and blood pressure
Statin therapy lowers mortality in heart failure


I've been doing OK since I arrived in Maryland; it's been 10-15 degrees cooler than in Austin except for the last 2 weeks. Right now it's as hot and humid as Austin. But even so it doesn't feel quite as bad, because there isn't heat soaked into the ground from months and months of temperatures near 100 degrees. There are still lots of shady trees, and the grass is green, which keeps the ground temperature cooler.

My big worry right now is that my insurance, from the Employees Retirement System of Texas, still hasn't told me what my coverage is for finding a new cardiologist up here, so I don't have a doctor. My old doctors back in Austin are not going to authorize my prescription refills in Maryland forever, so I really need to find a family doctor and a cardiologist soon, and I really should find an electrophysiologist as well, since it'll be time for another ICD/pacemaker reading/check-up in another month or so. So I guess I need to phone ERS and hassle them a bit, to find out what my coverage limits are now that I'm "out of area." (For that matter, I still haven't found anyone to cut my hair, either, and that needs doing, but at least I don't have to wait on insurance for that! Moving certainly discombobulates one's life, even when it's overall for the better.)

bunrab: (Default)

Tuesday, July 08, 2003

So how did I get diagnosed, anyway? I have allergies- had bad seasonal allergies all my life. Occasional episodes of reactive airway disease (RAD). So when I started having to stop to breathe a lot, and coughing a lot, we naturally assumed that the RAD was developing into asthma. Particularly in a city known for having something new pollinating every single month, this is not uncommon- keep irritating the bronchii, and eventually they rebel. And in medicine, there's a saying that goes "When you hear hoofbeats, expect a horse, not a zebra." Which is to say, that one looks first for the obvious and most common things - in someone with a history of allergies and respiratory problems, in a city where asthma victims fill the ERs pretty regularly, that would be asthma. It certainly wouldn't be heart failure, particularly not in someone under 50, who has no family history of any heart problems, doesn't have diabetes, doesn't smoke, etc. etc. So, my doctor kep trying newer (and more expensive) asthma inhalers, and larger doses. Trying all this took about 6 months- get a new set of inhalers, try them for a couple weeks, call the doctor and tell him it's not helping. Once we got up to the heaviest dose of Advair, the state of the art for asthma, and it didn't do a damn thing for me, my doctor had to admit he was stumped. So he sent me to a lung specialist (pulmonologist). Who took chest x-rays, took one look at them, took one listen at my chest, and told me to sit down. He delivered the diagnosis. He referred me to a cardiologist, but he was sure enough of the diagnosis to write me out prescriptions for a diuretic (furosemide, the generic of Lasix) and a bigger dose of Diovan than I already took for hypertension. (Diovan is one of the sartan bunch of drugs, the ACE II inhibitors. Diovan is valsartan. The prils are the original ACE inhibitors- lisinopril, Captopril, etc.) The pulmonologist also explained one of the rules of thumb for checking such things: pointing out on the x-ray, he showed how the heart sits slightly to one side of center. Normally, if one were to take that heart and imagine sliding it over so that one edge is just touching the sternum (front and center of the ribcage) then the other side of the heart would still be contained within the chest. An enlarged heart, however, sticks out past the ribcage, by an inch or two, if moved to such a position.

One of the things about such a diagnosis is that it seems as though, for the next few weeks, you lug the giant folder the chest x-ray is in, everywhere. Bring it to the site where you're getting your echocardiogram. Your EKG. Your first visit with the specialist. Your first visit to the specialist's nurse practicioner. Your first visit to the weekly clinic sessions. The hospital where you're getting your angiogram. After a month or so, apparently, the entire medical community of your city has copies of that chest x-ray, and you can stop carting the big folder around. And then when you sit in the waiting room, you can recognize who's new, because there they are, carrying their big folder around!

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