Tuesday, August 26, 2003
One of the things that bugs me about heart failure is the limit on drinking fluids. In the summer, I canNOT stick to 8 cups of fluid a day. I also get bummed about being allowed only one cup of caffeinated black tea a day, caffeine being a heart stimulant and therefore, theoretically, bad for me. I personally feel that doing without tea entirely would make me feel much worse; caffeine is good for my brain, if not my heart! But if it's only one cup, it's going to be a good one. Here are my favorite places to buy tea: Harney and Sons Plymouth Tea Thousand Cranes Tea
Also, some nice, inexpensive green teas (less caffeine) at Salada
- this is a brand I used to be able to buy all the time when I lived up north; Salada was our everyday brand when I lived in New York. Down here in Texas, supermarkets don't seem to have it, so I order it online. Since it makes sense to order at least 6 boxes at a time, I order some for me, and some for the kitchenette in the Faculty Resource Center at school. Bringing in boxes of scented and/or flavored tea for the gang makes me popular... I can skimp on throwing quarters into the jar that goes to buy cups and coffee.
Saturday, August 23, 2003
Well, I didn't get much done this week, did I. The faculty meetings took up more time than I thought, the air conditioning for the upstairs half of our house went out, and the internet access at school slowed down to a lame snail with a gritty shell. I spent all day Thursday at home, waiting for the AC repair guy, unable to use my computer because all the pets who normally live upstairs were downstairs in the library. "All the pets" includes 5 rabbits, 5 guinea pigs, a chinchilla, 2 hedgehogs, a cockatiel, and a cat. And then, once the repair guy finished, spent most of Friday, except when I was at school for yet another meeting/presentation, cleaning and re-arranging the animal cages, then returning the animals to their usual room. I make cages myself, and one of them is a huge cage with several levels, a 28" by 42" cage with an upper shelf (for another 4 square feet) for two of the rabbits, Fred and Ethel, and then on top of that, two more single levels, for the boy guinea pigs and the girl guinea pigs. Originally, those 8-square-feet cages held 4 guinea pigs apiece; we are down to two of each (Flo lives with Gizmo bunny, not with the piggies. She thinks she's a rabbit.) and they could get by with less space. We have two slightly smaller rabbit cages for one bunny apiece, with about 5 square feet of space on the ground floor plus a shelf for about another 2 square feet. So I took the top two cages off the big rabbit cage, and then built new single levels on each single rabbit cage, for the guinea pigs. So now each pair o' pigs has 5 square feet; everything is much easier to clean; the "big cage" is much lighter and easier to move, while the two smaller cages are heavier than they were, but still lighter than the big cage. All around easier to manage, plus everybody gets more sunlight. Email me
if you want lots more information on pet rabbits, pet guinea pigs, pet hedgehogs, pet chinchillas, and building cages - I've got a whole separate web site just for cages.
And now I have a cold. Felt it coming on last night. This is a real bummer, because I can't use Sudafed or any other brand of pseudoephedrine or any other type of decongestant. They are all stimulants, and strictly bad news for heart failure patients. Decongestants can cause arrhythmia and/or accelerated heartbeat. So I just have to sit here and let my nose drip. It's disgusting. I am going to go move away from the keyboard before it gets sticky with sneezes; I'll be back when the risk of sneezing on the moving parts goes down.
Monday, August 18, 2003
This week is the break between summer and fall semesters. No classes, just faculty meetings. So maybe I'll have time to post a little more this week.
It was my turn to do dinner last Friday, so I tried something out of a cookbook I just got: Hungarian Goulash from No Salt, No Sugar, No Fat Cookbook
. It wasn't bad at all. I found some yolkless egg noodles at Central Market, thereby reducing the cholesterol; on the other hand, I used low-fat yogurt rather than fat free. To me, it's worth it- the taste of fat-free just really turns me off. Same for sour cream, if I were to use sour cream instead of the yogurt. It's not a great cookbook, but it's a decent one for the price, $8.95. There's no pictures, that's a disadvantage. On the other hand, there is a section about stocking your pantry that could be very useful to most people.
My pantry tends to be heavy on canned NSA (no salt added) mushrooms, NSA tomato sauce, NSA chickpeas (garbanzo beans), pasta, brown rice, and couscous. So from the non-perishables I can put together something - mushrooms, chickpeas and rice with chili powder, mushrooms, chickpeas and rice with curry powder, pasta with tomato sauce and mushrooms - with no planning needed. Almost as fast as nuking a frozen dinner, with lots less fat and sodium. My freezer usually has a couple packages of turkey "cutlets" and some extra lean stew beef, which is also useful for stir-frying if you slice it up very thin. Some no-salt stir-fry sauce, the meat, and a package of pre-sliced veggies, and there's a meal, flavor varying by which sauce I use. The only work is slicing up the turkey or beef. I imagine one could use tofu for this too - I haven't tried it. If you use tofu, be SURE to check the sodium content - it varies wildly from brand to brand and style to style.
Vegetable broth. They sell low-sodium chicken broth and low-sodium beef broth, powdered or in cubes, but no one locally stocks powder or cubes of lo-so vegetable broth. Since we have a lot of vegetarian friends, I like to use vegetable broth. So what do I do? Well, the world's easiest is to save the liquid next time you open a can of lo-so green beans, a can of lo-so tomatoes and a can of lo-so corn. Freeze the liquid in an ice cube tray and take out a couple of cubes and nuke them for your broth. If you don't open them all at the same time, freeze them in layers- distribute the green bean liquid among all the spots in the tray, let it freeze, then when you get around to the corn, pour it right over the green bean ice, etc. That way each cube will still have a mix of vegetables in it. This works for almost any combination of vegetables; it doesn't have to be the ones I've listed here. If the canned vegetables you usually buy are mushrooms and Veg-All, that works. Use a different color ice cube tray than your regular ones, or place it in an entirely different spot in the freezer, so that someone doesn't accidentally drop veggie cubes into their iced tea.
Speaking of Veg-All, that's a source of a thicker vegetable base, for vegetarian stews. Pour the can of no-salt-added Veg-All, liquid and all, into the blender or food processor, and liquify it all, till you have a smooth puree. Then freeze it, as before. When you take out several cubes for a stew, you may even want to add a little water as you defrost the cubes. This also works as a half-decent starting point for rattatouille, gazpacho, and other vegetarian dishes.
Another method of producing quick vegetable broth, that I read of but haven't tried, is to buy the dried veggie bits sold in the spice aisles of the supermarket- usually, one can find dried parsley, dried bell (green) peppers, and dried carrot flakes. Dump small amounts of each into your measuring cup of cool tap water, then bring it to a boil. The dried veggies need no refrigeration, just keep them on your spice shelf. (And they also make great treats for pet rabbits and guinea pigs - I've used them for that purpose often!)
Monday, August 11, 2003
Looks like I've finally straightened out a hassle with my HMO. They weren't going to pay for some lab tests- ones which get done every few months, and which they have paid for before and since; they just weren't paying the April ones. Since I need to go get the tests done again this month, I had to get this straightened out, or the lab wouldn't do anything for me! So it turns out that the wrong billing code for the digoxin and magnesium levels were used. There's more than one code for those tests, depending on the diagnosis. So, I got the nurse specialist who originally asked for the tests to phone the lab and correct their codes, then they rebilled my HMO, which appears to have paid for everything now except for $17.60. No explanation of why they won't pay that part, but hey, if that goes unresolved, I can pay it. That's a lot more reasonable than some $255 that was outstanding before (not just the digoxin and magnesium, but that entire lab visit, were going unpaid, even though the incorrect codes were only on those two items.)
More about digoxin soon; it's next on my list AFTER I grade some exams, some final projects, file some more papers with the Employees Retirement System trying to get disability retirement, prepare some materials for a presentation, and attend three faculty meetings. Whee.
Friday, August 08, 2003
Whew. It's been a week. I've been making final exams, administering exams, and grading exams. I'm almost done, luckily.
Body mass index is a measure of height and weight. Body Mass Index between 25 and 29.9 is "overweight", and greater than or equal to 30 is "obese." BMI between 19 and 25 is normal, and below 19 is underweight. It should be noted that underweight people are more susceptible to some health problems too, though not as many as overweight people.
If the form above doesn't work, I've also put it on some of my own web space, so you can try it here.
Sunday, August 03, 2003
Today's link: Cholesterol drugs improve strange heart problem
A quote from the article:
Drugs that are commonly used to lower cholesterol levels appear to improve a mysterious type of heart disease with an unknown cause.
The disease, known as idiopathic dilated cardiomyopathy (IDC), results in an enlarged heart that doesn't pump properly. Unlike the most common type of heart disease, IDC is not due to a blockage of the coronary arteries that feed the heart. Although less common than other heart problems, it is the number one reason people get a heart transplant.
Statins, which include Pravachol and Lipitor, are frequently given to patients with high cholesterol levels. In addition, they have been shown to be useful for patients with heart disease involving the coronary arteries. However, it was unclear if statins were beneficial for IDC.
IDC is how my heart failure occurred, and probably the same for many of you - your heart is enlarged, no one knows why. Although they refer to it as "strange" it's strange in the sense of unknown cause, not in the sense of rare - because it's pretty common!
Bad, bad BunRab! I had a baked potato with butter on it at lunch, and Chinese food for supper which undoubtedly had some salt in the sauce. I didn't eat all the rice, soaked in all the sauce, however, as I used to do; I took each prawn and each snowpea and each walnut and sorta wiped the sauce off against my rice, before eating each piece. I spent part of the morning helping to empty folders of old music; I play in the volunteer municipal band, and we start rehearsals again in only 3 and a half weeks or so, so it's time to get last year's music back in the envelopes and new folders full of new music, all shiny and unwrinkled, made up. We have about 90 people in the band, and since many of us are over 40 and wearing bifocals, that means separate folders for just about everyone, since few of us can see well enough to share a stand. I'll be happy to start up this season feeling MUCH better than I did last year at this time, when I hadn't been diagnosed, and was coughing all the time and gasping for breath a lot, which is not conducive to playing the tenor saxophone. Now if only I knew my teaching schedule for next semester yet (which starts at about the same time), I'd be all set!
Friday, August 01, 2003
Ugh, it's been several days. Since I have started taking the spironolactone, I've been sleeping 12 to 16 hours a day, which starts leaving me with too little time to do things. (I've even been sleeping through meals!) So I put a call in to the doc, see if I can go off it again - whatever benefit it's supposed to incur, I think being asleep through most of the day outweighs that benefit.
Anyway, back to beta blockers. Let's see if I can redo my long post.
Adrenaline isn't just one thing, it's actually several. And the receptors for it around the body aren't just one kind, there are several. There are alpha-adrenergic receptors, and several kinds of beta-adrenergic receptors. Different areas of the body have different balances of these. When adrenaline hits the heart, it stimulates it to beat faster and harder - the famed fight-or-flight response. For a person with heart failure and a tendency toward tachycardia and/or arrhythmia, this is not good. So the class of drugs generally called beta-blockers, works to prevent the adrenaline from being received by the heart, so the heart won't be overstimulated.
OK. Beta blockers generally block one or more of the beta-adrenergic hormones. Beta blockers can be recognized by their generic names, which all end in lol
. As in, acebutelol, bisoprolol, labetalol, etc. There are also drugs that are solely alpha-adrenergic blockers, but they don't end in lol
. Terazosin, for example, is an alpha blocker used for hypertension and benign prostate hyperplasia. Most of the beta blockers are used as anti-hypertensives, anti-angina, and as anti-arrhythmics. And most of them aren't prescribed for CHF; in fact, most of them carry warnings that people taking them for other heart problems may develop CHF! Some are used for specific other purposes - timolol, for example, is used to treat glaucoma - it reduced the pressure of fluid in the eye. It's used on animals as well as humans - I know several dogs and rabbits who have had their eyes treated with timolol. That's one of the ones that carries CHF as a possible risk. Propanolol is one of the oldest of the beta-blocker class, and has been prescribed for angina and hypertension for nearly 40 years (brand name Inderal). It's also one that carries CHF as a possible risk.
On the other hand, carvedilol (brand name Coreg) is both an alpha and beta blocker, blocking more than one type of beta receptor. This was the first beta blocker approved for treating CHF, only a few years ago. Another one, metoprolol XL form, has been approved since then. Several studies have shown that carvedilol gives significant survival benefits to patients with advanced or severe heart failure; one study showed that it reduced death rates by 35%. This is probably the single most significant improvement in mortality rates and in hospitalization rates of any of the drugs prescribed for CHF. Despite the possible disadvantages, it's definitely worth taking.
Now the downsides of carvedilol. There's an extremely long titration period. Titration is the fifty-cent word for ramp-up, that is, building up to the therapeutic dose. Starting out on a full dose right away is guaranteed to make you feel a lot worse, and so many people wouldn't comply with continuing to take it. The ramp-up allows you to get used to the side effects more gradually. It takes about 10 weeks, starting at 3.125 mg and doubling every couple of weeks, to get to 25 mg twice a day. Even at the low dose, fatigue, tiredness, lethargy and slow heart rate are expected side effects. They gradually wear off - then come back for a few days each time the dose is doubled. So it's about three months before you really begin to feel better. One should be taking one's blood pressure and pulse
every morning, and if your pulse rate falls below 60, let the doctor know. Also, since the purpose of this drug is, in part, to slow the heart rate, one should not be doing exercises that call for a high target heart rate. No aerobics. Doctors recommend walking, yoga, and swimming (as long as you're not trying to do them competitively, high-powered and high-pressured) as exercises that keep you moving and flexible, without pushing your heart into fighting with the beta-blockers. One should also have one's digoxin levels measured regularly while taking beta-blockers.
There's your bunch of trivia for the day. Wasn't that exciting?