July 4-7, 2003 posts

Friday, July 04, 2003

Why should I have a diary about heart failure? Well, I'm younger, better educated, and more articulate than many people with this disease, so I guess I feel a little noblesse oblige, to communicate to others stuff your doctor may not have mentioned, or not in plain English, anyway, and also, of course, misery loves company.

I'm 49. I have no family history of heart failure, and none of the common indicators. I don't smoke; my high blood pressure has been under adequate control for years with medication; while I've been overweight, I've never been obese; I don't have diabetes. I don't have coronary artery disease. What I have is idiopathic cardiomyopathy, and an ejection fraction of 20%, which hasn't improved at all even after 6 months of the state-of-the-art medication regimen. I just got a pacemaker (or more accurately, a defibrillator that happens to be a pacemaker) three weeks ago today.

I hope to tell you about medical research I've read, about my experience with the pacemaker, about learning to live with a low-sodium diet, and so on. You'll also get side notes about my pets, my motorcycle, my reading habits, and my other health issues- doesn't that sound like fun?

For now, it's the Fourth of July. Let's put in a low-sodium picnic recipe.

Low-Sodium Three-Bean Salad.
one can NSA (No Salt Added) black beans, drained and rinsed.
one can NSA garbanzo beans (a/k/a chickpeas), drained and rinsed.
one can NSA string beans (a/k/a green beans), drained and rinsed.
One small white onion.
A handful of cilantro- or parsley if you can't stand cilantro. Out of a 25 cent bunch of cilantro, I use about 1/4 of the bunch for this, but you may want less.
One each green, red, and yellow bell peppers.
Sugar
Vinegar

Throw all the beans into a bowl. Chop the onion into small pieces and add it; chop the cilantro or parsley leaves into small pieces and add them. Slice peppers and remove all seeds and stems and pith, then chop them into squares, and throw them in the bowl, too. Now sprinkle two to three heaping tablespoons of sugar onto the mixture, and toss thoroughly, till you can't see the sugar any more. Pour about 1/2 cup of vinegar - good salad vinegar or red wine vinegar works best - over this; place a secure lid over the bowl, and refrigerate for at least two hours to let the flavors blend. It's even better if you can can let it chill overnight; if you think of it, a couple of times turn the bowl over to redistribute the vinegar and then put it back to marinate. Serve cold; serves six to 8 people, and my experience is that even people who aren't on a low-sodium diet will like this.

If cans of NSA food aren't available where you are, here's one on-line source:
Healthy Heart Market

posted by Kelly : 6:44 PM   

Saturday, July 05, 2003

Got back from a late supper. Eating out becomes something of a challenge when one is supposed to avoid sodium. So many things in restaurants have sauce on them, and sauce is pretty salt-laden. So there are some rules of thumb for eating at restaurants: avoid stuff with lots of sauce, avoid fried foods, avoid processed meats, blah blah blah. What is harder to figure out is what, besides green salad with no dressing, you can eat. So here's some things I've discovered:

Entrees with fruit in them are likely to have less salt than other entrees. Look for things with pineapple, in particular. In Mexican restaurants, this may mean a taco of shrimp and pineapple; in Chinese restaurants, it may mean sweet-and-sour something. These aren't completely salt-free, but they do have less salt than other dishes from the same menus. Luby's Cafeterias have a carrot-and-pineapple salad...

Baked potato. Ask if the kitchen has unsalted butter, and use a small slice of that, and ONE TEASPOON of sour cream. (So ask for the sour cream on the side.) Don't get bacon bits or cheese, but if they offer chives or green onions, or sliced mushrooms, put lots of them on the potato.

Swiss cheese. Swiss cheese is much lower in sodium than most cheeses; lower, in fact, than many "reduced sodium" cheeses. So you can get something with cheese on it, if the cheese is Swiss. Swiss cheese varieties include Emmenthaler and Gruyere. A sandwich of Swiss cheese and veggies is a good choice. One of my favorite places to eat serves a sandwich called the Flamingo: Swiss cheese, avocado (the good kind of fat!), bean sprouts, and tomatoes. I eat it without any mayo, of course.

Red Lobster has teriyaki-glazed fish, a couple different kinds. Of them, the tilapia, or rockfish, is the cheapest. The teriyaki glaze is surprisingly low-sodium, and according to published reports, that entree has only about 475 milligrams of sodium. Get a plain salad and a plain baked potato with it, and you're good to go. (Avoid those cheese biscuits, though!!)

If you're a meat eater, a small filet mignon has less sodium than any other beef entree on a steak menu. Provided, of course, that it is NOT served with bacon wrapped around it.

There, hope that helps. It's not a complete list, of course. But I'm glad to be able to give some specific suggestions of things one can eat, instead of all those lists of things not to eat.

One of the things that annoys me about restaurants lately is that here in Texas, the price of iced tea has been going steadily up. I don't know why that should be; the wholesale price of tea has not had any sudden drastic increases. But now a lot of restaurants are charging over $1.50 a glass for tea, and I don't think there's a glass of tea in the world worth $1.65, let alone $1.95. Just as well, I suppose, since I'm only supposed to have one cup of black tea a day, to keep down the caffeine, but still... Incidentally, the tea served in most Chinese and other Asian restaurants is often Jasmine tea, usually a green tea, so you can drink more of that, because it's got much less caffeine than black tea. Still, of course, following your doctor's recommendations as to total liquid intake for the day.

posted by Kelly : 10:29 PM  

Monday, July 07, 2003

You know, it's been thundering and lightning-ing on and off all day, and I don't know whether I should be more worried about lightning than I used to be. One can't, after all, put a surge protector on a pacemaker. On the other hand, since I ride a motorcycle, I already try to make a point of not getting caught out in the rain, so my chances of getting hit by lightning are lowered.

Why a motorcycle? Well, it's fun- if it weren't, all the other reasons wouldn't matter. But, for me at least, all the other reasons matter enough that if they weren't there, I wouldn't have bought a bike just for fun, either. My Honda Nighthawk gets 65 mpg city, 73 mpg highway. It cost only $3400 brand new. I can park anywhere- and since I teach on a university campus, that is an important point. That's why I first started riding- when I was in college, I lived in Boston, where parking is always scarce, and also where the gas crunch of '72 raised the price of gas three-fold. I've been riding for over 30 years now. Motorcycling is a risk, true. Being alive is a risk. Having heart failure doesn't change my perception of the risks of motorcycling at all. What I do to mitigate those risks resembles stuff that's good for us all anyway: never drinking and riding (alcohol is involved in many motorcycle accidents); never using recreational drugs and riding (ditto); always wearing the very best helmet I can afford, rather than the least I can get away with; wearing sturdy shoes or boots rather than flip-flops... You know what we call those people on bikes with flip-flops and shorts and no helmets? Organ donors. I almost always obey the speed limits. I take the Motorcycle Safety Foundation course every few years as a refresher. (They have a beginning rider course and an experienced rider course. Taking either will get you a 10% discount on your insurance in most states.)

I have a handicapped license plate (or disabled plate, if you prefer); I don't take advantage of it often, except when I have to go over to the University of Texas campus (which is not where I teach). Parking at UT is so awful; one needs every advantage one can get. I use UT's library a lot, which is why I'm there. Disabled parking puts me only half a block from the library door; motorcycle parking is an entire long block away, and car parking is something close to nonexistent without a special UT permit, anywhere withing campus. My doctor had no problems signing the paperwork for me to get the plate, not with an ejection fraction of 20%. I also got a hang-tag, or placard, as they call it, to use if I am in a car. This helps when I go grocery shopping. Walking up and down all the aisles of a large supermarket is pretty tiring all by itself, never mind the thought of carrying the groceries out to the far corners of the parking lot. Sometimes I even go ahead and borrow one of the electric carts to do my shopping; I know there are people lots worse off than I am, but if a cart's available, well, I use it. Store personnel are sometimes suspicious, because they've just seen me walk in from the parking lot. Do you get that a lot? The "you're not visibly crippled so you must be cheating on the handicapped thing" attitude? Sometimes I calmly offer to trade them whatever they think is wrong with them, with whatever handicap they are so sure I don't have. That usually shuts them up. On a good day, of course, I can walk the supermarket and push a regular cart, and I do so. But days when I've gotten too little sleep, or it's so hot that it's annoying my blood pressure, I definitely feel like I'm Class III. On the good days, I'd be counted as Class II based on results, although that 20% ejection fraction would still argue against it.

The funny thing about getting the handicapped plate for the bike is that apparently, it's quite common- the county clerk's office has piles of handicapped motorcycle plates to hand out, just like they do car plates and regular bike plates. I thought about that for a while, and then figured, with the lifestyles that many of the bikers lead- you know, the ones that make TV news, or that you can hear rumbling by your house in gangs - there are probably quite a few riders with emphysema and similar disabilities, that don't affect our legs directly, so we can handle all the levers and pedals, but do affect our ability to walk very far. And this is indeed a disability. The TXDOT (Texas Dept. of Transportation) form to apply for disabled plates lists as its very first qualified mobility impairment "cannot walk 200 feet without stopping to rest" even before the parts about using assistive devices such as walkers and wheelchairs. (That form, by the way, is from Harris County (Houston) web site, but is good all over the state - check your own county clerk's website for details of where to send the application.)

OK, if you aren't interested in motorcycles, that may have been more than you wanted to know- but then again, if you didn't know that heart failure qualifies you for handicapped plates even though you can still walk, I may have done my good deed for the day :-) Happy riding or driving, as the case may be.

posted by Kelly : 2:35 PM  

July 8-11, 2003 posts

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!

posted by Kelly : 9:13 PM  

Wednesday, July 09, 2003

P.S. Today's recipe:
Roasted Steak Fries.
Buy one large baking potato per person. Scrub them. Peeling is optional, according to your taste.
Slice each potato into 8 wedges lengthwise.
Pour a couple tablespoons of vegetable oil (the kind with the good fats in it please!) onto a baking sheet. Rub all sides of each potato wedge in the oil, and lay them out on the cookie sheet. Now sprinkle a spoonful - somewhere between a teaspon and a tablespoon - of your favorite no-salt seasoning mix over each set of wedges. Some ideas: any Mrs. Dash's seasoning; Chef Paul's Cajun Seasoning, no-salt version; "Italian Seasoning" which is usually a blend of thyme, oregano, basil, and other spices; even liquid garlic steak sauce without salt. Bake the wedges on the cookie sheet in a 350° oven until they are fork-tender, anywhere from 30 to 50 minutes depending on how big the original potatoes were and how large the wedges are.

Other places to order the Mr. Spice salt-free, fat-free, garlic steak sauce- and other terrific salt-free stir-fry sauces and meat marinades - include:
Peppers.com
Hot Shoppe
Healthy Heart Market

posted by Kelly : 4:32 PM

Well, I spent an exciting afternoon at the Texas Textbook Hearings. The TEA is considering adopting new biology textbooks this year, and there are many people who want all textbooks to "present evidence against evolution" and to include "alternative theories" such as so-called Intelligent Design. What, you may ask, does that have to do with heart failure? Well, although I don't have word-for-word of my testimony, here's roughly what I said:
"Hi, I'm _____ ______ and I teach at St. Edward's University. You've already heard from many of my academic colleagues, so I'm not going to repeat their testimony. Instead, I'm going to speak about why I have a very, very personal interest in making sure that Texas science teaching doesn't get weakened by watering down evolution or including intelligent design in biology textbooks. I have congestive heart failure. I just got a pacemaker a few weeks ago. The latest research on heart failure is being done on zebrafish, because they can regenerate damaged heart muscle, and this research is propelled by a full understanding of evolutionary biology. As far as I have been able to find out, intelligent design theorists and the Discovery Institute have contributed nothing to medical research, not even any testable hypotheses which could be the basis for future medical research. If Texas high school students are taught only the "weaknesses" of evolution, and/or are taught intelligent design, they are going to be at a severe disadvantage in getting admitted to medical schools. In fact, they'll be at a disadvantage in getting admitted to veterinary programs or even two-year college programs for medical lab technicians. I need good doctors. So if any of you are considering demanding that intelligent design be added to Texas textbooks, I want to ask you to ask yourself a very personal question: 'Am I contributing to medical research, or am I contributing to ______'s early death?' Thank you."

posted by Kelly : 4:12 PM

Friday, July 11, 2003

Got the pacemaker adjusted; I don't feel any different. I could bore you stiff with the settings AIR-R vs. DDD-R vs. just DDD but that would be more than anyone would want to know. I also got my permanent plastic pacemaker ID card to carry in my wallet at all times, replacing the temporary pasteboard one. Yeehah. I had already ordered, and received, several different forms of medical alert jewelry to wear. What I find most convenient is this small lightweight charm which can be hung on a chain around the neck, attached to a watch band, or for that matter hung from a hoop earring. It is very, very lightweight. Cheap, too.

What should be on your medical alert ID? That you have an implanted defibrillator and/or pacemaker; what cardiac meds you take (and for some of them, the dosage - while there's a wide safe range of how much Diovan or Lasix one can take, and Coreg only has 2 strengths, based on total weight, digoxin has a vary narrow range and switching dosages and even just switching brands can be harmful. So emergency personnel need to know that sort of thing.); any other meds you take that aren't optional. That is, while seasonal allergy medications are optional- you'll still live without them - you wouldn't want to suddenly have your thyroid medication or your diabetes medication or your anti-depressants discontinued without notice, so list them. List, of course, any allergies to medical products, and any really bad food allergies, as well (penicillin, peanut butter... I suspect you don't have to worry about allergies to shellfish though; I really doubt they're gonna feed you shellfish in a hospital :-)

Many people get medical alert bracelets, but I find them too large and heavy, particularly in the Texas heat, and bracelets in particular tend to be not a good thing to wear when one rides a motorcycle. Probably a heavy metal bracelet also wouldn't be a good idea for anybody who works with machinery all day, or for that matter at a computer keyboard all day. So I prefer the necklace. I did get a waterproof bracelet, though, to wear when I go swimming - the "charm" is not waterproof, really, and most silver necklaces don't take well to water; even gold isn't that fond of swimming pool chlorine. And having a necklace flapping around in the water probably isn't that safe, either. So that's one occasion where you'd want an alert bracelet, and not a metal one either, unless maybe it's stainless steel or titanium. Here's one with a quick-drying nylon band and a stainless steel tag; it's also velcroed, which makes it easier to fasten than some. And here's another place that sells lightweight fabric and/or plastic "pleather" velcro bracelets and titanium tags for medical ID's.

Our friend Liz is a vegetarian, and she's horrified when we occasionally eat meat. Usually, it is easier to make low-sodium foods if you are sticking mostly to vegetables, but there's that protein issue- tofu, the main vegetarian source of protein and meat-like substitutes, is chock full o' sodium. But there are some nice well-balanced meals that can be made without tofu.

Here's one of them. It's possibly the world's stupidest recipe- scarcely deserving of the word recipe- but hey, it works. It is great for those days when it's your turn to cook, and you're exhausted, but your spouse is also exhausted and therefore in no shape to complain about what gets served. It's got complete protein, vitamins and minerals, fiber, all that good stuff; its only flaw is that it seems too easy to be good for you.

The easiest vegetarian entree
1 can no-salt-added (NSA) diced tomatoes (if you like food spicier than bland, try diced tomatoes with green chilies)
1 can NSA black beans
1 can NSA kernel corn
1 tablespoon of whatever-your-favorite-no-salt-seasoning-mix-is (e.g., Italian seasoning, or chili powder, or Mrs. Dash)

Open and drain all three cans; toss contents and spice into a microwave-safe casserole dish and nuke until warm, about 4 minutes depending on the shape and height of the dish. Stir and turn the dish 1/4 of a turn halfway through.

Serves 2 with a bit left over if this is all you're serving; to serve 4, you could cook brown rice with olive oil and no salt, using the amount of water it says to on the package, and cooking for the length of time it says in the package, to make 4 servings of rice. That's more work, though. You could just open 2 cans of everything canned, instead.

posted by Kelly : 10:28 PM  

I'm not feeling very creative today (or rather, yesterday; I haven't gone to bed yet, but it's really tomorrow already). My spousal unit has been sick the last few days, and it's been a bit wearing on me, too. Friday I don't have to work, but I do have to go to school to help a student out this afternoon, and then I have to go by Austin Heart to have them change the programming on my pacemaker a bit.

I got the pacemaker put in 4 weeks ago today. There's still this big lump there - even when the last of the swelling goes away, there will be a bulge; it's not going to sink beneath the skin. Right now, it's part scar and part scab; I am not allowed to go swimming until it's all scar, no scab.

These days, getting an ICD/pacemaker put in is outpatient surgery. I wound up staying overnight, though, because they finished later in the day than expected. That was because this particular kind of pacemaker has three leads, instead of two, and they couldn't get the third one in. My veins were too "tortuous" to quote my doctor. So I don't have the advantage of bi-ventricular pacing they had hoped to get with this particular unit. It still does plenty for me, but not as much as we had hoped. If I get worse later on, they can go in through a different kind of incision, a keyhole incision in my chest rather than the one below the collarbone, and get the third lead in that way. That kind of surgery, although still not as drastic as open-heart, still requires several days in the hospital, so the doc says let's put it off until you really, really need it.

So, in lieu of anything more interesting, here's a meatloaf recipe. Not only is it low in sodium, but it's higher than most in potassium, because of the "secret ingredient." I guarantee that when you serve this meatloaf, no one will guess that there is a banana in it; it just tastes like a nice, moist meat loaf.

Banana Meatloaf
1&1/2 to 2 lbs of extra lean ground beef (95/5 or 96/4)
1 cup bread crumbs, low-sodium variety
1 egg, beaten to even consistency
1 banana, average ripeness, mashed
1 small onion, chopped into small pieces
1 tablespoon of Italian seasoning (or any mixture of spices you like in your meatloaf- some people like a teaspoon of chili powder, some like a teaspoon of curry powder...)
You can add a teaspoon of minced garlic if you'd like.

Mix everything together in a bowl, thoroughly. Place in non-stick loaf pan and bake in 350 degree oven for 60 to 70 minutes; check with fork to see if inside is cooked, and if you still see pink, cook another 10 minutes. Remove from oven and let cool for 10 minutes before trying to slice. Serves 4 to 6, with a slice left over for a sandwich the next day.

posted by Kelly : 2:03 AM

July 12-16, 2003 posts

Wednesday, July 16, 2003

My local newspaper, the Austin American-Statesman, has an article today (7/16/03) about low-sodium diets. Most of the article is on-line. If that link doesn't work because you find this blog after the date the article gets archived, email me, and I'll get you hard copy. There are a few things in the print version that aren't in the online version, mainly this:

Resources for sodium saving
· "The American Heart Association Low-Salt Cookbook" (Clarkson Potter, $22.95). Among the useful features are a list of ingredient substitutes, tips for dining out and a guide to herbs and spices.
· "The No-Salt Cookbook" by David C. Anderson and Thomas D. Anderson (Adams Media, $12.95). More than 200 recipes from guys who've been there. Also visit the Andersons' Web site: www.saltfree.com.
· The National Institutes of Health has developed something called the DASH diet (for Dietary Approaches to Stop Hypertension), a low-sodium, low-fat diet that has been proved to lower blood pressure and cholesterol: www.nhlbi.nih.gov/health/public/heart/hbp/dash.
· The U.S. Department of Agriculture's nutrient database lists the sodium content of hundreds of foods: www.nal.usda.gov/fnic/foodcomp/Data/SR15.

Please note that the use of quotes for book titles instead of italics is the newspaper's, not mine. The Statesman's editing has always been glitchful. You should see their hyphenation!

I just ate a can of "almond-flavored apricots." Not a very strong almond flavor, and somehow even mushier than canned apricots usually are. I think I would be better off buying apricots and sprinkling slivered almonds on them. I keep unsalted nuts around - slivered almonds on Shredded Wheat cereal is breakfast around here, and filberts (hazelnuts) are for snacks - about a dozen filberts in a handful is a nice protein snack mid-afternoon. Don't forget to read the sodium content on cereal boxes - even very sweet cereals can turn out to have a lot of sodium, while some that aren't sweet are sodium-free. Check different brands of puffed rice and puffed wheat. Granola especially needs watching - an amazing amount of fat and sodium can work its way into granola.

 posted by Kelly : 11:35 AM  

Tuesday, July 15, 2003

This semester, I am teaching classes Tuesday and Wednesday evenings. This makes my sleep schedule even weirder than it's always been. I find that I need more sleep - not surprising, with an ejection fraction of 20%, that I'm always tired. What I've tried to do last semester was to wake up at a normal hour - before 9 a.m. , which wasn't difficult because I had a 9:30 class to inspire me. Then, I'd come home and take a nap most afternoons, and wake up before Spousal Unit got home from work. This semester, though, I have office hours from 5:30 to 6:45 and class from 6:50 to 9:40. So I'm gone before Spousal Unit gets home, and then I'm wired from teaching and have difficulty falling asleep at 11-ish, our "normal" bedtime. I've been staying awake till, like, 2 a.m., and then sleeping till 11:30 or so. This is not only annoying to all my friends and relatives who are on a regular schedule, it's annoying to me, because I miss a big part of the day in which I could run errands to places that aren't open at 2 a.m., such as the post office. Also, I would like to see more of my spouse. I can't figure out how to fix it, though - just setting my alarm clock doesn't seem to work; I hit the snooze button, or even manage to turn it off entirely, without opening my eyes. What makes it harder is that I've always been a night owl by nature- this schedule is closer to my natural inclinations, so I am fighting between nature and my mind, which would like me to be a functioning human being pretty much overlapping with the rest of my city. And since the prior forty-mumble years of having to be at school or at work by 9:00 a.m., if not earlier, have not conditioned me to wake up before 9 naturally, I don't think conditioning works. Wish I knew what would.

Since that's all whining, it must be time to lighten things up with another recipe.
Summer Pickles
2 cucumbers, peeled and sliced into about 1/3" slices
1 white onion, sliced into thin half-rings
1 carrot or parsnip (parsnips are a sort of white carrot), sliced into "sticks" (you know, carrot sticks - long thin pieces, rather than round slices?)
Tablespoon of whole black peppercorns
Teaspoon of whole mustard seed
Teaspoon of caraway seed
Vinegar* - quantity to be determined after you do the rest.

In a sealable container such as Tupperware, around a quart size or a little larger, preferably with a flat bottom rather a curved bowl:
Lay down alternating layers of cucumber slices and onion and carrot pieces. After the first two layers, sprinkle half the spices (peppercorns, mustard, caraway) across the layer. Then layer the rest, and sprinkle the rest of the seeds on the top. Now pour in vinegar until it just covers the top spices. Seal the container, and stick it in the fridge. Whenever you think of it, turn it upside down and back again, to stir the flavors. The pickles are ready after at least 24 hours, and taste even better after 48 hours, and will keep for another week in the refrigerator, so you don't have to eat them all at once. You can serve this as a salad simply by slicing fresh tomatoes onto a dish and adding the pickles. You can easily double or triple this recipe, if you have larger sealable containers to work with.

*What kind of vinegar depends on taste. Myself, I like red wine vinegar for this; it's stronger than white vinegar. But you can try apple cider vinegar, or even one of the herb-infused vinegars, if you want. White vinegar is cheapest, which may recommend it to some people.

posted by Kelly : 11:09 PM 

Monday, July 14, 2003

One of the things that makes sticking to a low-sodium diet easy, for me, is making my own bread. I bought the West Bend Just for Dinner breadmaker from Amazon.com. (Try Thursdays - some Thursdays it's on sale for $39.99.) This breadmaker makes a small loaf of bread, about 8 slices, in 45 minutes. I started out using the recipes that come with it, leeaving out the salt and using unsalted butter instead of regular. The recipes work fine without salt- it's sugar that helps the yeast out, not salt. I usually throw in a bit of powdered ginger - it doesn't make the bread taste gingery, but it does give it a little of the sharpness that salt would. Over time, I've developed a basic pattern for loaves I like. If you have a larger breadmaker, just double everything in my recipe below, except the yeast- one package of yeast is still enough.

1/2 cup warm water (nuke tap water for 15 seconds)
1 tablespoon unsalted butter
1 cup bread flour (I use the store's house brand- it works fine)
1/3 cup whole wheat flour
1 tablespoon sugar
1/8 tablespoon powdered ginger
1 tablespoon Italian seasoning (oregano, thyme, basil)
1 package rapid-rise yeast or yeast that says it's for bread machines

Add to baking pan in the order your breadmaker's instructions suggest.

This makes a nice mild herb-flavored bread good with sandwiches. If you want something different, try these:

for a curry-flavored bread that goes very well with vegetable dishes, substitute 1 tablespoon (or less, to taste) of curry powder for the Italian seasoning and a scant 1/4 cup of crushed almonds (start with sliced or slivered almonds and crush them with your hand or a rolling pin.)

For breakfast, substitute 1 heaping teaspoon cinnamon for the Italian seasoning, and 1/4 cup raisins or mixed dried raisins and cherries.

If you're serving Italian food, add a tablespoon of minced garlic and 2 tablespoons grated Parmesan cheese, along with the Italian seasoning. The Parmesan has some sodium, true, but figure 1/8 (a slice) of 2 Tbsp. is not much.

When I make sandwiches, I use Swiss cheese (including Emmenthaler and Gruyere) because it's lowest in sodium of all the regular cheeses. Alpine Lace's Swiss has only 60 mg of sodium per slice. So I can make a sandwich of 2 slices of cheese, some avocado if it's in season, tomatoes, lettuce, and horseradish sauce of some sort (instead of mayo). My supermarket sells squeeze bottles of horseradish sauce for sandwiches, but you could also use any horseradish mix, or a teaspoon of horseradish mustard (100 mg of sodium, but that's quite a bit less than regular mustard!). The mustard is especially good if the sandwich contains leftover meatloaf (see earlier recipe), which is usually what I have for lunch the day after meatloaf for supper. Another thing that's good on meatloaf instead of using ketchup is fruit-flavored sauces, similar to chutneys. Fischer & Weiser, a local firm in Fredericksburg, Texas, makes a Seville orange-cranberry-horseradish sauce that goes well with meat loaf or any kind of poultry. It's 0 sodium, too. A horseradish sauce can also make a good dip for french fries, instead of ketchup, if you are not on a low-fat diet. (For me, I don't have coronary artery disease or any cholesterol problems, so I don't have to watch fat nearly as closely as I do sodium.)

Alpine Lace also makes a reduced-sodium Muenster cheese if you get really tired of Swiss cheese. The reduced-sodium Muenster actually has slightly more sodium than the Swiss, but it's still low enough to go ahead and put two slices on a sandwich. Around here, most supermarkets carry it; it's not a specialty item. If yours doesn't carry the Muenster but does have other Alpine Lace deli products, they should be able to order the Muenster for you. You've got to be aggressive with supermarkets; if you give them the product number and stand there and watch the manager actually write it down, chances are they will actually order it for you.

posted by Kelly : 1:54 PM  

Saturday, July 12, 2003

One of the books I ordered and read shortly after I got diagnosed was Success with Heart Failure by Marc Silver. It had some good information in it, although not much that I hadn't already found on the Web, but I didn't keep it because I found that the author's ego got in the way of reading it. Every chapter seemed to consist of about 50% Marc Silver congratulating himself on helping people nobody else could help, or trying procedures nobody else had thought of, or just having better surgeons than anyone else... there was this constant refrain of "I am the best heart failure doctor in the world" running through the book. It may or may not be true, I don't know, but it's tiring to read about regardless. Other books about heart disease tend to have only a single chapter about heart failure, so they have even less information. The net is the best source of info. If you can find Silver's book in the library, or used, it's probably worth it for that price; since about 50% of it is information, it's worth paying half-price for.

Not much else to say today. We had leftovers for supper, no interesting recipes spring right to mind right now, and I'm too lazy to go give you summaries of the other books I've looked at. Besides, I hear a bowl of chocolate sorbet calling my name.

posted by Kelly : 10:10 PM

July 17-21, 2003 posts

Monday, July 21, 2003

One of the stitches on the incision for the pacemaker hasn't dissolved. I have some experience with pulling out stitches, but the location of the incision means I'd have to do it looking in a mirror, and I feel less confident about my ability to do that. It's a knotted end- it's not going to pull out painlessly, either. So I guess I'll have to call the doctor and get someone in his office to remove it.

I know how to remove stitches, and lots of other minor medical procedures, because I have pets. I work closely with my veterinarians' office in taking care of my pets, often assisting them directly, and certainly getting lots of stuff to take home for follow-up care. So I know how to lance, drain, and disinfect abcesses; how to remove stitches; how to give injections to a wide variety of species, including humans, and so on. Sometimes I think I have a rather peculiar range of skill sets for a computer teacher who used to be an accountant. (I still have my CPA license; I just don't do that for a living any more.)

Having a lot of odd hobbies is useful, in that social ties help people to stay healthier (a sample (article about this; there's lots more available). One study I read said that people who belong to six or more social groups live longer than people who don't belong to any. Apparently, social groups can be as formal as a workplace, a school, or a church, or as informal as the people who share your hobby and always seem to be in the store at the same time you are, be it fishing, knitting, or stamp collecting. Playing cards once a month with people counts. Belonging to a quilting bee counts. Joining your neighborhood association counts. I suspect even just being one of the regulars who goes to any and all free lectures offered by the public library counts; probably the librarians know the regulars, and the regulars know each other, and chat, maybe even have coffee together, afterwards. In my case, I belong to several animal rescue groups; hang out at a couple of stores that cater to my hobbies a lot; belong to my local Mensa chapter; belong to several church/state separation groups; and also have way too many relatives. (One of my sisters called last weekend- I now have 32 nieces and nephews. Welcome, Brenna Leigh.) So I think I can safely say I have at least six social groups. I hope that means more people who will notice if I seem to be getting worse, or if I start declining a lot of invites without apparent reason and will therefore worry about me. More people potentially available to drive me to doctor's appointments if I'm in bad shape. More people to send me links to new medical information on the net that may help me. Those things, I suspect, are some of the reasons people with social networks are healthier.

posted by Kelly : 9:51 PM

Sunday, July 20, 2003

The heat really gets to me these days. I've never been fond of Texas summers; I moved down here 22 years ago, and still hate the weather. I'm even less fond of hot days now. The heat really makes me drag out my handicapped parking tag, because walking all the way across a parking lot seems way more than I can manage. I also am tired today, from doing some shopping. So this is a short day.

The question has no doubt occurred to you, does anyone make a no-sodium toothpaste? The answer, so far as I have been able to tell, is no. Besides sodium flouride, most toothpastes also have sodium saccharine, and sodium lauryl sulfate. Tom's of Maine has a couple of toothpastes, though, that contain only the last of these, no flouride or saccharine. First is their homeopathic-style toothpaste. Be sure to get the apricot flavor, not the baking soda flavor!! Baking soda is sodium! The apricot tastes a little odd to those used to minty commercial toothpastes, but you get used to it - that's what I'm using now. They also make a Natural Fluoride-Free Toothpaste which has no flouride or saccharine; don't order the peppermint or gingermint flavors, as those have baking soda in them. I have ordered the Cinnamint flavor, but haven't tried it yet.

posted by Kelly : 8:24 PM

Saturday, July 19, 2003

So let's talk more about drugs. ACE inhibitors, for example. ACE stands for "angiotensin converting enzyme." What that actually is, is a relative of adrenaline, and it's a stimulant that makes your heart beat harder and your blood vessels tense up, for lack of another word. So an ACE inhibitor blocks the ACE, and thereby keeps your heart from being stimulated too strongly.

Now, the ACE inhibitors have a couple of drawbacks, although they are a vast improvement over many earlier hypertension drugs. Many earlier drugs caused impotence in many male users, for example. The ACE inhibitors usually don't. They do, however, cause a really severe cough in about 20% of the people who take them, a bad enough cough to make people have to stop using them. In women, this cough is severe enough to cause involuntary urine release - even in young women and women who do their Kegel exercises. Men get the cough, too, but generally don't have to worry about peeing in their pants when they cough. Some of the 'prils - that's another nickname for this class of drugs, because all the generic names end in "pril," such as enalapril, quinapril, and lisinopril - are less likely to cause this that others, but still somewhat. The Essential Guide (see Thursday's post) says that the cough is rare to infrequent; my family doctor, my cardiologist, and quite a few online sources say it's 20% of the people who take them, and I'm inclined to believe that estimate. The Guide says that this side effect is most common with delapril, least common with quinapril.

Now, for those who have the cough, one can switch to one of the newer Angiotensin-II Receptor Antagonist family, also referred to as Angiotensin II Inhibitors. The nickname for these drugs has not entirely settled yet; some doctors call them ACE-IIs, some A-II-B's (with II pronounced as "two"), and some call them ARBs. You could also refer to them as the 'sartans, because all the generic names end in sartan - candesartan, losartan, valsartan, etc. I take Diovan, which is valsartan. I am one of the people who got a severe cough from two different 'prils, before convincing my HMO to pay for the newer drugs. Some HMOs prefer the 'prils because some are available in generic now, whereas all the 'sartans are still brand-name only. If you have that cough, and really want to switch, here's one approach: tell your doctor that the cough (a) interferes with your ability to properly perform your job functions, and/or (b) interferes with your quality of life and your ability to normally perform some of your activities of daily living. Those are catch-phrases, that usually will have a positive result, because otherwise the HMO might be accused of discriminating against the disabled - that's where that "activities of daily living" phrase comes in.

According to the Essential Guide, one study found that two of the medicines in this family did not work as well in African Americans as other high blood pressure medications. A couple of specific studies have been done, with very positive results, on using this family of drugs for heart failure - losartan in particular, and eprosartan if used in conjunction with other drugs. My cardiologist tells me that it is expected that further studies will show that all the 'sartans have this effect to some degree, although possibly not all of them work as well as losartan. Losartan has been shown to decrease left ventricular hypertrophy (enlargement of the left ventricle). On the other hand, losartan should not be used by people with liver problems (and some people with severe heart failure do have liver problems as well), while the other 'sartans may need dosage adjustments but will not be compromised by liver problems.

Whew, is that a bunch of trivia about drugs, or what? And there's still the digitalis glycosides, the loop diuretics, the beta blockers, and the cholesterol-lowering statins to go!! Aren't you excited?

OK, I can't let a day go by without either a link or a recipe. Right? Well, one of the groups of foods that is high in potassium is dried fruit, such as dried apricots. My absolute favorite place to purchase dried fruit is Sweet Energy. They also sell candied ginger, a terrific snack that is fat-free and sodium-free, albeit a bit sugary - if you are trying one of those glycemic-index diets, candied ginger would be a no-no. I love the stuff; a small bit goes a long way because the flavor is so intense. They also make a granola that's not too high in fat (it does have coconut flakes and almond slivers in it, though), has no sodium, and is sweetened with maple syrup instead of sugar. It's yummy, but it's NOT low-calorie. They have regular internet-special sales; you can also order by phone or mail, if you prefer. They have a print catalog.

 posted by Kelly : 9:52 PM 

Thursday, July 17, 2003

I had one of my regular visits with my cardiologist today. Because my ejection fraction hasn't improved, and I'm still frequently tired, he's decided to add spironolactone to my other prescriptions. I am already taking furosemide (generic of Lasix) as a diuretic, but spironolactone supposedly lets a person retain more potassium. I eat a lot of fresh fruit, so potassium hasn't been a noticeable problem- my blood levels are at the lower end of normal, but still within normal - but this diuretic supposedly works very well in conjunction with others. I of course immediately went to check my Pill Book and Essential Guide to Prescription Drugs. (If you follow those links to amazon.com, you will note that I have written reviews of both books.) The name of the drug is sort of funny - doesn't spironolactone sound more like some kind of blue-green algae than like a diuretic? Anyway, the books tell me that it's also an aldosterone antagonist, used for primary hyperaldosteronism (also known as Conn's Syndrome or Conn's Disease, usually caused by adrenal tumors or adrenal hyperplasia - information I found on the Web, not in these books). Anyway, the Pill Book tells me that in people with CHF, aldosterone levels can be 20 times higher than normal, causing water retention. Spironolactone helps the body release sodium and remove excess body fluids while retaining potassium. If you take spironolactone with an ACE inhibitor (more on those some other day), you actually wind up having to be careful of excess potassium, and get your blood levels checked frequently. I hope this doesn't mean I can't keep stuffing my face with melon and citrus fruits and kiwi fruit and even good ol' bananas. Also warns that this drug may increase digoxin levels. So, I have to go to the lab for bloodwork in 2 weeks, or sooner if I feel weirder than usual. Although potassium insufficiency (hypokalemia) frequently causes weakness and muscle cramps, apparently, according to The Pill Book, so do excessively high blood levels of potassium. Sheesh. Ya can't win.

The Essential Guide usually has longer and more thorough descriptions of the drugs it covers, although it covers fewer of them. It warns of more side effects for this drug than Pill Book does, including enlargement of male breast tissue and masculinization effects in women. I guess that is to be expected in something that affects hormones. (Aldosterone is one of the sex-related steroid hormones.) The Guide says that increased tolerance for walking and exercise can be expected from taking this drug. That is the goal, I suppose. In another few weeks, when I'm allowed to go swimming again (that healing pacemaker incision, you'll recall) it would be nice to have the energy to do so. I've gotten totally bored with yoga, and it's too d@mned hot to go walking. We'll see whether this works.

I found some really large cucumbers today, and an enormous parsnip, so one batch of summer pickles is more like two quarts this time than one quart. Emptied out the bottle of red wine vinegar and broke into the apple cider vinegar, even! Apart from their nice crunchy texture, the other reason to use parsnips in pickling is that saying "pickled parsnips" is so much fun!

posted by Kelly : 9:48 PM

July 23-28, 2003 posts

Monday, July 28, 2003

I was 99% finished with a long post about beta-blockers, when Windows decided to crash. I am too lazy to re-do the entire post right now; I'll get back to it tomorrow. Sorry 'bout that.

Oh yeah, vegetable broth - easiest way to make your own is to buy a can of no-salt-added Veg-All, pour it in liquid and all, and liquify it in the blender or food processor, then pour it through a strainer into a container, to filter out the largest of the remaining vegetable bits. Add water or carrot juice, to make 2 cups, then pour it into ice cube trays, so that you can store it for months and use 4 cubes at a time, as needed, to add to soup, stew, rice, etc.

posted by Kelly : 9:00 PM

Saturday, July 26, 2003

We're having people over for supper, and it's my turn to cook. Here's what I'm making:

Chicken and Rice
2 lbs boneless, skinless chicken breast pieces (you can use turkey instead, if you want - turkey is slightly lower in sodium than chicken see nutrition database)
1 cup uncooked brown rice
minced garlic or onion, to taste (a tablespoon or so)
1 cup low-sodium chicken broth (Use broth powder; you can also use vegetable broth, or mushroom juice or carrot juice - a vegetable flavor goes quite well with this.)
1 can ready-to-heat low-sodium cream of mushroom soup
1 small can no-salt-added mushrooms
pepper to taste, salt substitute to taste

Check the brown rice package to see how much liquid they say to use for cooking 1 cup of rice. Mix your cream of mushroom soup and your chicken broth together in a large measuring cup, then add water until you have 1/4 cup more liquid altogether than the rice package says.
Flour and then brown the chicken pieces in olive oil. Put the rice, pepper, garlic, and a dash of salt substitute into a casserole dish that has a cover. Pour the can of mushrooms, liquid and all, over that. Put the chicken pieces on top, pour the soup/broth mix over it, and dot the tops of the chicken pieces with little slivers of unsalted butter.
Cover the casserole dish, and bake at 350 degrees F for 1 hour.

You can add some more seasoning if you like; you know me, I throw a tablespoonful of Italian seasoning into almost anything. You could also try a couple teaspoons curry powder (without salt) and a handful of slivered almonds, for "instant Indian food."

Gotta go - kitchen awaits.

 posted by Kelly : 2:30 PM  

Thursday, July 24, 2003

You really have to watch out, even when reading labels, for wildly varying sodium counts. For example, I bought a box of a noodle dish; the sodium content per serving was labeled as, I kid you not, 0.6 mg, 0% of daily value - and yet salt was listed in the ingredients, and not as the last item, either! I suspect that there was a translation error somewhere (the product was made and packaged in Spain), and that this is really 0.6 grams, or 600 milligrams; the 0% DV is because having entered the 0.6mg, of course whatever program spits these things out is going to calculate that as 0% of 2000 mg per day. So do a reality check when you're reading - if you see salt or sodium in the ingredients, yet the label shows -0- mg, question it!

Likewise, counts can vary wildly even among similar products. Bremner's low-sodium table crackers: a 15 gram serving has 10 mg sodium. Breton's reduced-sodium whole-wheat table crackers, a 13-mg serving has 70 mg. Others are in between. And club soda or seltzer - certain big-name brands say "low-sodium" on their label - which is nominally true, since there's less than 130 mg - but have 30, 40 or even 60 mg of sodium per cup, while other brands that make very little fuss on their labels, such as Canfield's, have -0- sodium. Canfield's also makes a famous diet chocolate soda. I can't seem to locate a web page for Canfield's, though. Ask your grocer.

Diet soda - remember that saccharine is sodium saccharine; look for other sweeteners instead. Hansen's brand diet sodas have no sodium (I'm drinking diet Black Cherry flavor right now). Locally, I can buy Hansen's at quite a few places, including Whole Foods. Whole Foods carries a lot of organic brands of food, too, including Eden and Westbrae, both of which make many no-salt-added canned goods. I also shop at Central Market, a local chain of only a few stores, owned by HEB, a regional supermarket chain operating mainly in Texas. Central Market is the place to buy sodium-free, fat-free sorbet in a zillion flavors; last time I was browsing through their frozen stuff, they had pints of flower-flavored sorbet, as well as apricot, three kinds of chocolate sorbet, mango, pear & cinnamon, and such things as passion fruit. I'll admit, despite my love of fruit in general, I don't like passion fruit and guava. I guess they're acquired tastes. Anyway, I've found that the HEB chain is fairly responsive to customer input, and one can get them to order brands one likes with only a little bit of nagging.

Oh, and some really egregious sodium manipulation: spaghetti sauce is notoriously high in sodium, right? So I usually wind up ordering it from Healthy Heart Market (see link at right). But Spousal Unit was browsing the supermarket shelves a few months ago, and spotted a spaghetti sauce that claimed to have only 80 mg of sodium per serving. We brought it home- then noticed that the serving size given was **two tablespoons**!!! Most spaghetti sauces give their serving size as 1/4 cup, which is 12 tablespoons for those wondering. Who the heck would use only 2 tablespoons of spaghetti sauce??? Heck, even 1/4 cup is a bit scant for me - I like a little spaghetti with my sauce, you see.

So read every bit of those labels, people- don't just glance at the sodium line and assume that what's listed there accurately reflects normal use of the product!

posted by Kelly : 3:32 PM

Wednesday, July 23, 2003

Today it almost rained here; it did rain southwest of us, but here it was just overcast. The cloud cover was enough, however, to lower the 5:00 p.m. temperature to under 80 degrees. Five is the hottest time of day here, having to do with our latitude, our position with respect to the edges of our time zone, and daylight savings time. Anyway, it was positively pleasant to ride to school; with the 35-mph wind-chill factor on the bike, it was almost cool enough for a long-sleeved shirt. Not quite, though. And it won't stay like that long enough to actually make me feel better - it's going to be 98 degrees tomorrow, according to weather.com. Oh well. The class I teach Wednesday nights is "Quantitative Applications Software" - essentially, Excel basic-intermediate-advanced smushed into one semester, for the business majors - who will, after all, be using Excel or something much like it for the rest of their working lives. Unfortunately, the students in this class are doing pretty well; I say unfortunately, because I had a great extra credit project in mind if someone needed to do one. I was going to have them compile a list of nutritional data from various supermarket items into an Excel database, then use various pivot-table and filtering techniques to show me reports about sodium content. I figured if three people needed extra credit, one would get to find 30 canned-food items, one 30 frozen items, and one 30 dairy items, and then I'd have the beginnings of a nice list of stuff to buy or to avoid. Well, maybe next semester. I think it is a good project for them, even if I do have an ulterior motive! Better yet, have them go search on the Web and find nutritional data from, say, five different restaurants, for six entrees at each, and compile that into a database. If sometime during the fall you suddenly see a nice list here, you'll know that one of my fall semester students needed some extra credit!

posted by Kelly : 9:48 PM

August 2003 posts

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.

posted by Kelly : 8:53 PM

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.

posted by Kelly : 2:55 PM  

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.

posted by Kelly : 7:42 PM

Wednesday, August 13, 2003

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!)

posted by Kelly : 7:33 PM

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.

posted by Kelly : 1:55 PM  

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.
One of the courses I teach is HTML & JavaScript. I'm not sure how much JavaScript the blog software supports, but let's give it a try.
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.
To calculate your Body Mass Index, take your weight (in kilograms), and divide by your height (in meters) squared. Or, if the JavaScript works, try the little form below, which uses feet and inches and pounds.

Enter your height:

Feet: and Inches

Enter your weight in pounds:



Your Body Mass Index (BMI) is:



And now the fun part: for a given BMI, what does your weight need to be?

Enter the BMI you'd like to have:



To achieve the desired BMI, your weight should be:

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.

 posted by Kelly : 1:36 PM

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!

posted by Kelly : 1:18 PM

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!

posted by Kelly : 12:07 AM  

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?

posted by Kelly : 9:47 AM

September 2003 posts

Wednesday, September 17, 2003

I was really bad this evening- we ate Mexican, and I went ahead and had chips and queso. I am sooo tired of being good. I know most people break their diets far more often than I do. Mostly I'm happy with the fruit-and-nuts deal; I really like fruit, and summer is a great time for it. But all of a sudden I had this craving for queso. It was blocking all other thought out of my mind. I just HAD to give in. I suspect I'll have a rough night tonight; luckily, I don't have to be at school tomorrow until 2 p.m. This is the first time that I've had chips and queso since last December. Curra's, one of my favorite Mexican restaurants, serves their queso with lots of pico de gallo, guacamole, and ground beef in it. Mmmmmmmm.

I spent about three days' worth of spare time building a new cage for Chili the chinchilla. Turns out that Gizmo, our largest rabbit, could hop right up on top of Chili's old cage, sorta dangerous for Gizmo not to mention alarming to Chili. New cage is 3.5 feet tall, I think it will stop Gizmo in his tracks. It gives Chili more room to bounce, too, and I made it with an area tall enough for a 14" running wheel, something most commercial cages don't have room for. Chili will get more exercise than I do. He is 11 years old now, quite middle aged for a chinchilla, so he needs exercise at least as much as I do. (Average lifespan of chinchillas, depending on who you read, is anywhere from 12 to 18 years.) I still don't exercise much; it's BORING. Now, chasing down the chinchilla when he's having floor time, to get him back in his cage for the night, that's exercise I don't mind. It's amazing how nimble a 2-pound rodent can be!

posted by Kelly : 7:32 PM  

Tuesday, September 09, 2003

Tuesday nights are Band rehearsals. I play in the volunteer municipal band, an organization for people who never outgrew marching band. We've rehearsed every Tuesday evening except 6 weeks each summer for 21 years now. The band is getting greyer - there are some new members every year, but the core of people who started out 20+ years ago are all, well, 20+ years older. The guy who sits next to me had a heart attack a couple years ago. He has not lost weight since then, though - I worry about him. I've lost over 30 pounds since getting diagnosed with heart failure. I hope it will do me some good. One thing I noticed when rehearsals started up a couple weeks ago was the difference between my energy levels this year and last year at the same time. In August 2002, when rehearsals started, I hadn't been diagnosed yet, and we were still struggling to find out why I was always so short of breath. The corridor leading from the outside to the band hall is an uphill one; last year, in the length of a corridor that's only a hundred feet or so, I had to stop and rest 3 or 4 times along the way as I headed to the band hall. This year, while I still wouldn't want to sprint, especially while carrying 30 pounds of tenor saxophone, case, music, accessories, etc., I can walk quite steadily up the corridor without stopping. That's a vast improvement, due almost entirely to the diuretics clearing out my lungs.

The same sort of thing occurred at the Mensa RG in the previous post. The hotel where Lonestar holds its RGs has a set of stairs leading to the meeting rooms; the stairs wind around, 4 stairs, then a landing and a turn and 4 stairs in a different direction, then another landing and turn, and so on. Last year, I had to stop on every one of those landings and rest. This year, although I still wouldn't try and bound up the stairs 2 at a time, I could walk steadily up the stairs without stopping.

I still don't have as much energy as I'd like to, especially when the weather is really, really hot. I still need a nap every afternoon, and tend to sleep 10 or more hours a day rather than 7 or 8. But being able to breathe normally is a vast improvement in quality of life.

On nights when we have rehearsals, we tend to eat out before rehearsals. A pizza place called Frank & Angie's has a 2-for-1 special on individual pepperoni pizzas, the 10" kind. Now, pizza is basically a large lump of sodium and fat - cheese, pepperoni; the crust has salt in it, and tomato sauce is LOADED with salt. But these pizzas have relatively small amounts of tomato sauce, and I pick off half the pepperoni. And all I eat during the day before that is fruit and nuts - no sodium whatsoever during the day. So I have my entire 2000 mg allowance available to blow on the pizza. It's worth it to me. Especially during the summer, when plums and peaches and nectarines and pluots are 99 cents a pound, I have no trouble at all sticking to fresh fruit. I buy unsalted nuts in bulk, usually hazelnuts (filberts). So 3 pieces of fruit and a dozen nuts or so (a handful is anywhere from 8-15 nuts, depending on the type of nut and the angle I reach into the container) is lunch. There are lots worse ways to meet one's daily servings according to the food pyramid!

posted by Kelly : 9:29 PM  

Monday, September 01, 2003

Wow, here I haven't been for nearly a week. Sorry about that. I spent the weekend at a Mensa Regional Gathering, which stands for "let's invade an unsuspecting hotel, hold chocolate tastings, and stay in the hot tub till way after hours." Mostly, I was eating junk food from the hospitality suite, but the guy running hospitality did make some macaroni salad with no salt in it, so I had some of that. And the Bananas Foster (ever seen flaming bananas made in a crock pot?) was good.

I was presenting a workshop at the RG (crafts, nothing y'all would be interested in) and someone took pictures. It was amazing to see myself in the photos- I had not realized just how much difference 30 pound weight loss would mean. I look way different. And people who hadn't seen me since last Labor Day weekend noticed the difference - that was nice. (Austin holds a regional gathering Labor Day weekend, Dallas does theirs Thanksgiving weekend, Houston does theirs Memorial Day. About 80% of the people who go to each are the same people - and if you want to travel, you could attend a Mensa RG every weekend of the year somewhere in the country. All of which would feature chocolate and hot tubs, and pretty much none of which would feature any evidence of high intelligence. I don't go to any RGs but our own; I'm not that much of a party animal.)

'Scuse me, my hearing aid battery is beeping "I'm dying" at me - gotta go.

posted by Kelly : 9:53 PM

October 2003 posts

Thursday, October 30, 2003

I think I've mostly slept through the last couple of weeks. Haven't had time to post. I hate being so tired all the time! Also, my elderly laptop crashes more and more frequently these days - I'm afraid its days are numbered.

To make up for it, let me offer this interesting link:
http://www.heartcenteronline.com/myheartdr/home/research-detail.cfm?reutersid=3893
The gist of it is, heart failure patients should eat more! Now, I've enjoyed losing weight, but this article suggests I would be less tired if I ate more. Hmmm. Have to think about that. If this means I can eat more chocolate...

Also, as any good blogger should, let me offer another link. Nothing to do with heart failure per se, but lots to do with getting a lot of good reading material:
BookCrossing. A terrific community, and a great way for people to share books. The various forums are populated by many people who are sympathetic to the disabled, the very ill, the "different" in any way. I've had fun releasing books "into the wild" and sending them directly to other BookCrossers. If you're reading this blog, you like to read; if you like to read, you should check out BookCrossing.

posted by Kelly : 4:05 PM  

Wednesday, October 15, 2003

Banana ice cream

This is easiest if you have one of the little ice cream makers that you stick in the freezer ahead of time, so that the liner is cold. The kind where you then put the ingredients in the frozen liner, and stir once a minute for 20 minutes, until you have fairly firm ice cream.

Recipe: (double for a larger ice cream maker)
1 large banana, thoroughly mashed
1 can sweetened condensed milk
Additional sugar to taste (from 0 to 1/4 cup, depending on taste)
1 can evaporated milk (this is usually skimmed milk)
1/2 teaspoon lemon juice
Optional: a few drops of vanilla or almond extract
1/4 cup small semisweet chocolate chips

Blend ingredients together thoroughly in a bowl, then pour into the ice cream maker and follow manufacturer's instructions. If you do this before dinner, and then stir the thing once a minute till you are done eating, you have dessert ready as you come to it.

If you don't have an ice cream maker: Put bowl in freezer. 15 minutes later, remove from freezer and use eggbeater to thoroughly blend again. Freeze another 15 minutes and blend again. Do this one more time. Then freeze until time for dessert.

Makes 4 servings.

Also optional: add some finely diced candied ginger along with or instead of the chocolate chips. Or candied orange peel finely diced. Or dried apricots ditto.

If the canned milks are from skimmed milk, then this is a low-fat dessert. It's high in potassium (useful for those taking diuretics). If you use a small packet of Nutra-Sweet instead of sugar, then the only sugar is that from the sweetened condensed milk, so it's fairly low in sugar.

Note: you may be tempted to throw in more chips, AND all the candied fruit, AND the dried fruit. This is OK, but the texture will be less and less like ice cream, and you'll be left with more crystals in the frozen product, instead of a smoother finished ice cream.

posted by Kelly : 7:34 AM  

Tuesday, October 14, 2003

Bringing lunch to work - the continuing saga.

If you want to bring salads, first, you need Tupperware. Small containers you buy from the supermarket AREN'T as tight/spill-proof as Tupperware. The littlest size containers, often used to hold raisins in kids' lunches, are ideal for salad dressings.

Second:
Flavored vinegars, without anything else added, make excellent tart salad dressings. Or make your own - buy good red vinegar and throw in dried herbs and let them steep for a few days, shaking occasionally to distribute the flavors. Dried "Italian seasoning" mix works fine, as does "pickling spice" mix - a mix of several colors of whole peppercorns, some dried herbs, and dill. You could go ahead and add a little olive oil to this, but it tastes great without it.

Lemon or lime juice are also good bases for unusual dressings. Add a little bit of sugar, not nearly as much as for lemonade, to ReaLemon or ReaLime, or squeeze your own if you are a masochist, and then throw in poppy seeds, sesame seeds, little bits of chili pepper, etc. This kind of dressing works really well on salads that are made of mostly solider veggies, grated, rather than all greens. Grated carrots, bean sprouts, sliced cucumbers, grated beets, jicama (Jerusalem artichoke) tossed with just a few greens, and this kind of dressing, is very refreshing. Add green grapes to your regular salad, too, not just to fruit salad.

For sandwiches, you can get away with using zipper-top bags such as ZipLoc, but your sandwich can be squished flat in them. Again Tupperware can help you with this. And if you are making a sandwich with something messy in it, such as homemade guacamole (mostly avocado), then you decide which better suits your needs: a bag, which you can throw out, with the mess/spills in it, and not have to clean, or a Tupperware container from which you can easily scoop up spilled stuff and put it back in the sandwich, but then you have to rinse the container. Your call.

And of course, Tupperware is great for bringing dinner leftovers to work the next day for lunch. Leftover spaghetti with no-salt tomato sauce; leftover goulash made with light sour cream and extra lean beef, leftover macaroni made with low-sodium cheese sauce base (now that Heluva isn't selling low-sodium cheddar any more, I have to resort to stuff like that, instead of real cheese, sigh).

posted by Kelly : 1:47 AM  

Wednesday, October 01, 2003

Did you ever have one of those days where you wake up, and look at the row of ten pill bottles, and think "I just can't do this"? And then sit there for 15 minutes psyching yourself up to go ahead and spend a minute swallowing pills? I skipped mine one morning when I had that feeling- and certainly felt awful the next day. Wound up not even going to work. Every few months, I just wake up with that feeling, but usually I can talk myself into it by the time I finish showering and all. It's not that hard, it's just that sometimes the repetition of it all seems - boring, monotonous, pointless?

Also, my saxophone got stolen last week. One of the few reasons we have a car at all, instead of just the bikes, is because of the difficulty of carrying large musical instruments on a bike. Not impossible- there's a guy in the band who carries his tuba on his Harley. He's several inches over 6 feet, and has a tuba case with backstraps, so he can wear it like a backpack; the majority of the weight rests on the seat, and the straps stabilize it. However, for people in the 5'6" and under range, strapping on a tuba would be quite uncomfortable, would stick up above one's head, and would alter the center of gravity of the bike - and knowing where the center of gravity is and how your bike moves around it is one of the important elements of motorcycle riding. At least a tuba is fairly symmetrical in weight and shape; a tenor saxophone, while a few pounds lighter, is asymmetrical, making the weight distribution off-center, and making it difficult to put straps onto the case that would hang straight.

Luckily, we have replacement-value coverage on our homeowners', so I was only de-instrumented for a couple days. State Farm allowed me to come pick up the check in person, and I picked up my new horn Monday of this week. So I only missed one rehearsal, last week's.

The new horn doesn't have a soft case yet- the store didn't have them in stock; it's on order. So I had to carry it in the hard case, which is large and weighs a lot- puts the whole package to within a couple of pounds of the weight of a tuba. Heaviest thing I have carried in quite a while. But I was able to walk up the uphill corridor to the band hall without stopping, even carrying the case! I am doing OK, I guess! I still wouldn't want to try sprinting with a saxophone in hand, though - not that I ever really felt like it :-) The weather is slightly cooled off this week- it's finally no longer going over 90, and it's even dropping below 70 at night, and cooler weather always makes me feel more energetic, even long before I became ill.

My birthday is later this month- I'll be 50. I look under 40, and my innards, namely my heart, seems to be performing like someone over 60, so it averages out- I guess.

 posted by Kelly : 9:29 PM  

November 2003 posts

Monday, November 24, 2003

The full recipe makes 10 pounds of fruitcake; most years I only make a half recipe, 5 pounds, which is 3 largish loaf pans. Here goes:
1 cup seeded raisins*
2 cups seedless raisins* (*I usually use all seedless, mixing golden and brown raisins)
1 cup chopped dates
1 cup halved candied cherries
2 cups candied citron
1/2 cup candied lemon peel
1/2 cup candied orange peel
1.5 cups walnut or pecan pieces
-------
a note about all this fruit: it adds up to 10 cups. I usually don't stick to the exact list here - and I add dried cherries and/or cranberries to the raisins. So I usually wind up with about 12 cups altogether of fruit and nuts, frequently: 3 cups mixed candied fruit, 1 cup citron, 1 cup candied cherry pieces, 3 cups assorted dried raisins and cherries, 1 cup chopped dried apricots, 1 cup chopped dates, and 2 cups chopped nuts - pecans, usually, since I've been in Texas. Feel free to adjust this to your family's tastes - no citron, candied or dried pineapple instead of cherries, more orange peel, fewer raisins... as long as you have between 10 and 12 cups of dried or candied fruit and nuts, it will work. We now return you to your recipe...
-------
1/2 Tbsp grated orange rind
1/4 cup fruit juice- any kind you have around, grape, orange, pomegranate...
2.5 cups sifted flour
optional: half tsp salt (I've left this out for decades, and no one has ever complained)
1.5 tsp baking powder (I use the calcium-based baking powder substitute)
2 sticks (1/2 pound total) unsalted butter (note - you can substitute a cup of shortening for this, but the butter really tastes better)
1 cup white sugar
1/2 cup brown sugar
2 tsp cinnamon
1 tsp cloves
1 tsp allspice
1 tsp mace
1/4 tsp ginger
5 eggs, well beaten (Scramblettes/powdered eggs work just fine)
2 tsp vanilla extract

Make sure that there are no pits in any of the fruit, and no shells in the nuts; rinse all the fruit and pat dry. Combine fruit, nuts and grated orange rind. You need a HUGE bowl for this- a punch bowl works well. Pour fruit juice over fruits. In a separate bowl, sift flour, salt, and baking powder together. In yet another bowl, cream the butter (it helps if you microwave each stick for 10 seconds first) both sugars and all the spices, then beat in the eggs. Add the butter mixture to the fruit, then all the flour mixture, and mix THOROUGHLY. Make sure there's no clumps of dry flour there, and that ever piece of fruit has at least a very thin film of batter on it.

Line 3 loaf pans with non-stick parchment paper, or brown butcher paper, heavily oiled. Divide batter between the three pans- it will fill all of them all the way to the top and maybe a little rounded up in the middle. Smoothe the tops with a scraper. Decorate tops of cake with halves of candied cherries, chunks of candied pineapple, and/or almond slivers, as desired. (You can do none of those, or any one, or all. I like making almond-sliver snowflakes/stars.) Bake in a slow oven (275 to 285 degrees F, or 135-140 degrees C) for about 2 hours - depending on the size of your loaf pans. Check first at 1.5 hours, and keep checking at 15 minute intervals after that, till toothpick comes out clean. Remove from oven and let cool in pan, on rack, for at least a half hour. Remove from pan by lifting edges of parchment paper, then peel off the paper.

Now the fun part: once the cakes are completely cool, wrap each in a double layer of unbleached muslin. Pour cheap brandy over the top- about 1/4 cup per cake, soaking it into the muslin well. Wrap the muslin-covered cakes in tightly crimped aluminum foil. Then put the loaf, with its wrappings, in an airtight container- a heavy Ziploc freezer bag will do, or a nice decorative tin with a tight lid. Then, at least once every 2 weeks, haul out the entire arrangement, take off the aluminum foil, pour another 1/4 cup brandy over the muslin, and rewrap and return to tin. Ideally, you should start the fruitcakes the week after Easter, so that they will be 90% brandy by Christmas, but they'll be adequate if you make them 6 weeks before Christmas, and remember to brandy them about every 10 days. Unwrap the foil and muslin, wrap in decorative cling wrap or cellophane, and present to the recipients, with a warning about serving it to underage people or designated drivers :-)

posted by Kelly : 3:37 PM

Saturday, November 15, 2003

Yeehah! The state approved my disability pension! Given that I'm unlikely to live to 65 or whatever the retirement age will be by then, I wanted to get SOME of my own money back, and they agreed! This is great, because the paycheck I get from teaching a couple of courses at Sty. Ed's is about what you'd expect for working 6 hours a week, and I don't think I'm capable of trying to do full-time work again - both because of fatigue and because of the stress. The pension means that we can buy presents for the holidays this year, maybe even fly to see my parents (my Dad's got prostate cancer, and surgery, scheduled for next week, should be a breeze; I do want to make sure I see him before either of us gets too sick, though! He lives in Maine.) It means that next summer I can pay the electric bill including air conditioning without having to resort to eating rice and beans for most of August, which is what we seemed to be doing this summer. Not that I have anything against rice and beans, mind you, but even I get sick of garbanzo beans one day, black beans the next, garbanzo beans again... To celebrate, I zipped over to the supermarket and purchased candied fruit, to make fruitcakes- low sodium, low-fat fruitcakes, of course. I didn't make any last year. Really, to make this fruitcake recipe correctly one should make it about the weekend after Easter, and then marinate it in brandy every two weeks until Christmas, so that it's quite flammable. However, local supermarkets don't have candied fruit available in the spring- they only start stocking it around Thanksgiving. So it will be a very mild fruitcake. Or should I say, fruitcakes- the recipe makes about 10 pounds. It's from a 1953 cookbook that my mother was collecting - a volume a week from the supermarket - when she got married and then when she had me. So it's sort of a family heirloom. Besides the usual candied orange peel and citron, and some pineapple and cherries for the top, I have fresh Texas pecans (instead of the walnuts the recipe calls for) - why not use local stuff? And raisins, and chopped up dried apricots, and some dried cranberries to go with the raisins. The recipe makes a cake that is mostly fruit, held together with a cement of cake - sort of a concrete aggregate, if you will - as opposed to mostly cake. I read in some book or another about heart failure that the candied cherries are high in sodium, but I can't see anything on the ingredients label that looks even vaguely sodium-ish, so I must have imagined reading that.

Anyway, off to do some cooking. I will provide the fruitcake recipe as soon as I get a minute to transcribe it.

posted by Kelly : 2:49 PM

January 2004 post (no Dec. 2003)

Thursday, January 08, 2004

OK, New Years Resolution: get back to posting regularly.
December was giving and grading finals, followed by frantically finishing holiday presents and packing, followed by 2 weeks of visiting relatives. I'm glad to be home.

Travelling was a thrill - I have the ICD/pacemaker, and that makes airport security a hassle. The problem is, I don't *look* like a heart patient. I'm not elderly, I am otherwise healthy-looking (normal weight, not staggering or coughing or using a walker or wheelchair...). So anyway, nice long hand pat-downs at security, while spousal unit patiently drags all our luggage and coats through regular security.

Philadelphia-area temps were in the 50's, never went below freezing even at night. My sister Steph made lots of delicious food, either leaving out salt altogether for the dishes or putting aside a portion of things before adding salt. She did a great job. We had an organic turkey, uninjected - no salted butter basting sauce injections. Lots of vegetables. I really raised some awareness there on the amount of sodium in food!

One of the gifts I got was a pair of Lands End shoes, the "drivers moc" thingies. Those turn out to be great for airport security, even easier than sneakers. Lightweight, easy to slip on and off - I think their versatility in airports must be part of what has contributed to the huge success of these shoes.

We flew from Philadelphia to Oakland, CA by way of Houston - yes, that's 39th parallel to 38th parallel by way of the 31st parallel, but that's airport hubs for ya. Oakland is a smaller airport than San Francisco, as well as being closer to Jer's home. Emily was just turning 3, and she's a delightful little kid. Occasionally any 3-year-old is annoying, but she's nicer than most, if I say so myself.

Eating in Oakland was a bit more of a problem - they eat out more often, and since B is Asian-American, when she cooks at home it tends to be stuff with soy sauce. I finally convinced her not to try so hard - shredded wheat for breakfast, not scrambled eggs and homemade sticky buns. She made a stir-fry with a ginger sauce that had only 35 mg of sodium per serving, and then separated a portion out for me before adding soy sauce to the rest. That worked pretty well.

Did you know that airlines don't bother serving special meals any more for anything shorter than international flights? You can specify "low sodium" all you want on your reservations, it doesn't make a bit of difference. You get what they serve everyone else. Well, at least the bananas with breakfast were good. On the trip home, we had a long enough stop-over in Houston to eat supper in the airport, rather than depending on airline food, so I was able to find salad and fruit salad. Good old reliable fruit salad!

Well, back to catching up. New Year's Resolution: post here at least once every week, don't fall behind!

posted by Kelly : 2:23 PM

February 2004 posts

Saturday, February 28, 2004

Woo hoo! Low sodium cheese! If you're near a Central Market, run on over and check the cheese area labelled "German, Dutch and Danish" (that would sound so much better as Deutsch, Dutch and Danish) for Nokkelost. Only 45 mg of sodium per ounce! It's a slightly herbed cheese, there's a hint of cloves in it and a bit of caraway seeds. The downside? $19.95 per pound - yikes! But for cheese that you can eat as though you were completely normal, and also serve to normal people without them saying ewwwww, it's worth an occasional binge. We had potluck this evening, and everyone enjoyed the cheese- half a pound served as an appetizer was gone in no time. We served it with pumpernickel rye bread, and unsalted kosher dill pickles that I got from Healthy Heart Market.

posted by Kelly : 8:39 PM

Wednesday, February 18, 2004

So we were having friends over to dinner; they're Indian and vegetarian. I didn't want to try cooking Indian food- I'm sure they could do that better than we could. I thought I'd make chili - they are leaving TX for CA, chili would be the proper Texas send-off, right? I have several vegetarian "chili" recipes that are quick and easy, but pretty ordinary. I wanted to do something better, and I was thinking what about cashews? They are popular in Indian cooking, and would add some protein and some heft to the chili. So I googled for cashew chili recipes, found about 70 of them, and then merged them, added a couple of ingredients of my own, and left out the salt. The secret to leaving out the salt, in this case, is the green chilies - nobody notices that salt is missing when there's enough chili! So here's what I came up with: 

Cashew Chili
2 cans NSA (no salt added) beans - kidney beans or black beans or black soy beans (Eden sells these)
3 white onions, diced (other onions would work too, I'm sure, but if you use red or yellow, get smaller ones, so you don't have massively too much onion)
1 red bell pepper (green would do too, but red looks better in the chili), diced
1 cup diced celery (somewhere between one and two stalks, or one small pre-chopped container from the supermarket salad section)
2 cans NSA diced tomatoes with green chilies (Eden sells these)
1 small can NSA tomato paste (the Conta brand from Europe is not specifically NSA but it's very low sodium; when I can't find Hunt's NSA I get Conta which is only about 20 mg of sodium)
1 Tablespoon each ground black pepper, chili powder, cumin, oregano, minced garlic (I buy jars of minced garlic. I think this would be a couple cloves worth, if you did it from scratch)
1 bay leaf
2 Tbsp red wine vinegar
1 cup raw, unsalted cashews (the bulk bins at Whole Foods are one place to get these)
1/3 cup raisins

Heat a little olive oil in a frying pan, and sauté the onions, peppers, celery and garlic until the vegetables are translucent. Move them to a biggish stew pan/dutch oven. Add the beans and tomatoes INCLUDING the juice from the cans. Add everything else, stir thoroughly, and bring to a boil. As soon as it bubbles, cover the pot, lower the heat, and simmer for an hour and a half.

Serve with cornbread, seasoned with cumin; or corn chips and green salsa. Guiltless Gourmet makes unsalted blue corn chips. Healthy Heart Market has low-sodium cornbread mix; follow the directions and add 1 tsp cumin (or less, to taste - I like spices).
If you want slightly milder chili, make one can of tomatoes plain instead of with green chilies; if you want really bland chili (why?) make both cans of tomatoes plain.

posted by Kelly : 9:39 PM

Sunday, February 01, 2004

Less than a month since the last post!
I've been convincing friends to cook with less salt, and they are slowly discovering that it's not that difficult to make something tasty without automatically throwing in a teaspoon full of salt. We've been able to eat at other people's houses more often, and we've had people over for dinner at our house more.
Speaking of dinner, I'm off to find it now. But first, an extremely easy recipe: 

Sauteed Turkey (or Chicken)
pieces of chicken or turkey for 4 people (I use skinless boneless breasts of either)
flour
butter, olive oil
small can of no salt added mushrooms
cheap fruit-flavored wine

using a small handful of flour, lightly roll each chicken breast in flour.
Melt 2 Tbsp unsalted butter in a frying pan, and add a tablespoon of olive oil. Brown chicken on both sides.
Add can of mushrooms, liquid and all; add 1-2 cups apricot or peach wine, enough to almost completely cover the meat. Bring to almost a boil; turn down heat and simmer on low for an hour. Serve each piece of chicken with a spoonful of the mushrooms and thickened "sauce" over it.

Apricot or peach wine work best; apple wine would also work, but that would probably work even better with pork cutlets if you happen to eat pork. I dunno about cherry wine. Berry flavored wine would definitely NOT work for this.

posted by Kelly : 5:21 PM

March 2004 posts

Wednesday, March 24, 2004

Not fluid in the lungs, says the cardiologist's nurse. Could be anemia. But to order the blood tests for that, I have to go to my regular health care provider (family doctor). So I'm over to there in a couple days, so he can see me and order a complete blood count (CBC). It never hurts to have one of those once a year anyway, and my last one was January 2003!! I though one had been done since then - I've had blood drawn several times, but apparently it was all for more narrowly focused tests.

Liz, Gizmo says hello. The piggies say, where's the love?

posted by Kelly : 8:01 AM 

Sunday, March 21, 2004

Ya know, chasing a 13-pound rabbit around the room can make one short of breath even when there's not fluid in the lungs. In fact, chasing any pet rabbit can do that. Last weekend we took Fred & Ethel, the 9-lb French lops, to a party. All the humans had to keep fairly close eyes on their bunnies to keep arguments from starting- rabbits do not get along with strangers instantly. Although Fred and Sherman, the 16-lb Flemish Giant, did in fact get along instantly - they both decided to go sit in someone else's pet carrier, snuggled up together, glaring out at the world. Catching bunnies to put them back in their own carriers when the party was over was a challenge. Chasing, dragging bunnies out from under furniture...

Then this past week, I was suddenly all short of breath again. I hadn't gained any weight that I could tell, but I had all the symptoms of fluid in the lungs again. I called the doctor; got advice from the nurses to take double dose of furosemide (Lasix) for a couple days and see if that helped. I think it's helped a little, but I'm headed in to their office tomorrow morning to have them take a listen. I can't think of any reason for this to suddenly occur. Because it did, though, I wanted to avoid any restaurant food, even the stuff that's relatively low in salt, so I made several meals at home this weekend. Had friends over for a batch of the cashew chili (recipe somewhere below), and then tonight made a turkey meat loaf using the spice packet from Healthy Heart Market. Luckily, I had just ordered a bunch of stuff from Pete there, and had low-so cornbread mix to go with the chili.

One of our friends also gave us a couple of pounds of pecans from his back yard. I got several boxes of the Sweet N Low cake mixes from HHM, and I've been making those, throwing in a large handful of pecans to each. Works quite well. Advice: use a smaller pan than they say - if you use an 8" x 8" pan, you will have a thin, dry, flat cake. Use a 8" round pan or a 7" square pan (those come out to within an inch of the same area, if you're wondering- 7" square is 49 square inches of pan, and 8" round is just over 50 square inches) and cook for 30 minutes, rather than 8" square at 25 minutes, and they come out just fine.

Also resorted to making fruit salad again to go to a party; hey, it's hard to go wrong, and so much party food is out of the question. Our hostess did boil one batch of crawdads without any seasoning salt, but the corn on the cob had salt, and the potato salad, and of course all the pickles and olives. So I had crawdads, carrot sticks, and fruit salad.

Anyway, now to use up some more of my limited energy cleaning bunny litter trays. Good thing they're cute buns- they have to be, to be worth this much work!

posted by Kelly : 8:50 PM

April 2004 posts

Friday, April 30, 2004

I met a woman today who has been paralyzed from the waste down from a gunshot wound to the spine for the past 27 years. Last year she came down with breast cancer and had to have a double mastectomy and a long train of chemo. Then last month she broke her arm in a wheelchair accident. I feel awfully lucky by comparison.

We had an interesting and amiable discussion about the differences or lack thereof in outlook, between atheists and religious people, when faced with a terminal illness. I find that since I don't believe in an afterlife, if I'm going to do any good it has to be now; I don't get a chance to do penance or pray or beg for forgiveness later, and the only way I'll live on is to leave good memories of me behind.

I was in a spelling bee last week. My university entered a team at the last moment; with no prep and no practice we came in 3rd out of 15 teams. We also got mentioned in the newspaper articles with the winning team, due to our spectacular cheerleading section. No one else came close! We brought the university mascot, a young woman in a goat suit; a tuba player to play "Charge" for us, and a bunch of graduate students with megaphones and pom-poms. There was a team from another university, but all the had was a few balloons in their school colors, and they were spelled out by the second round. So we feel pretty smug. And the free luncheon provided to competitors included a huge tray of fresh fruit, so that I could actually eat something!

I found some more food online. Flying Noodle has quite a few varieties of spaghetti sauce which, while they aren't precisely low-sodium, are much less sodium than most, coming in at 240-290 mg per serving instead of the usual 450-500 mg (or worse!) I got some, and tried the Dell Amore Basil and Garlic flavor. Yum!

posted by Kelly : 1:20 AM  

Wednesday, April 14, 2004

Okay, turned out I need a slight adjustment in my thyroid medication. Easy enough.

Spoke to a local UU fellowship about CHF a couple Sundays ago. People with intelligent questions.

I am getting over a cold. Colds are a real bummer when you can't take decongestants such as Sudafed.

I'm not Jewish, but Passover does have an advantage- lots and lots of unsalted matzoh out there. I can eat many slices of matzoh in place of one slice of bread. And further, most of the candies that are kosher for Passover are dark chocolate, rather than milk chocolate. I like dark chocolate much better, and it happens to be lower in fat and sodium than milk chocolate, as well.

Back to sneezing. More when I am not at risk of crudding up the keyboard or the screen.

posted by Kelly : 6:46 PM

May 2004 posts

Friday, May 21, 2004

And an article from my local paper, the Austin American-Statesman, Metro & State section, Friday, May 21, 2004:

Small heart pump making big difference to patients
Small devices becoming a way to return patients to normal lives while they wait for transplants
By Juan A. Lozano
ASSOCIATED PRESS
Friday, May 21, 2004

HOUSTON -- A small blood pump bolstered not only 19-year-old Everardo Flores' failing heart but also his self-esteem.

"When I was in school, I would fall asleep in every class. I thought I couldn't learn," said Flores, who in November became the first U.S. patient to receive the next generation in heart pumps. "It was just I was so tired. But then they put the pump in, and there hasn't been a limit. . . . I feel good with it."

Flores is one of many patients who have received left ventricular assist devices at the Texas Heart Institute, which for more than 30 years has pioneered work in the development of this medical technology. Unlike earlier, bulkier pumps, the one Flores has weighs 12 ounces and is 2 1/2 inches long.

On Thursday, doctors with the institute, Flores and three other patients with heart failure discussed the benefits of this apparatus on the eve of a symposium that will delve into the pumps' history and future.

Doctors say the heart pumps are evolving from stopgap devices to permanent implants that can provide long-term care to some patients.

The device was created to help the heart's left ventricle, a large muscular chamber that pumps blood out to the body. Failing hearts become unable to circulate enough blood. A left ventricular assist device helps with the pumping and can keep a person alive until a new heart can be found.

"As many as 70,000 to 80,000 Americans are homebound with heart failure," said Dr. O.H. "Bud" Frazier, chief of cardiopulmonary transplantation at the heart institute, based at St. Luke's Episcopal Hospital. "Many can be returned to active lives while they wait for a transplant."

Since the 1980s, more than 5,000 patients worldwide have been helped by these heart pumps. The landmark research in their creation was initiated by world-renowned and Houston-based heart surgeon Dr. Michael DeBakey, who will speak at the symposium at St. Luke's, scheduled for today and Saturday.

For almost three years, Thurston Davis has continued his normal, busy life while he waits for a new heart.

Davis, 32, works at a barbershop in northwest Houston and helps take care of his two children, who were born after he received his first heart pump. He got a second pump in August.

"I never thought I would be able to do any of this because you feel you're going to be limited" after getting the device, he said.

Guillermo Torre-Amione, an assistant professor at Baylor College of Medicine, said that although up to 60,000 people could be eligible for a heart transplant each year, only about 2,200 are performed because of few available organs.

Dr. Stephen Westaby, a senior cardiac surgeon at Oxford University in England, said the supply of available hearts will never meet the demand. Doctors at Thursday's news conference said heart pumps will become less a bridge to transplant and more a way to return patients to health and normal lives.

"This is going to be the wave of the future," Westaby said. "There are 20 more blood pumps in development of the miniature kind. Artificial heart technology has never been in a better (state). It all started and continues in Houston."

Though various heart pumps are going through clinical studies around the country, only the HeartMate, a pump Frazier helped pioneer in the 1980s, has been approved for use by the Food and Drug Administration.

That has been somewhat frustrating for many doctors.

"There are barriers that are regulatory and there are scientific barriers," said Frazier, who has implanted more than 250 of the devices, more than anyone in the world.

posted by Kelly : 2:58 PM   

Thanks, Rick, for passing along this article!

Dual-chamber pacemakers can cut death risk up to 50% Study is the largest
yet of heart failure device

By Steve Sternberg
USA TODAY

Devices that synchronize the two halves of the failing heart and shock
hearts that falter cut the risk of death by more than one-third, a study
reports today.

The study, called Companion, involved 1,520 patients with heart failure,
progressive weakening of the heart muscle. It is the first major test of
dual-chamber pacemaker defibrillators in patients with heart failure from
all causes. The devices cut deaths plus hospitalizations by 34%.

As for death rates alone, the pacemakers reduced mortality by 36% overall
-- and by 50% in people whose heart failure did not result from a heart
attack. That's in addition to the 30% reduction patients get from the
best medication, says study leader Michael Bristow of the University of
Colorado-Denver.

''A 50% reduction in mortality is unbelievably large, especially on top
of medical therapy,'' Bristow says. ''It should become the standard of
care in this population.''

The risk of death dropped by 27% in people who developed heart failure
after having a heart attack, says the study in today's New England
Journal of Medicine.

A separate study of 458 heart failure patients, reported in the same
journal, found that defibrillators cut the risk of death from rhythm
disturbances almost in half, from 14% to 8%.

Two years ago, positive findings from a study called Madeit II prompted
Medicare and private insurers to pay for the $30,000 device, but only for
those with heart failure from heart attacks.

Roughly 5 million Americans have heart failure, also caused by viral
infection, alcoholism, high blood pressure, clogged arteries and factors
still unknown. Doctors say as many as 100,000 could benefit from the
special pacemakers, because the electrical pulses controlling their
heartbeat take longer to cross from one pumping chamber to another.

''These devices have great promise,'' says David Meyerson of Johns
Hopkins University and the American Heart Association. ''We're seeing
improved functional capacity, fewer hospitalizations and improved
survival beyond that from the best medicines alone.''

Some doctors have asked whether the device's expense will drain Medicare,
but Beverly Lorell, chief medical officer for Guidant, the study's
sponsor, says her company's device prevents costlier hospitalizations.

Hospital costs for heart failure are staggering, she says. Hospital bills
account for $14 billion of the $24 billion that will be spent on heart
failure in the USA this year. She says a study is underway to determine
whether the device is cost-effective.

© Copyright 2004 USA TODAY, a division of Gannett Co. Inc.

posted by Kelly : 2:18 PM  

Wednesday, May 19, 2004

Animal Trustees of Austin is putting together a vegetarian cookbook as a fundraiser. Since so many of these recipes are vegetarian - several of them vegan, even - I went ahead and contributed them to the cookbook, odd comments and all.

I try and stay involved in the animal rescue community, even though I don't run Guinea Pig Rescue of Austin any more. Next month, the House Rabbit Resource Network is having a rabbit-themed garage sale. Since I have enough rabbit craft kits to last me if I lived to be 100, never mind my current expected life span of rather less than that, I am sorting through them to donate some. Rabbit patterns. Stuffed rabbits, wood rabbits, styrofoam rabbits, quilted rabbits. We have one entire spare bedroom devoted to assorted arts and crafts, with a workbench, power tools, sewing machine, knitting machine, spare computer, sheets of Coroplast, rabbit-cage-building materials, etc. (This house does not have a garage, so we can't set up a workshop in the garage.) For some odd reason, we seem to have several cordless drills - more than there are humans in the household - as well as more than two toolboxes. We counted up glue guns once - we found seven of them, and who knows how many more are lurking somewhere.

Since I've had more time to sit around, I've also been knitting. I know, I know, everybody says "Oh, my grandmother does that!" Well, other people besides grandmothers do it, too! It's a very relaxing craft, good for blood pressure, heart rate, alpha waves, stress reduction (http://www.wellnessjunction.com/athome/stress/0324news.htm) in general - ideally suited for the heart failure patient. Of course, an avid knitter spends way too much buying yarn, but on the other hand, look what one can save by giving all one's relatives hand-knitted scarves and hats for holiday presents! (And they're lightweight to pack in one's luggage when one is going to be going through several airports during holiday travels!) My local yarn shop is Hill Country Weavers.


Another article about knitting and stress reduction (http://www.case.edu/stuaff/mind-body/newsletters/MB-May2004.pdf)- this one, I take pains to point out, from Case Western Reserve, an engineering university.

posted by Kelly : 10:53 PM

June 2004 posts

Saturday, June 19, 2004

Oh yeah, an addendum to the grapefruit juice. While one possible side effect is that your drug doesn't get digested properly at all, the other possible effect, depending on the drug, is that too much of it remains in your bloodstream, instead of getting eliminated (the liver bone's connected to the kidney bone) and so you can have the effect of an increased dosage - more chance of side effects, or of overdosage. Since it's too much trouble to detail the exact list of which drugs grapefruit juice renders too concentrated in the bloodstream and which ones it renders partly useless, let's just keep that rule of thumb in mind - avoid grapefruit juice within 2 hours of your pills, or at all if you're taking time-release medicines.

posted by Kelly : 2:04 PM  

Wednesday, June 16, 2004

I have a couple of different bits of medical alert jewelry. Most medical alert bracelets are mildly ugly; some are heavy chain and quite ugly. While one wants a medical alert bracelet to catch attention when needed, I personally don't want to have it always catching attention for its sheer ugliness. I ordered several different kinds of bracelets, charms, and a necklace, right after I got my ICD/pacemaker. One kind of charm allows you to put a great deal of wordage on it; I got two of them, listing not only my condition and the existence of the ICD/PM, but also the names of all the medications I take.

One of the reasons so much of this jewelry is made of metal is that it's strong; if you are in a vicious accident of some sort, and thrown from a vehicle, your bracelet should stay on; if you are in a fire, your bracelet should last through the heat and flames. Well, I suspect that if I'm in that kind of a fire, my medical alert bracelet will be the least of my worries. I want something that's reasonably strong, won't rust or tarnish, won't weigh a ton - so materials other than metal chain were something I wanted to try.

So I decided to string beads on various things and see what works for bracelets. There are several different kinds of medical alert tags/charms/plaques/bars/things-that-fasten-on-to-other-things. I have two of the lightweight charms, cheap thin base metal on one side and detailed teensy engraved plastic on the other, one smooth stainless steel thing made to slide on a strap somewhat the size and width of a watch strap (the strap it came with is cheap vinyl imitating snakeskin only in blue, fastened with way too much velcro which irritates the wrist), and one standard bracelet - heavy silver-plated chain, alert tag with a hole in each end, attached into middle of chain, and hard-to-manage fastener. (I suspect the cheap base metal and the plastic engraved disk would get destroyed or melted in an accident or a fire as easily as many other materials; they don't offer the same sort of invulnerability that stainless steel, silver, or gold does.)

So I tried crocheting with lamé filament, which works pretty well; I strung a whole bunch of brown-toned glass beads of various sizes and included a bead in almost every stitch, and stuck one of the little alert charms in there as just another bead. But there has to be some kind of fastener; I crocheted a little bit of gold colored elastic cord between the two ends. So it stretches a bit to get over my hand, and is still a bit loose on my wrist, but not quite loose enough to fall off. I don't like really loose bracelets; anything that might get caught on part of the bike isn't a good idea in my opinion. Then I thought I'd try perle cotton, because it's softer than lame filament but still fairly strong; I did the same thing with beads and an alert charm. Had to do the same thing with the elastic to make it not so loose it would slip off. The perle cotton is soft, but it doesn't look as jewelry-like as the filament does. I also tried making a small bracelet without a tag, out of some leftover overdyed 6-strand cotton floss; that's strong, and the variegations in it look better than the solid color perle cotton - with glass beads, it has quite a hippie look to it. I imagine hemp cord would be similar; I may try that. Hemp is supposed to be quite strong.

I wanted to crochet using the elastic cord as my yarn, but it's too heavy to string beads onto. And I tried making a loop of some heavy cord, and crocheting some crochet cotton around the loop; however, it's nearly impossible to make the ends of the loop of elastic stay together when pulled, and it IS impossible to keep the fabric cover of the cord from fraying and sticking out between the beads and stuff. So I pulled that experiment apart again, to re-use the beads. Maybe with special equipment I could do a really good crimp on the ends of the elastic; I am going to ask a friend who builds rabbit cages if I can borrow a few J-clips and her J-clip squeezer, and see if that would serve as a good crimp.

So far, I like the filament one best, and a friend admired it.

More experiments to come. I want to find a cheap source for the alert charms; they don't have to have nearly as much verbiage on them as I have on mine, and many people just get them saying "see wallet card." I might try making a few bracelets with that kind of generic tag and see if anyone might buy them.

Some other things I'm going to try: linen-cotton blend ribbon yarn (linen is quite strong); leather cord. I might look for finer elastic, that I could string beads on, but then it wouldn't be very strong. I tried some rayon/metallic yarn, but I knew even before I started that even though the rayon was quite comfortable, it wasn't strong enough; rayon frays quite easily, and that sucker will probably abrade and fall apart after only a few dozen wearings, so I'll have to keep an eye on it and take it apart and make something else before that happens. I want to look for more waterproof ideas, too; the stainless steel tag will resist a lot of water, and if I can find a bracelet material that also will, that would be cool. The various threads mentioned above might not mind water per se, but they do object to the chlorine in most swimming pools; if nothing else, the color would fade after only a few dunks in Little Stacy Pool.

posted by Kelly : 11:19 PM  

Wednesday, June 09, 2004

Recent medical articles point out that it is best to take your diuretics WITHOUT food, if you are taking a loop diuretic ("water pill"). The loop diuretics include furosemide (Lasix), bumetanide, torsemide, and ethacrynic acid. Food is known to alter the absorption of a number of drugs and significantly affect the rate at which people respond to the drugs. In the case of loop diuretics, even the PDR doesn't mention this. One study of Lasix showed that the drug reached twice the concentration in the bloodstream if taken while "fasting" than if taken with food. Fasting, in this sense, means no food for about two hours either before or after the pills are taken. Thus, if you take yours first thing in the morning, you should not eat breakfast until two hours later. If you eat breakfast first, then you should wait 2 hours before taking the diuretic, and then wait at least another 2 hours before eating lunch. Another study showed that the diuretic works best if taken before a meal, not after - so your best bet is to take your diuretic the minute you wake up, then do all your morning showering and exercise and stuff, then eat breakfast.

If you're like me, the furosemide (Lasix) takes about an hour and a half to kick in, and then I have to use the bathroom urgently. Since that's an hour and a half, a good rule of thumb is, after that initial pee (pardon the technical term), wait a few more minutes and then start making breakfast, and you'll be close enough to two hours for government work.

Of course you know that in general, you shouldn't take drugs with grapefruit juice. While there are some drugs that are not affected by grapefruit juice, so many of them are that you should just make it a rule. The same 2-hour limit works well - don't drink grapefruit juice within 2 hours before or two hours after taking any of your medications. With some drugs, particularly those designed to have a time-release effect, you shouldn't drink grapefruit juice at all. Time release capsules are like you are continuously taking the drug, so it's always within two hours of taking it. Your doctor and your pharmacist should give you this advice, but even if they don't, it's not a bad idea to just remember it yourself.
So here's your list:

If you are taking a drug that has SR, XL, TR, or other time release letters in its name, don't drink grapefruit juice at all.

If you are taking any prescription medication at all, then don't drink grapefruit juice within 2 hours before or after taking your drugs.

Of course, you can always ask your doctor and your pharmacist specifically about grapefruit juice - if they both say it's OK to drink it, then it's OK. But if you don't remember to ask, then use the above guidelines.

posted by Kelly : 2:17 PM

July 2004 posts

Monday, July 26, 2004

OK, the second version of the blueberry ice cream worked:

Blueberry Ice Cream
Makes 1.5 pints (3 cups)
You need to have a chilled cylinder for a small hand-cranked ice-cream maker such as Donvier or Nordic Ware, ready ahead of time.
In a bowl, place about 1-1/4 cups blueberries and 1/4 cup water. Nuke for 2 minutes, stirring once. Drain off water.
Combine stewed blueberries and 1/4 cup fruit juice - grape, cranberry, mixed berry, something in the dark red to purple fruit family. I use cranberry-mixed berry. In a food processor or blender, puree the berries; they don't have to be completely liquified, small bits of blueberry are still fine.
Pour this into a measuring cup; it should be about 1 cup. (If it's slightly less, don't worry. If it's less than 3/4 cup, then add more juice to get near a cup of mix.) Chill it for about 45 minutes, until it is no warmer than room temperature, and it can be a little cooler.
In a bowl, combine the blueberry mixture, 1/3 cup of sugar, and 1 cup of evaporated milk. Stir till thoroughly blended. Stir in 1/4 cup small pecan pieces ("broken" or "chopped fine" or "pieces").
Pour entire mixture into the ice cream maker, and follow manufacturer's directions for stirring. Mine say "Turn handle twice a minute for 20 minutes" but different ones vary. The result will be soft ice cream. Put the ice cream into a bowl and freeze it, to harden it to the point where it can be scooped. This should be somewhere between an hour and 2 hours. It will not be as hard as commercial ice cream but it will be hard enough to form shaped scoops in a bowl; it won't be "soft" any more.
This makes about 6 servings.

FAQ:
You only have about 2-1/2 cups ingredients there. Why don't you have 3 cups of ingredients?
Because when you stir ice cream, you are stirring air into it, and it gains volume - that is part of the process. When finished, you will have ice cream up to the top of the cylinder. If you were to pour 3 whole cups of ingredients in, you would not be able to thoroughly mix and chill the mixture, because it would start expanding over the top of the cylinder.
Can I add other ingredients?
You can substitute other add-ins for the pecans; do not exceed 1/4 cup, though. Miniature chocolate chips work well, or other nuts instead of pecans. You can also add a bit more sugar, if the first time you try this it's not sweet enough for you. However, don't exceed 1/2 cup of sugar, or you'll have too large a batch for the small ice cream maker.
What if I have a larger ice cream maker?
You can double or triple this recipe, except for the juice. Keep the amount of juice at 1/4 cup, and double (or triple) all the other ingredients. Doubling the recipe will make about 3 pints (6 cups) of ice cream, which is a quart and a half; if you have a half-gallon ice cream maker, this amount should work. Tripling the recipe will produce a little over 4 pints, which is a little over half a gallon, so it won't work in a half-gallon maker but will work fine in a 3-quart or larger maker. Above tripling, the proportions of things start changing; if you want to make more than triple the amount, you'll need a different recipe and a different kind of ice cream maker.

posted by Kelly : 9:06 PM  

Thursday, July 22, 2004

I am making blueberry ice cream even as we speak. With my old Donvier manual ice cream maker - you remember, the ones that you chill the cylinder ahead of time and then turn the little handle a couple of times a minute for 20 minutes? I'll let you know how it comes out - I'm not sure I got the proportions right. That is, I cut a much larger recipe down to one pint, but I'm not sure some of those things should be cut exactly in proportion to size. We shall see.

More precisely, it's ice-evaporated-skimmed-milk, rather than ice cream. Which does make a major difference in the fat content, and the sodium content as well. The sodium content in dairy products can vary wildly. I was looking at cans of evaporated milk, sweetened condensed milk, and filled evaporated milk, and noting a huge difference. Most of the sweetened condensed milks are 45 mg sodium per 2-tablespoon serving, of which there are about 10 to a can. Which means if you make a pint of ice cream using one can, it's got about 450 mg of sodium in it. That's a lot if you eat it all yourself - please be responsible and share your ice cream! Evaporated milk, on the other hand, has only 30 mg sodium per 2 tablespoons - no idea why the difference; if anything, I would think the addition of sugar to the sweetened milk would make it lower in sodium overall, but that's not the case. With evaporated milk, add your own sugar to the mix.

While I don't know yet how this blueberry ice cream will turn out, here's a recipe that's worked for me for years. This is for about a pint and a half.
Banana Ice Cream
1 ripe banana- doesn't have to be brown, just reasonably soft enough to mash
1 can evaporated milk
1/4 cup sugar
1/2 tsp fresh lemon juice, or the equivalent in bottled lemon juice
1/4 tsp grated lemon peel (dried is OK)
1/8 cup miniature semi-sweet chocolate chips
1/8 cup small pecan pieces (chips/crushed/chopped fine)

Mash the banana (hi, potassium!), then blend everything except the chocolate chips in a food processor or blender. Doesn't have to be completely liquified, just reasonably pureed. Chill mixture for half an hour in the refrigerator. Then, if you don't have two cups yet, add milk or cream to get up to 2 cups of mix. (Use skim milk for lowest fat; use heavy cream for creamiest taste, or whatever point in between on the milk-cream spectrum suits your diet. I use 2% milk.) Then add the chocolate and nuts. Pour into the ice cream maker and follow the directions that come with it. This makes a little under a pint and a half. If you have a larger ice cream maker, say one that makes two quarts (half a gallon) at a time, double everything EXCEPT the lemon juice and lemon peel.

posted by Kelly : 5:10 PM  

Friday, July 09, 2004

I will be AFK until Monday evening the 12th. Travelling.

posted by Kelly : 2:03 AM 

Tuesday, July 06, 2004

Some suggestions wanted. I want to make up a bunch of bracelets so that I have some "stock." But it's difficult to put the alert tags on before I have the info that goes on them. So I've been putting "See Wallet Card." I am considering having the following "in stock" :
Coumadin
Pacemaker
Heart Patient
ICD/Pacemaker

and a few miscellaneous ones:
Diabetes
Penecillin Allergy

Does that sound like enough to meet most needs? The "heart patient" one is less generic than See Wallet Card, but still general enough that a lot of people could use it even though it's not more personalized.

Colors I'm preparing:
Brown/gold
Red/gold
Green/gold
Green/silver
Purple/silver
Black/silver

I made one blue one, but the blue beads were really bad; I will have to find a better source of varied blue beads before I do that again. Blue, like green, should probably be on both silver and gold.

I sold the blue one already, and a red one. I have got to get pictures up so people can really get interested!

posted by Kelly : 10:23 PM  

Friday, July 02, 2004

All right! My medical alert bracelets for sale are up and running! I will have pictures posted shortly. Meantime, if you're interested in a lightweight yet strong bracelet with lots of glass beads, a plastic bead alert tag, and a free wallet card, e-mail me!

posted by Kelly : 4:59 PM

August 2004 posts

Friday, August 27, 2004

The bracelets are beginning to take off! This morning, I met with the woman who is planning the Juvenile Diabetes Austin chapter's fundraiser silent auction, to donate a few of my Medical ID Alert Bracelets for the auction. Should be great publicity for them. The fundraiser is October 2 at Oslo on 6th St., if anyone's interested!! I donated three bracelets, two that say "Diabetes" and one that says "See Wallet Card," plus she bought a bracelet right then and there - and when we stepped back out of the conference room, people who had no idea why I was meeting with her instantly noticed and complimented her on the bracelet. It was one of the lime green ones. She was first diagnosed with Juvenile Diabetes, not the usual Type II that you see in adults, at age 32, and has some of the same problems I do with "you don't look like you're disabled" just because we're not morbidly obese, elderly, or crippled, if you'll pardon the blunt word.

And then after class, I ran down to the dentist to get a crown glued back on, which had fallen off Wednesday night. I'll actually need to get the whole thing replaces; it was one of my older crowns, probably more than 15 years old since it's not on this dentist's records, and it was still the silver amalgam, and the build-up under it had eroded somewhat. So that's $500 out of pocket next month; it would be $1000 if I didn't have insurance. Bleah. I need new glasses too; my first paycheck for the school year isn't till September 30, and I can't even think about the glasses till then. Thank Cthulhu the hearing aids are still in great shape and don't need anything more than their steady diet of batteries - one thing that doesn't need fixing. Well, and no recalls on the pacemaker, either :-) so that's another thing that doesn't need fixing. And nothing in my CHF interferes with dental work - unlike, say, people who are taking blood thinners, who have to worry about anything that might cause bleeding from the gums.

In terms of recipes, I haven't done anything new lately - it is too hot here to cook. I have pretty steadily been making ice cream, the recipes for which are in previous posts. I add a little nutmeg to the blueberry ice cream for more flavor, and a little cinnamon and ginger to the banana ice cream. And Sam gave us two MORE bags of pecans from the trees in their back yard, so of course I throw big handsful of pecans into each batch of ice cream. Locally picked pecans are so tasty! And the fat in nuts is the "good" kind, which may be not just not bad for you but actually helpful in reducing some kinds of problems. Anyway, around the end of September when the weather finally drops below 90° I should start cooking again and get some new low-sodium recipes up here.

posted by Kelly : 2:38 PM  

Wednesday, August 11, 2004

When the temperature outside is higher than body temperature, I get lightheaded real easily. As long as my bike is moving, the evaporative cooling makes it OK, but at stoplights, I really feel it. I find I need to drink way more water in the summer; I know we're supposed to limit our fluid intake, but if I stick to the guidelines, I get dizzy. I have about 12 cups of fluid a day rather than 8 whenever the temp is over 85. (Remember, fluid includes most fruits, jello, sauces, sorbet and ice cream, and many other soft foods, not just stuff you drink out of a glass.) If you are getting that same lightheaded feeling a lot, ask your doctor whether you can drink more and take a slightly higher dose of your diuretic until the weather cools off again. Don't forget that the loop diuretics such as Lasix can make you sunburn easily!

posted by Kelly : 3:34 PM 

Wednesday, August 04, 2004

Hey! My Medical Alert bracelets are up for sale on eBay
You can also read more about them on my new web page.

posted by Kelly : 5:08 PM

September 2004 posts

Saturday, September 25, 2004

These last couple days I have eaten WAAAY too much sodium. It has been a busy week: one of my pet guinea pigs is performing in a play at the university where I teach (long story, but she's filling in for the part of Groucho the kitten, in Act 1 Scene 1 of "You Can't Take It With You.") So Friday was: teach class, run to the Quilt Show for my volunteer shift, realize I hadn't eaten lunch and wasn't going to get dinner till late at night, so I bought food at the concession stand at the quilt show. Needless to say, concession stands in public venues don't have low-sodium foods; they all tend toward the frankfurter-frito pie-popcorn end of things. So I had a chili dog. Then after the show, I ran home, we dropped Persephone off at the theatre, and went to hear the symphony, for which we had tickets. Then we drove back to the theatre, picked Persephone up, brought her home, and finally had supper. Today, I had time for a real lunch, but not the energy, after the two days of doing stuff all day, for a good homemade dinner, so after volunteering at the quilt show - and possibly stirring up a little business for my medical ID bracelets :-) -- we dropped Purr (her nickname) off at the theatre, and had fried shrimp for supper at a Vietnamese place in the poor-Hispanic-and-black area of Austin. Good shrimp, came with french fries and shrimp-fried-rice. I feel reasonably certain that the rice alone contained more than 2000 mg of sodium.

This fiscal year I'll be on the state retirement system's insurance plan; unfortunately, its prescription benefit is not quite as good as the city health plan, so I'll be paying more for most of my prescriptions. For starters, there's a $50 deductible per year per script. Ick. I keep thinking about the mail order part of the plan, where one can get 3 months for the price of two - but the last time I tried that, I constantly had to worry about stuff getting left out in the Texas summer heat and humidity. I'll have to see if this plan would be willing to ship via Post Office rather than UPS, so I could have it delivered to my PO Box, where it would stay indoors till I picked it up, rather than out on my back porch, subject to weather, passers-by, and who knows what-all. Sigh, another thing to remember to check on.

I get the new crown, to replace the one that fell off a rear molar a few weeks ago, on Monday. I guess I'm lucky; as long as I don't need dental work that requires general anesthesia, there's nothing in all these medications that interferes with dental work. Local anesthesia is fine, and should I perchance need painkillers and/or antibiotics, CHF and its medications are not incompatible with the opiod painkillers like Hydrocodone, nor with antibiotics. There are some heart conditions where dental work would be a lot more tricky. As long as I can still take acetaminophen (e.g., Tylenol) for mild pain, and hydrocodone or oxycodone for more serious pain, it doesn't bother me at all that I can't take any of the aspirin/__profen painkillers.

Anyway, after the last few days - and tomorrow will be just as bad, since there's Quilt Show, a matinee at the theatre, and, if it's not pouring rain, the community band I play in will be playing a concert in the park in the evening, so I'm sure we'll be catching whatever the heck food we can -- I think next week will be a mostly fruit salad sort of week. I'll just go buy a whole bunch of late peaches, early apples, early pears, a few bananas, and so forth, and have those for lunch every day. Whee!

posted by Kelly : 10:27 PM

Thursday, September 09, 2004

Whoo hoo! My ejection fraction is up to 25%!! Still not healthy, but a significant improvement over 15-20%!!!

posted by Kelly : 3:45 PM

October 2004 posts

Friday, October 15, 2004

I've been experimenting with pumpkin ice cream recipes. Finally got one I really like. I will like it even better when I get around to buying a real pumpkin; they're so easy to cook in the microwave! I used to have to use a pressure cooker to cook pumpkin, and frankly, I've never been real comfortable with the pressure cooker even though I used it for 20 years. Cooking pumpkin in the microwave wasn't feasible until microwave ovens got larger and stronger, about 10 years ago.

Pumpkin Ice Cream 

1 can solid-pack pumpkin (not pie filling), 15 or 16 ounces

1/2 can almond pie filling, or about 4 ounces of marzipan, softened

1/2 tsp pumpkin-pie spice (mixed cinnamon, ginger, allspice, and a bit of cloves)

3/4 cup to 1 cup sugar or Splenda (sucralose)

1 and 1/2 cans evaporated milk (use evaporated skim milk for a really low-fat treat!!)
Mix all ingredients together in a bowl - use a mixer or an egg beater - until the consistency is fairly smooth and doesn't have many lumps left, and it's all a nice burnt-orange color. Freeze in a half-gallon ice cream maker - I use the Donvier hand-cranked kind, and there's a similar Nordic-Ware hand-cranked maker, or you can use a counter-top electric ice cream maker. Whatever you use, it should have a capacity of about 1/2 gallon. After running the ice cream maker for the recommended time in its instructions, remove ice cream to a storage bowl, cover, and freeze for another hour in your freezer, to make it firm enough to scoop.

Optional: you can do any or all of the following:

add 1/3 cup chopped pecans

Substitute a tablespoon of maple syrup for 2 tablespoons of the sugar

If you don't like almonds, substitute a small banana for the almond pie filling - peel the banana and nuke it for 30 seconds to soften it, then puree it in a food processor and mix with the other stuff in the mixing bowl.

---

If you want to cook fresh pumpkin for this, here's how: slice an American Pie pumpkin or a Sugar pumpkin (NOT a Halloween jack-o-lantern type pumpkin) in half. Scoop out all the seeds. Then slice each half into eighths, cutting out the stem as you go around it. Do NOT peel the pumpkin yet!! Nuke the pumpkin 4 or 6 pieces at a time on a plate - arrange them in a ring around the outside edge of the plate, don't pile them up -, until soft enough to stick a fork in easily. This could be anywhere from 2 to 5 minutes, depending on your microwave and the size of your pieces - start with 2 minutes, if it's still hard, try another 1.5 minutes, and then another 1.5 minutes.

Rinse the cooked pumpkin under cold water to cool it off a bit. Then scrape the pulp right off the rind with a spoon - you should be able to push the soft pumpkin with very little effort. In a blender or a food processor, puree the pumpkin - it doesn't have to be completely liquid, just a fairly soft texture, like chunky applesauce. Use 16 ounces of it in the above ice cream recipe, or make pumpkin bread; if you have lots of cooked pumpkin, freeze it in 1-cup covered containers - if they're sealed well, the frozen pumpkin will be good for about 3-4 months. (After that, too many ice crystals form, and the texture decreases in quality.) Defrost pumpkin in refrigerator overnight, or in your microwave on low power.

posted by Kelly : 11:55 PM  

Sunday, October 03, 2004

It may be autumn on the calendar, but it's still around 90 degrees in the afternoon here. So I'm still making ice cream. This weekend, I made the banana ice cream mentioned earlier, except that used both a banana and a nectarine. I found my larger ice cream maker, the half-gallon one. So I nuked a banana and the nectarine until they were soft, pureed them in the food processor, added a whole can of evaporated milk instead of just 1 cup, threw in a half tsp of ginger, a tsp of lemon juice, a 1/4 cup orange juice, and 1/4 cup EACH of pecans and semi-sweet chocolate chips. It worked QUITE well, if I say so myself - everybody had large bowls of it and it disappeared quickly.

The weather is SLIGHTLY cooler though - it's getting down below 70 at night now - and that does make me feel a little better. I've always been a fall person, felt more energetic in the fall.

posted by Kelly : 9:08 PM

November 2004 posts

Tuesday, November 16, 2004

From the 8 October issue of "Science":
A particular strain of mutant mice have defective heart development, including problems with the myocardium and its electric signaling. Injection of nonmutant embryonic stem cells into blastocytes of these defective mice rescued the heart defects in the mutant mice, and injection of normal embryonic stem cells into the peritoneal cavity of pregnant mice rescued some of the heart defects in the mutant offspring.

My personal opinion is that we should be encouraging stem-cell research. As far as I can tell, the objections to this are based on religious beliefs which appear to hold that unused, unimplanted embryos are human beings, and that somehow if they're not implanted, it is better to let them have freezer burn forever than to use them for something of benefit to people. I also feel that doing medical research on human cells makes more sense than continuing to test things on animals; by using human stem cells, we can avoid some animal research and the attendant pain and suffering the animals may have.

I know that other people have strong opinions on this subject. I wouldn't mind hearing from people who have something to say that is NOT based solely on religious beliefs about embryos.

posted by Kelly : 10:59 AM  

Monday, November 08, 2004

Vitamin D - read an article in the October 9 "Science News" - turns out Vitamin D is more important than people think. Among other things, very important to leg strength. Many of us with heart failure worry that every leg cramp we get may mean we're potassium-depleted, but it can be other things. People living up north, not getting much sunlight, and not taking daily vitamins, may not be getting enough D.

Vitamin D also appears to provide some protection against MS, lupus, inflammatory bowel disease, and diabetes. If you're one of the people who has CHF as a side effect of diabetes, maybe more D could help both?

Also, too little vitamin D can lead to gum disease and tooth loss.

While this stuff isn't directly CHF-related, anything that helps our overall health, reduces stress on our hearts. So if you aren't already getting 600 IU of vitamin D daily, start!! Vitamin pills, a little more sunshine, and fruit juices fortified with calcium and Vitamin D are all good ways to get there.

posted by Kelly : 4:38 PM

December 2004 posts

Wednesday, December 29, 2004

Article from local newspaper; see bottom of article to get information on your own local hospital!

Austin area hospitals rated on heart, pneumonia care
Ratings aimed at giving more information to consumers, raising quality of patient care


By Mary Ann Roser

AMERICAN-STATESMAN STAFF

Wednesday, December 29, 2004

Austin area hospitals made grades ranging from fair to good for heart attack and heart failure care but generally received poorer marks for pneumonia care under new performance measures now publicly available.

The hospitals voluntarily reported data to the federal government, which posted the results for the first time earlier this month on its Medicare Web site at www.cms.hhs.gov/quality/hospital. The program judges hospitals on how often they followed the best practices for treating three serious conditions: heart attacks, heart failure and pneumonia.

The statistics, from the first three months of 2004, are designed to inform consumers and improve the quality of care.

Seton Medical Center earned the highest scores locally for heart care, doing as well as or better than half of the more than 4,000 U.S. hospitals taking part in the Hospital Quality Initiative. South Austin Hospital, which is part of the St. David's system, scored lower than six other Central Texas hospitals in treating certain aspects of heart attack and heart failure.

Meanwhile, the Georgetown Healthcare System did the best job among nine Central Texas hospitals in pneumonia care and scored in the top half of U.S. hospitals, although not in the top 10 percent.

Austin area hospitals that scored in the bottom half of those surveyed generally attributed their scores to weak documentation -- except in pneumonia care. All agreed they could do better, especially in giving a pneumonia shot to patients.

"What we found out at St. David's is a number of physicians were not documenting what they were doing" for heart patients, such as writing down that an aspirin was given to someone having a heart attack, said Dr. Steve Berkowitz, chief medical officer of the St. David's HealthCare Partnership. "These are process steps. When we look at outcomes, we know we do very well."

South Austin Hospital was listed this year as one of the top 100 hospitals in the United States for cardiovascular care, based on survival rates by Solucient, a health information company.

Seton also made Solucient's top 100 list for cardiovascular care, as did Scott & White in Temple and the Heart Hospital of Austin.

In the new report, based on seven measures for treating heart attack and heart failure, Seton performed better than 90 percent of the nation's hospitals on one measure and in the top half of the hospitals in the country on four other measures. It was just one percentage point below the top 50 percent on two other measures: giving beta blockers to heart attack patients when they come to the hospital and when they leave.

Scott & White scored in the top 50 percent of hospitals on five measures for cardiac care and in the lower half on two others for heart attack treatment: giving aspirin on arrival and departure.

The Heart Hospital scored better than half of U.S. hospitals on three heart attack measures and slightly worse on two. It also scored in the bottom half on the two measures used to gauge care of heart failure patients: assessing the function of the left ventricle and giving a blood-pressure drug for it.

"There should be noticeable improvements between the second and third quarters" of 2004 based on better documentation, said Torje Scott of Heart Hospital.

She said that the Texas Business Group on Health, which also lists hospital performance on its Web site, www.tbgh.org, shows that the Heart Hospital has lower death rates for heart attack and balloon angioplasty than other Austin area hospitals.

Brackenridge Hospital treated fewer heart attack patients but handled heart failure well, scoring in the top 10 percent in one category and close to it in a second.

Scores for St. David's Medical Center and North Austin Medical Center were mixed.

All of the hospitals, except Georgetown, scored in the bottom half of U.S. hospitals in vaccinating pneumonia patients. (Hospitals that treated fewer than 25 patients were not considered; the study said that was too few to be statistically reliable.)

Hospital officials said they had seen that as the responsibility of primary care doctors. Seton hospitals now have stickers to remind doctors and nurses to screen patients for pneumonia vaccination, said Michele Gonzalez, director of media and communications.

Hospitals should look on the measures as an opportunity to improve, and consumers should see them as a "starting point" to compare hospitals and ask questions, said Kevin Warren, director of quality improvement with the Texas Medical Foundation, which contracts with the Centers for Medicare and Medicaid Services to promote the information to consumers.

"It's an opportunity for hospitals to benchmark themselves against each other," Warren added. "How do they stack up to the top 10 percent of the hospitals in the country?"

maroser@statesman.com; 445-3619

Get a hospital score

Go to www.cms.hhs.gov/ quality/hospital. To get individual hospital reports, go to the highlights box and click on "data available." On the next page, go to the bottom and "select a state."

Go to city search, choose the city you want and hit "search by city."

Then, select the quality measures you want on the left (all can be selected) and choose a hospital.

The first column shows the results for the top 10 percent of U.S. hospitals surveyed, the second column represents the top half of U.S. hospitals, and the third shows the hospital you chose.

posted by Kelly : 8:42 PM

January 2005 posts

Sunday, January 16, 2005

From the January 8, 2005 issue of Science News:
Beat Generation: Genetically modified stem cells repair heart
Tissue engineers have for the first time used genetically modified human stem cells to repair damaged hearts in guinea pigs.
In experiments on guinea pigs, scientists have used genetically modified human embryonic stem cells to make a biological pacemaker. The implanted tissue has kept the guinea pig hearts beating after their natural pacemaker cells were destroyed. ... Unlike battery-powered pacemakers, says Li, stem cell-based pacemakers speed up or slow down in response to drugs that alter normal heart rate. ... His group [he's based at Johns Hopkins] has already learned how to genetically alter human pacemaker cells to fine-tune their firing rates. Adjusting the firing rate could be important because ordinary pacemaker cells beat slowly when implanted. The heart's natural pacemaker is a complex mixture of several cell types, Li says, so it's difficult to mimic its function with any single, unmodified cell type.

posted by Kelly : 1:19 AM  

Saturday, January 15, 2005

A few articles online that I've run across:

http://www.cms.hhs.gov/quality/hospital/SummaryOfMeeting.pdf This article is about a study which shows that ARBs, a/k/a AIIBs, angiotensin-II blockers, a/k/a "sartans" do as much good for patients with heart failure or left ventricular systolic disfunction as the older ACE inhibitors do. The protocols for standard treatment of heart failure will be rewritten to say ACEI or ARBs should be prescribed for HF patients. This is a report from a medical meeting, so it's fairly technical.

http://www.heartcenteronline.com/myheartdr/home/research-detail.cfm?reutersid=4985&nl=2
C-reactive protein, statin therapy measured in heart disease
Jan 05 (HeartCenterOnline) - A pair of studies appears to have confirmed the importance of C-reactive protein in coronary heart disease.

http://www.heartcenteronline.com/myheartdr/home/research-detail.cfm?reutersid=4977&nl=3
Dual pacemakers worth the cost, U.S. study finds
Jan 04 (Reuters) - Pricey pacemakers that regulate the heart's upper and lower chambers separately are worth the extra cost because they help keep patients out of the hospital, US researchers reported on Monday.
The fancier dual-chamber models cost about $3,000 more than single-chamber devices and do not help patients live any longer on average, but still save money over time, the government-funded study found.
"The dual-chamber devices significantly reduced the rates of atrial fibrillation and heart failure hospitalizations, which over the long term results in a highly favorable cost-effectiveness ratio," said Dr. David Cohen of Harvard Medical School in Boston, who led the study.


http://www.heartcenteronline.com/myheartdr/home/research-detail.cfm?reutersid=4981&nl=4
Eye disease predicts heart failure
Jan 05 (Reuters Health) - A common type of disease that involves the back of the eye, known as retinopathy, is a risk factor for heart failure, even in the absence of preexisting heart disease, high blood pressure or diabetes, according to a new report.

For the complete text of each article, click on the links given.

posted by Kelly : 4:24 PM  

Friday, January 14, 2005

I'm trying to get through a load of magazine articles I've torn out and saved up. Herewith a summary:

From Reader's Digest, December 2004:

CT scans are a safe way to diagnose illness or injury. But the growing trend of full-body CT scans by healthy people for early detection of tumors or heart problems may actually increase cancer risk. Don't get a full-body CT scan unless you are already at heightened risk for one of these diseases. From a study at Columbia University Medical Center.

Being overweight ups heart disease risk, and exercise cuts risk. Which is more important: losing weight, or exercising? Obese women who weren't active were 50% more likely to have a heart attack or stroke or die in the next four years than more active obese women. It's still not OK to be obese, but regardless of your weight, you'll be better off if you exercise than if you don't. From a University of Florida study.

From Science News. 9 October 2004:
From muscle strength to immunity, scientists find new Vitamin D benefits. Vitamin D reduces your risk of injury from falling. It appears to have a protective effect against MS, and possibly against other autoimmune diseases. It helps reduce the gum inflammation that can lead to tooth loss. It slows prostate cancer growth. It may aid in the prevention of type 2 diabetes - and many people with heart failure also have diabetes, so this effect is important for you. Recommendations: aim for at least 400 IU of Vitamin D daily, and 600 is even better.

However, note also from an earlier issue of Science News, summarized in the Dec 18 issue, that Vitamin D promotes weight gain in people who aren't getting enough calcium in their diets - so as you up your Vitamin D intake, make sure your calcium intake is also adequate!

And also from that year-end summary:
Guggul extract, a common dietary supplement for heart health and obesity, may impair the efficacy of many prescription drugs. Here's a link to that article online: http://www.sciencenews.org/articles/20041002/food.asp. Statins are one class of drugs whose effectiveness is reduced by guggul, and many of us with heart failure are taking statins. In general, don't take any dietary supplements purported to have health benefits without checking with your doctor for potential interactions with prescription medications.

From Science News, 4 December 2004:
Breathing polluted air - air with soot and other airborne particles - compromises the arteries' capacity to dilate and inhibits blood flow. This links cardiovascular disease and polluted air.

There, that's enough for the moment, and gets rid of a few millimeters of my accumulated paper pile.

posted by Kelly : 10:48 AM  

I contributed several of my recipes to a cookbook put out by Animal Trustees of Austin, as a fundraiser. Those of you who might want those recipes can find the cookbook here. It includes the salt-free summer pickles, the high-potassium fruit salad, three bean salad, black bean salad, and my most famous recipes, the cashew chili and the chickpea curry. Because we tried to give stuff animal related names, they are called "Chili and Chippy Chinchilla's Cashew Chili" and "Leapin' Lapin Legume Curry" in here, after my pet chinchillas and pet rabbits. So, while you can scroll through the archives here and find the recipes, if you'd like them in print, plus a bunch of other good vegetarian stuff, please help out ATA.

posted by Kelly : 10:35 AM

February 2005 posts

Thursday, February 10, 2005

Do you watch CIS and Without a Trace on Thursday evenings? Vivian on "Without a Trace" just got diagnosed with hypertrophic cardiomyopathy. They had her handle it about the same as I did - cry, and then go back to work because what the hell else can you do? Hers is apparently genetic - they reference an uncle who died in it. And it is true that high blood pressure, and high-blood-pressure-induced hypertrophic cardiomyopathy, are more common in blacks and some hispanics than in pasty white people. So it's a good issue for them to raise. The cardiomyopathy itself isn't the problem, it's the heart failure that results = an enlarged heart, if nothing else happened, would be sort of like having large fingers or something - just an individual anomaly. But when the heart walls are thicker, they can't pump as well; that's the heart failure part (for those of you reading this who aren't yourself diagnosed with heart failure.) Now the cause underlying the enlarged heart/thickened ventricle walls is more of a mystery. In some cases it's genetic, as with Vivian; in some it's due to a congenital heart defect; in many people it's due to morbid obesity and/or diabetes and/or heavy smoking weakening the heart. Or, as in my case, it is of completely unknown origin, which then adds another multisyllable word to the mix, making it "idiopathic hypertrophic (or dilated, in my case) cardiomyopathy." The thing is, I hate being able to pronounce those words perfectly and define them to a T - that's not a bit of trivia I really wanted to ever have to acquire, much as I love trivia. Anyway, for those who want a preview of what the plot arc for Vivian might be, it will probably involve: hospitalization for an angiogram or ten; getting a defibrillator/pacemaker; taking an awful lot of medications, all of which have their own fascinating side effects, and still facing a life expectancy of only 5-10 years. Yeehaw.

Perhaps having a character on a reasonably popular TV show have this will bring some attention to the fact that not all "heart disease" is due to cholesterol/clogged arteries/heart attacks. It seems as though for all that there are half a million people a year diagnosed with heart failure, no one has ever heard of it. Everything you read about "keep your heart healthy" from every source from Parade magazine to employer health fairs is aimed at coronary artery disease and low-fat diets and all that.

Heck, I was in a deli the other evening, and the menu listed several "healthy heart" entrees, giving the nutritional breakdowns for them. Various sandwiches and salads and a couple of pasta dishes. And some of them were like, OK, only 7 grams of fat - and 2933 milligrams of sodium!!! For those counting, total sodium intake per day, never mind per one meal, should be under 2000 mg. There were actually a couple items that were decent - a sandwich and a wrap that each had under 600 mg of sodium, which puts it into the range I will eat. Along with a side order of fresh fruit, that's a tolerable meal. But a lot of places, that fresh fruit/fruit salad/salad with no dressing and no croutons and no crackers and no crunchy bits is about the only thing I feel safe ordering. Why do so many people add so much salt to things? Vinaigrette salad dressing, for example - there are several terrific commercial vinaigrettes with fewer than 100 mg of sodium per serving, so we know it can be done; why, then, do most of them have 300 to 800 mg of sodium per serving?

And European canned tomatoes are canned without extra salt - most Italian brands of tomato paste, stewed tomatoes, etc. have like 15-50 mg of sodium per serving; why do American brands have 200 to 800 mg??

Whine, whine. I do hope that if they continue to follow this story arc with Vivian, they'll highlight the low-salt issue. Maybe show somebody trying to get a low-sodium fast lunch while on the job in New York City!!!

posted by Kelly : 10:17 PM

March 2005 posts

Thursday, March 31, 2005

Below are a whole bunch of excerpts, with references to the original articles. I'll summarize what they say, though: CHF patients who have left bundle branch blockage (LBBB) have a worse prognosis than other CHF patients. Biventricular (3-lead) pacing may improve the odds slightly for some such patients.

Why do I care about this? Guess who has LBBB - and in fact, said LBBB was noticed almost 10 years ago, when I was getting my gall bladder removed, and had an EKG. At the time, the doctors thought nothing much of it except that I should remember to mention it before any future EKGs or surgery; in and of itself, LBBB is not supposed to be dangerous. (Sort of like those prolapsed mitral valves aren't supposed to be too bad if that's all that's wrong...) And then, the partial fix for this is the 3-lead pacemaker... that would be the one they couldn't do on me, I have the pacemaker but they couldn't implant the third lead, something weird about the veins back there. Bleah.

Oh well. I've still got other factors in my favor, including having lost lots of weight.

Most of these articles are pretty technical; if you follow the links, be prepared for some very medical-research-y wordiness.

---

http://www.eurheartj.org/cgi/content/full/25/1/97
Mortality in congestive heart failure complicated by atrial fibrillation
... It is interesting that the proportion of patients with ischaemic heart disease (IHD) was found to be higher (53.3%) in group A (no LBBB or AF) than in the groups of patients with LBBB, AF or both (33.3–35.4%). This suggests that LBBB and AF are more commonly found in association with non-ischaemic cardiomyopathy, and secondly, patients with non-ischaemic cardiomyopathy have a worse prognosis than their counterparts with IHD. The aetiology of CHF may therefore be a confounding factor in this analysis, and it would be interesting to see the effect of AF and LBBB analysed separately for the ischaemic and non-ischaemic subgroups of patients. ...

http://www.eurheartj.org/cgi/content/abstract/23/21/1692
Cumulative effect of complete left bundle-branch block and chronic atrial fibrillation on 1-year mortality and hospitalization in patients with congestive heart failure. A report from the Italian network on congestive heart failure (in-CHF database)
Abstract
Background Many clinical variables have been proposed as prognostic factors in patients with congestive heart failure. Among these, complete left bundle-branch block and atrial fibrillation are known to impair significantly left ventricular performance in patients with congestive heart failure. However, their combined effect on mortality has been poorly investigated. The aim of this study was to determine whether left bundle-branch block associated with atrial fibrillation had an independent, cumulative effect on mortality for congestive heart failure.
Methods and Results We analysed the Italian Network on congestive heart failure (IN-CHF) Registry that was established by the Italian Association of Hospital Cardiologists in 1995. One-year follow-up data were available for 5517 patients. Complete left bundle-branch block and atrial fibrillation were associated in 185 (3·3%) patients. In this population the cause of congestive heart failure was dilated cardiomyopathy (38·4%), ischaemic heart disease (35·1%), hypertensive heart disease (17·3%), and other aetiologies (9·2%). This combination of electrical defects was associated with an increased 1-year mortality from any cause (hazard ratio, HR: 1·88; 95% CI 1·37–2·57) and sudden death (HR: 1·89; 95% CI 1·17–3·03) and 1-year hospitalization rate (HR: 1·83; 95% CI 1·26–2·67).
Conclusions In patients with congestive heart failure, the contemporary presence of left bundle-branch block and atrial fibrillation was associated with a significant increase in mortality. This synergistic effect remained significant after adjusting for clinical variables usually associated with advanced heart failure. We can conclude that this combination of electrical disturbances identifies a congestive heart failure specific population with a high risk of mortality. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved
http://adam.about.com/reports/000013_4.htm
...Conditions Associated with Left-Side Heart Failure and Their Effect on Severity
Left-side heart failure tends to be more severe than right-side heart failure, particularly when it is associated with the following conditions:

• Coronary artery disease.
• HIV infection.
• Amyloidosis.
• Chemotherapy with doxorubicin.
  The outlook is better in patients with left-side heart failure associated with the following:
• Idiopathic cardiomyopathy (the cause is unknown).
• Heart failure due to childbirth.

...Other Conditions Associated with Increased Severity in Heart Failure
Weight Issues. If heart failure patients are overweight to begin with, their condition tends to be more severe. Once heart failure develops, however, an important indicator of a worsening condition is the occurrence of cardiac cachexia, which is unintentional rapid weight loss (a loss of at least 7.5% of normal weight within six months).
Impaired Kidney Function. In one study of patients with advanced heart failure, impaired kidney function was the most important indicator for a poor outlook, even more so than heart function itself. (In the study, impaired kidney function was not associated with heart failure.)
Congestion (Fluid Buildup). According to one study, patients with severe symptoms who have congestion (fluid buildup) have poorer survival rates than those without fluid build up. In fact, two-year survival rates are 87% in those who were congestion-free compared to 41% to 67% in patients with various signs of congestion (e.g., swelling, difficulty breathing when lying down, weight gain from fluid buildup).
Atrial Fibrillation. This abnormal rhythm is a rapid quivering beat in the upper chambers of the heart. It is a major cause of stroke and very dangerous in people with heart failure.
Left Bundle Branch Block. Left bundle-branch block is an abnormality in electrical conduction in the heart. It develops in about 30% of heart failure patients and is a major risk factor for serious adverse heart events.
Sleep Apnea. With this disorder a person stops breathing during the night, perhaps hundreds of times, usually for periods of 10 seconds or longer. It is a very strong risk factor for heart failure, and patients with apnea have a higher mortality rate than those without it.
Depression. The presence of depression indicates a poorer outlook. Studies indicate that depression may have adverse biologic effects on the immune and nervous systems, blood clotting, blood pressure, blood vessels, and heart rhythms.
Seasonal and Daily Patterns. More emergency room visits and higher mortality rates have been observed during winter months and on Mondays in patients with heart failure. One factor in this higher risk may be sudden and strenuous exertion, particularly snow-shoveling, which is associated with a risk for heart attack in people with heart problems.

---

This one's an explanation of what LBBB is and why bi-ventricular pacing may help:

 

http://www.brighamandwomens.org/cvcenter/Patient/crt.asp
... Some patients with cardiomyopathy and CHF have an abnormality of the electrical system. The most common abnormality is a delay in electrical conduction through the left bundle branch. This is known as left bundle branch block (LBBB). Because the electrical signal to the left ventricle is delayed by left bundle branch block, the right ventricle begins to contract a fraction of a second before the left ventricle instead of simultaneously. The result is an asynchronous, or uncoordinated contraction of the ventricles. This uncoordinated ventricular contraction further reduces the pumping efficiency of an already weakened heart muscle in CHF patients. It is estimated that up to 40% of patients with cardiomyopathy and CHF have an uncoordinated ventricular contraction caused by electrical delay, most often LBBB. This electrical delay is visible on an electrocardiogram (ECG) as widening of the QRS complex and helps to identify patients who might benefits from CRT. (figure 3)... What is cardiac resynchronization therapy?
The idea behind CRT is simple: restoration of the normal coordinated pumping action of the ventricles by overcoming the delay in electrical conduction caused by bundle branch block (also called resynchronization).This is accomplished by means of a unique type of cardiac pacemaker. Common pacemakers are typically used to prevent symptoms associated with excessively slow heartbeats. The pacemaker continuously monitors the patient's heartbeat and delivers a tiny, imperceptible electrical charge to stimulate the heartbeat when necessary. Most pacemakers typically have 2 electrodes (or leads) one in the right atrium and one in the right ventricle, which permits the pacemaker to maintain the normal coordinated pumping relationship between top and bottom of the heart. These leads are connected to a battery pack (pulse generator) placed under the skin in the upper chest. In addition to the 2 leads (right atrium and right ventricle) used by a common pacemaker, CRT pacemakers have a 3rd lead that is positioned in a vein on the outer surface of the left ventricle. (figure 4) ...What to expect from CRT?
The response to CRT may vary greatly between patients. Scientific study involving more than 2,000 patients worldwide have consistently demonstrated modest improvements in exercise tolerance, CHF class and quality of life in most patients. Though these improvements may be noticed almost immediately in many patients, they may not be fully realized for weeks or months in others. Unfortunately, there are a small number of CHF patients who do not benefit from CRT therapy. Further research is needed to identify those patients who are mot likely to benefit.

---

And off on a tangent,
http://circ.ahajournals.org/cgi/content/full/103/3/375Clinical Investigation and Reports Sex Differences in the Prognosis of Congestive Heart Failure Results From the Cardiac Insufficiency Bisoprolol Study (CIBIS II)
Abstract
Background—Whether female sex is associated with a better prognosis in patients with congestive heart failure (CHF) remains uncertain. The Cardiac Insufficiency Bisoprolol Study (CIBIS) II showed that bisoprolol reduced all-cause mortality and morbidity rates in CHF patients treated with diuretics and ACE inhibitors. We examined whether survival was different in men (n=2132) and women (n=515) enrolled in CIBIS II. Methods and Results—Women differed from men with regard to age, NYHA functional classification, primary cause of CHF, and risk factors such as left bundle-branch block. After adjustment for baseline differences, the probability of all-cause mortality was significantly reduced by 36% in women compared with that in men (hazard ratio 0.64, 95% CI 0.47 to 0.86, P=0.003). Women also had a 39% reduction in cardiovascular deaths (hazard ratio 0.64, 95% CI 0.45 to 0.91, P=0.01) and a 70% reduction in deaths from pump failure (hazard ratio 0.30, 95% CI 0.13 to 0.70, P=0.005) compared with men. Kaplan-Meier survival analysis revealed a significant reduction in all-cause mortality among women treated with bisoprolol compared with men (6% versus 12% P=0.01) but not among women treated with placebo (13% versus 18%, P=0.10). However, this sex/ß-blocker effect was not significant in multivariate analysis. Conclusions—These results indicate that regardless of ß-blocker treatment and baseline clinical profile, female sex is a significant independent predictor of survival in patients with CHF.

posted by Kelly : 2:57 PM  

Wednesday, March 23, 2005

An article I tore out of Science (www.sciencemag.org) from 9 April 2004, that got lost in a stack and just now came to light, talks about "Renovating the Heart." The abstract says:

Inspired by reports that cell infusions can heal animal hearts, cardiologists are rapidly moving to test the idea in humans."

The therapy being tested involves taking cells from a patient's own body, and injecting them into the ailing heart. No really show-stopping results yet but there have been some successes and some warning signs that cell therapy can be dangerous. Some patients in one study developed arrhythmias - [but then, heart failure patients have a high risk of arrhythmia anyway, so is this due to the cell therapy, or something that would have happened anyway?].

Stay tuned.

posted by Kelly : 10:03 PM  

April 2005 posts

Thursday, April 28, 2005

Can you make a cake without sodium? Yes. First off, you DON'T need to add salt to make the cake rise. Many people think that yeast breads and quick breads/cakes won't rise if there's no salt. This is not true. The yeast in bread feeds off of sugar, not salt; salt just speeds it up a little. You can leave salt out of homemade bread willy-nilly. To me, it still tastes fine, but if you are going to be serving bread to people who aren't used to low-sodium cooking, you can do the following: Add a pinch (a spot about the size of the head of a nail) of regular salt to the bread, which is so much less than the recipes call for that the mgs of sodium will still be well under five mg per slice, and 2 pinches of potassium salt (such as NuSalt). You don't want to add more potassium salt for two reasons: (1) it tastes off to people who aren't used to it, and (2) normal people don't need that much potassium and it could even be problematic for them. So don't just substitute a teaspoon of NuSalt for a teaspoon of regular salt. You can also throw in a pinch of powdered ginger, along with your pinches of salt; the bread will not taste like ginger specifically, but it will taste a little less bland.

Back to cakes. Cakes don't use yeast; they use baking powder or baking soda to rise. Baking soda is sodium bicarbonate; baking powder is a mixture of baking soda, cream of tartar, and corn starch - still mostly baking soda, though. However, this is true mainly only in North America. In Europe, it is a lot more common to use baking powder made with calcium rather than with sodium. Calcium has many of the same properties as sodium - the three elements potassium, sodium, and calcium, are near each other on the table of chemical elements and all do similar things. This is why you'll see substitutes for salt involving potassium, and substitutes for baking powder involving potassium OR sodium. As I mentioned above, the substitutes involving potassium have to be used carefully, so that normal people don't get too much potassium; calcium doesn't cause that kind of concern. Most Americans don't get ENOUGH calcium in our diets, and may even benefit from the substitution of calcium-based baking powder instead of sodium-based.

The calcium baking powder most easily available in the USA is Rumford; it uses calcium phosphate instead of sodium bicarbonate. In my opinion, it's also an excellent baking powder; you are not going to lose anything in your baking by switching over to it. It does as good or better a job in cakes as regular baking powder. If your local supermarket doesn't carry Rumford, you can order it here. (Incidentally, according to their web site, Rumford also makes a cornbread mix that uses the calcium baking powder and is completely wheat-free as well.)

Another brand of sodium-free baking powder is Featherweight; it's available from Healthy Heart Market, whose link is to the right of this post. It is made of a mixture of monocalcium phosphate, potato starch, potassium bicarbonate. The potato starch gives it a very slightly different texture from corn starch, and in my opinion it does not rise as well as Rumford; you need to use a little bit more of it. If a recipe calls for a teaspoon of baking powder, try using between one-and-a-quarter teaspoons and one-and-a-half.

---

And now for something completely different:
A few recent articles about heart failure; I've provided links, but in case you aren't a MedScape member, I've copied the abstracts as well, so you can get the gist of the articles.

The Role of Candesartan in the Treatment of Chronic Heart Failure
http://www.medscape.com/viewarticle/502413?src=mp

Hugh F. Mcintyre
From British Journal of Cardiology
Abstract
The renin-angiotensin system (RAS) plays a fundamental role in cardiovascular pathophysiology. In particular, angiotensin II (AII) has been identified as a culprit in endothelial and vascular damage, elevated blood pressure, and cardiac failure. Pharmacological inhibition of this system is available through two mechanisms; the reduction of AII formation by inhibition of angiotensin-converting enzyme (ACE), and by direct blockade of the type 1 angiotensin II receptor by angiotensin II receptor blockers (ARBs).

Angiotensin-converting enzyme (ACE) inhibitors have a proven role in the management of elevated blood pressure and diabetes and may confer specific vascular benefit. In patients with chronic heart failure (CHF) secondary to left ventricular systolic dysfunction (LVSD), there is extensive evidence that, when compared to placebo, ACE inhibitors reduce morbidity and mortality. Randomised placebo controlled trials have also shown ACE inhibitors reduce all-cause mortality and major cardiovascular events after myocardial infarction.

Given the unequivocal benefit of ACE inhibitors, initial studies with ARBs in patients with LV dysfunction (in CHF and following myocardial infarction) have focused on two areas: the role of ARBs when compared with ACE inhibitors, and when combined with ACE inhibitors.

Only recently, with the results of the CHARM study, have the role of ARBs when compared to placebo in a population with CHF been clarified. This study also addressed the benefit of ARBs in patients with heart failure and preserved LV systolic function.

---

BNP Levels May Help Guide Carvedilol Therapy for Heart Failure
http://www.medscape.com/viewarticle/503627?src=mp
BY Megan Rauscher
NEW YORK (Reuters Health) Apr 20 - Carvedilol therapy is associated with a sustained decline in brain natriuretic peptide (BNP) levels in patients with congestive heart failure (CHF), research shows. This suggests, according to the investigators, that "serial BNP levels can provide some guidance" regarding the odds of carvedilol-driven improvement left ventricular function.

"Beta-blocker therapy improves symptoms, left ventricular ejection fraction, and survival in patients with CHF, but chronic effects on neurohormones have not been extensively investigated," Dr. Robert P. Frantz, from the Mayo Clinic in Rochester, Minnesota and colleagues explain in the March issue of the American Heart Journal.

They examined the relationship between clinical and echocardiographic parameters and serial neurohormones in 55 patients with CHF, most of whom had nonischemic dilated cardiomyopathy, treated with carvedilol over the course of 1 year. Forty-six patients completed 12 months of follow-up.

"We found that carvedilol therapy is usually associated with a decline in plasma BNP peptide levels," Dr. Frantz told Reuters Health. "The extent of change in BNP levels correlates with extent of change in left ventricular ejection fraction."

Specifically, at 12 months, left ventricular ejection fraction improved from 26% at baseline to 39%, and NYHA class improved from 2.3 to 1.8. BNP levels fell from 453 to 208 pg/mL at 6 months. Compared with baseline, levels remained significantly lower (233 pg/mL) at 12 months (p = 0.01).

"The relationship between changes in BNP levels and ejection fraction suggests that serial measurements of BNP may be a useful guide in monitoring patients with CHF who are being treated with carvedilol, but the relationship is not sufficiently strong to obviate the role for measurement of ejection fraction," Dr. Frantz said.

"If elevated BNP levels do not decline in a patient who is being treated chronically with carvedilol, it suggests that this patient may not have had improvement in ejection fraction and should be evaluated carefully," he added.

Am Heart J 2005;149:541-547.

---

FDA Approvals: Hyzaar, Panzem, Decapinol
http://www.medscape.com/viewarticle/503708?src=mp

Yael Waknine

April 21, 2005 — The U.S. Food and Drug Administration (FDA) has approved a new indication for losartan potassium plus hydrochlorothiazide tablets, allowing their use to reduce the risk of stroke in patients with hypertension and left ventricular hypertrophy; an orphan drug indication for 2-methoxyestradiol capsules, allowing their use for the treatment of ovarian cancer; and an oral rinse with a barrier mechanism of action for the reduction of gingivitis in patients aged 12 years and older.

Losartan Plus Hydrochlorothiazide (Hyzaar) for Stroke Risk Reduction in Hypertensive Patients With LVH

On April 5, the FDA approved a new indication for losartan potassium plus hydrochlorothiazide (HCTZ) tablets (Hyzaar, made by Merck & Co.), allowing its use to reduce the risk of stroke in patients with hypertension (HTN) and left ventricular hypertrophy (LVH). There is evidence, however, that this benefit does not apply to black patients.

The indication was approved in March 2003 for losartan tablets (Cozaar, made by Merck & Co.), the angiotensin II receptor blocker component of the combination product.

Approval of the indication was based on the results of the landmark Losartan Intervention for Endpoint Reduction (LIFE) study in 9,193 patients, showing that a losartan-based regimen reduced the risk of fatal and nonfatal stroke by 25% in patients with HTN and LVH compared with atenolol-based therapy for a median follow-up period of 4.8 years (total number of strokes, 232 vs 309; P = .001).

Both regimens achieved similar reductions in blood pressure and no significant differences were observed between groups with respect to risk of myocardial infarction or cardiovascular death.

The extension of this indication to the losartan-HCTZ combination tablet was based on the frequency of HCTZ coadministration with the study drug to achieve target blood pressure in both groups of the LIFE trial (losartan, 73.9%; atenolol, 72.4%). In addition, the company demonstrated that the losartan and HCTZ tablets used in the trial were bioequivalent with the combination drug.

The FDA notes that in the LIFE trial black patients with HTN and LVH receiving losartan had a higher risk of stroke compared with those receiving atenolol. This finding has not been confirmed thus far because of the difficulty of interpreting subset differences in large clinical trials. However, trial data do not support use of losartan for the reduction of cardiovascular risk in hypertensive black patients with LVH.

Losartan potassium plus HCTZ fixed-dose combination tablets were previously approved for the treatment of HTN. Their use for initial therapy is only warranted in patients with severe HTN in whom the necessity of achieving prompt control of blood pressure outweighs the associated risks

posted by Kelly : 1:36 PM  

June 2005 posts (no May 2005)

Thursday, June 09, 2005

From Science News, Vol. 167, No. 22, May 28, 2005, p. 341.

Positive Jolt: Electroshock therapy may have side benefit
Nathan Seppa

People with depression have high concentrations of norepinephrine, a nervous system hormone that signals blood vessels to constrict and ratchets up blood pressure, researchers report. Treating these individuals with electroshock therapy lowers their norepinephrine concentrations—and their heart rate and blood pressure too, scientists find.

A fast pulse, vessel constriction, and high blood pressure are valuable tools in a person's fight-or-flight response. But if high norepinephrine concentrations chronically keep a person in that state, it puts a strain on the heart, says Mitchel A. Kling, a psychiatrist at the National Institute of Mental Health in Bethesda, Md. Excess norepinephrine, he says, could partly explain the long-standing connection between depression and heart failure, which is a weakening of the heart. Depression doubles the risk of death in people with heart failure, as do high norepinephrine concentrations.

"Depression is not good for your heart, basically," says Kling.

He and his colleagues conducted standard clinical tests on 22 people with the most severe form of depression and 23 people free of depression. The groups were similar in age. Volunteers with depression had a higher average pulse rate and higher blood pressure than did people in the comparison group. Blood and spinal-fluid samples revealed higher concentrations of three stress hormones—norepinephrine, cortisol, and epinephrine—in study participants with depression than in the others. The stress-hormone differences showed up even during sleep.

Next in the study, eight of the depressed patients volunteered to receive a series of electroshock treatments, which are also called electroconvulsive therapy. Among psychiatrists, electroshock treatment remains controversial. Many depressed people show gains from it, but some complain of memory loss and other side effects. Its benefit sometimes lasts only a few days and, at other times, endures for months or years, Kling says.

The eight patients in Kling's study averaged nine electroshock treatments apiece over roughly 3 weeks. Four weeks after the last treatment, the patients again provided blood and spinal-fluid samples. These showed a clear drop in the concentration of norepinephrine, but not cortisol or epinephrine, the researchers report in an upcoming Proceedings of the National Academy of Sciences.

"To my knowledge, no one has ever looked at the effect of electroconvulsive therapy on the levels of norepinephrine," says cardiologist Inder S. Anand of the Veterans Affairs Medical Center and University of Minnesota in Minneapolis. Combined with other work, this research is "pretty convincing" that stress chemicals such as norepinephrine are being overproduced in the depressed brain, he says.

Even more interesting, he says, is that electroshock can change conditions in the brain to the point of reversing norepinephrine's oversupply.

Made by nerve cells, norepinephrine carries signals between the cells. Electroshock therapy might "reset" overzealous nerve cells in the brain and reduce their norepinephrine production, Kling hypothesizes. But the therapy's long-term benefits in this regard are unknown, he says.

Suppressing norepinephrine might nevertheless offer benefits for patients with heart failure, Kling says. Some of the many antidepression drugs on the market may reduce norepinephrine concentrations too, he says, "but there is surprisingly little data on that."
--------------------------------------------------------------------------------

If you have a comment on this article that you would like considered for publication in Science News, send it to editors@sciencenews.org. Please include your name and location.

References:

Gold, P.W. . . . and M.A. Kling. In press. Cardiac implications of increased arterial entry and reversible 24-h central and peripheral norepinephrine levels in melancholia. Proceedings of the National Academy of Sciences. Abstract available at http://www.pnas.org/cgi/doi/10.1073/pnas.0503069102.

Further Readings:

Aggarwal, A., et al. 2002. Norepinephrine turnover is increased in suprabulbar subcortical brain regions and is related to whole-body sympathetic activity in human heart failure. Circulation 105(March 5):1031-1033. Available at http://circ.ahajournals.org/cgi/content/full/105/9/1031.

Anand, I.S., et al. 2003. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 107(March 11):1278-1283. Available At http://circ.ahajournals.org/cgi/content/full/107/9/1278.

Carney, R.M., et al. 1999. Major depression, heart rate, and plasma norepinephrine in patients with coronary heart disease. Biological Psychiatry 45(Feb. 15):458-463. Abstract available at http://dx.doi.org/10.1016/S0006-3223(98)00049-3.


Sources:

Inder S. Anand
University of Minnesota, Minneapolis
Veterans Affairs Medical Center
1 Veterans Drive
Minneapolis, MN 55417

Mitchel A. Kling
National Institute of Mental Health
National Institutes of Health
Building 10, Room 2D-46
10 Center Drive
Bethesda, MD 20892-1284

posted by Kelly : 5:45 PM  

Friday, June 03, 2005

Someone sent me this article, which is interesting because I've been taking medication for an underactive thyroid for more than 20 years before my heart failure was diagnosed:

Researchers discover thyroid, heart failure connection
Plain Talk ^ | May 27,2005

Researchers at The University of South Dakota School of Medicine believe they are on the verge of changing the way physicians view the treatment of heart disease.

Along with several colleagues, A. Martin Gerdes, director of the School of Medicine's Cardiovascular Research Institute in Sioux Falls, has recently published groundbreaking research in a nationally recognized medical journal for establishing a connection between low functioning thyroid glands and the development of heart disease. Although treatment on human patients may be some time away, the team is excited at the prospect of standing on the cutting edge in a new trend in the field of heart medicine research.

The study, titled "Thyroid Hormones Induce Unique and Potentially Beneficial Changes in Cardiac Myocyte Shape in Hypertensive Rats Near Heart Failure," appears in the May issue of the American Journal of Physiology-Heart and Circulatory Physiology, published by the American Physiological Society. During the course of his study, Gerdes and his colleagues established that not only can a poorly functioning thyroid contribute to congestive heart failure; it also indicates a reduced likelihood of recovery, and an increased chance of death.

This study builds upon earlier work at the institute which showed researchers that whatever leads to heart failure is always preceded by changes in the shape heart cells. As pressure within the heart increases, stress causes the heart cells to stretch and flatten, and thereby weaken. The new study demonstrates that a moderate dose of thyroid hormones (TH) over 30 days "normalizes" the shape of the cardiac cells (myocytes) and reduces stress on the heart's wall nearly 40 percent.

The research team was pleased not only because the hormone therapy appeared to have a positive effect upon the distorted heart cells, but also because this research involves a new treatment approach.

"This is the first study to look at the implications of thyroid hormone therapy on hypertensive heart failure," Gerdes said.

Based on these encouraging findings, the authors of the paper feel that this new avenue of treatment warrants further study. However, Gerdes warned since "this is the first study to disclose these positive effects with TH, we don't yet have enough information to do this intelligently in humans. Care should be taken in administering TH to humans for heart disease since there is so little information available from animal studies," Gerdes said.

However, Gerdes was optimistic that the successes he and his research team have enjoyed will someday be applied to the treatment of heart disease in humans.

"We're really just looking at the tip of the iceberg here, but we believe this could be the beginning of the next big thing in the treatment of heart disease," Gerdes said.

http://www.plaintalk.net/stories/05...0526050167.html

posted by Kelly : 11:19 PM

July 2005 posts

Tuesday, July 26, 2005

Fresh articles via the Heart Center Online:
Insulin resistance associated with heart failure
Estrogen therapy may help prevent enlarged heart

Insulin resistance associated with heart failure
Jul 22 (HeartCenterOnline) - Insulin resistance appears to increase the risk of developing heart failure, according to a new study published in a leading medical journal.

Congestive heart failure (CHF) is a condition in which the heart does not pump enough blood to adequately supply the body. It is considered a degenerative condition with no cure, and it is a major cause of death. People with CHF are 4 to 8 times more likely to die than people without the condition, according to background information in the study.

The most common causes of CHF are high blood pressure and atherosclerosis. Other risk factors include diabetes and obesity.

Insulin resistance is a condition in which the body does not respond to available insulin as well as it should and is considered a forerunner of diabetes Until this study, insulin resistance, had not been considered a risk factor for developing CHF.

During the study, a team of physicians in Sweden tracked 1,187 men over the age of 70 between 1990 and 2002. During that time, 104 men developed CHF. After controlling for all the possible risk factors, including previous heart attack, high blood pressure, diabetes, smoking and high cholesterol, the research team found that insulin resistance is a valuable predictor for CHF.

The researchers speculated that the connection between obesity and CHF may be mediated by insulin resistance and called for further study. The study was published in the July 20 edition of the Journal of the American Medical Association.
Copyright 2000-2005 (HealthCentersOnline)
Publish Date: July 22, 2005

Estrogen therapy may help prevent enlarged heart
Jul 22 (HeartCenterOnline) - It may be premature to declare that estrogen replacement therapy has no place in preventing all forms of heart disease, according to researchers at the University of California, Irving (UCI).

In recent years, hormone replacement therapy with estrogen (HRT) has come under scrutiny because of findings released by the large, multi-year Women's Health Initiative. That study found that HRT did not prevent heart disease among post-menopausal women, as was once thought. Since those results were released, millions of women stopped taking HRT as a means to prevent heart disease.

However, the research team at UCI found that HRT prevented hypertrophic cardiomyopathy, or enlarged heart, among post-menopausal women who had experienced a heart attack.

According to a release describing the study, hypertrophic cardiomyopathy occurs in as many as 80 percent of people who experience heart attacks. It may lead to heart failure.

Among pre-menopausal women, heart disease rates are significantly lower than among men the same age. However, after menopause, the rate of heart disease among women climbs rapidly, eventually becoming more common among women than men. Heart disease is the leading killer of American women.

In prepared remarks, the authors of the study say that HRT deserves further study, despite the "intense reaction" to the findings of the Women's Health Initiative. The study appeared in the July 15 edition of the Journal of Biological Chemistry.
Copyright 2000-2005 (HealthCentersOnline)
Publish Date: July 22, 2005

posted by Kelly : 3:14 PM

Friday, July 22, 2005

It has been a while. We moved from Texas to Maryland. Where up until this week, it has been 10-15 degrees cooler than Texas. This week, the temperatures are about identical. But that's OK - it's the middle of July, it's supposed to be summer. At least here in the Baltimore area, summer will last for another few weeks, and it'll be getting cooler again by the end of August. In Austin, it will stay in the 90's till October.

Nothing much to write about. Gotta find a new cardiologist now that I'm here. That should be fun. Gotta figure out what my health plan will pay for, now that I'm out-of-state with reference to the Employees Retirement System of Texas. Yeeha.

Anyone taking beta-blockers is going to have problems with heat. If you are taking furosemide/Lasix or related diuretics, you will also have problems with the sun. Suggestion: invest in several cooling bandanas. (Like this one, http://www.brandsonsale.com/zecoba.html , although that's just an example. I have not personally ordered from these people, so I don't know if it's any good. It's just to show you the kind of thing I mean.) For playing in the band in outdoor 4th of July concerts, I wear 2-3 of these - one tied around my forehead, one around my neck, one sorta draped down the center of my back. They really help. I could stand being out in the heat for almost 3 hours with these. Don't overexert yourself, though - you shouldn't try to "tough it out."

posted by Kelly : 9:24 PM

August 2005 posts

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

posted by Kelly : 6:30 PM

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.)

posted by Kelly : 2:21 PM

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

posted by Kelly : 3:21 PM

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.)

posted by Kelly : 4:23 PM