bunrab | May. 14th, 2007

May. 14th, 2007

Thursday, March 02, 2006

The good news is, I'm home from the hospital, and only a little the worse for wear.
The bad news is, nothing good happened either, which is why I am back at the keyboard on Thursday evening. After digging around and poking under my heart for a couple more hours than planned, the doctors still could not get through a bit of membrane that's not supposed to be there, to get the new lead into the proper spot. Damn!

The upsides to this: I got to come home Thursday afternoon (although all I did once I got home was sleep). I'm not any worse off than I was before. I met some very nice people - the team of nurses was John, Joanne, and James, which has got to be confusing on occasion; had a nice conversation about motorcycle touring with John, and James has a peculiar sense of humor. Hari (whose full name I actually *can* spell and pronounce, but I'll spare you) told me stuff I didn't know about how Indians usually sign their names and why US counterfeiters/forgers/ID thieves always get it wrong. All in all, I picked up a nice amount of trivia to add to my stores. And the recovery people actually listened to me - when I woke up, there was a turkey sandwich and orange juice and cranberry juice waiting for me, which they let me gobble down right away.

The downsides: well, many things are the same as if the surgery had been successful: there's an incision in my chest, it hurts like hell, I need to take the same painkillers and antibiotics as if we had actually accomplished something. Sitting up to get out of bed is difficult when one can't use one's left arm to balance on or push with. I can tell that the sedative hasn't quite worn completely off yet-I'm making far more typos than usual. I guess that's in part because instead of being out of surgery by 11 or so, they kept trying, and it was after 1:00 before they said let's call it a day before we poke through something wrong, so I've had a larger dose of the sedative than expected.

And my shoulder is sore and I'm not going to keep typing for much longer, but I did want to give y'all this update. What the future holds: sometime in a few months, after this incision heals up, we discuss doing things the hard way - cracking open a couple of ribs so that the dr can peer right in at the heart directly rather than through fiber optics, and can actually push things aside if need be. That will be more serious surgery, requiring several days in the hospital and weeks of recovery, so I told him let's plan on after 4th of July- usually no band concerts from July 5 to the end of August, so if I can't play, that's the time not to. Although it will interfere with some nice bike riding weather. Anyway, not going to worry about it yet - sufficient unto the day is the wickedness thereof.

Now I am going to lie back down and rest my arm. And do my best to keep Pickle from jumping on it to offer me sympathy.

posted by Kelly : 8:57 PM

Tuesday, March 07, 2006

Another article:

Breathing training can help heart failure patients
Mar 03 (Reuters Health) - People with heart failure and difficulty breathing may benefit considerably from using a device to train the muscles involved in breathing, Brazilian researchers report.
The Threshold Inspiratory Muscle Trainer (Healthscan Products, Inc.) applies a load while subjects breathe in, thus training the muscles to become stronger.

Dr. Jorge P. Ribeiro of Hospital de Clinicas de Porto Allegre and colleagues randomly assigned 32 patients to either a 12-week home-based program using the device with an inspiratory load maintained at 30 percent of maximal inspiratory pressure, or to a placebo program in which the participants had no inspiratory load.

Muscle training resulted in a 115 percent improvement in maximal inspiratory pressure, and a 17 percent increase in peak oxygen uptake.

Also in a test measuring how far the subjects were able to walk in 6 minutes, the distance increased from an average of 449 meters to 550 meters, the investigators report in the Journal of the American College of Cardiology.

Active treatment patients also experienced an increase in quality-of-life scores.

The researchers point out that although the training was not continued beyond 12 weeks, part of the effect on maximal inspiratory pressure and on quality of life was still maintained after a year.

"Together with the observations from other small trials," Dr. Ribeiro told Reuters Health, "our data indicate that inspiratory muscle training is a safe intervention that can be considered for the management of patients with chronic heart failure, particularly those with weakness in inspiratory muscles."

Given these findings, the team also concludes that it may be worth screening heart failure patients for breathing muscle weakness.

SOURCE: Journal of the American College of Cardiology, February 21

posted by Kelly : 6:15 PM

A couple of recent articles about heart failure from Business Week. Business Week???? Not where I would have expected them, but hey, let's be glad people are finally noticing we're out there.

Spotting Heart Disease Early
MARCH 6, 2006
Heart Health
By Kerry Capell

Spotting Heart Disease Early
Roche and other companies are devising diagnostic tests that help more
patients prevent heart attacks. The next frontier: genetics-based screens

Diagnosing heart failure is time-consuming, expensive, and often inaccurate.
The condition, which occurs when the heart is unable to pump enough blood
throughout the body, afflicts 5 million Americans, with 550,000 new cases
reported each year. But its symptoms -- shortness of breath, swollen ankles,
and fatigue -- are vague and easily confused with other conditions such as
lung or kidney problems. This complicates and delays diagnosis while
increasing the chances of error. Missing a heart failure diagnosis puts
patients at high risk of serious problems -- or death -- while overdiagnosis
may lead patients to receive unnecessary and costly treatment.

BIG BREAKTHROUGH. Now, with a simple blood test, doctors can accurately
diagnose or rule out heart failure in minutes. Launched two years ago by
Swiss drug and diagnostics giant Roche Holding (RHHVF), the test measures
the levels of two proteins, NT and BNP, which are elevated when the heart
muscle is under stress. Levels of these proteins can be raised in cases of
heart failure, heart attack, unstable angina, pulmonary embolism, and acute
high blood pressure.

Initially, the test was used to diagnose heart failure and monitor its
treatment. But last month researchers at Massachusetts General Hospital made
a major breakthrough.

In clinical trials, the test proved able to predict long-term risk of death
in patients with shortness of breath. The researchers found that patients
with elevated levels of the proteins, regardless of the cause, had a higher
risk of dying within one year.

"CONSIDERABLE RISK." As a result, they believe the test can be used not
only to determine diagnosis but also to gauge long-term prognosis, allowing
doctors to quickly identify patients needing more aggressive treatment and
follow-up.

"The next logical step is to evaluate treatment interventions for those with
higher NT-proBNP levels to see if we can reduce their considerable risk for
death," says Dr. James Januzzi Jr., assistant professor of medicine at
Harvard Medical School and a staff cardiologist at Massachusetts General
Hospital, who led the research.

Such tests represent a major advance in the diagnosis of cardiovascular
disease. Led by Roche, the world leader in cardiovascular testing, many
companies now have diagnostic tools on the market to both measure a
patient's risk of heart disease and detect existing heart disease. More
tests can then distinguish the exact type of disease.

WORST OF THE WORST. For instance, Roche was the first company to introduce
a blood test for troponin, a protein released from dead or injured cells in
the heart muscle. This test can determine not only whether a patient has had
a heart attack but the exact extent of damage to the heart muscles.

Roche is now taking a much closer look at traditional risk factors for
cardiovascular disease such as cholesterol, in the hopes of developing
diagnostics that can pick up heart disease much earlier. So instead of just
looking at LDL, the so-called bad cholesterol, the company is looking at the
worst of the worst subsets of LDL to find very early indications of clogged
arteries, says Dr. Hendrik Hüdig, head of Roche Centralized Diagnostics'
marker program.

But pharmaceutical and diagnostic companies are moving beyond such
traditional markers and exploring a range of proteins and genetic mutations
to develop more sophisticated tools to enable earlier and more accurate
diagnosis.

PRECISE TARGETING. "What we're researching is how to assess which patients
are at risk, when will they develop heart disease, how their disease is
progressing, and whether treatment can be monitored," says Dr. Joachim
Eberle, head of research and development at Roche Centralized Diagnostics.

Diagnostics is the first frontier in the ongoing quest for personalized
medicine. But as scientists discover more about the exact proteins and genes
involved in specific forms of heart disease, they will in turn discover
potential targets for better and more effective medicines.

In the meantime, diagnostics companies are in a race to develop
sophisticated tests to target with greater precision those most at risk for
heart disease. It has proved a hard slog, since heart disease is not one
disease but many, which are caused by a complex combination of genetics and
environment.

GENETIC RISK SCORE. But Celera, an Alameda (Calif.) biotech co-founded by
genomics pioneer J. Craig Venter, is on the verge of introducing a new blood
test to help predict whether a patient has a high or low risk of developing
heart disease, independent of traditional risk factors such as high
cholesterol or diabetes.

In conjunction with researchers at Harvard, the Cleveland Clinic, the
University of California at San Francisco, and the University of Texas,
Celera has examined the genetic profiles of more than 30,000 patients. By
comparing genetic samples of patients who have had heart attacks with those
who haven't, they have found a number of novel genetic variations that
contribute to the development of coronary heart disease.

These variations form the basis of Celera's genetic risk score, which the
company says will be available in "a matter of months, not years." "People
will be able to determine definitively whether they carry incremental risk
for heart attack," says Celera President Kathy P. Ordonez.

NO SYMPTOMS. Such knowledge could even lead to preventative treatment. For
instance, patients who have no symptoms of heart disease but have a high
genetic risk score might be given cholesterol-lowering statins.

Currently, most doctors prescribe statins to patients exhibiting more than
two of the standard risk factors such as high blood pressure, high
cholesterol, or obesity. But as Ordonez points out, are more than 17 million
Americans fall into the category of moderate risk and therefore wouldn¹t be
treated. If these patients were armed with their genetic risk score, doctors
could intervene earlier and stop heart disease in its tracks.

Capell is a senior writer in BusinessWeek's London bureau

The only problem I see with the above is that the tests for NT and BNP wouldn't necessarily catch everyone, no matter what the article says. My BNP levels are completely normal. If that were a required criterion for diagnosis, I would still not be properly diagnosed.

Heart, Heal Thyself?
MARCH 3, 2006
Heart Health
By Catherine Arnst

Heart, Heal Thyself?
So far, stem cells have not delivered the results scientists hoped for. But
excitement is still rising

The dream of medical science is to train the body to repair itself in the
face of disease or trauma, and the main focus of this dream is the heart.
For five years, teams of doctors around the world have been trying to coax
adult stem cells, the body's innate repair kit, to regenerate damaged heart
tissue after a heart attack or other coronary disease.

These efforts have generated excitement among heart specialists, despite the
fact that clinical trial results have been uneven and no one is quite sure
how, why, or even if, stem cell therapy works. The excitement continues to
mount, despite a study released on Mar. 1 stating that one of the most
widely examined methods for delivering stem cells to the heart had failed.

BONE MARROW. A team of German doctors from Technische Universitat in Munich
reported on a rigorously conducted trial in the Journal of American Medical
Association (JAMA). Scientists injected G-CSF, a human growth factor known
to stimulate adult stem cells, within 12 hours after a heart attack.

There were 114 patients in the study, more participants than the three
earlier G-CSF trials combined. Half received the treatment, and the other
half were given a placebo. After six months of follow-up, the researchers
discovered that G-CSF did prod a significant number of stem cells to move
from the bone marrow, where they are produced, to the heart, with no serious
side effects.

Nonetheless, there was no improvement in heart function, throwing doubt on
the whole stem cell approach. "The answer is fairly unequivocal," says Dr.
Kenneth Chien, director of the cardiovascular research center at
Massachusetts General Hospital in Boston. "The stem cells did not improve
function."

DIRECT DELIVERY. Unequivocal or not, the failure of the German trial has
not dampened enthusiasm for heart regeneration. Several reports on stem cell
research will be highlighted at the American College of Cardiology meeting
in Atlanta on Mar. 11-14, and teams of doctors and biotech companies around
the world are continuing their research in this area.

Most are quick to point out that their methods are fundamentally different
from the German approach. If anything, the failure of G-CSF turned more
attention on the many efforts to deliver stem cells directly to the heart,
rather than indirectly trying to stimulate them with a growth factor.

There have been no human studies of the direct approach on the scale of the
German trial, and the many smaller studies have often been contradictory.
But even Chien, who considers himself a conservative when it comes to stem
cell therapy, says it is one of the more exciting areas of heart research.
"I don't think it should be considered a slam dunk, but I do think it is
promising long-term."

SHAPE SHIFTERS. Stem cell researchers, many of whom also treat patients,
are driven by a huge unmet need. Some 1.1 million Americans are struck by
heart attacks each year, and 4.8 million suffer from congestive heart
failure, in which the heart stops pumping effectively, with 400,000 new
cases diagnosed each year.

Both these conditions are caused by the destruction of heart muscle cells,
and there are few effective therapies that can counteract that damage.
Unlike most other tissues in the body, the heart does not regenerate itself.
When damage occurs, it merely grows scar tissue, which restricts pumping
even further.

Stem cells seem like an obvious solution. In an embryo, stem cells, which
are undefined, can turn into any tissue in the body.

Because of restrictions and ethical concerns about the use of embryonic stem
cells, however, most heart experiments involve adult stem cells extracted
from the bone marrow. The pioneers in this area are Drs. James T. Willerson
and Emerson C. Perin of the Texas Heart Institute at St. Luke's Hospital in
Houston.

ALMOST DOUBLE. In 2000, Willerson and Perin treated 14 Brazilian patients
with stem cells removed from their hip bones and directly injected with a
catheter to their damaged hearts. Within two months, the patients
demonstrated improved heart function, with almost double the pumping motion
in those parts where the cells were injected.

When one of those patients died 11 months after treatment, of unrelated
causes, the doctors discovered during an autopsy that there was clear
evidence of new blood vessel formation to the heart.

The team is now conducting a U.S. trial with 25 patients, and recently won
approval for another trial. "We realize that we've not identified the best
stem cells, or the best method of administration," says Willerson. "We don't
want to be part of the hype, but this is an exciting time."

SMALL SAMPLE. Willerson and Perin are using the patient's own adult stem
cells to avoid rejection by the body's immune system. But a small biotech in
Baltimore, Osiris Therapeutics, is aiming to come up with a more universal
approach by using donated mesenchymal stem cells (MSC).

These are universal to everyone, so they do not set off an immune reaction.
Animal studies indicate that the MSCs are prompted by inflammatory signals
to head to the site of an injury, and Osiris recently started a Food & Drug
Administration-sanctioned clinical trial to test the therapy in heart attack
patients.

Then there are stem cells that actually originate in the heart, discovered
only two years ago. These cardiac stem cells exist in very small numbers,
but doctors at Johns Hopkins School of Medicine have figured out how to
harvest them by taking a small tissue sample from the heart and then growing
them in culture.

FIRST PAGE. The cells have not yet been tested in humans, but when injected
into animals they appear to go straight to the heart and regenerate tissue,
says Dr. Eduardo Marban, chief of cardiology at Johns Hopkins. "The mystery
is: If these cells do work to heal the heart, how do they work?" questions
Marban. "We're reading the first page of a very long book here."

Long it may be, but Marban speculates that there could be evidence of
whether or not adult stem cells work in humans in a year or two. It will
certainly take longer to figure out why. There are many scientists in the
field who believe the stem cells may be merely "good neighbors" that are
prompting the heart's own healing process to kick into high gear.

That wouldn't be such a bad discovery, says Dr. David T. Scadden,
co-director of Harvard University's Stem Cell Institute. "In the short term
the stem cells may be providing something that reverses damage, but that
could lead to a whole new generation of studies into an off-the-shelf drug
that would perform the same function." In that dreamscape, heart attack
victims could just visit the pharmacy instead of the hospital.

Arnst is a senior writer for BusinessWeek in New York

posted by Kelly : 3:02 PM

Friday, March 31, 2006

In case you were wondering, I did indeed have the ICD removed. Now I am deviceless. My arm and shoulder are still a bit sore - the surgical "wound" from removing the whole device and letting the resulting "pocket" heal from the inside out is a bit more major than putting the device in was. And my other arm is occupied by a PICC line running IV antibiotics from a portable infusion pump. So it's a bit impaired too. Which is why you haven't seen any long entries here. As soon as the PICC line is removed next week, I'll have a long post about the whole experience, plus a post on today's visit with my regular cardiologist in which I learned that several classes of common antibiotics are arrhythmogenic (cause arrhythmias) and should be seriously avoided by people at risk for arrhythmia!

posted by Kelly : 7:16 PM

Tuesday, March 28, 2006

Of special interest to women:

( Heart devices may help women less than men: study )

posted by Kelly : 9:15 AM

I have been hearing from SEVERAL people just in the past week, who got diagnosed with LBBB, told not to worry, and a couple of years later got diagnosed with heart failure. This seems to be a distinct pattern emerging. You all know I'm not a doctor, so I can't make a diagnosis, but I can sure give you this advice: if your doctor tells you to ignore it, do at least 2 things: (1) get a second opinion, and (2) absolutely INSIST on an annual EKG, echocardiogram, and chest x-ray. If you need backup, print out some of the articles I've reprinted in this blog, and wave them in your doctor's face. You have every right to have your concerns taken seriously!

I have lots of other news, but typing is a bit difficult at the moment. Another post soon!

posted by Kelly : 9:15 AM

Friday, March 17, 2006

Well, crap. As you recall, I had surgery two weeks ago, and it wasn't successful - they did not manage to implant the third lead. Now there seems to be an infection in the pacemaker site. Going to have to go back in for surgery Monday morning. 5% chance it's harmless serum, they drain it, I go home. 95% chance it's infected, they will remove the whole pacemaker, which happens to be somewhat more complex and riskier than putting it in was (details provided at some future point when I feel more like typing), and have to stay in the hospital for several days because of the risks and so that they can keep me on IV antibiotics. Crap crapcrapcrapcrapcrap.

Little ray of sunshine, aren't I?

posted by Kelly : 4:43 PM

Thursday, March 09, 2006

Of course the incision itself is itching like crazy as it heals, but also some of the surgical tape seems to have induced some contact dermatitis, so there are patches of outlying itching as well.
Aloe vera gel. Benedryl gel. Cortisone lotion. Still itches.

posted by Kelly : 3:23 PM

Wednesday, April 12, 2006

So anyway, I've been going overboard in describing my hospital stay; let me digress here to some actual content. I may have mentioned that, since I want to remain ICD-less for a while, my regular cardiologist told me to avoid drugs that are known to cause arrhythmia.

Brief summary: avoid decongestants, non-sedating antihistamines, macrolide antibiotics ("mycins"), anything ending in "zole," and large doses of local anesthetics.

Of course we all know to avoid pseudoephedrine (Sudafed) and ephedrine (OTC asthma inhalers) and other drugs in that class. Were you aware that many herbal teas contain related compounds which can also cause arrhythmia? Avoid teas that contain "ma huang" or "Mormon tea" or "desert tea." Also, watch out for any other drug that is labelled as a decongestant - although pseudoephedrine is the most common, there are others. Several other asthma drugs are also stimulants that should be avoided by people at risk of arrhythmia: theophylline and albuterol, for example.

But then, there are more drugs that are arrhythmogenic, that fewer lay people know about. For example, most of the newer "non-sedating anti-histamines" have some possibility of causing arrhythmia. Terfenadine and astemizole are noted in particular.

But the ones you should be MOST aware of are very common, and at the same time very few family doctors/non-cardiologists realize that they are arrhythmogenic: the "macrolide antibiotics." These are the ones that end in "mycin" - such as erythromycin, clarithromycin (Biaxin), and azithromycin (Zithromax).

One study notes that erythromycin is especially likely to cause arrhythmia in patients who are taking calcium channel blockers. (diltiazem and verapamil are two such antihypertensive calcium antagonists). Diltiazem and verapamil themselves are potential causes of arrhythmia and death.

Several studies I read also mentioned that the "flouroquinolone" antibiotics (a/k/a "quinolones") could have this effect. The best-known quinolone is ciprofloxacin, a/k/a Cipro. Others include levofloxacin and gatifloxacin.

One drug that can have both anti-arrhythmia properties and arrhythmogenic ones is lidocaine. If you have already had sub-cutaneous (injected or IV) lidocaine and not had any negative effects, then you probably can continue to use it. In fact, "Local anesthetics, such as lidocaine and procainamide, are administered in advanced cardiac life support as antiarrhythmics." Local anesthetics are "cardiodepressive." But, there are two things to watch out for: (1) at high doses, these anesthetics can lead to severe vasodilatation and bradycardia leading to ventricular fibrillation and (2) for people who are on certain blockers - beta-blockers, calcium channel blockers, or H1-blockers - the effect of adding one of these anesthetics can overload the metabolism so it can't process the anesthetics properly. Always let your doctor - and your dentist!! - know that you are taking any of these drugs before they give you lidocaine, which is very common for dental work.

Several articles that discussed the macrolide antibiotics also mentioned that the "azole" anti-fungal drugs could cause certain types of arrhythmia.

There have also been a few reports of cisapride (Propulsid) causing arrhythmia.

Examples of macrolides:
Generic name/Trade name
Azithromycin/Zithromax
Clarithromycin/Biaxin, Biaxin XL
Dirithromycin/Dynabac
Erythromycin/Ery-Tab, Eryc, Ilosone, EryPed, various
Troleandomycin/Tao

Some reference articles, if you want lots more technical detail:
http://jpet.aspetjournals.org/cgi/content/full/303/1/218
http://www.ionchannels.org/showabstract.php?pmid=10444234
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10444234&dopt=Abstract

Note: the following site is not a medical site, and it's from a group that often has a political agenda; I don't endorse this site, and I suggest you take it waith a grain of salt and check everything in it with sites sponsored by reputable medical sources. Nonetheless, you may find it interesting:
http://www.worstpills.org/results.cfm?druginduced_id=7

posted by Kelly : 9:37 PM

Friday, April 07, 2006

Essay: What I did this March, Part 2.

So, at 6:00 a.m., once he had noted my room number and phone number and all that, spouse went home to get a few hours sleep. Right after that, more pus decided to gush out of the incision, and my nurse called over a bunch of the other nurses to see it, as none of them had ever seen anything quite like it before. They wound up using an abdominal pad rather than just gauze pads, to cover it; I got a clean hospital gown, and managed to get about half an hour of rest before other things started going on.

Here's what Sunday looked like:
8 a.m. breakfast and fresh bag of IV antibiotic.
8:40 a.m. IV finished, monitor beeps loudly till nurse comes in to re-set things.
9:00 Someone comes to take breakfast trays away.
10:00 morning medications - all my usual daily pills.
Noon - lunch brought in. (Default low-sodium tray, since I hadn't had a chance to pre-select a menu, and it included coffee, which I don't drink.) Also, another bag of IV
12:40 p.m. IV finished, nurse must attend beeping monitor
1:00 one of the miscellaneous cardiologists comes in to get my signed consent for surgery, which involves going over all the risks again. Since I am able to tell him everything that I was told on Friday, plus discuss a little about statistics and probability, and the risks of NOT getting the surgery, which they hadn't even mentioned, he agreed that yes, I probably was giving far more informed consent than most people.
2:00 Spouse returns to visit, having slept a bit, called all the necessary relatives and friends, etc.
Midafternoon sometime - the regular ward doctor drops by to see the new case and ask every single one of the same questions over again.
4:00 Another IV bag. Also, roomie's relatives and friends start showing up. She is a sweet little (4'1", she tells someone at one point) old lady, very popular. Her family and friends are nice - they all say hello to me as well, and make sure to ask if it's OK to move chairs around, etc.
4:40 IV finishes, the usual nurse needed. Also, afternoon "vital signs" - take everybody in the joint's blood pressure, pulse, and temperature.
5:00 dinner, again with coffee I don't want. But also, a menu for requesting particular food the following day!
6:00 take the dinner trays away.
8:00 visitors mostly leave, including spouse; it takes about half an hour for all of roomie's family to clear out. Also, another IV bag, and the usual follow-up 40 minutes later.
10:00 evening medications - doses of stuff that I take twice daily.
Manage to doze for over an hour!
Midnight - IV bag, of course, and
12:40 a.m. IV finished, monitor beeps, etc.
Then I manage to get almost three hours sleep!
4 a.m. another IV bag.
4:40 you guessed it
5:00 morning "vital signs" which include not only temp, BP and pulse, but also making the sleep-deprived get up and get weighed on a scale.
7:00 Dr Brinker stops by to wave hi and get me psyched up for surgery at 8:30. Spouse shows up, too, for waiting purposes.

That's not counting assorted doctors dropping in on my roomie, nor her monitor beeping for one reason or another, nor the ridiculous routine we have to go through in order to pee. So if you notice, I got maybe 4 hours sleep total in there.

At 8:30, I get wheeled off to the surgical suite!!

To be continued!

posted by Kelly : 10:53 PM

Tuesday, April 04, 2006

Essay: What I did this March, Part 1.
Today, I got the PICC line removed from my arm, which makes typing MUCH easier. So this seems like as good a time as any to fill in the details. As you'll recall from earlier entries, on March 2, I had surgery to try and implant the third lead from my device. When I originally got the device in 2003 (right when I started this blog!) the doctors in Austin had not been able to implant the third lead, the one that goes in the coronary sinus area to stimulate the other ventricle. As it turned out, several years of advances in technology and surgical procedures, and the reputation of Johns Hopkins here in Baltimore, still wasn't enough. After working on it for several hours, the doctors had to declare themselves defeated by a rather peculiar membrane which wasn't supposed to be there.

The longer a surgical site is open, the greater a chance for infection. When I went home on the 2nd, all seemed fine, and everything seemed to be healing up. But alas, that was deceptive. On March 11, we drove to Pittsburgh to visit some friends, and returned on Monday, March 13. That night I actually took a painkiller, which I hadn't done since the night right after the surgery, because my shoulder ached so much. I attributed this ache to overdoing it in Pittsburgh - which we certainly had done - Pittsburgh is a hilly city, and has nowhere near enough parking spaces, and I did more walking there than I usually do. Tuesday I awoke with a head full of cotton balls in place of a brain. Remind me NEVER to take oxycodone again - that sensation of brain numbness was far more distasteful than mere pain would have been. But anyway, somewhere in there, I began to have a fever and chills. By Wednesday, it was a full-blown flu-like illness; in fact, I assumed it was the flu. After a couple of days of sweating alternating with shivering fits, though, I noticed that the pacemaker area was inflamed and tender, and it also suddenly occured to me that no one had ever called me from the surgeon's office for the normal post-op follow-up appointment, which by then should have already occurred. So on Friday morning, I called the hospital. I talked to the surgeon's office, describing the problem and mentioning that I hadn't had a follow-up appointment yet. She said gee, you're right, wonder why that is? We've got a spot next Wednesday morning. So I wrote that in my pocket calendar, and went back to feeling miserable. An hour later, she called back, and said "I've talked to the EPs on call, and they think maybe someone should see you before next Wednesday; can you come in this afternoon and they will see you as soon as you get here?" Indeed. After managing to wash up (remember, I'm still feeling like I have a major case of the flu) and put on outdoor clothes, we drove over - a 20-minute drive turned into 30 minutes by the assorted lane closings and other hazards of urban streets.

As promised, within a minute of checking in at the desk, the EP on call saw me. He looked at the site, felt how it felt as though there was liquid in it, opined that it was almost surely infected and would definitely need exploratory surgery to find out for sure, and that if it was infected, the entire pacemaker would need to be removed. He then grabbed a senior guy who was in the area, to further take a look, which turned out to be Dr. Brinker. The two of them scheduled me for surgery first thing Monday morning, and discussed all the risks of removing the pacemaker with me. This is where this rambling personal essay gets interesting, because you all should know about this too.

→ Removing a pacemaker is harder than putting one in. Scar tissue has grown up around the device and the leads. Around the device, it's not too bad, especially in one that's only been in a few years, as mine was. Around the leads, however, since they are so thin, scar tissue is far more of an issue, usually thicker than the leads. The first thing doctors do to try and remove the leads is to fasten a teeny hook to the end and pull gently, hoping it will slide right out. This doesn't work often - I forget the exact percentage of the time, but I think they said around 10%. The rest of the time, the scar tissue is thick enough to block the lead from sliding. ● In those cases, what they have to do is use a "laser sheath" - a thin tube with a circular laser knife in it, which they then use to tunned through the scar tissue, around the lead, effectively creating a tunnel that the lead can slide through. This is where the risks come in. ● If the laser sheath cuts through anything besides scar tissue, the patient can be in serious trouble. ● The risk of death, although small, is still considerably larger than the risks of installing a pacemaker, or of any other surgery I've ever had done: 0.5%, or 5 in 1000. ● This is high enough that doctors are required to discuss it pretty seriously with the patient. ● Then there's another 1% chance of something getting nicked short of death but serious enough to require immediate heart surgery. ● The remaining 98.5% of the time, everything goes fine.

After being warned of this, and agreeing to the surgery nonetheless, we all shook hands and said our "See ya Monday morning!" farewells.

Warning: gross details ahead. Squeamish persons may want to skip this next few sentences. Friday night, pus began oozing out of the incision, which they had warned me might happen. Saturday, it got worse, and then, Saturday night, the incision
actually opened up a bit - visible holes a centimeter long - and pus began GUSHING out of it. At that point, I didn't think I could just sit around waiting for Monday morning. Once there are visible holes into the inside of my body, even I begin to worry. So, off to Hopkins' emergency room, arriving there around 1:00 Sunday morning.

Emergency rooms are no-one's favorite place. I didn't have to wait too long, though - only about an hour - in the waiting room, before someone could see me. There weren't even many people in worse shape ahead of me. Although Hopkins is in downtown Baltimore, it's not the emergency room that all the shootings and drug overdoses are generally brought to - there are other hospitals around the city that tend to get the majority of that sort of emergency trauma. So the waiting room was pretty quiet, and then the emergency "pod" I went to was quiet. The guy on duty for that pod was a very funny guy. As he was expressing all the rest of the liquid, and making notes, and ordering IV antibiotics and stuff like that, we were carrying on a fairly clear conversation. Of course, as an emergency room doctor, he sees plenty of stuff, including way more pus than I had, but he had to admit that it was certainly the most pus he had seen recently coming out of someone who was sitting upright and cheerfully talking to him. Later, when he was entering notes on the computer, we had a little word game going - was "copious" really adequate to describe that amount of liquid, or was it more than that? We came up with "voluminous" and even "oceanic."

While I was sitting there, with nurses doing blood draws in one arm, and setting up IV antibiotics into the other arm, and people trying to find an appropriate bed on an appropriate ward and a doctor on that ward who would officially admit me, other patients did come through. Someone with a migraine. A woman who had pulled a muscle in her groin, and was clearly angling for a doctor's note that said she couldn't work for the following week - which they refused to give her. And most interesting, a guy who had deliberately drunk a cup of ammonia cleaning fluid, for reasons only he knew. He was in handcuffs and accompanied by several of Baltimore City's finest. Turned out he had been living in a Federal halfway house, pre-release, and that's where he drank the fluid. The curtains between areas muffled most of the rest, but I did hear him say something about how they wouldn't give him any "medication" at the halfway house. When, at about 5 a.m., a doctor finally came to take me up to a bed in the cardiology ward, he was still in there, and cops were hanging around drinking ice water in the hallway.

To be continued!

posted by Kelly : 5:10 PM

Wednesday, April 26, 2006

another article

( Researchers develop a new way to assess heartbeats )

posted by Kelly : 11:06 PM

Tuesday, April 18, 2006

This week's interesting article:

( Girl's heart restarted after donor organ removed )

posted by Kelly : 12:39 PM

Tuesday, May 30, 2006

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

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

It gets more complicated all the time.

posted by Kelly : 3:47 PM

This week's article:

Common painkillers may raise risk of heart failure

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

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

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

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

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

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

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

SOURCE: Heart, May 2006.

posted by Kelly : 3:47 PM

Monday, May 29, 2006

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

posted by Kelly : 9:29 PM

Friday, May 26, 2006

More ICD news

Boston Sci finds battery problem in some devices

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

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

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

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

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

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

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

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

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

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

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

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

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

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

posted by Kelly : 8:04 PM

Tuesday, May 09, 2006

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

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

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

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

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

posted by Kelly : 2:11 PM

<hr>
This week's article:

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

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

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

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

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

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

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

posted by Kelly : 2:11 PM

Tuesday, June 13, 2006

This week's article:

Being overweight or obese can enlarge a teen's heart
Jun 08 (HealthCentersOnline) - The heart health of adolescents may suffer from excess body weight, causing abnormal heart enlargement and impaired pumping function by age 20.
Being overweight and obese has long been associated with an increased risk of heart disease. Obesity is the second leading cause of preventable death, contributing to serious health problems such as cancer, heart disease, diabetes, stroke and cancer. Over the past 30 years, childhood obesity has tripled in the United States. According to the U.S. Centers for Disease Control and Prevention (CDC), 16 percent of children ages 6 to 19 are considered overweight and childhood obesity has tripled in the United States.

The study examined data gathered from the Strong Heart Study (SHS), a 4,549-person study of cardiovascular risk factors and cardiovascular disease. The study specifically looked at information obtained during the examination of 460 participants, ranging in age from 14 to 20 years old. This group included 245 girls and 215 boys.

The researchers, made up of a team of physicians from the United States and Europe, used several diagnostic tools, including an ultrasound, to measure the size, shape and pumping function of the teens' hearts.

The study found that severe abnormalities in body build (such as being overweight or obese) paralleled cardiac changes, even in people as young as 18. The excess body mass appears to make the heart work harder, leading to an abnormally large heart.

"The main findings are that, when obesity is present, something happens in our hearts to increase its size and wall thickness, which cannot be understood by measurement of blood pressure," explained study author Giovanni de Simone, M.D., F.A.C.C. from the New York Presbyterian Hospital-Weill Medical College of Cornell University in New York, New York and the Federico II University Hospital School of Medicine in Naples, Italy, in a recent press release.

"This excess of cardiac mass, which we call 'inappropriate' in connection to cardiac workload, is also associated with a general impairment of the function of the heart to push blood into the arterial tree and also to distend its cavity to receive the blood returning from the periphery."

The results of this latest study appear in the June 6 issue of the Journal of the American College of Cardiology.

posted by Kelly : 9:55 PM

Tuesday, July 25, 2006

This week's article:

( High-dose diuretics raise mortality in heart failure )

posted by Kelly : 8:37 AM

Thursday, July 20, 2006

Well, the stress echo shows that my ventricles are discordant - one side blobs OUT when it should be squeezing in; when I exercise, my EF DROPS from 20% down to the 10-15% range. (In the middle of the walk, my blood pressure started dropping because of this. Apparently, this is significantly abnormal enough to wind the test down early.) The bi-ventricular pacemaker would definitely be at least a partial fix for this, if they could get that bi-v lead in, and it looks like it would be worth a third try at it. So, my cardiologist called another EP (electrophysiologist, the pacemaker surgeon) and I go in to see him in a few weeks, and we discuss what we'd need to do to make sure that a third try at putting in a third lead would not be a complete waste of time and money; what can he do differently to avoid the stuff the other EPs ran into? Since the new pacemaker would need to go in a different spot, because the old location is all scar tissue now, where, precisely, would we put it? (And if I was freaking out airline security before, having a pacemaker when I'm not a little old lady, imagine if I have a pacemaker in some spot other than the upper left thorax!) And a few other questions. But anyway, there's no question but that my heart needs the help.

I asked Dr. G, "Why don't people just believe me when I TELL them I get really tired when I walk?" (This is sort of a running thing, because every cardiologist I've ever seen says things like "Oh, you've got to walk more, it will help!" And I keep saying, no, it doesn't build up my stamina, it makes me feel worse! And they never believe me.) And he says it's because I don't panic enough. When I was on the treadmill, I was muttering that it was boring and that I'd like something to read, and maybe I'd just critique the technique of the painting I was staring at, and when the speed and incline increased, I told him that I really wouldn't want to do this for very long, and that it's not a pace I would choose if he weren't making me. Well, that was true. However, according to him, from what the echo was showing, what I *should* have been saying was "This is too much, stop the test, let me off this thing" while panting for breath. Because I wasn't panting for breath, and I could still finish a whole sentence, they didn't believe it till they could see the heart itself.

So OK, I'm supposed to get more upset and panic more often and get hysterical if I want people to take me seriously? C'mon.

Can I help it if playing the saxophone all these years has done wonders for my breath control?

Anyway. I also asked him about the beta blocker research I mentioned in my previous post, and he has read about that, and thought of me, too, and will be keeping an eye out for testing as soon as it's available. He's not so concerned with how much the Coreg costs me and my insurance company, as he is with not having the side effects if I don't have to. He expects the test to be available pretty soon, as these things go.

Baked potatoes with "steak" sauce:
2 large baking potatoes
1 tbsp unsalted butter
1 4-ounce can NSA sliced mushrooms (see the link to Healthy Heart Market at right)
1 tsp minced garlic
1/4 cup pine nuts
4 ounces Mr. Spice Garlic Steak Sauce (HHM has this, too)

IN saucepan, melt butter and stir in the pine nuts; stir them around for a minute or so. Add the mushrooms and garlic, and stir them occasionally till the pine nuts brown slightly. Add the steak sauce, stir, turn down heat, and simmer, while you nuke the potatoes for 8-10 minutes.

Slice potatoes open, serve sauce over them. This is a lot of sauce for 2 people (the way I like it) or a modest amount of sauce for 4 potatoes. The Mr. Spice sauce is both low-sodium and fat-free. To make a balanced meal out of this, serve it with salad that has diced fresh mozzarella in it - the kind that comes packed in liquid, in round balls - fresh mozzarella is only about 15-25 mg of sodium per ounce. This'll add some protein to the meal, 'cause the pine nuts alone aren't a whole lot of protein.

posted by Kelly : 6:50 PM

Sunday, July 16, 2006

I read a short blurb somewhere recently, that said that researchers have discovered a genetic basis for whether or not heart failure patients respond successfully to beta blockers, and that they are developing a fairly quick genetic test for it. This should mean that it will be possible to test new patients and see whether or not to waste anyone's time, energy, and money on expensive drugs such as Coreg, which also need complicated titration over a period of weeks. Since even my co-pay is expensive for stuff that's still brand-name only such as Coreg, and since the insurance company's share is even more, I'm sure they'd be happy to pay for the test the minute it's available. Since my EF has never noticeably improved, despite all the meds, it could be that I'm one of the people for whom beta-blockers don't work. It would be nice to be able to discontinue one of the meds, if that's the case. I mean, it would be nice if the drugs DID work, but if they don't, I can save some money and eliminate a few side effects.

I'll keep an eye peeled for more details about this one, and keep you posted.

posted by Kelly : 9:05 PM

Thursday, July 06, 2006

The July issue of Prevention magazine has ratings of various salsas they tested. Salsa certainly adds zing to food, and has the added advantages of being low-fat and generally low-cal. However, finding low-sodium salsa can be a pain. So, from among the 9 salsas that they gave the highest ratings to, here are the ones that are

Green Mountain Gringo Mild Salsa - 90 mg sodium per 2 Tbsp; available at natural foods stores and some grocery stores
Stonewall Kitchen Mango Lime Salsa - 35 mg sodium per 2 Tbsp; order at http://www.stonewallkitchen.com
Newman's Own Black Bean and Corn Salsa - 140 mg sodium per 2 Tbsp, which is right on the top edge of "low sodium" but this one has the advantage of being available in most supermarkets.
Robert Rothschild Farm Fiery Raspberry Salsa - 109 mg. sodium per 2 Tbsp; order at http://www.robertrothschildfarm.com

posted by Kelly : 6:40 PM

Sunday, July 02, 2006

New recipe:

Meatless Loaf
1 can NSA (no salt added) chickpeas/garbanzos
1/2 cup to 3/4 cup NSA bread crumbs
1/4 cup grated or shredded cheese - whatever you have on hand. Mozzarella, parmesan, romano, lo-so-cheddar... whatever.
about 1/3 to 1/2 cup finely chopped carrots - I started with shredded carrots and then chopped them further in the food processor
one 4-ounce can NSA mushrooms
2 eggs or equivalent egg substitute (e.g., EggBeaters)
4 to 6 tablespoons of barbecue sauce, to taste
1 heaping teaspoon all-purpose saltless seasoning (whatever brand you like - the kind with onion powder, garlic powder, parsley, and a bunch of spices)

Drain and rinse the chickpeas, then "rice" them. If you don't have a ricer (a sort of potato masher) then you should smush them with a fork. You don't want to use a food processor, unless it's a very weak one, because processing will turn it to mush, which won't have the same texture that ground meat does.
Drain the mushrooms, and chop them fine - a food processor pulsed for just a second or two will work for this.
Mix all ingredients thoroughly together, including the barbecue sauce.*
Pack the mixture into an 8 x 4 or 5" loaf pan. Smoothe the top.
Topping:
Sprinkle another Tbsp of bread crumbs and another Tbsp of grated cheese across the top. Then spoon 2 more Tbsp of barbecue sauce on top, and spread it around so it covers most of the loaf.

Bake at 375-400 degrees for about 35-40 minutes, or until the top looks done. Let sit in pan for 5 minutes before slicing. Makes 6 slices.

This is pretty complete protein-wise, and has the carrots and mushrooms in it, just about any sort of green vegetable or salad is a good side dish to make it a balanced meal.

*That's what really makes this taste like a meatloaf! If you are a strict vegetarian, make sure you get a barbecue sauce that has no animal products; some have worcestershire sauce in them, and worcestershire sauce has anchovies. So read the ingredients!! If all you're looking for is low-sodium, and you're not worried about the animal products, then you can try, among others, Stubb's - although it's not "low" sodium, it's about half the sodium of most other barbecue sauces. And tasty, too.

posted by Kelly : 7:08 PM

Tuesday, August 29, 2006

Wednesday I saw the electrophysiologist my cardiologist had referred me to, the one who's something like head of the entire department at Johns Hopkins, and yes, he did manage to convince me that I should go ahead and get another defibrillator/pacemaker. If they can't get the third lead in, he promises that they won't spend a couple extra hours poking around; instead, they'll close it up as is, and then in December, after all my holiday concert obligations are over, I'll go back in for a separate procedure for a mini-thoracotomy, where they sorta stretch the ribs apart and go plunk the lead down on the outside surface of the heart. But maybe, just maybe, they'll get the third lead in when they put the device in. We'll see. That surgery is September 11. They'll keep me overnight just for observation, although pacemakers can be outpatient surgery; just my history and stuff. So, more news on that as it happens.

posted by Kelly : 11:15 PM

Thursday, August 10, 2006

Surprising variety of low-sodium foods at Trader Joe's

I'm lucky enough to have a Trader Joe's about 5 miles away. If you are near one and haven't checked it out, try it. There are quite a few items that are low-so! For example, over in frozen entrees, there's two I particularly like: the Chicken Vindaloo (340 mg sodium for the entire 11-oz meal, and only 4 grams of fat), and the Thai Style Lemon Grass Chicken & Seasoned Rice (105 mg sodium!!, but 10 grams of fat.) In frozen veggies, there's Thai Style Soy Ginger Carrots with Toasted Almonds, 70 mg per 1/2 cup serving, about 7 servings per package - so if you're like me, and you're more likely to eat a larger serving, that would be 123 mg of sodium per 1/4 of a bag, or 163 mg per 1/3 of a bag (that last is the size serving I usually eat.)

They have a huge selection of unsalted nuts,and even some of their seasoned nuts aren't too high in sodium: the lime & chili cashews are 85 mg sodium per 1/4 cup. The Savory Thin Mini Crackers are 125 mg per serving, which sounds like it's edging on the high side until you read that a serving is 37 crackers!! (1/3 of the bag) - that's quite a big snack. And they have lots and lots of unsulphered, unsweetened dried fruit, no sodium at all and tons of fiber, and a terrific summer snack.

They also have quite a few varieties of potato chips and other chips that are much lower in sodium than the big-name chip brands. The Toasted Sesame & Ginger Potato Chips are only 85 mg per serving, while Roasted Garlic & Three Cheese Chips are 115 mg. And the Soy & Flaxseed Tortilla Chips are only 50 mg sodium per serving! Pair that up with some of the salsas that are lo-so (almost any of the fruit salsas, like the ones with mango or peach in them, are lo-so even in the big name brands) and you can really party.

And, I can't find a bottle right now, no idea where I put them away, one of their regular spaghetti sauces, not even designated as no salt added, is nonetheless under 200 mg of sodium per serving, which is quite low compared to most commercial brands on the regular shelves.

Of course, there are lots of similar items you can get from Healthy Heart Market (link over on the right) if you don't live near a TJ. But if you are near one, then you can save yourself both the shipping costs and the risk of shipping fragile items such as glass jars of spaghetti sauce or fragile potato chips, and save your HHM orders for the stuff that nobody carries locally, like the low-sodium olives and pickles.

Today's recipe:
Chick-Pea Salad
2 cans no-salt-added chickpeas (garbanzos)
1 small onion, diced small
1/4 of a bunch of parsley, stems removed, cut into small pieces
6 low-sodium black olives, diced small
1/4 teaspoon ground black pepper
1/4 cup red vinegar (red wine, apple cider, whatever vinegar you like)
2 Tbsp olive oil

Rinse the chickpeas, and remove any of the little translucent outer skins that are sliding off - just to make the salad more attractive. (It'll taste the same, but look a little odd, if the bits of outer skin are loose in there.) Then mix all ingredients in a bowl, toss thoroughly, and refrigerate for at least 2 hours, shaking the bowl occasionally to redistribute the vinegar and oil.

posted by Kelly : 2:51 PM

Friday, September 22, 2006

It itches while it's healing. To tone down the itching a bit, I've been putting some gel on it. There are a couple of kinds of gel that do a good job of muting the itching: antihistamine gel, such as CalaGel, and sunburn gel, such as Solarcaine with Aloe Vera, which has the topical anesthetic lidocaine in it. If you don't want that many ingredients, plain aloe vera gel is better than nothing, but a gel with a topical anesthetic works better. The gel, any gel, also serves as sufficient goo to get a 4"x4" gauze pad to stay in place, which keeps bra straps and other clothes from irritating the incision site. I am finding that my skin is so sensitive there that even a cotton sheet resting on the skin at night is annoying if I stir at all.

Speaking of sleeping, I prefer sleeping on my side. The new device is more or less in the top surface of my right breast, and if I try to sleep on my left side, the weight of it pulls down; probably not great for having the leads settle in properly, never mind it makes it ache somewhat. So I have been using stuffed animals to prop up the breast. Yes, I have a large collection of plush toy animals, or should I say, we have, because they're not all mine; some are my husband's. We are an egalitarian family: silly stuffed toys for all ages and genders. Our collection includes a ring-tailed lemur, a giant south american anteater (not life sized!), a manatee, several penguins, a platypus, a couple of manta rays, and quite a bit else. What I am finding the right size to sit propped under my breast while I lie on my side is a larger-than-life-size stuffed guinea pig - about twice as tall and twice as long as a real guinea pig. The manatee would probably work as well. If you don't have stuffed animals, then a small roll pillow (cylinder-shaped) would probably also work.

posted by Kelly : 6:10 PM

Thursday, September 14, 2006

Well, I have my new ICD/pacemaker, as of Monday, and as expected, they did NOT get the 3rd lead in this time either. The new device is on my right side, since the left side now has too much scar tissue; this means that the leads had to be placed across the chest, behind the sternum.

Things they don't tell you about placing leads across the chest: it winds up irritating and inflaming the tissue in there, especially the pericardium, which in turn means it HURTS every time you inhale more than the shallowest amount. It took about 2 days for it to stop being quite so painful, although I still had a short flare-up today for a while. And it is definitely still painful to sneeze, cough, or yawn. In hindsight, I'd say that one should avoid having this surgery during hay fever season when sneezing and coughing are likely...

Other side effects of doing the cross-chest lead placement: longer time period for restricting the range of motion and the amount of weight you can lift with the right arm and hand, since it's easier to dislodge the leads. So even though the visible bruising is already fading and the incision is starting to heal, I can't go back to normal activity completely as soon as the incision is healed, the way I did with the first pacemaker; instead I have to wait 6 full weeks before doing anything that involves lifting my arm above shoulder level or behind the plane of my body (putting it behind my back), or lifting more than 10 pounds with that arm. Annoying limitations.

On the good side, since I knew in advance this time that hospital food sucks, even at the great Johns Hopkins, I brought my own lunch and dinner in insulated bags, and ignored their food. I had low-fat yogurt, fresh fruit, low-fat pudding, reduced-sodium cheese, low-sodium crackers, and fresh-brewed iced tea, and completely ignored the stuff they brought on trays. Staff thought this was funny. My roommate thought I was wonderful, since she also was having a tough time with the bland hospital food; I gave her a nectarine and some of the cheese, and she was quite appreciative. Let's hear it for end-of-season nectarines and peaches!

posted by Kelly : 7:26 PM

Wednesday, September 06, 2006

And another article:

( Initiative helps minority heart failure patients )

posted by Kelly : 7:59 PM

This week's article:

( Surgery may help people with heart failure )

posted by Kelly : 7:57 PM

Thursday, October 26, 2006

An article from a few weeks ago:

Stomach acid drug may slow heart failure

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

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

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

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

SOURCE: Journal of the American College of Cardiology, October 3, 2006.

posted by Kelly : 1:21 AM

Monday, October 23, 2006

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

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

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

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

posted by Kelly : 11:30 PM

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

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

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

posted by Kelly : 11:30 PM

Thursday, November 23, 2006

This week's article:

Blood pressure may help predict heart failure risk
( Blood pressure may help predict heart failure risk )

posted by Kelly : 11:38 PM

Friday, November 17, 2006

My local newspaper (the Baltimore Sun) had an article a few days ago entitled "Working on MRIs that are safe for pacemakers." Subhead: "Patients with heart implants may be able to undergo diagnostic scanning procedure."

The article was cautiously optimistic; a study of the first pacemaker designed to withstand MRIs is scheduled to start at the end of this year. However, the article doesn't say whether this study applies to ICDs, or just plain pacemakers, and it doesn't make it completely clear whether the difference between ICDs and plain pacemakers matters for these purposes.

MRIs are used, among other things, to detect cancers.

posted by Kelly : 3:23 PM

Wednesday, November 15, 2006

Three magazines that might be useful (put 'em on your wish list for Chanukah/Christmas/Solstice/Festivus):

First off, strange as it may sound, I find the magazine Diabetic Living to be very useful for someone with heart failure. Many, many of the health concerns are the same for the two chronic illnesses, including the need to watch one's weight, to get regular medical care, to be very careful in evaluating proposed treatments (especially new ones). Plus, the magazine makes a very strong effort to make all its recipes low-sodium, or at least lower-sodium, as well as low-fat and low-sugar. I've gotten several excellent recipes out of there that suited me (low-sodium diet), my dad (diagnosed as diabetic a couple years ago at age 80, and also had a heart attack a year ago) and my spouse (borderline high cholesterol). The one catch to this magazine for CHF patients is that you may want to buy it off the magazine racks in the drug store or supermarket rather than subscribe, because if you subscribe, you'll get all kinds of bulk mail advertising assorted diabetic supplies you don't need. I buy it at CVS; most national drug store chains carry it and I've seen it in Safeway supermarkets. Diabetic Living

Prevention, put out by Rodale: this one's aimed at health in general. It used to be a bit flaky - Rodale publishes a lot of stuff having to do with alternative medicine and living lifestyles that tend toward the green/off-the-grid/deeply-into-yoga stuff. And they used to be completely uncritical about alternative medicine and all sorts of supplements. However, the past few years, they have tempered it a bit toward the real world, and they do more critical evaluations of the usefulness of alternative treatments, and offer lots of helpful advice for people undergoing any kind of medical care, as well as offering a lot of ways to live a healthier lifestyle. Many of their recipes use reduced-sodium ingredients, and are pretty healthy. Prevention

Science News, a weekly newsmagazine that offers 12 pages or so of very short articles about the latest in medicine and science. Although they emphasize science in their title, they give summaries of a lot of medical news, and any time there's a national meeting of one of the big medical associations, such as the American College of Cardiology, they have an entire page with summaries of half a dozen or so of the most important papers presented at the meeting. Intended for the regular educated person, not highly technical but the editors assume you are familiar with at least the general vocabulary of science. Science News

Tuesday, November 14, 2006

This week's news article:

Pump, with drugs, can reverse heart failure
( Pump, with drugs, can reverse heart failure )

posted by Kelly : 11:04 PM

Thursday, December 14, 2006

Easy recipe time!
Roasted Winter Vegetables
1 bag "Golden Nugget" or other fingerling (tiny) potatoes
1 bag pearl onions
1 sweet potato
1 butternut squash
1 bag parsnips (giant white carrots)
optional: 1 small box brussels sprouts, if you're not a supertaster who hates them
olive oil
fresh rosemary
fresh thyme

Scrub the potatoes, but you don't have to peel them. Peel the outer layer off the onions. Peel the sweet potato and cut it into 1" cubes. Peel the butternut squash and cut it into 1" cubes. Scrub and peel the parsnips, cutting off the tops, and cut them into 2" long segments at the thin end, 1" long segments at the thick end. Remove any wilted leaves from the brussels sprouts.

Place all the veggies in a large baking dish or casserole dish. Bloop a few tablespoons of olive oil over them, and toss till everything has a very slight touch of olive oil on it. Now strip the leaves from 4-5 branches of rosemary, and from 4-5 branches of thyme, and sprinkle them over the veggies. Toss the veggies again, so that the herbs are distributed throughout. Roast, uncovered, in a 350° to 375° F oven for about one hour, or until a fork stuck in a potato or cube of sweet potato goes in easily. Serve hot. This makes a lot - 8 people or so's worth - so if there are leftovers, they taste just fine rewarmed the next day.

The even easier version of this recipe:
Instead of all those kinds of veggies, just get one bag of the Golden Nugget potatoes and one bag of some other kind of tiny potatoes - "new potatoes" or "fingerlings" or anything else where each potato is only golf-ball size. Do the same bit with the olive oil and the herbs. But you don't have to do all that peeling and cutting. Same baking instructions.

posted by Kelly : 4:29 PM

Tuesday, December 12, 2006

This week's article:

Magnets may interfere with pacemakers and ICDs
Dec 08 (HealthCentersOnline) - Certain types of magnets that are becoming increasingly popular in clothing and jewelry may interfere with the function of pacemakers and other implanted cardiac devices, according to new research.
Implanted in the chest, pacemakers and implantable cardiac defibrillators (ICD) are two types of battery-powered devices that monitor and, if necessary, correct an abnormal heart rhythm by sending electrical charges to the heart.

Researchers in Europe recently evaluated several types of magnets to see if they were capable of interfering with pacemakers and ICDs that had been implanted in patients.

The study found that while traditional magnets commonly found in the home and office are not dangerous, other types of magnets can be. Specifically, the research found that powerful magnets made from neodymium-iron-boron (NdFeB) are capable of interfering with cardiac devices implanted in the chest.

NdFeB magnets are becoming increasingly popular in office products, toys, jewelry and some clothing. Because of this, the researchers urge the manufacturers of the magnets to place warning labels on their products.

The study included 70 patients, 41 with pacemakers and 29 with ICDs. Each of the patients was tested with two spherical magnets that were 8 and 10 millimeters in diameter, as well as a necklace made of 45 spherical magnets. In every instance, the magnets interfered with the implanted heart devices of the patients. After the magnets were removed, the devices all resumed their normal function.

"Physicians should caution patients about the risks associated with these magnets. We also recommend that the packaging include information on the potential risks that may be associated with these types of magnets," explained Thomas Wolber, a cardiologist at the University Hospital of Zurich in Switzerland and lead author of the study, in a recent press release.

The results of the study were published in the December 2006 issue of the journal Heart Rhythm.

posted by Kelly : 2:57 PM

Tuesday, December 05, 2006

This week's article:

Possible cause found for deadly rapid heartbeats
Nov 30 (HealthCentersOnline) - A recent study may help researchers to better understand the mechanism involved in a certain type of heart failure.
Heart failure is a chronic condition in which at least one chamber of the heart is not pumping well enough to meet the body's needs. This leads to congestion in the lungs or pulmonary blood vessels and may cause fluid backup or swelling in the lungs, legs and ankles.

Ventricular tachyarrhythmia is a type of tachycardia, or abnormally rapid heart rate, that originates in the lower chambers (ventricles) of the heart. Ventricular tachyarrhythmia can lead to ventricular fibrillation and/or heart failure.

Researchers from Germany may have found an explanation for why ventricular tachyarrhythmia occurs in some instances. Using mice and heart muscle cells from rabbits, the researchers were able to find a possible molecular reason for the abnormal heartbeats.

The study showed that a substance known as an "effector" for a protein called calmodulin may be improperly regulating the influx of sodium ions into the muscle of the heart. Previous research has shown that genetic problems with the regulation of the sodium ion influx puts a person at increased risk for ventricular tachyarrhythmia.

The researchers suspect that the disruption observed during the study may be a contributing factor to the onset of dangerous ventricular tachyarrhythmias that are associated with heart failure.

The results of the report were published online on November 22 in advance of its print publication in the December issue of the Journal of Clinical Investigation.

posted by Kelly : 1:40 PM

Wednesday, January 03, 2007

Happy New Year!

Well, 4 years (and a couple of weeks now) since I got diagnosed. The good news, I'm still alive. The bad news, my EF hasn't budged from 20% despite all medications, and three tries at implanting a third lead from the pacemaker to do bi-V pacing have all failed. Oh well.

I gained a few pounds this past year, and I need to lose it again. I think that's a battle all of us fight. I'm going to attempt to lose some of it by eating more vegetarian meals; I don't eat that much meat to begin with, but I'll eat less, and try to get more fish in there when I do feel like some fast protein. I've ordered lots of stuff from Eden Foods - almost all of their canned stuff comes in low-sodium versions, including some baked beans they didn't have last time I looked! - and the 12-pack of low-sodium cheddar from Heluva Good, to give me a good start on more home cooking, less eating out. Now to go peruse Healthy Heart Market and Mr. Spice, to round out my groceries - an order from each of them, and I think I'll be set for cooking meals several times a week for at least a month!

# posted by Kelly : 10:57 PM

Tuesday, March 13, 2007

Apparently, the marketing people from Coreg read this blog. They asked me if I'd be willing to add a link to Coreg's web site. I checked out the site, and decided that it would be worthwhile to add a link to the part of their web site that specifically discusses heart failure. There are some interesting bits of information in there, including differences in the incidence of heart failure among races, which I knew some of, but did not know that Mexican-American women have a lower incidence of heart failure than either Anglo or African-American women. So, you might also find interesting information by reading Coreg's site, despite its equally obvious commercial intent. It's by gathering information from as many sources as possible that we learn the most, right?

posted by Kelly : 2:04 PM

Another article of interest (I've been on antidepressants since long before I got diagnosed with CHF):

( Depression Worsens Outcomes for Heart Failure Patients )

This is especially interesting in light of something my cardiologist told me back when I first got started on Coreg (carvedilol), which is that many people get depression as a side effect of taking beta-blockers until they get fully acclimated to them, and that for that reason while the dose of Coreg is being titrated, which takes weeks, the cardiologist asks questions at every visit intended to detect depression and consider prescribing anti-depressants. So, depression is a side-effect of one of the medications used to treat heart failure, and depression can lead to worse outcomes in heart failure... we're sort of in a catch-22, aren't we!!

This is, of course, NOT a message that you should stop taking your Coreg; for one thing, for most people the benefits of the beta-blocker undoubtedly outweigh the risks, and for another thing, discontinuing any medication suddenly is a bad idea, and especially a bad idea for certain drugs including beta-blockers. Suddenly stopping taking your Coreg could land you in the hospital right quickly. However, if you are taking Coreg and feel fatigued, listless, have trouble concentrating, or have trouble sleeping through the night, these could be signs of depression, and you should ask your doctor about appropriate additional treatment for depression.

posted by Kelly : 1:42 PM

This week's article:

( Lipitor Approved for Additional Uses )

posted by Kelly : 1:39 PM

Right in about here is when Google took over Blogger, and all of a sudden my ability to post new entries went south, and repeated emails to Google's help have been entirely fruitless, answered by drones who keep telling me to just change my password. I will complain about that later!

If you read my friends page, it's gonna be extremely long because I'm in the process of transferring all the entries from my old Heart Failure blog at Blogspot over to a newly-created account here,

bunrab_mawhf. This is because since Google took over Blogger, access to posting at Blogspot sucks mightily. I am tired of arguing with their alleged "support" about why I can't post - it is NOT because I haven't changed my password, it is NOT because I have too many old temporary internet files, it is NOT because of cookies, come on people, I have already read all your help articles and it's NOT WORKING. So. Moving heart failure stuff here. Clutter.

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