The All-New Bunrab

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

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  

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.