Heart Failure Patients Can Be Properly Managed to Stay out of Hospital
The high hospital readmission rate of those who suffer from heart failure impacts adversely on both the cost of health care and the health and well-being of the patients themselves.
Nationally, one of every four heart failure patients is readmitted within 30 days of discharge and as many as 40 percent within six months. At the same time, studies have shown that with proper management, heart failure patients could be kept out of the hospital in at least 40 percent of cases.
Whereas it was once felt that heart transplants and other state-of-the-art technologies was the best way to help these patients, today the thinking is to start with the basics by educating and teaching people to make lifestyle changes. This includes teaching the importance of eating and exercising properly, and taking their medication, which can avoid having heart failure patients get to the point where they need a high-tech procedure to stay alive.
Heart failure, once called congestive heart failure, is when the heart can no longer pump enough blood to the rest of the body. With this often chronic condition, blood may back up in other areas of the body causing fluid buildup in the lungs, liver, GI tract, and arms and legs. This causes a lack of oxygen and nutrition to the organs and extremities, damaging and reducing their ability to work properly.
Coronary artery disease (or CAD), which is a narrowing of the small blood vessels that supply blood and oxygen to the heart, is the most common cause of heart failure. Diseases like emphysema and severe anemia can also contribute to heart failure.
Symptoms often begin slowly, and may only be apparent when one is active. They include shortness of breath, coughing, swelling of the feet and ankles, weight gain, heart palpitations, difficulty sleeping, loss of appetite and fatigue.
A preventive program often includes diet and exercise and other healthy lifestyle changes. Recommended diets include foods low in sodium and salt – which can mean avoiding such staples as cured meats, bacon, sausages, ham, cheese and bottled dressings – and the use of such spices as pepper, garlic and lemon instead of salt. Patients are urged to lose weight and, for those who smoke, to quit.
Doctors also closely manage the multiple medications that most heart failure patients take. This can include ACE inhibitors to open blood vessels and decrease the workload of the heart, diuretics that help the body eliminate fluid and salt, digitalis glycosides to help the heart muscle contract properly and treat heart rhythm disturbances, angiotensin receptor blockers to eliminate the side effects brought on by the ACE inhibitors, and beta blockers that can improve the heart’s pumping ability.
Prostate Cancer – Even More Prevalent than Breast Cancer
Prostate cancer is the number one form of cancer among men in the U.S., with 240,000 new cases diagnosed every year (according to the American Cancer Society). An estimated 11 percent of all men who have the disease will die from it, and it will affect one in six men (compared to one in eight women diagnosed with breast cancer) at some time in their life.
Many men with prostate cancer are most concerned about the possible effects of prostate cancer treatment – surgery, radiation, chemotherapy, hormone treatment, or some combination – which can result in impotence and/or incontinence.
As with most cancers, the earlier diagnosed the better. According to the American Urological Association, the survival rate is nearly 100 percent when prostate cancer is detected at an early stage when the tumor is still localized and has not spread.
For this reason, and because there are virtually no symptoms during the early stages, annual screenings are strongly recommended for Caucasian men beginning at age 50 and African-American and Hispanic men beginning at 40, and earlier for those with family histories. While statistically prostate cancer is more common among men 65 and older, doctors see many men with prostate cancer in their 50s and even in their 40s, particularly among those at higher risk.
The screening for prostate cancer is simple and painless. It consists of a blood test called a PSA (which measures prostate-specific antigen, a protein produced by cells of the prostate gland) and a digital rectal exam. The PSA has led to a 40 percent reduction in prostate cancer deaths since the mid-1990s.
A diet that is high in fat, meat and sugar and low in fruits, vegetables and fiber is considered a factor contributing to the disease. Studies have shown a strong relationship between consumption of saturated fat or dairy fat and prostate cancer, while polyunsaturated fats like Omega-3 fatty acids may help prevent the disease.
Exercise is associated with lower metabolism and weight loss, which can contribute to lowering the risk of prostate cancer. Studies to date, however, are inconclusive that exercise has a direct impact on prostate cancer risk. There are indications that smoking may contribute to the growth of prostate cancers.
Guidelines historically recommended annual screenings for men only up to the age of 75, as it was thought that older men should not be put through the rigors of treatment since they are more likely to die from something other than this slow progressing disease. However, there is some new thinking on this. Many older men are still active and healthy, and 75 is not as old as it once was.
Learning About Kidney Disease and Dialysis
Dialysis keeps alive an estimated 354,000 Americans who suffer from end stage renal disease. Dialysis becomes an ongoing and integral part of their lives, with a kidney transplant the only hope for breaking the routine (and staying alive).
In hemodialysis, blood flows, a few ounces at a time, through a special filter that removes wastes and extra fluids. The machine then returns clean blood to the body with the harmful wastes, extra salt and fluids removed. This helps control the patient’s blood pressure and maintains the proper balance of chemicals like potassium and sodium in the body.
Dialysis typically consists of a three-time a week regimen. Failing to show for an appointment has serious repercussions: even one missed session can result in excess fluids in the lungs, bloating and even death.
Living with kidney disease is difficult. Patients must maintain a very limited diet; this is especially difficult for those who tend to favor diets high in phosphorus (from such foods as beans, plantains, chocolate, dairy products). In addition, they must keep their salt and potassium levels low (potassium is prominent in fruits like oranges, bananas and cantaloupes) and eat foods high in protein like egg whites, chicken, fish and turkey. Their fluid intake – including soup, fluid from fruit – cannot exceed 1 liter per day (or about ¼ glass).
Loneliness Ups Health Risks for Seniors
New research shows that older adults who approach life with a positive outlook can reverse the negative health issues associated with a lonely life.
The study looked to see whether using self-protective strategies — such as thinking positively and avoiding self-blame in the context of common age-related threats — could prevent lonely older adults from exhibiting increases in stress hormones and inflammatory biomarkers.
Over a six-year period, the study measured self-protective strategies with a questionnaire that asked participants to rate such statements as, “Even if my health is in a very difficult condition, I can find something positive in life,” or “When I find it impossible to overcome a health problem, I try not to blame myself.”
The research team also asked the participants to what extent they felt lonely or isolated during a typical day and used saliva and blood samples to measure how much cortisol and C-reactive protein (CRP) the participants produced. Cortisol is responsible for stress-related changes in the body, while people with elevated CRP are at increased risk of inflammatory illnesses like diabetes, hypertension and cardiovascular disease.
Their findings showed that positive thinking helped protect against an increase in cortisol secretion. Four years down the road, additional tests showed the participants’ CRP levels had improved.
The researchers reported that for those older adults who did not report feelings of loneliness, this type of thinking had no effect, ostensibly because their social networks helped them deal with age-related problems.
Overall, these findings could contribute to successful aging. According to the research leader, “Older adults can be taught through counseling or therapy to engage in self-protective thoughts like staying positive when it comes to their own health. That means a better quality of life, both physically and mentally — something we all want at any age.”
Watch out for Malnutrition
Good nutrition is critical to overall health and well-being — yet many older adults are at risk of inadequate nutrition. Malnutrition in older adults can lead to:
- A weak immune system, which increases the risk of infections
- Poor wound healing
- Muscle weakness, which can lead to falls and fractures
In addition, malnutrition can lead to further disinterest in eating or lack of appetite — which only exacerbates the problem. Older adults who are seriously ill and those who have dementia or have lost weight are especially vulnerable to the effects of poor nutrition.
Here are some steps suggested by the Mayo Clinic that family caregivers can take to reduce the likelihood of loved ones becoming malnourished:
- Engage doctors. If your loved one is losing weight, work with his or her doctors to identify — and address — any contributing factors. This might include changing medications that affect appetite, suspending any diet restrictions until your loved one is eating more effectively, and working with a dentist to treat oral pain or chewing problems.
- Encourage your loved one to eat foods packed with nutrients. Spread peanut or other nut butters on toast and crackers, fresh fruits, and raw vegetables. Sprinkle finely chopped nuts or wheat germ on yogurt, fruit and cereal. Add extra egg whites to scrambled eggs and omelets. Add cheese to sandwiches, vegetables, soups, rice and noodles.
- Restore life to bland food. Make a restricted diet more appealing by using lemon juice, herbs and spices. If loss of taste and smell is a problem, experiment with seasonings and recipes.
- Plan between-meal snacks. A piece of fruit or cheese, a spoonful of peanut butter, or a fruit smoothie can provide nutrients and calories.
- Encourage regular physical activity. Daily exercise — even if it’s light — can stimulate appetite and strengthen bones and muscles.
- Provide food-savings tips. If your loved one shops for groceries, encourage him or her to take a shopping list to the grocery store, check store fliers for sales and choose less expensive generic brands. Suggest splitting the cost of bulk goods or meals with a friend or neighbor, or frequenting restaurants that offer discounts for older adults.
- Consider outside help. If necessary, hire a home health aide to shop for groceries or prepare meals. Also consider Meals on Wheels and other community services, including home visits from nurses and registered dietitians.
Can a Good Diet Fight Alzheimer’s Disease?
In the last few years, there has been an explosion in scientific evidence showing support for nutritional changes that can help prevent memory loss, as well as improve memory in patients with already diagnosed Alzheimer’s disease.
According to Alzheimer’s expert Dr. Richard Isaacson, author of “The Alzheimer’s Diet: A Step by Step Nutritional Approach to Memory Loss Prevention and Treatment,” certain steps can be taken to improve memory function for those with Alzheimer’s or mild cognitive impairment.
Dietary recommendations include:
- Regular use of antioxidants. One study found that people who ate a minimum of two servings at least of blueberries or strawberries multiple times a week over the course of their lifetime, could delay the onset of memory loss or dementia by up to two and half years.
- Fasting overnight for 12 – 14 hours. After this time, according to the author, your body produces something called ketone bodies, which supports energy for the brain and also protects it by using a safer or alternative energy source.
- Drinking cocoa powder. Some recent studies show that very specific types of dark cocoa powder can have a brain boosting effect and improve memory scores.
- Following a Mediterranean-style diet. This includes eating fruits and vegetables, lean proteins like fish, chicken and turkey, types of fish that are high in Omega-3 fatty acids like wild salmon, lake trout, sardines and albacore tuna, low fat yogurt and cheeses, and certain types of nuts and seeds.
- Drinking caffeinated coffee earlier in the day. There is some mysterious chemical in caffeinated coffee that is believed to actually protect brain function.
Dr. Isaacson says it’s all about following a comprehensive approach to fighting Alzheimer’s disease nutritionally, more than identifying any one miracle food.
It’s Oscars time again. Try to answer these multiple choice questions on some of the best movies ever made.
1) What was the first movie in color to win a Best Picture Oscar®?
A. Wizard of Oz B. Gone With the Wind C. Last of the Mohicans D. Giant
2) Who is the only performer to win an Oscar for playing a member of the opposite sex?
A. Dustin Hoffman B. Jack Lemmon C. Tony Curtis D. Linda Hunt
3) What was the last film to sweep best actor, best actress and best picture awards?
A. Gone With the Wind B. One Flew Over the Cuckoo’s Nest C. Network D. The Silence of the Lambs
4) Meryl Streep is a perennial best actress award nominee. Yet, until last year, she had not won an Oscar since 1982. What movie did she win that year for?
A. Sophie’s Choice B. Ironweed C. Music of the Heart D. Silkwood
5) Dustin Hoffman has won two Oscars. He won it for Rain Man and which one of these movies?
A. Tootsie B. Kramer vs. Kramer C. Midnight Cowboy D. The Graduate
6) Apparently it helps to play a real person, as four best actor award winners since 2004 played someone who really existed. Which of these award winning actors did not play a real person?
A. Colin Firth B. Philip Seymour Hoffman C. Jeff Bridges D. Jamie Foxx
7) Paul Newman was nominated eight times for Best Actor from 1958 and 1994, but won only one for his role in this movie:
A. Hud B. Cool Hand Luke C. The Color of Money D. The Hustler
8) The last movie to have two actresses nominated for a Best Actress Award was:
A. Thelma and Louise B. Little Women C. Titanic D. Chicago
9) Movies made from these great novels were all nominated, but only this one won an Academy Award as Best Picture:
A. To Kill a Mockingbird B. Dr. Zhivago C. Mutiny on the Bounty D. All the King’s Men
10) Chicago was the last musical to win an Oscar for Best Picture. The one prior to this, winning in 1968, was:
A. West Side Story B. Mary Poppins C. Oliver D. The Sound of Music