My Adventures with Heart Failure

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

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

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

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

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

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

Gotta go - kitchen awaits.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

# posted by Kelly : 1:54 PM  0 comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So how did I get diagnosed, anyway? I have allergies- had bad seasonal allergies all my life. Occasional episodes of reactive airway disease (RAD). So when I started having to stop to breathe a lot, and coughing a lot, we naturally assumed that the RAD was developing into asthma. Particularly in a city known for having something new pollinating every single month, this is not uncommon- keep irritating the bronchii, and eventually they rebel. And in medicine, there's a saying that goes "When you hear hoofbeats, expect a horse, not a zebra." Which is to say, that one looks first for the obvious and most common things - in someone with a history of allergies and respiratory problems, in a city where asthma victims fill the ERs pretty regularly, that would be asthma. It certainly wouldn't be heart failure, particularly not in someone under 50, who has no family history of any heart problems, doesn't have diabetes, doesn't smoke, etc. etc. So, my doctor kep trying newer (and more expensive) asthma inhalers, and larger doses. Trying all this took about 6 months- get a new set of inhalers, try them for a couple weeks, call the doctor and tell him it's not helping. Once we got up to the heaviest dose of Advair, the state of the art for asthma, and it didn't do a damn thing for me, my doctor had to admit he was stumped. So he sent me to a lung specialist (pulmonologist). Who took chest x-rays, took one look at them, took one listen at my chest, and told me to sit down. He delivered the diagnosis. He referred me to a cardiologist, but he was sure enough of the diagnosis to write me out prescriptions for a diuretic (furosemide, the generic of Lasix) and a bigger dose of Diovan than I already took for hypertension. (Diovan is one of the sartan bunch of drugs, the ACE II inhibitors. Diovan is valsartan. The prils are the original ACE inhibitors- lisinopril, Captopril, etc.) The pulmonologist also explained one of the rules of thumb for checking such things: pointing out on the x-ray, he showed how the heart sits slightly to one side of center. Normally, if one were to take that heart and imagine sliding it over so that one edge is just touching the sternum (front and center of the ribcage) then the other side of the heart would still be contained within the chest. An enlarged heart, however, sticks out past the ribcage, by an inch or two, if moved to such a position.

One of the things about such a diagnosis is that it seems as though, for the next few weeks, you lug the giant folder the chest x-ray is in, everywhere. Bring it to the site where you're getting your echocardiogram. Your EKG. Your first visit with the specialist. Your first visit to the specialist's nurse practicioner. Your first visit to the weekly clinic sessions. The hospital where you're getting your angiogram. After a month or so, apparently, the entire medical community of your city has copies of that chest x-ray, and you can stop carting the big folder around. And then when you sit in the waiting room, you can recognize who's new, because there they are, carrying their big folder around!

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.

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

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