Tuesday, July 25, 2006
This week's article:
SOURCE: The American Journal of Cardiology, June 15, 2006.
High-dose diuretics raise mortality in heart failure
Jul 20 (Reuters Health) - As the dosage of loop diuretics increases in patients with advanced heart failure, the risk of death also increases, according to findings of a study conducted at the University of California at Los Angeles.
"This is the very first study to look specifically at the relationship between various doses of loop diuretics and mortality," lead investigator Dr. Gregg C. Fonarow told Reuters Health.
"When studying whether a medication may be contributing to adverse clinical outcomes in a patient population," he noted, demonstrating whether or not the relationship is dose dependent is critical."
Diuretics are a class of commonly prescribed drugs that are used to treat heart disease and other illnesses. The drugs stimulate the kidneys to remove more water from the body, which is then passed through the urine. Loop diuretics are a strong type of diuretics.
Fonarow and his colleagues studied a group of 1,354 patients with advanced heart failure receiving treatment at their institution between 1985 and 2004. The average age was 53 [note from BunRab: not the usual 70-something!] years, 76 percent were male and the heart's ability to pump blood was reduced to an average of 24 [note from BunRab: I'd be delighted to be up to 24%!] percent.
The investigators divided the group into four sections, according to loop diuretic dosage. The four groups were similar in terms of age, gender, body mass index, cause of heart failure, history of high blood pressure and previous use of the diuretic spironolactone. The highest dose group had, on average, the lowest ability to pump blood, a well as lower levels of sodium and hemoglobin levels and higher levels of biomarkers of kidney disease.
As reported in the June 15th issue of the American Journal of Cardiology, there was a decrease in survival with increasing dose of loop diuretic. Survival estimates at 2 years were 83 percent with the lowest dose, 81 percent in the second group, 68 percent in the third group and 53 percent in the highest group.
Even after the data were adjusted to remove the effects factors that could also increase mortality -- including age, strength of other drug treatments, kidney function, smoking history and blood pressure -- diuretic dosage remained an independent predictor of mortality. For the high-dose group compared with the low-dose group, the mortality risk was increased by four-fold, the team reports.
Fonarow offered an explanation for the link between loop diuretics and mortality in heart failure. Loop diuretics, especially when given at higher doses, activate a part of the nervous system known to increase the risk of death in heart failure patients. Loop diuretics, especially at higher doses, can also contribute to worsened kidney function and electrolyte abnormalities.
Nonetheless, "loop diuretics currently are one of the only therapies for heart failure patients for the treatment of congestion along with dietary sodium restriction," Fonarow acknowledged.
He recommends that physician use loop diuretics at the lowest dose possible dose to relieve congestion. Some physicians (in the study) favored using higher than necessary doses of loop diuretics to keep their heart failure patients' free of fluid.' This study suggests that this practice should be avoided."
SOURCE: The American Journal of Cardiology, June 15, 2006.
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.
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.
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.
I'll keep an eye peeled for more details about this one, and keep you posted.
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
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
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.
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.
