Feel a Bit Unwell After a Meal? Here's Why.

If you feel especially tired or experience increased shortness-of-breath that makes you a bit (or very) uncomfortable after a meal, you're probably not imagining it.  The confusing part is your saturation as measured by your pulse oximeter may give you a good sat reading, but if you look at the heart rate, you may find it a bit high.  There are a number of reasons for all of this based in the biological sciences.  Here is what you need to know and a few tips for minimizing the discomfort.

Salty foods / meals are harder to handle.  Most of us know excessive dietary salt will cause our body to retain fluid which can contribute to elevated systemic blood pressure.  According to an abstract published in Nature in April 2002, there is a lot more to it.

"High salt intake increases the mass of the left ventricle (of the heart), thickens and stiffens conduit arteries and thickens and narrows resistance arteries, including the coronary and renal (related to the kidney) arteries. It also increases the number of strokes, the severity of cardiac failure and the tendency for platelets to aggregate (clot). In renal disease, a high salt intake accelerates the rate of renal functional deterioration. "

Since many PH patients are in some stage of right heart failure, this extra strain dietary salt places on the heart is particularly risky.  Also if you are taking diuretics – which place a burden on the kidney - extra salt may make matters worse.  So when you feel as though your body is struggling in some way to cope with a particularly salty meal, you are most likely not imagining it.  You've given your body a lot to handle at once.

How much you eat at any one time will also affect how you feel.  Although stomach size varies greatly from one person to the next, a very full stomach - capable of expanding four times its empty size - will most certainly contribute to your discomfort.   A very full stomach - located right below the diaphragm - will press upward on the diaphragm making it more difficult for this relatively weak muscle to expand and contract during breathing.  So when you fill up your stomach or expand it at all, you are affecting your lung function too.

Finally, digestion is dependent upon respiration to provide oxygen to muscles used in converting solid food to liquid as it moves through the digestive tract.  For the PH patient who may be unable to compensate for this extra demand of oxygen, it means that less oxygen will be temporarily available for other vital organs.  In some PH patients, where oxygen levels throughout the body may be lower than optimum to begin with, fatigue and shortness-of-breath after a meal may be more pronounced. 

So, it all adds up.  Too much salt, too large a meal,  the wrong kind of meal, and too little oxygen to go around can make for quite a lot of discomfort.

Here is how you can help yourself.
  • Avoid overly salty foods and meals
  • Become familiar with your salt tolerance
  • Eat small meals throughout the day rather than large meals
  • Avoid hard to digest foods (dairy, red meat, raw vegetables, spicy foods etc.)
  • Allow quiet time to rest and digest your meal after eating

Harmful effects of dietary salt in addition to hypertension, Nature
How do the digestive and respiratory systems work together, Livestrong
Volume of a Human Stomach, Livetextbook
Breathing and Motor Neuron Disease, MND


Medication Errors? How you Might Avoid Them.

Approximately 3 percent of hospital admissions in the U.S.are due to medication errors, but the problem is much larger than this. It is widely accepted that medication / prescribing errors are vastly under reported. The Food and Drug Administration gets at least 75 reports per month of mix-ups due to similarly named drugs and confusing labels. The problem has serious consequences for some patients.

The reasons for mix-ups can vary widely. If the physician’s handwriting is hard to read, the pharmacist might prescribe a similarly named medication. There might be a labeling discrepancy where the wrong drug is contained in the bottle or the correct drug at a different dose has been substituted in error. Also, patients can take drugs incorrectly by not following label instructions or confusing one pill with another.

Here’s what you can do to avoid being a victim of medication error:

At the Doctor’s Office

  • Read the script. Is it legible? If it is not, ask your doctor to print the drug name etc. to clarify it for the pharmacist.
  • Discuss what the medication is for.
  • Ask about potential side effects.
  • Discuss possible interactions with other drugs (including over-the-counter and supplements) you take.
  • Ask your doctor how long you should be taking this medication.
  • Ask how to handle missed doses. Do you double up, skip a dose or change the schedule?

At Your Pharmacy
  • Check the bottle carefully. Is this the medication you and your physician discussed? Is the dose correct? Are the instructions as you discussed?
  • Open the bottle and look at the pills. If this is a refill, do the pills look the same as the last medication you had? Are the pills consistent in size and color? There is a number on each pill. Does it agree with the number on the label? If the answer is no to any of these questions, take the bottle back to your pharmacist.
  • If your dosing changes and you have pills on hand, ask your pharmacist if these pills can be safely cut with a pill cutter. Some medications have special coatings that slow absorption and cannot be safely cut. Capsules should never be cut and some medications (e.g. Warfarin) are not good candidates for the pill cutter either because precision dosing is very important. Even a slight variation in Warfarin pill size means more or less active medication is being delivered.

At Home

  • Keep the medication stored in the original bottle. If some question arises about this drug, you will need the original container.
  • Some of us keep our medications on a certain shelf and assume when we pick up the bottle – even in a darkened room – we’re taking the right drug because that is where we keep it. Read the label. If you or someone has moved the drugs from one shelf to another, you might be assuming too much.
  • If you use pill trays, be careful in filling them. Don’t tackle this seemingly mindless task when you’re preoccupied or too tired to concentrate.
  • Keep a list of all medications you take including over the counter drugs, vitamins and supplements. This will help your doctor and your pharmacist in determining any drug interactions that might occur.
  • Store your medications in a cool, dry, darkened place away from moisture. Your bathroom is probably the worst place to store your drugs.

Finally – Disposing of Unwanted Drugs

Check with your local sanitation company to see if they have a program for safe disposition of unwanted prescribed and over-the-counter medications. Some municipalities will accept drugs along with other toxic materials.  Some cities are trying to work with drug companies, pharmacies and/or doctors to take back and safely dispose of old drugs, but this seems to be an issue that is largely unresolved.

It is widely held that we do not want these drugs in our water supplies or in our rivers or streams where they harm fish and other wildlife.  But perhaps help is on the way.  In October 2010, legislation passed to tackle this very problem at the federal level in the United States.  If the law is adopted, we may finally have a way to responsibly dispose of unwanted drugs.

New Federal Law Removes Barriers for Medicine Take-Back Programs

A new federal law - passed unanimously by Congress and signed by President Obama on October 12, 2010 - helps remove any barriers to creating a statewide program to safely return and dispose of left-over meds.


Pulse Oximeter: Do I Need One for Home Use?

Part of a routine visit with your PH specialist will typically include a weigh-in, a systemic blood pressure check and an assessment of the oxygen level in your blood using a pulse oximeter.

If your blood oxygen saturation fluctuates with your level of physical activity, investing in one of these devices for home use is a good idea. With a home unit, you can test yourself often and under various conditions to determine how your body is handling oxygen on a day-to-day basis. You might learn, for example, that your blood saturation level drops to an unhealthy level when you race up a flight of stairs, but stays at a healthy level if you take your time. You might also slip your pulse oximeter into your pocket so that you may test yourself at various elevations when you’re traveling, on a plane flight or any time you feel short-of-breath and wish to take a reading.

The price of a small, portable pulse oximeter is no longer prohibitive. You can buy pulse oximeters online for under $75 and while they might not be “medical grade” or quite as sensitive as the units in your doctor’s office, our experience with them has been good. Originally these small units were intended for pilots of small planes to use in unpressurized cabins, but more recently many new units have been introduced for use by heart and pulmonary patients.


Medicare Patients New to CPap

If Medicare is paying a portion of the monthly fee for your new CPap / BiPap machine, the machine will be owned outright by you after 13 months. That’s the good news. The bad news is that Medicare can stop paying for your machine within that first 13 months if you are not using it as directed. Within the first 13 months, your DME (durable medical equipment) supplier will report the sleep hours you have logged quarterly to Medicare. They obtain this information by reading a memory card located in your machine. If the numbers don’t show dedicated usage, you may lose your coverage for this equipment and be forced to make the remaining payments for the equipment out-of-pocket.

If you are having problems adjusting to your new machine, talk to the respiratory therapist at your DME about other mask options or changes in the machine settings that might make it more comfortable for you to use. Whatever you do, don't put it off for another day. You don't want to lose your benefits.


Extra Salt, More Lasix. Right?

While it certainly is tempting to double up on a Lasix dose now and then when we overdue it on salty foods, it’s not a wise move. Because Lasix is a powerful diuretic, you can actually lose too much water causing dehydration, dizziness and other serious side-effects.

Since most of us take this drug daily and it is often referred to as a “water pill”, it sounds harmless, but it is not. It, like all drugs, alters the body’s chemistry and can cause serious problems.

So take your Lasix – the name was derived from the phrase “lasts six hours” – every six to eight hours or as directed and don’t cheat. If after the holidays you don’t think your daily dose is handling your water well enough, schedule an appointment with your doctor to reevaluate the situation.


Immunity After H1N1 Vaccine Not Immediate

Although it varies from adult to adult, most people receiving the flu vaccine will be protected from the virus within eight to ten days. For children the immunity won’t take effect for about a month after their second vaccination. Even with immunity, you will want to keep up your guard when you’re in contact with others. Experts have not seen much variability in the H1N1 strain so far, but some mutation of the virus is expected over time.


Is it Safe to Take Expired Medications?

Since 1979, all drug manufacturers in the U.S. have been required by the FDA to label their products with an “expiration date” but what does this date really mean? Some of us have been lead to believe that all drugs will become toxic after this date, but with one reported exception involving tetracyclines, no case of this has ever been documented. 

The use by or expiration date is simply the date at which the manufacture guarantees the full potency and safety of the drug.   Most aspirin bottles give a use by date three years after manufacture and yet studies have shown that aspirin, if stored properly, has a much longer shelf life. Most drugs, like aspirin, will likely be safe for a much longer period of time than the “use by” date although it may lose some of its potency over time. It should also be kept in mind that a drug’s chemical composition may change over time if stored under less than ideal conditions. For example, aspirin, when exposed to moisture, breaks down into the same components as vinegar. Hardly toxic, yet not a very effective pain reliever either.

According to Harvard Health, “Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date. Excluding nitroglycerin, insulin, and liquid antibiotics, most medications are as long-lasting as the ones tested by the military. Placing a medication in a cool place, such as a refrigerator, will help a drug remain potent for many years.”

It should be noted however that not all medications can or should be refrigerated so it is important to read the label or package insert regarding proper storage instructions. No medications should ever be stored in a bathroom if the room contains a tub or shower. It has been shown that the high humidity within a bathroom can cause a rapid breakdown of some medications. All medications should be stored out of direct light in a cool, dry, dark location, out of the reach of children.

So, how can you use this information?   If the expiration date passed a few months or years ago and it's important that your drug be absolutely 100% effective (potent) – Flolan, Remodulin, Sildenafil etc. – you certainly need to respect the “use by” dates. However, you may want to think twice about throwing out your other medications just because the date on the label says that it has expired.

If you have any questions about the safety or effectiveness of any drug, ask your pharmacist. He or she is a great resource when it comes to getting information about your medications.  


You will find more on this subject at the following reputable sites:

Medscape:  Do Medications Really Expire?

Harvard Health:  Drug Expiration Dates.


In The News


What a Good Pharmacist Can Do For You

Few of us enjoy a close relationship with a pharmacist in our community and many may think pharmacists do nothing more than count pills. In actuality, pharmacists play a very important roll in advising both patients and medical professionals about the drugs they dispense. In the area of pharmaceuticals they are more knowledgeable than the average physician and they are the best people to go to for information about the drugs you take, both over-the-counter and prescriptions.

There are two classifications: those who graduate from pharmacy school and those who receive Doctorate degrees. The first carries the title pharmacist and the second is referred to as a Pharmacologist having earned a PharmD. Neither of them are doctors in the sense they cannot treat patients or prescribe medications.  Pharmacists and Pharmacologists work in tandem with Physicians to deliver the best care to the patient. Each has their own expertise and any “hierarchical order” is rather silly as these are both professions critical to patient health.

On every visit to our physicians, we are routinely asked to recite a list of the drugs we are taking including the dose. It’s a good idea to type up your list beforehand for your doctor to review.  If you cannot do this, then throw all your drugs in a sack and take them with you for your appointment. It would also be a good idea for you or a family member to ask for a periodic consultation with a pharmacist in your area. There is no fee for this service and the pharmacist may find something your doctor has missed. 

It does not matter whether you chose a small, independent pharmacy or the rx counter at a big box retailer, the training of the pharmacist on staff is the same. This does not, of course, mean that all pharmacists are created equal, but a good pharmacist will be strong in science and a good communicator. 

Read the Burear of Labor Statistics has to say about the scope of the work and the qualifications and training required to become a pharmacist.


Dark Chocolate Is Good For Your Health. Really!

Even modest amounts of dark chocolate ingested daily may improve your blood pressure and be beneficial to your heart. The breakthrough in research came about in 2002 when studies showed dark chocolate contains antioxidants called flavonoids, potent plant compounds also found in tea, red wine and some fruits and vegetables. Studies show that flavonoids slow the processing of "bad" LDL cholesterol into material that clogs the arteries, and at the same time make blood platelets less likely to clump and cause clots.

While all of this is good for everyone, of significance to the PH patient is the connection made between dark chocolate and the body's production of nitric oxide. NO is one of the pathways identified in the treatment of Pulmonary Hypertension and a target for some of the drugs many of us take. Dr. Norman Hollenberg of Brigham and Women's Hospital reported findings that flavanols may also be associated with controlling NO, another chemical that regulates the arteries. And according to an article in Med Page Today, The effect is not unlike that of sildenafil (Viagra) or the other inhibitors of phosphodiesterase-5, which also cause relaxation of smooth muscle in the vascular endothelium."

So, when you're choosing your daily sweet, make it dark. The dark choice is typically a bit more expensive and not quite as sweet, but is richest in flavonoids because of the way it's processed. Milk chocolate, which also has added butterfat, contains fewer flavonoids, while cocoa powder and chocolate syrups are currently processed with a method that removes most of the flavonoids.

Chocolate.org http://www.chocolate.org/health/dark-chocolate.html 
Med Page Today http://www.medpagetoday.com/Cardiology/Hypertension/6084  

In The News


Is it the flu, a common cold or gastroenteritis?

You need to know the differences.  Many of us confuse the common cold or "stomach flu" with influenza, but these are three distinct medical conditions with very different profiles. Neither the common cold nor influenza typically involves stomach upset. The term "stomach flu" actually refers to gastroenteritis which is not flu at all, but rather an infection that is caused by either a virus or bacteria. Medically referred to as gastroenteritis, it afflicts both the stomach and the small intestine.

In general, influenza is a much more serious illness that is especially dangerous to the chronically ill and the elderly. Gastroenteritis can also be very serious in patients on fluid restriction. If you are a PH patient, you should consult your doctor if you show signs of either of these conditions.

For more detailed information on the common cold, influenza, and gastroenteritis, visit the links below:

Common Cold and Influenza Differences
Gastroenteritis - viral
Gastroenteritis - bacterial

In The News


Is Stress Stressing You Out?

Researchers at the NIH have identified a gene they call the resilliance gene. This particular gene (NPY) plays an important role in stress management. It helps explain why some people stress out easily while others seem to be able to go with the flow. You will find an interesting article on this gene at Research Matters on the NIH website.


As a Rule, Cheese is Pretty Salty Fare!

Cheese can be a good source of calcium and protein, but if you are watching your salt intake, you need to know some types are high in sodium. As a rule, aged cheeses contain more sodium than younger cheeses and you will also see in the list below, processed cheeses are higher in sodium than many natural cheeses. But what is especially surprising is that cottage cheese - which many of us think of as a great option to round out a diet plate - is especially high in sodium and not a good choice at all for someone on a serious salt-restricted diet.

We always encourage people to check food labels, but ff you're buying at a deli counter, there won't be any food labels. So how on earth will you decide which are the best options for you?

We hope the list below will help you make smart choices when you're facing the dizzying array of wonderful cheeses from around the world available in most delis. It's possible to continue to enjoy cheese even on a salt-restricted diet. You just have to choose carefully.

Cheese: Milligrams of sodium per 1 ounce serving
  • American processed, sliced - 406
  • Anejo - 321
  • Asadero - 186
  • Asiago - 400
  • Blue - 396
  • Brick - 159
  • Brie - 178
  • Camembert - 239
  • Cheddar - 176
  • Chihuahua - 175
  • Colby - 171
  • Cottage cheese, 4 oz - 430
  • Cottage cheese, low fat, 4 oz - 360
  • Cottage cheese, fat free, 4 oz - 380
  • Edam - 274
  • Feta - 316
  • Fortina - 227
  • Goat - 104
  • Gorgonzola - 350
  • Gouda - 232
  • Gruyere - 95
  • Havarti - 214
  • Limburger - 227
  • Monterey jack - 152
  • Mozzarella - 118
  • Mozzarella, part skim - 150
  • Muenster - 178
  • Parmesan - 454
  • Processed, boxed - 410
  • Processed spread, jar - 490
  • Provolone - 248
  • Ricotta, 1/4 cup - 52
  • Ricotta, part skim, 1/4 cup - 78
  • Romano - 340
  • Roquefort - 513
  • Stilton - 220
  • Swiss - 74

Cream cheese: Milligrams of sodium per 2 TB
  • Cream Cheese - 84
  • Cream cheese, light - 150
  • Cream Cheese, fat free - 155


Oxygen Can Be Toxic!

If you're using supplemental oxygen all or part of the time, you may think if a little is good, more must be better. Perhaps you've set your concentrator a little higher than the doctor ordered so that you don't have to adjust the dial as you walk around the house. In truth, more is not better and in fact, too much oxygen can damage delicate lung tissue.

According to A Moment of Science (Indiana University), "Ironically, too much oxygen actually inhibits ventilation and ends up slowing down the delivery of oxygen to your body's tissues. Another problem is that certain tissues, like the lining of the lungs and the walls of the arteries, are very sensitive to oxygen. The cornea is also very sensitive to oxygen, and you may have heard of people who have gone blind because, as newborns, the oxygen levels in their incubators were too high".

You can easily optimize the benefit of your home oxygen therapy and protect your lungs by monitoring your own blood saturation levels as you move through your day. By learning how much oxygen you require during various activities, you'll be helping your lungs and yourself!


People Taking Diuretics Should Avoid Natural Licorice Products!

People with blood pressure issues and/or who take diuretics should avoid any products containing natural licorice. According to a Harvard Health Letter, a Natural licorice -- usually an imported product -- can raise blood pressure, sometimes significantly. It contains the chemical glycyrrhizin, which causes the body to retain sodium (and therefore fluids) and to lose potassium.

In two separate studies healthy subjects who ate three ounces of licorice twists a day for a few weeks suffered from edema, a low potassium level, and/or temporarily elevated blood pressure. People with hypertension, particularly those taking diuretics, would probably be far more susceptible to such effects and should therefore avoid candy, beverages, and smokeless tobacco containing natural licorice. They may be able to take heart, though, depending on their choosiness and the accuracy of their terminology: domestically produced licorice candy is generally made with artificial flavor, and the red stuff commonly called licorice really isn't.

Source: Harvard Health Letter


Be Careful In Selecting Your Holiday Bird

Did you know that self-basting turkeys are typically loaded with salty broth? A better choice for the sodium conscious out there would be to choose a fresh bird that has not been injected with broth (and salt) of any kind. The November newsletter from lowsodiumcooking.com - a site you may want to add to your favorite list - will show you how easy it is to limit your salt intake during the upcoming Thanksgiving holiday. Happy Holidays to all and bon appetit!


Certain Over-the-Counter Drugs Pose Special Hazards to PH Patients

When you visit your PH doctor, you'll want to provide a complete list of the medications you take. This list should include even casual use of over-the-counter (OTC) medications as some are contraindicated in patients with heart / lung disease such as pulmonary hypertension.

Decongestants — such as those contained in common OTC cold and flu aids — should be avoided. Another class of medications you should avoid is anti-inflammatory (NSAID) drugs such as ibuprofin (Motrin™, Advil™), indocen and Naproxen (Aleve™, Naproxyn™).

Decongestants cause the vessels throughout the body to constrict which could easily exacerbate PH symptoms. NSAIDs have been shown to contribute to worsening heart function and kidney/liver problems.

If you are unsure about the OTC drugs you take, you should always ask for advice from your pharmacist and then check with your PH doctor. It's better to play it safe than cause problems that could easily be avoided. When you have PH, you have enough on your plate!


Counting Calories From Fat? You're Probably Getting Extra Salt.

Do you ever see food products on the shelf claiming to be low in fat and low in sodium too? Probably not. There are very good reasons why.

In the never-ending search for tasty food products, manufacturers have learned from numerous focus groups what Americans want in the way of taste. We all seem to crave too much salt, confusing salt for taste in general. Fat is also a taste enhancer in foods, so when it is eliminated from a product or reduced, the flavor goes down, too. The manufacturers may make up for the deficit by increasing the salt content. Your good intentions in choosing low fat foods may actually be doing you harm.

Also, don't assume when a product claims to bes "reduced salt" it is necessarily low in salt. Soy sauce, for example, comes in regular and reduced sodium, but check out the numbers. While the sodium may be less in the reduced sodium version, it's still a whopping amount per tablespoon. One Tamari sauce sold on Amazon claims the reduced-sodium version is twenty-five percent lower than the standard product. This is not low!

Let's face it, it's a mine-field out here, but as a PH patient, you may want to shift your focus from carbs or fat to sodium in the foods you eat.

Further Reading:

In researching this subject, we found a grassroots website that discusses many aspects of this dilemma including product examples you'll want to know about. Check it out at: Low Salt Low Fat.com

You'll also find an excellent resource for home cooks looking for low sodium recipe ideas at: Low Sodium, Low Salt, Heart Healthy Cooking


Feeling Lazy? Maybe There is More To It

Many PH'ers tell us they are often fatigued without explanation. They postpone chores or opt out of activities because they say they are feeling so lazy. Many report they cannot decide whether it's true laziness, depression or something else.

Fatigue in pulmonary hypertension, a common complaint, is a sign that the body is struggling. When the muscles are chronically deprived of oxygen, fatigue is the result. And when fatigue is very pronounced, it may be a sign of worsening heart failure.

Of course, there may be more to it than even that. When one is chronically tired or short-of-breath, it's hard to find the will to get up and move, but is this laziness?

It is perfectly understandable why someone would put off chores after, for example, a particularly rough week of long days on a demanding job. No one would raise an eyebrow if the laundry had to wait. What some PH'ers, friends and family members sometimes fail to appreciate, is that someone with pulmonary hypertension feels like they are working overtime at a very difficult job nearly all the time. Everything is more difficult. Everything.

So give yourself a break. Keep in mind that your body is doing the best it can for you and you need to respect it, listen to it and pace yourself. If you were not "lazy" before your diagnosis and you still have the desire to do many of the things you enjoy, it's probably not laziness that is holding you back now.

Keep in mind too that a few dust bunnies never killed anyone, that as long as the health department does not condemn your living space, you're doing fine. Put your feet up and read a good book and don't worry about it.


What Your Hands May Reveal About Your Health

When you're visiting your doctor's office, does your doctor sometimes look closely at your fingers? A pulmonologist or cardiologist may be looking for signs of clubbing which is defined as a thickening of the flesh under the nails...causing the nail to curve downward, similar to the shape of the round part of an upside-down spoon. Clubbing is an indication of a heart or lung disorder causing chronically low blood oxygen levels.

There are other things your nails may reveal. Horizontal ridges may be another sign of trouble. Horizontal ridges, created when normal growth of the nail is interrupted, can be caused by many factors including, infection, toxins, underlying metabolic diseases or periods of reduced blood oxygen levels. These lines are called Beau's lines. If they are visible only on one nail, a nail infection may be the culprit but if the lines appear on all or most of the nails, you will want to bring it to the attention of your doctor during your next routine visit.

Writer's personal experience with Beau's lines: I am particularly interested in this topic because I had deeply creased thumb nail lines - both hands - for years before my own PH / hypoxic (chronic low blood oxygen levels) was diagnosed in the year 2000. A few months after starting on supplemental oxygen 24/7, my creases disappeared completely. Eight years later, I have had not one hint of Beau's lines.

Of course, my little experience is purely anecdotal and would probably make me look like a lunatic to my doctor's eyes if I mentioned it during a visit. To some doctors, spending time on a patient's nails is probably a little like reading tea leaves, interesting, but hardly hard science. Still, if your nails change in color or texture, it can signal something is going on that needs to be addressed.

For a more detailed discussion on clubbing and Beau's lines, we have listed a few online resources.

MedlinePlus Medical Encyclopedia: Clubbing of the fingers or toes

HealthMad.com - What Causes Ridges in Fingernails and What You Can Do About Them

azTeen Magazine - What Causes Fingernail Ridges?


Depression and Chronic Illness

Whether its called the blues, the blahs, moods, a funk, or anxiety: it is still the same beast – depression. Although common in those with a chronic illness, depression is often under treated, possibly because it carries the stigma of being a weakness. According to the Mayo Clinic, most health professionals today consider depression a chronic illness that requires long-term treatment, much like diabetes or high blood pressure.

Why do individuals with chronic illnesses get depressed? Possibly it is what patients see as the end of their familiar lives. Their life has changed and how they see themselves has changed as well. They often feel like they have no control over the events in their lives. The course of each day can no longer be predicted or controlled.

Common symptoms of depression are:
  • Difficulty concentrating, remembering details, and making decisions
  • Fatigue and decreased energy
  • Feelings of guilt, worthlessness, and/or helplessness
  • Feelings of hopelessness and/or pessimism
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Overeating, or appetite loss
  • Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
  • Persistent sad, anxious, or "empty" feelings
  • Thoughts of suicide, suicide attempts

Not everyone with depression will have the same symptoms. Also, the severity, frequency, and duration of symptoms will vary depending on the individual and his or her particular type of depression.

If you or someone you love is experiencing depression, no matter how mild, it is important to discuss your feelings and concerns with a medical professional. Depression rarely dissipates on its own.

Depression Caused by Chronic Illness - WebMD
Depression (major depression) - MayoClinic.com


Hot Weather Affects Water Retention

If you have an ongoing battle with your water weight, you need to know that you may retain a bit more than usual during spells of high temperatures. Even healthy people may retain some extra water during hot weather. As a PH'er you'll want to stay out of the heat as much as possible, keep your salt intake low and wait out the hot days. Ah boy, the joys of summer!


Humor and Laughter ARE Good For You. Really!

While there are no definitive studies to prove that laughter is good for your health, it sure feels good to let go and really laugh now and then. Yet most of us laugh all too infrequently. Let's face it, when you have a chronic illness that makes you feel draggy much of the time, it's not always easy to see the humor in things.

Medical experts will tell us laughter is worth pursuing. A good laugh or just looking at the funny side of life, can really elevate a mood and there are other benefits as well.

According to the University ofMaryland Medical Center's website, laughter and cultivating a good sense of humor can protect against heart attack. Other studies have shown that humor strengthens the immune system, changes body chemistry and a good hard laugh actually increases the amount of oxygen that reaches the brain.

In thinking about this topic, we decided to ask a few of our PH friends what they do to elevate their mood.

Annonymous writes: "I have a running joke with a friend who loves dark humor as much as I do. We speculate on the worst case scenario when it comes to being terribly disabled. We paint a bleak picture of someone with multiple problems and it's really dark stuff, but it makes us feel "lucky" just to have PH to worry about. And we get so tickled by the absurdness of it all.

I know our brand of humor is not for everyone, but it makes us laugh and I feel such a connection with my friend. We're revealing our fears, but having fun with it at the same time. It works for us."

Irene offers: "Humor is definitely therapeutic, no doubt about that. The movie Airplane does that to me. Also my grandkids make me laugh, usually when they're acting cute, but sometimes when they melt down I find it comical (strange for a grandparent?). Work can make me laugh since I'm lucky enough to work with people who find humor in some of the same things I do. Often times, it's either laugh or cry and I much prefer laughing."

Cheryl writes: "I love the movie Planes, Trains and Automobiles. It makes me laugh and laugh even though I know every scene. My husband looks at me like I'm crazy because I get so worked up, I'm nearly crying. I am not all that easily amused so this movie is a gem to me."

Nancy tells us: "Nothing can make me laugh more than watching animals or children at play. Seeing their complete joy in discovering the world around them always makes me laugh."

Michelle adds: "When I really need a good laugh, I turn to anything written by Larry David. He's a comedic genius. IMHO, no other sit-com has been as well written as either Seinfeld or Curb Your Enthusiasm.  I also turn to the stand-up comedy of Lewis Black & George Carlin.  My silly little dogs often make me laugh, too. Especially when they get the "Zoomies" and start running around the house at break-neck speed. That's a kick."

Seek out things that make you smile or laugh and pass them along to others and with us too. You will benefit in ways you cannot imagine. It really is good for your health.

Read more about the health benefits of humor and laughter:
University of Maryland Medical Center


Does Your Chicken Taste Salty?

The USDA allows producers of "All Natural" chickens to inject the birds with a sodium solution. This adds weight which increases the price and adds hidden salt to our diets. If you're trying to avoid salt - and most of us are - you'd better start reading the chicken label too!!!

LEARN MORE HERE: The Modesto Bee | Nutrition Quiz


Oxygen Anyone? How Can You Tell If You're Getting Enough?

Know About Blood Saturation
By now, you surely have used the gizmo called the pulse oximeter in your doctor's office. When you take your 6-minute walk, you will be checked periodically to see how much oxygen-rich blood is getting to your fingertips. Also, pulse ox readings are typically taken during routine visits to your cardiologist or pulmonoligist offices.

For PH'ers or anyone with a serious heart or lung issue, it's a good idea to have a pulse oximeter of your own for home use. By having your own pulse ox, you will be able to identify potential problems early. Also, by taking your readings around the house, you may become mindful of the need to slow down the pace. The goal always is to keep your blood sat reading above 90 and the closer it is to 100 the better.

If you are using supplemental oxygen, a pulse ox will help you identify the tasks that require more oxygen and the times when less is called for. It's to your advantage to actively manage the liter flow on your supplemental tank both to maximize the use of your oxygen when you are away from the house and to ensure you receive the right amount at all times. This is why some of us choose to wear a small gas or liquid tank even when we're in our own homes. You cannot actively manage the liter flow of a stationary unit.

Typically insurance companies do not pay for a pulse ox for home use, but there are a number of pulse ox units to be found online (Amazon.com) at all prices. Some are under $100 and my personal experience with a unit costing $79 is that it is dependable and accurate. If you are careful not to drop your pulse ox or get it wet, an inexpensive unit should be a fine choice.

Hey, my oxygen tubing must be kinked!!!!!
How can you tell if oxygen is flowing through your nasal cannula? Lick your lips and hold the nose piece close to but not touching your damp lips. You will feel the air flow on your lips. This sounds silly, but when you're half asleep and you wake up feeling short of breath and the cannula is firmly in place, you'll want to confirm that the gas is indeed flowing. It's not as easy to feel the flow on dry skin.


Places to Go, Things to Do You May Not Have Considered

If you want to go to some local attractions or programs but don't want to go alone, consider checking into day trips and classes that are commonly sponsored by local senior centers, rec centers and churches. Many centers and churches offer short classes, shopping trips and day trips to local attractions like parks, theatrical and musical events, museums, etc. The trips are usually free or available for a modest fee. They also arrange transportation from the sponsor's location.

Signing up for a trip is a good way to meet people in your own community who have similar interests. The trips usually require advance registration and often have a list for alternates if a cancellation is necessary.

Contact your local senior center (numbers are usually listed under city government in the phone book) about future trips. Or check with nearby churches and rec centers for programs they offer.

Spring is right around the corner so if you're fighting the cold weather blahs, it might be a good time to plan something to look forward to and soon!


Why You Should Discuss Sleep Apnea with Your PH Doctor.

Sleep apnea (cessation of breathing during sleep) is somewhat common and can run the gamut from mild to severe. If you snore loudly, do not feel rested upon awakening, awaken often during the night, OR need frequent naps you may have severe sleep apnea. But even if you have minor symptoms, the condition can contribute to your PH load so you will want to cover the topic with your doctor. Some physicians feel it should be included in a PH workup, but it is often overlooked. Testing typically requires an overnight stay at a special clinic; charges are usually covered by insurance companies. If you are found to have sleep apnea, you will most likely be fitted with a non-invasive ventilator (either cpap or bipap) for home use. If you have not been tested for apnea and you either have symptoms or think it may be a owner to your PH problems, you'll want to broach the subject during your next PH checkup.


Surviving in Cold Temperatures

Cold temperatures are nothing to be taken lightly, especially for individuals with a chronic respiratory disease like pulmonary hypertension. Pulmonary hypertension patients are often taking blood-thinners. Those patients should take special precautions in cold weather because they are more susceptible to frostbite and hypothermia. It is important to note that hypothermia (low body temperature) can occur indoors and sometimes, even in the middle of summer.

On emaxhealth.com, Dr. Paul Oh, medical director of Cardiac Rehabilitation Programs at Toronto Rehabilitation Institute says,
"Heart-related deaths increase by about 20 percent in winter months. There is approximately a one percent increase in death due to heart disease for every one Centigrade drop in temperature. The number of deaths due to cardiovascular disease peaks within one to three days following a cold snap. Because cold weather causes an immediate increase in blood pressure and increased heart rate."

To decrease the risk of cold exposure:
  • Wear layered clothing. Wear a cap to prevent rapid heat loss, even indoors if necessary.
  • Try to heat at least one room to 70 F.
  • Put an extra blanket on the bed or wear a cap or socks while sleeping.
  • Carry extra clothing, blankets and high-energy snacks (nuts, candy bars, cereal) in the car. Keep the gas tank near full to prevent icing in the gas line. Avoid traveling alone, and if stranded, never leave the vehicle and attempt to go for help. Use a cell phone to summon help.
  • Listen to weather forecasts and dress appropriately when going outside. Pay close attention to wind-chill factor and avoid going outdoors in extreme weather.
  • Avoid alcoholic beverages: they cause the blood vessels to dilate and the body to lose warmth.
  • Wear a mask or scarf around the mouth and nose in extreme cold or windy weather. The scarf will warm the inhaled air.
  • Try to get a warm, lightweight coat (down is ideal) for winter.


The Importance of Good Dental Hygine

Good dental hygiene is important in maintaining overall health. Untreated gum disease and poor oral hygiene habits can lead to serious heart disease. The theory is that bacteria from the mouth gets into the blood stream through tiny cuts making it possible for the bacteria to irritate the blood vessel walls and sometimes collect around heart valves. The worse the gum disease, the more dangerous the bacteria being released. The simple act of chewing, brushing and flossing can cause the release of some bacteria, but if the mouth is in a healthy state, bacteria won't be present in large quantities.

Don't neglect your oral hygiene. As a person with a serious chronic illness that taxes the heart, you certainly do not need to challenge your system further. See your dentist regularly and make sure he'she knows your diagnosis. You'll also want to discuss your use of blood thinners when applicable, and also your need to avoid pain medication that restrict blood vessels.


Surviving Holiday Shopping

The holidays can be stressful and for a person with a chronic illness like pulmonary hypertension, it is far too easy to overdo. It is extremely important that PH patients take precautions before plunging into the holiday shopping frenzy. We hope the tips that follow help to make your holiday season a great success while maintaining your health.

  • Shopping online is the way to go and this year, nearly everyone is offering online discounts and free shipping. It's easy and safe
  • It's never too late to check on the availability of a handicap plackard for your vehicle in your state. And if you have one, don't be afraid to use it. If you have PH and qualify for a plackard, you don't have to explain yourself to anyone.
  • If a store offers the use of an electric cart, use it. Don't be shy, these carts are for people like us. Using the cart will conserve energy and provide a seat during the potential and inevitable long wait at the check-out.
  • If you have portable oxygen on hand, take it along. Dealing with crowds and long lines taxes the body, so use that oxygen.
  • There are some great, light-weight, three-legged camp chairs out there so if you're going shopping with a friend and you do not have a scooter, ask your friend to carry the little chair for you. If you're stuck in a long shopping queue, you will find it very useful.
  • If a store does not have scooters, take a cart at the front door of the store even though you have only a few purchases planned. The cart can be used for support when you walk or stand. Besides holding your purchases, the cart can be used to carry your oxygen.
  • Try to shop when the stores are less crowded. Early to mid-morning (Monday through Thursday) may be the best time to avoid large crowds. Usually the shelves will be better stocked then, too.
  • While it's fun to check out new stores, you'll save a lot of energy if you shop at the tried and true where you know the layout well.
  • Whether you bag your own groceries or someone does it for you, make sure all preishible items are bagged seperately. If you're tuckered out when you return home, you can leave the other items in the bags to be shelved later.
  • Ask those bagging your goods to keep the bags a little on the light side. They will be much easier to carry in the house.
  • As about help in carrying your bags to the car. Also in some areas of the country, you'll find customer pick-up windows. If enough people ask for these kinds of services, the store may consider adding such a service in the future.
  • Invest in a foldable shopping cart to help transport bags from the vehicle into the house.
  • If you have a great deal of difficulty going out to shop, perhaps a friend, neighbor or relative would be willing to do it for you. Some senior service agencies and churches will provide these kinds of services on a volunteer-basis. Check in your area for availability of these services.
  • Call ahead for prescription refills and use pharmacies with drive-up windows whenever possible. Use mail-order and online pharmacies: many are reliable and dependable. Your insurance company may offer discounts through a specific mail-order pharmacy.
  • Shopping for clothing can be an exhausting experience even for those in the best of health. Know your measurements, write them down on a file card and carry it with you. Keep a small fabric measuring tape with you to check items like slacks and skirts. This can help avoid tiring trips to the dressing rooms. Know the stores return policy if the item does not fit when you get it home. Keeping measurements of family members will be helpful for holiday shopping.

In summary, if you pace yourself this holiday season by planning carefully and taking time outs to rest and rejuvinate, we think you'll enjoy plenty of holiday cheer.


The Importance of Weight Management

Are You Keeping Track of Your Weight? It's important to monitor your weight closely as excess fluid build-up can be gradual, dangerous and go unnoticed. Extra water causes the heart to work harder which is something no PH'er needs. While it's normal to gain two to three pounds in the course of a day, your weight first thing in the morning before you eat anything and after your Lasix has taken effect, should be consistent from day to day.

If you're holding onto water, there are two things you can do: limit your fluid intake and severely limit salt in your diet.

If you gulp down a 32 ounce soda, you'll have added two pounds of water to your weight in the blink of an eye. A healthy person might be able to handle copious amounts of fluid during a day, but not a PH'er. PH'ers should spread out their fluids consumption and stay hydrated,
but not overdo it. Too little fluid intake can also cause the body
to hold onto fluid so you'll want to discuss the right amount for you with your doctor.

Excess salt intake is another big problem. Did you know that 1 tsp of salt containns 2,000 mg of sodium? It is recommended that PH'ers and also others with heart disease, limit their intake to 2,000 mg. per day. And foods need not taste salty to be salty so take care in choosing the foods you eat.

In summary, get yourself a good scale and weigh yourself every morning. Be sure to report any sudden changes to your doctor.


Contingency Planning and Your DME

If you use an oxygen concentrator and/or a cpap or bipap machine, you'll want to have some contingency plans for possible power outtages.

To get started, read what the folks at COPD International have to say: COPD International


Consider Altitude in Making Your Travel Plans

Thinking About a Trip to the Mountains? Reconsider.

People who have lung disease may find they feel "healthier" on high pressure days. These people might also feel less well in the mountains or flights on commercial airplanes where the air pressure is low. This is because air has weight and higher pressure helps air enter the lungs more easily. Conversly, at elevations where the air is "thinner" the body has to work a little harder to breathe. Healthy people might not notice the extra load, but a PH patient probably will.

Pioneering scientists discovered atmospheric pressure (also known as barometric or air pressure)in the 17th century, and determined a startling new fact-that air actually has weight. Evangelista Torricelli, one of the first to discover atmospheric pressure, once said, "We live submerged at the bottom of an ocean of the element air." The Earth's gravitational field is pulling on air, and this pull, or "pressure" of air, is called atmospheric pressure.

At elevation even healthy people can have problems. At extreme altitudes, mountain climbers who get altitude sickness are experiencing pulmonary hypertension. If the climber is otherwise healthy and descends to a safer altitude to acclimate, the PH will most likely correct itself. For people with PH, choosing a destination at a higher altitude is asking for trouble.

So, if you are yearning to visit that mountain retreat, you'd better talk to your doctor before you finalize your plans. He/she may prescribe supplemental oxygen temporarily for your trip or advise you to pick a spot at sea level for your vacation.

For information on barometric or air pressure, visit: Nova Online


Caring for Caregivers

As important they are to their children, friends, spouses, or family members, caregivers need help, too. The following link lists the resources that are available to provide that help. Links show how to find help providing care, government benefits, legal matters, and end-of-life issues, long-distance caregiving, and resources for caregiver support.

For specific links on this topic go to: Caregivers' Resources - Official information and services from the U.S. government


Hot Tubs and PH

Does That Hot Tub Look Inviting? Forget it.

People with heart conditions including patients with PH, should avoid extreme heat including hot tubs. Why? In higher temperatures, we sweat to get rid of heat. During that process, blood is sent to the skin where temperatures are cooler, which opens up the blood vessels. In turn, the heart rate rises and blood pressure drops. That combination can be dangerous for anyone with weakened cardiovascular systems.


Exercise and PH

Just hearing the word "exercise" can fill a pulmonary hypertension patient with dread, but many recent studies revealed that some form of regular exercise might be beneficial. Frequently pulmonary hypertension patients avoid exercise because they do not have the strength, energy, or endurance to walk or do other strenuous activity, but it may be possible to get exercise from the comfort of a chair with little exertion.

Chair exercises are slow movements, such as rolling the shoulders or stretching the hands above the head while seated. These activities are safer for patients who might become dizzy doing the same technique while standing. The exercises sound simple, but don't underestimate their physical and mental benefits.

It is advisable, however, for PH patients to consult with their physician before attempting ANY new routine, and chair exercises are no different. Please note the precautions section on the following sites.

Some good tips and actual chair exercises can be found on the following sites: COPD International

North Dakota State University -- Donna Terbizan, PhD, Professor, Health, Nutrition and Exercise Sciences; Julie Garden-Robinson, PhD, LRD, Food and Nutrition Specialist, NDSU Extension Service

San Diego Eldercare Directory

University of Georgia - 34-page manual of chair exercises as a PDF file


Eat Well on a Budget

Don't spend your money on overpriced and oversalted prepared foods. If you're on a budget and have been told to watch your salt intake, your best bet is to make it yourself. It's not that hard to do.

My mother was a "cooking by scratch" enthusiast so some of the products I find in the supermarket are surprising and irksome. Although I did not have much interest in what my mother was concocting as a child, I did notice she did not buy many prepared things. Perhaps it was because there were so few on the shelves back in the 50's and 60's, but even later in life, she continued to cook from scratch.

When I look at what is sold in markets these days, it's amazing to me how much "convenience" foods cost and if you stop to think for more than a nanosecond about it, you will realize how dearly you pay for them compared to the raw materials they are made from especially when with a little bit of knowledge, you can make the same or better with relative ease.

In the case of Pasta Sauce, you're really getting robbed. Pasta sauce is nothing more than tomato sauce with some spices thrown in. You can buy an 8-pack of 15 ounce cans of organic tomato sauce at Costco for about #3.50. That is $.43/can. If you open up one of those cans, put it in a sauce pan, throw in some garlic, basil and chopped onion along with anything else that appeals to you and simmer it for ten minutes, you have pasta sauce. Pasta sauce can set you back $3.50 or more at the market so I think you see the point.

My other pet peeves? Here are just a few: Salad dressings, rice and pasta mixes, shake and bake, packaged croutons. Below you'll find a few words about each..

Salad Dressing - start with vinegar and oil and add spices and spices to flavor.

Rice Mixes - plain old rice or pasta is a lot cheaper and you can flavor it with anything you like. To your rice, add dried cranberries, unsweetened coconut, dried fruit or chopped nuts, some chicken broth in the cooking liquid. Be creative.

Shake and Bake - Duh, how about bread crumbs and herbs? That's all it is and your homemade mix won't have all the salt and other stabilizers they add to the commercial offering.

Packaged Croutons - This is how bread bakeries use old bread. Make your own by cutting old bread into squares, coating them with a little olive oil and garlic powder and popping them into the oven.

If you're on a budget, there are ways to eat well and spend your money wisely.


Travel with Oxygen

Travel with oxygen and other medical devices is a stressful event in the modern world, but it is possible and manageable. It helps to be as informed as possible on the restrictions and regulations.

The Transportation Security Administration (TSA) has a wealth of information on their website: TSA

Also check out their page on "Hidden Disabilities" where oxygen equipment and implanted medical devices are explained: TSA - Hidden Disabilities

Tired of the hassles and expense of traveling with oxygen by air? Alternatives are available for oxygen users taking a short trip. Consider the bus or train. Amtrak and Greyhound allow individuals to take their own oxygen systems on board (portable concentrators or tanks). No extra fees are charged.

Greyhound also does not allow smoking on their buses and there are designated smoking areas in the depots that can be easily avoided. Find more information here: Breathin' Easy


Interactions with Drugs

Grapefruit has been shown to affect the metabolism of many medications, increasing the risk of toxicity and adverse events. If you include grapefruit in your diet or plan to add it, discuss this with your physician.

For a more detailed discussion on this topic go to: The Center for Food-Drug Interaction


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