Managing Heart Failure

People diagnosed with heart failure (HF) usually have medications to increase how much their hearts can pump.  But as with most conditions, many approaches are needed to best manage heart failure.

A daily weight is essential because it is an early indicator of fluid retention from HF.  The best time to weigh yourself is in the morning, after urinating but before breakfast.  A weight gain of around 3 pounds in a day should be reported to the doctor since it indicates fluid may be backing up in various organs.

Generally people with HF are on salt restricted diets.  Salt contributes to water retention, which makes the heart work harder and causes shortness of breath and swelling in the ankles and legs.  Those with severe heart failure may have fluid restrictions.

Mild exercise can improve circulation, as long as it does not overly tax the person.

When we feel anxious or upset, our hearts beat faster and we breathe more heavily.  This can make HF worse.  Reducing stress helps manage HF.

Lying flat may cause shortness of breath. To improve sleep, it may be helpful to raise the head of the bed 45 degrees, or even sleep in a recliner.   And if the person uses oxygen, be sure the tubing is correctly in place and the nasal prongs are in the nostrils.

Dementia and the Holidays

As fun as the coming holidays can be, they can be packed with hazards for people with dementia. It means caregivers and families need to be especially vigilant about the safety.

Many decorations look like food and may even smell like the real thing. For instance, a Christmas tree decoration that looks like a gingerbread man may be even scented with gingerbread smell—making doubly appealing to try to eat. Other small decorations can be choking hazards. Artificial fruits, vegetables and nuts can look very real.

Candles that smell like pumpkin or apple pie can be a fire hazard if tipped over if a person reaches into it. Poinsettia leaves, contrary to popular belief, are not poisonous—but they will make a resident nauseated if he or she eats them.

People with dementia need routines—the same activities, in the same place, at the same time. Families should consider this carefully before deciding to take a loved one home for a holiday. The excitement, the car ride, change in surroundings and many people talking can cause the confused person with dementia to become agitated or upset.

Here are some tips for family members planning to take a loved one home for a holiday.

Planning

• Plan ahead. Let the facility staff know several days ahead so they have time to obtain medications and clothes.
• Allow extra time for everything, don’t rush the person.
• Try to keep as much as possible to their daily routine.

Decorations

• Use ribbon instead of sharp hooks when hanging decorations.
• Holly and mistletoe can be poisonous and berries pose a choking hazard.

Festivities

• Begin new traditions by letting another family be the host but try to go to a place familiar to your loved one.  
• Assign tasks to other family members so you do not become overloaded and stressed, which in turn causes your loved one to be stressed.
• Provide a nap before festivities. If you know the day will be long, you may want to attend only the most important part of the event.
• Plan for a quiet place for your loved one to go to if he or she becomes overwhelmed.
• Avoid alcohol.
• Be aware of their diet and diet restrictions. Cut up food into small bites.

Visitors

• Let your loved one know who is coming to visit.
• Have visitors and family call ahead to determine best time to visit.
• Small groups of visitors or family is advisable. Have them wear name tags as this might help with recognition.
• Reintroduce yourself as necessary. “Mary, my name is Betty.” And when she asks, “Are you my granddaughter?” say “yes” and shake her hand and act very comfortable about this introduction.
• If your loved one begins talking about the past, try not to reorient him or tell him he is wrong. Enter his reality and live his truth. Ask about the past memory.

Activities

• Reminisce about the past.
• Play holiday music familiar to your loved one.
• Read holiday cards aloud.
• Stuff stockings, watch a holiday video, look at family slides or pictures or albums, read scriptures, etc.

The Kitchen

• Monitor your loved one while in the kitchen.
• Give your loved one task to help with baking or decorating. Try baking cookies, making pudding, folding napkins, polishing silver, etc.
• Always check the microwave before turning on in case something was put in that is flammable.
• Check all trash cans before throwing out garbage

Shopping

• Don’t leave your loved one in the car or in the front of the store.  If you can’t take them in with you, try to arrange for someone to stay with your loved one.
• Shop during hours when stores are less crowded.
• Dress your loved one in a bright yellow shirt which is easy to see if you become separated. Be sure they have a purse or wallet with identification.
• Shop in smaller stores rather than the mall.

Travel

• People with dementia should never travel alone. Hire a personal care aid to travel if a family member is unable to accompany the resident.
• Be aware of balconies and other hazards in hotels.
• Travel may not be appropriate even with a companion if the person has:

1. Consistent disorientation or agitation in familiar settings
2. Wanting to go home when away from home on short visits
3. Delusional, paranoid, aggressive or disinhibited behavior
4. Problems managing continence
5. Teary, anxious, withdrawn behavior in crowded, noisy settings
6. Agitated or wandering behavior

Additional resources for caregivers.

Curried Lentil & Carrot Soup

One of the challenges of living with Chronic Obstructive Pulmonary Disease (COPD) or high blood pressure is maintaining a low sodium diet. Just because you have to limit your sodium intake doesn't mean you have to eat bland, boring food.

Our Pathways Recipe of the Month is Curried Lentil and Carrot Soup from a staff member in our Foundation department. This savory soup takes very little time to make, is very flavorful, and is healthy all around. It's a win-win recipe in my book!

If you have trouble finding red lentils, check your local health food store like Whole Foods, or an Indian market. I found them in Target in the ethnic foods aisle.

Curried Lentil and Carrot Soup

1 tablespoon oil
1 large onion, chopped
2 large carrots, peeled and chopped
1/2 cup red lentils
2 teaspoons curry powder
4 cups low sodium vegetable or chicken broth
1 bay leaf
4 cardamom pods (optional)
3/4 cup coconut milk or evaporated milk
1 tablespoon cornstarch mixed with 2 tablespoons water

In a Dutch oven, heat oil over medium heat. Saute onion and carrot until onions begin to color. Add lentils, curry powder, broth, bay leaf, cardamom pods, and coconut milk. Bring to a boil and then lower heat and simmer for about 15-20 minutes or until lentils are soft. Remove the bay leaf and cardamom pods (which should be floating on or near the surface).

At this point, you can either use an immersion blender to puree the soup, or you can leave all the chunks. Increase heat under the soup to high and add the cornstarch slurry (or as much as you need to get the soup to the right consistency for you). Top with sour cream if desired.

Serves 4.

By Mandi Cacioppo

Avocado Salsa, Low on Sodium but High in Flavor!

Pathways is starting a recipe of the month post on our blog to promote a healthy living lifestyle. Each month will feature an original healthy recipe from our employees. To start us off, I am presenting a recipe titled "Señora's Avocado Salsa".

You will need the following ingredients:

1 package (16 oz) frozen corn, thawed
1 can (15 oz) black beans (look for low sodium)
1 medium sweet red pepper, chopped
1 small onion, chopped
1 bunch cilantro, finely chopped
3 fresh tomatoes, chopped
3 garlic cloves, diced
1/4 cup lime juice
3 tablespoons cider or white vinegar
1 teaspoon dried oregano
1/2 teaspoon or less salt
1/2 teaspoon pepper
4 medium ripe avocados

In a large bowl, combine corn, black beans, red pepper, onion, cilantro and tomatoes. In a small bowl, whisk together the garlic, lime juice, vinegar, oregano, salt and pepper.

Mix well. Pour over corn mixture and toss to coat. Cover and refrigerate overnight.

Just before serving, chop avocados and stir into salsa. Serve with low sodium tortilla chips or as a side dish. Yield about 7 cups. Tip - if you place the avocado pit into the salsa, the avocados won't turn brown.

This is delicious. I was hesitant about a salsa with no spicy peppers in it, but this is really tasty. I tried it in tacos and it's great because you also get all the healthy benefits of the tasty veggies in the salsa. Next time I would add a bit less garlic because it was really strong, but that depends on your preference. I also added green onions because I prefer them in my salsa instead of a regular onion.

By Mandi Cacioppo, Sr. Marketing & Communications Coordinator at Pathways Home Health and Hospice. Recipe credit goes to my cousin Lynn Fors.

Living the Low Salt Life as a Heart Failure Patient

When you have heart failure, it is important to decrease the amount of sodium in your diet. Salt acts like a sponge, making your body hold on to extra water.

Eating too much of it can cause weight gain, increased blood pressure, make legs and feet swell and cause water to go to the lungs.  This makes your heart work harder and worsens heart failure systems. 

Check with your doctor to see how much salt you can have in a day. Most doctors recommend less than 2,000 milligrams (mg) or salt each day.

How much salt in a teaspoon?

• 1 teaspoon of salt = 2000 mg of sodium
• 1 teaspoon of baking soda = 821 mg of sodium
• 1 teaspoon of baking powder = 339 mg of sodium

Read food labels to help figure out how much salt is in the food. A good rule of thumb is to choose foods with less than 250 mg of sodium per serving.

Remember, a serving size is not necessarily an entire container of food. If a can contains 3 servings and you eat the whole can, multiply the sodium per serving by 3.

Read the Label - Serving Sizes

•  A can of soup has 300 mg of sodium per serving
• The can has 2 servings.
• You eat the whole can, or 2 servings.
• So you would have 300 mg x 2 or 600 mg of sodium.

Compare salt (sodium) in foods you eat often, especially processed foods like soup, lunch meat, cheese and frozen meals.  Sort the foods into higher or lower sodium groups.

To lower your sodium intake, stop adding salt to food during cooking. Try taking the salt shaker off the table and add other seasonings to add flavor such as lemon juice, onion or garlic power, or herbs.

Avoid high sodium foods like canned foods, hot dogs, cheese and cheese spreads, deli meats, bacon,  ketchup, soy sauce, salad dressings, barbecue sauce, and frozen meals that are high in sodium.

Replace high sodium foods with fresh fruits and vegetables, lean meats, low fat milk, reduced sodium cheese and cereals low in sodium. When you go out to eat, choose food on the menu marked “healthy choice” or “low sodium”. Ask for sauces and salad dressings “on the side” and ask the waiter for low salt recommendations.

Pathways participates in SVGives May 6th Campaign

Pathways Home Health & Hospice is participating in the one-day SVGives campaign. You should start seeing social media promotions from numerous non-profits that serve residents in the San Francisco Bay Area about this event. SVGives is scheduled for May 6^th.   

Here is a brief video that explains what SVGives is and how through the power of coming together, we can bring services and comfort to those who need it the most in our communities.

Learn More about SVGives

Tales of Love and Loss: Sharing the Past with Jeannine

"With calm conviction, and a touch of regret, she looked me in the eye and declared that everyone has a story to tell. She felt that such a significant task as preserving that knowledge should never be delayed until it is too late."

Hospice volunteers often listen to patients and their stories. One Pathways volunteer, Christy Yuen, chronicled the story of Jeannine. 

This week is volunteer appreciation week. Pathways would like to formerly applaud all of our volunteers who help our patient’s tell their stories. Thank you for giving your time and attention to other human beings when they need it the most.

Jeannine, an 89 year-old French lady, knew her days were numbered. More than anything, she wished to put her memories down on paper. I visited her three times before she suddenly passed away. During those special hours as I typed, her accented voice whisked us back into history… 

Like the children in C.S. Lewis’ The Chronicles of Narnia, I found myself in a world of adventure and war, love and loss. Pausing occasionally to clarify the spelling of a French name, Jeannine spoke for hours about her ancestors and their lives in France. She told stories of war, including her time as a resistance fighter in World War II, and of her father, a pilot, crossing over enemy territory on dangerous missions. She told stories of tragedy; stillborn babies, deaths from tuberculosis and pneumonia, and widows and orphans left behind by war. She remembered how elderly folks were forced to sleep on hard wooden floors in the wintertime while invading soldiers occupied their homes.

She also told stories of the human spirit, recalling how her uncle, a chef, made piping hot French fries for hordes of hungry children who waited on the streets for their parents to return home from working late. She described independent wives who rejected their alcoholic, skirt-chasing husbands in favor of raising their children alone and successfully running their own businesses. 

 Humor was frequently woven into her stories, such as the young woman who duped her boyfriend into marrying her, and a village that fooled the occupying enemy soldiers by playing a trick involving a sacrificed pig.

Interspersed throughout her monologues were heartfelt remarks about today’s world. She spoke with ease and fluidity about changing gender roles, the difficulty of learning a foreign language, intolerance towards homosexuals, and the importance of understanding cultural differences. She lambasted the government with characteristic poise and clarity in one breath, while bemoaning the loss of children’s innocence in the next. She remarked on the lack of opportunities for “kids to just be kids.” 

When she spoke about the physical, social, and psychological devastation of ongoing wars, her wise eyes would become rimmed with sadness. “We have not learned the lessons of the past,” she would say, slowly shaking her head.

Unfortunately, Jeannine and I did not get to finish her memoirs. I often remember something she told me at our first visit. With calm conviction, and a touch of regret, she looked me in the eye and declared that everyone has a story to tell. She felt that such a significant task as preserving that knowledge should never be delayed until it is too late.

For the privilege of sharing in her memories, for the insight she dispensed with such wit and character, and for all the reminders of what is truly important in life, I would like to thank Jeannine. Merci Beaucoup.

 

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