St. Stephen Health/Safety Ministry
The St. Stephen Health/ Safety
Ministry is looking to identify Licensed/Certifies Medical Professionals to assist in Health and Safety  issues during our mass schedules.  If you are a Licensed/Certified Medical Professional and are interested in assisting in the ministry, please contact
Allison Runyon at 678-371-0677.  I will explain the goals of the ministry.  Thank You in advance for your assistance.
 
 

Summer Safety Tips

Summer’s here, the kids are out of school, and everyone will be spending more time outdoors.
Here are a few things you need to consider.
 Be prepared for anything by checking the weather before you head outside.
 Lather on sunscreen anytime you’re outdoors, especially on small kids and infants.
 Wear the right clothing and accessories.
 Pack a refillable water bottle and first aid kit.
 Be vigilant about water safety, especially for those young and small kids.
 Know the risks and signs of heat exhaustion.
 NEVER leave your pets or children unattended in a car.
By John Chenus St. Stephen Safety Committee

Know The Signs of a Heatstroke
 High body temperature. A core body temperature of 104 F (40 C) or higher,
is the main sign of heatstroke.
 Altered mental state or behavior. Confusion, agitation, slurred speech,
irritability, delirium, dizziness, light-headedness, seizures and coma can all
result from heatstroke.
 Alteration in sweating. In heatstroke brought on by hot weather, your skin
will feel hot and dry or slightly moist to the touch.
 Nausea and vomiting. You may feel sick to your stomach or vomit.
 Flushed skin. Your skin may turn red, hot and dry as your body temperature
increases.
 Muscle weakness or cramps
 Rapid breathing. Your breathing may become rapid and shallow.
 Racing heart rate. Your pulse may significantly increase because heat stress
places a tremendous burden on your heart to help cool your body.
 Headache. Your head may throb.
 Seizures
By John Chenkus St. Stephen Safety Committee

What are direct oral anticoagulants? — These are prescription medicines that make your blood less likely to clot. They include a medicine called dabigatran (brand name: Pradaxa) and a group of medicines called factor Xa inhibitors: apixaban (brand name: Eliquis), edoxaban (brand names: Savaysa, Lixiana), and rivaroxaban (brand name: Xarelto). 
 These medicines are also known as "anticoagulants," "blood thinners," or "anti-clotting medicines." They are called "direct" because they block clotting factors directly. (Clotting factors are proteins in the blood that help it to clot.) This is different from how warfarin, another type of anti-clotting medicine, works. "Oral" means they are taken as pills.
How are these medicines different from warfarin? — Warfarin (sample brand name: Coumadin) has been used for many years to prevent and treat blood clots. The direct oral anticoagulants are newer. They work as well as or better than warfarin for most people, but they have some differences
●All of the anti-clotting medicines can cause bleeding. Some kinds of bleeding – like bleeding in the brain – are less likely with the direct oral anticoagulants than with warfarin.
●People taking these medicines do not need regular blood tests to check how their blood is
●For the direct oral anticoagulants, there are not as many medicines that affect the way they work. (For warfarin, there are many more medicines that might change the way it works.) But it's still important to talk to your doctor about any medicines you take.
●People with a mechanical heart valve (a device used to replace a damaged heart valve) need to take an anti-clotting medicine, but they should not take any of the direct oral anticoagulants. These people take warfarin instead.
●Pregnant women who need an anti-clotting medicine usually do not take direct oral anticoagulants or warfarin. They usually get a medicine called "low molecular weight heparin" instead. The common ones are enoxaparin (brand name: Lovenox) and dalteparin (brand name: Fragmin). They come as a shot. Some of the differences between the anti-clotting medicines can be serious, and others are more a matter of convenience. Talk with your doctor about which of the medicines is best for you. Why might my doctor prescribe an anti-clotting medicine? — The main reasons doctors prescribe anti-clotting medicines are to prevent blood clots or to treat blood clots that have already formed. Nothing can completely prevent all blood clots, but anti-clotting medicines lower the risk of clots.
These medicines do not dissolve clots, but they keep them from growing bigger and moving to another part of the body. Doctors prescribe anti-clotting medicines to prevent clots in:
●People who have a heart rhythm problem called "atrial fibrillation" – In people with this condition, the medicine helps lower the chances of stroke from a blood clot.
●People who have had hip or knee replacement surgery – These medicines help prevent a blood clot in the legs (called a "deep vein thrombosis" or "DVT") or the lungs (called a "pulmonary embolism" or "PE").
Doctors also prescribe anti-clotting medicines for people who have already had a clot, to prevent more problems. This includes: ●People who have had a stroke related to atrial fibrillation
 ●People who have had a DVT or PE The goal is to lower the chances that the blood clot might get bigger or move to another part of the body, and to lower the chances of new clots forming. If you need an anti-clotting medicine, your doctor might order blood tests to check how well your kidneys or liver work. If you have kidney or liver problems, the direct oral anticoagulants might not be right for you, or you might need to take a lower dose.
What do I need to do? — If you take one of these medicines to prevent blood clots, there are certain things you should do:
●Know the strength of your medicine, what the pills look like, and why your doctor prescribed it for you – The strength of the medicine is given in milligrams ("mg").
●Take your medicine exactly as your doctor tells you to – It is very important to take these medicines exactly as your doctor tells you to. Take them at the same time each day and do not skip any doses. Do not take 2 doses at once, change the dose, or stop taking this drug without talking to your doctor. Always refill your prescription before you run out of pills.
•Most anti-clotting medicines can be taken either with or without food. Rivaroxaban doses higher than 10 mg need to be taken with food.
•If you take apixaban, avoid grapefruit and grapefruit juice. That's because grapefruit can change the effects of apixaban.
●Do not take pain relievers like ibuprofen or naproxen – These can also increase your risk of bleeding, especially if combined with an anti-clotting medicine. If you need a pain reliever, ask your doctor which one is safe.
 Acetaminophen (sample brand name: Tylenol) is usually OK.
●Ask your doctor before taking any new medicines – This includes prescription medicines, over-the-counter medicines, and herbal remedies. Certain medicines and remedies can change the effects of these anti-clotting medicines.
●Wear a medical alert tag – Always wear a bracelet, necklace, or alert tag (or carry a wallet card) that warns people that you take an anti-clotting medicine and why. That way, if you are in an accident and are unable to explain your condition, responders will know how to care for you. Your alert tag should also have the name and phone number of an emergency contact person.
●Follow instructions specific to dabigatran – If you take dabigatran (brand name: Pradaxa), there are a few other things you need to be careful about:
•Keep dabigatran pills in the original bottle or blister packaging they came in – Do not put this medicine in any other container, such as a pill box or pill organizer. If your medicine comes in a bottle, use the pills within 4 months of opening it.
•Take dabigatran with a full glass of water after a meal – Do not lie down for at least half an hour after taking it. This will lessen the chance of heartburn or an upset stomach.
•Do not break, chew, or open the dabigatran capsules – If you cannot swallow dabigatran capsules whole, talk to your doctor. You might need to switch to a different medicine. That's because taking opened or broken dabigatran capsules can be harmful. What are the side effects of the direct oral anticoagulants? — The most common side effect is bleeding from any part of your body. The bleeding can be minor or sometimes serious. Bleeding can be inside your body, where you cannot see it. In certain cases, if you have serious bleeding, your doctor can treat it with a medicine that blocks the effects of your anti-clotting medicine. Is there anything I can do to lower the risk of bleeding? — Yes. You can:
 ●Avoid doing things that could lead to a fall, such as walking on slippery surfaces or climbing on a high stool.
●Avoid sports that might cause injury.
●Use care when handling sharp tools, or avoid them when possible. Examples of tools that could cause serious bleeding if they cut you are sharp knives, saws, and straight edge razors.
 ●Always use a seatbelt.
●Avoid using non-prescription medicines that contain an "NSAID" unless you talk to your doctor first. NSAIDs are a group of pain-relieving medicines that includes aspirin, ibuprofen, and naproxen.
●Avoid drinking too much alcohol, which can increase your risk of bleeding.
 ●If you see a new doctor, dentist, or nurse, let them know you are taking an anti-clotting medicine

Dr. Jonathan Powell, MD – St. Stephen Health Ministry
 

HEART FAILURE

INTRODUCTION — Heart failure is a condition that occurs when the heart cannot pump or fill with enough blood, which means that the heart must work harder to deliver blood to the body. The term "heart failure" is misleading because the heart does not completely fail or stop. Heart failure can be mild and cause minor symptoms that are only evident with exercise, or it may be severe, leading to symptoms at rest, or even life-threatening. The most common symptoms of heart failure are shortness of breath, feeling tired, leg swelling, and other signs of fluid retention.
Although heart failure is a serious condition, safe and effective treatments are available. Treatment can help you to feel better and live longer.
TYPES OF HEART FAILURE — The heart is composed of four chambers: The two upper chambers are the right and left atria, and the two lower chambers are the right and left ventricles. The left ventricle plays a key role because it pumps blood to the entire body. In a person with heart failure, the heart cannot adjust to the body's changing need for oxygenated blood (for example, when climbing stairs).
There are two main types of heart failure. They are defined based on whether the "ejection fraction" (which indicates how well the left ventricle is able to pump) is preserved or reduced:
●In "heart failure with reduced ejection fraction" (also called "HFrEF" or "systolic heart failure"), the heart is too weak. When the heart pumps, it doesn’t squeeze normally.
●In "heart failure with preserved ejection fraction" (also called "HFpEF" or "diastolic heart failure"), the heart is too stiff. When the heart pumps, it doesn’t relax and fill with blood normally.
HEART FAILURE CAUSES — Heart failure is caused by a disease or condition that damages the heart. Fortunately, treating these conditions during the early stages can often prevent or slow development of heart failure. The most common causes of heart failure include:
High blood pressure (hypertension) — In people with high blood pressure, the heart must work harder to pump blood. This increased workload can, over time, lead to an enlarged heart that does not work well.
Coronary heart disease — Coronary heart disease causes narrowing of the blood vessels that supply ("feed") the heart muscle, reducing the flow of blood through the vessels. As a result, portions of the heart muscle are deprived of oxygen (especially during exercise, when the body needs more blood supply and oxygen), and the heart does not perform its work as well. Coronary heart disease can also lead to a heart attack (also called a myocardial infarction), which causes permanent damage to the heart muscle. Coronary heart disease can cause heart failure when it impairs the function of the heart.
Heart valve disease — A number of conditions, including heart attack and aging, can damage the heart valves.
●The valve can become narrowed (stenosed), which interferes with blood flow through the valve and increases pressure in the heart.
●In other cases, the valve can become leaky (insufficient), causing blood to flow backward (regurgitation).
Some valves become both stenosed and regurgitant.
Cardiomyopathy — In cardiomyopathy, the structure and/or function of the heart muscle is altered, leading to a poorly pumping heart that may exhibit either HFrEF or HFpEF.
 
HEART FAILURE SYMPTOMS — As the amount of blood pumped by the heart (the cardiac output) decreases, a variety of symptoms can develop.
●Weakness, particularly of the legs when exercising.
●Lightheadedness or dizziness.
●Shortness of breath, which might require you to be less active or sleep with several pillows to elevate your head.
●A rapid heart rate, even while resting.
●Swelling in the lower legs and feet (edema) or in the abdomen (ascites).
●Feeling tired or fatigued quickly.
HEART FAILURE DIAGNOSIS — Heart failure is diagnosed based upon your medical history, an exam, and a series of tests. These tests can tell your doctor how well your heart is working and can help determine the cause of your heart failure. Tests may include:
●Electrocardiogram (EKG) – An EKG provides a picture of the electrical activity that causes the heart to beat. An EKG may detect conditions, such as an abnormal heart rhythm or a previous heart attack that could cause heart failure.
●A blood test known as brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP). The BNP or NT-proBNP level is elevated in people with heart failure.
●Chest X-ray – A chest X-ray shows the size and shape of the heart and the large blood vessels in the chest. It also can show if there is fluid in the lungs.
●Echocardiogram – An echocardiogram uses ultrasound (high-frequency sound waves) to assess the size and function of the heart's chambers and the structure and function of the heart valves. This includes measuring how well the left ventricle pumps (known as the "ejection fraction"). A follow-up echocardiogram can be done to see if your heart function changes over time.
●Exercise testing – An exercise test ("stress test") determines how well your heart performs during exercise. It is one way to look for signs of a shortage of blood supply to your heart caused by blockages in the coronary arteries. A doctor or nurse will see how your heart responds to exercise by looking at the EKG, blood pressure, and heart rate as you walk on a treadmill. In addition, pictures may be taken to measure the effect of exercise on the heart.
●Heart (cardiac) catheterization – Cardiac catheterization helps to measure how well the heart is functioning and provides pictures of the coronary arteries to look for blockages. During the test, a thin tube (the catheter) is inserted through a large blood vessel in the groin (or arm) and advanced into the heart. A dye is injected into the catheter to view the arteries and the structure of the heart by X-ray. The pumping function of the heart can also be assessed during catheterization.
●Other tests – Computed tomography (CT), magnetic resonance imaging (MRI), and nuclear scanning are sometimes used to look at the heart muscle and coronary arteries in specific situations.
HEART FAILURE COMPLICATIONS — Heart failure can cause symptoms and make you feel ill. It can cause dangerous, even life-threatening complications. Left untreated, heart failure generally is often a progressive condition. The goal of treatments for heart failure is to reduce symptoms, reduce the chance of developing complications, and slow or stop the progression of the underlying process. Some common complications include:
●Irregular heart rhythms (called arrhythmias), which can make symptoms worse or cause blood clots. Some irregular heart rhythms are life threatening.
●Kidney disease, which may be caused or worsened by heart failure. Kidney disease may also make heart failure worse.
●Liver disease, which may be caused by heart failure.
HEART FAILURE TREATMENT — In most people, heart failure is a chronic problem, meaning that it continues for months and years. Heart failure is generally treatable but rarely goes away completely. Treatment usually includes a combination of changes in your diet and lifestyle, medicines, and sometimes a device to protect your heart from abnormal rhythms.
Diet and lifestyle — Changes in diet and lifestyle are often recommended to treat heart failure. The most common recommendations include:
●Decrease salt and water – Salt in the diet can cause the retention of excess fluid in the circulation, lungs, and elsewhere in the body. Therefore, managing the amount of salt (sodium) in the foods you eat can help to keep heart failure under control. Ask your doctor how much salt you should eat. Low-sodium diets are discussed separately.
The amount of fluid you drink is also important. People with severe heart failure are often asked to drink less than 2 liters (66 ounces) of fluid per day. This includes all fluids. Your doctor might give you more specific guidance on fluid limits based on your condition.
●Weigh yourself every day – To monitor your fluid levels, weigh yourself every day at the same time on the same scale (eg, in the morning after you urinate but before eating breakfast). Be sure to wear the same amount of clothing each time you weigh yourself. If your weight increases by 2 pounds (1 kilogram) in one day, call your doctor or nurse. Also, if your weight increases by four pounds (2 kg) in one week, call your doctor or nurse. Gaining weight suddenly is one sign that you may be retaining more fluid than you should be.
●Control your weight – If you are overweight, your heart must work harder to supply blood and oxygen to your body. Losing weight can help you to feel better and reduces the strain on your heart. On the other hand, losing a lot of weight quickly can be a sign of severe heart failure. For advice on weight management, talk to your doctor or nurse.
●Stop smoking – Cigarette smoking increases your risk of having a heart attack and can worsen heart failure. If you smoke, talk to your doctor or nurse to get help with quitting.
●Limit alcohol – Drinking too much alcohol is not good for your heart or your health generally. People with heart failure should not drink more than one serving of alcohol per day (for women) or two servings per day (for men). One serving is 12 ounces of beer or 5 ounces of wine. If your heart failure is related to drinking too much, you should stop drinking alcohol completely.
●Cardiac rehab and exercise – Exercising most days of the week can help to improve the fitness of your cardiovascular system and exercising muscles, and thereby reduce shortness of breath and fatigue, which are common problems in people with heart failure. Becoming more active can also help you to feel better. For exercise advice, talk to your doctor or nurse. They might recommend a cardiac rehab program to help you develop a safe exercise plan.
Medicines — Medicines are often used to treat heart failure symptoms; some medicines have even been proven to prolong life. It is very important to take these medicines on time every single day. If you cannot afford or have trouble taking your medicines, talk to your doctor or nurse.
There are some differences in the medications used to treat "heart failure with reduced ejection fraction" and "heart failure with preserved ejection fraction."
Medicines for heart failure with reduced ejection fraction — Medicines commonly prescribed to treat heart failure with reduced ejection fraction include:
●Diuretic – People with heart failure often develop swelling (or edema) in the legs and fluid in the lungs. A diuretic (also called a "water pill") helps the body get rid of the excess fluid. The dose of diuretic requires careful monitoring and adjustment by your clinician, taking into consideration changes in your diet, underlying condition, or other medications.
●Angiotensin converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), or angiotensin receptor-neprilysin inhibitor (ARNI) – An ACE inhibitor, ARB, or ARNI widens blood vessels and lowers blood pressure, making it easier for your heart to pump. These medicines also protect the heart from hormone effects that can happen when a person has heart failure. ACE inhibitors can sometimes cause a dry cough, in which case an ARB may be preferred. The ARNI sacubitril-valsartan is a newer heart failure medicine that can be used instead of an ACE inhibitor. These medications can help prolong life.

Some examples of ACE inhibitors include enalapril, captopril, and lisinopril (brand name: Zestril). Some examples of ARBs include losartan (brand name: Cozaar) and valsartan (brand name: Diovan). The ARNI sacubitril-valsartan (brand name: Entresto) has two medicines in a single pill. One is the ARB called valsartan; the other is called sacubitril, and can help your body to retain less fluid and relax blood vessels.
 
●Beta blocker – A beta blocker can slow the heart rate and decrease blood pressure. A beta blocker also protects the heart from the adverse effects of certain hormones that are increased when a person has heart failure. It can take time to start working, and some people feel worse right after they start taking it. If your doctor prescribes a beta blocker, give it a little time to start working. This medication can help prolong life.

Some examples of beta blockers include carvedilol (brand name: Coreg), metoprolol (brand name: Toprol XL), and bisoprolol.

Ivabradine (brand name: Corlanor) is a newer type of drug to slow the heart rate. Your doctor might prescribe ivabradine if your heart rate is still a little fast with a beta blocker, or if you cannot take a beta blocker.
●Mineralocorticoid receptor antagonist – A mineralocorticoid receptor antagonist is a type of diuretic; it helps the body get rid of extra salt and fluid. However, it also helps the body hold onto potassium. That's important because other diuretics sometimes make the body lose too much potassium, which the body needs to work normally. Mineralocorticoid receptor antagonists might also protect the heart from hormone effects that can happen when a person has heart failure.
When taking this type of medicine, it is very important to have regular blood tests to check your potassium levels and see how your kidneys are working. Your doctor or nurse should follow the results of these tests closely.
Some examples of mineralocorticoid receptor antagonists include spironolactone (brand name: Aldactone) and eplerenone (brand name: Inspra).
●Nitrate with hydralazine – A nitrate and hydralazine work together to relax and expand blood vessels. This makes it easier for the heart to pump blood throughout the body. This combination of medicines is sometimes used in people who cannot take an ACE inhibitor. Unfortunately, the medicines often cause side effects (such as headaches and nausea), so doctors usually try other options before suggesting them.
These two medicines come in a single pill, but it is possible to get the two ingredients separately for much less money. The two ingredients come in pills of "isosorbide dinitrate" and "hydralazine."
●Digoxin – Digoxin helps the heart pump with more force. This can help reduce some of the symptoms of heart failure.
Medicines for heart failure with preserved ejection fraction — Medicines commonly prescribed to treat heart failure with preserved ejection fraction include:
●Diuretic – People with heart failure often develop swelling (or edema) in the legs and fluid in the lungs. A diuretic (also called a "water pill") helps the body get rid of the excess fluid.
●Mineralocorticoid receptor antagonist – A mineralocorticoid receptor antagonist is a type of diuretic; it helps the body get rid of extra salt and fluid. However, it also helps the body hold onto potassium. That's important because other diuretics sometimes make the body lose too much potassium, which the body needs to work normally. Mineralocorticoid receptor antagonists might also protect the heart from hormone effects that can happen when a person has heart failure.
When taking this type of medicine, it is very important to have regular blood tests to check your potassium levels and see how your kidneys are working. Your doctor or nurse should follow the results of these tests closely.
Some examples of mineralocorticoid receptor antagonists include spironolactone (brand name: Aldactone) and eplerenone (brand name: Inspra).
●Medicine to control high blood pressure – If you have high blood pressure, your doctor might prescribe medicines to control it.
Heart rhythm treatment — In some people with heart failure, an abnormal heart rhythm develops. Some abnormal heart rhythms are treated with medications.
If you have a condition that causes an abnormal heart rhythm, your doctor might recommend a device that shocks the heart and returns it to a normal rhythm. The device is called an implantable cardioverter-defibrillator (ICD). It is implanted under the skin in your upper chest.
Another potential problem in people with heart failure is abnormal electrical conduction in the heart. This can cause the walls of the left ventricle to contract out of sync, making the heart work less efficiently. A special type of pacemaker, called cardiac resynchronization therapy (CRT) or biventricular pacing, can treat this problem. A device that includes both CRT and ICD is available, if needed.
Surgery or stenting — Surgery is sometimes recommended for people with heart failure who also have coronary heart disease or severe disease of the heart valves. This might include heart valve surgery or coronary artery bypass graft (CABG) surgery or both.
In some cases, coronary heart disease can be treated with a coronary artery angioplasty or stent procedure.
Treatment for advanced heart failure — Heart transplantation can be helpful for some people with severe heart failure that has not responded to other treatments. However, careful screening is required to ensure that heart transplantation is appropriate. In addition, the supply of hearts for transplant is limited, so most people must wait for months or even years before a heart is available. People who have a heart transplant are followed closely before and after surgery, since there are numerous risks.
Your doctor might recommend a left ventricular assist device instead of transplantation OR while you wait for transplantation. These devices are implanted inside the chest and are designed to improve blood flow to the body when the heart pump is weakened.

Jonathan Powell, MD
jpowellmd89@gmail.com





HOW TO CARE FOR YOURSELF — Being diagnosed with heart failure can be frightening. There are a few basic guidelines that can help to manage your condition:
●Always take your medicines. Do not skip doses when you feel better. If you cannot afford your medicines, talk to your doctor or nurse.
●Tell your doctor if your medicines cause side effects or other problems. Your doctor might be able to switch to another medicine or lower your dose so that you do not have that problem.
●Look for signs that your heart failure is getting worse (ie rapidly increasing weight, increased swelling, increasing shortness of breath)
When to seek help — Call 911 for help if the following occur:
●Severe shortness of breath
●Chest discomfort or pain that lasts more than 15 minutes and does not get better with rest or nitroglycerin
●Fainting or passing out
Call your doctor or nurse if you develop any of the following, which can be signs of worsening heart failure:
●Increasing or new shortness of breath
●New or worsened cough, especially if you are coughing up frothy or bloody material
●Worsened swelling in your legs or ankles
●Weight gain of two pounds (1 kilogram) in one day or four pounds (2 kg) in one week
●Fast or irregular heartbeat
What is sodium? — Sodium is the main ingredient in table salt. It is also found in lots of foods, and even in water. The body needs a very small amount of sodium to work normally, but most people eat much more sodium than their body needs.
Who should cut down on sodium? — Nearly everyone eats too much sodium. The average American takes in 3,400 milligrams of sodium each day. Experts say that most people should have no more than 2,300 milligrams a day.
Ask your doctor how much sodium you should have.
Why should I cut down on sodium? — Reducing the amount of sodium you eat can have lots of health benefits:
●It can lower your blood pressure, which means it can help reduce your risk of stroke, heart attack, kidney damage, and lots of other health problems.
●It can reduce the amount of fluid in your body, which means that your heart doesn't have to work as hard to push a lot of fluid around.
●It can keep the kidneys from having to work too hard. This is especially important in people who have kidney disease.
●It can reduce swelling in the ankles and belly, which can be uncomfortable and make it hard to move.
●It can reduce the chances of forming kidney stones.
●It can help keep your bones strong.
Which foods have the most sodium? — Processed foods have the most sodium. These foods usually come in cans, boxes, jars, and bags. They tend to have a lot of sodium even if they don't taste salty. In fact, many sweet foods have a lot of sodium in them. The only way to know for sure how much sodium you are getting is to check the label (figure 1).
Here are some examples of foods that often have too much sodium:
●Canned soups
●Rice and noodle mixes
●Sauces, dressings, and condiments (such as ketchup and mustard)
●Pre-made frozen meals (also called "TV dinners")
●Deli meats, hot dogs, and cheeses
●Smoked, cured, or pickled foods
●Restaurant meals
What should I do to reduce the amount of sodium in my diet? — Many people think that avoiding the salt shaker and not adding salt to their food means that they are eating a low-sodium diet. This is not true. Not adding salt at the table or when cooking will help a little. But almost all of the sodium you eat is already in the food you buy at the grocery store or at restaurants.
The most important thing you can do to cut down on sodium is to eat less processed food. That means that you should avoid most foods that are sold in cans, boxes, jars, and bags. You should also eat in restaurants less often.
Instead of buying pre-made, processed foods, buy fresh or fresh-frozen fruits and vegetables. (Fresh-frozen foods are foods that are frozen without anything added to them.) Buy meats, fish, chicken, and turkey that are fresh instead of canned or sold at the deli counter. (Meats sold at the deli counter are high in sodium). Then try making meals from scratch at home using these low-sodium ingredients.
If you must buy canned or packaged foods, choose ones that are labeled "sodium free" or "very low sodium" (table 1). Or choose foods that have less than 400 milligrams of sodium in each serving. The amount of sodium in each serving appears on the nutrition label that is printed on canned or packaged foods (figure 1).
Also, whatever changes you make, make them slowly. Choose one thing to do differently, and do that for a while. If that change sticks, add another change. For instance, if you usually eat green beans from a can, try buying fresh or fresh-frozen green beans and cooking them at home without adding salt. If that works for you, keep doing it. Then choose another thing to change. If it doesn't work, don't give up. See if you can cut down on sodium another way. The important thing is to take small steps and to stick with the changes that work for you.
What if I really like to eat out? — You can still eat in restaurants once in a while. But choose places that offer healthier choices. Fast-food places are almost always a bad idea. As an example, a typical meal of a hamburger and french fries from a popular fast-food chain has about 1,600 milligrams of sodium. That's more sodium than some people should eat in a day!
When choosing what to order:
●Ask your server if your meal can be made without salt
●Avoid foods that come with sauces or dips
●Choose plain grilled meats or fish and steamed vegetables
●Ask for oil and vinegar for your salad, rather than dressing
What if food just does not taste as good without sodium? — First of all, give it time. Your taste buds can get used to having less sodium, but you have to give them a chance to adjust. Also try other flavorings, such as herbs and spices, lemon juice, and vinegar.
What about salt substitutes? — Do not use salt substitutes unless your doctor or nurse approves. Some salt substitutes can be dangerous to your health, especially if you take certain medicines.
Do medicines have sodium? — Yes, some medicines have sodium. If you are buying medicines you can get without a prescription, look to see how much sodium they have. Avoid products that have "sodium carbonate" or "sodium bicarbonate" unless your doctor prescribes them. (Sodium bicarbonate is baking soda.)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Figure 1

Table 1






What do labels about sodium mean?

What is high blood pressure? — High blood pressure is a condition that puts you at risk for heart attack, stroke, and kidney disease. It does not usually cause symptoms. But it can be serious.
When your doctor or nurse tells you your blood pressure, he or she will say 2 numbers. For instance, your doctor or nurse might say that your blood pressure is "140 over 90." The top number is the pressure inside your arteries when your heart is contracting. The bottom number is the pressure inside your arteries when your heart is relaxed.
The table shows how doctors and nurses define high and normal blood pressure. "Prehypertension" is a term doctors or nurses use as a warning. People with prehypertension do not yet have high blood pressure. But their blood pressure is not as low as it should be for good health.
How can I lower my blood pressure? — If your doctor or nurse practitioner has prescribed blood pressure medicine, the most important thing you can do is to take it. If it causes side effects, do not just stop taking it. Instead, talk to your doctor or NP about the problems it causes. He or she might be able to lower your dose or switch you to another medicine. If cost is a problem, mention that too. He or she might be able to put you on a less expensive medicine. Taking your blood pressure medicine can keep you from having a heart attack or stroke, and it can save your life!
Can I do anything on my own? — You have a lot of control over your blood pressure. To lower it:
●Lose weight (if you are overweight)
●Choose a diet low in fat and rich in fruits, vegetables, and low-fat dairy products
●Reduce the amount of salt you eat
●Do something active for at least 30 minutes a day on most days of the week
●Cut down on alcohol (if you drink more than 2 alcoholic drinks per day)
It's also a good idea to get a home blood pressure meter. People who check their own blood pressure at home do better at keeping it low and can sometimes even reduce the amount of medicine they take.
 
 

 
What does my lifestyle have to do with my blood pressure? — The things you do and the foods you eat have a big effect on your blood pressure and your overall health. Following the right lifestyle can:
●Lower your blood pressure or keep you from getting high blood pressure in the first place
●Reduce your need for blood pressure medicines
●Make medicines for high blood pressure work better, if you do take them
●Lower the chances that you'll have a heart attack or stroke, or develop kidney disease
Which lifestyle choices will help lower my blood pressure? — Here's what you can do:
●Lose weight (if you are overweight)
●Choose a diet rich in fruits, vegetables, and low-fat dairy products, and low in meats, sweets, and refined grains
●Eat less salt (sodium)
●Do something active for at least 30 minutes a day on most days of the week
●Limit the amount of alcohol you drink
If you have high blood pressure, it's also very important to quit smoking (if you smoke). Quitting smoking might not bring your blood pressure down. But it will lower the chances that you'll have a heart attack or stroke, and it will help you feel better and live longer.
Start low and go slow — The changes listed above might sound like a lot, but don't worry. You don't have to change everything all at once. The key to improving your lifestyle is to "start low and go slow." Choose 1 small, specific thing to change and try doing it for a while. If it works for you, keep doing it until it becomes a habit. If it doesn't, don't give up. Choose something else to change and see how that goes.
Let's say, for example, that you would like to improve your diet. If you're the type of person who eats cheeseburgers and French fries all the time, you can't switch to eating just salads from 1 day to the next. When people try to make changes like that, they often fail. Then they feel frustrated and tend to give up. So instead of trying to change everything about your diet in 1 day, change 1 or 2 small things about your diet and give yourself time to get used to those changes. For instance, keep the cheeseburger but give up the French fries. Or eat the same things but cut your portions in half.
As you find things that you are able to change and stick with, keep adding new changes. In time, you will see that you can actually change a lot. You just have to get used to the changes slowly.
Lose weight — When people think about losing weight, they sometimes make it more complicated than it really is. To lose weight, you have to either eat less or move more. If you do both of those things, it's even better. But there is no single weight-loss diet or activity that's better than any other. When it comes to weight loss, the most effective plan is the one that you'll stick with.
Improve your diet — There is no single diet that is right for everyone. But in general, a healthy diet can include:
●Lots of fruits, vegetables, and whole grains
●Some beans, peas, lentils, chickpeas, and similar foods
●Some nuts, such as walnuts, almonds, and peanuts
●Fat-free or low-fat milk and milk products
●Some fish
To have a healthy diet, it's also important to limit or avoid sugar, sweets, meats, and refined grains. (Refined grains are found in white bread, white rice, most forms of pasta, and most packaged "snack" foods.)
Reduce salt — Many people think that eating a low-sodium diet means avoiding the salt shaker and not adding salt when cooking. The truth is, not adding salt at the table or when you cook will only help a little.
The most important thing you can do to cut down on sodium is to eat less processed food. That means that you should avoid most foods that are sold in cans, boxes, jars, and bags. You should also eat in restaurants less often.
To reduce the amount of sodium you get, buy fresh or fresh-frozen fruits, vegetables, and meats. (Fresh-frozen foods have had nothing added to them before freezing.) Then you can make meals at home, from scratch, with these ingredients.
As with the other changes, don't try to cut out salt all at once. Instead, choose 1 or 2 foods that have a lot of sodium and try to replace them with low-sodium choices. When you get used to those low-sodium options, find another food or 2 to change. Then keep going, until all the foods you eat are sodium-free or low in sodium.
Become more active — If you want to be more active, you don't have to go to the gym or get all sweaty. It is possible to increase your activity level while doing everyday things you enjoy. Walking, gardening, and dancing are just a few of the things that you might try. As with all the other changes, the key is not to do too much too fast. If you don't do any activity now, start by walking for just a few minutes every other day. Do that for a few weeks. If you stick with it, try doing it for longer. But if you find that you don't like walking, try a different activity.
Drink less alcohol — If you are a woman, do not have more than 1 "standard drink" of alcohol a day. If you are a man, do not have more than 2. A "standard drink" is:
●A can or bottle that has 12 ounces of beer
●A glass that has 5 ounces of wine
●A shot that has 1.5 ounces of whiskey
Where should I start? — If you want to improve your lifestyle, start by making the changes that you think would be easiest for you. If you used to exercise and just got out of the habit, maybe it would be easy for you to start exercising again. Or if you actually like cooking meals from scratch, maybe the first thing you should focus on is eating home-cooked meals that are low in sodium.
Whatever you tackle first, choose specific, realistic goals, and give yourself a deadline. For example, do not decide that you are going to "exercise more." Instead, decide that you are going to walk for 10 minutes on Monday, Wednesday, and Friday, and that you are going to do this for the next 2 weeks.
When lifestyle changes are too general, people have a hard time following through.
Now go. You can do it!