Are you dehydrated?

One very good way to know if you are properly hydrated to to look at the color of  your urine. If it is a bright or dark yellow you are most likely dehydrated. When your body is properly hydrated the color of your urine is a very pale light  yellow. The mechanism in our bodies that makes us feel thirsty is very inefficient. By the time people feel thirsty they are usually already seriously dehydrated.  Remember happy muscles are hydrated muscles and the heart is a very important muscle. Drink liquids, water with a squeeze of lemon or lime, iced tea, carbonated water. Avoid sugary, caffeinated or alcholol based  beverages. Try to carry a bottle of water with you all day and sip on it throughout the day. Don’t just drink for activity get used to drinking fluids to always keep your body properly hydrated.

Below was shared by Anatomy in Motion:

When your water intake does not equal your output, you can become dehydrated. Fluid losses are accentuated in warmer climates, during strenuous exercise, in high altitudes, and in older adults, whose sense of thirst may not be as sharp.

Here are six reasons to make sure you’re drinking enough water or other fluids every day:

1. Drinking Water Helps Maintain the Balance of Body Fluids. Your body is composed of about 60% water. The functions of these bodily fluids include digestion, absorption, circulation, creation of saliva, transportation of nutrients, and maintenance of body temperature.

“Through the posterior pituitary gland, your brain communicates with your kidneys and tells it how much water to excrete as urine or hold onto for reserves,” says Guest, who is also an adjunct professor of medicine at Stanford University.

When you’re low on fluids, the brain triggers the body’s thirst mechanism. And unless you are taking medications that make you thirsty, Guest says, you should listen to those cues and get yourself a drink of water, juice, milk, coffee — anything but alcohol.

“Alcohol interferes with the brain and kidney communication and causes excess excretion of fluids which can then lead to dehydration,” he says.

2. Water Can Help Control Calories. For years, dieters have been drinking lots of water as a weight loss strategy. While water doesn’t have any magical effect on weight loss, substituting it for higher calorie beverages can certainly help.

“What works with weight loss is if you choose water or a non-caloric beverage over a caloric beverage and/or eat a diet higher in water-rich foods that are healthier, more filling, and help you trim calorie intake,” says Penn State researcher Barbara Rolls, PhD, author of The Volumetrics Weight Control Plan.

Food with high water content tends to look larger, its higher volume requires more chewing, and it is absorbed more slowly by the body, which helps you feel full. Water-rich foods include fruits, vegetables, broth-based soups, oatmeal, and beans.

3. Water Helps Energize Muscles. Cells that don’t maintain their balance of fluids and electrolytes shrivel, which can result in muscle fatigue. “When muscle cells don’t have adequate fluids, they don’t work as well and performance can suffer,” says Guest.

Drinking enough fluids is important when exercising. Follow the American College of Sports Medicine guidelines for fluid intake before and during physical activity. These guidelines recommend that people drink about 17 ounces of fluid about two hours before exercise. During exercise, they recommend that people start drinking fluids early, and drink them at regular intervals to replace fluids lost by sweating.

4. Water Helps Keep Skin Looking Good. Your skin contains plenty of water, and functions as a protective barrier to prevent excess fluid loss. But don’t expect over-hydration to erase wrinkles or fine lines, says Atlanta dermatologist Kenneth Ellner, MD.

“Dehydration makes your skin look more dry and wrinkled, which can be improved with proper hydration,” he says. “But once you are adequately hydrated, the kidneys take over and excrete excess fluids.”

You can also help “lock” moisture into your skin by using moisturizer, which creates a physical barrier to keep moisture in.

5. Water Helps Your Kidneys. Body fluids transport waste products in and out of cells. The main toxin in the body is blood urea nitrogen, a water-soluble waste that is able to pass through the kidneys to be excreted in the urine, explains Guest. “Your kidneys do an amazing job of cleansing and ridding your body of toxins as long as your intake of fluids is adequate,” he says.

When you’re getting enough fluids, urine flows freely, is light in color and free of odor. When your body is not getting enough fluids, urine concentration, color, and odor increases because the kidneys trap extra fluid for bodily functions.

If you chronically drink too little, you may be at higher risk for kidney stones, especially in warm climates, Guest warns.

6. Water Helps Maintain Normal Bowel Function. Adequate hydration keeps things flowing along your gastrointestinal tract and prevents constipation. When you don’t get enough fluid, the colon pulls water from stools to maintain hydration — and the result is constipation.

“Adequate fluid and fiber is the perfect combination, because the fluid pumps up the fiber and acts like a broom to keep your bowel functioning properly,” says Koelemay.

5 Tips to Help You Drink More

If you think you need to be drinking more, here are some tips to increase your fluid intake and reap the benefits of water:

Have a beverage with every snack and meal.

Choose beverages you enjoy; you’re likely to drink more liquids if you like the way they taste.

Eat more fruits and vegetables.

Their high water content will add to your hydration. About 20% of our fluid intake comes from foods.

Keep a bottle of water with you in your car, at your desk, or in your bag.

Choose beverages that meet your individual needs. If you’re watching calories, go for non-caloric beverages or water.

ICD’s: Resources, Decision Making, and What to Know

An ICD is an implantable cardiac defibrillator. They are used for people who are high risk sudden cardiac death due to heart arrhythmias  of  ventricular tachycardia or ventricular fibrillation. They are often implanted as a preventative measure when the heart has a poor pumping ability as this makes one prone to arrhythmias. If the ejection fraction (pumping ability) is 30% or less and doesn’t show signs of improving your healthcare provider may consider implanting one.

Special care should be placed not to put excessive strain on the shoulder, arm and torso area where the ICD is implanted. Doing so may damage the ICD or the leads going from the unit to the patient’s heart. For this reason strength training with heavy repetitive weights is often discouraged. The exercises which would potentially damage the leads involves exercises with the arms overhead, such as a Military or shoulder press, seated fly’s,overhead triceps press. By heavy weights we are talking about weights upwards of 100 lbs or more with repeated repetitions and multiple sets. The wiring goes under the first rib, repeated bending and stress to the wires in this area can damage the leads. If your work involves this type of activity be sure to discuss this first with your cardiologist.

Exercise Advice:

  • Exercise with a friend or family member who is familiar with your condition and knows what to do in the event of an emergency.
  • If you exercise at high intensities, you should make sure you have a specific guideline from your cardiologist about your heart rate range. If the heart rate is too high the ICD may sense it as Ventricular Tachycardia. Wearing a heart rate monitor can help you to watch your heart rate range and avoid exercises that spike the heart rate up into the threshold in which the defibrillator is programmed to respond. Your Cardiologist can adjust your ICD settings to recognize the difference between a normal increase in heart rate from exercise and that associated with an abnormal heart rate or rhythm. You should include a low-level 5 to 10 minute warm-up and cool-down phase for aerobic exercise (i.e., walking, cycling) to allow for a slow and steady increase in heart rate.
  • The ICD can be affected by magnetic or electrical fields. You should avoid this and opt for something simpler such as the sum of skinfolds. Heart rate monitors are unlikely to cause any problems in the gym setting. Avoid Bio electric Impedance devices which are used to measure body fat.
Decision Making:
I came across a New York Times article “A Heart Quandry”  recently with the following information. It is something to consider for anyone with an ICD.

Going against strong headwinds in his own community of heart specialists, Dr. Kramer emphasizes three important issues that come about when older patients with ICDs face battery depletion.

First, he asks heart doctors to re-evaluate whether the patient still benefits from the ICD. Perhaps, the original heart problem has improved?

Second, he points out that a patient’s experience living with the device may have changed their mind about keeping it active. Perhaps, a patient with inappropriate shocks no longer wants the device?

Third, since the original implant, a patient may have changed their goals of care. Many patients no longer desire life-sustaining shocks—for whatever reason. It’s their choice; but they aren’t often asked.

You may wonder why such obviousness isn’t the norm?

It’s because our healthcare system imparts significant barriers. Dr. Kramer nicely explains two important hurdles. One is that healthcare in the US is fragmented, especially for the infirmed and elderly. Patients may have many doctors, and care is often not well-coordinated. This means, an installer, a proceduralist like me, is left discussing end-of-life care with patients immediately before ICD surgery. That’s not good. I am married to a hospice doctor, so I sort of know how to manage these conversations. This is not the norm for procedure-oriented heart doctors. The other barrier to getting the elderly the best care is our system’s misguided incentives. In our current fee-for-service system, I am rewarded for doing, not discussing not doing. In fact, not doing stuff is very risky—both legally and professionally (ie. loss of referrals.)

Finally, Dr. Kramer and his colleagues call for heart doctors to take the lead in starting “the conversation” with ICD patients. He wants us to share the decision of using invasive, potentially dangerous or ineffective care with the patient. He also asks the scientific community to study the outcomes of patients who undergo elective ICD generator changes. These should not be controversial recommendations.

It’s a huge mistake to equate this kind of smart thinking to rationing. Aligning evidence-based care, especially potentially burdensome surgery in elderly patients, with the goals of the patient is not rationing.  It’s moral, ethical and obvious.


There are issues with ICD that patients struggle with. These include the comfort of the ICD, the cosmetic appearance,the stress of having it fire, frequency of battery replacement, leads wearing out, and it working appropriately. I have included a few great resources to help you in living with an ICD.

Sudden Cardiac Arrest Association           

Powered by Inspire

Boston Scientific

Cardiac Rehabilitation – Did you attend?

Only 30 % of patients who have an eligible diagnosis for cardiac rehabilitation services actually attend. Of those that do attend there is a very solid trend in the United States that 70% are male, and 30% are female. Minorities are even less likely to attend. 

There are many factors that contribute to the above statistics.

  • Were you referred to cardiac rehabilitation?
  • Do you have insurance that covers it?
  • Is the co-pay too high to attend?
  • Is the distance to the nearest facility too far a drive, or the cost of gas to expensive?
  • Transportation issues – such as being able to safely drive yourself, or not having transportation?
  • Do you feel like you are too young to attend or too old?

The lack of referral is an issue where it may be the physician has a pre percieved perception of what the services are. I ran into this issue frequently. Many healthcare providers percieve cardiac rehabiitation as a place for their patients to go and exercise. They often don’t realize the education that occurs. Exercise is important, but how about working with patients on learning a healthy diet, overcoming barriers to healthy lifestyles, tobacco cessation, support, risk factor education, stress management as a few examples of what one recieves in the rehabilitation setting. If your physician didn’t recommend it, it is ok to ask for a referral.

Insurance limits many, either they have a diagnosis that doesn’t cover it or the co-pays are exorbitant. I have seen co-pays of $100 per session. The programs can last up to 36 session so that can mean a pretty hefty out of pocket cost.  Most patients won’t  attend if their out of pocket for  co pays are greater than $30 per session. Yes you get a lot from attending, but add that into the co-pays from the hospital, the physician bills, the medication costs, the lost work, the laboratory costs and it is a hefty out of pocket cost to have a heart event. Many patients experience complications requiring further testing, physician visits, medications making the cost even higher. It isn’t unusual for a patient to come to rehabilitation and tell me they received their bill for open heart surgery and it was $150,000, or a stent costing $30,000. The usually have a second episode of chest pain when they see the first bill. 

How about travel? If you just had open heart surgery you probably are restricted from driving for 4 weeks, and then may not even feel healthy enough to drive self. Then you must rely on others two to three times per week to bring you to and from. Many rural areas do not have a public transport system that is reliable. Our bussing system might require you to spend 4-6 hours for transportation that is really only a 40 minute drive from the facility. Medicare will not cover telemed programs.

Why don’t women attend? Do they not feel comfortable thinking it is a gym? Do they have too many things on their plate to take care of themselves? Do they physicians not refer them, feeling they are already aware of what changes should be made or don’t think they would benefit?


There is no set age. In fact the younger the patient is the better in terms of making lifestyle changes and learning to cope with living with a chronic disease. Elderly people seem to benefit the most from the strength and conditioning as well as the social interactions. Our programs see people from ages 20- through their 90’s.

I think our Cardiac Rehabilitation programs do a poor job of catering to minority populations. When we study ethnically diverse regions we continue to note the same trends, it is primarily the white males that attend. Is this because we have few minorities staffing the programs. We teach with a cookbook approach, everyone is taught the same diet, the same stress management and lifestyle changes. Recently I was speaking to a group of Native Americans and they informed me that when we teach to a family it usually take seven generations for changes to take place. We certainly don’t address the spiritual needs or cultural differences. Do we teach how to modify the Arabic diet, or the African American diet? Can we effectively teach stress management if we don’t understand the family dynamics of different cultures? Nope most program don’t unfortunately. 

I would love to hear from those of you with heart disease why you may have chose not to attend.

If you are considering attending here are a couple of valuable links to check out:

Cardiac Rehabilitation Fact Sheets 

 or for a Spanish version 

To find a program near you or to find patient resources: 


Cardiovascular Risk – Not the same old info

I have to laugh when I hear people talk about it is the big pharmacy and  the medical community who are preventing us from curing diseases like heart disease and cancer. When they state there are simple cures, or that the companies don’t want to risk losing their profits and  are withhold lifesaving cures, I have to walk away. The human body is so complicated, and we are just learning how much we don’t know. It isn’t just about cholesterol, obesity, lack of exercise and smoking. There are so many factors that contribute to disease processes and we are only now beginning to understand them much less be able to manage them.

The comic link below shows many of the current lines of research of the contributing factors of heart disease. We continue to learn about the various issues which can cause the disease, then study to see if there is a way to modify these factors through pharmaceuticals or biotechnology. We certainly cannot use a one size fits all approach and care for patients as if the disease process is the same in each individual. Having worked in Cardiac Rehabilitation for a couple of decades, patients came in all shapes and sizes, some with perfect health habits, and others with every risk factor in the book. Lowering cholesterol and blood pressure helped some, but certainly not all. Many had great cholesterol numbers, and yet had severe heart disease. For some it’s genetics, but there is more to the story. How can one person get all the bad genes and the others miss out. One man I worked with who came from a family of 18 was alive in his late 70’s yet had lost 12 siblings before they were 40. They were raised on the same food, in the same environment. What caused his disease to present so much later than his siblings?

I have included an excerpt/link from The Fat Nurse whose blog can be found on WordPress at

Her information is credible and every heart patient should be able to talk intelligently about their disease including being able to ask their health care provider if there are other tests, or risk factors that should or could be evaluated. Health care providers might seem taken aback at first, but they are responsible to keeping up with the research. Sometimes it takes the patient to drive the clinician to learn more. Here are some of the cardiovascular risk factors that are discussed in the link below these include:

  • CRP
  • Apo B
  • Ldl – c
  • Ldl – P
  • Lp (a)
  • Lp-pla2

This comic goes over other measurements that are emerging on cardiovascular risk other than the conventional LDL HDL cholesterol measurements. A condensed simplified comic, but it may drive your curiosity to investigate more!