When is the last time you had a good guttural laugh? You know the kind, where you feel like you are short of breath, your stomach and face muscles feel sore, the kind that puts a smile on your face when you think of it later? This kind of laughing has similar effects on the body as exercise does, lowering blood pressure, reducing stress hormones, and burning calories.
There are some claims that children laugh more than 300 times a day, whereas adults laugh less than 20 times a day. Studies have shown people with heart disease responded less humorously to everyday life situations. They generally laughed less, even in positive situations, and they displayed more anger and hostility. Other studies have shown higher instances of conditions such as heart disease and dementia among those who live in isolation. Many who are socially isolated don’t get the opportunity each day to smile and laugh. If you struggle with social isolation, challenge yourself to find a way to laugh. It may be laughing at yourself, watching a funny movie, doing laughing exercises, joining a laughing group,or finding laughs on the internet. Challenge yourself to laugh.
Here are a couple of links to videos of laughing exercises:
Today I ran into a young woman I assisted in Cardiac Rehabilitation after she had a heart incident. One of the first things she said to me with a smile on her face was that her ejection fraction had increased from 15% to 55%. This means her heart essentially is functioning within normal limits of 50%-70% in it’s pumping ability. She went on to tell me she was off to go snowshoeing in the woods. I was so proud, as working with patients over time you learn and share a lot about your lives, and for her this was huge!
Ejection fraction is a measurement of the percentage of blood leaving your heart each time it contracts.
When the heart beats, it contracts or squeezes and then relaxes. During heart contraction, it pushes the blood within the pumping chamber out. When your heart relaxes, the chambers or ventricles refill with blood. No matter how forceful the contraction, it doesn’t empty all of the blood out of a ventricle. The term “ejection fraction” refers to the percentage of blood that’s pumped out of a filled ventricle with each heartbeat.
A normal LV ejection fraction is 55 to 70 percent. The ejection fraction may decrease if:
- A heart attack has damaged the heart muscle such that it cannot forcefully contract
- The valves of the heart are not working properly
- Blood pressure has been uncontrolled for a long period of time
- Weakness of the heart muscle, such as dilated cardiomyopathy
I get great gratification in this patient announcing this for another reason. I have a history of arguing with cardiologist about teaching patients their heart’s condition by reading their medical reports with them. As part of the intake to cardiac rehabilitation the charts are reviewed so both the patients and the clinicians have a solid understanding of their heart condition and the plan to manage the heart condition. Many patients enter rehabilitation with their last echo cardiogram or other studies showing the patient has a severely reduced ejection fraction. Some people will always have a reduced ejection fraction and others will recover depending on the severity of condition. A late presenting large heart attack may have permanently reduced pumping ability of the heart, where as a stent placed early in a heart attack may improve within a very short time. Other conditions slowly change over time, getting better or worse these include hearts that have cardiomyopathy, or pacemakers.
I believe heart patient’s understanding of their ejection fraction an important part of managing their health. The cardiologist was worried I would scare his patients. The cardiologist felt people would psychologically not improve if they knew their ejection fraction was low. Many people with a reduced ejection fraction will not have any significant functional limitations or symptoms. I have worked with people with ejection fractions in the 8-10% who can function pretty normal including performing weight or resistance training exercises. On the other hand some folks with an ejection fraction of 30-40% can feel symptoms of fatigue or shortness of breath with mild exertion.
For many through building structured exercise they can improve the muscular strength of their body thus reducing the effort the heart has to work to meet the demands for oxygenated blood. Exercise does improve the ejection fraction in many studies, but if it doesn’t it still improves the functional ability and quality of life of most individuals. Cardiac Rehabilitation programs often will note an improvement in patients ejection fraction. It is typical to undergo echo cardiogram studies approximately three month post intervention or event. I believe it is more of an insurance reimbursement issue which makes most scheduling occur at 3 months post, but also gives the heart time to recover and medical management to be fully effective, and this is typically how long a cardiac rehabilitation program lasts.
When the overeager patient comes in and wants to give themselves a workout equivalent to a stress test on their first few sessions of cardiac rehabilitation to prove to themselves they are ok, we will use information such as their ejection fraction to determine and educate how much effort they should safely perform. Then there is the scared patient who has been living with a reduced ejection fraction and had short of breath and gets a bi-ventricular pacemaker the cardiac rehabilitation staff encourages them to increase their workloads as their ejection fraction is likely much improved and now can feel safe pushing the intensity. Reviewing this information with you healthcare provider can help you to understand your heart and any limitations it may have.
Does this seem like a strange title? Well if you or a loved one has experienced a heart attack once back home the undertaking of grocery shopping can go from a one hour task to a two or three-hour task. This is common complaint heard in Cardiac Rehabilitation. Why? The task of determining which foods are to be avoided and what to replace them with takes a great deal of time. Reading the labels for fat and sodium content, determining vitamin K sources, or if the food contains grapefruit or others that could interact with medicines takes time.
Shop the perimeter
Discharge instructions include following a heart healthy diet. For most that means eliminating much of the processed and pre-packaged foods from the diet, as they are too high in saturated or trans fats, or too high in sodium. The best way to speed this process up is to try to shop the perimeter of the grocery store. Get your fresh fruits and veggies, stop by the butcher and select fresh-cut lean meats, get your low-fat dairy products,and purchase your baked goods that are whole grain, then be done. Eliminate the inner isles of the store (well other than the cleaning isle). The boxed foods are often high in saturated or trans fats because they replace butter. Butter goes rancid quickly and thus the products would have a short shelf life, so they substitute trans and saturated fats so the product can remain on the shelf for a year or more, although eating it reduces your shelf life 🙂
Vitamin K is an issue if you are discharged on the blood thinner Coumadin. While it is not necessary to eliminate vitamin K from the diet, it is important to get approximately the same dosage daily, to help avoid large swings in your INR rates. Try to eat the same portions of vitamin K each day. Many patients report they cannot eat foods with vitamin K, in fact we want them too, but we want them to understand the content and keep it similar from day-to-day. To learn more about Vitamin K and Coumadin click here
Grapefruit, blood oranges are a couple of items that effect the potency of medications and should be avoided at all cost. Statin – cholesterol lowering medications in particular are effected. Know what items contain grapefruit juice and avoid these. For more information about heart medication that interact with grapefruit click here
Sodium is in just about everything in the middle shelves. It is the preservative which again allows for the long shelf life. Avoid foods with 800 milligrams or more per serving. Remember the 1500 milligram daily goal shouldn’t be exceeded. Again if buying fresh foods and not processed is the easiest way to adhere to the guidelines. Learn more about sodium
It gets easier, and takes less time after a while. You learn what brands are best, and where to find them. You try new foods and decide what you like. Some hospitals have grocery store tours with dietitians to help you learn what is marketing and what is healthy.
Common marketing issues where you think you are purchasing healthy foods but are not
Ground turkey. Everyone comes to rehabilitation and tells me they had ground turkey burgers. I challenge them to go back and look at the percentage of fat in the ground turkey. Most of it contains 80% protein 20% fat, that is the same as most hamburger contains. It would be better to eat ground sirloin of 90% protein and 10% fat. Better yet, learn to make bean burgers – super easy to make and much better and less expensive as the pre- packaged bean burgers. Another one that I chuckle at is the milk choices. Patients come in proud they are no longer drinking whole milk, and report they are at 2%. Well I educate them to consider a glass of whole milk is about equal to three restaurant size pats of butter, 2% would equal 2 pats of butter, 1% equals 1, skim equals no saturated fat. Green labels also don’t mean. Peanut butter – read the labels it may say no trans fats, but contains partially hydrogenated oils…hmmmm….not a good choice. Select the peanut butter that is natural the kind that you must stir the oil into the peanut butter. Many foods are labeled trans fat-free, as if it were a recent change to make it healthier, when in fact they never contained trans fats.
A funny story one time I had a very young woman with serious heart disease proudly announce she made a good selection when she picked chicken gravy over beef….missing the point that gravy is fat and salt completely.
Working cardiac rehabilitation, one wants to take time off around Saint Patrick’s day and Easter. Often patients come in with weight up 10 lbs in one to three days, short of breath, swollen, and having elevated blood pressure. When asked, they report celebrating Saint Patrick’s day with sauerkraut and sausage, corned beef and cabbage, with lots of bread on the side, then celebrated Easter early with a ham dinner with gravy.
Caregivers take note, well-intentioned friends and family may have prepared meal or stocked freezers full of sodium laden foods thinking they are helping out during a medical crisis. Be alert to sodium and it’s effect on heart health. Programs such as Meals on wheels also has a tendency to have very salty meals.
If you find weight up, swollen feet/ankles/belly/face, shortness of breath and elevated blood pressure consider the dietary sources of sodium.
Sodium causes fluid retention, weight goes up, and is often treated with increased diuretics (Lasix, Aldactone, Demedex, Bumex, Zaroxolyn etc.). The body can become resistant to diuretics however, so adding more and more diuretics can be dangerous. These throw off the electrolytes and disrupt the sodium potassium balance of the body, which can set in motion additional heart problems including arrhythmia’s – irregular heart beats that could be deadly. Other side effects of diuretics include:
- increased blood glucose levels
- increased calcium
- increased cholesterol
- potassium loss
- increased uric acid, which might trigger a gout attack in certain people
Bought raw or in a can, corned beef brisket is very salty. One 3 ounce serving of cured corned beef has 964 mg of sodium, 40 percent of your daily value of sodium. In addition to sodium, corned beef is generally made from the fattier brisket areas, so the fat and cholesterol levels tend to be on the high side when compared to some of the more commonly available beef cuts. 1 cup of Cooked Sauerkraut has about 900 mg of sodium. Ham isn’t better – 4 oz. of ham can have between 1000 and 3000 milligrams of sodium.
Sodium, Salt, Na, MSG, natural flavors, natural spices, Sodium Nitrate,
- Monosodium glutamite,
- Sea salt,
- Disodium phosphate,
- Baking soda,
- Sodium citrate, sodium bicarbonate, sodium algonate, are all names of sodium.
If your diet is going be high in sodium, eat more potassium-rich foods. Potassium helps to lessen the dangerous effects of sodium. Foods high in potassium include bananas, potatoes, squash, spinach, raisins, cantaloupe, beans and lentils.
Rinsing foods such as sauerkraut, or canned beans or veggies in a colander can remove up to 40%. Read labels and aim for foods with 300 milligrams or less of sodium per serving.