Snowstorms and Heart Disease

If you are a heart patient you might be concerned about how the cold weather affects your heart.  The body constricts blood flow to the skin to conserve heat, which also raises blood pressure. Many experience angina when active in cold weather.

Advice for how to manage angina related to cold includes:

• Do a warm up indoors to dilate the blood vessels and get heart rate slightly elevated before outdoor exertion
• Create a zone of warmer air to breath by using a scarf, mask or parka
• Avoid large meals and alcohol before exerting outdoors. Blood flow gets diverted and doesn’t go to the heart or exercising muscles instead it works to digest the food.
• Discuss using nitroglycerine before activity with your healthcare practitioner. Using the nitro to dilate the vessels prior to cold air exposure is a method used by some.

Snow Shoveling for Heart Patients

• Warm up, do some light exertion to dilate the blood vessels and get the heart rate slightly elevated before really “digging out”

• Dress appropriately in layers, when you feel warm take layers off. Preventing overheating from being overdressed is as  important as dressing for the cold. Your heart  works harder to cool your body down. Sweating excessively will lead to being cold later.

• Do not eat a large meal or smoke prior to shoveling, these divert the blood flow away from the heart and exercising muscles.

• Push the snow don’t lift if  you can.

• Exhale on Exertion.  Breath out when pushing or lifting, don’t hold your breath!!!! Holding breath increases blood pressure even further than the cold and exercise already has.

• Switch sides keep alternating the shovel in left and right hand. The constant twist to one side produces muscle injury and can be hard to distinguish between muscles and heart. Muscle pain can be reproduced with touch or movement, whereas heart pain cannot be reproduced by touch.

• Take breaks, listen to your body don’t over do it. The body constricts blood flow to the skin to conserve heat, which also raises blood pressure.

• Stay fit enough to shovel snow. If you don’t exercise regularly you are not strong enough to shovel wet heavy snow. The cardiovascular demands are even more due to excessive cold temperatures. Train for snow shoveling by performing aerobic exercise and resistance training.

• If you have symptoms STOP

Dealing with Raynauds in the cold weather

Raynaud’s occurs when the fingers and/or toes come into contact with cold. Beta blockers medications actually can aggravate Raynaud’s by leading to increased blood vessel spasm. This class of drugs, used to treat high blood pressure and heart disease, includes metoprolol (Lopressor, Toprol XL), nadolol (Corgard) and propranolol (Inderal, Innopran XL). It is important to cover your feet and hands before they get cold with warm gloves and socks. Make sure they are not too tight allow for circulation. Prevent the symptoms by creating a barrier between your skin and the cold. Even if you are only going out for a short while keep your fingers covered and wear warm foot protection. Frostbite occurs much quicker in persons with Raynaud’s.

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Atrial Fibrillation is more common in Winter

The likelihood of being admitted to hospital or dying with atrial fibrillation, a life-threatening chaotic heartbeat common among the elderly, increases dramatically during winter months. Atrial Fibrillation is common in persons with heart disease. Be alert for symptoms of irregular heart rhythm, increased shortness of breath, increased fatigue. Additional factors contributing to the winter connection to atrial fibrillation  may include drinking too much alcohol which leads to high blood pressure, heart failure, and possibly even stroke due to the  atrial fibrillation.

http://www.hearthealthywomen.org/am-i-at-risk/am-i-at-risk/hfother2.html

http://www.nhlbi.nih.gov/health/health-topics/topics/raynaud/

My favorite Heart Stories

The last time I strapped skinny boards to my feet and threw myself down a hill was 30 years ago. Yesterday, I did it again.
The people at the Vasa Cross Country Ski Trail, held a benefit for women’s heart health. Somehow, I got talked into participating as a heart disease survivor. They promised me that I would only have to ski as far as I wanted and there would be chocolate and hot soup when I was finished. “Ok” I thought, “I can handle that.” I figured that I’d put on a pair of skis, putz along the trail a bit, talk to a few people and head back to the fireplace for that chocolate. It would be a cake walk….a chocolate cake walk.
They lied.
I got up, put on four pairs of leggings, two sweatshirts and pinned a hand warmer over my pacemaker to keep it warm. Over everything, I put on what I call my “Superhero” T-shirt. It has a detailed diagram of a human heart with a pacemaker-defibrillator. My girlfriend Andrea, picked me up and we headed out. I was a bit nervous. It had been a long time since I had done any kind of skiing. I wasn’t sure if I could handle the exercise in the cold. I didn’t know how it would affect my heart. The last thing I wanted to do was end up lying in the snow somewhere along the trail.
The venue was a sea of red and pink when we arrived. It was a good mix of experienced skiers and casual weekend skiers. I noticed that everyone seemed to have their own skis and we were one of the few who needed to rent equipment. The three “Lodge Dogs” helped me put on my boots with much sniffing and tail wagging. One was a huge droopy eyed bloodhound and let him have a good long sniff so he could search me out if I didn’t come back. I wondered if they could tie a cask of bourbon around his neck.
Tripping over the doorsill, I went out and stepped into the binding of the skis. They shot forward of their own volition! Good Lord, I had demon skis locked onto my feet. A friend gave me some quick instruction and we wobbled off down the trail. Just about the time I was starting to think that this wasn’t so bad after all, we came to the first hill. Trees on each side of the trail had large fluorescent triangle signs, I checked my map to see what they might mean. Steep hill. Oops.
An Olympic ski jump could not have looked steeper at this point. The hill dropped off like a cliff, zigged to the right, zagged to the left and then dropped off again. Someone in a one-piece spandex suit with flames went zipping past me and down the hill. I was sure I heard screams of terror as he disappeared over the precipice. The demon skis on my feet began to slide forward. “No, No,” I begged. “Don’t make me go there!”

It was too late. I gained speed. No amount of flailing my arms or feeble snow plow attempts could slow me. Well, one thing could. Falling down. At least you don’t roll far with six foot boards on your feet. I blinked the snow out of my eyes and realized that I was OK. I survived. One problem though, I had absolutely no idea how I was going to get up. There was nothing left to do, but laugh. My laughter echoed through the woods and was joined by that of my friends

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Pat, the more experienced of our little group came to rescue me. She tried to stop just above me, but tumbled over me instead. Now there were two people helplessly lying in the snow and laughing. As we struggled to untangle our poles, skis and bodies, I felt something hit me in the behind. It was Andrea’s ski. She was no fool. Removing her skis at the top of the hill, she was now walking towards us. Other skiers whizzed past us as we removed skis, got to our feet and put them back on again. Brushing the snow from my clothes, I looked back at the hill. It was a gentle curving slope, not a cliff after all

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Once you’ve fallen and given up any semblance of dignity, you’ve got nothing to lose. We were off again. The trail was beautiful. Snow was gently falling as we passed from hardwood forest to cedar swamp and stands of pale gray birches. Someone who passed before us wore Valentine tinsel and I would see the occasional tiny red heart left behind in the snow. The vibrant red looked like punctuation points in the expanse of whiteness. First I thought they were geranium petals and wondered that they should be there. Then I remembered seeing the woman wearing the tinsel at registration.
I found my stride. Step, glide. Step glide. The only sounds were the whisper of gentle wind in the tree tops, the quiet staccato of snowflakes hitting the paper number on my back and the sound of my skis sliding in the snow. Step, glide. Step glide. Nothing existed, but the winter landscape and I.After the climb up another hill, I paused while my heart beat dropped to an acceptable level. My friends were nowhere in sight. I had no idea whether I was still on the right trail or not. I fished the soggy map out of my pocket. According to it, I had not yet passed the halfway mark of the six kilometer trail.
SIX KILLOMETERS! What happened to “Ski as far as you want?” Where were the short cuts back to the lodge? WHERE’S MY CHOCOLATE? Oh well, might as well go forward. At least I wouldn’t face climbing back up that killer hill.
Step, glide. Step glide. One foot moving past the other. Time stopped. All the cares of the world dropped away. If ever there was a Zen moment in my life, this was it. I relaxed and became one with my surroundings. The only time I was called back into the present was when my heart would demand a rest at the top of another hill. Other skiers past me in both directions, I graciously stepped aside and smiled as they passed. Greetings were exchanged with people I have never met nor will likely see again. Step, glide. Step, glide. I was at peace with the entire world and all its inhabitants.
The trail turned to the West in the direction of the lodge. Unfortunately it also brought me to directly face the wind, the occasional snowflakes changed to a veil of wet slushy snow. My red scarf caught the snowflakes and was chill around my neck. Each breath I took brought cold air in contact with my lungs and the wires from my pacemaker. I knew that I needed to get out of the weather soon. Picking up the pace, I worried about leaving my friends behind. Hoping they would understand, I no longer waited along the trail for them to catch up.
Step, glide. Step, glide. Where the heck was that lodge? Every time I came to a bend in the trail or the top of a hill, I expected to see it. Signs with arrows pointing towards the finish taunted me. How much further could it be? Then I realized how far I had come. Five years ago, I was lying in a hospital bed not knowing if I was going to survive. Four years ago, I was still learning how to live. Three years ago, I wanted to ski this trail, but the weather was to cold and I had to pass on the event. Two years ago, I was beginning to speak out on heart disease. Last year I became a Womanheart Champion. This year, I was cross country skiing in my super hero T-shirt. Who knows what waits on the trail ahead?

The snow stopped stinging my face, even though it still fell. The tired muscles felt energized. My cold hands were strong as they gripped the poles to propel me. There was another hill ahead. I climbed. It was steep and at times my skis slipped backwards, but I would catch myself and push on. As I crested the hill, I saw large banners and bright flags marking the finish line. Just the day before the area was filled with cheering crowds as professional racers competed in the 27 Killometer Vasa Races.
There were no crowds today, only a large old bloodhound sitting at the gate. Did he know I was coming? The lack of cheering spectators made no difference to me. The big dog wagged his tail as I raised my poles in triumph. I’d done it. I beat the odds and won. I survived.
My friends came in about a half hour later, by then I had time to warm up a bit and change into dry mittens and boots. They had no idea what this day had meant to me. We were all cold and tired, but I had a new idea of what my limits are…..absolutely none. Now, where’s my chocolate?

Thanksgiving Reflections

Happy Thanksgiving!

Thank you all for reading my blog.  I reflect back a year and consider what  blessings I am thankful for. This blog is one of them. It has provided me a good outlet for all the information I enjoy learning, sharing and teaching. So to the 11,ooo viewers to day, a very grateful thank you.

Have you heard of the Let’s Talk Turkey campaign?

The Let’s Talk Turkey Campaign

This is a campaign to remind families while they are together to take some time to talk turkey. Talk about what matters to you in terms of your healthcare and your end of life wishes. It isn’t an easy talk but it is an important one. Express you wishes and desires. Make it so no one questions what you want. Make the decisions together, earlier rather than later. So when you are done eating turkey, take the time to talk turkey.

Sixty percent of people say it is “extremely important” to them that their family is not burdened by tough decisions.

Fifty-six percent have not communicated their end-of-life wishes.

One conversation can make all the difference.

It’s not easy to talk about how you want the end of your life to be, but it’s one of the most important conversations you can have with your loved ones. It isn’t just about filling out forms.  It’s about talking to loved ones about what you or they want for end-of-life care.

Advance Care Planning  can help you start this process. If you suddenly became unable to communicate, your family members would be asked to make numerous medical care decisions for you. Would they know what you want?

Click to access FINAL-2009RevisedACPBooklet-Excellus-Color-Web.pdf

http://www.nia.nih.gov/health/publication/advance-care-planning

Physician Orders for Life-Sustaining Treatment Paradigm

The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm program is designed to improve the quality of care people receive at the end of life. It is based on effective communication of patient wishes, documentation of medical orders on a brightly colored form and a promise by health care professionals to honor these wishes.

Effective communication between the patient or legally designated decision-maker and health care professionals ensures decisions are sound and based on the patient’s understanding their medical condition, their prognosis, the benefits and burdens of the life-sustaining treatment and their personal goals for care.

http://www.ohsu.edu/polst/

The Heart: An Incredible Electric Machine

A quick primer on the electrical system of the heart followed by two major breakthroughs in pacemaker technology this year.

A leadless, subcutaneous defibrillator makes the list of 5 biggest medical breakthroughs of the year.

Boston Scientific has begun marketing a FIRST-OF-ITS-KIND DEFIBRILLATOR after receiving FDA approval in September. The implantable device, which protects against sudden cardiac arrest, was developed by a California firm purchased by Boston Scientific and is expected to be a financial win for the Natick-based company. Unlike others on the market, the S-ICD does not touch the heart, instead sending electrical pulses to correct abnormal rhythms through wires implanted just beneath the skin.

http://bostonglobe.com/magazine/2012/10/27/biggest-medical-breakthroughs-year/pLJDenlFAN3XFwwsxfU7CI/story.html

No More Batteries: Piezoelectric Pacemaker Powered By The Heart

An experimental device converts kinetic energy from beating hearts into electricitythan can power a pacemaker, meaning the chance for no more batteries in the future, according to a talk at the American Heart Association’s Scientific Sessions 2012.

The study is preliminary but a piezoelectric approach is promising for pacemakers because they require only small amounts of power to operate. Batteries must be replaced every five to seven years, which is costly and inconvenient.  Piezoelectricity might also power other implantable cardiac devices like defibrillators, which also have minimal energy needs.

“Many of the patients are children who live with pacemakers for many years,” said M. Amin Karami, Ph.D., lead author of the study and research fellow in the Department of Aerospace Engineering at the University of Michigan in Ann Arbor. “You can imagine how many operations they are spared if this new technology is implemented.”

Researchers measured heartbeat-induced vibrations in the chest. Then, they used a “shaker” to reproduce the vibrations in the laboratory and connected it to a prototype cardiac energy harvester they developed. Measurements of the prototype’s performance, based on sets of 100 simulated heartbeats at various heart rates, showed the energy harvester performed as the scientists had predicted — generating more than 10 times the power than modern pacemakers require. The next step will be implanting the energy harvester, which is about half the size of batteries now used in pacemakers, Karami said. Researchers hope to integrate their technology into commercial pacemakers.

Two types of energy harvesters can power a typical pacemaker: linear and nonlinear. Linear harvesters work well only at a specific heart rate, so heart rate changes prevent them from harvesting enough power.

In contrast, a nonlinear harvester, the type used in the study, uses magnets to enhance power production and make the harvester less sensitive to heart rate changes. The nonlinear harvester generated enough power from heartbeats ranging from 20 to 600 beats per minute to continuously power a pacemaker. Devices such as cell phones or microwave ovens would not affect the nonlinear device, Karami said.

http://www.science20.com/news_articles/no_more_batteries_piezoelectric_pacemaker_powered_heart-96003

 

Meditation Lessons

Meditation

Just saying this word to new cardiac rehabilitation patients would put them into a stress response. Meditate! Who has time for that? Yeah right some old hippy remedy, or what monks do.  I can’t do that. Most people don’t understand the purpose or how to meditate. Quieting the brain is the key to successful mediation. Many think they are relaxing when reading, watching television, or playing on the computer. These activities engage the brain they don’t quiet the brain. There are many benefits one can receive from meditation benefits:

1- It lowers oxygen consumption.
2- It decreases respiratory rate.
3- It increases blood flow and slows the heart rate.
4- Increases exercise tolerance.
5- Leads to a  deeper level of physical relaxation.
6- Good for people with high blood pressure.
7- Reduces anxiety attacks by lowering the levels of blood lactate.
8- Decreases muscle tension
9- Helps in chronic diseases like heart disease, arthritis etc.
10- Helps in post-operative healing.
11- Enhances the immune system.
12- Reduces emotional distress
13- Enhances energy, strength and vigor.
14- Helps with weight loss
15- Reduction of free radicals, less tissue damage
16- Drop in cholesterol levels, lowers risk of cardiovascular disease.
17- Improved flow of air to the lungs resulting in easier breathing.
18- Prevented, slowed or controlled pain of chronic diseases
19- Relaxes our nervous system

20- Increases serotonin level, influences mood and behavior.

21- Resolve phobias & fears
22- Helps control own thoughts
23- Helps with focus & concentration
24- Improved learning ability and memory.
25- Increased feelings of vitality and rejuvenation.
26-Helps let go of the little things
27- Increased ability to solve complex problems

28- Helps keep things in perspective

29- Provides peace of mind, happiness
30- Helps you discover your purpose
31- Brings body, mind, spirit in harmony
32- Increased acceptance of oneself
33- Helps learn forgiveness
34- Changes attitude toward life
35- Helps living in the present moment

Meditation takes practice

I often talk about having a tool kit, and understanding how the tools work through knowledge and practice.  It may seem hard initially but with practice becomes easy. Then the next challenge is to remember to use your stress management, meditation and relaxation skill when you need them the most.  When stress occurs we rarely think “Oh lets mediate.” No we are busy responding to stress. With heart disease consider using when dealing with the emotional component of accepting the chronic health condition that heart disease can bring. Accepting it, forgiving yourself, letting go of the old you, accepting the new you, changing your lifestyle, the stress of relationships. Use it when anticipating or receiving medical care, waiting during fearful times.

You Can Meditate. Here are some tips for meditation that might make a daily meditation practice feel a little more manageable.

Practice

• Find or create a quiet, relaxing environment.
• Sit with good posture.
• Relax the whole body, muscles, skin, tongue, ears, neck,…everything.
• Let your attention focus on only the flow of your breath.
• Silence your mind

“Rest” in the rare silence that meditation offers

• You should be comfortable enough to concentrate, but not so comfortable that you feel the urge to sleep.
• The benefits of meditation can be experienced long before the practitioner has been successful in maintaining focus or clearing the mind, simply as a result of the practice.
• Make time to meditate. Start with 5-1o minutes.If you find it difficult to meditate for the length of time you have chosen, try a shorter time for a while. Almost anyone can meditate for a minute or two without experiencing intrusive thoughts. Then, as the mind calms, you gradually lengthen your meditation session until you have achieved the desired length of time.
• It is easy to lose track of time while meditating. Being concerned about time can be distracting to meditation. Some people find it helpful to set a timer and let it be concerned about how long you have to meditate.
• With good posture,you breathe easier as your lungs will have more space. In fact, you may notice how most of the muscles in your torso work to help you breathe, from the muscles in the base of your pelvis to the ones in your neck, centered on the main breathing muscle, the diaphragm. They work just a little, assisting the diaphragm. If you notice this, it’s a good sign you have established a good posture. The right posture is easy and comfortable.
• Don’t worry about whether or not you are doing it right. Do what works best for you. What works for some people might have other techniques that might not work for you.
• Trust the process.

 

Being in the present – If you are reflecting on past events – take a time out and be in the present. What around you is positive, is it the sunshine, the breeze, family, friends, a flower, a pet, a companion, a song…take the time to be in the present. Sure the past comes back, but if it is too much to bear and you can tell it is effecting your health, teach yourself through meditation to  be in the present.

Breathe – Sounds like a cliché right? Well it isn’t. When we experience a major stress we often breathe short and shallow only filling the top most portion of our lungs. Take a few deep cleansing breathes. Make your belly extend out when you breath in.  This is a great one to practice and use when you experience a health stress. If you are lying in the ER freaking out about what is happening and feeling powerless, use the breath. Meditate or focus on nothing more than taking a breath in through your nose, feel the air as it travels down into your chest. Try and make it feel like you are bringing the breath right down to your pelvis.Then slowly exhale out through your mouth. Listen to the sound, feel the cool air go in, and the warm air come out.

                                                                               

Imaging  – This one is my favorite for when those stressors haunt me at night and I can’t sleep. Put your focus to where you are feeling peaceful. For me it’s at the beach. What do you see? What do you feel – warm, cold, a breeze, the warm sand, the cool sand below? What do you smell? What do you hear – the waves lapping the shore, the birds, children laughing.  Sure at first you hear the clock ticking and the voices in your head pulling you away from your peaceful place, but the more you practice this the better you are at tuning them out. Initially just stop and acknowledge the things breaking you away, but then go back to your peaceful spot. This is a great one to practice during medical procedures, it helps to keep your heart rate, blood pressure and respiration rate lower, and gives you a sense of control.