12 Key Questions to Ask Your Doctor if You Have Heart Failure
Heart failure (HF) is the primary diagnosis in one million hospitalizations and costs the American health care system almost 30 billion dollars annually. It affects almost five million Americans and leads to about 300,000 deaths each year. Heart failure is a devastating disease as it increases the incidence of depression and hospital/nursing home admission. It decreases the ability to care for oneself and increases disability and death. Heart failure is an inability of the heart to pump out enough blood to meet the needs of the body. As a result of a poor pumping heart, the cells of the body are unable to get adequate oxygen resulting in many of the symptoms of heart failure. As heart failure progresses it activates the nervous and endocrine system. The activation of these systems results in a progression of the disease. Treatment options are focused on stopping the negative impact of the activated nervous and endocrine system. Becoming knowledgeable about disease is an important part of having a successful health care experience. Individuals must have a basic understanding of his or her disease. The better you understand your diseases the better you can partner in your medical care.
No one has a greater interest vested in your well being than you. Physicians manage very busy office practices and may overlook some important aspects of your care. It is imperative that you help your health care providers give you the care that is needed to prevent death and disability. As part of health care responsibility you need to understand your disease. Below are a list of questions you should ask your health care provider if you have heart failure. 1. What type of heart failure do I have? The two main types of heart failure are systolic heart failure and diastolic heart failure.2. What is my ejection fraction? When am I going to have my next echocardiogram? Ejection fraction is the percentage of blood beat out with each beat. Patients with systolic heart failure have an ejection fraction less than 40-50%. Physicians frequently monitor the progression of the disease in patients with serial echocardiograms. There are other ways to determine ejection fraction, but the echocardiogram is the easiest way to do this.3. What caused my heart failure? There are a number of causes of heart failure. It is important that you know what caused your heart to fail so it can be avoided in the future.4. How often should I weight myself? What should I do if I gain X pounds? Keep the weight form above your scale. Heart failure patients are prone to fluid overload and should weigh themselves everyday. This is to determine the degree of fluid overload that may occur on a day-to-day basis. If you gain a certain amount of weight your doctor will want you to call, come to the office or take an extra water pill. Talk to your doctor about the specific plan he/she wants for you. 5. Should I restrict the amount of salt and/or fluid in my diet? Most people with heart failure should restrict the amount of salt they consume. Binges of high salt foods may lead to an acute exacerbation of heart failure. Talk to your doctor about how much salt you should eat in a given day. Avoid large quantities of food containing a lot of salt including processed food, canned foods and bagged snack food. Some individuals with heart failure benefit from a restriction of the amount of fluid that they take in. Talk to your doctor if a fluid restriction is important for you.6. If you have systolic heart failure; should I be on an ACE-I, ARBS, and/or BB? You will unlikely be on all three medicines but aggressive treatment would likely put you on at least two of these drugs.7. If you have systolic heart failure; should I be on an aldosterone agonist (spironolactone) or digoxin? Spironolactone is a drug that has been shown to improve outcomes in those with severe heart failure. Digoxin may be helpful in some patients with heart failure. 8. Should I pay to attention to how much I urinate? Not urinating enough may indicate that you are retaining more fluid and may be at risk for going into acute heart failure. 9. Do I have any evidence of lack of blood flow to any area of my heart? Have you checked for it? Many patients with heart failure have evidence of coronary heart disease, which can make their heart failure worse, and should be evaluated. It can be evaluated by a number of different means including a stress test or cardiac catheterization.10. Are my risk factors controlled? Blood pressure, cholesterol, diabetes. It is important in patients with heart failure and other risk factors to control them to prevent progression of heart failure.11. Should I see a cardiologist? Many patients especially those with severe heart failure, see a cardiologist. Cardiologists are doctors that specialize in treating patients with heart problems. 12. Should I exercise? The answer to this is almost always yes. Special precautions are often taken prior to and during exercise. Talk to your doctor about any testing that should take place prior to exercise such as a stress test. Talk to your doctor about any precautions that you should during exercise. Some health care systems are associated with a cardiac rehabilitation program or and exercise facility that specializes in congestive heart failure. For more information on heart failure check out a the free ebook: Chronic Disease Guide: How to Prevent and Treat Common Chronic Diseases. The chapter on heart failure can be found at http://www.mini-medicalschool.com/CHF.html
Birth Control & The available Contraceptive Pills
Oral contraception are an effective form of birth control. Contraceptive pills are aligned on the basis of the ingredients of the pill. They are majorly classified into combined oral contraceptive pill (COCP) and progestogen-only pill (POP). The combined oral contraceptive pill (COCP) or the pill contains an oestrogen and a progestogen. Yasmin, Cilest, Dianette, Marvelon, Mercilon, Microgynon and Qlaira are some of the most popular forms of the combined oral contraceptive pills. The progestogen-only pill (POP) or the mini-pill contains only a progestogen. Cerazette is a popular progestogen-only pill. The contraceptive pills must be taken correctly according to the prescription, regardless of their ingredients. The contraceptive pills have other health benefits for women too- treating painful periods, heavy periods, premenstrual syndrome and endometriosis. Some oral contraceptive pills have been found to treat extreme cases of acne.
Yasmin contains two active ingredients ethynylestradiol and drospirenone; which are artificial versions of the naturally occurring female sex hormones, oestrogen and progestogen. Both, work together to stop conception by overriding the menstrual cycle. Yasmin pill has become a very popular choice for women as it produces lesser side effects than most pills. These mild side effects include headache, menstrual changes, breast pain, abdominal pain and nausea. Cilest has been known to clear bad cases of acne and cases of endometriosis. Dianette prevents conception, and also treats cases of acne and excessive hair growth. Marvelon, Mercilon and Qlaira stop conception, and can also fight acne, reduce the symptoms of menstrual pain and make the menstrual bleed lighter. Microgynon is preferred by many women since it has lesser chances of causing weight gain compared to other pills. Cerazette is suitable for women who are sensitive to oestrogen. Oral contraception provides nearly 99% protection but should be combined with additional protection during the pill-free days to be on the safer side.
Brain Based Therapy – A Remarkable Way to Treat Chronic Pain
It is estimated that nearly one third of our US population suffers from some form of intense pain that they have had on a regular ongoing basis. Pain is typically classified as chronic if the person has experienced repeated multiple episodes over an extended period of time, or if someone has had continual pain longer than 3 months.
Chronic pain comes in many forms; headaches/migraines, back pain, leg/sciatic pain, neck pain, arm pain/numbness, restless leg syndrome, pain from disc bulges/herniations, and pain from stenosis (a narrowing of the spinal canal). Chronic pain sufferers can also experience dizziness or vertigo and may develop phobias that prevent them from leaving their home or engaging in social activities.
Stress is the single greatest cause of chronic pain, and it comes in many different varieties including physical, chemical, and emotional stresses. Physical stresses include car accidents, work injuries, falls, repeated movements or heavy lifting. Chemical stresses include poor diet, a lack of proper nutrition, inadequate water intake, lack of exercise, smoking, alcohol, and medications. By far the greatest contributing factor to long term chronic pain is emotional stress. Examples include loss of a loved one, divorce, physical/mental abuse, anger, anxiety, financial issues, and unresolved conflicts are the major emotional triggers leading to sustained pain.
To make the problem worse, chronic pain sufferers often experience changes in their metabolism leading to weight gain, sensitivities to chemicals in the environment, food allergies, and serious changes in mood or behavior. Those who suffer with chronic pain very frequently become depressed, anxious, and have great difficulty with their sleep. Many times there are feelings of hopelessness associated. In severe cases of pain, some people may feel so lost, they even consider suicide as a solution.
Others with chronic pain find themselves unable to work, care for their family, or even enjoy the most simple pleasures of life. These people find themselves at the mercy of their chronic pain, and are not really living life, but are rather just ‘existing’. This is not the way life was meant to be, and far too many people in our community are just ‘getting by’ because the intensity of their pain is robbing them of their vital years.
In addition, many chronic pain conditions such as fibromyalgia, chronic fatigue, and other neurological conditions leave doctors scratching their heads about how to treat these patients. Most commonly medications are used to treat the symptoms and in some cases surgery. This can help the chronic pain sufferer for awhile, but rarely if ever do the medications create any sort of positive change in the pain, let alone address the underlying cause of the person’s pain. Surgery, especially for bulging or herniated discs has a dismal failure rate of over 50%!
As a result of the many health issues that arise from chronic pain coupled with the mixed results of the many treatments, many people are left wondering if they will ever get out of pain. Many more are left thinking to themselves they will ‘just have to live with it’ as so many in pain are told by their doctors.
Perhaps you or someone you care about has been to all the doctors, has had all the medication, has been to therapists and chiropractors, and yet still finds themselves in pain. It is tempting to think that just because someone has been to all the top specialists, seen all the best therapists, and taken the latest drugs, that there may not be any more answers left, however, I want to introduce you to a new form of care called Brain Based Therapy.
What is Brain Based Therapy or BBT? BBT is a method of care that first focuses on the reasons why someone is experiencing chronic pain, and then assesses how well the person’s brain is functioning. The human brain is like a master super computer that is constantly monitoring, running, and adapting your body with the goal to keep things working normally. The brain was designed to function as a whole single unit that fires together. But when a person experiences too much stress, the brain is overloaded and cannot fire or work properly. As a result, the brain becomes imbalanced and one side typically over fires while the other side under fires.
Ultimately the imbalanced brain cannot respond to stress properly or control the body normally and the end result is pain. If this imbalance in the brain is not handled initially, the pain almost always becomes chronic. So when I first meet with a person who is experiencing chronic pain or any pain for that matter, it is vital to do a complete neurological assessment of the patient’s brain function.
Using specific tests and having the patient perform carefully observed movements with their body, it is possible to determine the area of the brain that is not firing normally. This is the KEY to determining if the patient is a candidate for Brain Based Therapy and it also the method I use to determine the exact treatments to use with the patient.
There are a wide variety of treatments available in BBT to help the chronic pain patient get rid of their pain. A vast majority of people see tremendous changes and are pleasantly surprised by how gentle and effective the treatments are in BBT.