Pumping Marvellous

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• use small cups instead of mugs
• try to spread your daily allowance over the whole day
• try drinking very cold or very hot fluids – it takes longer
• if it is very hot or you have a fever or diarrhoea, you should drink an extra 100-300ml

Now for tips when you are thirsty

• suck on a ice cube
• limit caffeinated drinks (including coffee, tea and some fizzy drinks)
• limit alcoholic drinks
• use lemon and glycerine mouthswab sticks
• chewing gum or sugar free sweets
• eat frozen fruits
• add lemon juice to your tea or mineral water
• carry around a little spray bottle of water and when you feel thirsty spray into your mouth, small enough for pocket or handbag. For the ladies and for the guys!

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Why do doctors feel the ankle of their heart patient

This is a topic that is highly searched through search engines so from a heart failure perspective I will explain in the simple language of “patient speak”. I would like to make you aware that their are other diagnosis conclusions but I am just coming from the Heart Failure perspective.

Fluid accumulation can cause an oedema and in Heart Failure patients the most common and noticeable area that swelling manifests itself is on the ankles and legs and sometimes the abdomen. The accumulation occurs because your left ventricle is not pumping as well as it should be and therefore due to the heart being the engine room of the body it struggles to get rid of fluid therefore it accumulates. If you have Heart Failure then you should really be restricting your fluid intake to 1.5-2 litres per day. You will probably be on diuretics if you have Heart Failure and these enable the Kidneys to get more fluid out of your system as urine. Examples of Diuretics can be found in our medicine / drug section.

It is also very important to reduce your salt content to no more than 2grams of salt a day, in other words no more than a teaspoon. We understand this is very difficult but you can go a long way to reducing it by not putting salt in your cooking or on the table and also not eating ready prepared meals. You will get use to it, try spicing your food?

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Variation in Mortality Rates for Heart Failure Patients

Another reason for Pumping Marvellous to exist and flourish, especially for those without support.

A major new audit of heart failure patients in England and Wales has uncovered wide variations in mortality rates.

The National Heart Failure Audit analysed 21,294 medical records for patients admitted to hospital for heart failure between April 2009 and March 2010. It found that, overall, about 32 per cent of heart failure patients died within a year of hospital admission.

The report underlined the value of cardiologists and specialist heart failure services, as mortality rates fell to 23 per cent for patients with access to these. It also showed that in-patient mortality is 12 per cent for heart failure patients on a non-cardiac ward, compared to just six per cent for those on dedicated cardiac wards.

Clinical lead Dr Theresa McDonagh, chair of the British Society for Heart Failure, said: ‘This audit shows that patients admitted to hospital with heart failure have an unacceptably high death rate.

‘Outcomes for these patients can be significantly improved by having specialist cardiology input to their care, administration of appropriate evidence-based doses of key drugs and follow-up by specialist services.’

The audit, which is run jointly by the NHS Information Centre and the British Society for Heart Failure, also revealed that many patients do not get the recommended dose of drugs such as ACE inhibitors and beta blockers.

Just 60 per cent of patients for whom dosing information was available were prescribed beta blockers – which can reduce mortality by around a third – and two-thirds received less than half of the recommended dose.

And of those patients for whom information was available on ACE inhibitors – which can halve mortality during the first year after discharge – half received less than 50 per cent of the target dose.

Dr Mike Knapton, associate medical director of the British Heart Foundation, said that treatment for heart failure should be given the same priority as that for heart attacks.

‘But while there have been huge improvements in the management of heart attack patients, the same cannot be said for people with heart failure,’ he claimed.

‘There are more than 700,000 people living with heart failure in the UK and this number is set to increase, so it’s vital we address this issue.’

Without sounding arrogant we could have told you so on each statement made within the commentary above.

Salt and fat content ‘too high’ in child hospital meals

A lot of people don’t realise how bad excessive salt is for you. This excerpt was taken from the BBC website which demonstrates credible evidence against Hospital cuisine. If they can’t get it right then who can.

Very interesting piece and very pertinent to yours and your children’s future. This article highlights a major contributor to the “ticking time bomb.”

Salt and saturated fat levels in food should be kept low to guard against the risk of diseases, campaigners say.There is too much salt and fat in the food served to children in hospital, a survey suggests.

Research from Consensus Action on Salt and Health (Cash) found 85 of the 189 child hospital meals tested would be too unhealthy to be served in schools.

The meals exceeded salt and fat limits for school lunches introduced in 2008.

Campaigners want ministers to bring in nutritional guidelines for hospital food. The Department of Health said it was concerned about the findings.

The research also found that one in three of all 451 meals surveyed would be classified as “red” for saturated fat or salt, according to the Food Standards Agency‘s traffic light labelling scheme.

A chicken tikka masala and rice served in a hospital, for example, was found to contain 14 times more salt (2.2g) and 8.5 times more saturated fat (6g) than a chicken and vegetable balti with rice, served in a school.

“When such great progress has been made on what pupils are eating in school it is shocking that children in hospitals are being ignored” said Professor Graham McGregor of the Wolfson Institute of Preventive Medicine.

A hospital lasagne contained nearly six times more salt than a lasagne served in schools – 3.2g compared with 0.57g.

The survey found that pizza in hospital contained nearly double the amount of salt of a school version (2.43g compared with 1.35g per portion).

A sticky toffee sponge pudding with butterscotch was also 6 times higher in saturated fat than a similar pudding served in a school (19g compared with 3g per portion).

Diet-related diseases

The findings came from a survey carried out by Cash and campaign group Sustain, which looked at the nutritional content of meals which were provided by leading hospital food suppliers across the UK. They then compared them with the nutritional standards set out for schools – which set out limits for particular meals.

Professor Graham McGregor, from the Wolfson Institute of Preventive Medicine and chairman of Cash, said: “With everything we know about the risk of children developing high blood pressure and diet-related diseases such as obesity, it is vital to keep their consumption of salt and saturated fat as low as possible, while still being appetising.”

Diet guidelines

No more than 6g salt a day, 2g for Heart Failure Patients
Men – no more than 30g saturated fat a day
Women – no more than 20g saturated fat a day
Source: NHS

“When such great progress has been made on what pupils are eating in school it is shocking that children in hospitals are being ignored.”

The government introduced mandatory school nutritional guidelines in 2008 to try to make sure that children were given the right mix of energy and nutrients in their school lunches.

A survey by the School Food Trust this year shows that 41% of primary school pupils now eat school lunches, an increase of 2.1% on 2008-09.

MP Joan Walley believes there should be legal nutritional standards for food served in all public sector institutions, like hospitals, care homes, universities and in the armed forces – not just schools. She said: “It is really important that children are served food in hospital which they like, but we must also make sure that it is nourishing and healthy for them to eat.” She has introduced a bill to Parliament and says the onus is now on the government to accept it.

A Department of Health spokesman said they were concerned about the survey’s findings.

“We recognise the importance of good quality food for patients of all ages, both in terms of improving their health and in relation to their overall experience of services. “Tools are available to support caterers in assessing the nutritional content of meals.”

My opinion it will get worse before it will get better due to the cuts. It’s an easy area to skimp and save, just add more pepper and spices if you know what I mean!

This is an interesting post based around intelligent pills and Heart Failure patients.

A new era of “intelligent medicines” is heralded today with the disclosure that the NHS is about to begin trials of pills that contain a microchip, reminding patients when to take them.

When the pills are swallowed the “edible” microchips react with the acid in the stomach sending a message to a sticking plaster containing a sensor strapped to the shoulder. If the patient has forgotten a dose, the sensor delivers a text message to the patient’s phone reminding them to take their pills.

In addition, the sticking-plaster sensor monitors the patient’s bodily functions such as heart rate and can recommend adjustments to the dose accordingly, which can also be delivered to the patient via text message. The sensor can also send messages via the internet to carers and, if wanted, other family members, updating them on the patient’s condition.

If successful, the system could improve patients’ well-being while reducing costs by avoiding unnecessary hospital admissions.

The technology, developed by the US company Proteus in California, is being tested initially on 40 NHS patients with heart failure at Imperial College Healthcare Trust in London and the Royal Berkshire Trust in Reading. If successful, the four-month trial will be followed by a larger year-long trial starting in 2011 to measure the effect of the system on reducing hospital admissions.

Patients in the NHS trial will be given versions of two standard heart drugs – bisoprolol, a beta blocker that slows the heart beat, and furosemide, a diuretic that reduces fluid in the tissues – with the microchips incorporated in them.

The sticking-plaster sensor will measure heart rate, physical activity and whether the patients remain lying down while sleeping. If they are frequently forced to sit up, that is a sign of increasing fluid on the lungs, a common and potentially serious side effect of heart failure which requires urgent adjustment of the dose.

Research suggests that between a third and a half of patients do not take their medicines as instructed, leading to worse health, more hospital admissions and wasting $290bn (£186bn) a year in the US, according to a report by the New England Healthcare Institute published last year.

Unpleasant side effects, confusion over instructions, forgetfulness, language barriers and feeling “too well” to need medicine are among the reasons cited for non-compliance. People with chronic conditions such as diabetes and high blood pressure are least likely to stick to the regime prescribed by their doctor.

Nicholas Peters, professor of cardiology at Imperial College and a consultant to Proteus, said: “The whole idea of this technology is to inform patients about their own well-being, to encourage them to take the tablets and to take responsibility for their own health. It can help them stay stable and prevent them getting on to the slippery slope that leads to hospitalisation.”

“People may say, ‘Why do you need technology to detect a missed dose? If I feel ill I can adjust the dose.’ But, in heart failure, once symptoms worsen it is often already too late. There is a narrow window. The patient can become fluid over-loaded and hospitalisation is the inevitable next step.”

The microchip could be placed in almost any medicine. The technology has already been trialled in the US for psychiatric disorders where compliance is a particular problem.

Mobile-phone networks have already developed applications to remind patients to take their medicines, but the Proteus system, called Raisin, takes it a stage further. Networks could offer the application at a discount as an inducement to customers to join.

Dr Jerry Gurwitz, a geriatrician at the University of Massachusetts Medical School and expert on drug errors, said persuading patients to take the drugs they need is a challenging problem, especially among older people who live alone. “I think any person who is practising medicine is going to say it’s one of the biggest challenges and frustrations of providing care to patients right now,” he said.

The Proteus system has received the EU’s consumer and health stamp of approval and the company is expected to seek regulatory approval for widespread use in the EU next year.

Interesting post on Alcohol

I was in Lloyds Pharmacy this afternoon picking up my bucket load of drugs and I picked up a really useful device and instantly thought of Pumping Marvellous readers.

I am sure Lloyds will love me for this but it is a little invention produced by the East Lancs PCT, now I am sure this has been out for a long time but I was really impressed with it.

Now I don’t really drink alcohol so I am probably not the best person to comment on this but here goes.

It is a black wheel looking thing which tells you the units per drink and the calories per drink. There are a set of measures so if you can’t get your hands on one of these then here goes –

Regular Cider 5%ABV – 1 pint (568ml) – 2.8 units and 250 calories
Strong Cider 7.5%ABV – 275ml bottle – 2.1 units and 99 calories
Guinness 4.1%ABV – 1 pint (568ml) – 2.4 units and 210 calories
Port 20%ABV – 50ml glass – 1 unit and 78 calories
Sherry 17.5%ABV – 50ml glass – 0.9 units an 77 calories
Alcopop/Ready to Drink 5%ABV- 275ml bottle – 1.4 units and 200 calories
Standard Beer/Bitter 3.6%ABV – 1 pint (568ml) – 2 units and 182 calories
Standard Lager 4%ABV – 1 pint (568ml) – 2.3 units and 200 calories
Premium Beer / Lager 5%ABV – 330ml bottle – 1.7 units and 142 calories
Premium Beer / Lager 5%ABV – 1 pint (568ml) – 2.8 units and 244 calories
Super Strength Lager 9%ABV – 440ml can – 4 units and 250 calories
Whiskey/Bourbon/Brandy 40%ABV – 35ml measure – 1.4 units and 78 calories
Gin/Vodka/Rum 37.5%ABV – 35ml measure – 1.3 units and 72 calories
Wine/Champagne 12%ABV – 750ml bottle – 9 units and 555 calories
Wine/Champagne 12%ABV – 125ml glass – 2.1 units and 133 calories

Hopefully this will make you think twice about consuming alcohol.

Your Daily Allowance

In the UK the department of health recommends that an adult man does not drink more than 3-4 units of alcohol and an adult woman 2-3 units of alcohol as a maximum in any one day.

Managing Heart Failure in extreme Heat

I am currently going through my first summer after being diagnosed with Heart Failure in January 2010. Writing this I am thinking maybe I should write this next year when I am an expert but the subject is always at the top of my mind so nothing like the present but I thought I would need some help so the following is an excerpt from the British Heart Foundations website.

“Extremely hot weather can cause dehydration and heat exhaustion. Heat and humidity can
interfere with the body’s natural cooling process. If you have a heart problem, extreme
heat may place an extra burden on your heart and circulation.

Excessive sweating in hot weather increases the loss of fluid from your body. This reduces
the total blood volume. This will increase the workload of your heart and the demand for
oxygen, which can lead to angina if you have coronary heart disease. Losing too much
body fluid will also increase your internal body temperature, which could be life-threatening if left untreated.

If you are in hot and humid weather, it is very important to wear light, comfortable clothing. Managing your fluids is a very difficult process as you are trying to balance excess perspiration as well as the diuretic action of your drugs. If you feel as though you need to increase your fluids have a chat with your clinician. However if you need to take more fluid on board then sip the fluid or have a look at some of my tips, sweets, frozen grapes and water spray. Try to avoid caffeine-based drinks because these act as a
diuretic. (That means that they increase the amount of fluid you get rid of through your kidneys.)

Symptoms of heat exhaustion include heavy sweating, cold clammy skin, dizziness,
muscle cramps, shallow or fast breathing, nausea and vomiting. If you have any of these
symptoms, get medical attention immediately.

It’s a good idea to consult your doctor if you have any concerns about extremes of
temperature or have plans to travel to a country with either a hot or cold climate.

Health spas, saunas, jacuzzis and steam rooms

If you have a heart condition or have high blood pressure, it is generally advisable not to
use spa facilities – including baths, saunas, jacuzzis or steam rooms. In particular, don’t
use facilities that involve a sudden change of temperature – for example, having a hot
sauna and then plunging into a cold bath. If you particularly want to use any of these
facilities, ask your doctor about it first. Depending on what heart condition you have, your
doctor can give you advice on which types of facilities you should avoid.

Diuretics

Diuretics used to be known as water pills because they stop fluid collecting in your body and make you urinate more often. These are one of the most common treatments in heart disease. However, there have been only a few large studies into how effective they are in heart failure.

Researchers have combined the findings from smaller studies and concluded that diuretics extend life and improve symptoms of heart failure. Clinicians recommend them for people with heart failure who have signs of fluid retention, such as swollen ankles or breathlessness due to fluid in the lungs. Doctors will vary the dose of diuretic depending on your symptoms.

There are many different types of diuretic, but some of the most widely used for heart failure are bendroflumethiazide, chlorthalidone and furosemide.

Hi Nick

I was reading this with interest, and just thought that maybe carrying a spray type bottle with water in might let you just moisten your mouth and tongue without consuming large volumes?

You could even freeze the water or juice if you plan to carry it around all day, then as it melts during the day it will still be cold and refreshing.

This is a great tip from one of my friends in the East Lancs Primary Care Trust – it could help you stop smoking but it also manages your fluid intake. I think it is a real tasty tip!

“Hi Nick,
A tip that I give to people who are trying to quit smoking without weight gain is to suck on frozen grapes. Lots of them love it, its low in sugar and calories, it’s sweet and tasty and will contribute a little to your ’5-a-day’. Just as good for the management of fluid intake and a healthy alternative to ice-lollies and boiled sweets.”

Angela