National 5 (Spotlight Weekly)

Taking Control

Taking Control Lifestyle changes can even help slow the progression of heart diseases

By AKSHAY SHARMA

The term "heart failure" couldn't sound bleaker, and anyone familiar with it knows it is a frightening and serious medical condition. The physical symptoms, combined with the depression and anxiety that it can sometimes provoke, may make you feel weak and vulnerable, as if you've lost control of your life.

But as debilitating as heart failure can be, there is still a great deal that you can do to improve your condition. "Taking control can make people with heart diseases feel better," says Bhagwan Koirala of the Shahid Ganga Lal Hospital. "It feels good to be doing something positive, and there's evidence to suggest that it really can help your emotional state."

Taking control of your treatment will help more than your state of mind. By being on top of your condition - learning about your condition, following your doctor's recommendations, taking your medication, eating well and even exercising - you may also greatly improve your prognosis.

Heart Center : High expectations

Good nutrition is an important aspect. Obesity is a major contributor to the condition, and eating a diet low in fat and high in fruits and vegetables is important. In general, you also should limit your alcohol and caffeine intake.
Experts agree that people with heart failure should follow a low-sodium diet. But how low? Some experts observe there are problems with eating a diet too low in sodium and that there are other factors to consider. "One thing that's clear from my work is that food just doesn't taste as good when you're eating a low-sodium diet," Koirala told SPOTLIGHT. Because of this, it's a diet that's not only difficult to stick to, but also one that may contribute to nutritional problems.

"The low-sodium diet sometimes causes people to reduce their caloric and nutritional intake," Koirala says. "When you start trying to follow a 2-gram sodium diet, there are a lot of foods that you may not be able to eat. Also, foods high in protein also may be high in sodium, so when you reduce salt, you also reduce protein."

Protein deficiency can lead to unhealthy weight loss and muscle wasting, which are serious - and often underestimated - symptoms of heart failure. "Heart-failure patients seem to be nutritionally out of balance," says Koirala. He believes nutrition is an important issue to address, especially for those about to undergo major surgery. "I think that we need to be looking at a bigger picture of adequate nutrition and there's still a lot we don't know," says Koirala. For now, he recommends a diet that restricts sodium but also follows basic nutritional advice. You should talk with your doctor, nurse, or dietician about what sort of diet and sodium restrictions make sense in your case. Given the weakness that many heart patients experience - even make moving across a room exhausting - the idea of exercise may seem ludicrous. "We used to tell heart patients to just rest," says Koirala, "but now we know that in many conditions, you're probably healthier if you get a little exercise."

Indeed, a recent statement from the American Heart Association, based on a review of the medical literature, indicated that exercise seems to be beneficial for heart patients, even for those with advanced forms of the disease.
Of course, patients absolutely must check with a doctor before undertaking an exercise plan. But all sorts of aerobic activity - walking, biking, and swimming, for instance - appear to be beneficial in many cases. Exercise improves the condition of blood vessels and lowers the levels of harmful hormones in the bloodstream. Exercise also makes people feel better, it improves symptoms, and it makes it easier to do normal, everyday physical tasks that can become difficult in advanced stages of heart diseases. Heart specialists recommend 20 to 30 minutes of aerobic activity three to five days a week; people with advanced heart conditions may need longer warm-up periods.
However, some doctors caution we still need more data from large studies before we can be sure of the types and amounts of exercise to recommend for heart failure. They also points out that the benefits of exercise have been shown only in patients who were medically stable.

Dr. Koirala : Picture of preseverance

"I think that exercise may play an important role in treatment," says Prasant Barakoti, MD, internal medicine professor at the University of Pokhara. Although he cautions that "we don't know all of the answers yet", he is optimistic about a new study of exercise in heart failure patients that has just begun.

Getting a good night's sleep is, not surprisingly, good for people with heart diseases - just as it is for anybody. But for people who sleep less than eight hours a night, a recent study suggested that the less you sleep, the higher your risk of developing heart disease. The reasons aren't entirely clear, but it is known that during sleep, the pulse, blood pressure, and levels of certain hormones are lowered, allowing the body to rest.

Unfortunately, some medications used to treat heart conditions may make it hard to sleep soundly. For instance, people taking diuretics often wake up several times a night to go to the bathroom; talk to your doctor about scheduling your doses to help lessen or prevent this problem. A particular concern for people with heart failure is a connection between this heart problem and sleep apnea, a disorder in which a person temporarily stops breathing for ten seconds or more while asleep. Sleep apnea - usually caused by a physical obstruction in the airway - is seen in about a third of people with heart failure. Treatment involves surgery or wearing a breathing mask during the night. A recent study showed that treatment with the breathing mask - called CPAP - improved symptoms of both heart failure and sleep apnea.

There are a number of other ways that heart patients can take control of their disease. The most important is to see your doctor regularly and to establish an effective partnership with medical professionals. Good management of your condition improves your prognosis, reduces the chances of being hospitalized, and improves your quality of life, say experts. Sticking with your drug treatment is also crucial. No matter how beneficial a drug has been proven to be in clinical studies, it's not going to help you unless you take it. This is true for other conditions like high blood pressure or diabetes. If side effects are making it difficult to take your prescriptions, talk to your doctor.

On your own, you should be weighing yourself daily and checking for signs of swelling called edema - a sudden weight gain could be a sign of fluid retention. And if you still smoke, you need to quit. You should also limit the amount of exposure that you get even to second-hand smoke. Reducing stress and anxiety is important, although your condition can certainly provoke such feelings. Depression is a risk for people with heart failure.
"A lot of people with heart failure become depressed," says Dr. Barakoti, "anywhere from 20 percent to 60 percent." He also notes that, in some groups, depression can worsen the prognosis. However, he thinks doctors generally are aware of the problem and looking out for it. He also stresses that health professionals need to make certain that older people with heart disease get the support they need at home. "People tend to isolate themselves when they're sick, and we need to be looking at family and support systems for people with heart failure," Dr. Barakoti adds.

The healthcare system should be doing much more to prevent people from reaching the late stages of the disease, according to Dr. Barakoti. "I think that the rise in heart diseases can be slowed significantly by early detection and aggressive medical treatment," he says. "But the problem is that these patients don't get into the hands of specialists until they become sick, and by then it's too late for aggressive preventative intervention. People who have late-stage heart failure represent a failure of our medical system."

Dr. Koirala believes that doctors need to make sure they give patients concrete advice about diet and other lifestyle changes they need to make. "It's not enough to say, 'Take it easy,' or, 'Watch your salt,' or, 'Try to walk more,'" he says. "People need more specific information." While heart failure remains a very serious and dangerous disease, people diagnosed with it have good reason for hope.

"The one message that I think is worth getting across is that the current management of heart failure is far better than people think," says Dr. Barakoti. "Every paper on the management of heart failure starts out with an obligatory statement about how terrible a disease it is and how bad the prognosis is. But that's really wrong. The prognosis is now quite good and so much better than it once was."