Transcript LIVING SUCCESSFULLY WITH HEART FAILURE

PALOMAR
POMERADO
HEALTH
SPECIALIZING IN YOU
Living
Successfully
with Heart
Failure
HMJ1 12.07
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Table of Contents
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Welcome
Contact Information
Introduction
What is Heart Failure?
What Causes Heart Failure?
Other Questions to Ask
How Does it Feel to Have Heart Failure?
What Should Concern Me?
Taking Care of Yourself
Weigh Yourself Daily
Take Your Medications Exactly as Directed 14
Types of Medications
It Helps to Eat Food High in Potassium and
Low In Sodium
Follow a Low Sodium Diet
Herb Seasoning Suggestions
Dining Out
Guidelines for a 2 gram (2000 mg) Sodium Diet
Reading Food Labels
Sample Food Label
Avoid Drinking Too Much Fluid
Limit Alcohol
Stop Smoking Now
Relapse Prevention for New Non-smokers
Know Your Diabetes Risk
Get regular Exercise
Exercise Routines
Exercise Smart
Suggestions for Energy Conservation
Activities of Daily Living
Make This Plan a Permanent Part of Your Life
Notes
Home Medication Log
Daily Weights
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Welcome to Palomar Pomerado Health (PPH).
The mission of PPH is to heal, comfort, and promote health in the communities
we serve. Our vision is that PPH will be the health system of choice for patients,
physicians, and employees and be recognized nationally for the highest quality of
clinical care and access to comprehensive services. Our goal is to provide you
with excellent healthcare.
Our visiting policy is individualized and flexible based on the needs of our
patients and family members.
The packet you are receiving has general information you may find helpful in
dealing with your condition, or your loved one’s condition. Additional handouts
will be given to you for any other risk factors that may be present. Handouts are
available for medications you may be taking or will take at home. These
handouts will be given to you when you are admitted and others may be added
before you go home.
Your nurse or your primary healthcare provider can answer any questions you
may have. We encourage you to write down your questions or comments on the
“Notes” pages provided at the back of this booklet. Please use these pages to
speak to your nurse or primary healthcare provider about anything regarding
your hospital stay with PPH.
We want your experience to be as pleasant as possible. If we can help you with
anything, please do not hesitate to ask. For any questions, comments, or
concerns, please call the nurses’ station directly for immediate assistance.
Palomar Medical Center
All prefixes are: 1-760-739
Surgical, 8th Floor: 3840
Medical/Oncology, 7th Floor: 3740
Intermediate Care, 7th Floor: 3790
Telemetry, 6th Floor: 3640
Critical Care, 6th Floor: 3655
Orthopedic/Stroke, 5th Floor: 3540
Pomerado Hospital
All prefixes are: 1-858-613
Medical/Surgical/Telemetry,
4th floor: 4440
Medical/Surgical/Telemetry,
3rd floor: 4340
Critical Care/Intermediate Care,
2nd Floor: 4339
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Contact Information
Please write down important contact
information in the spaces below. You may
want to share this information with family
members and friends.
• Doctor Treating Me for Heart Failure
Name: ________________________________
Address: ______________________________
City: _______________
State: _____
Zip code: _________
Phone number: _________________________
• Other Important Phone Numbers
– Ambulance, fire department, or emergency
services: 911
Pharmacy: _____________________________
Other doctors or nurses:
____________________________________
____________________________________
____________________________________
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Introduction
Many people with heart failure lead normal, active
lives. They do so because they have learned to take
good care of themselves. This book is designed to
help you learn to live successfully with heart failure.
We want you to learn about your body, the disease,
and methods of treatment. You can take control
over heart failure by carefully following proper
medication advice and healthy lifestyle changes. If
you do so, you too may be able to lead an active and
satisfying life!
This booklet provides basic information on heart
failure. It will help you:
♦Understand your treatment plan
♦ Learn how to actively work with your doctor or
nurse so you can feel better
♦ Learn how to overcome common stumbling
blocks in following your treatment plan
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What Is Heart Failure?
Many people misunderstand exactly what heart failure
means. Heart failure does not mean that your heart has
stopped or is about to stop. Heart failure is a serious
illness in which the heart doesn’t pump blood through
your body as well at it should. Your heart still beats, but
it pumps less nutrient-and oxygen-rich blood to the rest
of your body. Because of this, heart failure can make
you feel tired or weak. Heart failure can also cause
swelling and fluid buildup in your legs, feet, and even
your lungs. Fluid backing up into the lungs is often
referred to as “congestion,” which is why heart failure
is sometimes called “congestive heart failure” or CHF.
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WHAT CAUSES HEART FAILURE?
What Causes Heart Failure?
Heart failure usually occurs when another problem
makes the heart weak or stiff so it doesn’t pump or
fill normally. Coronary artery disease is a common
cause of heart failure. Other causes include
previous heart attack, high blood pressure, infection
of the heart muscle, lung disease, and problems
with the heart valves.
Ask your primary healthcare provider what causes
your heart failure. There may be special things you
can do to care for yourself that are not included in
this booklet.
The cause of my heart failure is:
___________________________________________________
___________________________________________________
___________________________________________________
___________________________________________________
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Other Questions to Ask
Asking questions can help you talk about heart failure with
your doctor or nurse. Talking with your healthcare
providers will help to ensure you are receiving the best
possible care. Your health is an active partnership
between you and your doctor or nurse.
Do I have blockages in my coronary arteries?
Reason for asking this question: Coronary artery disease is a
common cause of heart failure. With this disease, blockages
in the coronary arteries decrease or cut off the blood supply
to portions of the heart muscle. It can be possible to open the
blockages and restore blood supply to the heart. This can
improve heart function and reduce your symptoms. Knowing
if your heart failure is a result of blocked coronary arteries
can help your doctor plan the best treatment for you.
Is my blood pressure high?
Is my blood pressure under control?
Reason for asking this question: High blood pressure is a cause
of heart failure and it can make heart failure worse. Reducing
blood pressure to normal levels is a way to reduce strain on
the heart. It is important to know whether your blood
pressure is under control. Your doctor can help to make sure
it is managed well.
Are my heart valves damaged?
Reason for asking this question: Heart valve damage is a cause
of heart failure. Sometimes, valve damage can be repaired so
that heart failure improves.
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Other Questions to Ask
What is my heart function (ejection fraction or “EF”)?
Reason for asking this question: Heart function is commonly
assessed by using a number call the ejection fraction. The
ejection fraction is not a number of the amount of heart
muscle that is still working rather it refers to the
percentage of blood that is pumped out of the heart each
time it beats.
A heart will not pump out all of the available blood with each
beat. A normal heart pumps out, or ejects, about 50-65%
of the blood inside. If the heart is damaged, the ejection
fraction can fall below 40%. This is called systolic heart
failure. You can have a normal ejection fraction and still
have heart failure. This can be related to a condition
called diastolic heart failure.
An echocardiogram is commonly used to evaluate heart
function. The test can tell you and your doctor about your
heart and heart valve function.
It is important to know your heart function because it can
help to determine the severity of heart failure. It will also
help to guide your care. Once your primary healthcare
provider has evaluated your heart function, it is not
necessary to keep testing it.
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How Does it Feel to
Have Heart Failure?
People with heart failure often have the
following symptoms:
Shortness of breath, wheezing or coughing
with activity
Weakness or tiredness
Problems with breathing when lying down
Waking up at night coughing or short of
breath
Swollen ankles, legs, belly, and/or feet
Increased heart rate, or heart palpitations
Loss of appetite
Weight gain
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What Should Concern Me?
Just because symptoms are common does not mean you
should ignore them! Call your primary healthcare
provider for any of the following:
Increased ankle swelling
Problems breathing at night
Weight gain or loss of 2-3 pounds in 2-3 days or 4 pounds
in a 7 days or less
 A change in your ability to sleep
 An increase in coughing, wheezing, or shortness of breath
 Increasing fatigue
 Decreasing ability to be active
 Nausea and/or loss of appetite
CALL 911 IMMEDIATELY if you have any of the following:
•Prolonged chest pain that does not respond to nitroglycerin.
•Extreme shortness of breath or trouble breathing.
•Feel like passing out.
•You feel your pulse is irregular or rapid or feel a fluttering in
your chest (palpitations).
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Taking Care of Yourself
The treatment of heart failure typically involves several steps.
The steps are listed here and explained more later in this booklet.
Weigh yourself daily
Take your medications exactly
as directed
Follow a low sodium diet
Avoid drinking excess fluids
Avoid alcohol consumption
Maintain a normal body weight
Get regular exercise
Know the warning signs of heart failure
Stop Smoking
Keep follow-up appointments
Make this plan a permanent part of your life
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Weigh Yourself Daily
A sudden weight gain is one sign that you are retaining fluid.
Weigh Yourself:
At the same time every day
(preferably first thing in the morning)
Without clothes or in lightweight clothing
After you urinate
Before you eat breakfast
Write your weight down every day for your records.
 Bring your record with you when you visit your doctor
If you have a weight gain or loss of 2-3 pounds in 2-3
days OR 4 pounds in 7 days or less, call your primary
healthcare provider.
* “Daily Weights” sheets are provided at the back of
this booklet for your convenience.
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Take Your Medications
Exactly as Directed
Medications typically given for heart failure include:
• Blood vessel dilators
(ACE inhibitors, beta blockers and many others)
• Diuretics/water pills
• Aldactone, Spironolactone
• Potassium Supplements
• Heart strengtheners (Digoxin, Lanoxin or Digitalis)
* “Medication Schedule” sheets have been provided
at the back of this booklet for your convenience. Use the
sheets to keep track of the medications you take, how
often you take them, why you take them, and if there
are any special instructions for taking them given to
you by your primary healthcare provider.
Blood vessel dilators can be ACE inhibitors, beta
blockers, or others. Blood vessel dilators make the blood
vessels relax so it is easier for the heart to pump blood into
vessels. Ask your nurse or pharmacist for detailed
instructions on the medications you are given.
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Type of Medications
ACE inhibitors work much like the other blood vessel
dilators.
Common ACE inhibitors include Capoten (Captopril),
Vasotec (Enalapril), Zestril (Lisinopril) and Altace
(Ramipril). These drugs help to keep your heart
failure from getting worse. Sometimes they even
shrink an enlarged heart back to normal size. No
matter how well you feel, do not stop taking this
medication without your primary healthcare
provider’s advice.
Beta blockers are other drugs that relax the blood
vessels and also relax the heart, possibly lessening
the stress which may play a part in the heart failure.
Common beta blockers include Carvedilol (Coreg) or
Metoprolol (Toprol XL or Lopressor). They are
used in stable patients and in combination with
water pills and other blood vessel dilators.
• Some patients may initially gain weight, have swollen
ankles, or shortness of breath.
NOTIFY your primary healthcare provider if this
happens.
• Some patients feel slightly weak or dizzy at first; this
effect usually goes away within a few days.
Other vasodilators include Norvasc, Isordil,
Apresoline, Minipress, Sorbitrate, and others.
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Type of Medications
Diuretics are water pills that help your kidneys produce
more urine. This results in less fluid for your heart to
pump. With less to pump, the heart does not need to
work so hard.
Commonly prescribed water pills include Furosemide
(Lasix), Bumex (Bumetanide), Zaroxolyn
(Metolazone), Hydrodiuril (HCTZ), and Diuril
(Chlorothiazide). Along with an increase in urination,
you may feel thirsty. Thirst and urination are normal
effects of diuretics. Do call your primary healthcare
provider if you are taking diuretics and experience:
• Dizziness
• Severe weakness
• Severe leg cramps
Potassium supplementation helps to control your heart
rhythm. Potassium is a mineral that your body needs.
Some water pills cause you to lose potassium (KCL)
along with urine. If this happens, you may need to take
extra potassium. It is often prescribed in tablet, liquid,
or powder form. The liquid or powder forms should be
mixed in 3 to 4 ounces of fruit juice or water to avoid
stomach upset. Liquid potassium is salty and bitter.
Do not let the taste keep you from taking this essential
medicine!
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Type of Medications
Aldactone or Spironolactone are aldosterone antagonists
(hormone blockers). This medication may be started in a
low dose and increased gradually. Blood potassium and
creatinine (for kidney function) will be closely monitored
the first few weeks of therapy and then on a regular basis
after that. Your doctor may take you off all potassium
supplements if you are on this medication.
Digoxin (Lanoxin) is medicine that strengthen the heart
muscle help assure that more blood is pumped with each
beat. Digoxin, a commonly used heart strengthener, is
usually taken once daily. Call your primary healthcare
provider if you feel any of these possible side-effects:
• Loss of appetite, distaste for food or bad taste in the
mouth
• Nausea or vomiting
• Bluish or yellowish vision
• Skipped heart beats, dizziness, palpitations, or rapid
heart beating
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It Helps to Eat Food
High in Potassium and
Low In Sodium
• Dried fruits (raisins, prunes, apricots,
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•
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•
•
•
figs, dates)
Fresh fruits (bananas, cantaloupe,
grapes, oranges, honeydew melon, fruit
juices)
Fresh vegetables (avocados, potatoes,
beets, greens, spinach, peas, tomatoes,
mushrooms)
Dried vegetables (beans, peas)
Fish (flounder, halibut)
Fresh meats (turkey, beef)
Decaffeinated coffee
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Follow a Low Sodium Diet
Getting Started:
A moderate 2 gram (2000 mg) per day diet restriction is
essential Ask your primary healthcare provider how
much sodium you can eat. Table salt contains 40%
sodium and 60% chloride, so use it sparingly. One
teaspoon of table salt contains about 2300 mg of
sodium! Sodium is a naturally occurring ingredient in
almost all foods. Fresh, unprocessed foods are naturally
low in sodium. High amounts of sodium are found in
many canned, pickled, convenience, packaged, processed
and “fast” foods. Give yourself time to adjust to reduced
sodium in your diet. Remember, salt is an acquired taste
and it can be unlearned. Be patient and learn to enjoy
new flavors in foods.
Salt Substitutes:
There are two basic types of salt substitutes, the “herb”
type and “potassium chloride.” It is important to know
the difference because some people should avoid the
potassium chloride salt substitute (common brand
names being NuSalt or NoSalt).
You should discuss use of potassium chloride (or KCl) as
a salt substitute with your primary healthcare provider
before using it. This compound may act as a strong drug
for some people. On the other hand, herb seasonings can
be enjoyed by almost everyone.
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Herb Seasoning Suggestions
Beef
Curry, basil, bay leaf, dill, mustard, onion or garlic,
mushrooms, sage, tarragon, thyme, grape, nutmeg, parsley,
pepper.
Chicken
Cloves, pineapple, paprika, sage, tumeric, oregano, cranberry.
Fish
Dill , curry, lemon rind and lemon juice, tomato, ground
pepper, chervil.
Pork
Cloves, applesauce, caraway, rosemary, thyme, chives, basil,
onion or garlic.
Eggs
Paprika, tarragon, parsley, onion, jelly, curry, chervil, tomato,
mushrooms.
Vegetables
Garlic or onion, basil, dill, green pepper, unsalted salad
dressing, vinegar, tomato, mushroom, mint, mace.
Desserts
Vanilla, extracts of other flavorings, mace, nutmeg,
cinnamon, ginger, allspice.
Spice blend recipe
1 tsp chili powder
2 tsp ground oregano
2 tsp black pepper
1 T garlic powder
3 T paprika
6 T onion powder
3 T poultry seasoning
Combine all ingredients and store in an air tight container.
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Dining Out
Here are some suggestions for reducing sodium when eating in restaurants:
• Choose foods without sauces or ask for the sauce on the side so you can
control the amount you eat.
• Patronize those restaurants where food is cooked to order.
• Ask your server for chopped onions, chives, lemon, or other fresh herbs to use
as flavorings.
• Frequent authentic ethnic restaurants. They often use fresh ingredients for
flavor instead of relying on salt and processed (salt laden) foods.
• Ask the server to suggest some low salt alternatives.
• Choose ala carte and pick the most simple foods such a plain green salad,
baked potato, etcetera.
• Carry your own herb seasoning blend with you.
Suggestions For Reducing Sodium In Your Diet:
• Eat fresh fish, meats, vegetables and fruits.
• Avoid convenience foods like soup, frozen or canned prepared main dishes
such as “TV” dinners, ravioli, pot pies, pizza.
• Avoid sausages, luncheon meats, hot dogs, ham, bacon, and other cured or
smoked meats, poultry and fish.
• Don’t cook with salt or add salt to your food at the table.
• Season with lemon, onions, spices and herbs such as pepper, paprika, curry, or
dill.
• Avoid seasoned salts like garlic salt and onion salt.
• Use “Low Sodium” or water-packed canned vegetables, or rinse and drain
regular canned vegetables before cooking.
• Avoid hidden sources of sodium such as soy sauce, steak sauce, teriyaki sauce,
barbecue sauce, monosodium glutamate (MSG), and meat tenderizers.
• Avoid pickled foods or foods packed in brine such as relish, pickles,
sauerkraut.
• Avoid salty snacks such as corn or potato chips, salted nuts, salted crackers.
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Guidelines for a 2 gram
(2000 mg) Sodium Diet
Food Groups
MILK
Suggested Daily Servings
Limit to 3 cups per day (1 cup = 8 oz.).
VEGETABLES
Unlimited fresh, frozen, and
low-sodium canned vegetables
BREAD
Limit to 5 servings per day (1 serving =
1 slice bread or 1 dinner roll). If you eat
more than 5 servings per day, switch to
“Low Sodium” bread. Avoid all quick
breads such as biscuits, pancakes, waffles
and corn bread; self-rising flours; stuffing
mixes; regular bread crumbs;
breads/rolls/crackers with salted tops.
PASTA/RICE/BEANS
Unlimited. Avoid commercially prepared
rice & pasta mixes.
CEREALS
Unlimited unsalted cereals such as cooked
cereals (non-instant) and puffed wheat or
rice.
FRUIT
Unlimited fresh, frozen or canned.
MEAT/POULTRY/
EGGS/EGG SUBSTITUTE
6 oz. per day (1 egg = 1 oz. Meat)
MISCELLANEOUS:
Crackers, popcorn, pretzels, nuts. Unsalted
only, peanut butter, cheese, butter,
margarine.
SOUP
Low sodium only.
CARBONATED BEVERAGES
Limit to no more than 50 mg.
sodium per day from this source.
DESSERTS
Limit desserts (cake, cookies, pie, etc.) to 1
to 2 servings per day.
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Reading Food Labels
It is important that you read food labels to determine the sodium content of foods.
Sodium content is expressed in milligrams (mg) per serving.
It may also be helpful to know that certain words used on labels must mean what they
say as defined by the government:
Key Words
Meaning
“Sodium Free”
negligible sodium (less than 5 mg per serving)
“Very Low Sodium”
35 mg sodium or less per serving
“Low Sodium”
140 mg sodium or less per serving
“Less Sodium”
20% sodium reduction from the original
product
“Reduced Sodium”
at least 25% reduction from the original
product
“Light in Sodium”
50% sodium reduction from the original
product
“Unsalted”
“Without Added Salt”
“No Salt Added”
no salt used during processing
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Serving Size
Always keep the serving size in mind when you
inspect the label because all of the nutrient
categories are based on this.
Nutrition Facts
Serving Size 1/2 cup (114g)
Servings Per Container 4
Amount Per Serving
Calories
Total kilocalories per serving
Calories 90
Calories from Fat 30
% Daily Value*
Total Fat 3g
Total Fat
Total grams (g) fat per serving. Try to limit fat
calories unless you have trouble gaining or
maintaining your weight. Always try to limit
saturated fat, especially if you need to lower
your blood cholesterol level.
5%
Saturated Fat 0g
0%
Cholesterol 0mg
0%
Sodium 300mg
13%
Total Carbohydrate 13g
4%
Dietary Fiber 3g
Sodium
Total milligrams (mg) sodium per serving.
This is salt! The chemical name for “salt” is
“sodium chloride”. This label tells you that a
1/2 cup serving contains 300 mg of sodium.
Remember to limit your daily total to no more
than 2000 mg to 3000 mg.
12%
Sugars 3g
Protein 3g
Vitamin A
Calcium
80%
4%
•
•
Vitamin C 60%
Iron
4%
*Percent Daily Values are based on a 2,000
calorie diet. Your daily values may be higher
or lower depending on your calorie needs:
Calories
2,000
2,500
Total Carbohydrate
Total grams (g) of carbohydrate per serving.
Sub-categories identify the amount of added
sugars and nutritionally important dietary
fiber.
Total Fat
Less than 65g
80g
Sat Fat
Less than 20g
25g
Cholesterol
Less than 300mg 300mg
Sodium
Less than 2,400mg
2,400mg
Total Carbohydrate
300g
375g
Fiber
25g
30g
Calories per gram:
Fat 9
• Carbohydrate 4
•
Protein 4
Protein
Total grams (g) protein per serving. Choose the
lean sources of animal protein such as lean red
meat, poultry, fish and fat-free or lowfat milk.
Or, try vegetable protein sources such as beans,
cereals and grains.
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Avoid Drinking
Too Much Fluid
Most people with heart failure can drink normal
amounts of fluid. Do not restrict your fluids unless
specifically told to do so by your primary healthcare
provider. But, everyone with heart failure should
avoid excess fluids; try around 48oz – 64oz or
1.5 – 2 liters a day.
• Drink fluids at intervals throughout the day
• Avoid drinking large amounts of fluid all at once
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Limit Alcohol Consumption
As a general rule, you should not drink alcohol at all.
It damages heart cells and can further weaken your
already-weak muscles. Any alcohol use is strongly
discouraged. Ask your primary healthcare provider
what is right for you.
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Stop Smoking Now
Smoking can make heart failure worse, so if you
smoke, you should stop immediately.
Quitting takes hard work and a lot of effort, but you
CAN quit smoking.
For counseling or to register for PPH Kick the Habit
Program, please call the Cancer Resource Center at
(760) 739-3943 or (858) 613-4044.
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Relapse Prevention for
New Non-smokers
Think of yourself as a non-smoker.
•
Decide that cigarettes, or any tobacco products, are not an option!
•
Refer to yourself as a non-smoker, not as an ex-smoker
Watch out for the top 3 triggers.
•
Being around smokers
•
Alcohol
•
Highly emotional situations
– (Remember to watch yourself for your personal triggers as well.)
You can manage your weight when you quit.
•
Stay active
•
Drink water and eat healthy meals
•
Keep low-fat, low-calorie snacks on hand
– (Remember to follow the specific dietary or fluid guidelines and/or restrictions
that your primary healthcare provider has discussed with you.)
You can manage stress when you quit.
•
Incorporate stress reducing activities in your new lifestyle
•
Use stress management techniques
If you “slip” (smoke or use tobacco products), do not let it turn into a relapse.
•
Ask yourself what went wrong
•
Fine tune your strategies and recommit to quitting
•
One cigarette does not mean that you are a smoker again!
If you have a relapse, you can get back on track.
•
Ask yourself if you still want to quit
•
Find a NEW reason to quit
•
Revise your strategies, commit to quit, and set a new date
•
Join, or rejoin, a support group to help you stay a non-smoker
For more information, or to register for PPH Kick the Habit Program,
contact the PPH Cancer Resource Center
at 760.739.3943 or 858.613.4044.
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Know Your Diabetes Risk
Type Two Diabetes Mellitus (Type 2 Diabetes) is a metabolic disorder characterized by the
body’s inability to produce enough insulin and or the body cells being resistant to insulin.
Therefore, there is an abnormal elevation of blood sugar.
Why should I be concerned to know if I have Type 2 Diabetes?
Type 2 Diabetes rarely occurs alone. People that are newly diagnosed with Type 2 Diabetes
usually already have a disease such as High Blood Pressure and/or Abnormal Cholesterol
levels. High blood sugar is not just high blood sugar. If left untreated, high blood sugar will
harm large and small blood vessels – every cell of your body is affected.
What are the risk factors of Type 2 Diabetes?
•Diabetes is more common in African Americans, Latinos, Native Americans, Asian
Americans, and Pacific Islanders (however, Type 2 Diabetes is seen across all race / ethnic
groups).
•Age over 45 (the older one gets the higher the risk – however children as young as 8 years of
age are being diagnosed with Type 2 Diabetes).
•First-degree relative (sibling or parent) with Type 2 Diabetes.
•Overweight, especially being overweight around the ‘belly’ (apple shape).
•Sedentary (inactive) lifestyle.
•Women who had gestational diabetes or gave birth to at least one baby weighing more than 9
pounds (if your mother had gestational diabetes while pregnant with YOU, you are at risk).
•Having other health problems such as: High Blood Pressure, Abnormal Cholesterol, and
other Cardiovascular Diseases.
•Other co-existing factors that could increase your risk – smoking, continual high stress
levels, and depression.
•The more risk factors you have, the more at risk you are of developing or having Type 2
Diabetes.
Don’t Ask – Don’t Tell – Absolutely NOT!
•Uncontrolled diabetes is the leading cause of blindness, renal failure, and limb amputations
(not associated with injuries).
•The leading cause of death in the United States is heart disease (68% of these people had
diabetes).
•Two out of three people with diabetes die from heart disease and stroke.
•It is estimated that once a person is diagnosed with Type 2 Diabetes, he or she likely had
diabetes for at least 5 to 7 years before being diagnosed.
Ask Your Primary Healthcare Provider for Further Evaluation to See If You Have
Diabetes or Are at Risk. Prevention and Early Diagnosis and Treatment To help Prevent
the Complications of Uncontrolled Diabetes is Crucial!
For more information, contact PPH Diabetes Health
at 760.739.2865 or 858.613.4164.
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Get Regular Exercise
We used to believe that people with heart failure should rest, rest, rest. Now we
know that regular exercise is essential! Even short periods of bed rest cause
weakness. Research shows that you can exercise safely.
Remember to talk to your primary healthcare provider first before starting an
exercise program.
Along with prescribed medication, exercise will:
 Help you feel better – stronger and with less breathing trouble.
 Help you to walk farther, work or shop with less fatigue and enjoy fun
activities longer.
 Help you sleep better at night.
 Help maintain and/or improve your balance and help prevent falls.
 Help you lose weight if needed.
 Help you feel more positive and confident.
Help you relieve some stress.
Which type of exercise is the best?
The best exercise for your heart is “aerobic” exercise. Pick activities that are
continuous and have a smooth flow:
Walking
Riding a bicycle (stationary or regular)
Swimming
Water exercise or walking in a pool
Plan to do different things in different settings so you have fun and stay interested!
30
Exercise Routines
How much exercise is enough?
Start off slowly. Increase the time and level of activity gradually. Remember that any
time you spend a day or more in bed or in the hospital, you will be weaker than
usual. Let your body be your guide.
How long should I exercise?
Start with 2-5 minutes of easy walking. Rest for 2-5 minutes.
Then do 2-5 minutes more of easy walking.
As you become stronger, gradually increase your walking time.
Keep your rest time at 1-2 minutes.
Keep doing this until your total exercise time is about 20 minutes. When you
can walk for 20 minutes without stopping, slowly increase your walking time
to 30-40 minutes.
If you start having trouble breathing or feel worn out, you have done too
much. Stop, rest, and make sure to do less the next time.
You don’t have to do all of your activity at once either. For example, you can
go on two short walks instead of one long one.
How often should I exercise?
Try to exercise 4-6 days each week if you feel well.
Make exercise a part of your daily routine, like daily weights and taking your
medicines. The key is to get moving as many days as you can.
How hard should I exercise?
Keep your effort light and comfortable. You should be able to walk and talk
at the same time. If you have trouble breathing or feel worn out, you are
doing too much. Do not push yourself.
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Exercise Smart
Listen to your body. Rest when you are tired, relax when you are under stress,
and let your healthcare team know when you are not feeling well.
Choose activities that you enjoy. Exercise with a buddy if you can.
As you exercise, stay “slow and steady.” Avoid activities that require a quick
burst of energy. Keep your effort light to moderate.
If you exercise shortly after taking your medicines, you may become dizzy or
faint. A change in timing of exercise will often relieve this problem.
Avoid extreme heat or cold. If it is hot or humid out, move your workout indoors
to a cooler time of the day. Walk in a shopping mall or follow an exercise video at
home (pick an easy one).
Drink enough fluids to stay hydrated depending on your fluid allowance.
Any time of the day is fine for exercise. But wait at least two hours after a large
meal. Also, do not exercise if you have not eaten for a long time. A light meal 1-2
hours before exercising is ideal.
If you get tired easily, walk on flat ground when possible.
Dirt or cinder walking tracks, grass playing fields, parks, nature trails, and golf
courses are wonderful for walking. Wear loose fitting clothes and comfortable
walking shoes. Running shoes may be easier on your feet.
Before you exercise, “warm up” for a few minutes by doing your activity at a
slow pace. This will help blood flow to your muscles and ease you into the
exercise. After the warm up, do some stretching. This will keep your muscles
flexible and lower your risk of injury.
After you finish your exercise, ease into a “cool down” phase. Do this by
repeating your warm up routine for a few minutes. Always allow some time after
your activity to rest and relax.
32
Exercise Smart
Skip exercise any day that:
You are not feeling well.
You have had a weight gain over 2-3 pounds in 2-3 days or 4 pounds in 7
days or less. Be sure to call your primary healthcare provider if this
happens.
You have unusual ankle swelling or bloating in your stomach.
You are having more trouble breathing, or are coughing or wheezing.
Stop exercising immediately if you feel any:
Pressure or pain in your chest, neck, arm, jaw or shoulder.
Dizziness, lightheadedness or nausea.
Unusual shortness of breath.
Unusual tiredness.
Heartbeat that feels unusual - too fast, too slow, or feeling like your heart is
“skipping a beat.”
Any other symptom that causes you concern.
Call your healthcare provider for:
Shortness of breathing lasting 10 minutes or more.
Dizziness or lightheadedness.
Chest pain.
Nausea, vomiting or cold sweat.
*Remember to speak with your primary healthcare provider first before
starting an exercise program.
33
Suggestions for Energy
Conservation
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Plan Ahead and Organize Your Work
– change storage of items to reduce trips or reaching
– delegate when needed
– combine motions and activities and simplify details
Schedule Rest
– balance periods of rest and work
– rest before fatigue
– frequent, short rests are beneficial
Pace Yourself
– moderate pace is better than rushing through activity
– reduce sudden or prolonged strains
– alternate sitting and standing
Practice Proper Body Mechanics
– when sitting, use well-supporting chair
– adjust work heights-work without bending over
– bend at knees and hips, not at back
– carry several smaller loads or use a cart
Limit Overhead Work
– use long handled tools
– store items lower
– delegate
Limit Isometric Work
– breathe evenly, do not hold your breath
Identify Effects of Your Environment
– avoid extremes of temperature
– eliminate smoke or noxious fumes
– avoid long, hot showers or baths
Reduce Stress
– learn relaxation techniques
– physical exercise reduces stress
– anticipate fatigue and stress and plan ahead to reduce stress
Prioritize
– decide what activities are important to you, and what could be delegated
– use your energy on important tasks
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Suggestions for Energy Conservation:
Activities of Daily Living
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•
•
Washing & Bathing
– Wash hair in shower, not over sink
– Sit and use a terry robe instead of drying off with a towel
– Use a shower organizer over the shower head to avoid leaning
and reaching
– Use safety strips on the floor of the tub
– Install a grab rail
– Use a shower bench or lawn chair to sit while showering
– Use a handheld shower while sitting
– Use moderate temperature water rather than hot
– Use a long-handled sponge or brush to reach feet and back
Grooming/Hygiene
– Sit when grooming
– Don't lean forward unsupported
– Rest elbows on counter or dressing table
– Use long-handled brushes or combs to avoid
holding arms overhead
– Use elevated commode seat
Dressing
– Loose fitting clothes allow you to breathe more easily
– Organize early so you won't have to rush
– Lay out clothes before starting, to avoid extra steps
– Bring your foot to your knee to apply shoes and socks so you
won't have to lean over
– Wear slip-on shoes
– Use a long-handled shoe horn and sock aid
– Fasten bra in front and then turn to back
– Wear button front shirts rather than pullovers
– Use a reacher and/or a dressing stick
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Suggestions for Energy Conservation:
Activities of Daily Living
•
•
•
•
Doing Laundry
– Use a laundry cart on wheels
– Use an automatic washer and dryer if possible
– Sit to transport clothes to the dryer if possible
– Use a commercial pre-wash instead of scrubbing
– Wash bras and socks in a lingerie bag to avoid
tangling
– Drain hand washables and press the water out
instead of wringing
– Sit when ironing
– Adjust the ironing board height
– Slide the iron onto an asbestos pad between items to avoid lifting
– Use a lightweight iron
– Hang clothes on the doorknob instead of the top of the door
Taking Care of the Kids
– Plan activities around the table or in the living room to allow sitting
– Instead of going to the zoo, go to the park where you can sit or lie
down
– Delegate some of the childcare responsibilities if possible
– Teach smaller children to climb on lap instead of being lifted
– Teach children to make a game out of some of the household chores
Working
– Plan workload around your best time of day
– Arrange workspace ergonomically
– Take periodic rest breaks
Getting Out
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–
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Wear comfortable clothing
Use adaptive equipment
Select less strenuous activities
Go out with a friend
Use a wheelchair or golf cart
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Suggestions for Energy Conservation:
Activities of Daily Living
•
Preparing Meals
– Assemble all ingredients before you start
– Use cookware you can serve from
– Use smaller appliances (mixers, toaster,
microwave)
– Use electric knife and can opener
– Buy ergonomically designed utensils
– Transport items on a rolling cart
– Store frequently used items at chest level to avoid bending and
stretching
– Line ovens and burner drip pans with aluminum foil
– Sit while preparing food
– Rest elbows on table or counter
– Let dishes soak rather than scrubbing
– Let dishes air dry
– Use a dishwasher if possible
– Delegate dishwashing
– Use a jar opener
– Use a rubber mat or towel under mixing bowls to help steady
them when mixing
– Don't lift heavy pans off the stove
– Ladle the food out at the stove
– Use mitten pot-holders to take advantage of the entire hand to
lift
– Use place mats instead of tablecloths - they are more hygienic
and easy to clean
– Use lightweight utensils
– Prepare double portions and freeze half for later
– Drag garbage bags instead of lifting
37
Suggestions for Energy Conservation:
Activities of Daily Living
•
•
•
Walking/Moving
– Wear low-heeled shoes
– Wear shoes with a shock-absorbent sole or insole
– Use a wheelchair for long trips (the mall for example)
– Maintain good posture when retrieving
– Use cruise control if possible
– Install hand rails and ramps
– Place chairs strategically to allow stops
– Disconnect automatic door closing mechanisms
Housekeeping
– Spread tasks out over the week
– Do a little bit each day
– Delegate heavy work
– Hire help
– Use a wheeled cart or carpenter's apron to carry supplies
– Do whatever you can sitting
– Use long-handled duster, mop etc.
– Use a long-handled dust pan
Shopping
– Make a list first
– Have someone help put groceries in the car
– Use a power scooter if the store has one
– Request store assistance with shopping and
getting to the car
– Shop at less busy times
– Shop with a friend
– Delegate shopping
– Shop online!
Note: "Suggestions for Energy Conservation" was written by Eileen Donovan, PT, Med. A physical
therapist at the University of Texas M.D. Anderson Cancer Center. The publisher and author grant
permission to photocopy these "Suggestions for Energy Conservation" so that they can be shared with
patients.
38
Make This Plan a Permanent
Part of Your Life
The attention you give to following your treatment plan will pay off
for you! You can improve your ability to be active and your quality
of life by following this treatment plan. We know that following a
treatment plan can be difficult. If you are having trouble sticking to
your treatment plan, please do not change anything. Talk with your
nurse or primary healthcare provider for help!
The Hurdles People Often Experience Are:
• Cost of medicines
• Side-effects of medicines
• Lack of time to exercise
• Complexity of treatment
• Difficulty following recommended diet
We can help and we want to help. Talk with your
nurse or primary healthcare provider about
these barriers and we can work out solutions
together! We are here for you!
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