Pulmonary Hypertension: How (and Why) to Embark on a Lower-Salt Lifestyle - Health Essentials from Cleveland Clinic
Pulmonary Hypertension: How (and Why) to Embark on a Lower-Salt Lifestyle - Health Essentials from Cleveland Clinic |
- Pulmonary Hypertension: How (and Why) to Embark on a Lower-Salt Lifestyle - Health Essentials from Cleveland Clinic
- Walking Together: My Sons' High School Graduation Was Extra Special - Pulmonary Hypertension News
- PAH Patients' Poor Adherence to PDE-5i Linked to Adverse Effects - Pulmonary Hypertension News
| Posted: 24 Jun 2019 05:00 AM PDT Most of us could probably stand to dial back our salt intake: According to the American Heart Association, the average American consumes twice the recommended amount per day. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy "Cutting back on salt is important for everyone, even if they do not have a chronic condition like pulmonary hypertension ― but for those that do, it becomes essential," says Mindy Rivera, CNS. Salt mattersWe need to consume at least some sodium ― it helps maintain a normal fluid balance in the body and is essential for muscle function (including the largest and most important muscle ― the heart). But when too much sodium accumulates, the body holds onto water in an effort to dilute it. The amount of fluid surrounding our cells and the volume of blood in the bloodstream also increase, forcing the heart to work harder to pump blood throughout the body. It also puts extra pressure on the blood vessels. Over time, this can increase risk for heart attack, stroke and heart failure. Pulmonary hypertensionIf you have pulmonary hypertension, your heart is already working overtime to pump blood to your lungs through narrowed arteries. "Extra salt intake causes the body to retain more fluid, and therefore further strains the heart to have to pump it through the body," Rivera says. "This can lead to swelling in the legs and abdomen, and worsening shortness of breath." Reducing your sodium intake may help control symptoms and reduce your risk of future heart problems. Sodium vs. saltIt's important to understand that sodium and salt are not exactly the same thing. When most of us use the word salt, we're referring to what we sprinkle on our food. Sodium is the chemical element in salt ― both table salt and sea salt are about 40% sodium by weight.
If you have pulmonary hypertension, your doctor can help you decide how much sodium is appropriate for your diet. Surprise! There's sodium in thereGoing low-sodium doesn't just mean being less generous with the salt shaker. Actually, your best defense is taking a metaphorical magnifying glass to the ingredient labels at the grocery store. "People often mistakenly believe that kicking the salt shaker is the only part of a low-salt diet," Riviera says. "Unfortunately that isn't true; most of our salt intake in America comes already in our foods." And it's in places you might not suspect ― like the chicken you pick up from your grocery store. "Often, fresh poultry has been injected or brined in a salt solution prior to packaging, which can make it a high-sodium food regardless of how carefully you prepare it," she explains. To avoid extra salt, read the packaging for clues like "sodium," "broth" or "saline." Many other foods in your grocer's aisles may be loaded with sodium, too. Check the sodium content before buying items like:
Put a positive spin on itA low-salt diet does not have to be the end of tasty food. In fact, it can be an opportunity to buy less packaged food and experiment with new ingredients, recipes and cooking methods in your own kitchen. It might be hard at first, but over time, your taste will evolve to prefer foods with lower sodium levels (yes, truly ― multiple studies show it). Try jazzing up your food with:
You might have heard about salt substitutes, but check with your doctor before using them ― they could be dangerous for people with certain conditions. It's helpful to keep in mind why making this change to a lower-salt diet is important to you, whether that's to eat healthier or feel less short of breath or stay out of the hospital, Rivera says. "It's also important to recognize that decreasing your salt intake in a sustainable way probably won't happen overnight," she says. "Progress is key."  |
| Posted: 24 Jun 2019 07:00 AM PDT My son's pulmonary arterial hypertension (PAH) was idiopathic, which means it developed suddenly with no known cause. He was healthy until he became symptomatic at 6 years old. Before then, we only brought him to the doctor for checkups and the occasional ear infection. He was an early walker who quickly mastered running and decided that was his preferred pace. His daycare providers were concerned that this little toddler was going to hurt himself because he wouldn't slow down. As he grew into a little boy, he took off into sports, playing soccer and T-ball, and taking karate classes. Perhaps it was a slow progression. We weren't looking for any health concerns, so the decline in his energy levels seemed to happen suddenly. We suspected something was wrong when instead of running, he would walk the soccer field with his arms above his head, taking deep breaths. We knew something was amiss when just as he was about to score a goal, he sat down on the field insisting he couldn't go any further. Self-preservation taught him to walk instead of run, and two years later, he was diagnosed with PAH. For the next five years, our lives revolved around making different types of goals for him, such as staying well enough to graduate from the eighth grade, and remaining sufficiently stable to receive a heart and double-lung transplant. A few weeks shy of what would have been the start of his freshman year of high school, my son received his life-saving transplant. While his peers were making new friends and settling into their classes, he was recovering from major surgery. A week after transplant, he became ill with posterior reversible encephalopathy syndrome (PRES), a rare side effect from an antirejection medication that caused chronic migraines and seizures. The cure was switching medications, but the PRES symptoms remained for several months, making it impossible for him to attempt any schoolwork. Five months post-transplant, he started online high school classes. He worked hard to catch up through summer vacation so that by the fall he was walking the halls of a high school for the first time. He managed to complete the year while facing new medical challenges that required several hospital stays and clinic visits. His lungs began to develop bronchiolitis obliterans (scarring and inflammation), which can lead to chronic rejection. He was started on an aggressive treatment called extracorporeal photopheresis (ECP). Each hospital treatment took at least four hours, and this continued for several months. When you add monthly intravenous immunoglobulin and basiliximab infusions, high doses of prednisone that caused migraines and body aches, as well as antibiotics that made him nauseous, it was incredible that he attended school at all. The good news was that the ECP worked, and his pulmonary function tests showed improvement. However, after a year of stress trying to stay caught up academically, and not knowing what other medical challenges he might later face, my son walked out on the last day of his sophomore year and returned to online education. His was a wise decision because he faced subsequent unforeseen challenges with kidney disease and high blood pressure. It took a lot of determination and self-discipline — including sacrificing two more summers to additional classes, plus an extra year of high school — to reach his goal. But he did it. On June 15, 2019, he graduated from high school alongside his brother, who is one year younger. It was both appropriate and emotional to see the brothers take that walk together. As the sibling of someone who is chronically ill, my youngest has also made sacrifices, faced fears, and struggled to adjust to a life that is different from that of his peers. Both boys were proud of each other as they received their diplomas together. In this fast-paced world, people tend to feel rushed into accomplishing things. What my son has taught me through his pre- and post-transplant experiences is that life should be a walk, not a race. You don't have to keep up with the masses to succeed. If you are always running, then unexpected challenges will feel like hitting a brick wall. Those who walk can see the roadblocks ahead and figure out a better path to avoid them. The journey might be longer, but it will feel more rewarding when you arrive at your destination.  *** Note: Pulmonary Hypertension News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Pulmonary Hypertension News or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to pulmonary hypertension.  |
| PAH Patients' Poor Adherence to PDE-5i Linked to Adverse Effects - Pulmonary Hypertension News Posted: 24 Jun 2019 07:00 AM PDT Adverse effects are associated with poor adherence to phosphodiesterase-5 inhibitors (PDE-5I) as treatment for patients with pulmonary arterial hypertension (PAH) treated via an integrated care model at an academic institution. Hospitalization events, out-of-pocket costs and frequency of dosing did not play a role, a study shows. Led by researchers at Tennessee's Vanderbilt University Medical Center, the study, "High Rates of Medication Adherence in Patients with Pulmonary Arterial Hypertension: An Integrated Specialty Pharmacy Approach," was published in the journal PLOS ONE. PAH is a rare, progressive disorder characterized by high blood pressure (hypertension) in the arteries of the lungs. It manifests in shortness of breath (dyspnea), especially during exercise; fatigue, chest pain, and fainting. Phosphodiesterase-5 inhibitors (PDE-5I), such as Revatio (sildenafil) and Adcirca (tadalafil), have demonstrated benefits for PAH patients, including eased symptoms and improved quality of life. Still, some studies have found that less than half of patients prescribed a PDE-5I were adherent after six months. Researchers aimed to investigate the causes for this, in the context of an integrated pharmacy practice model implementing interdisciplinary team-based care. In this model, pharmacists are embedded in the clinic to assist with insurance approval, patient counseling, and management of adverse effects, with the goal of improving patient outcomes. The study enrolled 131 patients (70% females, median age 55 years) who were followed for over two years. More than half (62%) were non-smokers and 71% had government-funded insurance. Of all participants, 89% had mild to moderate functional impairment, being classified as functional class II or III. This classification includes four classes and is used to rate how ill patients are (class I: least sick; class IV: most sick). Sixty-six percent of patients were treated with Adcirca and 33% with Revatio. A review of patients' clinical records and pharmacy claims showed that the integrated model was associated with high overall adherence rates, with 94% of patients taking the prescribed PDE-5I 80% or more of the time. However, eight patients had lower treatment adherence levels. These patients were more likely to have reported an adverse reaction. The most common events reported were headache (24%), reflux (11%), diarrhea (11%), leg pain (6%), and nausea or vomiting (5%). In contrast, hospitalization events, out-of-pocket costs (median of $.62; ranging from $0 to $354.71), and frequency of dosing were not found to be associated with adherence to PDE-5I therapies. Although this study included a small group of patients, "[those] receiving care within the high-touch, integrated model maintained high rates of medication adherence over a two-year period," researchers said. Additional studies are still warranted to further explore the impact of this integrated care model on improving PAH patients' adherence to therapy when prescribed dual or triple treatment regimens, common among this population, they said.  |
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