Living With Heart Failure A Patient Guide
Living With Heart Failure A Patient Guide What is in this booklet? How does a healthy heart work? ..................................................................... 2 What is heart failure? ...................................................................................... 2 Symptoms of heart failure ............................................................................... 3 Some of the causes of heart failure ......................................................... 3 Managing heart failure .................................................................................... 4 Are there any treatments for heart failure? ............................................ 4 Eating less salt ....................................................................................... 5 Drinking less fluid ................................................................................. 12 Weighing yourself.................................................................................. 13 Medicines ............................................................................................. 14 Exercise ................................................................................................ 21 Rest and relaxation .............................................................................. 23 Goals of treatment ................................................................................ 24 Alternative therapy interactions ............................................................ 25 When to call your doctor or go to Emergency ............................................ 26 Record of my weight ..................................................................................... 27 Resources ...................................................................................................... 28 1 Taking an active role in managing your heart failure can improve your health. This may mean making some changes in your lifestyle. You will need to learn about heart failure and what you can do to feel better. You and your family will work with the health care team to meet your needs. We want to help you be as healthy as you can be so you will feel well and not have to be admitted to the hospital. How Does a Healthy Heart Work? The heart is a strong muscle that pumps blood to all parts of the body. It delivers oxygen and nutrients to organs and tissues and helps to remove waste products. The heart has 4 chambers. The 2 chambers on the right receive blood from the tissues and organs. Blood is then pumped through the pulmonary artery to the lungs. As the blood flows through the lungs, it picks up oxygen from the air you breathe. The blood then flows through the pulmonary veins to the chambers on the left. The oxygen-rich blood is pumped from your heart into the aorta for distribution throughout your body and to the heart muscle. The chambers are separated by valves. The valves open so the blood can flow through. They then close to keep blood from moving backward. What is Heart Failure? Heart failure is a medical condition in which the heart muscle has been weakened or become stiff. The heart is not able to pump blood as well as it should to supply needed oxygen and nutrients to your body. Heart failure does not happen overnight – it is a progressive disease for which there is no cure. Over time the heart’s chambers become larger and weaker as a result of damage to the heart. The degree of heart failure can range from mild to severe. Heart failure does not mean that your heart is about to stop working or that you are about to die. Congestion occurs when fluid builds up in the lungs and/or other body tissues, causing them to become congested. 2 Symptoms of Heart Failure Why are my ankles and feet swollen? When your heart is weak, less blood is pumped with each heart beat. As a result, less blood flows to your organs and muscles. The blood returning to the heart backs up in the veins. This backup pressure forces fluid from the blood to leak through the blood vessel walls into the tissues. The fluid causes swelling (edema) in the legs and ankles. The fluid can also collect in your lungs, stomach or liver. Why am I short of breath? Fluid may also collect in the breathing spaces of the lungs or your heart may not be able to pump enough blood to supply oxygen to all the tissues when you are doing some activity. This can cause breathing problems when you lie down or when you are active. You may notice some or all of these symptoms of heart failure: • shortness of breath. It may be present all the time or just when you are active. • waking up at night with shortness of breath or a smothering feeling that makes • shortness of breath when lying flat • a dry hacking cough that will not go away. It is often worse at night. • a sudden weight gain (2lbs. in 1-2 days or 5lbs. in a week) • swelling in your feet and ankles • swelling/bloating or tenderness in your stomach area • feeling more tired than usual • loss of appetite • cold arms and legs Some of the causes of heart failure are: • high blood pressure • damage to the heart muscle from a heart attack • heart valves that do not open and close well • toxins such as drinking too much alcohol, chemotherapy, cocaine and other drugs 3 • a virus or bacteria that attacks the heart muscle • severe lung disease • a heart defect that has been present since birth or has been passed on by your parents • a complication of pregnancy • diabetes • unknown Types of heart failure: These conditions can affect the ability of the heart to pump blood around your body in 2 ways. • The heart pumps with less force, so less blood moves through the rest of the body. • The heart may have become stiffened and is unable to stretch enough to accept all the blood returning from the lungs – the pumping function remains strong but there is not as much blood volume being pumped with each heart beat. Managing Heart Failure Are there any treatments for heart failure? Heart failure is a chronic, progressive, lifelong condition. The goal is to control your symptoms by careful management and to prevent them from getting worse. Your plan of care may include: • • • • • • • Medicines eating less salt drinking less fluid rest and relaxation exercise stopping smoking surgery may be indicated for some patients (such as valve replacement or coronary artery bypass graft) 4 Other things you can do to improve your heart function and health are: • having a flu shot every year • do not drink any alcohol • drink no more than 2-3 cups of fluids high in caffeine each day • eat less fat (if needed, ask us for more information) • do not smoke • lose weight if you are too heavy • wear clothes that allow good blood flow in the legs. Tight stockings, garters and knee-highs hinder the flow of blood in your legs. • do not lift, pull, or push heavy objects • reduce stress We will now explain the treatments for heart failure Eating Less Salt Cutting down on salt can help you feel better and improve your health. Normally the body balances your salt and fluid levels. When the heart is weakened, your body has trouble getting rid of excess salt, which causes fluid to build up. The heart must work harder to pump the excess fluid. Many foods have salt or sodium in them naturally. You may have a total of 15002000 mg (1.5-2 grams) of sodium in your diet each day. This accounts for the natural salt in your food. You should follow a no added salt diet. This means that at the end of the day when you have added all the sodium content from everything you have eaten, the total should not be above 1500-2000mg. Here are some ways to cut down on salt: You will be choosing foods lower in sodium if you follow these guidelines. • Low sodium on a label means 140 mg or less a serving. • Prepare and cook all foods without adding salt. • Do not add salt at the table. Remove the salt shaker from the table. • Cook “from scratch”. Do not eat prepared, processed and convenience foods. The salt content is very high in prepared foods. Pick foods naturally low in sodium. 5 • Monitor the serving size for the sodium content – if you eat more than one serving size your sodium intake increases as well. • Try flavouring your food with a mixture of allowed spices. Season your food with herbs such as Mrs. Dash®, pepper, garlic (fresh, flakes, powder, not garlic salt), curry, pepper, dill and lemon. • Do not use salt substitutes unless you discuss it with your doctor or dietitian. If you are using salt substitutes make sure they do not contain potassium. This could be harmful to you. (Please check with a member of your health care team). • No canned food except fruit or products labeled no salt added. Do not use any other canned products such as canned beans, meats, spaghetti, soups, sauces and stews. • Do not eat foods or take medicines that contain salt or sodium compounds. The words “sodium”, “soda”, or the symbol for sodium “Na” on the label will help you to recognize the product that contains a salt compound. • Do not use medicines which contain sodium (some laxatives, Eno®, AlkaSeltzer®, Bromo®, Rolaids®). When in doubt ask your pharmacist or doctor. • Many restaurant food items such as pizza and milkshakes, made from mixes, are high in salt and should be avoided. • When you eat out, stick with plain food, for example: plain baked, broiled, or steamed meat and vegetables rather than those with sauces, marinades and/or gravy. Do not order soups, chowders, or casseroles. Tell the waiter that you are on a salt free diet and the chef may prepare a salt free meal for you. • Go easy on the salad dressing and other condiments. They are often high in salt. • Stay away from fast foods. They usually have a lot of salt in them especially Chinese, Mexican and fried chicken. • The larger grocery stores usually have nutrition consultants who you can call to set up an appointment. They can assist you in finding low sodium foods in their stores. • Many franchised fast food outlets and family restaurants have nutrition information sheets which you can ask for to help you make healthier low sodium food choices. • Do not eat snacks with salt on them (such as potato chips, pretzels, salted crackers, nuts). 6 Grain Products 5-12 servings each day, 1 serving = 1 slice of bread or 125ml cooked items Best Choices Avoid • All yeast breads • Commercial mixes – bread, rolls, pancake, biscuit, muffin, cookie • Self-rising flour, Bisquick® • Commercial bread stuffing • Quick cooking and instant cooked cereals • Unsalted cooked cereals • Ready-to-eat cereals (unlimited): - Frosted Mini Wheats® - Muffets® - Puffed Wheat® and Puffed Rice® - Quaker Harvest Crunch® - Shredded Wheat® - Spoon Size Shredded Wheat® - Shredded Wheat N’Bran® - Sugar Crisp® • Limit all other cold cereals to 125ml (1/2 cup) each day • Pasta cooked without salt • Preseasoned pasta mixes: (Hamburger Helper®, Kraft Dinner®, Mr. Noodles®, canned spaghetti) • Rice cooked without salt • Pre-seasoned rice: Rice A Roni® • Plain unsalted crackers • Salted crackers 7 Vegetables and Fruit 5-10 servings each day, 1 serving = 125ml (1/2 cup) Best Choices Avoid • Any fruit or fruit filling to which sodium preservatives have been added. • All fresh, frozen, canned fruits, fruit juices and fruit drinks • Dried fruit without sodium benzoate and other sodium preservatives • Canned vegetables • All fresh and frozen vegetables – low sodium V8® • Canned vegetable juices – tomato juice – Clamato® – V8® • Regular tomato sauce and paste • Canned or bottled spaghetti and pizza sauce • Tomato paste without salt added • Tomato sauce without salt added • Sauerkraut • Stewed tomato without salt added • Pickles • Seaweed • Scalloped potato mixes • Instant potatoes • Vegetables seasoned with bacon, ham, or pork 8 Meat and Alternatives 2-3 servings each day, 1 serving = 30ml Best Choice Avoid • Fresh or frozen meat, fish, poultry • All meat, fish or poultry that has been smoked, cured, pickled, salted, processed or dried such as: - bacon - ham - luncheon meats/deli meats (pepperoni, salami) - Kosher meats - canned beef - sausage - wieners/hot dogs - bologna - salt cod - smoked herring - sardines, anchovies - lobster, crab • Some shellfish with caution • Dried peas, beans and lentils • Any meat, fish, or poultry that is canned or frozen with salt • Unsalted nuts, seeds, peanut butter and other nut spreads • Commercial frozen dinners • Frozen meat pies, fish sticks • Canned beans • Salted sesame and sunflower seeds • Salted nuts • Picked eggs 9 Milk Products Adults - 2 servings a day, 1 serving = 250ml milk or 175g yogurt or 50g cheese Best Choices Avoid • Milk, cream (limit to 500mls/day – 2 cups/day) • Buttermilk, chocolate milk • Yogurt, ice cream – use as part of milk allowance occasionally • Malted milk • Commercial chocolate drinks • Evaporated milk • Ovaltine® • Purchased eggnog • Cheese: low sodium, cottage cheese • Processed cheese spread: Cheese Whiz® • Limit all other cheese to a maximum of 30g (1 oz.) a day (except those under “Avoid”) • Processed cheese slices • Blue, Feta, Gouda, Romano, Parmesan, Edam, Provolone, Roquefort, Camembert cheese • Unsalted cream soups, chowders and cream sauce made with milk allowance Fats • Unsalted butter, unsalted margarine • Shortening, lard, cooking oils • Unsalted gravies • Limit: - regular butter, margarine - low sodium commercial salad dressing - mayonnaise and Miracle Whip® • Commercial salad dressing containing bacon, bacon fat, salt pork, bacon bits • Salad and vegetable dips made from dehydrated mixes • Regular canned soups • One-third less salt canned soups • Bouillon, consommé, broth, OXO®, dried soup mixes Soups • Unsalted homemade soups • Split pea soup made with ham bone 10 Sweets Best Choices Avoid • All except those listed under “avoid” • Commercial muffin and cookie mixes • Store bought baked goods tend to be higher in salt than home-made baked goods • Canned puddings • Instant pudding mixes • Hires Root Beer® • Water treated by water softener Other • Pop-except those listed under “avoid” • Mineral water • Gatorade® • Postum® , tea, coffee • Salt, seasoning salt • Herbs, spices • Celery salt, onion salt, garlic salt • Vinegar • Seasoned pepper, lemon pepper • Flavourings • • Tabasco sauce Any mixed spices containing salt: steak spice, chicken spice • Cream of tartar • • Popcorn Accent®, MSG (mono-sodium glutamate) • Baking soda and baking powder can be used in moderation • Sodium sucaryl • Sandwich spread, horseradish, soya sauce, oyster sauce, HP Sauce®, Heinz 57 Sauce® • Salsa, picante and taco sauces Allowed in limited portion 5ml (1 teaspoon each day): • Worcestershire sauce • Prepared mustard • Ketchup • BBQ sauce, chili sauce and relish • Salad dressing 11 Drinking Less Fluid REMEMBER 1. Where salt goes water follows. 2. Even if you are thirsty, this does not mean your body needs more fluid. Most people with heart failure hold extra fluid in their body. This means there is extra fluid for a weak heart to pump around. Drinking less fluid and eating less salt will reduce the amount of fluid in the body. You may find these measurements useful: 1 ounce (oz) = 30ml (cc) A ml is the same size as a cc. 1 ounce = 2 tablespoons 1 cup = 8 ounces (oz) = 240ml (cc) 4 cups = 32 oz = 1 quart = 1000ml = 1 liter You should not drink more than 1 1/2 - 2 liters (6-8 cups) of fluid a day. This includes all liquids. Keep in mind that many foods contain large amounts of fluids (anything that melts at room temperature is considered a liquid). Examples of fluids are: • pudding, sherbet, Blizzards®, Jell-O®, yogurt, frozen yogurt, ice cream, frozen ice cream bars and Popsicles® • soup • juice, juice in fruit (such as 1/2 grapefruit or 1 orange or 1 medium/large apple = 1/2 cup) remember melons, such as watermelon, have a lot of fluid • water, tea, milk, coffee, milkshakes, pop • ice cubes • Alcohol is not recommended but if you drink beer, wine, or alcohol you must count it as fluid. 12 Tips • Keep a 2-liter container handy. Every time you take a drink, pour an equal amount of water into the container. When the container is 3/4, full you have had about 1.5 litres (6 cups). This is the maximum amount of fluid you are allowed to drink in that 24 hour period. • Space your fluids over the day. This will become easier. • Take your pills with as little fluid as possible. This fluid must be counted. • Try sucking on hard, sour candy when you are thirsty (sugarless for people with diabetes). • Keep some grapes in the freezer. They are good to chew on when you are thirsty. If you have diabetes, you should not eat frozen grapes as they are high in sugar. • Gargle with cold mouthwash or cold water. Weighing Yourself A sudden weight gain means that your kidneys are holding onto water and salt. You do not gain “fat” overnight. Weigh yourself everyday to see if your body is holding too much water. You should: • Use the same scale every day. • Wear clothing that weighs about the same each time you weigh yourself. • Weigh yourself when you first get up in the morning, after going to the bathroom, before you get dressed or have breakfast. Keep the scale on a flat surface (not carpet). Keep a record of your daily weights. • Let your health care team know if you gain 2 lbs in one day or 5 lbs in a week. 13 Medicines There are medicines for heart failure that produce different effects. In general, they help stop some of your symptoms and prevent your heart function from getting worse. Take your medicines exactly as your doctor has prescribed. Missing a dose or taking too much medicine can cause serious problems. Some people with heart failure are admitted to hospital because they did not take their medicines as instructed. 1. ACE Inhibitors These pills relax your blood vessels so your heart does not need to work as hard and lower blood pressure. Name _______________________________ How much am I to take? ______________ When do I take it? ____________________ Side effects Call your doctor or the Clinic if you have: • weakness • dizziness • dry hacking cough • dry itchy skin • if you have any signs of an allergic reaction (this is a rare problem) call your doctor right away: - rash - swelling of the face, mouth, tongue, or throat - shortness of breath or wheezing 14 Tips • Get up slowly from a sitting position so that you do not get dizzy. Low blood pressure and dizziness are usually associated with an increased dose. This should only last a few days. • Separate your ACE inhibitor from your beta blocker by at least 2 hours. • Do not drink alcohol. • You will need to have routine blood work done to monitor your potassium and creatinine levels (a measure of one of your electrolytes and kidney function). Your health care team will let you know how often this should be done. 2. Angiotensin Receptor Blockers (ARBs) They work in much the same way as the ACE inhibitors. They are often prescribed when people cannot take ACE inhibitors. Name _______________________________ How much am I to take? ______________ When do I take it? ____________________ Side effects • Similar to ACE inhibitors. See page 14. Tips • Similar to ACE inhibitors. See above 3. Beta Blockers These pills: • slow your heart rate • help your heart pump more blood with less work • control high blood pressure Name _______________________________ How much am I to take? ______________ When do I take it? ____________________ 15 Side effects Call your doctor or the Clinic if you have: • headache • weakness • slow heart rate • fatigue • sleep changes (drowsiness or unable to sleep) Tips • Take this medicine at the same time everyday (should be about 12 hours apart). If you are taking these pills twice a day, take them in the morning and at bedtime. • If you have diabetes, check your blood sugar often (these pills can hide the symptoms of a low blood sugar). • Take Carvedilol with food. 4. Diuretics These medicines are often called “water” or “fluid” pills. They help the kidneys to get rid of salt and water. Diuretics should be taken in the early morning. This will help you to avoid going to the bathroom during the night. If you are prescribed a fluid pill twice a day, take the second dose 5-6 hours after the first dose. Please remember that the dosage of your diuretic may change over time and/or you may sometimes need to take more than one type of diuretic. Do not be surprised or alarmed about this. Your health care team will advise you on how to take these medicines. Name _______________________________ How much am I to take? ______________ When do I take it? ____________________ 16 Side effects Call your doctor or the Clinic if you have: • leg cramps • unusual fatigue • weakness Tips • You will need periodic monitoring of your electrolytes and kidney function. Your health care team will tell you how often this should be done. Potassium – Sparing Diuretics This medicine is used for sodium retention and swelling when you are only partially responsive to other fluid medicines. It may also be used to treat low potassium levels when other medicines are inadequate. Name _______________________________ How much am I to take? ______________ When do I take it? ____________________ Side Effects • breast tenderness • high potassium levels Tips • You will need periodic monitoring of your potassium level and kidney function. Your health care team will tell you how often this should occur. 17 5. Digoxin This is given to increase the pumping action of your heart and regulate your heart rate. Name _______________________________ How much am I to take? ______________ When do I take it? ____________________ Side effects Call your doctor or the Clinic RIGHT AWAY if you have: • a bad taste in your mouth • nausea • vomiting • diarrhea • an irregular heart rate • blurry vision • halos around lights or objects Tips • Do not take with antacids (such as Maalox® or Diovol®). • Do not take this medicine for at least 6 hours before you have blood drawn to check your digoxin level. 6. Potassium The heart muscle needs this mineral to work properly. Some diuretics can cause potassium loss. You should eat foods high in potassium (such as bananas and citrus fruit) each day. You may need to take potassium medicine. Name _______________________________ How much am I to take? ______________ When do I take it? ____________________ 18 Side effects Call your doctor if you have any of these symptoms of potassium loss: • weakness • muscle cramps • nausea and vomiting • heartburn Tips • Do not change the amount of potassium you are taking without contacting your health care team. • Take the medicine with food or milk. • Do not lie down right after taking this medicine. 7. Anticoagulants (blood thinners) They prevent blood clots from forming. Name _______________________________ How much am I to take? ______________ When do I take it? ____________________ Side effects Report these signs of bleeding to your doctor RIGHT AWAY: • large bruises • bruises that do not fade • bleeding from a small cut that does not stop after 10 minutes • bleeding from gums that does not stop for a long time after brushing • brown or rusty colored urine • black or red bowel movements • frequent nose bleeds • severe headache that does not go away • unusual severe stomach pains • coughing up bloody phlegm 19 Tips • Do not take a double dose to make up for a missed dose. Report missed doses to doctor or Clinic on your next visit. • Be very careful when you are doing activities where you may cut yourself such as shaving with straight razors, sewing, gardening, cooking, and woodworking/handyman jobs. • Keep all your appointments for blood tests. • Do not drink alcohol. • Ask your pharmacist about any over-the-counter medicines and natural health product you are considering. • If you cut yourself: — apply pressure to the cut immediately — call your doctor if the bleeding does not stop in 10 minutes. • Wear a MedicAlert™ bracelet. 8. Hydralazine (Apresoline®) with Nitrates A combination of these medicines may be used when a patient can not take ACE inhibitors. They help your heart pump blood more easily by relaxing the blood vessels. Name _______________________________ How much am I to take? ______________ When do I take it? ____________________ Side effects • dizziness • headache • flushing • nausea and vomiting 20 Tips • Take these medicines with liquids at mealtime. • Report rash, fever, or joint pain to your doctor. • Headaches tend to be worse when you first start taking nitrates. Acetaminophen (Tylenol®) can help. Follow the directions on the bottle. • When taking nitrates, it is important to have a “nitrate-free” period. If you are using a nitro patch, remember to put it on in the morning and take it off at night. If you are taking pills 3 times a day, take these with meals. • DO NOT take with medicines such as Viagra®, Levetra®, or Cialis®. 9. Other Medicines You and your health care professional will discuss all medicine choices. Exercise Many people feel better when they exercise regularly. Discuss any plans to start or increase your exercise program with your health care team. Regular exercise can: • decrease the symptoms of heart failure • improve your general health • delay the progress of heart failure Exercise does not need to be stressful to be helpful. Tips • Exercise when you have the most energy. • Rest often. It would be better to walk for 5 minutes 3 times a day rather than one 15-minute walk. • Gradually increase your activity, for example walk for 5 minutes for 1-2 weeks, then walk for 10 minutes on the 21 3rd and 4th week, and walk for 15 minutes on the 5th and 6th week. Continue to increase your activity gradually. • Do not: - lift heavy objects - push heavy objects - shovel snow - do an activity that requires you to hold your breath • Always exercise within your comfort levels. • You should feel recovered 1 hour after exercising. If exhausted the next day - you have done too much. Decrease the time and speed. • If you cannot walk and talk you are walking too fast. • Stop exercising if you feel: • more short of breath than usual • weak or tired • dizzy • pain or discomfort • tightness in your chest • your heart pounding (palpitations) • your heart is racing My health care team’s recommendations about my activities: Walking _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Climbing stairs _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 22 Housework _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Hobbies and Recreation _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Sex _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Driving _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Job _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ Rest and Relaxation Things that can aggravate stress: • Cigarettes • Alcohol • Caffeine • Sugar 23 Coping strategies that can help you take charge of stress: • Make rest periods a high priority. Schedule them before and after any activities. • Is there is a time during your day when you are at your best? Set aside that time for your most demanding activities. • Divide difficult tasks into smaller ones. Take frequent breaks. • Do not feel guilty for not getting much done. • Hire a high school student who may charge less to do heavy housework and yard work. • Check grocery stores in your area for delivery services. • Apply for a handicapped parking permit. • Take advantage of community resources and services. • Use the yellow pages to locate needed items. Goals of Treatment Heart failure is a chronic disease which does not go away. Therefore it is very important for you and your family to be involved in determining your treatment goals and plan of care. Heart failure is a progressive disease. This means that over time your heart will continue to weaken. This time frame varies and you may feel relatively well for several years. At first, you may only have increased symptoms on an occasional basis but over time this will become more frequent. With each of these episodes, your heart continues to weaken. Your health care team will help you to monitor your health status. Realizing that there is no cure for heart failure, you may want to make some plans for your future health care. What would you like in the short term as well as long term? Your health care team would like to discuss your goals and plan of care. Please remember there are a number of treatment options available for your condition. Not all of them may be right for you. For each of your treatments, you should know what are the short term benefits/risks/side effects as well as what are the implications for the future. You may decide you do not like one treatment option and therefore refuse it, or you may decide you would like to try another treatment knowing there are long term implications you may have to make a decision about at a later date. Your goals of treatment can be written down and given to the various members of your health care team. These written instructions are called “Advanced Care Directives”. 24 Advanced care directives tell your health care team what your wishes are for your treatment when you are no longer able to do so. They come into effect only when you are no longer competent to make decisions (until this point, you will be involved with all decisions about your treatment). There are 2 components to advanced directives. The first is the “living will” which tells your health care team what or how your health care decisions are to be made. They may contain specific instructions or may define general principles to be followed when any health care decisions are made. The second part of an advanced directive is the “Proxy” which is also known as a “Substitute Decision Maker” or “Durable Power of Attorney for Health Care”. This “proxy” is the person whom you have decided will make your health care decisions when you are no longer able to do so. Although in Nova Scotia, a living will is not legally binding, it is useful to open the lines of communication between you, your family and your health care team, and can help to guide your future health care. The proxy portion of the advanced directive is legal in Nova Scotia. Advanced care directives are not permanent. You may change your mind about any health care decision at any time. In fact, it is important to regularly update your advanced directive. However, it is also important to make sure your proxy, your family and your health care team know about any changes you make. Part of your care involves regularly evaluating your goals and plan of care and making any needed adjustments. Please do not be upset – it does not mean you are about to die. This is normal practice. You may obtain further information about advanced directives by going to http://www.cdha.nshealth.ca/patientinformation/nshealthnet/0024.pdf We are also concerned about your caregivers. They may have some stress/strain which may affect their health. Your health care team will routinely assess them for signs of caregiver strain/burden. They are also encouraged to seek help from the various member of the health care team as well as the various community agencies. Alternative Therapy Interactions Many patients have questions about alternative or herbal therapies. We know that the ingredients in some alternative therapies interfere with the action of heart failure medicines and may have other harmful actions. 25 The following may interfere with the medicines used to treat heart failure: • ephedra (ma hung) • ephedrine metabolites • Chinese herbs • hawthorne (cratageus) products • over – the – counter cold medicines The substances listed below can interact with blood thinning medicines: • garlic • ginseng • gingko • coenzyme Q-10 • St John’s Wort Be sure to tell your health care team about any natural medicines or alternative or herbal therapies that you are taking. Remember this includes herbal drinks such as green tea. Beware of extravagant claims about the benefits of alternative or herbal therapies. Never take any of these in place of your regular medicines. When to Call Your Doctor or Go to an Emergency Department Call your doctor sooner rather than later, if you: • notice your breathing is more difficult • become short of breath lying down or awaken short of breath at night • gain 2 pounds overnight or 3-5 pounds in 1 week • have swelling in your hands, feet and/or abdomen • have blurred vision • feel bloated or your stomach is upset • have any side effects from your medicines 26 Go to an Emergency Department or call 911 if you: • have tightness or pain in your chest • are very short of breath • are coughing up pink, frothy mucus Record of My Weight Date Weight Date 27 Weight Resources You can access some of these resources on your own. You will find the names of the contact people and phone numbers listed. With some other resources, your doctor, or nurse will need to make a referral for you. You can call and use these programs on your own QEII Smoking Cessation Program This program will help you understand your smoking habit and will assist you in the process of quitting smoking. You will be working in a group with a facilitator who will help you to achieve your goal. Nicotine patch and gum are available free of charge with this program but please remember to check with your health care team first. For information and registration call: Capital Health Smoking Cessation Program 424-2025 Metropolitan Dispensary Medicines can cost a lot of money. However, it is important that you continue to take the prescribed medicines for your heart failure. If you cannot afford these medicines, you should get in touch with a social worker who can assess your resources. The social worker may refer you to the Metropolitan Dispensary for your medicines. They are provided at the fees determined by the Dispensary. If you do not have a social worker, you can call the Department of Community Services in your area. Frozen Favourites Meal Program The VON of Greater Halifax has a meal program that provides healthy, home style-frozen meals for older adults, people recovering after a hospital stay and caregivers. You can ask for special meals to meet your needs. For ordering information, cost of the meals and deliveries, and other information, please call 454-5755 (Monday - Friday, 9 am - 4 pm). Emotional Concerns Heart failure can greatly affect the way you live. Such changes can often result in an emotional burden that is more than you can cope with. If you feel you need some help resolving such emotional concerns, you can ask a member of your health care team to refer you to a psychologist. 28 You can contact the organizations we have listed for more information: Self Help Connection 422-9183 Association of Psychologists of Nova Scotia 422-9183 Heart and Stroke Foundation They can provide you with information about heart health. They also have education and support programs that you might find useful. To reach the Foundation, you can call: 423-7530 in Halifax or 1-800-423-4432 elsewhere in Nova Scotia. Internet Resources The Heart and Stroke Foundation of Canada has information that you can access using the Internet. The website address is www.heartandstroke.ca. Canadian Heart Failure Network www.chfn.ca Heart Failure Society of America www.hfsa.org You will need a referral from your doctor/nurse to use the following resources: Heart Failure Clinic (Medicine) and Heart Function Clinic (Cardiology) These 2 clinics have similar goals. The goals are to educate you about heart failure and heart disease in general. You would meet experienced nurses who run these clinics and provide regular follow-ups. Your doctors can refer you to these clinics. Your doctor can call 473-3802 or 473-3205 for information. Hypertension Education Program Some people who have heart failure also have high blood pressure (hypertension). This education program helps you understand how you can help control your high blood pressure. There are 3 educational group sessions. Each session lasts for about 2 hours. Spouses or significant others can attend. You can be referred to this Clinic if you are currently attending any of the ambulatory care Clinics in Capital Health. Ask your nurse/doctor to call 473-6158 to register. 29 Notes _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ _______________________________________ 30 When to Call Your Doctor or Go to the Emergency Department Call your doctor sooner rather than later, if you: • notice your breathing is more difficult • become short of breath lying down or awaken short of breath at night • gain 2 pounds overnight or 3-5 pounds in 1 week • have swelling in your hands, feet and/or abdomen • have blurred vision • feel bloated or your stomach is upset • have any side effects from your medicines Go to an Emergency Department or call 911 if you: • have tightness or pain in your chest • are very short of breath • are coughing up pink, frothy mucus. Looking for more health information? Contact your local public library for books, videos, magazine articles and online health information. For a list of public libraries in Nova Scotia go to HTTP://publiclibraries.ns.ca Capital Health promotes a smoke-free and scent-free environment. Please do not use perfumed products. Thank you! Capital Health, Nova Scotia www.cdha.nshealth.ca Prepared by: Rosalind Benoit MN, RN; Joan Clark RN; Carla Purcell RN, BScN; Anna Svendsen RN, MS, CCN(C), Capital Health, Halifax © Approved by: Jonathan Howlett, MD Contributors: Mike Callaghan BSc Pharm; Danielle Aldous BSc, BSN, PDt Illustrations by: LifeART Health Care 1 Images, Copyright © 1994, TechPool Studios Corp. USA; Jennifer Strong and Steve Nixon Designed and Printed by: QEII Audio Visual and Printing Departments WG85-0152 Rev.09/2008 The information in this pamphlet is to be updated every 3 years. 31
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