Silvia Herszkopf, MS, RD, LMNT, LD

Amazing Angels Home Health and Hospice would like to provide you with some important information about Warfarin (Coumadin®) and diet. Warfarin (Coumadin®) is an anticoagulant, which means it reduces the body’s ability to make blood clots. Your healthcare provider may prescribe this medication temporarily after a surgery or make it a permanent part of your medication regimen following episodes of abnormal blood clotting or some procedures such as mechanical heart valve replacements. When taking Warfarin (Coumadin®), the most important thing is to maintain your levels within a therapeutic range (a range that will prevent clotting) that is monitored by a blood test called an INR (International Normalized Ratio). If your level goes too low, you are at risk for blood clots. On the other hand, if your level goes too high, you are at risk for bleeding.

You should always tell your healthcare provider which medications and herbal products you are currently taking before starting on Warfarin (Coumadin®) and notify them of any changes. Several prescription medicines and over-the-counter products can interact with Warfarin (Coumadin®), potentially affecting your INR and the way you clot

You may be wondering why diet would interact with your INR levels. Some foods, especially the dark green leafy vegetables (see below), are high in vitamin K. Vitamin K plays a key roll in the blood clotting process through a similar mechanism as the drug Warfarin (Coumadin®). You should not stop eating these foods since they are heart healthy and provide a good source of fiber and lutein. However, the recommendation is to be consistent with the intake of foods that are high in vitamin K. This means that you should eat small and similar amounts of dark green leafy vegetables each day. Avoid eating a lot of these vegetables one day and none the next day. If the intake of your vitamin K fluctuates, your INR levels will fluctuate as well.

Below you can find some examples of vegetables that are high and low in vitamin K.

Vegetables HIGH in Vitamin K

• Asparagus

• Broccoli

• Brussels sprouts

• Cabbage

• Cauliflower (same family as broccoli)

• Endive

• Escarole

• Greens (collard greens, turnip greens, mustard greens)

• Kale

• Lettuce (except iceberg lettuce)

• Spinach

• Swiss chard

Vegetables LOW in Vitamin K

• Celery

• Carrots

• Corn

• Cucumber

• Eggplant

• Green beans

• Peas

• Potatoes

• Tomato

• Zucchini

Other Products and Vitamins That May Interact With Warfarin (Coumadin®)

• Many nutritional supplements such as Boost®, Ensure®, and Carnation Instant Breakfast® contain vitamin K. If you are currently taking any of these supplements, just make sure you take them regularly and inform your healthcare provider to adjust your medication or supplements as needed based on your INR levels.

• Vitamin C: Doses above 500 mg per day may lower your INR level.

• Vitamin E: Doses above 400 IU per day may increase your INR level.

• Multivitamins: Most multivitamins have vitamin K. If you are already taking them, it is recommended that you take them every day to maintain your vitamin K levels consistent. Always check with your healthcare provider to maintain your optimal INR levels.

• Alcohol: Drinking more than 2 drinks per day may elevate your INR levels and put you at risk for bleeding. One serving size of an alcoholic beverage is considered 12 oz beer or wine cooler, 8 oz malt liquor, 5 oz wine, or 1.5 oz of 80 proof distilled spirits (gin, vodka, whiskey, etc). Contact your healthcare provider if you drink alcohol in excess.

April is National Occupational Therapy month. Here at Amazing Angels Home Health & Hospice we offer Occupational Therapy (also known as OT) as a service for your loved ones.

Occupational Therapy is the teaching of how to perform activities of daily living as independently as possible, or how to maximize independence in the case of disability. Some key points that Occupational Therapy is aimed towards are:

1)    Helping people recovery from injuries to regain skills

2)    Providing support to older adults experiencing physical or cognitive changes

3)    Helping people with disabilities to participate fully in social situations

Occupational therapy services typically include evaluations of the client’s home, recommendations for adaptive equipment if needed, training on how to use the equipment, and direction and education for family members and caregivers. Occupational therapy practitioners have a holistic perspective, in which the focus is on adapting the environment to fit the person, and the person is an integral part of the therapy team.

Here at Amazing Angels Home Health & Hospice, we have a great team of members that provide Occupational Therapy, as well as, Physical Therapy and Speech Therapy. We are committed to taking care of any home health or hospice need.

Risk Factors of Heart Disease

There are many contributing risk factors that are a part of heart disease. They are:

1. Age

a. People whose age range is 65 years or greater make up approximately 82% of coronary related deaths.

b. Older  women who have heart attacks are more likely than older men are to die from them within a few weeks.

2. Male Sex (Gender)

a. Overall, men have a greater risk of heart attacks as they also happen earlier in life then those often in women.

b. In post-menopausal women death rates from heart disease increases, but it is still not as great as men’s death rate.

3. Heredity

a. People whose parents have heart disease are more likely to develop heart disease.

b. African American have more severe blood pressure and high risk of heart disease than Caucasians.

c. Among Mexican Americans, American Indians, native Hawaiians and some Asian Americans heart disease risk is higher.

Preventable risk factors are:

 1. Tobacco Smoke

a. Smoker’s risk of heart disease increases 2-4 times of a non-smoker.

b. Quitting smoking is a great way to reduce your risk of heart disease

2. High Blood Pressure

a. High blood pressure can be managed with medication

3. High Blood Cholesterol

a. High cholesterol can be managed with medication

4. Obesity and overweight

a. People with excessive hydrated body fat are more likely to have a stroke and/or heart disease even if they do not possess any other risk factor.

b. Even losing just 10lbs can decrease your risk of heart disease.

Other things that impact your risk of heart disease are stress, alcohol, diet and nutrition. An active lifestyle with good nutrition and diet can go a long way in preventing and decreasing your risk of heart disease.

Prevention

With heart disease as the leading cause of death in America coupled with so many risk factors working against you, heart health may seem daunting. The good news is that there are ways to lower your risk and ways to positively impact your overall health. Committing to a heart-healthy lifestyle is where it all starts.

1. Choose a healthy diet

a. A healthy diet is one of the best ways to prevent and fight heart disease.

b. Your food should be nutrient-rich foods full of vitamins, minerals, fibers and low in calories.

c. Fruits, vegetables, fish, lean protein and fat-free products are the key to a well-balanced diet.

2. Physical Activity

a. Being physically active at least 30 minutes a day

b. Something is better than nothing! Start out easy, even 15 minutes at a time may offer some benefits.

3. Limit Drinking Alcohol

a. Too much alcohol contributes to high blood pressure, leads to heart failure and strokes.

b. Moderate your amount of alcohol.

c. “Moderate amount” for someone in good health is about one drink for women and two drinks for men per day. If you have health complications you should consult your doctor before drinking.

4. Reduce Stress

a. Stress is usually connected with our bad habits, such as smoking, over eating and making negative choices when things get overwhelming. Try replacing these habits with positive habits (i.e. go on walks, deep breathing, or tackling those projects you have been putting off).

b. Take a Breath. Remember to pace yourself. Take a moment to think about what important things you need to get done today.

c. Plan ahead. This allows you enough time to accomplish your daily tasks.

5. Laughter

a. There are some studies that show laughter had a positive impact on your over all well being.

6. Sleep

a. Try to get 6 to 8 hours of sleep each night.

b. Studies have shown that lack sleep can affect you negatively. It affects the amount of energy you have and your concentration.

The good news is that the best defense against heart disease in your control, your lifestyle. Being active, eating right, and limiting stress are all things that you can manage. Making responsible heart-healthy choices can save you in the long run. Remember it’s never too late to start, and you do not have to try to take it all on at once. Try to implement one or just a few things at a time so it becomes habit. These habits will get you on the path to a heart-healthy lifestyle.

Heart Health Awareness Month

February is Heart Health Awareness month. Heart health is a very important part of your health. In America, heart disease is the number one killer. Over 82 million American adults are estimated to have one or more types of cardiovascular (heart) disease. This means one in three people have some type of heart disease.

Signs and Symptoms of a Heart Attack

1. Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
2. Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
3. Shortness of breath with or without chest discomfort.
4. Other signs may include breaking out in a cold sweat, nausea or lightheadedness.

As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Learn the signs, but remember this: Even if you’re not sure it’s a heart attack, have it checked out (tell a doctor about your symptoms). Minutes matter! Fast action can save lives — maybe your own. Don’t wait more than five minutes to call 9-1-1 or your emergency response number.

2011, “Warning Signs of a Heart Attack”, American Heart Association [online] available at http://www.heart.org

What is a Heart Attack?

 Your heart muscle needs oxygen to survive. A coronary attack (heart attack) occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because coronary arteries that supply the heart with blood can slowly become thicker and harder from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis . When a plaque in a heart artery breaks, a blood clot forms around the plaque. This blood clot can block the artery and shut off blood flow to the heart muscle. When the heart muscle is starved for oxygen and nutrients, it is called ischemia. When damage or death of part of the heart muscle occurs as a result of ischemia, it is called a heart attack or myocardial infarction (MI).

2011, “About Heart Attacks”, American Heart Association [online] available at http://www.heart.org

Heart Health

In our next blog we will discuss Risk Factors, Prevention, and what you can do to start a heart-healthy lifestyle !

What is Truth and What is Myth About the Flu?

In continuation of our desire to separate truth from myth and the flu.

 Myth #4: Vaccines are dangerous.

 In recent years, there’s been growing mistrust of vaccines, including the flu vaccine.  Some believe that there could be a link between vaccines — specifically the ingredient thimerosal — and developmental disorders in children, like autism.  However, there is no evidence that vaccines cause autism, and experts say that we’re losing sight of how important vaccines are.

“Vaccines are, arguably, the greatest medical advance in history,” says Perl.  They’ve prevented more illness and death than any treatment.”

If you’re still concerned, you should know that there are thimerosal-free flu vaccines available.  In fact, every year, manufacturers produce more of this vaccine than people use.  If you want your child to get it, just ask your doctor.

Flu Myth #5: Antibiotics can fight the flu.

 Antibiotics only fight bacterial infections.  Flu – whether it’s typical seasonal flu or swine flu — is not caused by bacteria, but by a virus.  So antibiotics have absolutely no effect on any kind of flu.  But this message just won’t sink in for some people.

“We still have oodles of patients coming into the doctors, or bringing their children to the doctors, who want antibiotics for influenza,” says Schaffner. 

However, there are instances of flu complications that involve bacterial infection.  The flu virus can weaken your body and allow bacterial invaders to infect you.  Secondary bacterial infections to the flu include bronchitis, ear infections, sinusitis, and most often, pneumonia.  

Some patients with the flu want antibiotics just in case they might develop a complication.  But Hay says this attempt at prevention doesn’t work.  It could make things worse.  “If you take antibiotics unnecessarily and then really do wind up with a secondary bacterial infection, then it might be resistant to those antibiotics,” Hay tells WebMD.

If your flu symptoms are getting better and then suddenly get worse, call your doctor. This may be a sign of a bacterial co-infection.

Flu Myth #6: There is no treatment for the flu.

 Two antiviral drugs are highly effective against the flu: Tamiflu, in pill form, and Relenza, which is inhaled. These drugs are most effective if taken within 48 hours of your first flu symptoms. But the drugs are beneficial even if taken 48 hours after symptom onset.

Neither Tamiflu nor Relenza cures the flu.  But they can reduce the amount of time you’re sick by one or two days and make you less contagious to others. These drugs work with both the typical strains of seasonal flu as well as swine flu.

Flu Myth #7: Cold weather causes the flu.

 No matter what your grandmother may have said, going outside in the winter hatless does not increase your risk of flu.  While there might seem to be a connection — since flu season coincides with colder months in the U.S. — there isn’t.  After all, flu season is the same throughout the whole country: even if it’s frigid in Minnesota, it’s still warm in Florida.  The rise and fall of flu season each year has more to do with the natural cycle of the virus, although experts aren’t exactly sure how it works.

Colder weather might increase the risk of flu in one way: We might come into closer contact with other people because we’re all stuck inside.  That could make it easier for the virus to spread.

What’s the truth about the flu, and what’s myth?

Myths about the flu are everywhere. According to many experts, misconceptions and rumors about the flu are as hard to contain and as hard to fight as the virus itself.

“There are urban myths and rural myths about the flu,” says William Schaffner, MD, chairman of the department of preventive medicine at Vanderbilt University’s School of Medicine in Nashville, Tenn.  “Flu myths are everywhere.”

Unfortunately, flu myths are common even among the people who should know better, like health care workers. Given that influenza can be serious and even fatal, it’s crucial that we all know what’s fact and what’s fable.  So as a public service, and with the help of some flu experts from around the country; WebMD helps debunk these flu myths:

Flu Myth #1: The seasonal flu is annoying but harmless.

There has been a lot of focus on swine flu, but it’s important to remember that the run-of-the-mill seasonal flu can be a serious condition itself. “A lot of people just think of the flu as a very bad cold,” says Curtis Allen, a spokesman for the CDC in Atlanta.  But it’s much worse than that.

For one, you usually feel terrible.  In addition to the congestion and cough, you’re apt to have nasty body aches and fever, which are less likely with a garden-variety cold. “When you get the flu, you know it,” says Christine Hay, MD, assistant professor at the University of Rochester Medical Center.  “You feel like you’ve been hit by a Mack truck.”

Aside from the short-term misery and lost workdays, flu can have more serious implications.  Sure, most people who get the seasonal flu recover just fine. But the seasonal flu also hospitalizes 200,000 people in the U.S. each year.  It kills about 36,000.  That’s close to the number of women killed by breast cancer each year, and more than twice the number of people killed by AIDS.

Flu Myth #2: The flu is only dangerous for the elderly.

It’s true that the people most likely to become seriously ill or die from the seasonal flu are over age 65.  But flu can become risky for anyone, even healthy young adults.  Some of the most susceptible people to seasonal influenza are young children. Ninety percent of H1N1 swine flu deaths have been in people under age 65, while 90% of seasonal flu deaths are in the elderly. And both seasonal and pandemic flu are particularly dangerous for very young children.
“Children under 2 years have some of the highest rates of hospitalization from [seasonal] flu,” says Hay.  Children under 6 months are at the most risk from the seasonal flu because they’re too young to get the vaccine.  To protect infants from the flu, keep babies away from people who have the flu. Parents and caretakers of infants should get vaccinated.

Flu Myth #3: If you’re young and healthy, you don’t need to worry about getting the vaccine.

First of all, we should all get the seasonal flu vaccine.  Sure, if you’re in good health, you’ll probably recover from the seasonal flu just fine.  But why suffer through the flu if you can avoid it? Second, protecting yourself isn’t the only reason to get vaccinated.

“Healthy adults forget that while they themselves might be at low risk for getting serious flu complications, other people in their family might not,” says Hay. If you have a small child at home, or an older parent, your failure to get yourself vaccinated could endanger them.

And that’s true on a larger, societal level. People with the weakest defenses, like children under 6 months, can’t get the flu vaccine.  Their safety depends on the rest of us getting immunized.

Check back for more myths in our next blog.