Monday, January 22, 2018

My Love Affair ... With Salt

Today marks 10 full days post my first visit with my cardiologist.  In those 10 days I have spent countless hours learning about my love affair with salt.  Memories of a recent sermon float in and out at least once a day.  In that sermon, our pastor talked about Matthew 5:13 "You are the salt of the earth; but if the salt has become tasteless, how can it be made salty again?  It is no longer good for anything, except to be thrown out and trampled under foot by men."  The phrase "Stay salty, my friend" is what I remember most.  Jesus, I believe, meant that His disciples were to serve as preservatives (salt), stopping the moral decay in the world.  I could write more on this, however I want to focus more on the physical aspects of "being salty".

I'm not a doctor, but I'm pretty sure that the human body requires sodium, a crucial electrolyte, to function.  If you are relatively healthy and your doctor hasn't had the "cut back on added sodium" conversation with you, there is probably no reason for you to be concerned with moderate intakes of sodium.  Because my brain works the way it does, until it becomes a firmly established routine, I'm likely going to obsessively count each milligram … for everyone else I did see a bit of very common sense advice … 1) eat real food, 2) add salt when appropriate to make your food taste good … that's it.

As I noted in my last blog post, because of a family history of heart issues and congestive heart failure, my cardiologist is having me weight myself daily to help keep the fluid retention in check.  If I gain more than 2 pounds in a day I am to call my cardiologist.  As of this morning (1/22/18), 10 days after starting Lasix, I have shed 34 pounds of fluid weight.  The edema is gone from my legs, feet and ankles.  I no longer struggle to catch my breath.  The breathing issue was the most concerning to me.  It was having an impact on daily activities.  It got to a point where I was having to make choices between washing clothes and washing dishes - I only had enough stamina to complete one or the other.  While this doesn't make me like household chores any more than I did previously, I was pretty excited to get all of the laundry done in one day this weekend!

When I was a child, I remember Dad having to watch his sodium intake and it became habit to taste my food before adding seasoning.  I do love salt and prefer flaky sea salt over table salt - despite this affinity to salt, I usually do not add salt to prepared foods.  SO, where was the extra sodium coming from?  After getting over the shock of "no more cheese" I started taking a closer look at the sodium content of the foods that I normally buy.  I've been reading labels since I was pregnant because I had gestational diabetes and have remained conscious of the number and kind of carbohydrates I am eating.  I have never had a reason to keep track of sodium content until now - and I was surprised by some of the things I found.

I love salads, lettuce, veggies are, with the right dressing, a very low sodium choice … wouldn't you think?  Not at Arby's it isn't.  There isn't that much roast turkey, bacon or cheese on the Roast Turkey Farmhouse Salad and it is a healthier choice than the Smokehouse Chicken sandwich … choosing the salad over the sandwich saved me 300 calories and 1130 mg of sodium - however the salad still added 870 mg of sodium to that day's intake - without dressing!  That salad represented 44% of the 2,000 mg I am currently trying to stay under (this is bound to change after my next doctor visit).

Another sad surprise, at least to me, is the amount of sodium contained in a bag of the microwave popcorn I bought from the Boy Scouts this fall.  One bag of popped corn (about 4 cups) has 890 mg of sodium - compared to my other favorite, oil popped popcorn, the same amount of popcorn brings with it only 2 mg of sodium.  I know that air popped popcorn would be even healthier for me, but I've never liked air popped & today I'm writing about sodium, not fat.

I grew up with farm grown veggies and beef (plus a variety of wild game that we hunted locally) - we had some packaged meals, but mostly it was food that Mom made from scratch.  While in college and the early years of my first marriage, I turned to processed foods because they were a more affordable option for us.  After I had my son I tried to make more meals from scratch, but we were still on a tight budget and fresh foods seemed to be a luxury.  I'm not going to go back through my old food journals, but it wouldn't surprise me to learn that I was routinely consuming an average of 3,500 mg of sodium daily basis.  No more … right now my average consumption is hovering just under 1,700 mg!

I'm just beginning to relearn how to cook with fresh ingredients and it has been kind of challenging for me.  By the time I pick my son up after work we are both dangerously close to the "hangry" stage and "here, have an apple while I make dinner" doesn't even work on me, let alone the starving 9-year-old.  Maybe the next segment of this adventure will include freezer meals that I will feel good about the child eating…  If you have any favorite recipes or websites that give a good breakdown of how to package up individual servings of yummy lower sodium, made from scratch with love meals, please let me know!!

Monday, January 15, 2018

Straight to the Heart

Life is a series of many, many adventures that stitch together as part of the journey through life.  Some of these adventures are ones that I share with those around me.  Then there are the adventures that cause me to feel like I have been stranded on an island without any resources.  Today I decided to write about an adventure that is beginning to unfold before me.  One that started out with me feeling lost and alone after a shipwreck.

I'm pretty sure you are fully aware that I am not a doctor; however, just to be clear, I AM NOT A DOCTOR.  My motivation for writing about this is to encourage you through your journey through life, to remind you that your body is YOUR body - YOU have to advocate for your health.  I also want to talk about the importance of recognizing when the fear of bad news causes MUCH more damage than hearing the truth will cause.

I am no stranger to the challenge of the weight gain/loss yo-yo.  I have struggled with my weight most of my life.  It seems that, real or imagined, the older I get the harder it is to lose weight, regardless of my diet and exercise efforts.  It has been incredibly frustrating and disheartening.  Over the past couple of years I started talking to my doctors about why it is so difficult for me to lose weight.  The responses have typically been along the lines of "Well, you just need to watch your portion sizes" or "You just need to get more exercise".

In mid to late October, 2017, I started to notice increased asthma symptoms.  The symptoms would improve and then appear again.  The week before Thanksgiving, after lunch, I sat down in my recliner and took a short nap.  When I woke up I found that I was struggling to get a full breath, as if I had a weight sitting on my chest.  Additionally, my fingers were so swollen that I could not make a fist.  My grandma had congestive heart failure in the months prior to her death, and I had promised her that I would take my health seriously … so I made an appointment with my family doctor.  During that appointment my blood pressure was normal.  The doctor asked more family history questions, but was really focused on the fact that I couldn't walk from one room to another room without becoming out of breath.  After a blood draw, a chest x-ray and an EKG at the clinic I was sent to the hospital for a chest CT scan.  Those showed that I had not had a heart attack, I did not have any fluid in the pericardial cavity (space around the heart), there was no evidence of pneumonia and they also found no pulmonary emboli (blood clots in an artery in the lungs).  Good news, so why was I still struggling to breathe?

The doctor put me on Prednisone to help improve my breathing.  While on Prednisone my breathing actually became more labored and I felt, very much, like I had puffed up like a grape.  I had read that staying hydrated helped reduce the fluid retention caused by Prednisone - so I drank over a gallon of water each day.  My doctor's nurse called me on the Monday after Thanksgiving to find out how I was doing.  She scheduled an appointment for me for the following day.  That same day I figured out that one of the ingredients in a product I had been using on my scalp contained pine oil.  As I was reading the ingredients list I reached down and scratched my leg without thinking.  The next morning I woke up to find that leg swollen and covered in hives.  It didn't take me long to figure out what happened because I break out in hives when I come in contact with pine.  While I was talking with my doctor I expressed a concern about how much I was drinking compared to how much I was eliminating and that it seemed I was holding on to about half of what I was drinking.  The doctor noted that I had some edema in both legs and said that it should correct itself after I was done taking the prednisone.  He then ordered an abdominal x-ray and had me take Miralax to address mild constipation.

I knew that our church would have several poinsettias during the Christmas season so I had started taking Benadryl to counter my allergy to poinsettias and continued to attribute my breathing difficulties on that allergy.  Just before Christmas I had an appointment with my endocrinologist.  He walked in the exam room, sat down and demanded to know what was going on.  I wasn't sure what he was talking about because, except for the breathing I felt pretty good.  He proceeded to tell me that I had gained 33 pounds in less than 4 months.  I was SHOCKED.  I admit that, at some point, I noticed that my clothes were getting tighter and a friend had commented that I looked like I was pregnant.  Even so, I was shocked by this information.  I was expecting a lengthy conversation about my eating and exercise habits.  Instead he wanted to know more about the scans that my family doctor had ordered, then he made a call to get a copy of the reports.  We talked about the possibility of Cushing Disease or other possible endocrine system explanations.  He also made it very clear that he was not ok with the lack of diagnosis.  By the time I left he had received the reports from the other doctor and told me to expect a call from my family doctor.  I also was to collect a 24 hour urine sample to test my creatinine and cortisol levels to rule out Cushing Disease.

I think I was annoyed by the whole thing because I just wanted to be able to breathe easily and enjoy Christmas with my family, instead I was an emotional wreck, tormented by my fear of the unknown.  While I visited with my parents, I spent a lot of time resting and talking with my folks.  Some of our conversations, coupled by my being down on myself for not being able to lose weight prompted me to resume a food log, primarily tracking calories, which showed me that I was eating an average of about 2,000 calories a day.  Because my primary symptom was shortness of breath, I kept thinking "I just need to start walking consistently again", the problem being that I couldn't walk from the car to the house without resting to catch my breath.

After returning from Christmas break I completed the 24 hour collection and visited with my family doctor.  During that visit I expressed concern about not really understanding why I was there.  He pulled up the reports from both the CT scan and the EKG and told me that both indicated that I have an enlarged heart, so he thought it would be a good idea to follow up with an echocardiogram.  Even though my blood pressure was normal, he agreed that we needed to follow up on it.

If you have never had an echocardiogram, it is really cool to watch!  I was fascinated by it.  I asked a lot of questions and when I asked about what the red vs blue was, I made a comment about preferring purple … the doctor chuckled and told me purple would be a really bad thing to see during this scan!  Before the scan began my blood pressure was a little higher than normal, so they told me they would check it again after the scan, assuming it would come down as I was just laying down for the scan.  For most of the scan I was laying on my left side, until the very end when he had me lay on my back.  That's when I felt the panic well up.  I was already struggling to breath and being flat on my back only makes breathing harder.  I hate not being able to control panic attacks.  The doctor announced he was done and that I could sit up.  As I struggled to get my breathing under control again they hooked up the blood pressure cuff and were shocked that my blood pressure had gone up to 158/124!  The doctor didn't hold me at the hospital, but he did call my doctor's office.  40 minutes later I was at my family doctor's office because the nurse wanted to check my pressure herself.  It had gone back down to 124/78.  She also had learned that all of the lab work ordered by the endocrinologist had come back "normal".

While the music team was practicing that Sunday morning, I was struggling to breathe again and I started to feel a bit weak as well … I actually wound up sitting down, on stage, during 1st service worship.  Between services I was approached by two different women, one who just wanted me to know she was keeping an eye on me and that I was in her prayers.  The other shared the story of her mother-in-law, who had retained a tremendous amount of fluid in her midsection before they find figured out that she was suffering from undiagnosed ovarian cancer.  Since I had been diagnosed with PCOS (Polycystic Ovarian Syndrome) when I was in my late 20s, it seemed possible that a flair-up was causing fluid retention - but that was just a guess.  After church I had a whole list of "stuff" I had wanted to do, yet all I had the energy to do was curl up and take a nap.

On Monday, January 8, my doctor's office called to schedule an appointment to review the echo findings with my doctor and discuss 'next steps'.  On Tuesday I met with the doctor who was perplexed about why my blood pressure has been so consistently normal, yet the echo had uncovered that my veins are not dilating properly.  I asked him if this had anything to do with the 33 (plus) pounds I had gained since August.  I told him about the food log and the average daily calories I have been eating.  His response was unexpected.  None of this "weight" was because of fat or food … it was, in his opinion, fluid and no amount of dieting was going to help.  He also told him that he wanted me to have the best care possible, so he referred me to the Avera Heart Hospital (actually the clinic attached to it) in Sioux Falls.  That night I shared part of my story with the ladies in my church group, I also reached out to a couple of friends asking for prayers - and I prayed myself to sleep.

The clinic had a cancelation for the next afternoon so off to another appointment I went.  Feeling bloated and out of shape, I stepped on yet another scale and burst into tears.  I had gained another 6 pounds in a day.  In the past I have said some really mean things to myself, things that I would never say to another person … this time the only thing I could think to say is "help me get control of this".  The nurse was very kind and told me that we would figure this out together.  Turns out she wasn't even my doctor's nurse.  After a couple minutes my doctor's nurse came in and took a very detailed history.  She listened patiently and assured me that I will not be alone in this.  During our conversation she started listing out foods that I should avoid.  Most of the foods she listed are already ones that I don't eat, or, at least I don't eat often.  Then she talked about deli meats and most cheeses - not because of fat or cholesterol … because of sodium content.  WAIT, did you just say no more cheese???  Really?  Yes, she really said no cheese. 

OK MINDY, move on … you don't even know what the doctor is going to tell you, so FOCUS (yeah, good luck with that).

The doctor came in and asked me even more questions and listened to my heart and then we talked about the 'diagnosis' … Idiopathic Cardiomyopathy … essentially, based on the initial exam, none of the most common causes of cardiomyopathy "fit" me.  Somehow I'm not surprised by this … there is very little about me that is "normal" so why should this be any different??  The cardiologist talked, at length, about the excess fluid I have been carrying around and why it was interfering with my breathing.  He started me on Furosemide (20mg) and Lisinopril (10mg) to start getting the fluid out of me and help my veins dilate as they are supposed to.  In addition to the medications and limiting excess salt consumption, I also need to weigh myself daily and phone the nurse right away if I gain more than 2 pounds in one day.  I am also wearing a heart monitor for two weeks and then meet with the doctor to review the results.  It's kind of cool because it also has a button I can push when I experience symptoms that I, then, write down in a log book at the two can be compared!  I started taking these medications on Thursday morning and by Monday (this morning) I have lost 20 pounds, can walk up and down stairs without needing to rest to catch my breath and feel better than I have felt in over two months!

One of the verses we have been studying in Life Group is Matthew 5:8 "Blessed are the pure in heart, for they shall see God."  More than once, during this past week, I have a cried when I start thinking about this.  The thought keeps returning:  Jesus is concerned with our spiritual center ... and it is our "job" to make sure our physical center is cared for.  I can't help but feel that I was led down this path … each event had been set up in such a way that my faith would be stretched and strengthened.  If I had not listened to my endocrinologist, I may well have been putting nails in my own coffin.  My fear of unknown potential bad news could well have cut my life shorter than my Creator intended.  As long as the fear of the unknown holds us captive we will never find answers … once that fear is defeated the unknown becomes known and resolution is possible.

One other word of encouragement - even the best intentioned comments can be hurtful if it based solely on surface information.  Don't be afraid to share your story - at the same time, don't feel obligated to explain your health situation if you are not comfortable doing so.  Please remember that you are not alone.


I know I have a long road ahead of me and I am thankful for every day the Lord allows me to have here on this beautiful blue marble.  Thank you for being part of this journey.