Pros: A thorough and comprehensive look at the disease
Cons: none for me
The Bottom Line: The book is written in an easy to read style that isn't threatening to the average person, still it has all the important information for caretakers and physicians.
ed_grover's Full Review: Marc A. Silver - Success With Heart Failure: Help ...
2005 is The Year of the Heart and February was Heart Awareness Month. Since I always like to be au courant with things, I think my body decided I should experience something in this area as soon as possible and I learned the hard way early in December of 2004. One day I was talking on the telephone to a friend who just had returned home from having three heart bypasses. He smugly asked, "And how are you doing?"
All I remember is that before I had a chance to answer in the same tone of voice, I became very short of breath and had to hang up. Thank God I had the smarts to dial 911 immediately. The paramedics were there within minutes and I was on my way to the emergency room of the nearest hospital. Some overzealous young intern wanted to shove a breathing tube down my throat, but I was still aware enough to nip that move in the bud.
I should add here that I have a copy of my Living Will and a copy of my Power of Attorney for Health Care in all of my pertinent medical files at both doctors' offices, the hospital, at home and with my representatives.
Most of my friends thought I had a heart attack. I didn't. What I had was an episode of Pulmonary Edema, which is kind of like drowning in your own body fluids and very scary. A heart attack is a different thing. It involves the breakdown of the muscles of the heart and is caused by blood vessel and artery blockage, among other things, that stop the delivery of blood to the muscle resulting in pain or angina and then the attack. The more damage that's done by repeated attacks of angina or more than one hear attack, the more likely it is that you can experience heart failure. Fortunately, my blood vessels are clear at the present time and I have no pain. Heart attacks can lead to heart failure, but it's not likely the other way around.
Dr. Silver tells about a talk he gave at a support group called Mended Hearts. He found out that two-thirds of the audience had a spouse, relative or friend who had heart failure. When asked to define what it was he got less than one in three answers that were correct . . . and he took anything even close to the true definition. Well then, what's heart failure, you ask? Here is his simple, easy to understand explanation:
"Think of the heart as a blood pump, which carries oxygen or the fuel to the rest of our bodies—including arms, legs, abdomen, liver, kidneys and the brain. Heart failure is a condition in which the heart does not adequately perform its duties as a blood pump."
I was diagnosed with hypertension (high blood pressure) in the late 1970s, went on a low sodium diet and maintained it fairly well until the last year or so when I "fell off the salt wagon" in a multitude of sneaky ways. High blood pressure is the major cause of heart failure and over 60 million Americans suffer from that alone. I found out I had an enlarged heart about three years ago but nothing was said to me about this condition except that my heart wasn't pumping out enough blood and oxygen to meet my body's needs. I was told that with care and medication I could lead a healthy, normal life for some time to come.
The heart pumps the blood through the kidneys, which in turn gets rid of excess salts and water in the body. When a weakened heart isn't pumping properly (and mine was only putting out a third of what it should), the kidneys can't do their job. The water is stored in various areas of the body like around the heart and lungs, the ankles and legs and wherever else there is room. This results in edema, or swelling. My excess fluid all went to my gut and around my lungs and resulted in the pulmonary edema attack.
If you have high blood pressure take it seriously, get adequate medical treatment in the form of medications, go on a serious low-sodium diet, exercise and watch your total fluid intake. As for smoking and drinking, stop now. If you think you don't have a problem, think again. Cigarettes and booze are just plain bad for you and your heart and I'm here to tell you that even though I quit drinking over 20 years ago and it's almost 10 years for quitting cigarettes, it all catches up with you in the end. If you have hypertension you should seriously think of ditching all forms of caffeine.
All this information came at me in a lump, and on an impulse I decided to see what our local library had on the subject. I found the third edition of Success With Heart Failure: Help and Hope for those With Congestive Heart Failure by Marc A. Silver M.D. This book assures us that CHF is not an automatic death sentence and gives those if us afflicted with it the hope, help and treatment that is available for all forms of the disease. Heart failure is not limited to the elderly; the young rock star, Jim Morrison, died of heart failure.
The book opens with a forward by a physician who is, among other things, Clinical Director for the CHF Cardiomyopathy and Transplant Center of Brigham and Women's Hospital and an Associate Professor of Medicine at Harvard. On a page titled "How To Read This Book," Dr. Silver explains that it is organized into sections discussion what heart failure is, how one gets it, how it is diagnosed and treated among other things.
The first chapter is titled, "Don't Be Angry, and Dr. Silver writes that CHF can happen naturally right under our noses. He uses the analogy of symptomatic heart failure is often referred to as "the straw that breaks the camel's back." A patient can feel great at one moment, able to carry groceries, mow lawns and so on, and suddenly be transformed into a person who cannot even walk up the stairs without gasping for breath and having to rest.
"This sudden transformation causes a great deal of uncertainty, fear and depression." Anger and depression can cause roadblocks in your recovery, so just acknowledging that you might have a problem opens a door to an improved attitude, better mental health and gives you a feeling of empowerment and control so you can make better decisions about your care.
Dr. Silver asks a few questions of the 500,000 new cases that are diagnosed every year. If you can answer yes to any of the following questions, you are not alone.
1. Are you a sixty-five-year old man whose heart failure was caused by years of untreated high blood pressure?
2. Are you a young woman whose diagnosis seemed out of the blue, without even your doctors being unable to identify the cause?
3. Have you been struck by the most common cause for hospitalization in people over the age of sixty-five?
Stages of Heart Failure
Stage A: In patients who are at increased risk for developing CHF from assorted medical conditions such as hypertension, coronary artery disease, or diabetes mellitus, the heart structure and function are not yet affected. Therapies include treatment of hypertension, smoking cessation and weight loss, and ACE inhibitors where appropriate.
Stage B: In cases where patients have abnormal heart structure and/or functions but have not manifested signs or symptoms, the potential therapies are are the same as Stage A with the addition of beta-blockers in appropriate patients.
Stage C: In patients with symptomatic heart failure (this is where I am), there is abnormal heart function and the therapies are the same as above with the addition of digoxin and diuretics, along with coronary revasculization and repair of mitral regurgitation in selected patients.
Stage D; In patients with extremely advanced heart failure, the structure is severely abnormal the therapies include investigational therapies as well as end-of-life counseling and hospice.
Dr. Silver adds that the important aspect of these stages is that you can never go back, so work to maintain your health.
Generally when people find out the have congestive heart failure they go through the same stages that people go through when they find out they have inoperable cancer or some other terminal illness. Elisabeth Kubler Ross explains all that in her book On Death and Dying. I must admit I knew the steps of this process from my bout with oral cancer in 1979-80, but I never expected to not be filled in completely about what to expect and what to not expect. I only got a fuller explanation after "the horse was out of the barn," so to speak.
I have a problem "letting go" and my anger remains. Right now it's subliminally directed at those who neglected to make it perfectly clear to me that the big things I should have been aware of. These were my diet with a constant weight level and a limit of 2,000 milligrams of sodium a day, exercise and a limited fluid intake. After reading Dr. Silver's book, I'm now aware of the questions and some of the answers I should be given when I talk about my condition with my cardiologist and primary care physician. My four-month review is coming up in April and I expect to hear some good news. Good communication is part of the problem in understanding what CHF is.
CHF is the medical jargon for Congestive Heart Failure and it was at one time considered a one way street to the end of life. Most patients who first hear the words heart failure equate the term with fatality and an array of emotions emerge . . . or rather, don't emerge. These emotions have an impact on physicians, nurses and family members. Psychological effect of your prognosis so please be sure to read this book (or any book on the subject) and become more informed about your treatment and recovery.
I received some of the conventional treatments for heart failure after my admission to the hospital. Previously, the doctor tried several drugs and I had some rather severe side effects and they were discontinued in favor of one with less side efects. I am now on a low dosage of Digoxin to make my weakened heart beat more strongly. I take an ACE inhibitor that opens my blood vessels and arteries to make it easier on my pumping heart. A rather strong diuretic (water pill) to remove excess water, potassium to replace the potassium that is lost to diuretics and fluid restriction of no more than 100 milligrams of fluid a day.
In the hospital (and for a month after I got out) I was limited to only 50 milligrams of fluid a day in order to get rid of as much of the "nasty" water as I could. I suffered dry mouth and it was difficult to take the multiple medications I had to take . . . some of which required a full glass of water (8 oz.). That was hard and I wasn't aware that ice cream, Jello, soups and anything else that was primarily liquid or turned to liquid had to be deducted from the total intake. Now that my intake has increased, I feel less thirsty, but I'm still aware of everything I eat or drink.
There are five appendices in the book that discuss everything from a glossary of heart failure terms to some rather scary photographs of deteriorated hearts, feedback to the author, and a section on Heart Failure and exercise. Yes, sex is exercise and is included. On page 215 there is a list of resources and help for patients with heart failure that includes professional organizations, support groups, drug information, and books to read that are recommended by the author. There are lots of links available through Google that give the details about congestive heart failure, explaining what it is, symptoms, treatment, how common and how serious it is.
I've been seeing things on television and getting newspaper clippings about the problem from concerned friends. These days, even if you are lucky enough to qualify for and get on a list for a heart transplant, it's still stress making and worrying. Just lately I saw a feature on TV about some sort of mesh bag that can be place around the heart to give it additional support. It looked like it was made from a pair of mesh stockings and reminded me that I wouldn't want that either, even if I could afford it. I'm too vain to want that horrible scar all down my chest, not to mention any of the stripping of veins from my legs. I still gotta get to the nude beach a few more times. (Perseus Publishing, ISBN: 0-7283-0600-8, paperback).
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