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CARDIAC SURGERYPPaattiieenntt IInnffoorrmmaattiioonn
Before Your Surgery 1
In The Hospital 2
Going Home 3
Diet 4
Activity 5
Risk Factor Reduction 6
Medication 7
Home Health 8
Cardiac Rehabilitation 9
Additional Resources 10
4/07
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BEFORE YOUR SURGERY
Tests/UnitIf your surgery is scheduled at the office,you will be
instructed where to report forPre-surgical Testing and given an
appointment.
You will need blood tests, chest x-ray and EKG
If you are already in the hospital, these will bedone either
before surgery or before you gohome to wait for surgery.
Treatments/Special EquipmentThe night before surgery, please do
thefollowing:
n Shower using anti-bacterial soap
n Shampoo hair
n Trim nails and remove polish
n Medications/Pain Control
n Stop all aspirin and aspirin products(Ibuprofen, Motrin,
Plavix) seven (7)days before surgery.
n Bring a list of medicine you take toPre-surgical testing.
n The anesthesia doctor will tell you whatmedicine to take the
morning of surgery.
Breathing ExercisesYou will be instructed in how to deep
breatheusing an incentive spirometer (IS). Practiceusing this
device before surgery because yourlungs will need to be exercised
frequentlyafter surgery.
Coughing is also necessary to help clear thelungs of excess
fluid.
ActivityContinue normal activity unless otherwiseinstructed by
your doctor.
DietEat whatever you would like for dinner theevening before
surgery, but do nnoott eat or drinkanything after midnight. You may
have sipsof water in the morning with medications youwere
instructed to take.
TeachingThere is a video and a booklet available thatexplains
what to expect before and after surgery.
Discharge PlanningIf you live alone, plan to have someone
staywith you around the clock for about one totwo weeks after
surgery.
Before Your Surgery 14/07
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IN THE HOSPITAL
DDaayy ooff SSuurrggeerryy
Tests/UnitYou will go immediately from surgery to theCardiac
Surgery Unit (CSU) located on the8th floor at Borgess.
Recover from surgery in the CSU.
Blood tests, chest x-ray and EKG are done.
Treatments/Special EquipmentIn the CSU you will have the
followingequipment:
n Breathing tube connected to a breathingmachine. This is
removed once you areawake and strong enough to breathe onyour
own.
n I.V. catheters will be in your arms andneck.
n Drainage tube entering through yournose to the stomach.
n Foley catheter to drain urine.
n Chest drainage tubes that exit belowyour breastbone.
n You will be on a heart monitor at all times.
Medications/Pain ControlMedication will be used that will help
yourelax and control pain.
Your nurse will frequently check with you tomake sure that you
are comfortable.
Breathing ExercisesIt is important to use the incentive
spirometer(IS) every hour whenever awake. Your nursewill assist you
in CSU.
When coughing, hold a firm pillow over yourchest to help support
the incision and thebreastbone as it heals.
ActivityAfter the breathing tube is removed, the nursewill
assist you to sit on the side of the bed(dangle) a couple of times
during the first day.
DietYou may have sips of water to take medicationas instructed
in Pre-Surgical Testing the morningof surgery.
You may have ice chips once the breathingtube is out and sips of
liquids once the stomachtube is removed.
VisitorsWe welcome immediate family members tovisit their loved
ones after surgery. Understandthat patients require a great deal of
rest soplease limit the amount of time each visit.
No children under age 16 allowed in the CSUto visit.
Your nurse will be glad to answer questionsyour family may
have.
In the Hospital 24/07
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POSTOPERATIVE/RECOVERY PHASE
Tests/UnitTransfer to the Cardiac unit when you are stableand
ready to leave the CSU.
n Staff will monitor your heart 24 hoursa day.
n Lab test third day after surgery.
n Other tests or exams as needed.
Treatments/Special EquipmentThe telemetry box used to monitor
your heartfits in a pocket on your gown with wires thatare attached
to adhesive patches on your chest.
n Temporary pacemaker wires are ofteninserted during surgery and
are removedbefore going home.
n Oxygen is provided for a few daysafter surgery.
n Blood oxygen levels are measured daily byplacing a clip on
your finger connected toa monitor.
n When your level is above 90 percent,the oxygen will be
discontinued.
n If you use oxygen at home, it will becontinued throughout your
stay.
Medications/Pain Controln Pain medication is ordered for you to
have
every 4 hours as needed.
n Let your nurse know when you are in pain.
n If you were taking any medications athome before surgery and
think you shouldbe receiving it after the surgery, let yournurse
know.
Breathing ExercisesContinue to use the IS every hour while
awake.
Activityn Sit up in chair the morning after surgery.
n Walk a short distance or as far as you feelyou are able to go
with help.
n Receive instructions on how to movewithout hurting your
chest.
Dietn Advance to Cardiac (low salt and
low fat) diet.
n Limited liquid intake and nnoo ccaaffffeeiinnee.
In the Hospital 34/07
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n For diabetics, use 1800-calorie ADA diet.
n It is not unusual to have a low appetiteand food may not taste
as good to youfor a while.
n Your family can bring in food from homeafter checking with
your nurse.
Teachingn Learn how to care for your incisions.
n Ask questions about your diet.
n If you smoked cigarettes before surgery,you will be counseled
about smokingcessation.
Discharge Planningn Meet with a Case Manager (Registered
Nurse) after surgery.
n Discuss plans for care at home.
n The Case Manager talks to your insurancecompany to make sure
that servicesprovided at home are covered by yourpolicy.
In the Hospital 44/07
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DISCHARGE/REHABILITATION PHASE
Tests/Unitn Stay on cardiac unit until you are ready
to go home.
n Discharge to home is usually within 3 to5 days after
surgery.
n Everyone heals at a different rate, therefore,the time frame
for you is adjusted to howwell you are recovering.
Treatments/Special Equipmentn Staff will monitor your heart
rate
and rhythm at all times until youare discharged home.
n If you cannot maintain a blood oxygenlevel above 90 percent at
all times, youmay require oxygen at home until youimprove.
n The Respiratory Therapist will evaluatefor oxygen at home, if
necessary.
Medications/Pain Controln You will be given a prescription for
pain
medication. Call your surgeon’s officefor a refill.
n Aspirin is to be taken daily to help keepyour new by-pass
graft open for goodblood flow to the heart muscle. Yourdoctor will
order the dose.
n Review your list of medications withyour nurse when you are
discharged.
n Ask questions if the medications aredifferent than what you
have at home.
n Make sure you have prescriptions fornew medication.
Breathing Exercisesn The IS will go home with you.
n Continue to use the IS device every hourfor the next 3 to 4
weeks.
Activityn A nurse will walk with you four times a
day and monitor your blood pressure andpulse before and
after.
n Walk alone if you are steady on your feetor with a family
member during othertimes in order for you to get strongermore
quickly.
n DDoo nnoott lleett aannyyoonnee ppuullll yyoouurr aarrmmss
ttoohheellpp yyoouu oouutt ooff bbeedd oorr uupp ffrroomm aa
cchhaaiirr.
n A referral for cardiac rehab will be made.
Dietn Remain on the Cardiac diet.
n Keep fluid intake to about 2 liters(2 quarts) per day.
n DDoo nnoott aadddd ssaalltt ttoo ffoooodd; eat processedfoods,
or food high in sodium (processedcheese, lunch meats, ham,
bacon).Sodium (salt) leads to retention of fluidin the body
tissue.
n Eating several small meals a day isrecommended.
n Focus on eating foods high in proteinto promote healing.
Going Home 54/07
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Teachingn Read and follow the heart surgery
notebook provided.
n Your and your significant other shouldread all of this
information.
n Ask questions about what to expect afterleaving the
hospital.
Discharge Planningn Patients are referred to a Home Nursing
Agency before they leave the hospital
n The Home Nurse will visit you afterdischarge to monitor:
– Temperature, pulse, blood pressure,weight
– Heart rhythm (EKG)
– Lung sounds and blood oxygen level
– Incisions and healing
– Medications and effects they haveon you
– Draw blood tests, if needed
Going Home 64/07
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DURING YOUR RECOVERY AT HOME
General InformationEach patient who has heart surgery will
responddifferently. The procedure may be done tobypass clogged
heart arteries, and/or repairor replace a heart valve that is
leaking or toosmall. Recovery will depend on your surgerytype and
general health.
It is important to know that certain things area normal part of
the recovery process. This iswhat you need to do every day to help
monitoryour progress:
n Weigh yourself every morning at the sametime wearing about the
same amount ofclothing and record in log on page 13.
n Cough, breathe deeply and use yourincentive spirometer every
one to twohours.
n Take your temperature twice daily – inthe morning and in the
evening and record.
You may have difficulty falling or stayingasleep at night. This
will gradually improve.It is always wise to take a pain pill
beforebedtime. You may be more comfortable ina recliner the first
few nights at home.
Most patients experience constipation aftersurgery related to
pain medications and adecrease in normal activity. All patients
haveover-the-counter stool softeners listed on thedischarge
instructions. Make sure you purchasethese stool softeners when you
get the restof your prescriptions filled and take themas
prescribed. If you are taking your stoolsofteners and have still
not had a good bowelmovement, contact your home care nurse
orsurgeon for further directions.
Feeling depressed or experiencing mood swingsmay also occur
after surgery. Be sure to tellyour home care nurse or call your
primarycare doctor if these feelings persist.
You may have a lump at the top of your chestincision. This will
disappear with time.
What is Home Care?Before you come to the hospital, arrangeto
have someone stay with you for at leastone week after surgery.
Also, your surgeonusually orders home health care when youare
discharged. The purpose is to support yourrecovery as much as
possible. The registerednurse from a home health care agency
willprovide thorough assessments and educationin your home
environment. Your home carenurse will be working with your doctor
aspart of your health care team for recoverymanagement. A home care
nurse will visityou the day after hospital discharge and
thengenerally twice a week to monitor temperature,pulse, blood
pressure, weight, lung soundsand blood oxygen. The nurse will
continueteaching you about your recovery managementand
medications.
Going Home 74/07
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MedicationsYou will receive prescriptions you need
beforedischarge. Be sure to have them filled bythe time you arrive
home from the hospital.A nurse will discuss your medications with
youbefore your discharge and at initiation of homecare visits. You
will also receive an instructionsheet about all of your
prescriptions. If youhave any questions, please ask the nurse, orif
you are at home, contact your surgeon orvisiting nurse. Only take
medications listedon your discharge instructions.
IncisionA small amount of drainage from your legwounds can be
expected for the first week to10 days. If you notice any redness,
swelling,fever or unusual drainage, it could indicateinfection and
you should call your surgeonimmediately. Any drainage from your
chestincision should be reported immediately to thesurgeon or your
visiting nurse agency. Severaloutside factors can affect your
discomfortaround the incision area, including:
n A change in the weather
n Too much or too little activity
n Sleeping in one position too long(sleeping on either side is
encouraged)
n Poor posture
If you experience discomfort, you may takea pain pill or two
extra-strength Tylenol. It isnormal to have swelling of the foot or
leg fromwhich you have had veins removed. Keepingyour foot or leg
elevated will eliminate thisproblem. Check your legs daily for
increase inswelling and notify your surgeon or home carenurse if
this occurs. Avoid sitting in one positionor standing for a
prolonged period of time.
You may have white tapes over your incisions.As they loosen,
they should be removed. Theyshould all be off by 10 days after your
surgerydate. Your home care nurse will assist you inremoving these
tapes if needed.
Take your temperature twice a day. Call yoursurgeon or home care
nurse if you experiencea fever higher than 101 degrees.
Your BreastboneDuring the first six weeks after surgery, youmust
protect your breastbone. All of theguidelines listed under
LLiiffttiinngg should befollowed. In addition, it is important that
youavoid lifting your arms above your head andany strenuous
movement of your arms at morethan a 90-degree angle from your
body.
Going Home 84/07
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Lifting Restrictionsn Five-pound restriction for the first
four weeks
n Five to 10-pound restriction for eightto 10 weeks
n Fifteen-pound restriction for 10 to 12weeks
n No restriction after three months unlessinstructed otherwise
by your surgeon
BathingShowers are best for the first several weeksafter you
return home. Since you will be weak,it is best to sit on a chair or
stool during yourshower. This will help you avoid falling or
deepbending. Lather your incision(s) with Dial soapand warm (nnoott
hhoott) water, rinse thoroughlyand dry gently. Keep your
incision(s) cleanand dry. Don’t apply lotion or ointments
toincisions unless ordered by your surgeon.NNoo bbaatthhss
uunnttiill aapppprroovveedd bbyy pphhyyssiicciiaann.
WeightWeigh yourself daily. You can establish aroutine by
getting up, emptying your bladderand then weighing yourself. Some
patientshave the tendency to gain water weight. If youshould
experience a rapid weight gain in oneday, it is more than likely
water. Please keepa record of your weight and if you experiencea
weight gain of three to five pounds overtwo to three days, please
call your surgeonor visiting nurse.
Diet Decreased appetite after surgery is common.This will
gradually return to normal. Frequentsmall meals may help increase
your appetite.If you wish to speak with a dietitian beforeleaving
the hospital, please talk to your nurse.You will have a chance to
review yourprescribed diet and ask any questions withyour visiting
nurse.
DrivingNo driving the car the first four weeks afteryour return
home. You can ride as a passengerin a car at any time. You may take
short tripsriding in a car, but when traveling, get out ofthe car
every hour to walk around and stretchyour legs. You may ride in the
front seat withseat belt fastened and the seat pushed back asfar as
possible. It is not necessary to deactivatethe air bag.
Drinking AlcoholAn alcoholic beverage with your eveningmeal or
at bedtime is permitted. If you are ontranquilizers or other
medication, do not mixalcohol with the tranquilizers, pain pills
orsleeping pills.
SmokingIIff yyoouu hhaavvee nnoott aallrreeaaddyy ssttooppppeedd
–– nnooww iisstthhee ttiimmee ttoo ddoo ssoo.. Studies have shown
thatsmoking increases heart rate and bloodpressure, and narrows the
blood vessels.Contact the Borgess Wellness Center
at226699..222266..55442266 for additional smokingcessation
resources.
Going Home 94/07
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SexSome patients have concerns about having sexafter open-heart
surgery. Avoid positions thatmight put a strain on your breastbone.
Do notuse Viagra or a similar medication unless youdiscuss it with
your surgeon. Other than that,there are no particular
restrictions.
VisitorsPlease limit your visits during your first twoweeks at
home. Although friends and familymean well, a lot of visitors can
be tiring andslow your recovery. Don’t hesitate to excuseyourself
from company if you feel rest isneeded. Remember, your health is
whatmatters most.
Your Four- to Six-Week Check UpYou will be given an appointment
date beforeyou leave the hospital to see your surgeonand
cardiologist in four to six weeks followinghospital discharge. At
this time, your physicianswill discuss with you when or if you may
returnto work and what changes you should makein everyday
activities.
EmergenciesIn case of an emergency, call 911 in yourcounty
immediately. If you go to an emergencyroom, please take the name of
your surgeonand cardiologist, along with your yellowdischarge
papers.
Going Home 104/07
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GENERAL RECOVERY FROM SURGERY
Chest Discomfort You May ExperienceAfter Cardiac
SurgeryFollowing cardiac surgery, it is common toexperience some
chest discomfort. Informyour home care nurse of any discomfort
andhe/she will teach you about the pain scale andhow to best manage
your pain. If you do nothave a home care nurse, call your
surgeondirectly. You may or may not experience oneor more of the
following after surgery.
n Incision discomfort
n Muscle, bone and joint discomfort
n Indigestion or heartburn
Incision DiscomfortThe amount of discomfort you may experienceis
highly individualized. Incision discomfortis pain located along the
site of your incision.Tenderness may be noticed when the areaaround
the incision is touched. You may feela dull ache or throbbing
sensation and in someinstances, a sharp or burning sensation.
Youmay notice discomfort with coughing, deepbreathing, walking or
exercising. The incisiondiscomfort is usually more noticeable 2 to
3days after surgery and decreases with time.
Muscle, Bone and Joint DiscomfortThe surgeon must be able to see
your heart inorder to perform your surgery. A special
chestinstrument is used during the surgery thatallows the surgeon
to see your heart. Youmay feel discomfort in your muscles, bonesand
joints after surgery due to some of the
equipment required. Muscle, bone and jointdiscomfort may be
noticed in your back,shoulders and ribs. This discomfort variesfrom
patient to patient. You may feel a dullache or possibly a sharper
sensation.Discomfort may be noticed with increasedmovement or when
touched. The discomfortshould decrease with time. If you have
ahistory of arthritis before surgery and aretaking medication for
arthritis, remind yoursurgeon or home care nurse. The
surgeon/nursecan make sure you have a prescription foryour
medication after your surgery. This willhelp to decrease your
discomfort and helpwith your recovery.
Indigestion or HeartburnIndigestion or gastric discomfort may
occur.If you have a history of indigestion esophagealreflux, remind
your surgeon or nurse. Antacidsor other medication may be
prescribed todecrease or prevent this discomfort.
Cause for ConcernAny discomfort that does not decrease withtime
needs to be reported to your home carenurse. If you experience any
pain that issimilar to the chest pain you had beforesurgery,
contact your home care nurse orsurgeon, or call 911
immediately.
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tthhaatt iissppeerrssiisstteenntt,, sseevveerree,, ccaauusseess
ddiiffffiiccuullttyy iinnbbrreeaatthhiinngg,, sswweeaattiinngg oorr
ccoouugghhiinngg,, ccoonnttaacctt991111 iimmmmeeddiiaatteellyy.
During Your Recovery at Home 114/07
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When Should I Report Something?By being aware of what to watch
for and callwith questions right away, you can avoidcoming back
into the hospital. Two commonreasons for return to the hospital are
HeartFailure and Atrial Fibrillation.
If you are still working with a home healthagency, call your
nurse ffiirrsstt and he/shewill help you decide if the doctor needs
tobe called. If you have been discharged fromhome health service,
call your cardiologistwith these problems.
Heart FailureIf you have had previous damage to a heartmuscle or
surgery for valves that were notworking properly, you will need to
watch forsigns of heart failure. This simply means thatthe heart is
not working efficiently, not that ithas stopped. SSiiggnnss ooff
hheeaarrtt ffaaiilluurree iinncclluuddee
n Sudden weight gain of 2 to 3 pounds in3 days, oorr not losing
the water weightafter your surgery.
n Increased swelling of the legs, feetor belly.
n Increased trouble breathing, especiallyneeding to sleep with
more pillows or inan upright chair to be able to breathe.
Atrial FibrillationSurgery itself can be irritating to the
heartmuscle and can cause irregular heart rhythmknown as atrial
fibrillation. Checking yourpulse each day is an important way to
catchthis change early and let your doctor know.Many times this
irregular rhythm starts in thefirst 2 or 3 days after surgery and
is beingcontrolled with medication. Usually it willchange back to a
regular rhythm in a fewdays. Atrial fibrillation may also occur
afteryou go home. Some people may needadditional procedures or
medications toregulate the heart rhythm. CCaallll iiff
n Your heart rate is faster than 120 beatsper minute.
n Your heart rate is suddenly more irregular.
n You feel pounding in your throat or chest.
n You suddenly have trouble breathing.
Reasons to Call 911n Severe sudden dizziness or
lightheadedness/unconsciousness
n Severe difficulty breathing
n Choking
n Seizures
n Persistent chest pain not related toincisions or muscle
pain
n Uncontrolled bleeding, coughing upbright red blood
n Injury from a fall
During Your Recovery at Home 124/07
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During Your Recovery at Home 134/07
WEIGHT AND TEMPERATURE LOG
Date Weight a.m. Temp p.m. Temp
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Diet 144/07
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Diet 154/07
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DIET AND CARDIOVASCULARDISEASE
Following a healthy diet is important tocontrolling
cardiovascular disease. The U.S.Department of Agriculture has
updated the foodpyramid to reflect a more heart-healthy plan.
CCoommppoonneennttss ooff FFooooddIf you are trying to make
heart-healthy changesto your lifestyle and diet, it is helpful to
knowsome basics about nutrition, starting with thecomponents of
food.
Facts About Calories:n You need enough calories to maintain
your energy level, but no more thanyou can burn off. This is
called anenergy balance.
n If you take in more calories than youburn, you gain
weight.
n If you take in fewer calories than youburn, you lose
weight.
n If you balance the two, you maintainyour weight.
n Even when you are dieting, however,calories should not be cut
back so muchthat your energy needs are not met. Thenumber of
calories you need dependsprimarily on age, gender, and activity
level.
Facts About Dietary Cholesterol:…… rreemmeemmbbeerr::
““cchhoolleesstteerrooll--ffrreeee””
ddooeess nnoott mmeeaann ““ffaatt--ffrreeee..””
n Dietary cholesterol is a fat-like substancefound in all foods
of animal origin: eggyolks, meat, poultry, fish, milk, and
milkproducts.
n Because our bodies make cholesterol,it is not required in our
diets. However,because most people eat foods thatcontain
cholesterol, it is important toavoid excessive amounts. The
amountof cholesterol you consume can affectyour blood cholesterol
levels.
Facts About Fats:n All fats contain about the same number
of calories
n tteeaassppoooonn ffoorr tteeaassppoooonn,, tthheerree iiss
nnoollooww--ffaatt ffaatt.. Fat is the most concentratedsource of
calories, supplying more thantwice as many calories per gram as
eithercarbohydrates or proteins. Most peopletend to get far too
much fat in their diets,which contribute to health problems suchas
obesity, high blood cholesterol, andheart disease. While coconut
and palmoils contain no cholesterol, they are highin saturated fat
and should be avoided.
n Fatty acids are the basic chemicalunits in fat. They may be
saturated,polyunsaturated, monounsaturated,or transfats. These
fatty acids differin their chemical compositions andstructures and
in the way in whichthey affect your blood cholesterollevels,
according to the following:
Diet 164/07
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Saturated Fatsn Is used by the liver to manufacture
cholesterol.
n Is considered the most dangerous kind offat because it has
been shown to raise bloodcholesterol levels, particularly the
LDL.
n Should comprise no more than 10 percentof your daily calorie
intake.
n Examples include: meats, butter, cocoabutter, coconut, and
palm oils.
Polyunsaturated Fats:n Do not appear to raise blood
cholesterol
levels.
n Examples include: safflower, sunflower,corn and vegetable
oils, margarines andsoybean oils.
Monounsaturated Fats:n Do not seem to have any affect on
blood
cholesterol
n Examples include olive and canola oils.
Trans Fats:n By-products of hydrogenation, a chemical
process used to change liquid unsaturatedfat to a more solid
fat. Structurally similarto saturated fat, trans fatty acids may
havea great impact on raising total and LDLcholesterol levels.
n Examples include stick margarine andfats found in commercially
preparedcakes, cookies, and snack foods.
n Total fat intake should be no more than 30%(30 percent) of
your daily calorie intake.
Facts about Fiber:n Fiber is the indigestible portion of
food.
There are two types of fiber: soluble andinsoluble.
n Soluble fiber – found in such foods asoat bran and dried beans
can lower bloodcholesterol in some people.
n Insoluble fiber – found in foods such aswheat bran and is
known to have manybenefits. While this type of fiber has notbeen
found to lower cholesterol, it is usefulin weight control because
it creates afeeling of fullness.
Diet 174/07
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Facts About Sodium:n Although salt is the major contributor
of
sodium in our diets. Sodium and salt arenot the same, contrary
to popular belief.
n A teaspoon of table salt contains 2,300milligrams of sodium.
Sodium is a mineralneeded to maintain body fluids and propernerve
function. It occurs naturally in somefoods, but most of the sodium
in our dietscomes from seasonings and ingredientswe add to foods.
Although sodium isessential, most of us consume morethan we need.
In some people, too muchsodium in the diet can cause the
bloodpressure to rise, putting them at risk forheart disease or
stroke.
CChhoolleesstteerrooll iinn tthhee BBlloooodd
Facts About Cholesterol:Cholesterol is a waxy substance that can
befound in all parts of your body. It aids in theproduction of cell
membranes, some hormonesand vitamin D. The cholesterol in your
bloodcomes from two sources: the foods you eatand your liver.
However, your liver makesall of the cholesterol your body
needs.
Cholesterol and other fats are transported inyour blood stream
in the form of sphericalparticles called lipoproteins. The two
mostcommonly known lipoproteins are low-densitylipoproteins (LDL)
and high-densitylipoproteins (HDL).
What is LDL (low-density lipoprotein)Cholesterol?This type of
cholesterol is commonly calledthe “bad” cholesterol, and is a type
of fat in theblood that contains the most cholesterol. It
cancontribute to the formation of plaque buildupin the arteries,
known as atherosclerosis.
YYoouu wwaanntt yyoouurr LLDDLL ttoo bbee llooww.. TToo hheellpp
lloowweerr iitt::
n Avoid foods high in saturated fat, dietarycholesterol, and
excess calories
n Exercise
n Maintain a healthy weight
n Stop smoking
What is HDL (high-density lipoprotein)Cholesterol?This type of
cholesterol is known as the“good” cholesterol, and is a type of fat
in theblood that helps to remove cholesterol fromthe blood,
preventing the fatty buildup andformation of plaque.
YYoouu wwaanntt yyoouurr HHDDLL ttoo bbee aass hhiigghh
aassppoossssiibbllee.. SSoommee ppeeooppllee ccaann rraaiissee
HHDDLL bbyy::
n Exercising for at least 20 minutes threetimes a week
n Kicking the cigarette habit
n Avoiding saturated fat intake
n Decreasing body weight
For others, medicine may be needed. Becauseraising HDL is
complicated, you should workwith your physician on a therapeutic
plan.
Diet 184/07
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Checking Your Blood CholesterolLevel:A cholesterol screening is
an overall look at,or profile of, the fats in your blood.
Screeningshelp identify people at risk of heart disease. Itis
important to have what is called a full lipidprofile to show the
actual levels of each typeof fat in your blood: LDL, HDL,
triglycerides,and others. Consult your physician regardingthe
timeliness of this test.
Both Borgess-Pipp Health Center and theBorgess Health and
Fitness Center offer opencholesterol screenings for total
cholesterol andHDL for a cost of $10. A more complete
profileincluding total cholesterol, HDL, LDL andtriglyceride levels
is available for just $15.Results are given at the time of
testing.CCaallll ttoo sscchheedduullee aann aappppooiinnttmmeenntt
aatt eeiitthheerrBBoorrggeessss--PPiipppp HHeeaalltthh CCeenntteerr
aatt ((226699)) 668855--00772233oorr BBoorrggeessss HHeeaalltthh
aanndd FFiittnneessss CCeenntteerr aatt((226699))
555522--22220000..
What is a Healthy Blood CholesterolLevel?High blood cholesterol
is a significant riskfactor in heart disease. Lowering
bloodcholesterol through increased physical activity,weight loss,
smoking cessation and properdiet lowers that risk. However,
bloodcholesterol is very specific to each individualand, for that
reason, a full lipid profile is animportant part of your medical
history andimportant information for your physician tohave. In
general, health levels are as follows:
n LDL – less than 100 milligrams/perdeciliter (mg/dL). Less than
70, may berecommended by your doctor.
n HDL – less than 40 mg/dL puts youa high risk for heart
disease.
n A total cholesterol level below 200mg/dL is considered
desirable.
Statistics About Cholesterol:Elevated cholesterol is a risk for
many Americans.Consider these statistics:
Approximately 100,870,000 Americanshave total cholesterol levels
of 200 mg/dLand higher, which is considered borderlinehigh
risk.
About 40,600,000 American adults haveblood cholesterol levels of
240 mg/dL andhigher, which is considered high risk.
Diet 194/07
-
What are Triglycerides?Triglycerides are another class of fat
found inthe bloodstream. The bulk of your body’s fattissue is in
the form of triglycerides.
Triglyceride Levels and Heart Disease:The link between
triglycerides and heart diseaseis under clinical investigation.
However, manypeople with high triglycerides also have otherrisk
factors such as high LDL levels or lowHDL levels.
What Causes Elevated TriglycerideLevels?Elevated triglyceride
levels may be causedby medical conditions such as
diabetes,hypothyroidism, kidney disease or liverdisease. Dietary
causes of elevatedtriglyceride levels may include obesityand high
intakes of fat, alcohol andconcentrated sweets.
A healthy triglyceride level is less than 150 mg/dL.
Diet 204/07
-
HEART-HEALTHY EATINGTO LOWER CHOLESTEROL
Why Lower Cholesterol?You hear it all the time: “Watch your
cholesterol!”Our bodies do need some cholesterol, but toomuch can
be harmful. That’s why we need tokeep it at a healthy level.
Cholesterol is a fat-like substance. It can buildup on the walls
of blood vessels and block theflow of blood. That can lead to a
heart attackor a stroke. But you can take steps to loweryour
cholesterol and help your heart!
A diet high in saturated fat, trans fat, andcholesterol can
raise your blood cholesterol tounhealthy levels. It helps to cut
down on eggyolks, high-fat meats, fried foods, and full-fatmilks
and cheeses. Other things can affectyour cholesterol. These include
your age, sex,weight, genes, and how active you are.
First, Get Your Cholesterol CheckedThere are two types of
cholesterol: LLDDLL —the “bad” kind that builds up in your
bloodvessel — and HHDDLL — the “good” kind thattakes the “bad” kind
away.
Recommended levels:
n Total Cholesterol . . . . . less than 200
n HDL. . . . . . . . . . . . . . . . 35 and above
n Triglycerides . . . . . . . . less than 200
n LDL . . . . . . . . . . . . . . . . less than 100
Your cholesterol level is checked by a bloodtest. You can get
numbers for your totalcholesterol, your HDL, your LDL, and
yourtriglycerides (another kind of blood fat). Ingeneral, your
total number should be under200. If it is 200 or above, your doctor
willprobably want to know what the other levelsare and watch them
closely.
For women, it appears that a low HDL leveland a high
triglyceride level are more likelyto predict heart disease than the
LDL level.
You and your doctor can decide what yourgoals should be, based
on your risk factors.
A Heart-Healthy DietIf your cholesterol is in the desirable
range,great! Your goal is to keep it that way. Eat ahealthy diet,
get regular exercise, and stay atyour best weight. That’s probably
what youhave been doing all along.
If you need to lower your cholesterol, a dietlower in saturated
fat and trans fat can helpyou do that. Eat plenty of whole
grains,vegetables, and fruits.
Diet 214/07
-
Where Are Saturated Fat AndTrans Fat Found?SSaattuurraatteedd
ffaatt is found in fatty meats andfull-fat dairy products. Coconut
and palmoils also have saturated fat.
TTrraannss ffaatt is found in deep-fried foods andstore-bought
baked goods and fried snacks.Oils that have been hardened (like
solid whiteshortening) are high in trans fat. Use liquidoil
instead, when you can. Tub or liquidmargarine is lower in trans fat
than most stickmargarines. If you do use stick margarine,choose one
that lists liquid oil as the firstingredient.continues
Cholesterol in food you eat also raises cholesterollevels in
your body. Cholesterol is found onlyin foods that come from
animals, like eggs,meat, and milk. So choose low-fat or
fat-freeversions of these foods. Eat egg whites insteadof the whole
egg.
YYoouu ccaann hheellpp lloowweerr yyoouurr
cchhoolleesstteerrooll wwiitthh aaddiieett tthhaatt iiss::
n Low in saturated fat and trans fat.Avoid full-fat milk and
cheese, butter,fried food, and high-fat meat, sauce, andgravy. Use
tub or liquid margarine insteadof stick. Avoid solid white
shortening.
n Low in cholesterol.Cut back on animal products. Avoid
eggyolks. Try beans or soy foods instead of meat.
n Rich in fiber and whole grains.Eat five or more fruits and
veggies eachday. Eat whole wheat breads and pastas,brown rices, and
whole-grain cereals.
Your doctor or dietitian can help you create aheart-healthy
eating plan to suit your tastesand lifestyle. There are easy ways
you can cutfat from your diet and help lower cholesterol.
What About Pills?Some people try diet and lifestyle changesand
still cannot lower their cholesterol. Inthose cases, a drug that
lowers cholesterolmay be prescribed by the doctor. It is
stillimportant to eat heart-healthy foods, getsome activity, and
stay at a healthy weightwhen taking these drugs. This can
helpreduce the amount of medicine needed.
Diet 224/07
-
Diet 234/07
DECREASE THE RISK OF CORONARY ARTERY DISEASE
EAT THESE
n Choose fish, shellfish, chicken and turkeywithout skin, lean
beef, pork, veal and lamb.
n Acceptable beef cuts include: flank, round,sirloin,
tenderloin, ground round, chuck roast,rump roast and stew meat.
n Trim all visible fats before cooking(including skin off
poultry and fish).
n Place meats on a rack to allow fats to dripoff while
cooking.
n Bake, roast, broil, stew, poach, steam, braise,grill,
microwave or stiry fry with little or noadded fat.
n Limit meat, chicken and fish to 6 ounces per day.
n Try more meatless meals with rice or otherlegumes and grains.
(example: kidney, garbanzo,pinto, lentil, great northern, split
pea)
n Choose non-fat dairy products: 1/2%, 1%, orskim milk, non-fat
cottage cheese, cheese madefrom partly skim milk, mozzarella,
buttermilk,non-fat yogurt, non-fat sour cream and non-fatcream
cheese.
n Limit egg yolks to two per week.
n Use egg whites or commercial egg substitutesinstead of whole
eggs. (can substitute 2 eggwhites for 1 whole egg for baking
purposes,or use 1/4 cup egg substitute).
n Choose cheeses that are made for skim milk orwhose labels say
they have less than 5 grams offat per ounce.
n Sherbet, frozen yogurt, fudge bars, popsicles, andice milk are
all good alternatives to ice cream.
INSTEAD OF THESE
n Avoid deep fried meats, poultry and fish, aswell as high fat
or marbled meats, such asduck, goose, hot dogs, sausage,
bacon,luncheon meats, cold cuts, canned stewsor hash, prime ribs,
regular hamburger.
n Avoid organ meats: liver, heart, brain, kidneyand gizzards
n Avoid breading or flouring foods beforebrowning – bread and
flour absorbs fat.
n Avoid whole milk products: whipped cream,half & half,
cream, whole milk, evaporated orcondensed milk, hard cheeses, cream
cheesesour cream.
n Avoid non-dairy creamers, whipped toppingsmade with saturated
fats, puddings made withwhole milk, and ice cream.
DAIRY PRODUCTS AND EGGS (2 - 3 servings)
In order to decrease the risk of coronary artery disease eat
wisely - lower yourintake of cholesterol, saturated fat and total
fat.
your fat intake is: _______ grams of fat/day your cholesterol
intake is: _______ milligrams/day
MEAT, FISH AND POULTRY (2 - 3 servings)
-
Diet 244/07
DECREASE THE RISK OF CORONARY ARTERY DISEASE
EAT THESE
n Choose any of the following polyunsaturatedoils in moderation:
safflower, sunflower, corn,soybean and cotton seed oil.
n Choose non-stick sprays or pump margarine.
n In small amounts use Monounsaturated fats,such as peanut oil,
olive oil or canola oil.
n Select soft tub margarine with oil as the firstingredient.
n Choose salad dressings and mayonnaise thatcontain
polyunsaturated oils, or choose the fatfree variety.
n Choose cereals, cooked or dry, at breakfast,and for quick
snacks.
n Plain pasta, noodles (except for egg noodles),rice, dried
beans and peas are low in saturatedfat and cholesterol. Prepare
them with acceptableingredients such as margarine and low fat
sauces.
n Try to use foods rich in fiber. Bran cereal, wholewheat
breads, 7 grain cereal, whole cookedgrains like millet, barley,
oats couscous, andbulgar.
INSTEAD OF THESE
n Avoid these saturated fats: butter, lard,
shortening,chocolate, coconut, coconut oil and palm oil.
n Avoid foods made with any of the above as amajor
ingredient.
n Avoid deep fried foods.
n Avoid breads that contain a higher proportionof saturated fat:
biscuits, croissants, crescentrolls, danish pastries, cheese and
egg breads,fruit breads and muffin.
n Avoid granola cereals that are made withsaturated fat.
n Avoid crackers and snack foods with more than3 grams of fat
per ounce.
STARCHES AND BAKED PRODUCTS (6 - 11 servings)
VEGETABLES AND FRUITS (5 or more servings daily)
FATS AND OILS (use sparingly)
n Include any fruit or vegetables prepared without fat
daily.
n Avoid vegetables in butter, cream or cheese sauces or those
prepared with saturated fats.
-
COOKING UP LOWERBLOOD PRESSURE
High blood pressure can sneak up on you.Most people who have
high blood pressuredo not feel sick. But if high blood pressure
isnot lowered, it can lead to a heart attack or astroke. It also
can damage the kidneys and theeyes. That is why it is important to
get yourblood pressure checked at least once a yearand to keep it
in the healthy range.
Blood pressure is given as two numbers.AA rreeaaddiinngg
aabboovvee 114400 oovveerr 9900 iiss ttoooo hhiigghh.A healthy
level often can be reached withouttaking medicine. See the “recipe”
for lowerblood pressure below. If you do not have highblood
pressure, these guidelines can help youprevent it.
Recipe For Lower Blood Pressuren Eat 8-10 servings of fruit and
vegetables
each day.
n Eat 7-8 servings of grains each day.Choose whole grains
often.
n Eat 2-3 servings of foods high in calcium,such as low-fat
dairy products, each day.
n Keep your diet moderate in fat.
n If you are overweight, losing just 10pounds can help lower
your blood pressure.
n Get some physical activity each day. Aimfor 30 minutes, or 10
minutes three timesa day.
n Cut back on processed foods and otherfoods high in sodium.
n Limit alcohol.
The Main Ingredient: Fruits, Veggies,and GrainsChances are the
servings of fruits, vegetables,and grains listed above may be more
than youare used to eating. If so, increase these foodsin your diet
one serving at a time.
n Add another serving of a fruit ora vegetable.
n Have whole-wheat bread instead of white.
n Choose fresh or canned fruit at snack time.
Increase your intake of vegetables and grainsby making them the
main event. Eat meatlessmeals more often. Put beans and rice,
pasta,vegetable lasagna, or vegetable stir-fry onyour weekly
menus.
Trim The FatTo reduce fat in your diet, replace fatty foodswith
less fatty foods.
n Look for low-fat or nonfat milk, cheese,yogurt, and sour
cream.
n For protein, eat cooked dry beans often.When you eat meat,
choose fish, poultry,and lean cuts of meat.
n Broil, grill, bake, or roast meat insteadof frying. Cook
ground meat and thenrinse it under hot water before using itin the
recipe.
n To avoid sauces and dressings that arehigh in fat, season food
with herbs andspices instead.
n Try to use half the margarine or butteryou use now. Use spray
margarine.
Diet 254/07
-
EEaatt aallll tthhee ffrruuiittss aanndd vveeggeettaabblleess
yyoouu wwaanntt!!Whole-grain pastas, breads, and cereals aregood
for your heart, too.
If you crave something crunchy at snack time,have plain popcorn,
graham crackers, orpretzels. Feel like something cold or creamy?A
Popsicle, Jello, sherbet, or low-fat icecream or yogurt may do the
trick. Crispveggies with a low-fat dip make a good snackpacked with
nutrients. A small serving ofdried fruit is sweet, chewy, and high
innutrients, but low in fat.
Move A Little, Lose A LittleLosing even a little weight helps a
lot. If youare overweight, dropping just 10 pounds canbring your
blood pressure into the healthy range.
Being more active helps the pounds come off.Try to be physically
active in some way everyday. Work your way up to 30 minutes a
day.It does not have to be done all at once. Youcan break it up
into 10 minutes at a time ifyou like. Do something you enjoy so it
canbecome a part of your lifestyle, not just aquick fix. Buddy up
with a friend or familymember to make it more fun.
Just moving around more helps! Lose theremote and get up to
change the TV channel.Take the stairs. Walk the mall.
Paired with your healthy diet, a little exerciseeach day can
keep you at a healthier weight.You’ll look good and feel great.
Choose Low-Sodium FoodsCutting back on sodium may help your
bloodpressure. We need only a small amount ofsodium in our diet,
and we usually eat morethan we need. Most of the sodium we eatcomes
from foods we do not prepare ourselves.These are foods like frozen
dinners, packagedmixes, canned and dry soups, cold cuts,
cannedvegetable juices, white breads, and snacks likechips, salted
nuts, cakes, cookies, and somecheeses. Restaurant foods are high in
salt. Eatless of these foods.
Using foods that are fresh and preparing themyourself when
possible can help you controlyour salt intake.
What About Alcohol?You may have heard that a glass of red
wineeach day can help your heart. But if you havehigh blood
pressure and you do not drinknow, it is best not to start. Drinking
too muchalcohol can raise your blood pressure anddamage the heart,
the liver, and the brain.Also, it may be dangerous to drink
withcertain medicines. If you do drink, limit itto one serving a
day.
Blood Pressure MedicineMild high blood pressure can often
becontrolled with diet and exercise. You mayneed medicine to lower
very high bloodpressure. But even if you take medicine foryour
blood pressure, you still need to eatright and balance your healthy
foods withsome physical activity! This can help youneed less
medicine.
Diet 264/07
-
Start Now!You do not need special foods and complicatedmeal
plans to lower your blood pressure. Youcan start to lower your
blood pressure now byfollowing the guidelines above. Eat a diet
richin fruits, vegetables, and whole grains. Keepyour diet moderate
in fat. GGeett aa lliittttllee eexxeerrcciisseeeevveerryy ddaayy..
YYoouu’’rree oonn yyoouurr wwaayy!!
NOTES:
Diet 274/07
-
HOLD THE SALT!
Too Much Salt?Salt – also called sodium and sodium chloride –is
an important mineral that helps your bodyfunction. It helps
maintain fluid balance inyour body.
The adult body only needs a small amount ofsalt to function
properly – about 2,400 milligrams(oorr aabboouutt 11
tteeaassppoooonn) daily. Chances are, youare eating much more than
that.
WWhhyy?? Small amounts of salt are found naturallyin many foods.
However, salt is often used infood processing. In fact, most of
your saltintake probably comes from salt that has beenadded to
prepared foods. In addition, peopleoften add salt to their food
because they believeit enhances flavor.
Why Is Too Much Salt Bad ForMy Health?There are good reasons to
consider reducingyour salt intake.
Extra salt in your diet may lead to hhiigghh
bbllooooddpprreessssuurree, which increases your risk of
heartdisease, stroke, and kidney damage.
Lowering your salt intake can lower your riskof developing these
dangerous conditions.
How Do I Follow A Healthy Low Salt Diet?Fresh, fruits, fresh
vegetables, fresh meat,chicken, and fish, fresh eggs, dairy
products,and grain products are all part of a healthy,low-salt
diet.
Look for low-salt products in the supermarket.Because many
people have to reduce their saltintake, many products are made for
low-saltdiets. Even foods that usually have a lot ofsalt, such as
bacon and peanut butter, havelow-salt versions.
What Foods Should I Avoid?Ask your doctor or dietitian what
foods to avoid.
In general, you should not eat:
n Frozen vegetables with sauces
n Pickles, relish, and olives
n Sauerkraut
n Canned vegetables
n Vegetable juices
n Frozen meals
n Lunch meats or deli meats
n Processed meats, such as hot dogsand sausages
n Packaged gravy mixes
n Boxed macaroni and cheese
n Pancake mix
n Biscuit mix
n Instant hot cereal
n Buttermilk
Diet 284/07
-
n Cheese spreads
n Salted crackers
n Antacids
Also, these products may have a lot of salt:
n Cheese
n Gravy mixes
n Ketchup
n Chili sauce
n Mustard
Look out for these high sodium ingredients:
n Monosodium glutamate
n Sodium chloride
n Sodium benzoate
n Disodium phosphate
n Baking soda
n Baking powder
Other Tipsn Eat a variety of foods in moderate amounts.
n RReeaadd llaabbeellss ccaarreeffuullllyy!! Choose foodswith a
moderate amount of salt andsodium.
n Eat freshly prepared foods (rather thanfrozen foods) as often
as possible.
n Do not add salt to recipes.
n Do not keep salt on your table. Learnto enjoy the natural
flavor of foods!
n Use herbs and spices to flavor food.“Mrs. Dash” is a common
favorite.
n Ask your doctor or dietitian about saltsubstitutes. Salt
substitutes can be foundnear the spices in your supermarket.
n Increase the amounts of fruits and vegetablesyou eat. These
foods have very little salt.They are also very healthy.
n Make small changes in your eating habitsat a time.
EEvveennttuuaallllyy,, hheeaalltthhyy eeaattiinngg
wwiillllbbeeccoommee ppaarrtt ooff yyoouurr
lliiffeessttyyllee!!
Source: Copyright 2000, Aspen Publishers, Inc.Dietitian’s
Patient Education Resource Manual Revised
Borgess Blend1/8 tsp. garlic powder1/4 tsp. onion powder1/4 tsp.
white pepper powder
2 tsp. paprika1/2 tsp. parsley1/4 tsp. oregano powder1/4 tsp.
celery powder1/4 tsp. ground Marjoram1/4 tsp. ground Thyme1/2 tsp.
dry Mustard1/4 tsp. basil powder1/4 tsp. curry powder
Diet 294/07
-
READING FOR GOOD EATING
What The“Nutrition Facts”Label Does:n Creates a single system by
which all
products can be compared.
n What nutrient claims about fat really mean:Helps you make
better, more informeddecisions about the food you eat.
n Provides uniform definitions for nutrientclaims such as
“free,” “light,” “reduced,”“high,” and “good source.”
FFaatt FFrreeee – Less than 0.5 grams of fat perserving. May
also be referred to as “nonfat.”
LLooww FFaatt – 3 grams of fat or less per serving.
RReedduucceedd FFaatt – At least 25% less fat perserving than
the traditional item. May alsobe referred to as “lower fat.”
LLiigghhtt – At least 33% fewer calories or 50%less fat per
serving than the traditional item.
LLeeaann – Less than 10 grams of total fat,4.5 grams of
saturated fat, and less than95 mg cholesterol per serving.
EExxttrraa LLeeaann – Less than 5 grams of total fat,2 grams of
saturated fat, and less than 95 mgcholesterol per serving.
Adapted from Browne MB. Label Facts for Healthful Ealing.Dayton,
Ohio: Mazar Cotp; 199133-38.
Dietary Guidelines For AmericansThe new food label supports the
DietaryGuidelines for Americans-seven suggestionsfor a healthful
diet from the US Departmentsof Agriculture & Health and Human
Services.The % Daily Value on the label allows you tochoose foods
to balance your intake of certainnutrients like fat, saturated fat,
and cholesterol.Nutrient content claims on the food labelsuch as
“high” and “good source” allow youto identify foods high in fiber
and vitaminsA and C. Nutrient content claims such as“low fat” and
“reduced fat” allow you todecrease the total fat in your diet. The
DietaryGuidelines are the following:
n Eat a variety of foods.
n Maintain healthy weight.
n Choose a diet low in fat, saturated fat,and cholesterol.
n Choose a diet with plenty of vegetables,fruits, and grain
products.
n Use sugars only in moderation.
n Use salt and sodium only in moderation.
n If you drink alcoholic beverages, do soin moderation.
Diet 304/07
-
Analyzing The New Nutrition Label
SSeerrvviinnggss ppeerr CCoonnttaaiinneerr :: Refers tothe
number of servings included inthe package. This package contains10
frankfurters (hot dogs)
CCaalloorriieess aanndd CCaalloorriieess ffrroomm FFaatt
::Calories measure the energysupplied from food. Caloriesfrom fat
reflect the number of fatcalories the product provides perserving,
not the percentage ofcalories from fat.
%% DDaaiillyy VVaalluue:: The percent dailyvalues help you see
how a food fitsinto a 2,000 calorie reference diet.They tell you if
a food contains alittle or a lot of a nutrient. This hotdog only
has 2% of the daily value forfat, which is low fat. The overall
goalis to attain 100% of your daily valuethroughout the day by
eating a varietyof foods.
CCaalloorriiee CCoonnvveerrssiioonn
IInnffoorrmmaattiioonn::Reflects the number of calories pergram
provided by carbohydrate, fat,and protein. Notice that fat
containsmore than twice the calories pergram (9 calories) than
carbohydrateor protein (4 calories).
Diet 314/07
NNeeww TTiittllee:: Indicates theproduct carries with the
1990nutrition labeling and the newlabel information established –L
Education Act.
SSeerrvviinngg SSiizzee:: Serving size isnow based on the amount
mostcommonly eaten.
TToottaall FFaatt:: The amount of fatincluded in each serving
(in grams).It is recommended that your overalldiet, not necessarily
any one fooditem, contain no more than 30% ofcalories from fat on
average.
NNeeww RReeqquuiirreedd NNuuttrriieennttss ::Reflect the current
public healthemphasis. New required nutrientsinclude saturated fat,
cholesterol,sodium, dietary fiber, and sugars.
DDaaiillyy VVaalluueess FFoooottnnoottee:: Dailyvalues reflect
current nutritionrecommendations. The two listingsshow daily values
for both 2,000and 2,500 calorie diets. For example,the daily value
for fat is 65 gramsfor 2,000 calories and 80 gramsfor 2,500
calories. Of course, yourindividual calorie needs may
vary.Remember, the percent daily valuesare based on a 2,000 calorie
diet.
Nutrition FactsServing Size One Hot Dog (45 g)Servings Per
Container 10
Amount per Serving
Calories 45 Calories from Fat 15
% Daily Value*
Total Fat 1.5 g 2%
Saturated Fat 1 g 5%
Cholesterol 15 mg 5%
Sodium 430 mg 18%
Total Carbohydrate 2 g 1%
Dietary Fiber 0 g 0%
Sugars 2 g
Protein 5 g
Vitamin A 0% • Vitamin C 8%
Calcium 0% • Iron 2%
*Percent daily values are based on a 2,000calorie diet. Your
daily values may be higheror lower depending on your calorie
needs:
Calories: 2,000 2,500Total Fat Less than 65g 80 g
Sat Fat Less than 20 g 25gCholesterol Less than 300 mg 300
mgSodium Less than 2,400 mg 2,400 mgTotal Carbohydrates 300 g 375
g
Dietary Fiber 25g 30 g
Calories per gram:Fat 9 • Carbohydrate 4 • Protein 4
Above information was taken froman actual product label.
-
Diet 324/07
NUTRITION COUNSELING
Individual nutrition counseling isavailable with Borgess
RegisteredDieticians. For an appointment, callCentral Scheduling at
269.226.6999..
The BBoorrggeessss LLiigghhtt HHeeaarrtteedd CCooookkbbooookkis
available for your reference at the:
Borgess Gift Shop269.226.7380
Borgess Public Relations269.226.4878
Borgess Food and Nutrition Office269.226.5945
-
HOW ACTIVE SHOULD I BE?
Once you have returned home, you shouldbe able to increase your
activity a little bitevery day. Pace your activity throughoutthe
day. Your surgeon recommends a cardiacrehabilitation program, much
like the oneoffered at the Borgess Health & FitnessCenter. Call
the Borgess Cardiac Rehab Centerat 269.552.2200 for more
information aboutBorgess programs available in your
community.Walking is the best form of exercise andshould be done
with a friend or spouse. Incold weather, walking inside at a school
orshopping mall is preferred. (You may be ableto find a school or
shopping mall that offersa set time for walkers). In temperatures
ofabout 50 degrees, you may walk outside.Rest for 30 minutes after
meals before doingyour exercises/walking.
Please make sure you get eight to nine hoursof sleep a day. In
addition to that, two dailynaps up to an hour each are
encouraged.
SSttoopp aannyy aaccttiivviittyy iimmmmeeddiiaatteellyy iiff
yyoouu ffeeeell sshhoorrttooff bbrreeaatthh,, nnoottiiccee
iirrrreegguullaarr hheeaarrttbbeeaattss,, ffeeeellffaaiinntt oorr
ddiizzzzyy,, oorr yyoouu hhaavvee cchheesstt ppaaiinn..
RReessttuunnttiill tthhee ssyymmppttoommss ssuubbssiiddee.. IIff
tthheeyy ddoo nnoottssuubbssiiddee wwiitthhiinn 2200
mmiinnuutteess,, nnoottiiffyy yyoouurr ddooccttoorr..
Activity 334/07
-
WHEN TO RESUME USUAL ACTIVITIES
Activity 344/07
Weeks 1 to 4
Light housekeeping:n Dustingn Setting the tablen Washing dishesn
Folding clothes
Light gardening:n Potting plantsn Trimming flowers
Cooking meals
Climbing stairs
Church
Passenger in car
Shampooing hair
After 3 to 4 Months
Continue activitiesfrom week 1 to 3 months(but you may be able
totolerate more)
Heavy housework:n Scrubbing floors
Heavy gardening:n Shoveling snown Rakingn Diggingn Mowing
Walking dog on leash
Sports:n Football/soccern Tennisn Softball/baseballn Bowlingn
Golfingn Huntingn Weight liftingn Joggingn Motorcycle riding n
Bicyclingn Water skiingn Push-upsn Skydivingn Swimmingn Fishingn
Light aerobicsn Boatingn Horseback riding
After 4 Weeks orDischarge by Surgeon
Continue activities of weeks1 to 4 (but you may be ableto
tolerate more)
Return to work part time ifapproved by your surgeon
Heavy housework:n Vacuumingn Sweepingn Laundryn Ironing
Walking on treadmill orusing stationary bike
Business or recreationaltravel (follow weightrestriction with
luggage)
Driving a car or small truck
-
RISK FACTOR REDUCTION
What Are Risk Factors For HeartDisease?There are two main
categories of risk for heartdisease — uncontrollable and
controllable.
UUnnccoonnttrroollllaabbllee RRiissee FFaaccttoorrss are
basicallyhereditary. They include:
n Gender — men are more likely to sufferfrom heart disease
uunnttiill the age of 55when menopause and less estrogen makea
woman’s risk increase to equal the riskof men.
n Age — risk increases as you age.
n Family history — your risk is greater ifyou have a father or
brother with heartdisease before age 55, or a mother orsister with
heart disease before age 65.
n Diabetes — although diabetes can beinherited, it is also often
brought onby lifestyle and obesity, and it can becontrolled to
lower the risk of onsetof heart disease.
CCoonnttrroollllaabbllee RRiissee FFaaccttoorrss are related
tolifestyle choices. At the tope of the Centersfor Disease Control
and Prevention’s list ofprimary risk factors for all chronic
diseasesare smoking, poor nutrition and sedentarylifestyle.
Living a healthier lifestyle can help preventheart disease. A
healthy lifestyle includes
n Following a heart-healthy diet
n Following a regular exercise program
n Eliminate all tobacco products
Further detailed information on healthy lifestylechanges are
included in this notebook.
Risk Factor Reduction 354/07
-
SMOKING
Most people associate cigarette smokingwith breathing problems
and lung cancer.But did you know that smoking is also amajor cause
of heart and vascular diseasefor men and women?
About 30 percent of all deaths from heartdisease in the U.S. are
directly related tocigarette smoking. That is because smokingis a
major cause of coronary artery disease.
A person’s risk of heart attack greatlyincreases with the number
of cigarettes he orshe smokes. Smokers continue to increasetheir
risk of heart attack the longer theysmoke. People who smoke a pack
ofcigarettes a day have more than twice the riskof heart attack
than non-smokers. Womenwho smoke and also take birth control
pillsincrease several times their risk of heartattack, stroke and
peripheral vascular disease.
Cigarette smoke not only affects smokers,when you smoke, the
people around you arealso at risk for developing healthy
problems,especially children. Environmental tobaccosmoke (also
called passive smoke or second-hand smoke) affects people who
arefrequently around smokers. Second-handsmoke can cause chronic
respiratoryconditions, cancer and heart disease.
How Does Smoking Increase the Riskof Heart Disease?The nicotine
present in smoke causes
n Decreased oxygen to the heart
n Increased blood pressure and heart rate
n Increase in blood clotting
n Damage to cells that line coronary arteriesand other blood
vessels
How Can Quitting Smoking Be Helpful?Now that you know how
smoking can beharmful to your health and the health of thosearound
you, here are some ways quitting canbe helpful. If you quit smoking
you will:
n Prolong your life
n Reduce the risk of disease, includingheart disease, heart
attack, high bloodpressure, stroke, vascular disease, lungcancer,
throat cancer, emphysema, ulcers,gum disease and other
conditions
n Feel healthier — after quitting, you won’tcough as much,
you’ll have fewer sorethroats and you will increase your
stamina
n Look better — quitting can help youprevent face wrinkles, get
rid of stainedteeth and improve your skin
n Improve your sense of taste and smell
n Save money
Risk Factor Reduction 364/07
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HHooww ttoo QQuuiittThere’s not one way to quit smoking that
worksfor everyone. To quit, you must be ready bothemotionally and
mentally. You must also wantto quit smoking for yourself — not to
pleasefamily or friends. It helps to plan ahead. Thisguide may help
you get started.
What Should I Do First?n Pick a date to stop smoking and
then
stick to it
n Write down your reasons for quitting.
n Read over the list every day, before andafter you quit. Here
are some tips tothink about.
– Write down when you smoke, whyyou smoke and what you are
doingwhen you smoke. Your will learnwhat triggers your to
smoke.
– Stop smoking in certain situations(such as during your work
break orafter dinner) before actually quitting.
– Make a list of activities you cando instead of smoking. Be
ready todo something else when you wantto smoke.
– Ask your health care provider aboutusing nicotine gum, patches
orlozenges. Some people find theseaids helpful.
–Join a smoking cessation supportgroup or program. CCaallll
yyoouurr llooccaallcchhaapptteerr ooff tthhee AAmmeerriiccaann
LLuunnggAAssssoocciiaattiioonn oorr tthhee
MMiicchhiiggaannTToobbaaccccoo QQuuiitt lliinnee aatt
11--880000--448800--QQuuiitt
How Can I Avoid Relapsing?n Don’t carry a lighter, matches
or
cigarettes. Keep all smoking remindersout of your life.
n If you live with a smoker, ask that personnot to smoke in your
presence.
n Don’t focus on what you are missing.Think about the healthier
way of lifeyou are gaining.
n When you get the urge to smoke, take adeep breath. Hold it for
10 seconds andrelease it slowly. Repeat this severaltimes until the
urge to smoke is gone.
n Keep your hands busy. Doodle, play witha pencil or straw or
work on a computer.
n Change activities that were connectedto smoking. Take a walk
or read a bookinstead of taking a cigarette break.
n When you can, avoid places, people andsituations associated
with smoking. Hangout with non-smokers or go to places thatdon’t
allow smoking, such as the movies,museums, shops or libraries.
Risk Factor Reduction 374/07
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n Don’t substitute food or sugar-basedproducts for cigarettes.
Eat low-calorie,healthy foods, such as carrot or celerysticks,
sugar-free hard candies or chewgum when the urge to smoke strikes
soyou can avoid weight gain.
n Drink plenty of fluids, but limit alcoholicand caffeinated
beverages. They cantrigger urges to smoke.
n Physical activity. Exercising will helpyou relax.
n Get support for quitting. Tell others aboutyour milestones
with pride.
n Work with your doctor to develop a planusing over-the-counter
or prescriptionnicotine-replacement aids.
How Will I Feel When I Quit?You may crave cigarettes, be
irritable, feelvery hungry, cough often, get headaches orhave
difficulty concentrating. These symptomsof withdrawal occur because
your body isused to nicotine, the active addicting agentwithin
cigarettes.
When withdrawal symptoms occur within thefirst two weeks after
quitting, stay in control.Think about your reasons for quitting.
Remindyourself that these are signs that your body is
healing and getting used to being withoutcigarettes. The
withdrawal symptoms are onlytemporary. They are strongest when you
firstquite bit will go away with 10 to 14 days.Remember that
withdrawal symptoms areeasier to treat than the major diseases
thatsmoking can cause.
You may still have the desire to smoke sincethere are many
strong associations withsmoking. People may associate smoking
withspecific situation, with a variety of emotionsor with certain
people in their lives. The bestway to overcome these associations
is toexperience them without smoking. If yourelapse, do not lose
hope. Seventy-five percentof those who quit smoke again. Most
smokersquite three times before they are successful. Ifyou relapse,
don’t give up! Plan ahead andthink about what you will do next time
youget the urge to smoke.
Risk Factor Reduction 384/07
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MEDICATION
What Medications Am I Taking?TTaakkiinngg yyoouurr
mmeeddiiccaattiioonn aass pprreessccrriibbeedd iiss oonneeooff
tthhee bbeesstt tthhiinnggss yyoouu ccaann ddoo ffoorr
yyoouurrsseellff..You may begin with only one or twomedications and
then have more added later. Itis not uncommon to start with more
than oneeither. It may take days or even many weeksto find the
right doses or combination ofmedicines that work best for you.
Don’t bealarmed if your doctor makes a few changesalong the
way.
TTaakkee tthhee mmeeddiiccaattiioonn aass iinnssttrruucctteedd..
Skippingdoses, letting your pills run out or stopping onyour own
can cause serious problems. Do notstop taking any pills or take
extra pills withoutchecking with your doctor.
AAnnyy mmeeddiicciinnee ccaann hhaavvee ssiiddee
eeffffeeccttss.. Be sureto tell your doctor right away if you think
youare having problems.
BBee ssuurree ttoo tteellll yyoouurr ddooccttoorr aabboouutt
aallllmmeeddiiccaattiioonnss yyoouu aarree ttaakkiinngg, including
thosefor other problems like diabetes, high bloodpressure,
emphysema or kidney disease.
TTaallkk ttoo yyoouurr ddooccttoorr oorr pphhaarrmmaacciisstt
bbeeffoorreettaakkiinngg hheerrbbaall pprroodduuccttss,,
ssuupppplleemmeennttss,, oorr oovveerr--tthhee--ccoouunntteerr
mmeeddiiccaattiioonnss.. Many over-the-counter products and
supplements haveingredients similar to medication and
somecombinations are dangerous.
KKeeeepp aann uuppddaatteedd,, ccoommpplleettee lliisstt ooff
yyoouurrmmeeddiiccaattiioonnss wwiitthh yyoouu aatt aallll
ttiimmeess.. When youtravel keep your medications with you—not ina
suitcase.
IIff yyoouu ccaannnnoott aaffffoorrdd yyoouurr
mmeeddiiccaattiioonnss,, tellyour health care provider. Help may be
available.
DDoonn’’tt rruunn oouutt ooff aannyy mmeeddiicciinnee.. Get a
refill aweek or two before you run out.
WWhheenn aa nneeww mmeeddiicciinnee iiss ssttaarrtteedd,, aasskk
ffoorr ttwwoowweeeekkss ooff ssaammpplleess or ask that the
pharmacyonly fill two weeks worth of the prescription.If you don’t
tolerate the new medicine,you won’t waste a full prescription. If
themedicine works, you can always fill the restof the
prescription.
IIff iitt iiss ppoossssiibbllee,, ttrryy ttoo uussee tthhee
ssaammee pphhaarrmmaaccyyffoorr aallll yyoouurr
pprreessccrriippttiioonnss.. This will increasethe chance of the
pharmacist finding drugs thatare dangerous when used together,
repeatedmedicines and other problems.
Medication 394/07
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CCoommmmoonn MMeeddiiccaattiioonnss AAfftteerrOOppeenn
HHeeaarrtt SSuurrggeerryy
Beta BlockersBeta blockers provide a combination of effectsto
protect the heart from being over-stimulatedby adrenalin. Adrenalin
can cause the heartto work too hard, have fast, irregular beatsor
increase blood pressure.
Beta blockers decrease the workload of theheart and improve how
it pumps during restand exercise. These drugs are used before
andafter heart surgery to keep the rhythm regularand prevent or
treat atrial fibrillation.
Beta blockers are proven to help people withmany types of heart
disease to live longer.
It is common to feel worse (sad, tired, problemswith sex) before
you feel better when betablockers are started. This usually clears
in amatter of weeks.
Do not stop taking a beta blocker withoutyour doctor’s help or
instruction. Your heartcan react to a sudden stop of a beta
blockerby increasing its speed or workload, whichcan be
dangerous.
CCaallll yyoouurr ddooccttoorr iiff yyoouu tthhiinnkk yyoouu
aarree hhaavviinnggaannyy ooff tthheessee ssiiddee
eeffffeeccttss::
n Dizziness
n Low heart rate (less than 60 per minute)
n Shortness of breath that keeps gettingworse
n Wheezing
n Tiredness that keeps you from all activities
Angiotensin Converting EnzymeInhibitors (ACE-I)AACCEE--II are
used when there has been damageto the heart muscle, and the pumping
abilityof the heart has been weakened. This is usuallyfrom heart
attack or other damage before openheart surgery. ACE-I are also
used to controlblood pressure. They have the following actions:
n Relaxes arteries to make it easier for theheart to pump blood
forward.
n Increases blood flow to the kidneys tohelp clear fluid.
It is common to increase the dose of ACE-Iover time. You may
feel worse for a littlewhile, but usually feel better after a
coupleof weeks.
Blood tests may be ordered to measure levelsof kidney function
and potassium.
CCoommmmoonn ssiiddee eeffffeeccttss tthhaatt yyoouu
sshhoouulldd rreeppoorrttttoo yyoouurr ddooccttoorr aarree::
n Cough
n Rash
n Swelling of the tongue, face or difficultyswallowing
n Dizziness
n Low blood pressure (less than 90 for thetop number)
Medication 404/07
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VasodilatorsVasodilators may be used to relax bloodvessels, or
decrease blood pressure if youcannot take an ACE-I or your doctor
hasdetermined another drug is better for you.
Common vasodilators are nitroglycerin ina patch or pill (such as
Imdur), Angiotensin-Receptor Blockers (Cozaar or Diovan),
andhydralazine.
SSiiddee eeffffeeccttss yyoouu sshhoouulldd rreeppoorrtt ttoo
yyoouurrddooccttoorr iinncclluuddee::
n Rash or skin irritation
n Dizziness
n Low blood pressure (less than 90)
DiureticsDiuretics are also called “water pills” becausethey
make the kidneys get rid of water throughurination. Getting rid of
extra water makesyour weight go down (or keeps you fromgaining
water weight).
Not everyone has to take a diuretic – yourdoctor will decide if
you need a diuretic todecrease or prevent water retention.
Using diuretics can cause your body to losepotassium and other
electrolytes. You may beasked to take a potassium replacement
tocounteract this effect.
Side Effects of Diuretics Include:n Leg cramps
n Dizziness or lightheadedness
n Skin rash
DigitalisDigitalis (also called Lanoxin) may help theheart to
pump more strongly and regularly.
Digitalis is also used to control a rapid orirregular
heartbeat.
Digitalis is usually added after ACE Inhibitorsand Beta
Blockers, but in some cases, is usedwithout these drugs.
NNoottiiffyy yyoouurr ddooccttoorr iimmmmeeddiiaatteellyy iiff
yyoouueexxppeerriieennccee aannyy ooff tthheessee ssiiddee
eeffffeeccttss::
n Confusion
n Changes in vision – seeing yellow or green
n Nausea and vomiting
n Slow pulse (heart rate)
Medication 414/07
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MEDICATION SCHEDULE
Medication 424/07
Med
icat
ion
Mor
ning
Noo
nSu
pper
Bedt
ime
(tim
e)(ti
me)
(tim
e)(ti
me)
SM
TW
TF
SS
MT
WT
FS
SM
TW
TF
SS
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WT
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-
Medication 434/07
MEDICATION SCHEDULE
Medication Morning Noon Supper Bedtime (time) (time) (time)
(time)
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[Section 8]
Home Health
(Leave this section blank—home healthprovider (hopefully
Borgess) inserts patientinformation.)
Medication 444/07
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CARDIAC REHABILITATION
WWhhaatt iiss CCaarrddiiaacc RReehhaabbiilliittaattiioonn??A
cardiac rehabilitation program is designedto meet the needs of the
individual patient,depending upon the specific heart problem
ordisease, and supervised by a cardiac physicianand a team of
cardiac professionals.
The goal of cardiac rehabilitation is to helpyou reverse your
symptoms and maximizecardiac function. Cardiac rehabilitation
includes,but is not limited to, the following activities:
n Establishing a progressive exerciseprogram to build fitness
and functionalcapacity
n Providing educational classes to helpadjust to or change
lifestyle and habits,such as:
– Smoking cessation classes
– Nutrition classes
n Offering stress management techniquesand techniques to reduce
anxiety
n Counseling and educating you about yourspecific heart
condition/disease and thebest way to manage that specific
condition.
n Preparing you to return to work – ifappropriate – able to meet
the physicaland psychological demands of the job.
Cardiac Rehabilitation 454/07
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Why Should I Go?
Cardiac rehabilitation is your first step torecovery. Our team
of professionals willgently lead you through our
comprehensiveprogram with two goals in mind
n Provide you with a safe, individualizedexercise program.
n Educate you and your family membersabout heart disease and how
to reduceyour risk factors.
Throughout your rehabilitation process, ourteam will offer
encouragement and supportevery step of the way. While in
rehabilitation,you will have the opportunity to
attendhealth-specific classes on important topics,including stress,
heart disease risk factors,medications, exercise and nutrition. In
addition,you will have a personalized appointmentwith a
dietitian.
Class StructureMonitored cardiac rehabilitation sessions areheld
on Monday, Wednesday and Friday. Youwill be monitored continuously
on a heartmonitor during your exercise sessions. Wewill also take
your blood pressure frequentlyand assess your needs while you
exercise.
What Should I Bring?During your initial orientation, a
registerednurse will evaluate you. We will obtain yourmedical
history and assess your individualhealth needs. Please bring a list
of yourmedications to the orientation. This will helpin hour
initial health assessment.
What is the Cost?Cardiac rehabilitation is a
Medicare-coveredbenefit. Private insurance companies willreimburse
according to your policy.
Cardiac Rehabilitation 464/07
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ADDITIONAL RESOURCES
CCoommmmuunniittyy RReessoouurrccee LLiissttffoorr
CCaarrddiiaacc SSuurrggeerryy
Borgess Visiting Nurse269.343.1396
Borgess Cardiac Rehabilitation269.552.2200
Borgess LaboratoryGull Road site269.226.5917
Woodbridge269.324.8473
BBoorrggeessss PPhhaarrmmaaccyy269.226.8336
BBoorrggeessss NNuuttrriittiioonn
SSeerrvviicceess269.226.8336
Smoking Cessation SupportIntegrative Medicine (acupuncture,
hypnosis)269.552.2282
DeLano Outpatient Clinic269.226.5600
Borgess Center for Diabetes Care269.226.8321
Borgess Spiritual Care269.226.4898
Websites/Resourceshttp://www.borgess.com www.borgess.com
http://www.emedicine www.emedicine
http://www.americanheart.orgwww.americanheart.org
Additional Resources 474/07