Once upon a time there was a 60 year old man who really liked milkshakes and cigarettes. He liked them so much that every time he smoked a cigarette he drank a milkshake, he smoked a pack a day. He had complaints of unresolved chest pain, jaw pain, left arm pain, shortness of breath at rest, fatigue (especially with exertion). One sunny afternoon, after these symptoms progressed, he came into the ER with a STEMI and had a CABG surgery. After his CABG he was transferred to the SICU where Kelis, his nurse assessed him. First Kelis attached the cardiac monitor, pressure lines, noted existing drips, attached the ventilator and end-tidal carbon dioxide and pulse ox monitor. Peripheral pulses and signs of perfusion were checked as well as the chest tube placement and output (<150ml/hr). Body temperature was recorded and rewarming occurred because the body temperature was less than 96.8F. The nurse began by oxygenating the patient to maintain adequate SpO2. She increased room temperature and used a warming blanket to prevent hypothermia. Pain was managed by splinting the incision and using a PCA pump. Cardiac output was maintained by giving fluids and blood products. An ECG monitor was used to monitor for dysrhythmia. As a result of these actions the patient was free to return home after copious amounts of education were given, “I can teach you, but you have to change.”

CHF—Once upon a time there was a 69-year old caucasian man named Donald Trump who had an orange comb-over. He was very angry. He reported high levels of stress. His favorite food was Freedom Fries and he ate them at almost every meal.

His health history included hyperlipidemia, a sedentary lifestyle, hypertension, obesity, heavy alcohol use and probable drug abuse. He had complaints of frequent awakening a night with shortness of breath, his favorite pink socks not fitting, recent weight gain of 7 lbs in the last week, dizziness, fatigue, weakness, a cough, chest pain, and heart palpitations

The nurse assessed the patient, finding dependent pitting edema, nocturnal paroxysmal dyspnea, confusion as evidenced by incoherent ranting about building walls and healthcare. He had obvious bilateral JVD with wheezing and bibasilar crackles. He appeared anxious and was leaning forward breathing heavily. He had a decreased urine output since admittance. His vital signs were:

Heart Rate: 127

Blood Pressure: 190/120

Spo2: 92%

Temp: 98.7

Resp Rate: 26

The nurse began to do a thorough medication history. Due to his recent stress and confusion, Trump had not been remembering to take his Carvedilol for his hypertension. He had been taking 800 milligrams of Ibuprofen 3 times a day for headaches. The patient was put on Lasix and Spironolactone. He was given oxygen via a nasal cannula. The head of his bed was elevated. The nurse educated the patient about taking his medications and lifestyle and diet changes.

As a result of these actions, the patient began to urinate, was able to sleep, maintained a normal blood pressure, reported no chest pain or shortness of breath and his lungs were clear. He lost the 7 lbs of weight he had gained over the next several days.

Once upon a time there was a 50 year old African American male who had a history of hypertension, hyperglycemia, with BMI of 32, and family history of father passed away at age 55 with Acute MI. He presented to the ED with signs of/complaints of severe chest pain at rest, starting 30 minutes ago, shortness of breath, fatigue, and nausea. The nurse assessed the patient finding HR-110 regular, BP-145/90, Resp-21 shallow, Sat02 92% on room air, temperature- 98.6, chest pain 7/10, pressing, radiating to left arm and jaw, diapheretic, pale, and cap refill 4 seconds.  Nurse ordered 12 lead EKG and drew Labs, began to administer morphine sulfate 2mg IV, Oxygen 4L nasal cannula, nitroglycerin 0.4mg sub-lingual, and aspirin 325mg PO. Patient was re-administered nitroglycerin 5 minutes later and 10 minutes later. As a result of these actions the patient presented with HR 120, BP 90/60, Resp 25, Sat 02 88% with 4L O2, temp 98.6, pain unrelieved at 8/10, shortness of breath, ST elevation on EKG monitor, now prepare for cath lab.

I imagine how difficult it would be for a patient to suddenly switch their diet of comfort to a low-sodium heart healthy alternative. I’ve only experienced a patient’s reaction to this new diet once in clinical, and the first sentence expressed when looking at the cardiac tray was “That’s not real food, that’s cardboard”. I can’t help but think I would react similarly, as according to my daily assessment of sodium intake, a reduction in sodium would serve me well.

My meals consisted of:

Breakfast

-Whole wheat toast with 1/2 avocado (Na+ 280 mg + 10 mg)

-1 cup orange juice (Na+ 2 mg)

Lunch

-Trader Joe’s Field Fresh Chopped Salad with Grilled Chicken (Na+ 220 mg)

-1 cup seedless red grapes (Na+ 3 mg)

-Water

Snack

-Peanut butter pretzels (Na+ 160 mg)

-Water

Dinner

-1 cup Magic Mineral Chicken Broth with vegetables (Na+ 880 mg)

-1 serving Simply potatoes mashed potatoes (Na+ 330 mg)

Total sodium intake: 1,885 mg

Recommended 24 hour sodium intake: 1,500 mg

I decided to take a look at my diet on a day where I hadn’t slept too much, didn’t have time to cook, and had to work a very busy night shift. While I know that I have been eating healthy other days – incorporating salads and healthy snacks like hummus and carrots – I knew this day would be pretty bad. I thought it would be a good day to pick because I sort of had to eat what was quickly available to me, plus the sleep deprivation didn’t help me make the healthiest of choice. Basically, doing this meal check, I saw that just the burger put me well over the Heart Healthy diet needs. The sodium alone put me well over how much I would need to consume on a heart healthy diet. You have to wonder, how some patients manage to make the adjustment, especially if they are leading very busy lives both at home and work. I’m not saying it is not possible, but I can see it being very hard to change habits of eating out if it is something they do 1-3 times per week. Essentially they would have to stop all together or switch to healthier dining out options that can include fruits or salads.

“Breakfast” – Almond butter and honey toast

Almond butter (1tbs): Na 72 mg, Fats 1 g

Whole wheat bread: Na 132 mg, Fats 0 g

Honey: Na 1mg, Fats 0g

Water – Na 0, Fats 0g

“Lunch” – Habit cheeseburger and fries with water

Cheeseburger: Na 1,770mg, 36g fat

Fries: Na 164mg; Fat 3g

“Dinner” – None

Snacks – none because I forgot them on the counter at home before work, so LOTS of water on my overnight.

My meal for today consisted of the following:

Breakfast:

-2 pieces of Orowheat Country Potato Toast and 2 pieces of  Laughing Cow Swiss Cheese  (Fat: 10g// Na: 650 )

Lunch (Sharky’s Wood Fire Mexican Grill):

-Chicken Breast Half Power Plate with Mexican Rice and Grilled Vegetables (Fat: 10.1g// Na: 1391.7 mg)

Dinner

-Habit Charburger and 1.5 size order of fries (Fat: 62g// Na: 2370 mg)

Based on my diet for today, I think I will have a difficult time adjusting to a low fat and low sodium diet because most of the foods that I enjoy eating are dependent on fats and sodium. Also, being from a Filipino culture, most of our dishes are high in sodium and fat. Therefore, the taste would just be different and maybe difficult to adjust to.

1.Breakfast: Oatmeal

2.Lunch: Veggie Burger

3.Dinner. Pear and Gorgonzola Salad

4.Beverages

For this day I consumed a total of 880 mg of Sodium. Sodium is in almost everything. It is an important part of our diet. If I had to cut down on my consumption of Sodium for cardiac issues I would be able to do it. The difficult and disciplined part would be: reading every label and calculating  my sodium intake for the day.

Yesterday I spent the day entertaining some friends who were visiting for Labor Day weekend. A huge part of showing someone a good time in Santa Barbara, besides seeing the mission and the courthouse, is taking them to all the best restaurants and the local hipster ice cream shop and so on. I try to be conscious of my eating habits, for both health and financial reasons, but yesterday my single goal was to keep everyone happy– dieting took the backburner. For breakfast I ate my kale, pear, lime, ginger, celery smoothie that I try to make a habit. But once I met up with my friends we had tacos and ice cream downtown for lunch. The taco meat was definitely salty and fatty, and the ice cream was probably all the saturated fat I was supposed to eat all day. However, I don’t know the exact amounts of either; there was no food label or calorie counter in the taco stand. Eating at restaurants must be so difficult for Cardiac patients when they really don’t have a choice what type of food their loved ones are asking for. It seems like many people would end up being polite, and choose not to make a fuss and tell their children, “Actually my doctor told me I can’t eat this type of food.” Without knowing the content of the food the food you’re ordering, and often not being able to choose a restaurant with healthier options, eating out must be a source of stress and discouragement for many adults trying to limit their salt and fat intake. After dinner, another friend made us all steak and yams and cold slaw. When eating the yams, I mentioned “These are amazing, what did you put in them?” My friend replied, “Heavy cream and a big stick of butter.” I had thought the yams were the “healthy” part of the meal! Unless you are sitting at home, cooking for yourself, reading every label and measuring your daily allotment of fat and salt specifically, it seems impossible to really know what you’re eating. In one day of being social and polite, I ate salty, fatty red meat twice and washed it down with ice cream and butter mixed with yams– all without ever seeing a single food label or any nutritional information.

I had planned on tracking my food for today, September 8th, as I kept forgetting to take photos of my meals over the last few days and thought it would be nice to add some photos to the post. Then I started thinking about it and to get a realistic view of what I actually eat I decided to analyze what I ate yesterday. I try to be pretty conscious of what I eat and yesterday wasn’t necessarily a “bad” day but I was at home studying with not much food left in the fridge so I ended up snacking for lunch instead of prepping a healthier meal.

I plugged my meals into the USDA’s SuperTracker website to get a good analysis of my nutrient and calorie intake. Some foods were a little difficult to input, but I did my best to reconcile the nutritional information of what I ate with the options they had available on their site.

This is a summary of my meals from yesterday:

Breakfast: Quinoa sauteed red bell pepper, onion, and mushrooms topped with sheep’s milk feta and a boiled egg

Lunchtime Snacking: Seedless green grapes, carrots and white bean hummus, TJ’s flattened bananas, and TJ’s thai chile and lime cashews, TJ’s mango icecream bar… not the best lunch

Dinner: Rice noodles with broccoli, onion, and mushrooms in a garlic, ginger, soy sauce. Apfelshorle to drink (sparkling water and apple juice).

Looking at my daily food group targets I don’t think I did a bad job:

I went slightly over for my fruit intake but the majority was whole fruits. I also went over for my veggie intake which I think is great. I almost hit my protein target and was under on my grains target but feel I had plenty of fiber.

I was significantly under on my dairy but I thought I would have hit my calcium and B12 needs with other food groups. Unfortunately I was under the target in both of these nutrients. I usually snack on more cheese, eat meat a couple times a week, and have quite a bit of fortified almond milk so I hope this isn’t an issue. It would be interesting to track my intake over an extended period of time to see if I hit the targets.

Now for the heart healthy diet… I went over the limit on both saturated fat and sodium intake!

My overall fat intake wasn’t too bad. It made up 34% of my daily calories, largely in part to my large snack of cashews which I definitely don’t eat on a regular basis.

My saturated fat was a bit high (13% of my total calories). There is a lot of information that has recently circulated about cooking with olive oil at high heat so I’ve tried to start cooking more with coconut oil and ghee or butter. Researching more about different types of oils and how they are affected when used for cooking has been on my to do list for awhile. Regardless of their safety when heated, I should be conscious of the amount of oil I use when cooking.

I was also over on my sodium intake but thankfully not by too much. I typically don’t cook with a lot of soy sauce but I do use salt and love salty cheeses like feta. Despite this I did go on a long run yesterday and think I sweat out my fair share of sodium in the heat. I also try to stay away from processed foods and know that many are prepared with large amounts of sodium.

I think following a heart healthy diet or any kind of restrictive diet would be difficult. I love food and tend to let myself eat what I want as long as it is in moderation. However, I definitely can’t say I always moderate myself appropriately, especially when studying or writing a paper

Thankfully there are many tools available that can help an individual monitor how they eat and exercise and how it affects their health. I know a large part of keeping myself active involves setting goals and tracking my workouts. It can be very motivating when you’re able to track your progress and see improvement.