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Patients monitor own heart health

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When Dr. Dale G. Renlund first saw the patient diary that was being proposed by staff in the heart failure program he directs at LDS Hospital, he thought it was "cutesy." And not likely to make an impact.

He was wrong, he now says. Something as simple as having heart-failure patients weigh themselves and write it down every day, so they can see what they're gaining and losing, can save their lives. Because for heart failure patients, sudden extreme weight gain means they're retaining fluids (even as much as 30 to 50 pounds in a very short time) and that's putting stress on their ailing hearts that can be lethal.

Heart failure — how to prevent it, treat it, live with it — is the topic of today's Deseret Morning News/Intermountain Health Care Hotline. From 10 a.m. to noon, Renlund and nurse practitioner Jill A. Hall will answer questions about the disease, which afflicts close to 5 million Americans.

Hall calls it a "devastating illness that creeps up over time." And she warns that women, in particular, tend to downplay the symptoms so that by the time the patient seeks help, damage to the heart muscle has been happening for some time.

Saving a patient from heart failure, a weakening of the heart muscle so that it can't pump hard enough to distribute adequate blood, involves that person's active participation. The team at LDS Hospital has come up with a number of simple education tools and a catchy acronym to help.

They preach "MAWDS," which means take your Medicine, stay Active and Weigh yourself each day, follow your Diet and recognize your Symptoms. Self-monitoring is as important to a heart failure patient as it is to someone with diabetes.

Heart failure treatment has changed in the last two decades — and so has the outlook for those who suffer from the potentially deadly illness. Medications and medical devices, new practices and techniques let people live longer and better.

Doctors used to tell patients with heart failure to take it easy so they didn't strain their heart. Now they push them to exercise, because it will make them feel better and strengthen that weakening heart.

Monitoring weight is one of the most important things a patient can do. Someone who gains 2 or more pounds in a day needs to call his or her treatment provider. Ditto for those who gain 5 or more pounds over their ideal weight. If the gain is from fluid retention, the treatment plan may need changed.

Heart failure patients must limit how much sodium they eat to less than 2000 mg of salt each day. And while most people are told to drink lots of water and other fluids to maintain good health, those with heart failure must limit themselves to less than 2 liters of fluid each day.

They must know the symptoms of the illness so they can stay on top of it: excessive weakness or exhaustion, shortness of breath (especially when lying down), a hacking and usually unproductive cough, bloated stomach, swollen feet and ankles and weight gain.

"Patients are living with this in our community," said Hall, "but we can alter the course of the disease process" with proper and early treatment.

Short of a heart transplant — and there are nowhere near enough hearts available to meet that need — heart failure is not a "curable" disease. But patients can see significant improvements. Renlund said the goal is to help them manage their disease long enough and well enough that they enjoy their lives fully and eventually die of something else.

E-mail: lois@desnews.com