I am on a low to no sodium diet

Sodium

It's present in nearly all foods.
It's essential to life.
It enhances the flavor and texture of many foods.
It can be difficult to sort out all the facts about it.

You might be surprised to learn that most of the sodium in your diet doesn't come from the saltshaker.

About 75 percent of sodium comes from salt added to foods during manufacturing. Salt has many purposes in food including enhancing natural flavors, preserving freshness and improving texture.

Some common sources of sodium are canned soups, vegetables, and tomato juice; processed meats such as ham, bacon, hot dogs and lunch meats; frozen entrees and pizzas, packaged seasoned rice dishes, and pickles.

About 5 to 10 percent of sodium intake comes from salt added during cooking or at the table, and another 10 percent comes from sodium found naturally in foods.

Questions & Answers about

Salt vs. Sodium

Q = How do salt and sodium differ?

A = Table salt is 40% sodium. The other 60% is chloride. Salt (sodium chloride) is the major contributor of sodium in our diets.

Q = Should I try to eliminate foods with sodium from my diet?

A = No. Sodium is an essential nutrient. The body needs a small amount of sodium. Health experts suggest choosing a diet moderate in salt and sodium.

What is Sodium?

Sodium is an essential mineral or micronutrient which along with potassium helps to regulate the body's fluid balance. Unlike other minerals, sodium (or sodium chloride, alias salt) has a recognizable and popular taste, and is widely added to snack foods and other processed foods.

Sodium deficiency is not common, and according to some experts the average Western diet provides more than 5 times the recommended daily allowance of sodium. Excess sodium intake is linked with high blood pressure and heart disease.

Dietary sodium is measured in milligrams (mg). The most common form of sodium used is table salt, which is 40 percent sodium. One teaspoon of table salt contains 2,300 milligrams of sodium.

Salt for human consumption is produced in different forms: unrefined salt (such as sea salt), refined salt (table salt), and iodized salt. It is a crystalline solid, white, pale pink or light gray in color, normally obtained from sea water or rock deposits. Edible rock salts may be slightly grayish in color because of this mineral content.

Chloride and sodium ions, the two major components of salt, are necessary for the survival of all known living creatures, including humans. Salt is involved in regulating the water content (fluid balance) of the body. Salt cravings may be caused by trace mineral deficiencies as well as by a deficiency of sodium chloride itself. Conversely, overconsumption of salt increases the risk of health problems, including high blood pressure.

PROCESSING TABLE SALT

Since the 1950s it has been common to add a trace of sodium ferrocyanide to the brine in the United Kingdom; this acts as an anticaking agent by promoting irregular crystals. Sodium ferrocyanide has been banned in the United States and a similar ban has been discussed in the United Kingdom, but was determined to be unnecessary. These agents are hygroscopic chemicals which absorb humidity, keeping the salt crystals from sticking together.

Some anti-caking agents used are tricalcium phosphate, calcium or magnesium carbonates, fatty acid salts (acid salts), magnesium oxide, silicon dioxide, calcium silicate, sodium aluminosilicate, and calcium aluminosilicate. Concerns have been raised regarding the possible toxic effects of aluminium in the latter two compounds; however, both the European Union and the United States Food and Drug Administration (FDA) permit their use. The refined salt is then ready for packing and distribution.

What is a Diet Moderate in Sodium?

Food labels state that the "daily value" for sodium is
less than 2,400 milligrams per day.


Health experts realize that many people consume more than 2,400 milligrams of sodium per day. Less than the 2,400 milligram sodium goal may be unnecessarily low for many healthy people.

Other individuals on medically prescribed diets might need to consume less than 2,400 milligrams of sodium per day.

Here's what food product labels tell you about sodium:

Sodium Free	Less than 5 milligrams sodium per serving
Low Sodium	140 milligrams or less sodium per serving
Reduced/Lower Sodium	At least 25% less sodium per serving when compared to a similar food
No Salt Added	No salt is added during processing (when this product is normally processed with salt). The product may not be a sodium free food, so check the nutrition facts

THE HISTORY OF SALT

In the Iron Age, the British evaporated salt by boiling seawater or brine from salt spri­ngs in small clay pots over open fires. Roman salt-making entailed boiling the seawater in large lead-lined pans. Salt was used as currency in ancient Rome, and the roots of the words "soldier" and "salary" can be traced to Latin words related to giving or receiving salt.

During the Middle Ages, salt was transported along roads built especially for that purpose. One of the most famous of these roads is the Old Salt Route in Northern Germany, which ran from the salt mines to shipping ports.

In colonial India, only the British government could produce and profit from the salt production conducted by Indians living on the coast. Gandhi chose to protest this monopoly in March 1930 and marched for 23 days with his followers. When he arrived on the coast, Gandhi violated the law by boiling a chunk of salty mud. This march became known as the Salt March to Dandi (see below). People across India began making their own salt in protest, and the march became an important milestone in the struggle for Indian independence.

Salt production also played a significant role in early America. The Massachusetts Bay Colony held the first patent to produce salt in the colonies and continued to produce it for the next 200 years. The Erie Canal was opened primarily to make salt transportation easier, and during the Civil War, the Union captured significant Confederate saltworks and created a temporary salt shortage in the Confederate states. It continues to be important to the economies of many states, including Ohio, Louisiana and Texas.

Aside from economics, salt also has cultural and religious significance. It has long been used in Shintoism to purify things, and Buddhists use salt to repel evil. In Judeo-Christian traditions, salt was used to purify people and objects, as an offering, and to seal covenants. There are numerous references to salt in the Old and New Testaments of the Bible. One of the most famous is Lot's wife, who was turned into a pillar of salt in Genesis after disobeying God's command. A rock-salt pillar that stands today on Mount Sodom is known as "Lot's Wife" (see below).

There are lots of sayings related to the use of salt. It was often traded for slaves, which is the origin of the expression "not worth his salt." Someone who is the "salt of the earth" is a dependable, unpretentious person. "Salting the earth," on the other hand, refers to an ancient military practice of plowing fields with salt so that no crops could be grown.

FMLA: Family Medical Leave Act (originally posted Dec 17)

When my12 weeks of FMLA leave was recently approved, I found out I would only be paid if City of Jacksonville employees donated their own leave time to me. That's right, FMLA is unpaid leave. I will go three months without pay unless City employees donate. I wanted to share the facts about FMLA with everyone. This is a federal program that many people know nothing about. For more information, visit http://www.dol.gov/elaws/esa/fmla Frequently Asked Questions and Answers Q: How much leave am I entitled to under FMLA? If you are an "eligible" employee, you are entitled to 12 weeks of leave for certain family and medical reasons during a 12-month period. Q: Does the law guarantee paid time off? No. The FMLA only requires unpaid leave. However, the law permits an employee to elect, or the employer to require the employee, to use accrued paid vacation leave or, subject to certain restrictions, sick or family leave, for some or all of the FMLA leave period. When paid leave is substituted for unpaid FMLA leave, it may be counted against the 12-week FMLA leave entitlement. Q: May I take FMLA leave for visits to a physical therapist, if my doctor prescribes the therapy? Yes. FMLA permits you to take leave to receive "continuing treatment by a health care provider," which can include recurring absences for therapy treatments such as those ordered by a doctor for physical therapy after a hospital stay or for treatment of severe arthritis. Q: Which employees are eligible to take FMLA leave? Employees are eligible to take FMLA leave if they have worked for their employer for at least 12 months, and have worked for at least 1,250 hours over the previous 12 months, and work at a location where at least 50 employees are employed by the employer within 75 miles. Q: Do the 12 months of service with the employer have to be continuous or consecutive? No. The 12 months do not have to be continuous or consecutive; all time worked for the employer is counted. Q: Do the 1,250 hours include paid leave time or other absences from work? No. The 1,250 hours include only those hours actually worked for the employer. Paid leave and unpaid leave, including FMLA leave, are not included. Q: Do I have to give my employer my medical records for leave due to a serious health condition? No. You do not have to provide medical records. The employer may, however, request that, for any leave taken due to a serious health condition, you provide a medical certification confirming that a serious health condition exists. Q: Can my employer require me to return to work before I exhaust my leave? Subject to certain limitations, your employer may deny the continuation of FMLA leave due to a serious health condition if you fail to fulfill any obligations to provide supporting medical certification. The employer may not, however, require you to return to work early by offering you a light duty assignment. Q: Are there any restrictions on how I spend my time while on leave? Employers with established policies regarding outside employment while on paid or unpaid leave may uniformly apply those policies to employees on FMLA leave. Otherwise, the employer may not restrict your activities. The protections of FMLA will not, however, cover situations where the reason for leave no longer exists, where the employee has not provided required notices or certifications, or where the employee has misrepresented the reason for leave. Q: Can my employer make inquiries about my leave during my absence? Yes, but only to you. Your employer may ask you questions to confirm whether the leave needed or being taken qualifies for FMLA purposes, and may require periodic reports on your status and intent to return to work after leave. Also, if the employer wishes to obtain another opinion, you may be required to obtain additional medical certification at the employer’s expense, or rectification during a period of FMLA leave. The employer may have a health care provider representing the employer contact your health care provider, with your permission, to clarify information in the medical certification or to confirm that it was provided by the health care provider. The inquiry may not seek additional information regarding your health condition or that of a family member. Q: Can my employer refuse to grant me FMLA leave? If you are an "eligible" employee who has met FMLA’s notice and certification requirements (and you have not exhausted your FMLA leave entitlement for the year), you may not be denied FMLA leave. Q: Will I lose my job if I take FMLA leave? Generally, no. It is unlawful for any employer to interfere with or restrain or deny the exercise of any right provided under this law. Employers cannot use the taking of FMLA leave as a negative factor in employment actions, such as hiring, promotions or disciplinary actions; nor can FMLA leave be counted under "no fault" attendance policies. Under limited circumstances, an employer may deny reinstatement to work - but not the use of FMLA leave - to certain highly-paid, salaried ("key") employees. Q: Are there other circumstances in which my employer can deny me FMLA leave or reinstatement to my job? In addition to denying reinstatement in certain circumstances to "key" employees, employers are not required to continue FMLA benefits or reinstate employees who would have been laid off or otherwise had their employment terminated had they continued to work during the FMLA leave period as, for example, due to a general layoff. Employees who give unequivocal notice that they do not intend to return to work lose their entitlement to FMLA leave. Employees who are unable to return to work and have exhausted their 12 weeks of FMLA leave in the designated "12 month period" no longer have FMLA protections of leave or job restoration. Under certain circumstances, employers who advise employees experiencing a serious health condition that they will require a medical certificate of fitness for duty to return to work may deny reinstatement to an employee who fails to provide the certification, or may delay reinstatement until the certification is submitted.

My Road Trip from FL to NY (originally posted Dec 12)

Images from along the way...






From left to right, top to bottom:
Bridge; Brutus with Mom in the back seat;
South of the Border in North Carolina; Mona - our GPS guide;
the Moon visible during the day; my father while driving.


My parents, myself, and my dog Brutus left Jacksonville, FL for West Monroe, New York at 10am on Monday, December 8. We drove about 400 miles each day. The first day we drove through Georgia and South Carolina to North Carolina. We decided to sedate Brutus since he had never traveled in the car more than 15 minutes before. He was one calm pup and slept most of the trip (even without medication on the second and third days).

My mother and I joined Brutus cat-napping continually throughout the day while my father drove hour after hour. We stopped to eat our lunch at a rest stop in SC. We enjoyed our meal outside, enjoying the last of the nice weather. That evening, my father and I enjoyed a steak dinner while my mom stayed with Brutus and she dined on McDonald’s as a special treat.

The next day, we all got up early and enjoyed breakfast in our room. We were on the road by 8am. We traversed North Carolina and bits of West Virginia and Maryland. Virginia seemed like a long drive because we avoided Richmond and Washington, D.C. Virginia was covered with horse and cow farms and the mile-long fences directed us from one magnificent homestead to another. Once in Pennsylvania, the weather and the landscape changed dramatically. The rolling hills and well-manicured farms were replaced with rocky and wooded hillsides.

When we reached the New York border, the temperature was 46 degrees. Within approximately 20 minutes, the temperature dropped to 32 degrees and driving became difficult for the first time during our journey. Before we knew it, we had passed through Binghamton where I had visited my friend Karen many times, Cortland where I had lived and worked before moving to Florida, and finally Syracuse where I went to graduate school. The entire trip was about 1120 miles, 21 hours of driving, and took almost 4 tanks of gas. It snowed as soon as we got home.

CHECK UPS (originally posted Dec 6)

I went to see my doctors this week
for my post-hospital checkups.

My pilonidal cyst is healing very well. The incision has shrunk from 4.5 cm long and 2.5 cm deep to 3.0 cm long and .5 cm deep in just three weeks. The home aid nurse said that I have healed faster than anyone she has seen before. The infection that the home visit nurse detected was found to be harmless and I can now change the packing every two days instead of each day.
That makes my mom happy since she is my in-home nurse.



The last two weeks I have slowly built my stamina up by going on "outings." I went to the Light Parade Downtown (see photo above) and watched a movie at a friends house. I am now able to be up and about for much longer and I don't get as out of breath as easy. I am napping frequently, but not for as long. Most importantly, I am learning my limits. That makes my father happy - he keeps me on a pretty short leash.

I also saw my cardiologist this morning. My blood pressure and heart beat is good. He is adding COREG to my current medications that include Lasix, Lisinopril, and Digoxin.

Coreg (carvedilol) is prescribed for the treatment of mild-to-severe chronic heart failure of cardiomyopathic origin, usually in addition to diuretics. Coreg is indicated to reduce cardiovascular mortality in clinically stable patients.

Lasix (Furosemide) is a diuretic.


Lisinopril is in a group of drugs called ACE inhibitors.
ACE stands for angiotensin converting enzyme.
Lisinopril is used to treat high blood pressure (hypertension),
congestive heart failure, and to improve survival after a heart attack.

Digoxin treats heart failure and slowing the heart rate in patients with chronic atrial fibrillation, a type of abnormal heart rhythm. It may also be used for other conditions as determined by your doctor. Digoxin is a digitalis glycoside. It works by increasing the force of contraction of the heart and slowing heart rate.

THANK YOU for the LOVE and SUPPORT (originally posted Dec 5)

Over the last month, I have received so much love and support
from friends, family, and colleagues.
Thank you Thank you Thank you!

Beautiful flowers, humorous gifts, and inspirational cards
have not only raised my spirits,
but have given me the reassurance that I needed.

When I was in the hospital,
all of the nurses and phlebotemists would comment on my flowers.
They said that they were the MOST beautiful flowers.

I always said that my friends and family have great taste.
In response, the would add that
I definitely have a lot of people who love me.

I felt very loved and I never felt alone
when I was in the hospital.
Thank you for the company.

When I got home, I received just as many flower deliveries.
The dogs went crazy every time the doorbell rang
which made everyone jump and made my heart skip a beat (in a good way).

I received so many cards that warmed my heart.
It is wonderful to know how important you are to people...
too bad it takes an unfortunate event to find out.

I teared up several times reading emails,
listening to messages, and receiving Facebook and Myspace notes.
Those tears helped make me strong
and encouraged me not to give up because people believed in me.

Thank you for all of your love and support in all of the many forms.

Dilated Cardiomyopathy (originally posted Nov 22)

Basic Facts This is an abbreviated version of the complete article.* Cardiomyopathy is a term for chronic disorders of the heart that reduce its ability to pump blood. The weakened heart compensates for reduced output of bloodby dilating, or enlarging, to hold more blood. Dilated cardiomyopathy is a common cause of congestive heart failure.

Click here to see an animation of cardiomyopathy.

Cardiomyopathy is a chronic disorder that occurs when the heart weakens and can no longer pump sufficient amounts of blood. Although there are several types of cardiomyopathy, the most common form is dilated cardiomyopathy, in which the heart enlarges to compensate for its inability to pump blood effectively.

By dilating, or enlarging, the heart holds and pumps a higher volume of blood. In addition, the enlarged heart might temporarily increase the force of each heartbeat or elevate the heart rate (number of heartbeats per minute) to continue pumping an increased amount of blood.

WHAT ARE THE SYMPTOMS?

Because the body compensates for dilated cardiomyopathy, the disease may have no symptoms initially. As the condition worsens, the heart may perform normally when a person is resting, but may cause symptoms during periods of exercise or psychological stress.

Dilated cardiomyopathy is a common cause of congestive heart failure, the symptoms of which are often the first indication that a person has cardiomyopathy. Symptoms of congestive heart failure include:

• Shortness of breath
• Shortness of breath while lying down
• Swelling of feet, ankles, legs, or abdomen
• Awareness of one's own heartbeat
• Lung congestion
• Fatigue

CAUSES AND RISK FACTORS

Although most cases of dilated cardiomyopathy result from unknown causes, known causes include:

• Myocarditis (inflammation of the heart's walls)
• Ischemia (lack of oxygen in the heart)
• A previous heart attack
• Severe coronary artery disease
• Heart valve disease
• Chronic alcohol abuse
• Chemotherapy drugs
• High blood pressure
• Arrhythmias (disturbances of the heart's rhythm or rate)
• Autoimmune illnesses (such as lupus or rheumatoid arthritis)

DIAGNOSIS

A physician diagnoses dilated cardiomyopathy after a physical examination. He or she may check for shortness of breath during exercise and weakness. The physician may also hear rales, or wet crackles, through a stethoscope, indicating fluid in the lungs.

To confirm the diagnosis, the physician may order tests, including:

• Blood tests
• Chest x ray
• Echocardiogram
• Electrocardiography (ECG)
  
• Cardiac catheterization and angiography

TREATMENT APPROACH

A physician may recommend that the patient first make lifestyle changes, including:

• Rest adequately
• Control weight
• Stop smoking
• Consume alcohol moderately
• Exercise moderately
• Limit sodium in the diet

The physician may also prescribe medications to control the symptoms of heart failure that can accompany dilated cardiomyopathy, including:

• Angiotensin converting enzyme (ACE) inhibitors
• Anticoagulants
• Beta-blockers
• Calcium channel blockers
• Digitalis
• Diuretics
• Nitrates
  
• Vasodilators

Patients with severe congestive heart failure that is associated with
dilated cardiomyopathy may require a heart transplant.

My broken heart (originally posted Nov 22)

THIS IS HOW IT HAPPENED

On Sunday, November 2, I started to feel more tired than usual. After work Monday and Tuesday, I came home and went straight to bed. Wednesday at work I could not walk to The Landing without sitting down several times (it is only about 50 feet between buildings). After vomiting that day, my coworkers kicked me out of the building and sent me to the doctors.

My doctor treated me for asthma and sent me for blood tests and a chest xray, which I had done the next day. Meanwhile, I slept all day Thursday and Friday, barely able to walk to the bathroom without becoming extremely fatigued. By Friday night, I was frustrated and not convinced that the asthma diagnosis was correct. My friends Beth and Lee brought me to the Emergency Room at St. Vincent's Hospital.

I was admitted to the hospital when the doctor ran an EKG and found some irregularities in my heartbeat. I was immediately hooked up to a heart monitor which I wore for the remainder of my stay.

On Saturday morning, I met my cardiologist, Dr. Jonathan Constantin. I nicknamed him Dr. Bling Bling because he is quite handsome and a snappy dresser. I later learned that others called him Dr. Gigalo. Regardless, he proved to be a very compassionate and informed doctor.

The first test I was given was an echocardiogram.

What is an Echocardiogram?

An echocardiogram is a test in which ultrasound is used to examine the heart. The equipment is far superior to that used by fishermen. In addition to providing single-dimension images, known as M-mode echo that allows accurate measurement of the heart chambers, the echocardiogram also offers far more sophisticated and advanced imaging. This is known as two- dimensional (2-D) Echo and is capable of displaying a cross-sectional "slice" of the beating heart, including the chambers, valves and the major blood vessels that exit from the left and right ventricle. Above is an example.

The test showed that I had an enlarged left ventricle which was only ejecting oxygen-rich blood to my body at 10%. Average ejection fraction is 50%. Ejection fraction (Ef) is the fraction of blood pumped out of a ventricle with each heart beat.

Finding out that my heart was pumping out very little blood was very scary. I was relieved to finally know what was wrong with me. It just didn't seem like it should be happening to me. Maybe they read the wrong test. I mean, I am 33 years old. Even my doctor said I was "special". These are problems that older people deal with. Heart failure was not something I thought I had to worry about.

Dr. Constantin explained that cardiomyopathy can be caused by a virus that settles in the heart. Searching for the virus would be a waste of time because it would not alter the treatment at all. Dilated cardiomyopathy can be inherited. It also can be caused by certain diseases, conditions, and substances, including:

· Coronary artery disease and heart attacks
· Infections, especially viral infections that effect the heart muscle
· Alcohol, especially when a person has a poor diet
· Complications during pregnancy
· Certain toxins, such as cobalt
· Drugs, such as cocaine, amphetamines, and some cancer medicines
· Diseases such as diabetes and thyroid disease

The next test I had was a heart catheterization to make sure I did not have any blockages.

What is cardiac catheterization?

This is a procedure to examine blood flow to the heart and test how well the heart is pumping. A doctor inserts a thin plastic tube (catheter) (KATH'eh-ter) into an artery or vein in the arm or leg. From there it can be advanced into the chambers of the heart or into the coronary arteries. This test can measure blood pressure within the heart and how much oxygen is in the blood. It's also used to get information about the pumping ability of the heart muscle.

I was given a sedative and a local anesthetic during the procedure. Although I could have watched everything, I fell asleep. I awoke to a nurse holding pressure on my thigh . That was strange. I had to lay flat without moving for four hours following the procedure. After it was all done, I only had two small pinholes on my upper right thigh. I am pleased to report that no blockages were found.

With these tests finished, Dr. Constantin was able to determine the best course of treatment. When he mentioned changes in lifestyle, diet, habits, and the possible need for a defibrillator and perhaps a heart transplant, I have to admit that I was shocked, angry, and sad. My parents shared my range of emotions.

While in the hospital, my sister Anne Marie was a constant consultant as a former respiratory therapist. She helped us figure out which questions to ask, what to expect, and helped put everything in perspective.

After all of this, on day seven of my hospital stay, I was subjected to the worst test ever - an MRI. I developed a pilonidal cyst at the base of my spine after about 5 days in the hospital. When I complained of the soreness, everyone thought it was a bed sore. I had no bump, no redness, and no pain when I entered the hospital. I was given an egg crate to sit on and some cream. Finally, after a large, pinkie shaped/sized sore developed, the general medicine doctor, Dr. Doan, or as I prefer to call him, Dr. Duh, ordered an MRI. "An MRI for my butt?" I asked.

What is a pilonidal cyst?

A pilonidal cyst is a unique kind of abscess that occurs in or above the crease of the buttocks. Pilonidal cysts often begin as tiny areas of infection in the base of the area of skin from which hair grows (the hair follicle). With irritation from direct pressure, over time the inflamed area enlarges to become a firm, painful, tender nodule making it difficult to sit without discomfort. These frequently form after long trips that involve prolonged sitting.

MRIs SUCK!!!

They tape you down, stick you in a tube (mine was smaller than the one in this picture), put ear plugs in your ears, turn on a wicked loud roaring noise, and leave you there FOREVER. Then, they pull you out, stick "contrast" in your arm, and put you back in again.

It was AWFUL! I had to lie on my back, where the sore was located - that hurt a lot! And I had to go to the bathroom. By the time it was over, I was squeezing the emergency bell and excited to return to my room.

The MRI revealed that the bump was a pilonidal cyst. That meant surgery to drain and remove it. That meant a few more days in the hospital. My care shifted from my heart condition to a bump on my butt. I went into surgery at 9:30am, was in the operating room by 11:15am, and out of recovery by 12:30pm.

I was not able to be anesthetized because my ejection fraction is so low, so I was given a local anesthetic and a sedative. Luckily, I fell asleep again. All I remember is moving onto the operating table, being covered with warm blankets, thinking that there were a lot of people needed to remove a bump, and noticing how cold my exposed tukus felt. When I was roused from my slumber, I thought I was in an episode of Doctor Who. I swore I was in a hospital bed in the Tardis. It seemed very real.

Every day since the surgery, the wound has been cleaned and dressed. A home care nurse comes every few days to take my vitals and to take a look at the incision. Earlier this week, a bit of infection was detected. I went to Solantic for a culture and we are waiting to find out the results. Yeah!