“Cardiac rehab therapists work with patients who have chronic heart disease or who have had heart surgery to improve wellness and strength.”

American Heart Association

National Cardiac Rehabilitation Week

Cardiac rehabilitation, also called cardiac rehab, is a customized outpatient program of exercise and education. Cardiac rehabilitation is designed to help you improve your health and help you recover from a heart attack, other forms of heart disease or surgery to treat heart disease.

Cardiac rehabilitation often involves exercise training, emotional support and education about lifestyle changes to reduce your heart disease risk, such as eating a heart-healthy diet, keeping a healthy weight and quitting smoking.

The goals of cardiac rehabilitation include establishing an individualized plan to help you regain strength, preventing your condition from worsening, reducing your risk of future heart problems,C and improving your health and quality of life.

Research has found that cardiac rehabilitation programs can reduce your risk of death from heart disease and reduce your risk of future heart problems. The American Heart Association and American College of Cardiology recommend cardiac rehabilitation programs.

Why is this rehab. done?

Cardiac rehabilitation is an option for people with many forms of heart disease. In particular, you may benefit from cardiac rehabilitation if your medical history includes:

Heart attack/Coronary artery disease/Heart failure/Peripheral artery disease/Chest pain (angina)/Cardiomyopathy/Certain congenital heart diseases/Coronary artery bypass surgery/Angioplasty and stents/Heart or lung transplant/Heart valve repair or replacement/Pulmonary hypertension.

Don’t let your age hold you back from joining a cardiac rehabilitation program. People of all ages can benefit from cardiac rehabilitation.

Cardiac rehabilitation isn’t appropriate for everyone who has had heart disease. Your health care team will evaluate your health, including reviewing your medical history, conducting a physical examination and performing tests, to make sure you’re ready to start a cardiac rehabilitation program.

Rarely, some people suffer injuries, such as strained muscles or sprains, while exercising as a part of cardiac rehabilitation. Your health care team will carefully monitor you while you exercise to lower this risk and will teach you how to avoid injuries when you exercise on your own. There is also a small risk of cardiovascular complications.

During cardiac rehabilitation

The first stages of most cardiac rehabilitation programs generally last about three months, but some people may be in programs for a longer period. In special situations, people may be able to do an intensive program that may last one or two weeks, several hours a day. During cardiac rehabilitation, you’ll likely work with a team of health care professionals, which may include cardiologists, nurse educators, nutrition specialists, exercise specialists, mental health specialists, and physical and occupational therapists.

Cardiac rehabilitation includes:

  • Medical evaluation. Your health care team will generally perform an initial evaluation to check your physical abilities, medical limitations and other conditions you may have. Ongoing evaluations can help your health care team keep track of your progress over time.During your evaluation, your health care team may look at your risk factors for heart complications, particularly during exercise. This can help your team tailor a cardiac rehabilitation program to meet your individual needs, and the team can make sure it’s safe and effective for you.
  • Physical activity. Cardiac rehabilitation can improve your cardiovascular fitness through physical activity. Your health care team will likely suggest low impact activities that have a lower risk of injury, such as walking, cycling, rowing, jogging and other activities. You’ll usually exercise at least three times a week. Your health care team will likely teach you proper exercise techniques, such as warming up and cooling down.You may also do muscle-strengthening exercises, such as lifting weights or other resistance training exercises, two or three times a week to increase your muscular fitness.

    Don’t worry if you’ve never exercised before. Your health care team can make sure the program moves at a comfortable pace and is safe for you.

  • Lifestyle education. You’ll usually receive support and education on making healthy lifestyle changes, such as eating a heart-healthy diet, exercising regularly, maintaining a healthy weight and quitting smoking.Your health care team may give you guidance about managing conditions such as high blood pressure, diabetes and high cholesterol.

    You’ll likely have opportunities to ask questions about such issues as sexual activity. You’ll also need to continue taking any medications you’ve been prescribed by your doctor.

  • Support. Adjusting to a serious health problem often takes time. You may feel depressed or anxious, lose touch with your social support system, or have to stop working for several weeks.If you get depressed, don’t ignore it. Depression can make your cardiac rehab program more difficult, and it can impact your relationships and other areas of your life and health.

    Counseling can help you learn healthy ways to cope with depression and other feelings. Your doctor may also suggest medications such as antidepressants. Vocational or occupational therapy can teach you new skills to help you return to work.

Although it may be difficult to start a cardiac rehabilitation program when you’re not feeling well, you can benefit in the long run. Cardiac rehabilitation can guide you through fear and anxiety as you return to an active lifestyle with more motivation and energy to do the things you enjoy.

Cardiac rehabilitation can help you rebuild your life, both physically and emotionally. As you get stronger and learn how to manage your condition, you’ll likely return to a normal routine, along with your new diet and exercise habits.

It’s important to know that your chances of having a successful cardiac rehabilitation program rest largely with you. The more dedicated you are to following your program’s recommendations, the better you’ll do.

After cardiac rehabilitation

After your cardiac rehabilitation program ends, you’ll generally need to continue the diet, exercise and other healthy lifestyle habits you learned for the rest of your life to maintain heart-health benefits. The goal is that at the end of the program you’re confident to exercise on your own and you’re empowered to maintain a healthier lifestyle.


Cardiac rehabilitation is a long-term maintenance program, and you’ll generally need to continue the habits and follow the skills you learned in the program for the rest of your life. After about three months, you likely will have developed your own exercise routine at home or at a local gym.

You may also continue to exercise at a cardiac rehab center, a fitness center or a club. You may also exercise with friends or family. You may remain under medical supervision during this time, particularly if you have special health concerns.

Education about nutrition, lifestyle and healthy weight may continue, as well as counseling. To get the most benefits from cardiac rehabilitation, make sure your exercise and lifestyle practices become lifelong habits.

Over the long term, you may:

  • Gain strength
  • Learn heart-healthy behaviors, such as regular exercise and a heart-healthy diet
  • Cut bad habits, such as smoking
  • Manage your weight
  • Find ways to manage stress
  • Learn how to cope with heart disease
  • Decrease your risk of coronary artery disease and other heart conditions

One of the most valuable benefits of cardiac rehabilitation is often an improvement in your overall quality of life. If you stick with your cardiac rehab program, you may come out of the program feeling even better than before you had a heart condition or had heart surgery.


“Gout is a condition caused by accumulation of excess of uric acid in the bloodstream which deposits unwanted in the joints of the body. Gout can damage the hearing capacity of the ears and in severe cases can affect the kidney functions.”



Part II What is Gout? Knowing what factors increase uric acid & what severe conditions that can develop if with Gout.


You’re more likely to develop gout if you have high levels of uric acid in your body.

Factors that increase the uric acid level in your body include:

  • Diet. Eating a diet that’s high in meat and seafood and high in beverages sweetened with fruit sugar (fructose) promotes higher levels of uric acid, which increases your risk of gout.
  • Alcohol consumption, especially of beer, also increases the risk of gout.

  • Obesity. If you are overweight, your body produces more uric acid and your kidneys have a more difficult time eliminating uric acid, which greatly increases your risk of gout.
  • Medical conditions. Certain diseases and conditions make it more likely that you’ll develop gout. These include untreated high blood pressure and chronic conditions such as diabetes, metabolic syndrome, and heart and kidney diseases.
  • Certain medications. The use of thiazide diuretics — commonly used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone an organ transplant.
  • Family history of gout. If other members of your family have had gout, you’re more likely to develop the disease.
  • Age and sex. Gout occurs more often in men, primarily because women tend to have lower uric acid levels. After menopause, however, women’s uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 30 and 50 — whereas women generally develop signs and symptoms after menopause.
  • Recent surgery or trauma. Experiencing recent surgery or trauma has been associated with an increased risk of developing gout.

People with gout can develop more-severe conditions, such as:

  • Recurrent gout.

    Some people may never experience gout signs and symptoms again. But others may experience gout several times each year. Medications may help prevent gout attacks in people with recurrent gout. If left untreated, gout can cause erosion and destruction of a joint.

  • Advanced gout.

    Untreated gout may cause deposits of urate crystals to form under the skin in nodules called tophi (TOE-fie). Tophi can develop in several areas such as your fingers, hands, feet, elbows or Achilles tendons along the backs of your ankles. Tophi usually aren’t painful, but they can become swollen and tender during gout attacks.

  • Kidney stones.

    Urate crystals may collect in the urinary tract of people with gout, causing kidney stones. Medications can help reduce the risk of kidney stones.

Too much uric acid in the blood can result in uric acid crystals being formed and deposited in and around joints. Conditions that can impair the kidneys’ ability to eliminate uric acid also include:

Some types of kidney disease or certain drugs or lead poisoning.

Consuming too much purine-rich food (such as liver, kidney, anchovies, asparagus, consommé, herring, meat gravies and broths, mushrooms, mussels, sardines, and sweetbreads) can increase the uric acid level in blood. However, a strict low-purine diet lowers the uric acid level by only a small amount. In past times, when meat and fish were scarce, gout was considered a rich person’s disease.

Combining a high-purine diet with alcohol or beverages containing high-fructose corn syrup can worsen matters because all of these beverages can increase the production of uric acid and interfere with its elimination by the kidneys.

For unknown reasons, not all people who have hyperuricemia develop gout.

Risk Factors for the Development of Gout

Beer (including nonalcoholic beer) and liquor

Foods and drinks containing high fructose corn syrup

Certain foods and drinks containing high fructose corn syrup

Certain foods (such as anchovies, asparagus, consomme, herring, meat gravies and broths, mushrooms, mussels, all organ meats, sardines, and sweetbreads), low dairy intake, certain cancers and blood disorders (such as lymphoma, leukemia, and hemolytic anemia), certain drugs (such as thiazides diuretics, cyclosporine, pyrazinamide, ethambutal, & nictotinic acid), an under-active thyroid=hypothyroid- ism, lead poisoning, obesity, psoriasis, radiation therapy, Cancer chemotherapy, Chronic kidney disease, certain rare enzyme abnormalities, and starvation.



“Gout is a condition caused by accumulation of excess of uric acid in the bloodstream which deposits unwanted in the joints of the body. Gout can damage the hearing capacity of the ears and in severe cases can affect the kidney functions.”


Part I What is Gout. Understanding the disease, its symptoms, and how uric acid is removed normally by the body.

Gout is characterized by sudden, severe attacks of pain, redness and tenderness in joints, often the joint at the base of the big toe.

Gout — a complex form of arthritis — can affect anyone. Men are more likely to get gout, but women become increasingly susceptible to gout after menopause.

An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire. The affected joint is hot, swollen and so tender that even the weight of the sheet on it may seem intolerable.

Fortunately, gout is treatable, and there are ways to reduce the risk that gout will recur.

The signs and symptoms of gout almost always occur suddenly — often at night — and without warning. They include:

  • Intense joint pain. Gout usually affects the large joint of your big toe, but it can occur in your feet, ankles, knees, hands and wrists. The pain is likely to be most severe within the first four to 12 hours after it begins.
  • Lingering discomfort. After the most severe pain subsides, some joint discomfort may last from a few days to a few weeks. Later attacks are likely to last longer and affect more joints.
  • Inflammation and redness. The affected joint or joints become swollen, tender, warm and red.
  • Limited range of motion. Decreased joint mobility may occur as gout progresses.

Gout occurs when urate crystals accumulate in your joint, causing the inflammation and intense pain of a gout attack. Urate crystals can form when you have high levels of uric acid in your blood.

Your body produces uric acid when it breaks down purines — substances that are found naturally in your body, as well as in certain foods, such as steak, organ meats and seafood. Other foods also promote higher levels of uric acid, such as alcoholic beverages, especially beer, and drinks sweetened with fruit sugar (fructose).

 Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much uric acid or your kidneys excrete too little uric acid. When this happens, uric acid can build up, forming sharp, needle-like urate crystals in a joint or surrounding tissue that cause pain, inflammation and swelling.
Stay tune for Part II tomorrow!


“The average annual cost of scald injuries is 44 million dollars a year.  Over 136,000 children were seen in emergency rooms for burn injuries in 2011.  1100 children die each year from fire and burns.”

American Burn Association

Burn Awareness Week


This week is National Burn Awareness Week (NBAW) – which is an excellent opportunity to increase burn awareness and prevent fires from occurring! During NBAW, want to bring attention to fire safety and prevention to help lower the number of burn injuries.

Burn Injuries

Approximately every minute, someone in the United States endures a burn injury severe enough to require treatment. Lionel Crowther is one of the many firefighters who was injured while on duty. Crowther responded to what seemed to be a routine garage fire, but within minutes, a flashover occurred. When the fire was cleared, two fire captains had been killed, and Crowther was among four severely injured firefighters.


Unfortunately, Crowther’s story is not uncommon, but with an increased awareness of fire safety and prevention, we can lower the number of fire-related injuries and deaths together. NBAW is the perfect time to learn more about fire prevention and what you can do to prevent and prepare for a home fire.

  • Smoke Alarms: Did you know that three of every five fire deaths resulted from fires in homes with no working smoke alarms? Smoke alarms that are properly installed and maintained play a key role in reducing fire deaths and injuries. They should be installed on every floor and in every sleeping room. Be sure to test them once a month and replace the batteries at least once a year.
  • Fire Extinguishers: It is also important to have at least one fire extinguisher on every level, especially in the kitchen. In many cases, fire extinguishers are the first line of defense and often contain or extinguish a fire.
  • Escape Routes: Ensure that every room has at least two escape routes in case of a home fire. You may need to purchase escape ladders, especially for second story rooms. Escape ladders are not required by law, but they could be beneficial in case of a house fire. Once you establish escape routes, practice at least twice a year.
  • Teach: It is essential to teach the whole family about fire safety and what to do in case of an emergency. This includes making an emergency communications plan, knowing where to meet up outside, and making sure everyone knows how to call 9-1-1.


“According to a report from the American Heart Association, not only is heart disease the leading cause of death in this country, but heart failure is the leading cause of hospitalizations among adults 65 and over. Each year, 1 million patients are newly diagnosed, costing Medicare $17 billion.”

American Heart Association AHA


Left sided and Right sided Congestive Heart Failures!

chf-part-i  chf1


The definition of heart failure, it occurs when the heart loses its ability to pump enough blood through the body. Usually, the loss in pumping action is a symptom of an underlying heart problem, such as hypertension and CAD = coronary artery disease. The term heart failure suggests a sudden and complete stop of heart activity but actually the heart does not suddenly or abruptly stop. Instead the way it works is heart failure usually develops over time, years. The heart first compensates with the disease or illness the individual has but, just like a car, after wear and tear the heart goes into decompensating to heart failure due to the heart decline. How serious is this condition? It varies from person to person depending on factors like an individual with obesity & unhealthy versus a person in healthier condition. All people diagnosed or not diagnosed with heart failure lose a pumping capacity of the heart happens as they age but diagnosed with heart failure makes the engine of the body a challenge in doing its function properly. The pump loss is more significant in the person with heart failure and often results from a heart attack (actual scaring to the tissue=death to that tissue area) or from other diseases that can damage the heart. The severity of the condition determines the impact it has on a person’s life. At the other end, extremes, treatment often helps people lead full lives if the person follows the meds ordered by the doctor including the diet and activity/exercise the doctor orders to the patient with heart failure (compliance so important). There are different levels of heart failure but even the mildest form is a serious health problem, which must be treated. If not the pump (the heart) will just get worse in doing its function properly. To improve the chance of living longer in an individual with heart failure, patients must take care of themselves, see their physician (cardiologist) on a regular basis, and closely follow treatments (as ordered) with knowing what heart failure actually to understanding how the disease works (is the failure on the right side or left side? Which in time will effect the other side in time). In knowing what side the failure is on will make you understand what signs and symptoms to expect.


Types of Heart Failure


The term congestive heart failure (CHF) is often used to describe all patients with heart failure. In reality, congestion=the buildup of fluids in the heart for not pumping correctly, just like pipes in a home not working properly=back up of water in the pipes, happens with CHF also to the fluids (blood) backing up in the lungs.   This is just one feature of the condition and does not occur in all patients. There are two main categories of heart failure although within each category, symptoms and effects may differ from patient to patient. The two categories are:    1-Systolic heart failure (systolic is the top number of your blood pressure=the heart at work). This occurs when the heart’s (muscle-myocardium) ability to contract (pump=being active) decreases, particularly starting on the L side of the heart where the muscle of the heart is thickest and most powerful (myocardium=heart muscle). The left side of the heart sends the highly oxygenated blood that just came from the lungs to be pumped out throughout the body to send oxygen (nutrients) to all our tissues.   When the heart is in left sided failure it cannot pump blood with enough force to push a sufficient amount out of the heart into the circulation through the aorta. This is not sending nutrients=oxygen like it does when not in failure.  The aorta is a artery (vessel) that leaves the L side of the heart (left side of the heart=highly oxygenated rich blood). Due to the heart not using enough force pushing the blood forward in the aorta this causes the blood to back up and cause it to go back up from the aorta into the L lower to the L upper chamber of the heart that goes further back up into the pulmonary vein into the lungs=congestion in the lungs due to the heart failure.


2-Diastolic heart failure (diastolic is the bottom number of your blood pressure which is the pressure when the heart is at rest). This failure occurs when the heart has a problem relaxing. The heart cannot properly fill with blood because the muscle of the heart due to trying so hard to compensate over a long period of time with disease (ex. High B/P, Obesity, etc…) strains the heart in doing its function that failure finally starts that the muscle of the heart (myocardium) becomes stiff. This causes the heart to lose its ability to relax to allow proper filling of the heart in upper and lower chambers=back up of the blood.   This failure starts on the right side of the heart causing the blood to back up away from the heart and may lead this blood that is highly concentrated with carbon dioxide to accumulation especially in the feet, ankles and legs. Some patients may have lung congestion.


Causes of Heart Failure:


As stated, the heart loses some of its blood pumping ability as a natural consequence of aging. How- ever, a number of other factors can lead to a potentially life-threatening loss of pumping activity.


As a symptom of underlying heart disease, heart failure is closely associated with the major risk factors for coronary heart disease: smoking, high cholesterol levels, hypertension (persistent high blood pressure), diabetes= abnormal blood sugar levels, and obesity. A person can change or eliminate those risk factors and thus lower their risk of developing or aggravating their heart disease and heart failure through healthy habits performed routinely, proper dieting, and balancing rest with exercise.


Among prominent risk factors, hypertension-HTN (high blood pressure) and diabetes are PARTICULARLY IMPORTANT. Uncontrolled HTN increases the risk of heart failure by 200 %, compared to those who do not have hypertension.   Moreover, the degree of risk appears directly related to the severity of the high blood pressure.


Persons with diabetes have about a two to eight fold greater risk of heart failure than those without diabetes. Women with diabetes have a greater risk of heart failure than men with diabetes. Part of the risk comes from the diabetes association with other risk factors for heart disease such as high cholesterol or obesity or other risk factors. However, the disease process of diabetes also damages the heart muscle.


The presence of coronary disease is among the greatest risks for heart failure. Muscle damage and scarring caused by a heart attack greatly increase the risk of heart failure. Cardiac arrhythmias, or irregular heartbeats, also raise heart failure risk. Any disorder that causes abnormal swelling or thickening of the heart sets the stage for heart failure.


In some people, heart failure arises from problems with heart valves, the flap-like structures that help regulate blood flow through the heart. Infections in the heart are another source of increased risk for heart failure.


A single risk factor may be sufficient to cause heart failure, but a combination of factors dramatically increases the risk. Advanced age adds to the potential impact of any heart failure risk.


Finally, genetic abnormalities contribute to the risk for certain types of heart disease, which in turn may lead to heart failure. However, in most instances, a specific genetic link to heart failure has not been identified.