LIVING SUCCESSFULLY WITH HEART FAILURE

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PALOMAR POMERADO HEALTH SPECIALIZING IN YOU
Living Successfully with Heart Failure
HMJ1 12.07
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Table of Contents

• Welcome 3
• Contact Information 4
• Introduction 5
• What is Heart Failure? 6
• What Causes Heart Failure? 7
• Other Questions to Ask 8
• How Does it Feel to Have Heart Failure? 10
• What Should Concern Me? 11
• Taking Care of Yourself 12
• Weigh Yourself Daily 13
• Take Your Medications Exactly as Directed 14
• Types of Medications 15
• It Helps to Eat Food High in Potassium and Low
  In Sodium 18
• Follow a Low Sodium Diet 19
• Herb Seasoning Suggestions 20
• Dining Out 21
• Guidelines for a 2 gram (2000 mg) Sodium Diet 22
• Reading Food Labels 23
• Sample Food Label 24

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Welcome to Palomar Pomerado Health (PPH). The
mission of PPH is to heal, comfort, and promote
health in the communities we serve. Our vision is
that PPH will be the health system of choice for
patients, physicians, and employees and be
recognized nationally for the highest quality of
clinical care and access to comprehensive
services. Our goal is to provide you with
excellent healthcare. Our visiting policy is
individualized and flexible based on the needs of
our patients and family members. The packet you
are receiving has general information you may
find helpful in dealing with your condition, or
your loved ones condition. Additional handouts
will be given to you for any other risk factors
that may be present. Handouts are available for
medications you may be taking or will take at
home. These handouts will be given to you when
you are admitted and others may be added before
you go home. Your nurse or your primary
healthcare provider can answer any questions you
may have. We encourage you to write down your
questions or comments on the Notes pages
provided at the back of this booklet. Please use
these pages to speak to your nurse or primary
healthcare provider about anything regarding your
hospital stay with PPH. We want your experience
to be as pleasant as possible. If we can help you
with anything, please do not hesitate to ask. For
any questions, comments, or concerns, please call
the nurses station directly for immediate
assistance.
Pomerado Hospital All prefixes are
1-858-613 Medical/Surgical/Telemetry, 4th floor
4440 Medical/Surgical/Telemetry, 3rd floor
4340 Critical Care/Intermediate Care, 2nd Floor
4339
Palomar Medical Center All prefixes are
1-760-739 Surgical, 8th Floor 3840 Medical/Oncolo
gy, 7th Floor 3740 Intermediate Care, 7th Floor
3790 Telemetry, 6th Floor 3640 Critical Care,
6th Floor 3655 Orthopedic/Stroke, 5th Floor 3540
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Contact Information

• Please write down important contact information
  in the spaces below. You may want to share this
  information with family members and friends.
• Doctor Treating Me for Heart Failure
• Name ________________________________
• Address ______________________________
• City _______________ State _____
• Zip code _________
• Phone number _________________________
• Other Important Phone Numbers
• Ambulance, fire department, or emergency
  services 911
• Pharmacy _____________________________
• Other doctors or nurses _________________________
  __________________________________________________
  _________________________________

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Introduction
Many people with heart failure lead normal,
active lives. They do so because they have
learned to take good care of themselves. This
book is designed to help you learn to live
successfully with heart failure. We want you to
learn about your body, the disease, and methods
of treatment. You can take control over heart
failure by carefully following proper medication
advice and healthy lifestyle changes. If you do
so, you too may be able to lead an active and
satisfying life!This booklet provides basic
information on heart failure. It will help you
?Understand your treatment plan ? Learn how to
actively work with your doctor or nurse so you
can feel better ? Learn how to overcome common
stumbling blocks in following your treatment plan
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What Is Heart Failure?
Many people misunderstand exactly what heart
failure means. Heart failure does not mean that
your heart has stopped or is about to stop. Heart
failure is a serious illness in which the heart
doesnt pump blood through your body as well at
it should. Your heart still beats, but it pumps
less nutrient-and oxygen-rich blood to the rest
of your body. Because of this, heart failure can
make you feel tired or weak. Heart failure can
also cause swelling and fluid buildup in your
legs, feet, and even your lungs. Fluid backing up
into the lungs is often referred to as
congestion, which is why heart failure is
sometimes called congestive heart failure or
CHF.
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WHAT CAUSES HEART FAILURE?
What Causes Heart Failure?

• Heart failure usually occurs when another problem
  makes the heart weak or stiff so it doesnt pump
  or fill normally. Coronary artery disease is a
  common cause of heart failure. Other causes
  include previous heart attack, high blood
  pressure, infection of the heart muscle, lung
  disease, and problems with the heart valves.
  Ask
  your primary healthcare provider what causes your
  heart failure. There may be special things you
  can do to care for yourself that are not included
  in this booklet.
• The cause of my heart failure is
  __________________________________________________
  _
• __________________________________________________
  _
• __________________________________________________
  _ _______________________________________________
  ____

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Other Questions to Ask

• Asking questions can help you talk about heart
  failure with your doctor or nurse. Talking with
  your healthcare providers will help to ensure you
  are receiving the best possible care. Your health
  is an active partnership between you and your
  doctor or nurse.
• Do I have blockages in my coronary arteries?
• Reason for asking this question Coronary artery
  disease is a common cause of heart failure. With
  this disease, blockages in the coronary arteries
  decrease or cut off the blood supply to portions
  of the heart muscle. It can be possible to open
  the blockages and restore blood supply to the
  heart. This can improve heart function and reduce
  your symptoms. Knowing if your heart failure is a
  result of blocked coronary arteries can help your
  doctor plan the best treatment for you.
• Is my blood pressure high?
• Is my blood pressure under control?
• Reason for asking this question High blood
  pressure is a cause of heart failure and it can
  make heart failure worse. Reducing blood pressure
  to normal levels is a way to reduce strain on the
  heart. It is important to know whether your blood
  pressure is under control. Your doctor can help
  to make sure it is managed well.
• Are my heart valves damaged?
• Reason for asking this question Heart valve
  damage is a cause of heart failure. Sometimes,
  valve damage can be repaired so that heart
  failure improves.

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Other Questions to Ask

• What is my heart function (ejection fraction or
  EF)?
• Reason for asking this question Heart function
  is commonly assessed by using a number call the
  ejection fraction. The ejection fraction is not a
  number of the amount of heart muscle that is
  still working rather it refers to the percentage
  of blood that is pumped out of the heart each
  time it beats.
• A heart will not pump out all of the available
  blood with each beat. A normal heart pumps out,
  or ejects, about 50-65 of the blood inside. If
  the heart is damaged, the ejection fraction can
  fall below 40. This is called systolic heart
  failure. You can have a normal ejection fraction
  and still have heart failure. This can be related
  to a condition called diastolic heart failure.
• An echocardiogram is commonly used to evaluate
  heart function. The test can tell you and your
  doctor about your heart and heart valve function.
  
• It is important to know your heart function
  because it can help to determine the severity of
  heart failure. It will also help to guide your
  care. Once your primary healthcare provider has
  evaluated your heart function, it is not
  necessary to keep testing it.

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How Does it Feel to Have Heart Failure?
People with heart failure often have the
following symptoms

• Shortness of breath, wheezing or coughing
• with activity
• Weakness or tiredness
• Problems with breathing when lying down
• Waking up at night coughing or short of
• breath
• Swollen ankles, legs, belly, and/or feet
• Increased heart rate, or heart palpitations
• Loss of appetite
• Weight gain

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What Should Concern Me?
Just because symptoms are common does not mean
you should ignore them! Call your primary
healthcare provider for any of the following

• Increased ankle swelling
• Problems breathing at night
• Weight gain or loss of 2-3 pounds in 2-3 days or
  4 pounds
• in a 7 days or less
• A change in your ability to sleep
• ? An increase in coughing, wheezing, or shortness
  of breath
• ? Increasing fatigue
• ? Decreasing ability to be active
• ? Nausea and/or loss of appetite

• CALL 911 IMMEDIATELY if you have any of the
  following
• Prolonged chest pain that does not respond to
  nitroglycerin.
• Extreme shortness of breath or trouble breathing.
• Feel like passing out.
• You feel your pulse is irregular or rapid or feel
  a fluttering in
• your chest (palpitations).

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Taking Care of Yourself
The treatment of heart failure typically involves
several steps. The steps are listed here and
explained more later in this booklet.

• Weigh yourself daily
• Take your medications exactly
• as directed
• Follow a low sodium diet
• Avoid drinking excess fluids
• Avoid alcohol consumption
• Maintain a normal body weight
• Get regular exercise
• Know the warning signs of heart failure
• Stop Smoking

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Weigh Yourself Daily

• A sudden weight gain is one sign that you are
  retaining fluid.

• Weigh Yourself
• At the same time every day
• (preferably first thing in the morning)
• Without clothes or in lightweight clothing
• After you urinate
• Before you eat breakfast
• Write your weight down every day for your
  records.
• Bring your record with you when you visit your
  doctor
• If you have a weight gain or loss of 2-3 pounds
  in 2-3
• days OR 4 pounds in 7 days or less, call your
  primary
• healthcare provider.
• Daily Weights sheets are provided at the
  back of this booklet for your convenience.

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Take Your Medications Exactly as Directed

• Medications typically given for heart failure
  include

• Blood vessel dilators
• (ACE inhibitors, beta blockers and many
  others)
• Diuretics/water pills
• Aldactone, Spironolactone
• Potassium Supplements
• Heart strengtheners (Digoxin, Lanoxin or
  Digitalis)
• Medication Schedule sheets have been
  provided at the back of this booklet for
  your convenience. Use the
  sheets to keep track of the medications you take,
  how often you take them, why you take
  them, and if there are any special
  instructions for taking them given to you by
  your primary healthcare provider.

Blood vessel dilators can be ACE inhibitors,
beta blockers, or others. Blood vessel dilators
make the blood vessels relax so it is easier for
the heart to pump blood into vessels. Ask your
nurse or pharmacist for detailed instructions on
the medications you are given.
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Type of Medications

• ACE inhibitors work much like the other blood
  vessel
• dilators.
• Common ACE inhibitors include Capoten
  (Captopril), Vasotec (Enalapril), Zestril
  (Lisinopril) and Altace (Ramipril). These drugs
  help to keep your heart failure from getting
  worse. Sometimes they even shrink an enlarged
  heart back to normal size. No matter how well you
  feel, do not stop taking this medication without
  your primary healthcare providers advice.
• Beta blockers are other drugs that relax the
  blood vessels and also relax the heart, possibly
  lessening the stress which may play a part in the
  heart failure.
• Common beta blockers include Carvedilol (Coreg)
  or Metoprolol (Toprol XL or Lopressor). They are
  used in stable patients and in combination with
  water pills and other blood vessel dilators.
• Some patients may initially gain weight, have
  swollen ankles, or shortness of breath.
• NOTIFY your primary healthcare provider if this
  happens.
• Some patients feel slightly weak or dizzy at
  first this effect usually goes away within a few
  days.
• Other vasodilators include Norvasc, Isordil,
  Apresoline, Minipress, Sorbitrate, and others.

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Type of Medications
Diuretics are water pills that help your kidneys
produce more urine. This results in less
fluid for your heart to pump. With less to
pump, the heart does not need to work so
hard. Commonly prescribed water pills include
Furosemide (Lasix), Bumex (Bumetanide),
Zaroxolyn (Metolazone), Hydrodiuril
(HCTZ), and Diuril (Chlorothiazide). Along
with an increase in urination, you may feel
thirsty. Thirst and urination are normal
effects of diuretics. Do call your primary
healthcare provider if you are taking
diuretics and experience Dizziness
Severe weakness Severe leg cramps Potassium
supplementation helps to control your heart
rhythm. Potassium is a mineral that your body
needs. Some water pills cause you to lose
potassium (KCL) along with urine. If this
happens, you may need to take extra
potassium. It is often prescribed in tablet,
liquid, or powder form. The liquid or powder
forms should be mixed in 3 to 4 ounces of
fruit juice or water to avoid stomach
upset. Liquid potassium is salty and bitter.
Do not let the taste keep you from taking this
essential medicine!

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Aldactone or Spironolactone are aldosterone
antagonists (hormone blockers). This
medication may be started in a low dose and
increased gradually. Blood potassium and
creatinine (for kidney function) will be closely
monitored the first few weeks of therapy
and then on a regular basis after that.
Your doctor may take you off all potassium
supplements if you are on this medication.
Digoxin (Lanoxin) is medicine that strengthen
the heart muscle help assure that more
blood is pumped with each beat. Digoxin, a
commonly used heart strengthener, is
usually taken once daily. Call your primary
healthcare provider if you feel any of
these possible side-effects Loss of
appetite, distaste for food or bad taste in the
mouth Nausea or vomiting
Bluish or yellowish vision
Skipped heart beats, dizziness, palpitations, or
rapid heart beating
Type of Medications
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It Helps to Eat Food High in Potassium and Low
In Sodium

• Dried fruits (raisins, prunes, apricots,
• figs, dates)
• Fresh fruits (bananas, cantaloupe,
• grapes, oranges, honeydew melon, fruit
• juices)
• Fresh vegetables (avocados, potatoes,
• beets, greens, spinach, peas, tomatoes,
• mushrooms)
• Dried vegetables (beans, peas)
• Fish (flounder, halibut)
• Fresh meats (turkey, beef)
• Decaffeinated coffee

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Follow a Low Sodium Diet
Getting Started A moderate 2 gram (2000 mg) per
day diet restriction is essential Ask your
primary healthcare provider how much sodium you
can eat. Table salt contains 40 sodium and 60
chloride, so use it sparingly. One teaspoon of
table salt contains about 2300 mg of sodium!
Sodium is a naturally occurring ingredient in
almost all foods. Fresh, unprocessed foods are
naturally low in sodium. High amounts of sodium
are found in many canned, pickled, convenience,
packaged, processed and fast foods. Give
yourself time to adjust to reduced sodium in your
diet. Remember, salt is an acquired taste and it
can be unlearned. Be patient and learn to enjoy
new flavors in foods. Salt Substitutes There
are two basic types of salt substitutes, the
herb type and potassium chloride. It is
important to know the difference because some
people should avoid the potassium chloride salt
substitute (common brand names being NuSalt or
NoSalt). You should discuss use of potassium
chloride (or KCl) as a salt substitute with your
primary healthcare provider before using it. This
compound may act as a strong drug for some
people. On the other hand, herb seasonings can be
enjoyed by almost everyone.
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Herb Seasoning Suggestions
Beef Curry, basil, bay leaf, dill, mustard,
onion or garlic, mushrooms, sage, tarragon,
thyme, grape, nutmeg, parsley, pepper. Chicken Clo
ves, pineapple, paprika, sage, tumeric, oregano,
cranberry. Fish Dill , curry, lemon rind and
lemon juice, tomato, ground pepper,
chervil. Pork Cloves, applesauce, caraway,
rosemary, thyme, chives, basil, onion or
garlic. Eggs Paprika, tarragon, parsley, onion,
jelly, curry, chervil, tomato, mushrooms. Vegetabl
es Garlic or onion, basil, dill, green pepper,
unsalted salad dressing, vinegar, tomato,
mushroom, mint, mace. Desserts Vanilla, extracts
of other flavorings, mace, nutmeg, cinnamon,
ginger, allspice. Spice blend recipe 1 tsp chili
powder 2 tsp ground oregano 2 tsp black
pepper 1 T garlic powder 3 T paprika 6 T onion
powder 3 T poultry seasoning Combine all
ingredients and store in an air tight
container.
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Dining Out

• Here are some suggestions for reducing sodium
  when eating in restaurants
• Choose foods without sauces or ask for the sauce
  on the side so you can
• control the amount you eat.
• Patronize those restaurants where food is cooked
  to order.
• Ask your server for chopped onions, chives,
  lemon, or other fresh herbs to use
• as flavorings.
• Frequent authentic ethnic restaurants. They
  often use fresh ingredients for
• flavor instead of relying on salt and
  processed (salt laden) foods.
• Ask the server to suggest some low salt
  alternatives.
• Choose ala carte and pick the most simple foods
  such a plain green salad,
• baked potato, etcetera.
• Carry your own herb seasoning blend with you.
• Suggestions For Reducing Sodium In Your Diet
• Eat fresh fish, meats, vegetables and fruits.
• Avoid convenience foods like soup, frozen or
  canned prepared main dishes
• such as TV dinners, ravioli, pot pies,
  pizza.
• Avoid sausages, luncheon meats, hot dogs, ham,
  bacon, and other cured or
• smoked meats, poultry and fish.

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Food Groups Suggested Daily
Servings MILK Limit to 3 cups per day (1 cup
8 oz.). VEGETABLES Unlimited fresh, frozen, and
low-sodium canned vegetables BREAD Limit
to 5 servings per day (1 serving
1 slice bread or 1 dinner roll).
If you eat more than 5 servings per day,
switch to Low Sodium bread. Avoid all quick
breads such as biscuits, pancakes, waffles
and corn bread self-rising flours stuffing
mixes regular bread crumbs
breads/rolls/crackers with salted
tops. PASTA/RICE/BEANS Unlimited. Avoid
commercially prepared rice pasta
mixes. CEREALS Unlimited unsalted cereals
such as cooked cereals (non-instant) and
puffed wheat or rice. FRUIT Unlimited
fresh, frozen or canned. MEAT/POULTRY/ 6
oz. per day (1 egg 1 oz. Meat) EGGS/EGG
SUBSTITUTE MISCELLANEOUS Crackers,
popcorn, pretzels, nuts. Unsalted only,
peanut butter, cheese, butter, margarine.
SOUP Low sodium only. CARBONATED
BEVERAGES Limit to no more than 50 mg.
sodium per day from this source. DESSERTS
Limit desserts (cake, cookies, pie, etc.) to
1 to 2 servings per day.
Guidelines for a 2 gram (2000 mg) Sodium Diet
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Reading Food Labels
It is important that you read food labels to
determine the sodium content of foods. Sodium
content is expressed in milligrams (mg) per
serving. It may also be helpful to know that
certain words used on labels must mean what they
say as defined by the government Key
Words Meaning Sodium Free negligible sodium
(less than 5 mg per serving) Very Low
Sodium 35 mg sodium or less per serving Low
Sodium 140 mg sodium or less per serving Less
Sodium 20 sodium reduction from the original
product Reduced Sodium at least 25
reduction from the original product Light in
Sodium 50 sodium reduction from the original
product Unsalted Without Added Salt no
salt used during processing No Salt Added
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Nutrition Facts Serving Size 1/2 cup
(114g) Servings Per Container 4 Amount Per
Serving Calories 90 Calories
from Fat 30
Daily Value Total Fat 3g
5 Saturated
Fat 0g
0 Cholesterol 0mg
0 Sodium 300mg
13 Total Carbohydrate 13g
4 Dietary Fiber 3g
12 Sugars
3g Protein 3g Vitamin A 80
Vitamin C 60 Calcium 4
Iron 4 Percent Daily Values
are based on a 2,000 calorie diet. Your daily
values may be higher or lower depending on your
calorie needs Calories
2,000 2,500 Total Fat Less
than 65g 80g Sat Fat
Less than 20g 25g Cholesterol
Less than 300mg 300mg Sodium
Less than 2,400mg 2,400mg Total Carbohydrate
300g 375g Fiber
25g 30g Calories
per gram Fat 9 Carbohydrate 4
Protein 4
Serving Size Always keep the serving size in mind
when you inspect the label because all of the
nutrient categories are based on this.
Calories Total kilocalories per serving
Total Fat Total grams (g) fat per serving. Try
to limit fat calories unless you have trouble
gaining or maintaining your weight. Always try
to limit saturated fat, especially if you need to
lower your blood cholesterol level.
Sodium Total milligrams (mg) sodium per serving.
This is salt! The chemical name for salt is
sodium chloride. This label tells you that a
1/2 cup serving contains 300 mg of sodium.
Remember to limit your daily total to no more
than 2000 mg to 3000 mg.
Total Carbohydrate Total grams (g) of
carbohydrate per serving. Sub-categories
identify the amount of added sugars and
nutritionally important dietary fiber.
Protein Total grams (g) protein per serving.
Choose the lean sources of animal protein such as
lean red meat, poultry, fish and fat-free or
lowfat milk. Or, try vegetable protein sources
such as beans, cereals and grains.
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Avoid Drinking Too Much Fluid

• Most people with heart failure can drink normal
  amounts of fluid. Do not restrict your fluids
  unless specifically told to do so by your primary
  healthcare provider. But, everyone with heart
  failure should avoid excess fluids try around
  48oz 64oz or
• 1.5 2 liters a day.
• Drink fluids at intervals throughout the day
• Avoid drinking large amounts of fluid all at
  once

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Limit Alcohol Consumption

• As a general rule, you should not drink alcohol
  at all. It damages heart cells and can further
  weaken your already-weak muscles. Any alcohol
  use is strongly discouraged. Ask your primary
  healthcare provider what is right for you.

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Stop Smoking Now

• Smoking can make heart failure worse, so if you
  smoke, you should stop immediately.
• Quitting takes hard work and a lot of effort, but
  you CAN quit smoking.
• For counseling or to register for PPH Kick the
  Habit Program, please call the Cancer Resource
  Center at [phone] or [phone].

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Relapse Prevention for New Non-smokers

• Think of yourself as a non-smoker.
• Decide that cigarettes, or any tobacco products,
  are not an option!
• Refer to yourself as a non-smoker, not as an
  ex-smoker
• Watch out for the top 3 triggers.
• Being around smokers
• Alcohol
• Highly emotional situations
• (Remember to watch yourself for your personal
  triggers as well.)
• You can manage your weight when you quit.
• Stay active
• Drink water and eat healthy meals
• Keep low-fat, low-calorie snacks on hand
• (Remember to follow the specific dietary or fluid
  guidelines and/or restrictions that your primary
  healthcare provider has discussed with you.)
• You can manage stress when you quit.
• Incorporate stress reducing activities in your
  new lifestyle
• Use stress management techniques

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Know Your Diabetes Risk

• Type Two Diabetes Mellitus (Type 2 Diabetes) is a
  metabolic disorder characterized by the bodys
  inability to produce enough insulin and or the
  body cells being resistant to insulin. Therefore,
  there is an abnormal elevation of blood sugar.
• Why should I be concerned to know if I have Type
  2 Diabetes?
• Type 2 Diabetes rarely occurs alone. People that
  are newly diagnosed with Type 2 Diabetes usually
  already have a disease such as High Blood
  Pressure and/or Abnormal Cholesterol levels. High
  blood sugar is not just high blood sugar. If
  left untreated, high blood sugar will harm large
  and small blood vessels every cell of your body
  is affected.
• What are the risk factors of Type 2 Diabetes?
• Diabetes is more common in African Americans,
  Latinos, Native Americans, Asian Americans, and
  Pacific Islanders (however, Type 2 Diabetes is
  seen across all race / ethnic groups).
• Age over 45 (the older one gets the higher the
  risk however children as young as 8 years of
  age are being diagnosed with Type 2 Diabetes).
• First-degree relative (sibling or parent) with
  Type 2 Diabetes.
• Overweight, especially being overweight around
  the belly (apple shape).
• Sedentary (inactive) lifestyle.
• Women who had gestational diabetes or gave birth
  to at least one baby weighing more than 9 pounds
  (if your mother had gestational diabetes while
  pregnant with YOU, you are at risk).
• Having other health problems such as High Blood
  Pressure, Abnormal Cholesterol, and other
  Cardiovascular Diseases.
• Other co-existing factors that could increase
  your risk smoking, continual high stress
  levels, and depression.
• The more risk factors you have, the more at risk
  you are of developing or having Type 2 Diabetes.
• Dont Ask Dont Tell Absolutely NOT!
• Uncontrolled diabetes is the leading cause of
  blindness, renal failure, and limb amputations
  (not associated with injuries).
• The leading cause of death in the United States
  is heart disease (68 of these people had
  diabetes).

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Get Regular Exercise

• We used to believe that people with heart failure
  should rest, rest, rest. Now we know that regular
  exercise is essential! Even short periods of bed
  rest cause weakness. Research shows that you can
  exercise safely.
• Remember to talk to your primary healthcare
  provider first before starting an exercise
  program.
• Along with prescribed medication, exercise will
• ? Help you feel better stronger and with less
  breathing trouble.
• ? Help you to walk farther, work or shop with
  less fatigue and enjoy fun activities longer.
• ? Help you sleep better at night.
• ? Help maintain and/or improve your balance and
  help prevent falls.
• ? Help you lose weight if needed.
• ? Help you feel more positive and confident.
• Help you relieve some stress.
• Which type of exercise is the best?
• The best exercise for your heart is
  aerobic exercise. Pick activities that are
• continuous and have a smooth flow
• Walking
• Riding a bicycle (stationary or regular)
• Swimming
• Water exercise or walking in a pool

31
Exercise Routines

• How much exercise is enough?
• Start off slowly. Increase the time and level of
  activity gradually. Remember that any time you
  spend a day or more in bed or in the hospital,
  you will be weaker than usual. Let your body be
  your guide.
• How long should I exercise?
• Start with 2-5 minutes of easy walking. Rest for
  2-5 minutes.
• Then do 2-5 minutes more of easy walking.
• As you become stronger, gradually increase your
  walking time.
• Keep your rest time at 1-2 minutes.
• Keep doing this until your total exercise time is
  about 20 minutes. When you can walk for 20
  minutes without stopping, slowly increase your
  walking time to 30-40 minutes.
• If you start having trouble breathing or feel
  worn out, you have done too much. Stop, rest,
  and make sure to do less the next time.
• You dont have to do all of your activity at once
  either. For example, you can go on two short
  walks instead of one long one.
• How often should I exercise?
• Try to exercise 4-6 days each week if you feel
  well.
• Make exercise a part of your daily routine, like
  daily weights and taking your medicines. The key
  is to get moving as many days as you can.
• How hard should I exercise?
• Keep your effort light and comfortable. You
  should be able to walk and talk
• at the same time. If you have trouble breathing
  or feel worn out, you are
• doing too much. Do not push yourself.

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Exercise Smart

• Listen to your body. Rest when you are tired,
  relax when you are under stress, and let your
  healthcare team know when you are not feeling
  well.
• Choose activities that you enjoy. Exercise with a
  buddy if you can.
• As you exercise, stay slow and steady. Avoid
  activities that require a quick burst of energy.
  Keep your effort light to moderate.
• If you exercise shortly after taking your
  medicines, you may become dizzy or faint. A
  change in timing of exercise will often relieve
  this problem.
• Avoid extreme heat or cold. If it is hot or humid
  out, move your workout indoors to a cooler time
  of the day. Walk in a shopping mall or follow an
  exercise video at home (pick an easy one).
• Drink enough fluids to stay hydrated depending on
  your fluid allowance.
• Any time of the day is fine for exercise. But
  wait at least two hours after a large meal. Also,
  do not exercise if you have not eaten for a long
  time. A light meal 1-2 hours before exercising is
  ideal.
• If you get tired easily, walk on flat ground when
  possible.
• Dirt or cinder walking tracks, grass playing
  fields, parks, nature trails, and golf courses
  are wonderful for walking. Wear loose fitting
  clothes and comfortable walking shoes. Running
  shoes may be easier on your feet.
• Before you exercise, warm up for a few minutes
  by doing your activity at a slow pace. This will
  help blood flow to your muscles and ease you into
  the exercise. After the warm up, do some
  stretching. This will keep your muscles flexible
  and lower your risk of injury.
• After you finish your exercise, ease into a cool
  down phase. Do this by repeating your warm up
  routine for a few minutes. Always allow some time
  after your activity to rest and relax.

33
Exercise Smart

• Skip exercise any day that
• You are not feeling well.
• You have had a weight gain over 2-3 pounds in 2-3
  days or 4 pounds in 7 days or less. Be sure to
  call your primary healthcare provider if this
  happens.
• You have unusual ankle swelling or bloating in
  your stomach.
• You are having more trouble breathing, or are
  coughing or wheezing.
• Stop exercising immediately if you feel any
• Pressure or pain in your chest, neck, arm, jaw or
  shoulder.
• Dizziness, lightheadedness or nausea.
• Unusual shortness of breath.
• Unusual tiredness.
• Heartbeat that feels unusual - too fast, too
  slow, or feeling like your heart is skipping a
  beat.
• Any other symptom that causes you concern.
• Call your healthcare provider for
• Shortness of breathing lasting 10 minutes or
  more.
• Dizziness or lightheadedness.
• Chest pain.
• Nausea, vomiting or cold sweat.

34
Suggestions for Energy Conservation

• Plan Ahead and Organize Your Work
• change storage of items to reduce trips or
  reaching
• delegate when needed
• combine motions and activities and simplify
  details
• Schedule Rest
• balance periods of rest and work
•  rest before fatigue
• frequent, short rests are beneficial
• Pace Yourself
• moderate pace is better than rushing through
  activity
•  reduce sudden or prolonged strains
• alternate sitting and standing
• Practice Proper Body Mechanics
• when sitting, use well-supporting chair
• adjust work heights-work without bending over
• bend at knees and hips, not at back
• carry several smaller loads or use a cart
• Limit Overhead Work
• use long handled tools

35
Suggestions for Energy Conservation Activities
of Daily Living

• Washing Bathing
• Wash hair in shower, not over sink
• Sit and use a terry robe instead of drying off
  with a towel
• Use a shower organizer over the shower head to
  avoid leaning and reaching
• Use safety strips on the floor of the tub
• Install a grab rail
• Use a shower bench or lawn chair to sit while
  showering
• Use a handheld shower while sitting
• Use moderate temperature water rather than hot
• Use a long-handled sponge or brush to reach feet
  and back
• Grooming/Hygiene
• Sit when grooming
• Don't lean forward unsupported
• Rest elbows on counter or dressing table
• Use long-handled brushes or combs to avoid
• holding arms overhead
• Use elevated commode seat
• Dressing
• Loose fitting clothes allow you to breathe more
  easily

36
Suggestions for Energy Conservation Activities
of Daily Living

• Doing Laundry
• Use a laundry cart on wheels
• Use an automatic washer and dryer if possible
• Sit to transport clothes to the dryer if possible
  
• Use a commercial pre-wash instead of scrubbing
• Wash bras and socks in a lingerie bag to avoid
• tangling
• Drain hand washables and press the water out
• instead of wringing
• Sit when ironing
• Adjust the ironing board height
• Slide the iron onto an asbestos pad between items
  to avoid lifting
• Use a lightweight iron
• Hang clothes on the doorknob instead of the top
  of the door
• Taking Care of the Kids
• Plan activities around the table or in the living
  room to allow sitting
• Instead of going to the zoo, go to the park where
  you can sit or lie down
• Delegate some of the childcare responsibilities
  if possible
• Teach smaller children to climb on lap instead of
  being lifted

37
Suggestions for Energy Conservation Activities
of Daily Living

• Preparing Meals
• Assemble all ingredients before you start
• Use cookware you can serve from
• Use smaller appliances (mixers, toaster,
• microwave)
• Use electric knife and can opener
• Buy ergonomically designed utensils
• Transport items on a rolling cart
• Store frequently used items at chest level to
  avoid bending and stretching
• Line ovens and burner drip pans with aluminum
  foil
• Sit while preparing food
• Rest elbows on table or counter
• Let dishes soak rather than scrubbing
• Let dishes air dry
• Use a dishwasher if possible
• Delegate dishwashing
• Use a jar opener
• Use a rubber mat or towel under mixing bowls to
  help steady them when mixing
• Don't lift heavy pans off the stove

38
Suggestions for Energy Conservation Activities
of Daily Living

• Walking/Moving
• Wear low-heeled shoes
• Wear shoes with a shock-absorbent sole or insole
• Use a wheelchair for long trips (the mall for
  example)
• Maintain good posture when retrieving
• Use cruise control if possible
• Install hand rails and ramps
• Place chairs strategically to allow stops
• Disconnect automatic door closing mechanisms
• Housekeeping
• Spread tasks out over the week
• Do a little bit each day
• Delegate heavy work
• Hire help
• Use a wheeled cart or carpenter's apron to carry
  supplies
• Do whatever you can sitting
• Use long-handled duster, mop etc.
• Use a long-handled dust pan
• Shopping

Note "Suggestions for Energy Conservation" was
written by Eileen Donovan, PT, Med. A physical
therapist at the University of Texas M.D.
Anderson Cancer Center. The publisher and author
grant permission to photocopy these "Suggestions
for Energy Conservation" so that they can be
shared with patients.
39
Make This Plan a Permanent Part of Your Life

• The attention you give to following your
  treatment plan will pay off for you! You can
  improve your ability to be active and your
  quality of life by following this treatment plan.
  We know that following a treatment plan can be
  difficult. If you are having trouble sticking to
  your treatment plan, please do not change
  anything. Talk with your nurse or primary
  healthcare provider for help!
• The Hurdles People Often Experience Are
• Cost of medicines
• Side-effects of medicines
• Lack of time to exercise
• Complexity of treatment
• Difficulty following recommended diet

We can help and we want to help. Talk with your
nurse or primary healthcare provider about these
barriers and we can work out solutions together!
We are here for you!
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