Potassium and food

Taken from here.

Foods to add to your diet

Foods are considered low in potassium if they contain 200 milligrams (mg) or less per serving.

Some low-potassium foods include:

• berries, such as strawberries and blueberries
• apples
• grapefruit
• pineapple
• cranberries and cranberry juice
• cauliflower
• broccoli
• eggplant
• green beans
• white rice
• white pasta
• white bread
• salmon

Foods to limit or avoid

Foods are considered high in potassium if they contain more than 200 mg per serving. These should be eaten in very small quantities, or avoided completely.

Limit high-potassium foods such as:

• bananas
• avocados
• raisins
• prunes and prune juice
• oranges and orange Juice
• tomatoes, tomato juice, and tomato sauce
• lentils
• spinach
• Brussels sprouts
• split peas
• potatoes (regular and sweet)
• pumpkin
• dried apricots
• brown or wild rice
• whole wheat products, including pasta and bread
• milk
• bran products
• low-sodium cheese
• nuts
• beef
• chicken
• tuna

How to leach potassium from fruits and vegetables

If you can, swap canned fruits and vegetables for their fresh or frozen counterparts. The potassium in canned goods leaches into the water or juice in the can. If you use this juice in your meal or drink it, it can cause a spike in your potassium levels.

The juice usually has a high salt content, which will cause the body to hold onto water. This can lead to complications with your kidneys. This is also true of meat juice, so be sure to avoid this, too.

Foods with low potassium

Foods with low levels of potassium

Grains	Foods prepared with white flour (eg, pasta, bread), white rice
Beverages	Non-dairy creamer, fruit punch, drink mixes (eg, Kool-Aid), tea (<2 cups or 16 ounces per day), coffee (<1 cup or 8 ounces per day)
Sweets	Angel or yellow cake, pies without chocolate or high-potassium fruit, cookies without nuts or chocolate
Fruits	Apples (1), apple juice, applesauce, apricots (canned), blackberries, blueberries, cherries, cranberries, fruit cocktail (drained), grapes, grape juice, grapefruit (½), mandarin oranges, peaches (½ fresh or ½ cup canned), pears (1 small fresh or ½ cup canned), pineapple and juice, plums (1 whole), raspberries, strawberries, tangerine (1 whole), watermelon (1 cup), lemons
Vegetables	Alfalfa sprouts, asparagus (6 spears), green or wax beans, cabbage (cooked), carrots (cooked), cauliflower, celery (1 stalk), corn (½ fresh ear or ½ cup), cucumber, eggplant, kale, iceberg lettuce, mushrooms (fresh), okra, onions, parsley, green peas, green peppers, radish, rhubarb, water chestnuts (canned, drained), watercress, spinach (raw, 1 cup), squash (yellow), zucchini, scallions, turnips, turnip greens
Proteins	Chicken, turkey (3 ounces), tuna, eggs, baloney, shrimp (all 1 ounce), unsalted peanut butter (1 tablespoon)
Dairy products	Cheddar or swiss cheese (1 ounce), cottage cheese (½ cup)
Nuts, seeds, and legumes	Macadamia nuts, pecans, cashews, walnuts, almonds, peanuts, sesame seeds, sunflower or pumpkin seeds, chia seeds, flax seeds (all 1 ounce)

Unless noted, one serving is ½ cup (4 ounces). These foods have a low level of potassium (less than 200 mg potassium per serving on average). Be sure to measure the portion sizes of each food and calculate the total amount in each meal to maintain your low-potassium diet (eg, average of 2000 mg potassium per day).

feeling blessed

This is a copy of my post to Facebook, on 21 September 2018:

I've been in and out of ERs and hospitals for close to a month. Had two operations that should've been fairly straightforward, but became high-risk because of my underlying IPAH - Idiopathic Pulmonary Arterial Hypertension, a terminal illness of the lungs, that affects the heart. I'm blessed to have come through it all so well because of my brilliant doctors at UMSC (University Malaya Specialist Centre), and the support of my husband and two children. I'm feeling good now, and fingers crossed, I'm discharged tomorrow. So I'll be back soon. I've missed you guys 😘

Pursed-lip breathing

Pursed Lip Breathing Helps Reduce Stress and Anxiety

Read the full article here.

Excerpt: "This way of breathing reduces the number of breaths you take by slowing your breathing. This keeps your airways open longer, allowing more air to flow in and out of your lungs. It also strengthens your respiratory muscles. Simply breathe in through your nose with your mouth closed and breathe out at least twice as long through tightly-pressed (pursed) lips. I breathe in for a count of two, and out for a count of four. You can use pursed lip breathing when you are short of breath to get your breathing back under control and calm yourself down."

do not stand at my grave and weep

by 

Mary Elizabeth Frye

SOB, but 'normal' oxygen levels

Read the full article here. Although the article is about COPD, it applies to PH as well.

Skeletal Muscle Abnormalities

Rising from bed – getting dressed – taking a shower – going to work – we rely upon our skeletal muscles to perform all our daily activities. Skeletal muscles are found throughout the body. Their primary role is that of supporting the skeleton and voluntarily moving the bones. When our muscles are fit and well-conditioned, daily activities are a breeze; when our muscles fatigue easily from prolonged disuse, daily activities are far more challenging.

Although COPD primarily affects the lungs, skeletal muscle abnormalities are a secondary consequence of the disease. Shortness of breath and fatigue, common symptoms of COPD, often cause patients to limit their physical activity for fear of worsening breathlessness. The vicious cycle of prolonged inactivity, fatigue, and increased breathlessness with exertion leads to decreased muscle fitness and weakness. Remaining immobile for long periods of time causes the skeletal muscles to slowly decrease in size and eventually atrophy, or waste away.2

How Do Skeletal Muscle Abnormalities affect Oxygen Saturation?

When your muscles are called upon to perform any type of physical task, they have to work harder, which increases their demand for oxygen; this is why exerting yourself increases your heart rate and breathing.  In contrast, calling upon weak muscles to perform physical activity requires much more effort, leading to greater fatigue and breathlessness, more so than if your muscles were fit. Take, for example, climbing 3 flights of stairs; even if you’re moderately active, you’re likely to experience some degree of breathlessness by the time you reach the top. Now imagine your muscles are extremely weak from inactivity; simply rising from a chair or walking across a room can lead to breathlessness.

Unlike shortness of breath directly related to lung impairment however, breathlessness caused by skeletal muscle abnormalities may not always correlate with oxygen saturation. This means it’s entirely possible to experience breathlessness, without seeing a drop in your oxygen saturation level.3

Exercise: The Key to Breathlessness

The answer to breathlessness from COPD, heart failure, and/or skeletal muscle dysfunction is exercise. In fact, the American College of Cardiology reports that people who have COPD and heart failure together are prime candidates for exercise training. What’s more, skeletal muscle abnormalities can be completely reversed by participating in an exercise training program or a cardiopulmonary rehabilitation program.3

exercise and PH

Taken for an article:

PH Patients Seen to Have Little Daily Exercise, Leading to Lower Odds of Survival, Study Finds

Some excerpts:

"International guidelines recommend that all adults should have at least two hours and 30 minutes a week of moderate exercise, or at least 75 minutes per week of vigorous exercise, to achieve optimal health."

      *****************************************

I walk for at least 30 minutes every day. Most days, it's 40 or even 50 minutes, if I'm feeling good, and I'm enjoying my music. Hahahaha. 

If I'm having a not-so-good day, I walk slowly. Otherwise, I walk as briskly as I can, but not manic lah. If I'm having an off day, I won't walk at all. 

My Fitbit monitors my heart, and usually I hit my peak heartrate.

If we go out, I don't wear the Fitbit, and just walk. The stupid thing only registers steps if I swing my hand!!! So, I could be out walking for 2 hours, and I won't even make my 3,500 steps, and that messes with my mind.

The 6-minute walk is how they asses how well we're doing. And how I much I walk and how I feel helps me monitor myself.

Susan Sontag's book

Below, are excerpts from Wiki about the book, which I would like to get my hands on.

Synopsis

Illness as Metaphor served as a way for Susan Sontag to express her opinions on the use of metaphors in order to refer to illnesses, with her main focuses being tuberculosis and cancer. The book contrasts the view points and metaphors associated with each disease. Tuberculosis was seen as a creative disease , leading to healthy people even wanting to look as if they were ill with the disease. However, lack of improvement from tuberculosis was usually seen as lack of passion in the individual. Tuberculosis was even seen as a sign of punishment by some religions, such as Christianity, leading the afflicted they deserved their ailment.^[2]

Sontag then made the comparison between the metaphors used to describe tuberculosis and cancer, with cancer being defined as a disease that afflicts people who lack passion, sensuality, and those who repress their feelings. Sontag also mentioned how multiple studies have found a link between depression and people afflicted with cancer, which she argues is just a sign of the times and not a reason for the disease, since in previous times physicians found that cancer patients suffered from hyperactivity and hypersensitivity, a sign of their time.^[2]

In the last chapter, Sontag argues that society's disease metaphors cause patients to feel as if society is against them. Her final argument is that metaphors are not useful for patients, since metaphors make patients feel as if their illness is due to their feelings, rather than lack of effective treatment.^[2] The most effective way of thinking about illness would be to avoid metaphorical thinking, and focus on only the physical components and treatment.^[3]

brain fog and migraines

Taken from here.

ronic low oxygen levels, sleep-related breathing disorders, lack of proper circulation, and gas exchange impairment are all factors that have contributed to the neurological consequences that have been more prominent in my life recently. Pulmonary hypertension affects more than just the heart and lungs. After recent neurocognitive testing, doctors confirmed that low oxygen and a buildup of CO2 have affected my brain and neurocognitive function. I frequently suffer from debilitating migraines, feel as though I am in a fog during the day, and notice that I have been having trouble learning and processing new information.

Before my pulmonary hypertension diagnosis, I was no stranger to migraines. Migraines are more than a headache. It’s the type of pain and discomfort that makes me sensitive to noise, touch, and sight. The type of migraine I get from lack of oxygen is different from other migraines I’ve previously experienced. The difference is that I usually don’t see an aura or have spotty vision beforehand.

My biggest warning sign that I’m having a hypoxia migraine is sensitivity to light and a sharp pain that feels like a shock at the back of my head. I try to pay attention to the warning signs before it gets this bad. To help limit this type of headache, I monitor my oxygen levels and make sure to stay well hydrated through the day. Staying proactive is an important part of managing symptoms. Luckily, these types of migraines are helped with an increase in oxygen flow, pain-management medication, and rest.

Not only do I feel pain from migraines as a result of low oxygen, but neurocognitive abilities are also affected. One of my most noticeable cognitive impairments is frequent episodes of brain fog. For me, this happens when I am speaking and listening to others. It’s as if I look completely alert but I am not taking in any of the information and am unable to repeat the information back to anyone. This can get difficult if others think I am not listening to them. I frequently will stop during the middle of a conversation and say, “What was I just saying?” I lose my train of thought in a matter of seconds, even if it’s a topic I’m very interested in.

Not only has brain fog limited my ability to have conversations, but it also has made me forget to take medications, or I take an extra dose of medicine by accident. These frights have made things clear: I need to treat my brain fog. I have been in the habit of writing everything down, using lists, having a pill organizer, and have made people more aware of my condition so they don’t think I’m “not listening.”

My memory, as well as my ability to learn and process information, have been noticeably different with my increase in oxygen demand. It frustrates me to think back to a time when I could easily memorize pages upon pages of information. I achieved almost a 4.0 grade point average upon graduating college. Now, unless I finish a book within a few days of starting it, I completely forget what I have read. It is hard for me to remember new information that I am learning and keep it in my short-term memory.

My recall and retrieval of new information is a struggle. I’m repeating myself often and looking back on things I have learned to try to trigger my memory. I’m upset when things around me feel as if they are new all over again. My response time to others and my surroundings is noticeably delayed. On days when others really can see this effect on me, I stay away from driving and use caution when doing daily activities.

It is difficult to feel the impact of pulmonary hypertension on various systems of the body. In my opinion, the most upsetting impact is the toll that it takes on neurocognitive functions and having to manage debilitating migraines. Not only is it frustrating when noticing these symptoms in yourself, but it also can be equally upsetting for others around you to notice changes.

What is PAH - chart

PH - what people think it is!!!

silencing our inner voice

An article I found here, which I reproduce below.

This is so me:

“You shouldn’t be sitting around all day. If you don’t get up and do something, people will think you’re just lazy.”

“You shouldn’t use your illness as an excuse to rest and take a break.” 

“Why can’t you get the energy to go out for drinks after dinner like everyone else? They won’t want to go out with you anymore because you can’t keep up like everyone else.” 

“Why could you work out yesterday but you can’t even move today? Mind over matter. Don’t let this limit you.”

This dialogue sounds like an abusive, degrading, and extremely negative encounter. Although it may seem like these are being said to me by someone else, the truth is, these are the inner thoughts that I tell myself. Living with a chronic illness takes a toll on the body, but also affects the mind.

On days I am physically feeling down and frustrated with the state of my health, I become self-critical. The dialogue taking place in my mind leaves me feeling defeated and ashamed of having a physical illness. I compare myself to others who are more physically able, judge myself based on what others my age can do, and try to convince myself that if I “just tough it out,” I could overcome how I’m physically feeling.

None of what I tell myself is true. As I manage my life with a chronic and life-altering condition, my worst critic is myself.

The reason many of us with chronic illness have inner conflicts is we feel our bodies are failing us. It’s easy for my mind to say there’s no one to blame but myself. When fueling my thoughts with self-blame, I try to remind myself that having a chronic illness is not something I have control over. The only thing I have control over is how I care for myself day-to-day.

Filling my thoughts with self-blame and criticism, and telling myself to “just move on,” is not how I should care for myself. It’s important to realize that chronic illness is not my fault. Feeling I have to hold myself responsible negatively impacts my mental health. It hinders my ability to care for myself in the best way possible. When my mind fills with negative thinking, I easily feel as though I’m not worthy of self-care.  

I’m extremely hard on myself when it comes to how I’m physically feeling, and also how I’m mentally coping. I tell myself, “You shouldn’t feel sad, you’re going to get depressed. There are people out there who have it way worse than you.” My critical side tells me that feeling depressed or overly anxious is a sign of weakness. Because of this, I fail to acknowledge my feelings of anxiety and depression as they arise.

With the help of a therapist, I am working on allowing myself to feel the sadness, frustration, and anger on days when it seems like my body isn’t doing what I want it to do. Recognizing these feelings as they arise allows me to express them appropriately and not store them away.

Managing a life with chronic illness is difficult. It’s easy to look for someone or something to blame when feeling out of control. When the body I am living in fails me, it’s no surprise that the easiest person to blame is myself.

I have a reason to feel upset about my illness. My anxiety, depression, anger, and frustration is valid. But when the inner critic voice creeps into my mind, I shouldn’t give into it. When I feel like giving in, I stop and think about the advice I would give to a friend in a similar situation. I would never tell someone struggling to “just get over it” and would never compare their bad day to someone else’s. I’ve learned that practicing kindness toward myself and being OK with not being OK is the greatest form of self-care. It’s time to silence the voice of my inner critic.

Flying with PH

Flying with pulmonary hypertension

Air travel with a lung condition - a good one

What happens to your body during a flight - for everyone, not just PH-ers

If you can walk 50 metres on the level without needing oxygen, at a steady pace, without feeling breathless or needing to stop, you are not likely to be troubled by the reduced pressure in aircraft cabins. - I've read this a couple of times, already. In some cases, they say 100 metres. 

drugs that interact with sildenafil:

I found this list here, and I thought I'd put the list down for easy reference, should the need arise.

List of drugs that may cause excessive decrease in blood pressure
_____________________________________________________

Nitrates:

Generic Name	BRAND NAME
Isosorbide dinitrate	DILATRATE-SR, ISORDIL, SORBITRATE
Isosorbide mononitrate	IMDUR, ISMO, MONOKET
Nitroglycerin	MINITRAN, NITRO-BID, NITRO-DUR, NITROSTAT, TRANSDERM-NITRO
Alpha Blockers
Generic Name	BRAND NAME
Doxazosin**	CARDURA**
Prazosin*	MINIPRESS*
Terazosin*	HYTRIN*
Tamsulosin**	FLOMAX**
Alfuzosin***	UROXATRAL***

Drugs that may cause sildenafil toxicity:

Generic Name	BRAND NAME
Amprenavir	AGENERASE
Aprepitant	EMEND
Atazanavir	REYATAZ
Clarithromycin**	BIAXIN**
Conivaptan	VAPRISOL
Cyclosporine	NEORAL, SANDIMMUNE
Darunavir	PREZISTA
Dasatinib	SPRYCEL
Delavirdine	RESCRIPTOR
Diltiazem**	CARDIZEM, CARDIZEM CD, DILACOR XR, TIAZAC**
Erythromycin	EES, ERYTHROCIN
Fluconazole	DIFLUCAN
Fluvoxamine**	LUVOX**
Fosamprenavir	LEXIVA
Grapefruit Juice
Imatinib	GLEEVEC
Indinavir	CRIXIVAN
Itraconazole*	SPORANOX*
Ketoconazole	NIZORAL
Lapatinib	TYKERB
Mifeprestone	MIFEPREX
Nefazodone*	SERZONE*
Nelfinavir	VIRACEPT
Posaconazole	NOXAFIL
Quinupristin	SYNERCID
Ritonavir	NORVIR
Saquinavir	FORTOVASE, INVIRASE
Telithromycin*	KETEK*
Troleandomycin	TAO
Verapamil	CALAN, CALAN SR, COVERA-HS, ISOPTIN, ISOPTIN SR, VERELAN
Voriconazole	VFEND
Zafirlukast*	ACCOLATE*