​Iron Deficiency in Women: Can You Be Iron Deficient Without Anemia?

Introduction: I felt strongly compelled to write this blog on heart failure as it is such a pertinent issue in the aging population today. Before I go into details on this, Id like to address the definition of this disease process. Heart failure occurs when the heart doesnt pump well and fails to deliver adequate oxygen to the body. As a result, fluid builds up in the body and vital organs dont get the blood that they need. This can make it harder for individuals to perform everyday tasks and can lead to eventual overall decline. Problem:Heart failure is the number one reason for hospital admissions in older adults, and often leads to multiple readmissions (Agarwal et. al., 2021). As a cardiac nurse for many years, I can attest to the fact that heart failure is the biggest reason for multiple hospitalizations in seniors. Patients come in and out for problematic symptoms, sometimes coming into the hospital as often as every month. The three biggest symptoms I see that result in hospital admissions are shortness of breath (particularly when lying flat), weight gain, and swelling in the legs.One reason for such frequent admissions is the complexity of heart failure itself. It is a complicated clinical syndrome and is notoriously difficult to manage. A lot is put on patients to manage their heart failure at home, and this can be a challenge. In addition, individuals may have some level of cognitive impairment or multiple other comorbidities, making it even more challenging to perform the extensive monitoring needed to prevent heart failure from worsening. The importance of education:Education is also important in the treatment of heart failure. Unfortunately, this often does not get done. When I first started working in acute care back in 2004, every patient received extensive education in managing their heart failure prior to discharge. Nurses would provide lengthy verbal education on the importance of medication adherence, daily weights, low salt diet, and other factors, in addition to providing the patient with a heart failure educational pamphlet prior to discharge. Over the years, however, hospitals have increasingly faced staffing shortages and high nurse turnover. As a result, a lot of important patient education is not getting addressed. A lack of awareness and understanding in patients on how to manage their heart failure is definitely a key reason for worsening heart failure and repeated hospitalizations. Management:From a clinician standpoint, the goal in addressing heart failure is twofold: we want to reduce symptoms and prevent mortality. The best way to do this is through patient/family education and implementation of a treatment plan. A proper treatment plan will include such lifestyle modifications as a low salt diet, quitting smoking, and getting regular physical activity. A low salt diet can be incredibly helpful in preventing further fluid build up in the body. The American Heart Association recommends that all individuals consume no more than 2,300 mg of sodium per day (AHA, 2024). In todays era of processed and packaged food, a majority of the American population consumes much more than that, and it comes in the food itself rather than the saltshaker. Maintaining a low sodium diet has one other priceless benefit that I often do not see emphasized enough in heart failure: it can help reduce blood pressure. Almost half of all heart failure patients have uncontrolled hypertension (Heart Failure, 2022). It is a major risk factor in the development of heart failure and managing it can greatly reduce heart failure symptoms and decrease stress on the heart. Current guidelines recommend maintaining a systolic blood pressure of less than 130. Medication management is another important factor in the management of heart failure. This often includes the use of diuretics, beta blockers, and other medication classes that I will not go into detail on. I wanted to discuss diuretics and beta blockers because these are the two medications in heart failure that I see non-compliance with the most. I witness individuals often not taking one or the other for two main reasons:  they either dont understand the importance of them or they dont like the side effects. Seniors can often have difficulty getting up to go to the restroom. Diuretics cause frequent trips to the restroom because their purpose is to get excess fluid off the body. Many individuals do not comply with their prescribed diuretic because of the hassle of frequent bathroom trips. Unfortunately, ineffective diuresis causes heart failure to worsen and puts further stress on the heart. I often see non-adherence to beta blockers due to their side effects. The two biggest symptoms that get reported to me are fatigue and dizziness. As in the diuretic, a beta blocker can also help reduce the stress on the heart, and heart failure symptoms can worsen if the prescribed dose is not adhered to. Its important to maintain prescribed medication regime and if any negative symptoms are experienced to discuss them with the doctor. One final thing:I wanted to touch on one final monitoring recommendation for heart failure because it so often gets missed: daily weights. Weighing oneself daily is of tantamount importance in heart failure and can identify early on if heart failure is worsening. This can lead to early intervention, thus decreasing potential hospitalization. Adherence to this all too often does not occur. I see patients come into the hospital for large amounts of weight gain often 20 or more lbs. Many patients report that they never stepped on the scale to assess for weight gain and often do not get admitted to the hospital until symptoms are severe such as severe weakness and shortness of breath. In heart failure its recommended to contact the doctor if weight goes up by more than 2 pounds in a day or greater than 4 pounds in a week. The doctor can make modifications in the treatment regime and hence reduce potential hospitalizations and mortality. Conclusion:Heart failure is complex but manageable. Early action can prevent hospital admissions, reduce mortality, and optimize quality of life. Having ongoing guidance from an experienced clinician can be of great benefit if you or your loved one is having difficulty managing heart failure and other disease processes. Please do not hesitate to reach out to me if you have any further questions. I want to help and make the process of aging as stress free as possible while promoting positive health outcomes.  My name is Laura Carson and I have been a Registered Nurse (RN) for over 20 years and have witnessed firsthand the challenges and complications that aging presents. It affects not only the aging themselves but also their families and loved ones. Health care is complex, and in this increasingly fragmented and overburdened system, it can be extremely helpful to have a professional oversee all aspects of care. As your eldercare manager, I will comprehensively assess the needs of your loved one and we will work together in establishing a care plan. I will assist you and your family with difficult decisions and help promote healthy communication on issues that are often difficult to address and navigate. Contact me for a 20 minute free consultation at 714-403-7040.  References:Blood Pressure and Glycemic Control Among Ambulatory US Adults With Heart Failure: National Health and Nutrition Examination Survey 2001 to 2018 (April 28, 2022). Heart Failure. Almost half of heart failure patients have uncontrolled hypertension and diabetesAgarwal, M., Fonarow, G., & Ziaeian, B. (February 10, 2021). National Trends in Heart Failure Hospitalizations and Readmissions From 2010 to 2017. https://pmc.ncbi.nlm.nih.gov/articles/PMC7876620/Weber, C. (May, 2023). Heart Failure Pharmacology.  How much sodium should I eat per day? (2024). American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day  

As we enter the fall and winter season this year, things look a little different. Many seniors continue to isolate at home because of the Coronavirus pandemic and this can take a toll on their mental health.Its important for seniors to work with their families, caregivers and health professionals to develop a plan that allows them to safely take part in activities they love and maintain positive mental health through activity and connection.At any age, our health and wellbeing are enhanced by regularly participating in the things that bring us purpose, hope and joy. For seniors, taking part in these activities can be more difficult, older people who feel younger than their age show less brain aging, better memory and less depression. And studies show that staying engaged is important for a seniors mental and physical health. Medical professionals recognize that social determinants of health, especially those that affect mental, social, emotional and spiritual wellbeing, impact health outcomes and quality of life.There are always opportunities for meaningful moments and joyful days with a little planning, conversation and intentional action.Fall ActivitiesFall activities tend to focus on connecting with loved ones, enjoying the  turning season and spending time outside before the weather gets icy.This year, many people cant see their favorite sports teams play in person. But fall is a dream for seniors that enjoy football, baseball and hockey and there are ways to participate virtually. Seniors and their loved ones can watch together over a video call or have a socially distanced viewing party at home, as long as everyone adheres to recommended safety guidelines.Enjoying fall foliage is an activity in itself, and can be done sitting on the porch, going for a short walk or on a longer hike outside. Raking leaves can even be fun when done with loved ones.Eating is another activity that seems to be more fun in the fall family dinners for those isolating together, baking projects and Halloween fun are all opportunities for seniors to participate in activities they enjoy while maintaining their nutrition goals. Winter ActivitiesThe holidays are filled with opportunities to enjoy music, celebrations with family and community service.Holiday shopping is a fun activity usually done outside of the house. However, online shopping may be the best way for seniors to get their gifts without visiting the mall.Singing, dancing, playing instruments and listening to holiday carols are ways that seniors can enjoy music, no matter what the weather looks like outside. Streaming music services often have a wide selection, allowing seniors to pick their favorites to listen to through a phone, virtual assistant or computer.While there are ways that seniors can serve others year-round, volunteering can be even more meaningful around the holidays. Finding virtual volunteer opportunities is even easier this year writing letters, knitting blankets and finding old coats and sweaters to donate can all be done safely at home. Comfort Keepers can HelpAt Comfort Keepers, we create individual care plans for every client. These plans include wellness goals that consider physical, mental and emotional health. Our caregivers can help support physician-prescribed diet and exercise plans, provide medication reminders, provide transportation to appointments and help seniors engage in the activities they love the most. And, our caregivers can help senior stay connected with loved ones through video chats, phone calls and care updates. We believe that every senior should experience the best in life. If you have questions about Comfort Keepers uplifting in-home care services, please contact us today. 

At some point, in life we all experience stress. Its not always a thing. Yet prolonged stress can lead to both emotional damage.  Different individuals experience stress in ways and understanding the triggers of your stress and effective methods to alleviate its symptoms can prevent the development of severe health problems down the line. Engaging in relaxation techniques may even proactively ward off stress before it escalates.  What signs indicate that someone is experiencing stress? Feeling stressed is your bodys way of responding to changes, in your life routine. Activities you're doing regularly. There are times when a little stress can push you to overcome fears or get things done; much stress can have negative effects on your well being.It's crucial to be aware of the signs of stress, on so that you can take steps to manage them right from the start.  Feeling queasy in the tummyExperiencing discomfort, in the chest area.Frequent head pain.Tightness, in the musclesFeeling tired or having trouble sleeping. Forgetting thingsFeeling easily annoyedSerious health issues could also lead to these symptoms appearing. It's crucial to discuss your symptoms with a healthcare provider at all times. If you experience symptoms such, as chest pains don't hesitate to seek medical help. What kinds of stress exist there? Sudden stress is normal and doesn't last long; it can feel exhilarating. Give us a boost to tackle moments such, as exams or work problems.  When someone experiences stress due, to specific situations it can lead to both mental and physical health issues arising from constantly feeling overwhelmed by rushing through tasks and taking on too much work while struggling with organizational challenges.  Long term stress is something that persists when we overlook or fail to address the sources of stress in our lives. If left unchecked and not dealt with stress could lead to serious health issues, like heart attacks or strokes and even prompt thoughts of suicide.Post traumatic stress disorder (PTSD) which arises from a event sometimes manifests, as flashbacks,nighmares or episodes of anger.  If one overlooks the signs of stress. They worsen to a level h it may progress into anxiety disorder where an individual experiences intense apprehension or dread concerning routine activities, in life even after the initial stressor is removed. Tips, for coping with stressOne effective approach, to handling stress involves identifying the factors that trigger stress in your life foremost.  If you find yourself overwhelmed by stressors talking to a healthcare about your symptoms is recommended.  Some basic strategies, for dealing with stress include; Engage in activity such, as a half hour walk or a yoga session to maintain your well being.Establish objectives. Ranking to determine the tasks that require attention and those that can be postponed.Engaging in calming practices such, as meditation and mindful breathing exercises.Let us assist you in managing and reducing stress.  It's hard to eliminate all the stress, in your life; however there are methods to deal with it effectively.   Blue Cross provides a range of health initiatives that can assist you in recognizing the sources of your stress and maintaining it at bay by opting for lifestyle options. Some individuals may also engage in an internet based behavioral health initiative such, as Learn to Live.* This course assists in recognizing issues and grasping the functioning of ones mind before teaching strategies to manage anxiety or stress effectively.  Visit your member portal to check if this program is part of your coverage or reach out to customer support using the contact number provided on the back of your Blue Cross ID card. If you need assistance, in locating a physician to help with your stress management needs please reach out to customer support. Search for a doctor online.