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Heart failure, sometimes known as congestive heart failure or CHF, is a chronic condition in which the heart doesn’t pump blood as well as it should. It can occur if the heart cannot pump blood or fill the chambers adequately. Certain conditions such as coronary artery disease or hypertension, will gradually leave your heart too weak or stiff to fill and pump as it should.

Not all cardiac conditions that lead to heart failure can be reversed. However, some treatments can improve the signs and symptoms of heart failure, which will help you live longer. Some lifestyle changes like regular exercise, reducing sodium in your diet, managing stress, and maintaining a healthy weight can improve heart health and quality of life. One way to prevent heart failure is to prevent and control conditions that directly lead to heart failure. These conditions include but are not limited to coronary artery disease, hypertension, diabetes, or obesity.

Symptoms of Heart Failure

You should see your doctor or call 9-1-1 if you think you are experiencing a heart attack. Please see your doctor to be checked for heart failure if you experience any of the following symptoms.

• Shortness of breath, aka dyspnea, when exercising or lying down
• Fatigue
• Weakness
• Swelling (aka edema) in your legs, ankle, and feet
• Rapid/irregular heartbeat
• Reduced ability to exercise
• Persistent cough or wheeze with white or pink colored phlegm
• Increase in urination at night
• Abdominal swelling (ascites)
• Rapid weight gain due to fluid retention
• Lack of appetite
• Nausea
• Difficulty concentrating/decreased alertness
• Sudden, severe shortness of breath and coughing up pink, foamy mucus
• Chest pain, if your heart failure is caused by a heart attack

Stages of Heart Failure

There are four stages of heart failure 1, 2, 3, or 4. As heart failure progresses through the stages, a person’s survival rate for 5+ years decreases.

Stage 1 
Those in stage 1 do not yet have issues with the pumping function of their heart. However, they do have a high risk of developing heart failure due to presence of related conditions like those listed above. People in stage 1 don’t have issues with the structure of their heart or how their heart works. It is rare to experience symptoms in this stage of heart failure. But a person may have symptoms related to other cardiac conditions.

Stage 2
Those in stage 2 of heart failure begin to have a reduced pumping function from the heart. This can lead to an enlarged left ventricle. The left ventricle pumps the blood rich in oxygen through the aortic valve and into the rest of the body. This area builds up while trying to overcompensate for the reduction in pumping function. An enlarged left ventricle can also result from previous heart attack(s). Some people in stage 2 remain asymptomatic.

Stage 3 
In stage 3, people will begin to show some of the symptoms above. Most are currently undergoing treatment either before or during stage 3.  The symptoms usually appear in this stage due to problems with the pumping chamber of the heart (or left ventricle). The patient may benefit from a referral to palliative care for enhanced symptom management.

Stage 4 
People in stage 4 have advanced heart failure and exhibit symptoms even when at rest. This stage is severe and may require advanced, specialized treatment or hospice care, depending on the patient’s treatment plan.

Check out our previous post on how palliative care can benefit patients with heart failure here. 

If you or a loved one is in need of St. Anthony’s Palliative or Hospice Care, please call us at (270) 826-2326 or make an online referral. 

Sources found here and here.

For over 10 years, the day after Tax Day is National Healthcare Decisions Day. After getting your taxes filed, it’s usually a good idea to discuss the wishes of your family. From April 2020-April 2021, these decisions have looked a little different and the way we have been living has been really changed. How many Americans look at advance directives has taken more of a profound meaning.

With the impacts of COVID-19, you never know what is going to happen. Remember last January and February before COVID became so widespread? We all had plans for 2020; some awesome resolutions, weddings, graduations, proms, homecomings, big birthday parties, vacations, and so much more. Then COVID hit and hit hard. All plans came to a screeching halt. Stay at home orders were invoked, along with mask mandates. Unfortunately, many Americans contracted COVID and some never recovered and passed away. Many of those people passed away without advance directives in place, which left family members trying to honor wishes that were not communicated.

Having advance directives is certainly not a new idea, but COVID did force everyone to look at what they want at the end of life and talk about their wishes with loved ones. There are huge benefits to the patient and family by having advance directives in place prior to hospitalization. These can include peace of mind for the patient because they know they will get their wishes honored and peace of mind for the family knowing they don’t have to guess or worry in this stressful time. After a loved one becomes chronically ill or unable to speak, these advance directives will come in handy! Your wishes will be crystal clear to medical professionals and loved ones.

St. Anthony’s Hospice and Palliative care helps patients get their wishes in order! Not only do we have copies of the 5 Wishes booklet to help you get started (for free), we can also help witness and notarize your documents, as well as help you get in contact with an estate attorney to draft the documents for you. We also honor end of life wishes by allowing the patient to be at home and ensuring all patients will have the highest quality of life and are able to die with dignity.

Call us today at (270) 826-2326 or make an online referral to see how hospice or palliative care can help you.

Chronic Kidney Disease (or CKD) refers to lasting kidney damage that progressively worsens over time and all 5 stages of kidney damage. These stages range from very mild (stage 1) to complete kidney failure (stage 5) The stages of CKD are based on the kidney’s ability to filter waste and extra fluid from the bloodstream. In the early stages, a person’s kidneys can still filter waste but in the later stages, your kidneys will have to work harder to get rid of waste or may not be able to do so at all. Over 30million people in the United States are living with CKD. How your physician measures your kidney function is by the estimated glomerular filtration rate (or eGFR). The eGFR is a number based on your creatinine levels, which is a waste product in your blood.

While anyone can be diagnosed with CKD, some risk factors that increase your risk include:
1. Diabetes
2. High Blood Pressure
3. Heart Disease
4. Family History of CKD
5. Being African American, Hispanic, Native American, or Asian
6. Being over 60 years old

Understanding the different stages of CKD can help a patient be more educated on the disease process and make appropriate healthcare decisions. We wanted to help you learn more about this disease.

Stage 1
In stage 1 CKD, you have mild kidney damage and an eGFR of 90 or greater. Most of the time, this means your kidneys are healthy and functioning well but you do have other signs of kidney damage. These signs of kidney damage can include protein in your urine or actual physical damage to your kidneys. Some ways to slow the progression of CKD if you are in stage 1 include:
– Controlling your blood sugar if you are diabetic
– Control your blood pressure
– Maintain a healthy diet
– Don’t smoke/vape or use smokeless tobacco
– Strive for 30 minutes of exercise at least 5 days per week
– Maintain a healthy weight
– Talk to your doctor about medications or vitamins to help protect your kidney function
– Get an appointment with a kidney doctor, or nephrologist, even though you have a primary care provider

Stage 2
In stage 2 CKD, you have mild kidney damage an eGFR between 60%-89%. Most of the time, this means your kidneys are healthy and functioning well but you do have other signs of kidney damage. These signs of kidney damage can include protein in your urine or actual physical damage to your kidneys.

Some ways to slow the progression of CKD if you are in stage 2 include:
– Controlling your blood sugar if you are diabetic
– Control your blood pressure
– Maintain a healthy diet
– Don’t smoke/vape or use smokeless tobacco
– Strive for 30 minutes of exercise at least 5 days per week
– Maintain a healthy weight
– Talk to your doctor about medications or vitamins to help protect your kidney function
– Get an appointment with a kidney doctor, or nephrologist, even though you have a primary care provider

Stage 3
Stage 3 is split into 2 stages, Stage 3a and Stage 3b. In Stage 3a, you have an eGFR between 45%-59%. In Stage 3b means you have an eGFR between 30%-44%. This means there is some damage to your kidneys and they are not functioning as well as they should be.

Many people do not exhibit symptoms in Stage 3, but if you are exhibiting symptoms they can be:
– Swelling in the hands and/or feet
– Back pain
– Urinating more or less than normal

Also in Stage 3, a person is more likely to start having health complications as waste builds up in your body. These can include:
– High blood pressure
– Anemia, or a low number of red blood cells
– Bone disease related to hyperphosphatemia or high levels of phosphorus in the blood

To prevent Stage 3 CKD from progressing, you can:
– Control your blood sugar if diabetic
– Control your blood pressure
– Don’t smoke/vape or use smokeless tobacco
– Eat a healthy diet and meet with a dietitian
– Exercise for at least 30 minutes, 5 days per week
– Get to and maintain a healthy weight
– Visit a nephrologist in addition to your primary care provider
– Ask your physician about medications to control your blood pressure and those to improve kidney function

Stage 4
Stage 4 CKD means you have an eGFR between 15%-29%. This means your kidneys are moderately to severely damaged and not working as well as they should. Stage 4 is the last stage before kidney failure and should be taken very seriously. Stage 4 is where palliative care can benefit the patient!

Many people begin to exhibit symptoms in Stage 4, which can include:
– Swelling in the hands and/or feet
– Back pain
– Urinating more or less than normal

Also in Stage 4, you will likely have health complications as waste builds up in your body. These can include:
– High blood pressure
– Anemia, or a low number of red blood cells
– Bone disease related to hyperphosphatemia or high levels of phosphorus in the blood

To prevent your Stage 4 CKD from progressing to complete kidney failure, you should:
– Regularly see your nephrologist
– Meet with a dietitian to help with your healthy diet
– Regularly take blood pressure medications as prescribed by your doctor

In Stage 4 it is time to begin talking with your nephrologist about the starting dialysis or preparing for a kidney transplant.

Stage 5
Stage 5 CKD means you have an eGFR less than 15%. This means your kidneys are either getting very close to failure or they have completely failed. If your kidneys fail, waste will build up in your blood which makes you very ill. Stage 5 is where hospice or palliative can help!

Some of the symptoms of kidney failure include:
– Itching
– Muscle Cramps
– Nausea & vomiting
– Not feeling hungry
– Swollen hands and feet
– Back pain
– Urinating more or less than normal
– Trouble breathing
– Insomnia (or trouble sleeping)

Once your kidneys have failed, kidney transplantation or dialysis are your treatment options. However, should you choose quality of life, hospice can help! If you choose quality of life in tandem with your treatment, palliative care can help! A kidney transplant is when a donor kidney is taken and transplanted into your body. If you can find a living donor, you may be able to plan for a kidney transplant and palliative care earlier. Dialysis assists your body in removing excess water and waste from the blood when your kidneys can no longer do it themselves. Palliative care can be used in conjunction with a kidney transplant and/or dialysis.

Palliative Care and Chronic Kidney Disease
When a patient is facing late-stage kidney disease (stage 4 or 5), St. Anthony’s Palliative Care team can help to manage symptoms and bridge the gap between the patient and their physician/nephrologist by providing an extra set of eyes and ears in the home. Palliative care can also help the patient access additional resources and support in the community.

Our palliative care team helps patients match their care plan to their personal goals as the patient explores options from transplant to dialysis to comfort care only.

To learn more about St. Anthony’s Hospice or Palliative Care, please call us at (270) 826-2326 or make a referral online.

Resources for this article found here.

Have  you ever paid attention to how your provider talks about treatments and how much like war-talk there is?

Really think about it…
“We’re going to win this battle with cancer.”
“Let’s rally behind Aunt Sally for her battle with breast cancer.”
“The infection has infiltrated his kidneys.”
“She’s having a heart attack.”

Ultimately life is not a battle to be won; nobody comes out alive. But don’t think about it in a negative light. Life is a gift! A beautiful gift given to each and every one of us that allows us to make a difference. Using your senses to explore the world is a privilege.

For religious people, life does not just end at death. Some believe in reincarnation. Some believe in an eternal afterlife. Some believe we only continue to exist in memories. Regardless of the differences in beliefs, death is a mysterious part of life that nobody really knows what happens when that time comes.

How do you know when to switch from the “warfront” of traditional medicine to embracing what is to come and living out the remainder of your life with the best quality care?

Dying comes in stages- denial, anger, bargaining, depression, and acceptance. Not everyone experiences all 5 steps or  even in that order. If one of these steps has been a person’s mindset their entire life, there is a bigger chance they will go out that way. For example, if a person has been angry their whole life, they may approach death feeling angry. Same goes for denial, depression, bargaining, and acceptance.

Whatever the person’s mood or however close they are to accepting their inevitable fate, we always face the question, “when do I stop aggressive treatment? when do I shift to hospice care?” Shifting from fighting for a longer life to a fuller life is never easy but hospice care is there to help.

Nearing the end of life does not necessarily mean the patient is close to death. While hospice care is for patients with a life-limiting illness that should the illness run it’s normal course, the patient has a life expectancy of 6 months or less. A patient must meet hospice eligibility requirements set by the Centers for Medicare and Medicaid Services. You can see a list of general eligibility requirements here.

We’ve said it so many times, hospice does not hasten death! Rather, when a patient’s physical, psychological, spiritual, financial, and social symptoms are properly managed, a patient can live for much longer. If hospice care is started early in the disease process, a patient receives more benefits!

Beginning hospice care early in the terminal diagnosis, ensure all symptoms are expertly managed which improves quality of life and can even improve quantity of life. The patient receives care from nurses, aides, social workers, and chaplains in the location of their choosing. Many patients receive care in their own home or in an assisted living facility, skilled nursing facility, or the Lucy Smith King Care Center. Hospice care is considered to be the ideal model for the most compassionate, highest quality care for those nearing the end of life. It offers the services and support that most Americans want when facing a life-limiting illness.

Hospice care uses an interdisciplinary team approach. This means we treat the whole person, from their physical symptoms to psychological to social to spiritual, and everything in between. Hospice care allows patients to keep their current physician, should their physician choose to follow, and their current caregiver! We don’t force loved ones to stop caring for the hospice patient, we encourage them to continue and empower them by teaching valuable skills and educating on the disease and dying processes.

“Human beings are physical, psychological, spiritual, and social entities and ought not to be reduced to any one dimension. The notion of totality of a holistic approach to the person is critical in all dimensions of health care.” -Ron Hamel, Making Health Care Decisions.

When initially diagnosed with a life-limiting illness, our focus should be completely on curing the patient and/or defeating the disease. At this point, the patient should consider a palliative care referral. Visit our website here to learn about the difference in hospice and palliative care.

We should always have those “what ifs” in the back of our mind to be realistic.
“What if we get to a point where the treatments aren’t working?”
“What if my quality of life is really taking a hit with these treatments?”
Be prepared and pay attention to look for the signs that your quality of life is taking a hit. Check out an article on quality indicators for end of life care here. Or just think about it- can you tolerate more treatments without being sick or extremely weak? Do I feel up to doing things I have always loved like going out to eat, going on a walk, gardening, visiting with friends or family or pets, etc.?

Encourage your loved one to listen to that internal voice that says “I’m done” or “Enough is enough.” Once you hear that voice, it’s time to shift the focus from treating the disease to treating the person. Always remember, when you are told “there’s nothing more that can be done,” there is always more that can be done! Meaning it’s time to focus on quality of life!

A dying person is still a person. They can still hear, feel, love, cry, see, etc. They are just a person with a shorter life expectancy. Grant your loved one’s wishes. Go to the beach one last time. Take a boat ride. Go for a picnic in the park. Just sit and listen to stories about their life. Focus on increasing that quality of life! Even under St. Anthony’s Hospice care, we don’t limit you to being homebound. We help our patients honor their last wishes and travel. Now, that doesn’t mean we pay for it, but we do help find the help the patient needs. For example, if your loved one wants to go to Florida for vacation, we contact a hospice provider wherever you go in Florida to be sure the patient is still getting the quality care needed while traveling.

Hospice care is exceptional end of life care. It’s not admitting defeat or giving up. Hospice gives the patient the quality of life and dignity they so deserve.

If you know me personally, you know I’m a big Queen fan. I wanted to close this out with some lyrics from “Who Wants to Live Forever” that I think pertain really well to focusing on quality of life and not fearing death.
“Who wants to live forever
There’s no chance for us
It’s all decided for us
This world has only one sweet moment set aside for us
Who wants to live forever”
Our fate has already been decided for us. We aren’t promised another day, so many every day count.

If you or a loved one is in need of palliative or hospice care, please call us at (270) 826-2326 or make a referral here.

Sources for this blog post- https://www.bmj.com/content/bmj/291/6511/1820.full.pdf and
CareNotes “Hospice Care: When Enough is Enough” by Fr. Dick Sparks, C.S.P., Ph.D.