detrusor overactivity (urge incontinence)

Pantry

Dry goods:
- PASTA/NOODLES: different kinds of pasta, some rice, some oats, some dry beans and
lentils. Quinoa, and quinoa is a high protein grain that's also high
in fiber.
-  Flour on hand for baking: baking powder, and a little bit of sugar on hand, for days when you feel like baking something. I also love using nut flours, like almond meal and hazelnut flour. But if you're not a big fan
- Nuts:  different kinds of nuts and some dried fruit in your food cupboard.
- SPICE: chili powder, coriander, black pepper, and dried thyme. There's a bottle of vanilla essence in
there too, for days when I want to bake.
- Onions, garlic, and potatoes in a dark cupboard near my pots and pans. Apparently keeping them in a dark place prevents them from sprouting, at least for a week or so.

- Fridge: eggs, some milk, butter, cheese, and yogurt in it. Carrots and tomatoes
in the vegetable drawer, and some frozen peas in the freezer.

- In some places you can actually order a farm box to be delivered to your door every week, from
a local farm. It's kind of an automatic way to increase the variety in your diet. And it's also surprisingly affordable.

=>  you can make a simple pasta dish with a tomato sauce and some sprinkled cheese. You can make a quinoa salad with chopped carrots and some fresh lemon juice, or lentils and rice, or
beans and rice.

And you can dress these up with your favorite spices and flavor them with
onions and garlic.

For breakfast, you can always make oatmeal or scrambled eggs if you're in a pinch, and you can make pancakes, cakes, or cookies for occasional treats.

Now another benefit of storing some non-perishable food items in
your kitchen, is that you can buy in bulk, and sort of stock up when these
foods are on special at the supermarket. So you end up actually saving money on
your meals. Remember that even if you only have time
to boil some pasta and sprinkle some grated
cheese on top, and maybe cut up a fresh fruit, that meal
will almost certainly be healthier for your
family than a fast food dinner. My mom used to say, it's better to be real
than to be perfect. You don't need to cook like Julia Child in
order to feed your family well. Even Julia Child emphasized fearlessness
in the kitchen. One of her most famous quotes was this.
She said, learn how to cook, try new recipes, learn from your mistakes, be
fearless, and above all, have fun.

6 ingredients for every kitchen

1 - Olive oil: more expensive one for your salads, cheaper one for cooking
2 - Salt: good for your salty tongue receptors!
3 - Lemons/Limes: good for your sour tongue receptors!
4 - Onion
5 - Garlic
6 - nice-looking meats
=> enough to make a meals!

Processed foods

Highly processed foods have a lot of ingredients. 

Less processed foods have fewer ingredients. 

Buy the one with fewer ingredients

Processed foods mean anything that canned or packaged. 

CHF

CHF is caused by fluid overload in the heart and. CHF is totally different from COPD. COPD is all about the lungs. Why is it called congestive heart failure? Because it's so much fluid. What kills HF pt? How does it kill the pt? It's the hypoxia. The real immediate problem is hypoxia, not fluid overload. It's not how much fluid int the body but it's how much fluid in the lungs. When the pt is having HF, that's the main problem. Why is there fluid in the lungs? Congestion means it's referring to the lungs. If you do a CXRAY, you'll see big heart. What's congestion? What do you see on cxray? You'll see big heart but that's not important, what's important? FLUID IN THE LUNGS. You'll see pulmonary edema = fluid overload/cushiness/leaking out in the lungs. Pulmonary edema  = that's what you'll see. When CHF pt comes in, the real problem is hypoxia. You can help solve that and makes that better by giving oxygen. But ultimately, you also have to know the root cause.  And, the root cause or the cause is pulmonary edema. PULMONARY EDEMA. So, what we need to know is then to get the fluid out of hte lungs. When the pt is SOB and hypoxic, do you care about getting the fluid out of the legs? NO, you care about getting the fluids out of the lungs: you want to get the pt's legs down ont he ground. Is it going to get their fluid in the legs worse? Yes. What's the problem? The LEFT ventricle. The left ventricle takes blood from the lungs and sends to the rest of the body. The right ventricle tkes blood from the rest of the body and sends it to the lungs. So, CHF, we have blood going to the lungs but we can't pump it out. There's fluid in lungs. Our main problem is the Left ventricle is not strong enough to pump fluid out. So if pt has CHF, FLUID IN THE LUNGS = HYPOXIC. And, if I make the Rt ventricle stronger, will that make the problem better or worse? worse. They may have some weakness in the Rt ventricle but the main problem is the Left ventricle is not effective enuf to pump the blood out. So, the way we can treat that is that we can make the heart stronger. This is a temporary fix. Slowing the gas pedal when the engine is already not doing so well. So, the meds like digoxin and dopamine and dobutamine will stimulate the heart and cause the heart to pump more out. If the heart is okay, it will regulate itself and it will try to push the left side harder to get that fluid out. So, how do we address it otherwise? We give them meds that cause pulling blood in the legs? Stand them up, put the legs down, use gravity. You can give the NTG. What does NTG do? It's a vasodilator. If I vasodilate my peripheral vein, what does that do? I pull more fluid out. It will only go so far tho. Bc you didn't get rid of any fluid in the body but you just move it around to somewhere else. How do I get the fluid out of the body? You actually have to use diuretics. If there's less fluid in the body, there's more fluid going to the Rt ventricle or what? Less. The Rt ventricle is going to pump less. And, the Lt ventricle job easier or harder? Easier.

What's the most common cause of CHF? HTN is a common cause. Sure. What else? too much IV fluid - might be a cause acutely in a pt in a hospital and unable to control their fluid bc their doctor/nurse is giving too much fluid but usuaully not in the world. Why does the pt have a weak heart? Not smoking but smoking makes it worse. Kidney failure? pretty close. CORONARY ARTERY DISEASE due to recurrent MI and hyperlipidemia. The 2 most common causes of CHF = CORONARY ARTERY DISEASE due to recurrent ischemia to the heart and infarction which kill the vessels in the heart and make the heart thin and dilated too large  and weak. The other common cause of CHF in older ppl but not until they're very old is HTN leading to thickening of the heart bc the heart to work hard to push the BP so it gets bigger and thicker and the ventricle cavity smaller. And, they have diastolic or systolic HF? DIASTOLIC. Why diastolic HF? Why? bc it's too thick and it cannot dilate. It's old heart and it's thick. Main issue is poor diastolic function. This is a particular common cause in pt who's older and long-standing HTN. So, if 88 y/o women comes to clinic with HF and she never smokes and she hasn't had many medical problems all her life. She's probably has diastolic HF. If 48 y/o african american man, who eats meat smokes and drinks gambles and does drugs doesn't take care of himself and comes to ur clinic and hospitalized, coronary artery disaese HF, primarily systolic HF bc the heart is too thin so it cannot pump.

PE: edema in legs. Hears fluid in the lungs (crackles).

~bf

COPD

COPD usually caused by smoking. COPD = chronic obstructive pulmonary disease. Chronic means >6mo. Obstructive means there's a blockage. Pulmonary means the lungs. So, COPD is the obstructive dz of the lungs. We used to call it emphysema = damage of the alveoli, they are very thin. They don't have much air exchange. They kinda thin out and they get bigger. Lungs is like sponge = tiny little holes and pockets for air to move around. It looks like sponge. It should look like a sponge. COPD lungs are mostly air. And, that's bad. We don't want lungs to be full of air. The lungs should be a sponge. COPD lungs and chest x-ray, it's much more overinflated and clear. U should be able to see it on CXRAY. It's going to look more black.
They also used to be chronic bronchitis. Chronic inflammation of the bronchi. They get narrowed and they get full of junk and they get narrower and they get infxn. They can have some phlegm and coughing and can be like asthma.
When the pt is having a very difficulty time breathing and they try to exhale, it doesn't work. And, that doesn't work. You'll see pt trying to breathe out slowly. They have prolonged expiratory phase. They breathe out very long and slowly with their mouth closed. That's what they call purse lip breathing. They do this to compensate for obstructive bronchi.
Now we know that it's not one thing or another. Most pt have emphysema or chronic bronchitis. Most ppl have features of both. So, hyper-inflated lungs, difficulty breathing, coughing, more infxn, chronic. Do their lungs get oxygen better or worse? Worse? Because damage of alveoli and obstructive bronchi. What's their pulse ox going to be ? Less than normal.

PE: no fluid sounds in lungs (no crackles). but hyper-resonating sounds (egophony).

atelectasis

it can be normal or it can be severe or bad. A lot of time some atelectasis is normal if you've been in bed all day and not getting around. That's why you need the pt to take a deep breath a couple times before you do the pulse ox. If they've been in bed all day, have them take a couple of breaths to clear out atelectasis. Atelectasis has nothing to do smoking. It's usually due to pt staying in bed all day.