Understanding the connection between heart health and brain function
When you live with atrial fibrillation, you may take medication to prevent blood clots and control uncomfortable symptoms. While this can improve your quality of life in the short term, the long-term outlook may be less rosy. That’s because new research shows that AFib symptoms and common treatments could damage the brain, leading to a decline in memory and language skills.


A network of nerves and blood vessels connect these two organs, but the heart and brain can influence each other through a variety of pathways. Some studies have shown an association between AFib and Alzheimer’s disease, which means there could be processes at play that you might not have considered.
The mental decline known as dementia is a frightening reality, but it’s certainly not set in stone. You can help or hinder your body with your lifestyle and treatment choices, but first you’ll need to understand some of the challenges you could face when you live with AFib.
Stroke risk is a factor
Blood clots leading to stroke are major concerns for anyone living with AFib – they’re also a direct link between heart and brain function. An irregular heartbeat left untreated can cause blood to pool in the heart and clots may form in the pooled blood. If a clot travels to the brain and lodges in a blood vessel, you could experience the classic physical signs of stroke, like blurry vision, slurred speech, and weakness on one side of the body.
Strokes can manifest in different ways. Some strokes come with sudden and pronounced symptoms, while others are silent. These small and quiet strokes can go undetected, affecting cognition in more subtle ways. Over time, that damage can add up, and cognitive changes can become more obvious.


Your risk increases with age
Aging is a challenge for a lot of people at the best of times; the older we get, the tougher certain actions, reactions, and natural processes become. Your AFib risk and your dementia risk rises as you age, especially as you approach 80.
One study published in the journal Neurology found that AFib can bring on Alzheimer’s at an earlier age than in people without AFib. This report didn’t tie cognitive decline to stroke – rather, patients with AFib who had never had a reported stroke still experienced earlier cognitive decline than average.
The effect of AFib treatment on dementia risk
It seems that there’s some link between AFib and dementia (though studies continue to determine just how strong that link is). There also appears to be a connection between certain AFib medications and the risk of mental decline.
Blood thinners could actually protect the brain
The good news about the heart-brain link is that certain blood thinning medication could actually help to stall the onset of dementia. Results of a recent study published in European Heart Journal show that AFib patients on a blood thinning medication at the beginning of the study were 29 per cent less likely to develop dementia than the other participants.


Where does the benefit come from? One theory is that anticoagulants like Warfarin not only protect against major strokes, but also against mild or mini-strokes, the often invisible events that could add up to significant long-term cognitive decline.
Where does the benefit come from? One theory is that anticoagulants like Warfarin not only protect against major strokes, but also against mild or mini-strokes, the often invisible events that could add up to significant long-term cognitive decline.
However, there’s a fine balance when it comes to blood thinners and brain health: while blood thinning medication is designed to prevent clots, too much of it can cause microbleeds in the brain. The lesson here is that close monitoring could make all the difference. Speak with your doctor regularly about tracking the amount of medication in your body and revisiting your treatment plan periodically to make sure dosage is still sufficient.

Lifestyle changes for mental longevity
Losing weight and improving your general cardiovascular fitness could have a measurable impact on cognitive complications. One 2016 study found that, of the 355 AFib patients who participated in weight loss interventions, those who sustained their weight loss didn’t feel the burden of their AFib to the same degree as others – In fact, they were more likely to remain in a normal sinus rhythm.
Since the effects of AFib can feed cognitive problems, it follows that the fewer AFib symptoms and episodes you have, the better it will be for your mental health. That’s a good reason to incorporate regular exercise into your AFib management plan.
Looking ahead and staying positive
More studies are needed to unveil more details of the AFib-dementia relationship, but recent findings show promise. There’s a bigger push to figure out how to use this relationship to our benefit, and for now, a good amount of evidence to suggest you should consider blood thinners as a main course of defense.
In addition to thinning your blood, focus on other ways to manage heart dangers like high blood pressure. Since early intervention is so often the key to avoiding the worst case scenario, it’s crucial that you communicate well with your doctor. As new studies are scheduled and research advances, your medical team may be able to tailor a treatment plan to protects your brain as well as your heart.

5 tips to keep your A-fib in check


When you’re diagnosed with atrial fibrillation, you might think that life as you know it is over. Now you will have to watch for triggers, be prepared to handle sudden symptoms, and generally keep a lower profile than other heart-healthy people.
In reality, there’s plenty that you can do to keep living the life you want – or make it an even happier, healthier, and more rewarding existence despite having Afib.


It’s true that heart palpitations, chest discomfort, and anxiety are not fun to live with. But although it can be difficult to completely eradicate AFib symptoms, you can diminish their severity and frequency by making some clear and straightforward lifestyle changes. If you want to take your health seriously, consider these approaches to a stronger cardiovascular system.


Tip #1: Make exercise a part of your life
You’ve heard it before, but it can’t be said often enough: if you want to improve your energy, strengthen your heart, and increase your longevity, you need to make exercise a part of your everyday routine. Of course, living with AFib means minding your limits, so you’ll need to moderate your workout routine with the help of sound medical advice from your doctor and a keen focus on your body’s signals.
Strenuous exercise can make an irregular heartbeat worse, but moderate exercise can bring long-term benefits, like weight loss and lower blood pressure – and that can help you ward off heart failure, which is a major risk for AFib patients. Consider a routine that balances regular, moderate aerobic exercise with stretching and strengthening activities like yoga.


Tip #2: Minimize stress as much as possible
Not only is stress a common trigger for AFib, it appears to affect the severity of symptoms, too. Psychological stress, which can manifest in forms like anxiety and depression, has prompted patients to visit their doctor more often with AFib complaints. Likewise, if you’re prone to anxiety or high-stress states, even moderate AFib symptoms could feed the cycle.
Stress is personal and unique – your stress relief program should be as well. The first step is to be more observant: learn what brings on stress, where it tends to happen, and why you have such a difficult time controlling it. Then, explore your options. From innovative workouts to face-to-face therapy sessions, there are plenty of stress-relieving resources at your fingertips (and no reason to wait any longer to try them).


Tip #3: Reduce your salt intake
High-sodium lifestyles are the norm in North America, and they’re slowly chipping away at our health. It’s true you need salt to live, but when you take in too much – more than 1500 mg a day – your body’s mineral balance is thrown off, your blood pressure can go up, and your heart rhythm can suffer. Not a good combination for anyone, especially people with AFib.
One simple first step is to decrease the amount of sodium you eat, which means drastically reducing frozen, processed, or takeaway meals. Pay close attention to labels (some foods have a surprising amount of sodium) and get used to cooking with flavorful herbs and spices rather than salt. You may also want to pay more attention to your minerals: electrolyte imbalances can feed AFib, so it might be time to up your magnesium and potassium to counter the sodium you take in.


Tip #4: Watch out for stimulants like caffeine and alcohol
Stimulants can feel great when you’re consuming them, but your heart often bears the health burden. If you’re prone to heart rhythm irregularities, you’re probably even more vulnerable to an adverse reaction to stimulants like caffeine, alcohol, and other drugs.
Remember that stimulants can hide in products that seem harmless. Coffee and cola are prime caffeine sources, but caffeine can also be found in pain relievers and chocolate treats. Energy drinks are some of the worst offenders: they’re loaded with stimulating compounds, so even if they’re labeled “caffeine-free” you should avoid them altogether.


Alcohol is one of the most common stimulants, and it has a direct impact on heart health. Even a couple of drinks can raise blood pressure and increase the risk of palpitations, so moderation is key. Wondering what moderation looks like for AFib sufferers? It can come down to personal physiology, so listen to your body and talk with your doctor about it.


Tip #5: Try your best to avoid infections like the flu and more
Getting sick is never comfortable, but it can be dangerous when you live with AFib. The flu is particularly threatening: symptoms like high fever can lead to dehydration, and respiratory problems causing hypoxia can stress your cardiovascular system.
Your best defenses against the flu are frequent hand washing and the annual flu shot. Worried that this year’s vaccine won’t offer much protection? It’s still worth getting, because even if you were to contract the flu, the symptoms could be much more manageable – and that can make a big difference when those symptoms are known to interfere with your heart disorder.


Implement these tips by establishing a routine
How long does it take to form a habit? A lot depends on how difficult it is to adopt, and how quickly you can weave it into your daily routine. Some research suggests that it takes a little over two months for a new behavior to become automatic, which means you’ll have to stay focused on your lifestyle changes for a while, especially when it comes to tips like exercise and eating well.
It’s easy to slide into old patterns, especially when life gets hectic. You may fare better with some support, like working out with a group or joining conversations in online forums to share challenges and tips on keeping (or kicking) a specific habit. The idea is to make it as easy as possible on yourself to adopt positive, lasting changes for the good of your heart.

Antibiotics and probiotics


Your intestinal bacteria are actually an integral part of your immune system, and researchers are discovering that microbes of all kinds play instrumental roles in countless areas of your health. For example, beneficial bacteria, also known as probiotics, have been shown to:

•         Modulate your immune response and reduce inflammation
•         Produce vitamins, absorb minerals and break down indigestible dietary fiber, turning it into beneficial short-chain fatty acids
•         Eliminate toxins from your body
•         Benefit your mood and mental health
•         Boost weight loss

Beneficial bacteria in your gut (microbiota) controls the growth of disease-causing bacteria by competing for nutrition and attachment sites in your colon. This is of immense importance, as pathogenic bacteria and other less beneficial microbes can wreak havoc with your health if they gain the upper hand.
Antibiotics, of course, indiscriminately destroy bacteria of all kinds which is one of the reasons why antibiotics should only be used when absolutely necessary. In fact, taking antibiotics is associated with antibiotic related diarrhea in about 40% of the cases. And in some cases, the overgrowth of bacteria named Clostridium difficile which can cause severe illness that manifest itself with bloody diarrhea and inflammation of the bowel wall (colitis). Lastly, lets not forget the unpleasant yeast infection that afflicts some women after a course of antibiotics.
Furtheremore, some studies have shown that changes to the gut microbiota caused by excessive antibiotic use in early life may even increase the risk of weight gain and obesity.


So, the logic is simple: beneficial bacterial in the gut are damaged by antibiotics. So why not replace them with the "beneficial" bacterial strains in probiotics to assist gut bacteria returning to a "balanced" state and prevent these listed complications?
The answer is actually very complicated. In fact, a recent Israelli study showed at least one way in which probiotics might not be beneficial.
The participants were given antibiotics and split into two groups: the first group was given an 11-strain probiotic preparation for four weeks; the second was given a placebo, or dummy pill. The researchers found the antibiotic damage to the gut bacteria of those in the first group allowed the probiotic strains to effectively colonize the gut. But this colonization delayed the normal recovery of the microbiota, which remained perturbed for the entire six month study period. In contrast, the microbiota of the second group returned to normal within three weeks of finishing antibiotics.
It's more likely a diverse community of thousands of different types of microbes working together can provide health benefits. This microbial community is as individual as each one of us, meaning there is not just one configuration that will result in health or illness.
So, it's unlikely that the addition of one or even 11 strains of bacteria in a probiotic could somehow balance this complex system. This research exposes a perhaps unexpected truth: we still don't know what types of bacteria are truly beneficial or even what constitutes a healthy microbiome.
On the other hand, research has also shown that taking probiotics can significantly decrease the incidence of antibiotic related diarrhea by 50%. In fact you would only need to treat 10 patient taking antibiotics with probiotics to have one patient benefit. That is, the NNT (number needed to treat to benefit ONE patient is 10). Referring to the prevention of C. difficile colitis the number needed to treatment would be 25, but a reduction of C-diff associated diarrhea of 66%.
If this is true, then everybody taking antibiotic prescription should get a probiotic prescription. But the question is, which kind of probiotic is best? What is the optimal dose? Are there any diet recommendations she should follow during this recovery time to improve the restoration of your normal gut flora? All these questions we will answer in this video.
First lets than tackled the question, which probiotic is best? The short answer is,  we do not know. Because it will depend on your unique underlying microbacterial flora of your gut,it will also depend on your age, comorbidities, and how long you have been sick for. A couple probiotics that are commonly recommended are the bacteria Lactobacillus , and Saccharomyces. It is not that we know that these 2 are the best probiotics, but these 2 are the ones that we have the most evidence for promoting a beneficial effect.
Also to consider is the probiotic formulation...Probiotics are live bacteria that naturally die off at a faster rate when left at room temperatures. To get the most out of a probiotic while taking an antibiotic, try a refrigerated one. Refrigeration keeps flora-replenishing cultures alive longer. Many over-the-counter probiotic supplements are sold unrefrigerated in the vitamin or digestive aisle, so you could end up with a cell count that can change over time. Ask your doctor or pharmacist about a refrigerated brand like Florajen Probiotics, which is kept cold from the time of manufacture through time of purchase at the store. This helps maintain its potency so you can be sure you’re getting a consistent cell count with every serving.
What is the Best Time to Take Probiotics, and for how long?
Though they're often paired, experts typically advise against taking probiotics and antibiotics at the exact same time. So if a person is taking an antibiotic in the morning and at night, It is recommended having the probiotic at lunch.  (Generally speaking, a catch 22 with trying to colonize the gut with new bacteria using probiotics while taking antibiotics is that antibiotics tend to kill off those new bacteria as well.) Clinicians and dietitians typically say that probiotics should be taken until at least a week or two after the course of antibiotics is completed, since medicines continue to affect the gut microbiota after they’re stopped.
Some experts have suggested to take the probiotics in the form of spores. This is the equivalent of the 'seed' form of the good bacteria. Therefore the antibiotics cannot kill the spore, and the good bacteria can then grow unhindered.
Do you have to purchase a probiotic or is there a  way to get these in your diet? Is there a diet that promotes the probiotic effects?
You can get probiotics naturally from foods like fermented soft cheeses, sauerkraut, kimchi, miso soup, kefir (a milky, fermented probiotic beverage), and yogurt.  These foods contain a number of healthy bacterial species, such as Lactobacilli, which can help restore the gut microbiota to a healthy state after antibiotics. While it’s gut-smart to add these foods to your diet, you may also want to add a probiotic supplement containing billions of cultures like Florajen, as these probiotic-rich foods are sometimes not enough.
Supplementing your diet with fiber will also help the new bacteria thrive and grow. Fibrous compounds pass undigested through the small intestine and into the colon, where they act as fuel for bacterial fermentation.
However, dietary fiber can slow the rate at which the stomach empties. In turn, this can slow the rate at which medicines are absorbed. Therefore, it is best to temporarily avoid high-fiber foods during antibiotic treatment and instead focus on eating them after stopping antibiotics.
So make sure you eat plenty of vegetables, fruits, and whole grains after the completion of the antibiotic regimen.


 There are also some pre (pre not pro) PREbiotic food to consider adding to your diet.
Red wine, for example, contains antioxidant polyphenols which not only help healthy bacteria grow inside your gut but also can help lower blood pressure and cholesterol. Supplementing your diet with cocoa can also help keep the pesky clostridum at bay.
A food that you should  avoid while taking probiotics...GRAPEFRUIT. The body uses the p450 system localized in the liver to digest the contents found in grapefruit. A lot of antibiotics use the same system for it's metabolism and therefore can cause competition for the antibiotic breakdown and lead to dangerously high levels of said antibiotic in the blood. This is particularly true for erythromycin.
DO NOT take calcium supplements while on antibiotics, since they can decrease the absorption of the antibiotic into the system especially the quinolone antibiotics like CIPRO.

How do you know if you have Atrial Fibrillation?

Atrial fibrillation, also known as AFib, is a condition that causes your heartbeat to be irregular and it also speeds up your heart rate. If you’re affected, chances are you’ve had at least some of the symptoms, even if you haven’t realized what they point to. Continue reading to learn more about AFib and gain an understanding of some key warning signs and symptoms.

Why do some people have atrial fibrillation?
Atrial fibrillation causes the atria (the two upper chambers in the heart) to beat irregularly and out of sync with the ventricles (the two lower chambers of the heart). The upper chambers “quiver” due to erratic electrical signals and this produces a rapid and irregular heartbeat.
Technically, you’re more likely to have atrial fibrillation if you’re older but plenty of younger people are affected by it too. Atrial fibrillation can also run in families.
Other factors that can make atrial fibrillation more likely include high blood pressure (especially if it’s not controlled through medication and diet), chronic conditions, and problems affecting the heart such as heart disease, heart attack, congenital heart defects and abnormal heart valves.

What does atrial fibrillation feel like?
For most people, atrial fibrillation is symptomatic and there will be warning signs that something isn’t right. The first sign of atrial fibrillation can be a missed or skipped beat, followed very quickly by a “thudding” or “flipping” feeling in the chest and a fast, racing heart rate. This is one of the most common signs of atrial fibrillation and it can be really scary, to the point of feeling like you’re having a heart attack.

Symptoms can be fairly minor or very intense, depending on how severe your atrial fibrillation is. Some people only get a few relatively minor symptoms and can still go about normal life with them, while others are completely debilitated.
Some of the common symptoms that people with atrial fibrillation can experience include:

• Heart palpitations, which produce sensations of a racing, “flipping”, quivering heartbeat — a lot like a fish reacts when out of water
• Pain/discomfort in the chest
• Feeling short of breath
• Fatigue and weakness, even when doing simple tasks that aren’t exhausting
• Feeling faint and exhausted after an episode of atrial fibrillation
• Finding it difficult to do anything very physical, such as exercising
• Dizziness and feeling light headed
• Confusion
• Sweating
• Feeling panicky and anxious

What do these symptoms actually feel like? Some of the comments that are often made by people with atrial fibrillation are:

• “My heart feels like it’s going to burst out of my chest”
• “I feel completely wiped out”
• “My heart is fluttering around like a butterfly”
• “I feel like I’m having a heart attack”
• “My heart feels as though it is flopping around in my chest”
• “My heart has started pounding like I’ve just run a marathon”

Symptoms may not be there all the time and many people find that they go into atrial fibrillation every so often – mostly out of the blue. Others have persistent symptoms that never seem to go away.
Does everyone get symptoms?
Some people with atrial fibrillation don’t have any symptoms at all. This is known as asymptomatic atrial fibrillation, or silent AFib, and is most likely to show up during a routine medical examination.

Types of atrial fibrillation
There are a few different types of atrial fibrillation and this can affect which symptoms you may experience and how long they last.
1. Paroxysmal atrial fibrillation can come on randomly and suddenly, with symptoms lasting hours or sometimes just minutes. It doesn’t last more than a week and the episodes usually end on their own. The symptoms can begin anytime and include palpitations, breathlessness, anxiety, and fatigue and weakness that develops very quickly. Feeling physically exhausted afterwards is very common with this type of atrial fibrillation.
2. Persistent atrial fibrillation lasts longer than seven days. Symptoms can be the same as with paroxysmal atrial fibrillation. Treatment is needed with this type of atrial fibrillation as heart rhythm doesn’t return to normal by itself.
3. Long standing persistent atrial fibrillation is longer lasting than even persistent atrial fibrillation and usually carries on for at least 12 months.

We have all seen or heard of the typical case: a fiery red leg that is warm to touch and patient feels sick with fever or chills. Objectively you might find dermal edema (skin swelling), lymphatic dilation, and neutrophil infiltration. 

There is plenty we can talk about empiric antibiotic choice but for practical purposes you should just do Keflex QID if it is uncomplicated cellulitis, and Bactrim DS 2 tabs BID for cellulitis complicated by purulence formation (wether that be abscess or phlegmon). 

But what about steroid use? Back in 1997 there was a randomized trial that studied 112 patient hospitalized for cellulitis. In immunocompetent and non diabetics patients, the antibiotics were given alongside a weeklong tapering dose of prednisolone vs placebo. Those in the steroid group, benefited from:
1. decrease in healing time
2. improved length of hospital stay
3. duration of IV therapy 
The follow up of these patients showed NO difference in relapse or recurrence. 

This applies to non-diabetic patients being discharged from the ER with the diagnosis of cellulitis. These patients often come back for re-examination after subjective belief of treatment failure. You see, many of our patients cellulitis are instructed to come back if the infection area is progressing despite treatment. Some of them will show you permanent marker lines drawn on their previous visit showing that the infection has clearly increased. However most of this increase is due to inflammation response and not true failure of treatment. Steroids, and its effect on the inflammatory response can help alleviate some of this inflammatory response symptoms sooner and give the patient an early sense of improvement. Therefore the use of steroids would result in less 24-48 hour revisits to the ER, and decrease chances of patient admission to the hospital for ‘perceived failure of treatment’.

So why isn’t steroid use standard care? Clinical fears of immunosuppression (decreasing the body’s ability to fight infection) or significant side effects of the steroids scares providers into not using this as standard therapy. 

As for me…my mind is made. Steroids in uncomplicated cellulitis is a GO and will be part of my standard treatment of such patients.

A special gift to our nurses on this 'Nurses Week 2019'