PPH Symptoms

PPH is generally diagnosed by physical examination.  Typical signs of persistent pulmonary hypertension include altered heart sounds, parasternal heave, pulmonary regurgitation, elevated jugular venous pressure, peripheral edema (swelling of the feet/ankles), ascites (abdominal swelling due to fluid), hepatojugular reflux, and clubbing.

Further testing can include pulmonary function tests, electrocardiograph (ECG), arterial blood gas measurements, chest x-rays, CT scans, and ventilation or perfusion.  Normal pulmonary pressure is 12-16 mm Hg – pulmonary hypertension is present when the pressure exceeds 25 mm Hg.

There are five different types of PPH:

1. Arterial PPH;
2. Venous PPH;
3. Hypoxic PPH;
4. Thromboembolic PPH; and
5. Miscellaneous PPH.

PPH is often difficult to diagnose because the symptoms begin very gradually.  Symptoms of persistent pulmonary hypertension include shortness of breath, dizziness, fainting – all of which are exacerbated by physical exertion.  Other symptoms include non-productive cough, angina pectoris, fainting or syncope, lips and skin that turn blue, peripheral edema (swelling around the feet and ankles), and hemotysis (coughing up blood).  Finally, PPH can result in a significant decrease in exercise tolerance, and even lead to heart failure.

PPH Treatment

Treatment is determined based on the typed of PPH.  Arterial PPH can be treated with lifestyle changes, oxygen therapy, oral anti-coagulants, diuretics, and digoxin.

Pulmonary venous hypertension is synonymous with congestive heart failure, meaning treatment options center on optimizing left ventricular function.  This can be achieved though the use of diuretics, ACE inhibitors, beta-blockers, or to simply repair/replace the valve.

Left untreated, PPH patients have a survival rate of 2-3 years.  However, with proper treatment, expected survival rates can exceed 10 years.

Fen-Phen and PPH

The drug combination fenfluramine/phentermine, usually called Fen-Phen, is an anti-obesity treatment that utilizes two anorectics.  Fen-Phen was sold under two trade names: fenfluramine (Pondimin) and dexfenfluramine (Redux).

A three-year study, published in 1992 showed that Fen-Phen was extremely effective in maintaining a significant weight loss.  However, when the patients stopped taking Fen-Phen, most regained their weight.

In 1996, an article in the New England Journal of Medicine showed a statistically significant rise in persistent pulmonary hypertension in patients taking Fen-Phen.  Due to these and other side effects, in late 1997, the FDA recommended that Fen-Phen no longer be prescribed.

The FDA ordered fenfluramine and dexfenfluramine off the market in September 1997 after those drugs were linked to heart valve problems.  Fenfluramine is one of the ingredients in Fen-Phen, and dexfenfluramine is closely related to fenfluramine.  These drugs are manufactured by Wyeth Pharmaceuticals and American Home Products.

PPH Lawsuits

Clearly, this drug combination used for rapid weight loss was extremely unsafe.  The manufacturers of Fen-Phen promoted this drug as safe and effective.  As shown in the study referenced above, the drug is not safe – thousands of patients taking Fen-Phen now have various cardiovascular and lung problems, such as persistent pulmonary hypertension.  In addition, the drug is not effective – studies show that patients who stop taking Fen-Phen almost always regain the weight they originally lost.

Upon the release of the information regarding the pulmonary and cardiac risks of Fen-Phen, the Association of Trial Lawyers of America formed a group to seek damages from American Home Products, the distributor of fenfluramine (Pondimin) and dexfenfluramine (Redux).

Estimates of total liability ran as high as $14 billion.  As of February 2005, Wyeth was still in negotiations with injured parties, offering settlements of $5,000 to $200,000 to some of those who had sued, and stating they might offer more to those who were most seriously injured.

According to a 1999 article in The New York Times, a Texas woman was awarded $23.3 million for heart damage she suffered after taking the diet drug combination known as Fen-Phen.  The final settlement amount is undisclosed.

If you or someone you know has primary pulmonary hypertension, you should contact a Fen-Phen lawyer today to discuss your case.  If you have been diagnosed with primary pulmonary hypertension (PPH), please contact a PPH lawyer today for a free consultation.

If you are suffering from dizziness, chest pains, skin turning blue, or difficulty breathing, you may have persistent pulmonary hypertension – a difficult disease to diagnose.  The best step you can take is to contact your medical provider for further testing.  If you believe you have PPH, you should contact an experienced PPH lawyer today to assist you with your Fen-Phen claim.

We get a wonder fruit about every 5 years.  I think the last one was Pomegranate.  And of course since the fruit is good for you, that means that a plethora of nutritional supplement companies are going to make pills from Acai berry.  This is especially true with any fruit that can lay any claim as a weight loss supplement, which Acai berry also does.  But does this really work?

The Acai Berry is a small grape-sized, purple fruit that grows on the top of the Acai Palm, which is only found in the Amazon Jungle.  yet another reason we should maybe not tear the damn thing down.  Like most things in the Amazon, the Acai berry was used exclusively by locals until recently discovered, presumably by a hungry lumberjack.

The Acai berry is difficult to harvest because it goes bad very quickly, and is a delicate thing to ship.  There has been a small rush of domestic Acai berry growers in the United States, mostly due to the value of the berry.

The idea of any sort of medicinal use is not a new one.  Brazilians have long used the oil of the Acai berry to treat diarrhea, which of course can be a very serious ailment in the middle of the rain forest.  But the fact that the Acai berry contains more Oxygen Radical Absorption Capacity than other super-fruits like pomegranate, blueberries and strawberries is what makes this so popular.

There is little to no doubt that the Acai berry is one one of the most potent sources of antioxidants, even trumping Ginkgo Biloba.  But some of the benefit claims seem a bit outrageous.  Yes, Acai berry will likely provide you a little more energy, which could lead to increase activity to burn more calories, and even lead to having more sex.  But it’s often marketed as a weight loss drug.  The fact is, Acai berry is a fruit, and companies are making vitamins from it.  I would think for it to be a true energy supplement, it would need to be mixed with other sorts of supplements.

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Since then KFC has actually gone to the trouble of eliminating transfats from their meals.  This doesn’t make KFC healthy, but it does help a little in the national fight against obesity.

But we all know that the fast food industry is slowly poisoning us.  Morgan Spurlock’s excellent documentary did a wonderful job of documenting the health deterioration of a pure McDonalds diet.  While companies try to downplay what they do to us, you can’t help but wonder how far they go for their profit.  Are they as bad as the tobacco companies that go out of their way to make an addictive product and market it to children?  

U.S. News put out an excellent story yesterday that I think many will find interesting.  They listed the top ten things food companies don’t want us to know.  Here they are:

Junk food companies throw billions of dollars into marketing campaigns targeting children.  The FTC says that junk food makers spend 1.6 billion annually in television and online advertising specifically to reach kids.  

This is not really news.  We have all been eating Cookie Crisp and Sugar Pops for a while.  After all, despite what the silly rabbit says, Trix are for kids.

Food companies invest in research that put them in the best light.  Again, not surprising that they will only spend money on studies that show their product to be healthy.  

Junk food companies donate significant money to nutritional associations.  For example, The American Dietetic Association, or ADA, takes money from Coca-Cola.  How I doubt the ADA will release a statement saying Coke is the missing food group, clearly their purchase of access to an association we trust should be some cause for concern.  

More processing equals more profits, but also equals less nutrition.  High margin items are derived from commodity crops that are higher in calories, while lower in nutritional value.  In general, the less healthy, the better the profits.

The healthier you eat, the less you eat.  High processed foods are less satiating than natural foods.  An apple will fill you up more than a cup of processed apple sauce. Eating foods in the rawest form gives you the best nutrition.  

Don’t fall for the healthier versions of food.  Most schools have gotten rid of the sugary sodas, only to replace them with sugary “sports drinks”.  Despite the marketing, these are not healthy alternatives to soda.  

Don’t trust the labels.  It’s not that the label is lying, but I certainly notice an awful lot of the “zero trans fats” labels.  All of a sudden cookies are supposed to be healthy because they don’t contain “trans fats”, despite the fact they contain a lot of saturated fat.  This is a great example of the food companies trying to play off public perception.  In case you don’t know, saturated fat is very bad, trans fat even worse.

The food industry applies a lot of pressure to keep things confusing.  While the government may want to tell us to not eat meat more than twice a week, this would not please some major parts of the food industry.  So instead we get advice like “avoid excessive intake of high saturated fats through meat”, or something like that.  

Beware of organizations like the Center for Consumer Freedom.  These are funded by food maker to fight anti-obesity campaigns.  These are the guys working for companies like Coca-Cola, and Wendy’s that try to stop schools from removing soda machines.  

Food companies will take drastic action to silent critics.  If an organization comes out with a study that displeases the food industry, they will likely get a lot of heat from multiple directions.  Look what the meat industry did to try to silence Oprah.  

In the end, we are responsible for ourselves.  Junk food companies are going to try to sell us things that we enjoy, and there is nothing wrong with that.  We simply need to start treating some things like the poison it is, regardless of how pretty the box, how good it tastes, or the fact it may have a free price inside. This is especially true when it comes to our children.  It’s time to start taking nutritional responsibility away from companies.  This means less restaurants and frozen meals, and more fresh cooking at home.

It’s frustrating because it wouldn’t be that hard for them.  For example, on my last trip to Vegas I had a layover in Portland.  It was early and I had 2 hours, so I thought I would grab some breakfast.  I passed the fast food places and went to the best restaurant I could find.  Of course they offer “health food”…fruit.  But I wanted an actual breakfast, so I ordered a breakfast sandwich.  This consisted of an egg omelet with cheese, bacon, served on an English muffin.  I requested whole wheat toast to replace the muffin.  The sandwich also came with hash browns.  As I ate my diet defeating meal, it occurred to me that it’s not much different than the meals I eat at home for breakfast.  Except that I use Egg Beaters, turkey bacon and whole wheat toast.  I don’t usually include potatoes, but when I do they are baked.  My breakfast is under 300 calories less than 4 grams of fat.

How much extra effort would this really be for the restaurant?  Switching out to Egg Beaters and turkey bacon would cut the calories nearly in half, and fat by 75%!

And while were on the subject, has anyone else tried baking potatoes instead of frying them.  I just cut a potato up, coat them in Egg Beaters, add spices and bake.  They come up just like french fries, except zero fat.  They are still white carbs, so it’s not perfect for a diet, but much better than fried food.

I’m a big believer that restaurants should have to list the calories, fat and other nutritional info on their food.  It would help us all make better choices, and it would motivate restaurants to start making things much healthier.  I’m hoping to see more help from the government, like this site that helps to you exactly what you should be eating, based on age, height, weight, etc…

[tags]diet, food, health[/tags]

Some of you may already know that I have been working on losing weight the past couple of years. I have been going through this process for about the past 2 years (since I moved to Ashland), and have had my ups and downs. I thought sharing some of that experience on my blog may both help someone else who is looking for information about weight loss, and provide me with some accountability when I have to update the site with my weight.

I should start off saying that I wasn’t always overweight. I started off as a pretty skinny kid. But after breaking my leg at age 10 I was confined to a bed, then full body cast for months. After that I started to put on a little weight. That lasted about 4 years, but then I started college, and unlike most college freshmen, I thinned out. Even through my “chubby” kid years I was never very overweight. There were certainly many kids in worse shape than I, but I wasn’t in good shape until my teens.

From 14 – 17 I stayed in shape mostly by just moving a lot. I had few occasions to exercise, but I seemed to have a good metabolism. And then at 17 I joined the Army. I obviously spent the next year working out wether I wanted to or not. After getting injured I was discharged, and in pretty good shape. It was the first time I felt an urge to exercise after sitting around the house all day. And it seemed like for the next year I got in even better shape. But something started to change at some point. After 20 I started slowing down a little. I had moved to the mid-west and was experiencing those cold winters when I didn’t leave the house much. Soon the combination of pizza delivery and no exercise started to catch up with me. My pant size, which had usually fluctuated between 32 and 34 had gone up to 36 – 38. I didn’t give it much thought, I just figured I should start working out soon. As a matter of fact, some people said I looked better with a little extra weight.

But as you may know, getting fat is a self accelerating event. Soon I started to notice I had less energy, and my eating habits continued to worsen. My shirt size started to increase from large to x-large, and pant sizes were now moving up to the 38 – 40 level. It didn’t occur to me that I was nearing the topping off point of clothes sizes. By the time I reached 23, things had gotten to that point. I was now being forced to occasionally shop at a Big and Tall store. On the up side, I was the smallest size they offered!

I now had a son, and a lot more stress in my life. When money is tight, and you have had a stressful day, few things can cheaply satisfy you like a pizza. And so the trend continued.

This is starting to bore even me, so let me skip to the (fatty) meat of the subject. As 2 years ago I hit my highest weight yet at 415! I had gone from from 190 to 415 in a little over a decade. And for the first real time, I felt it. I couldn’t walk up a couple flights of stairs without getting a little winded. I was now no longer on the low end of the Big and Tall selection. And I was feeling the impact in social areas as well. I made the decision that when I moved to Ashland, things would change.

So the move came, and I started eating a bit more healthy without really even trying. Weight slowly started to come off. But it was a couple months into Ashland when I decided to start working out more. My weight had already come down to 393, which was good for a couple months with just eating a little better. I then started an aggressive diet through Nutrisystem. If you have done Nutrisystem, you know what it tastes like (and for that you have my sympathy), but it does work. It’s easy, but not fun, to stick to. You just eat what they tell you. I did this without working out for the first month, and the results were pretty good. I lost about 25 pounds the first month.

The next month I started adding some treadmill time to my workout. I was really out of shape, so the most I could do was 20 minutes at 2.5 MPH and no incline. But by the end of the month I was doing 30 minutes and feeling much better. And of course I lost more weight, although not as much. I continued at that pace for another 60 days and started to feel better.

But I was starting to get sick of the Nutrisystem food. I decided that it was possibly time to take the training wheels off a bit. I wrote down the calories, fat content and other items from the box and went to the store. It was difficult to find frozen foods that matched exactly. I noticed most had a little more calories and fat. Although the differences were small, and it looked like mainly due to portion size. But one big thing I noticed was the decrease of sodium, which was sometimes as much as 1/3 what was in Nutrisystem. So I made the switch and increase my treadmill speed.

The weight loss continued and my clothes sizes started to shrink. My pant size dropped down from a top end of 54 to around 46. My shirt sizes didn’t decrease as much. I went from 5X to 4X.

I was at about 350 when I decided to add weights to my work out. How it didn’t seem to increase my weight loss, it definitely made my clothes fit a little better. I also started to eat more freshly prepared meals like salmon and grilled chicken.

Things were progressing nicely and last November I went to see some friends in Las Vegas. I was hoping to be under 300 when I went, but I was stuck at 315, and had been for a month. But it was still nice to see people I hadn’t seen for nearly 100 pounds.

In December I suffered a minor set back. After playing with my Michael and his new Nintendo Wii, my shoulder was feeling a sharp pain. I stopped working out with weight for a while while I recovered, but the pain persisted. After a couple months of continued pain, I went to a doctor and then to physical therapy. My weight loss continued, but I felt a little less healthy without the weight work out. I finally broke the 300 barrier in March.

One major issue in my weight loss has always been traveling. It’s very hard to keep in an exercise routine while on the road, and of course the food choices I make are never as good. Traveling while fat has always been a bit stressful, and in accordance with no logic I can explain, that seems to mean I make bad decisions on food. It’s like a vacation time from my diet.

Since my girlfriend has been in school out of state the past couple of years, this also put some added pressure on that. It’s hard to explain to her I don’t want to travel to see her because it sets me back months on my weight loss, but it’s a reality. If I lose an average of 10 pounds per month, and then gain 10 on a 5 day trip to see her, thats a huge set back. I will go so far as to say that if I hadn’t traveled in the past 2 years, I would be near my goal weight.

This of course is a pretty irresponsible excuse for letting my weight continue to effect my life, but a reality I have had to face. And that reality came to hit home a little harder during the spring.

As some know, I have decided to travel a bit more for fun. The first place I went was Costa Rica. By the time the trip came around in May, I had gotten my weight down to 297. Not exactly thin, but a total weight loss of 118 pounds. The hotel didn’t have a gym, but I did a lot of walking. The food was a bit of a downfall, but I was on vacation, and I will not regret eating the best piece of coconut cream pie I have ever had, while sitting on a beach in Tamarindo.

When I returned, I was called to travel again for work, which would take me out of town for another week. I hadn’t checked the scale yet, and was off. I didn’t work out, and I eat like crap on that trip. When I returned I was in the middle of moving to a new house. In the move, the treadmill wasn’t set up, so I went months without using it. Finally I brought myself to the scale after months of inactivity. I had gained over 20 pounds in about 90 days! Fortunately my pants size is still at 42, although they were lose in Costa Rica at that size. My shirt size is still at 3X, which was nearing the 2X point before my trip.

On the up side, my shoulder is finally feeling a better. It’s now only occasionally sore, and is getting better everyday.

I have started hitting the treadmill again, and watching the calories. I have already gotten back down to 314. I plan on being back to where I was by the end of October.

I’m going to post weekly updates on my Asides here for anyone interested in keeping track. I’m also going to start posting the things I notice make the difference. Hopefully this will help keep me true to the goal.
[tags]weight loss, dieting, nutrisystem, exercise, obesity[/tags]