Sit Right While Sitting Tight!

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Countless issues have arisen in the last month which has dramatically impacted upon our working lives; from the closure of crèches and schools to the mass opening of temporary home offices across the country. While this undoubtedly will contribute to the containment of COVID-19, we need to set ourselves up appropriately in our make-shift office environments to minimise the effect of these potentially un-ergonomic spaces on our posture and spinal health. Likewise if you are self-isolating and find yourself sitting for prolonged periods of time, you are also putting excess strain on your back.

This article will include some helpful tips to optimise your home working space and also some short instructional videos on how to include regular activity stretches throughout the day to address the muscles imbalances that can arise due to prolonged sitting.

How to sit better

This video provides instructions on how to assume the correct posture while seated at a desk. In summary

  • Both feet flat on the floor
  • Uncross ankles and knees
  • Thighs parallel to floor
  • Sit on both sit bones equally
  • Tuck chin in to lengthen back of neck
  • Shoulders back and in line with ears
  • Shoulders in line with hips

If you do not have a desk and are perching on kitchen stools or slumping on couches over coffee tables, try to adapt your position so that you are achieving as many of the above alignments as possible. For example, if you are using a kitchen stool, place a number of big books under your feet until both feet can be flat on the books and thighs parallel to the floor. If you are sitting on the couch, move towards the front end of the couch, shift your weight as to sit evenly on both sit bones and allow the spine to extend up. To avoid straining the neck muscles, position the top of your monitor to just below eye level. If working with a laptop alternate between propping the laptop up on books when performing reading activities to having it flat on a table for typing tasks so that elbows can be at 90 degrees.

Regular Activity Breaks

We know now that prolonged time spent sitting is as bad for your cardiovascular health as smoking. Furthermore, it is a significant contributor to chronic musculoskeletal problems including disc degeneration, nerve impingement and low back pain. For these reasons, it is now recommended that we take a 2-3 minute break from sitting every 30 minutes. We can use these 3 minutes to address some of the muscle imbalances that can occur due to too much sitting such as weak leg muscles and rounded shoulders. This next instructional video includes 4 stretches that can be scattered throughout your working day/week and will help improve your overall posture.

Undoing the Sitting

Finally, even if you sit with good posture and take regular activity breaks, excessive sitting leads to a build up of pressure in the lower back. Also, constantly rounding your shoulders over stretches the back muscles and impedes the ability of your rib-cage to expand, an important component of effective breathing. This last video will address these two issues and take you through a series of movements to release both the upper and lower back and restore your spine to optimal functioning and ready to sit another day!

Croí Superheroes – You can be a Hero for your community too!

April 28th is International Superhero Day! Watch the video below to hear from a few of our Croí Superheroes. 

You can be a superhero for your local community. Please give now and help us fight heart disease and stroke. 

Survey outlines the impact of COVID-19 on Heart Patients and Heart Patient Organisations

Several studies have confirmed that those most vulnerable to adverse or poorer outcomes from contracting the coronavirus are individuals living with cardiovascular disease, especially those living with heart failure, hypertension and diabetes.

Ironically at a time of greatest need when heart patients rely on the support of patient organisations, COVID-19 is also significantly impacting on these support structures. A survey conducted at the beginning of this month (April 2020) by the Global Heart Hub, the umbrella organisation for heart patient organisations across the world, has shown that, as expected, there has been an increased demand for information and support from patients, their carers and the general public, but at the same time, patient organisations themselves are battling the effects of the pandemic.

The Global Heart Hub survey on the impact of COVID-19 on patient organisations across 19 countries has reported that already almost half these groups have experienced a cut in their income and a third have had to reduce their staff numbers. The principal reason for reduction in income is cancellation or postponement of events which were either primarily fundraising events or events that were dependent on sponsorship. Interestingly, across some of the organisations who reported no change in income status are those who had already received their grant or sponsorship income for 2020, but their future income may be in jeopardy if the crisis continues over the rest of the year. In reporting on the increased demands on organisations, the ‘stay at home’ policy across the world has forced most organisations to provide information and support online or by telephone. Many organisations reported that one of the reasons for the increased outreach from patients, carers and members of the public has been the difficulty experienced in accessing GP’s and Pharmacists.

What is reassuring to note from the survey results is that patient organisations are keeping themselves informed through reputable sources and the vast majority of patient organisations (81%) are in direct contact with clinical experts for advice and guidance.

The global survey reports that the top three greatest impacts of the pandemic on patients are:

  • Heightened fear and anxiety from their vulnerability due to their underlying health issues;
  • Concerns and fears as a result of cancelled or postponed appointments and procedures;
  • Increased anxiety due to isolation and loneliness as a result of the ‘stay at home’ or ‘cocooning’ policies.

As many of these individuals are older persons with already limited social interaction opportunities, the restrictions on movement coupled with the fear of contracting the virus are a cause of considerable anxiety with many commenting on their ‘fear of the future’. Equally of great concern to those with heart conditions is access and availability of COVID-19 testing. The vast majority of patient organisations (82%) across the world commented that individuals with heart conditions are not viewed as ‘urgent’ for COVID-19 testing.

Many people living with heart conditions report a range of fears and anxieties which are largely the same range of fears as everyone else – fear of infection, uncertainty about the future, economic uncertainties etc. Understandably however, the fear of being infected is the number one fear of all heart patients across the world. As a consequence, patients are now very fearful of going to hospital (in case they are exposed to the virus). This is reflected in the experience of hospitals across Europe and beyond where many people with heart attack symptoms are delaying or avoiding going to hospital, as evidenced by a dramatic reduction in heart attack admissions. This has led to an urgent call by the President of the European Society of Cardiology, Professor Barbra Casadei who emphasised that “Instructions to ‘stay at home’ and ‘don’t come to hospital’ do not apply to those with heart attack symptoms”. She added that people with symptoms of heart attack should immediately phone the emergency services because hospitals have designated areas for heart attack patients to prevent the spreading of the coronavirus.

Equally, the fear of attending hospital is influencing heart patients to decline scheduled procedures or surgery even when it’s clinically indicated as necessary or their doctor recommends it. Consequently, some patients are avoiding procedures such as heart valve replacement for fear of virus infection post procedure. This is in spite of medical advice that there is no evidence that the virus infects implanted devices or causes infective endocarditis in those with valve disease.

Unsurprisingly, a common concern among patients and their carers is the amount of ‘fake news’ and unreliable information that is circulating on social media. Patient organisations are therefore playing a very important role in supporting patients and their carers by providing reliable and accurate information in this time of greatest need.

Croí’s Top Tips for Stress Management

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It is important to recognise that stress is part and parcel of our daily lives, especially with COVID-19, and while it cannot be avoided we can learn to deal with it. While the link between stress and cardiovascular disease is not well understood, we know that stress impacts on the blood clotting mechanism, it increases your blood pressure and when you are stressed you are more likely to lead an unhealthy lifestyle. For example as a coping mechanism people are more likely to increase their caffeine intake, smoke more cigarettes and drink more alcohol and be less active when they are stressed.

  • Be aware of what causes your stress. Being aware of this this gives you the opportunity to try to prevent stress or to manage the situation more effectively. You may not be able to avoid stress, but knowing what triggers you to become stressed can help you manage it differently.
  • Manage your time. Develop a system that works for you, not against you. Learn to prioritise, make lists and praise yourself for getting through the various tasks.
  • Try to create a good work-life balance. All work and no play is a recipe for burnout. Try to find a balance between work and family life, social activities and downtime.
  • Learn to accept what you cannot change. For example we cannot control other people behaviours or reactions.
  • Have a laugh every day. Rigid thinking and behaviour is a prime source of stress, whereas laughter can uncork the pressure and release built up tension. Laughing also helps us get a better perspective on the problem and tends to make us feel more lighthearted.
  • Keep a worry diary. Using a worry diary can help calm the mind by getting worries out of your head, allowing you to see them from a distance. Write out each worry, your feelings and fears, how likely it is to happen and your evidence for and against your worry coming true.
  • Exercise regularly. Exercise can help tackle stress and allow your body and mind to unwind, as well as releasing endorphins into the body (feel good hormones).
  • Try relaxation exercises and mindfulness. With regular practice, exercises such as deep breathing or progressive muscle relaxation can help to reduce stress.
  • Eat and sleep well. Eating and sleeping well will help manage stress more effectively.
  • Build a range of supports. Building up a range of supports is important in managing stress. It can be beneficial to accept help from others, share your worries with someone you trust as the saying goes ‘a problem shared is a problem halved’.

Finally, remember be patient with yourself, gaining control over stress can take time.

Turkey Burgers and Sweet Potato Fries

Recipe from Croí Lead Dietitian, Suzanne Seery

Eating out can be a social and fun experience with family or friends and is one of the things that many people are missing at this time. Our Dietitians have a series of heart healthy ‘fakeaway’ takeaway recipes that the whole family can get involved in preparing, with the added benefits of being low in saturated fats, full or fibre and a good source of lean protein. Enjoy!

Serves: 4
Preparation time: 20 minutes
Cooking time: 45 minutes

 

Turkey Burger with Sweet Potato Fries Recipe

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Ingredients for turkey burgers:

  • 400g turkey mince
  • 1/2 red pepper finely chopped
  • 1 red onion, finely chopped
  • 1 clove garlic, minced
  • Zest of half a lemon
  • 1-2 cups frozen peas/petit pois
  • 1 cup brown bread breadcrumbs
  • 2–3 dessert spoons of olive oil
  • Chili powder & black pepper
  • 1 chili (optional)

Ingredients for Sweet Potato fries:

  • 2 large or 4 small sweet potatoes
  • Salt, black pepper and paprika to season
  • Olive oil
  • Low fat Crème Fraîche (optional for serving)

Side Salad:

  • 8 handfuls of spinach
  • 1/2 red pepper, sliced
  • 1 pack of cherry tomatoes
  • 1/2 onion, thinly sliced (red or white)
  • Dressing: 1 part olive oil to 2 parts lemon juice and pinch of cracked black pepper.
  • Drizzle dressing over salad and serve

Method:

Preheat the oven to 200°C/gas mark 6.

Sweet Potato Fries:

  • Chop the sweet potatoes in half and slice length ways.
  • Place on an unlined baking tray and drizzle with the olive oil.
  • Season with salt and pepper and paprika, tossing well so that all the wedges are coated with the oil and seasoning.
  • Cook in the oven for 30 to 40 minutes, until the edges are brown and crisp.

Turkey Burgers:

  • In a large bowl, combine the minced turkey, onion, red pepper, egg,  garlic, lemon zest, frozen peas, breadcrumbs and olive oil.
  • Mix really well – you may need to get your hands in! Once combined, make into four equal-sized patties.
  • Place the burgers on the lined baking tray and cook in the oven alongside the sweet potatoes for 20 to 30 minutes, until cooked through.
  • Serve the burgers with sweet potato fries and side salad and a dollop of low fat crème fraîche if you like.

Croí adds its Voice to Global Call to Heart Valve Patients

Among those most impacted by COVID-19 are individuals living with heart disease or with specific heart conditions such as heart valve disease.

“People with underlying heart disease or with certain heart conditions such as heart valve disease are among the most impacted by the coronavirus because of factors outside of their control, but also due to some things under their control,” says Croí CEO Neil Johnson, who has joined a global call for heart valve disease patients and their carers to take as much control as possible of their heart health during this global pandemic.

The global COVID-19 crisis has put an enormous strain on health systems which face the battle of limiting the spread of coronavirus, while at the same time providing the treatment and care that will save lives. As a result of this, healthcare systems across the world are having to change the way they work and how they prioritise, impacting patients presenting with many conditions, including heart valve disease.

The Global Heart Hub, an umbrella organisation for heart patient organisations, is advising those living with heart valve disease and other heart problems that while there may be disruption and delays to appointments and treatments, urgent treatment for conditions such as heart valve disease still needs to be undertaken.

“Many of the indicators that suggest a patient requires early or urgent intervention are symptom driven, so it is crucial that patients monitor their symptoms and report any deterioration to their nurse, doctor or heart specialist,” says Wil Woan, chair of the Global Heart Hub Heart Valve Disease Patient Council. The Global Heart Hub’s Heart Valve Disease Patient Council, of which Croí is an affiliate, has resources to help patients track their symptoms and he is encouraging patients and their carers to use them (www.globalhearthub.org).

Referring to factors under a patients control, Croí has added its voice to the global call in response to the concerning trend of some heart patients with severe symptoms or severe disease avoiding hospitals, not attending appointments or not contacting the emergency services on time for fear of contracting COVID-19. Croí’s Neil Johnson says: “By not seeking or receiving urgent treatment, these patients may be putting their lives at greater risk. We urge these patients to monitor their symptoms closely and report any deterioration. We are aware that this is a worrying period for patients across the world whose concerns about COVID-19 and potential isolation from loved ones is hampering their willingness to seek appropriate medical advice and treatment.”

Locally, Croí, a founding member of the Global Heart Hub, is providing support to patients and their carers through this challenging time. The Croí health team is available by phone Monday to Friday to provide information and support to those living with heart disease, stroke and obesity.

The Global Heart Hub is the umbrella organisation for heart patient organisations across the world and one of its core objectives is to create partnerships, share information and to leverage the power of the patient voice to deliver the best outcomes for all patients across the world. In the case of heart valve disease, where severe disease requires treatment, the Global Heart Hub is calling on healthcare systems and physicians to ensure that those who need urgent treatment still receive it, even in these challenging times.

“It is important that, together, we make clear that when the COVID-19 crisis relents, heart valve disease patients around the world will need and should receive treatment. Cancelled or delayed heart valve surgeries or interventions will need to be prioritised because we know that early intervention is optimal in returning patients to a good quality of life,” Woan, Global Heart Hub.

Click below to download the new heart valve disease Symptom Tracker resource.

Advice For Individuals Recovering From A Recent Cardiac Procedure

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Due to COVID-19, people admitted to hospital for cardiac care are being discharged quickly to reduce their possible exposure to infection. The consequences are that many patients and carers are not getting adequate time with doctors and nurses to understand their condition and its treatment. The following information has been developed specifically for patients who have just been discharged from hospital post a cardiac procedure.

It is important to remember that our hospitals will continue to treat heart patients where urgent emergency dictates. If you have symptoms that could be a heart attack or stroke, or if your heart symptoms get worse you should still call 999 for immediate assistance

WHAT SHOULD I DO IF I HAVE RECENTLY HAD OPEN HEART SURGERY INCLUDING HEART BYPASS AND HEART VALVE SURGERY?

Patients who have recently had surgery have an increased risk of infections due to cuts/incisions which may be exposed to germs. The normal risk of infection for open heart surgery patients is low, but in the current situation you should take every extra measure to limit your risk of infection.

It is important to keep the wound site clean and dry. Observe for any signs of infection such as, redness around the wound, discharge from the wound which may be evident on the dressing, and pain or swelling around the wound site.

Your medical team will have advised you on your expected recovery before being discharged home. This includes making sure you take lots of rest in the first 2 weeks following surgery. In this time, you should continue to do gentle exercise around your home and garden. You should avoid leaving your house and follow the COVID-19 recommendations on the website around cocooning.

You should eat a healthy, well balanced diet to boost your healing and recovery.

If you do begin to feel unwell you should contact your GP, hospital medical team or call the emergency services.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD A TAVI?

A TAVI (Transcatheter Aortic Valve Implantation) is a procedure that is used to replace the aortic valve. It is generally performed under local anaesthetic, but sometimes under general.

TAVI is a less invasive approach which allows the replacement aortic valve to be inserted via a catheter usually through a small incision in the groin. TAVI is now a recommended, safe and cost-effective alternative to open heart surgery for patients with severe symptomatic aortic stenosis not just at high-risk, but also at low and intermediate-risk of surgical complications.

If you have recently had a TAVI procedure, you have heart valve disease. This places you at higher risk of developing complications if you catch the COVID-19 virus.

On average it takes 2-3 months to recover fully from a TAVI procedure. Cocooning is advised to individuals who have had this procedure within this time frame.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD an Angiogram or Angioplasty?

Individuals who have recently had an angiogram or an angioplasty (plus or minus stents) are usually discharged from hospital the same or following day.

You can return to light duties within a few days and are usually safe to drive a week after the procedure. We would recommend against this at present due to the increased risk of exposure to the COVID-19 virus.

Heavy lifting should be avoided while the artery is healing. If you have had an emergency angioplasty, i.e due to a heart attack you will need to take a few weeks off work and follow the advice around cocooning. For more information on advice following a heart attack click here.

There is a small risk of developing a haematoma (bruise) around the wound site, this should settle with rest. If it becomes worse or red and painful contact your GP via the telephone, for further advice.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD a cardiac device implanted?

There is no evidence that the COVID-19 virus infects any type of implantable device, such as a pace maker or defibrillator. These devices can help stabilise your heart condition.

If you have recently had an ICD (Implantable Cardiac Defibrillator) or PPM (Permanent Pace -maker) fitted you should avoid heavy lifting and pulling with the affected arm for the first 4-6 weeks. This gives the device and leads a chance to settle in.

If you were advised that you had stitches in the wound site, you should still attend your GP or practice nurse to have these removed. Be sure to phone first to arrange an appointment.

You may have been told you will also need to have your device checked. This is usually around 6 months after insertion. You will be contacted by the cardiology department of your local hospital if this affects you. You may also have been set up with remote patient monitoring.

You may or may not notice when your ICD has delivered treatment, as this can vary from person to person. It can range from a fluttery feeling in the chest to an incredibly painful thump in the centre of the chest. It may be accompanied by feeling dizzy or faint.

If you experience this, you should contact your cardiac investigation team. If you continue to feel unwell after having a shock delivered you should contact the emergency services immediately.

WHAT SHOULD I DO IF I HAVE RECENTLY HAD a Cardiac ablation?

Ablation is a treatment used to treat some arrhythmias (abnormal heart rhythms). If you have recently had an ablation you may continue to have some symptoms such as palpitations following the procedure. This is very common and you shouldn’t let it concern you. It is usually takes 8-10 weeks following the procedure for doctors to determine if it has been successful.

There is a small risk of developing a haematoma (bruise) around the wound site, this should settle with rest. If it becomes red and painful contact your GP via the telephone, for further advice.

Due to the COVID-19 pandemic it is unlikely you will have you’re follow up within 8-10 weeks. You will still be seen in your local hospital but it is likely it will be delayed. This is to keep both you and the medical staff safe. Until you have been reviewed by your consultant you should continue to take your medication, and contact your GP by telephone if you have any concerns.

Kids Pizza Quesadillas

Recipe from Croí's Dietitian

Looking for are a healthy meal for all the family that’s ready in under 15 minutes? These fuss-free pizza quesadillas or “pizzadillas” are a fun way to get the kids involved hands-on in the kitchen. When children are included in preparing or choosing meals, they are more interested in eating what they’ve created. With just 3 basic ingredients, let them use their creative flare to customize their own with various toppings. Remember children need supervision at all times in the kitchen and an adult should take charge frying the quesadillas.

Dietitians tip: This is a wonderful way to encourage tasting new vegetables. The more colourful the better!

Serves: 2

Prep time: 15 mins

Approximate nutritional value (per pizzadilla, not including additional toppings): 330 kcalories, 41g carbohyrdrates, 12g protein, 13g fat.

 

Kids Pizza Quesadillas Recipe

Ingredients:

  • 4 kids sized wholegrain wraps
  • ~ 4 tbsp. marinara or tomato-based pasta sauce
  • 50g grated cheddar cheese

Filling suggestions:

  • Leftover chicken + sweetcorn + chopped peppers
  • Sliced ham + cooked mushrooms
  • Red/yellow peppers + torn spinach
  • Switch to mozzarella cheese + baby tomatoes
  • Leftover cooked broccoli + chicken

Method:

  • Use the wholegrain wrap as your base.
  • Using the back of a spoon in a circular motion, spread 1-2 tbsp of the tomato-based sauce onto your wrap. You can use less sauce if you prefer but be careful not to add too much or it will spill out while cooking.
  • Sprinkle on half of the grated cheese.
  • Add the filling of your choice – get as creative as you like!
  • Place the second wrap on top and press gently to keep the pizzadilla together
  • Add a teaspoon of olive oil to a frying pan and fry the quesadilla for 2-3 minutes each side until it begins to turn golden brown.
  • Slice into pizza-like wedges and enjoy!

We would love to see your pizzadilla creations so send us a picture and we will share your designs! Why not use different veggies to making a face? Just make sure to take a picture before the top wrap goes on!!

Quesadilla

Other Home Workouts!

Workout with our Croí Instructors

Vicky Harkin Yoga for Croí

#2 Chen Tai Chi Ireland Niall O Floinn Online Classes - Beginners Level 1 Revision Week 9-10

#4 Tai Chi Ireland /Brasil Niall O Floinn and Abel Cezar Bento - Beginners level 2 rev. week 9-10

#1 Chen Tai Chi Ireland Niall O Floinn Online Classes - Beginners Level Week 1-8

#3 Chen Tai Chi Ireland Niall O Floinn Online Classes - Beginners Level 2 week 1-8

Disclaimer for online videos: Performing these exercises is at your own risk. Croí cannot be held responsible or liable for any injury or harm incurred while exercising using the online resources provided on our website. Those unaccustomed to exercise or with special health considerations should consult their medical practitioner before performing any exercise.

COVID-19: Performing CPR in the Community

FAQs for Performing CPR in the Community

The recent COVID-19 outbreak has generated many questions and concerns about potential exposure during CPR administration. The best protection from infection is to follow the recommended procedures and guidance highlighted in the FAQs below.

Can I get COVID-19 from performing CPR?

Yes, you can get COVID-19 from performing mouth-to-mouth CPR. We strongly advise anyone in the community to do COMPRESSION-ONLY CPR. Studies have shown that compression-only CPR in adults may be as effective as combined rescue breaths and chest compression in the first few minutes of cardiac arrest. It is still important to call 112 or 999 and apply an AED (Automated External Defibrillator) as normal.

It is at your discretion to perform or not to perform mouth-to-mouth on a loved one or family member. If you choose to perform breaths, it is recommended you use a barrier device, such as a pocket mask or face shield, to help protect yourself.

If you choose to perform Compression-Only CPR, first call 112 or 999 and then push hard and fast in the centre of the person’s chest, on the lower half of breast bone, until advanced help arrives. If you think the person may have COVID-19, please state your concerns to the emergency response dispatcher so those who respond can be aware of the potential for COVID-19 transmission.

Should I still do the breaths for CPR in a suspected/confirmed COVID-19 case?

In a suspected or confirmed COVID-19 case use compression-only CPR and apply an AED as soon as possible.
For a child or an infant, the cause of the heart stopping is likely to be due to a respiratory issue, so breaths are really important. Most children or infants are provided CPR by a family member or friend. Consider performing compressions and breaths, especially if you know the child/infant. If you do not feel comfortable giving breaths, or are concerned for COVID-19, you can consider only performing compression CPR until help arrives and apply the AED as normal.

Can I still use an AED?

Yes. Early AED use is still very important. AED pads can be placed on the person’s chest as directed by the AED prompts. Use the AED as directed. There are no additional directions needed for coronavirus. Clean the AED surface after use with simple disinfectant to kill the virus, following the manufacturer’s guidelines. Protect yourself and others by wearing gloves when cleaning, and then washing your hands with soap and water, or using an alcohol-based hand sanitizer. Avoid touching your face (e.g., eyes, mouth, or nose). Follow HSE guidelines on hand washing here.

After performing resuscitation - are there any precautions I should take?

After performing resuscitation, individuals should wash their hands thoroughly with soap and water for a minimum of 20 seconds; alcohol-based hand gel is a convenient alternative. See HSE guidelines on hand washing here.

I have given mouth-to-mouth. What should I do?

If you have given mouth-to-mouth resuscitation, there are no additional actions to be taken other than to monitor yourself for symptoms of possible COVID-19 over the following 14 days. Should you develop such symptoms, please contact your GP.

If you need support, you can contact the Croí Health Team on 091-544310 Monday – Friday from 9:00am – 5:30pm or you can email us at healthteam@croi.ie.

Further information: