Author’s Note: The following passage is an excerpt from the Part 3 of my book “Summer in the Waiting Room: How Faith, Family, and Friends Saved My Life.”
After returning home from the hospital, I went to a class to learn how to live a full life with a compromised heart. The topics included information about how the heart works, suggestions for healthy living, exercises that strengthen the heart muscle without adding stress to it, and facts about the different medications necessary to keep the heart functioning.
The material for the six-week program was delivered by nurses, nutritionists, pharmacists, physical therapists, and other content experts in a classroom setting. At 46, I was clearly the youngest of the 30 or so participants in a class of mostly ornery and impatient 70 and 80 year-olds set in their ways and grumbling about aches and pains.
Learning about a heart-healthy diet was enlightening. The standard information about avoiding fatty and fried foods, red meat, and processed sugars was like a review of a basic nutrition class. The reason and importance of staying away from salt was the most informative part of the program. To understand why this is important, we learned about how the heart works for someone with congestive heart failure.
A simple definition of congestive heart failure is a weakness of the heart that leads to a buildup of fluid in the lungs and surrounding body tissues. Blood from the lungs enters the lower left heart chamber to send oxygenated blood into the body to feed its muscles and organs. A massive heart attack kills off muscle that’s necessary to keep the organ pumping efficiently. The end result is that the blood that’s left in the chamber has nowhere to go. In extreme cases like mine, the blood backs up into the lungs, causing shortness of breath and more stress on the heart.
Salt enters the picture because it’s consumption leads to fluid retention. For someone with congestive heart failure, a weak lower left heart muscle and fluid retention make for a dangerous situation. Weight gain from fatty foods and water retention from salty foods is a deadly formula. What I learned in the nutrition section of the class has literally saved my life and kept me out of the hospital.
To understand how the dynamic works is to understand the numbers. The Federal Department of Agriculture (FDA) recommendation for daily sodium intake (the official term for salt) is 2,400 milligrams. For congestive heart failure patients, the recommended daily amount of sodium intake is 1,500 milligrams. Processed food, fast food, and most restaurant meals are unusually high in sodium.
For context, a typical dinner at the Olive Garden Restaurant demonstrates how much sodium is in the food we eat. My favorite meal there was the chicken parmigiana with pasta, one serving of pasta e fagioli soup, a couple of breadsticks and Diet Cokes, and cheesecake and coffee for dessert. Total sodium intake for that one meal is over 5,500 milligrams, nearly four times the daily allowance for someone with heart failure.
Sodium hides in unexpected places. Bread, dairy products, sauces, condiments, cold cuts, hot dogs, baked goods, and cured meats should be avoided for heart-healthy eating. Hot dogs? Really? One of my favorite vices is a Mark’s hot dog with everything on it. What has become known to my family as the “No Muthafucka, You Can’t Have a Hot Dog” story is a rallying cry for me to maintain a disciplined low-salt diet.
It all started the day the class learned about a heart-healthy diet. The nutritionist began by talking about the evils of common unhealthy foods for the heart. During the discussion about the ills of fried foods and fatty red meat, the presenter mentioned hot dogs while listing the “no-nos” for heart failure patients. There was a gasp and an immediate reaction from my elderly classmates.
The sound in the room was filled with murmurs and hands shot up into the air as people started asking questions. “Why are hot dogs bad for you?” “Do I have to stop eating hot dogs?” “Where can you buy low sodium hot dogs?”
The nutritionist went on to breakdown the sodium intake of a basic hot dog. Frankfurter: 600 milligrams. Bun: 200 milligrams. Relish: 120 milligrams. Mustard: 60 milligrams; Ketchup: 160 milligrams. The grand total: 1,140 milligrams for a regular old hot dog with relish, mustard, and ketchup. That was more than two full meals of the daily allowance for heart failure patients. The conclusion was to stay away from hot dogs.
There was a revolt!
The questions came fast and furiously. “What about low sodium franks?” “Buns?” “Relish?” “Ketchup?” My classmates started exchanging ideas. “You can buy low-sodium ketchup at Whole Foods,” said a visibly upset woman. “I’ll just eat the hot dog and bun without condiments,” shouted a distinguished-looking, but irritated gentleman.
Despite the efforts of the presenter, hot dogs dominated the remainder of the session on nutrition. I learned a couple of things that day. First, grilling a few hot dogs isn’t such a good idea if you want to stay away from the emergency room. Second, don’t mess with the old folks’ hot dogs.
The hot dog saga finally came to an end when the nutritionist calmed the crowd down by promising to bring the issue back up for discussion at another time. That other time came three weeks later during the summary session. In addition to the content experts, a cardiologist participated in the class.
The hour included a review of everything needed for living a healthy lifestyle with congestive heart failure. The class began with the cardiologist recommendation to have a disciplined exercise and medication regimen, avoid stress, and eat a heart-healthy diet. A 75 year-old woman sitting next to me named Ruth raised her hand within seconds of the doctor completing his opening statement.
Ruth had been my seat neighbor for the entire program. She was a nice grandmotherly woman who loved cooking, hated exercise, and planned little changes to her life. She half-jokingly told me that she never exercised a day in her life and saw no reason to start. Furthermore, she couldn’t imagine changing her diet.
“It’s worked for me so far,” she snickered. “Look at you. You’re young, you exercised regularly, and you’re here with us too,” she ribbed me with a mischievous smile. She had a point. If I had lived a long life before the heart attack, I probably would have the same outlook.
When the doctor called on Ruth, she asked the question that was on everyone’s lips. “Doctor, is it true that we can’t eat hot dogs?” The room erupted in a buzz of activity. Heads nodded in agreement. Others raised their hands as well to add their two cents. The chaos that ensued three weeks earlier was starting to bubble up again.
I chuckled to myself, amazed at the emotional appeal of hot dogs. I get it though. Hot dogs played a major role in my life. My mind wandered for a split second to the time at Mark’s Hot Dogs when I had asked Sandra to get married. While my classmates prepared for battle over hot dogs, I reminisced about that magical night in east San Jose.
This hot dog madness had to end. I felt like standing up and saying, “no muthafucka…you can’t have a hot dog!” in my best Richard Pryor imitation. Of course, I didn’t do it. But as I was laughing at my own joke amid the commotion in the room, the doctor put the matter to rest. “No,” he said. “You shouldn’t eat hot dogs.” The doctor had spoken. The revolt had ended.
The last time I had a hot dog was before June 7, 2010.