VIII. NONDRUG THERAPY
A. Advice on Drugs, Salt, Diet, Potassium, Alcohol, and Exercise
Medications must be continued as directed. Herbal reme¬dies are not recommended for the management of heart failure and these substances should be avoided. Do not stop any medications without consulting a physician. Digoxin is usually necessary for a lifetime and diuretics are continued in some in a small dose for a lifetime. We strongly advise you to take your medications with you on each visit to your doctor so that they can be rechecked or altered.
It is essential that the patient learn to live with a low-sodium diet. This does not mean that the individual must go to extremes and follow a 0.5–1 gm sodium diet. To achieve a low salt intake, simply do the following:
• Do not add salt in cooking or at the table. If taste is a problem, use a salt substitute after testing several preparations on the market. Salt substitutes have potas¬sium instead of sodium and are therefore better for you, but they should not be used if you are taking an ACE inhibitor.
• If you have kidney trouble, you retain enough potas¬sium; therefore, extra potassium is not required. It is such an important and confusing area that both patient and physician must be careful. If you are taking an ACE inhibitor (captopril, enalapril), spironolactone, Aldactazide, Dyazide, triamterene, or Moduretic (Moduret) do not use excessive amounts of salt substitute, eat a potassium-rich diet, or take potassium supplements without the advice of your doctor. Appropriate advice from your doctor depends on blood tests to evaluate kidney function and electrolytes, which include blood potassium. • Use foods containing small quantities of sodium. For further information on salt intake, see the chapter Hypertension.