I the Heart Failure consult yesterday in SLC at IHC. It was very illuminating. I saw a Nurse Practitioner whom I have seen before. After examination she called in a cardiologist who had just read my file along with the Echo CG.
Her examination involved looking and listening (stethoscope). Once again, she did that thing where I put up my chin with my head slightly turned so that she could watch one of the arteries in my neck. She allowed that that observation was one of the great tools in her toolbox. I knew that it told her about how much water I was carrying (not much). But there was more. She then positioned me in repose on the gurney lying on my back with the bed slightly elevated under my head. She repeated her listening (and looking) with the stethoscope added for several elevations more toward the vertical. Then she said, I want to get a cardiologist in here. Uh oh.
Within 10 minutes a young dude came into the room. We went through my family history, particularly my closest relatives. Both my brothers are gone as well as my mother and father. Dad was only 64 when he died but was a chronic asthmatic for 30 years so a heart attack seemed reasonable. My youngest brother died at 56 but he was morbidly obese and a long time pot smoker. Notwithstanding that, I think heart failure was the cause. My middle brother died at 78 from multiple causes it seemed. But Jan reminded me he was fitted with a heart valve long before that. My mother lived to 97.
The cardiologist launched an explanation into the aortic valve. Some of us have an aortic valve that is tri-folded, others one that is bi-folded. There is also an intermediate one that is sort of a tri-fold. Given western ways (esp diet) the aortic valve can calcify with ageing. I think they said that this was particularly the case for one type of valve (bi-folded?) over the other. Apparently this is highly heritable, ergo, inform our daughter. They suspect that I am a candidate for a new aortic valve. (My brother's valve was an aortic replacement.)
There is apparently one more definitive test. The heart is stressed. I asked via treadmill? No, they do it on the table.
So, I am being referred to their heart structure team. These guys do nothing but valves and stents, I guess. The cardio doc said that they are very impatient, ie, get ready to go!
The procedure is essentialy out-patient. (COVID saw to this.) It is an up-the-groin (femoral) artery)-into-the-heart procedure of which I have had several now. They inject ink and check it all. And then do their thing. If all goes well, the procedure is probably a morning process and one escapes late in the day. I related that all my arteries and veins passed close examination during my 2015 heart failure. The cardio guy said, time passes.
So, I wait. I should hear pretty quickly, but they didn't shoot off a prescription they were supposed to yesterday and I had to remind them this morning, so it may take a bit of time for them to catch up. Also the NP wants to review the file to see if we have missed any blood tests at this end.
Meanwhile, the nurse practitioner says, don't lift any weights.
Thursday, May 28, 2020
Saturday, May 23, 2020
Get your biscuits in the oven....
Well I know a little more now than before.
1. The echo cardiogram came in with an ejection fraction in the range of 35-40%--a little bit better than what the tech shared with me earlier. More is better!
2. My good sleeping continues and I feel somewhat less fatigued--good signs.
3. A little problematically, my weight continues to fall; I can still feel the torsemide working every afternoon. (One urinates a lot.) My weight is now about 205, so the torsemide is responsible in part for at least a 10-12 lb weight loss. However, it appears to be at the nadir as it has stabilized for several days in a row.
4. It is probably a very bad sign that my appetite is poor. Jan is making excellent dishes and I just cannot eat very much of them. However, that just may mean that I am now ingesting sensible amounts of food, eg, 3-4 oz meat portions. But it has never been this way before except when I was doing chemotherapy back in 2011-2012.
5.I had a raised amount of gamma globulin in my last blood test which my doc had repeated to ensure its validity. Gamma globulin increases as part of the immune function which is the body's response to fight a virus, bacterium or fungus. It should not be raised continuously. Unfortunately, it is also associated with the presence of cancer particularly when it remains raised. Multiple myelomas, leukemias, lymphomas are mentioned.
6. Hence, next up is a consult with the Gossner Cancer Center and one of the nurse practioners there. (They now have two oncologists.) They want two more urinalyses that have specific names which I have forgotten since I was doing business elsewhere when the Center called. That was yesterday. I putzed around and never got to the lab today and they won'r reopen until Tuesday. I don't know whether these are on the spot or whether I take them home.
All of the foregoing suggests my consult will be late next week when they have the lab data.
I smell a bone marrow biopsy in my future. Been there, done that. Not fun, but doable.
7.The possibility of a new or recurring old cancer has lurked in the mirror for nearly 10 yrs now.
I will try to remain positive.
1. The echo cardiogram came in with an ejection fraction in the range of 35-40%--a little bit better than what the tech shared with me earlier. More is better!
2. My good sleeping continues and I feel somewhat less fatigued--good signs.
3. A little problematically, my weight continues to fall; I can still feel the torsemide working every afternoon. (One urinates a lot.) My weight is now about 205, so the torsemide is responsible in part for at least a 10-12 lb weight loss. However, it appears to be at the nadir as it has stabilized for several days in a row.
4. It is probably a very bad sign that my appetite is poor. Jan is making excellent dishes and I just cannot eat very much of them. However, that just may mean that I am now ingesting sensible amounts of food, eg, 3-4 oz meat portions. But it has never been this way before except when I was doing chemotherapy back in 2011-2012.
5.I had a raised amount of gamma globulin in my last blood test which my doc had repeated to ensure its validity. Gamma globulin increases as part of the immune function which is the body's response to fight a virus, bacterium or fungus. It should not be raised continuously. Unfortunately, it is also associated with the presence of cancer particularly when it remains raised. Multiple myelomas, leukemias, lymphomas are mentioned.
6. Hence, next up is a consult with the Gossner Cancer Center and one of the nurse practioners there. (They now have two oncologists.) They want two more urinalyses that have specific names which I have forgotten since I was doing business elsewhere when the Center called. That was yesterday. I putzed around and never got to the lab today and they won'r reopen until Tuesday. I don't know whether these are on the spot or whether I take them home.
All of the foregoing suggests my consult will be late next week when they have the lab data.
I smell a bone marrow biopsy in my future. Been there, done that. Not fun, but doable.
7.The possibility of a new or recurring old cancer has lurked in the mirror for nearly 10 yrs now.
I will try to remain positive.
Thursday, May 14, 2020
knowledge...
Since last I posted I have met with a couple docs and had several tests that appear illuminative:
1. I have tested negative for CORONA19. I was retested again today.
2. Chest x-rays showed some striations (?) in the lungs, apparently leading to my primary doc getting me back on torsemide (10 mg/day). He suspected I was carrying water and making it harder for my heart to work against that. He was right!. Though I watch my ankles for swelling and my weight for consistency, neither was a good enough signal. The torsemide has shed me of 5-8 lbs of water to this point. I can feel my ankle joints starting to ache which means I may not have much more to give. Weight today = 210.8 lbs. Haven't been there in years.
Another upshot of the torsemide: the first night I had the best sleep in months. That has continued. I am sleeping a lot which may mean I need a bunch of it in the bank. And I have some more energy, not normal amounts, but definite gains.
3. Blood work I don't know enough to comment on except to say that whatever measures sugar in the system, mine is too high. (With no appetite, sweet is where one goes!)
4. Echo cardiogram. This is the one where the tech rolls a ball around on your chest and shoots a million pix of the heart doing its work. This order surprised me because I thought we were going to do a regular 12-line ECG. I had forgotten about a datum from this test that is among the most significant in re heart function: the ejection fraction. This is the amount of blood forced by a ventricular stroke from one side of the heart to the other.
Normally the ejection fraction is above 50%. When I had heart failure in 2015 and arrived at IHC Murray, mine was a 12 or 13%. When I left there a couple of treatment weeks later, I was back over 30%. And I was a couple weeks after that too high (>35%?) to qualify to have cardiac rehab here in Logan, My last ejection fraction was taken in 2018. It was 50%.
My echo cardiogram was this morning. Normally, the techs like to give nothing away because they only get the data they don't interpret it. Often they are terse. But my tech today told me the number was around 30%. Definitely diagnostically important. After it is read today, my doc will get the results tomorrow.
He also said there was some concern about pulmonary pressures. The pulmonary arteries and veins convey used and fresh blood from and to the heart from the lungs. So that is something to ponder.
In sum, looks as though I have some heart failure again. We'll wait to see what my primary doc's next move is. I think maybe a consult via telephone will occur before my next appointment which is Tues. A repeat of chest x-ray is scheduled then no doubt to check how the lungs look after the torsemide regimen.
I am optimistic.
1. I have tested negative for CORONA19. I was retested again today.
2. Chest x-rays showed some striations (?) in the lungs, apparently leading to my primary doc getting me back on torsemide (10 mg/day). He suspected I was carrying water and making it harder for my heart to work against that. He was right!. Though I watch my ankles for swelling and my weight for consistency, neither was a good enough signal. The torsemide has shed me of 5-8 lbs of water to this point. I can feel my ankle joints starting to ache which means I may not have much more to give. Weight today = 210.8 lbs. Haven't been there in years.
Another upshot of the torsemide: the first night I had the best sleep in months. That has continued. I am sleeping a lot which may mean I need a bunch of it in the bank. And I have some more energy, not normal amounts, but definite gains.
3. Blood work I don't know enough to comment on except to say that whatever measures sugar in the system, mine is too high. (With no appetite, sweet is where one goes!)
4. Echo cardiogram. This is the one where the tech rolls a ball around on your chest and shoots a million pix of the heart doing its work. This order surprised me because I thought we were going to do a regular 12-line ECG. I had forgotten about a datum from this test that is among the most significant in re heart function: the ejection fraction. This is the amount of blood forced by a ventricular stroke from one side of the heart to the other.
Normally the ejection fraction is above 50%. When I had heart failure in 2015 and arrived at IHC Murray, mine was a 12 or 13%. When I left there a couple of treatment weeks later, I was back over 30%. And I was a couple weeks after that too high (>35%?) to qualify to have cardiac rehab here in Logan, My last ejection fraction was taken in 2018. It was 50%.
My echo cardiogram was this morning. Normally, the techs like to give nothing away because they only get the data they don't interpret it. Often they are terse. But my tech today told me the number was around 30%. Definitely diagnostically important. After it is read today, my doc will get the results tomorrow.
He also said there was some concern about pulmonary pressures. The pulmonary arteries and veins convey used and fresh blood from and to the heart from the lungs. So that is something to ponder.
In sum, looks as though I have some heart failure again. We'll wait to see what my primary doc's next move is. I think maybe a consult via telephone will occur before my next appointment which is Tues. A repeat of chest x-ray is scheduled then no doubt to check how the lungs look after the torsemide regimen.
I am optimistic.
Sunday, May 10, 2020
coping
Can't sleep; might as well post!
We came back early by a couple weeks from AZ this year when it became clear that large changes were in store for all of us. It was an uneventful trip just before local services were shuttering. Since then we've had the usual winter/spring mix of weather characteristic of N Utah. Gorgeous!
As with most of the nation since that time we have been sheltering in place and for the most part, it has not been arduous. More of the public interfacing has befallen Jan, so she might challenge the arduousness inference. We've adapted to shopping on line and all the rest. It was notable upon arrival here how many didn't seem to take the risks very seriously. And perhaps they are correct--at least at this time--since we are rural, spread has not been quick. There are only a few deaths from Covid 19 for our Public Health region at this time.
On the other hand we have both been feeling poorly. And yes, it is all classic upper respiratory stuff. All of the symptoms of Covid 19 have visited: persistent dry cough; nasal discharge; sore throat; shortness of breath; fatigue; some shivers; but no fever.
My annual physical comes up next week, so I had to be tested for the virus to gain access to the hospital/clinic where our doc works. Woo hoo: negative!
But I am listless. I have little energy. I am more short of breath. The drainage from sinuses continues. I built up pretty well in AZ and was getting 30 min 3 times a week on the exercycle. I have lost the muscle mass. I have lost the stamina. I tried to substitute walking and compromised my right knee. It has taken weeks for it to not be painful. This is a vicious cycle.
Yet on the positive side my vitals are good: bp near/above 120/80; resting heart rate in low 60s. Most of all my heart rhythms do not seem changed: clear sinus rhythm daily on the single lead iwatch ECG function.
So why do I feel like crap? One suspect may be my CPAP mask. A 90-day summary shows a high rate of apneas/hypopneas per hour that has been going on for months. Maybe I have more classic bronchitis/pneumonia going on. I just don't know.
But starting Tues I am going to find out!
Be safe all..
We came back early by a couple weeks from AZ this year when it became clear that large changes were in store for all of us. It was an uneventful trip just before local services were shuttering. Since then we've had the usual winter/spring mix of weather characteristic of N Utah. Gorgeous!
As with most of the nation since that time we have been sheltering in place and for the most part, it has not been arduous. More of the public interfacing has befallen Jan, so she might challenge the arduousness inference. We've adapted to shopping on line and all the rest. It was notable upon arrival here how many didn't seem to take the risks very seriously. And perhaps they are correct--at least at this time--since we are rural, spread has not been quick. There are only a few deaths from Covid 19 for our Public Health region at this time.
On the other hand we have both been feeling poorly. And yes, it is all classic upper respiratory stuff. All of the symptoms of Covid 19 have visited: persistent dry cough; nasal discharge; sore throat; shortness of breath; fatigue; some shivers; but no fever.
My annual physical comes up next week, so I had to be tested for the virus to gain access to the hospital/clinic where our doc works. Woo hoo: negative!
But I am listless. I have little energy. I am more short of breath. The drainage from sinuses continues. I built up pretty well in AZ and was getting 30 min 3 times a week on the exercycle. I have lost the muscle mass. I have lost the stamina. I tried to substitute walking and compromised my right knee. It has taken weeks for it to not be painful. This is a vicious cycle.
Yet on the positive side my vitals are good: bp near/above 120/80; resting heart rate in low 60s. Most of all my heart rhythms do not seem changed: clear sinus rhythm daily on the single lead iwatch ECG function.
So why do I feel like crap? One suspect may be my CPAP mask. A 90-day summary shows a high rate of apneas/hypopneas per hour that has been going on for months. Maybe I have more classic bronchitis/pneumonia going on. I just don't know.
But starting Tues I am going to find out!
Be safe all..
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