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Old 06-07-2017, 01:35 AM   #1
BigV
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Congestive Heart Failure

Health update

I have been very slowly deteriorating. Man... I'm out of breath. Whew. That's a long driveway. Dang. When did one flight of stairs have so many steps? Shit, I'll just wear loafers, shoestrings are for losers.

Like that.

I can't say, oh, it was xyz date and then the shit hit the fan. But... bending over to tie my shoes, I would pant and heave like I was being chased. And I felt like I'd heroically overindulged at the Thanksgiving Dinner of the Gods! I felt so full... but... I hadn't really eaten a lot. I thought, well, shit. I have a football sized tumor just over my belly. It's crushing my lungs. That's why I can't take a full breath. And I was a little wheezy/bubbly in my breathing. Not much of a cough.

Monday a week ago, I took a bath in the middle of the night and that made the breathing much easier. But when I came back to bed and laid down on my back, I felt like I was being choked. Like an invisible hand was gripping my throat. Like a heavy, sodden wet towel was doubled over and laid across my neck I panted and gasped for minutes, I couldn't catch my breath. From laying the fuck down in bed.

If I'm gonna keel over and die in bed from overexertion you can be sure it will be with a happy ending. None of this dying from pulling the blankey up to my chin bullshit. So, Tuesday I agreed to see the urgent care office after work.

They sucked.

They made me wait a really long time, they communicated less than the average goldfish, and then said, we can not do anything for you, so I called ahead to the emergency room across the street for you. ?!?!? wtf? You have someone to take you right? No, let me out of here dumbass. Clearly I had that mind/body synchronization thing in full effect.

So off to the ER. They're much nicer, much more involved. I had an EKG, an electrocardiogram, which, let me tell you, sounds a lot more interesting that it is to experience It takes a couple minutes to open the packages of and apply the little adhesive terminals, ten seconds to do the test, then another couple minutes making bald patches in the shape of little adhesive terminals. I wasn't super hairy when I got there and I was less hairy when I left. Fortunately, the underwhelming EKG meant that there was nothing interesting about my heart, electrically speaking.

Off to the xray suite. The technician asked if I wanted to ride, I begged him to let me retain this last shred of my dignity, so we walked. He's a nice guy. But I have "really long lungs" and it took him about four tries with each view front and side to get the whole lung on the "film". Take a deep breath, now hold it, ... beep OK. Develop/digitize, rinse, repeat.

Back to my ER bench/bed/cooling board. Lots of people came in briefly, it seems, take some blood, take some measurements, make sure I wasn't too well covered up with that "gown". One fellow came in to take me to the CAT scan suite. He was really nice even though he wouldn't let me walk. We talked, he liked to talk, turns out he teaches a course(s) at the local college for radiology technicians, including how to run this machine. He's been doing it for 37 years. I felt I was in good hands. The CAT scan is a torus shaped machine that has a set of imaging devices along the ring of the torus which rotates at 120 rpm. It takes many pictures of your insides as your body moves along a line normal to the plane of rotation. Your body moves on a low carriage through the hole in the doughnut as the cameras in the doughnut take many pictures while you move. The pictures are "assembled" much like a still camera takes multiple exposures to create a panoramic picture. The images of a CAT scan are stitched together to make "slices" of your insides, and the computer can do it in all three axes, and give the viewer a chance to "move" through the slices. It's really cool. One specific purpose of my CAT scan was to see how my blood was moving, or not moving. This was accomplished by injecting me with dye that was opaque to the radiation and then moving me through the machine. Where the dye flowed in my blood, the radiation would be blocked and appear white on the final image. Knowing where I SHOULD have blood flowing meant they could compare what they saw with what they expected and deduce if I had a blockage somewhere. To my knowledge, they did not find any blockages.

Nor from the blood tests where the presence of certain enzymes can reveal blood clots--none of those either. Some enzymes found in my blood were slightly elevated, enzymes that are present when the heart is stressed. No shit. But the cause of this stress is still unknown. Only a procedure where the use a catheter in my arteries and burrow their way to my heart will they be able to find out if the cause was exertion (probably, hopefully) or some partial or complete blockage, which would be bad. At that time, a stent would be deployed at the location of the blockage to re-enlarge the occluded portion of my blood vessel. But, that's in the future.

They brought me some medicine in a little syringe about the size of my pinkie finger, they pumped three of them into the rig attached to my right arm. This was furosemide, trade name Lasix. You can read about it at the link, the take away is that it is a powerful diuretic. After those three little shots I peed three times for a total of 2500 ml in a little over half an hour. That stuff does not mess around. You had better have a clear path to the toilet, the urine is on the way. I was being wrung out, and that is a good thing. The other end of this process is my fluid intake. At first I thought they were just being inconsiderate, "No, you can't have a drink of water, how about a nice little cup of ice?" The fluid restriction started then before I even knew it, and they were very strict about it. I spent the next two days being thirsty most of the time.

Next came an ECG, and echocardiogram. A sonogram of my working heart, just like you see where the doctor applies the gel to belly of a pregnant woman to show the fetus. Mine was higher, though there was an uncomfortable similarity of bellies. The ECG in the ER was just a quickie, I would have a formal one in the hospital later--spoiler alert--this is what conclusively determined the kind and degree of my congestive heart failure.

Congestive heart failure. That's what the guy told me, right there in the little ER room. I was gutted, shattered. WTF? I'm not dead yet! Heart. Failure. What a fucking gut punch.

I have had my share of sadness in my life, but this really affected me. I can see now that it was mostly the combination my knuckleheaded delusion that "I can't be sick, I'm just a little out of breath from being fat."; and of my different understanding of the phrase "heart failure", as a layman, compared to the doctor, a professional. I had an understanding of those words in the vernacular, but he was using them in a very specific medical context. As you can tell, I have recovered from my shock, but I promise you, it was a blow.

I should say that Twil met me at the urgent care place and followed me to the ER across the street. I didn't have any of my communication tools, but she did and thankfully got in touch with my kids. They were surprised and worried, but I reassured them. She stayed with me the whole time in the ER and she and her daughter got all the cars home, about ten miles away. The hospital was much closer to the house.

After that short, sharp shock, there was a lot of waiting around, more urinating, more waiting, more checking in on me and then finally a ride to the hospital. Those ambulance drivers all decked out in their tactical looking gear. Young guys, friendly, but not friendly enough to drive through Wendy's or Jack-In-The-Box. Bastards. I told them my treat! I was hungry. Whatever. They didn't drop me or stab me or "accidentally" take me to the morgue, so, I guess they're ok.

In the hospital now, about... midnight I guess. I was surprisingly alert as my regular bedtime is around ten pm. More machines that go ping, I had to surrender my pocket knife and my leatherman. One man's tool is another bureaucrat's WEAPON. I got a little claim ticket after signing away who the fuck knows what I signed. They gave me some scrubs bottoms like pajamas, size large. Child's large. I managed to get the waistband almost halfway up my thighs before they relented and let me have a grown up pair (which didn't stay on while I slept--too restrictive). Still lying down-ish, those hospital beds have a lot of adjustments. I got an IV drip and a blood pressure cuff and a blood-oxygen meter. Imagine the least convenient combination of locations for where to plug that stuff in, into the wall and into me, then separate those locations by the hospital bed with balky brakes. I had shit draped across me all the time, tubes, hoses, leads, wires, grrrr. I wound up holding the umbilical with my left hand against the rail so that any movement by my right hand wouldn't be brought up short by the IV stand. It worked out but it was awkward.

I did see a doctor for about five minutes, the one that was on duty I suppose and he explained what would be happening. Observation, more tests, especially that ECG, interpretation of the results of those tests, rinse, repeat. The nurses finally decided that I didn't represent a threat to their safety or their attendance to their appointed rounds and let me be. For a couple hours at a stretch, at least. The kitchen was closed but the nurse took pity on me and brought me green jello. Nom.

Time for some shuteye (until the next post).
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Old 06-07-2017, 01:36 AM   #2
BigV
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My night was interrupted periodically by a trip to the bathroom. It was kind of an ordeal. Yank the cord out of the wall, disconnect the blood pressure cuff, leave the oxy meter dangling and beeping and then me and my new bff, Stan d'IV shuffled off to the toilet. They gave me strict instructions to pee into the graduated bottle so they could measure my output. It worked out. There was a lot of output. Back to the bed, I could connect the bp cuff and the oxygen meter on my own, but I didn't bother plugging in the IV machine. I just let it run on the battery and the nurse would plug it in when the next one came in. I wasn't really prepared/in shape to bend over and fight with the cord/outlet behind the bed. Screw that.

I did get to sleep in, which was nice. And all the nurses and technicians were nice. Apparently my attitude and outlook improved overnight as well as my ability to breathe easily. No longer did I feel as though I was being choked when I lay down or bent over. HUGE relief. Lots of people came and went, and I met the new doctor. He explained a few things that I'd heard before, like congestive heart failure. (!) For the medical community it means my heart was failing to deliver enough oxygenated blood to my body, simple enough. The *cause* of this failure, which is on a continuum, not just pass/fail, dictates the corrective action. Also, consequences of the heart failure produce symptoms that exacerbate the failure, and round and round in a vicious cycle.

Edema is a poster child for this. That is why everybody kept poking my ankles and shins. They were checking for the presence and degree of fluid retention. My ankles are just an easy place to check, my lungs and torso were where the problem was most noticeable to me, struggling to breathe. And that's why they wrung me out with that furosemide. Your heart (and mine) pumps your blood and every other fluid that moves. Weak heart pumping (heart failure) means this stuff doesn't get to your kidneys like it should, it accumulates, round and round, worse and worse.

That was the opening diagnosis, now the question was "why?". The weak pumping action could be caused by high blood pressure, guilty. It could be caused by other things, which I don't really understand sufficiently to be able to explain it here. It has to do with what part of the heart is weak, the right or left side, etc,. They figured it out though, and have mapped out a plan accordingly. As I said, I'm guilty of the high blood pressure, and am now (back) on my medicine for that. And there's another medicine for the strength of my heart. As well as more furosemide. The upshot is that my heart was being overtaxed and now the medicine is making it easier for it to do its job.

During the day, the ECG technician came in for my examination. It was extremely interesting. What she did was use the probe to show a movie of my heart, different places in my heart as it was beating. Then, she used the machine to draw on frames of the movie and measure the size of the chamber at its largest and then half a beat later at its smallest. By comparing the two sizes they're able to compute what's called the "ejection fraction" or EF. A healthy EF is between 50 and 70 percent, meaning on each beat, the heart pumps out between 50 and 70% of the blood that flows in. My EF is 35%. Yikes. This is considered a moderate degree of heart failure.

This was the main test that confirmed the early diagnosis and defined the initial treatment plan. I have medicine to reduce my blood pressure, the medicine to make my heart work more easily, aspirin as a blood thinner, etc. I've also been urged to limit my sodium intake, and limit my fluid intake. Keeping the fluid level low and lower makes it easier to pump my blood. Exercise as tolerated. And checkups. I guess I'm a grownup now that I have a cardiologist.

It was a scary experience but I am ON BOARD NOW.
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Live a good life. If there are gods and they are just, they will not care how devout you have been, but will welcome you based on the virtues you have lived by. If there are gods, but unjust, then you should not want to worship them. If there are no gods, then you will be gone, but will have lived a noble life that will live on in the memories of your loved ones. -- Marcus Aurelius, philosopher and writer (121-180)
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Old 06-07-2017, 05:50 AM   #3
limey
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Quote:
Originally Posted by BigV View Post
My night was interrupted periodically by a trip to the bathroom. It was kind of an ordeal. Yank the cord out of the wall, disconnect the blood pressure cuff, leave the oxy meter dangling and beeping and then me and my new bff, Stan d'IV shuffled off to the toilet. They gave me strict instructions to pee into the graduated bottle so they could measure my output. It worked out. There was a lot of output. Back to the bed, I could connect the bp cuff and the oxygen meter on my own, but I didn't bother plugging in the IV machine. I just let it run on the battery and the nurse would plug it in when the next one came in. I wasn't really prepared/in shape to bend over and fight with the cord/outlet behind the bed. Screw that.

I did get to sleep in, which was nice. And all the nurses and technicians were nice. Apparently my attitude and outlook improved overnight as well as my ability to breathe easily. No longer did I feel as though I was being choked when I lay down or bent over. HUGE relief. Lots of people came and went, and I met the new doctor. He explained a few things that I'd heard before, like congestive heart failure. (!) For the medical community it means my heart was failing to deliver enough oxygenated blood to my body, simple enough. The *cause* of this failure, which is on a continuum, not just pass/fail, dictates the corrective action. Also, consequences of the heart failure produce symptoms that exacerbate the failure, and round and round in a vicious cycle.

Edema is a poster child for this. That is why everybody kept poking my ankles and shins. They were checking for the presence and degree of fluid retention. My ankles are just an easy place to check, my lungs and torso were where the problem was most noticeable to me, struggling to breathe. And that's why they wrung me out with that furosemide. Your heart (and mine) pumps your blood and every other fluid that moves. Weak heart pumping (heart failure) means this stuff doesn't get to your kidneys like it should, it accumulates, round and round, worse and worse.

That was the opening diagnosis, now the question was "why?". The weak pumping action could be caused by high blood pressure, guilty. It could be caused by other things, which I don't really understand sufficiently to be able to explain it here. It has to do with what part of the heart is weak, the right or left side, etc,. They figured it out though, and have mapped out a plan accordingly. As I said, I'm guilty of the high blood pressure, and am now (back) on my medicine for that. And there's another medicine for the strength of my heart. As well as more furosemide. The upshot is that my heart was being overtaxed and now the medicine is making it easier for it to do its job.

During the day, the ECG technician came in for my examination. It was extremely interesting. What she did was use the probe to show a movie of my heart, different places in my heart as it was beating. Then, she used the machine to draw on frames of the movie and measure the size of the chamber at its largest and then half a beat later at its smallest. By comparing the two sizes they're able to compute what's called the "ejection fraction" or EF. A healthy EF is between 50 and 70 percent, meaning on each beat, the heart pumps out between 50 and 70% of the blood that flows in. My EF is 35%. Yikes. This is considered a moderate degree of heart failure.

This was the main test that confirmed the early diagnosis and defined the initial treatment plan. I have medicine to reduce my blood pressure, the medicine to make my heart work more easily, aspirin as a blood thinner, etc. I've also been urged to limit my sodium intake, and limit my fluid intake. Keeping the fluid level low and lower makes it easier to pump my blood. Exercise as tolerated. And checkups. I guess I'm a grownup now that I have a cardiologist.

It was a scary experience but I am ON BOARD NOW.
Blimey! Keep taking the tablets, mate!

Sent from my SM-G935F using Tapatalk
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Old 06-07-2017, 06:12 AM   #4
Griff
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Good luck brother, stick with the program.
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Old 06-07-2017, 09:39 AM   #5
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Thanks for the detailed update. It's fascinating how all that stuff works together. Or doesn't.

I'm happy to hear you are on board now. In hindsight, it appears it was a mistake to stop taking the high blood pressure meds.

I hear about your experiences and think about how it might apply to my own situation. If I am ever told I should take high blood pressure medicine, I'm sure part of me would be weighing the cost vs. benefit of that. You're supposed to flip your mattress and rotate your tires. Brush your teeth. Oh, and try to get your medical numbers into the correct range. It's super easy to ignore things and not see immediate consequences. So why worry? But congestive heart failure is some scary shit.
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Old 06-07-2017, 10:10 AM   #6
xoxoxoBruce
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It'll probably kill you, but if you follow instructions it will take a long long time. I've been on the program for years and it works. You'll feel better and get back to a pretty normal life. The worst thing you can do is get depressed about it. It's here, it's real, you can deal with it.
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Old 06-07-2017, 11:02 AM   #7
lumberjim
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I had this exact experience 3 years ago. Keep taking the pills, keep under 2300mg of sodium a day. And my big thing was getting the CPap. Oops. Noon. Time for my furosimide and coreg.
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Old 06-07-2017, 12:30 PM   #8
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~Billy Crystal as Fernando Lamas



I can't give anybody health advice, but you know better than anyone all the reasons you have for hanging around a while yet.

Take the pills, do the thing.

Is any of this due to genes, y'know did Dad and Uncle Milford suffer from it too? Or were you just blessed with this all by yer lonesome?

Both my grandfathers died from heart related issues at 50.

I turn 49 this month.
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Old 06-07-2017, 12:12 PM   #9
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Fuck...
Do the right thing. You know what that is.
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Old 06-07-2017, 11:07 PM   #10
Clodfobble
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"On board" is the most important thing. The rest is just showing up. Glad you're on a path to recovery.
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Old 06-30-2017, 04:08 PM   #11
Iggy
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Originally Posted by Clodfobble View Post
"On board" is the most important thing. The rest is just showing up. Glad you're on a path to recovery.
I second this. Glad they found the issue and are treating it.

Heart issues aren't good, but if they can be treated now that you know about them. My mother died at 43 of a massive heart attack. Both her parents (my grandparents) were diagnosed with congestive heart failure 20+ years before they finally passed. Grandfather had quintuple bypass surgery and grandmother had quadruple bypass surgery. Both lived for a long time (~15ish years) before they passed. I've heard bypass only "lasts" 10 years, but if you listen to the doc it can last longer. All that to say, this doesn't have to be the end. It is better for them to catch it now than for you to have a heart attack out if the blue.

How did your appointment on the 19th go?
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Old 06-08-2017, 10:39 AM   #12
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What they all said. That's what got my dad, but he was not on board; a long story but the upshot is let the experts do their work.

Good news is that this is manageable. I've got salt sensitive hypertension and once you get the hang of limiting salt, a lot of health shit will fall in line as your BP normalizes.

Great writing, by the way!
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Old 06-08-2017, 03:33 PM   #13
xoxoxoBruce
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Yes, he did an Elspode on the presentation post.
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Old 06-08-2017, 03:38 PM   #14
Gravdigr
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Originally Posted by footfootfoot View Post
Great writing, by the way!
Quote:
Originally Posted by xoxoxoBruce View Post
Yes, he did an Elspode on the presentation post.
It was vurry nize, I thought.

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Old 06-09-2017, 11:21 PM   #15
BigV
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Originally Posted by footfootfoot View Post
snip--

Great writing, by the way!
Quote:
Originally Posted by xoxoxoBruce View Post
Yes, he did an Elspode on the presentation post.
Quote:
Originally Posted by Gravdigr View Post
It was vurry nize, I thought.

This is what I have to say about that:




I touched the net!

MOM! I touched the net!

This is the Best. Day. Of. My. Life.

Thanks guys. I'm deeply flattered by your high praise.
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Live a good life. If there are gods and they are just, they will not care how devout you have been, but will welcome you based on the virtues you have lived by. If there are gods, but unjust, then you should not want to worship them. If there are no gods, then you will be gone, but will have lived a noble life that will live on in the memories of your loved ones. -- Marcus Aurelius, philosopher and writer (121-180)
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