Archive for March, 2011

I have not written anything in my blog for a couple of weeks. I didn’t have to. Nothing changed, so there was nothing to talk about. That is until last Friday.  It was early in the morning. About 6 am Friday morning.  Now normally, my eyes would open, I would fuss around a bit, and get out of bed. Not today. I couldn’t turn over. I couldn’t move my head to look at the clock. I am guessing at the time because darkness still filled the spaces through the window. I could barely breathe.  I was connected to the oxygen concentrator. It is set for 3 liters per minute,, yet still I struggled to breathe. I lay there quietly. Not able to yell for help. Not able to help myself.

A few hours later, Denise came in to check on me. I was barely responsive. “Do you want me to call an ambulance”?  I heard her ask.  “No”. I responded. She retorted, “do you want me to take you to the emergency room”? Again, my response was no.  I asked her to go to the medicine cabinet. Get 4 tabs Aldactone (100 mg), 4 tabs of Lasix ( 160 mg) and 2 tabs of potassium (20meq). She helped me take the pills and get me comfortable on the bed.

Around noon, I got up and slowly made my way to the living room. I am in heart failure and this morning  it reminded me just how sick I am. 

For the last 2 weeks I went about my business, working on the book, working in my garden and, well feeling almost normal. Don’t misunderstand though. I never feel normal healthy. I do, however have periods where life is not such a struggle. I can almost forget that I am sick. I think that is why they call congestive heart failure a chronic disease. It never ends, does it. Today is a mostly good day. I am almost completely recovered from the last episode. I can get back out in the back yard and get my bell peppers planted. But I can never truly relax. I know that without provocation or warning I can be back in bed, lying there like a smoked salmon. Oh that reminds me. Denise and I have to get some lox and bagels tomorrow.

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So the question is: which is worse?  Being over weight because you eat too much, or being over weight because you are in heart failure.  I don’t know. The truth is I am both. I am overweight both ways. When I stopped smoking a year and a half ago I put on 20 pounds. I also added  8 to 10 pounds because I don’t always eat right, and because I can’t be as active as I would like. My heart failure added weight this time as well. More than 10 pounds. How do I know what weight belongs where. Well let me explain.

 I lost 12 pounds in the last 5 days. All with the help of diuretics. ( medicine that pulls fluid out of me). If I had not had extra fluid built up in me I would have had symptoms of dehydration. Muscles cramping, dry mouth, achy all over and weak. I had none of those symptoms. The weight I dropped was nearly all extra fluid from heart failure.

The message is that I am glad I am not completely over weight because of bad habits. And my heart is not working as hoped. No revelations, except to say that sometimes doctors and nurses will look at you like you’re crazy. Blood work normal, palpations moderately ok. What is this guy talking about? They don’t usually come out and say it, but you know they are thinking it.

Over 2 billion people on earth. Guess how many different ways some diseases can present themselves. Doctors have the impossible task of sorting that out. My advise: find a doctor that you can build a long term relationship with. The better they know you, the better they can tell if something is really wrong. In this day of moving toward government run health care, the concept of “continuity of care” seems to have taken a back seat.

You want to save some money on health care? Continuity of care may just hold the answers.

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The short answer is no. But in the eyes of the medical community…maybe.

For the last couple of years, I have been struggling with weight gain, particularly in my abdomen. Remember, I had to go see the liver lady? From all appearances, my liver was failing right along with my heart. That may still be happening. Remember all those trips to the hospital?  Having the doctors remove all that fluid, and losing ten or fifteen pounds in just a couple of days? Time and again my abdomen would rise outward from my pants like a mound of bread dough. Day by day, it would get bigger and bigger until I reached the point of being hospitalized. It is a cycle I am re-visiting over and over again.

I saw my cardiologist today. My stomach is once again distended. He begins the examination.  Lungs clear – check. Legs not swollen – check. Last BNP was 66 – check. Palpate the abdomen unremarkable – check.  Well let’s think about this for a minute, shall we? I have almost no symptoms of congestive heart failure today. Oh, I have a very sick heart, and I am in end stage heart failure. Today, however I do not present the symptoms.

I was at cardiac rehab this morning and couldn’t finish my exercises. My muscles ache. I am weak. The doctor said that all those syptoms are expected from a patient with an MVO2 of 12. Remember, MVO2’s less than 16 may qualify you for a transplant. Mine is 12. Briefly, you will remember that the MVO2 measures how well your body (heart too) uses oxygen. My lungs can oxynigate the blood alright, but my body can’t use the oxygen.

By now, you might be asking yourself,  “how is all this relevant to Brian being a fat bastard”? Well I will tell you. I stopped smoking a year and a half ago. I gained weight, as we all expected. When I quit I was 205 pounds.  Six months later I was 220. I thought that was it.  The right side of my heart is failing. Increase swelling of the abdomen is consistent with that.  The doctors were seeing fluid in my abdomen. My hospital stays were removing large amounts of fluid off of me in very short periods of time. There was no reason to think my weight gain was anything but heart failure. Then, the liver issue came up and it was reasonable to assume that the weight was a result of heart and liver failure. The notion that I was eating too much never entered my mind.

The fat bastard in me was hiding all along. Deep down inside of me, my fat bastard was waiting to emerge. Today, the doctor proposed a plan that would at last unmask the fat bastard in me. I will take double the lasix I normally take. I will do this for three days. If I lose the weight and feel good, my problem is clearly fluid retention. If I lose the weight and feel dehydrated and sickly, I may be a fat bastard. I will begin the “Fat Bastard” experiment first thing in the morning. Stay tuned to see which one of me will emerge.

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