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Archive for April, 2011

Just how sick must a person be to be offered a new heart? Sounds like a simple question.  The truth is there is no black or white answer. There  are tests; that if your body fails them will only serve to keep you in the running.  Results of those tests, may tell the doctor that you simply are not ready for a heart yet. Lets look at some of those tests, and compare my results to the standards many transplant hospitals use to help determine eligibility.

The first test, one we talked about a few months ago is called an mVo2 test.  According to “CHF Patients.com”, “The Vo2max is also called the mVo2 test or the CPX test – for cardiopulmonary stress test. This test shows the maximum amount of oxygen your heart can provide to your muscles during sustained activity. Vo2max is the point at which your body cannot increase its intake of oxygen despite an increase in exercise intensity.  Doctors consider this a true measure of your heart’s ability to keep you going. In most medical centers, a Vo2max score of 14 (in ml/kg/minute) or less qualifies you for heart transplant. One test result never tells the whole story, of course.” My test result for this test just a few months ago was 12. As the article mentioned, one test never tells the whole story.  Lets keep looking.

Your ejection fraction (EF) is also used as a gauge.  According to the   Cleveland Clinic, this is what EF results mean.     

What do the numbers mean?

Ejection fraction is usually expressed as a percentage. A normal heart pumps a little more than half the heart’s blood volume with each beat. We are looking at left ventricular ejection fraction.

A normal LVEF ranges from 50-70%. A LVEF of 65, for example, means that 65% of the total amount of blood in the left ventricle is pumped out with each heartbeat.

The LVEF may be lower when the heart muscle has become damaged due to a heart attack, heart muscle disease (cardiomyopathy), or other causes.

An EF of 35 to 40% may confirm a diagnosis of systolic heart failure. Someone with diastolic failure can have a normal EF.

An EF of less than 35% increases the risk of life threatening irregular heartbeats that can cause sudden cardiac arrest (loss of heart function) and sudden cardiac death. An implantable cardioverter defibrillator (ICD) may be recommended for these patients.

Hummm. I have a defibrillator built in. I have a history of Ventricular Tacardia, but is this enough to get a new heart? Lets keep looking. From here, most web information is vague. Nobody wants to say anything bad.  In 2006, when I was in the care of the Methodist Specialty and Transplant Hospital, the doctor was unable to get a reading. My EF was only listed as less than 10%. That’s when they decided to put that bi-ventricular pace maker in me. It helps my heart squeeze.  Last year, my EF was up to 15 to 20%.  Thank you bi-ventricular pace maker. Now like I said, the available literature is too chicken to set the standard for messed up hearts. Luckily our government does that for us. According to the Social Security Administration, an EF of less than 30% is considered 100% disabled. So, lets just say, if your EF is less than 30%, you are in the ball park for a transplant.

Two important indicators to determine just how sick you are, and if you stand any chance of getting a new heart. Unfortunately, getting a new heart is a complex issue. One that requires many facts, looked at both separately and in conjunction with other data. I failed these indicators.  How will I fare against the other criteria. I will let you know next week.

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In these days of insurance driven medical care, it is crucial that we take control of our medical care. Now I am not talking about treating yourself. I am talking about standing up for what you know is the right course of action. Let me share with you a story, the conclusion of which has resolved not 10 minutes ago.

As you may have read, I spent the first week or so of April in the hospital. Doctors were gaining control of COPD run amuck. The COPD threw me in to heart failure. It was a mess. Anyway, while I was in the hospital they stopped my Coumadin. Coumadin (warfarin) is a medicine they use to prevent blood clots. I have a DVT (deep vein thrombosis) is my left thigh. Not just now. All the time. The doctors remedy for this is to bring my INR (lab test to measure clotting time) to a level of 3.0 to 3.5 .  That is very high. To put this into perspective, the average heathy person’s INR is 1.0  For someone who had a heart attack, they may keep your INR up to 2.0.  When I get bumped, I bruise. If my dog scratches me, I bleed.  INR level 3.o or higher is high.

So When I was preparing to leave the hospital, my INR was back to about 1.2. Far too low for me, so the doctor ordered me to take “Lovonox”.  Roughly speaking, it is a synthetic heparin. The patient (me) must inject this into my stomach two times a day.  And yes, it hurts. Doctors use this as a bridge, of sorts to keep me from clotting untill the Coumadin brings my INR to 3.0.   Are you still following me?  Good.  This is a routine that I have played, over and over again. I have become an expert at bringing my INR back up.   I know how my body will react. I know how fast the medicine will work. So imagine my surprise when the nice lady at the Coumadin clinic called me last week to tell me my INR was not where she and the doctors wanted it.    Imagine my chagrin (is that a word?) when she began to adjust my medicines in a way that I knew would cause me more blood tests and more inconvenience. Every time I need a blood test I must go to Brooke Army Medical Center. I really like most of those folk and the care they give me, but I HATE THE PARKING!!!! I is a pain in the butt to go there.

Therefore, in the spirit of good medicine, and my sanity, I declared MEDICAL MUTINY!! I had a plan that would protect me from those mean blood clots and save me some trips to the parking lot. Win Win. I called the Coumadin lady.  Answering machine.  The next day she called, but I was out. I tried her later that afternoon.  No luck.  A few days later, I would see my cardiologist. I will implement my strategy and fill in the doctor when I see him next week.

The next week came and I had my appointment with the cardiologist. I shared with him my problem with the  course of action that the Coumadin lady had suggested. I then shared with him my plan. He agreed my plan was the right way to go.  This morning I went to the hospital to get my blood tested.  3.0!!! I knew I was right.

The moral of the story is this: listen to your doctors and nurses. They are almost always right. If you think they are not, you must question them.  In this time of insurance driven health care, some doctors and some nurses use the cookie cutter approach to practicing. While that may work most of the time, never be afraid to speak up and ask “WHY”.

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Some of you may have noticed my conspicuous silence in the Facebook world. Last  Sunday I succumbed to a one -two punch of COPD and Heart failure. Now normally I can whether one or the other, but having them both come to visit togethe…well it was too much.  The thing is, the double dose of illnesses was unavoidable. There was virtually nothing I could have done to side step this event. 

Spring time in South Texas brings with it tons of allergens.  Oak pollen so thick, everything outside is coated with a coat of the devilish yellow dust. Now I am not normally very sensitive to pollen, but this year is turning out to be an uncommonly high pollen count year. And, as you know, my lungs are not in the best shape.  As the pollen count rose, so too did the level of irritation in my lungs. By last Monday or Tuesday I could sense me hedging closer and closer to a COPD exacerbation. ( flare up)  When Friday came along (last Friday) I could barely breathe. I was using my rescue inhaler every couple of hours. I needed full-time oxygen support. My wife Denise thought I should go to the emergency room. I should have then, but my step-grandson Jake was having his 16th birthday party on Saturday.

The party was very nice. I was glad I went, but during the party I noticed something else. I was losing strength. My stamina had drained away, my lungs weren’t working and I was in my crouching, old man with a cane stance. Yep! I am in heart failure. We left the party.  Denise wanted to take me to the emergency room that evening, but I hedged. No, I would wait it out and see how I felt in the morning.

When Sunday morning came along, I was in full-blown heart failure and full on COPD exacerbation.  The stress from the COPD had been too much for my heart. I can always gauge how sick I am by how long it takes me to get through the E.R.’s triage system and to the back for the help. In this instance, a new world record. Less than 2 minutes. As soon as my smiling, wheezing, grey skinned self presented at check in, they whisked me directly to the help.

Well,  after 5 days of steroids, breathing treatments, and other supportive procedures I was able to leave the hospital. I am still weak. I still have some heart failure symptoms and COPD symptoms, but I am getting better. This episode was closer to disaster than I liked to think., More so than I will discuss with Denise. One major organ failure; no big deal. I can handle it. Two major organs failing…makes life a bit dicier.  For those that have followed this blog, you know, my liver is looming in the background. Slowly, but surely doing bad things. I was lucky this time. The hospital and staff at Brook Army Medical Center are amazing. You guys are the best. They may have very well saved my life. Hard to tell, and way too much drama to contemplate. I wonder though: How many more of these episodes will I be able to endure? Stay tuned and we’ll see!

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