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Archive for September, 2011

Does that describe the relationship you have with your doctor? If so, don’t worry. You are in the company of most people.  So I guess if most people follow their doctor’s advice blindly, it’s alright. Right? HELL NO!!

Wait untill I tell you what happened to me this past week-end.

Friday evening I was preparing for bed in the usual manner. One of the things I always do is check my leg size in a mirror. No I am not caught up in some vanity play thing…thank you. I have a chronic DVT in my left leg. I check it every day by comparing the size of one leg against the other. The idea being that if my left leg is bigger, the clot may be on the move, or growing again. So Friday night I examined my legs. I notice a change. My left leg is definitely larger than the right leg. Also, I notice that the back of my knee was puffed up. It was as if half of a tennis ball were there. I decide to go to sleep and check on it in the morning.

The next morning I rose and immediately felt the back of my knee. Dam! The swelling was still there.  My calf aches like it is starved for blood. So was the  increased size of my left leg. I check with Denise. She agrees. My leg is too big. It must be a blood clot. So, early Saturday morning Denise takes me to the emergency room.

Going to the emergency room is always an adventure. My significant heart history invariably gets in the way of what I am complaining about. The triage nurse begins. I tell her why I am here. I am afraid that part of the clot may break off and it needs to be checked. To make matters worse, I did thow a clot once in 2003.  When the clot lands in your lung, it is called a pulmonary embolism. I was brought to the back within minutes. They begin with the exam. “Yes”, they say. “Your leg is swollen”. Remarkable! They order x-rays and an ultra sound. While I am waiting for that , someone comes in with a syringe. I do not ask what it is. Turns out it was morphine. Well that was it. Did anyone ever tell you that Morphine can actually induce pain?

According to Drugs.Com – Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, throat, or tongue); confusion; disorientation; fainting; fast, slow, or irregular heartbeat; hallucinations; mental or mood changes (eg, agitation, exaggerated sense of well-being); seizures; severe or persistent constipation or stomach pain; severe or persistent dizziness, drowsiness, or headache; shortness of breath; slow or shallow breathing; sudden chest pain; swelling of the hands, ankles, or feet; trouble urinating; unusual bruising or bleeding; unusual tiredness or weakness; vision changes (eg, blurred vision).

I have taken the liberty of bold facing the one’s that apply.

Not five minutes later I was having chest pain. Me and my big mouth told someone. That was that. The focus shifted from my leg to my heart. And they changed up medicine on me too. They used something called Fentanyl. The doctors told me it was 100 times more powerful than Morphine. I don’t know if that is true, but that is what I was told. The morphine I was given earlier clouded my judgement and I allowed the medicine to be given.

According to Drug.Com – Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; fainting; hallucinations; muscle rigidity; seizures; severe or persistent dizziness, headache, or light-headedness; slow or irregular heartbeat; slow or shallow breathing; trouble breathing; weakness

That set me up. My blood pressure dropped. 78 over 42. That was too low for them so they hooked me up to fluids in an effort to bolster my blood pressure. It worked except for one little detail. I have congestive heart failure (CHF) and they just pumped a liter of fluid in me. I had a heart failure exacerbation now. After 12 hours in the emergency room, I finally settled down and stabilized. As they brought medicines for me to take, I would ask them what it was, and decide if I would take it. I refused everything the emergency room had to offer.  Now it was time to move to the ward. I settled in. They told me I couldn’t leave the bed. A “fall risk” they say. “No”, I said. “I am not going to use a urinal in the bed. I do not like that. I am capable of walking to the bathroom”. They agree as long as I am escorted. Later that evening it was time for pills. They bring a bunch. I ask them to tell me what every pill is. They go through the list, and everything seems like the normal pills. Then they say the name of a drug I am not familiar with. I as them what is. They do not know. I told them to get back with me when they do and I will consider taking it. They never returned with an answer.

The next morning I was feeling good. I still did not get my leg fixed. As for the heart problems, well once the drugs wore off I was alright.  Then the nurse comes in for the morning pills. Again she tries to slip that pill to me. I reject the pill and tell her I will not take the pill without talking to the doctor. Around lunch time the doctor, followed by the interns, residents and students comes in. After the usual small talk he asked why I refused the new pill. I tell him to tell me about the pill. I don’t want to take new medicines unless it is really necessary. He says it is to control angina (heart pain). Then I say, so is it a vaso-dialator like nitro glycerin? He took a step back.  Apparently he wasnt expecting me to know such things. He said no, it wasn’t. Then I say, well what is it? (Get this) He said he didn’t know. It was approved for something else, and someone realized it also controlled angina.  Hmm, How does it work. He says, I don’t know. Then I tell him thank you, but I will pass on that medicine, It was almost like they had to do something. Afterall, I was in the hospital. They thew something at me hoping something would stick. It did not.

Managing your health is a complicated endeavor. More complicated if you have lots of problems. That makes your role in participating in the health care decisions for you even more important. Always ask the doctor “why this drug”. Always ask the doctor to explain how it works. Ask the doctor if the are alternatives. Ask the doctor if you will probably do fine without it. The point is, ask your doctor. Don’t sit quietly by and allow the doctor to just do stuff to you.  Take control of your health care.  Don’t follow blindly into the night.

for more information on patient advocacy, check here.    http://patients.about.com/

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by Dr. Shay Fabbro

Most people don’t give much thought to the formation of blood clots. They are an essential part of life since without them we would bleed to death if we got a cut. But there are times when clots can be dangerous, especially when they form when there isn’t a reason to. They can block arteries and cause all sorts of havoc for people with congestive heart failure (CHF), like Brian has.

The Clotting Process

The process of forming a blood clot starts when a blood vessel is broken, by either a small papercut or deep gash. Special cells found in the blood, called platelets, can detect the breaks in the blood vessels. They change shape, from round to spiky, and stick to the broken vessel. These little cells secrete a bunch of different proteins that all play a role in recruiting more platelets to the wounded vessel, where they pile on top of one another, forming a plug. Another special protein called fibrin lays across the plug, much like we lay a gauze pad across a large wound. This fibrin meshwork helps to seal the wound so that healing can begin.

Breaking Down Blood Clots

Once the blood vessel is healed, the blood clot needs to be broken down. A set of proteins called the plasminogen activator (PA) system take care of breaking down the clot so that blood once again flows freely in the vessel. I’m sure all of us have had a nasty cut…or ten (what can I say, I’m a clutz!!!). The scab doesn’t just disappear into thin air; the disappearing scab is being broken down by the PA system!

Atherosclerosis

Atherosclerosis is a fancy word for hardening of the arteries. It’s caused by collections of fat, cholesterol, and other stuff that builds up on the walls of the blood vessels, occluding them. These deposits will continue to grow until they completely block the blood vessel. Blood carries oxygen to every cell in our bodies. If blood doesn’t flow, then our cells can’t get enough oxygen, which will cause them to die. When Brian’s heart was damaged by the occlusion, this meant that his heart had to work even harder since some of the cells were dead. The harder his heart worked, the weaker it became, so that it couldn’t pump the blood his body needed. This causes him to have a low ejection fraction (EF), which is a  measurement of how much blood is pumped to the body.

Controlling Blood Clots

There are many instances where someone needs a little help to control the formation of blood clots: recent surgery, broken bones, cancer, confined to bed, family history of blood clots, sitting for too long, and in Brian’s case, CHF. Unwanted blood clots can cause heart attacks and strokes, which are the leading cause of death in the US.

Drugs to Control Blood Clots

There are a number of drugs a physician may prescribe to help control the formation of blood clots:

1) Aspirin-this one is a big one, and easy to get your hands on. A low-dose aspirin tablet taken every day can thin the blood so that clots don’t form. It is important to note that when on a daily aspirin regimen, the patient can’t simply stop taking the aspirin as this can cause clots to form. The decision to stop taking the drug should always be discussed with your doctor.

2) Heparin-this strong anticoagulant is something that is given through an IV, so it usually must be given in the hospital. The nature of this drug also means that the patient must be carefully monitored. This means a lengthy stay in the hospital, which can impact jobs and cause financial stress.

3) Warfarin (Coumadin)-this anti-clotting drug is given in pill form, making it easier to give to patients. Other drugs can interact with Coumadin (aspirin, Tylenol, ibuprofen, certain vitamins and antibiotics) so it’s important for patients to tell their doctor all medications they are taking. Brian is on this drug, which helps to control the clotting in his legs.

4) Plavix-Brian is also taking this drug, which is an anti-platelet drug to help prevent strokes and heart attacks. Many of you may have seen advertisements for this on the TV J

Drugs to Control Plaque Deposits

Since Brian had occlusions in his blood vessels, he must also be a drug to control the build-up of fats and cholesterol:

1)      Lipitor-This is also a drug that Brian is currently taking. It decreases the amount of cholesterol in the blood. And it’s another one you may have seen on TV.

http://thechosenbook.com/

http://shayfabbro.com/about/

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Last week, my guest blogger Fran Lewis’  post was very well received. The post touched the hearts of many people. More are reading her post even after nearly a week.  As a reminder:  My guest bloggers will be published each Monday. That is if I can get enough people to contribute.   The next guest is scheduled to appear on September 23 rd .  She has a post that I know many of you will find  interesting.

All of the guest blogs will be health related, as that is what I do. I felt the need to keep the guests in the same…genre, if you will.

In the past, there was no rhyme or reason for when a blog would get published. That is all changing too. The schedule will be:

Weekly Update Saturday’s

Guest Blog Monday’s

My blog Thursday’s

I encourage all of you to tune in and subscribe to the blog. There are some very interesting stories on the horizon.  If you would like to write a guest blog, let me know.  Follow this link for the details.  http://www.facebook.com/note.php?note_id=246784205353709   Participate too. Comment on them, and if you like, ask questions as well. I will answer all questions. I will do my best to get the guest blogger to answer  questions you may have for them.

Here is a teaser for you.  The guest blogger for next Monday is Dr Shay Fabbro. Get to know her here: http://shayfabbro.com/

For information about me and my book, along with links to everything, go to: http://www.brianhayden.com/

Take a peek at these great reviews!!  http://www.amazon.com/dp/1456060953/

One important note!  For now, please refrain from buying my book. I expect this situation will be resolved soon, and you may buy all of my books soon!

Thanks for your support. Enjoy the read.

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September 27, 1989 marked the beginning of a new life for me. A life where my health would deteriorate.  My health worsens month after month – year after year; until the only health I had …well I didn’t have any. I had run out of health, and run out of time. Move forward to 2006.

This was a particularly difficult time for both Denise and me. I, of course was very sick. On top of which I was fighting depression. The shrink I was seeing as part of the transplant team once asked me if I was depressed. Well, let me think about that. My heart is failing, I barely have the strength to get out of bed, I cannot play with my grandchildren, I am no longer able to work and I feel like throwing up most of the time. YES. I am depressed.  I was miserable. I was miserable and Denise was having to take my crap and take care of me.  Denise suggested we get a dog. I have always loved dogs, and for most of the time our children lived at home we had at least one dog. At first, I was hesitant. Who would house break it? Who would take care of it? No, I do not think we should get a dog. Denise insisted we look anyway.

We went to a local animal shelter to look at the dogs. We saw a couple of adult dogs that seemed nice enough, but there was no real chemistry.  The next stop was the puppy area. Almost immediately, we both noticed a caged run that had three or four puppies. By the look of them they were German Sheppard’s. Perfect, I thought. Let’s see if we can find that one puppy that I can connect with. I opened the gate, and sat on the floor of the run. Two of the puppies came up to me. One of the puppies was particularly cute. When he got excited, his lip would curl up. I think he was making an Elvis impersonation. To the untrained eye, it may look like an angry snarl, but I have worked with animals for years, and that was no snarl. It was a smile. We immediately took him home and placed him into our hearts. His name was Bear.

It is hard to know sometimes why animals bond with some people and not with others. It was clear from the very beginning that this little puppy would be mine. As the weeks past, Bear and I became very close. I think he knew instinctively that I was very sick. He took up the job of making me better. He would follow me everywhere I went. Go to the kitchen, and he tagged along. Go to bed, and he was at the foot of the bed until I moved. If I went to the bathroom, he would sit outside by the door and await my exit. Bear loved the grandchildren too. Bear was so gentle with them. He allowed the babies to do pretty much anything they wanted. He loved it. If the boys got too rough, he would simply walk away. The one game those boys loved to do with bear is run. They would run around the back yard, and Bear would chase them. Then, the boys would run after Bear and try to catch him. I really enjoyed watching my grandsons play with  Bear. Over the months, Bear remained playful and gentle. He was a great companion for me, and a relief for Denise.

Bear, Me and my Son's dog Buddy

Denise could go to the store and not worry about me being by myself. As much as all of my doctors, Bear helped me to live. In a time when all of the doctors had written me off and sent me to hospice, Bear stayed at my side. The love of a pet, particularly a dog, has healing powers not yet fully understood. While I consider Denise my guardian angel, bear is second in command and I believed he helped me survive that period in my life. Retirement communities and nursing homes have known about this phenomenon for years. Bring a gentle pet to one of those facilities, and the residents eyes light up.  Dog is God’s gift to us, and one of his ways to remind us he cares.

(DOG _ GOD)

 One thing though: Bear did not grow to the size one might expect of a German Sheppard. As it turns out, he was a mix between a German Sheppard and a Border Collie. He had most of the look of a German Sheppard, but the hair coat of the Border collie. Well, he could not really be named Bear with any sort of conviction. Look at him. He is just too cute, and only about 35 pounds. No, we would have to find another name for this little bear.                                             BOO BOO!

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                              By Fran Lewis

               http://www.gabina49.webs.com/ 

In August of 2003 my family’s life drastically changed.   On August 25 of that year, my mom got sick.   She woke up with a sharp pain in her back and could hardly breathe.   She called my Aunt and told her to come down to her apartment and not to call my sister or me.   She wanted to handle this without worrying either one of us.   However, this was not to be.

 My Aunt called 911 and they responded to the call but insisted that one of her children be present when they did initial exam and assessment.   I was and still am the only one who knows what meds my mom takes and how often and the dosage.

 After dealing with the preliminary issues and arriving at the hospital, the staff immediately addressed my mother’s issues and concerns.   They did numerous tests to find out what had caused her problem.   From what she was saying, it sounded like she did not remember taking her blood thinner medicine and had overdosed on it by accident.   She had always been very careful with her Coumadin.   However, she had been forgetting to take it and was forgetting a lot more too.   Frightening this might seem it only got worse.

 From this hospital, she was taken by ambulance to another one where they thought they could address what they believed was an aortic aneurysm.   However, this was incorrect.

 The following morning I received a call from the heart surgeon in charge of my mom’s case asking permission to operate before it was too late.   Of course, I did not hesitate and allowed him to save her life.   Fortunately, I got there just in time to see her before surgery.   This was the last time she would sound lucid or clear for a very long time.   She came out of the operation with many more problems.   She had died twice on the table and had to be revived.   (I was told this later on)   She began to slur her words and not understand what was happening around her.   The physical operation was a success but her mental capacity for dealing with things and understanding what was happening around her were greatly diminished.

 When she finally came home from the hospital 2 weeks later she had to reenter the next day due to complications that no one realized when she was discharged.   Because of four, more stays in the hospital my family and I noticed that her ability to process information and deal with daily situations had been compromised by the surgery and the anesthesia that was given.  She even realized that she could not remain alone for any long period.  

 Due to all of the stays in the hospital and many other factors that changed her ability to care for herself, we were forced to find help for her by enlisting VNS to find us aides to care for her the right way.   Unfortunately, this turned out to be costly to my family and me. I had to change my lifestyle and my way of living which no one seems to care about. I had to retire from teaching early and find other interests that I could pursue at home. One of course is writing books and the other short stories. I have even tried to publicize the fact that I am writing a book about Alzheimer’s as a resource for other families to be able to learn more about this illness and to get the help and care they need for a loved one.

 The only problem is that no one realizes that as the person who has to deal with nurses, doctors, home care agencies and home care providers that you still need to take time for yourself and have some kind of life. I have been nowhere for the last 7 years since my mom was diagnosed with this awful illness. She is getting much worse and now rather than make her presence known she just sits and stares all day while sitting on her chair in front of her television.

  Although the aides do try and sometimes succeed in taking her out in her wheelchair to get some air and possibly run into an old friend who might stop and say hello, she often rebels and refuses to leave her chair. It seems like it is her safety net and she is afraid of anything that is different or change in general.

 It is really hard to remain calm and neutral when it comes to other family members that go away on vacation and do not check and see how my mom is or if there is something that I might have planned or need to do. They usually plan their flights, or trips and tell me about them when they have their trips finalized. This gets me quite upset and I often get into it with the other person. I try to explain that there are times that I would like to just do something during the day or even stay over in a hotel with my husband for the night. The home health aides are not allowed to give my mom her meds. I have to give them to her twice a day. I can put them together once in a while in the morning but the pill she takes to stay calm should not be given in a double dose in the morning. She will be too calm and possibly sleep throughout the day making it hard for the day aide to feed her.

 People forget that caregivers might actually do other things during the day. So, when I state that I am busy writing an article for a magazine, or just for one of my books, or to post on one of the many sites that I belong to, people often say, “What are you busy with, you don’t work.” I work from home and probably get more done in a day then they do working in an office. I never put anyone down and I respect whatever other’s do. I worked for over 36 years in the NYC Public Schools and I miss working with the students in reading and writing everyday. I had fun teaching my writing classes and working with students in reading and teaching the classics was not only fun but also, rewarding.

 Caregivers are people too and not just people who provide time and care for a person that is ill. They need to understand that the caregiver needs time to regroup and regenerate him or herself and take time to feel. Caregivers: Are Special People: Tips to Help      You Survive

 As the primary and only caregiver for my mom whom has Alzheimer’s I have had to develop different ways to keep myself active and my mind stimulated? All too often as a caregiver you become so immersed in taking care of the needs of the person who is ill that we forget about our own.   When you make the decision to care for the family member at home you are really taking on a challenge of herculean proportion. Everyday is different and every challenge unique and must be handled differently but with kindness and care.

 When a person has Alzheimer’s the hardest thing to deal with is their forever changing erratic behaviors. They can be calm one minute and out of control or violent the next. These behaviors tend to put a lot of stress and strain on the caregiver.

 Here are some kindness tips for both caregivers and volunteers to help make your job easier.

                        Kindness Tips

 

  Always say good morning when entering a patient’s room

  1.   Address the patient by name and tell the patient your name
  2.   SMILE!
  3.   Explain the task you are going to perform before you do it and explain the task as you are performing. Patients are often leery or afraid of strangers and    need to feel confident and safe with you.
  4.   If a patient needs assistance bathing, eating or walking help them and do not leave them before they complete the task.
  5.   Patients that need help eating: You need to make sure that person eats and are fed. Make sure that you do not leave the tray untouched and if you have to  feed the patient you need to do it with kindness and patience.
  6.   Ask the patient if they need help dressing or assistance going to breakfast or any other area of the home or hospital
  7.   If you are bringing magazines or books allow the person to choose
  8.   Never speak to a patient as if they were a small child
  9.   Speak to people with respect and as an adult
  10.   Making sure that the person’s environment is safe
  11.   Make sure you have a list of things that need to be done for that person and complete them
  12.   Meet with other volunteers and discuss their successes
  13.   When you speak to a patient make sure that you make eye contact and have their attention
  14.    Speak at eye level and speak clearly
  15.    Use simple and direct statements
  16.     Never raise your voice
  17.     Include the person in your conversation: Talk to the person not at the person
  18.     Never speak to them as if they are a third party and not in the same room
  19.     Speak to them as an adult not a small child
  20.     Listen to their concerns and show a lot of understanding
  21.     Never leave a patient in distress

 

Remember: What you are doing is a blessing to the person who can no longer handle life alone and who needs your love, support and assistance. Remember they did not choose this disease unfortunately it chooses them. Alzheimer’s is really deadly and unfortunately there is no cure. But, let’s hope with research and better understanding of the causes that someday there will be a solution.

 

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Thank you Doreen McGettigan for your informative post last week. It was very well received. More continue to read it even after nearly a week.  As a reminder:  My guest bloggers will be published each Monday. That is if I can get enough people to contribute. Right now I have four committed guests.  The next guest is scheduled to appear on September 19th .  She has an important story to tell. A story that either has or will affect nearly all of us. Please tune in.

All of the guest blogs will be health related, as that is what I do. I felt the need to keep the guests in the same…genre, if you will.

In the past, there was no rhyme or reason for when a blog would get published. That is all changing too. The schedule will be:

Weekly Update Saturday’s

Guest Blog Monday’s

My blog Thursday’s

I encourage all of you to tune in and subscribe to the blog. There are some very interesting stories on the horizon.  If you would like to write a guest blog, let me know.  Follow this link for the details.  http://www.facebook.com/note.php?note_id=246784205353709   Participate too. Comment on them, and if you like, ask questions as well. I will answer all questions. I will do my best to get the guest blogger to answer  questions you may have for them.

Here is a teaser for you.  The guest blogger for next Monday is Fran Lewis.  Get to know her now.  http://www.facebook.com/note.php?note_id=261661050532691

For information about me and my book, along with links to everything, go to: http://www.brianhayden.com/

Take a peek at these great reviews!!  http://www.amazon.com/dp/1456060953/

One important note!  I am severing my relationship with my publisher. I am asking all of you to postpone your purchase of my book, “Death:Living To Talk About It” . I really don’t like doing this, but I think it is for the best. With a bit of luck my book will be for sale again real soon.

Thanks for your support. Enjoy the read.

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Fighting heart failure is a relentless battle. Today I awoke, barely able to get out of bed. My abdomen distended. Hands swollen. Even my legs, which normally takes several hours of awake time to feel the extra weight were beginning to swell. My arms are heavy. Walking today is a chore. Breathing too. Denise and I were going to have a nice day. Lunch, shopping and just hanging out.  I am afraid that must be delayed. Instead, we will stay at home.

Do you remember, several months ago I was in a cardiac rehab program?  The idea was to get as fit as I could before taking my run at a heart transplant. At first it seemed to be working. Then, after a few months of training the strangest thing happened. I began getting worse. Not better – worse.  It seemed  at this point , exercise was causing the heart failure symptoms. The doctors stopped the rehab. I would have to do this without the aid of exercise. At least for now.

Then, as you might recall, two weeks ago I had a heart attack.  An occlusion of a small artery in the left branch of my coronary arteries. The results are unclear. Even the procedure is changing. I was told that I received a second stent. It was near the existing one. A message from my heart failure nurse a few days ago told of a different story. Apparently the area that was stented back in 1995 once again closed. The new stent was placed inside the old one. A stent inside a stent. We are not sure how long this one will last because it drastically narrowed the artery they were trying to open. For now, they say it should help. “We want you go back into cardiac rehab Brian”  the doctor said. He feels that with the improved blood flow that I might be able to tolerate rehab this time. “Sounds good”, I replied. I will do whatever is necessary to forge a better life .

Last Thursday was my first exercise period. The staff was happy to see me back. This is my third return in four years. Perhaps the “Lucky Three” will be the charm. The exercise program went without a hitch. Arm crank – 3 minutes. Tread mill set on 2.0 lasted for 6 minutes. I concluded with some arm exercises using 3 pound weights.  Piece of cake. I went home. The next day Denise and I went for a walk at a park in the neighborhood. I walked slowly, but I did two laps. Each lap is .35 miles. That was pretty good. Saturday came and we once again hit the track. About half way through the first lap, I began struggling to breathe. My legs were aching. It was clear to me, I was not oxygenating the muscles the way I should be. I made it around the track one time and stopped. Sitting on a park bench, catching my breath and watching Denise finish her laps.

When Sunday rolled around, I did not feel like I had the strength to walk.  We were going to visit my grandchildren later. We just hung out around the house.  Monday rolled around  and I had gained five-pounds. That is to say five pounds since the previous Thursday. About a pound a day. I was feeling weak and lethargic (tired). So, you must by now understand that when yesterday (Tuesday)  presented itself I was apprehensive. I still felt poorly. My next rehab appointment was just a few hours away. I cant do it. Not now. I called to cancel. I called my heart failure nurse. I cancelled the day.

It is 6:58 a.m. on Wednesday morning. I am lying in bed, my eyes only half-open. I cannot move my arms or legs. The weight of them is too much. I cannot breathe either. I have the oxygen thing in my nose. I must concentrate on breathing through my nose. Finally about an hour later I drag myself out of bed. I am nauseated and sick. I feel swelled and uncomfortable. I am now ten pounds more than I was just 6 days ago.  I take my pills, and put a call in to the CHF nurse (congestive heart failure). Then, I sit down and relay this story to you, while I await to see if I will be called in and hospitalized once again.

Congestive heart failure is relentless. Despite our best efforts to control it, CHF is a force of nature. As you would not expect to control a tornado, or a hurricane, CHF cannot be contained for long. You can prepare for it, minimize the effects of a direct hit and minimize its effects while the storm is in progress.  But like all things,  at some point mother nature will reclaim what is hers.  There is no avoiding it. That is the way of the universe. . That is the truth. That is my truth.

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