Sept 27: Cardiologist update

Saw my local cardiologist last Friday, so here's the update.

First regular echo since the surgery last year. There was a stress echo in December to evaluate the pressure in my lungs with exertion. It was dramatically better than before the last surgery. This is the first regular echo to evaluate the rest of my heart.

Left atrium is still enlarged. Disappointing because the LA was enlarged before the first two surgeries and both times it returned to normal, at least briefly. Dr. Hammer is hopeful it will not increase, maybe decrease over time. Only time will tell. Potential badness would be it stretching out enough to damage my heart's normal pacemaker and put me into atrial fibrillation. A Fib is common in older people, means the top part of the heart doesn't contract but just "quivers" like a bag of worms. It's not good in people with mital valve problems, because then there isn't a contraction to help the blood flow through the MV.

Mechanical mitral valve looks like it's working perfectly. Small regurgitation back into the LA, but that's normal after replacement. Beats severe regurgitation, which was what lead to the heart failure and rest of the mess.

Repaired tricuspid valve (the less important one on the right side between the top and bottom) also looks good, just trace regurgitation, which is normal. Also beats the severe regurg from before.

Left ventricle has maintained it's shape. This is really good news. The mitral valve is made up of two leaflets that are sort of shaped like hot air balloons, with the ropes attached on to the inside walls of the LV. These ropes, called cordae tendineae, help the LV hold it's cone-like shape. When most valve replacements are done, they leave the posterior (rear) leaflet, which is the smaller of the two, in place so that there is still some tension to help keep the LV shape. In my case, since the opening (annulus) of the valve and the LV itself are so small, they had to take everything out. Dr. Cohn (surgeon) told me he had taken out every piece of tissue he could to make the cavity as large as possible on the basis that it would help more blood to enter more easily through the small opening if it was going into a cavity that is as large as possible. The Fellow (senior cardiac surgery resident) told me that the had "never seen Cohn work as hard" as he had on my heart trying to give me the best possible outcome.

The right ventricle still hasn't improved. It is hypokinetic, meaning that it doesn't squeeze well. This more typically happens after someone has had a heart attack to the muscle that has died off. In my case it is because of the damage done by the extreme pressures that built up in my lungs passing on the high pressure to the RV. It was supposed to get better. Dr. Hammer is still hopeful.

So, what does this all mean? Well, I'm much better than I have been for the last four years. I'm still not feeling as well or able to do as much as before I got sick. But, it's only been a little over a year since the third surgery, so there is still hope for improvement. There is, quite literally, no one to compare me to or to look at for a gauge as to what comes next. Uncharted territory. Anybody's guess. Sometimes being unique really isn't a good thing.

I still tire, often feeling it at the consistent time of 2:00 to 3:00 in the afternoon. I recover more quickly now, which is good. If, however, I get overly tired (as I did the day the friends were here to work on the basement) it seems to take me days, even 10 days, to feel better again. Annoying thing: I still can't crouch. You know, like you do to get something off a lower shelf? After only about 30 seconds I start getting dizzy and lightheaded. I still can't cross my legs for more than 10 minutes at a time or else the same thing happens. Best guess is it's the extra work needed to push against that pressure. Peeing--as I continue to mention--is still a central issue. If I'm busy going around doing physical things then I don't go to the bathroom. When I get home and am resting on the couch is when the kidneys seem to kick in again. This indicates that while the heart is allowing me to do things, it still isn't functioning enough to do some of the basics, like completely perfuse the kidneys, although it makes up for it quickly.

So, what's next?

Right now the most imporant thing that I can do for myself is to lose weight. The less mass my heart is trying to support, the easier it will be. It was a battle to maintain my weight, which returned to Spring 2004 levels, and not gain more. Now I'm really attacking it, helped by the treadmill desk and walking slowly but for longer periods of time. I've slashed my food intake to about 1,000 to 1,200 calories a day and eat disgustingly healthy. Despite all this, I've only dropped 9.5 pounds in 6 weeks. So far, no one's noticed, but my clothes aren't as tight. The minimum amount of weight off is another 13.5 pounds, which would be about 23 pounds less than I've been currently hauling around. In Cohn's opinion it's another 20-25 pounds. For a 45 year old female with a sluggish metabolism that's a really tall order. Especially since I can't do a lot of exercise. But it is the single most important thing I can do for myself, the thing that has the greatest chance of my staying stable, or possibly improving, over the long haul. So that's what I'm concentrating on.

So, I'll post my gains in exercise and the losses on the scale and hope for the best.

Thanks for checking in, Laurie