I
have talked before about my heart worries, about the fear that I have
that all is not well in my heart after all (see this entry from last
month:
https://livingwithfh.blogspot.com/2017/12/the-tricky-balance-between-trusting.html).
Although
most of the time I feel OK ( I have never in my life felt 'great',
really), there are some symptoms that sometime worry me more than
others. My neuropathy in my hand and arm, and the strange pains in my
chest, also my weird voice that has gotten raspier and quieter with
time, after my surgery are not worrisome to me that much. But the
weird blood pressure which persists and the shortness of breath which
feels like a lack of air when I try to exercise even a little bit do
worry me. Is my heart truly OK?!
With
a move across country and with trying to find the right doctor to
figure this all out (and not really finding one I can truly trust so
far) the worry seems to grow bigger. The new cardiologist I have seen
in my new home state seems to be overwhelmed by the weight of my
heart concerns, at least this is how I feel after having seen her for
the past three months now. Anyway, this is about the new findings in
some tests that she ordered rather than about my relationship with
her as my caregiver. That is a topic for another post!
As
I was mentioning in the blog linked above, because of these concerns I have, and because she finally listened, she ordered a holter
monitor for a couple of days and a cardio-pulmonary stress test. A
month or so later I finally received the results to both of these
tests. Apparently, the delay was caused by her not being able to explain the results herself and waiting to find a more "senior" cardiologist to interpret them. How's that for not worrying?!
She
did not have much to say about the holter monitor, other than “my
heart was beating faster when I recorded the discomfort I was
having.” However, she did not say what
mishe have caused my heart to beat
faster, especially when most of the times when I recorded the
discomfort were at rest. For those of you who have not had a holter
monitor attached to your chest before, it is a device
(http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Holter-Monitor_UCM_446437_Article.jsp#.WlzccqinHIU)
that is connected to all these wires (like a mini-EKG machine). The
wires are attached to your chest with stickies. It is the size of a
mini-ipod or so, and you wear it for any amount of time (a day to a
week). You cannot shower when you wear it. When you have any kind of
chest discomfort, like palpitations, short of breath, chest pain or
pressure, there is a button on it that you have to press to signal
the holet that you are having an “event”. At the same time, you
record the time this happened in a journal and you specify what you
were doing at the time when this happened. When they receive back the
monitor from you, they put the reading of the monitor together with
your report to understand what really happens with the heart in the
moments when you recorded the discomfort.
Outside
of a brisk walk one day when I recorded shortness of breath, all the
'events' I recorded in my journal and signaled on the monitor were at
rest. So, why my heart was beating faster, I am not sure and the
doctor did not explain. But another bullet point has been added to my
concern list, as you can imagine.
Then,
she also ordered a cardio-pulmonary stress test. Although I have done
many stress tests in my life, I had never done one of these before.
It is not pleasant. Nothing hurts, but it is very awkward and very
uncomfortable. As you are walking on a treadmill, they hook you up to
an EKG machine to monitor the function of your heart. There are two
techs in the room: one watching your lungs and one watching your
heart. They put this mouth piece in your mouth and they clip your
nose: you can only breathe in the mouth piece which is connected to
this hose which measures your lung capacity and other variables. You
cannot swallow your saliva during this and you run on a treadmill
with this whole setup on you for as long as you can. They speed up
your treadmill and they increase the angle of the incline slowly as
you exercise.
The
test is supposed to find out whether you have any kind of impairment
to exercise, whether from the heart or from the lungs. The way my
cardiologist explained, there could be three things that stand
between you and a good cardio exercise: it could be physical
de-conditioning, which is a fancy way to say that you're out of
shape. It could also be a pulmonary impairment, where your lungs
don't fill up with enough oxygen for whatever reason. And there can
also be a cardiac or circulatory impediment which would mean that
either your heart does not pump enough oxygen to your body (which
could point to a 'bad pump function' of the heart) or the exchange
between the heart oxygen and your body is limited, because of
blockages in your circulatory (arterial) system.
They
found no pulmonary impairment, according to the doctor, although some
of the decoding I did does say that there is a limited oxygen
exchange at the level of the alveoli. But it is unclear to me whether
that is on the lung or the circulatory side.
They
also found physical deconditioning, which I know is there, because
after years of limitations, I can only push myself so much to do
cardio exercising. So, I know I don't do enough to stay
in shape.
What
they found out more clearly, was that I have a mild to moderate
cardiac impairment. Apparently, they can measure something called the
VO2 max or the VO2 peak, which is the maximum amount of oxygen your
body gets during exercise. For more on the VO2, see
https://en.wikipedia.org/wiki/VO2_max.
Based
on my weight, age, etc, the VO2 prediction is 31.30
mL/kg/min. At my level of extreme exercise, it is 19.90 mL/kg/min for
me,
which is at about 64% from where it needs to be. Related to this, the
value of the METS (oxygen uptake in ml/kg/min) was only 7.43, and
from what I read for a woman my age it needs to be around 9.5.
So,
to unscramble all this: my body does not get enough oxygen when I
exercise. The doctor says this could be due to either or both of
these things:
- my aortic valve does not work sufficiently strong to push the oxygenated blood out to the body or my heart muscle doesn't work sufficiently to do the same thing.
- I have still blockages in my (heart or body) arteries that prevent my muscles (including the heart muscle) to get enough oxygen.
The
next step would be more tests to figure out which of these two
possibilities is actually at play.
But
before I plunge into those, I must find a new cardiologist.
I
am praying that whatever they find it does not involve more surgery
and opening up more blood vessels, but … God willing, I'll deal
with whatever when I get there. Should I be so lucky to get there
before there is a bigger problem.
Much
health, everyone, in the new year and beyond and may your diagnoses
and plan of action be crystal clear!
