Checking 'ejection fraction' for heart improvements

(Find a penny, pick it up and all day long you’ll have…goodness only knows how many germs and bacteria on your fingertips…Good luck trumps germs, though, so I pick it up. Hand sanitizer, where are ya when I need ya?

My flu or wicked cold or whatever is finally gone. I feel good so it's back to walking, lifting, and getting as healthy as possible. Does better health translate into better writing? You be the judge…)

“That is the story of the day.”

The cardiologist said the preceding after hearing my answer to his question, “What brings you here?”

I told him about everything leading up to my hospitalization in March with pulmonary and cardiac sarcoidosis. Dr. Charles J. Mattina of Long Branch, N.J., is a good listener. I like his follow up questions and demeanor. He is another doc hired in my on-going fight against the disease.

His role is crucial. Cardiac sarc kills. There is no sugarcoating it. We will know more about my heart after I undergo an echocardiogram. I do know my left ventricle is weak, two thirds weaker than it should be. Doctors at Northwestern Medical Center concluded that the sarcoidosis that scarred my lungs also weakened my heart.

A Northwestern electro-cardiologist recommends the installation of a defibrillator to shock my heart into a normal rhythm in case it beats awry, causing sudden cardiac death. He recommended that action in March, but after careful consideration and getting a second opinion, I am opting to see if prednisone and methotrexate will contain the damage.

I was sick during the winter of '08-09, the coldest winter in Chicago in 30 years. The cold air clamped down my lungs like an icy vice grip. Every breath was piercing pain. Every step, labor. But I went to work - two jobs in fact and did what I had to do to survive. Thanks to my friends I made it through. If I could live through that, I figure I can live through almost anything.

“If I was in your position, I would have made that decision,” said the cardiologist about my strategy.

Thursday, my new cardiologist will test my election fraction, which measures how well the left ventricle functions. This is usually expressed in percentages and the good folks at the Cleveland Clinic explain it pretty well. I’ll try it: With each beat, a normal heart pumps a little more than half its volume. A range of between 50 percent and 70 percent is acceptable. A lower ejection fraction signals problems with the heart, including a heart attack or disease like cardiomyopathy.

My ejection fraction was in the mid-30s when it was last measured in Chicago. I have given up cigarettes, exercise and have been consistent with medications to project the heart. I am eager to see if the situation has improved.

I like my chances, but I am open minded and ready for anything. If we don’t like the results, we’ll try something else. I am not surrendering to sarcoidosis. Too many people to see and too much stuff to do.

...Flu shot: Round two...

I’m going to roll up my sleeve and take the H1N1 swine flu vaccine shot when it becomes available. I won’t be first in line, but I will not be the last. I will do my best to avoid situations where I can get sick, but unless I decide to live in a plastic bubble, I will be out in the world and run the risk of running into someone who sneezes without covering their mouths or..picks their nose and …yuck...wrote about that always you know what grosses us out! I am taking the shot as a precaution. The pros outweigh the con. Let me know what you are doing and why. And good luck!

Reblog this post [with Zemanta]">

Properly fitting clothes replace distress of "OL" readings

My clothes are no longer tight.

I do not grunt and struggle to get out of a chair or off the floor.

I can touch my toes. I can see my toes...

I am lighter and more flexible than I was in March when I visited my folks in Lakewood, N.J. I’ve lived in Lakewood for about six weeks now. Size-wise, I still consider myself a dancing bear.

But I definitely feel smaller. The question that haunts me is this: How big was I? Where are the haters when they are needed? Haters would tell me that I was so big I needed a personal zip code.

I asked my mom; I see where I got my diplomacy skills. “Well, you’ve been working hard (to lose weight) since you’ve been here,” she said. “That is all that matters.”

All my dad would say, after my prompting, was “Trust me, you were big!” But he won’t go any further.

The last time I was weighed was in mid-August. I was 306 or 308. It depends on which scale you believe. Both were in doctors’ offices. Both were those old stand-up scales. I stepped on a couple of digital bathroom scales in August. They registered OL, over limit or over load. Sigh.

Apologies to whoever found their scale smashed into bits in the wake of my visit.

“Can a scale really jump from two stories to its death, David?”

“Well, I’ve been in the news game for a while and I’ve seen all kinds of strange…Oh, look at the time! ‘Gotta go! ‘Gotta go!”

The most I ever weighed in my life was 330 pounds, according to my health records. That is NFL lineman big. That was in 2005 and, in about four months, I dropped to 270 after a doctor expressed concern.

But I was not on prednisone back then. Prednisone and methotrexate appear to be keeping at bay my lung and heart sarcoidosis symptoms (I’ll know more later this month), but prednisone makes me ravenous. Between mid-March, when I started the prednisone regiment, and mid-May I went from 295 to 321 pounds. I ate everything under the sun and asked for seconds. Thirds. I was on 60 mgs of prednisone, a high dose. There were other fun side effects, too, including mood swings. Not good. I got my appetite under control and weighed in at 297 in mid-July. However, it was difficult to maintain the discipline needed to fight the drug-fueled urge to eat all the time. So, I got up to 306-308...OL on the electronic bathroom scales! Damn...

However, these past few weeks...I think I finally got it together. I walk two to four miles a day, work out with barbells, TRY not to eat after 9 p.m.

Also, my prednisone dosage has been cut in half. This might be the edge I need to get a handle on the diet. I am reading about how hard it is to lose while taking prednisone, but, experts and patients alike, also say it can be done.

I am trying hard because reducing and controlling my weight is key to curbing sleep apenea, heart disease, making it easier on my lungs. Too much is at stake.

I visited a new internist four weeks ago. He recommended I weight myself every day to gauge progress. I chucked that idea. Instead, I try on clothing. I do that once a week. Slowly but surely, stuff that once was tight now fits.

Starting today, I am going to cut off food after 7 p.m. We'll see how it goes.

I will be weighed again on Sept. 22. Whatever the new weight I will let you in on it. I will be visiting a new cardiologist and, after my new routine, I anticipate encouraging news.

Whatever happens, I’ll write about it, draw inspiration from the event and will keep fighting to get things right.

Good-bye, for now, to favorite food

This is a photo of me and one of my most favorite foods, a hot dog.

Not just any hot dog. A Texas Weiner. There is a rich history behind this tasty treat.

My good friend Charlotte Fiorito shot this photo on July 27, my birthday. I turned 44. That day, I also said good-bye to to hot dogs in an effort to save my life.

Hot dogs are loaded with fat and sodium. I am taking prednisone to reduce symptoms of heart and lung sarcoidosis. A major side effect of prednisone is weight gain through the retention of water and sodium. It is difficult to say good-bye to the foods you love when you are on prednisone because another prednisone side effect is insatiable hunger. Prednisone patients are ravenous 24-7.

The last time I had hot dogs was July 27. I ate a Texas Weiner with Charlotte while we were on a remember-back-when tour of Plainfield, N.J. That Weiner touched off a craving. I had to have more hot dogs. Later that night (or early morning July 28?) while my folks were asleep, I raided the basement freezer for more.

“This is crazy. I really should not be eating this,” I thought to myself as I nuked the dogs, pulled the relish out the fridge and got the rolls ready. “This is crazy,” I said as I slathered the buns with mustard and relish, put the dogs on and “This is crazy…”

Can’t think full mouth…

After eating those dogs, my lower legs swelled so badly I had to lie down and prop up my feet to reduce the swelling. I was actually afraid to check my blood pressure. It would have been too depressing. If I stand a chance of beating this disease and controlling the prednisone side effects, I thought to myself, I have to rein in this appetite no matter what.

Diet and exercise became the goal. I’ve been walking with my dad and lifting weights every day at least five days a week. I walk a few miles every day and lift weights five days a week.

I won’t weigh myself just yet. I have an important doctor’s appointment on Sept. 8. They can weigh me then. Last time I was weighed was three weeks ago and I was 306. I am now trying to gauge success by how my clothes fit. They are getting loose, which is a good sign. I also gauge success by blood pressure reading results. When I moved home, my readings were in the 150s/90s range, with a new in the 170s/110 (that was at wake up…sleep apnea)…Now the readings are in the low 130s/80s, with a couple in the 120s/70s range. The readings are much closer to the 125/85 my doctors want me to maintain.

(This photo shot on Aug. 20, 3-1/2 weeks into working out. Shirt, pants are no longer tight!) I’m feeling better. I am moving better. I assume I am losing weight. We will see on Sept. 8.

It’s tough to say no to hot dogs. We as a nation consume billions of them. They will be front and center at the majority of cookouts this Labor Day weekend. How can one resist. The key, for me, is moderation. I have not had one in more than a month now. I can do one. It will not kill me. After that, the only dog in my life is Tobie, my parent's beloved golden Labrador.

After Jackson's death, spotlight remains on sudden cardiac arrest

Image via Wikipedia

The deaths of Michael Jackson and ad pitchman Billy Mays pushed heart disease to center stage these past two weeks.

Some 300,000 Americans die each year of sudden cardiac arrest, according to figures from the American Heart Association. The survival rate is low. Folks do survive, though, especially if they receive medical help within the first 10 minutes of an attack.

With that in mind, I interviewed Dr. Ajoy Kapoor is a cardiologist and sarcoidosis specialist based in New Haven, Hamden and Branford, Conn.

He explains sudden cardiac arrest; what people can do to prevent and treat it.

I want to be transparent: Dr. Kapoor was among the doctors who tested me in 2005, when I was first diagnosed with sarcoidosis. It was inactive back then, slight evidence of scarring of lung tissue. I have always been good about going to the doctor for regular check-ups, but I asked for exams checking specifically for signs of flare-ups. That may have helped me avoid the situation in which I find myself.

Here's what Dr. Kapoor had to say:

Q: What is sudden cardiac arrest?

A: Basically, it is the abrupt lose of heart function. In generic terms, in laymen’s terms, the abruptness of the loss of function is key.

Q: How is sudden cardiac arrest different from a heart attack?

A: Heart attacks are a broad category. Not all heart attacks result in sudden cardiac arrest. Not all heart attacks or myocardial infarctions cause sudden cardiac arrest.

Q: What causes sudden cardiac arrest?

A: Lose of blood flow. Blockage of an artery. An arrhythmia, an irregular heartbeat or the actual heart muscle of valve might physically be disrupted. You can disrupt it in a way to create a whole in the heart or valve. Seventy percent of cases have atherosclerosis, coronary heart disease (at its roots); another 30 percent is caused by a variety of arrhythmias (cardiomapolies; dilated heart; congenital heart abnormalities; valvular abnormalities).

Q: Who is at risk for sudden cardiac arrest?

A: If they are young, it could be due to congenital abnormalities, cardiomypothy; heart attack.

Other contributing facts are

- Smoking

- High blood pressure

- High cholesterol

- Diabetes

- Smoking

- Lack of exercise

Then there are many things we still don’t know. One can have good cholesterol, be a non-smoker and still die of sudden cardiac arrest. So, we also follow markers of inflammation. But none of these gives us a complete picture.

Q: What tests can I take to find out if I am at risk for sudden cardiac arrest?

A: Give your doctor your history physical; submit to an EKG (electrocardiogram); blood work. Then decisions can me made on that information and those results. Some people may need extra testing and some people may not need extra testing.

Q: Are there definitive treatments for sudden cardiac arrest?

I stress prevention. It is important to modify life style. Smoking cessation, exercising, lowering cholesterol, (controlling) diabetes. People need to take care of themselves. Prevention is key.

#

Folks do survive sudden cardiac arrest. Their stories at the Sudden Cardiac Arrest Association Website are uplifting. Check them out and have a great, safe Independence Day weekend.

Celebrity deaths grim reminders of heart disease

Michael Jackson via last.fm

For Michael Jackson and Billy Mays, the Grim Reaper apparently showed up in the form of heart disease.

Sarcoidosis has affected my own heart, so the deaths of these two celebrities made me sit up and take notice.

It was initially reported that sudden cardiac arrest killed The King of Pop. However, the cause of death was “deferred” by the L.A. County coroner’s office until more test results are available. That could be weeks from now.

Autopsy results last week indicate that Mays, pitchman extraordinaire for Oxyclean and other product lines, died of a pulmonary embolism.

Same difference says the spokesman of the Sudden Cardiac Arrest Association.

During the autopsy, Mays showed signs of hypertension and arteriosclerosis disease of the heart, both known risk factors for sudden cardiac arrest, says Dr. Vince Mosesso, the SCCA medical director, in a press release.

Mosesso says SCA is responsible for more than 300,000 deaths annually in the United States.

“…In many cases the first sign of heart disease is sudden cardiac arrest,” Mosesso says. “(The deaths are) a reminder that we should all make every effort to know about, avoid or modify the possible risk factors for heart disease. Those with diagnosed heart disease should be vigilant in their medical care and lifestyle habits to reduce the risk of cardiac arrest.”

Risk factors include:

- high blood pressure

- atherosclerosis (coronary artery disease)

- previous heart attack, heart failure

- diabetes

- smoking

- obesity

Sudden cardiac arrest is a silent killer, so know the symptoms and what questions you should ask your doctor so he/her can help determine your risk. With sudden cardiac arrest, the heart suddenly and unexpectedly stops beating. Blood stops flowing to the brain and other vital organs, according to National Heart, Lung and Blood Institute Website.

Pulmonary embolism (PE) is a condition in which the pulmonary artery or one of its branches is blocked, according to the National Heart and Lung Association Website. It usually occurs when a blood clot from a vein becomes dislodged and embolizes to the arterial blood supply of one of the lungs, according to www.nhlbi.nih.gov/.

According to reports including comments from Dr. Vendand Adams, the-Tampa-based Hillsborough County Examiner, Mays “had an enlarged heart, a thickening of the wall of the ventricle which takes blood to the heart." The results of other autopsy reports are pending.

Jackson’s situation is still shrouded in secrecy. However, millions heard the 911 call from Jackson’s house and read or heard that Jackson’s cardiologist, Dr. Conrad Murray and then paramedics tried unsuccessfully to revive him.

There was also a report that the doctor prescribed or administered Demerol and Oxycontin to Jackson. Through attorneys, Murray has denied the assertion.

SCA usually causes death if it's not treated within minutes. Heart attacks are different from SCA. The heart can continue beating during an attack. SCA prevents that, shutting down the supply of oxygen-rich blood to vital organs. News accounts say that paramedics sent up to 3/4s of an hour trying to revive Jackson.

I’m paying close attention to results from the Jackson autopsy because my heart has been compromised by sarcoidosis, according to my physicians. They say that there is evidence of myocarditis, inflammation of the myocardium or muscular part of the heart, and cardiac sarcoidosis. It was probably caused by an infection and it can lead to heart failure or sudden death if continues to deteriorate. We are closely monitoring progress.

As I wrote in an earlier blog post, I have a team of docs, electro-cardiologists, who want to place a playing-cards-deck-sized defibrillator in my chest, just in case. But I am on prednisone and methotrexate, both of which suppress the immune system. The surgery to install a defibrillator is minor, but there’s still a risk of infection, so no operation. Not yet.

My goal (after consultations with several specialists) is to see if the heart stabilizes or gets better over the next few months. I have never felt a palpation or other problems, but I must admit that this heart thing is an albatross around the neck. I don’t think I am timid because of the problem, but I am damn sure always aware on a certain level.

I walked 1-1/2 miles Tuesday and thought about it as I began to break a sweat and breathe heavily.

Myocarditis can be treated with antibiotics; anti-inflammatory medicines to reduce swelling; diuretics to remove excess water from the body; low-salt diet and reduced activity. The condition is known to improve, doctors say, but is also known to get worse. To me, that is when the defibrillator would come in handy. But not at the moment. I like my odds of overcoming this.

We’ll try hard and we’ll see where we are at the end of July.

I expect to see a change for a better the next time we look at chest pics. I am getting stronger, I feel it. I do not think I am hoping against hope.

Meanwhile, God bless, Michael, Billy.

#

Mosesso is urging patients to follow some basic healthy heart guidelines:

- Share with your physician any family history of heart disease or sudden death and symptoms you have, including chest discomfort, shortness of breath, palpitations, indigestion and abnormal sweating, especially if associated with exertion or exercise

- Carefully follow physician recommendations on prescribed drug therapies for blood pressure, heart disease, diabetes and high cholesterol

- Exercise regularly. Even a regular walking routine of 30 minutes per day can significantly improve heart health

- Don’t smoke

- Maintain a healthy diet low in saturated fat, high in fiber and heavy on fresh fruits, vegetables and low fat, high-protein seafood and meats

Mosesso also urges people to learn how to do cardio pulmonary resuscitation and automated external defibrillator.

For more information, please visit www.suddencardiacarrest.org or view SCAA’s educational video on sudden cardiac arrest at http://www.youtube.com/watch?v=vXFEIoNkfQo.

Meanwhile, God bless you, Michael, Billy.

(Friday: More on sudden cardiac arrest)

Methotrexate haze

Tuesdays were like any work week day. I hate them. Not close enough to Friday. But over the past few months, I've really come to despise Tuesdays because that's the day I take mexthotrexate, a chemo drug given to me to stem the aggressive swelling of the lymph nodes in my lungs, which had grown to the point that they were blocking oxygen to my lungs and ultimately my heart. Which could have caused a fatal heart attack. Needless to say that is not good.

Sarcoidosis (2) lymph node biopsy" style="border: medium none ; display: block;" width="300" height="226">Image via Wikipedia

Sarcoidosis sucks. Anyway, I will take the drug and it's side affects - I am experiencing are acne; chills and fever; dizziness; general body discomfort; hair loss (Not a really a biggie for me. See bio pic!) itching; loss of appetite; lowered resistance to infection; nausea; sensitivity to sunlight; sore throat; stomach pain; unusual tiredness. I'm thankful that I don't experience the vomiting. I do wish I was experiencing the loss of appetite. Prednisone is still making me eat everything. I'm tired from all the meds, too, so walking of late has been a struggle. But I'm still going for it. I remain upbeat as possible by remembering I do not have the worst methotrexate side effects, including red, swollen, or blistered skin; seizures; serious infection (herpes, hepatitis, blood infection); trouble breathing; unusual bleeding or bruising; unusual pain and discoloration of the skin; vision changes; vomit that looks like coffee grounds; yellowing of skin or eyes. Tuesdays are tough because the other drugs I am taking to combat prednisone's stimulant side effects make me very sleepy. Tuesdays are almost a wash. Better to stay in bed out of the way so one doesn't have to deal with zig-zagging through speedy traffic along Lake Shore Drive (my favorite road in Chicago. Seriously). But life doesn't allow for many time outs, so I will rise early to eat breakfast, take my meds, do my two-mile walk and get through the rest of the day. Thank God I am tolerating these drugs as well as I am, but I have to admit that they are starting to get to me. And I could be on this regiment for the next six months to a year. Is there anyone out there who has good coping methods when it comes to dealing with any of these medications? I'd sure like to hear from you.