Notes on the Road to Recovery

It’s now been a a few weeks past three months since my heart attack.

As I indicated in my first post, there were some bumps on the road to recovery, specifically my second hospitalization and a couple visits to the emergency room. All were due to fluid problems in the pericardium or pleura.

Well, the bumps continued beyond that first post.

In early April, I was having a very difficult time with coughing and shortness of breath. I had to use a walking stick when outside and away from the house; mostly for psychological support (but at times it provided support when I needed to rest; nothing would be worse than having to sit down on the side of the road while taking a walk).

A visit to the heart failure lab resulted in a chest X-ray that showed another pleural effusion. This confirmed what had been suspected as I had swollen ankles for the first time.

So it was back to being an inmate at Tacoma Genera hospital for another week – a week of drug-induced diuresis (increased production of urine) to eliminate all the fluid in the tissues. As before the nurses and the food made it bearable.

In five days they dropped my weight another ten pounds to the point they said I was now dry. As an aside, since the start of this adventure I’m down around 35 pounds; it’s a proven but not recommended approach to weight loss.

While I was in the hospital, the surgical cardiologist decided that more diagnostic information was needed so they performed a right-heart catheterization. It sounds worse than it was. A catheter was sent down the right jugular vein and pressures and flows within the heart were measured. I was awake for it and it was rather boring as they were calling out numbers that made no sense to me.

It turns out I wasn’t in as bad shape as the doctor feared. Pressures in the heart are a bit lower than normal in the right chambers and a bit higher in the left chambers; the belief is the heart’s left chambers (where the coronary artery was blocked) are still stiff from the heart attack and the right chambers may be compensating.

At the same time, the flow of blood through the heart was 4.6 liters/minute (normal range is typically 5 to 7.6). As my regular doc said if he hadn’t known he would have thought he was looking at a undamaged heart.

After getting out of the hospital I had a cardiac stress test. Wearing neoprene bondage headgear and breathing through the mouth, I got to walk on an increasingly steeper treadmill. I think I did okay but I was really sucking wind at the end. Still have to get the results on that one.

At this point, I do feel a good deal better. The persistent cough has disappeared. I can get a good night’s sleep. As long as I watch my diet – keeping sodium and fluid intake below recommended limits my weight stays steady.

Walking farther is getting slowly better. On the flat I’m not fast but I’m steady. Going up hills or stairs I have to make sure I’m breathing correctly. And as I found out in the clinically supervised workouts I do at cardiac rehab, I can push the envelope and wind up sucking a bit of wind.

But overall, I feel almost normal – most of the times.

The plan going forward is to continue with the current course of medication (six different drugs) and continue my supervised workouts at cardiac rehab.

July will be the six-month mark. Cardiologists say that it can take that long for a damaged heart to reorganize after a heart attack. My cardiologist will have me go through another echocardiogram that month.

If the ejection fraction is above 35% (it was 20-25% after the heart attack), it means one of the markers for the heart’s health has demonstrably improved. If not, then we will be having a discussion of other options.

I’m not going to think about those options now; we both remain hopeful the current plan will work and my heart will continue to improve.


Author: Tom

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