Thursday, March 22, 2012

Warning - This Post is a Snoozer

If you’re like me, the more you know about something the better.  I always want to know what, why, where, and how.  And somehow this helps me.  I had an echocardiogram last week and found out that, despite the device installation, my ejection fraction is still just 15-20%.  It may just take more time.  Also, the medication that I had asked my cardiologist to reduce must now be put back at the higher dosage.  I guess I don’t have a medical degree after all. 
I feel great most of the time; I work full time and seriously do anything I want.  I am focused on living life to the fullest.  Losing weight and exercising more are still squarely on my target.  I am happier than I’ve ever been.
The following information was copied from a US News article written in conjunction with the Mayo Clinic.  Even though this article is from 2008, I learned a few new things.  It is a long read but you’ll find it interesting if you have dilated cardiomyopathy:
Cardiomyopathy is a general term used to describe a diverse group of diseases of the heart muscle. For most people with cardiomyopathy, their hearts don't function normally because the heart has become enlarged, abnormally thick, abnormally rigid, or unable to transmit electrical impulses in a normal fashion. These changes in the heart muscle correspond to the four principal types of cardiomyopathy—dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Included in each of these categories are several dozen types of cardiomyopathy that are distinguished from one another based upon their individual cause.
Coronary artery disease, inflammatory diseases, viral or bacterial infections, chronic alcoholism, and metabolic and blood disorders are some of the more common conditions that can lead to cardiomyopathy. Genetic mutations, including some that run in families, can also cause cardiomyopathy. However, many forms of cardiomyopathy have no apparent cause; these are said to be idiopathic. Although it can affect people of all ages, sometimes even at birth, certain types of cardiomyopathy are more likely to occur in specific age groups, in men more than women, or in people of certain ethnic groups.
Many people can live long, healthy lives not even realizing that they have cardiomyopathy because they have no symptoms. For others, cardiomyopathy leads to serious complications including heart failure, abnormal heart rhythms, or sudden death. Cardiomyopathy is a leading cause for heart transplants and the most common identifiable cause of sudden death in young athletes. If the symptoms of heart failure develop, the outlook for people with cardiomyopathy can be discouraging—only one out of every three patients survives more than five years following the onset of heart failure. However, the symptoms and complications of many forms of cardiomyopathy can be effectively controlled using medication, surgery, and/or simple lifestyle changes.

The structure of the heart is analogous to a two-story house with four rooms or chambers. On the main floor are the two largest rooms, the left and right ventricles. The ventricles are the main pumping chambers of the heart. In a healthy heart, the left ventricle is the stronger pumping chamber. The wall between these two rooms is called the ventricular septum. Upstairs, there are two smaller rooms, the left and right atria. The atria function primarily as receiving chambers for blood, but they also help out slightly with pumping. The wall between the two atria is called the atrial septum.
The valves of the heart function like one-way doors that help control the direction of blood flow; this keeps the heart working efficiently. The four valves in the heart are the tricuspid, mitral, pulmonary, and aortic valves. Proper functioning of the mitral valve, which connects the left atrium to the left ventricle, can be important for people suffering from heart failure associated with dilated cardiomyopathy. The mitral valve keeps the blood flowing into the left ventricle, where it is pumped out of the heart and circulated throughout the body.
The pulmonary and the aortic arteries are the main pathways for blood in and around the heart. The pulmonary artery shunts blood from the right ventricle to the lungs. The pulmonary veins channel blood from the lungs back to the heart into the left ventricle. The aorta channels blood from the heart to the body. The coronary arteries, which branch off the aorta, distribute blood to the heart itself.

In general, the right side of the heart is responsible for pumping blood to the lungs. In a healthy heart, oxygen-depleted blood enters the heart at the right atrium, where it is pumped down into the right ventricle. When the right ventricle fills, the heart contracts strongly and pumps the blood through the pulmonary valve into the pulmonary artery, which carries the blood to the lungs. The pulmonary valve keeps the blood moving toward the lungs, preventing it from mixing with oxygen-rich blood.
In the lungs, the carbon dioxide in the blood is exchanged for oxygen. The oxygenated blood leaves the lungs and returns to the heart via the pulmonary veins, re-entering the heart at the left atrium. Exiting the left atrium through the mitral valve, the blood flows into the left ventricle. When the left ventricle fills with blood, the heart contracts strongly, pumping blood out through the aortic valve into the aorta to circulate oxygen to the rest of the body.
Ejection Fraction and Cardiomyopathy:
The primary pumping action of the heart is like a spring that contracts and relaxes. When the heart is relaxed, the ventricles simultaneously fill with blood. When the heart contracts, the ventricles eject a portion of the blood they contain to either the lungs (via the pulmonary artery from the right ventricle) or the rest of the body (via the aorta from the left ventricle). That exact portion of blood pumped out of the ventricles is called the ejection fraction. In a healthy heart, the ejection fraction is greater than 55-60 percent. If the ejection fraction falls below 55 percent, the heart is no longer able to circulate an adequate amount of blood to the body at a normal heart rate. A decrease in the volume of blood circulating throughout the body can cause a cascade of changes in the body's metabolism.
Like a spring, if a ventricle is continually overextended or stiff, it no longer functions properly. An overextended ventricle can lose the ability to contract, reducing the ejection fraction. The inverse problem can also occur where the ventricle is abnormally stiff. In this scenario, the ventricle no longer relaxes enough to fill adequately with blood. As a result, the volume of blood ejected from the heart is abnormally low because less blood has entered the heart.
Dilated cardiomyopathy, a common form of cardiomyopathy, is characterized by an overall enlargement or stretching of the heart muscle accompanied by a decrease in the heart's ability to contract. Dilated cardiomyopathy usually begins with stretching of the left ventricle; in some cases, the right ventricle may become affected as well. Dilated cardiomyopathy can lead to heart failure, a decrease in the heart's ability to contract and pump blood out into the arteries of the body. Other complications include disturbances in the heart's electrical system known as arrhythmias, blood clots forming within the heart, and sudden death, any of which can occur at any stage of the disease.
Although it can occur in infants and the elderly, dilated cardiomyopathy occurs most frequently between the ages of 20 and 60. It is three times more common in men than women and more common in African-Americans than Caucasians.
The progression of dilated cardiomyopathy can be rapid; some studies have found that 50 percent of deaths due to dilated cardiomyopathy occur within two years of diagnosis, although the risk of dying within one year for all patients with heart failure symptoms is about 12 percent. In general, the worse the symptoms, the worse the outlook. For example, a patient with mild breathlessness during significant exertion may have a 5 percent chance of dying within a year, while a person who has these symptoms while sitting in a chair may have a 30-50 percent risk of dying within a year.
When cardiomyopathy is caused by coronary artery disease (CAD) it is known as ischemic cardiomyopathy, the most common type of cardiomyopathy. People with ischemic cardiomyopathy often develop the same signs and symptoms as those with other forms of dilated cardiomyopathy. However, with ischemic cardiomyopathy, the symptoms are caused by narrowed or blocked coronary blood vessels restricting blood flow and oxygen to the heart tissue, which damages the heart muscle. Even though the signs and symptoms are the same, ischemic cardiomyopathy has traditionally been considered separate from dilated cardiomyopathy because coronary artery disease typically causes localized damage to the heart as opposed to the generalized damage of all heart cells associated with dilated cardiomyopathy. More importantly, the damage to heart muscle associated with ischemic cardiomyopathy can be reversed in some patients by opening the blockages caused by CAD. For this reason, almost all patients with a new diagnosis of dilated cardiomyopathy undergo a coronary angiogram to evaluate the condition of their coronary arteries.
Dilated cardiomyopathies can be caused by many other conditions or the cause may never be identified. In the United States, dilated cardiomyopathies other than ischemic cardiomyopathy account for 50,000 hospitalizations and over 10,000 deaths annually—and these statistics are on the rise. Other common types of dilated cardiomyopathy include:
Inflammatory cardiomyopathy can develop as the result of viral, bacterial, or autoimmune infection as well as myocardial inflammatory disease. Some of the infectious and inflammatory conditions that have been linked to inflammatory dilated cardiomyopathy are lymphocytic and giant cell myocarditis, Lyme disease, HIV, mumps, influenza, Epstein-Barr, and hepatitis B and C.
Familial (genetic) cardiomyopathy accounts for roughly 20 percent of all cases of dilated cardiomyopathy where no other cause can be identified. The details of the genetic link are not well understood but it's clear there is a genetic predisposition to developing dilated cardiomyopathy in some families. As such, evaluation of all first-degree relatives to rule out a "silent" familial cardiomyopathy is recommended for people whose dilated cardiomyopathy cannot be attributed to a specific cause.
Alcoholic cardiomyopathy usually begins to develop after about 10 years of heavy alcohol consumption.
Toxic cardiomyopathy may develop after exposure to certain toxins including cocaine, methamphetamines and some chemotherapy drugs.
Peripartum cardiomyopathy can develop in women during the last trimester of pregnancy or within five months after childbirth. Women often recover completely from peripartum cardiomyopathy, but it may recur with future pregnancies.
Valvular cardiomyopathy can develop when the workload on the heart in increased due to a malfunctioning heart valve.
Tachycardia-induced cardiomyopathy, caused by chronic rapid heart rate, is important to identify because the symptoms of heart failure can be reversed in these people by treating the arrhythmia.

The change in the heart muscle associated with the principal types of cardiomyopathy is the result of the interplay of a variety of factors. Genetic mutations in the cells of the heart muscle, other diseases, environmental and lifestyle factors, and the body's own survival mechanism can contribute to the development of cardiomyopathy.

Dilated cardiomyopathy can be thought of as a compensatory reaction of the heart to a weakened heart muscle. The cause of the weakening may be unknown or it may be associated with many different risk factors including viral infections, exposure to toxins and drugs, or coronary artery disease, as in ischemic cardiomyopathy.
In people with dilated cardiomyopathy, the heart enlarges to compensate for the inability of a weakened muscle to eject the amount of blood needed by the body. Stretching helps compensate for the weakened muscle in two ways. First, the overall volume of the heart is increased, thereby increasing the volume of blood ejected into the circulatory system. This action is analogous to a person squeezing a flexible plastic bottle. A strong person might be able to squirt out 50 percent of the contents of the bottle with each squeeze. If the person's grip is weakened and he is only able to eject 25 percent of the contents, only half as much liquid will exit the bottle. However, if the person had a bottle that holds twice as much, 25 percent of that bottle would be twice as much volume. In dilated cardiomyopathy, the heart is acting like the plastic squeeze bottle, dilating its chambers to try to maintain the amount of blood pumped to the tissues of the body by a heart whose ejection fraction is diminishing.
Stretching the heart muscle can also increase the strength of the contraction. Starling's Law, a basic principle involving the function of the heart, describes this phenomenon: the more the heart muscle stretches, the greater the force of its squeeze. The heart functions much like a spring whose coils are overstretched and then released to snap back into shape. If this action continues repeatedly, the heart will eventually lose the ability to regain its original shape, like an overstretched spring.
The heart can also compensate by beating faster. Although beating faster can improve circulation temporarily—normal hearts do this during exercise—a chronic increase in heart rate (tachycardia) can lead to dilated cardiomyopathy or serious arrhythmias.
The kidneys may also try to compensate for the decreased circulation by increasing the volume of blood and fluid in the circulatory system. Ironically, this compensatory mechanism exacerbates the situation by causing swelling in the legs and abdomen, and fluid accumulation in the lungs.
All of these compensatory mechanisms—dilating, stretching, beating faster, retaining fluid—evolved to keep the blood pumping to the body on a short-term basis following an injury or dehydration. In the long term, though, the heart responds like a spring that's been overextended; eventually, it can no longer return to its shape and function effectively. Then the dilated heart becomes more of a dam than a pump, with blood pooling inside an enlarged heart that is no longer capable of circulating blood. The most effective treatments for dilated cardiomyopathy focus on blocking these compensatory responses.

Risk Factors:

Medical research continues to reveal how different risk factors interact to influence a person's health and lifespan. Understanding your risks allows you to develop a strategy and make lifestyle choices accordingly. Your decisions then balance the value you place on your health with the risks that may compromise your health in the future. An increased risk does not mean the disease is inevitable; risk refers to the possibility that a disease could occur in the future.

The risk factors for dilated cardiomyopathy include both lifestyle choices as well as genetic traits. Many of the risk factors are actually other diseases. Uncommon bacterial or viral infections, rare blood disorders, and other inflammatory diseases can lead to dilated cardiomyopathy in some people.

Saturday, March 10, 2012

I hate to Exercise

Yes, I hate the very thought of having to "exercise" every day.  After a day at my job, the last thing I want to do is exercise.  But something I "hate" even more than exercise is wasting money.  If you're like me, you have spent countless dollars on gym memberships, exercise equipment, exercise classes, exercise tapes, etc. etc.  And are you still using/doing anything that you spent that hard-earned money for?  Chances are, the answer is NO.  But what if I told you that you could spend less than $100 on the perfect exercise for you and it would last you for the rest of your life?  And you might not even spend that much if you already have some of this "equipment".  You can use:  hand weights - I like the Jillian Michaels set (Walmart) that includes a set of 3#, 5#, and 8#.  You will also want MUSIC - an ipod shuffle (Walmart again) is $50.  You may or may not want a pedometer - $20 on Amazon - to keep track of your steps.  That is good motivation.  You might also want a mat - $15 (Walmart; no I don't work there).  And you will need a place - a bedroom, spare room, basement (that would be great).  That's it !

Aim for once a day, but realistically you may just find you can do it every other day.  It doesn't matter; whatever you do is more than you're doing now, right?  With your favorite music on your ipod shuffle (some fast, some slow songs), and your weights and mat, just MOVE around the room.  Admit it, you've been to enough classes and watched enough tapes to know what "moves" work your body the best.  And just do your favorite ones, and as many reps as you want.  Don't do those dang ones that hurt.  You don't want to dread this time tomorrow.  You can add in some jumping jacks or fast walking, or jogging if you have a basement.  Whatever makes you FEEL GOOD!  And do it for as long as you feel comfortable.  Slow moves on the slow songs; fast moves on the fast songs.  If the jumping jacks are too much, stop and do some overhead presses.  If lunges are too much, get down on the floor and do some leg lifts.  ANYTHING you want; you're the boss here!  No one else is telling you what to move where and for how long.  I personally guarantee you will feel great and the best thing is, you were in charge of your body and your health.  Happy "not exercising" to you!

Monday, March 5, 2012

I know some beautiful people....

Today's post will not be about me.  It will be about having faith when you are in a battle.  Listen to these words from Steve Kline as he shares from his heart some things he has learned during his wife's cancer treatments.  Dawn is still living with cancer today, over 6 years now, and still has a cheerful attitude and faith that she will be healed.  I think you will find this testimony from her husband very inspiring...

Steve Kline - 11/15/09:
"While I was thinking about the last four years of Dawn's battle with cancer and not receiving the answer we wanted - divine healing - the Holy Spirit really made three things stand out: 1) we've had to settle in our minds that God is in control; 2) our attitude is critical; and 3) God wants to change our thinking.

Dawn has done everything the Bible says to do to receive healing. She has asked God, thanked God, been anointed by the elders of the church, memorized the Word so that it is in her heart, put her name in the scriptures, had an untold number of people pray for her, forgiven others, and seen all kinds of doctors in different countries. Despite all of this effort and doing the .right. thing Dawn still has not been completely physically healed.  There have been many times when we have asked why, what is He doing, why won't He heal Dawn, when will He heal her and so on. During this battle I've come to the conclusion that the answer to any of these questions is that God is in control. Years ago Dawn and I were really struggling in our marriage. During that time I received my first true revelation of scripture, where the words were more than just words on a page, from the Holy Spirit. The scripture was Romans 8:28 . .And we know all things work together for good to those who love God, to those who are called according to His purpose.. I have settled in my mind that no matter what happens in my life it is going to work together for my good. I know only God can do this because He.s the only one that has known me throughout all of eternity. It.s a choice we have to make. It.s as simple (and difficult) as choosing to go with God or choosing to go on our own. How we deal with the circumstances of life hinges entirely on that decision.

The Bible says that God has given us a joy that the world can't take away and that we have the strength of Christ. As I have watched my wife go through her battle seen the truths of those two scriptures play out in her life. Not only has the right attitude helped her build her faith but it has impacted the faith of others too. For a while Dawn was receiving treatment at a hospital in Mexico. I went with her for a week (her mom and best friend had been with her previously). At this hospital everyone had to eat in the cafeteria unless they were completely bed ridden. During our first lunch a woman walked across the room to Dawn and said that Dawn had a beautiful smile and that Dawn's smile was a blessing to her. The woman said that Dawn.s smile was a blessing because she could see that Dawn still had joy. This memory will always stay with me and brings tears to my eyes this day because it reminds how my wife's smile is the Holy Spirit working through her. And, it shows that our testimony doesn't come from what we say but how we live out the Word in our lives. Christians and non-Christians have to deal with the same issues of life but it.s how we handle those issues that separates the two groups. Dawn's been receiving chemo treatments for almost two years now, but she doesn't let these treatments hinder any aspect of her life. This summer we were riding our bikes 10 miles at a time and she has started watching two small children. While so many that have gone through the same circumstances see their physical health deteriorate you can't any effect of the treatments on Dawn. She truly has the strength of Christ. She's gone through the fire but there is no smell of smoke on her.

In John 12 Jesus tells us that He has come to draw all things to Him. I believe every situation or circumstance in our lives comes about so that Christ can draw us closer to Him. But, to be drawn closer to Him we have to change some of the ways that we think. The Bible tells us that we meet renew our minds and not be conformed to this world. It tells us to meditate on the Word day and night. It tells us to think about things that are holy and righteous and the things that are above.  Since Dawn was diagnosed I've been praying (even begging) God to give Dawn supernatural healing. I wanted Him to miraculously heal her so that she could walk into the doctor's office and have some tests done that showed her cancer free. Then, the doctors, my parents, and other family members would have to recognize God's healing power and that He is real.  But, while we were at the hospital in Mexico (which was a Christian hospital) the doctor that owned it was giving a talk about various new treatments they were studying. After the talk he asked if there were any questions. One person asked the doctor if he had ever witnessed a supernatural healing. The doctor asked the patient what she meant by supernatural healing and the patient described something similar to what I wanted to see happen with Dawn. The doctor said he believed that can happen but that he hadn't personally witnessed it. But, he had witnessed a man whose bones and body were so riddled with cancer that he should have been dead or at best bedridden. But, despite what doctors thought this man should be the man was able to walk in and out of the hospital and enjoy a quality of life others thought impossible. The doctor said he considered that a supernatural healing.  In that moment God began to change my thinking. And, over the next couple of years of seeing my wife LIVE despite the circumstances of her life God has completely changed my thinking. Supernatural healing is and can be a miraculous taking away of disease and
sickness. But, in a way, that.s the simple thing for God to do and sometimes defeats the purpose of why Jesus came - to draw all things to Him. God has changed my thinking to understand that it is more miraculous, more supernatural (if there is such a thing) to have cancer cells in your body but to live as if they are not there. That requires true faith and application of the Word in your life. God has shown me that is more miraculous than divine healing. And, Dawn.s living with joy and strength despite the circumstances has touched more people than a divine healing would have. Some would have dismissed the divine healing as the cancer just going away or the treatments healing her. But, there is no denying the source of her joy and strength despite the struggles when so many others have become discouraged and lost hope."