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My Adventures With Heart Failure
formerly on bunrab.blogspot.com
Every now and then one has to pay some attention even to archival journals, to keep LJ from deleting them, so here's a post in this one.

Battery still holding out above the elective-replacement level on the ICD, but close enough that we expect that at my August device check, it will have fallen into that range, and we'll schedule the replacement for the week after that. Since they don't have to replace the leads, which is by far the most difficult part of placing a device, the whole thing will be outpatient surgery with a minimum of anesthesia, a good thing after my anesthesia-induced bout of extremely low blood pressure on the occasion of last September's try (the fourth try, and definitely the last) at placing the third lead. That was a minor disaster - not a major one, since I'm only slightly worse off than before, but nonetheless not fun and there is that /slightly/ worse off. More details over on my regular blog, I guess, if you care to look there.

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... via crustycurmudgeo:
http://www.theregister.co.uk/2009/08/10/internet_connected_pacemaker/

Docs wire up world's first internet-connected pacemaker

Beware the Ping O' Death


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And an adventure: we attempted to go to Ben Cardin's health care town hall this evening. Arriving at 5:30, we were still too late to get in - the line was already more people than the capacity of the hall and standing room combined. But we did participate in a few of MoveOn's chants a wave a few signs, and we spent some time waiting in line before finding out it was hopeless. And while we waiting in line, I had some civil discussions with "them" - the wingnuts with the death panel and hitler nonsense - and we even managed to reach a couple of small points of agreement, so I don't feel the time was wasted. One woman was handing out a table of alleged wait times for specialists under the Canadian plan, and saying how horrible that would be; I told her something she apparently didn't know, namely how long the wait for specialists is right now here in the USA if you don't happen to have the advanced super-premium health care insurance. With some guys, we veered off onto other topics, and I got them to agree that my riding a 65 mpg. motorcycle might actually be at least as worthwhile a move to reduce our foreign oil dependence as their idea of drilling in ANWR. I gave another person a complete rundown on exactly how complicated prescription drug plans currently are, and how many staff CVS employs in figuring out all the different plans, vs. actually doing pharmacy stuff like discussing medicines with patients. And with a few people, we managed to at least civilly arrive at an agreement that ANY plan devised by committees of multiple human beings who answer to multiple special interest was going to have flaws in it, including the current ones.

I also explained Godwin's Law to a few wingnuts who didn't want to hear it, but I felt better. Clearly, people who try to conflate Obama and Hitler have lost so many screws that there's really no point in trying to reason with them.

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From Health Day:
Multaq Sanctioned for Heart Rhythm Disorders
Atrial fibrillation or atrial flutter

THURSDAY, July 2 (HealthDay News) -- Multaq (dronedarone) tablets have been approved by the U.S. Food and Drug Administration to promote a normal heart rhythm in people with atrial fibrillation or atrial flutter. These conditions cause the heart to beat too quickly and can prevent it from pumping blood correctly.

The drug's label, however, will contain a "black box" warning that the medication could cause deadly reactions in people with recent severe heart failure, the agency said Thursday in a news release.

In clinical testing involving more than 4,000 people, Multaq lowered the rates of cardiac hospitalization or death from any cause by 24 percent, compared to an inactive placebo, the FDA said. The most common side effects were diarrhea, nausea, vomiting, fatigue and weakness.

Multaq is produced by French drug maker Sanofi-Aventis.

More information

The FDA has more about this approval.

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Sodium, Potassium Intake Tied to Heart Disease
Study finds 24% greater risk per unit increase in salt-to-mineral ratio
MONDAY, Jan. 12 (HealthDay News) -- Too much sodium and too little potassium in one's diet may increase one's risk of cardiovascular disease, a new study suggests.

The findings, based on a long-term analysis by the U.S. National Heart, Lung, and Blood Institute of almost 3,000 people with pre-hypertension, also suggests that increasing potassium consumption along with the common wisdom of lowering one's salt intake may reverse the risk.

Researchers found that for people with high normal blood pressure levels (120 to 139/80 to 89 mmHg), every unit increase in the person's sodium-to-potassium ratio raised his or her chance of cardiovascular disease by 24 percent.

The findings were published in the Jan. 12 issue of the Archives of Internal Medicine.

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Viagra May Shield Heart From Blood Pressure Damage
Sildenafil appears to delay dangerous heart muscle expansion in mice
MONDAY, Jan. 5 (HealthDay News) -- Tests in mouse hearts show that sildenafil, the key ingredient in Viagra, may shield hearts from damage caused by high blood pressure, a new study suggests.

Investigators said that sildenafil appears to influence RGS2, a single protein essential in the reactions that initially protect the heart's blood-pumping function from spiraling into heart failure. The findings, published online Monday in The Journal of Clinical Investigation, suggest that sildenafil may prove useful in the treatment or prevention of heart damage due to chronic high blood pressure.

"Sildenafil clearly prolongs the protective effects of RGS2 in mouse hearts," senior investigator Dr. David Kass, a cardiologist and professor of medicine at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute in Baltimore, said in a Hopkins news release.

After a week of inducing high blood pressure in the mice, the team found that the hearts engineered to lack RGS2, or regulator of G-protein signaling 2, expanded in weight by 90 percent, and almost half of the experiment animals died of heart failure. In the mice with RGS2, the dangerous muscle expansion, known as hypertrophy, was delayed, growing by only 30 percent, the researchers found, and none of those mice died.

Later testing showed that treating hypertensive mice that had RGS2 with sildenafil showed enhanced buffering, less hypertrophy, and stronger heart muscle contraction and relaxation. In addition, these mice showed as much as 10 times lower stress-related enzyme activity compared to their untreated counterparts. The study also found that sildenafil had no effect in mice lacking RGS2.

The study involved more than a half-dozen experiments, all performed within the last three years, designed to zero in on RGS2's role in stalling hypertrophy.

"The evidence is piling up that unbridled Gq signaling is driving a central biological chain reaction in heart failure, and that by extending the protective effects of RGS2 or by developing a test for its presence, researchers can develop new therapies or improve existing ones, including ACE inhibitors and possibly sildenafil, for people with heart failure who will benefit most," Kass said.

Doctors currently use so-called ACE inhibitor and ARB inhibitor drugs to block Gq signaling. These drugs are the most common treatment for heart failure, which afflicts more than 5 million Americans each year, killing more than a quarter million of them, according to the study.

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In my last post, I mentioned taking pseudoephedrine (actually store brand, but Sudafed is so much easier to type) for a nasty cold, where I couldn't sleep for the postnasal drip and hacking cough. I took it one night, worked well, managed to get through the day without it, took it again the next night - just one, to last long enough to get to sleep. It felt so great - I could feel the line of dryness moving up my nose like the terminator moving across the face of the earth. So, I took a third one the next night - and got woken up a few hours later getting zapped by my defibrillator. So much for the Sudafed experiment. There's a reason they tell us not to take that stuff.

Got an appointment with the cardiologist in a couple weeks - didn't see the need to go in right away, since I can tell what happened and why, and I know enough not to do it again.

Meanwhile, saw regular doctor today, got Astelin nasal spray, which is supposed to clear up the snot locally in the nose, without affecting the whole system or causing high blood pressure or racing heart. I sure hope it works. I am really, really tired of being a great waddling ball of slimy snot.

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I know, it's been a while. I've been lazy!
I have had a cold the last few days, and the postnasal drip has been SO awful that, damn the torpedoes, I have been taking pseudoephedrine at night - otherwise I can't sleep for the slime draining through my nose and throat. Yes, Sudafed is on the no-no list for heart failure patients and anyone with high blood pressure - but darn, I think going without sleep, coughing and sneezing all night, is a more immediate threat to my health than the stimulant effects of Sudafed. I've been doing without it during the day - I'm not going overboard on this.

News article:
Doctors Call for Human Studies of New Defibrillators

Human studies must be conducted before important new technology is used in heart defibrillators, say two prominent heart doctors who helped shed light on previous medical device defects.

The new "four-pole connector" technology is a more compact way of connecting heart defibrillators to wires -- called leads -- that conduct electricity to the heart. It would allow defibrillators to be smaller and leads thinner, which would make the implant procedure easier, the Wall Street Journal reported.

The U.S. Food and Drug Administration plans to allow defibrillator makers to sell the new implantable cardioverter defibrillators (ICDs) without conducting human studies, something that "is not in the best interest of patients," cardiologists Dr. Robert G. Hauser and Dr. Adrian K. Almquist wrote in this week's New England Journal of Medicine.

The Minneapolis Heart Institute doctors said they're concerned the new technology could be prone to potentially deadly short-circuiting, the Wall Street Journal reported.

The FDA disputed the cardiologists' claim that the agency has decided to allow the new devices to be sold without human testing, the newspaper said.

(from HealthDay, Scout News LLC)

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A slightly digressive introduction to today's post. First, y'all may remember that I play baritone saxophone in the Baltimore Symphonic Band. Well, since last September, the band had been planning a trip to Eastern Europe to perform some concerts. I figured I wouldn't be able to go, as the trip involved considerable walking and other exertion, and squirrel_magnet was going to go while I stayed home. Back at the beginning of January of this year, though, my father-in-law passed away unexpectedly (we had expected it this year, but not so soon.) Which resulted in (a) S not having to worry about trip-cancelling insurance in case his dad took a turn for the worse just before the band was due to leave in July, and (b) S coming into a bit of money, enough to indulge in a couple luxuries, such as a new tuba for him, a new saxophone for me - and, this scooter!, which I could have sworn I posted about but I don't see it here. So anyway, this scooter is airline-approved, and about a third lighter than the next lightest scooter around, and folds into a shape and size smaller than a full-size suitcase. So, we suddenly realized, I could go to Europe! Because I would not have to try to walk long distances through airports, and walking tours of each city we visited, and uphill and down! (My walking ability varies, but is much less in hot weather such as July, maybe a couple hundred feet - less than one block, without having to rest and catch my breath - and uphill, it's maybe four steps before having to rest.)

So, scooter in hand, we went to Croatia, Slovenia, and Austria in July, and there are posts about it over at my regular blog, bunrab. But I thought I'd share a few extra pictures and thoughts with you guys, who might be more interested in the scoot's abilities than the run of the mill LJ-er.

Me in my band uniform, on the scooter, in Opatija, Croatia, on the road leading down to the amphitheatre where we were to perform:


Croatia has lots of palm trees! There are many seaside resort towns; Opatija, where we stayed, is one of them, and this picture was taken in another town, Pula, which we visited with our tour group.


One of the things Pula is famous for is its ruin of an amphitheatre from Roman times - Croatia is not really far from Italy, and the Romans had quite a presence. Anyway, you will note that the ruins are up a hill; this is about the steepest hill the scoot could do unassisted. For anything steeper, it needed just a light push from a person to help it get going - not a serious effort as if the person were trying to shove the whole weight uphill by themselves, just a slight push.


Our trip ended in Vienna, Austria, and Wien turns out to be extremely scooter-friendly because it is extremely bicycle-friendly. There are bike lanes everywhere, curb-cuts for bikes everywhere, places to lock a bike outside every building; the step-up onto public transportation is quite low compared to the step-up onto most US busses or trolleys; and also practically every cafe has sidewalk seating so I didn't have to pull the scoot inside and up stairs. Here's me in a bike lane:


And at a cafe, eating pastry; you can see the scooter folded up just at the right edge of the picture. It takes about 10 seconds to fold up, and about 15 seconds to unfold; less with practice and the right phase of the moon and the wind in the right direction.

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From Health Day News:
A new genetic cause of enlarged heart has been identified by an international team of scientists, who said their finding could lead to new treatments.

In research with rodents and humans, the scientists found that the gene osteoglycin (Ogn) regulates the growth of the heart's left ventricle, it's main pumping chamber. When Ogn behaves abnormally, the heart can become enlarged, BBC News reported.

The study appears in the journal Nature Genetics.

It was already known that irregular heart growth can be caused by obesity, high blood pressure and strenuous exercise, but the influence of genes is largely unknown, BBC News reported.

"But, now that we are unraveling how genes control heart growth, we can gain a better understanding of common forms of heart disease. This could lead to new and more effective ways of treating people," said researcher Dr. Stuart Cook.

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I just finished reading The Surgeons: Life and Death in a Top Heart Center by Charles R. Morris. It's a fascinating book. The hospital in discussion is Columbia-Presbyterian in New York. Morris "embedded" himself there, staying in the cardiac area, attending surgeries sitting in the back near the nurses, attended staff meetings, all that stuff. He opens with a little history of heart surgery and an typical patient. Incidentally, although this is written for a popular audience, he does assume some slight knowledge on the part of the reader - for example, he doesn't stop to define "comorbidity" as in "Like many heart patients, Goldfarb suffers from a variety of comorbidities..." He describes how doctors and nurses "suit up" and create a "sterile field" around the patients, and then pretty much cut-for-cut describes Mr. Goldfarb's heart valve replacement.

He describes the different specializations within cardio-thoracic surgery: it's not just "heart surgeons" in general. There's the bypass specialists, the anesthesiologists, the pacemaker-and-defibrillator surgeons (he doesn't mention it, but in my experience they are usually called electrophysiologists, or EPs), the pediatric specialists.

Of particular interest: the difference between those surgeries in which the patient is put on a heart pump, and "off-pump" surgeries. The various range of outcomes of transplants. He describes a failed pediatric transplant - the patient dies. No avoiding the tough issues. The whole way the transplant process works - he goes along with a "harvest" team to get the heart from a donor, and talks about teams from other hospitals there to harvest other organs from the same donor, and what it's like to have several different teams working on one body.

Also of interest to heart failure patients would be the discussion of the LVAD, and also the chapter on the development of "cath labs" used by cardiologists, which is something different from cardiac surgeons (if you've had an angiogram, you've been in a "cath lab.")

And there's a big section on "The Problem With Drug Companies" and another on how to determine "best practices" as well as some controversial issues about evaluating different studies on various practices and on rating the hospitals.

It's a fascinating book - this barely begins to describe it. He's a good writer, and the book moves right along; we get to know the doctors and nurses as people. He has editorial comment as well as just description of what's going on, and it's useful input for anyone who is following the US's continuing struggle over how we provide health care and to whom.

Interestingly, I also happened, quite accidentally, to recently re-read Lewis Thomas' The Youngest Science: Notes of a Medicine-Watcher and it was interesting to compare his descriptions of medical practices and hospital routines from the 1930's and 1950's to Morris's of half a century later.

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