My Adventures with Heart Failure

So how did I get diagnosed, anyway? I have allergies- had bad seasonal allergies all my life. Occasional episodes of reactive airway disease (RAD). So when I started having to stop to breathe a lot, and coughing a lot, we naturally assumed that the RAD was developing into asthma. Particularly in a city known for having something new pollinating every single month, this is not uncommon- keep irritating the bronchii, and eventually they rebel. And in medicine, there's a saying that goes "When you hear hoofbeats, expect a horse, not a zebra." Which is to say, that one looks first for the obvious and most common things - in someone with a history of allergies and respiratory problems, in a city where asthma victims fill the ERs pretty regularly, that would be asthma. It certainly wouldn't be heart failure, particularly not in someone under 50, who has no family history of any heart problems, doesn't have diabetes, doesn't smoke, etc. etc. So, my doctor kep trying newer (and more expensive) asthma inhalers, and larger doses. Trying all this took about 6 months- get a new set of inhalers, try them for a couple weeks, call the doctor and tell him it's not helping. Once we got up to the heaviest dose of Advair, the state of the art for asthma, and it didn't do a damn thing for me, my doctor had to admit he was stumped. So he sent me to a lung specialist (pulmonologist). Who took chest x-rays, took one look at them, took one listen at my chest, and told me to sit down. He delivered the diagnosis. He referred me to a cardiologist, but he was sure enough of the diagnosis to write me out prescriptions for a diuretic (furosemide, the generic of Lasix) and a bigger dose of Diovan than I already took for hypertension. (Diovan is one of the sartan bunch of drugs, the ACE II inhibitors. Diovan is valsartan. The prils are the original ACE inhibitors- lisinopril, Captopril, etc.) The pulmonologist also explained one of the rules of thumb for checking such things: pointing out on the x-ray, he showed how the heart sits slightly to one side of center. Normally, if one were to take that heart and imagine sliding it over so that one edge is just touching the sternum (front and center of the ribcage) then the other side of the heart would still be contained within the chest. An enlarged heart, however, sticks out past the ribcage, by an inch or two, if moved to such a position.

One of the things about such a diagnosis is that it seems as though, for the next few weeks, you lug the giant folder the chest x-ray is in, everywhere. Bring it to the site where you're getting your echocardiogram. Your EKG. Your first visit with the specialist. Your first visit to the specialist's nurse practicioner. Your first visit to the weekly clinic sessions. The hospital where you're getting your angiogram. After a month or so, apparently, the entire medical community of your city has copies of that chest x-ray, and you can stop carting the big folder around. And then when you sit in the waiting room, you can recognize who's new, because there they are, carrying their big folder around!