If I need a job, I am now well qualified to be a professional pin cushion!

One thing that has never changed in my life is that I hate the sight of blood -  my blood, someone else’s blood, blood coming out of a rare steak.  When I get a paper cut, I quickly put a Bandaid on it so I don’t have to see the red stuff flowing from my arm into the test tube.  Ever since I have been placed on 81 milligrams of low dose aspirin, my blood seems to flow even more quickly.  Maybe that is a good thing because in the last few years, I have had to go through enough blood tests to feel like a pin-cushion.  So in the plus column, maybe having a faster blood flow helps to get the blood tests done faster.

In general, should one be concerned about the impact the process of either donating blood or having routine blood tests has on your body?  Nope - the body employs some very efficient processes that can replace blood components relatively quickly.  According to the Central California Blood Center’s website platelet and plasma components are replaced in the body quicker than red blood cells. Platelets and plasma will return to normal levels within a few hours of donating. The red blood cells, the oxygen-carrying cells, can take two weeks or longer to fully return to normal.  Your doctors, or the blood donation sites, will make sure that you wait a sufficient amount of time before your next donation or blood test.
​

As much as I hate to see my own blood leaving my body, I know that blood tests have become an important facet of my life.  You see, when you have heart failure, there are a number of blood tests that are periodically performed to gauge the level of your heart failure symptoms, and to make sure that your treatment is not impacting other functions in your body.  So I think that the tests are a great way to identify potential problems before they escalate.

So the lab technicians have become just as much a part of my life as the advanced heart failure doctor, the cardiologist and the cardiac nurses that I see every few months.   I always tell them that while they can take as much from me as they need, I will not be watching the process of the blood flowing into the test tube.  (They usually get it – although I did have one technician take the test tube after the blood was taken and put it right in front of my eyes to make sure that she had spelled my name correctly.  Needless to say, I did not appreciate that experience).  It seems that I have been tested about every two to three months in the last few years.  Depending on the results of a test, I may have to do a follow-up retest a month later.

One of the tests that I had last year is known as the B-type natriuretic peptide (BNP) blood test.  That is quite a mouthful.  What does it mean?  Well BNP is a substance your body makes when heart failure develops. The levels in your blood go up when your heart failure symptoms get worse.   So the test is performed either to check to see if you have heart failure, and/or to check to find out how severe your heart failure is, and/or to check to see how you are responding to your treatment for heart failure.

I had a BNP test in May of 2016.  The website that the doctor’s office uses sent me an e-mail that my test result was in.  When I logged on to the website, I saw that that my BNP result was 400.  There was a little legend with the result that said: Less than 100 pg/mL is considered normal. In general, the more serious your heart failure, the higher your levels of BNP will be. But test results vary by age, sex, and body mass index. Normal values tend to go up with age. They also tend to be higher in women and lower in men.

I wondered where my situation fell on the heart failure spectrum.  There was no additional information to indicate whether 400 was considered to be really abnormal, or just a little abnormal.  I needed to have the information put into a fuller context but I was afraid to do research on the web without someone to help me translate the information.  I was also afraid not to know what the result meant.  My sister took the bull by the horns and found the following helpful explanation on the Cleveland Clinic website: 

BNP levels below 100 pg/mL indicate no heart failure. 
BNP levels of 100-300 pg/mL suggest heart failure is present. 
BNP levels above 300 pg/mL indicate mild heart failure. 
BNP levels above 600 pg/mL indicate moderate heart failure. 
BNP levels above 900 pg/mL indicate severe heart failure.
 
My sister added her very practical comment:  “I would think 400 would be a good indicator of your condition of mild heart failure, which you have otherwise you wouldn't be seeing a heart failure doctor.”  Thank God for sisters who hang in there with you, and who apply the common sense that seems to have disappeared from your body along with the blood that went into the test tube!

As I write this, I realize that the test result is almost a year old, so I'm not sure if I am still in the same range.  But just having one result like this gives me hope that despite having a very low ejection fraction, a leak in my mitral valve that is moderate to severe, and chronically low blood pressure, I am doing well enough to fall into the mild category (at least according to the Cleveland Clinic).  I'd like to think my discipline and my continual monitoring of lots of different factors has contributed to this.  But whatever the cause is, the result from this test gives me hope that I can stay as active as I have been over the last few years, and hopefully even improve a bit.  Because I have learned that you need to keep hope alive to be able to stay as positive and respectful of your heart as possible.  

What other tests are there?  Of course, my primary care doctor always performs a cholesterol panel for my annual physical.  My results are always in the normal range.  Another blood test that is periodically performed with the annual physical is either a comprehensive metabolic panel (CMP) or a basic metabolic panel (BMP).  Additionally, my heart doctors also ask me to have a BMP performed periodically. 

As is the case with all blood tests, the technician takes a sample of blood.  This particular sample is then analyzed for levels of important substances, such as sodium and potassium (sometimes called electrolytes), albumin (a type of protein) and creatinine (which relates to one’s kidney function).  (The difference between the CMP and BMP appears to be that the CMP also tests the liver function). 

What can these metabolic panels show?  They can indicate that there is a strain on organs such as the kidneys and liver which can result from heart failure.  I really do not mind doing the test because other than not liking to see blood, there is no pain.  I may need to make sure that I sit around the doctor’s office for a minute or two to make sure I do not become dizzy (since by then I have taken a few drugs that may cause dizziness – add taking the blood out and there is need for this extra precaution).   I realize that the tests are important because if you have a sick heart, you do not want to add a sick liver or a sick kidney to the list.

The results may occasionally show a little bit of elevation or decrease from the normal ranges.  But it has never been a deviance that shocks or concerns the doctors.  I suspect that small deviances can be due to a number of reasonable circumstances.  So I have learned not to freak out if there is a .1 elevation in my potassium.  Sometimes my sodium might also be slightly low, usually because I have taken in too much fluid.  But I think I am becoming quite adept at figuring out the right amounts to eat and drink to keep everything in balance.

​So yet another lesson that heart issues are very similar to life issues.  Everything needs to be in balance if you want to avoid adverse consequences for your heart, and to have the flexibility to constructively handle life's continual unpredictability.  So I’ll be happy to be a pin cushion for as long as it takes to keep this heart as healthy as possible, and my perspective of life as balanced as possible..