The words diminishing returns and risk might make you think that you have stumbled onto a blog about playing the stock market.  Nope.  I am talking about when you reach the point when your medical condition might be at a standstill or even deteriorating.  You begin to evaluate treatment decisions that cause you to weigh your chances of improving versus having side effects and adverse reactions (also known as risk).

Of course, if you were to go into the hospital for surgery or a medical procedure, you won’t get wheeled into the operating room or procedure lab until you have been advised of the risks and consented to take on these risks.  Well, it is the same when you are part of a clinical study.  You truly realize that there are no guarantees that treatment or surgery will be successful when you see the description of possible bad things that might happen. 
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When I first examined the consent package for the Meteoric – HF research study, I was intrigued to learn that I would have the option to undergo two subject interviews.  The consent package said: 

• The objectives of the interview are to learn more about patients’ experiences with chronic heart failure and the study drug, as well as to inform the measurement of patient reported outcomes in future studies. * * * During the interview, you will be asked about your experiences with heart failure, your symptoms, and your activities of daily living.

Wow – this was an opportunity that I had been wishing for since heart failure darkened my doorstep and changed my life.  My response, just as it had been for the study itself, was “Where do I sign up?”.  But as I read further, it dawned on me that perhaps not everyone in the study will be inclined to participate.  Why do I say this?  Because the consent package itself says that “You can refuse to answer any question, take a break, or discontinue your participation in the interview at any time.”  The exact same information was also communicated to me when I had Interview #1. 
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When I saw my heart failure doctor at my appointment on October 30, he indicated to me that the future for heart failure treatments is promising.  There are some new drugs in the development and the investigation stage.  Some of the drugs could make the patient feel better, others could improve the heart’s function.

He mentioned that the hospital that his program resides in currently has a clinical study for one of these drugs, and my  name had been mentioned as someone who might be interested in that study.  The drug under investigation is known as omecamtiv mecarbil, and the purpose of the drug would be to improve the heart’s pumping ability.  My reaction was – where do I sign up?!?
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You may recall that for a few years, I have used the occasion of the New Year to reflect on what I had accomplished in the outgoing year.  I started this habit based on the advice of a former therapist.  She also recommended that I develop a list of goals that I wanted to work on in 2020, and I adopted that suggestion as well.

I have to admit that the first year, I was not certain whether I wanted to adopt this as a tradition going forward.  I was not one to make “New Year’s Resolutions” each year.  I was such a consummate planner that I did not see the need to make a special effort for what I would do in the New Year.  I would just continue to always plan my life out as I always had. 
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In previous posts, I have talked about the importance of a routine.  If you have read those posts, you may wonder why I am asking the question about whether a routine can have a downside, or can even undermine one’s health.

I do not mean to send mixed messages.  Certainly, if I didn’t have a routine for taking my medications, following dietary and fluid restrictions, keeping up with a daily exercise schedule, and making and keeping medical appointments, my heart health would likely be in really bad shape.  I always get kudos from my health care providers for following instructions, and in large part, my success is due to my discipline in maintaining a routine.
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Every year, my family prepares Christmas list so we don’t waste our time in stores trying to figure out the perfect gift.  So this year, my family knew I was interested in gifts like:  charms for a charm bracelet; a cross necklace; exercise clothes; cotton sweaters; a calendar; etc.  There would be some surprise because there would be discretion in the colors and designs of the requested items.  But at least I led them to the ballpark where they would have a good chance of scoring a home run.

But it dawned on me that while there were a lot of beautiful, distinctive things on my list – things that were colorful, or tributes to my faith or my fashion sense, I really did not have anything for my heart.  Sure maybe the exercise clothes could be in the heart category because I exercise to strengthen my heart, but my sense is this is more in line with my fashion sense.
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Lately, there have been episodes in my life where it seems like God is giving me a cue on either the outlook or direction I should take in my life.  No, I haven’t heard the voice of God speaking to me, nor have I seen any eye-popping events like angels appearing before me with arrows pointing me toward a particular path.

It’s just a series of events that leads me to a realization that shapes how I should organize my life, new goals I should implement, or how to deal with a problem.  Some people would scoff and consider these to be coincidental events – kind of like move along folks, no influence of God to see here.
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As a chronic congestive heart failure patient, it seems to me that I am taking a lot of medication.  My nurses assure me that there are other patients who take even more, so I guess I should be grateful that I do not have even additional pills to swallow

 have become familiar with a number of drugs in the last six years.  I have also reviewed a good variety of product packages, product information documents and patient inserts.  So I have some suggestions to perhaps help the pharmaceutical industry develop additional drugs, revisit medication names, and add more clarity to the patient information we need to review before we put a pill into our bodies.
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October and November are autumn months, and autumn has always been my most favorite time of the year.  But even though I love the change of colors, and putting on sweaters, wool outfits and even gloves and hats, the season holds some challenging moments.

Why?  Well my Dad’s birthday is in October and my Mom’s birthday is in November.  And they both passed away in the autumn.  So, I have bittersweet memories when autumn rolls around.  My Mom passed away last November, and my Dad passed away during the last week of September in 1996.  This means that my memories of my Mom are more recent and thus, more vivid.  But I have great memories of both that are helping me manage and I hope at some point perhaps even stare down heart failure.
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