Test Results: Take 2

Probably the worst moment of my life in the battle against heart failure (or my worst moment at all for that matter) was when I had the echocardiogram that showed my ejection fraction had slipped to 15.  To recap, an ejection fraction is the measure of how well your heart is pumping out blood.  It helps the doctors diagnose and track the progress of heart failure.   According to the American Heart Association, a normal heart's ejection fraction may be between 50 and 70.  So when the ejection fraction slipped to 15, this was not encouraging.

The fateful echocardiogram occurred in July of 2014.  After that event, my heart device was upgraded to include a defibrillator function and I added an advanced heart failure doctor to my team.  A number of tests were conducted to determine that I was not in the need of a heart transplant.  So while my outlook on life was improving, I learned that I needed to be very sensitive to any signs of change and to keep maintain my disciplined approach to diet and exercise.  
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By the fall of 2015, my physical fitness had improved with exercise.  I was taking a full regimen of heart drugs, and had been able to take a two week trip to Italy and see a lot of sights.  Life was good and I wanted it to stay that way.  So I was very superstitious about having another echocardiogram.  In my mind, it was the test itself and not my heart that had caused the diminished ejection fraction.  So I wanted to avoid another echocardiogram like the plague.  I am aware that this was not a rational thought but when your heart condition is damaged, I think this fact can distort your ability to be objective and keep your emotional reactions in check.

I saw my advanced heart failure doctor in December of 2015.   Once again, I worried the technician who took my blood pressure and realized how faint and abnormally low it was.  I understood that I was the outlier, so I did not best to reassure her that while this was standard for me and that I was fine.  Other than that, I got a really good report.  The doctor went over the results of my September treadmill stress test and said they were outstanding.  I was in the 83rd percentile of the normal population for my age group.  I think this meant that I was in better shape on this test than 83 percent of the rest of the normal population - not just those with heart failure.  So I would say that mean I was rocking it. 

The doctor did want me to get another echocardiogram.  I probably whined something like:  “OOOHHHH NO - Do I have to?”  I explained to him that the thought of having another test scared me, especially since each time I had the test, my results worsened.   Thankfully, he did not tell me I was being unreasonable.  I think he really understood the anxiety that I had over the test.  I also think it helped that I had such a good result on the stress test that if I was really opposed to the echo, it was not a deal breaker.  So what he told me instead was that he thought the test was a good measure of how my heart was doing, but if I really did not want to have it, he would not jump up and down.  

Because he was so very understanding and kind, I decided to suck it up and said that I would get with my cardiologist’s office and schedule the echocardiogram.  Deep down in my heart, damaged as it was, I knew it was silly to be scared of a test.

I scheduled the echocardiogram for mid-January of 2016.  I tried to be optimistic in the days preceding the test.  I kept telling myself that I had gained so much ground.  I reasoned that the results definitely would be better – or at least they would not have worsened.  But I still felt this little black cloud over my head as I got ready to go in for the test.

So I did what I always do when I am nervous about something.  I became really chatty when the technician started the test.  Fortunately for me, the technician was both competent and friendly and we had a nice chat while she was conducting the test.  In fact, we talked so much that I almost forgot the purpose of the appointment.

What do you talk about when you’re nervous during a heart test?  Well, for me a natural subject is my unusual heart health which led to the test.  I certainly was an unusual case, having been so healthy for years.  The ups and downs of my path through heart failure seemed like a television drama, at least to me.  So we covered that topic for quite a while during the test.  It helped that the technician was very pleasant and the conversation was so easy.

The conversation was so diverting that it took me a good while to realize that I wasn’t hearing that spooky “glug, glug, glug” sound that I had noticed during previous echocardiograms.  That caused me a bit of pause.  Was my heart not working well at all such that you couldn’t even hear it?  I began to wonder if I had scheduled myself for the right test. 

So after a short time mulling over the “how come there is no noise” question, I asked the technician why I was not hearing a “glug, glug, glug” sound.  She said “Oh, I always turn off the sound when I do the test because it bothers some patients”.  So it was good to know (1) I wasn’t the only one who thought the sound was spooky, and (2) I could ask the technician to turn off the sound in the future.  (My cardiologist later confirmed that this is an appropriate request).

As had been the case with past echocardiograms, my technician gave me a card with a phone number to call in for the results in two days. But the card also said that the doctor would call before then if there are abnormalities. I laughed when she gave me the card because the two times I had the test in the past, my doctor called me before the two days period because the results were "abnormal".  The technician and I both figured I would hear from him directly as well. But after two days, I had not heard a thing from my doctor.

So I called the number on the card.  When connected to the office system, I entered a number written on my card and was placed into a phone tree system where there was a message from my doctor.  He said that previously I had an enlarged heart and a weakened heart, and the heart function was low. The echocardiogram which had just been performed showed that the heart size had returned to normal. The doctor clarified that I still had a weakened heart and the heart function was still low. But he said he thought that the return of the heart to a normal size was encouraging news. He told me to stay the course with what I was doing, and he would like me to have another echocardiogram in 6 to 12 months.

I was so excited that I listened to the message about 3 times before I contacted my sister.  Then I listened another few times before I e-mailed my doctor to let him know how thrilled I was.  Although I was still not where I wanted to be, I felt like everything I have done - from taking the increased levels of meds, getting appropriate rest, eating right, watching my fluid intake and exercising as much as I could – all these things had made a huge difference.

​I also agreed with my doctor, I felt that the change in my heart size would start to have a positive impact on my heart's overall condition and the function level of my heart.  I finally had some test results that demonstrated the extent of my efforts.  I was filled with joy!