We went to sleep last night expecting a freezing temperature at daybreak this morning. We are finishing breakfast while watching deer amble around the back fence just 30 feet away and the thermometer reads 40 degrees Fahrenheit (~5C). The sky was clear last evening and (apparently) expected to stay that way so we would have experienced rapid radiative cooling. Instead, the flow of the jet stream shifted unexpectedly our way from over the Pacific Ocean just off Washington State’s NW corner. That shift brought enough moisture into our atmosphere to prevent the cooling we were told to expect. Either that or there is one huge forest fire sending a pall of smoke and warmth our way and covering the sky. Without further investigation it is hard to tell.
Nancy’s recovery is continuing but there too is an unexpected turn. I suppose it is unexpected for us but not for the cardiologists involved in her case. (Metaphor alert!) They, having been years at this, are not surprised by much and have gone down all the various paths, even those less traveled. At our recent appointment, the receiving (or check-in) nurse was a heart patient and the doctor too. His pulmonary valve had been replaced by the same surgeon that replaced Nancy’s mitral valve. About 8 years after the replacement that tissue valve began to fail and he then had an artificial valve implanted. The parts in our truck don’t last that long but, still, when you fix something you like to think it will stay fixed.
With hearts there are many things to measure besides beats per minute and the one at the top of the list today is called the ejection fraction.
Below is a link that gives a clear explanation:
http://www.medhelp.org/posts/Heart-Disease/EJECTION-FRACTION-/show/869616
“Ejection fraction (EF) is a measurement of how well the heart is pumping. It represents a percentage of the total blood volume in the left ventricle that is pumped (ejected) with each beat of the heart. As with any pump not all of the liquid is pumped out with each cycle. Normal EF is in the 50-60% range. Values higher than this are termed “hyperdynamic”, meaning that the heart is forcefully contracting. The lower the EF the worse the heart function. A general breakdown of values is as follows: 40-50 % mild dysfunction; 25 – 39% moderate dysfunction; < 25% severe dysfunction.”
The most recent test of Nancy’s heart (done when she went to the ER a few weeks ago – and under the stress of excess fluid) showed and ejection fraction of about 25% — note this is about half the normal as defined by the above statement.
Nancy’s heart also exhibits atrial fibrillation. The Mayo Clinic staff have a description of “a-fib” on the web:
http://www.mayoclinic.com/health/atrial-fibrillation/ds00291
As I read that I think of the most recent truck repair – replacing all the wiring components that keep the spark plugs firing well and in proper sequence. I knew this work need doing and so, just before we went to pick up the new horses, into the mechanic we went. I hate breakdowns at any time, but with 3 horses that are new to us and on an interstate highway such an episode is to be avoided.
Well, the human body functions with electrical impulses also and those that are directing Nancy’s heart are a little bit in need of help. The help comes in the form of a modern “pace maker” and is called an implantable cardiovertor defibrillator or ICD. The link here is helpful:
http://www.nhlbi.nih.gov/health/dci/Diseases/icd/icd_whatis.html
The very last paragraph of the above page mentions a special procedure called cardiac resynchronization therapy (CRT) involving a device able to pace both ventricles at the same time. Nancy’s primary cardiologist suggested we discuss this route with the implanting specialist. His opinion, at the moment, is that this is a less traveled road and one she need not take.