Wednesday, November 26, 2008

Symptoms - How Do You Know?

With a failing heart valve, the difficulty in self assessing symptoms feeds into denial. When I went to see my cardio last August, I had no reason to suspect that my visit would be any different than the previous year’s visit. In 2007 he gave me an echocardiogram and told me at the end of the visit that things were pretty much the same as they had been when he last saw me in 2004. So, no change, no worsening but for a little bit of heart enlargement in three years was good news. However, this year the results of the echo were quite different. “Your valve opening is a little smaller,” he told me. “If you get any dizziness, chest pain, shortness of breath, or fainting, you’ll need to get medical attention,” he continued. Well, this was a major change from the previous year to be sure! And here I was expecting the same old unchanged diagnosis.

“Any chest pain, dizziness, fainting, or shortness of breath?” This had been the first question the cardio asked me last August. “No, none.” I replied. But actually, in retrospect, that was an incorrect answer. What exactly is “shortness of breath” or “Dyspnea?” Here’s a medical definition: a feeling of difficult or labored breathing that is out of proportion to the patient's level of physical activity. I wish I had looked that up a long time ago. I’ve been huffing and puffing for a long time now. Climbing a few steps, or walking up a slight hill causes me to pant. That is labored breathing which is out of proportion to the level of activity. After all, until sometime in 2005 I had been jogging three times a week. I stopped, not because I wanted to but because I simply couldn’t do it anymore. I asked one cardio about this and he blamed it on my getting older and putting on weight. That was wrong. In retrospect, I now believe that the valve problem was the reason I couldn’t jog anymore. I was becoming symptomatic as a result of progressive aortic valve disease. But I needed help assessing my own symptoms – help that was not forthcoming.

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