Dr. P. called me this morning

Dr. P. himself called me a little while ago.  He advised that he had a discussion with The Dr. this morning.  The call to me was specifically to tell me to stop taking carvedilol, a beta blocker that he prescribed when I saw him last week.  The intention was to try it at an ultra low dose 3.25 mg instead of the standard 50 mg.  The drug had the intended effect of lowering my pulse rate.  For the first time in years it was under 100 every time I checked it during the last week.  My weakened lungs make my heart work harder and that causes not only congestive heart failure and heart attacks but my pulse rate is seriously high all of the time, which I figured cannot be a good thing.  Unfortunately the main side effect of the drug is difficulty in breathing.  I have noticed that I got short of breath easier in the last week than normal.  I think I was willing to accept the trade off, but, The Dr. wants me to stop taking it.  So, stop it I will.  We can discuss it together during my next appointment, which I imagine will be in the next week or two.  

From Web MD

Chronic obstructive pulmonary disease (COPD) and heart failure both cause difficulty breathing. For people who have both COPD and heart failure, identifying the cause of breathing symptoms can be challenging.

Symptoms of COPD and Heart Failure

COPD and heart failure cause the same main symptom: shortness of breath with exertion. People with COPD, heart failure, or both, have a limited ability to exercise, climb stairs, or walk long distances. Difficulty breathing occurs for different reasons in COPD and heart failure.

People with COPD have difficulty exhaling all the air in their lungs because of lung damage -- often from years of smoking. When it takes longer to exhale completely, it’s hard to increase the rate of breathing. Most people with COPD breathe comfortably while resting. During exertion, though, breaths start coming in before air from the last breath has been exhaled, and shortness of breath results.

In people with heart failure, the heart does not pump blood efficiently. As in COPD, most people with heart failure can breathe easily when at rest. With activity, blood flow must increase, and the heart must pump harder and faster. If the heart can’t keep up, blood “backs up” into the lungs. This fluid congestion causes shortness of breath.

COPD and Left-Sided Heart Failure

Heart failure in the left ventricle is the most common form of heart failure. Left-sided heart failure is most often caused by high blood pressure or coronary artery disease. COPD and left-sided heart failure are not directly related. However, the two conditions may influence each other. For example, low oxygen in the blood from COPD may put excess strain on the heart, worsening left-sided heart failure. Excess fluid in the lungs from heart failure can make breathing even more difficult for someone with COPD.

COPD and Right-Sided Heart Failure

Severe COPD can cause heart failure in the heart’s right ventricle, a condition called right-sided heart failure or cor pulmonale. In severe COPD, oxygen concentration in the blood falls to abnormally low levels. In response, the walls of the main blood vessels inside the lungs (pulmonary arteries) change. The blood pressure inside these arteries goes up, as well. This is one type of a condition called pulmonary hypertension.

The heart’s right ventricle pumps blood through the pulmonary arteries into the lungs. High blood pressure in the pulmonary arteries puts excess strain on the right ventricle. Over time, the right ventricle may become stretched and dilated, and fail to pump blood effectively.

Right-sided heart failure causes fluid to accumulate in the body, such as in the legs and abdomen. Many conditions other than COPD also cause pulmonary hypertension and right-sided heart failure.  

I think we are just about there, the referral to the thoracic surgeons at Notre Dame Hospital is almost in my hands.   I remain calm and detached.  I feel good.  I will not be surprised by anything once I get the referral.  The surgeons might not want to help out an ex smoker.  I might not have the genetic makeup they need.  Those things will not matter if they happen.  It will just be the way things go.  However, having gone this far I would be mightily disappointed if I did not at least make it far enough to meet those good doctors at Notre Dame Hospital.