'n Hand en tand bekgeveg teen die asemdief PH (Pulmonale Hipertensie)

[Meraai vannie Baai]

En daar bars my borreltjie van ekstase vandag. Nog steeds nie mooi seker hoe om die kloutjie by die oor te bring nie.

Vandag weer die week se bloedtoetsuitslae van Woensdag met dok bespreek en net om myself te vergewis ek het reg gehoor verlede week, vra ek hom weer is dit moontlik dat die nuwe medikasie die drukking in die longe gaan verminder?

Sy antwoord het my nog steeds in die war. "It is not going to bring the pressures in your lungs down - instead it's going to increase it. It will help protect your heart against the abnormal force it was beating with before but the way it is slowing it down will now increase the PH pressure, you need to go back to the cardiologist. See if we can start you on some new medication for the pressure."

Hoe nou? Ek weet nie. Ek weet wraggies nie. Verward en onseker is al wat ek weet.  Het 'n glasie wyn nodig 

[Meraai vannie Baai]

Vanoggend bevestiging gekry uit 'n betroubare bron. Dok was reg. Die beta blocker wat voorgeskryf is om die ritme afwyking in toom te hou moes deur sommige PH pasiente gestaak word nadat die Pulmonale Hipertensie drasties verhoog het en die SOB (short of breath episodes) vererger het. Soos wat hy gister dan ook aan my probeer verduidelik het. Blykbaar weeg hulle die risiko na weerskante op en besluit watter orgaan se behandeling prioriteit kry. In die geval - die hart.

Dok verduidelik die skade van volgehoue abnormale drukking is reeds daar en onomkeerbaar. Die hart kan beskerm word teen homself deur die 'output' met 50 persent te verminder. Glo nog steeds dat 'n wonderwerk sal gebeur en in my geval die drukking verminder. Klou daaraan vas.

Baie maters/familie het hande gevat - ek staan mos voorbarig op die hoek en skreeu: kom bid saam en binne 'n uur of twee skaam ek my so rooi soos die smurfie se hoed van Naas, en gaan vee weer uit. Die wete daar dat hulle wat omgee, bid reeds saam

Ongelukkig veroorsaak die medikasie ook 'n newe effek van vogopbouing wat die lewe ietwat ongemaklik maak en op aanbeveling sal ons die skaal dophou en met volgende besoek aan dokter die gewigtige nommers oordra.

Op meer positiewe noot beinvloed die medikasie ook die werking van die rottegif (warfarin). Spook op die oomblik om die dosis weekliks aangepas te kry dat dit nie branderplank ry nie. My arm voel soos 'n speldekussing en die uwe lyk soos haar paspoortfoto maar ek glimlag darem in die werklike lewe nog wyd - die pille het veroorsaak dat ek een gifpilletjie per dag minder hoef te drink vir die volgende twee weke.   

Wat ookal gebeur - sal getrou soos altyd kom dokumenteer vir ingeval nog persone in dieselfde oorlog veg 

[Meraai vannie Baai]

Soos belowe rapporteer ek terug. Afgelope paar dae het die newe effekte van die medikasie my kniege behoorlik geknak. Bloeddruk het hardnekkig geweier om normaal hulle gang te gaan ons het die syfers half skrikkerig dopgehou en getrou aangeteken/fotos geneem as bewys van wat gebeur.  Deur die dag was beide die sistolies en diastolies baie laag met gepaardgaande duiseligheid. Ek is meer gewoond aan syfers soos 160/90 en skielik voel dit of ek al swewende, spook-spook speel met myself en lyk die tellings deurgaans so:



Om te verhoed dat ons paniekbevange raak het ek dokter Google se hulp ingeroep want nie Outop of ek het 'n idee wanneer is lae bloeddruk te laag nie. Het wel besef dat stilgedra 'n baie veilige opsie is aangesien die warfarin dosisse wipplank ry op die oomblik en onbeheerde bloeding altyd 'n wesenlike gevaar is.

Die volgende inligting was dus vir ons goud werd. Ek het die oorlog emosioneel gewen deur myself in te lig oor presies wat gebeur binne ons are wanneer die hart sy werk verrrig.

Ek haal aan:

The heart pumps a constant supply of blood around the body through arteries, veins and capillaries. Blood pressure is a measure of the force of the blood on the walls of the arteries as the blood flows through them.

It's measured in millimetres of mercury (mmHg) and recorded as two measurements:
systolic pressure – the pressure when your heart beats and squeezes blood into your arteries
diastolic pressure – the pressure when your heart rests between beats

Some experts define low blood pressure as readings lower than 90 mm Hg systolic or 60 mm Hg diastolic — you need to have only one number in the low range for your blood pressure to be considered lower than normal. In other words, if your systolic pressure is a perfect 115, but your diastolic pressure is 50, you're considered to have lower than normal pressure.

A sudden fall in blood pressure also can be dangerous. A change of just 20 mm Hg — a drop from 110 systolic to 90 mm Hg systolic, for example — can cause dizziness and fainting when the brain fails to receive an adequate supply of blood.

And big plunges, especially those caused by uncontrolled bleeding, severe infections or allergic reactions, can be life-threatening.

Heart problems. Some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure.

These conditions may cause low blood pressure because they prevent your body from being able to circulate enough blood.

Medications that can cause low blood pressure.
Some medications you may take can also cause low blood pressure, including:

*Diuretics (water pills), such as furosemide (Lasix) and hydrochlorothiazide (Microzide, Oretic)
*Alpha blockers, such as prazosin (Minipress) and labetalol
*Beta blockers, such as atenolol (Tenormin), propranolol (Inderal, Innopran XL, others) and timolol
*Drugs for Parkinson's disease, such as pramipexole (Mirapex) or those containing levodopa
*Certain types of antidepressants (tricyclic antidepressants), including doxepin (Silenor), imipramine (Tofranil), protriptyline (Vivactil) and trimipramine (Surmontil)
*Sildenafil (Viagra) or tadalafil (Cialis), particularly in combination with the heart medication nitroglycerin

BRON: https://www.uab.edu/mix/stories/diastolic-blood-pressure-how-low-is-too-low
“Physicians are busy people, and like it or not they often focus on a single number,” Guichard said. “Systolic blood pressure is the focus, and diastolic pressure is almost completely ignored.” That is a mistake, he argues. “The majority of your arteries feed your organs during systole. But your coronary arteries are different; they are surrounding the aortic valve, so they get blood only when the aortic valve closes — and that happens in diastole.”

“isolated diastolic hypotension,” which refers to a low diastolic blood pressure (less than 60 mm Hg) and a normal systolic pressure (above 100 mm Hg). Older adults who fit those conditions are at increased risk for developing new-onset heart failure, the researchers found.

“Years ago and until recently, doctors were treating blood pressure so aggressively that many patients couldn’t even stand up without getting dizzy,” Guichard said. “We want to empower patients to know that you don’t have to drop those numbers all the way down to nothing, to the point where you can’t play with your grandkids or play golf or take a simple walk around the block because your blood pressure is so low. I think it’s important to raise awareness in this area, especially for older people.”

A diastolic blood pressure of somewhere between 90 and 60 is good in older folks. Once you start getting below 60, that makes people feel uncomfortable. A lot of older folks with low diastolic pressures get tired or dizzy and have frequent falls. Obviously, none of that is good news for people who are older, who potentially have brittle bones and other issues.

Your coronary arteries are fed during the diastolic phase. If you have a low diastolic pressure, it means you have a low coronary artery pressure, and that means your heart is going to lack blood and oxygen. That is what we call ischemia, and that kind of chronic, low-level ischemia may weaken the heart over time and potentially lead to heart failure.

 Low diastolic blood pressure increased one’s risk for heart failure.

BRON: http://www.mayoclinic.org/diseases-conditions/low-blood-pressure/basics/causes/con-20032298

[Meraai vannie Baai]

You also have an interest in diastolic heart failure. What is that?
There are two different types of heart failure: one where the pumping function of the heart is abnormal — that is known as systolic heart failure — and one where the relaxation function is abnormal — that is known as diastolic heart failure. We have lots of medicines for, and experience treating, systolic heart failure, which is also called “heart failure with reduced ejection fraction” — everything from beta blockers, ACE inhibitors and ARBs to mineralocorticoid receptor antagonists and statins.

Diastolic heart failure, or “heart failure with preserved ejection fraction,” has no approved pharmacologic therapies to date. It was widely overlooked, to be honest, until about 10-15 years ago, when physicians realized that these poor patients were having terrible heart-failure symptoms but none of the classic objective measures of heart failure. In most cases, you can’t even tell the difference between a person with systolic and diastolic heart failure based on their symptoms. On the inside, however, their heart is pumping just fine; the problem is their heart is stiff — it doesn’t relax as well as it should. That stiffness leads fluid to back up into the lungs and extremities and causes a lot of the symptoms that you have with systolic heart failure, but the pumping function of the heart is normal.

Now that there is an awareness of diastolic heart failure, we’re realizing that it is a very common problem. It looks like there are as many people with diastolic heart failure as with systolic heart failure. As a matter of fact, there may even be more people with diastolic heart failure.

It has become a heavily studied form of heart failure right now. Everyone is clamoring to get a medicine to help these patients, because it turns out to be very prevalent, and a lot of times they have the same morbidity and mortality as people with systolic heart failure.

Sudden drops in blood pressure most commonly occur in someone who's rising from a lying down or sitting position to standing. This kind of low blood pressure is known aspostural hypotension or orthostatic hypotension. Another type of low blood pressure can occur when someone stands for a long period of time. This is called neurally mediated hypotension.

Postural hypotension is considered a failure of the cardiovascular system or nervous system to react appropriately to sudden changes. Normally, when you stand up, some blood pools in your lower extremities. Uncorrected, this would cause your blood pressure to fall. But your body normally compensates by sending messages to your heart to beat faster and to your blood vessels to constrict. This offsets the drop in blood pressure. If this does not happen, or happens too slowly, postural hypotension results.

BRONNE: https://www.uab.edu/mix/stories/diastolic-blood-pressure-how-low-is-too-low
http://www.webmd.com/heart/understanding-low-blood-pressure-basics

[PM]

Dit is baie goeie inligting, dankie Matertjie.  Hoop dit gaan sommer gou weer "normaal" daar by  julle.

[Meraai vannie Baai]

Dankie baie baie vir inloer PM 

Ek moet vandag reel vir 'n opvolg echo by die kardioloog. Dokter verwag dat die hartmedikasie die PH gaan verhoog en as ons na alles kyk en dit ontleed, lei dit ons na 'n baie meer positiewe antwoord in die opsig dat die drukking eerder sal verminder. Dit maak net meer sin want een van die moontlike oorsake word uiteindelik behandel.

The prognosis and life expectancy for a person with pulmonary hypertension is improving as newer treatment options become available; however, prognosis may depend on the underlying disease or condition that is causing pulmonary hypertension
http://www.medicinenet.com/pulmonary_hypertension/article.htm

Ons is nie dokters of opgelei in enige mediese rigting nie, so of die twee oues van dae hier gryp na grashalms of vashou aan 'n moontlike wonderwerk  sal ons eers weet na die uitslae van die nuwe echo. Tot nou toe het ek nog nie die moed gehad om te bel nie.

Statistieke het bewys dat gevorderde PH meer fataal is as borskanker, as ek net dink aan die dokter se woorde dat die drukking gaan verhoog en dan sal val onder 'severe PH' - wil ek weghardloop  Ons kan dit nie aanvaar nie. Wraggies nie.

[PM]

Die moeilikste deel is dat 'n mens so magteloos is om iets daaraan te doen.  Bly sterk in jou geloof.  Ons weet mos dat elkeen van ons 'n pad het om te loop.  Sterkte en voorspoed.  (((((Raaitjie)))))

[Meraai vannie Baai]

  PM.

Ek het toe gister die moed bymekaargeskraap om te reel vir die echo. Normaalweg wag mens tot drie maande vir 'n afspraak en wonder bo wonder is die echo geskeduleer vir Donderdagmiddag 3.30. Nog net twee slapies en gewoonlik twee weke se wag dat die uitslae na jou huisdokter gestuur word.  Verlede keer het ek dieselfde aand 'n oproep gekry van die kardioloog met die nuus dat die drukking nog steeds daar was en niks het verander nie  Hierdie keer glo ons gaan die uitslae positief wees 

[Meraai vannie Baai]

Die toets is gedoen en ons is bitter dankbaar dat die kardioloog gou tydjie gesteel het om te kom gesels na die tyd anders was daar nog twee weke se 'opvreet-van-binne-wag' vir die uitslae.

Abnormale drukking in hart en longe nog steeds daar. Blykbaar lek die een klep meer as voorheen MAAR daar het vir ons reeds 'n wonderwerk gebeur in die opsig dat die drukking nie verhoog het soos wat verwag was.

Die nuwe medikasie het beslis 'n beter lewenskwaliteit gebring waaroor ek innig dankbaar is. Hier is 'n aanhaling oor presies wat hierdie medikasie doen deur die hart te beskerm in die proses om onderliggende skete wat hartversaking weens PH kan verhoog, intoom te hou:

The goal is to try and treat the underlying causes.  To prevent congestive heart failure, medications such as beta blockers, ACE inhibitors and diuretics are used. 

Beta blockers block the effects of the sympathetic innervation of the heart.  This decreases the hearts workload, so it needs less blood and oxygen.  This aids in lowering blood pressure and helps to control abnormal beat rhythms that are either too fast or irregular.
Diuretics help to remove excess fluid from the body decreasing edema (swelling).

Duisend dankies vir elkeen wat aan ons gedink het en opgedra het in gebede.
 

[Meraai vannie Baai]

Ons stryd het onverwags 'n nuwe vorm aangeneem na ek Vrydag nog 'n oproep van die kardioloog ontvang het. Indien die nuwe toetse positief is wag daar nog 'n rare (hoe ironies) oorlog waarin die uwe en gade liefs nie wou deel wees nie. Besig om naarstiglik inligting te versamel sodat ons lendene omgord is ingeval ons in die voorste linies geplaas word. Sodra ons die uitslae ontvang het sal ek soos altyd my deel van bewusmaking doen. 

[Naas]

(((((Raatjie en Outoppie)))))


 

[Meraai vannie Baai]

Dankie baie baie dierbare mater van ons. Sodra die uitslae ontvang is sal ek terug rapporteer. Tot dan - bid asb saam ons vir 'n negatiewe uitslag.

[Meraai vannie Baai]

Die toets is gedoen en ons het so pas die uitslae ontvang. Dit was negatief!! Daar is ander oorsake betrokke wat minder skrikwekkend in voorkoms sal wees. Ek jubel en juig!!

 

Intussen het ek redelik nagevors oor die raar toestand wat as hoofverdagte beskou was in die proses om alle moontlikhede van die oorsprong van agteruitgang van die werking van die hartklep te ondersoek.

Ek het reeds voorheen redelik aandag gegee aan die 5 verskillende tipes van PH. Een van die vertakkings is PH wat in groep 2 val nl. (Pulmonale Hipertensie) a.g.v LHD (left heart disease).

Ten spyte van vooruitgang in klassifisering en evaluering, is dit nog steeds die weeskind wanneer dit kom by bewusmaking van lewensbedreigende komplikasies waarvan ons tot verlede week nie eers bewus van was nie en met navrae by ander PH pasiente en bewusmakingsveldtogte - ewe onbekend blyk te wees - Pulmonary hypertension (PH) in the setting of carcinoid syndrome (Ca-PH)

Een van die komplikasies van hartsiektes wat aanleiding kan gee tot PH is tricuspid valve regurgitation. Wanneer hierdie toestand nie fyn dopgehou word nie kan dit  fatale gevolge inhou vir die pasient. Dit was dan juis die agteruitgang van my klep se werking wat die nuwe verwikkelinge tot gevolg gehad het.

Weens die klem op 'left heart disease en PH' kry die belangrikheid van die klep wat tussen die regterhartkamers voorkom nie altyd die nodige aandag nie en verontagsaam dokters dikwels die simptome van wanfunksie. Agteruitgang en verweer van kleppe met meegaande simptome, kan stelselmatig geskied sonder dat die 'vyand' Carcinoid Syndrome ge-identifiseer word.


Carcinoid Syndrome.

Carcinoid tumours are rare neuroendocrine malignancies. The most malignant of the carcinoid tumours tend to arise from the ileum and must be invasive or metastasise to produce the carcinoid syndrome which is characterised by facial flushing, intractable secretory diarrhoea, and bronchoconstriction.

The incidence of carcinoid tumours is approximately 1 in 75 000 of the population of whom about 50% develop carcinoid syndrome. Once the carcinoid syndrome has developed, approximately 50% of these patients develop carcinoid heart disease which typically causes abnormalities of the right side of the heart - carcinoid heart disease (CHD) with fibrotic endocardial plaques and associated heart valve dysfunction that classically involves the tricuspid valve.

Usually, only carcinoid tumours that invade the liver result in pathological changes to the heart.

Advanced changes of tricuspid valvular disease has been shown to be associated with poor long-term survival, and carcinoid valvular disease, rather than tumor dissemination, is the cause of death in approximately one-third of these patients. Serotonin is presumed to be the catalyst for the cardiac fibrotic process.

Nearly 95% of patients with present with right-sided heart valve disease, characterized by tricuspid insufficiency and pulmonary stenosis and the subsequent development of pulmonary hypertension.

Pulmonary hypertension (PH) in the setting of carcinoid syndrome (Ca-PH) is usually due to fibrous lesions on the endocardium of valves.

Bronne:
http://emedicine.medscape.com/article/282515-overview
http://ceaccp.oxfordjournals.org/content/11/1/9.full
http://www.mayoclinic.org/diseases-conditions/tricuspid-valve-regurgitation/symptoms-causes/dxc-20120490
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1768473/

[Meraai vannie Baai]

Een van die betroubaarste toetse vir carcinoid tumors is 'n Chromogranin A (CgA) Testing

The Chromogranin A (CgA) blood test is a good marker to help detect and monitor the activity of carcinoid tumors in general. This includes carcinoid tumors that secrete certain hormones that are associated with carcinoid syndrome as well as carcinoid tumors that do not cause carcinoid syndrome. Elevated levels of CgA are found in 80-100% of patients with carcinoid tumors.

Bron: http://www.carcinoid.com/patient/understanding/carcinoid-syndrome-diagnosis.jsp#Chromogranin


Why Early Diagnosis of Carcinoid Syndrome Is Important
Carcinoid tumors are often difficult to diagnose because there are few if any symptoms. In fact, many carcinoid tumors are found through unrelated surgery or at autopsy. But, if metastasis occurs, patients may experience the uncomfortable and sometimes debilitating symptoms of carcinoid syndrome.

Unfortunately, the symptoms of carcinoid syndrome are often too vague for doctors to rule out other possible conditions, and they may misdiagnose the disease as something else, such as irritable bowel syndrome. Misdiagnosis then puts patients at a higher risk for carcinoid crisis, a dangerous condition that can occur at the time of surgery, which can be a life threatening complication of carcinoid syndrome.

Because of the difficulty involved, there may be a delay of approximately 5-7 years in correctly diagnosing carcinoid syndrome. This emphasizes the need for early recognition of the symptoms of carcinoid syndrome, and continued testing for the disease.

For anaesthetic purposes, patients with carcinoid tumours should be regarded as suffering from a multi-system disease and so require thorough pre-planning followed by post-operative management in a high dependency environment by clinicians who are well versed in the complications associated with carcinoid.

[Meraai vannie Baai]

Dankie Elsa vir die pragtige gedig en dankie vir elkeen wat saam ons gebid het vir negatiewe uitslae.
Hierdie drie dae was nie maklik nie