The day had come to head back to Cleveland.  Lou had arranged his travels, so he would be in Cincinnati the day I would leave for Cleveland.  He would drive up and pick me up at the airport and go with me to the appointments the next day.

I finally finished my day at work and rushed home to get my bag, change clothes and pick up Robin. She would be dropping me off at the airport and picking me up the next evening. Rush, rush, rush.

We pulled up at the drop off spot at the airport and I made my way to the ticket counter to get checked in. All went smoothly at check in and through security. I got to my terminal and had a chance to catch my breath and wait for the plane to come in. I finally got on the plane and in my seat. The flight was uneventful and I arrived in Cleveland late that night. Lou was there waiting and we got on the road for the 25 miles into the city and the hotel where we would be staying that night. We checked in and arranged for an early morning shuttle to the hospital.

Morning came quickly, as we were both very tired and anxious to get answers. The shuttle driver dropped us off at the front entrance, and I went in to get checked in at the lab. Dr Thamilarasan had ordered more blood work, ekg and chest xray. I finished all of that and headed down to get my echo done.

The echo lasted a very long time….even longer than normal, as Dr Tham wanted to get extra pictures of what was going on with my heart. After the echo was complete, I checked in for my visit with Dr Tham.

I was called back and vitals and history were taken. We also went over all my medications. I gave the nurse all the copies of labs, xrays, echos, ekgs and visits since I was last there 7 months ago, including my latest echo done at UVa. Dr Thamalarasan came into the room 15 or so minutes later. he was very kind and polite as he always is, but he didn’t sugar coat anything. He told us my heart was failing, my EF was still down around 25% and that I needed to see the heart failure team. He mentioned the “T” word again. He also told us he wanted to admit me and get more tests done….namely a TEE to see what else was going on. Of course I told him I was scheduled to fly home after my appointments that day. He just said lets see what Heart Failure tells me.

So, with my head still reeling, we make our way up two floors to see yet another doctor….one specializing in heart failure.

Dr Thamalarasan had set up this appointment with Dr Wilson Tang. I was called back into the exam room by the nurse, vitals and history taken. And then a heart failure fellow came in. She spent about 45 minutes in there with us asking questions, answering questions and getting to know me and my history. She then told us she was going to go out and speak with Dr Tang and that they would be back in shortly.

Soon, there was a knock on the door, and Dr Tang came in followed by the fellow. We went over the same ground and then he told us that I needed to be admitted, I needed to get a right heart cath done, I needed to do another metabolic stress test and I needed to meet with EP.

I’m like….whoa! I have a flight to catch in a few hours, and I’m scheduled back to work tomorrow! Dr Tang took this all in stride and said, that’s fine…then you will need to come back within the month and get this all done. But, he did want me to meet with the EP that afternoon before I left. He had already had it arranged. He also said that my heart had become stiff and that I would be needing a transplant. He adjusted a lot of my medications…took me off of some and added others. He explained, its a balancing act at this point. Either extreme, too much or too little, would cause even more heart failure symptoms. So, we would try this new medication regimen. Dr Tang spent over an hour with us. He had us plenty scared. Lou asked some questions, but mainly, if I were to stay 1) could it be done as outpatient, and 2) when could we start and how long would it take. Yes, all could be done as an outpatient and the EP he had in mind wanted to do some more invasive tests as well. It would depend on what he told us and what he wanted to do. So, off we went to the next appointment….the EP.

So, down we go one floor to the EP department. I get called back into the room and first get my device interrogated. Then I get put into a room. Yet another time that day, we go over my history and problems. The nurse leaves and a few minutes later, Dr Bhargava walks in and introduces himself to us. More questions and answers between us, and then he gets down to business. His feeling after looking at my echo, is that the myectomy caused a complete left bundle branch block (very common post a well executed myectomy) and that my heart just couldn’t compensate. He said I have an asynchronous left ventricle….meaning my left and right ventricles (bottom chambers of the heart) weren’t beating in synch, which is, what he felt, causing the lowering EF. His suggestion was to put in an upgrade to the ICD I already had in place. Essentially, he would add a 3rd lead into my left ventricle and pace both ventricles as close to 100% as possible. He also wanted to a procedure to make sure that my arteries were clean and that he would be able to thread the new lead in without issues.

I put a call into my supervisor, and she was very sympathetic and accommodating. So all of these additional tests were scheduled for that week. Lou and I were able to escape back to the hotel to try and organize our thoughts with these new developments. My mind was certainly reeling!

The new tests were scheduled quickly. Although, I would need to be off my coumadin for several days for a couple of them….those tests were scheduled for later in the week. So, another week of fun filled testing in my future! Yippee!

I got the tests done, and it was decided that I would be a great candidate for a BI-V upgrade. It was hoped that the Bi-V would help me keep my heart for as long as possible (a transplant has a shelf life), or even help prevent that from ever happening! The implant was to be scheduled for about 5 weeks later, the first opening Dr Bhargava had in his schedule. My other tests showed what we already knew. My heart had stiffened, my mitral valve was still leaking mildly, and that my aortic valve had started leaking. So, the race was on trying to preserve my heart for as long as possible.

The fun just never stops!