What Options Do I Have?

[CGTMHI]

i am 55 yrs old, i have diabetes and conjestive heart failure, i am taking the following medications;

amaryl 8 mg a day,
lassix 80 mg a day,
lipator,
lisiniprill 20m  one a day,
coreg 6. 2 a day,
an 80 mg aspirin,
humalog insulin up to 3 shots a day, (on a sliding scale)

i have just received my results from stress test and echo, and on the echo i see the word cardiomyopathy, and the doc said my heart is bad, said it is not pumping blood like it should and is enlarged also...on the bottom of the page the doc wrote (poor prognosis) and now im scared really bad.

i have a right below knee amputation also due to the diabetes, this happen 10 yrs ago....i dont know wht to do...i have changed heart doctors because the first one was so far away from me and i honestly didnt feel confortable with him...plus he didnt explaine anything to me, my regular doctor told me all this stuff, so what do u! think, i knwo u cant really say much due to the fact u dont see me or my med records...im just curious, is there help for a patient like me with cardiomyopathy? What options do i have and is the heart med im on the good stuff?  what questions should I be asking my heart doctor?....please let me know as im  worried...

[Cleveland Clinic]

Cindy,

I'm sorry to hear of your ordeal.

I'm not sure exactly what question you are asking, it sounds like you are making more of a plea for help.

Without a complete review of your medical records it would be difficult to give you an answer about your regimen. True you are on a good core regimen for heart failue which consist of an ACE inhibitor(lisinopril), a beta blocker(coreg) and lasix. However you are not on maximum doses of either the ace or the beta blocker. There are other medications which may also help like aldactone.

There are an ever increasing number of other modalities for heart failue and these technologies are rapidly advancing. One example would be biventricular pacing.

The best indicator for prognosis in heart failure really is your symptoms and how much you can do or are limited by the heart failure.

I would strongly encourage you to seek care from a cardiologist that specializes in heart failure. They have resources so you medication doses can be more closely monitored and titrated up aggressively.

There is a specized heart failure center here at the clinic and most academic centers would have something similar.

good luck

[Dr. Erik]

It sounds like you are on all the right medications. Is it possible that your diabetes has been poorly controlled for most of your life? This would explain your poor heart condition at such an early age. I don't know if you can reverse any damage that has been done. One thing you can do is to keep your diabetes under good control as to not let your heart deteriorate
anymore. Another is to seek an opinion from a cardiologist from a big institution such as a teaching hospital. I wish you the best of luck!

[Dr. Erik]

One thing I forgot to mention was you should be on a statin drug like Zocor. Zocor is the only statin drug that is inidicated for the treatment of heart failure in patients who also have Diabetes. This is a new indication and you should discuss this with your Cardiologist right away! This can prolong your life.

[Cleveland Clinic]

erik, you sound like one of the drug reps!

Cindy, Lipitor is a statin drug, i would imagine you are on it for CAD or abnormal lipids.

While having pronouced effect on patients with atherosclerotic disease and marked effects on lipid profiles in patients with diabetes, the effects of statins aside from cholesterol benefits in patients with ischemic and nonischemic cardiomyopathy is presently unclear.

[tessa0825]

I cant believe that any Dr. would just give a PT a copy of a report like this and not also offer an indepth explanation and allow you to ask any questions you have about your conditions and the terminology of the report....I think as PTs the most important thing we can do for ourselves is to find Drs. and specialists, that we can become comfortable enough with, to have open back and forth conversations....Have you considered asking for a referal to one of the good training hosp.? I wish you the best of luck and Im sorry you are going through all this...Tessa

[Dr. Erik]

I apologize. I did not see  Lipitor on the list of meds the first time I saw it. Please disregard my comment on statin drugs.

[jan]

Cindy,

I don't have much to offer, but the teaching hosp I volunteer at has a CHF clinic, maybe you can find one in your area.

Best of luck to you!