Tawkin' Med

Diastolic function. Ejection fraction. COPD. Kidney-induced anemia. Pulse ox. FEV1. CHF.Rheumatic factors. Hemoglobin A1C. CAT scan.

These are the kinds of phrases that I am learning as a result of my mother's continuing -- and, we think, increasing -- weakness. She's got multiple problems -- her ejection fraction, the percentage of blood in a ventricle that's pumped out when the heart beats, is low; it ought to be somewhere north of 60 or so; its around 40. Her lung capacity is diminished as a result of smoking for forty years; she stopped about forty two years ago. Put together these mean that she isn't pumping as much blood as normal, so there's less oxygen-carrying blood cells being pushed through the body, but she's also putting less oxygen into the blood cells each time she breathes. (I know how that transfer happens, but I'm not totally clear on the physiology of the blood cell that lets it carry the oxygen.)

The CHF is Congestive Heart Failure; the COPD is Chronic Obstructive Pulmonary Disease. So far as I know, they're actually talking about the same thing, that being: the lungs are getting congested. The source, though, is different -- the CHF is because enough blood isn't getting pumped, so its backing up in the lungs, which is where the Congestion is happening, even though the title would lead you to believe that the congestion is in the Heart; the COPD is saying that the transfer in the lungs is diminished because of diminished lung capacity. This leads to the FEV1, the Forced Expiratory Volume in the First second, which is how much air you can push out in one second; her's is about .6 liters, which is apparently about forty percent of what they'd like it to be. So she can't push out an acceptable amount of air in that interval. Yet when she's tested for pulse ox readings, which is the amount of oxygen saturation in the blood, both at rest and while walking,she does okay. So that sounds like there is enough oxygen in the cells -- even if, perhaps, there aren't enough cells. How that ties to FEV1, I dunno. But she gets out of breath an awful lot, and quite easily.

Additionally, or possibly related, she's anemic -- not enough to get a shot of something or other that would help; apparently, the magic reading is 'below 10' , which is a hemoglobin measurement in grams per deciliter; thats when you're 'officially' anemic. She's at 10.3, 10.2, 10.1, 10.0...and thats it. She's been told that it could be that her kidneys are 'not signalling the bone marrow to produce enough red blood cells'; she was told by the same doctor, during the same session, that she has indicators for Rheumatoid Arthritis (as distinct from degenerative arthritis), which could also be the source of her anemia. Apparently she doesn't actually have RA, just flags that suggest it.

And, of course, she's a diabetic. That, at least, seems pretty straightforward and under control.

You know whats needed? An expert who will clue you in on a) what questions to ask, and b) what needs to be followed up on, and c) what information each of the many doctors needs. Is this a marketing opportunity? I think so -- and when I see these people starting to market personal medical records (because a) the older you get, the more likely something evil's going to happen to you, possibly when you're no where near home), I find myself wondering how such a record keeping/tracking/translation function would work.

And by whom. At the moment, it's us. And while its fun to watch a doctors eyes widen when you casually ask 'how's her ejection fraction' and 'isn't that FEV1 a little low?', its like having to understand the normal wear on brakes when you bring your car in for an inspection. You don't want to have to know that -- this is why you have the experts. Have THEM fix it. But in this medical environment, the guys who fix the brakes work in this office, the guys who tune the carburetor work in a different one, and the ones who handle the air conditioning -- well, they move around. In that environment, you're lucky that your car runs at all.

Which is the feeling I'm starting to get about my mother.