Dr Fett

[pattynav]

Dr Fett~

OK, I have been wanting to ask you a few questions for about a week now, but as you read on you will realize just how illogical my decision making skills have been recently. I decided to stop taking my meds about 3 weeks ago...mainly out of frustration of having an unchanged EF , still feeling symptomatic =depression. My rationial was that discontinuing the meds certainly couldn't make me feel any worse...and in truth it hasn't. I actually may even stretch to say I feel a bit better...probably some of it has to do with finally have a normal range B/P versus 80's/40's, but why else would be the cause of feeling better? Is it all med side effect related? Is this truly a "bad" decision? I am not feeling as frustrated as a few weeks ago and can see going back on the meds if I had to BUT, well I guess I do not understand the mechanism of the meds to see how it can make a difference if it hasn't yet in the last 18 months...Does that make sense?
Also, why is it that there is such a increase in incidence of depression in heart related problems than any other chronic illness? Is it just the shear number of people affected by heart problems that make it seem like there is an increase in incidence or is there an actual chemical relation between the heart and seritonin,etc.... Thanks for your help.

[JAMESFETT]

I think you are mostly wondering, "When does healing kick-in with treated PPCM?"

We don't understand many of the mysteries of the healing process. Nevertheless I am convinced of two things:

1)The earlier effective treatment (ACE-inhibitor and beta-blocker) can be started the better the outcomes, and
2)Healing can continue for a very long time, certainly into and through the 4th year after treatment.

I also THINK that the presence of virus in the myocardium prevents full recovery and may be associated with worsening of systolic function. IF this is the case, knowing whether or not virus is present becomes a very important issue; and particularly if one is to use an immunomodulating treatment with prednisone and azathioprine, both "non-conventional" treatment possibilities.

So, I encourage continuation of maximum tolerable dosages of these meds and consideratioin for endomyocardial biopsy with PCR testing for virus and immunohistochemical staining of biopsy material.

I wish I could be of more help. There surely must be chemical imbalance issues associated with chronic disease depression.

JD