work..

[pistons22girl]

Dr.Fett,
My work wants me to start back soon. I am 6 wks dx today.. As far as I know (as of last echo) I'm still at 35%.. I work a desk job, as an office manager for a cash advance service. They were going to promote me and I'd be getting a pay raise after having my child, then came along PPCM.. :eek: I love my job and was very excited about my promotion I'd be getting after my maternity leave. Now, I'm not sure that I can go back.. since I have PPCM. It is mainly a desk job.. but I'm not sure if the stress of work will prolong healing. It's not a physical job, but it's not the bed rest I've been on either. My question is, do you feel it would be a good idea to go back soon..? Or should I take some more time to heal and give up my job? They need someone to run the place soon, and I'm just not sure if me going back is in my health's best interest. If it's not safe to go back I'll wait, jobs come and go, hearts don't.. Thanks.

[Stephanie'sbigheart]

I am not Dr. Fett but wanted to say...Hey if you can afford it stay home with that beautiful baby! You are so young work can wait!

Hugs! Stephanie

[JAMESFETT]

This is what I have said for others in your situation: I think you are not quite ready, and your physician should be able to certify that you are not yet ready until your EF starts up from 35 %. When are you to have your next echo? Another two weeks would be a reasonable wait, and then to see.

JD

[SusanD]

If it is at all possible (financially, etc) then wait. My Dr. would not ok me to return to work until 6 months out and my EF was up to 40-45%. Most jobs have a short-term disability policy, so you should look into yours and maximize your time to recover. When all is said and done you want to have no regrets and to know that you gave it all you could with rest and taking care of yourself. Trust me, even though it sounds like just a desk job, it is going to be hard physically.

What does your cardiologist say?

[pistons22girl]

my cardiologist thinks I'm just good-to-go, "see you in 6 months.. you'll be fine til then".. thats why I'm getting a 2nd opinion. My cardiologist seems to think its no big deal, that PPCM heals and I can return to work. I don't feel he takes my case seriously. That's the thing, I don't have the money to stay home.. But I refuse to go back to work if it's bad for my health.

Dr.Fett, I see my new cardiologist on the 21st and I'm not sure if he'll do an echo or not. That's why I was requesting you could maybe speak with him or provide me w/a note explaining why you think I need another echo so soon.. If you could I'd appreciate it.

I agree with you guys though. I want to see improvement on my echo and see that I'm healing before I take any big steps. I need to work with Christmas approaching and all, but I need my health even more. My family doesn't understand. They all tell me to get back to my normal life, b/c that's what my cardiologist says.. Everyone thinks I'm fine. But I know different. I know that if I don't take this seriously and get the echo's & rest I need, it can get worse. But maybe I will just take off a little longer.. At least until I see some improvement.

Dr.Fett, is there a name for that echo you was talking about with another mother? Where they only check the EF% & Left Ventricle size? I'm going to request he just does that on the 21st and see if I can't convince him. thanks guys

[JAMESFETT]

I was talking about a regular echocardiogram, but for follow-up it does not need to be a full, formal exam, because what is needed is to know the current left ventricular size and ejection fractin as the most important. I would be happy to speak with your cardiologist, if he or she would like to e-mail me at the address below I will then connect by telephone, should he or she wish.

JD

[SusanD]

Megan, I am really, really sorry you have not found a cardiologist who is sympathetic and empathetic to emphasize to your family and your employer just how serious an EF of 30-35% can be. I have to wonder how HE would be if faced with a similar situation and how he would feel working a full day. :rolleyes:

[4girlsmama]

IF you can stay home please do. Your family needs you for a long time to come! I didn't have the option of staying home, and I feel fatigued all the time:( I wish I could take some time off, but it's not an option. I am a teacher so I do have part of June, July and 2 weeks in August off and I am very thankful for that.

[miachic]

You can ask them for a limited echo. That's what my cardio called it and it lasted about five minutes but he got the measurements that he needed. I hope your new cardiologist is a better fit for you!

[pistons22girl]

ok, that's what I'll ask for.. a limited echo. I don't expect them to continue doing echos on me constantly.. but I'd like to have my EF% measured & my LV size until improvement is shown. Susan, I know 35% is pretty serious.. but I try to think positive, that I will recover. Dr.Fett thinks things are looking up.. and my symptoms are not getting worse.. That's a good sign right? This is really hard.. I'm glad I have this board and people who understand to talk to about this.

[pistons22girl]

another thing, Susan said a EF of 30-35% is serious. Since mine is 35%, is there a chance it could be lower.. like around 30%, and they just rounded up to 35%??

[JAMESFETT]

No, not likely. And it could be higher since it has been awhile since your last echo, and you are certainly improving clinically. Let's hope the EF is also better. Once you know it is on the upswing then one can be more relaxed about the whole process. One of the reasons to know that it is not staying the same is that one can slowly increase dosage of medications in order to help the function upward--not only do these meds help improve the circulation, they also help to reverse the abnormal pathology, the very things that cause PPCM in the first place.

JD

[pistons22girl]

so maybe try my original dose before it was lowered, like 100 mg twice a day, instead of 50 twice a day? the first time around they lowered my BP so low I almost passed out every time I stood up. I lowered them, BP still around 90/60 and I have more energy. If I go back to my original dose should I be concerned that my BP will bottom out??

[JAMESFETT]

You'll need to work that out with your cardiologist. I can only provide information, I cannot prescribe. It is essential to work out any changes of treatment with your own physician, so hopefully you will soon have a satisfactory arrangement. I'm sure your doctor now or even later doesn't want to receive his/her information from someone on the www. Hence, so important to gather all the information you can, but still to have a good working relationship with your own doctor.

JD

[SusanD]

Susan, I know 35% is pretty serious.. but I try to think positive, that I will recover.

Oh, I can totally see that from your posts. However, all the positive thinking in the world is nothing if you aren't surrounded by people who empathize and are understanding in regards to your diagnosis. The problem with PPCM is that you tend to look fine on the outside. Withy no visible or wound and no visible window to watch an enlarged heart, your husband and family have no way of really seeing how this affects you. Complaints of fatigue, dizziness, etc. are often seen by family as psychiatric type complaints. I know family is well meaning and they don't want you (when I say *you* I mean all of us in general) to dwell on your disease and be upset. But in the process, they forget that you still need to rest and to guard your energy and protect your heart.

If they (your family) are constantly pushing you to "move on", go back to work and be normal, then in my humble opinion they do not *really* understand your whole disease. My cardiologist had to sit my husband down and TRULY explain what it meant to have an EF of 25-30%, his expectations for recovery and his expectations for my family on how to treat me on a day to day basis. In no way did he make a cardiac cripple out of me, but he reminded me that at the moment my job was to take care of myself and the baby and nothing after that truly mattered. I could push it, go back to work too early and everything would suffer and it could possibly delay my recovery.

[pistons22girl]

I agree doc, I need to find a doctor who takes this seriously (not on a 6 month basis) and hopefully is well-informed in PPCM. I wish I had a cardiologist who was as informed in it as you are.. I just really value your opinion and knowledge.

Susan, thanks for understanding. When something is SO rare, nobody around you actually understands. I even feel like my dr. brushes it off as it's nothing. I'm glad other women can relate.

[JAMESFETT]

One thing to remember when you and your cardiologist really are on track is that when and if you need to increase your ACE-I and/or B-B, do it very slowly so that you will be able to tolerate it. The greatest reason for not reaching treatment goals is trying to increase too quickly, and then having to back off because of low blood pressure. A gradual titration, that's the trick.

JD