Question: Dear Dr. Iliri,
It is XXXX again, with test results, and of course many questions. When I have tests, I tell myself each time that if the results are normal, I will make sure to resume my normal life without limits, but anxiety begins to set in the very evening of my tests. I must break free from this pattern, but hoped to get some reassurance from you.

My echo report is attached. My EF is 70, everything is pretty much normal and my cardio says my recovery is complete. My holter (I don't have the report yet) showed .01 % PVCS, about 100, and no other issues. My last holter, last May had 50 PVCs and the one in April 2015 had 900. Others since my ablation have shown about 20 PVCs. I didn't feel PVCs during the 24 hours so I believe they must have been during exercise as I went to the gym twice, so about 90 minutes of the holter was during aerobic exercise, although only moderately vigorous.

I am happy and ready to move on with my life, but wanted to ask your opinion on a couple of issues.

Is 70 EF not considered too high? 3 weeks after my ablation, my EF was 60, but seems to have gone up just a bit more since then. Sometimes I read that over 65 is worrisome.

Is 100 PVCs not worth worrying about? My cardiologist says that he is as worried about 100 as he would be about having 0, that 100 is nothing at all. I know I feel PVCs only very rarely.

I have been off of the carvedilol completely for 2 1/2 months. Do you think that is adequate time to assess that it wasn't the carvedilol which cured my cardiomyopathy? My cardiologist is scheduling another holter/echo in 6 months, then one year after that, then two years. Do you agree with this plan? Should I still worry that only the carvedilol was helping my heart and I could become sick again?

My resting heart rate remains low, at about 50, but since being off the carvedilol, my heartrate goes up more with exercise and with other things like eating and simply walking around when I first wake up. Would the holter have found anything troublesome? Is it normal to have this variation, which was somewhat suppressed with the beta blocker?

Lastly, of course, my ever-consuming obsession with fluid retention. You told me before that there may be slight variation in urine output when one is standing as opposed to being completely reclined. Is this difference very minor? Because I was told to lie down as much as possible when I was very sick, I still keep trying to recline and be still after meals and drinking a lot of fluid for fear that being active will make me retain more water. It is quite difficult, as you can imagine, to do this, as I work, take care of my parents and young son, and have a home to take care of. Is this simply crazy behavior which is likely not affecting anything at all noticeably? I used to never sit all day, was running around at work, playing with my son, but now I've become used to this insane behavior of trying to be as inert as possible after meals/drink. Is this my imagination that it really affects anything at all? In my crazy head, if I'm up and about right after drinking a lot, I will retain so much fluid that I will immediately go into heart failure.

Thank you so very much, Dr. Iliri, for your many months of sage advice, kind wisdom, clinical brilliance, and unending patience. I can't tell you how much you've helped me.

I hope you are well, and hope that soon I can tell you that my OCD is done and that I'm building Internet-connected schools in Cambodia with my company.

Many many thanks,

XXXX

Dear Dr Iliri,
Thank you so much for your continued help. While I still struggle with my OCD I can now see that I am improving.

I believe my PVCs started because of extreme stress- job with much responsibility, small child, taking care of two very disabled sick parents, and a divorce. I still live in the same conditions with no end in sight. My mother, in particular is a cause of deep grief - she had sudden dementia, two hip breaks and now is like an infant and her care is extremely difficult as she cannot move or speak, she only screams. We have a part time aide who comes while I'm at work. I am unable to have leisure time because l have so many people to take care of. Our healthcare system doesnt provide help for my parents- to get them care elsewhere would take $30,000 USD a month. It feels quite hopeless.

I am, of course, worried that my stressful life will make me sick again. I went from having functional parents to having two aged infants I must diaper and feed like babies. And it is a sad existence to hear them scream and cry. They should not be at home but there is no easy solution.

Should I be worrying that this stress could weaken my heart again? I must find a way to change things but it is extremely difficult. I also feel sad and angry as no one helped me when I was sick. While my doctors told me to stay in bed, I could not stop taking care of people. I didnt even stay in hospital overnight for ablation because I had to care for my mother, including lifting her right after my surgery. I accept these duties but am terrified that I am at risk for another serious illness.

Thank you so much.
XXXX

Dear Dr Iliri,
Thank you so much, as always. I see you as a therapist/philosopher, not just a physician. You are very calming and wise and I try to hold onto your words when my anxiety is at its worst.

Today I have been worrying that I am about a pound heavier than yesterday despite eating lightly as usual, exercising, and staying well hydrated. My old cardio's advice to "run, don't walk to the ER if you see even one extra pound" has been going through my head all day. I know logically that one pound is nothing but he scared me so much, told me I would die as soon as I stopped meds. I have been med-free, now, for three months.

It has been 3 1/2 weeks since my last echo. I wish I could simply feel all will be ok but I know in 5 months I will have another echo and already I worry about that one- that that echo will be abnormal. I think I would feel better if no more tests were necessary and I could forget but while I continue to be monitored, I live in fear. I will be watched for at least two more years, and maybe forever, I don't know. It feels a bit like being pregnant but never having th



the baby. It feels like a never-ending situation. I just feel so at risk all the time and spend so much time concerned about fluids/eating/weight. I wish I could forget it but very very difficult. I feel like my brain has been changed by my brief but severe illness. I know I must stop thinking like this to get my life back.

Do you truly believe I am in no physical danger and this is all OCD and anxiety and I have no reasons to feel so much fear?

Many many thanks, XXXXX.

Dear Dr Iliri,
I have a bit of an unusual question- as you know, I have been quite fluid obsessed for some time and have been concerned that I may have damaged the nerves of my bladder by pressing down on my abdomen so much. As of a few weeks ago, it seems the bladder sensations have increased, have felt more normal, as I was before. Could carvedilol have had anything to do with that? Should I worry that I have some other kidney/bladder dysfunction?

It gets hard for me, at this point, about a month after an echo, to believe that I'm truly still ok. I wish there was a home echo machine which I could use for constant reassurance. I do know I have to stop worrying so much about fluid and my heart but the hold it has on me is so stronf.

Many many thanks for all your help. You are wonderful.

Thank you and have a wonderful weekend.
XXXXX