He’s Knocking on My Door

Category: Articles

  • My Morning Health Check: The Numbers I Track Every Day

    My Morning Health Check: The Numbers I Track Every Day

    Living with heart failure and kidney disease means that every morning begins with a small collection of measurements. The process can be tedious, but it has become an important part of understanding what my body is doing and recognizing changes before they become larger problems.

    This is the routine developed for me with guidance from my medical team. It is not medical advice or a monitoring plan for everyone. Your doctors should determine which measurements and warning signs matter for you.

    Starting with a Consistent Weigh-In

    My routine begins after I use the bathroom and before I eat or drink anything. I try to wear approximately the same amount of clothing each time and always use the same scale in the same location.

    These details may sound overly particular, but consistency makes it easier to tell whether a change on the scale is likely real or simply caused by different clothing, food, fluids, or the time of day.

    The American Heart Association recommends weighing yourself each morning after urinating, before breakfast, without shoes, and while wearing the same type of clothing.

    I record my weight and compare it with both the previous day and the preceding week. The general warning levels I watch for are:

    • A gain of approximately 2–3 pounds in one day
    • A gain of 5 pounds or more in one week
    • Any different threshold my medical team has instructed me to follow

    A sudden increase does not automatically prove that I am retaining fluid, but it is a reason to look more closely at my other numbers and symptoms. The American Heart Association explains that rapid weight gain can be an early sign of fluid retention in people with heart failure.

    Tracking Body-Water Percentage

    My scale also estimates my body-water percentage. I convert that percentage into pounds using this formula:

    Body weight × body-water percentage = estimated pounds of body water

    For example, if someone weighs 200 pounds and the scale reports 50% body water:

    200 × 0.50 = 100 pounds of estimated body water

    I do not treat this number as a precise measurement or as proof that I am retaining fluid. Consumer body-composition scales can be affected by hydration, food, skin contact, time of day, and other factors. I use it as another trend to compare with my previous readings.

    If my weight and estimated body water rise together—especially if I also notice swelling, shortness of breath, or other changes—that gives me more information to discuss with my medical team.

    An Important Scale-Safety Warning

    Body-composition scales use bioelectrical impedance analysis, or BIA. They send a very small electrical signal through the body to estimate measurements such as body fat, muscle mass, and body water.

    People with pacemakers or certain other implanted electronic medical devices should not use impedance-based features unless the device manufacturer and their medical team have confirmed that it is safe. Some compatible scales provide a weight-only or pacemaker-safety mode that disables these features.

    I have a loop recorder and an artificial heart valve rather than a pacemaker. Even so, I checked with my cardiologist before using this type of scale. Anyone with an implanted medical device should check the instructions for the exact scale and speak with a qualified medical professional before using its body-composition functions. Withings explains how BIA and its weight-only safety mode work here.

    Blood Pressure and Heart Rate

    Next, I record my blood pressure and heart rate.

    For me, a higher-than-usual blood pressure reading can be one clue that my heart is working harder or that something has changed. A lower-than-usual reading—especially when accompanied by dizziness, weakness, or lightheadedness—can raise questions about dehydration, medication effects, or whether too much fluid has been removed.

    A single reading does not tell the complete story. I look at the measurement alongside my weight, symptoms, medication use, and recent trends. I do not change my diuretics or other medications based only on my spreadsheet unless my medical team has given me specific instructions to do so.

    Glucose

    I also record my glucose. Tracking it alongside my other measurements gives me a more complete daily picture and helps me notice patterns that might otherwise be missed.

    Blood glucose can be affected by food, medication, illness, stress, activity, and sleep, so the context surrounding the number matters. As with my other readings, I follow the targets and reporting instructions given to me by my health care team.

    Recording Everything in One Place

    I currently track all these measurements in an Excel workbook:

    • Weight
    • Daily and weekly weight changes
    • Body-water percentage
    • Estimated pounds of body water
    • Blood pressure
    • Heart rate
    • Glucose
    • Symptoms and other notes

    Google Sheets would work well for the same purpose. The most important part is keeping the information organized and easy to review over time.

    My cardiologist and nephrologist review these records regularly. Having the information collected in one place makes it easier for them to see patterns and understand what has been happening between appointments.

    What I Want to Build Next

    My next goal is to create a dashboard within the spreadsheet. I would like it to use green, yellow, and red indicators:

    • Green: Measurements are within my usual range
    • Yellow: I am approaching a threshold and should pay closer attention
    • Red: A measurement has reached a limit established by my medical team and may require action

    The thresholds will need to be personalized. A number that is normal for one person may not be normal for someone else, particularly when heart disease, kidney disease, diabetes, and medications are involved.

    Eventually, I would like to turn this system into an app that makes daily tracking easier. When I finish the spreadsheet dashboard—and if I develop the app—I will share what I learn.

    Tedious, but Worth Doing

    I will be honest: completing this routine every morning can feel repetitive. There are days when I would rather step off the scale, forget the numbers, and get on with my morning.

    However, these measurements give me a clearer picture of my health. One isolated number may not mean very much, but changes across several days can reveal a trend worth paying attention to.

    This is what I personally do to monitor my health each day. It does not replace professional medical care, and I follow the thresholds and instructions established by my cardiologist and nephrologist. Anyone who wants to begin a similar routine should first ask their medical team what to measure, how often to measure it, and which changes should prompt a phone call or urgent care.

  • What Is HFpEF?

    What Is HFpEF?

    How Can I Have Heart Failure If My Heart Is Pumping Normally?

    That was one of my first questions after learning that I had heart failure with preserved ejection fraction, commonly called HFpEF.

    My echocardiogram showed that my ejection fraction was in the normal range. If my heart was still pumping normally, how could I possibly have heart failure?

    The answer is that ejection fraction tells only part of the story. HFpEF is not primarily a problem with how forcefully the heart squeezes. It is a problem with how well the heart relaxes and fills between beats.

    It is also important to distinguish a normal ejection fraction from a normal heartbeat. A person can have a preserved ejection fraction while also having an abnormal rhythm, valve disease, conduction problems, or other cardiac conditions, like me.

    What Does “Preserved Ejection Fraction” Mean?

    Ejection fraction measures the percentage of blood that the left ventricle pumps out with each contraction. In HFpEF, that percentage is generally 50% or higher.

    However, a normal percentage does not necessarily mean that the heart is moving a normal total amount of blood.

    Imagine a flexible balloon that expands easily and fills completely. Now imagine a thick, stiff balloon that can hold only a smaller amount. Both balloons might empty the same percentage of their contents, but the stiff balloon starts with less inside it.

    Something similar can happen with HFpEF. The heart may eject a normal percentage of the blood inside the ventricle, but because the ventricle cannot relax and fill properly, the total amount of blood pumped may still be insufficient—especially during physical activity.

    The National Heart, Lung, and Blood Institute describes HFpEF as a condition in which the left side of the heart becomes too stiff to relax fully between beats. That stiffness prevents it from filling with enough blood to meet the body’s needs efficiently.

    What Is a “Stiff Heart”?

    The heart works in two main phases:

    • During systole, the heart contracts and pushes blood forward.
    • During diastole, the heart relaxes so its chambers can refill.

    With HFpEF, the squeezing phase may remain relatively strong, but the relaxation phase is impaired. The left ventricle does not expand as easily as it should. More pressure is therefore required to push blood into it.

    This is why HFpEF was once commonly called diastolic heart failure.

    The problem may become more noticeable during exercise or other activity. The body needs more oxygen-rich blood, the heart rate increases, and the ventricle has less time to fill. A stiff heart may not be able to increase its output enough to meet that demand.

    This can contribute to symptoms such as mine:

    • Fatigue
    • Shortness of breath
    • Reduced exercise tolerance
    • Lightheadedness
    • Swelling
    • Rapid weight gain
    • Difficulty breathing while lying flat

    How Does Pressure Build Up?

    When the left ventricle cannot fill easily, pressure begins to rise inside it. That increased pressure can travel backward into the left atrium and then into the blood vessels in the lungs.

    As pressure rises in those vessels, fluid can move out of the bloodstream and into surrounding tissue. In the lungs, this congestion can cause shortness of breath, coughing, reduced oxygen levels, and difficulty breathing while lying down.

    Congestion can also affect the right side of the heart and the veins returning blood from the rest of the body. Fluid may then collect in several places, including:

    • Feet and ankles
    • Lower legs
    • Abdomen
    • Lungs
    • Tissues around internal organs

    Some people first notice tighter shoes, sock marks, swollen ankles, abdominal fullness, or an unexplained increase in weight. Others experience worsening shortness of breath before obvious swelling appears.

    How Is Excess Fluid Removed at Home?

    For many people with heart failure, fluid management begins at home. The exact plan should be developed with a cardiologist or other healthcare professional and may include:

    • Limiting sodium, mine is around 1200mg a day
    • Following a prescribed fluid limit, mine is 1.5 liters a day
    • Taking an oral diuretic, sometimes called a water pill
    • Monitoring weight, blood pressure, symptoms, and swelling daily
    • Contacting the healthcare team when warning signs appear

    Diuretics help the kidneys remove extra sodium and water through urination. This can reduce congestion and make it easier for the heart to work. It also make you having to use the washroom much more frequently.

    A person should not begin taking extra diuretic medication or change the dose unless their clinician has provided specific instructions for doing so. Too much diuretic can cause dehydration, low blood pressure, electrolyte abnormalities, or worsening kidney function. I’ve been in the hospital for this.

    What Happens If Home Treatment Does Not Work?

    If oral medication is not removing enough fluid—or symptoms are becoming severe—hospital treatment may be necessary.

    In the hospital, clinicians can give diuretics intravenously. IV medication enters the bloodstream directly and may work more quickly and reliably than oral medication.

    The healthcare team may also:

    • Measure urine output
    • Monitor daily weight
    • Check kidney function
    • Check sodium, potassium, and other electrolytes
    • Monitor blood pressure and oxygen levels
    • Adjust heart failure medications
    • Treat the condition that triggered the worsening congestion

    In uncommon, severe cases where medications are not effective, a specialized filtration procedure may be considered to remove excess fluid. Most episodes, however, are treated with carefully monitored IV diuretics.

    Why Daily Monitoring Matters

    Fluid can accumulate before it becomes obvious in the feet or ankles. For that reason, daily weight is one of the most useful early-warning tools for someone living with heart failure.

    Weight should generally be checked:

    • Every morning
    • After using the bathroom
    • Before eating or drinking
    • On the same scale
    • In similar clothing

    The American Heart Association advises contacting the healthcare team about a sudden gain of approximately 2–3 pounds in one day or 5 pounds in one week, because it may indicate fluid retention. These are general guidelines; each person should follow the limits established by their own healthcare team. These are the thresholds I have also established with my doctors.

    Blood pressure should also be recorded regularly, but there is no single blood-pressure threshold that applies to everyone with HFpEF. Both high and low blood pressure can create problems. The appropriate range depends on medications, kidney function, symptoms, and other medical conditions.

    A useful daily record can include:

    • Weight
    • Blood pressure
    • Heart rate
    • Swelling in the feet or legs
    • Shortness of breath
    • Ability to lie flat comfortably
    • Fatigue or lightheadedness
    • Diuretic use
    • Sodium and fluid intake, when directed

    The trend often matters more than a single number. A gradual weight increase, falling blood pressure accompanied by dizziness, or steadily worsening breathing deserves attention even when no individual reading appears extreme. I track these daily in an Excel spreadsheet. I will make a post and explain how and what I track.

    A Normal Ejection Fraction Does Not Mean a Normal Heart

    HFpEF can be confusing because the heart may still appear to squeeze normally on an echocardiogram. But the heart must do more than squeeze—it must also relax, fill, and respond when the body requires additional blood flow.

    A stiff ventricle cannot perform those jobs efficiently. Pressure rises, blood backs up, fluid accumulates, and symptoms develop. That is genuine heart failure, even when the ejection fraction remains preserved.

    Living with HFpEF means learning to notice small changes before they become emergencies. Daily monitoring, medication, sodium awareness, and communication with the healthcare team all play important roles in keeping fluid and symptoms under control.

    This article is based on personal experience and general educational information. It is not medical advice. Medication doses, fluid limits, sodium goals, and warning thresholds should be established with a qualified healthcare professional.

  • Why I Created “He’s Knocking on My Door”

    Why I Created “He’s Knocking on My Door”

    There are moments when life gets your attention quietly. Then there are moments when it pounds on the door.

    For me, health problems did not arrive all at once. They accumulated over time—atrial fibrillation, a stroke, heart failure, severe aortic stenosis, kidney disease, diabetes, and a hip that has made simply walking difficult. Eventually, I underwent a transcatheter aortic valve replacement, or TAVR. I came through it with a new heart valve, but that was not the end of the story.

    I still live with fatigue, limitations, uncertainty, and days when my body refuses to cooperate with what my mind wants to do. Activities that once seemed ordinary can require planning, rest, and help from my family. I have had to learn that recovery is not always a straight line and that a successful medical procedure does not necessarily mean life immediately returns to normal.

    That is where the name “He’s Knocking on My Door” comes from.

    It reflects the feeling that mortality is no longer some distant idea. It has knocked loudly enough that I cannot pretend not to hear it. But this site is not intended to be about giving up or waiting for the worst. It is about answering that knock by choosing to live as fully and honestly as I can.

    Over the past year, I have lost more than 100 pounds. I have changed how I eat, greatly reduced sodium, tracked my weight and other health measurements, and learned how quickly an ordinary meal can affect someone living with heart failure. I am preparing to exercise again, rebuild strength, and hopefully regain some of the independence that illness and severe hip pain have taken away.

    None of this has been easy. I do not have a miracle formula, and I will not pretend that positive thinking makes serious medical problems disappear. What I do have is lived experience—the mistakes, fears, frustrations, small victories, and practical lessons that rarely fit into a short medical appointment.

    I created this blog to share that experience.

    I also want to be honest about how often I may be able to update it. I can only write on the days when I am feeling well enough. Fatigue, pain, appointments, and other health problems may sometimes keep me away longer than I planned. There may be gaps between posts, but that does not mean I have abandoned the site. It simply means I am taking care of myself and will return when I am able.

    Here, I plan to write about living with heart disease, recovering after TAVR, managing a low-sodium lifestyle, continuing weight loss, beginning exercise with physical limitations, and navigating the emotional side of chronic illness. I will also share low-sodium recipes, useful tools, questions worth asking doctors, and the everyday adjustments that have helped me.

    This is my personal journey, not medical advice. Every person’s health and treatment are different, and important decisions should be made with qualified healthcare professionals. But sometimes it helps to hear from someone who understands what it feels like to live between appointments, test results, symptoms, and uncertainty.

    If you are facing serious health problems—or helping someone you love through them—I hope this site reminds you that you are not alone.

    The knock at the door changed my life.

    What I do after answering it is still being written.