25 tips to manage the crushing fatigue of heart disease

by Carolyn Thomas   @HeartSisters

For my whole life BHA (Before Heart Attack), I can hardly remember feeling real fatigue. Oh, sure, I’d feel sore working long hot days on our fruit farm as a teenager. Or sleepy after pulling those all-nighters in college. Or out-of-my-mind exhausted coping with a teething baby and a sleepless toddler. Or tired at the end of a stressful day juggling deadlines in my public relations career. Or maybe even pleasantly pooped after my running group finished a long road race. But generally speaking, on a day-to-day basis, never ever the kind of severe fatigue I experienced AHA.

I’ve always  been one of those disgustingly perky early risers who leaped cheerfully out of bed the minute one droopy eyelid cracked open to discover the clock showed anything past 4:30 a.m.  Once I finished leaping, I’d hit the coffeepot and then the shower, in that order. Then away I’d go, tap dancing 90 mph to meet the day ahead, rarely slowing down until I hit the pillow much, much later that night.

But after I was discharged from hospital following my heart attack, I was gobsmacked to suddenly experience daily bouts of extreme bone-crushing fatigue that I could never have even imagined existed before. 

I remember, for example, going for a walk one day with my son, Ben, shortly after coming home from hospital. My post-op instructions from the CCU had been to walk outdoors one block a day for the first week, two blocks a day the second week, etc.  Ben and I had barely made it to the stop sign at the end of our block when I had to grab his arm to lean on for support all the way home. I couldn’t believe it! I felt like a frail old lady, barely able to shuffle one foot in front of the other. And when we finally returned home (slowest pace in recorded history), I could hardly make it to the couch to recover from the exertion of this simple little walk.

What was happening to me?!?

It’s hard to describe this kind of relentless fatigue to those who have never experienced it, or to explain fatigue that is not relieved by just resting. And nobody had warned me in hospital that this relatively common reality during cardiac recovery was heading my way. I could find only a handful of research studies confirming what I was experiencing.

A 2008 Swedish study out of the University of Gothenburg, for example, found that about half of all patients who survive a myocardial infarction (heart attack) are still experiencing “onerous fatigue” four months after the infarction.(1)

Dr. Pia Alsén, author of this study, observed:

“Many people experienced the fatigue as new and different, not related to physical effort or a lack of rest; it occurred unpredictably and could not be attributed to any definite cause.”

The elusive cause of the fatigue might also lie in the damage done by the heart attack itself. When heart muscle is damaged from being deprived of oxygenated blood flow during a heart attack, scar tissue is formed on the damaged heart muscle, decreasing the pumping efficiency in the affected area. The resulting reduction of blood flow can produce fatigue, depending on the size and location of the scar tissue.

If you’re a heart patient diagnosed with mitral valve prolapse (MVP – one of the most common conditions that affect our heart valves), your mitral valve is enlarged and unable to close correctly, preventing blood from flowing normally throughout your body. When your organs don’t get an adequate supply of oxygenated blood due to MVP, you can experience extreme fatigue.

Some medications that you are taking for heart disease can also cause fatigue. These include the beta blockers (atenolol, metoprolol, etc.) and statin drugs to treat high cholesterol (Lipitor, Zocor, Crestor). 

And if you also have a sleep disorder like sleep apnea (a condition linked to heart disease), you can feel extreme fatigue during the day.

Weakness, fatigue, and shortness of breath are to be expected in virtually all those recovering from a heart attack. Heart patients being discharged from hospital should be advised before going home that they may find just getting out of bed, taking a shower, and dressing can feel utterly exhausting, especially in the early days and weeks.  See also: Why Taking a Shower Is So Exhausting for Heart Attack Survivors

It’s important to remember that symptoms like crushing fatigue can also be found in thyroid, depression and other medical conditions. It’s possible to have both heart disease and a second condition that is also contributing to your exhaustion.

Kelly Young, founder of Rheumatoid Arthritis Warrior, describes the kind of fatigue so many patients with chronic illness experience. She wrote:

“All of a sudden on Monday afternoon, it felt like it was 2 a.m. and I should be in bed. This is not the same as being tired. It’s more like being sick with the flu. I can remember the ‘good’ feeling of tired after working hard. This is not it – this is being sick. It can come at any time of day or night. 

“This fatigue is not always the result of physical activity. It can suddenly develop for no apparent reason. This fatigue can last hours or days. It makes movement very difficult.

“It is not a psychosomatic condition.”

Here’s Kelly’s list of tips in managing severe fatigue common among those living with a chronic illness (shared by her blog readers at RA Warrior):

  • Budget energy wisely. Guard energy.
  • Have a regular schedule. Or go to bed early.
  • Do gentle modified stretching or yoga.
  • Nutritious balanced snacks such as protein bar and fruit.
  • Get the best sleep at night possible.
  • Get the best bed possible.
  • Use heat to fight fatiguing pain.
  • Eat on a regular schedule.
  • Eat enough protein.
  • Take small naps.
  • Relaxation or meditation techniques.
  • Alternate periods of activity and rest.
  • Check for deficiencies such as iron or vitamin B-12.
  • Treat the disease as aggressively as possible.
  • While resting, plan for what you’ll do when you are more able.
  • Fruit juice & sympathy.
  • Check for side effects of medicines. Take them at the best time of day to avoid fatigue.
  • Accept the reality that the list will not be accomplished today.
  • Caffeine.
  • When the body says “No more” – stop.
  • Watch a movie.
  • Take large naps.
  • Delegate and oversee.
  • Blue Kryptonite!

1. Alsen, P., Brink E. & Persson, L-O. (2008). Living with incomprehensible fatigue after recent myocardial infarction. Journal of Advanced Nursing, 64(5), 459-68.

 

NOTE FROM CAROLYN: I wrote much more about the surprising fatigue that’s so common among heart patients in my book, A Woman’s Guide to Living with Heart Disease”. You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the JHUP code HTWN to save 20% off the list price).

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Q:  Have you had to deal with severe fatigue since your heart disease diagnosis?

See also:

Why taking a shower is so exhausting after a heart attack

Exhaustion: the ‘leaky emotion’ of chronic illness

I need a nap!

Depressed? Who, me? Myths and facts about depression and heart disease

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182 thoughts on “25 tips to manage the crushing fatigue of heart disease

  1. Reading the comments above make me realize that I am not alone. I had just retired March 1st, at 63 years of age and went to see my son in California, March 5th (I live in Illinois) and had a heart attack the next day.

    I knew that something was wrong before I went to see my son and had talked to my GP before going. I had an EKG and an echocardiogram before going and had scheduled to have a stress test after I came back.

    The day after I went to see my son I borrowed his bike and went for a ride. I stopped twice before going 10 miles, unheard of for me that was used to riding 30-50 mile rides with no effort. I called my son and asked him to come pick me up. Something was just not right.

    The next day I went into the emergency room and declared I thought I was having a heart attack. A quick blood test showed that yes, I was indeed having one. I’m sure this had been going on for a while. A long story short, I had 98% blockage and received a stent.

    Since then I have never been the same. Just no energy to do anything. I have learned to force myself through the tired feelings to do chores around the house. I used to average 18-20 mph on the bike. Now I do 15. What the hell? After reading the testimonies on this website I’m realizing I’m not alone. It’s a balm to the soul to realize it’s not just me.

    I’m currently in cardiac rehab but the efforts required are modest, at least right now. I’m told the medications put a kind of governor or restricter on my heart which reduces how fast it will beat. This restricts how much effort I can produce and thus reduces my speed on the bike.

    My cardiac doctor also had me tested for sleep apnea and I found out it is severe. Now I have the apnea machine to use at night. Again, what the hell? All these changes.

    I have an appointment scheduled to speak to my cardiac doctor to discuss these things. I”m hopeful I can get a change in meds or something to help.

    I want to fight through this and push extra hard when I go out on a bike ride. The rehab person says no, not yet. It has to be approached gradually. The heart has been damaged and it’s important to approach this gradually. I will cede to her advice.

    Liked by 1 person

    1. Hello Tom – thanks for sharing your perspective. Yours is a familiar story to many of us, especially since you are in VERY early days yet, not even three months since your cardiac event. As you can see from the dozens of reader comments here, you’re not alone.

      It also sounds like your pre-heart attack self was fit and healthy and able to do pretty well what you want, when you wanted to. Now you’re dealing with side effects from cardiac meds you never needed before, you’re trying to get your brain wrapped around what has happened, you’re using a CPAP machine at night, and probably wondering ‘Who is this guy?’

      Going from being active to suddenly having “no energy to do anything” can feel almost impossible to comprehend. I’ve written a lot about this profound transition both here and in my book, and how it can impact one’s life.

      You might want to read “The Bumpy Road Between Diagnosis and Getting Better“, for example (with several links listed at the end to other articles on similar topics, too).

      Few of us were warned about any of this before hospital discharge. Your cardiac rehab coach is correct: you’re still healing. Listen to what she tells you.

      While you’re waiting to start feeling more like your old self (which WILL happen) your only job right now is to become the world expert in your diagnosis. Instead of “fighting” or “pushing”, try deliberately slowing down and even smelling the flowers while you are leisurely enjoying your bike rides.

      You may wish this weren’t true, but the reality for most of us is that this process is going to take as long as it takes. A year from now, I predict you’ll look back on this overwhelming time as a series of dark moments that gradually became brighter month by month. Good luck to you…

      Like

  2. Thank you for this. My husband, 71, is still taking two hour naps a year after his heart attack. Mind you, he is still on a myriad of medicine for PTSD, depression and diabetes. He also suffers from chronic back pain. He has just had a steroid back shot after coming off blood thinners. He does the best he can.

    Liked by 1 person

    1. Hello Maryann – I’m not a physician so cannot comment specifically on your husband’s situation, but I can say generally that it doesn’t seem surprising that a person with his long list of chronic diagnoses takes 2-hour naps.

      Aside from fatigue as a side effect of many medications, I’m hoping he’s getting specific therapy for each of those diagnoses, and particularly with his mental health concerns (in PTSD and depression, crushing fatigue is common). Good luck to both of you – as his spouse and primary caregiver, you too are likely feeling exhausted yourself.

      Like

  3. When I was in a cycle of non-exercise and fatigue, my cardiologist gave me some very good advice. He said to start with just a 10 min walk… even just inside your apartment to prove to yourself you can do it. When you are ready… add 1 min at a time or another 10 min walk later in the day.. Success can breed further success.

    Also, I love the weightlessness of the pool because of knee pain. You don’t have to swim, you can go to the pool and make up your own water aerobics or take a class. Sometimes prepping to go to the pool can seem too much so I take a couple 10 min walks.

    Liked by 1 person

    1. Such good points, Jill. Start small, wherever you are. And every little bit counts. At one point, I remember the realization that every day by mid-afternoon I was going to feel this crushing exhaustion – whether or not I had gone out for a walk or done anything physical at all.

      So I might as well go for that walk!! The only other option is to avoid movement because I’m feeling so fatigued, which is rarely a good option – and I’ll still end up feeling fatigued! But often, as you have no doubt found, too – a regular routine of exercise often means we can actually do more over time, often to our surprise.

      Like

    2. I have had 3 heart attacks in the last 3 years, after my last heart attack in april 2018 i have felt i have never got my energy back some days i can barely make it home, since i walk 2 miles to work and 2 miles home a day. After my heart attack in 2018 they took me back in the cath lab 2 days later because they thought the stent had closed up, but they missed a second small blockage that was too small to open but said it should be ok.

      I just had a cath done 3 weeks ago for abnormal stress test but said everything was fine other than the small blockage which they said was too small to open and too small to bypass still.

      I am so worn out all the time i have stopped taking my meds to see if that helped but to no avail. Just don’t know what to do anymore, so tired of being worn out!!

      Liked by 1 person

      1. Hello Maria – sorry to hear you’re going through all this. Please make an appointment with your doctor to make sure that this “worn out” feeling isn’t due to another unrelated cause, and also to double-check that the meds you have stopped taking will not end up making your heart condition worse. It’s important not to stop (or start) medications without your doctor’s supervision because in some cases, it can be very dangerous to stop. I hope you get some relief soon…

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    3. I know just what all that feels like, I had a mild heart attack at Christmas, told my heart wasn’t damaged, but had mild valve problem and partially blocked artery, no stent was put in so it was the awful meds that did it for me, so weak, and fatigued.

      I suffer with PTSD and terrible night and day anxiety, I’ve lost so much weight too because anxiety has put me off food most of the day. I could cry some days I feel so awful. I was so fit I thought, good weight, walked and I loved to swim. So full of energy. I don’t know what’s hit me.

      Have a holiday booked, so scared to go. All this has ruined my life. I never got told by anyone I would feel this way when I came out of hospital. I thought it was me handling it badly and being a wimp. I’m still back and forth to Doctors controlling meds, as had bad reactions to Beta Blocker. So I sympathise with everyone out there if they feel like I do.

      Liked by 1 person

      1. Hello Gloria. You might be reassured to learn that for most heart patients, the first year is typically the worst. Celebrating your one-year “heart-iversary” this Christmas will be a milestone to look forward to. Meanwhile, I hope that if you haven’t done so already, you will also seek out help from a pastor, a peer counselor or a professional talk therapist to help you manage your “terrible day and night” anxiety. That level of anxiety needs immediate help.

        I have an idea for you re your upcoming holiday, which may or may not work, but it has worked for me: we know that the less we do, the less we feel like doing, and the more exhausted and isolated we feel, which can make our symptoms even worse in a vicious circle. This is where the skill of pacing will come in handy.

        Rather than being “scared” to go on holidays, try re-defining what things will make you happy (and plan more of these things) and what things will be too exhausting for you. Pleasure is a distraction that works. Even sitting on a bench in a park on a lovely day enjoying the view can feel surprisingly helpful and restorative. Remember that most of us who live with chronic exhaustion feel tired whether we have gone on an outing or just crashed on the couch all day. In fact, we can often feel worse after the latter. Researchers also tell us that those who tend to have a hypersensitive nervous system can interpret even normal movements (things that are not at all dangerous to your body) as being extremely dangerous – when actually, just the opposite can often be true. Seems like you have lots of experience of not being as anxious or fatigued as you feel now, and you’d like to get that back again.

        So on your holiday, since you can anticipate that you’re going to feel tired anyway, you might as well decide early in the day which things sound like the most fun/least stressful – and just do them. In our Regional Pain Clinic, for example, we talk a lot about pain self-management. I wrote about this here. I know you’re talking specifically about weakness, anxiety, fatigue – not pain – but symptoms are often closely linked, and the brain is very powerful. Best of luck to you…

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  4. Well it’s 6 years since my heart attack and i still suffer with severe fatigue. I know i have depression and osteoarthritis my body is not up to much exercise so i just try to get by the best way i can

    Like

    1. You have a triple threat, John: heart disease, depression, osteoarthritis. Any one of those can cause extreme fatigue. You might be interested to know that many studies suggest exercise is actually an effective way to address depression. Seems counter-intuitive, but the less you move, the less you’ll feel like moving, the worse you’ll feel – and vice versa. You’ll still feel very tired afterwards for a while, but give this a try. Start with slow walks or a swim, as best you can.

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  5. Omg it’s so nice to see i’m not alone…

    I had a heart attack 13 years ago at the age of 41 and had to have open heart surgery. After about 4 years I started to feel the fatigue and now it’s overwhelming, I’m tired all the time, I work 40 hours a week so I feel like my life consists of working and sleeping. I use to fight it but would end up getting sick so now I nap when I can and am usually in bed by 9pm during the week so I can function.

    Liked by 1 person

    1. Hello Alexis – you have learned to accommodate and tolerate what sounds intolerable. I’m sure you have mentioned this to your doctors but there may be an issue that’s not yet been identified. Ask for a second opinion.

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    2. Alexis – Honor your self, and thank the Universe for the time to take naps…. enjoy them and don’t feel guilty about taking what rest you need…. Also, explore possibilities with your MD, Nutritionist, etc.
      But always with a positive attitude… not ” fighting against” the fatigue but moving towards balance and wellness. I spent years researching and analyzing the possible causes of my fatigue…What I found was that several different things were contributing to making it worse instead of better. By gradually changing those things…. I would say I am 75% improved …. Some days 90% and some days 50% … there is always some fluctuation: Here are culprits I found that contributed to my increased fatigue: Statins, Beta Blockers, Anemia, Thyroid, Unmanaged diabetes, Refined carbohydrates.
      You may want to explore these with your health care professional. On top of the REAL fatigue we tend to place a huge amount of mental emotional suffering wishing we felt better, guilt because we are tired, forcing ourselves to do more than we are able … etc. You might want to explore Flower Essence Therapy, Essential oils, supportive friends and books. You are a Soul, a Spirit, a kind loving human being…. don’t let your body define you.

      Like

    3. hi i had my heart attack 3 yrs ago, and omg i am always tired. Dont matter how much i sleep. im so tired i cant do a whole lot at 1 time. cant keep up with house work. yard work etc. i sleep in my chair off on all the time. almost every time i sat in chair, it just keeps going on and on and on. i dont know what to do. i hate it. i`m 57

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    4. I hear you. I was 52 with my first heart attack then 54ish with my second and 55 with my third i am now 56 I am so worn out that i go to bed on sunday night by 4-5pm and during the work week by 7pm everyone thinks i am crazy but no, just so so tired!

      Like

  6. Thank you for this supportive info! After three years of tests and procedures I have now been diagnosed with CAD (coronary artery disease) with no further support offered. My cardiologist has said that the continued exhaustion, shortness of breath and inability to sleep fully or lay on my side has nothing to do with good old hearty and I will be referred back to my GP.

    It’s impossible to describe the anquish and despair that comes over me with all of this and I would be really grateful for any readers comments if they have had similar to manage. I question medications and dosage as they cause further problems!

    I miss the person I once was and yes it’s tough meeting the new one in the mirror every morning! Take care everyone – and a big hug x

    Liked by 1 person

    1. Amanda, “anguish and despair” are awful emotions to deal with… I’m not a physician so can’t comment specifically on your situation, except to say generally that I hope you have gone back right away to your GP. For example, if cardiologists say your symptoms are not heart-relateda – well, SOMETHING is causing them and that needs to be identified and treated. It’s entirely possible, because of the wide range of potential causes of each of your symptoms, that these symptoms aren’t heart-related.

      Many patients find it helpful to start a Symptom Journal; just track the date, time of day, the symptom, how long it lasts, what you were doing/eating/feeling in the hour or two leading up to the start of symptome. Often, a pattern can begin to emerge that can be helpful to physicians in solving the medical mystery. Good luck to you…

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  7. Quite often I fall asleep in my lounge chair and I don’t mean to. I’ll be watching television and before I know it I’ve missed the end of the show I was watching or the news. But I’ve fallen asleep in the past before in this manner. What I find different now is that I pass out, I don’t know how to explain it any better than that. I have no conception that I am “falling asleep” and I find this rather disturbing.

    I’m also sleeping more during the day too. It’s like I don’t want to go to bed at night, even tho I’m tired and may even start dropping off when I’m at the kitchen table. This happened to my husband and my dad so it must happen more often than I know. I feel like I am becoming a vampire! But I’d rather sleep at night because business matters, etc. happen during the day (like grocery shopping, going to the bank) so I want to be awake then. So I sometimes wonder how much of this fatigue is due to my CHF and how much to my turning my sleep hours around.

    Liked by 1 person

    1. Hi Vickie – it seems that you may be answering your own question: when you turn your sleep hours around (sleep more in the day, sleep less at night), it makes sense that it encourages more of the same pattern. And as we age, it’s also common to experience a decrease in the deep-sleep stage during the night, and an increase in periods of wakefulness. Falling asleep in front of the TV (or reading a book) can be a regular complaint. It’s hard to tell how much is directly caused by your CHF, and how much your experience is similar to that of your Dad and husband. Some sleep tips that might help…

      Like

  8. I have ridden the fatigue roller coaster for years…. with cardiomyopathy, diabetes and coronary disease. I used to get fooled by a couple of days or weeks of “normal” energy…. thinks by I was finally “cured” only to become besieged by another dip of twice daily naps and slow motion activity. I have come to peace with it and have discovered a couple physiologic conclusions:

    1) It is not a sin or moral deficiency to sit in a chair or take a nap.
    2) I am not the person I was “before” nor am I my friend, my neighbor or that lady on TV
    3) I am perfect exactly as I am in any given moment, fatigue has nothing to do with who I really am.
    4) I know my body better than anyone else….I am not lazy, crazy or stupid.

    When I feel mentally alert but need to physically rest I like to send Love and Compassion to people places and things I care about….I can help the world from my chair in this way
    If I have a bit of energy I will challenge my self with a 10 min walk inside the house…. maybe with a bit of music.

    I have type2 diabetes and keeping my blood sugars controlled gives me more energy
    I have also found that CoQ10 supplements, which help the mitochondria (the energy factories in muscle tissue) increase my physical energy. If you are on statins, studies have shown that statins cause a decrease in the body’s CoQ10 so something to consider with your health care professional.

    Respect yourself, your body and your energy….Do Not beat up on yourself because you can’t do what you used to do…..or put off life until you have more energy….Enjoy life from a chair, enjoy your naps, there is beauty in EVERY moment… don’t miss it!!

    Liked by 1 person

    1. Hello Jill! I like your four ‘conclusions’ – brilliant! And I also like picturing you in your chair sending love and compassion out to the people you care about. I do believe that this IS helping the world, with the added bonus of making you feel more stable and centred while you’re doing it.

      My cardiologist also recommended that I consider taking CoQ10 – there are lots of (small) studies but findings seem to be split: some – especially those on athletes – find “statistically significant improvement in measures of fatigue’ and “decreased exercise-induced muscle injury” while others show no significant improvement in outcomes. It also seems that the elderly taking statins have a greater risk of having low CoQ10 levels (one study said as high as 11%).

      Like

  9. Hi,
    I just came across this post. I suffered a heart attack in April 2018 at 61 years old. I have been so tired. I’m so happy to know that I’m not alone. People just don’t understand that your always tired, not just tired but so exhausted. I’ll definitely be following.

    Liked by 1 person

    1. Hello Marie and welcome. You are in relatively early days yet – just five months. You are definitely NOT alone – welcome to the club that none of us ever wanted to join! You’re so right, it is hard for others to understand this kind of fatigue (in fact, I could have never understood it myself until after my own diagnosis). Take it easy, rest up as much as your body is telling you to, but mention this to your physician. It’s important that physicians understand how common (and how debilitating) this exhaustion can feel.

      Like

  10. In between my naps I pushed myself to find the answer of my fatigue. Over a few months I’ve been going to my doctor to find out why I was starting to be fatigued. During that time I had knee pain and had an MRI. They saw what they thought was cancer. Not what I wanted to hear.

    I did a full workup at a fine cancer treatment center in Goodyear, AZ. No cancer! What a relief. However, they found I had thick blood and needed to have that treated. Before I could even think of treatment, I had my heart attack one week later.

    I now have a stent and have even more fatigue. I call it losing my spark. Like the other stories I’ve read, I was working out, eating right, walking, doing the house improvements and enjoying my girlfriend. In the months and weeks leading up to the heart attack, tests were done, blood was looked at, and all looked good. Not one doctor thought thick blood was a real concern but it is. The wonderful doctor at the cancer center was very concerned and was shocked when she called to discuss my blood tests that showed no signs of cancer when I told her of my heart attack. She was so good that she called my heart doctor to explain the danger of thick blood which I hope he already knew. So I was very interested when I saw the statement of the loss of self because I related that to my “loss of spark”. I’ll check back to comment and hopefully let you know if I get any spark back since I have been very hard on myself for losing it.

    I’m not alone but did feel that way. It’s been less than a month since the stent was inserted so I’ve got a long way to go but this site has given me the right questions to ask when I see the heart doctor again. Not knowing what I don’t know is the hardest question to find and get an answer to.

    Liked by 1 person

    1. Hi Richard – you are in very early days since your heart attack. No wonder you’ve been hard on yourself lately. I think “losing your spark” is a pretty accurate description of feeling like you’ve somehow lost yourself after a traumatic diagnosis. The good news is: you’ve identified it early and as time goes by, you’ll be learning new skills to help yourself regain that spark.

      Your comment about thick blood is not a very common one: It’s called polycythemia vera (POL-e-si-THEE-me-ah VE-rah) and apparently PV is a relatively rare blood condition in which your body makes too many red blood cells. The National Heart Lung and Blood Institute has more interesting info here.

      You are so correct: not knowing what you don’t know is the hardest question to find! Your only job now is to become the world expert in your own diagnosis. You have lots of time to do this so take it easy, little by little, no hurry, but we know that knowledge is power when it comes to our very important health issues as you recuperate. Best of luck to you…

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      1. Thank you Carolyn. I’ve been looking for answers when I came across your wonderful website. It seems the docs are a little busy and glad I don’t have questions but I’ll have plenty on my next visit.

        I’ll follow up as time goes by and I’ll certainly look up the link you included. I know that prevention is at the top of the list and I feel I closed the gate after the horse got out on this one. Not knowing it was heart related fatigue surprised all involved.

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