The New York Heart Association standardized the definition for a Class IV heart disease patient as
"Individuals with cardiac disease that results in the inability to carry on any physical activity without experiencing discomfort. Even at rest, they may experience symptoms of cardiac insufficiency or anginal pain; discomfort increases with any physical activity." (1994)
B-type Natriuretic Peptide (BnP) or N-terminal pro b-type natriuretic peptide (NT-proBnP) is a blood test that is used to help diagnose whether or not a patient is at risk for heart failure, and to grade the severity of that heart failure.
BnP is a hormone that serves the purpose of regulating the blood volume in the body, and also helps define how hard the heart must work to circulate the blood. The BnP is the active hormone, and it's counterpart NT-proBnP is an attached non-active hormone.
It is produced in the heart's left ventricle -- the main pumping chamber in the heart -- and when it is stretched from having to work harder, it produces increased amount of the BnP hormone. Before your heart gives out from congestive heart failure (CHF) it will release massive amounts of the hormone into your blood as it struggles with every beat.
Someone who has a heart disease and is taking medications to control that disease, such as an ACE inhibitor, beta-blocker or diuretic will normally have a lowered BnP rate.
The normal range for a person's BnP count in the standard hospital-administered blood test is 0-200. At a BnP count of 200 you're considered at "mild risk" for a congestive heart failure. 200-400 is considered "moderate risk" and the person can be expected to have a slightly limited range of physical activity. 400-600 BnP count is also considered "moderate" but with a marked limitation of physical activity. 600-900 BnP count is considered a "severe risk for heart failure" and when my Grandpa and I checked him into the ER the day after he fell at home in the middle of the night, his BnP level was at 4,900.
His heart was giving out.
Of the above listed New York standardized Class IV heart disease patient description, ever single word of it fit his description perfectly.
His apnea had progressed into central apnea, an increased "symptom of cardiac insufficiency" and while his airway remained open while he slept, often his chest muscles and diaphragm would temporarily fail. The dropping blood oxygen would signal his brain to gasp in breath, but unlike the usual form, he wouldn't awaken with the sharp intake, instead staying asleep.
Gone was the snoring, he slept quietly in his hospital bed between central apnea attacks, but he was dying.
The dementia had progressed to the point where only once or twice for a brief moment each day would he recognize myself or any other family member that was with him every moment.
He had lived for almost 86 years, and I'd known him for only 23 of them but loved him like only a grandson could love a grandpa.
He was given God's mercy every moment of his life and it didn't stop when he entered the John L. McClellen Memorial Veteran's Hospital on 4300 West 7th Street. He had the kindest, most sincere and understanding doctors a terminal patient could ask for. They resisted the urge to keep him unconscious much of the time, allowed his family members to carefully make each decision with prayer and consistency for the desires he'd previously expressed, and they followed up with him often.
C.C. Donald rapidly progressed over the week he was in the hospital--within a few days he began sleeping twelve to eighteen or twenty hours at a time, denying food, and growing rapidly weaker. He was at first more combative, then less, then more again, and soon every waking moment he was "on the job" again, working as a block mason in Southern California.
He spoke only of needing to get back to work, install a window, finish up the blueprints, find another measuring tape and progress on his deadlines.
Deadlines that had long since past, but his frail, weakening heart and mind found peace in the memories there.
Often war vets return to Korea or World War II and their mind relentlessly brings them back to the memories of the horrific things they experienced there, but my grandpa was safe as he traveled back to work, needing to move "that pile of bricks over there."
He loved Jesus and not only read but pored over the scriptures in their original languages daily. He loved my Grandma and had he made it until August they would've been married for 60 years. He had three sons and my Mom was his youngest daughter. The day before he passed away she went to his desk in back at home and found chocolate stashed right where he knew she and all the other kids and grandkids would find them.
Just after midnight, early Thursday morning my Grandpa Donald went to see Jesus face-to-face and singlehandedly ask him more theological questions than Luther, Calvin and Piper combined.
My Dad watched as he slept and his carotid pulsed once, then no more as he passed away quietly in his sleep.
He loved lemonade, the Java Chocolate shakes from Arby's, big, thick slices of bread covered in a thick layer of peanut butter, and big breakfasts with eggs, bacon, toast, and preferably Grandma's homemade turkey burgers.
Conrad Calvin Donald's Obituary