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I went to my heart failure specialist on Friday, Aug. 3, 2007, for my usual testing and blood test, exam, etc. My Ejection Fraction continues to drop, this time to 20%, down from the 25% measurement in May 2007.

This is a continuing trend as my EF was 35% in the October 2006 measurement.

That gives us a 15 - 20 percentage point drop in 10 months.

This is baffling to my doctor, as he says I am "optimally treated" with the industry best practices for prescriptions as well as having a bi-ventricular pacemaker with an ICD.

We discussed the point at which transplant begins to be a factor, and he said we are not ready yet, and there is no real formula. It is really a factor of when they deem I have a better chance of survival as is, or with a transplant.

Action steps moving forward are to get my blood test results, and package up the echocardiogram and other results, and send them to the stem cell researcher I visited in Germany in June.

Then I had the conversation with my children, and we are working on a plan for contingencies while we can. We don't want to have certain conversations under acute situations.

I am grateful for my wonderful children and how they are working me. I am a lucky man.