oh, boo hoo..

Hard to believe we have been in AZ for almost a month. Last time I sort of reported on the weather--there isn't any really important health stuff to report, thank goodness--because it was its usual nice self here. To add to that, we have had several days this week, prior to rain due today, where one could bask by the pool, mid-afternoon. Mid and upper 70s briefly. 

I only mention this to bring up another matter: I think we have grown accustomed to the warmer weather here. I note that in Cache Valley, before we left, it felt more cold to me than it had in years past. And this was before the icebox weather that they have been in since then. The first year here in AZ I was in shorts and tee shirts anytime it was over 60 degrees. Now not so much. Those temps now feel kind of cool. Have we adapted? More than likely. More often than not one is resorting to a cover up in the house and out and about. Blame it on the chemo or just old age, or a combination of those. In any case, it doesn't feel as warm here to me as it has in past years.

Since everyone knows that 25% of body heat is lost via the head the best thing to warm up or to cool down is to put on or take off a hat. Since my cabeza now shows more skin than ever this is a third variable in my heat regulation. I occasionally think I look like one of those kids who wears a toque all year. Or maybe I am beginning to understand why they do it.

It will be a quiet one for us this evening--not just because it is rookie night out--but also because we are too old to want to stay up late enough to see in the New Year. It'll be there tomorrow, if we are, and that's soon enough.

Happy New Year!

in the nick of time...

My faithful reporters in Cache Valley tell me that it has been very cold, with some snow more recently, and good air. The air here in the Valley of the Sun looks pretty good, but looks can be deceiving. We are not perched--as we are at home--in a position to see the inversions. Today the forecast is for moderate air quality.

Yesterday was the first workout day at the new place (LA Fitness). They have several of everything so there was no problem getting in a good workout. Notably, their equipment is all of the Nautilus variety, that is, weight bars and pulley systems. The problem with such systems is that once one starts the weights moving in a particular direction the actual weight being lifted reduces due to inertia. (My physics friends can tell me what this should be.) I realized how fortunate we are at Aqua Werks in CV to have the  compressed air systems that keep the resistance of the chosen weight the same through the arc of movement. But, mustn't be picky. Silver Sneakers (can you say Medicare?) pays for it. (I wonder how long that will last?) So I am very happy to have such a place within a few miles.

The only reason I bring this up is to say that I dressed to work out in shorts and a Tee with just a thin fleece to get from the car to the building. By the time the work out was finished the fleece was unnecessary. I stayed in the shorts, Tee and sneakers for the rest of the day. I was fully reminded why we come here each winter. Today it is supposed to be 73. 

Happy days..

heigh-ho, heigh-ho....

It's off to AZ we go!

Saw the opthalmalogist yesterday morning. As I type this I am doing so without any glasses! Good outcome. My eye pressures were normal (13 mm). I have a wee astigmatism in each eye and correction at about 2.00+. No longer do I require glasses for driving. (That has been lovely.) Now I have to decide how to proceed. One pair of glasses in which the astigmatism is corrected and they are single-readers; or bi-focals in which there are the above plus some strengthening of far distance. Or how about one of each? 

If I just do readers, I am back to always carrying them and needing to remember where they are; whereas the other pair would be worn all the time. We'll see.

I have been fighting the usual upper respiratory infection that always seems to get me in the fall of the year. I have been closely monitoring (on doc's advice) and don't think it is headed to my lungs. As yet, I have taken nothing for it, and it seems about to resolve itself after one week. You may recall that last year, such a bout headed into pneumonia. I believe that I am much healthier this year and, therefore, more able to fight off disease. (Mustn't get cocky.)

We left home yesterday and will reside in SLC for a couple days. Then we will keep going south before the next scheduled storm. 

Happy holidays!

cataracts be gone...

Had the second cataract (right eye) removed last Thurs morning, two weeks after the left eye.  Everything went smoothly.  Same deal with the transparent eye patch except that the surgeon said the next day if I slept mostly on my back that I could probably forego the patch on the subsequent nights. (He is cognizant that I wear a BIPAP machine at night and I stay pretty immobile when that is on.) That eased the recovery process some.

The right eye seemed to be cloudier longer than the left. Now after 6 days it seems pretty clear. The acuity is not quite as good as the left but that may improve with time. In my second day inspection he saw that my eye pressure was pretty high (32 mm). Normal range is 10-22 mm. An eye drop was used to relieve the pressure which was due to post-surgery swelling. As an aside, he said that at some pressures only a little higher than where mine was to relieve the pressure they squeeze the eyeball to extrude some vitreal (sp) fluid from the surgical wound. Ouch!! Fortunately, I avoided this outcome.

I can almost read now without glasses. The left eye is particularly acute. If the right eye gets any better I think I will be essentially normal-sighted. If so, an incredible outcome. I am not wearing my glasses now for driving. They seem to not be right for the job. My guy likes to retest vision at 3 weeks post-surgery. Since we are leaving for AZ before that time, he will test at 14 days and I will carry a script to AZ to have whatever glasses I need made there. I think the right eye may still have a wee astigmatism and prescription glasses will be necessary to correct that. All  will be revealed.....

In the meanwhile, have a fine Turkey Day.

a trip to the dentist?

My left lens is gone! It happened yesterday and went according to plan. I wore a transparent eye cover for the remainder of the day and to sleep with. Today, no patch except for sleeping. Then for three nights. Eye drops three times per day. The eye drops are some special compound compounded by a compounding pharmacy. (Is that a compound sentence?) My guess is that the compound contains a slug of antibiotic plus lubricants of some sort.

My left eye vision uncorrected seems good. I now see how my vision is tinted yellow by the color my right lens has become. Of course, everything is brighter. 

It was interesting to sit there (recline there?) and feel the poke in the eye and the vacuuming process, which, indeed, sounded like the device was hoovering out material. The anesthesiologist said that any time I wanted more joy, all I had to do was ask. I didn't. It really was no more uncomfortable then dentistry--certainly less pain--more a matter comparatively of having to assume the position for a time longer than one wanted to. I had some concern last night that my BIPAP mask would not seal well because of the eye patch. Not a problem.

And, yes, the waiting for the surgery was much longer than the process itself.

Right eye in two weeks.....

not leaving well enough alone..

Little to report on the heart front, happily. Health seems to be good. Cut down on the hay fever and allergies with the spraying of the box elder bugs. Now the windows are a mess. But, oh well, an easy trade off. Workouts continue apace. We are looking forward to proceeding south in a month or so.

But wait, there's more. Doing the cataract thing. One eye this Thursday and  the second in two weeks. The shades over my eyes have grown progressively worse, as happens to most of us of a certain (advanced) age. The procedure now takes 20 min. They make a 2 mm incision into the sac that holds the lens. Then they blast that with ultra sound and suck it out. I do not remember how they get the new lens in because it would also initially have to be 2 mm small. I am sure that intake and post-op recovery will add an hour on each end, but the efficiency is really remarkable. And there is money to be made. It was interesting to me how long it was to get an appointment for the annual check up; but when I mentioned surgery, the doors were flung open and I was welcomed in almost immediately. My long time opthamologist will do the procedure. When he examined me last week, he had done 9 before coming into the office. Can you say moolah? He tells me he has been doing them for many years, virtually error free. Gambler's fallacy, anyone? Both lenses will be for long vision as I understand it, with prescription glasses for reading.

To be continued....

good news and threes..

Is it good news that comes in threes? Well, depending on how one counts, I am closing in. Today the shock doc, the ablator, took me off all heart medication! No more amiodarone; no more Eliquis. (The latter was $42 each prescription.) The former was toxic as discussed previously. (The third area of toxicity appears to be liver.) Tapering off? No. Amiodarone has a half-life of a couple weeks and so peters out on its own. The doc also thought there was no need for the apaxiban (Eliquis); instead, back to a baby aspirin each morning. The apaxiban is gone in a couple days. This is all wonderful news.

Now it is back to careful monitoring of all systems, but particularly speeding heart. They expect my resting HR to climb some in the absence of the amiodarone. Exercise seems to be bringing that down. I now have multiple readings in the high 60s at the time of arising.

And the former hypertension is gone. As has happened to a good friend, this is probably due to weight loss and as a corrollary (sp?) improved heart function. So exercise and maintaining a good weight will be critical.

But one must be cautious. It has been too easy these past few days to be a little less careful with the sodium thing.

nice news

It is official: I no longer have heart failure! So says the PA who examined me an hour ago. I don't see them again until next May. If anything changes I am to call. She said they can do quite a bit over the phone. She also said that Mayo in AZ has a top rated heart failure team now--it wasn't so a couple years ago--and Mayo  is only 10 min from our winter digs.

Tomorrow the rhythm kings--the shock docs, the ablators. They are important because only they can take me the toxic rhythm drug I am on (Amiodarone). It is toxic to eyes, lungs and a third area which I have forgotten. She thinks they may fade out the dosage. We'll see. I have only been on it for 3 months, well within the range of acceptability. When I go off that I will have to be cognizant of speeding heart.

More news tomorrow....

allergy season

It's allergy season for me. The eyes itch and the  nose  runs. Sneeze rate increases. So far it hasn't been bad enough that I have begun to ingest any OTC meds. But I am using eye drops (Zaditrol) which the Walgreen's guy said just came off the prescription list last year. It does a pretty good job of reducing eye itch.

For me the big thing it to not let the post-nasal drip develop into upper respiratory distress, bronchitis and the  rest.

A contributing factor is the infestation of box elder bugs we go through this  time of year. They really are benign as most bugs go. They are just pesty. Watching TV in the evening they gravitate to light sources which may mean they are flying about your head. They love our south facing windows and walls. This time  of year those surfaces radiate a lot of heat. The exterminator is scheduled in a couple weeks--they were a month out when I booked them--and when they were here a couple of years back their spraying  did a great job. In fact when the bugs get onto our tiles where they were sprayed two years ago they soon die. This suggests to me that the pesticide remains active (and us breathing it). But the outside mainly is  what contributes to the inside problems. They need to respray down to the foundations and on the windows. (There goes the  window washing job of a few weeks ago!). Ah, the joys of being a home owner. All of the foregoing is to point to the fact that when I kill them, or vacuum up their carcasses I end up short of breath and sneezy. They are clearly a contributor to the allergy blues.l

Everything else is trucking along just fine. The workouts proceed apace. I can now open some jars with difficult lids that I haven't been able to for a long time. My time in the aerobic part of my workout is steadily increasing as is the  exertion level on the bike and the amount of weight I am hoisting. Still not where I want it but improving each week. I miss salt and the foods that contain it, eg, cheese. But I can have some usually verboten foods if I plan my day wisely. For example I can keep sodium virtually out of a 500-600 calorie breakfast easily. That gives some room to carefully measure out an amount of cheese and crackers that won't put me over top which  is 2000 mg in a day. All in all not bad.

Hopefully the good news continues....

losing it?

I think I am beginning to lose it. My immediate memory (aka working memory) is going in the tank.You may recall that my regular doc suggested that I might expect this as a delayed consequence of chemo. (Not delayed enough, I suspect.) Lately, I have been searching (memory) for names and been unable to find them. This is a well known outcome of aging, I know; but mine seems to me a little precipitous. So much so that I am able to notice it happening--unlike the frog in warm water that gets hotter and hotter.

Here are some other manifestations. Those of you who are of a certain age--you know who you are!--may relate. I will be listening to a friend's story and, half way through, will think of something to add to it, or of a tangent that follows from it. Now, by the time he has finished with his story, what I wanted to say is lost to me. Sometimes it may come to me in a few seconds later, other times not. 

Related seems to be the case where I start to tell a story, and I go to a tangent that is appropriate to the story and by the time I finish with the tangent, I have forgotten what the main story is. Didn't used to happen. Sometimes I simply say, what was I talking about? This is good feedback particularly if they say, we haven't a clue. Again, the point may eventually come back to me a few minutes later, or not at all.

I believe that one of the tests for senility (ie, among other things the loss of working memory) goes something like the following: The neurologist recites a string of 5-7 numbers. (Without tricks, these many numbers are about what the average person can recall.) You repeat them and are asked to remember them. He then asks you to do a(n) (interfering) task, that requires some computation. Then a few minutes later you are asked to recite the number string. Normal people can do this, easy, peasy. I am afraid to have this test done.

To repeat: I would like to think that this is normal aging--for our society--but it may not be. (I say for our society because the death of brain cells may be hastened by our lifestyle.)  Martini anyone?

status quo all over again

A strange sequence of events. Well the stomach flu (if that is what it was) receded a few days ago and then came back. After a couple more days, it receded again. I doubt it will return, but who knows? This parallels some experiences I used to have with sore throats when I was much younger. I would have one for a few weeks and then it would recede--sometimes as long as a month--only to make a re-appearance. Usually, the second bout was more brief than the first.

Healthy living? I have had a dynamite week which has included 3 workouts. I can already feel a conditioning effect in muscle tone and new muscle. Most of the time it takes about 6 weeks to see a conditioning effect and I think-with fits and starts--it probably has been about that long. But a great week also contains eating out with friends.

Water retention. I have begun to be aware of the increase in water retention when I increase my sodium intake. I was getting 8-9 days between torsemide pills (Lasix). But when I ate out several times this week, while I attempted to be careful, I often cannot tell where my sodium intake for a restaurant meal is. I had to take a torsemide this morning after only 6 days. More data clearly needed. I also suspect that this may be a lifetime condition. Merde!

O2 and me. You may recall in an earlier post that my sleep doc suggested to me a trial of going without supplemental O2 overnight. O2 in the blood is measured in percentages and is called oxygen saturation. It is what is measured when the doc puts the little clamp thing (actually an oximeter) on your finger when reading your vital signs. (For those really into it a good oximeter can be bought at WalMart for about $40). The reading is in percentages. Normal is above 90%. Anything below 90% on a continuing basis is not good for one, since lower percentages involve the death of one's brain cells. I take one O2 saturation measure every morning upon arising and do a blood pressure measure, too. The heart failure team wants these data.

In my awake state (most days!), I am well above 90%. No problemo. But during sleep my respiration rate falls so much that I am below 90% without O2.  The sleep doc is wondering whether my strengthened heart may not need supplemental O2 to keep my oxygen saturation within normal limits. Well, a couple of natural experiments have occurred that appear illuminating. The first was when I forgot to plug in my new portable O2 concentrator and it ran on its lithium battery until said battery pooped out at 3 a.m. one morning. When I arose a little later the first readings I got from the oximeter were well down in the 80s. Not good. The second was more subtle--no obvious human error involved. The O2 delivery tubing crimped where it joined the device and so, while the concentrator was running and producing O2, said O2 was not reaching yours truly. Another very low reading ensued upon arising. Well down in the 80s.  I think the question about whether I need supplemental O2 at night has been asked and answered. At least for awhile. (To his credit, the sleep doc suggested I try without O2 intentionally later in the year, presumably to measure this with a more strengthened heart.)

Music.  While I can no longer play my trumpet(s)--I have north of a dozen!--I am compensating by attempting to learn to play arranger's piano. Essentially this is what jazz pianists play: chords in the left hand melody in the right. It is challenging, but a blast. I look forward to getting in at least an hour per day, often more (until my back objects). I may not have the 10,000 hours it takes to get good at this kind of skill, but I am damned sure going to use what I have left in this way. I am helped in this by a longtime friend who is very adept at jazz piano (as well as saxophone and flute and arranging music). I may never get good enough to play for anyone save me, my ownself. That is just fine.

All for now....

pride goeth...and all that

I knew I shouldn't have been so upbeat last post! A presumed intestinal virus has attacked me.  In fact, according to my journal, it attacked the next day after the last post. All of my friends have had some variety of this before I did. For most it resolved in days, maybe a week max. For some, vomiting accompanied the diarrhea in the first days; for me, no vomiting.

With my compromised immune system I am now entering the second week of it. A call to my regular physician's nurse informed me that as much as two weeks of it is not unusual. For the most part I can engage in daily activities but the condition lurks and is persisting. Moreover, the major symptom between attacks of diarrhea is gas-induced cramps. You might correctly guess that a lusty, corrective fart is not in the cards. And then when one races to the toilet and sits, the cramp has gone--only to reappear when one lies back flat in bed. (TMI dude!)

As you might guess, my workouts are in the toilet--pun intended, and I have cut out eating out with my buds for awhile. Hopefully, this will resolve by the next time I post. 

I am wondering whether this is a silent epidemic?

nada mucho

All is well and there is nothing major to report. I know that some of you worry when I don't publish regularly. Usually, that is because I don't have anything to say. (I know that is a very unusual state for me!)

I had to take a torsemide (lasix) the other day because my weight started to increase about a pound a day for a couple days. That bled off about 5 lbs of water and my weight jumped back to where it had been, and a few pounds below. So far, it looks as though I may need to take one of those every couple weeks (with potassium, too.)  I hope the interval among these pill takings increases. I don't see any obvious correlates with water retention. Perhaps it is a function of heart weakness. Or maybe it occurs when the sodium amounts go out of bounds.

Having trouble at restaurants where I don't have a published nutrition list ahead of time, so that I can figure what is low sodium. Obviously there are some general guidelines: bread is usually a no-no; as are processed meats. In general, I figure I can go off the rails a little at lunch as long as I cut down my sodium intake for the rest of my meals. In some cases--a large hamburger--not possible. Of course, the published nutritional guidelines are associated primarily with chain restaurants. And, many of our good (?), little places here don't know the nutritional values of what they are serving. Really, if this is one of life's little problems it is not worth mentioning, no?

Workouts are going well. Seeing some definite toning and some new development, too. Actually look forward to them now.

Really, it's all good and there is nada mucho to say.

more of the same,,,

It is fire season here in the west. We have fires burning all around us. When the prevailing winds are from the NW we get smoke from Idaho and Oregon fires; from Wyoming in the NE where parts of the Grand Teton NP are closed. When last I wrote, we had a major burn just a few miles to our west that really put visible smoke in the air. But for a few weeks we've had a reprieve. The air has been beautiful, mostly in the "green category". However, the reprieve is over. We have a fire up Logan Canyon near the Beaver Mountain Ski Resort (voluntary evacuations from that area). I used to bike that canyon. In the early mornings the colder--heavier--air from the mountains would whistle down that canyon and you would swear you could pedal no farther. After you'd biked up 20 miles or so, and the day began to heat, the wind would change direction and be in your face on the way down! It often seemed as if there were no justice. Today the canyon winds have filled our valley with smoke. Once again we cannot see the surrounding mountains.

And just when I was starting to feel good lung function again. When I last left off it was with a prescription for some aureomycin. The pharmacy where I get the prescription filled said that they wouldn't recommend taking this antibiotic because it had an additive effect with some of the medication I was on. I was ready to pooh-pooh the idea until Jan said they wouldn't have made the statement unless there was strong evidence of the effect. So I called the heart failure clinic and they said, we'd rather you didn't take that one. So I called the prescribing physician's nurse and told her what had happened and she got me a scrip for some amoxicillin which does not interact with any of my current medications. She also said thanks for the information which I took to mean that such an effect was unknown to the prescribing doc. In any case it was all academic since I felt that I was getting better without any antibiotic, and, in fact, I have not taken it. Let's chalk up one for my crummy immune system. But today I am hacking and can feel my lungs burning. We have some wind outside as I type this. Hopefully, it will clear the air before I get back in the situation I was in a few weeks ago.

I saw the sleep doc today. This is a mandatory appointment where Medicare finds out whether I am actually using a piece of (new) equipment (the BIPAP machine) they are paying for. I am. During all sleeping hours. The new machine, as with most devices these days communicates, with a server somewhere via wi-fi and the doc simply has to download the information about me. Someone is truly watching over me. Well, not so much probably. But the data are there for the doc to read. And read he did. He reported to me that I am averaging  1.1 apneas or hypopneas per hour, well below clinical significance (5 per hr). Very good news, indeed. Recall that my baseline rate--unmasked--was 24 per hour. Thus, the new mask which covers nose and mouth really works well. And I find it is not much to tolerate. He doesn't want to see me again for a year.

An aside: this week I bought a travelling O2 concentrator. They are expensive and the medical equipment company has no arrangement with Medicare on them because the pay out rate is small enough that they wouldn't recover the cost of the device. Such a purchase allowed me to take back the rental concentrator we were keeping in SLC (at $100 per month!). Medicare justifiably only pays for one of these which we have here at home. It made sense that in a couple years I would reach the cost of the portable device, which also was easy to pack and take with us. It has its own rollers and is about the size of a briefcase. And it solves the problem of airline travel since this device could easily store overhead on a plane. (Medical devices do not count against one's total luggage.) In any case I've got one. And the sleep doc says you are doing so well that you might want to experiment in a few months going without O2. I may have just bought an expensive piece of equipment that I may not need. He also said that they can loan me an oximeter that connects to my BIPAP so that I can measure O2 concentration over night. I will do this in a couple months and we'll see. I should be able to do an ABA with it.  Look at the O2  saturation with and without supplemental O2. Definitely worth a look.

So, back to life its ownself some more...

what goes up...

Minor Set Back? I walked into our local Urgent Care this morning. I have been fighting for a couple weeks with an upper respiratory problem. This is not atypical for me at this time of year. August is often the month that begins my allergy season. I started to get a little wheezy and then we were afflicted with several days of the worst air we've ever had. Forest and grass fires surrounded us. It got so that we couldn't see the mountains ringing our valley. Shades of our winter inversions!  I began taking OTC meds that  we had on hand, eg, Zirtec, etc. That has kept me sort of in a not-getting-better state. And then I had a really bad day yesterday which may have due to taking some leftover cough syrup with codeine. That may have interacted with my other drugs. I was lethargic and sleepy all day. Then I had a terrible night where my BIPAP machine was making my sinuses very painful. I slept upright in my bedroom chair using the canula for O2 because I couldn't lie down without the machine blasting air into me. Whenever I lay flat I would cough. Enough already!

We are so lucky. The nearest insta-care is just five minutes away and it is a part of our hospital network. I can usually waltz in there and be immediately served. This morning was no different. There was no one ahead of me. Long story short: the doc said, "Sounds pretty gunky in there." They took a picture to make sure there was no incipient pneumonia--there wasn't--and I walked out with a script for a Z Pak, an antibiotic.  We'll see what that does. I quipped to the doc that the antibiotic was being given despite any convincing evidence of a bacterium. His comment: "Yeah, its what we do."  We'll see how this plays out.

Taste Buds. I had a sudden revelation that perhaps the diet and the prior heart stuff was not the proximate cause of my so-called change in taste of food and drink (especially wine!). I am dropping my jaw within my BIPAP machine during the night and I generally am awakening with a severely dry mouth. Last night when I used the canula and slept upright, not so dry. More taste in my food this morning! Do not know how to proceed on this one, but I have an appointment upcoming with the sleep doc and will make inquiries.

Off to workout...

more positives

This is the ninth day I have not needed a water pill (torsemide = lasix). The trace edema appears to be a thing of the past. Yea! Witness the fact that my weight variation is in tenths of a pound overnight most times, well within the margin of error as the political clowns say.  Currently I am at 212.9 (this morning) and would probably like to be several--but not too many pounds--lighter. Some of the weight charts show 6'4" at 204 lbs.

I can feel the strengthening of my workouts proceeding apace. I am adding weight and reps and time on the cycle virtually every workout. No hurry. So far I have not paid much in the way of discomfort the day after a workout, suggesting I am not overly stressing my bod.

Slept almost 9 hours last night with only one, brief, interruption. Go BI-PAP!

a couple a things

Yesterday, I visited with my local internist.  I have been seeing him for over 30 years so we are pretty familiar with each other. He said that my recovery had made his day and that were I not in good physical condition and healthy before the recent events, the outcomes might have been quite different. He has been able to follow along because the Budge Clinic is a part of the Intermountain Health Care system. So SLC and Logan records are transparent.

In pretty clear terms he thought that the advent of my heart failure was due to my chemotherapy. In my mind, the more proximate cause was the discontinuation (necessary!) of my beta blocker (attenolol) after 27 years and it was then that my heart manifested arhythmias. That would not discount the compound weakening effects of the chemo as a precursor or setting event and as causal in the bradi-cardi syndrome I was in (ie fast upper chambers, slow lower chambers) prior to all of this.

He asked whether we were going to go to AZ for the winter. I said we would like to. He said there is nothing to stop us. Onward!

As part of our foray into causes I noted that I was surprised to see in the literature provided to me as a patient, that sleep apnea was a correlate, if not a cause, of heart failure. I mentioned that as a part of the pneumonias I was pretty much defeating the nose pillows in my former C-PAP machine (to get rid of apneas), but that the new one with a mask covering nose and mouth seemed to have restored the quality of sleep that I was getting earlier. (I now have a BI-PAP machine which means that they can set one pressure for inhaling and another pressure for exhaling. I believe mine is set for 20 psi on the inhale and 15 or 17 psi on the exhale.) In any case the new machine and mask seem to work well, much to my long-suffering wife's pleasure--I am quiet now during sleep--and that I was getting much better sleep. That is all good.

 I also mentioned my continued use of O2 to keep my O2 saturation levels above 90% while I sleep. One of my sleep problems during the pneumonias was the O2 levels dropping into the 80s and below during sleep. Somewhere in this he mentioned the increased likelihood of dementia. I am assuming that was in relation to sleeping with O2 levels less than 90%. I will keep using the O2 during sleep. I hope the reference was not broader than that! At this point I don't know what is happening to my O2 during sleep, however, I assume the SLC guys were tracking that--while I was on O2 there--and did not report anything untoward.

I see him again in 3 mos before heading out of state.

Workouts continue and I feel better on each occasion.

getting back to life its ownself

Stepping out a little. Jan and I attended a couple of plays by the local repertory company and that was good fun. Before one we went to an actual restaurant. We shared a salad and each had a separate entre. The entre was too much for each of us. And to top it off we each ordered the same, so it would have been easy to split. Blindly splitting an entre is something we appear loath to do in unknown situations, but we need to start because each of us is eating much less.

A note on a side effect of a low sodium diet.  The low sodium diet I am on has substantially changed my taste buds. Not only am I now hypersensitive to salted foods, I have lost my taste for wine! Horrors! I opened a very good bottle of wine the other night as a test case and it tasted not like wine to me at all. I did no more. Yesterday, I tried a glass of sparkling rose and it tasted better (and better). I want to be really careful about how much alcohol I imbibe in these early days, well, later days, too. But as we all know, a 5-oz glass each day is heart healthy.

Hidden sodium.  With help of the sodium police (herself, that is) we are rigorously staying below 2000 mg per day. The average American ingests about 8000 mg per day. Eating in restaurants produces some challenges.  Sodium lurks everywhere.  But by scrutinizing menus on the computer, one finds that most chain restaurants now provide full nutritional info on their foods. One of my simple pleasures at home (and in AZ) is to eat lunch out each week. I have a two pairs of friends with whom I eat on each of Tues and Thurs. These turn out to be gab/rant fests which seem good for the soul. Then I have other friends--not quite as calendar driven--who often fill one or more of the remaining weekdays. I don't want to give these up.  But lets look at the challenge.

Take Jimmy Johns (JJs) as an example. They do sub sandwiches which I very much like. First off, sodium is high in most breads and it is through the roof in deli meats. What to do? Well, an examination of  JJ's menu shows that many of their sandwiches approach the sodium limit for the day. Many are 1500 mgs or higher. However, one can also find the Big John, which is a roast beef sandwich for 1150 mgs. So on a Thurs, if I am careful with the rest of the day, I can still be below 2000 mg. Calorie counts  with these foods, while important, are not really an issue. I have also found some acceptable dishes at Olive Garden.  More as I explore.

Some low sodium testimonies. The sodium police have been greatly helped by purchasing a number of low sodium cook books. At least a couple of them are introduced with what I am calling "miracle stories". One is written by a man whose heart was so completely failed that he was on a transplant list and given only a few months to live. He adopted the lowest sodium regimen he could and has lived for a couple decades without a new heart. If memory serves, his heart totally recovered. A second was written by a 21-yr-old woman who had failed kidneys. She was on dialysis 3 times per week. A low sodium diet and her kidneys recovered. These are at least food for thought (no pun).

More torsemide (i.e., Lasix).  Maybe I am just slow, but I noted a gradual increase in my weight over the past 2 weeks. I attributed this to inaccurate calorie counts. (Carefully counted out desserts are on my diet when I get only around 1500 calories of food on a given day and I had dessert several days in a row.)  Additionally, there were the difficulties of evaluating the restaurant meal out this past week. And on the same day I also lunched out. So, my perception was that I was probably busting my diet a little.  But I got an overnight gain of more than a pound two days ago. Also, I still have build up of trace edema in my feet and ankles each evening. This gathers over the day--starting when I get on my feet each morning. Yet, it is largely (?) gone the next morning. 

Looking back at my notes I saw that I last took a torsemide pill on 17 July. At that time I had jumped 2 lbs overnight from 216 to 218. That torsemide, the second in several days, did not lower my weight. I figured that I was void of extra water. By 30 July my weight had crept up to 222 with a 2-lb jump in one day. I took a torsemide. Overnight my weight dropped 6 lbs! And this morning it is 215.4. Also my ankles and feet feel thin! So, my calorie counts are probably pretty accurate and weight gain is water retention. I will have to believe in those counts and be more ready to accept weight gain as water retention. (Except for a substantially higher frequency of whizzing the torsemide seems relatively benign.)

Working out.  Second one this morning. Increased weight and/or reps on each exercise and increased cycle time to 15 min. Feeling good!

cardiac rehab?

Yesterday I was to start cardiac rehab. On the way to the lab at Logan Regional Hospital I received a phone call from the lab. The caller told me that Medicare would not cover any work they did with me because my last echo-cardiogram showed an ejection fraction of 50+, where 50-75% is considered normal. Apparently one's heart has to be less than efficient at no more than 35% on this variable. If I wanted to continue it would cost me about $150 per session. Since I was only 2 min away by that time we agreed that I would come in and they would provide me with information.

They were very helpful. In the discussion I really found out that I should restart the exercise program that I was doing before the pneumonia(s) commenced last fall. And it involved the usual: an aerobic component (walking; cycling), an anaerobic component (building muscle tone and new muscle), a balance component (standing on one leg), and stretching for a cool down.  In other words pretty much what any complete fitness program would like you to do.  And, of course, I could do that anywhere. So I returned to where I was working out last fall and did some light cycling, some light lifting, just to ensure that I hadn't wasted the morning. (It felt good!)

The only extra benefit, it seemed to me of the cardiac rehab lab was that all the rehabers were remotely wired to a front computer console so that the staff could monitor heart function in each. I would be working out without this feedback.

They also suggested that I start at about 60% of my max heart rate for the aerobic work. Max HR is 220 less one's age, for me, 220 - 77 = 143. 60% of that number is about 86.  Well, I had trouble keeping my HR down to that level during the cycling component of my workout. It wanted to float around 100 and that was doing a lot less than I am used to. I usually set the effort level at easiest (to start) and then pedal around 60 rpm. To keep my HR down I had to reduce that to around 40 rpm. Didn't feel like much of a workout at the time. I only did 10 min. On all of the weight bearing exercises I did a single set at much lighter weights than usual.

Today I feel a bit more tired than usual. And I don't have any serious muscle pulls or pain suggesting yesterday's workout level was about right for starters. 

Onward: a new chapter begins, getting fit once more. 

My only fear now is a return of pneumonia this fall following allergy season.

better news

We were advised to call in after 1 pm on Monday after earlier scheduling put the procedure at 9 am. We did and were told to be in hospital by 2 pm. By 3 we were all checked and by 4 I was on the table.

Several surprises along the way: first, I had converted back to a normal sinus rhythm sometime over the weekend. I could not tell, but probably it was concurrent with my HR returning to normal. Just a guess. Second, what I assumed as a conscious process that would take a few minutes was not. The procedure was described as 3-4 hours! With general anesthetic. Also I found out what kills the rock stars on over medication with the new pain killers: there is no warning. It seemed to me in the past that you could feel yourself going nighty-night and maybe get a joke or two in.  In this one, I asked the anesthesiologist if he had started and he said 2 minutes, then I was gone! Lights out immediately. No chance to say, I need to take an antidote for this. Don't mess with the fentanol family. Also, the procedure required three pokes--two groin, one each side, and one neck. When I had some similar studies done some 27 years ago, it was one poke. They also catheterized me because the procedure required plenty of water in the tools. I am getting tired of being catheterized! So quite a few things were different this time out. The surgical staff had a collective laugh about the crudity of procedures back in the day compared to the current state of the art.

My procedure lasted about 3 hours. I was back in recovery before I was conscious and don't remember the doc talking to Lisa and Jan. I found out later that he said it went well and they had blasted an area that was producing atrial flutter and an other one that was producing a-fib. I didn't know that they differentiated these two conditions. (They had described my Friday experience as atrial flutter; perhaps that was why I was able to recover normal sinus rhythm on my own?) The next day I asked about size of the blast and he said millimeters. He also is not worried about diet or exercise; I can start cardiac rehab right away. (I think I'll give it a few days,) No heavy lifting, but that was about all.

I feel pretty darn good, better than when they had got my heart back to an ejection fraction of 50+. My appetite is finally returning, making my quest to maintain my current weight of 220 more challenging. But we are determined to go low salt/sodium and count calories, and measure water intake.

So while this seems like an end, there is the matter of the heart doing its own thing. Many of these ablations take two runs when another (missed? unseen?) path shows up months or even years down the road. A friend who lives down the road in our neighborhood was out chopping weeds when I called on Friday. He had to go back for a second. The second ablation was much more successful. But my doc said he was optimistic. But who knows, he may always be optimistic.

Cautiously, it may now be time to really heal....

Thanks to all of you who follow/lurk on this blog for your best wishes. They are highly valued.

bad news

Well, I am back in a-fib. HR currently is 171 and has been fluctuating between 150 and 170. We are headed directly to SLC where they will do an ablation of whatever wonky circuits they can find. That is scheduled for sometime Monday with an over night stay in the hospital. I will be in a-fib until that time, so they must think I can manage until then. I am to take action if I get anymore "symptomatic" which I take to mean start passing out, etc.

All was going swimmingly this morning. Jan and I were preparing a down-and-back run to N SLC for her to get her hair done. I stood up from the dining room table and was immediately dizzy. I reported the symptom by telephone. Thereafter I found that my HR was up and was not coming down so I called the Clinic Nurse who suggested in light of the rapid HR that I hie to the emergency room here in Logan for an ekg. Then I recalled that I was still wearing the 30-day holter monitor so after switching extensions a few times the e-phys people were able to tell me that I was in a-fib.  Saved an ER trip here in Logan. 

The e-phys people are going directly to the ablation since I have already had two cardio-versions, the shock treatments. And I am supposedly on a rhythm drug, the amiodarone. The occurrence this morning suggests that those were temporary fixes.

Pacemaker doesn't necessarily follow ablation, but it probably puts me a step closer thereto.

So, to be close to the hospital where the procedure will be done on Monday, we will leave shortly for SLC and squat there with Lisa until Monday. After that, we'll see.

PS: I took some torsemide this morning since I gained a pound overnight. Would this have made me more susceptible to a shift in rhythm?

torsemide and me..

A quick note: Do the docs know what they are doing in my case? Oh, yes they do. Yesterday, with one day on the torsemide, I lost 6 lbs!!! Now back at 218. So, they were absolutely correct, I was starting to carry water again.

I didn't take any this morning because I don't think I have that much more to give. I will wait a day and then re-evaluate. This follows their orders fairly well: they wanted a couple days of torsemide followed by use on an as needed basis.  The only change I have made is to give it a single day.

Having to wear the compression sox. Getting them on and off is taxing, but they do the job. Not much of a fashion statement though.

mostly good news

Jan and I spent what seemed like all day--but was really only 4 hours!--at Intermountain Health Care Center today. I was scheduled for an echo-cardiogram at 10 am. We waited until 11 to be called in. Then a tech came in to give me an unordered EKG. Wires crossed we believe. The echo was (re-?)scheduled for 1 pm. (We think that was a result of the earlier EKG screwup.) So there was nothing to do, but sit outside in the sun and have a yogurt and await 1 pm. That appointment started on time! And went swimmingly.

The echo-cardiogram, as most of you who are old enough know, is where they slide a gelled up ball over your chest (or other body parts) to see inside and take 70+ pix, in this case, of the heart. I was mostly interested in the ejection fraction number. Recall that a normal echo for me last Oct showed about 55%, which is in the normal range (ie 55-70%).  Upon entering the hospital a few weeks ago in a-fib it was about 15%. Today it was 55% again! Yea! That's substantially good news. I am on no heart medication because my heart is mostly normal. (There is some subjectivity in the 55 number; the normal error range  is + or - 3, so it could be as low as 52 or as high as 58, and not be significantly different. (One cardiologist thought I was probably around 50.)
.
Then why am I still getting some trace edema? Skinny feet in the am; fat feet by evening. Well, apparently my atria are somewhat sclerotic, which means less pliable than they once were. So, whilst my heart is squeezing wonderfully (see ejection fraction above) the upper chambers don't rebound like they used to.

So, it is back on a minor dose of torsemide (20mg) for a few days along with potassium for kidney function. The clinic was concerned that I have gained about 4 pounds (219 to 223 this morning). But the weight gain has been gradual, so we weren't concerned. Since Jan makes me assiduously count calories, I know I have been under 2000 daily since we left the hospital. Ergo, there should be no weight gain. The docs think it may be water weight. Therefore, a di-uretic. If I have not lost the 4 lbs by Friday, I am to call the clinic. So, that is a fly in the ointment.

They were also going to take my heart monitor off this morning and we could have left it there with them. Jan even went to the car to get the package. However, this decision was reversed when the doc actually looked at the data and found (8 seconds!) of V-tach across the two weeks of my using the device. It occurred on a Monday night at 8:30 pm a couple weeks ago. Was I thinking impure thoughts? I have no idea what was going on at the time, but I do know that I was not symptomatic. So I have to do the complete 30 days. Oh well, that is only about a week more.

Other than the small glitches and our impatience, all-in-all, a pretty good day.

much ado...

Awoke yesterday and weighed immediately, which I usually do, on Jan's wonderful Weight Watchers' scales. Up 2.7 lbs! Alarm bells. I am supposed to call in to the Cardiac Nurse if a sudden weight gain--which in this case is over 2 lbs in a day--so I did. What amazed me most was that I got a quick call back from one of the PA's on the unit who was clearly up on my case.  Granted in the 5 min it took for her to return my call she could have (and should have) examined my file. But I remember doing case reviews as a consulting psychologist. All the ongoing cases are reviewed, say, once a week, by the complete staff, so it is highly likely that she didn't have to do much review at all. In any case,  she was back quickly.  She listened to my activity level report for the day before (a fair amount what with picking up Jan's car which still had a couple problems), getting my car gassed, and doing some driving. 

Of course the worry is about edema. As reported, when I checked into the hospital a couple weeks before, I had a bunch.  Daily, I am awakening with pretty skinny feet and ankles except that by the end of the day, my feet and ankles are swollen again. Without weight gain, and until this I was without weight gain, not a problem. As my heart gets stronger even this little bit of edema should go away. That's one theory, sure.  Another is that I might have to go on a di-uretic such as lasix on a permanent (?) basis. That also means dosing with phosphate daily. I hope not!

The PA did not want to go to di-uretics because on my first usage, in hospital and thereafter, I dehydrated to the point where one of my kidney measures showed up bad (creatin??). So:

She said, "I want you to have a quiet day". Bang, zip. There went my plans to attend the Annual Cruise In parade.  For those of you unfamiliar with this 34-yr tradition, herewith a synopsis: About 1000-1500 custom cars descend on Cache Valley every summer, about now, for a week of showing their cars (fairgrounds). There are various activities throughout the week. Judging the cars takes place on Saturday afternoon and this activity culminates with a give away (this year a juiced up 1970 Camaro SS) and a parade of the cars. In actual fact almost no one of the judged cars ever participates in the parade. The cars are too expensive to risk it. But every half-finished, half started custom job, or simply the fact that you have a new Ferrari or an old Packard is grounds to pony up the few dollars it costs to enter the parade. The police close a bunch of streets and the cars drive (rev?) through town and, we, the residents sit on our lawns and cheer them on and suck a cold one and inhale exhaust fumes.  All in good sport. 

We usually gather at the home of close friends which is located on the route and thereafter have a potluck dinner in their lovely back yard. Not this year for moi. Damn. Maybe next? 

Usually one can sit at home and watch the judging on a local TV channel. Not this year: technical difficulties (which is monopoly speak for the station has not ponied up the price to be on our cable). Rats, foiled again.

But I had a good book handy and a nice small supper, so while I missed seeing all the clan, I was and am happy.

This morning, the feet are skinny again and there is no further weight gain. In fact a 1/2 lb loss which is probably within normal daily variation.  Again, in medicine, slow wins.

an update of little consequence?

Just a wee update:
1. Weight holding at 219; ergo diet about right; under 2000 mg sodium by half most days
2. Ambling around the house sans cane
3. Went up and down the few steps into our great room with aplomb
4. Drove the Mazda to the repair shop in Logan on Monday
5. Sleeping prone (no angle) for the first time in many years and getting near 8 hrs a night
6. Going through entire days without naps
7. Getting stronger every day
8. Looking forward to the cardiac rehab workouts!

It's all good!

grayson and janet's not-so-excellent adventure

Well faithful followers, an eventful week has passed. Let me first provide a couple personal details that I am not sure appear earlier. When I had on 25 lbs of water weight at the beginning of the current crisis, I was 262 lbs. Today a few weeks later, I am 219 lbs (and in total absence of muscle tone). You do the arithmetic. I am putting some weight back on though eating less than 1800 cals per day. I have been a little dehydrated and the heart failure team has upped my daily H2O to 86 oz which I am not doing. I am finding it easy to do the 2000 ml--around 67 oz though and usually end up the day near that. I don't recommend my experience as a way to lose weight! I am probably rehydrating, accounting for some of the weight gain.

We drove to SLC last Wed to attend my first clinic in the Cardiac Failure unit there at IMC in Murray UT and stay the remainder of the week in SLC with Lisa.

I am really impressed with the people I have met there.  But I have bamboozled the clinic. They have dc'ed all but one heart med--a nasty, side-effect laden drug called amiodorone.  In addition, I am on a coumadin-like drug called Eliquis (see the TV ads). I take a staten still and now a sleep aid called trazodone at bedtime. Myself, I have discontinued the boat load of supplements I had built up over the years. Life is simpler on that front. I am getting occasional edema in my lower extremities after being on my feet a lot, but it dissipates over night. If that doesn't totally go away with my recovery, ie no daily build up at all, I anticipate a continued association with lasix and potassium. But let's not go there yet. Life is simpler without them. And, my rehab program has not yet begun.

So, they are data gathering. I am wearing--for 30 days--a three-lead heart monitor. The leads hook up to three sticky paper electrodes (?) a new group of which I install, post-shower, daily. The wires go into a battery-powered unit about a half-inch thick by 2" on a side, like a deck of cards cut across the middle. That slides easily into a front pants/shorts pocket. It is accompanied by a several-generations-old cell phone in my other pocket on which I am to report any symptoms. The phone has been re-purposed to do this. There is a choice among 10 or so--dizziness, pain, etc. I have only called in once to clarify whether I should report being light headed, since that is not on the symptom list. (They made a note.) Any light headedness I am experiencing usually follows my pill taking about an hour or so in the a.m.. Other than that, I have reported nothing, since there has been nothing to report! The idea, as I understand it, is that the company supplying the equipment--the crafty devils--gets the monitor data and sends it to the hospital along with points on the data chart, if any, where symptoms are reported so the symptoms can be correlated with the heart data. I just have to keep the phone within 15 feet of the heart monitor during use, so it resides next to the bed overnight and I carry it all during the day. There are the appropriate batteries and charging schedules to make sure the stuff has the juice to go 24-hrs per cycle. Change over today will follow the close of this post. At the end of the 30 days the entire show goes in a handy mailer, remembering to take the batteries out of the monitor so it doesn't go beep in the p.o.

Other than that I have an appointment to see the clinic again in a couple weeks at which I believe I will get an electro-cardiogram. They are interested in a normal sinus rhythm data set, since the one that led me into the hospital was taken during a-fib. I am interested too, since I desperately want to see what my ejection fraction looks like during recovery.

In the meanwhile it is 2000 ml of liquids, less than 2000 mg of sodium, and 1800 or less calories daily for this kid for the foreseeable future. On which I am happy, because my lovely wife is inventive and a recording fool. 

The Not-So-Excellent Adventure. On the  way home on Sunday afternoon we were proceeding north on the 15 at speed, about 70 mph when Jan was forced to run over a large piece of what looked like cattle guard or some such iron structure, maybe six inches high, four feet across and maybe six-nine feet wide.  We hopped up on it and off it with the left side of the car. The front wheel was impacted and we awaited bad outcomes. But nothing immediately happened. We got into the far right lane and proceeded. It wasn't ten miles and the left rear tire blew.  Fortunately we were at the 12th street exit ramp into Ogden onto which we limped with flashers going. We pulled off the road but left the affected tire on the pavement. 

This being Utah and it being Sunday a couple nearby tire shops (Les Schaub; Jack's Tire and Oil) we knew would be closed. The rear of the car was filled with perishables for me. No O2 if we stayed somewhere nearby. (I am using O2 at night through my bipap machine.) We were driving away from the dealership in N SLC where the car would need to go. 

But this is Utah. In 10 sec or so a car parks in front of us and asks if we need help. We say yes. He says, I'll change the tire for you. Empty out the rear, get out the donut, jack up the car, all of which he did in jig time. I said how fortunate for us that the person who stops is adept. He had a nicely trimmed, salt-and-pepper goatee, and full sleeves for those of you who know the terminology. He said he was going home to change out brakes on a car there. He also said that if it were his mum and dad out there, he hoped that someone would help them. I thought who the hell is he talking about. That's the doddering old fool I've become. Of course, the reference was to the 77 and 75 yr old he was helping. He would take no money. In no time we were driving the 89 North--no freeway that--at the sedate speed of 50 mph. And safely home 90 minutes later. Now I have to call the dealer (90 miles), and the insurance company to see how to proceed. I am not sure we can get to the dealer without being on the freeway and we are endangered there at 50 mph. Oh well, it will all work out.

Henry Hawk and His Relatives. Hawks are falling into our bed room chimney. We had one last week. They usually tend to be kestrels and I have no idea why they do that. The chimney is capped with an arch so perhaps they mistake it for a hollow tree. We usually give them a couple days to quiet down and open the flue and they drop into the fire place which is fronted by a heavy duty screen behind which they attempt to attack us.  Then Jan or I throw a towel over them and release them out our bedroom door. We did that with Henry, a mature kestrel, this week on Mon. In any case, what was unusual with this last episode was that another drops down in there on Tues and we let it sit over night--we are leaving for SLC--see above, in a couple hours. We open the flue. This one doesn't want to come down. Well, this is rural Utah. The animal control guy knows us from a nearly annual visit to pick deer carcasses of those who have not survived the winter. He's there in 45 minutes reaches up and grabs the hawk. It turns out to be a young one and it further turns out that as a boy he used to trap them and train them to bring back bits of hamburger they would throw out--all highly illegal, of course.

All for now...hopefully a quiet couple of weeks during which I have nothing to report of consequence.

whoops there or 2 steps forward etc

So things are going along swimmingly. Getting stronger everyday. Eating good small meals, dealing with daily 2000 ml liquid restriction and 2000 mg sodium, getting in 1000 steps yesterday. All the right steps. 

Last night my evening bp began to be normal = 119/84, for the first time in a couple weeks.When that happened I was to add into the chemical mix, lisonopril at bed time. I did. It's a very small dose of the stuff (2.5 mg) but I think it is time released.

This morning I arose feeling as though the meds were whacking at me. More powerful than even in the hospital. I had breakfast, did the whole shower thing and settled into the living room while our house person cleaned the bedroom. I felt very tired, put my head back and (probably) passed out. When I awoke a little later it was to stars and an inability for a couple moments to clear my head. My O2 saturation was in the 70% range and then all over the map as we got the in-house O2 going. A call to IHC's team said to get to the hospital, so out came the emergency troops, and in my 78th year I finally rode in an ambulance.

There went the morning. Full assays, room O2 vs cannula O2, etc.

Verdict: back on O2 while home all day--I have only been using when sleeping--and no more lisonopril until I see the docs on Wed in SLC.

BP at noon was still a respectable (for me) 94/63. That's where it has been for awhile. 

Hopefully, I will not be writing this again.  Back onto the O2 now.

It's alive!!!!

Where to start? Almost 2 weeks have gone by since I last posted, most of which were spent in the Intensive Care Unit of the Heart Failure Institute at Intermountain Health Care's flagship hospital in Murray, Utah.  Murray is a suburban community of SLC, and is, most fortuitously only 5 min from our town home, where Lisa abides.

The docs in Logan decided I needed to be there and at the time of day, and the digression of having to go through Emergency to get an ambulance, we would be best served by driving ourselves.  We did. That was Tuesday June 7.  We arrived before dark, but not much, and they had a full team on me in no time. I was there until late afternoon, Thursday June 16. It was determined that I was in full a-fib on arrival (and probably had been for some time). The next day I was scheduled for an internal cardio-version. (The shock doc was a beautiful, incredibly smart woman.) They put me out, stuffed the tube down my esophagus and gave me two shocks, a big one followed by a small one. This put me back in normal, sinus rhythm. Some time during this I was catheterized and they began siphoning off all the water I had accumulated (and wasn't getting rid of with oral Lasix.) by IV drips. When I began the oral Lasix on May 31, I was 262 lb. Today I am 220 lbs.  42 lbs in 2 weeks.  I don't recommend this as a weight loss procedure!

I did a follow up day in Intensive Care and then down a floor to the regular heart failure folk. Sometime in that period, I jumped back into a-fib again and they returned me to Intensive Care and the shock doc. This time they did an external cardio-version and I was in normal sinus and have been since. 

Finally, they scoped the arteries and veins of my heart, with me awake. After that it was down to a room with a more private shower and toilet to wait out the residual water loss.  That took a couple days and we are still on a di-uretic, But today I believe we are there--root, bottle and branch.

Out of the hospital on Thursday, June 16 we repaired the five minutes to familiar surroundings and set up home there for a couple days. We are finally home today in Hyde Park--where Jan will be guarding the door against well wishers. In any case, we will be back down to SLC quickly for followup clinics and will take our time going back and forth. (If Hyde Park gets too warm, we can head for the ac in SLC.)

Significant findings.  I have a severely weakened heart that has no physical damage. At this time there is nothing to do except live to make it stronger. In medicine, the shock doc says. "Slow wins." I am still on blood thinners, vasodilators, diuretics and a couple woo-woos (adiodarone) I don't know how to classify but are specifically for ventricular function.  My heart healthy diet will be laid on a substrate of no more than 2000 ml (about 64 oz) of water and no more than 2000 mg of sodium, daily. (There will never be another Big Mac.)  Really, from here on out, no prepared foods. The water restriction was the most onerous thing about the hospital stay. Well, hold that, the catheter was a close second. Well, hold that, the constipation was a close third.

After not being able to walk into the hospital, I am today without a walker, getting up and down more easily each day. With all of the vasodilators and such I must guard against sudden BP drops but that hasn't happened yet. 

Optimism rules!

bad news

Well, the internist called last evening with the echocardiogram results. There is a major number they use to determine overall strength of the heart. It is based on how much blood the left ventricle moves to the lungs with each stroke. It is called the ejection fraction. In a normal heart this is about half the blood in the heart so the fraction is set as a percentage, eg, 55%. Normal range is 55-70%. MY EF IS 15%. In other words I have a failing, if not already failed pump.

I think Mike was dumbfounded. I believe that he thought I had a strong heart. He might have even said that the EF from my last echo-c-gram was normal. I asked about pacemakers. Too late, they are based on a healthy heart. He mumbled something about looking at outside veins and arteries but that doesn't sound productive. I will hear more today after he and the cardiologist consult. I am guessing that once that left ventricle is injured it stays injured.

My own sporadic numbers reflect the downturn. More O2 readings below 89%--way below with HRs in the 30s,

I haven't yet asked the critical questions: how long? what kind of terminal event? etc. 

how are we doing?

Answer: Not so hot! My stamina is now at the point where I can barely walk across the house. Having a shower takes a tremendous act of will. I am too tired to read--the book keeps falling on the floor. I have zero appetite. I force myself to eat a quarter of a sandwich. Jan has been making fruit smoothies. They taste good until I have had maybe a couple ounces. We've invested in Ensure. The lasix is doing its work: occasional good whiz and dropped about 7 lbs of the 25 I put on.

The Sleep Study.   The sleep study was same old, same old, but conducted beautifully. They tried a number of masks and of course the only satisfactory one was the full face. They had the supplemental O2 if needed and full oximetry with pulses. They reported that I was not in less than 90% saturation territory long enough for them to turn it on. Between times they were bugging me I seemed to sleep well and was surprised to see one of them by my bedside. With light out by 9:30, I was finished by 5:30. So, if they had a good tight sealing mask that I could not defeat, they were able to drive me by those periods when I usually jerk awake. It may also have helped that I did a full tab of the trazodone to start the proceedings. 5-7 days before official results on this. Sleep last night was wholly in bed--no chair for almost 8 hrs. It was interrupted,though.

Echo Cardiogram. Nicely conducted in the Cardiology Lab, this morning. Took 84 pix. Interesting share: SVTs all over the place some as high as the 180s? Those numbers equate with what I have seen on my little Wal Mart oximeter. No effort in breathing! Didn't seem to make any difference: there were SVTs. This will be read in 48 hrs and distributed.

Fall. I fell last night turning to sit in my chair and the chair squirted away dumping me on my lower back. This has led to further back weakness today and the cane is back with me for a while. Couldda been worse.

My Honey. In two days Jan and I will been married for 54 yrs. What a very special person she is. I could not have gotten through these past few months without her. We will have to find a special occasion once this mess concludes.

i"m awake!

Last night I had another good first half to the sleep cycle, maybe 4-4.5 hrs. Then it all went to hell and I was up and down the remainder of the night. Compounding my worry about the sleep study night in the lab tonight is the fact that I am so exhausted now that when I stop typing even, I begin to fall asleep. Yet if I allow myself that luxury then I won't have a full night tonight. I have one ace up my sleeve however. Today I began to wonder if I am getting one half the sleep cycle it is because I am taking 1/2 a dose of the sleep meds. May logically follow. Anyway under their close supervision (Yeah a bunch of grad students) I should pop a whole tab tonight and get lucky.

I think that they get EEG data tonight, but I don't recall whether they get concurrent EKG.  Seemed there were plenty of electrodes that last time I did this.  And are they getting basic functions: HR, pulse, O2 saturation in real time? All will be revealed. Oh, did I mention the conduction gel?

retention of water and other facts

Last post I neglected to tell you the gory weight details. If you return to the very first of these posts you will note I put my weight out each post so I (we) could determine progress. I think I started treatment for my cancer in Oct 2011, I was 232 lbs. At that point I was worried about losing too much weight during the chemo. Well, that didn't happen. Not quite sure where I ended up (238 lbs?) and I have not seen 232 lbs since. But it has always been my implicit initial goal, to recover that weight. I got as high as 252 or so, and then I have been working to bring that down slowly. (I lost the records from my old phone when I upgraded to the new iphone 6.)

The records I do have show me at 245 in May 2015 dropping gradually to 237 May 12, 2016--about 8 lbs lighter than the previous May. (Until I started this a moment ago, I didn't realize that I had a year's data in here.) I weigh at the same time of day each instance, about every two weeks on a Weight Watchers' scale. Imagine my horror when 12 days later I am a whopping 249. One week after that (May 31, yesterday) I was 262! So, I have risen 25 lbs in 19 days. Surely, cause for concern. 

These data attracted the attention of my Internist with whom I visited last evening to be prescribed the famous, lasix, or some cheap version thereof.  It did start the process as several, normal whizzes occurred after I took a pill. But today they have subsided, so it is not like just opening a door permanently, this will require the whole prescription. But even that little bit shows a teeny bit of skin definition where there was none the day before, eg ankles. Still morbid however. I am to weigh every day. Lasix is good for the edema produced by congestive heart failure, kidney failure.

About the causes of the edema, see below, but before that, I am scheduled for Sat June 4 for sleep studies in the lab at the hospital. I hope I can get enough hours that they can get the required data. Appropos that: I believe the trazodone is beginning to work as I had several good hours last night. None of the bliss yet, however, of sleeping a full 8 hrs without rising. I was there before the damn pneumonias started in 2015, maybe never to return?

The Internist wants to get me with the Cardologist sooner than June 10. I think, he thinks, though the office data don't support it, that my heart function is in some jeopardy (congestive heart failure?). He reiterated the possibility of a pace maker. Hopefully, there is no rush to judgment while some of the other stuff works out. But the chicken and the eggs are all in this together! I know that a few good nights' sleeps will give me some perspective.

worrisome and worisomer

Well, surprise, surprise: the system moved along quickly enough Thursday that I had an O2 concentrator by bedside Thursday afternoon. And, we had also picked up the sleeping meds. So, given that today is Saturday, I have had 2 nights with O2 and with sleep meds.

The Good, The Bad, The Ugly. The good clearly relates to being able pretty much to sleep in any position without O2 starvation, That has been nice. I have even been able to lower my bed out of hospital elevations. I put quite a few hours on  the machine during the day  since the bod was hungry for it, and by then, I was nearly narcoleptic. The bad is that it is another set of tubes to constantly adjust. And the extra weight of these tubes rapidly detaches the seal on my CPAP. The Ugly is the truth: I have not instantly been able to sleep 8 hours at a time. Rather, my sleep is still broken into the segments that I have mentioned before. Usually 4 hours give or take and then some fussing with regard comfort and switching among my sleep stations. Yeah, but what about the sleep meds--trazodone--50 mg tabs--(I am starting with 1/2s)? Well, at first night time perception seemed a little affected, but there was no immediate drop off the cliff into instantly deep sleep. Since I've never experienced any sleep meds ever, maybe I was expecting an effect that doesn't exist. It seemed that going to sleep was similar to before, with maybe less anxiety. But when I got up the next day, there was a huge, quasi-hangover feeling of dragging around an elephant. That experience was not replicated last night, but all else was. So, in sum, there are improvements--nothing dramatic. Going to sleep and staying asleep are less problematic. But last night was more similar than not to prior times: I had to move among my sleep stations to seek comfort.

(Yes, purists, I know we input two variables at once (O2 + trazodone. So, sue me.)

Other Troublesome Crap. All of a sudden I've developed edema in my feet and ankles and most of my legs, I attributed that initially to sleeping in the recliner where in one position the feet are on the floor. I thought it would retreat. It has not. Of course inflammation is the body's response to injury in general. I've had some in the past couple years coincident with being on my feet--long walks for example where I feel stressed at the end. But it has always resolved before now.  I have had little appetite since the current crisis started. Truly, I cannot finish a regular portion of anything. I am also not drinking any alcohol. This has been coming on for a couple weeks and I have gone with it in the interest of dropping some weight. And, I have. Imagine my surprise when I stepped on the scale the other day to see that I have gained about 12 lbs! Clearly, it is water. I don't have the urge to whiz. I worry about heart function here, since my youngest brother (morbidly obese) died at 56 yr of consumptive heart. I wonder which doc should attend. Probably cardio guy. Except that my appointment with him is two weeks away. Time to find out.

Miscellanous. I found out this morning that my home oximeter records continuously, so if I am recording I can go to sleep and recheck it a minute or so later without taking it off and putting it back on. I put it on this morning since I thought I detected tachycardia. I did! At least high HR of 160. I did some relaxation mantras and the next reading was normal. That was repeated several times. It was right at the time my overnight oximetry chart showed it to be, 4 a.m. I think this is also the period of greatest HR variability (chicken v egg) and other functions from my Holter Monitor results.