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!