again?

Well, I was right to worry. We went to a Christmas party last Friday night where I was in close proximity to about 50 other people--we all had a great time!--but within the traditional incubation period of 48 hours, by Sunday night my sinuses were draining so much that once again I couldn't leave the Kleenex box. Almost immediately I could feel lung involvement--wheezing and expectoration.

I thought that I might out wait this one as well, but that was not happening. I couldn't handle the sinus pain generated by my CPAP machine use. I slept very little that night. By Monday morning I was dealing with heavy mucus and in quite a bit of pain. So, I am now two days into a full course (7 days) of amoxycillin at 1000 mgs twice a day. At this point my body is grateful. But I am sleeping extra hours during the day and still sleeping most of the night.

I thought that perhaps I was being hubristic  when I harbored the possibility that the autumnal gombu wouldn't get me twice as it has before. But note that the first paragraph of my last post certainly entertains the idea that it could well happen.

While it would appear that I am self-diagnosing as well as self-medicating only the latter is uncontested. I had permission on these upper respiratory things that it they didn't clear up I was to not wait but act. I have done so. Heavy green mucus directed the act. The antibiotic  appears to be working. Hold that thought.

It's all good and that's scary

Last post I worried about whether I would weather (har har: whither do I wander) an autumnal cold. I did. And it was without any antibiotics. It was pretty much gone in a week. And,  as yet, it has not returned. However, the advent of some post-nasal drip that is irritating my throat is ominous. Our humidifier has ceased to function well and new filters are on order. Until then it is difficult to raise the humidity in our bedroom, given the almost continuous running of the gas furnace for this place.

We are in full blown winter mode here in N Utah. There has been little snow, yet the ground is covered. The famed Utah powder is in little evidence; however, the ski resorts now almost all make their own snow. But the skiers know the difference. When the skies clear it has been quite cold such as  in the single digits with highs in the 20s. When it snows the temps rise to the mid-30s and it almost feels balmy. There is early evidence of forthcoming winter inversions with all the pollutants trapped in the valley (where we now live). Oh, to be already in AZ. 

Yet there is optimism: often the jet stream starts to dive south by January and stays there through spring. Most of the snow in this area occurs from January through March. When snow happens here the storms clear out the pollution. But this doesn't change the  fact that when one needs to take out the garbage and the recycling one must fully dress for the occasion. Since we have no garage we can't store the detritus in a couple cans. It must be trundled to a dumpster which is slightly farther than where our cars reside under a carport. Speaking of which we now get into freezing cold autos for the first time in 23 years. We really miss (oh, boohoo) our prior heated garage. What a luxury that was! Now we understand the utility of heated seats. But we persevere.

An AZ appearance depends on construction progress. On that score we are maybe a month away. The cabinets are going in; the tiling is almost complete. We need carpet, drapes, appliances, some lighting, some plumbing stuff, and counter tops and that's about it. Then I need to defeat the female nesting instinct--good luck with that!--and see whether we can get moved fairly quickly.  So, the end is in sight.

Touch wood, we are healthy and happy.

Merry Christmas, faithful followers and a great ano nuevo.

some good news...some not so good

This is the 7th day of a good old fashioned head cold, ie, upper respiratory infection. Last Sunday my sinuses started draining to the extent that I could not separate myself from a box of Kleenex. And they gave me incredible pain. There were a couple days of this wherein I did not leave the apartment. I lost my taste for food. Into it a day or so, I started some benadryl to cut the production of mucus and some tylenol for pain. It wasn't long before I began expectorating. My sleep mask so irritated my sinuses that I could only stand it for a few hours at a time. At the peak of it, I cancelled lunch on Tuesday. Then, per usual, there were the lung sounds of wheeziness and a great deal of coughing. I took a couple hits on the atrovent inhaler nearly every day. Taste is slowly returning. The headaches are fewer and farther between. The coughing has diminished. The drainage, too. While I am still not finished with this episode, there appears to be light at the end of this particular tunnel. And the course of this particular bout appears to be falling within the common 7-10 day period.

I am sure that this sounds familiar to most of you--these symptoms that--with variations such as sore throats and middle ear infections--hit us all every once in awhile. I have been a fairly long time without a cold. And, given my history of a seriously compromised immune system and the pneumonias that have followed, I take them very seriously. As luck would have it, my semi-annual check up occurred right in the middle of this. My doc concurred with the lay diagnosis. He said that my history has led to bronchiactisis, so my lungs are ready to be further compromised. When he examined me all was clear. Since he was going out of town the next week he asked if I wanted a script for an antibiotic, so that if there wasn't abatement during the usual period, I could start self-treatment. I demurred saying that I had a complete dose of amoxycilin that I had wangled the prior year before visiting Mexico. We agreed on the dosage levels.

When I was a younger person this kind of infection would hit me in autumn, pre-winter most years. It would run the course above. Then it would come back in a couple weeks with a diminished vigor, usually just for several days. And then it would retreat for a year. I think I should expect that again.

I am babbling at length here out of a perverse joyfulness. If this bout resolves on its own, so-to-speak, then it says something about my immune system, doesn't it? Could it actually have developed some of its old strength? I am prepared to think so. A great deal has changed post my heart ablations. Now that the heart is in better rhythm than it used to be I feel healthier overall. (Everyone keeps telling me how good I look!)  Others think so, therefore, I am (with apologies to Descartes).

So, that's the good news out of the bad, but wait, a bit more bad: Jan now has it, too. (My bad!) This is unusual but I am guessing it is because we find ourselves in the more confined environment of the apartment. I fully expect she will survive, and probably come out of it more quickly than I.

achalasia redux

For those new to this blog, I will define the above: It is the absence of the usual motile contractions of the esophagus when one swallows, terminating in the opening of the lower esophageal sphincter which permits the chewed food to enter the stomach and upon closing, stops the food from returning--with stomach acid--back into the esophagus. Those of us with achalasia--a rare group--don't have any of the above functions. Food slides down the esophagus only  by the force of gravity and remains there and ferments if not permitted to go farther. 

The condition is rare enough that the gastro docs, back in the day here in the far north of Utah didn't diagnose it. However they were sentient enough to send me to a gastro clinic at the University of Utah where I met an about-to-retire doc (Ashworth) who entubed me and diagnosed it in 30 seconds. He had only  seen 6 cases in over 30 years of practicing, so we shouldn't hammer too hard on the country docs of the time up here. Ashworth had a balloon at the end of the tube and inflated it to the point that the lower esophageal sphincter was rendered permanently open. This was an immediate cure which he tested by asking me to drink 8 oz of water at once. I could and did! Prior to this I had lost 35 pounds and was subject to frequent regurgitation along with painful heartburn.

The cure was not without its downsides. Since my esophagus was rendered permanently open to my stomach, the stomach acid had to be neutralized. Enter omeprazole, trade named, Prilosec. Ashworth said the Europeans had been taking 1000s of these things for long periods of time without side effects. So we titrated a dose--one morning, one evening-- that pretty much reduced my investment in (and dependence on) Rolaids. I have been taking omeprazole now for over 25 years. (All of this began with uncontrollable reflux ie heartburn). Not protecting the esophagus from acid causes the body to try to grow stomach tissue there and may result in Barrett's disease which is cancer of the lower esophagus.

The causes of achalasia are unknown but a South American parasite is suspected. My own case appeared a couple years after a trip to Peru.

So why bring all of this back to the light? Because, occasionally I get a flare up in which the esophagus starts to spasm. These are felt as deep hiccups and produce a heavy mucus. Usually they are caused by unregulated eating, eating too quickly, not chewing up fibrous foods, etc. I don't get these very often and they are usually solved by waiting for the esophagus to clear, that is, to let gravity do its work. This means cessation of eating and drinking. It stops my family cold when they see me stop my own part in the festivities. They have become adept at spotting this. But, as I say, it usually resolves without me having to leave the table. It doesn't appear to relate to the spiciness of foods.

However a few months ago whilst dining at a fine SLC establishment I had to seek out the restroom and regurgitate the contents of the meal. And the evening continued just fine. So yesterday I had fish and chips with a couple old friends at lunch. I had planned not to eat much for dinner and I think I held to that--but apparently, not sufficiently. (I had an apple and some peanuts. I was aware the apple had a very firm skin and I thought I chewed it thoroughly. A while later, still being hungry, I fixed myself a couple english muffins with peanut butter. A deadly combination!

After awhile the hiccups started as the esophagus rebelled. It took 5 hours to resolve with multiple trips to the sink to vomit. Each time I would get immediate relief only to have the pain--did I mention the pain?--start in again. I think this is first time that the spasms have been accompanied by pain. It was pretty excruciating, producing ague. When I finally let Jan talk me into going to the ER at about 12:30 am, I was weary of the pain and worried that there was no resolution without help. The motion of the car made me sick enough that we had to pull over so that I could upchuck once more. On this occasion I finally felt the relief that usually means the episode is over. We pulled into the parking lot of the ER and I determined that we didn't need to be there. Clean belches that are a harbinger that all is again well--they tasted of peanuts--were occurring. 

So much of late life is spent trying to figure out how not to hurt yourself. And I apparently haven't been working hard enough at that. Time to consider some things again--until the next unguarded moment!

has it been a month?

For the few faithful, I apologize: It has been a month since I blogged. Was I having a good time? Not necessarily. Was I having a bad time. Not necessarily. As often seems the case, there has been not much out of the ordinary happening, so yours truly seems less inclined to communicate. Bad Grayson! Here is a synopsis for the still interested:

The new abode continues to progress. It is dried in, as they say, which means that it has all its windows, its waterproof siding (Tyvek), and its roof shingles. It does not, as yet, have exterior doors, though they have been ordered. That is, at least in part, due to the sheet rock guys, who slop a lot of mud around and make a lot of gypsum dust (which cannot be good for anyone to breathe!). They have been known to trash doors. 

We are fortunate to have this much completed and all of the wood necessary to have come this far. There are several housing starts in our new community that are sitting there with footings, foundations, slabs and walls, but no roof trusses. They have been awaiting the same in a couple cases at least a month. The trade guys are really worried about impending shortages due to Mom Nature. For example, it is likely that the timber industry in the NW will have a shortage of raw product soon due to a big fire season. Our cabinet guy is finding that his particle board is rising steeply in price. Add to that the increased demand in the SE in rebuilding after a horrendous hurricane season. There will be heavy demand on wood products. Can you say inflation?

Decision making, perhaps unsurprisingly, continues apace. It simply shifts to whatever is next. We are daily consulting with the design people in town about cabinet color/style, carpeting, other flooring and the coordination of all of it. On top of that we may be pouring cement for the short driveway and the walkways on each side of the house and some landscaping as early as next week. The developer seems to want to accomplish this before it gets too cold and/or snowy. The sheet rock guys didn't know that we wanted rounded corners everywhere. A friend, acting as, landscaper-in-chief hasn't got the final plans to us necessary to the next concrete pour. While all of these are not my favorite activities--they cannot be faulted for being boring. Under the heading of "What Was I Thinking?", how could I have thought we could have lived in SLC and commuted to accomplish what we have so far? The same (failed) logic may also reflect in whether we escape Utah this winter at all.

I have not seen NOAA's predictions for winter here, but I fear another normal one, sans drought. Here are a couple clues: The Sierra Nevada have already received snow this fall--during the last days of summer--which apparently is the earliest such has happened since modern record keeping. (They had to close the eastern exits from Yosemite briefly last week.) We get our winter weather from this flow. We have had an abrupt ending to bermuda shorts weather (damn!) this week along with accompanying rain. All of this is really great for everyone who loves winter, except those whose arthritis flares in the wet and cold, and who may fall and break stuff because it is icy out there. Only time will tell.

Personally, not much change to report. Working out a lot more consistenly. I got three outings in this week, and two last week. I can feel new muscle. Portion size at meals is still not under control so I have gained about 4 lbs. Back in the day I found that typically under this regimen about half my weight gain is fat. My blood pressure appears to have risen to what looks like borderline hypertension (eg 140/90). My 38" waist is starting to strain some of my chinos. The fall season here seems to increase socialization in everyone, so there is much eating out and getting together, all of which is marvelous, but not helpful health-wise.

We now have a month of apartment living and cannot really complain. We hear our upstairs neighbors walking around, but that is about it. Most everyone in the complex is either a working stiff or a student (not mutually exclusive), so is gone most of the day. Repairs, though not our concern, don't happen any faster than if one were in his/her own home. One gets on the list of work orders and waits one's turn. (We are awaiting a new receptacle for a hot plate. It has arrived but not been installed.)

Jan is undergoing some dental problems--a bone graft of 5 years has given out and she is getting a new one. Much pain. Guarding against sepsis. An unusual event for her. We hope the new graft takes. 

That's about it....

it has happened...

Well, we find ourselves well-situated in a 3-bedroom apartment in the southern regions of Logan. This unit became available only a couple weeks before we sold the house. It is on the ground floor and 1300+ sq ft. The extra space meant that we had to change the movers plan somewhat by delving into 2 storage units instead of one. But we have emptied one and cancelled the month-to-month lease on it. Hurrah for small favors. But the remixing of the remaining units and the extra space has meant that hours have been spent finding stuff to furnish the apartment. Fortunately, that phase seems to be ending. We moved in 2 nights ago and are settling quickly into apartment life. Nice not to be living out of suitcases though we had a hugely good time residing at our best friends' abode. Now to learn a new stove --electric (ugh!)--and heating and cooling, etc. Our lease is for 7.5 months but I expect we'll be moving out before then. Jan doesn't agree. She will not be rushed!

The new abode continues its construction unabated. We have had to actually slow the progress down in order to have time to make reasoned decisions. The HVAC guys cut holes in the roof on the solar side suspiciously close to where the panels are to go. They were working off an early set of plans. Plug and replace. The electrical guy wants final placements on boxes and cans but such cannot happen until the cabinet guy weighs in on where placement will not interfere with cabinets, etc. He will have to move some set cans and put in more boxes before he can pull wire. The guest bathroom drain was placed for a tub-shower when it was shower-only.  Cut the slab and move it. On and on it goes. One needs to be there daily. The framers have been a joy to work with and earned a dozen pastries, accordingly. To this point I do not know the extent of the hemorrhage of dollars. That may resolve tomorrow when we meet with the title company. Anxiety rules.

Health-wise, who knows? Fall allergies seem to be arriving early. We are no longer up in the hills and therefore into more murky air. I seem to have a perpetual croup. Blood pressure is still elevated and I have picked up a number of pounds because I have not been self-monitoring absent my own scales and bp cuff etc. Now, that changes. When living with good friends it was very easy to gather at 5 pm (or earlier) to begin to celebrate the end of the day. 

Not looking forward to wintering here.

it may be happening

The movers arrive tomorrow! The house settlement is the day after. When the house closes after being recorded at the start of next week, we start a new (old!) chapter. Old because for the first time in roughly 50+ years we will be living in an apartment for some time. For the last 23+ years we have been living on a bench on a hillside, with a 600-foot driveway. Next door neighbors, not! Now our next door neighbors will be a wall away. What could possibly be unhappy with this picture?

There are still boxes to pack; there are still trips to be made to three--count 'em--storage units; there are difficult art pieces still to deal with. Need I belabor the point? Tonight is our last night here. Then it is motel, friends, and the SLC townhouse until our apartment is ready mid-August. Then it is an unknown--but probably 6-8 months--time until our new house reaches completion. Then the process reverses itself and two of the storage units will cough up their contents. (The third will be emptied in a few weeks to furnish the apartment.)

All of this appears to be correlated with a rise in blood pressure to borderline hypertensive. That is, the vicinity of  130+/90+. This may in part be due to my currently relaxed posture on sodium intake. Weight is reasonably stable at 220. On the positive side the increased physical activity is probably more good than bad. I seem to be avoiding serious back tweaks (knock wood) perhaps because of the lifting program of this past year. Sleeping has not been that great seemingly because of the increased tension involved in this much change. It has also been very warm here. Who decided this was a good idea?

On the other hand, it is the start of a new adventure with all its challenges. For two near octogenarians, why not?

nada mucho otra vez

Well, health is maintaining. I have been on the reduced dose of Amiodarone now for about a week and no palpitations. I think after a month or so I may inquire about cutting the pill in half. It is a nice tablet and should divide easily. Sleeping has been hit and miss given sinus problems abetted by my sleep mask. For example, I had too much discomfort this morning with head pain and just decided not to fight it. I arose at 4 am, got the LA Times crossword done in 30 min and ate breakfast. Now to see if I can last until this afternoon for a nap.

No house news. We should be seeing an apraiser soon. The clients' drop dead date is July 12. I thought we might hear before this weekend. We'll see. Rough plumbing on new place today or tomorrow, rough electrical after that and slab pour next week.

update, solamente

There are those who understand that when I do not post, things are probably a-okay. But there are those who also worry that when I do not post, it is because I may be indisposed, that is unhealthy, that is, unable to post. My habit is usually the former, not the latter. I am acutely aware of when I am sick (doh!) and feel the  strongest urge then to communicate my woes. When things are going well, not so much.

Well, things appear to be going well, that is, health-wise. Everyone tells me how good I look. So, I must be well.  And, it is true that I am tolerating the new meds with no problem. It has been about 3 weeks since their start and I don't feel much when I take them anymore. Another week or so and I get to cut the doses in half and we'll see then whether I can maintain on the lower dose.  Given the potential toxicity of the amiodarone I will be glad to cut back, and even more glad if I can get off it. But that's for another day. Suffice to say, I have had no further palpitations.

I have experienced a couple nose bleeds with our dry weather and warm south winds. I imagine that is partially due to the blood thinner (Eliquis). But the bleeds stopped without professional intervention, so that is a plus. 

We are still packing boxes, that is Jan is mostly packing boxes but I am adept with a hand-truck given youthful experience for several years slinging Coca-Cola. So I marshal the boxes to the car and from the car into the storage unit. Not a bad division of labor. In any case she wouldn't let me pack boxes. When we first did car travel I would pack the  car and she would always re-arrange my work. So I stopped. More to the point, when I do laundry I sort differently than she does. My rules are pretty explicit; hers are more like fuzzy sets--the category boundaries are loose and often unknown to mere mortals; moreover they are not explainable it seems. So almost inevitably I would get the wrong stuff together in the boxes and she would redo it. So, see above. Note that these arrangements have worked for 55 years as of last week!

Our home buyers, had health problems and backed out of our house sale but not before losing their earnest money. So the stress level has mounted again. But the prior negotiations involved a second bidder, and they have now made an offer, which we have accepted. We'll know by tomorrow whether they will continue. So the clock resets. We'll just keep packing.

and now?

Started the amiodarone and Eliquis--the blood thinner--yesterday with breakfast. They made me a little whiffy, that is airy-fairy, that is, light-headed. But that soon passed and the day went normally. In fact, we pushed back to our regular routine of getting a load of boxes into the  4Runner and out to the storage unit. No problem with palpitations last night from that exertion, or the excitement of a good piano lesson, or lunch with a bud. Not so much whiffiness with the second dose at supper. And, maybe not so much this morning, either. Also, seemingly slept quite well. But I can feel it. The next goal is to get back to my regular workouts.

More as it happens...

some clarity?

Since I last posted I have seen two docs--one in the heart failure unit of IHC and the other from the Heart Rhythm group in the same shop. Neither of them (plus the new heart doc in Logan) seem too concerned. The heart failure doc said I will probably be dealing with this the rest of my life in some form or another. Once a dicky ticker, always a dicky ticker. But there are, as we earlier hypothesized, a couple alternatives left. One is to go back to some heart rhythm medicine--amiodarone in particular, along with a blood thinner. The other is to go back on the table. Chances of going right to a pacemaker: pretty low. Rhythm doc said they probably created this new short circuit with the scar tissue from last year's ablation. He owned it!  We had a nice long discussion and with Jan's help, settled on the least invasive procedure, for now, the meds. The discussion included the amiodarone's side effects: it is toxic to lungs, liver, kidneys in the  long run. But he thinks that after a full dose for a month I can try a half dose and see whether that keeps the gallops away. There was an alternative drug but one had to spend a couple days in hospital to make sure that it didn't become fatal. Apparently some people don't tolerate it well. But what if the two days weren't enough and one  went home and then it was fatal? Didn't bear thinking about that too long. The upside apparently was that if one  could tolerate it, in the long run it had fewer side effects than the amiodarone. So, I picked up the drugs on the way home, and had a cold draft with lunch. What me worry?

positive bad news?

Another episode last evening. I was changing into some lounge pajama pants for the evening's TV fare and in so doing felt my let-down reflex occur. That is, all of a sudden my body just relaxed. Almost immediately my heart kicked into high gear. The first reading showed 160 bpm. I did several val salva maneuvers to little effect. Then Jan tried lifting my legs straight up from a prone position while I bore down. Still no change. Readings around 174. Oxygen levels still good. So I tried sitting on the toilet--fully clothed--since that is the position we are almost all in when we val salva every day. Instant conversion! HR dropped into the low 100s and then into the 90s. Yahoo! So, the bad news is the recurrence. The good news is that I (we) were able to stop it from continuing and thereby avoided another ER journey. It may be notable that these incidents are seemingly related to the parasympathetic branch of the autonomic nervous system. They usually start when I am relaxing in the evening. Perhaps the inhibitory nature of the sympathetic nervous system which keeps one alert and humming prevents the heart from speeding too much? For example, I have yet to have a tachycardia episode during a workout. They always occur sometime later when I am not active.

I was told by the last ER doc not to exert and Friday I was good--hung out, showered, puttered a bit, practiced, read--a nice day. And nothing happened, but then I have, to this point, not had these as a daily occurrence. Yesterday, I stepped it up a little, very little I thought. A local concern had a warehouse sale of linens they manufacture. Included were their gel foam beds. We bought a bunch of stuff that was knocked down 70% to make way for new product lines: a queen mattress, pad, frame, sheets, pillow cases, etc. Since these were all beautifully boxed they could just fit them into the Mazda. We drove directly to the storage unit and schlepped the boxes into it. We shared each box and even scooted one of them. It was really very little exertion. I hope this level of involvement is not too much for me henceforth since it will make me a virtual invalid. But--see above--the inevitable seemed to follow.

On the way to SLC today to begin the med rounds tomorrow a.m.

..ad nauseum

Yesterday's episode began as I was finishing a snack of hummus and a cracker before dinner. I felt the now familiar adrenalin surge followed by my heart beginning to palpitate. I walked quickly to the bedroom where my  oximeter/pulse meter was and read a 174 bpm. I tried several val salva maneuvers including the imitation of a person blowing up a balloon. No clear result. We got in the car and headed for the ER--again. They reacted quickly. This time, alarmingly, they strapped on shock electrodes for possible use. EKG showed the high rate with lots of PVCs, but they said the rhythm looked stable, though fast. The ER doc had me lie flat, take a breath and hold while exerting the downward abdominal pressure of the val salva maneuver. At the same time, he lifted both my legs straight up as though he was stretching my hamstrings (which he did a little). Down came the HR! Everyone was happy. An X-ray to see whether there was anything about lung condition contributing to this was negative. Blood lab was normal. 90 min after arrival, I was on the way home, with the admonition not to exert myself. Didn't seem as though I was before the onset of the PSVT. I did have a stimulating lunch with friends and this seems to correlate with an attack later on only because I am always lunching with friends. Yesterday I had a good morning at the piano and did no lifting, so exertion seemed minimal.

I did find out that on the prior ER visit I was given adenosine. It is quick acting and stops the heart for a second or two. They also administered a rate stabilizer (diltiazem) and as I mentioned in a prior post, some Xanax (alprazolam)

Cardiology Consult

I wanted to establish a relationship with a local cardiologist in the same clinic in which my primary care occurs. A new doc replaced the cardiologist I started seeing the prior year just before he retired. We had a good discussion. His analysis: I am headed for another ablation. He will watch from the sidelines. As it happens, I am scheduled next week for a session with the doc who did the prior ablations. He moved very quickly with those when my heart was cleared by the heart failure team last year and I expect he will move quickly again. That appointment is 4 days hence. The day  before that I meet with the heart failure clinic. 

There are risks with an ablation for recurrent PSVT. Apparently there are two pathways close together that communicate from ventricles to atria. One needs to go. But sometimes both are inadvertently ablated because they are so close. At this point ventricles and atria cannot communicate leading to a pacemaker implant. The new doc was surprised that they didn't do a PSVT ablation at the same time they did the atrial flutter and atrial fibrilation ablations last year. He said that while atrial ablations are about 70% effective, about 90% of PSVT ablations are usually effective. We'll see about all of this on Tuesday in consultation with the experts.

..and, again!

Almost identical precursors for this week's episode. Watching TV--we just started to stream The Americans. This is a spy drama about two Soviet-era spies posing as a happy family (which they are) while Mom and Dad do their nefarious business. Half way into the first episode I felt the now familiar palpitations of my heart doing more than pitty-pat. The sensation seems to move my body away from the back of my easy chair--it is that strong. My oximeter read 174 bpm. I tried some val salva maneuvers in place to little effect. So, off we went once again to the ER. The receptionist saw me coming and said, high heart rate? And I said yes. (The joys of small town living.)

This time the episode continued into the ECG. The ER doc decided to administer a med via IV that would briefly pause the heart--within a couple seconds--to allow the heart's own pacemaker to re-assert itself. This worked. The rest was the usual. Blood draw to check for unusual stuff. None detected. Lie there until vitals are stable. Home after a couple hours. Call the regular doc this morning to see how to proceed. The night's sleep was foreshortened but good, probably assisted by a small dose of Xanax administered in the ER to aid my anxiety.

Self-Analysis

We had a pretty big weekend prior to this. It involved a couple large meals and more than usual alcohol intake. We did our annual pilgrimage to Jackson WY to visit Signal Mountain Lodge where Lisa and Stephanie used to work. This meant dinner at the Blue Lion in Jackson where I ingested a full rack of lamb chops. This meal was preceded by a Manhattan and appetizers and accompanied by a bottle of wine shared with my wife and daughter. Of course it was followed by a shared desert. Later at our cabin by the lake I drank a beer with our host. I slept well on the usual BIBPAP and O2 combination, unlike the preceding year when we left in the middle of the night and my downward slide into heart failure really began.

Breakfast was a granola bar and oj in the cabin. Lunch was back in Jackson at the Wort where we all had their superb corn chowder and I followed that cup with a beef pot pie. No alcohol. We walked the streets a little and then I repaired to the car to read while the women shopped.

Dinner was in the bar at Signal. It consisted of appetizers--wings and nachos accompanied by a couple margaritas which were followed by fish and chips. You can see that this is a seriously compromising nutritional set of affairs.

Sunday morning was the full breakfast in the Lodge--eggs, sausage, hash browns, etc. The big meal at 3 pm in the dining room is their seasonal opener. Appetizers were a cheese board and trout cakes followed by prime rib and a shared desert. The three of us shared a bottle and a half of wine while our host confined himself to beer.

Monday morning on the way home we had breakfast at The Bunnery in Jackson and that again involved the full meal deal: eggs, sausage and pancakes.

All of this detail is provided to show that I was seriously off the rails in many respects. But the weekend was relaxing overall. We read and slept. I felt little anxiety.

We all had a look at our new property upon return to Logan and watched the beehive of construction activity on the development. Wow! Lunch was a Cuban sandwich at Even Stevens. Thereafter I had a good one hour nap.

Late afternoon I sat at the piano and started to practice. Almost immediately things did not go as well as I would have liked and I felt frustrated and angry. Since I have a lesson on Wednesday I could feel anxiety well up inside. I continued to play. Jan was packing boxes around me and I was tasked with deciding which of a number of generations of cords, computer parts and etc we should keep and which should be sold and which should be given away. I did it, though I could still feel the frustration and anger.

We had a pleasant supper of a couple croissant sandwiches we had brought from The Bunnery with a glass of wine. I watched an hour of Rachel Maddow on the daily Trump miscues and didn't feel especially energized by it. Then came the Americans and the rest is history.

So what in all of this is relevant to my condition? Who the fuck knows? I have not had this internal welling up of frustration and anger that seems to follow or is caused by an adrenalin bump before. Somehow this appears to set the stage for a later trigger--hot news or a thrilling program or some such to lead to the PSVT.

And it is not at all good that the interval between these events is decreasing and the events are lasting longer. 

Stopping now and calling my regular doc, though I expect little help. I am on schedule for the Heart Failure Clinic and the Rhythm Specialists early next week in SLC. Can't be soon enough.

one more, once?

Honey, it happened again! Last night I was watching the brouhaha following the James Comey firing and I felt my heart pounding. I quickly took my pulse with my oximeter and recorded a 160 bpm. Jan was at a book club session. I tidied up around me and prepared to drive myself to the ER--about a 12-min shot--and took one more reading. 174 bpm! So I got in the car started down the road and called Jan who met me at the hospital.

The ER was somewhat busy. A life flight helicopter was on the pad spooling down and an ambulance was in the loading bay. People were standing in the seating area. The admit-person always alerts when one presents with a high HR, but no one came to get me for a good 5 min. Once in the room I joked how they better hurry with the ECG otherwise they could miss the event. The ECG cart was there quickly and they wired me up. A joke happened. I don't know whether I cracked it or someone else did. But I had a good laugh and my heart rate came crashing down to normal. They all gasped because it happened quickly. And once again the ECG missed most of the event. 

The rest was routine: heart in normal sinus rhythm; blood draw; wait for labs; find out labs are perfect; wait for paperwork; go home.

They label this presentation PSVT for Paroxysmal Supra-Ventricular Tachycardia. That = above the ventricles; high HR. I think it is a post-endocrine dump event.  The interesting thing is that it appears to occur sometime after the stress that produces the endocrine dump, almost like a rebound effect. The dumper here is undoubtedly the adrenal system. Can I point to stress before both of these events? Oh yes. Let me count yesterday's ways.

1. Yesterday (Tu) was a day after my work out on Mon--which was the same sequence in the prior event. In fact, the day of the week was the same. The event occurred in the evening in both occurrences. Both times I was sedentary when the event began. Last night's was earlier in the evening. During the day I did some lifting of boxes. I practiced my piano for several hours. I had lunch with my same buds as the prior event. (What is it about them?)

2. Psychological stress is high right now. The famous scale that shows the levels of stress in uncommon human environments ranks death of a close family member as first, divorce as second, and moving as third. WE ARE MOVING.

We have accepted an offer on our home and the deal will close August 1, all else equal. We have chosen a lot and a home to build. All of this took much mental energy. The home will require at least 5 months of construction. We will be homeless for several months. We have been looking for an apartment in an extremely tight market. We have been working our finances hard.  We are packing daily and moving non-essentials to a storage unit. There are discussion tensions between Jan and me owing to the known unknowns. Many plates are spinning in the air.

Yesterday, the contractor resolved many financial questions when he offered to build the home for us on spec. We will make a down payment to get construction going with the remainder of the home's cost due when our house closes. Our down payment will be returned to us if our house fails to sell.  This is all win-win. I think we felt immense relief. We are accepting this deal. Tension should should decrease, no?

3. I got engrossed in the drama of the Washington Follies, ie, the James Comey firing, yesterday late afternoon and was still watching the analysis when the attack occurred. I was highly stimulated by what was occurring, especially by the thought that our democratic system was being tested, and had been so stimulated for several hours. 

This is different from the prior event as there was concurrent stimulation, so this might have been a direct response to a high adrenalin flow, rather than some sort of rebound effect.
I will have to reflect: I don't recall the prior time, but last night there was no pre-prandial alcohol. One wonders. It may have been ameliorative.

Wiki says that stimulants such as caffeine and nicotine and psychological stress may be involved. So, I am at least one out of three. I  did drink quite a bit of tea yesterday--a couple cups with breakfast and several at a sushi lunch. One can apparently try the valsalva maneuver which is pressing down as though trying to have a bowel movement. Or pretend to blow up a balloon. Quickly, pass me a trumpet! Next time I will try one of these methods to see if they have any effect. Because if this continues the rhythm docs will want to get involved again with their cardio-versions  (shocks) and ablations.

Probably not the end of this.....

a shot across the bow?

We have returned to dear old Cache Valley. The air has been sparklingly clean. But it has also been unseasonably cool. We had a hard freeze (26F) here the night before last and last night the temperature hovered around the freezing point. Moreover, the mid-afternoon highs have only been in the 40s. We started back last Thursday only to get reports of a late spring snow storm in central and southern Utah that was to wreak havoc with I-15. 3-10 inches of snow were predicted with 10-20 in the mountains. When we got to Las Vegas the winds were so high that you could not see the skyline entering the city for the dust. We over-nighted to miss the snow the next day and the high winds continued. But the roads were dry when we resumed on the following day. 

When I say unseasonable I forget that this is a normal water year for the state. In fact, well above normal for most drainages. It was a big snow year, which we thankfully missed, which reminded people of the years before the long drought. Also, this is not an El Nino year. So maybe we are just back to the normal that was.

Anyway, I have been in excellent health for the past winter, working out religiously. But, I have fallen off the low-sodium diet, at least in a strict adherence way. My alcohol consumption has resumed. And I have gained weight. As of Sept last year I was 206 pounds. This morning I am 217. So I have put on 11 pounds in 7 months. I am definitely carrying new muscle, but probably new fat as well. In the past when I did the before and after fat tests my weight gains seemed to be about 50-50. That is, for every pound of muscle, I gained a pound of fat. I'm really not unhappy with where I am now--I think 220 may be a good baseline for me--but 206 made me look too thin. Yet with the return to 5000 ft of elevation from about 1300 ft I can feel the extra weight.

The Shot.  Last night I felt my heart rate was high and so took my pulse. I was racing along at 161-2. And for 20-30 minutes that rate did not change. The on-call nurse at IHC recommended an immediate trip to the emergency room and we went. When they got me hooked up, we watched the heart slow down and blood pressure return to normal. Fortunately, the heart settled back into the correct sinus rhythm. They drew blood, took a chest picture, and kept me for a couple hours before sending me home. All the test reults were normal. So, what happened?

I don't know. We are under quite a bit of stress. I am preparing my income taxes which I loath doing; the house is being shown today--to people who are returning for a second look (fingers crossed!)--and I worked out hard on Monday morning. I have resumed lunches with my pals. I was quite high yesterday (already in fib?) during the lunch period, perhaps because I missed the stimulation of discussion with my colleagues. On reflection, I don't think there was much discussion since I monopolized it. I have been fighting my BiPAP machine's mask this past few nights as well. So, maybe what we have here is someone who needs to slow down and smell the roses again. 

I will contact the rest of my docs today. I will begin watching my diet more closely. I will cut out the alcohol. I will moderate my workouts. Belated resolutions. Nuff said.