Well, it is snowy and blowy. Tonight we expect all-time record lows. Think variability owing to climate change! And the last I looked, it was still October. Seems as though we should have headed south already. But that is still a little more than a month away.
I successfully finished my first year as an octogenerian in Sept of 2019.
Prior to that, I had a second ablation in Oct of 2018. That solved most of my heart rhythm problems, until it didn't. In July of 2019 I needed a cardioversion because my heart rate was hovering around 120 for days on end. The docs figured that was a fluttery rhythm, a 2 for 1 atrial to ventricular. That was successful, too. Now I am on a minimum dose of amiodarone which is a heart rhythm drug that would be better if I were not on it. It is toxic to some people.
But I write now because my several readers complain that I only post when my condition is dire, T'ain't necessarily so (courtesy the Gershwins). It is actually possible that I am a new man. I hesitate to embrace this condition too hastily, since pride goeth before a fall and all of that. Permit me to wax:
1. I take a 30-sec ECG daily upon awakening because that shows me my heart function. The docs think that the Apple technology on this is pretty good. Insofar as I know the watch draws 3 inferences: a. sinus rhythm; b. inconclusive c. atrial fibrilation. (A fourth signals that a rhythm cannot be characterized because the HR is over 120 bpm.) I have recorded many Inconclusives and worried about them until the docs explained to me that the watch is counting the extra beats I have (PVCs) and is considering them variabliity. So, one searches for the sinus rhythm outcome. And one is getting it! The last Inconclusve I had was 10 days ago. Since then it has been all sinus rhythm. I haven't had an Atrial Fibrillation outcome since Sept.
2. I have shed some more weight, perhaps 6-7 lbs and am now in the 215 lb area as opposed to 223 or so. I have slightly more stamina.
3. My workout schedule is not leading to high HRs or AFib. I feel stronger.
4. My bp is nicely normal circa 120/80 and usually below.
5. My average HR is 62 bpm. My workouts do not produce HRs above 80 bpm.
6. Food tastes better.
7. Sleeping through the night even with a regular 60-min afternoon kip
7. My piano playing is improving. (Okay, so that is an exaggeration.)
These comprise a picture of a guy in (boring) good health! They have been accompanied by a general sense of well-being that I haven't felt for ages. Perhaps my heart is finally healed. Or maybe I am in the manic phase of bipolar disorder?
This all makes me suspicious as though I am being set up for the big fall......
Tuesday, October 29, 2019
Thursday, August 29, 2019
well, all is well...
My few readers--the ones I know of because they email me or speak to me directly--complain that I only post when I am complaining about my immanent demise. Of course, the whole idea of this blog originally (2011!) was to simplify my cancer experience to a single communication. And, it just evolved from there--but not very far--because I have had maybe a tad more than the normal difficulty of ageing gracefully. I am very thankful that I continue to age, given the alternative.
Today, I report on a followup to a procedure I had done a month ago. At that time, I believe I reported that I had a number of days in a row where my heart rate was constantly at 135 bpm or above. My iwatch won't do an ECG when the HR is above 120, so I had to guess that I was in a-fib or a-flutter during this period. I was unable to reduce the rate with anything I tried. The rhythm people at IMC suggested I come for a cardio-version which is the application of shock to the heart in order to get back into sinus rhythm. It was an out-patient procedure and it fixed me up just fine, as they say.
I have had no high heart rate since the procedure, and I was able to resume my former activity levels right away. Since then, I have monitored my heart rhythm by doing a daily ECG via the iwatch. I have only occasionally been graced with the conclusion "Sinus Rhythm". Almost all of the outcomes are "Inconclusive", to which the watch says to wit: if this outcome continues, see your heart guy. So, I was interested in what a full 12-lead ECG would show, since that is the first and usually the only thing they do other than vitals.
I had taken a reading at home before the appointment and got an Inconclusive. The 12-lead ECG was normal and the discussion with the PA was very informative. I am getting some extra heart beats, perhaps a ventricular contraction to get in sync with the auricle which has already beaten. These are really common and not of concern. In a signal detection analysis these extra beats would be considered noise, rather than signals, the signal being the sinus wave. I can see the extra beats strewn among the sinus waves on my iwatch. If there are several of them in the 30-sec sample then the watch concludes: "Inconclusive". If there are none or very few it will conclude: "Sinus Rhythm". Again, in signal detection terms, the Inconclusive conclusion could be considered a false negative. The iwatch is very conservative on this. If y'all know anything about signal detection (or inferential statistics for that matter) you will know that the cutoffs (ie criteria) for these inferences can be changed by external contingencies.
Well enough of that in-the-weeds stuff. Really all I have to do now is reset my own criteria. If I see enough sine waves in a 30-sec sample on the watch and I otherwise feel well (eg no rapid HR) then things are cool whether the watch says Inconclusive or not.
And that is where we are: things are cool.
Today, I report on a followup to a procedure I had done a month ago. At that time, I believe I reported that I had a number of days in a row where my heart rate was constantly at 135 bpm or above. My iwatch won't do an ECG when the HR is above 120, so I had to guess that I was in a-fib or a-flutter during this period. I was unable to reduce the rate with anything I tried. The rhythm people at IMC suggested I come for a cardio-version which is the application of shock to the heart in order to get back into sinus rhythm. It was an out-patient procedure and it fixed me up just fine, as they say.
I have had no high heart rate since the procedure, and I was able to resume my former activity levels right away. Since then, I have monitored my heart rhythm by doing a daily ECG via the iwatch. I have only occasionally been graced with the conclusion "Sinus Rhythm". Almost all of the outcomes are "Inconclusive", to which the watch says to wit: if this outcome continues, see your heart guy. So, I was interested in what a full 12-lead ECG would show, since that is the first and usually the only thing they do other than vitals.
I had taken a reading at home before the appointment and got an Inconclusive. The 12-lead ECG was normal and the discussion with the PA was very informative. I am getting some extra heart beats, perhaps a ventricular contraction to get in sync with the auricle which has already beaten. These are really common and not of concern. In a signal detection analysis these extra beats would be considered noise, rather than signals, the signal being the sinus wave. I can see the extra beats strewn among the sinus waves on my iwatch. If there are several of them in the 30-sec sample then the watch concludes: "Inconclusive". If there are none or very few it will conclude: "Sinus Rhythm". Again, in signal detection terms, the Inconclusive conclusion could be considered a false negative. The iwatch is very conservative on this. If y'all know anything about signal detection (or inferential statistics for that matter) you will know that the cutoffs (ie criteria) for these inferences can be changed by external contingencies.
Well enough of that in-the-weeds stuff. Really all I have to do now is reset my own criteria. If I see enough sine waves in a 30-sec sample on the watch and I otherwise feel well (eg no rapid HR) then things are cool whether the watch says Inconclusive or not.
And that is where we are: things are cool.
Thursday, July 25, 2019
whingeing, etc
to whinge: Brit term not widely used in the olde US&A. Means to complain incessantly about minor things. When I received feedback (not published) from a couple close friends about my last post, whingeing was the descriptor that popped immediately to my mind. You all can just substitute the American term: whining. One suggested that I was suffering TBS: too many birthdays syndrome. Another said he wished that I wouldn't write because if he hadn't heard, he'd know that all was fine. Hah! They were correct, rereading suggested whingeing. I guess for a guy normally still optimistic (yes, even about American politics) it was a different feel. I must have been feeling sorry for myself. On the other hand, if you are truly being spied on you may have paranoia, but it is justifiable paranoia--reality based paranoia. So here is what happened next.
Last Sunday I had trouble sleeping. It seemed to me that my energy level was down and I continued to feel lethargic (see the prior post!). But it had been hot here and we have been entertaining or being entertained alot. So I just added it to the list of something more to whinge about. For a number of days my afternoon naps were increasing in length. Sunday night my HR bumped up to >135 bpm. It did not come back down. My iwatch simply told me it could not do a conclusive ECG because the pulse rate was too high. It stayed up for days. It is hard to sleep when part of your system is stll charging along. Finally on Tuesday I called the rhythm specialists at IHC and did an extensive telephone consult. Since what little (30 sec) of actual heart activity on the watch I could see looked still like sinus rhythm but at a higher rate, they thought I probably had an atrial flutter. Close inspection after that of the pulse rate function on the watch showed two non-overlapping distributions--one in the 60s, the other in the 130s. They scheduled a cardioversion (you know with the paddles and the shock and such) to see if they could shock the heart back into the correct rhythm. So we came to SLC and spent the state holiday Wed (Pioneer Day aka Pie and Beer Day) here and the procedure occurred this morning.
So that is how I spent my morning. The set up for the procedure takes much more time than the procedure itself. One is sedated so an IV line is required. They were not sure of their success when I awoke while the NP was discussing the outcome with my wife and daughter. She wassuggesting an amiodarone drip when my heart went back to normal. So all is well. I can feel muscles pulled probably during contractions, but otherwise, I feel like a new person. Now one hopes that the old ticker stays in sinus. I can live with that.
Last Sunday I had trouble sleeping. It seemed to me that my energy level was down and I continued to feel lethargic (see the prior post!). But it had been hot here and we have been entertaining or being entertained alot. So I just added it to the list of something more to whinge about. For a number of days my afternoon naps were increasing in length. Sunday night my HR bumped up to >135 bpm. It did not come back down. My iwatch simply told me it could not do a conclusive ECG because the pulse rate was too high. It stayed up for days. It is hard to sleep when part of your system is stll charging along. Finally on Tuesday I called the rhythm specialists at IHC and did an extensive telephone consult. Since what little (30 sec) of actual heart activity on the watch I could see looked still like sinus rhythm but at a higher rate, they thought I probably had an atrial flutter. Close inspection after that of the pulse rate function on the watch showed two non-overlapping distributions--one in the 60s, the other in the 130s. They scheduled a cardioversion (you know with the paddles and the shock and such) to see if they could shock the heart back into the correct rhythm. So we came to SLC and spent the state holiday Wed (Pioneer Day aka Pie and Beer Day) here and the procedure occurred this morning.
So that is how I spent my morning. The set up for the procedure takes much more time than the procedure itself. One is sedated so an IV line is required. They were not sure of their success when I awoke while the NP was discussing the outcome with my wife and daughter. She wassuggesting an amiodarone drip when my heart went back to normal. So all is well. I can feel muscles pulled probably during contractions, but otherwise, I feel like a new person. Now one hopes that the old ticker stays in sinus. I can live with that.
Sunday, June 23, 2019
the only sure thing being the absence of a sure thing....
Sure enough, upon return from a very nice trip to the NW for a few days, I came down with my usual post-travel upper respiratory infection. I rode it out without antibiotics but it took several weeks and I haven't really felt right since. TMI: loads of mucus, hacking, and expurgating. That's over now but appears to have left me permanently tired and short of breath. This is exactly how I felt when I was experiencing heart failure the first time.
To compound matters of chicken and egg: my new BIPAP mask appears to have worked only a few weeks in keeping down my AHI (Apnea/Hypopnea Index). About the time I started fighting with the fit of the thing last week, I started to have trouble going to sleep. That first big apnea would jerk me awake, searching for O2. Lately, this has led to morning naps as well as afternoon naps to catch up. (I wish I could see daily data on this.)
The only other bit of data I have is that I haven't seen a sinus rhythm indication on my Apple Watch now for several weeks. (I have been off the amiodarone since April.) The reading I get is something they call Inconclusive which means, not sinus rhythm, but not A-Fib either.
I am becoming a recluse. Going anywhere doesn't interest me too much. Depression symptoms anyone?
I have been informally dieting and have lost maybe >10 lbs since returning from PHX. (Interestingly, that has not helped my stamina.) It didn't seem too hard to do, maybe because I am less interested in food.
So, is this normal deterioration? The three year slide? Who knows? I think I'll start with the rhythm docs in SLC and see what is shakin'.
To compound matters of chicken and egg: my new BIPAP mask appears to have worked only a few weeks in keeping down my AHI (Apnea/Hypopnea Index). About the time I started fighting with the fit of the thing last week, I started to have trouble going to sleep. That first big apnea would jerk me awake, searching for O2. Lately, this has led to morning naps as well as afternoon naps to catch up. (I wish I could see daily data on this.)
The only other bit of data I have is that I haven't seen a sinus rhythm indication on my Apple Watch now for several weeks. (I have been off the amiodarone since April.) The reading I get is something they call Inconclusive which means, not sinus rhythm, but not A-Fib either.
I am becoming a recluse. Going anywhere doesn't interest me too much. Depression symptoms anyone?
I have been informally dieting and have lost maybe >10 lbs since returning from PHX. (Interestingly, that has not helped my stamina.) It didn't seem too hard to do, maybe because I am less interested in food.
So, is this normal deterioration? The three year slide? Who knows? I think I'll start with the rhythm docs in SLC and see what is shakin'.
Thursday, May 16, 2019
and the beat goes on...
We are back in Utah and have been so now for about 7 weeks. Our re-entry was seamless. There were occasional snows, but the springiness of the season made them disappear quickly. Lately we have been unseasonably warm, but that changes tonight for several days of wet weather with snow levels down to 6500 ft. (No worries, we are at 4500 ft). Everyone is happy for weather that delays the rapid melting of the snowpack.
My re-entry checkup with my electro-rhythm doc in SLC went well: He discontinued the amiodarone and I have not had any negative outcomes from that. My ECG was in good sinus rhythm.
My sleep doc wanted to see me since I hadn't seen him for a couple years, so I got a readout from my BIPAP machine for 90 days and did an overnight oximetry as he wondered about my continued use of O2 at nite. In general all was okay. I am a little high on apneas/hypopneas at 6+ per hour. They like one to be at <5. The oximetry suggested some O2 desaturation periods that he suspected were from a leaky mask, so he gave me a new kind built more for peeps with facial hair (c'est moi!). I have now used it twice and I think he may be right--good sleep last night and nap yeaterday afternoon. Jan said I was much quieter, too.
During the desaturations I wandered down to less than 90% on 50+ different occasions and those occasions appear to line up with where the BIPAP shows leaking. But the O2 seems to be keeping me well into the 90%s much of the time and I am in the 90s during waking periods all the time.
Two interesting side notes: We did our annual pilgrimage to Signal Mountain Lodge north of Jackson Hole WY for Mother's Day. We ate our usual large meal in Jackson with a drink and some wine and I didn't take my evening pills until we reached the Lodge later on. Later in the evening my heart went all tachy on me--rates from 120-150 bpm. I couldn't get it down. This went on for quite some while--a couple hours--before it came down, but when it did my watch indicated I was in A-fib. Next morning the A-fib was replaced by an Inconclusive indication and since then I returned to sinus. I was very limited in my stamina at that elevation which is around 7000 ft. Returning to UT has given me back a little more juice.
The other side note is that when we climbed out of Mesquite NV on the way home from AZ to the higher elevations of UT, my nightly rate of apneas/hypopneas virtually tripled. And it continued at that level up until the 90 day reading I took for the sleep doc. It is possible that a bad sealing sleep mask accounts for some of the increase and that the new one will lower that rate. It is clear, however, that elevation is not particularly good for me and there may be a significant difference in my apnea based on elevation.
Yet, I am back steadily in the gym--riding the recumbent bike and using the weight machines several times per week and I feel pretty good, in spite of it all. In fact the sleep doc when looking at my chart and doing the mental arithmetic said to me, "You're 80?" that felt pretty good, too.
Flying to Seattle next week to see whether we are still capable of air travel and city navigating on our own. Stay tuned.
My re-entry checkup with my electro-rhythm doc in SLC went well: He discontinued the amiodarone and I have not had any negative outcomes from that. My ECG was in good sinus rhythm.
My sleep doc wanted to see me since I hadn't seen him for a couple years, so I got a readout from my BIPAP machine for 90 days and did an overnight oximetry as he wondered about my continued use of O2 at nite. In general all was okay. I am a little high on apneas/hypopneas at 6+ per hour. They like one to be at <5. The oximetry suggested some O2 desaturation periods that he suspected were from a leaky mask, so he gave me a new kind built more for peeps with facial hair (c'est moi!). I have now used it twice and I think he may be right--good sleep last night and nap yeaterday afternoon. Jan said I was much quieter, too.
During the desaturations I wandered down to less than 90% on 50+ different occasions and those occasions appear to line up with where the BIPAP shows leaking. But the O2 seems to be keeping me well into the 90%s much of the time and I am in the 90s during waking periods all the time.
Two interesting side notes: We did our annual pilgrimage to Signal Mountain Lodge north of Jackson Hole WY for Mother's Day. We ate our usual large meal in Jackson with a drink and some wine and I didn't take my evening pills until we reached the Lodge later on. Later in the evening my heart went all tachy on me--rates from 120-150 bpm. I couldn't get it down. This went on for quite some while--a couple hours--before it came down, but when it did my watch indicated I was in A-fib. Next morning the A-fib was replaced by an Inconclusive indication and since then I returned to sinus. I was very limited in my stamina at that elevation which is around 7000 ft. Returning to UT has given me back a little more juice.
The other side note is that when we climbed out of Mesquite NV on the way home from AZ to the higher elevations of UT, my nightly rate of apneas/hypopneas virtually tripled. And it continued at that level up until the 90 day reading I took for the sleep doc. It is possible that a bad sealing sleep mask accounts for some of the increase and that the new one will lower that rate. It is clear, however, that elevation is not particularly good for me and there may be a significant difference in my apnea based on elevation.
Yet, I am back steadily in the gym--riding the recumbent bike and using the weight machines several times per week and I feel pretty good, in spite of it all. In fact the sleep doc when looking at my chart and doing the mental arithmetic said to me, "You're 80?" that felt pretty good, too.
Flying to Seattle next week to see whether we are still capable of air travel and city navigating on our own. Stay tuned.
Tuesday, February 19, 2019
keepin' on...
Happy New Year! Yes, yes, it is late to offer these greetings but I haven't posted since last year. Per usual, no news is good news and that still turns out to be the case.
We have been in AZ since the second week of December and are enjoying the absence of snow and cold and inversions. Relatively speaking, it is a cold winter here--it froze this morning and the high will only be in the mid-50s--but who's complaining? The sun is out and it is distinctly better than N Utah. The cooler weather (today 15 degrees F below average) here actually means improved air since it is often accompanied by rain and wind, so that has made us additionally happy. We are reliably informed that Utah is having a great snow year which often means to them, as well, the relative absence of inversions and the associated bad air. Still, better to be here than falling on the ice up there.
I arrived here with an upper respiratory infection that took a number of weeks to resolve. I treated it only with OTC nostrums and rode it out. (Long ago, I should have invested in Kimberly-Clark or whomever else it is who makes Kleenex.) Whilst that infection bordered on bronchitis, it never seemed to quite go that far. I was pleased when my immune system apparently rose to the occasion. I have seen similar infections return for a second blast--usually not as severe as the first--and that one did. It arrived a few days after we returned from a week-long Jazz Cruise in the Caribbean after sucking airplane air. Then, it did not seem to be responsive to Vicks Vapo-Rub, etc and I could feel my lungs beginning to get involved. I had prepared for such an eventuality by having my regular doc prescribe a dose of Azithromycin in which the complete course is 5 days. (I carry that with me during travel, especially where there are sanitation concerns, eg, Mexico. That did the trick and I was healthy again in 10 days and have remained so since.
I acquired an Apple Watch (Series 4) and it is a wonder, but also a mixed blessing. It continuously reads heart rate which is important to me to see what my twice-ablated ticker is up to. (Spoiler: not too much!) Right now, sitting here, I am at 57 bpm. And according to the electro-phys guys that is fabulous. The mixed blessing part comes with another watch feature: it also does a 30-sec ECG--obviously 1 lead only. From what I have read one should not diagnose from this output because it produces about 20% A-fib false positives. I have had NO A-fib indications. But I am often out of sinus rhythm and this I don't know about. There are lots of people who get along just fine without being in sinus rhythm but that is obviously the preferred state.
Does the watch err on the side of concluding the absence of sinus rhythm appropriately, or are there signal detection problems there as well? Of course there are! The more precise question is: am I seeing signals or noise? And, how long do I tolerate seeing this outcome before I take some action. (At present I am getting this reading about 50% of the time. The rest of the time I am in sinus) Well, here is what I think.
Since we are going back to UT in 30 days or so, I will wait. The aforementioned rhythm stuff is asymptomatic, it does not bother me. I am not overly light-headed. I am able to work out and I feel 80-yrs strong. I am still limited in walking because of all my other problems. My spring meetings with all my docs occur shortly after our return and a complete ECG is the first thing the rhythm guys do. Answers are forthcoming. No worries.
I have had one occasion of high hr that was about 122 bpm. It came while watching a particularly suspenseful television program a few weeks ago and has not repeated. It resolved on its own in a minute or so. If that frequency increases I will have to act more quickly. But for now: NOT.
We have been in AZ since the second week of December and are enjoying the absence of snow and cold and inversions. Relatively speaking, it is a cold winter here--it froze this morning and the high will only be in the mid-50s--but who's complaining? The sun is out and it is distinctly better than N Utah. The cooler weather (today 15 degrees F below average) here actually means improved air since it is often accompanied by rain and wind, so that has made us additionally happy. We are reliably informed that Utah is having a great snow year which often means to them, as well, the relative absence of inversions and the associated bad air. Still, better to be here than falling on the ice up there.
I arrived here with an upper respiratory infection that took a number of weeks to resolve. I treated it only with OTC nostrums and rode it out. (Long ago, I should have invested in Kimberly-Clark or whomever else it is who makes Kleenex.) Whilst that infection bordered on bronchitis, it never seemed to quite go that far. I was pleased when my immune system apparently rose to the occasion. I have seen similar infections return for a second blast--usually not as severe as the first--and that one did. It arrived a few days after we returned from a week-long Jazz Cruise in the Caribbean after sucking airplane air. Then, it did not seem to be responsive to Vicks Vapo-Rub, etc and I could feel my lungs beginning to get involved. I had prepared for such an eventuality by having my regular doc prescribe a dose of Azithromycin in which the complete course is 5 days. (I carry that with me during travel, especially where there are sanitation concerns, eg, Mexico. That did the trick and I was healthy again in 10 days and have remained so since.
I acquired an Apple Watch (Series 4) and it is a wonder, but also a mixed blessing. It continuously reads heart rate which is important to me to see what my twice-ablated ticker is up to. (Spoiler: not too much!) Right now, sitting here, I am at 57 bpm. And according to the electro-phys guys that is fabulous. The mixed blessing part comes with another watch feature: it also does a 30-sec ECG--obviously 1 lead only. From what I have read one should not diagnose from this output because it produces about 20% A-fib false positives. I have had NO A-fib indications. But I am often out of sinus rhythm and this I don't know about. There are lots of people who get along just fine without being in sinus rhythm but that is obviously the preferred state.
Does the watch err on the side of concluding the absence of sinus rhythm appropriately, or are there signal detection problems there as well? Of course there are! The more precise question is: am I seeing signals or noise? And, how long do I tolerate seeing this outcome before I take some action. (At present I am getting this reading about 50% of the time. The rest of the time I am in sinus) Well, here is what I think.
Since we are going back to UT in 30 days or so, I will wait. The aforementioned rhythm stuff is asymptomatic, it does not bother me. I am not overly light-headed. I am able to work out and I feel 80-yrs strong. I am still limited in walking because of all my other problems. My spring meetings with all my docs occur shortly after our return and a complete ECG is the first thing the rhythm guys do. Answers are forthcoming. No worries.
I have had one occasion of high hr that was about 122 bpm. It came while watching a particularly suspenseful television program a few weeks ago and has not repeated. It resolved on its own in a minute or so. If that frequency increases I will have to act more quickly. But for now: NOT.
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