functional

 I've done it again: Way too much time betwixt posts. I can (and will) make an excuse. Here it is: I was in too much pain to sit at this machine. You may correctly conclude that since I am at this machine now, pain must no longer be an issue. Almost true, but not quite true. Let's go back in time. 

Shortly after my last post in Sept I began physical therapy (PT). It was a thorough go, Three days a week I had--in this order: heat; ultrasound; deep tissue massage; exercises to strengthen the back and torso; ice, and TENS = Transcutaneous Electrical Nerve Stimulation. When my exercise times increased, this extended to about 2 hours per session.

Last week I was doing 25 minutes on a hand bike (using hands to turn a stationary bicycle crank); 25 minutes on a recumbent bike and 10 minutes of leg presses on a slant board. In other words about a 60-minute workout, with the other 60 minutes being the therapy treatments. I ended up essentially conducting my own workouts and my PT guy was sanguine about that.

This has all been successful. At the beginning I couldn't do anything for very long and used help to get up from the massage table, for example. No longer! I still tighten up and use some heat when I need to in the mornings at home. My PT guy is willing to schedule me on an as needed basis for the rest of my treatment, if any.

So, the past couple weeks I cut back to two sessions per week (T, Th). I really only stopped thereafter because I became fearful of the small spaces in which patients were working out at the same times. Maybe it's unreasonable fear: most of us are not breathing heavily and we are all masked, but the context has changed. First, I have less need to be there, but, second: In Utah right now we have very high COVID-19 positivity rates, ie above 20%. The governor--a strong conservative--wishes to restrict no one's freedom, so has been reluctant with the mandates. Only last week was the first statewide mask mandate. There will be many here who do not give fig for mandates. It is not a good time for an old person with multiple co-morbidities to be fraternizing with strangers.

I had plans to fade out the treatment part of the workout--just doing that on an as needed basis--and picking up at the gym where I used to workout. It has a bigger footprint than where I have been for my PT and is only allowing 4 persons at a time to use the space. So, that is still a possibility. 

I had enough energy yesterday to do some minor pruning of our trees in advance of full on winter. (We have snow on the ground today.) And I am a bit more uncomfortable than I have been, but I will stop now, feed myself, get a nap and all will be well.

A Walking Wreck

I have once again let too much time elapse between updated posts. There is much to tell.

My MRI confirmed the compression fracture, but of T7, not T8. (What's one vertebra between friends?)

For insurance purposes I needed to get a bone density scan. I suspect that they needed to find a problem there that would help explain a compression fracture from a simple accident like falling off a bike that was not moving. The results of this scan were both fortunate and unfortunate. They scanned three places: the lower lumbar region of the spine and the femur necks emerging from the hips, left and right. The unfortunate parts were that all three areas showed reductions in bone density. The lumbar spine area qualified as osteopenia and the femurs as osteoporosis. The latter means considerably increased risk of fracture.The fortunate part is that this qualified me for the kyphoplasty.

Within a week of the MRI and the bone density scan, I was on the table for the kyphoplasty. That was this past Monday. The procedure was about as simple as described. An IV drip contra bacteria. A little conscious sedation. A little recovery. Home in 2.5 hours.

Since then, I have had NO REDUCTION IN PAIN LEVELS. This outcome does not make me very happy, needless to say. The first couple of days I put off any inferences of a poor outcome figuring what was happening was a result of the surgical injury and resultant healing. But I believe that this inference cannot be sustained any longer.

When I arise in the morning my back feels pretty good. By the time I have made a simple breakfast, sat there and eaten it while reading the news--maybe an hour or longer--I have to change positions, move to another chair, get up, etc. The pain at that time sometimes is an 8 on the scale (0-10). It is alleviated by lying down. And, I can go to sleep and apparently rest quite well since I am supine. I can also sleep on my side as well as my back without discomfort. If I have to sneeze or cough, however, the resulting pain almost puts me out.

So, I don't know whether this is nerve pinching, muscles cramping, or some combination thereof. I suspect the latter. I have thought of the analogy of a chain. If you tighten up one link, it may change its relationships with all of the others. I am hopeful that something simple like some directed physical therapy might help defray further problems.

I am doing no meds. I did ice for a couple days after the procedure. So, there is still the Tylenol fallback. And THC gummi bears are not far from my mind, it this turns out to be chronic.

My first follow up visit is next Tuesday when I will find out next steps.....

FOB leads to BB

 Well, an informative consult with an ortho doc this morning in re back pain.

I have probably broken my back! Hence: FOB (Fall Off Bike) has led to BB (Broken Back). More precisely, a compression fracture of T8.

X-rays point to T8 which is the 8th (thoracic) vertebra. The pix show some compression in the upper endplate of the vertebra which should be flat, not concave.  MRI will be scheduled next to get a better picture of things.

If the MRI results concur, then a procedure called kyphoplasty follows. Essentially, it is the insertion of a balloon into the fracture, its inflation to restore bone height, and then the insertion of bone cement into the vertebral body. Happily, it is an outpatient procedure called minimally invasive. AKA vertebroplasty, which is often used to prevent hunchback.

My guy recommends a spinal surgical center nearby. He says they are doing this procedure all the time.

Outcomes are positive in a majority of cases, with pain relief after 24 hours. If improvements occur with more conservative procedures (eg icing, heat etc) in 4 to 6 weeks, then the patient is probably not a candidate for the procedure. I am 3 weeks plus since my accident.

More to be revealed....

why oh why?

 It has been about 10 days since I proved myself a fool. The intervening time has not been uneventful.

A couple days after being in the ER I saw an ENT doc for the first time since high school. 

Back in the day, I developed a condition known as "swimmer's ear". This was a bacterial infection of the outer ear canal. At the time it was treated by a long cotton wick covered with aureomycin--an antibiotic--inserted in the ear canal right up to the ear drum. I recall that it affected my trumpet playing because of the imbalance of sound between the two ears. Aureomycin was a good drug, not unlike penicillin. Later they found that using aureomycin too frequently in the ears would lead to hearing impairment. Oops. Then it was back in the pool!. While we didn't have one in our family, almost all my friends' homes in Scottsale did, so we were always swimming somewhere. And, of course, there was much less AC in those days and the pool was a way to stay cool in summer. (Quick Google search: Aureomycin is now used in cattle feed. It protects the guts of cows. It was the first tetracycline; it was discovered in 1945. Generic name: chlortetracycline.)

But, I digress.The ENT guy pulled the plug from my left nostril and no bleeding ensued. I had been off my blood thinner several days at that point. I was still sore of nose and scabbed of knee. I was not to blow my nose, or otherwise strain for a few days. No lifting as case in point. He showed me some nasal gels (which have helped) and I was done.

I don't think I have written that the ER doc followed up on the phone with me after my accident, I was surprised because that had never happened to me as a result of other trips to the ER. He wanted to warn me that with a head strike that there was a possibility of a brain bleed several days post-accident. So, if I started to get headaches I was to return to the ER asap. Well, I didn't. Get headaches. (One of my neighbors suggested that these sort of delayed reactions are why insurance companies want to sette quickly after an accident.That way they are not responsible for them.)

Instead, what I got was back pain and it appears chronic. I have been relatively free of debilitating pain now for some 40 years. The fall appears to have rearranged my spine. It feels very much like I have herniated a disc in my thoracic region at about the lower level of my shoulder blades. On a scale of 10 this pain is about a 5, but with spasms--oh yes, spasms--it hits an 8 or 9. Tylenol is getting me to sleep at night and I am relatively better each morniing. But by noon I am really hurting. Tried icing and massage and heat. All provide some temporary relief and then--. So, an othopedic consult is scheduled for Aug 26. I will not go through another operation on my spine.

Meanwhile.....

I was scheduled for an angiogram at the Heart Failure Clinic at IMC Murray. This was not without its own drama. We were scheduled at 7 am so we broke our pandemic rule and stayed overnight in SLC with Lisa. When I was sitting watching my family unload the car--sorry, no lifting--a blood vessel bursts in my right nostril. It is brought under control fairly quickly because I am required not to be on any blood thinners prior to the angiogram. But there is familial concern about the procedure the next morning. 

I inform the docs on arrival and they decide to proceed cautiously. They do not find any evidence of what might have caused my weakened left ventricle. There is some narrowing of vessels and some increased pressure in the aortic artery but not, apparently, enough to stent anything. We are left to conclude that: either the chemo program is what caused the event or as a good friend says we can blame it on TMB = Too Many Birthdays.  

Hubris: Definition and Illustration

For those of you with long memories, ie 50 yrs back, you may recall that I was a bicycle rider. Between the ages of 30 and 40 I was pretty serious. Psych grad students and I would ride to 

Wood Camp Hollow in Logan Canyon and back 3 times a week.  Colleagues and I would do lazy 25-30 milers on Saturdays. A former Aggie head coach and I would shuck our hangovers from the parties at his place, after 4 hours of sleep, and meet at 6 am. I did one Century ride and was finished, before LoToJa really got started, by a spinal cord surgery (L5-S1 hemilaminectomy). After recovering from the surgery, I started swimming 3 times a week in the Unversity's pool. and did that for 10 years focusing exclusively on unweighted exercise. Not incidentally, I worked up to a one mile swim in about 3 months and maintained that for the 10 years. It put me in the best physical shape of my life

When we moved to Hyde Park we lived on a steep hillside with a 600 ft driveway. One could get a bike down the hill easily, but coming back up from Hyde Park City was a serious climb. My bike hung there unused for the 20+ years we were in Hyde Park. During that period a colleague and longtime fishing partner and friend died and his family gave me his bike. One of his two sons gave him the bike so that he could get around the little beach town in which they stayed during a couple months each winter in Baja. He didn't have it long before he died. Eventually I sold my racing bike and the remaining bike stayed until we moved out of Hyde Park. Our daughter claimed the bike. She, too, was a flash in the pan. She had it serviced and rode it for a number of months until she lost interest.

With the closing of the economy and the virus around us it has been difficult to get aerobic exercise. The clubs where we rode stationary bikes for aerobic workouts were closed. And my knees will not support daily walking. I need to take the weight off them for at least a day or two before going out again.  But why not try the bicycle again? Much slower of course. On the flat, etc. Surely, I am capable of that little bit. So, I put a few dollars into the bike again to tune it up and got it back yesterday.

Hubris: According to Siri it is overconfidence. 

The proprietor of the bicycle shop said that for people my age, he could show me how to get on and off. While I was cognizant that I might have that problem, I discounted it. Afterall, I had years of experience--accident free! He said not to be embarassed since he did it all the time. I ignored him.

When we arrived home with the bike I found that I could not mount it standing free, so I put it against the house and used the house to maintain my balance. In a few seconds I was speeding down the street in our development. There is maybe a 1-degree downslope the way I was headed and I seemed to gain a lot of speed very quickly, so after a 100 yards or so I neatly turned around and pedalled up-slope. My legs protested but it was only 100 yards. Approaching our garage--door open, one car in, and one car out--I realized that I didn't have a plan for getting off. 

The details at that point are a bit fuzzy but the outcome was not. I braked to a halt behind my car to put my left (dead) foot on the ground to be followed by my right (not so dead) foot and then Jan could steady the bike while I got off. Unfortunately, I failed to include her in the plan.  One or both of my legs failed to support me and I came off the bike over the bar and landed on both knees and abdomen, followed by my spine actually curving with the kinetic energy of the fall, and My nose hitting something in our storage shelves.  

Blood flowed. I took a minute to inventory and felt I had full function but not the initial strength to rise. The rest goes as you might expect. I worked the nosebleed with ice and towels and got it under control after 20 minutes. We cleaned and sprayed my scraped knees.  Tylenol helped the pain. We got dinner going and I took my evening pills, which included an Eliquis (blood thinner). I thought it is timed release and I have never had a sustained bleed using it. All went well until 9:30 or so when a vessel popped in my nose. I fought it for an hour and Jan drove me to the ER. We were there until 1 am. They did a CAT scan for the "headstrike" I had sustained and packed my left nostril.

So last night I couldn't use my CPAP machine and therefore had no O2. I slept sitting up in a chair, not well, because I kept being awakened by apneas. I hope today I can. I see an ENT doc on Friday after 2 days of no Eliquis and we'll see where we go from there.

Dumb, dumb, dumb.

But the bike still calls to me.....

Is it still hubristic?

reading the tea leaves...

I followed up on the report of my TEE--trans-esophagyeal echo-cardiogram, since it left me in limbo as to how to proceed. Our health system here has a computer portal that one can log into and contact the docs, and see clinical reports, and lab results. It is a great site. They promise to make contact to answer questions sent to them in 48 hr--and for the most part--they do. First, my layman's summary of the TEE:

1. My ejection fraction is around 35%. My last but one was 50%. 50% or higher is considered normal. The ejection pressure is produced by the action of the left ventricle. I have a weakened left ventricle. That was established earlier and still exists. Its weakness apparently results in the lowered ejection fraction.

2. My aortic valve function shows mild-moderate stenosis. They only remove and replace the aortic valve if it is severely stenotic. So I am not a candidate at this time. 

The NP who is following my case answered my written enquiry with a telephone call that was quite productive. Since the outcome of my TEE is non-conclusive for what they expected, that is, the aortic valve is not the problem, they still don't have an acceptable reason why my heart went into the beginnings of failure again. She talked of my experience this time as an event for which they have no cause. I liked that wording since it seemed to me to more mimic my experience which seemed like a sudden onset after a long fight with an upper respiratory virus. 

One possible cause is the RCHOP--the acronym for the chemotherapy I had for my cancer 8-9 years ago.  Apparently there is some evidence that those poisons can produce organ damage at much later dates.

To rule out other possible causes they want to do an angiogram. In this they poke the femoral artery in the thigh and thread their way up into the heart where they can check pressures, and arteries for blockages, etc. She called this angiogram the gold standard. It is scheduled for Aug 12. It will require most of one day since although the procedure is relatively short, they have to make sure that the hole they make in the artery heals enough before they let you go.

In the meantime I am permitted to exercise so long as I don't become anaerobic that is, breathless. But that means that I can do more than I am currently. I am contemplating retrieving my road bike from my daughter and seeing if I can make some simple rides around the flat, back streets of town.

We'll see.....

nothing to see here...

Much ado about little. I had the TEE (Trans-Esophygeal-Echo cardiogram) on Wed. Most of the 5 hrs was spent waiting for the doc to do the damn thing. As I figured, having experienced a number of upper GI endoscopies, this was little different. I have misled you all earlier by speaking of a camera taking pix: actually it was ultrasound. But they still take pictures, I believe. In any case the entire procedure was about 20 min of the 5 hrs.
The result is that I have mild to moderate aortic valve stenosis. And they only R and R the aortic valve if the stenosis is severe. So then they had to decide which team there in the Heart Institute was going to continue to monitor me--structural or heart failure--and the heart failure group won (?). I am scheduled with them for a 2-month follow up.
I am ambivalent. On the one hand I thought that a new aortic valve might make me feel better; on the other hand I have to continue to manage myself in such a way that I feel better--and I am not sure how to go about that. I have tried recently to exercise and to walk but they don't together seem to do much but make me weaker. 
Is it possible that I am simply in the waiting period? end of an era? end of life? don't call us, we'll call you? etc ad nauseum? Well, except intellectually, I am not going to worry about all of that.
Instead, it is a gorgeous morning, and I am going to go for a walk....

getting ahead of oneself

Well checking back I see that there is a little news that constitutes an important update (at least to me). After the kerfuffle with the lisonpril (see prior post) the heart failure team wasted no time getting me scheduled with the structural team. I had forgotten that they all wanted another test. That test is a naso-pharyngeal echo cardiogram called a TEE (the T is for Trans-). So, I am not yet scheduled for a removal and replacement of the aortic valve. This is where getting ahead of myself comes in.
The TEE consists of inserting a camera into the esophagus where it is very close to the heart. Thereafter it is just an echo-cardiogram in which over 30 min or so they take a bunch of pix.  It requires mild sedation and fasting, etc, but is essentially out-patient. My appoinment is for 3 pm on Wednesday and they say to budget 4-5 hrs with them. The long time is to wake up from the anesthetic and get stable. Obviously, one does not drive oneself home! Fortunately I have a driver who has been with me (and I with her) for 58 yrs (Yea!!) The results of the TEE will, presumably, determine the possible RandR of the aortic valve.
The scheduling of the TEE involved its own set of problems. To wit, when the doc doing the TEE was informed that I have acalasia (no esphageal motility), he freaked. I had forgotten to mention this condition to anyone because it was sometime before I understood what the next test was that I would get. The doc wanted me to cosult with my local upper GI guy (whose practice may be on hold while he fights his own cancer. His office never got back to me. In the meanwhile the Clinical Coordinator for the Structural Team had a chance to visit further withe the doc doing the TEE. He told the doc that I have been living (successfully) with the acalasia for some 30 yrs. That doc removed the requirement for the consult and we rescheduled the TEE for the second time. Then they didn't call me to schedule yet another COVID-19 screen for the TEE. When I asked about that we again had to reschedule the TEE to fit in a COVID test that fell within 48-72 hrs of the TEE. That in turn meant that I needed to find a testing place in Logan that was operating on Sunday (yesterday). No problem as it turned out. The usual place (this is my third swab) in North Logan was open for 4 hrs. I got 'er done.
(If you've not had one there is little to be troubled about: it does feel funny to have a probe that far up your nose being swirled for 10 sec but most of the time for me that has been novel, not painful.)
So barring additional screwups we proceed to SLC Wed for the TEE and thence, who knows? I say this because my diagnosis at this time appears to be mild stenosis of the aortic valve. Would they replace it if the TEE still shows mild? We'll see.
Stay tuned....

but wait....

I finally heard from the IMC Heart Failure Clinic today. But before that:
At the prior appointment the NP wanted me to start lisonopril. It will help my heart's efficiency, she said. I said, that stuff destabilizes me, makes me light headed and feel like I'm passing out. She prescribed the smallest dose possible: 2 mg once a day at bedtime. I took it the first night--no problem. I took it the second night--no problem. The problem came after breakfast the next morning when I started to pass out when getting up from the table. I was wooly and staggery for some time thereafter and solved the problem with my CPAP machine with its 2 liters of O2 and a subsequent nap. I emailed the clinic to tell them I was taking no more lisonopril. (This is Sat morning). This experience was eerily similar to the one that put me in the ambulance from Hyde Park a number of years ago and presaged the cascade of events that preceded my heart failaure soon thereafter. The same drug was the catalyst..
Then yesterday I had an extensive consult with an oncologist at the Logan Gossner Cancer Center. He wondered why I was there. Seemingly it was a result of a couple high readings of gamma globulin in recent urinalyses. A raised gamma globulin level is an outcome of the body fighting some invader.  The Center was responsible for a follow up urinalysis in which I collected every drop for 24 hours. They were looking for proteins which shouldn't be there. I think they are somehow measured by weight. We talked of my earlier mantle cell lymphoma. He examined my lymph nodes. The upshot was that I didn't really have a measurable amount of this protein in my urine. A hint, no more. Could he have meant the result was maybe a false positive? He seemed to buy the possibility that the raised levels of gamma globulin may be associated with my chronic upper respiratory stuff which has abated somewhat with the warmer weather. Conclusion: watch and wait. They will see me again in 3 months.
Then this morning, the Heart Failure Nurse calls me to see if I am getting my blood labs done today. I say, what labs? My understandng was they would reread my file which contains a bunch of blood tests recently. (Apparently not a metabolic panel.) Then we could see whether we needed more. She went away to discuss. Come to find out the metabolic panel was to see the effect of the lisonopril which since I had discontinued it was now moot. Of course it was good to hear that I was not ouf of sight and out of mind.
She affirmed that I was referred to the Structural Team on Monday. This was the remaining question I had. So, the game is truly afoot.

...and your buns in the bed...

I the Heart Failure consult yesterday in SLC at IHC. It was very illuminating. I saw a Nurse Practitioner whom I have seen before. After examination she called in a cardiologist who had just read my file along with the Echo CG.
Her examination involved looking and listening (stethoscope). Once again, she did that thing where I put up my chin with my head slightly turned so that she could watch one of the arteries in my neck. She allowed that that observation was one of the great tools in her toolbox. I knew that it told her about how much water I was carrying (not much). But there was more. She then positioned me in repose on the gurney lying on my back with the bed slightly elevated under my head. She repeated her listening (and looking) with the stethoscope added for several elevations more toward the vertical. Then she said, I want to get a cardiologist in here. Uh oh.
Within 10 minutes a young dude came into the room. We went through my family history, particularly my closest relatives. Both my brothers are gone as well as my mother and father. Dad was only 64 when he died but was a chronic asthmatic for 30 years so a heart attack seemed reasonable. My youngest brother died at 56 but he was morbidly obese and a long time pot smoker. Notwithstanding that, I think heart failure was the cause. My middle brother died at 78 from multiple causes it seemed. But Jan reminded me he was fitted with a heart valve long before that. My mother lived to 97.
The cardiologist launched an explanation into the aortic valve. Some of us have an aortic valve that is tri-folded, others one that is bi-folded. There is also an intermediate one that is sort of a tri-fold. Given western ways (esp diet) the aortic valve can calcify with ageing. I think they said that this was particularly the case for one type of valve (bi-folded?) over the other. Apparently this is highly heritable, ergo, inform our daughter. They suspect that I am a candidate for a new aortic valve. (My brother's valve was an aortic replacement.)
There is apparently one more definitive test. The heart is stressed. I asked via treadmill? No, they do it on the table.
So, I am being referred to their heart structure team. These guys do nothing but valves and stents, I guess. The cardio doc said that they are very impatient, ie, get ready to go!
The procedure is essentialy out-patient. (COVID saw to this.) It is an up-the-groin (femoral) artery)-into-the-heart procedure of which I have had several now. They inject ink and check it all. And then do their thing. If all goes well, the procedure is probably a morning process and one escapes late in the day. I related that all my arteries and veins passed close examination during my 2015 heart failure. The cardio guy said, time passes. 
So, I wait. I should hear pretty quickly, but they didn't shoot off a prescription they were supposed to yesterday and I had to remind them this morning, so it may take a bit of time for them to catch up. Also the NP wants to review the file to see if we have missed any blood tests at this end.
Meanwhile, the nurse practitioner says, don't lift any weights.

Get your biscuits in the oven....

Well I know a little more now than before.
1. The echo cardiogram came in with an ejection fraction in the range of 35-40%--a little bit better than what the tech shared with me earlier. More is better!
2. My good sleeping continues and I feel somewhat less fatigued--good signs.
3. A little problematically, my weight continues to fall; I can still feel the torsemide working every afternoon. (One urinates a lot.) My weight is now about 205, so the torsemide is responsible in part for at least a 10-12 lb weight loss. However, it appears to be at the nadir as it has stabilized for several days in a row.
4. It is probably a very bad sign that my appetite is poor. Jan is making excellent dishes and I just cannot eat very much of them. However, that just may mean that I am now ingesting sensible amounts of food, eg, 3-4 oz meat portions. But it has never been this way before except when I was doing chemotherapy back in 2011-2012.
5.I had a raised amount of gamma globulin in my last blood test which my doc had repeated to ensure its validity. Gamma globulin increases as part of the immune function which is the body's response to fight a virus, bacterium or fungus. It should not be raised continuously. Unfortunately, it is also associated with the presence of cancer particularly when it remains raised. Multiple myelomas, leukemias, lymphomas are mentioned.
6. Hence, next up is a consult with the Gossner Cancer Center and one of the nurse practioners there. (They now have two oncologists.) They want two more urinalyses that have specific names which I have forgotten since I was doing business elsewhere when the Center called. That was yesterday. I putzed around and never got to the lab today and they won'r reopen until Tuesday. I don't know whether these are on the spot or whether I take them home.
All of the foregoing suggests my consult will be late next week when they have the lab data.
I smell a bone marrow biopsy in my future. Been there, done that. Not fun, but doable.
7.The possibility of a new or recurring old cancer has lurked in the mirror for nearly 10 yrs now. 
I will try to remain positive.

knowledge...

Since last I posted I have met with a couple docs and had several tests that appear illuminative:
1. I have tested negative for CORONA19. I was retested again today.
2. Chest x-rays showed some striations (?) in the lungs, apparently leading to my primary doc getting me back on torsemide (10 mg/day). He suspected I was carrying water and making it harder for my heart to work against that. He was right!. Though I watch my ankles for swelling and my weight for consistency, neither was a good enough signal. The torsemide has shed me of 5-8 lbs of water to this point. I can feel my ankle joints starting to ache which means I may not have much more to give. Weight today = 210.8 lbs. Haven't been there in years.
Another upshot of the torsemide: the first night I had the best sleep in months. That has continued. I am sleeping a lot which may mean I need a bunch of it in the bank. And I have some more energy, not normal amounts, but definite gains.
3. Blood work I don't know enough to comment on except to say that whatever measures sugar in the system, mine is too high. (With no appetite, sweet is where one goes!)
4. Echo cardiogram. This is the one where the tech rolls a ball around on your chest and shoots a million pix of the heart doing its work. This order surprised me because I thought we were going to do a regular 12-line ECG. I had forgotten about a datum from this test that is among the most significant in re heart function: the ejection fraction. This is the amount of blood forced by a ventricular stroke from one side of the heart to the other. 
Normally the ejection fraction is above 50%. When I had heart failure in 2015 and arrived at IHC Murray, mine was a 12 or 13%. When I left there a couple of treatment weeks later, I was back over 30%. And I was a couple weeks after that too high (>35%?) to qualify to have cardiac rehab here in Logan, My last ejection fraction was taken in 2018. It was 50%. 
My echo cardiogram was this morning. Normally, the techs like to give nothing away because they only get the data they don't interpret it. Often they are terse. But my tech today told me the number was around 30%. Definitely diagnostically important. After it is read today, my doc will get the results tomorrow. 
He also said there was some concern about pulmonary pressures. The pulmonary arteries and veins convey used and fresh blood from and to the heart from the lungs. So that is something to ponder.
In sum, looks as though I have some heart failure again. We'll wait to see what my primary doc's next move is. I think maybe a consult via telephone will occur before my next appointment which is Tues. A repeat of chest x-ray is scheduled then no doubt to check how the lungs look after the torsemide regimen.
I am optimistic.

coping

Can't sleep; might as well post!

We came back early by a couple weeks from AZ this year when it became clear that large changes were in store for all of us. It was an uneventful trip just before local services were shuttering. Since then we've had the usual winter/spring mix of weather characteristic of N Utah. Gorgeous!

As with most of the nation since that time we have been sheltering in place and for the most part, it has not been arduous. More of the public interfacing has befallen Jan, so she might challenge the arduousness inference. We've adapted to shopping on line and all the rest. It was notable upon arrival here how many didn't seem to take the risks very seriously. And perhaps they are correct--at least at this time--since we are rural, spread has not been quick. There are only a few deaths from Covid 19 for our Public Health region at this time.

On the other hand we have both been feeling poorly. And yes, it is all classic upper respiratory stuff. All of the symptoms of Covid 19 have visited: persistent dry cough; nasal discharge; sore throat; shortness of breath; fatigue; some shivers; but no fever.
My annual physical comes up next week, so I had to be tested for the virus to gain access to the hospital/clinic where our doc works. Woo hoo: negative!

But I am listless. I have little energy. I am more short of breath. The drainage from sinuses continues. I built up pretty well in AZ and was getting 30 min 3 times a week on the exercycle. I have lost the muscle mass. I have lost the stamina. I tried to substitute walking and compromised my right knee. It has taken weeks for it to not be painful. This is a vicious cycle.

Yet on the positive side my vitals are good: bp near/above 120/80; resting heart rate in low 60s. Most of all my heart rhythms do not seem changed: clear sinus rhythm daily on the single lead iwatch ECG function.

So why do I feel like crap? One suspect may be my CPAP mask. A 90-day summary shows a high rate of apneas/hypopneas per hour that has been going on for months. Maybe I have more classic bronchitis/pneumonia going on. I just don't know.

But starting Tues I am going to find out!

Be safe all..

existentialism

Sorry about the prior post which, apparently, existed only in draft form until I discovered it earlier today.

My health continues to be good. There are a few minor things to comment on:

1. For several months after my last (fall) ablation I always got a sinus rhythm finding from my iWatch. More recently I have observed fewer sinus outcomes and more Inconclusives. These have not been of great concern since one of the rhythm docs said the watch is reading my PVCs and that generates the Inconclusive outcome. In fact, all of my readings to date have included the nice spike of the sinus wave in good synchrony. However, it is interesting that for a number of months I was not getting any extra beats. So that has changed. At this point I am unaware of what this may mean to my heart's healing after the ablation process. I do know that the prior ablation was not permanent and such changes may indicate that my heart is again undergoing changes.

2. Lately I have recorded a couple A-fib outcomes on the iWatch. These seem asymptomatic. That is, they are unaccompanied by anything that I can feel. They have been first readings of the day--usually when I arise. When I get going a few hours and take a second ECG the a-fib outcome is gone. These have not been accompanied by elevated heart rates, nor by the anxiety of feeling that the heart is up to something beyond one's control. As an aside: I have largely been unable to elevate my heart rate during exercise. (Nor have I directly tried to.) But a couple times this winter I got a high HR while looking at the Workout page on my watch which monitors HR during exercise. These have been momentary. My docs say that the amiodarone that I take limits HR. But there have been these couple breakthroughs. I'll keep a watch on this.

But all of this pales in the face of the elephant in the room: the corona virus (COVID-19). Turns out that this thing is most deadly in people over 80 (tick that box), and in people with preexisting conditions (tick that box, too). (Is that 2 strikes?) Tick a third box when one's immune system has been compromised by chemotherapy.  (Tick tock; tick tock). Time is up!

The Wujuan data show an overall mortality of some 2%--approximately.  For those whose average age was 82 yrs it was almost 22%. So what to do? Best estimates at this point are that the virus will run its course in 18-24 months, almost as much time as it will take to develop a vaccine.

I am not panicking. But with my decreased lung function, several bouts of pneumonia, and the other correlates, I am a prime candidate. What to do? During the chemo process with its attendant immune system blasting, I self-isolated. Instead of eating out with friends for lunch I invited them over. We stopped going to large gatherings. We stopped travel. Life was still pretty good. We are contemplating heading back north a week or so early to settle in at home and contemplate next steps. 

Personal probability estimates are so tough: It just seems intuitive that driving is safer than flying because accidents during flight seem so final. Of course, driving turns out to be a lot more dangerous. So, if you are with 8000 other people at a spring training game--outdoors--is the chance of infection greater than being in an auditorium indoors with 300 prople listening to jazz? Who the hell knows? Pondering this in any greater detail will make us all crazy.

Continuing the good news

Still working on changing my history of not posting so long as things are good. They. Are. Still. Good.

We have escaped winter in Utah, which we understand is normal, that is, snow at least every week, and, sometimes for days on end. The state's coffers should be filling with ski money. Here, we are expecting a high of 70 F.  The front yard is full of quail attacking a seed ball.  All good.

So good in fact that I have cut back on my condition measures. Not doing bp anymore since it is the most involved. Weight scales are in the bathroom next to the bedroom and cannot be avoided; Apple watch on wrist daily leads to an easy ECG with little response cost. So, still two of three, but I am not recording any of it since it is boringly repetitive. If changes occur, I will restart the recording process.

Workouts continue. Eating out somewhat less helps with sodium levels and weight. Again, all good.

Keepin' on...