YIKES!!!

Yesterday I received a letter in the mail from the University of Kansas Health Sciences System. I didn’t think too much about it until I opened it. At the top of the page, sort of like a memo it said:

Cardiovascular Medicine – Heart Rhythm Management

My eyes scanned the letter to the bottom of the page to see which cardiologist it was from. And there was the name of the cardiologist who implanted the defibrillator into my chest cavity in April 2022.

I continued to read the letter and saw this heading:

Device Alert Letter: Important message regarding your cardiac implantable device

Now that is something you really don’t want to see in print, at least I didn’t. The following paragraphs were not much more heartening that that heading despite that they were neither in bold nor italics.

Your implanted defibrillator is designed to deliver high-energy shocks to terminate an abnormal fast heart rhythm should one occur. Boston Scientific has informed us that under rare circumstances, the device’s ability to detect those rhythms may become disabled for a 24 hour interval during which time a shock therapy may not be delivered if needed.

The company has reported that to date, there have only been three (3) reported occurrences of that behavior out of 136,000 patients with these devices. If this were to occur, the likelihood of dying from this event is estimated to be 1 in 46 million at 1 year (0.000000002%).

So . . . I called today and set up an appointment on the same day that I have an echocardiogram in a couple of weeks scheduled by my everyday cardiologist. What they will do is update the software in the ICD in order to correct the potential for death.

I guess it might be good to pray that in the next eighteen days, I don’t become the fourth out of 136,000 patients!

And so continue the adventures in Geriatric Land.

The Saga Continues

So here it is over a year later. I guess when one only posts every year, it doesn't really qualify as a journal, does it?

If you follow me on Facebook, you may know that last summer I started going to physical therapy again, because I was thinking that I would have my left knee replaced. In order to do so, I was going to lost a few more pounds. In addition, the orthopedic surgeon would not replace the left knee unless I got my A1c down below 7.0.

I achieved both of those goals finally in the spring of 2023. Well, I lost a few pounds and my December checkup with the endocrinologist had my A1c under 7.0. Unfortunately, it did go back up a little by the spring to slightly over 7.1. The endocrinologist is OK with that and said that he would approve a knee reaplacement with the orhopedist.

However, at my spring appointment with the orthopedist, the doctor was pleased that I was having no pain - really with my knee. He had previously injected my left knee with a steroid (or wherever at my previous appointment to alleviate any pain before replacing it.

I had gone to that appointment thinking that I would either schedule knee replacement surgery or at least to have another injection.

NOPE!!

Since I was having no adverse symptoms, the orthopedist decided that at least at this time, a knee replacement was unnecessary. Furthermore, since I was having no pain, an injection would not be necessary.

It's funny how when you build up expectations, that good news doesn't seem like good news until it really sinks in . . . and I've had all summer to think about it and it has finally sunk in that not having to have any medical procedure is indeed good news.

Again, if you follow me on FB you may have noticed that I have re-started physical therapy after a recess of about ten months. This time, I am building up the strength in my left kneek so that I won't feel like am limping all the time with unequal leg strength. I have found out that my calves, the left one in particular, are very weak. While I am not a ballet dancer, I find it almost impossible to stand on the balls of my feet. I guess I knew that because I need a step stool to get up to the cabinet above my sink, but I guess I didn't realize just how weak my calves were. Through physical therapy exercises, I have eventually been able to raise my heels an inch or so off the ground, which is much better than the zero when I first started.

On the diabetes front, the endocrinologist said I didn't need to check my blood sugar as often since it seemed to be remaining steady. However, I continued to check it nearly as often as I had before and I'm glad that I did.

When I went for my yearly physical with my primary care physician, a UTI was discovered, so we had to adjust my meds until that cleared up. As I reintroduced the offending medications to my system, I started having some very low blood sugar readings . . . even after I had eaten meals with high carb counts. So . . . in the last week, I have been taking that offending medication at a lower dose, and blood sugars seem to be calibrating. I'm monitoring it for another week and will call the endocrinologist again to let him know what my blood sugar readings have been so he can adjust that medication again, if necessary.

Meanwhile, I did have another steroid injection at the base of my right hand middle finger because it has been locking up. It was somewhat painful to try to hold my bow to play. Thankfully, that injection has cleared that up. I suppose it is reassuring to know that should I need to give someone the bird, my middle finger won't lock up now. Then again, since I no longer drive, I don't find myself in traffic jams where I feel the necessity for that action as I did when I had to deal with bad drivers. The injection that I had in my left hand over a year ago is still doing its job, and that's a good thing. The left hand fingers are the ones that do more work than the right hand ones in viola playing!

About a month ago, I received an email that read:

Hi David,

I hope you are doing well! On behalf of the Alumni Board of Governors, I am excited to let you know that you have been selected as the 2023 Distinguished Alumni Award recipient. This award is given out to an alum who has had ongoing, meaningful engagement with Jewell. You are a very deserving recipient. We will present the award during our Celebration of Golden Classes and Alumni Awards on the evening of Friday, September 29. I hope you will accept the award and that you are able to join us. If so, please let me know and I will share additional information.

Congratulations!

This was from the alumni office at William Jewell College. There are three main alumni awards presented each year. The Distinguished Alum Award is presented to someone who graduated at least fifteen years ago. Those of you who know me, know that I am well beyond that. Then there is the Truex Award which is presented someone who graduated fifty or more years ago. (I missed that by three years.) And there is also the Honorary Alumni Award presented to someone who did not graduate from Jewell, but who has served the Jewell community witn ongoing meaningful engagement.

I am proud to accept this award, but did not want to publish anything until it was officially announced by the college. And I noticed at the end of last week that my name was published on the William Jewell College as the honoree for the award this year. So if you didn't know before, here it is! I am proud to to be accepting this award the same night that Susan Tideman is receiving the Honorary Alum Award. I know Susan from my days serving on the Jewell Alumni Board of Governors.

So . . . with all my medical accomplishments - that is to say, weight loss of about eighty pounds - my suit was just way too big for me. So, I am having a new suit made so that I can be all spiffy for Homecoming 2023 at Jewell. The dinner will be on the evening of September 29 and tickets for the festivities can ordered from the Homecoming 2023 page of the William Jewell College website. Just maybe getting a new custom-tailored suit will inspire me to post again before an entire year has passed!

So . . . that's the exciting news for now and cross you fingers that you will see a new blog before August 2024!

Time Marches On . . .

I got on the bus this morning with the intention of riding to Starbucks at Crown Center to gather my thoughts on recent medical visits for this blog entry. I forgot that they were setting up Crown Center for Boulevardia’s new venue for that event. So . . . here I am at Messenger. Of course that gave me an excuse to have an Ibis pastry with my coffee!

Wednesday, June 15, was my second post-op visit to the cardiologist. He was not very talkative, but seemed pleased with my progress. I think that this cardiologist is more of an introverted person and perhaps more introspective, as well. He is the polar opposite of my previous cardiologist, who was quite gregarious. At my last appointment with her, she greeted me with a hug as soon as the PA had collected all my vitals. Anyway, back to Wednesday’s visit . . . blood was drawn for labs. There was nothing concerning from the lab results as far as my heart is concerned. The cite of the incision continues to heal as it should.

Endocrinology had ordered some tests as well. Unfortunately, my A1c went up three tenths of a point, so I guess knee surgery is not in the near future for me . . . again. Part of the rise of my blood sugar level was due to the surgery. As with my first knee replacement, my blood sugar rose and stayed up for awhile. The diabetes team is changing my meds in effort to bring my A1c down, so hopefully it will be regulated soon. I will be doubling my Ozempic dosage and will possibly stop taking the Glimepiride.

While I am writing about orthopedics, my right ankle is a bit painful. My noticing of this started after I stopped taking the NSAIDS because of my elevated creatinine level. Some of my fingers are experiencing arthritic pain. The increased awareness of this is probably because I’m no longer taking the NSAIDS (shortened to anti-inflammatories) so I will soon be calling the orthopedist about my ankle and for a referral regarding my hands. The physical therapy practice finally received the prescription for PT for my knee. They called while I was in my PCP’s office yesterday. I will return that call today. The PT facility is about a half miles from my apartment, so I will walk there and get in some exercise a couple of days per week. This will be a partial fulfillment of exercise that cardiologist, weight management team, and diabetes team are happy about. Unfortunately, the physical therapist who worked on my first knee is on vacation right now, so I will begin therapy on July 1.

In the weight management department, I have started losing weight again. I’ve been averaging 1 to 1.5 pounds per week, so I am on the right track.

As I wrote earlier, I was at my PCP’s office yesterday. I had an annual physical and will spare you details about that. He was a bit concerned about the diabetes team removing one of my diabetes meds from my daily regimen so I will discuss that with the endocrinology PA. I mentioned earlier that I have stopped taking the anti-inflammatories. Instead I am taking Tylenol and Turmeric. After seeing the doctor, I discovered that I am taking too low a dose to be effective. Hopefully, all the arthritic pains that seem to be creeping up on me will decrease with the adjustment of the dosages.

So . . . if you are coming to this blog from the link on Facebook, this about sums up my geriatric adventures since my entries in May. I guess even if you are not coming here from the Facebook link, it’s still a summary of those adventures/misadventures. It appears that I will be spending at least as much time in doctors’ offices as I have been. It has become apparent that retirement is necessary in order for one to have enough time to sit in the doctors' offices as one's body deteriorates!

—

I would be remiss not to mention that when I went for my first post-op check-up after my defibrillator surgery, I saw my dear friend, Paul Ingold. He and Roger were waiting in a family practice clinic waiting. I did not see them, but Paul called out, “There’s David Alonzo.”

I was on my way to my own medical appointment, so I only stopped for a very short period of time to say hello and be on my way. I had no idea that Paul was very sick at the time. A few days later, I found out he had been admitted to the ICU. He’d been diagnosed with cancer and other complications.

Paul and I both went to William Jewell College and were in the same residential house our senior year.

When I moved back to Kansas City in 1999, I visited Broadway Church and when I turned around in that pew, I saw Paul from 23 years ago! He had just moved to Kansas City for very similar reasons that I had and I believe it was his first time to visit the church since he moved to KC. We both eventually became members of that church and our friendship deepened. About 15 years later, I joined a different church and our encounters decreased, although we did always see each other at an annual William Jewell Homecoming gathering at the home of our mutual friends Mark Morris and Carolyn Cupp. The last time was for a bon voyage party for another Jewell friend who was retiring to New England.

Sadly, Paul succumbed to his illness on June 10. I will definitely miss his smile and pithy humor.

Adventures in the Geriatric Zone continue . . .

If you are a Facebook user, you might have seen my post of last Friday:

Fun fact: A remote heart monitor, if placed on the side table on the right side of a queen sized bed may interfere with the Amazon Echo Show on the left side.

I found this out last Thursday when I pressed the button on the little white box that sends data to the cardiologist weekly from the defibrillator that has been implanted in my chest cavity!

The light was flashing on the box, so I pushed the button to send data. Thinking it would just do its thing, I walked away from the box. An hour or so later, I came back into the bedroom and it was still flashing. I thought, maybe I didn’t press hard enough and tried again, this time staying with the box and hopefully seeing a signal that the data was sent.

No such luck!

So, as a patient with a fairly new ICD, I tried not to panic, but called the cardiologist’s office. I left a message that my magic little white box was not working. The nurse called me back and gave me the number of the help line of Boston Scientific, manufacturers of the ICD and the magic white monitor box. The customer support person stayed online with me to troubleshoot what was going on and finally she asked, “Do you have an Amazon Echo device near your device?”

I did not define on the side table on the opposite side of the bed as “near,” but apparently I was incorrect in not doing so. She asked me to unplug the Echo Show that was on the opposite end table and the data went through.

The Echo Show now resides just below the 55” TV screen in the living room.

And now I know that as, my friend David Hunker said, I had one “magic device interfering with another magic device.” Just another example of ain’t technology grand . . . except when it isn’t?

May 2 - A Full Day at KUMC

Sorry to the folks who got teaser pictures from yesterday's visit to KUMC. I am not composing this post until Tuesday morning from the beautiful Starbucks at Brookside!

For those of you who are coming here from the Facebook album, you have the summary of the day. For those who are arriving here from elsewhere, here goes:

• Cardiology post-op visit
• Orthopedics initial visit
• Urgent Care visit,

I On Sunday, May 1, I received an email saying that I was on a waitlist for orthopedics (regarding my unreplaced knee) and that an appointment had become available on Monday afternoon. I accepted the appointment with the knowledge that I would be at the Medical Center all day long. So I packed my messenger bag accordingly with iPad, cellphone, reading material - after all the appointments were five hours apart.

So I arrived at my cardiology appointment at 9:45 AM. The main purpose of this appointment was to make sure that the incisions were healing as they should.

They were. Great news, right? During the appointment I turned off my phone, which turned out to be a mistake.

I asked the cardiology nurse to direct me to the orthopedics office.

She checked all upcoming appointments and all she could find was an upcoming orthopedist appointment in June.

WHAT??

II

So I checked my patient portal and found the same information. I did find the text message that said I had an appointment at 3:00 PM. So armed with that, I found the orthopedics office and checked in by showing the text message. They asked me to be seated and the nurse would be out.

In the meantime, I checked my voicemail which had come in while I was in the cardiolgy office about the cancellation of the appointment. It was not a satisfactory explanation why I had a new appointment a month and a week after my original appointment or for that matter why the new appointment was being cancelled.

The orthopedics nurse came out about a half hour later (it was after all still four hours until the appointment) and explained that initial visits were not scheduled at 3:00 in the afternoon because the doctor takes longer with new patients in order to assess what is going on. Then she kindly asked, "Does that make sense?"

Of course, it did.

However, advocating for myself, I replied, "Yes, that makes sense. However, it doesn't really explain why the automated service offered me this new appointment time when I really did not fit within the parameters. May I speak to someone who is in charge of scheduling?"

I got a look like he doth protest too much and remained in my waiting room chair for someone to come out and help me. Finally about noon tne nurse came back out and apologized and said, we can see you this morning if you're OK with that.

I was. Even though it was noon when I got in. That was much better than waiting until June since I was already there!

Anyway, I now have new X-rays of my left knee. As I knew from my old X-rays, there is virtually no cartilege. And this winter there were many days of left knee pain. Also walking, especially on uneven surfaces, my left knee would feel like it would buckle, much like my right knee did before it was replaced.

[If you've been following my health reports, you know that the surgeon who replaced my right knee retired between the time of the replacement and the end of the Covid lockdown. This is why I'm establishing a relationship with a new orthopedist.]

Anyway, back to the findings of the orthopedist. Because of my diabetes, my blood sugars are still too high to consider a knee replacement. It is very close, however, my most recent A1c was 7.1 and orthopedics at KU will not consider knee replacements until A1c is under 7.0.

So . . . the doctor gave me an injection in the left knee. A knee brace guy came in to fit a knee brace. And the nurse sent a referral for physical therapy, which should start soon.

At this point, I'm not sure if I will have the PT at KU or where I had it after my right knee surgery. In either case, it will occur before decisions about surgeries or other possibilities rather than after.

I'm happy to explore other options than surgery, anyway. Several friends have suggested stem cell therapy. I don't know if this is covered by Medicare, but it doesn't hurt to inquire.

III Three days before the surgery, [I let them know that I was having an earache. I asked them to check it out because I didn't want something like that to put a wrench into the surgical process.] They found nothing that impede the surgery, so I had the ICD inserted on April 22.

However, throughout the week after the surgery, I had recurring earaches and they have gone down to a sore throat. These have been fairly mild, but bothersome. So I decided to go to the urgent care center at KU before going home. (My PCP is on vacation this week.) They checked it out and found that I did have an ear infection. I was glad to find this out because it did feel very much like infections that I had forty or fifty years ago, commonly known as swimmer's ear.

The urgent care doctor prescribed a five day round of antibiotics. Normally, he would also have prescribed a decongestant, but thought the cardiologist might not be amenable to that since it sometimes causes higher blood pressure.

So this ends this post about my continuing adventures in the Geriatric Zone.

First post-op report

Today is Tuesday, April 26, five days after the doctors inserted the subcutaneous implantable defibrillator and lead with defibrillation threshold evaluation/reprogramming into the left side of my chest, just below my left underarm. There is a much smaller incision at the center of my chest. Both areas have remained pretty sore, but today the pain is much more bearable.

Strangely, when my right knee joint was replaced two years ago, I felt almost no pain. Doctors and nurses seemed to be astounded whenever I said my pain level was about 0.5. I remember taking one of the hydrocodone/acetaminophen pills after the knee operation was completed, but this time I have been popping the pills every six hours like clockwork! The pain has stayed around 2.5 from the time I was in the hospital except for the time that I have been asleep. Today, actually, the pain has pretty much subsided and now it is going into the itchy stage, which I think means it is healing.

Saturday evening, I went to bed on my flat, non-hospital prop-your-head-up bed. I slept pretty soundly, but I had great difficulty getting out of bed. It may have been paranoia that I would pull apart the wound which was just held together by the Dermabond surgical glue and, of course, there was no nurse to help me to get out of the bed. There is no bandage. The surgical fellow who discharged me on Saturday morning assured me that there was no real need for the paranoia, but based on past experience with my appendectomy from nearly sixty years ago, I sort of felt like there should be something holding my innards in - like stitches and lots of gauze. But that no longer is the name of the game. Even my knee a couple of years ago didn't really have much of a dressing covering the wound. And like that wound, stitches are supposed to organically dissolve. (Actually, the knee had stalples rather than stitches and the chests incisions had only glue.)

Visually, the little defibrillator that is under my skin doesn't really protrude too much, however, since it is a new permanent fixture, even though it only sticks out a tiny bit, it seems like a foreign object that I'm sure I will eventually get used to.

Sunday night and Monday night, I slept in my recliner in the livingroom to avoid the fifteen minute ordeal that getting out of bed was on Sunday morning, but I think I will try to sleep in my bed again tonight because I did sleep much more soundly in my lovely queen size bed which allows for much more sprawling.

Thursday, the monitor box is supposed to flash and I'm supposed to press the button to send all the data from the little box inside of my body. It is my understanding that the monitor box will flash weekly on Thursdays to let me know that it is time to press the button. My CPAP monitors my nightly sleep pattern, but I don't have to press any buttons to submit data . . . it just sends the data every night. And I just take the little SD card to the pulmonologist and he extracts the data at my yearly appointments.

All of these new gadgets make me feel like I should be able to do outstanding feats of superhuman strength like Col. Steve Austin, the Six Million Dollar Man, but alas, despite the new body parts and/or enhancements, it just keeps my lungs breating and my heart beathing and my joints bending!

Interestingly, there there are no warnings against getting the incision wet. Normal hygiene is possible. However, I have been admonished to just pat dry.

I went to church Sunday morning for a special Earth Day outdoor service. Yesterday I took the bus to pick up some stuff I needed from the store. And right now I am at Starbucks using up their unsecure wi-fi to type up this blog entry. Things are more normal than they were in the first month of Covid lockdown. But I think that is how it is supposed to be.

Pre-operative assessment / cardiology nurse office visit

I am at KU for my hour and a half pre-anesthesia appointment for my upcoming procedure on Friday. This is to be followed by a half hour visit with the cardiology nurse.

The phrase "I’m going to have a defibrillator implanted" now glibly [is that the correct adverbial form of that word?] rolls off my tongue. Then I realize that before a year ago, I didn’t really know what that meant. I then further realize that it may sound more intimidating than it really hopefully will be. It is not open-heart surgery. It is however, implanted in one’s chest, so it definitely is surgery.

My friend, Mark McDonough, described it this way:

As I recall from EMT training, an internal defibrillator, like the the portable ones placed in many public buildings and some churches, provides an electric shock to the heart if heart goes into Afib (atrial fibrillation) or other arrhythmia). From what I’ve heard, it’s not terrible but you will know if it goes off.

This, no doubt, is why I’ve heard it called a zapper. Another friend, Katy Nolen O'Dowd, said that her husband has one and that it has been a life saver on more than one occasion. I was first diagnosed with heart failure about eight years ago, but so far, I’ve not had a serious heart incident, so this is a very proactive move and I will have to break myself of the habit of popping my cellphone into my shirt pocket.
. . .

Now that the pre-operative assessment appointment is over, I understand why the appointment was for an hour and a half. It wasn’t just an appointment with the anesthesiologist’s PA.

• First I met with a pharmacist to establish what meds I am taking and which ones I should stop until Friday and which ones I should not take on the day of the procedure.
• This was followed by an appointment with a visit with a surgery nurse to collect an exhaustive medical history, followed by the collection of vials of my blood, just in case I need a transfusion and to test the blood for any bad juju that might be there.
• And then finally, I did meet with the anesthesiologist’s PA to let me know what I should do Friday morning, what would be happening to me so I don’t feel the incisions being made, etc. etc.

So . . . I spent about half an hour with each of these professionals.

Then I crossed the hall to cardiology. They took my vitals again. Went over my meds list again. Asked me my full name and birthdate again. And again, it wasn’t just the cardiology nurse.

• After vitals were taken, I met with very nice gentleman who administered a vector test with Boston Sllcientific. This will help the surgeon know where to put the wires in the right place once the incisions are made.
• Then the cardiology nurse took over and let me ask questions and also gave answers about things I didn’t know I should question.

So now, I wait the two days until the procedure which will take place on Friday at 1:00 PM. I am supposed to report to the hospital at 10:30 AM.