Tuesday, April 26, 2022

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.

Wednesday, April 20, 2022

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.

Saturday, April 16, 2022

Pandemic: Part 2 - 2021

As I said in a previous post, I started de-isolating myself after the Great Lockdown in the fall of 2020. I started seeing my primary care physician for office visits in October and December of 2020. After these visits, he referred me to the cardiologist at KU and also to the endocrinology department at KU for my diabetes. I also saw him in March, May, September and November for regular check-ups.

So . . . In February of 2021, I had my first office visit with a new cardiologist. This would result in an eleven visits directly related to heart problems during the year. On February 19, I had the first appointment with the cardiologist at KU. At this appointment, the cardiologist just went over my medical history.

I started having Telehealth visits with a physician’s assistant in the endocrinology department every few months starting in March 2021, with one visit in person to check for diabetic neuropathy in my feet. I also had my annual eye exam in August for vision and diabetic retinopathy. I also have cataracts that have remained small for five years, so they are not yet at the point that they need to be removed.

On March 22, I had an echocardiogram. It was at this point that there was some concern about my heart function. I had been concerned about being tired much of the time and becoming out of breath after walking just two or three blocks. Because of the low ejection fraction, the cardiologist ordered several other tests during the month of April. These included cardiac catheterization, MRI, nuclear stress test, and treadmill stress test. I had a visitation with one of the cardiology nurses after one of these visits in which she cross-examined me about my how I was feeling, how I was living, etc. I guess the cardiologist felt that she was a health sleuth that could probe me for answers better than he could. And that time, they decided to test some of the blood they had collected for anemia and for iron absorption. Not really sure which of the symptoms I described led them to prescribe those tests, but it was just a few days before my next visit with another cardiologist in the practice on June 4, who specialized in implanting defibrillators. He gave me all the lowdown. Then I asked, “Have you been informed that I’ve been diagnosed with iron deficiency and anemia? I just got those results yesterday.” He hadn’t. The conversation about defibrillator implantation came to a halt!

At this point, the cardiologist called in an order to endoscopy for a complete upper and lower GI. Lovely! I had had a colonoscopy five years earlier so, I get to have another five years early. I’d never had an upper GI before, however, so this would be a new experience. When I called endoscopy the next day, they had received the cardiologist’s order, but their next open appointment was in five months. So I spent the summer months wondering what might be causing the anemia and iron deficiency. In the meantime, I started taking iron supplements and Vitamin C at the suggestion of the cardiologist. I had check-ups with the cardiologist in July and October, at which point he was perturbed that endoscopy could not get me in any sooner than the end of November. He ordered another echocardiogram for November 1 and called to see if I could get my upper/lower GI any sooner.

The November echocardiogram proved hopeful because my ejection fraction was up to what it had been before the Great Lockdown. Actually, it pretty much stayed at that level ever since I was first diagnosed with heart failure ten or so years ago, except for the echocardiogram in March.

On November 11, I had a preliminary visit with the gastroenterologist about what would be happening with the Upper/Lower GI endoscopies. And on November 19, I had the procedure. Fortunately, the results were not entirely conclusive concerning internal bleeding, so I would need another procedure which involved swallowing a mini-camera, a capsule endoscopy. I’ve already posted in the blog about this in the entry for April 6, 2022.

However, because of the disparity between the two echocardiograms, the echocardiograms, the cardiologist ordered a MUGA Scan before the year was out.

Three days before Christmas I had the MUGA Scan. The short story here is that the hopeful news about my heart function from the November echocardiogram was not verified. And this is the reason that in one week I will be having a defibrillator implanted.

The cardiologist also wanted me to lose weight, so he referred me to the weight management clinic at KU. I had one initial visit with the doctor and several periodic visits with a physician’s assistant in the department every couple of months from May 2021 on.

I became concerned because of news that some CPAP machines had been recalled. I have been using a CPAP because of sleep apnea since the fall of 2001. Fortunately, my machine was not one of the ones that was recalled, but now I have established a relationship with a pulmonologist at KU as well as the myriad other specialists I have been seeing. Because of technology, my sleep patterns are monitored year-round and my sleep health seems to be pretty good. My very first CPAP machine in 2001 was much larger and it did not have an SD card to record my sleep patterns to send them to the pulmonologist. Unless something changes drastically, I will only have to see the pulmonologist once a year. I realize that this is not especially interesting reading and that it is full of medical terms which I may or may not have explained accurately, but it was to the best of my understanding. And now it is here in this blog so I don’t have to re-type it every time someone asks, “How are you doing?”

Tuesday, April 12, 2022

Pandemic: Part 1 - 2020

This is the first part of my Pandemic tale. It all started in March, 2020.

On March 12, 2020, I had a first date with someone. We had chatted on Facebook and decided to go for pizza at Minsky’s. Five hours later, the world completely closed for about nine months and it remains partially closed to this day. Thankfully, masks and vaccines have partially rescued the world from the dreaded lockdown.

By the way, there wasn’t a lot of chemistry with the person I dated, so eventually the direct messages slowed down until now and I am not sure my Facebook friends list even has that name any more.

As a person who tests consistently as INFP on the Myers-Briggs Personality Type Indicator, I thought the lockdown hadn’t really affected me much. I know that it didn’t have the psychological effect that many spoke about on TV.

I became very familiar with Netflix TV series:
  • Queen’s Gambit
  • Tiger King
  • The Circle
  • The Circle France
  • The Circle Brazil
  • ETC . . .
I found out that I could watch foreign language reality shows and read the closed captions in English while the alleged real folks were talking in French or Portuguese. This was a testament to my endurance because I usually can’t even watch a documentary if I have to read subtitles. I wonder if that skill will be useful for something later in life. I also re-watched Downton Abbey, the 90s TV show Sisters, and Six Feet Under at least twice on DVD or Blu-Ray. In addition to Netflix, I subscribed to the Hulu/ESPN/Disney+ package so I could watch the filmed version of Hamilton. And that list of shows . . . It seems so long ago! In addition, I framed a bunch of pictures and hung them on my apartment walls. Re-arranged furniture. Various and sundry Pandemic stuff! So now my humble abode is much cozier and more aesthetically pleasing.

So, you may be asking yourself, what effect did the lockdown have on David?

Well, here goes:

I started going to places other than the grocery store in October. The first thing was my great niece’s wedding; I went there because it was an outdoor event. I started calling doctors and making appointments. First my primary care physician. Then I called to make an appointment with my cardiologist for a yearly check-up that was three months overdue. (Here’s the rub.) My A1c had skyrocketed to 12.1. The cardiologist’s office said you’ll have to come in to see Dr. So and So; I had no idea why my cardiologist of about ten years wouldn’t see me. So, as one does, I Googled her. I found out she had died of a heart attack three months earlier in the latter part of the Lockdown. She was only 50 years old. In what year could that have happened other than 2020!

So eventually, I started a long series of doctor visits at KU Medical Center, where all my specialists are now, since KU is easily accessible by public transportation. (By the way, all buses here in Kansas City have been free since 2020.)

So the next blog posts will be a rundown of the battery of tests that went down during the year 2021 and that have led to a continuing regimen of doctor visits in the present year!

Wednesday, April 6, 2022

April 6

As I said in yesterday’s post, updates on my health vanished into thin air when I downloaded the mobile app for Blogger. So I am going back to the old fashioned way, by updating the blog on a browser. While I intend to replace those posts mostly in chronological order, this one will be about the most recent occurrences since some friends have already read David’s Medical History 2021.

I got the untranslated results of the capsule endoscopy, on April 1. If they had sent me the results and had not scheduled a doctor’s appointment, it would have been a clever April Fools’ Day joke. However, my appointment with the gastroenterologist was on April 5. I wanted to make sure to hear what the doctor had to say before I shared them with the public.

It’s funny, as you are in the geriatric zone, the doctors look like they only recently graduated from high school. Then you realize that indeed they did graduate relatively recently!! So, the very young doctor patiently explained the results . . . rather like a grandchild teaching his grandpa to play an video game.

I had read the endoscopy report, as a homework assignment before the office visit. I interpreted it to mean they found nothing that would explain the iron deficiency or anemia. The doctor gave me an A on my translation. Pretty good for an old guy who never took that foreign language in high school or college!

So I asked, “Does that mean I’ll just be taking iron supplements and Vitamin C ad infinitum?” He seemed reluctant to answer in the affirmative. He decided that I should have blood drawn before I left the medical center. Thanks to the miracle of modern technology, my smartphone buzzed me to give me the results of the blood tests before I even arrived home from the office visit. However, my very young doctor sent me a message this morning that read:
Iron deficiency has continued to improve. Your other vitamin levels were normal. You are still mildly anemic but I suspect that this is unrelated to iron and related to other medical problems. (Anemia of chronic disease) I would say stay on your current dose of iron for now.
Since the iron has to be taken on an empty stomach and because it works better in an acidic environment, I wake up each morning and take a 65mg tablet of ferrous sulfate - that sounds much fancier than plain old iron tablet - and a 500mg tablet of ascorbic acid - that sounds more formidable and much more likely to induce pity in my readers – and then I wait for an hour before I take the rest of my morning medications and breakfast and proceed with my day.

Since the anemia is probably related to one of the myriad geriatric ailments that I have ... diabetes and heart disease among them ... maybe the defibrillator implantation coming up in a couple of weeks will help.

The weight management doctor at my last appointment noted two things. First, I hadn’t lost any more weight after the initial twenty or so pounds. And second that my creatinine level was high and suggested that I talk to my PCP about stopping Naproxen which I had been taking for arthritis pains. Naproxen is an NSAID and NSAIDs tend to mess with kidney function and an elevated creatinine level means that one's kidney function has been thrown out of kelter. I did. He agreed. He wrote:
You can safely take Tylenol up to 2 tablets 4 times a day as needed. Also, over the counter Turmeric supplements are also somewhat helpful as an anti-inflammatory that would not affect the kidney function.
So now, I just await the implantation of the defibrillator on April 22. In addition, I also have made an appointment with an orthopedic doctor at KU because the surgeon from Research Medical Center who replaced my right knee in 2019 has retired during the Pandemic. My left knee is beginning to feel like the right one did before it was replaced.

Tuesday, April 5, 2022

Entering the Geriatric Zone

OK . . . so some of you saw my posts here about my health in 2022 and they have vanished! I downloaded the mobile blogger app that was supposed to miraculously make it easy to manage this blog. Apparently, it is not nearly as intuitive as they seemed to think it was. It didn't make managing blog posts easier. Instead, I accidentally erased all the posts since February 2022 and see no way to retrieve them. So I guess I will start again!

I saw an old friend the other day whom I'd not seen in many years. (We went to high school together to give you an idea.)

I said to her, "I am quietly and slowly entering into the geriatric zone."

She replied, "Oh, not me. I briskly slid right in."

I counterreplied, "Well, yes. I guess I'm just in denial."

So over the next week or so, I will re-collect my thoughts about what my health has been like since the great lockdown of 2020 due to the Covid Pandemic and I will post these recollections as well as any updates so that those friends of mine who care to read the musings of a senior citizen who is a mere two years shy of 70!

No one was ever so astute as Rod Serling when he said, "You are about to enter another dimension, a dimension not only of sight and sound but of mind. A journey into a wondrous land of imagination. Next stop, the Twilight Zone!" Or perhaps even moreso when he said, "A journey into a wondrous land of imagination.” Very similar things can be said about the geriatric zone. I’m not sure how wondrous this land of imagination is or whether I actually could have imagined how wondrous (or unwondrous) the land would be. In fact I am seeing and hearing the Zone, but I’m not sure I am really mindful of the zone at all. At times, I am quite sure that I am losing my mind, but here are some of my musings about health after age 65!

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 ope...