dreamshark

 Yup, the tree pollen is flying, specifically my nemesis Juniper/Poplar.

I didn't even see the pollen.com notification until I noticed that my eyes were itchy and went looking for the email notice. Yeesh, it's only at Low/Medium level and it's really bothering me. Not a good sign. 

 Richard had his 2nd hip replacement yesterday. Surgeon said it went fine, although it was a difficult procedure due to R's skeletal issues. Everybody at Methodist hospital (including the doctor himself) seems to believe that this surgeon is one of the very best. They keep saying things like, "And we routinely monitor for excess blood loss, although that's never a problem with Dr. Johnson's patients...."  When the nurses who clean up after you have nothing but good things to say, I figure that means you really are competent, so that's reassuring. 

Just like last time, R had a miserable first night in the hospital. His back is so bad that they just can't seem to make him comfortable, although all the nurses and staff seem to be trying hard. He'll probably spend the next 2 nights in the hospital recliner and then come home Friday. Any way, that's what happened last September with the right hip. Game party will be proceeding as usual. 

Methodist Hospital is becoming more and more like a luxury hotel. It's always been a nice hospital with pleasant public spaces and an excellent cafeteria (important for family members waiting around). Last time we were there they had instituted a "room service" approach to food: patients can order anything they want from the room service menu any time between 6:30 and 6:30. They are apparently renovating all their rooms, one wing at a time. We got one of the new rooms, which is a large, sunny single with all sorts of guest furniture including a sleeper sofa. Just yesterday they were having a little celebration in the lobby to roll out the new, redesigned hospital gowns that actually cover the patient's backside!  

Unfortunately the beds are still too hard for patients with skeletons full of bone spurs, so Richard is not happy. But he'll be home soon.

Richard had hip replacement surgery for his right hip on Tuesday. The surgeon said it went great, although he made a point of telling each of us separately that the hip was "a real mess" (bone spurs everywhere - hip was practically frozen - don't know how he was walking on that thing). Because of the bone spur problem, he got a small dose of radiation to the area afterwards to discourage bone overgrowth. It's good to know that they are familiar with bone spur disorders and have a method of compensating for it.

He'll be coming home on Friday morning sometime and intends to host the Friday night game party as usual. He's grumpy and uncomfortable, but looking forward to having a fully functioning hip sometime soon. He's in Methodist Hospital if anyone feels like calling or stopping by for a visit. But he'll be home soon, so not a big deal.

He got a nice little Medtronic pacemaker installed on Friday and it went fine. The echocardiogram that they did before the procedure showed no additional abnormalities and good ejection fraction (60%). We had Dr. Schultz at Methodist Heart Clinic (highly recommended). His initial explanations were clear and his post-surgical follow-up was surprisingly hands-on. He said he had installed about 3,000 pacemakers, so I guess he knew what he was doing.

Since there isn't much else to do while sitting in a hospital room with an uncomfortable and grumpy patient, I watched the oscilloscope. The pacemaker is set to kick in whenever pulse rate drops below 60 bpm. Measurement is on a momentary basis, so there should never be more than a second between heartbeats. Before the pacemaker, there were some very obvious intervals of 3-4 seconds even in a time window of a couple of minutes. Once the pacemaker was installed, no more of that. The heart monitor displays the pacemaker beats slightly differently so you can see exactly what is going on. There is typically at least one pacemaker beat every minute. Sometimes these helper beats are very intermittent. Other times there will be a stretch of 30-60 seconds where pretty much ALL the beats are from the pacemaker. At these times Richard's pulse was precisely 60 bpm. So... working exactly the way it's supposed to. And he clearly needed it.

The biggest problem was back pain from the fall on July 3. X-Rays did not show any fractures, but there clearly is minor but painful bone damage (probably to the bone spurs that glue his spine and ribs together). The staff was very patient and did their best to find comfortable positions for him, but after a whole day of being shifted from bed to wheelchair to another bed or table he was in a lot of pain. He had a very bad reaction to the opioid-based pain meds (dilaudin), which just made him more miserable. Once the narcotics finally wore off, he was back to just Tylenol. From my personal experience I have always suspected that acetaminophen is just a big word for "placebo" but it does seem to work for Richard. Unfortunately the hospital nurses had never heard of doxylamine, an OTC sleep aid that works like magic on Richard. They gave him some other hospital type sleeping pill that didn't work nearly as well, so he had a bad night.

He was still very out of sorts when I went back to collect him on Saturday morning. However, he perked up a lot once he got home. His back still hurts, but now that he can move around on his own he is much happier. He's sleeping in a recliner, but that seems to work pretty well for him. The incision doesn't seem to be bothering him at all, and he is no longer having dizzy spells! It will probably be another month before his back has healed, but the next available date for the rescheduled hip surgery was in September, so he has plenty of time to heal. 

That's the pollen count in Minneapolis today according to pollen.com. Although they never explicitly said so, I had always assumed those numbers were on a scale of 1-10. Apparently not.

A couple of days ago I had an angiogram and posted So They Tell Me I've Had a Heart Attack.

Today I had a visit with an ElectroPhysiologist (EP) - which is a cardiologist with additional training in the electrical systems of the heart.
Briefly, he agrees that the chaotic looking collection of electrical events picked up over 24 hours by the Holter Monitor is not exactly normal, but says that it isn't dangerous and probably isn't substantially affecting the heart's ability to do its job. Besides, there isn't a lot he can do about it without taking unnecessarily heroic measures.

It's not A-Fib (Atrial Fibrillation) or V-Fib (the even worse ventricular form). It's not one of the drop-dead-suddenly arrhythmias. Just, to use Doc S's metaphor, a handful of impatient little soldiers stationed all over the heart that can't bring themselves to wait for The General to give the order to shoot so they jump in there and start firing off heartbeats on their own. If there was just one of these rogue soldiers, he could be "ablated," but apparently there are too many of them to track down. And I don't need a pacemaker because The General is still perfectly capable of firing off heartbeats in a timely manner. The reason my heartbeat is so irregular is that the normal heartbeats keep running into the PVCs and PACs, which can result in skipped beats or extra beats in various entertaining rhythms.

However, all the cardiologists, even the rhythm specialist, are concerned about this alleged "silent heart attack" and its after-effects. There seems to be some concern over the minor damage already present, which I guess makes the heart more likely to wear out eventually, or something. But it turns out my ejection fraction really isn't all that low. Whoever read the echocardiogram estimated the EF at 45% (where normal is 55%+). But Dr. H, who did Monday's angio, estimated it right at 55%. So nothing to brag about, but really in the low normal range. Mostly they are concerned that anybody who has had one heart attack, be it ever so small, is at risk to have another.

So, to make a long story interminable, the only solution is drugs. I certainly prefer that to the more invasive alternatives, but am still not entirely convinced that I need to suddenly become one of those people with the enormous sorted pill boxes. I've been dithering for years now over whether my borderline blood pressure really needs to be medicated, but was finally converted by The Sprint Study. When the NIH is so startled by their results that they stop the study early because they feel guilty about what they are doing to the control group, you have to take notice. So okay, I'll take blood pressure medicine. And I'm okay with taking a statin, since there seems to be a lot of evidence that they reduce incidence of both repeat heart attacks and stroke, and I'm now officially in the high risk group. And sure, why not a baby aspirin? Sounds pretty harmless.

But I'm still on the fence about the beta blocker. If Dr. C (my primary cardiologist) agrees with the other two I guess I'll give it a try. But I'm going to start slow and watch like a hawk for side effects. 

As part of the general drying up process involved in getting older, my fingernails have been deteriorating for some years now. I used to have fairly nice looking nails, despite a very minimalist approach to maintenance. But in the past 10 years they have started splitting into layers at the end, peeling, and breaking. The technical name for this phenomenon is onychoschisis.

I tried obsessively rubbing hand lotion into the nail bed, tea tree oil, and of course nail hardener. It just got worse. I finally decided to try taking biotin, a B-vitamin that seems to be particularly important to nail health. The annoying thing about this approach is that because it takes 4 months for a nail to grow out, it's a long time before you can see if it's working. And of course I didn't write down anywhere exactly when I started with the biotin, but I think it was in late March or early April. In any case, more than 4 months ago.

So has it helped? Well... I THINK so. On the plus side, I have managed to grow all 10 nails long enough that there is a little white showing at the end of every nail. When I started this regimen, about half my fingernails looked like I had bitten them to the quick (and I have NEVER bitten my nails!). So that's an improvement. I think they are not so brittle. On the other hand, several nails still show split layers under the coats of clear nail hardener. They just aren't breaking off as easily.

There could be other reasons for that besides the biotin. For one thing, it is summer. Skin and nails dry out terribly in the winter, and rehydrate in the humid days of summer. Secondly, I recently switched to a different brand of nail hardener. Maybe NutraNail just works better than Sally Hansen? So in the spirit of the retired System Tester, I just cleaned off my nails and applied two coats of Sally Hansen. We'll see how that works. I do want to know the truth, but if all the pretty little new white tips on my nails break off again, I'll cry.

I'd like to say that you were a good, loyal old molar. But actually, you were kind of a crappy tooth all along, the bad apple that spoiled the barrel. It's your fault that the lower right quadrant of my mouth ended up with 3 crowned teeth in a row while the other 29 were smugly perfect.  I probably shouldn't have held onto you as long as I did. But bad apple or not, you were MY bad apple. So when they tried to tell me that you just weren't worth saving, I went into denial and kept on enabling and enabling. "There's nothing really wrong with this tooth," I insisted. "It only hurts when I chew on it!"  But technically, that's what molars are for - chewing. And a molar that you can't chew on isn't much of a molar. So I finally gave in and had you extracted today. And the bright side of the mess you made of the neighborhood is: the crowned teeth on either side are ready and willing to support a bridge to replace you.

( Cut for graphic content )

Doctor did not find Richard's arm nearly as disturbing as I did, but did agree it was bad enough to merit a course of oral antibiotics. He didn't seem at all worried about taking the arm to the Caribbean or tell him to stay out of the water (which would pretty much defeat the point of going).  So that's a relief.

On the other hand, I seem to be coming down with a cold, which is a bummer. On the other hand, if I'm going to get a cold at this time of year, the tropics seems like the place to do it.  When I get colds in the fall they tend to turn into winter asthma. Maybe a little bit of tropical heat and sunshine will be just the thing.

In other news, American Airlines has cancelled 300 flights this week.  The pilots union denies "job action," insisting that it is just coincidence so that so many of their pilots aren't feeling well. So... we'll see how that goes.  Checking the details of my trip insurance...

By mid-week he was feeling pretty good, but still a little weak.  We went to a movie at the Lagoon on Wednesday and had to walk about 1/4 mile from parking.  A couple of days earlier  that would have been too much, but to his surprise it was no problem.  The rash was the last symptom to disappear.  It faded very gradually for a few days.  This morning it is completely gone.  So he was sick for almost exactly a week, but not really very sick.  The most dramatic symptom was the rash; the most debilitating was the fatigue.

He never did see a doctor.  I talked him into calling his clinic (the Park Nicollet Blaisdell/Franklin one) on Tuesday, just to see if they were interested in diagnosing a case of West Nile for the records.  They weren't especially.  The nurse was interested in the rash and thought that some of the doctors :might like to see it," but it didn't sound like anyone would even bother to do a blood test if he went in.  And yes, there is a simple blood test for this thing.  According to the most recent Strib article, 10 of the 32 diagnosed cases so far in Minnesota were detected in blood donors that had no symptoms. Other than that, I guess the only way this disease is being tracked is in the tiny minority of people that get sick enough to be hospitalized.  Such is the state of epidemiology in the most medically advanced country on earth. 

There was a dead sparrow on our front steps on Thursday morning.