dreamshark: (Default)
 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. 
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 Both Richard and I have Medicare Advantage coverage from Health Partners (Freedom Vital). It's a very comprehensive HMO-style plan that only costs $64/month per person, and we've been very happy with it. Co-pays are about what we were used to with the old corporate-provided insurance plan: $15 to see a regular doctor, $40 for specialist, etc. 

We've both been to the doctor in 2017, and for some reason the Park Nicollet system is no longer requesting a co-pay when we check in. I hate to call Health Partners to complain, but it makes me a little nervous. 
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 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.
dreamshark: (sharon tire)
Richard seems to be doing just fine recovering from his hip replacement, but is feeling a bit discouraged that he hasn't been miraculously healed overnight. Ask just about anybody about their hip replacement surgeries and they are so enthusiastic about it that you get the impression it was a "Lo, and I rose from my wheelchair and walked!" kind of experience. Hip replacements tend to have very good outcomes, and I think a lot of people kind of edit their memories of the post-surgery period with that in mind. It's not actually that easy, at least with an older patient who still has bone spurs and arthritis in all his other joints.

Anyway, surgery was last Tuesday and he came home on Friday. He is hobbling around with a walker and definitely needs the pain meds every 4 hours. He is spending most of his days and all of his nights in one or the other of our big recliner chairs. The hardest part for him is getting up. We have one magic chair inherited from his father that actually rises up on its hind legs and tilts the occupant out onto his feet. This is finally coming in very handy. He has been shifting back and forth between the magic recliner and the one that is actually comfortable but hard to get out of.

Even though he was too worn out on Friday to actually play any games, he enjoyed having gamers over to amuse and distract him. Thanks to the folks who came. Here's what the magic recliner looks like.
dreamshark: (sharon tire)
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.
dreamshark: (sharon tire)
I wake up this morning and my nose itches. I've been coughing off and on all summer, but now I'm sneezing uncontrollably too. I check the date - mid August. Aha. I remind myself that in Minnesota the ragweed bursts into cancerous bloom in mid-August instead of September, which is when I always expect it.

I check my email. There's a notice from pollen.com. Two days ago, it was just grass and nettles. Today it's ragweed. Level 9. 
dreamshark: (sharon tire)
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. 
dreamshark: (sharon tire)
So... Richard finally scheduled a hip replacement, a procedure that has been in the "when not if" category for some years. At his required pre-op physical he mentioned to his primary doctor that the brief episodes of light-headedness he has been complaining about for years have been getting more frequent, so doc did an EKG. Results were vague but concerning, so he was scheduled for some additional heart tests for right after the Fourth.

On July 3 he had a camp chair malfunction at the Bloomington fireworks display, falling over backwards and landing hard on his back. This resulted in continuing pain that fits the diagnosis of cracked ribs, although in his case it is more likely cracks in the latticework of bone spurs that glues his ribs and vertebrae together. Not much pain sitting still, but moving around causes sharp pain. Last time this happened it took at least a month for the pain to clear up, so he didn't think he'd be able to handle hip surgery next week. So we rescheduled the hip surgery for early September (the first time slot available) and cancelled the nuclear stress test. However, he had already done the 24-hour Holter Monitor, and I finally got around to driving out to the heart center yesterday to turn it back in for analysis.

Well, this morning we got an urgent phone call from the Heart Center. They looked at the Holter results and he needs a pacemaker, STAT. They really wanted him to come in TODAY and get it installed, but he'd eaten by the time they talked to him. So we talked to the nurse just now and scheduled the whole thing for tomorrow - consultation with electro-cardio guy, echo-cardiogram, and pacemaker installation. The pacemaker installation is apparently pretty routine, but he'll be in the hospital overnight Friday for observation.

Considering that his symptoms have not changed a bit in at least a year, the sense of urgency conveyed by the cardio nurse seems a little overblown. Certainly his daytime symptoms don't seem severe. But apparently it's worse at night, with pauses of up to 5 seconds, which is cause for serious concern. Well, now that we know that he could die in his sleep it is worth worrying about, but chances seem good that he'll make it through another night. A lot of older people have a lazy sinus node, which is pretty easily fixed by a pacemaker. I just hope that's the only problem. Well, we'll find out tomorrow, I guess. I'm thankful we have good insurance and access to a top-notch heart center like Methodist Hospital.
dreamshark: (sharon tire)
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.
dreamshark: (sharon tire)
So I started taking some new meds after learning that sometime in the past I had a heart attack that I completely failed to notice. Most of these are the type of maintenance meds that have no really obvious effect except that years go by without you dropping dead.

The statin, for instance. I'm supposed to go in to the clinic in a few weeks and get my cholesterol checked, and then maybe I'll know if that one is helping. I don't notice any side effects, so that's good.

It took a few weeks to really kick in, but the BP med (Losartan) does seem to have lowered my blood pressure noticeably. I used to average around 137/85. My average is now 121/75. There are still a few outlier high readings (153/89) but way fewer of those than I used to get. There is a lot of variability in individual readings, but the average has been holding steady.

But the Toprol - OMG. That's the beta blocker I was hesitant about taking because of the side effects. After much discussion with my cardiologist, we decided to start by cutting the smallest available pill in half for an effective dose of 25mg. I started it a week ago. According to my BP monitor, my resting pulse immediately dropped from about 58 to 52. BP is maybe down a little bit too, but it's so erratic it's hard to tell without a larger sample.

The day after starting the Toprol I went to the gym and did the exact same treadmill workout I've been doing for the past month or two: 20 minutes "cruising" at 3.4 mph with three 1-minute intervals at 4.0. My cruising HR has been about 124 for many years. With the Toprol it starts at 114, and very very slowly increases to 119. Similarly, it's 5-10 beats below normal during faster intervals.

This is actually exactly what this medication is supposed to do - calm down the heart. I just didn't expect the effect to be so pronounced at such a low dose. And I didn't expect it to kick in immediately. Of course, maybe it's not done kicking in. Maybe the effect is going to keep increasing. I certainly hope not. I do feel just a little light-headed now and then. Tolerable at this level, but not if it gets worse. Thank God I didn't start with the full 50mg dose - I probably would have keeled right over.
dreamshark: (sharon tire)
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. 
dreamshark: (sharon tire)
But not recently. Sometime between 3 months and 8 years ago. And I am wracking my memory and my health notes to find even the slightest suggestion when such a thing could have happened. Sure, I know that the definition of "silent heart attack" is that you don't realize it's happening. But if there is heart damage, how could you not notice a sudden decline in heart function immediately afterwards? I have been complaining off and on for the past few years that I get more and more out of shape each winter and have a harder time each year getting back to what I consider my base level of fitness, but I am after all getting older each year. And since I had to give up skating in 2012, I do slack off in physical activity during the winter, so it's hardly surprising that every spring my cardio fitness is down. There was never an unexplained drop.

All I know is that whatever "inferior anterior" damage they are seeing was not there in the stress echocardiogram I had in January 2008. And from the looks of things, the damage "wasn't recent" (which the doctor defined as "in the last 3 months.")

Well, in the end it doesn't matter much. Whatever happened was minor and shows no indication of being about to happen again. All my coronary arteries are clear and happy, except that one of the little roads leading off the end of the right coronary artery stops in an abrupt dead end down near the bottom of the heart. The damaged area is too small to stent, and isn't really leading to anything anyway, so it's there to stay. Presumably, that's why November's echocardiogram showed slightly degraded function in the heart muscle down in that very area.

And most likely none of this is even related to the problem I came in with - the irregular heartbeat. I've had that for at least 15 years, which is why I had the stress-echo back in 2008. At the time the arrhythmia wasn't enough to worry about, and the alleged silent heart attack hadn't even happened yet. Now the arrhythmia is worse, but we're still investigating whether it's worth doing anything about. Investigation still ongoing. I'm still perturbed, but much less so now that I know I'm not about about to be whisked away for a heart bypass. 
dreamshark: (sharon tire)
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.
dreamshark: (sharon tire)
While waiting for a prescription at CVS today I noticed that they have a new spokesman for their Important Health Messages.
dreamshark: (sharon tire)
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 )
dreamshark: (sharon tire)
My distance vision, anyway. I've been vaguely aware ever since I entered the bifocal years that each time my bifocal prescription increased, the distance prescription got a little less strong. But this process seems to have picked up speed, to the point where I was actually AWARE of the fact that the prescription in my 2-year-old glasses was over-correcting. Road signs were getting blurry, and I had to tilt my head back to look through a less strong part of the lens to see them clearly.

So I got my eyes checked, and sure enough, the distance correction was a bit too strong. Then I LOOKED at the prescription she wrote down. It's -3 diopters in my bad eye and -2.75 in the other. Seriously? I'm pretty sure that my prescription used to be -5.0 and -4.5 diopters. The prescription dive mask I got in 2001 is -5.0 and -4.0 (because they didn't have 4.5).

I'm still not particularly happy about this whole aging thing, but in the midst of the encroaching stiffness and slowness it's nice to find a little Easter egg.

ETA: This is even stranger than I thought. I just looked up how to read an eye prescription and discovered that the -3.0 is in my LEFT EYE (OS) and the -2.75 prescription is my RIGHT. For my whole life my left eye has been the "good eye." The one that used to be -5.0 was the right. Unless the eye doctor mixed up the prescriptions, my right eye has caught up and passed the left eye. Which can't be right, because I definitely see better out of the left. I'm confused. I hope she didn't write down the prescriptions wrong.

It turns that "diopters" are the inverse of meters. So a prescription of -3.0 diopters means that I can see clearly up to 1/3 meter (13"), and after that things get fuzzy. That seems about right, actually. That's about where I hold my iPhone when I look at it with my glasses off (and I always take my glasses off to look at things up close - never could get used to bifocals).

Anybody else notice that their vision is improving with age?
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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...
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We're scheduled to leave on our trip to St. John tomorrow at oh-dark-thirty.  Richard has a cut on his arm that has just not been healing and has now gotten infected. It's not responding to topical antibiotics and is looking worse every day. It doesn't hurt him a lot, but I'm suspecting staph, which scares me to death for various good historical reasons. He kept insisting that it was "getting better" but it's not, it's getting worse. I made him an appointment for this afternoon, and I'm worried sick that it's serious enough that it will need more care than what he can get in a single afternoon.

Also, we're flying American.  Not because they are a good airline (they clearly are not) but because they were much cheaper than all the alternatives. In fact, the amazingly affordable airfare was what made me decide to do this trip in the first place. Well, I guess you get what you pay for.  American has been in bankruptcy and embroiled in labor disputes for a year or two now, so I didn't anticipate it would take a sudden turn for the worse three days before our trip. But they announced layoffs this week, the pilots are "absolutely not" engaging in a slowdown action, and flights are being cancelled and delayed right and left. I did buy trip insurance, so if the pilots actually go on strike or Richard ends up in the hospital we just cancel and get our money back. But it's far more likely to be some stressful middle ground.

So right now, the eagerly anticipated vacation is not feeling so good.  :-(
I can't help but feel it's my fault for looking forward to this so much.
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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. 
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So apparently there's this new study that proves that sitting is sooooo bad for you that even if you exercise every day and run marathons on the weekend, sitting for longer than 20 minutes at a time will make you die young.  The solution is supposed to be "so simple!"  Just stand up every 20 minutes!  I'm  a little dubious about all the confidently presented statistics about how many minutes your life is extended by (how on EARTH would you do that calculation?  Wouldn't you need a group of subjects with desk jobs who had been standing up every 20 minutes for at least 10 years to be able to see if that helped?) 

But my biggest health problem the last few years is stiffness.  I've always tended to stiffen up excessively after even mild exercise, but now it's to the point where I'm having a hard time exercising because it hurts too much to get started.  (Once I loosen up, the types of exercise I do don't hurt, and in fact feel pretty good. It actuall is the standing up part that hurts the most). So I thought I'd give it a try.  I've set a timer on my iPhone to go off every 20 minutes to remind me to stand up and stretch.  And you know what?  20 minutes is a really short time! 

In fact, there goes my timer again.  Damn.
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